Final Exam Review Flashcards
(408 cards)
1
Q
what does the acronym SIRS stand for?
A
systemic inflammatory response syndrome
2
Q
how does SIRS differ from sepsis
A
sepsis has to have a confirmed infection
3
Q
What included in the sepsis one hour bundle?
A
-drawing lactate level and blood culture
-administering broad spectrum antibiotics
-administering IV fluids (for lactate 4 mol)
-giving vasopressor if needed (to maintain a MAP of 65)
4
Q
What lab value is most indicative of sepsis?
A
increased lactate
5
Q
What can be found around a surgical site that will indicate infection
A
redness
6
Q
Is serous drainage from a surgical site expected?
A
yes
7
Q
Before administering antibiotics for sepsis, we must ensure
A
blood cultures were drawn
8
Q
A urinary output of 15 mL is indicative of what
A
organ dysfunction
9
Q
What is the most effective way to stop the spread of infection
A
hand hygiene
10
Q
What are risk factors for developing sepsis?
A
being above 80, DM, post surgery
11
Q
What is an example of a modifiable risk factor for cardiovascular disease
A
smoking, diet, sedentary lifestyle, psychological variables (stress)
12
Q
what does the P wave on an EKG represent
A
atrial depolarization
13
Q
What does the QRS complex represent on an EKG
A
atrial repolarization and ventricle depolarization
14
Q
What is a normal cholesterol level
A
less than 200
15
Q
What is the correct sequence of atrial conduction through the heart
A
SA node, AV node, bundle of HIS, purkinje fibers
16
Q
What is the preferred diagnostic test for DVT
A
venous duplex ultrasound
17
Q
When should we monitor levels of IV unfractionated heparin
A
at least daily
6 hours after initiation
6 hours after any dosage changes
18
Q
Assessment findings of DVT include
A
unilateral pain, warmth, redness, swelling
-has a sudden onset of pain
19
Q
when calculating heart rate on a strip, we should determine there are how many large boxes (as in how many equal 6 seconds)
A
30 (or three tick marks at the top)
20
Q
Normal sinus rhythm has a heart rate between
A
60-100
21
Q
What is the normal value for the PR interval
A
0.12-0.2
22
Q
What is the normal value for QRS interval
A
0.06-0.10
23
Q
What is the normal value for the QT interval
A
less than 0.44 seconds
24
Q
sinus bradycardia has a heart rate of
A
less than 60
25
What are prevention measures for DVT
early ambulation, SCDs, compression stockings, fluids, calf pump exercises, anticoagulant therapy
26
What lab is indicative of cardiac damage
troponin
27
What can be used for treatment of sinus bradycardia
IV atropine, oxygen, and IV fluids
28
What drugs are dabigatran, rivaroxaban, apixaban, and edoxaban
oral anticoagulatns
29
What is the benefit of using oral anticoagulants
allow for fixed doses without frequent lab monitoring
30
A patient was given benzocaine prior to bronchial surgery, the nurse knows the patient is at risk for?
methemoglobinemia
31
What is methemoglobinemia
when hemoglobin in the cell no longer works. leads to chocolate colored blood and decreased oxygenation
32
What is the antidote for methomeglobenemia
IV methylene blue
33
Should a rapid response be called for a patient with methomeglobinemia?
YES
oxygen and sitting them up will not help. crash cart has the antidote
34
What is a complication of tension pneumothorax
deceased cardiac output
35
Why does tension pneumothorax cause decreased cardiac output
when blood vessels in the lungs are collapsed there is not enough blood return to the heart. decreased heart filling --> decreased cardiac output
36
What is the best method to confirm placement of a chest tube
X-ray
37
When a patient presents to the ED with a chest trauma, what should the nurse address first?
-chest expansion
-capillary refill
-PERRLA
-orientation
chest expansion
38
What is the ABCDE method of treating emergency chest trauma s
airway, breathing, circulation, disability (LOC), exposure (removing clothes)
39
What does it mean to assess the airway in ABC
making sure it is patent and not closed
40
What does it mean to assess breathing in ABC
assessing breath sounds and chest expansion
41
What does it mean to assess circulation in ABC
check capillary refill
42
Following a lung biopsy, which assessment finding would require immediate follow-up?
increased temp
productive cough
incisional discomfort
absent breath sounds
absent breath sounds
43
What is tidaling?
when the water seal container of a chest tube rises and falls with inspiration and expiration
44
is tidaling a normal finding?
yes
45
is continuous bubbling in the water seal container considered a normal finding?
No, may indicate air leak
46
the absence of tidaling in the water seal container may represent
fully expanded lung, obstruction in the chest tube
47
Are we allowed to milk the tube of a chest tube?
no
48
What is flail chest
paradoxical chest wall movement
49
You are caring for a patient in respiratory distress, o2 sat 89%, RR 30. What is the best course of action?
apply oxygen
reposition
encourage IS use
notify provider
apply oxygen
50
Hyperparathyroidism can put the patient at risk for?
fractures
51
Why does hyperparathyroidism increase risk for fractures?
causes calcium to leave the bone and enter the blood stream (hypercalcemia)
52
Grave's disease is a type of autoimmune disorder that causes
hyperthyroidism
53
What are s/s of hyperthyroidism/ Grave's
heat intolerance, weight loss, increased appetite, insomnia, tachycardia
54
If TSH is elevated, T3 and T4 are
decreased
55
If T3 and T4 are elevated, TSH is
decreased
56
Would TSH or T3 be elevated in hypothyroidism
TSH
57
a patient with parathyroid hormone deficiency would have increased or decreased calcium levels/
decreased
58
What is thyroid storm?
When patients with hyperthyroidism enter an acute attack causing release of too many hormones at once
59
What is the best indicator for thyroid storm
increase in fever
60
Most common causes of thyroid storm
trauma, infection, vigorous palpation of goiter
61
Will patients in thyroid storm be hyperthermic or hypothermic
hyperthermic
62
Following a thyroidectomy, it is important for the nurse to inspect
behind the clients neck
63
What is an important complication of thyroidectomy
hemorrhage
64
What are trousseaus and chvostek signs
indicators for hypocalcemia
65
How to test for chvostek sign
tap the face and see if there are spasms
66
How to test for trousseau's sign
use a blood pressure cuff and see if the wrist curls
67
A positive trousseaus sign indicates
hypocalcemia
68
What is the most severe form of hypothyroidism
myxedema coma
69
Myxedema coma is precipitated by
stress
70
What are s/s of myxedema coma?
bradycardia, hypotension, respiratory failure
71
Following a thyroidectomy, it is important to monitor for?
airway patency
72
What can damage the airway following a thyroidectomy?
nerve damage, hypocalcemia induced tetany, edema
73
If a patient develops stridor after a thyroidectomy, the nurse knows this is caused by
swelling
74
Is stridor after a thyroidectomy an emergency?
yes! notify provider as soon as possible
75
If a patient develops stridor after a thyroidectomy, the nurse should
contact provider and prepare for intubation
76
A patient with hypothyroidism will be prescribed
levothyroxine
77
to prevent thyroid crisis in a patient with hyperthyroidism, the nurse can?
encourage rest, keep environment quiet, room away from nurses station, limit visitors, provide cooling blanket
78
What should you tell a patient regarding diabetes management and sick days?
take insulin as prescribed
79
How often should a patient with diabetes take their blood glucose while sick
q 2-4 hours (more than normal)
80
What should the blood glucose range be for a patient with diabetes in the hospital
140-180
81
Should a diabetes patient who is sick remain NPO?
No, this can cause hypoglycemia
82
If a patient with diabetes is alert and oriented, but a blood sugar of 60, what is the best action
administer 15 g of oral carbohydrates
83
If the blood sugar is 51-70, how many carb snacks should we give
15 g carb snacks
84
If the patient has a BG of <50 but is alert and oriented, how many carb snacks should we provide
30 g carb snack
85
What is the ideal target range for BG at home (for diabetes)
70-110
86
What are examples of a 15 g carb snack
4 sugar cubes, 4 tsp of sugar, 1 tbs honey/syrup, 120 mL fruit juice, 5 hard candies
87
If a patient is not awake or alert, has an IV site, and is hypoglycemic we should administer
IV dextrose
88
If a patient is not awake or alert, no longer has IV, and is hypoglycemic we should administer
IM glucagon
89
After administering IM glucagon, what is the next nursing action?
turn them on their side (glucagon causes them to throw up and we do not want them to aspirate)
90
what are signs of diabetes type 1
abrupt onset, increased thirst, hunger, weight loss, and urination
91
What are signs of diabetes type 2
frequently no symptoms, thirst, fatigue, blurry vision
92
In a patient with type 1 diabetes, what is a sign of hyperglycemia
confusion, polyuria, hunger, tachypnea
93
What are complications of a client with DKA and on IV insulin
hypokalemia, hypoglycemia
94
What is the onset of regular insulin
30 minutes
95
If given regular insulin, it is important that the patient eats within
30 minutes
96
We should tell those with type 2 diabetes that exercise
can have a hypoglycemic effect, so they may need less insulin
97
What are the places insulin can be administered?
back of arms, abdomen, thigh, buttocks
98
Insulin is given at a 90 degree angle unless
there is not enough subcutaneous tissue (then it is 45)
99
How often should someone with diabetes check their feet
daily
100
If someone with diabetes cannot see their feet, what can they do
have someone else look, use a mirror
101
How should a patient with diabetes wash their feet
with lukewarm water and soap. dry thoroughly
102
Are nurses allowed to cut the toenails of patient with diabetes
no (let podiatry do it)
103
Should a patient with diabetes go barefooted?
no
104
What are signs and symptoms of a ureteral stone
severe pain, nausea, vomiting, pallor, clammy skin
105
Pyelonephritis is
infection of the kidneys
106
Pyelonephritis can be caused by
reflux of urine from the bladder
107
What is the most common cause of UTI and pyelonephritis
e - coli infection
108
What are sx of pyelonephritis
flank pain, fever, chills, anorexia with or with out vomiitng
109
What is the most common cause of kidney stone
dehydration
110
what is a common complication of chronic kidney disease
anemia
111
For patients with polycystic kidney disease, it is important that they monitor their
blood pressure and daily weight
112
A woman is more at risk for cystitis because
their urethra is close to the rectum
113
a client with uric acid stones should decrease the intake of
purine
114
Examples of purine sources
organ meats, poultry, fish, red wines, sardines, and gravies
115
Is pink-tinged urine expected following a cystoscopy?
yes
116
Following a cystoscopy, the patient should report
dark red urine (indicate of bleeding)
117
Following cystoscopy, patients should increase fluid intake in order to
decrease dysuria
118
is a patient NPO before a cystoscopy?
yes, NPO at midnight
119
What is a normal WBC count level
5-10,000
120
what is a CAUTI
catheter associated urinary tract infection
121
A catheter should only be in place for
no longer than medically needed d
122
Following a kidney biopsy, the patient should be on
strict bedrest
123
Following a kidney biopsy, what may be indicative of bleeding
flank pain, hematuria, on the bed
124
What to do with a limb that has been cut off in the community
put in watertight sealed bag, place in ice water
125
If a limb is amputated in the community, the patient should hold the limb
above the heart if possible
126
What is the purpose of bucks' traction
reduce muscle spasms
127
Special considerations for skeletal traction
frequent pin care to reduce infection
128
What is most indicative of fat embolism
petechiae on the chest
129
What are other s/s of fat embolism
hypoxemia, dyspnea, tachycardia, agitation, headache
130
What is an impacted bone fracture
when the ends are jammed together
131
What is a comminuted fracture
the impact fragments bone into several pieces
132
What causes flail chest
when 3 or more ribs are broken in 2 separate places
133
What is the biggest indicator of tension pneumothorax
tracheal deviation
134
A transverse fracture is a break that goes
straight across bone shaft
135
an oblique fracture is a break that goes
through the bone shaft at an angle
136
What can help prevent flexion contracture
lie prone every 3 h for at least 20-30 min
137
What surgery causes flexion contracture the most
total knee arthroplasty
above the knee amputation
138
How long do we elevate the limb following a total knee arthroplasty
only the first 24 hours
139
What should we always ensure in patients with bucks and skeletal traction
make sure they are free hanging and not on the bed
140
What assessments should be made by the nurse while in Bucks and skeletal traction
skin color, temperature, distal pulses, capillary refill, movement, and sensation
141
signs of compartment syndrome
6 P's
-pulselessness
-paralysis
-paresthesia
-paleness
-pain greater than expected
-paralyzed
142
What is phantom limb pain
limb pain felt in an amputated body part
143
what medication is most appropriate for phantom limb pain
iv calcitonin
144
where does pain from carpals tunnel occur
thumb, first two fingers and palm
145
What test is done for carpal tunnel
Phalen's test
146
What is the phalen's test
flexion of the wrist assessing for paresthesia
147
What does RICE stand for
rest, ice, compression, elevation
148
What age does GERD mostly occur
middle aged and older adults
149
How to reduce the contributing factors of GERD
-eat small frequent meals
-remain upright after eating
-avoid triggering foods
150
What foods should be avoided in GERD
-spicy foods, tomatoes, citrus foods, caffeine, alcohol, carbonated beverages, chocolate
151
What medications can be used to treat GERD
PPI's (-azole) antacids, H2 blockers (famotidine)
152
Symptoms of sliding hernia
GERD symptoms (dyspepsia, regurgitation, dysphagia, belching, chest pain)
153
Symptoms of rolling hernia
fullness after eating, breathlessness, feeling suffocated
154
Why is an NG tube placed after fundoplication
prevent wrap from becoming too tight around esophagus
155
Initial drainage from NG tube after fundoplication
dark brown with old blood
156
8 hours after fundoplication, NG tube drainage should appear
yellowish green
157
why is it important to ensure an NG tube is anchored properly after insertion
re-insertion could cause perforation
158
risk factors for developing esophageal tumors
smoking and obesity
-malnutrition, untreated GERD, alcohol
159
What is Barrett's epithelium
-caused by GERD
-premalignant esophageal cells
160
Many ulcers in PUD are caused by
H. pylori
161
What drug would the nurse expect to be ordered in a patient with postoperative ileus
alvimopan
162
A small bowel obstruction is likely to cause severe electrolyte imbalances due to
profuse vomiting (can contain fecal matter)
163
Does a large bowel obstruction have major fluid and electrolyte imbalances
no , vomiting occurs much less
164
Key characteristic of large bowel obstruction
ribbon shaped stool
165
Risk factors for colorectal cancer
FAP, > 50, genetics, family history, smoking, obesity
166
What are biggest indicators for colorectal cancer
rectal bleeding, change in stool consistency, anemia
167
Anemia in colorectal cancer is likely to cause e
fatigue
168
ABD pain and fullness are signs of colorectal cancer? T or F
true
169
Does colorectal cancer cause weight gain or weight loss
weight loss
170
Patient education for FOBT
-no NSAIDs or anticoagulants 7 days before
-no red meat, aspirin, or vitamin C (350mg) 3 days before
171
How many stool samples are needed for a FOBT
2-3
172
FIT vs FOBT
FIT is not altered by medications or foods
173
Best method for treating CRC
surgery to remove the tumor
174
How should a healthy stoma appear
reddish pinks and moist (small bleeding expected first 6-8 wks)
175
why is it important to remeasure the stoma q week for the first 6-8 weeks
stoma shrinks in size
176
How long after colostomy should it begin functioning
2 - 3 days
177
Stool from ascending, transverse, and descending colostomy
ascending: liquid
transverse: pasty
descending: more solid
178
Initial cause of appendicitis includes
hard pieces of stool
179
What is ulcerative colitis
edema and inflammation of the colon
180
Where does ulcerative colitis occur
rectum and rectosigmoid colon
181
Crohn's disease occurs in
the entire GI tract (mouth to anus)
182
Crohn's disease contains ____ which are openings in body parts that shouldn't be there
fistulas
183
Signs of peritonitis include
ABD pain, ABD tenderness, ABD distention, rigid and boardlike, bowel sounds diminishing
184
Where does appendicitis pain occur
RLQ
185
Why are enemas and laxatives contraindicated in appendicitis
cause appendix to rupture, increasing risk for peritonitis
186
What type of foods should those with diverticular disease avoid? Why?
seeds, nuts, corn, popcorn, figs
-these may block diverticulum and cause diverticulitis
187
Priority nursing action for patient with gastroenteritis
fluid replacement
-could be IV fluids
-could be oral gatorade or pedialyte
188
Rigid-board like abdomen, fever, tachycardia, fever, nausea, vomiting are signs and symptoms of
peritonitis
189
What foods should be avoided in celiac's disease
barley, rye, wheat
190
Complication of ulcerative colitis includes
low hemoglobin and hematocrit (due to bloody stools)
191
Which is not a s/s of crohns disease
-anemia
-weight gain
-diarrhea
-weight loss
-RLQ pain
weight gain
192
Crohns disease diet
low in fiber, raw vegetables, and lactose
193
Famotidine, used to treat PUD, should be taken
at night
194
Sepsis in the older adult may present as
confusion, AMS, incontinence
195
what is qSOFA
used in non-icu settings
-systolic < 100
-AMS
-tachypnea >22
196
A qSOFA score of __ requires more testing
2
197
a SOFA score of ___ indicates a greater risk of poor outcomes in the ICU
greater than 1
198
What are symptoms of bradycardia
syncope, confused, CP, hypotensive
199
Patients with bradycardia may require laxatives because
straining to defecate is a form of valsalva maneuver (which causes bradycardia)
200
Those with sinus tachycardia are going to be at risk for
low cardiac output
201
VTE's risk factors include
virchow's triad
-hypercoagulability (oral contraceptives)
-venous stasis (immobility)
-injury (prostate surgery/smoking)
202
What is Homan's sign? is it best practice
test used to assess for DVT in the calf, this is NOT USED
203
Two diagnostics for VTE
venous duplex ultrasound, d-dimer
204
LMWH patient education
-how to self administer injection
(enoxaparin)
205
Heparin toxicity antidote
protamine sulfate
206
Warfarin toxicity antidote
vitamin k
207
patient teaching for warfarin
-eat consistent amounts of vitamin K
-electric razor, medical alert bracelet
208
Unfractionated heparin adverse effect
fatal agranulocytosis (do not administer if platelets < 150,000)
209
What chest injury is mostly cause by rapid deceleration event like MVA
pulmonary contusion
210
Pulmonary contusion causes hemorrhage to occur between the alveoli, resulting in
decreased breath sounds, decreased gas exchange, hypoxemia
211
If laying patients with pulmonary contusion on their side, they should be placed
good lung down
212
What is flail chest
3 or more fractures ribs occurring in 2 or more places
213
Flail chest increases patient risk for
paradoxical chest wall movement, tachycardia, cyanosis, hypotension,
214
What is the hallmark symptom of tension pneumothorax
tracheal deviation to unaffected side, absent breath sounds, respiratory distress
215
Can patients smoke or use a bronchodilator before pulmonary function test
No smoking 6-8 h, no bronchodilator 4-6 h
216
symptoms of pneumothorax, pleural effusion, and hemothorax
asymmetrical chest wall expansion, diminished breath sounds
217
What are the most important nursing consideration for thoracentesis
-patient must stay completely still
-monitor for pneumothorax post procedure
218
How much fluid is allowed to be taken during thoracentesis
1,000 mL
219
What is the name for crackles felt underneath the skin during pneumothorax
subcutaneous emphysema/ crepitus
220
After bronchoscopy, the patient must be NPO until
the gag reflex is returned
221
After lung biopsy, it is important to obtain an x-ray to assess for
presence of pneumothorax formation
222
What are the two types of NPPV
CPAP and BiPAP
223
CPAP vs BiPAP
BiPAP has two levels: different for inspiration and expiration
CPAP maintains one level throughout
224
How much water must be kept in the water seal container of the chest tube
2 cm
225
What are the only reasons we can clamp a chest tube
-checking for air leak
-changing the tubing
-removing
226
What should we do if the chest tube is pulled out
place tube in two inches of sterile water, clamp with hemostats, cover site with sterile gauze
227
During transport, the chest drainage system should remain
upright and below the level of the chest
228
If output for a chest tube is greater than ___ , contact provider
70
229
Most patients with type 2 diabetes have this comorbidity
metabolic syndrome
230
Metabolic syndrome includes
abdominal obesity (35 or 40 in), hyperglycemia (fasting > 100), hypertension (systolic 140, diastolic 90), hyperlipidemia (triglycerides 150 or more)
231
Other risk factors for diabetes type 2
family hx, AA/hispanic/Pacific Islander, high birth weight babies, PCOS
232
A1C level for diabetes
6.5 or greater
233
Patients with diabetes should maintain an A1C of
7.0 or below
234
Patients with diabetes should avoid these foods
empty calories (candy and soda), trans and saturated fats, high alcohol consumption
235
After exercise, why should diabetics check glucose more frequently
they may need decreased insulin doses
236
Exercise education for patients with diabetes
-neuropathy: be cautious of activities that can cause falls
-retinopathy: no raising BP due to risk of hemorrhage or retina detachment
237
What would inhibit a person with diabetes from exercising
blood glucose not within 100-250, ketones in the urine
238
What is the most common oral anti diabetic medication
metformin
239
Metformin will decrease the blood levels of
folic acid and vitamin B
240
Basal and bolus insulin doses
basal: set dose
bolus: short acting and taken at meal times
241
When should a sick patients with diabetes notify their provider
-ketones in urine 24 h
-glucose > 250
after 2 treatments
-hypoglycemia
242
Hallmarks of DKA (seen in type 1)
-BG >300
-fruity breath
-Kussmauls (deep and rapid)
-ketones in urine
-metabolic acidosis
243
Hallmarks of HHS (seen in type 2
-bg > 600
-frequent urination, dehydration
244
why are BUN and creatinine elevated in DKA and HHS
-dehydration
245
should patients with diabetes ever go barefoot
no
246
How to prevent diabetic retinopathy, nephropathy and neuropathy
-maintain glucose levels within normal limits
247
Diabetic nephropathy disease progression can be slowed by
ACEs(-pril) and ARBS (-sartan)
248
What endocrine gland is the master gland
pituitary gland
249
Hypopituitarism, caused by decreased growth hormone, can lead to
decreased bone density and increased risk of fractures
250
Hallmark symptoms of acromegaly
enlarged face hands and feet
coarse facial features
vision and voice changes
enlarged organs
251
how to test for acromegaly
growth hormone supression test
-oral glucose given, if GH doesn't change = acromegaly
252
Acromegaly is treated with dopamine agonists, bomocriptine mesylate and cabergoline, what adverse reactions can these cause
chest pain, dizziness, watery nasal drainage = CSF leak
253
After hypophysectomy, we should monitor patients for
-nucchal rigidity and headache = meningitis
-watery nasal drainage and increased swallowing (halo sign or glucose present) = CSF leak
254
treatment for CSF leak
bedrest
255
Pt education for hypophysectomy
no bending at waist, no coughing/sneezing/blowing nose/ brushing teeth
256
Most important thing to monitor in patients with hyperthyroidism
increase in temperature (could indicate progression to thyroid storm)
257
symptom specific to grave's disease
exopthalamus
258
Hyperthyroidism is treated with methimazole and propylthiouracil, what are patient teaching points for these medications
-they suppress immune system so avoid large crowds, monitor for infection
259
Patient teaching for radioactive iodine
-sit while urinating
-flush 2-3 tiems
-avoid contact with pregnant and children one week
-do not share utensil
260
Following a thyroidectomy, a patient experiences tingling in the mouth/toes/fingers, what should the nurse prepare to administer?
IV calcium gluconate
(pt has hypocalcemia)
261
expected lab values with hypoparathyroidism
decreased PTH, calcium and magnesium
increased phosphorus
262
expected lab values with hyperparathyroidism
increased PTH, calcium, and magnesium
decreased phosphorus
263
Hyperparathyroidism increases clients risk of
hypercalcemia --> kidney stones, fractures
264
What is lugol's solution
treatment for hyperthyroidism (drink through straw 10-14 days before surgery)
265
if serum calcium levels increase, PTH
decreases
266
if serum calcium levels decrease, PTH
increases
267
Calcitonin use
decrease calcium levels
268
Decreased levels of estrogen put the female client at risk for
osteoporosis
269
Kyphosis puts the patient at risk for
falls
270
common cause of osteomyelitis
animal bites, open fractures
271
Post-operative osteomyelitis can result from surgically implanted fixation devices. what pathogen causes this
MRSA
272
What medications treat MRSA
iv vancomycin, dabtomycin, linezold
273
ABX therapy for osteomyelitis may be longterm and often requires placement of
PICC lines
(6 weeks iv abx, then 4-6 wks oral)
274
Hyperbaric oxygen therapy can be used to
promote wound healing in pts with osteomyelitis
275
complete vs incomplete fractures
complete is entire width of the bone
276
closed vs open/compund fractures
open/compund protrudes out of the skin
277
Simple vs comminuted fractures
comminuted can have multiple fracture lines
278
Displaced vs non displaced fractured
displaced the bone fragments do not stay in alignment
279
Compression fractures are usually seen in the ___ and are most common in what population?
spine ; older adult
280
Pathologic/spontaneous fractures are caused by
osteoporosis
281
oblique fractures
break at an angle
282
complications of fractures
DVT, fat embolism, compartment syndrome, infection
283
What is the earliest sign of compartment syndrome
paresthesia
284
What is the treatment for compartment syndrome
fasciotomy
285
Chronic complication of fractures
avascular necrosis , chronic pain
286
Why should NSAIDs be avoided in patients with a fracture
delay bone healing
287
What is open reduction vs closed reduction
open reduction is surgically resetting, closed reduction is pulling the bones back into alignment
288
Plaster casts are used less often because
-they take 24 hours to dry
(smell musty while drying as well)
289
Fiberglass casts are more utilized because
-they weigh less
-dry much faster
290
If someone has a wound under their cast, or still have severe swelling, what may the provider do
cut a window in the cast or cut the top to allow for swelling
291
Patient education for casts
-report any tingling, cold digits, paralysis (may indicate compartment syndrome)
-do not stick things in cast
292
Skeletal traction requires what to prevent infection
frequent pin care
293
What to do if an amputaiton happens in the community
-assess ABC
-sterile dry gauze
-apply pressure and elevate above heart
-do not remove gauze
294
Treamtent for Phantom limb pain
-iv calcitonin
-tens unit
-gabapentin (nerve pain)
-beta blockers (dull burning)
295
How long do we elevate the stump after amputation
24 hours only
296
Complications of amputation
-neuroma
-flexion contractures
297
how to prevent flexion contracture
-do not elevate after 24 h
-ROM exercises
-turning
-lying prone
-firm patress
298
Why do we do the figure 8 dressing after amputation
compress bottom of stump to shape it for prosthesis
299
treamment for carpal tunnel
-wear brac
-NSAIDs
-surgery
300
Treatment for sprain
RICE
301
Hallmarkers for cystitis infection on a UA
-leukocyte estrerase, nitrites, WBC, RBC, casts
302
Creatinine cannot be altered by other disease processes other than kidney dysfunction. T or F
true (why creatinine is the best indicator of kidney dysfunction)
303
Education for 24 hour urine
-begin after your first void
-keep on ice
-get every single drop
304
the bacteria that causes UTI and pyelonephritis
e-coli
305
IF patient hasn't voided in 6h, the nurse should
obtain bladder scanner
306
a kidney ultrasound requires ____ ml of fluid before examination
500-1000
307
What is a KUB
x-ray of kidneys, ureters, and bladder
308
Which kidney diagnostic test measures for GFR
renal scan
309
Is pink-tinged urine after cystoscopy an expected finding?
yes
310
Patient education before and after cystoscopy
-npo, bowel prep before
-increase fluids after
311
a voiding cystourethrography uses contrast dye to assess for
back flow of urine to the kidneys (takes x-ray during voids)
312
After kidney biopsy, the pt must remain on strict bedrest ofr
2-6 hours
313
Why is it important to monitor BP in someone receiving kidney bipsy
HTN increases risk of bleeding, complication of kidney biopsy is hemorrhage
314
Sx of UTI
-cloudy/foul smelling urine
-frequency, urgency, burning while peeing
-pain with urination
-abdomen pain (from bladder spasms)
315
number one way to prevent CAUTI
hand hygien
316
Sx of pyelonephritis
-chills, fever, CVA tenderness, flank pain, nausea, vomiitng
317
Complications of chronic pyelonephritis
-increase BUN and creatinine
-hyperkalemia
-hyponatremia
318
acute glomerulonephritis is commonly caused by
strep infection
319
Chronic glomerulonephritis symptoms
-HTN, fatigue, protein and blood in urine, edema, electrolyte imbalances, decreased GFR
320
ABX used to treat UTI, pyelonephritis, glomerulonephritis
trimethoprim, trimethoprim/sulfamethoxazole, nitrofurantoin
321
urinary analgesic used for UTI
phenazopyridine (will turn urine orange or red)
322
Most common cause of renal calculi
dehydration
323
symptoms of kidney stones
severe, sudden pain, flank pain, abdomen pain, urinary frequency, nausea, vomiting
-cholicky pain: comes and goes
324
Patient education for lithotripsy
strain urine after
325
Nursing interventions for nephrostomy tube
-drain 4-5 times a day
-change bag 3 times week
-avoid bathing, swimming pools, and hot tubs
326
priority for polycystic kidney ydiseae
maintaining hypertension
327
sx of PKD
-distended abdomen, abd pain, HTN, constipation,headaches, foul odor = infection, edema
328
Why should we use NSAIDs cautiously in PKD?
reduce blood flow to kidney y
329
Patients with PKD should limit
aspirin, protein and sodium
330
pts with glomerulonephritis should restrict?
-sodium, water, potassium, and protein
331
elevated amylase and lipase can indicate
acute pancreatitis
332
Frequent vomiting causes what acid-base imbalance
alkalosis
333
Frequent diarrhea causes what acid base imbalance
acidoss
334
What is an acute ABD series
x-ray of the client's chest, abdomen while supine, abdomen while sitting
335
Pre and post nursing interventions for EGD and ERCP
pre: no NSAIDs/anticoagulants for one week, NPO
post: assess gag reflex
336
Severe adverse reaction of colonoscopy
bowel perforation --> abdominal guarding and tenderness
337
Clients may eat a soft diet a few days prior, avoid NSAIDs, take colase, and must do bowel prep for colonoscopy. T or F
true
338
What diagnostic test is most accurate for GERD
pH monitoring (monitors pH level for 24-48 hours)
339
Is volvulus risk low for sliding or rolling (paraesophageal) hiatal hernia
sliding
340
What surgery can be done to treat hiatal hernia
Nissen fundoplication
341
Pre and post nursing interventions for LNF
-pre: stop smoking, lose weight
-monitor NG and chest tube, eat soft diet, continue anti-reflux meds for one month
342
Pre interventions for esophagectomy
-stop smoking 2-4 weeks before
-do pulmonary strengthening
343
Why is respiratory care so important with esophagectomy
they are on ventilation first 16-24 h after procedure
344
Are we allowed to irrigate NG tube after esophagectomy
NO
345
Post surgical complications for esophagectomy
-cardiovascular (hypotension)
-wound management (prevent anastomosis)
-NG tube (no irrigation or oral care important)
-nutriton (J tube until no anastomotic leak is confirmed)
346
Causes of acute gastritis
alcohol, caffeine, coffee
347
Chronic cause of gastritis
h . pylori
348
Will acute or chronic gastritis include symptoms of pain, dyspepsia, hematemesis, and melena?
acute
349
Chronic gastritis does not produce symptoms until
ulceration occurs --> leading to N/V and pain
350
Chronic gastritis leads to deficiency in what vitamin?
b12
351
Gastritis can be treated with mucosal protectant medications such as
sucralfate and carolfate
352
Symptoms of peptic ulcer disease
epigastric tenderness and pain, dyspepsia
353
Ulceration of an ulcer in PUD can lead to
peritonitis (rigid boardlike abdomen and fever)
354
What are the three types of ulcers in PUD
stress, gastric, duodenal
355
Stress ulcers are more likely to cause
bleeding
356
What type of peptic ulcer occurs 30-60 min after food, is rarely worsened by food ingestion, and has hematemesis?
gastric
357
what type of peptic ulcer causes hyper secretion, is relieved by food, has melena, and occurs 1.5 hours after a meal?
duodenal
358
Most common complications of ulcer
perforation, pyloric obstruction, bleeding
359
What is the urease breath test?
-test for h.pylori, can be used to diagnose peptic ulcer disease and gastritis
360
What antibiotics can be used to treat H.pylori
clarimycin and amoxicillin
361
Early symptoms of gastric cancer
dyspepsia, abdominal discomfort, epigastric and back pain
362
Late symptoms of gastric cancer
N/V, weight loss, iron deficiency anemia
363
Largest complication of gastrectomy
dumping syndrome
364
patient education on how to prevent dumping syndrome
avoid fluids with meals, eat high protein-high fat low carb diet, small and frequent meals
365
Early sx of dumping syndrome
vertigo, achy, syncope, pallor, diaphoresis, desire to lay down
366
Late sx of dumping syndrome
sx of hypoglycemia: dizziness, diaphoresis, confusion, palpitation
367
Causes of mechanical obstruction
tumors, scarring, adhesions, volvulus
368
Causes of non-mechanical obstruciton
decreased peristaltic functions
369
Complications of small and large bowel obstruction
hypovolemia, acid-base imbalances, sepsis
370
Why do we insert an NG tube for obstruction
decompression
371
CRC signs and symptoms can vary based on
location
372
symptoms of right sided CRC
weight loss
373
symptoms of transverse colon CRC
dark red blood, abdominal pain, using BR more often
374
Rectosigmoid colon cancer
-change in stool, blood
375
After a colon resection, what may the patient have
temporary or permanent colostomy
376
timeline for abdominoperineal resection
wound may drain for 1-2 months, complete healing does not occur for 6-8 months
377
IBS diagnostic
hydrogen breath test
378
IBS - c medications
psyllium hydrophilic muciloid, linaclotide
379
IBS- d medications
loperamide antidiarrheal, psyllium, alosetron (used cautiously in women)
380
A hernia is caused by
weakness in abdominal wall
381
strangulated hernia is caused by
coming through bowel wall and twisting
382
s/s of hemorrhoids
bright red blood, itching, swollen/distended veins
383
untreated peritonitis can lead to
sepsis
384
If our patient has knees flexed in a fetal position and pain relief, this is an identifier for
peritonitis
385
Peritonitis can cause elevated ____ and ____ due to
BUN and creatinine ; hypovolemia
386
After abx solution is irrigated into client with peritonitis, this is the priority nursing actions
keep them sat up to keep drains draining properly
387
Order of symptoms for appendicitis
abdominal pain --> nausea vomiting
388
What is McBurney's point
where the pain of appendicitis localizes to
389
Can we give a client with appendicitis laxatives or enemas
NO, increases risk of rupturing
390
Order of symptoms for gastroenteritis
nausea / vomiting --> abdominal pain --> diarrhea
391
Patients with gastroenteritis are very at risk for this electrolyte imbalance due to excessive diarrhea
hypokalemia
392
Antidiarrheals should be used sparingly in gastroenteritis because
lomotil is habit forming, may cause toxic megacolon
393
What disease produces 10-20 liquid, bloody stools a day
ulcerative colitis
394
Why can patients with ulcerative colitis develop anemia
chronic bleeding from ulcers
395
Which disease process causes 5-6 loose, non bloody, steatorrhea stools
crohns disease
396
Other than abdominal pain, will ulcerative colitis cause any physical assessment abnormalities
no
397
Albumin, hemoglobin, and hematocrit are increased or decreased in ulcerative ecolitis
decreased
398
What diagnostic can be used for ulcerative colitis
MRE
399
What is an MRE diagnostic test
NPO 4-6 hours before, glucagon subcutaenous injection administered, allows for bowel to tbe seen
400
Diagnostic test to show ulcerative colitis vs crohn's
contrast via barium enema
401
Medications for ulcerative colitis and crohns disease
aminosalicylate: sulfasalazine, mesalamine
Glucocorticoids: prednisone
Antidiarrheals: loperamide (Immodium), diphenoxylate hydrochloride, atropine sulfate (Lomotil)
Immunomodulators: adalimumab
402
Client educations for adalimumab
avoid large crowds / infected people
403
What foods should a client with ulcerative colitis avoid
corn, pepper, carbonation, smoking, nuts
404
Two common problems for Crohn's disease
malabsorption, fustila formation
405
Folic acid and b12 will be high or low in crohns disease
low --> pernicious anemia
406
Why is nutritions os important with crohns disease
-heals promote healing of fistulas
407
can we give enemas to people with diverticulitis
no (may cause perforation and peritontonitis)
408
