Med Surge Flashcards
(239 cards)
1
Q
What is Addison’s disease and what are the s/s?
A
Hyposecretion of adrenal hormones (mineralcorticoids, glucocorticoids - cortisol, and androgens - aldosterone) Occurs in all age groups and affects both sexes. Can be life-threatening. Treatment involves taking hormones to replace the insufficient amounts.
S/S: fatigue, weakness, dehydration, low BP, hyperpigmentation, low resistance to stress, alopecia, weight loss, pathological fractures, depression, lethargy, emotional lability. Patho: low na+ & dehydration, low blood volume / shock, high K+/metabolic acidosis/ arrythmias, low blood sugar and insulin shock
2
Q
what are the precipitating factors of an addisonian crisis?
A
physical or emotional stress, sudden withdrawal of hormones
3
Q
What are the s/s of an addisonian crisis?
A
n/v, abdominal pain, fever, extreme weakness, severe hypoglycemia, hyperkalemia, and dehydration. bp falls leading to shock/coma/death.
4
Q
How do you treat an addisonian crisis?
A
Administer hydrocortisone
Carefully monitor IV infusion of 0.9% NaCl or DSW/ NaCl
Administer IV glucose, glucagon
Administer insulin with dextrose in normal saline
administer potassium-binding and excreting resin (e.g., sodium polystyrene sulfonate) Monitor vital signs
5
Q
what is Reynaud’s disease?
A
excessively reduced blood flow in response to cold or emotional stress, causing discolouration of the fingers, toes, and occasionally other areas. This condition may also cause nails to become brittle with longitudinal ridges. Treatment involves encouraging circulation and avoiding vasoconstriction.
6
Q
what is impetigo, s/s?
A
highly contagious bacterial skin infection most common among pre-school children. s/s : skin lesions/rash with honey-colored scabs. It is primarily caused by Staphylococcus. if intreated may cause glomerulrlonephritis. treat with antibiotics.
7
Q
What are the s/s of toxic shock syndrome?
A
Temp
8
Q
What is the diet for a patient with Meniere’s disease? why?
A
low-sodium diet to prevent fluid retention (specifically the endo-lymphatic fluid found in the laybrinth of the inner ear.
9
Q
What is Meniere’s disease?
A
A disorder of the inner ear that causes spontaneous episodes of vertigo (a sensation of a spinning motion), fluctuating hearing loss, ringing in the ear (tinnitus), and sometimes a feeling of fullness or pressure in your ear. In many cases, Meniere’s disease affects only one ear. Chronic. Episodes usually last 20min-2H, but may last 24 h. severe N/V may occur. Vertigo is uncommon and could be a sign of stroke, brain tumor, multipul sclerosis or cardiovasc. disease.
10
Q
Diet for cystic fibrosis.
A
High protein, high calorie b/c of impaired intestinal absorbtion. salty foods recommended due to excess sodium loss during sweating.
11
Q
What foods help manage smells from a colostomy? other methods?
A
cranberry juice, buttermilk, parsley, and yogurt help prevent odors. crackers, toast and yogurts help prevent gas. may also use a commercial deodorant. avoid skipping meals, chewing gum, drinking beer, and smoking.
12
Q
RX for ectopic pregnancy.
A
Abortion - if allowed to grow may kill mother because of hemorrhage. Methotrexate or surgery.
13
Q
correct positioning after lumbar puncture
A
flat supine; to prevent headache by preventing leakage of CSF at site.
14
Q
diet for dumping syndrome.
A
increase fat and protein. decrease carbs because they are the first to be digested (want to slow digestion), decrease fiber.
avoid drinking fluids with meals (none 1h before or 2h after), 5-6 small meals per day, lie down after eating.
15
Q
what is the cerebrum and what are the 4 lobes?
A
The cerebrum controls emotions, hearing, vision, personality all voluntary actions and more. The 4 lobes are frontal, temporal, occipital, parietal
16
Q
what is the the location and function of the temporal lobe?
A
Responsible for processing auditory information from the ears (hearing)
17
Q
what is the the location and function of the frontal lobe?
A
Carries out higher mental processes such as thinking, decision making, and planning,where our personality is formed
18
Q
what is the the location and function of the occipital lobe?
A
Responsible for processing visual information from the eyes
19
Q
what is the the location and function of the parietal lobe?
A
Processes sensory information that had to do with taste, temperature, and touch
20
Q
what are the functions of the left hemisphere of the brain?
A
Responsible for control of the right side of the body, and is the more academic and logical side of the brain: analytic thought, logic, language, reasoning, science, math, written, number skills, right hand control, speech
21
Q
what are the functions of the right hemisphere of the brain?
A
Responsible for control of the left side of the body, and is the more artistic and creative side of the brain: art awareness, creativity, imagination, intuition, insight, holistic thought, music awareness, 3d forms, left hand control, spacial awareness
22
Q
Symptoms of right hemisphere damage
A
issues with attention, perception, reasoning and problem solving, memory, social communication, organization, insight, orientation, may be unaware of his or her impairment and be certain that he or she can perform the same tasks as before, unmotivated, spatial-perceptual difficulties. (these individuals may be seen as uncooperative, confused, overly dependent or unmotivated.) , impulsive, disoriented to person place and time.
23
Q
Symptoms of left hemisphere damage
A
personality changes, communication problems and some paralysis on the right side,behave in a cautious, compulsive, or disorganized way and are easily frustrated, may be slow to take action or to respond to questions, impaired speech
24
Q
normal urine output
A
The normal range for 24-hour urine volume is 800 to 2000ml per day (33-83ml per hour) (with a normal fluid intake of about 2 liters per day). if output is below 30ml/h further eval is needed.
25
what is the effect of increased carbon dioxide on intracranial pressure? what are the potential implications for patients? (Nursing Care)
CO2 causes dilation of cerebral blood vessels. Ensuring adequate ABC's is priority for patients with head injuries or increased ICP.
26
Name the 12 cranial nerves, their functions, and how to assess their functionality
oh oh oh tiny tits are fun and give virgins awkward hips:
I: Olfactory - smell - ASK IF THEY CAN SMELL
II: Optic - vision - VISUAL ACUITY TEST
III: Oculomotor - motor control of some eye muscles and eyelid - PERRLA (pupils equal round reactive to light and accommodation), GAZE UP, DOWN, OUT
IV: Trochlear - motor control of some eye muscles - GAZE DOWN AND IN
V: Trigeminal (dentist) - chewing - FACIAL SENSORY
VI: Abducens - motor control of some eye muscles - GAZE TEMPORARILY
VII: Facial - motor control of facial muscles, salivation, taste and cutanious sensations - FACIAL EXPRESSIONS
VIII: Vestibulococholear (auditory) - equilibrium, hearing - HEARING TEST
IX: Glossopharyengeal - salivation, sensations of skin taste and viscera - GAG REFLEX
X: Vagus - motor control of heart and viscera, sensation from thorax , pharynx, and abdominal viscera. - CHECK THE UVULA IS MIDLINE
XI: Accessory (spinal) - motor impulse to pharynx and shoulder - SHOULDER SHRUG
XII: Hypoglossal - motor control of tongue, some skeletal muscles, and some viscera , sensation from skin and viscera - TOUNGE MOVEMENT
27
What is Autonomic dysreflexia and what are the symptoms? What are a few nursing actions
Autonomic dysreflexia (AD), also known as autonomic hyperreflexia, is a potentially life-threatening condition which can be considered a medical emergency requiring immediate attention. AD occurs most often in spinal cord-injured individuals. Acute AD is a reaction of the autonomic (involuntary) nervous system to overstimulation. It is characterized by paroxysmal hypertension (the sudden onset of severe high blood pressure) associated with throbbing headaches, profuse sweating, nasal stuffiness, flushing of the skin above the level of the lesion, slow heart rate, anxiety, and sometimes by cognitive impairment.
Nursing actions: high fowlers, potentially admin hydralazine (vasodilator)
28
priority nursing actions for a woman in labor showing late decelerations on the fhr monitor.
position on left side, 02, IV, notify hcp
29
what is the timeline for alcohol withdrawal?
withdrawal : 5-35 hours after last drink, 48 hours grand mal seizures, 72-96 hours delirium tremens - at high risk for seizures.
30
priority assessments preceding femoral angiogram
location and description of peripheral pulses, color, mobility and temp of extremity
31
what is the priority assessment for a damaged parathyroid gland.
check blood calcium levels. parathyroid hormone level decreases, which causes a decrease in blood calcium level (pth pulls calcium from bones to use)
32
early s/s for hypocalcemia
tingling fingers , toes , and lips
33
level and s/s hypoglycemia
50mg/dl, dizzy, tremble, anxiety, hunger, weak
34
tracheostomy care: catheter size, 02 level, wall suction range
half the size of the trach opening, 100% 02, wall suction set at 80-120mmhg
35
chron's diet
low fat, high protein, low residue, non-irritating, high in minerals, high cals.
36
what is a lumbar laminectomy and why is it done?
performed to relieve spinal stenosis. incision in lower back and removal of bone spurs and thickened tissues.
37
how do you perform a log roll?
need 2 people, draw sheet, and pillow. using draw sheet shift pt to one side of the bed. place pillow in between the 2 legs, with pt supine and arms either crossed or stretched forward, maintain spinal and hip alignment. put side rail up on side to roll toward, then both people should roll the pt to the side using the draw sheet. if the side position will be maintained prop with pillows.
38
what is lupus?
chronic autoimmune disease that occurs in flareups and remissions, most common in women of childbearing age and 2-3 times more likely in african women, but anyone can get. not contagious. severity ranges from mild to deadly and can usually be treated - pt can live a full life.
Symptoms vary but can include fatigue, joint pain, rash/butterfly rash on face, and fever.
may include:
Pain: in the muscles, can occur while breathing, can be sharp in the chest
Mouth: dryness or ulcers
Skin: scaly rashes or red rashes
Psychological: anxiety or major depression
Hair: hair loss or loss of scalp hair
Whole body: fever, malaise, anemia, or fatigue
Also common: sensitivity to light, blood in urine, raynaud's syndrome, face rash, water retention, joint stiffness, swelling, headache, acute episodes, or weight loss
39
what conditions is a moist warm compress used for? Nursing considerations?
Dry eyes and other eye problems, cellulitis, thrombophlebitis, stiff joints or chronic muscle and joint pain.
Moist heat may penetrate better.
Don’t apply heat for longer than 20 minutes, unless your doctor or physical therapist recommends longer.
Don’t use heat if there’s swelling. Use cold first, then heat.
Don’t use heat if you have poor circulation or diabetes.
Don’t use heat on an open wound or stitches.
40
when to use cold therapy?
Any cold treatment should be used for 24 to 48 hours after an injury. Cold therapy is good for sprains, strains, bumps, and bruises that may occur in sports or lifting. Apply cold packs or ice bags to injured areas for no more than 20 minutes at a time, removing the cold for 10 minutes and reapplying it again.
41
how is lyme disease treated?
antibiotics - may result in total recovery , but may cause residual syndromes to develop.
42
s/s lyme disease?
Pain: in the joints or muscles
Skin: bull's eye pattern rash or red rashes
Whole body: fatigue, fever, or malaise
Joints: stiffness or swelling
Also common: headache, redness, or weakness of limb
43
what is the incubation period for rubella?
14-21 days. it is contagious 7 days before rash appears to 5 days following onset.
44
can pregnant women receive the rubella vaccine?
no, it will put the baby at risk. also, exposure to rubella during pregnancy could harm the baby and abortion may be considered.
45
what syndrome can lithium use cause?
nephrogenic diabetes insipidus. this occurs when lithium is taken in doses that are toxic to the kidney, damaging nephrons and inducing DI.
46
what are the s/s of diabetes insipidus?
polyuria, excessive thirst. DI is the inability to regulate fluids
47
what are the dietary needs of a patient taking litihium?
adequate/increased consumption of water and adequate salt intake to compensate for the water and salt loss in polyuria
48
what is SIADH? what are the s/s? what are the causes?
SIADH is the syndrome of inappropriate anti-diuretic hormone secretion. too much ADH, causing water retention (diluting the blood and concentrating the urine. [edema is NOT a symptom]
ADH is found in the pituitary gland, so this could be caused by disruptions in the pituitary such as any increase in the ICP. It is commonly found in cancer patients as some cancers and cancer treatments cause it.
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The following cancers can cause SIADH:
small cell lung cancer
non–small cell lung cancer
mesothelioma
lymphoma
Ewing sarcoma
thymoma, which is a type of thymus cancer
primary brain tumours
head and neck cancers
stomach cancer
duodenum cancer
pancreatic cancer
bladder cancer
prostate cancer
uterine cancer
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Some cancer treatments can also lead to SIADH. These include chemotherapy drugs such as cyclophosphamide (Cytoxan, Procytox), ifosphamide (Ifex) and vincristine (Oncovin). Other medicines used in cancer treatment, including opiate pain medicines such as morphine, can also lead to SIADH.
49
if a pregnant woman has a drop in blood pressure from medication or other reasons, what is the best position to put her in and why?
lying on the left side in order to take pressure off of the vena cava , which will improve fetal circulation, and also with her legs flexed to increase venous return.
50
what is the first thing to do for a patient whose trach. tube has become dislodged and they cannot breathe?
extend their neck back to create a patent airway. after that, you may use a hemostat (clamp) to open the airway, perform mouth to stoma breaths, replace the trach tube, or bag either the stoma (while keeping the mouth and nose closed or visa versa).
51
Is there communication between the upper airway and the stoma of a patient who has undergone a tracheostomy or a laryengectomy?
it depends. often, if the person has a permanent stoma there is no communication, but best practice is to ask ahead of time and have a sign posted. this will effect how to resuscitate the patient in case of emergency, or how to give air if trach tube becomes dislodged.
52
after a vascectomy, can a man get a woman pregnant?
there may still be some sperm stored in the vas deferins for up to 6 weeks, so couples are encouraged to use condoms during this time.
53
how should a client be positioned for the first 24 hours after a below the knee amputation?
fowlers with effected leg elevated on pillows to decrease edema , venous return and comfort.
54
how should a client be positioned after the first 24 hours after a below the knee amputation?
every 2-3 hours they should lye prone for 25 min. this an other positions should be used to prevent hip contractures. adduction is good , abduction is bad. (another source says 30 min 3x day)
55
in terms of delegation, what are the rules of thumb for the types of patients to give to: Nursing assistive personelle
LVN/LPN?
NAPs should perform standard unchanging procedures.
LVNs should work with stable patients with expected outcomes. (can draw labs and give po and IV meds++, NG and G tube feedings, Insert foley, wound care)
Only RNs can assess, handle unstable patients, take phone orders, start IVs, care for central lines+
56
what causes metabolic acidosis?
hyperchloremin: losing too much base (diarrhea), kidney damage (cannot eliminate acid), diabetic ketoacidosis, lactic acidosis: chronic alcohol use, heart failure, cancer, seizures, liver failure, prolonged lack of oxygen, and low blood sugar, and prolonged exercise; aspirin or methanol poisoning
57
what causes respiratory acidosis?
Respiratory acidosis occurs when too much CO2 builds up in the body. Normally the lungs remove CO2 while you breathe. However, sometimes your body can’t get rid of enough CO2. This may happen because of:
chronic airway conditions, like asthma
injury to the chest
obesity, which can make breathing difficult
sedative misuse, including overuse of alcohol
muscle weakness in the chest
problems with the nervous system
deformed chest structure
58
what are the available vaccines that are considered to be live?
measles, mumps, rubella, chickenpox, and nasal spray flu vaccines contain live but weakened viruses
59
what amount of time must pass after a traumatic head injury for a patient to be eligible for thrombolytic therapy?
3 months
60
is it preferable for an altzheimer's patient to be in a private room or a semi private room?
semiprivate room because they need to be oriented often and having another person to talk to will help with that.
61
what time of the day is the best for giving methylphenidate?
it is best to give ritalin after breakfast. had appetite reducing effects. med will last all day
62
what is a normal platlet range?
A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood.
Having more than 450,000 platelets is a condition called thrombocytosis; having less than 150,000 is known as thrombocytopenia. Risk of spontaneous bleeding occurs
63
what is the major difference between in-hospital catheterization and in -home catheterization ?
in the home it is not a sterile procedure, but a clean one. catheters can be washed and reused. sterile gloves not needed
64
s/s of preeclampsia
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In addition to swelling, protein in the urine, and high blood pressure, preeclampsia symptoms can include:
Rapid weight gain caused by a significant increase in bodily fluid.
Abdominal pain.
Severe headaches.
Change in reflexes.
Reduced urine or no urine output.
Dizziness.
Excessive vomiting and nausea.
Vision changes.
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Signs of severe preeclampsia include fetal distress, abdominal pain, seizures, impaired kidney function, and fluid in the mother’s lungs.
65
risk factors for preeclampsia
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These include:
being pregnant with multiple fetuses.
advanced maternal age (over the age of 35)
first pregnancy.
obesity.
history of hypertension or diabetes.
history of kidney disorder.
pregnancy in early teens.
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66
when does fetal quickening occur?
20 weeks in mulitgravida and 18 weeks in a primigravida
67
treatment for preeclampsia
Delivery of your baby is the only cure for preeclampsia.
During pregnancy, your condition will be monitored and managed to ensure you and the baby remain healthy. If you are at 37 weeks gestation or later, you may be induced. At this point, the baby has developed enough and is only minimally premature.
If your preeclampsia is mild, your doctor may recommend:
bed rest
reduced salt intake
increased water consumption
regular doctor’s visits
68
do you need a clean catch or a sterile catch for a culture and sensitivity urine collection?
sterile. use antiseptic wipe then urinate into cup without anything touching cup.
69
what is one priority assessment after a cholecystectomy?
check the color of the feces (and urine) if the bile isnt reaching the intestines as it should it will result in clay colored stool. the bile duct may be blocked and the bile may be draining into the liver , which will cause more problems such as jaundice, n/v, itching and infection.
70
what are the appropriate actions for a mother in labor having late decelerations?
lye on left side, inrease IV, admin 02
71
how do you score an APGAR?
2 points for : HR (120-160), resp effort, color, muscle tone , reflex irritability
72
what level of precaution is warranted for disseminated herpes zoster?
airborne - neg pressure room , n95 mask, door closed at all times
73
what is the difference between herpes zoster and disseminated herpes zoster?
DHZ is the same virus , but is defined as 20 or more skin lesions, indicaing that the disease has likely spread to internal organs, and can be fatal. DHZ reqires airborne precautions while shingles does not. with shingles simply covering the leision will prevent the spread.
74
what is the timeframe for an expected low grade fever reaction to an immunization?
Fever with most vaccines begins within 24 hours and lasts 1 to 2 days.
With live vaccines (MMR and chickenpox), fever and systemic reactions usually begin between 1 and 4 weeks.
75
what is the expected onset and duration of swelling associated with vaccine injection?
Most local swelling, redness and pain at the injection site begins within 24 hours of the shot. It usually lasts 2 to 3 days, but with DTaP can last 7 days
76
what is cushings syndrome?
Cushing syndrome occurs when your body is exposed to high levels of the hormone cortisol for a long time. usually caused by medication, otherwise may be caused by pituitary tumor.
s/s: a fatty hump between your shoulders, a rounded face, and pink or purple stretch marks on your skin. Cushing syndrome can also result in high blood pressure, bone loss and, on occasion, diabetes.
Complete recovery possible, but chances increase with prompt treatment
77
how does medication induced cushings syndrome occur?
overuse of corticosteroids. treatment: taper off. if abruptly stopped, pt could die of adrenal insufficiency.
78
while hospitalized, how long should a post surgical client wear anti-embolism stockings?
the entire time they are in the hospital. they should only be removed for bathing and then replaced once the skin is dry. they should remain on at night and alway be on when out of bed.
79
what is multiple sclerosis?
A disease in which the immune system eats away at the protective covering of nerves.
s/s: Vision loss, pain, fatigue, and impaired coordination are symptoms. Remission may follow attacks.
Pain: in the back or eye, can occur in the back due to head nod or with eye movement
Tremor: can occur during precise movements, in the hands or limbs
Muscular: difficulty walking, inability to rapidly change motions, involuntary movements, muscle paralysis, muscle rigidity, muscle weakness, problems with coordination, stiff muscles, clumsiness, muscle spasms, or overactive reflexes
Urinary: excessive urination at night, leaking of urine, persistent urge to urinate, or urinary retention
Sensory: abnormality of taste, numbness, pins and needles, or uncomfortable tingling and burning
Whole body: dizziness, fatigue, heat intolerance, poor balance, vertigo, or weakness
Visual: blurred vision, double vision, or vision loss
Sexual: erectile dysfunction or sexual dysfunction
Speech: slurred speech or impaired voice
Psychological: anxiety or depression
Also common: acute episodes, constipation, cramping, difficulty swallowing, difficulty thinking and understanding, headache, heavy legs, mood swings, numbness of face, rapid involuntary eye movement, sleep deprivation, tongue numbness, or difficulty raising the foot
80
what are the recommendations regarding pregnancy for women with lupus?
wait until 2 years after DX, and wait 5 months after last flare up to get pregnant.
81
what is the recommended sleeping / bed arrangement for a person with Parkinson's?
sleep on a firm mattress with no pillow, so that the spine can lay flat - not flexed. this will slow/ prevent the body from becoming permanently flexed over time.
82
what must patients with cystic fibrosis supplement in their diet ?
along with digestive enzymes, salt (sodium and chloride) must be replaced. diet must be high fat , high cal, high protein.
83
what is the recommended diet for patients with kidney disease?
maintain fluid balance with a normal fluid intake of 1-2 L/day, but avoid excess fluid due to potential retention.
avoid consuming excess salt, potassium, phosphorous or other electrolytes because the kidneys may not clear them.
cautiously take any medications that are cleared by the kidney
avoid consuming excess protein because protein not used by the body will be broken down into waste that may not be cleared by the kidney
eat high calorie foods to prevent weight loss. breads and pastas are recommended.
84
what is the target weight gain of a patient hospitalized for anorexia? What is this patient at risk for until they reach this weight?
the initial target weight, is 85% of ideal weight. Until they reach at least 80% of their ideal weight, they are at risk for hypotension, cardiac arrhythmias, poor muscle tone, increased risk for infection, abnormal liver function, and damaged kidneys.
85
How much weight gain is safe for a person recovering for anorexic wasting?
maximum of 2lbs per week because growth in excess of this could put excess strain on the heart, which has diminished output from starvation.
86
what is the best way for a patient with peripheral arterial insufficiency to increase blood flow to the limbs?
rather than apply heat directly to the periphery, it is best to apply heat, such as a heating pad to the center of the body, the abdomen for example, which will cause reflex vasodilation. otherwise the client may burn their skin as a result of decreased sensation in the periphery.
87
what is dissociative personality disorder?
multipul personality disorder
88
what is bells palsy? what causes it?
Bell's palsy is a paralysis or weakness of the muscles on one side of your face. Damage to the facial nerve that controls muscles on one side of the face causes that side of your face to droop camera. The nerve damage may also affect your sense of taste and how you make tears and saliva. This condition comes on suddenly, often overnight, and usually gets better on its own within a few weeks.
The cause of Bell's palsy is not clear. Most cases are thought to be caused by the herpes virus that causes cold sores.
In most cases of Bell's palsy, the nerve that controls muscles on one side of the face is damaged by inflammation.
89
what is the treatment for bells palsy?
It is often caused from inflammation of the facial nerve, so it is treated with corticosteroids such as prednisone. Antiviral meds such as acyclovir may also be taken is herpes is suspected.
Extra care must be taken of the effected eye, oral care, ear care so that permanent damage is not caused due to inability to sense problems.
Any swelling or increased ICP or intra-ocular pressure must be addressed to promote healing and prevent permanent damage. moist heat can help with this and promote comfort as well.
Facial exercises are not recommended early on in treatment.
90
in an emergency situation, it is better for one person to take the role of leader, or for leadership to be assumed by everyone?
one person will be better able to manage a crisis because time will not be spent discussing different ideas, and more time will go into needed actions.
91
what is the purpose of the z-track method?
it is a way of administering substances via IM injection that are irritating to the skin and sub -q tissues. - it prevents leaking of the substance into sub-q and skin tissues
92
what is myxedema? s/s?
word used synonymously with severe hypothyroidism. also describes a characteristic shin change seen in hypothyroidism that involves swelling of the skin and underlying tissues giving a waxy consistency - causes a mask-like facial expression.
other s/s: lethargy, weight gain, cold intolerance, dry hair, thickened skin, enlarged tongue, drooling
93
what is myasthenia gravis? s/s?
chronic autoimmune neuromuscular disease characterized by muscle weakness that increases during periods of activity and improves after periods of rest. Certain muscles such as those that control eye and eyelid movement, facial expression, chewing, talking, and swallowing are often, but not always, involved in the disorder. The muscles that control breathing and neck and limb movements may also be affected.
s/s: drooping of one or both eyelids (ptosis), blurred or double vision (diplopia) due to weakness of the muscles that control eye movements, unstable or waddling gait, a change in facial expression, difficulty in swallowing, shortness of breath, impaired speech (dysarthria), and weakness in the arms, hands, fingers, legs, and neck.
has periods of remissions and exacerbations
94
are shingles contagious?
only to people who have not previously had chickenpox (or the vaccine)
95
when administering oral medication to an infant , what is the best method?
put liquid med in an empty nipple or medicine syringe for the baby to suck out. never recline the baby or squirt the medicine into their mouth to avoid aspiration. give meds before meals to encourage consumption and do not mix with needed foods such as formula.
96
what is talipes equinovarus?
club foot. full recovery possible if treated with serial casting during childhood.
97
What is the normal duration and frequency of labor contractions?
Mild contractions generally begin 15 to 20 minutes apart and last 60 to 90 seconds. The contractions become more regular until they are less than five minutes apart. Active labor (the time you should come into the hospital) is usually characterized by strong contractions that last 45 to 60 seconds and are three to four minutes apart.
contractions should occur less frequently than 2 min and not reach 90 seconds or longer.
The frequency of the contractions is measured from the beginning of one contraction to the beginning of the very next contraction. This not only includes the duration of one contraction, but also the rest period between the two.
98
how can you tell if contractions are braxton hicks or true labor?
Contractions are Braxton Hicks contractions if they remain irregular, do not get progressively longer as time passes, and are relieved by movement /position change.
99
what is the immunization schedule for Hep B?
Initial (often birth), 1 month after first, 6 months after first.
100
what is the best way to evaluate for fluid status?
daily weights!
101
what diet changes must be made for a patient that has an ilesotomy?
Do not eat foods that are hard to digest for 6 to 8 weeks after your surgery. (tough meat, nuts, seeds, and raw fruits and vegetables).
After 6 to 8 weeks, regular foods with limited hard to digest items , such as corn, nuts, seeds, and celery.
Do not eat foods that cause cramps or diarrhea. When you start eating these foods again, eat small portions first and gradually increase the amount you eat.
Reduce gas and odor. Do not use a straw to drink liquid. Eat slowly. Some foods, such as broccoli, cabbage, beans, eggs, and fish may cause gas. Fresh parsley, yogurt, and buttermilk may help to reduce odor and gas.
You may need to drink about 1 to 2 extra glasses of liquid each day to prevent dehydration. Ask your healthcare provider how much liquid you should drink each day.
102
how often should you change an illeostomy bag?
Q3-5 days or any time it leaks
103
what types of ostomies can you irrigate? what does this accomplish?
you cannot irrigate an ileostomy because it will cause dehydration. you may irrigate colostomies. this will eliminate the need to wear the collection bag for a period of time (up to 2 days) the stoma can be plugged during that time.
104
what is the proper technique to use a cane?
hold cane in hand of the strong side. first step is with the strong side, then put can out then step with weak side. this is the same for going upstairs. going downstairs, is cane, effected leg, then strong leg.
105
where should the nurse stand when instructing a client how to use a cane?
slightly behind them on their strong side. have one hand on their waste holding onto a gait belt.
106
if an infusion of iv fluids or parenteral meds is behind, what do you do? do you infuse faster?
Never play catch up with any IV fluids without an order. if there is an allowable range ordered, it is ok to increase the flow rate otherwise, increase the amount of time the fluid infuses for.
107
in a patient with type 1 diabetes, what is the appropriate action regarding administration on the morning of a major surgery?
hold regularly administered insulin (any intermediate/long acting and daily short acting) and only give sliding scale short acting based on blood glucose. BG will be altered based on NPO status.
108
can you turn a patient in Bucks traction?
yes. you must turn them q2h. if the person has a fracture, turn them only to the unaffected side. the traction device should stay intact and you should use pillows /wedges to maintain traction alignment/integrity. hob should be 15-20.
109
in bucks traction, what method us used to counteract the pull of the weights?
the foot of the bed is raised. no trapeze or footboard is indicated.
110
what is a Sengstaken–Blakemore tube ?
a medical device inserted through the nose or mouth and used occasionally in the management of upper gastrointestinal hemorrhage due to esophageal varices
111
What is the purpose of the T tube?
After a cholcystectomy, it is inserted into the common bile duct - and drains out of the abdomen - with the intention of preventing the build-up of bile in the common bile duct due to swelling. The build-up of bile along with the swelling can prevent healing of the bile duct resulting in leakage of bile from the common bile duct into the stomach. Uncontrolled leaking can be life-threatening. Dye can be injected into the T-tube and an X-ray used to demonstrate any residual stones. Once the absence of residual stones is confirmed, the T-tube is removed. The tiny hole in the common bile duct normally heals without a trace, but in some patients bile can leak through the hole and cause the very problem that the T-tube was meant to prevent.
expected drainage is green and 500-1000ml in the first days then decreases.
112
how does a baby inherit Rh +/- status?
The Rh factor is inherited—passed down through parents’ genes to their children. If the mother is Rh negative and the father is Rh positive, the fetus can inherit the Rh gene from the father and could be either Rh positive or Rh negative. If the mother and father are both Rh negative, the baby also will be Rh negative.
113
when will there be an Rh sensitization?
when you have an Rh- mother with an Rh+ fetus
114
what type of heart problems are a complication of rheumatic fever?
rheumatic fever that resulted in carditis is known to cause valve disease. may lead to valve stenosis and heart failure.
115
what is the proper way to treat a pneumothorax in the field?
cover loosely with a sterile dressing so that air can escape but not continue to be sucked in. do not seal shut.
116
in a child with spina bifida (meylomeningiocele), does corrective surgery restore function lost by damaged nerves?
no, function of nerves below the site of the spina bifida cannot be recovered.
117
why would a client report itching to the nurse if they are beginning use with a pca?
they may be allergic to the narcotic being administered.
118
what is impetigo and what is it's hallmark symptom?
highly infectious superficial bacterial infection. most commonly seen in infants and children. honey colored crusts, usually on the face. usually clears on its own in 2-3 weeks, but antibiotics shorten course.
119
why is it important for a post-partum mother to empty the bladder if the fundus is soft?
a full bladder contributes to fundal softness
120
what is the proper method to change a wet to dry dressing on an infected wound?
remove old dressing without wetting first in order to debride the infected and necrotic tissue, clean out wound as indicated , reinsert sterile wet gauze cover with dry 4x4 and tape.
121
What is the lecithin–sphingomyelin ratio (aka L-S or L/S ratio) ? What is the desired range?
A test of fetal amniotic fluid to assess for fetal lung immaturity. Surfactant is a mixture of lipids, proteins, and glycoproteins, lecithin and sphingomyelin being two of them. The amniotic fluid maintains the level of lecithin and sphingomyelin equally until 32–33 weeks gestation, when the lecithin concentration begins to increase significantly while sphingomyelin remains nearly the same. As such, if a sample of amniotic fluid has a higher ratio, it indicates that there is more surfactant in the lungs and the baby will have less difficulty breathing at birth. An L–S ratio of 2 or more indicates fetal lung maturity and a relatively low risk of infant respiratory distress syndrome, and an L/S ratio of less than 1.5 is associated with a high risk of infant respiratory distress syndrome.
122
Correct positioning for liver biopsy
supine with arms raised above the head
123
What are the types of fluids that should be ingested by a patient with a flaccid bladder?
promote acidic urine to prevent uti and kidney stone formation.
drink prune, cranberry, tomatoe, bullion
avoid lemonade, milk, citrus, carbonated beverages
124
post appendectomy positioning?
hob 30'-45' to reduce stress on suture line.
125
what is an appropriate fluid volume/24h for a 50 lb child?
100 ml/kg for the 1st 10 kg of wt. He
50 ml/kg for the 2nd 10 kg of wt.
20 ml/kg for the remaining wt.
So, for a 50 lb, basically 23 kg child, maintenance fluid rate would be:
1000ml+500ml+60ml=1560ml/24
126
is it appropriate for a person to have all of their iv maintainence fluids be D5W? why?
no, there are no electrolytes and will result in electrolyte imbalance.
127
what is the normal range for central venous pressure? (cm H2O)
5-10 cm H2O or 2-6mmhg
128
what temperature should people set the water heater at to prevent burns? (ie. if they have sensory issues etc.?)
120' F or less
129
what does RACE stand for?
RESCUE: remove anyone in danger. If necessary move patients behind the next set of fire doors.
ALARM: activate the nearest fire alarm.
CONTAIN: confine the fire by closing the surrounding windows and doors.
EXTINGUISH or EVACUATE: if the fire is small and you can extinguish it safely, use an extinguisher. If you cannot safely extinguish the fire, evacuate.
130
under what circumstances and for how long can you put a person in restraints? what is the protocol for having a physician's order for the restraints?
If the person is a harm to themselves, others (or I believe property). Usually, restraints are not kept on past 24 hours, a new order is needed every 24 hours with a reason for restraints. if a person is put in restraints, the nurse has 24H to get a written order form the Dr.
131
What is Haemophilia A? What is treatment for this?
Haemophilia A is a genetic deficiency in clotting factor VIII,[1] which causes increased bleeding and usually affects males. About 70% of the time it is inherited as an X-linked recessive trait, but around 30% of cases arise from spontaneous mutations.
132
Can an LVN:
- draw labs?
- administer IV meds?
no and no.
133
18 infections that can compromise a pregnancy
Bacterial vaginosis - increased risk of preterm birth and having a low-birth-weight baby, preterm premature rupture of the membranes (PPROM), and uterine infection after delivery. A few studies show a connection between BV and second-trimester miscarriage.
Chicken pox - If you get chicken pox during the first or second trimester of pregnancy, there's a slight risk (probably less than 2 percent overall) that your baby will get something called congenital varicella syndrome (CVS). The risk is highest if you're infected between 13 and 20 weeks' gestation.
Chlamydia - Women who have chlamydia during pregnancy tend to have higher rates of infection of the amniotic sac and fluid, preterm birth, and preterm premature rupture of the membranes (PPROM)
Cytomegalovirus - does not effect adults- 10 to 15 percent of newborns infected with CMV in the womb have serious complications that are present at birth, such as central nervous system abnormalities, growth restriction, an unusually small head, an enlarged spleen and liver, jaundice, and a rash caused by bleeding underneath the skin. Some of these babies die.
Fifth disease (parvovirus)-In a relatively small percentage of cases, parvovirus infection during pregnancy can lead to miscarriage, stillbirth, fetal anemia, and sometimes inflammation of the baby's heart.
Flu - pregnant women are effected by the flu more, so get the vacciene during pregnancy (not the live one), should also give beby some protection.
Gonorrhea higher rates of miscarriage, infection of the amniotic sac and fluid, preterm birth, and preterm premature rupture of membranes (PPROM)
```
Group B strep
Hepatitis B
Herpes
HIV
Listeriosis - from foods
Rubella (German measles) - worst
Sexually transmitted infections
Syphilis
Toxoplasmosis
Trichomoniasis
Urinary tract infections
```
134
if a confused client becomes distressed and combative during a bath, what is the proper thing to do?
stop the bath and redress. the bath may be continued later, but with confused clients it is difficult to know why they are distressed. it is more important to regain calm than to get clean.
135
how are vancomycin-resistant enterococcus (VRE) infections treated?
Likely multiple antibiotics, blood samples to assess presence of VRE. Do not share personal items such as towels or razors.
Keep your environment clean by wiping all frequently touched surfaces (such as countertops, doorknobs, and light switches) with a disinfectant, especially if someone in the house has a VRE infection.
Standard and contact precautions: Wear gloves when touching the patient and the patient’s immediate environment or belongings, Wear a gown if substantial contact with the patient or their environment is anticipated, Perform hand hygiene after removal of PPE; note: use soap and water when hands are visibly soiled (e.g., blood, body fluids), or after caring for patients with known or suspected infectious diarrhea (e.g., Clostridium difficile, norovirus), Clean/disinfect the exam room accordingly (refer to Section IV.F.4.), Instruct patients with known or suspected infectious diarrhea to use a separate bathroom, if available; clean/disinfect the bathroom before it can be used again.
136
what is tyramine and what are tyramine containing foods?
Tyramine is an amino acid that helps regulate blood pressure. It occurs naturally in the body and is found in certain foods such as: bananas, avacados, nuts, seeds, snow peas, citrus fruits like orange, grapefruit, tangerine and lemon, as well as pineapple
Aged cheeses: aged cheddar, Swiss; blue cheeses such as Stilton/Gorgonzola; and Camembert. Cheeses made from pasteurized milk are less likely to contain high levels of tyramine, including American cheese, cottage cheese, ricotta, farm cheese and cream cheese.
Cured meats, which are meats treated with salt and nitrate or nitrite, such as dry-type summer sausages, pepperoni and salami.
Fermented cabbage, such as sauerkraut and kimchee.
Soy sauce, fish sauce and shrimp sauce.
Yeast-extract spreads, such as Marmite.
Improperly stored foods or spoiled foods.
Broad bean pods, such as fava beans.
Tyramine amounts can vary among foods due to different processing, storage and preparation methods. While you're taking an MAOI, your doctor may recommend eating only fresh foods — not leftovers or foods past their freshness dates.
137
what diet is important to follow for a patient taking MAOIs?
restrict tyramine containing foods . These foods can cause a dangerous increase in blood pressure when combined with MAOIs
138
what is a clinical pathway? what are they used for?
A set of practice guidelines based on a specific client diagnosis, which provides an overview of the multidisciplinary plan of care.
139
risk factors for cataracts
```
Increasing age
Diabetes
Drinking excessive amounts of alcohol
Excessive exposure to sunlight
Exposure to ionizing radiation, such as that used in X-rays and cancer radiation therapy
Family history of cataracts
High blood pressure
Obesity
Previous eye injury or inflammation
Previous eye surgery
Prolonged use of corticosteroid medications
Smoking
```
140
what is tubal ligation
Tubal ligation is surgery to close a woman's Fallopian tubes.
141
what s Asterixis?
hand tremors , similar to clonus, that occur when the pt's hands are extended. it looks like a jerking motion. it is involuntary. it happens as a result of liver problems.
142
what is ataxia? ataxic breathing?
the loss of full control of bodily movements - uncoordinated movements. ataxic breathing is irregular, random pattern of deep and shallow respirations with irregular apneic periods.
143
what is apraxia?
not using items for their intended purpose.
144
is shaving an acceptable method of hair removal prior to surgery?
no. hair clippers or depilatory cream may be used. shaving increases risk of post-op infection.
145
is it ok to remove a scab/dried blood from a skin graft during a dressing change?
yes. scabs promote bacterial growth and infection!
146
What is Paresthesia?
an abnormal sensation, typically tingling or pricking (“pins and needles”), caused chiefly by pressure on or damage to peripheral nerves.
147
What is Waxy flexibility?
Waxy flexibility is a psychomotor symptom of catatonic schizophrenia which leads to a decreased response to stimuli and a tendency to remain in an immobile posture.
148
what is Guillain-Barre syndrome?
an acquired inflammatory disease in which the immune system attacks the nerves resulting in demyelinization of the peripheral nerves. It is usually ascending in nature and can lead to respiratory paresis or paralysis. must assess for respiratory failure.
149
can an LPN administer meds?
yes. they may administer meds that are routine
150
can ace inhibitors be taken during pregnancy?
no. they should be avoided at all times during pregnency.
151
what are Universal precautions ?
Universal precautions is an approach to infection control to treat all human blood and certain human body fluids as if they were known to be infectious for HIV, HBV and other bloodborne pathogens.
152
why are Kayexalate enemas given?
given to patients with hyperkalemia to decrease K+ in blood
153
what percent of total dietary intake should be protein? if patient has impaired renal function?
normal- 10-35%, renal problems - 10-20%
154
what is a positive Chvostek's sign?
tetany - hyper-excitability due to hypocalcemia. flick the cheek and it twitches. this also is an indicator of hypoparathyroidism because the parathyroid secretes PTH - parathormone, which pulls calcium from the bones.
155
what is a positive Trousseau's sign
tetany - due to hypocalcemia. assessed by inflating a BP cuff on the upper arm. positive sign if the the hand and fingers react with flexion and adduction. this also is an indicator of hypoparathyroidism because the parathyroid secretes PTH - parathormone, which pulls calcium from the bones.
156
what hormone deficiency is responsible for Diabetes Insipitus?
not enough ADH - anti-diuretic hormone, causes diuresis of dilute urine. only water is lost, not Na+. blood becomes concentrated.
157
where is ADH found ?
pituitary, so head injury often causes problems with ADH secretion.
158
signs of increased ICP
Signs of increased intracranial pressure also include papilledema, elevated systolic pressure, wide pulse pressure, decreased pulse, and slow respirations. Projectile vomiting is classically associated with increased ICP.
159
what is a pneumonectomy?
removal of a lobe of the lung
160
where do chest tubes go post-pneumonectomy?
there are no chest tubes - the plueural space has been removed.
161
what type of IV tubing (incl. drip factor) do we use for children and infants?
microdrip - it only comes in 60gtt/ml
162
how often must the IV site be checked for blood return / infiltration when irritating drugs/vessicants are being administered?
hourly - the IV site is more prone to problems due to vessel breakdown
163
when is it acceptable to recap a needle ?
never (at least not on the NCLEX)
164
what is the proper way to store insulin?
manufacturers say to refrigerate, but in the short term it is best to keep at room temp because the injection will be less painful.
165
what are the EKG changes associated with hypokalemia?
Earliest :decrease in the T-wave amplitude. As potassium levels decline further, ST-segment depression and T-wave inversions are seen, while the PR interval can be prolonged along with an increase in the amplitude of the P wave.
v-tach and v-fib are commonly seen, and occasionally an atrioventricular Heart block is seen.
166
diet for nephrotic syndrome
low salt, fat and cholesterol, with emphasis on fruits and vegetables. (protein is necessary but changes may be made by doctor), sometimes fluids will be restricted
167
what are the possible tissue changes involved in insulin administration?
lipoatrophy and hypertrophy. With lipoatrophy, fatty tissue under the skin disappears, causing dents in the skin at the injection site. Hypertrophy is the overgrowth of cells, usually fat cells, that makes the skin look lumpy. It can look similar to scar tissue. By rotating the injection site, you can avoid some of these problems.
168
how should the client's chief complaint be recorded in the chart?
in the client's own words. - it would be a quote not including any objective information.
169
what type of precautions should be instituted for TB?
airborne
170
what causes a curling's ulcer?
burn victims are at risk for getting curling's stomach ulcers. their gastric ph must be assessed and attended to if less than 5. reduced plasma volume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa.prevention: fluids, antacids, protonpump inhibitors.
171
what is the expected weight gain during pregnancy/each trimester?
first trimester 3-5 lbs total. 2nd and 3rd trimester 0.66-1.1 lb /week.
172
what does NCLEX consider to be a good weight loss diet?
low fat. they include simple sugars / carbs and some fats. retarted.
173
discharge instructions for minor head injury
Usually wait 48 H to return to normal activity.
Take only plain acetaminophen (Tylenol, Datril, Panadol) for headache or pain.
Do not take aspirin or ibuprofen.
Do not take sedatives, painkillers or drink alcohol of any kind.
avoid blowing nose or cleaning ears for 48H
check LOC Q3-4 H - wake up at night for 48H
174
what is the proper way to clear a clot in a chest tube? why?
do not milk the chest tube, instead squeeze the tube and release over the area the clot is located, guiding it down the tube. milking can cause extreme negative pressure in the pleural space
175
is it ok to clamp a chest tube?
no. it increases the chance of a tension pneumothorax because it allows a buildup of pressure in the pleural space. exceptions: a trial before chest-tube removal and looking for an air leak
176
what is the abbreviation hs?
at bedtime
177
s/s and complications of lead poisioning
```
s/s: Developmental delay
Learning difficulties
Irritability
Loss of appetite
Weight loss
Sluggishness and fatigue
Abdominal pain
Vomiting
Constipation
Hearing loss
Complications: poor brain development, damage the kidneys and nervous system in both children and adults. Very high lead levels may cause seizures, unconsciousness and possibly death.
```
178
what changes in weight are seen in people with undiagnosed type 1 diabetes?
weight loss
179
what is the proper way to draw up 2 types of insulin into the same needle?
clear before cloudy. alcohol swab, inject air into cloudy without touching the needle to the insulin, draw out needle and inject air into clear, draw up clear (rapid acting) and then remove and draw up cloudy (intermediate-long acting) ... the air should be injected separately to prevent unintended mixing
180
how often should an ostomy bag be changed?
1 x / week or if leaking
181
which is a better indicator of pain relief: client report or physical cues?
physical cues
182
what foods must be avoided for patients with latex allergies? (cross reactive?)
tomato, avocado, peach, nectarine, apple, apricot, banana, carrot, celery, cherry, chestnut, fig, grape, kiwi, melon, passion fruit, papaya, pear, pineapple, plum , potato. (this is kaplan's list, but there are more)
183
instructions for 24 hour creatinine clearance test.
collect all urine in sam container for a full 24h period. keep urine in refrigerator. no limit on fluids. Do not eat a meal high in protein before the test. avoid strenuous activity during the collection period.
184
what do you do if you experience fever when taking an SSRI?
notify physician because it is a sign of serotonin toxicity - deadly
185
normal bilirubin levels in newborns. level of bilirubin that calls for phototherapy?
In a newborn, higher bilirubin is normal due to the stress of birth. Normal bilirubin in a newborn would be under 5 mg/dL, but up to 60 percent of newborns have some kind of jaundice and bilirubin levels above 5 mg/dL. Requires phototherapy: A bilirubin level greater than 15mg/dL in infants 25 to 48 hours old, 18 mg per dL (308 mol per L) in infants 49 to 72 hours old, and 20 mg per dL (342 mol per L) in infants older than 72 hours. Older children and adults should have levels between 0.3-1.9ml/dL.
186
what is scleral buckling?
operation done to repair detached retina. primary issue - avoid increased ICP - coughing/strain of any kind
187
what is the proper way to transition from heparin to warfarin?
Initiate warfarin on day 1 or 2 of heparin therapy and overlap until desired INR (in some cases - DVT++ overlap must be maintained for a minimum of 5 days until desired INR (>2.0) maintained for 24 hours) , THEN discontinue heparin - not before. also dont change the heparin does, even though warfarin has been shown to increase the aPTT.
188
what is one important thing that might prevent complete release of dialysate in peritoneal dialysis?
a full colon. assess last bm
189
diet for GERD
low fat, low acid, avoid mint, carbonated beverages, chocolate
190
what iv solution is given for rehydration ? why?
0.45 NS because it is hypotonic and will shift fluids back in to the intracellular space
191
proper precautions for rubella?
droplet
192
proper precautions for rsv?
contact
193
what might subcutaneous emphysema indicate?
pneumothorax - esp following opening in the chest - chest tubes
194
priority action in sickle cell crisis?
iv rehydration - normal saline - reverse the cause - min 200ml/h. 2nd thing is O2 administration.
195
migrane triggers
fatigue, chocolate, cheese, coffee, waiting too long to eat - hypoglycemia, fluctuations in estrogen, bright lights, odors, certain activities - exercise
196
s/s of oxygen toxicity
disorientation, breathing problems, and vision changes such as myopia. Prolonged exposure to above-normal oxygen partial pressures, or shorter exposures to very high partial pressures, can cause oxidative damage to cell membranes, the collapse of the alveoli in the lungs, retinal detachment, and seizures. Oxygen toxicity is managed by reducing the exposure to elevated oxygen levels.
197
can a nurse insert a chest tube if it has fallen out?
no, instead apply a tented dressing to aid air release of the pleural space.
198
how do you determine the expected fundal height of a pregnant woman?
use Gele's rule: for weeks 24-34 fundal height correlates to the week of pregnancy. ex: 26 weeks pregnant, fundus is 26 cm from the top of the pubic bone to to the top of the uterus /fundus.
10-12 weeks- slightly above symphysis pubis
16 weeks - halfway btw symphysis pubis and fundus.
20-22 weeks -umbilicus
28 weeks - 3 finger-breaths above umbilicus
36 weeks - below ensiform cartilage
199
risk factors for GERD
female, over 45 years old, obesity, Bulging of top of stomach up into the diaphragm (hiatal hernia), Pregnancy, Smoking, Dry mouth, Asthma, Diabetes, Delayed stomach emptying, Connective tissue disorders, such as scleroderma
200
how long does a person who had a VTE remain on warfarin for?
minimum 3 months.
201
when recording the intake for peritoneal dyalisis, what is included?
any fluid that was retained. this would be the total amount of dialysate absorbed (in 2000ml, out 1900ml = 100ml absorbed) plus any other liquid that was ingested during dialysis. (800ml of juice) it the client voided at this time it would be included in the calculation of the output - not input.
202
how many oz are in a cup of water?
8oz
203
what is superior vena cava syndrome?
a group of symptoms caused by obstruction of the superior vena cava. More than 90% of cases of superior vena cava obstruction are caused by cancer. Characteristic features are edema of the face and arms and development of swollen collateral veins on the front of the chest wall. Shortness of breath and coughing are common.
204
what is the expected order of labor of the primigravida/primipara? (same thing if fetus has passed 20 weeks)
effacement, decent and dilation - primigravida dilate 1-1.2 cm per hour
205
what is the expected location of the fundus immediately after birth, at 12 hours after birth, 2 days after birth, one week after birth?
At 12 hours after delivery, the fundus is typically 1 cm above the umbilicus, but this does vary. The uterus descends into the pelvis approximately 1 to 2 cm per day. About a week after delivery, the fundus should be halfway between the umbilicus and the symphysis pubis. immediately after birth, the fundus is low, but contractions
206
how do you perform fundal massage?
If the fundus is boggy, gently massage the uterus with a rotating motion while supporting the lower uterine segment until it feels firm. Without stabilization of the lower segment, the uterus could invert, and severe hemorrhaging could result.
207
what are beta blockers used for? what is the common suffix for BBs? what are the typical side effects / adverse effects for BBs? name as many BBs as you can.
Beta blockers are often used to manage cardiac arrhythmias, protecting the heart from a second heart attack after a first heart attack, and, in certain cases, hypertension. Drugs in class: Propranolol, Metoprolol, Atenolol, Bisoprolol, Carvedilol, Nebivolol, Timolol, Sotalol, Labetalol, Nadolol, Pindolol++. SE: Diarrhea, Stomach cramps, N/Vrash, blurred vision, muscle cramps, and fatigue
208
how do beta blockers work?
Beta blockers primarily block β1 and β2 receptors and thereby and thereby the effects of norepinephrine and epinephrine. By blocking the effects of norepinephrine and epinephrine, beta blockers reduce heart rate; reduce blood pressure by dilating blood vessels
209
nursing considerations for beta blockers
dont stop abruptly - make cause arrhythmias/sudden death. Must watch for respiratory distress and heart failure cause by the BB - BBs slow the heart rate.
210
what are ace inhibitors for?
HTN - they dilate the blood vessels, also for CHF. they relax vessles, decrease blood volume and pressure and decrease the o2 demands of the heart.
211
what is the common suffix for ace inhibitors? list as many as you can.
-pril. perindopril, captopril, enalapril, lisinopril, and ramipril.
212
common adverse effects for ace inhibitors
hypotension, cough, hyperkalemia, headache, dizziness, fatigue, nausea, and renal impairment.
213
what are calcium channel blockers used for ?
many things: Dihydropyridine (DHP) calcium channel blockers used to reduce systemic vascular resistance and arterial pressure. (may lead to reflex tachycardia. suffix -dipine: amlodipine, nifedipine++)
Phenylalkylamine CCBs reduce myocardial oxygen demand and reverse coronary vasospasm, and are often used to treat angina (verapimil
Benzothiazepine CCBS reduce arterial pressure without producing the same degree of reflex cardiac stimulation caused by dihydropyridines. ex: Diltiazem
other - ex: gabapentin: used to treat epilepisy
214
what drugs can be given if an overdose of vasopressive drugs such as and ace inhibitor is taken?
activated charcoal po within 3 hours, calcium glutonate , atropine
215
s/s of thyroid storm
```
racing heart rate (tachycardia) that exceeds 140 beats per minute and atrial fibrillation
high fever
persistent sweating
shaking
agitation
restlessness
confusion
diarrhea
unconsciousness
```
216
how is potassium related to acid base balance ?
hyperkalemia = acidemia; hypokalemia = alkalosis. one can cause the other and visa versa because the ions move in and out of the cell to achieve ph homeostasis
217
at what point does a new mother need to begin using contraceptives?
immediately - regardless of breastfeeding. oral contraceptives may not be used during breastfeeding. return of ovulation usually returns after breastfeeding is complete, but is not reliable. use barrier method, timing, diaphram etc. if breastfeeding
218
what is an Iis an intravenous pylogrmam ?
An IVP can show the size, shape, and position of the urinary tract, and it can evaluate the collecting system inside the kidneys.
During IVP, a dye called contrast material is injected into a vein in your arm. A series of X-ray pictures is then taken at timed intervals.
219
what does calcium gluconate do?
reverses respiratory depression and other symptoms caused by magnesium or certain heart medicines. Treats calcium deficiency. Treats black widow spider bites, lead colic, and a condition called rickets. This medicine is also used in life support and life-threatening heart conditions - cardiac arrest
220
what electrolytes must be assessed for thiazides?
thiazides are diuretics that "spare" calcium and waste potassium. hypercalcemia and hypokalemia are priority assessments
221
what do loop diuretics do with K+
waste
222
what can be given to counteract hypercalcemia?
phosphorous, steroids
223
what foods have phosphorous?
anything with protien
224
priority for calcium / efectiveness for vit D activation?
must see sun to activate vit D
225
foods with magnesium
spinach, flax cucumber, mustard greens, summer squash, broccoli, halibut, turnip greens, pumpkin seeds, peppermint, green beans , celery, kale, sunflower seeds, sesame and flax seeds.
226
what is the common sign of sodium imbalance - either hypo or hyper Na+?
neuro changes
227
what does giving insulin and glucose help fix hyperkalemia?
insulin carries both glucose and K+ into the cell, decreasing the serum K+
228
what are benzodiazapines used to treat? what are some examples and what are the common suffixes?
These properties make benzodiazepines useful in treating anxiety, insomnia, agitation, seizures, muscle spasms, alcohol withdrawal and as a premedication for medical or dental procedures. -pam, -pine, -diaz-. examples:Alprazolam, Chlordiazepoxide, Diazepam (valium), Lorazepam (ativan)
229
what is buerger's disease?
inflammation and thrombosis in small and medium-sized blood vessels, typically in the legs and leading to gangrene. It has been associated with smoking.
230
what is the Somogyi Effect?
When blood glucose levels drop too low, the body sometimes reacts by releasing counterregulatory hormones such as glucagon and epinephrine. These hormones spur the liver to convert its stores of glycogen into glucose, raising blood glucose levels. This can cause a period of high blood sugar following an episode of hypoglycemia.
231
how/ when should oral steriods be taken ?
in the morning with food - causes GI upset and difficulty sleeping. avoid alcohol
232
s/s of steroids
```
Acne
Blurred vision
Cataracts or glaucoma
Easy bruising
Difficulty sleeping
High blood pressure
Increased appetite, weight gain
Increased growth of body hair
Insomnia
Lower resistance to infection
Muscle weakness
Nervousness, restlessness
Osteoporosis
Stomach irritation or bleeding
Sudden mood swings
Swollen, puffy face
Water retention, swelling
Worsening of diabetes
```
233
why must muscle weakness be reported in patients taking po steroids?
It is the 1st sign of adrenal insufficiency. Typically, the adrenal glands can recover and begin producing normal amounts if the dose of steroid medication is slowly decreased. If stopped suddenly they can trigger a life-threatening condition known as acute adrenal insufficiency, where the adrenals cant produce enough hormone.
234
what is the role of aldosterone?
regulates K+ secretion, Na+ retention, and H2O retention
235
what is normal PaO2?
75-100mmhg - different from SaO2, which should be 94% or higher
236
what is neuroleptic malignant syndrome? s/s , cause?
Syndrome only caused by use of neuroleptic drugs. Characterized by:
Severe muscular rigidity
Hyperthermia (temperature >38°C)
Autonomic instability
Changes in the level of consciousness
The most important intervention is to discontinue all neuroleptic agents. In most cases, symptoms will resolve in 1-2 weeks.
237
normal newborn heartrate
120-160
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do steroids cause hypo or hyper kalemia?
hypo
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acceptable range of temp for enema -?
98-105
