Final Weeks 1-7.5 Flashcards Preview

SEMESTER FOUR!! Nursing 214 > Final Weeks 1-7.5 > Flashcards

Flashcards in Final Weeks 1-7.5 Deck (73)
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1

Drugs used in caution with renal disorders

diuretics

antibiotics

NSAIDs

2

Kayexalate

Used for hyperkalemia to remove potassium by GI tract. Poops it out.

Monitor K levels

Don't give to: patients with an ileus

Assess: BP, CHF, dig toxicity if taking digoxin, arrythmias, assess bowel function

3

Reglan

Phosphate binder, removes phoshorous.

Give with food so it can bind with food

Monitor phosphate and calcium levels

4

Addison's Disease

Low hormone.

Weight loss

Na: Low

K: High

Hypovolemia

A/N/V/D

Hypotension

Anemia

Fatigue

TNIs: Assess VS, esp. BP, assess for fluid deficit

BP should be: LOW

 

5

Addison's Crisis

Hypotension and shock

6

Cushing's Syndrome

Too much hormone.

Truncal obesity

Thin skin

Moon face

Hirsuitism

Acne

GI upset/ulcers

Mood swings

Poor wound healing

Osteoporosis

Na: high
Water retention

K: low

Can't fight infections

TNIs: assess VS, especially BLOOD PRESSURE, assess for fluid volume excess

BP should be: HIGH

 

7

Prednisone

GI symptoms/ulcers

Poor wound healing

Monitor: daily weights, I/O, s/sx of infection, temperature

Give with milk or food to decrease GI symptoms

Titrated to lowest effective dose

Teach not to d/c abruptly, must be tapered

If long term use: every other day dosing to decrease adverse effects

8

Solumedrol

GI symptoms/ulcers

Poor wound healing

Can be given: PO, IV, IM, PR, intra-articular (avoid SC)

Monitor: weights daily, I/O, s/sx of infection, temperature

Give with milk or food to decrease GI symptoms

One dose given in AM to prevent adrenal suppresion

Titrated to lowest effective dose

Teach not to d/c abruptly, must be tapered

Increase intake of potassium, calcium, vitamin D, protein

If long term use: every other day dosing to decrease adverse effects

9

Asterixis

Flapping tremors of hands/arms associated with hepatic encephalopathy (ammonia levels too high due to liver disease)

10

Fetor Hepaticus

musty, sweet odor on breath due to accumulation of digestive by-products associated with hepatic encephalopathy

11

TNIs Portal Hypertension

  1. Monitor for bleeding from varices
  2. Teach to avoid spicy/rough foods and activites that increase portal pressure (valsalva, sneezing, coughing, retching/vomiting) d/t risk of hemorrhage
  3. Teach to avoid aspirin, hepatotoxic OTC drugs, alcohol to avoid continued liver complications

12

TNIs Portal encephalopathy

  1. Monitor for behavioral/orientation changes, speech changes, blood pH, ammonia levels
  2. Limit physical activity (ammonia is a by-product of protein, exercise)
  3. Lactulose: po or pr ammonia detoxicant. Take on empty stomach, assess stool, monitor lytes

13

Spironolactone

Potassium SPARING diuretic.

Hyperkalemia is a side effect.

Asses: lytes

Give in AM with food if nausea occurs

Monitor: weights, I/O

Used with ascites

14

Liver Biopsy

Needle between ICS on right side with CT guidance

TNIS:

check coagulation status pre-procedure

Ensure blood is typed/cross matched

VS before, during, after

Ensure consent signed

Explain breath holding on expiration when needle is inserted (lungs deflated, liver in normal place)

 Patient lies on R side for 2 hours to splint puncture site; then lie flat 10-14 hours.

Complications: hemorrhage, pneumothorax, shock, peritonitis

15

Paracentesis

Used for those with ascites with impaired respirations or pain

TNIs: teaching, informed consent, empty bladder, measure abdominal girth/weight. High fowler’s during procedure, sterile procedure, measure volume removed (750-1000mL), monitor site, bandaid to site, measure abdominal girth, weight, VS, monitor lytes, s/sx of infection.

Complications: intraperitoneal hemorrhage, perforation of organs, hepatic coma, peritonitis, hypotension/shock from rapid removal of fluid

16

Diet for Cirrhosis

High calorie (3000/day)

High carbs

Low to moderate fat

Sodium/fluid restriction if ascites/edema are present

Protein from animal sources, might be limited flare up of symptoms

17

Neonate RR

 

30-60

18

Infant RR

20-40

19

Retration location

Start at intercostals.

If increased effort is needed supra/infra clavicular seen

20

Children RR

15-25

21

Adult RR

12-20

22

What indicates hypoxia?

Agitation/restlessness

23

What indicates hypercapnia?

Lethargy/somnolence

24

FEV1

amount of air exhaled in the first second of a quick and forceful expiration that is done at the hospital

25

PEFR

maximal airflow during expiration. red, yellow, green zones. helpful in moinitoring bronchoconstriction in asthmatics

26

Ventilation/Perfusion Scan

used to check for presence of PE (not definitive, probable.)

TNIs: undress to waist, no metal, informed consent, check for allergies, void, explain procedure. Inhaled (ventilation) and injected (perfusion) isotopes – diminished radioactivity suggests lack of perfusion of airflow

27

Thoracentesis

used in pleural effusion r/t heart failure (fluid fills the pleural space, can cause infection) to diagnose, remove fluid or instill meds; sterile technique. Chest xray always performed after procedure to check for pneumothorax.

TNIs: signed consent, explain procedure, pain meds, baseline VS, position upright with elbows on overbed table, feet supported. Instruct not to cough or talk. Monitor vs and o2 sat. observe for hypoxia and pneumothorax afterwards. Verify breath sounds in all lung fields. Encourage deep breathing. Chest tube may be used for persistent pleural effusions instead of doing repeated pleural taps

28

The three problems with asthma

  1. bronchoconstriction
  2. increased mucus produciton
  3. inflammation

29

Asthma Triggers

allergens, resp infections, homrones, exercise, ASA, NSAIDs, beta blockers, food additives, air pollution, GI reflux, emotional stress

30

Status Asthmaticus

meds: controllers, rescuers, IV corticosteroids.

Focus on correcting hypoxemia and improving ventilation.

TNIs: frequent LOC assessments, O2 therapy, monitor VS, ABGs, IV fluids, possible SC epi, HOB up, prepare for intubation

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