MedSurg Flashcards
MedSurg (367 cards)
1
Q
Bacterial, fungal, and viral causes of meningitis?
A
bacterial- N meningitidis, S. pneumoniae, H influenzae
fungal- AIDS
viral- measles, herpes, arboviruses (West Nile)
2
Q
What are some s/s of meningitis?
A
excruciating headache, nuchal rigidity, photophobia
fever and child
nausea and vomiting
ALOC- confusion, disorientation, coma, seizures, lethargy
tachycardia
hyperactive DTR
RED macular rash for meningococcal meningitis
restlessness and irritability
K and B signs (K- extension of knee, Brudzinski- neck flexion causes knees and hips to flex)
3
Q
Lab tests for meningitis, and gold standard
A
urine, throat, nose, and blood culture and sensitivity
CBC
CSF analysis- cloudy bacterial, elevated WBC, protein, and CSF. Decreased glucose in bacterial (GOLD)
CT and MRI to detect IICP
4
Q
first thing to do with meningitis patient
A
isolate, report, and abx
5
Q
older meningitis patient are at increased risk for what?
A
pneumonia
6
Q
Meds to take care of meningitis and close contacts
A
ceftriaxone & vanco combo
phenytoin
acetaminiphen/ibuprofen
ciprofloxacin and rifampin (prophylactic)
7
Q
complications of meningitis and nursing interventions
A
Increased ICP- increase HOB to 30, and give mannitol, no coughing
SIADH- administer demeclocycline and fluid restrictions
septic emboli- gangrene and DIC can occur, monitor circulation and coagulation, especially in extremities
8
Q
Stroke risk factors?
A
DM, obesity, htn, smoking, cocaine use, a-fib, hyperlipidemia, hypercoagulability
9
Q
stroke diagnostic procedures
A
CT without contrast- w/in 25min determines type
MRI- edema, ischemia, and necrosis
lumbar puncture- blood in CSF for hemorrhage or ruptured aneurysm
GCS
10
Q
acute stroke intervention
A
NIHSS Q 4 hrs, 0:none, 21-42: severe
v/s Q1-2 hrs and monitory for sys-180+
fever can cause IICP
O2 status
cardiac monitor for arrhythmias
hypoglycemia
elevate HOB to 30
seizure precautions
11
Q
long-term stroke intervention
A
communication skills- expressive and receptive aphasia,
safe feeding with swallowing and gag reflex and SLP- put food in back of mouth on unaffected side with chin down
immobility- atelectasis, pneumonia, pressure injury, DVT ROM Q 2 hrs
hemianopia or hemiparesis- teach them to scan environment
shoulder subluxation- support affected arm
edema- massage from extremities toward body
bladder training offer urinal Q2 hrs
12
Q
meds for stoke
A
thrombolytic within 4.5 hrs in ischemic
anticoagulants- warfarin for a-fib
antiplatelet- aspirin within 24-48 hrs to prevent more clot formation and inhibitors
antiepileptic if they have seizures
13
Q
right-sided stroke affects what ? s/s
A
left-sided hemiplegia
reckless and poor judgement
impulsive
depth perception loss
spatial loss
14
Q
left-sided stroke affects what? s/s
A
right-sided hemiplegia
language aphasia
emotional (anger/depression)
aphasia
reading and writing are difficult
15
Q
What are the risk factors of MS?
A
women 20-40
viruses
living in cold or temperate climates
16
Q
What are some triggers that cause relapse of MS?
A
viruses
cold climates
physical injury,
emotional stress,
pregnancy
fatigue
overexertion
17
Q
What are some of the main categories of s/s for MS?
A
cerebellar- vertigo and tinnitus, ataxia
paresthesia- Lhermitte’s (electric shock)
spasticity- ataxia, muscle weakness, fatigue
incontinence- bowel and bladder dysfunction
cognitive changes- memory loss, impaired judgment and emotional disturbances, and depression
speech- dysarthria (slurred and nasal speech), scanning
optical- neuritis, diplopia, dizziness, and scotomas (patches of blindness)
18
Q
What is the gold standard for diagnosing MS?
A
MRI for plaques
19
Q
Monitor for what in MS patients?
A
visual acuity- eye patches to strengthen and scan the environment
speech patterns
swallowing
activity tolerance- space out tasks
skin integrity-
toileting- self-cath and fluids to prevent UTI
support- family, and depression
20
Q
What is Charcot’s neurologic triad?
A
in MS patients, consists of scanning
speech, intention tremor, and nystagmus, with symptoms characteristically worsening after a hot shower
21
Q
What are some medications for MS?
A
DMARDS, interferon, prednisone, dantrolene and baclofen for spacicity (don’t stop suddenly and report weakness and jaundice), propanolol (ataxia)
22
Q
What are some risk factors of pneumonia?
A
weakened cough or epiglottal (gag) reflex- anesthetics, stroke
intubation
air pollution
snoking
viral URIs
aging
chronic diseases
23
Q
what are some ways pathogens can reach the lungs and cause pneumonia?
A
aspiration- ng tube, intubation
inhalation
hemaogenous spread
24
Q
what is the diff between CAP and HAP?
A
CAP happens before 48 hours after admission, and HAP happen later than 48 hours, but higher mortality and likely drug-resistant, or VAP, more than 48 hrs or longer after intubation, and also more costly
25
What is the CURB-65 in pneumonia?
confusion, uremia, respiratory rate, blood pressure, age ≥ 65 years, which predicts 30-day mortality
26
Which is worse, viral or bacterial pneumonia, and which is more common?
bacterial is more severe and viral is the most common type
27
What is consolidation and some indicators
bronchia breath sounds
egophony
increased fremitus (vibration)
alveoli are filled with fluid, pus, blood, or other instead of air
28
what are some medical situations that increase the risk of aspiration pneumonia?
seizures,
anesthesia
head injury
stroke
alcohol use b/c sedation and vomiting
swallowing problems (dysphagia)
NG tube
enteral feeding
29
what is the fungal pneumonia called, what causes it, and complications?
pneumocystitis jiroveci pneumonia, in HIV-negative immunocompromised persons that can spread to other organs, can die from it
30
What is one of the most important life-threatening infectious complications after a hematopoietic stem cell transplant?
cytomegalovirus pneumonia
31
What are some lung-related assessment findings of pneumonia?
fine or coarse crackles b/c cluids
dullness to percussion- pleural effusion
use of accessory muscles
cyanosis of mouth or conjunctiva
AMS
sputum is green, yellow, or rust colored
hemoptysis
32
what are the differences in lung sounds of pneumonia vs COPD?
COPD- hyperressonance b/c more air and dullness in pneumonia b/c more fluid/secretions
33
When should a sputum culture be taken if someone has pneumonia?
before starting abx, and a blood culture if the patient is really ill because it could lead to sepsis
34
What are some physical assessment findings for asthma?
Coughing Wheezing
Mucus production
Use of accessory muscles
Prolonged exhalation
low oxygen saturation (low SaO2)
Barrel chest or increased chest diameter
35
What is the expected value of a FEV1 in asthmatics? (forced expiratory volume in the first second of blowing out)
A decrease in FEV1 by 15% to 20% below the expected value is common in clients who have asthma. An increase in these values by 12% following the administration of bronchodilators is diagnostic for asthma.
36
Nursing actions for dealing with radioactive patient?
wear dosimeter
Limit visitors to 30-min visits, and have visitors maintain a distance of 6 feet from the source. and 16 y.o. and above
keep lead container in room and use tongs
In most cases, all linens and dressings are kept in the client’s room until the radiation source is removed, to ensure it is not lost in the trash or laundry
37
pt teachings for surgical interventions of cancer excision
Head of the bed elevated 30° when awake and support their arm on a pillow.
Lying on the unaffected side can relieve pain.
wear sling to support arm when ambulating
avoid administering injections, BP, or venipuncture
38
wound care for surgical interventions of cancer excision
Drains are usually left in for 1 to 3 weeks
Avoid placing the arm on the surgical side in a dependent position
Perform early arm and hand exercises (squeezing a rubber ball, elbow flexion and extension, and hand-wall climbing) to prevent lymphedema and to regain full range of motion.
No constrictive clothing and avoid cuts and injuries to the affected arm.
39
Skin allergy test client ed and considerations
hold corticosteroids and antihistamines for 48 hr to 2 weeks, as instructed by the provider.
ACE inhibitors, Beta blockers, theophylline, nifedipine, and glucocorticoids can alter results
40
How often should you check non intact skin in people with AIDS?
Q 4 hrs
41
What are some contraindications of arthroplasty?
recent or active infection such as UTI
arterial impairment to affected extremity
client unable to follow postsurgical regimen
comorbidity such as uncontrolled DM/htn, cardiac or respiratory conditions
42
Laboratory Tests for cholelithiasis
Increased WBC - inflammation.
Direct, indirect, and total blood bilirubin- possible bile duct obstruction
Amylase and lipase can be increased- pancreatic involvement.
Aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and alkaline phosphatase (ALP) (increased with liver dysfunction) can indicate the common bile duct is obstructed.
43
What pain meds are preferred for acute biliary pain? What about mild to moderate pain?
Opioid analgesics, such as morphine sulfate or hydromorphone, are preferred for acute biliary pain.
An NSAID, such as ketorolac, is used for mild to moderate pain. Monitor for GI bleeding.
44
cholecystitis nsg interventions
observe stool for clay colored stool and dark urine
Jaundice, icterus (yellow discoloration of the sclera), clay-colored stools, steatorrhea, dark urine, and pruritus
45
MRSA care to reduce transmission
bath in chlorhexidine solution to reduce transmission of MRSA to other areas of the body
46
GI issues only pertaining to Crohn's
diarrhea and loose stools 5/day
steatorrhea
fistulas (need more protein and calories, but less fiber)
usually no bleeding
"string sign" on x-ray, indicating constriction in segment of terminal ileum
K+, Mg, and Ca, Folic acid and B12: decreased
mainly RLQ pain
47
GI issues only pertaining to ulcerative colitis
liquid bloody stools (10-20/day)
passage of mucus, pus, and blood from the bowel
hypocalcemia and anemia b/c impaired Ca+ absorption in the colon
K+, Na, MG, Ca and Cl decreased
Mainly LLQ pain
48
To dos for venous insufficiency
Elevate legs for at least 20 min, four to five times a day.
Elevate the legs above the heart when in bed.
Wear elastic compression stockings. Apply them after the legs have been elevated and when swelling is at a minimum
49
expected finding for PVD? especially in legs, pain and color
Aching pain and feeling of fullness or heaviness in the legs after standing
Stasis dermatitis is a brown discoloration along the ankles that extends up the calf relative to the level of insufficiency.
Edema.
Stasis ulcers (typically found around ankles).
50
expected finding for PAD? especially in legs, pain and color
Burning, cramping, and pain in the legs during exercise (intermittent claudication)
Numbness or burning pain primarily in the feet when in bed
Pain that is relieved by placing legs at rest in a dependent position
Bruit over femoral and aortic arteries
Decreased capillary refill of toes
Decreased or nonpalpable pulses
Loss of hair on lower calf, ankle, and foot
Dry, scaly, mottled skin/ thick toenails
Cold and cyanotic extremity
Pallor of extremity with elevation
Dependent rubor (redness) of the extremity
Muscle atrophy
Ulcers and possible gangrene of toes
51
how to relieve pain of pad vs pvd
(PActivityD), focus on lifestyle changes like regular exercise (walking until discomfort, then resting), quitting smoking, managing blood pressure and cholesterol, and maintaining a healthy diet;
(PeleVate
D), elevating legs, wearing compression stockings, and avoiding prolonged sitting or standing
52
What degree should the HOB be elevated for meningitis patients?
30
53
What does it mean if BUN and creatinine are both elevated? what if only BUN is elevated?
renal insufficiency vs dehydration
54
How often should you check the cast n/v status?
check every hour for the first 24 hrs
55
What is feverfew used for and what does it interact with?
fevers, headaches, and arthritis, menstrual cramps, n/v
feverfew interacts with naproxen and increases risk of bleeding
56
What is cast syndrome?
reaction to wearing a large cast over the abdomen which is simlar to claustrophobia causing nausea, vomiting, GI upset, and electrolyte imbalance due to compression of the duodenum
57
What is acute chest syndrome?
a serious complication of sickle cell disease, a genetic blood disorder. It occurs when sickle-shaped red blood cells block blood flow to the lungs, causing inflammation and damage. S/s include espiratory infection and debreis from sickled cells cause sob, cough, tachypnea, pleuritic pain
58
What are some things to manage stomatitis?
no glycerin for mouth cleaning, but oral hygiene after every meal and Q 4 hrs and cooled liquids and ice chips
59
How many inches of buffer should a skin barrier have around the stoma?
1/8 in
60
what does hiccupping with a pacemaker mean?
a potential problem with the pacemaker lead placement, often signifying that the lead has perforated the heart muscle and is inadvertently stimulating the diaphragm, causing hiccups; this is considered a serious issue and requires immediate medical attention to adjust or replace the lead.
61
What is the most definitive diagnostic to identify the intensity of the infection and the degree of liver damage?
pre- fast midnight on day of procedure in case of complication
intra- supone position and hold breath while needle is inserted, apply pressure
post- assist client to right side-lying position and maintain for several hrs assess v/s pain, bleeding, and pneumothorax signs
62
What type of diet should hepatitis get?
Provide a high-carbohydrate, high-calorie, moderate-fat, and moderate-protein diet after nausea and anorexia subsides, and small, frequent meals to promote nutrition and healing.
63
How long should a patient with hepatitis abstain from sex?
Avoid sexual intercourse until hepatitis antibody testing is negative.
64
When should people get FOBT or sigmoidoscopy?
start at age 50 and every five years
65
What foods and meds to avoid before FOBT
Avoid red meat, anti-inflammatory medications, and vitamin C for 48 hr prior to testing (to prevent false positives).
66
What are risk factors to colorectal cancer?
Adenomatous colon polyps
African American descent
Inflammatory bowel disease (ulcerative colitis, Crohn’s disease)
High-fat, low-fiber diet
Age older than 50 years; 1 in 7 new diagnoses are in adults younger than 50
Long-term smoking/alcohol consumption
Physical inactivity
Infection exposure to Helicobacter pylori, Streptococcus bovis, John Cunningham virus, and human papillomavirus
Personal or family hx of cancer
67
What are some ways to minimize complications of chemo-induced thrombocytopenia?
use stool softener, electric razor, soft-bristle toothbrush
close-toed shoes
apply pressure for approx 10 minute after blood obtained
68
What is pheochromocytoma, and what should you look for?
a rare tumor that grows in the adrenal glands, which are located above the kidneys. It produces excessive amounts of the hormones epinephrine (adrenaline) and norepinephrine (noradrenaline). These hormones regulate blood pressure, heart rate, and other bodily functions
monitor BP and HR like hypertensive crisis, increase calories, and no caffeine
69
What are the five H's of pheochromocytoma?
hypertension
headache
hyperhidrosis (excessive sweating)
hypermetabolism
hyperglycemia
70
What are some assessment findings of Polycystic kidney disease?
family hx
dull pain- increased size or possible infection
sharp pain- ruptured cyst of possible kidney stone
headache
hypertension from kidney ischemia
enlarged abdomen
hematuria
kidney failure
71
What are some nursing actions for Polycystic kidney disease?
controlling htn w/ mids
measure BP and daily weights,
pharm and nonpharm pain relief methods
NSAIDS-CAREFUL
dry head to abdomen or flank
abx- ciprofloxacin and trimethoprim-sulfamethoxazole
hydration status- monitor urine specific gravity
constipation prevention
low sodium
72
What is the main characteristic of Ménière’s disease?
Episodic vertigo, tinnitus (ringing in the ears), and fluctuating sensorineural hearing loss.
73
How to reduce vertigo from Ménière’s disease and other inner ear problems?
restrict fast head movement
move slowly
avoid caffeine and alcohol
diuretic to decrease fluids in semicircular canals
space fluid intake throughout the day
decrease salt such as MSG and processed meats
74
Where is the pain in pancreatitis and does it get referred anywhere?
mid epigastric pain to the left shoulder or back
75
What are some physical assessment findings of pancreatitis?
Seepage of blood-stained exudates into tissue as a result of pancreatic enzyme actions causes Turner's signs Ecchymoses on the flanks
Cullen's sign- Bluish-gray periumbilical discoloration
Abdominal distension and rigidity (peritonitis)
Generalized jaundice because blockage of common bile duct prevents removal of bilirubin from the liver
Absent or decreased bowel sounds (possible paralytic ileus)
Warm, moist skin; fruity breath (hyperglycemia)
Ascites- leakage of pancreatic enzymes
Tetany due to hypocalcemia (pancreatic lipase binds to ca+ in bloodstream and removes from circulation
Trousseau’s sign: hand spasm when blood pressure cuff is inflated
Chvostek’s sign: facial twitching when facial nerve is tapped
76
How would you rest the pancreas in acute pancreatitis?
NPO: No food until pain-free
Severe pancreatitis: Enteral or parenteral nutrition
Resume diet with bland, high protein, low-fat diet with no stimulants (caffeine); small, frequent meals QEBP
Antiemetic administered as needed
NG tube: Gastric decompression (for severe vomiting or paralytic ileus)
No alcohol or smoking
Limit stress
Pain management
77
What are some medications for pancreatitis?
opioid analgesics, morpine, ketorolac
abx- imipenem for necrotizing pancreatis
decrease gastric acid secretion: histamine receptor antagonist- cimetidine & PPI- omeprazole
Pancreatic enzyme- Pancrelipase to take with food to digest fats and proteins
78
Client education for pancrelipase?
Monitor and report persistent adverse effects such as headache, cough, dizziness, and sore throat.
Contents of capsules can be sprinkled on nonprotein foods.
Drink a full glass of water following pancrelipase.
Wipe lips and rinse mouth after taking medication (to prevent skin breakdown or irritation).
Take pancrelipase after antacid or histamine receptor antagonists.
Take pancrelipase with every meal and snack.
79
major types of urinary incontinence:
stress- small amts loss from increased ab pressure like sneezing, laughing make post menopause
urge- inability to stop peeing from overactive detrusor muscle with increased bladder pressure from UTI or overactive bladder
Overflow- when the bladder becomes too full and cannot empty properly. This leads to involuntary leakage of urine, often in small amounts, when bladder overdistention, obstruction of the urinary outlet, or an impaired detrusor muscle and neurogenic disorder or enlarged prostate
reflex- involuntary loss usually without warning- hyperreflexia of the detrusor muscle, usually from spinal cord dysfunction or stroke or MS
Functional: Loss of urine due to factors that interfere with responding to the need to urinate (cognitive, mobility, and environmental barriers) can't access toilet in time
Transient: Reversible incontinence due to inflammation or irritation (UTI), temporary cognitive impairment, disease process (hyperglycemia), medications (diuretics, anticholinergics, sedatives)
80
Bone biopsy pre, intra and post procedure
side-lying
pt will feel pressure and brief pain and crunching sound
20 minute procedure
apply pressure to biopsy site
sterile dressing cover
bed rest 30-60 minute
monitor for bruising, fever, and bleeding
avoid aspirin that affect clotting but give acetaminophen
81
What kind of electrolyte imbalance might PPI's cause?
hypomagnesemia
82
Why might H&H and platelet count be decreased in hepatitis?
because of esophageal varicies
83
Lab results for hepatitis
ALT/AST/ALP elevated
bilirubin- elevated
blood protein- decreased due to lack of hepatic synthesis
blood albumin- Decreased due to the lack of hepatic synthesis
Hematocrit: Decreased
Platelet count: Decreased
PT/INR- Prolonged due to decreased synthesis of prothrombin
ammonia levels-Increase when hepatocellular injury (cirrhosis) prevents the conversion of ammonia to urea for excretion.
blood creatine- Can increase due to deteriorating kidney function
84
What are some meds for cirrhosis or hepatis?
Diuretics: Decrease excessive fluid in the body
Beta-blocking agent: Used for clients who have varices to prevent bleeding
Lactulose: Used to promote excretion of ammonia from the body through the stool
Nonabsorbable antibiotic: Can be used in place of lactulose
85
What is Ankle-brachial index (ABI)?
The ankle pressure is compared to the brachial pressure. The expected finding for ABI is 0.9 to 1.3. ABI less than 0.9 in either leg is diagnostic for PAD.
Health care providers calculate ABI by dividing the blood pressure in an artery of the ankle by the blood pressure in an artery of the arm
above angle and over brachial artery
86
What are some examples of modifiable risk factors?
Hypertension
Hyperlipidemia
Diabetes mellitus
Cigarette smoking
Obesity
Sedentary lifestyle
Familial predisposition
Female sex
Advanced age
Elevated C-reactive protein
Hyperhomocysteinemia
87
What is the pre, intra, and post procedure for thoracentesis?
informed consent
obtain preprocedure x-ray to locate pleural effusion and locate insertion site
position patient upright with arms and shoulders supported\
keep still!
surgical asepsis- assist
document client response and fluid removed
apply dressing over site
auscultate for reduced breath sounds
deep breathe
postprocedure CXR
88
What is the max amount of lung fluid to remove at one time?
1 L at a time to prevent re-expansion pulmonary edema
89
What are some complications after a thoracentesis?
Mediastinal shift
Pneumothorax- w/in first hr after thoracentesis
bleeding
infection
90
What are some indications of a deviated trachea?
pain on the affected side that worsens at the end of inhalation and exhalation
affected side not moving in and out upon inhalation and exhalation
increased heart rate
rapid shallow respirations
nagging cough
feeling of air hunger
91
What is the amount of drainage from a chest tube that should be reported to a provider?
mL/hr or more
92
What are the steps to take if you see a hematoma after a cardiac cath?
Monitor for sensation, color, capillary refill, and peripheral pulses in the extremity distal to the insertion site.
Assess the groin at prescribed intervals and as needed.
Hold pressure for uncontrolled oozing/bleeding.
Monitor peripheral circulation.
Notify the provider.
93
What are the finding of an Acute hemolytic transfusion reaction? including v/s
chills, nausea, anxiety, hemoglobinuria (red or brown urine)
chest tightening and pain, low-back pain,
fever, tachycardia, hypotension, tachypnea (hemodynamic instability)
Impending sense of doom.
94
What is a priority intervention for a client with renal calciuli?
force at least 3KmL of fluids IV or PO/day
strain all urine for calculus
provide pain control
maintain proper pH of urine (thiazide diuretics and allopurinol
95
What are some contributing factors of urolithiasis?
obstruction and urinary stasis
uric acid stones (excessive purine)
immobilization
males ages 20-40
decreased fluid intake
96
What are some findings in the pee that might occur with renal calculi?
Flank pain suggests calculi are located in the kidney or ureter.
Oliguria/anuria occurs with calculi that obstruct urinary flow.
Hematuria
97
What are the steps for Extracorporeal shock wave lithotripsy (ESWL)?
lay them flat
topical anesthetic for 45 minutes prior
assess for gross hematuria and strain urine
education- bruising and peeing blood are normal
98
What are some foods to avoid for a patient with renal calculi?
animal protein to decrease ca+ precipitate
too much sodium and ca+
oxalate: spinach, black tea, rhubarb, cocoa, beets, pecans, strawberries, peanuts, okra, chocolate, wheat germ, lime peel, and Swiss chard
99
What are some meds to help prevent renal calculi?
Thiazide diuretics (hydrochlorothiazide) - increases calcium reabsorption.
Orthophosphates - decreases urine saturation of calcium oxalate.
Sodium cellulose phosphate - reduces intestinal absorption of calcium.
100
What are some causes of respiratory acidosis?
hyperventilation
brain tumors, cerebral aneurysm, stroke or overhydration, trauma, or neurologic diseases
pneumothorax/hemothorax, flail chest, obesity, sleep apnea, tumors, or deformities
101
What are some causes of respiratory alkalosis?
anxiety, intracerebral trauma, salicylate toxicity, or excessive mechanical ventilation
asphyxiation, high altitudes, shock, or early-stage asthma or pneumonia
102
What are some causes of metabolic alkalosis?
too much base: Increased HCO3-, Decreased H+ concentration
Oral ingestion of excess amount of bases (antacids)
Loss of gastric secretions (through prolonged vomiting, nasogastric suction)
Potassium depletion (from thiazide diuretics, laxative overuse, Cushing’s syndrome, hyperaldosteronism)
103
What are some causes of metabolic acidosis?
Excess production of hydrogen ions (liver, kidney, and pancreas impairment)
Diabetic ketoacidosis (DKA)
Starvation
lactic acidosis- heavy exercise, seizure, hypoxia
excessive acid intake- Ethyl alcohol, Methyl alcohol, acetylsalicylic acid (aspirin)
inadequate elimination of h+- kidney failure, severe lung problems
inadequate production of bicarb- kidney failure, pancreatitis
diarrhea
104
What is the difference b/w Bi-pap and CPAP?
BiPAP delivers two different air pressure levels, one for inhaling and one for exhaling, while CPAP provides a constant, single pressure level throughout the breath cycle so it can keep the airway patent
105
What are the blood electrolyte levels in someone with ESRD? What about urinalysis
Decreased sodium (dilutional) and calcium; increased potassium, phosphorus, and magnesium
Urinalysis: Hematuria, proteinuria, and decrease in specific gravity
106
What are the stages of kidney damage?
Stage 1: Minimal kidney damage when GFR within expected reference range (greater than 90 mL/min)
Stage 5: Kidney failure and end-stage renal disease with little or no glomerular filtration (less than 15 mL/min)
107
What are the phases of AKI?
Onset: from onset until oliguria develops, and lasts for hours to days.
Oliguria: from kidney insult; urine output is 100 to 400 mL/24 hr w/ or w/o diuretics; and lasts for 1 to 3 weeks.
Diuresis: from kidney recovery; diuresis of a large amount of fluid occurs; and can last for 2 to 6 weeks.
Recovery: until kidney is fully restored up to 12 mos
108
What are the RIFLE stages of AKI?
Stage 1 (risk stage): Blood creatinine 1.5 to 1.9 times baseline and output < 0.5 mL/kg/hr for 6 hr+
Stage 2 (injury stage): Blood creatinine 2 to 2.9 times baseline and output < 0.5 mL/kg/hr for 12 hr+
Stage 3 (failure stage): Blood creatinine 3 times baseline and output <0.3 mL/kg/hr for 12 hr+
109
Types of AKI
Prerenal: volume depletion and prolonged reduction of blood flow to kidneys like meds and spesis
intrarenal- direct damage to kidney like trauma, infection, and acute nephrotoxins like contrast and hemolytic rxn, alcohol, lupus
postrenal- occurs from bilateral obstruction of structures leaving the kidney, kidney stones, prostatic hyperplasia, spinal cord injury
110
What are some lab tests results for AKI?
BUN/CREAT
Electrolytes
Hematocrit
urinalysis
ABG
BUN/Creat- increased
Electrolytes: Sodium can be decreased (prerenal azotemia) or increased (intrarenal azotemia); hyperkalemia, hypermagnesemia, hyperphosphatemia, hypocalcemia. (same as AKI)
Hematocrit: decreased
Urinalysis: presence of sediment (RBC, casts)
ABG: metabolic acidosis
111
What are some nephrotoxic drugs to avoid?
antimicrobial medications (aminoglycosides and amphotericin B), NSAIDs, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and IV contrast dye
112
Peritoneal dialysis can remove what from the blood? and cause what imbalances>
Peritoneal dialysis can remove protein from the blood as well as excess fluid, wastes, and electrolytes.
Hypoglycemia from the blood absorbing glucose from the dialysate.
Hyperlipidemia can also occur from long-term therapy and lead to hypertension.
113
What are nursing interventions for pre, intra, and post-hemodialysis?
assess patency and v/s throughout
withhold meds that lower BP and morning meds
weight the pt before and after
complications- air bubbles and hypotension, cramping
administer anticoags like heparin
Monitor vital signs and laboratory values (BUN, blood creatinine, electrolytes, Hct). Decreases in blood pressure are common
Avoid invasive procedures for 4 to 6 hr after dialysis
114
What are the inflow, equilibration (dwell time) and drainage times for peritoneal dialysis?
5-10 min and clamp immediately
30 min of equilibration
10-30 min of drainage
115
How often does hemodialysis occur?
three times per week, for 3- to 4-hr sessions. It involves insertion of two needles, one into an artery and the other into a vein.
116
What are the risk factors of acute glomerulonephritis?
Acute post-streptococcal glomerulonephritis
Recent upper respiratory infection or streptococcal infection (usually in kids)
117
What are some assessment findings for glomerulonephritis?
urine
pain
demeanor
body
v/s
urine- decreased, cloudy, tea colored hematuria, proteinuria, dysuria
pain- vague discomfort, headache,
demeanor- irritable, ill looking, lethargic,
body- anorexic, periorbital and facial edema (worse in the morning), vomiting, encephalopathy (seizures)*, gonadal swelling
v/s- mild-severe hypERtension, low grade fever
118
What foods should be avoided with glomerulonephritis?
Possible restriction of sodium and fluid.
Restrict foods high in potassium during periods of oliguria.
Restrict protein for severe azotemia.
119
what is the difference between glomerulonephritis and nephrotic syndrome?
Glomerulonephritis is a kidney disease that damages the glomeruli, while nephrotic syndrome is a set of symptoms that indicate kidney problems. Nephrotic syndrome can be caused by some types of glomerulonephritis and involves protein wasting.
120
What are some manifestations of nephrotic syndrome?
Weight gain over a period of days or weeks
Facial and periorbital edema: decreased throughout the day
muehrcke lines (white lines parallel to the lunula)
dark frothy colored urine
decease urinary output
BP within range or slightly below and htn is RARE
121
What should the diet be for someone with nephrosis?
low sodium, potassium, moderate protein, and high calorie diet
122
What are some medications for nephrosis?
corticosteroid, furosemide
plasma expanders: 25% albumin to decrease edema
cyclophosphamide (immunosuppressant)
123
What does CKMB indicate and how long does it take to increase and how long does it remain elevated for?
Normal Levels?
4-6 hrs,
2-3 days
0% total CK or 30-170 u/L)
124
What does Troponin indicate? how long does it take to increase and how long does it remain elevated for?
Normal Levels?
2-3 hrs and 7-14 days
less than 0.1 for Trop T
less than 0.03 for Trop I
cardiac damage only
125
What does Myoglobin indicate? how long does it take to increase and how long does it remain elevated for?
Normal Levels?
2 hrs and goes away within 2 hrs
less than 90 mcg/L
cardiac and skeletal damacge
126
What should the general levels be for cholesterol?
total
LDL
trig
HDL
Total- less than 200
LDL- less than 150
Trig- less 100
HDL- greater than 50
127
expected range for:
RBC
WBC
Hgb
Hct
RBC: 4-6
WBC: 4-11
Hgb: 12-17
Hct: 37-48( approx 3'x hemoglobnin range
128
expected range for:
PT
INR
aPTT
Platelet
PT- 10-12
INR- <1
aPTT: 30-40
Platelet: 150-400K
129
What does BNP test for and what is the normal range?
tests for heart failure and less than 100 usually because this is released by the ventricles in the heart in response to stretch and overload
130
What does d- dimer test for and what is the normal range?
usually under 0.4, but increased with clot
131
What is the expected reference range for
CVP
PAWP
CO
SCO2
CVP: 2-6
PAWP: 6-15
CO: 3-6L
SCO2: 60-80
132
What are some considerations for an echo and how long will it take?
lie on left side and takes less than one hour
133
What are some preop and postprocedure considerations for Transesophageal echocardiography?
NPO for 6 hr
monitor client's vitals and gag reflex
maintain the HOB at 45 degrees
134
What are some pre, intra, and post procedure for cardiac cath?
pre
NPO for 6 hrs
mark distal baseline pulses
metallic taste
w/hold metformin 48 hrs
intra- get ready to intervene for arrhythmias
post- check v/s four times the first fifteen minutes, 2x's the next hour, and four times in the next four hrs
n/c check every 15 min for the /first 2 /hr and every 30 minutes
apply pressure for min of 15 minutes
monitor for bleeding or hematoma
increase fluid
bed rest and extend hip for 4-6 hr
antiplatelet or thrombolytic
135
How often to check neurovascular and v/s post angiography?
v/s Q 15 for first hr, Q30 min for 2nd hr, Q1 hr for next 4 hours and everye 4 hrs thereafter
n/v- Q15 min for first 2 hr, then every 30 min until the pt sits up
136
pt ed for an angiogram?
lay supine
leave dressing on for 24 hrs
avoid strenuous exercise
no lifting more than 10 lb, or 5 lb if arm was used
increase fluid intake and no metformin 48 hrs post
137
What dysrhythmias would you cardiovert electrically?
atrial
SVT
v-tach with a pulse
138
when is atropine used generally and what kind of heart rhythm?
increases the HR by counteracting the /muscarine-like actions of acetylcholine and usually used for symptomatic bradycaerdia
139
What are three medications used to treat /ventricular dysrhythmias that are symptomatic?
Amiodarone, lidocaine, beta blocker
140
What are some meds to give to a-fib, SVT, and v-tach with a pulse?
amiodarone, adenosine, verapamil- antiarrhythmics
141
What are some considerations for elective cardioversion?
pre- anticoagulation therapy for 4-6 wks prior b/c possible clot formation during surgery
hold digoxin 48 hrs prior
post- assess for irregularities, embolism, and decreased CO and possible HF
142
What are some pacemaker modes?
asychronous- fixed with ventricular demand- fires at a constant programmed preset rate regardless of HR
synchronous- on demand and fires if HR drops below a predetermined rate
variable rate is when it senses oxygen demands and increases firing rate
143
How long will a pacemaker battery usually last?
10 yrs and it must be replaced or 9 yrs for a lithium ICD battery
144
What are some pacemaker placement prostprocedures
assess for hiccups, electrical thermal burns esp for older dehydrated patients
145
client ed for pacemaker placement postprocedure
carry id card with manufacturer's name, model #, mode of function, rate parameters, and expected battery life
wear sling when out of bed and don't raise arm above shoulder for 1-2 wks
check pulse daily
activity restrictions incl. contact sports for 2 mos
never put stress on incision site
no MRI or some heat therapy
146
What are some s/s of mononucleosis??
Splenomegaly--> rupture
Lymphs swollen
Appetite loss
Sore throat
Hepatic involvement/headache
147
What is an early indication of DMII in females?
recurrent vaginal yeast infections and polyuria
148
nursing care for child with epistaxis
sit up child with head tilted forward slightly
apply pressure to nares for at least 10 min
do not pack nose with anything, but breathe through mouth
ice pack over bridge of nose
149
What are some classic manifestations of osteogenesis imperfecta
Multiple bone fractures (fragile bones and deformities)
Blue sclera
Early hearing loss
Small, discolored teeth
150
What is the recomended medication for osteogenesis imperfect and SE and nursing actions?
Bisphosphonate therapy (pamidronate) to increase bone density and prevent fractures
IV.
hypokalemia, hypomagnesemia, hypocalcemia, hypophosphatemia, thrombocytopenia, neutropenia, dysrhythmias, kidney failure, general malaise
Monitor for respiratory infections.
Vaccines containing live viruses are not recommended.
151
nursing intervention for scabies
Apply a scabicide (5% permethrin cream) over the entire body to remain on the skin for 8 to 14 hr; repeat in 1 to 2 weeks.
Treat entire family and persons that have been in contact with infected person during and 60 days after infection.
Wash underwear, towels, clothing, and sleepwear in hot water.
Vacuum carpets and furniture.
Apply calamine lotion or cool compresses until itching subsides following treatment.
Difficult cases: May use oral ivermectin.
152
nursing interventions for pediculosis capitis
1% permethrin shampoo
Spinosad 0.9% topical suspension for children 4 years and older. Benzyl alcohol 5% in infants 6 months and older.
Remove nits with a nit comb, repeat in 7 days after shampoo treatment
Wash clothing, bedding in hot water with detergent. Place items unable to be laundered in a sealed plastic bag for 14 days.
Difficult cases: use malathion 0.5%
153
When does Reye's syndrome occur in children and adolescents?
This occurs when aspirin is used for fever reduction in children and adolescents who have a viral illness (chickenpox or influenza).
154
What is rheumatic fever?
Rheumatic fever usually occurs within 2 to 6 weeks following an untreated or partially treated upper respiratory infection (strep throat) with GABHS.
155
what are some expected findings of rheumatic fever?
hx of recent upper airway infection
fever
tachycardia, cardiomegaly, new or changed heart murmur, muffled heart sounds, pericardial friction rub, and report of chest pain
lark polyarthritic joints that come and go
pink, nonpuritic macular rash on trunk
CNS involvement (chorea) of face, and fine motor
irritability, poor concentration and behavioral problems
156
What is the Jones criteria used for and what are some major and minor criteria?
Major criteria
Carditis
Subcutaneous nodules
Polyarthritis
Rash (erythema marginatum)
Chorea
Minor criteria
Fever
Arthralgia
157
what are some nursing care of rheumatic fever?
bed rest during the acute illness.
antibiotic as prescribed.
good nutrition
Assess for chorea (nervousness, behavioral changes, decreased attention span).
158
what are meds for rheumatic fever?
Prophylactic treatment regimen, which can include one of the following.
Two daily oral doses of penicillin V
Monthly IM injection of penicillin G
Daily oral dose of sulfadiazine
159
s/s of Wilms tumor
Mass is usually found by caregivers during routine bathing or dressing of their child in kidneys or abdomen and metastasis is rare and occur before 5 y.o.
Painless, firm, nontender abdominal swelling or mass- do not palpate
Fatigue, malaise, weight loss
Fever
Hematuria
Hypertension- monitor for this
Manifestations of metastasis include dyspnea, cough, shortness of breath, and chest pain
160
What are some dx for wilms tumor?
Abdominal ultrasonography
Abdominal and chest computed tomography (CT) scan
Inferior venacavogram (rule out involvement with the vena cava)
Bone marrow aspiration (rule out metastasis)
161
What is the nursing care for paralyitic poliomyelitis? s/s and precautions?
pain/stiffness in back, neck and legs with signs of CNS paralysis, so ROM with analgesics
respiratory complications
contact precautions
162
How often should you reposition a pulse ox for an infant?
every 4-8 hrs b/c tissue necrosis
163
How much weight loss for mild dehydration in infants and children, and manifestations
3-5% -infants
3-4% children
behavior, mucous membranes, BP normal
pulse in anterior fontanel, possible slight thirst
cap refill greater than 2 sec
164
weight loss and Manifestations of moderate dehydration
6-9% infants
6-8% children
cap refill b/w 2-4 sec
possible thirst and irritability
dry mucous membranes, decreased tears and skin turgor
normal to sunken ant. fontanel
Think: moD. Dry mucous membranes, decreased tears
165
weight and manifestations of severe dehydration
10%+ in infants
10% in children
cap refill 4+ sec
very dry mucous membrane
tented skin
extreme thirst
no tear with sunken eyeballs and anterior fontanel
oliguria and anuria
Think of a dry desert with a waterless oasis shaped in an eye, with fissures in the packed sand and no rain.
166
In what cases would you give oral rehydration solution?
first for mild and moderate cases of dehydration
167
why is it bad to give rapid fluid replacement for hypertonic dehydration?
risk of cerebral edema, so administer maintenance IV fluids as prescribed
168
What are some teachings to maintain a pavlik harness?
don't adjust straps
use undershirt, wear knee socks, assess skin, massage gently under straps
avoid lotions, pawders
169
What kind of dietary restrictions are there for nephrotic syndrome?
protein (depends), sodium, and fat restrictions
170
What is a child with nephrotic syndrome at risk for and nursing consierations?
edema , infection and anuria, so assess and clean skin
171
What is aplastic anemia and what complications does it come with?
usually a virus causes temporary decreased RBC, platelets, and WBC- susceptible to infection
172
What two conditions are pediatric patients allowed to take aspirin?
rheumatic fever and kawasaki disease
173
What kind of agent should activate charcoal not be used with? why?
poisoning with corrosive agent because they could burn tissue and then the charcoal could infiltrate
174
When is varicella no longer contagious?
when the vesicles have crusted over, which is about 6 days after they appear
175
What are some prescriptions for hypertrophic scarring and itching?
Apply hydroxyzine or diphenhydramine if prescribed for itching.
176
How much should the output be for a burn patient if they weigh less than 30 kg? what about less?
0.5 to 1 mL/kg/hr if the child weighs less than 30 kg (66 lb).
30 mL/hr if the child weighs more than 30 kg (66 lb).
177
overarching phases of burn management (acute, management, and rehab
Maintain airway and ventilation (priority action)
Provide and monitor fluid replacement therapy
Monitor for manifestations of shock and notify the provider of findings.
manage pain
prevent infection
provide nutritional support
restore mobility
psychological support
178
What are the layers and severity of burns?
1st- degree: Superficial epidermis, but blanches with pressure and no blisters
2nd-degree: Superficial partial thickness damage to entire epidermis and moist, Deep partial thickness, damage to entire epidermis and some parts of dermis, mottled red to white
3rd degree: Full thickness, red, to tan, black-brown or waxy white
4th degree: Full thickness all layers to muscle fascia and bones with eschar or charring
179
What are some ways to reduce scarring and contractures with burns?
assist with active or passive ROM 3x's daily
neutral positions with limited flexion
ambulation asap
compression dressings for 2 yrs to increase mobility and decrease scarring
massage scare with lotion
180
What are types of biologic skin coverings
Allograft (homograft): donations from human cadavers for partial- and full-thickness burn wounds
Xenograft (heterograft): Skin from animals (pigs) for partial-thickness burn wounds
Amnion: human placenta; requires frequent changes
Artificial skin: Two layers of skin made from beef collagen and shark cartilage
181
s/s of graft sites
Discoloration of unburned skin surrounding burn wound
Green subcutaneous fat
Degeneration of granulation tissue
Development of subeschar hemorrhage
Hyperventilation indicating systemic involvement of infection
Unstable body temperature
182
what are some nursing actions to maintain graft sites?
Discoloration of unburned skin surrounding burn wound
Green subcutaneous fat
Degeneration of granulation tissue
Development of subeschar hemorrhage
Hyperventilation indicating systemic involvement of infection
Unstable body temperature
183
how to use PFT's and for what?
most accurate tests for diagnosing asthma and its severity.
Forced vital capacity (FVC) is the volume of air exhaled from full inhalation to full exhalation.
Forced expiratory volume in the first second (FEV1) is the volume of air blown out as hard and fast as possible during the first second of the most forceful exhalation after the greatest full inhalation.
Peak expiratory flow is the fastest airflow rate reached during exhalation.
A decrease in FEV1 by 15% to 20% below the expected value is common in clients who have asthma. An increase in these values by 12% following the administration of bronchodilators is diagnostic for asthma.
184
Which biohazard has a vaccine? or can be prevented with meds?
Anthrax- administer for high risk or give ciprofloxacin or Doxycycline IV/PO
Yellow fever and argentine hemorrhagic fever
smallpox: can vaccinate within 4 days of exposure
185
What are some common s/s of anthrax? Cutaneous?
Fever
Cough/SOB
Muscle aches
Mild chest pain
Meningitis
Shock
Sweats (often drenching)
Starts as a lesion that can be itchy
Develops into a vesicular lesion. later necrotic with the formation of black eschar
Fever, chills
186
anthrax treatment?
includes one or two additional antibiotics (vancomycin, penicillin, and anthrax antitoxin)
187
manifestations of botulism?
Tongue- Difficulty swallowing, Slurred speech, Sensation of a thickened tongue (difficulty controlling tongue)
Double vision
Descending progressive weakness
Nausea, vomiting, abdominal cramps
Difficulty breathing
188
Prevention/treatment of botulism
Airway management
Antitoxin
Elimination of toxin
189
What are some manifestations of the plague
Yersinia pestis bacterium is the causative agent
Pneumonic plague: fever, headache, weakness, pneumonia with shortness of breath, chest pain, cough, and bloody or watery sputum.
Bubonic plague: swollen, tender lymph glands, fever, headache, chills, and weakness.
Septicemic plague: fever, chills, prostration, abdominal pain, shock, disseminated intravascular coagulation (DIC), gangrene of nose and digits.
190
how to prevent and treat the plague?
Contact precautions until decontaminated or buboes no longer drain (bubonic, septicemic); droplet precautions until 72 hr after antibiotics (pneumonic)
Treatment: Streptomycin/gentamicin or tetracycline/doxycycline.
191
How to educate for testicular cancer
Perform monthly testicular self-examination is best performed during or after a bath or shower when the scrotum is relaxed.
Move the penis to the side, and examine one testicle at a time.
Hold the testicle between the thumb and fingers of both hands and roll it gently between the fingers.
Look and feel for any hard lumps; smooth rounded bumps; or change in size, shape, or consistency of the testicle.
It is expected for one testicle to be larger or hang lower than the other.
Palpation of the epididymis can feel like a lump.
192
What are some triggers of sickle cell pain?
decreased oxygen and fluid
blood loss
illness
high altitude
stress
extreme temp
193
what are some lab tests for sickle cell anemia?
CBC- hgb- decreased, WBV and bilirubin and reticulocyte elevated, peripheral blood smear- sickled cells
Sickle-turbidity
hemoglobin electrophoresis
transcranial doppler for CVA risk detection
194
What are nursing interventions for sickle cell anemia?
IVF to dilute blood
blood products
pain control
bed rest and monitor resp status
prophylactic penicillin
vaccines for children
195
pain management for sickle cell crisis?
mild-mod: acetaminiphen/ibuprofen
warm packs to painful joints
opioids
hydroxyurea for antineoplastics (monitor for anorexia and low WBC), usually for cancer
elevate hands and feet
196
client education for sickle cell disease?
vaccines
no high altitude
good hand hygiene, fluid intake
genetic counseling
don't over exercise
197
vaso-occlusive crisis acute vs chornic
acute- severe pain and abdominal pain, hematuria, obstructive jaundice, visual disturbances
swollen joints- dactylitis
chronic- respiratory infection and osteomyelitis, retinal detachment, systolic murmur, renal failure and enuresis, liver cirrhosis, hepatomegaly
seizures
skeletal deformities, jaundice can lead to gallstones
leg ulcers because decreased blood flow
198
PAD s/s of
pain
ulcerations
temperature
edema
pulse
color
sharp stabbing worsens with activity and walking
lowering feet to dependent position may relieve pain
very painful gray base ulcers found on heel, toes, and dorsum of feet with clean edges
no edema
diminished or absent pulse
rubor on dangling, cool and hairless usually
199
PVD s/s of
pain
ulcerations
temperature
edema
pulse
color
dull aching and cramping when sitting or standing
elevating feet can relieve pain
moderately painful pink base on medial aspect of ankle with jagged edges
warm and thick
edematous esp at end of the day
usually present
mottled and pigmented with veins and spots
200
client education for venous insufficiency
avoid crossing legs, constrictive clothing or stockings
wear elastic compression stockings after legs are elevated and legs are skinnier from less swelling
keep stockings on the whole day
good diet
201
client education for vein stripping
must wear elastic stockings after bandage removal
elevate legs when sitting and avoid danling
engage in ROM of of legs
202
client education for ulcer formation
wound vac
occlusive hydrocolloid dressing for 3-7 days
o2 therapy
high zinc, protein, iron, and vit A and C
203
client education for positioning for PAD?
don't cross legs
no compressive or restrictive garments
don't elevate legs above the heart because it can slow arterial blood flow to the feet
204
nursing care and ed for PAD
exercise gradually and increase slowly. go just beyond the point of pain
keep warm environment and insulated socks
never apply direct heat
avoid cold exposure, stress, caffeine, and smoking
205
What does CKD do to:
sodium and water balance
potassium balance
elimination of nitrogenous waste
magnesium
erythropoietin
acid-base balance
activation of vit D
phosphate elimination
sodium and water balance: hypertension and edema because retention
potassium balance: increased in blood because unable to excrete
elimination of nitrogenous waste- increased in the blood because kidneys can't filter out
magnesium- elevated
erythropoietin- decreased, so low RBC and anemia
acid-base balance- acidosis because lac ko
activation of vit D is decreased to reabsorb Ca+ but calcium is not being absorbed
phosphate elimination- increased serum levels in blood because unable to absorb.
206
Diet for CKD
moderate to low amount of protein
phosphate and potassium restriction
sodium restriction
water restriction because edema and lowered GFR
207
what type of foods are high in phosphate and who should avoid?
CKD patients
poultry, fish, dairy, soda oatmeal
208
What is the difference between neutrophils, eosinophils, and basophils?
all types of granulocytes
Neutrophils: most abundant- engulf and destroy bacteria and other pathogens.
Eosinophils: Involved in allergic reactions and fighting parasitic infections.
Basophils: Release histamine and other chemicals that contribute to inflammation and allergic responses.
209
what level is considered neutropenia and when to enact precautions?
less than 2K, and if less than 1K, then do precautions
210
What is left shift?
An increase in the number of immature white blood cells (neutrophils) , called band cells, in the blood. It's a sign of infection or inflammation.
211
What are normal levels of ESR? CRP?
ESR: 20
CRP: 3
212
What do low levels of CBC mean?
Neutrophils: acute bacterial infection rheumatoid arthritis (NBA)
lymphocytes: viral infection (MMR), leymphocytic leukemia, Multiple myeloma
monocytes: tuberculosis (Mt.)
eosinophils: allergic excema, reactions and parasitic infections (EPA)
basophils: allergic, hypersensitivity and leukemia
213
difference between active-natural and active-artificial immunity
active-natural- normal antibodies that respond to live pathogen that enters naturally
active- artificial- body's response to a vaccine
214
difference between passive-natural and passive-artificial immunity
passive-natural- antibodies are passed through mother to fetus or newborn
passive- artificial- body's response to administrations of immune globulin after exposure, but after some time, individual is not protected
215
When should pregnant women get Td?
Tdap should be given between 27-36 weeks to protect the fetus from pertussis
216
contraindications to MMR?
people born before 1957 b/c already considered immune
pregnant
anaphylactic rxn to gelatin or neomycin
217
pneumococcal vaccine series administration?
for those 65+ and older than 2
for those without immunizations ever, give PCV13 and then PPSV23 6-12 mos later
Just one dose of PPSC23 is ok
218
HepA vaccine series
2-3 doses for high risk at least one month apart
219
who should receive zoster vaccine?
two doses 50+ or immunocompromised 19y.o.+
220
what are some things to document after vaccine administration?
date
route
site
type
manufacturer
lot number
expiration date
221
What is the difference between cancer staging and grading?
grading is to see if the cancer cells are malignant (type) and staging is to see the extent of cancer spread
222
What are three ways a tumor can be staged?
Tumor (T)
TX: Unable to evaluate the primary tumor
TØ: No evidence of primary tumor
Tis: Tumor in situ
T1, T2, T3, and T4: Size and extent of tumor
Node (N)
NX: Unable to evaluate regional lymph nodes
NØ: No evidence of regional node involvement
N1, N2, and N3: Number of nodes that are involved and/or extent of spread
Metastasis (M)
MX: Unable to evaluate distant metastasis
MØ: No evidence of distant metastasis
M1: Presence of distant metastasis
223
What are the tumor grades?
GX: Grade cannot be determined.
G1: Tumor cells are well differentiated. (good)
G2: Tumor cells are moderately differentiated.
G3: Tumor cells are poorly differentiated, but the tissue of origin can be established.
Tumor cells are poorly differentiated, and determination of the tissue of origin is difficult.
224
What are parneoplastic syndromes? how ware they managed?
complication of cancer. T cells in the body attack normal cells rather than cancerous ones. They result in changes in neurologic function (movement, sensation, mental function).
Management includes minimizing the immune system response by administration of steroids, immune factors, plasmapheresis, or irradiation
also use vision and hearing aids
225
how does cancer cause superior vena cava syndrome? nursing actions
bstruction (metastases from breast or lung cancers) of venous return and engorgement of the vessels from the head and upper body
Manifestations: Periorbital and facial edema, erythema of the upper body, dyspnea, and epistaxis
position semi-Fowlers and high-does radiation for emergency temp relief
226
What is tumor lysis syndrome and nursing manifestations? Nursing interventions
TLS occurs when tumors are rapidly destroyed, releasing intracellular content into the bloodstream faster than the body can process them. This rapid release causes hyperkalemia, hyperphosphatemia, and hyperuricemia. Without correction, TLS leads to kidney injury and changes in cardiac function that can lead to death.
Older age increases risk and certain chemotherapy agents and types of cancer.
Gastrointestinal distress, flank pain muscle cramps and weakness, seizures, and mental status changes
Administer IV fluids and encourage fluid intake of 3 L daily, including consumption of alkaline fluids to lower uric acid levels.
Administer medications (diuretics, allopurinol, sodium polystyrene) to reduce potassium, uric acid, and phosphorus levels.
227
when to do breast cancer screening?
40-44 years of age: Start screening mammograms yearly if desired
45-54 years of age should receive annual mammograms
>55 years of age: mammograms every other year or yearly if desired. Continue screenings for a long as client’s condition is good and if client has 10+ years to live
228
when to do colorectal cancer screening?
45 years of age (start) up to 75 years of age should receive stool screening/visual examination (if client has 10+ years to live)
76-85 years of age: decision for screening is dependent upon the client’s personal preference, life expectancy, general condition, and previous screening history
> 85 years of age: screening no longer required
229
how often should colorectal stool and colonoscopy be done?
Stool:
Fecal immunochemical (FIT) or guaiac based fecal occult blood (gFOBT) annually
stool DNA (every 3 years)
Visual:
Colonoscopy every 10 years
CT colonoscopy (virtual) every 5 years
Flexible sigmoidoscopy every 5 years
230
when to start colorectal cancer screening?
40 years of age for those who are at highest risk
45 years of age for those who are at higher risk
50 years of age for those who are at average risk
Prostate specific antigen (PSA) digital rectal examination (DRE) (if desired)
Retesting every 2 years if PSA less than 2.5 ng/mL,
PSA > than 2.5 ng/mL (provider should discuss the pros and cons of testing and consider the client’s health, preference and beliefs).
231
when to start and do cervical cancer screening?
25 years of age (initiation) up to 65 years of age
Papanicolaou (Pap) test with co-test for HPV every 5 years
Papanicolaou (Pap) test without co-test for HPV every 3 years
232
When to start and do lung cancer screening
Client who are a current smoker, fair condition of health, 20 pack per year smoking history or quit within past 15 years:
50-80 years of age yearly low-dose helical CT (LCDT)
receive counseling to quit if currently smoke and talked about benefits, limits, and harms of screening, can go to center that has experience in lung cancer screening and treatment
233
What are some ways that a patient might exhibit cancer?
Change in bowel or bladder habits, change in shape or texture of a body or skin region
Difficulty eating, chewing, swallowing, or decreased appetite
Non-healing sores or wounds, or a cough or hoarseness that does not go away
Unexplained pain, night sweats, fatigue, weight loss, or weight gain
Unusual bleeding
234
how do positrons act with cancer?
they measure positrons that are uptaken faster with cancer and can be seen with PET scans like mammography
235
what is external bean radiation therapy and why is it better than internal brachytherapy?
delivers radiation in small doses to targeted area and is not hazardous to others. proton therapy involves use of charged protons to transfer energy
don't eat read meat because dysgeusia
monitor for radiation injury to skin and pat dry
stay away from heat sources
236
How should Lugol solution be used before thyroidectomy?
Thyroid medications should be taken with juice 5-7 drops 3 times/day about 10 days before surgery
237
criteria for acute care treatment of psychobiologic disorders
Weight loss of 20% of ideal body weight or less than 10% body fat
Unsuccessful weight gain in outpatient treatment, failure to adhere to treatment contract
Vital signs demonstrating heart rate less than 50/min, systolic blood pressure less than 90 mm Hg, body temperature less than 36˚ C (96.8˚ F)
ECG changes
Electrolyte disturbances
Psychiatric criteria: severe depression, suicidal behavior, family crisis, or psychosis
238
What are three tests designed to screen for eating disorders
Eating Disorder Inventory- measure and range of severity of eating disorder features
Eating Disorder Examination-
Eating Attitudes Test- 40Q to serve as global index for anorexia symptoms
239
protective factors for suicide
Feelings of responsibility toward partner and children
Current pregnancy
Religious and cultural beliefs
Overall satisfaction with life
Presence of adequate social support
Effective coping and problem-solving skills
Access to adequate medical care
240
environmental factors that increase risk of suicide
Access to lethal methods, such as firearms
Lack of access to adequate mental health care
Unemployment
241
psychosocial and biological factors that increase risk fo suicide
Biological factors
Family history of suicide
Physical disorders (AIDS, cancer, cardiovascular disease, stroke, chronic kidney disease, cirrhosis, dementia, epilepsy, head injury, Huntington’s disease, and multiple sclerosis).
Psychosocial factors
Sense of hopelessness
Intense emotions (rage, anger, or guilt)
Poor interpersonal relationships at home, school, and work
Developmental stressors, such as those experienced by adolescents
History of trauma/abuse
242
What are two screening tools for delirium?
Confusion Assessment Method (CAM): For delirium
Neelon-Champagne (NEECHAM) Confusion Scale: For delirium
243
The plan of care for clients who have personality disorders vary according to the cluster they are in.
Cluster A: Emphasize client skill and resource development in finding and maintaining interpersonal relationships.
Cluster B: Develop skills to limit dramatic and inappropriate behaviors.
Cluster C: Provide education and therapies to learn how to best manage feelings of anxiety.
244
which personality disorders can benefit from assertiveness training?
Clients who have dependent and histrionic personality disorders often benefit from assertiveness training and modeling as well as psychotherapy.
245
What are some therapies for wet macular degeneration?
laser therapy to seal leaking blood vessels
injections of bevacizumab or ranibizumab
246
What are differences between associated cataracts and complicated?
"Associated" cataracts, like age-related cataracts, are primarily due to another disease such as DM, hyperparathyroidism, Downs, and chronic sunlight exposure while "complicated" cataracts arise from underlying eye diseases or conditions, potentially leading to more rapid progression and complex treatment needs.
247
Health promotion and prevention for cataracts?
wear sunglassess when outside, and annual eye exams over 40 and good eye health
248
What are some s/s of cataracts?
decreased visual acuity and color perception, and night vision
diplopia
progressive and painless vision loss
visible opacity
absent red reflex
249
What is the urine output for oliguria?
100-400 mL/24
250
What are some medication for AKI?
Administer diuretics (furosemide, mannitol, ethacrynic acid) to promote increased filtration of blood by kidney.
251
What is the urine output for anuria?
less than 100 mL/day
252
nutrition for AKI
Implement potassium, phosphate, sodium, and magnesium restrictions, if prescribed (depending on the stage of injury).
Restrict fluid intake, if prescribed.
Possible total parenteral nutrition (TPN). Protein requirements are individualized based on several factors including client’s nutritional status, catabolic response, and cause of injury.
253
why should patiens with ckd have protein restrictions
although CKD usually has protein in the urine, it can also prevent the kidneys from functioning properly, and excess protein can overload them
254
What are some medictions to deal with electrolyte imbalances in AKI?
Calcium channel blocker to prevent the movement of calcium into the kidney cells and to maintain cell integrity and increase the glomerular filtration rate (GFR).
Sodium polystyrene sulfonate replaces sodium with potassium in the intestinal tract to promote potassium excretion.
Sorbitol induces a bowel movement to promote excretion of excess potassium.
In an emergency, IV medications (dextrose, insulin and calcium) can be required to reduce potassium.
Administer sodium bicarbonate if the client has severe metabolic acidosis.
For hyperphosphatemia, administer phosphate-binding agents.
255
When should you do a fluid challenge in AKI and why?
Administer IV fluid therapy as a fluid challenge to promote kidney perfusion, or as fluid replacement if the client is in the diuretic phase to determine if the AKI is due to hypovolemia (prerenal) or other causes
256
expected findings of CKD
Nausea, fatigue, lethargy, involuntary movement of legs, depression, intractable hiccups
In most cases, findings fluid volume overload
Neurologic: lethargy, decreased attention span, slurred speech, tremors or jerky movements, ataxia, seizures, coma
Cardiovascular: fluid overload, hyperlipidemia, hypertension, dysrhythmias, heart failure, orthostatic hypotension, peaked T wave on ECG (hyperkalemia)
Respiratory: uremic halitosis with deep sighing, yawning, shortness of breath, tachypnea, hyperpnea, Kussmaul respirations, crackles, pleural friction rub, frothy pink sputum
Hematologic: anemia (pallor, weakness, dizziness), ecchymoses, petechiae, melena
Gastrointestinal: ulcers in mouth and throat, foul breath, blood in stools, vomiting
Musculoskeletal: osteodystrophy (thin fragile bones)
Renal: urine contains protein, blood, particles; change in the amount, color, concentration
Skin: decreased skin turgor, yellow cast to skin, dry, pruritus, urea crystal on skin (uremic frost)
Reproductive: erectile dysfunction
257
what would be in the urinalysis report of CKD?
Urinalysis: Hematuria, proteinuria, and decrease in specific gravity
258
nutrition and hydration requirements of CKD
Control protein intake based on the client’s stage of chronic kidney disease and type of dialysis prescribed.
Restrict dietary sodium, potassium, phosphorous, and magnesium.
Provide a diet that is high in carbohydrates and moderate in fat.
Restrict intake of fluids (based on urinary output).
259
What are some medications to avoid with CKD?
! Avoid administering
antimicrobial medications (aminoglycosides and amphotericin B),
NSAIDs,
ACE-I, and ARB except in early stages
IV contrast dye- nephrotoxic
antacids with magnesium
260
meds for CKD
Digoxin: a cardiac glycoside that increases contractility of the myocardium and promotes cardiac output; monitor potassium and give dig after dialysis
Sodium polystyrene: increases elimination of potassium
Epoetin alfa: stimulates production of red blood cells; given for anemia
Ferrous sulfate: an iron supplement to prevent severe iron deficiency
Calcium carbonate
Furosemide or bumetanide: loop-diuretics administered to excrete excess fluids (avoid in ESKD)
261
Teachings for calcium carbonate
Taken with meals to bind phosphate in food and stop phosphate absorption.
Take 2 hr before or after other medications.
Can cause constipation, so clients can require a stool softener.
262
What is the protein intake for those on hemodialysis and AKI? What about those with CKD and not on dialysis?
What about CKD and dialysis?
1-1.4 g/kg /day
0.6-1 g/kg/day
1.3 g/kg/day
263
nutrition for nephrotic syndrome?
restrict fluid and sodium
protein 1 g/kg/day
264
urotlithaiasis nutrition
calcium oxalates
uric acid stones
increase water and decrease animal proteins and sodium
decrease oxalates- rhubarb, beets, spinach, peanuts, sweet potatos chocolate
purines avoid, organ meats, shellfish, and red meats
265
What are some early signs and then additional signs of disequilibrium syndrome?
Disequilibrium syndrome results from too rapid a decrease of BUN and circulating fluid volume. It can result in cerebral edema and increased intracranial pressure.
early: nausea and headache.
Manifestations include nausea, vomiting, changes in level of consciousness, seizures, and agitation.
266
nursing actions for hypotension during dialysis?
Carefully replace fluid volume by infusing IV fluids or colloid. Slow the dialysis exchange rate.
Lower the head of the client’s bed.
For severe hypotension that does not respond to fluid replacement, discontinue the dialysis.
267
When would you milk a dialysis tube
Carefully milk the peritoneal dialysis catheter if a fibrin clot has formed.
268
Who are candidates for peritoneal dialysis?
Are unable to tolerate anticoagulation.
Have difficulty with vascular access.
Have chronic infections or are unstable.
Have chronic diseases (diabetes mellitus, heart failure, severe hypertension).
269
what electrolytes can arise from peritoneal dialysis?
Hyperglycemia and hyperlipidemia
Hyperglycemia can result from glucose in the dialysate.
The blood can absorb glucose from the dialysate.
Hyperlipidemia can also occur from long-term therapy and lead to hypertension.
270
What is the expected findings for acute glomerulonephritis via pathophysiology?
inflammation of the glomeruli causes coagulation in the glomeruli to increase GFR and cause oliguria and mild to severe hypertension
inflammation of the glomerulus also causes hematuria and cloudy teac-colored urine
mild protein excretion causes periorbital edema and facial edema that is worse in the morning
271
lab tests for glomerulonephritis?
Throat culture: to identify possible streptococcus infection (usually negative by the time of diagnosis)
Urinalysis: proteinuria, smoky or tea-colored urine, hematuria, increased specific gravity
Kidney function: elevated BUN and creatinine. Decreased glomerular filtration rates
Blood studies: decreased blood protein(hypoalbuminemia), decreased Hgb, Hct (anemia), elevated erythrocyte sedimentation rate (inflammation)
Antistreptolysin O (ASO) titer: positive indicator for the presence of streptococcal antibodies; other serologic testing to determine presence of previous streptococcal infection
Blood complement (C3): decreased initially; increases as recovery takes place; returns to normal at 8 to 10 weeks post glomerulonephriti
272
What is the expected findings for nephrotic syndrome via pathophysiology?
idiopathic cuse creates massive amounts of proteins (especially albumin) to pass into the urine resulting in decreased blood osmotic pressure and edema in the lower extremities and facial and periorbital edema
proteinuria causes frothy dark urine
hypoalbuminemia causes hyperlipidemia because the liver is trying to make up for lost abumin
hypertension is rare
273
nutrition of glomerulonephritis
Possible restriction of sodium and fluid.
Restrict foods high in potassium during periods of oliguria.
Restrict protein for severe azotemia.
274
nephrotic syndrome blood chemistry
Hypoalbuminemia: reduced blood protein and albumin
Hyperlipidemia: elevated blood lipid levels
Hemoconcentration: elevated Hgb, Hct, and platelets
Possible hyponatremia: reduced sodium level
Glomerular filtration rate: normal or high
Total calcium: decreased
Erythrocyte sedimentation rate (ESR): increased
275
meds for nephrotic syndrome
Corticosteroid: prednisone
Diuretic: furosemide
Plasma expanders: 25% albumin: Increases plasma volume and decreases edema in severe cases
Immunosuppressant: cyclophosphamide: Administer for children who cannot tolerate prednisone or who have repeated relapses of nephrotic syndrome, or to induce remission
276
What are some cleft lip post op care?
Back
Upright
Clean with hydrogen peroxide or water
comfort
aspirate/antibiotic ointment
elbow restraints
277
What are some cleft palate post op care?
side-lying
soft after liquid diet (NPO for first 4 hrs, liquids only for first 3-4 days and then progress to soft)
soft utensils
278
GER in children nursing care
small frequent meals
thicken formula with 1 tsp to 1 tbsp rice cereal per 1 oz formula
avoid foods that cause reflux
elevate head after meals
place supine to sleep
279
What are expected findings in infants with GERD?
spitting up or forceful vomiting, irritability, excessive crying
blood in vomitus
respiratory problems
280
What are some complications of GER/GERD in children?
recurrent pneumonia, weight loss, and FTT
281
hypertrophic pyloric stenosis findings
projectile vomiting after feeding especially after worsening obstruction
can be blood-tinged
constant hunger
olive-shaped mass in RUQ and possible peristaltic wave
FTT- pallor, cool lips, dry skin, decreased skin turgor rapid pulse, etc.
282
What are some preop actions for pyloromyotomy? What about some postop actions?
NG tube, NPO, daily weights
provide IV fluids, analgesics, weight, start clear liquids 4-6 hrs and then advance to breast milk or formula 24+hrs
283
What are the expected findings of newborns, infants, and children with Hirschsprung's?
Newborn- No meconium within 24 to 48 hr after birth
Episodes of vomiting bile
Refusal to eat
Abdominal distension
Infant- Vomiting
Failure to thrive
Constipation
Child- Foul-smelling, ribbonlike stool
Undernourished, anemic appearance
Abdominal distention
Visible peristalsis
Palpable fecal mass
Constipation
284
Therapeutic procedures for Hirschprung's Disease?
Surgical removal of the aganglionic section of the bowel.
Temporary colostomy can be required.
285
complications of Hirschprung's Disease
Enterocolitis: try to resolve inflammation, preventing bowel perforation, maintaining hydration, initiating antibiotic therapy, and performing surgery for colostomy or ileostomy if there is extensive bowel involvement.
measure abdominal girth, and monitor for electrolyte imbalance, peritonitis, and blood product replacement
Anal stricture and incontinence- Bowel-retraining therapy
Can require further procedures (dilatation)
286
What is intussusception and when do they occur?
Proximal segment of the bowel telescopes into a distal segment, resulting in lymphatic and venous obstruction and edema in the area. With progression, ischemia and increased mucus into the intestine will occur.
Common in infants and children ages 3 months to 6 years.
287
expected findings of intussusception
SUDDEN episodic abdominal pain
SCREAMING with drawing knees to chest with episodes of pain
Abdominal mass (SAUSAGE-shaped)
Stools mixed with blood and mucus that resemble the consistency of RED CURRANT JELLY
Vomiting
Fever
Tender, distended abdomen
288
Nursing care and therapeutic procedures for inussesception
Stabilize the child prior to the procedure.
IV fluids to correct and prevent dehydration
Nasogastric (NG) tube for decompression
Air enema- With or without contrast
Performed by a radiologist
Hydrostatic enema- Ultrasound-guided
No radiation required
289
What is the diseases where there is a complication resulting from failure of the omphalomesenteric duct to fuse during embryonic development.
Meckel’s diverticulum
290
expected findings of Meckel’s diverticulum and the most effective dx test
Rectal bleeding, usually painless
Abdominal pain
Bloody, mucus stools
Radionuclide scan: Meckel’s scan is the most effective diagnostic test
291
What is one of the main causes of AKI in early childhood?
HUS
292
pathos of HUS
The endothelial lining within the arterioles of the glomeruli becomes inflamed and causes the red blood cells clog the kidneys. This leads to the intravascular coagulation.
Toxins enter the bloodstream and destroy red blood cells.
Diarrhea-positive (D+) HUS is 90% of cases; caused by ingestion of SHIGA toxin producing Escherichia coli. Associated with consuming undercooked meat (beef), exposure to SHIGAwater (swimming pools), and drinking unpasteurized apple juice.
Diarrhea-negative (D-) or atypical HUS: various causes; nonenteric infections, disturbances in the complement system, malignancies, or genetic disorders
293
expected findings of HUS
Occurs after prodromal period of diarrhea and vomiting
Occasionally occurs after varicella, measles, or a UTI
Loss of appetite
Irritable/Lethargic/Stupor
Hallucinations
Edema
Pale skin color
Bruising, purpura, petechiae, or rectal bleeding
Anuric and hypertensive in severe form
Reduced urinary output or increased with mild cases
Fever
294
medication for HUS
Monoclonal antibodies (eculizumab) minimize the recurrence of D-HUS.
295
client ed for HUS
Teach the family to avoid undercooked meat, especially ground beef. Internal temperature of meat should be at least 74° C (165° F).
Avoid unpasteurized apple juice and unwashed raw vegetables.
Avoid alfalfa sprouts.
Avoid public pools.
NO ANTIMOTILITY medications for diarrhea.
10% mortality die
296
Classic triad for HUS?
Hemolytic anemia
AKI
Thrombocytopenia
297
HUS labs
CBC: Decreased hemoglobin and hematocrit
Urine: Positive for blood, protein, and casts
Elevated BUN and blood creatinine
Fibrin split products in blood and urine (thrombocytopenia)
298
What are some priority nursing actions after cataract removal?
Preventing increase in intraocular pressure
preventing infection
Administering medications
Providing pain relief
Teaching about self-care and fall prevention
299
client education for cataract removal
sunglasses outside or in brightly lit areas
Report manifestations of infection such as yellow and green drainage
Avoid things that increase IOP such as bending over at the waist, sneezing, blowing your nose cough, straining, head hyperflexion
Limit activities such as tilting the head back to wash hair
Cooking and housekeeping, rapid jerky movements such as vacuuming, sports, driving
best vision is not expected until four to six weeks following
300
what should the patient report after surgical removal of cataract
Pain with nausea and vomiting indicating increased IOP or hemorrhage
changes such as lip swelling, decrease vision, flashes or floaters
301
what are the differences between primary open angle glaucoma and primary angle closure glaucoma
In primary open angle, the humor outflow is decreased due to blockages in the eyes drainage system causing a gradual increase in IOP
in primary angle closure, the angle between the iris and sclera suddenly closes requiring immediate treatment
302
what is the expected range for IOP or intraocular pressure
10 to 21 mm/hg
303
what are some expected findings of primary open angle glaucoma including intraocular pressure?
Headache
Mild eye pain
Loss of peripheral vision
Decreased accommodation
Halos seen around the eyes
21mm Hg+, usually around 22-32
304
what are some expected findings of primary angle closure glaucoma
decreased or blurred vision
Colored halo scene around lights
pupils non reactive to light
Severe pain and nausea
Photophobia
Rapid onset of elevated IOP of 30 or higher
305
what does tonometry and gonioscopy do?
Tonometry measures IOP with glaucoma
gonioscopy is used to measure the drainage angle of the anterior Chamber of the eyes
306
what are some medication tips for treating glaucoma
use every 12 hours
Instill one drop in each eye twice daily
Wait 5 to 10 minutes between eye drops if more than one is prescribed
307
Medications for glaucoma
miotic medications - cholinergic agents, carbachol, echthiophate, pilocarpine- constricts pupils to allow for improved circulation
adrenergic agonists - apraclonidine, brimonidine tartrate, dipivefrin hydrochloride- limits production of aqueous humor and dilates pupils
beta blockers – timolol first line for glaucoma and it decreases IOP by reducing aqueous humor production
carbonic anhydrase inhibitors- acetazolamide, dorzolamide: reduces aqueous humor production
prostaglandin analogs-binatoprost and latanoprost: increases the outflow of uveosclera by dilating blood vessels and trabecular mesh
systemic osmotics- IV mannitol, oral glycerin: emergency treatment for primary angle closure glaucoma
308
What should the PR interval be less than?
0.12-20 sec
309
What should the GRS interval be less than?
0.12 sec
310
What is the difference om QRS in premature atrial contraction and PVC?
PAC has a skinny QRS
PVC has a wide QRS
311
Where should the transducer be level with? and zeroed to what pressure?
Place the client in supine position prior to recording hemodynamic values. Head of bed can be elevated 15° to 30°.
Level transducer with phlebostatic axis (4th intercostal space, midaxillary line), which corresponds with the right atrium.
Zeroed to atmospheric pressure
312
Where would you measure preload?
Afterload?
Right heart: CVP
Left heart: PAWP
Afterload:
Right heart: pulmonary vascular resistance
Left heart: systemic vascular resistance
313
What causes elevated preload? decreased preload?
Crackles in lungs
Jugular vein distention
Hepatomegaly
Peripheral edema
Taut skin turgor
decreased:
Poor skin turgor
Dry mucous membranes
314
What causes elevated afterload? decreased afterload?
Cool extremities
Weak peripheral pulses
Decreased:
Warm extremities
Bounding peripheral pulses
315
When do you level the transducer?
Level the transducer at the phlebostatic axis before readings and with all position changes.
316
How do squamous, basal and malignant melanoma look like?
Squamous- rough, scaly lesion with central ulceration and crusting with possible bleeding
basal- open lesions with superficial blood vessels, waxy and pearl like with well-defined borders
malignant melanoma- irregular and multicolored with itching, cracks, ulceration and bleeding. (on upper back and lower legs
317
What are the different types of leukemia?
Acute lymphocytic leukemia (ALL)- typically found in kids under age 15; most common type of childhood leukemia; 5-year survival rate is approximately 91%
Acute myeloid leukemia (AML)- usually in adults 55+ but can affect kids. survival rate is 26%
Chronic lymphocytic leukemia (CLL)- about a third of leukemia cases 50+, but common adult leukemia
Chronic myeloid leukemia (CML)- Slow-growing cancer that usually affects adults; risk of CML increases with age.
Chronic myelomonocytic leukemia (CMML)- Usually 60+ and rarely found in people under 40.
318
expected findings of acute leukemia
Bone pain
Joint swelling
Enlarged liver and spleen
Weight loss
Fever
Poor wound healing (infected lesions)
Anemia manifestations (fatigue, pallor, tachycardia, dyspnea on exertion)
Bleeding (ecchymoses, hematuria, bleeding gums)
Headaches, behavior changes, decreased attention
319
expected findings of hodgkins and non-Hodgkin's
Lymphadenopathy: painless, enlarged lymph node (usually in the neck with HL), which is a typical finding.
Other possible manifestations include fever, night sweats, unplanned weight loss, fatigue, and infections.
Client may report abdominal fullness and prolonged swelling of lymph nodes.
320
with pancytopenia, which temp for fever would you look out for?
Monitor for infection (WBC, cough, alterations in breath sounds, urine, or feces). Report temperature greater than 37.8° C (100° F).
321
nursing actions for Thoracoscopy, bronchoscopy, mediastinoscopy
Keep client NPO 4 to 8 hrs prior to test.
Provide throat lozenges or sprays for report of a sore throat once the gag reflex returns following procedure.
Monitor for bleeding and check breath sounds.
Chest x-ray following procedure might be required if a pneumothorax is suspected
322
cancer marker for uterine cancer
Alpha-fetoprotein (AFP): elevated
Cancer antigen-125 (CA-125): positive
323
tumor marker for pancreatic cancer
CA 19-9
324
tumor marker for ovarian cancer
Epithelial tumor: Cancer antigen-125 (CA-125) elevated (greater than 35 units/mL)
325
What is PUVA therapy used for, how often, and administration considerations
A psoralen photosensitizing medication (methoxsalen) is administered followed by long-wave ultraviolet A (UVA) to decrease proliferation of epidermal cells like psoriasis
Methoxsalen is given orally 1 hr before UV treatments.
Treatments are given two to three times per week, avoiding consecutive days.
326
nursing actions and client ed for PUVA therapy
client wears eye protection during treatment and for 24 hr following a treatment (indoors and outside).
sunscreen
Notify the provider of extreme redness, swelling, or discomfort.
Long-term effects include premature skin aging, cataracts, and skin cancer.
Obtain regular eye examinations.
327
pt ed on how to use corticosteroids for psoriasis
Observe skin for thinning, striae, or hypopigmentation with high-potency corticosteroids.
administer fo only 4 weeks, and take med break
occlusive dressing or gloves after topical up to 8 hrs/day
avoid high potency on face and skin folds- scalp ok
328
client ed for vit D analogs for psoriasis?
Limit sun exposure due to increased risk of developing skin cancer and monitor for them.
Adhere to proper application. Do not put on face.
329
client ed for vit A for psoriasis?
(tazarotene) slows cellular division and reduces inflammation and causes sloughing of skin cells.
contraindicated during pregnancy
avoid sun or artificial UV
330
diet for cholecystitis
limited fat intake to reduce stimulation of gallbladder
331
diet for pancreatitis
a low-fat, high-protein, and high-carbohydrate diet.
supplements of vitamin C and B-complex vitamins.
332
liver disease diet
Protein needs are increased to promote a positive nitrogen balance and prevent a breakdown of the body’s protein stores.
Carbohydrates are generally not restricted, as they are an important source of calories.
Multivitamins (especially vitamins B, C, and K) and mineral supplements
Alcohol, nicotine, and caffeine should be eliminated.
333
physicial assessment findings of angina or MI
Pallor, and cool, clammy skin
Tachycardia and heart palpitations
Tachypnea and shortness of breath
Diaphoresis
Vomiting
Decreased level of consciousness
334
what are some signs not associated with MI?
Not associated with nausea, epigastric distress, dyspnea, anxiety, diaphoresis
335
how heavy are the weight of a halo or other skeletal traction?
weights 15-30 lbs
336
What are some things to do as a client needing neutropenic precautions?
Discard liquid beverages that have been sitting at room temperature for longer than 1 hr.
Wash toothbrush daily in the dishwasher or rinse in a bleach solution.
bathe/shower with antimicrobial soap.
337
some physical assessment findings of pulmonary embolism
Pleural friction rub
up: Tachycardia, Tachypnea, Low-grade fever
down Hypotension, cyanosis (O2 sat)
Diaphoresis
Adventitious breath sounds (crackles) and cough
Heart murmur in S3 and S4
Petechiae (red dots under the skin) over chest and axillae
Distended neck veins
Syncope
338
GI management for CF
high protein and calories 3x's/day with snacks and fluid
admin pancreatic enzymes w/in 30 minutes of food, it DAKE, laxatives and stool softeners
histamine- receptor antagonist and motility for GERD
up salt intake esp during hot weather
339
expected finding of GER or GERD in infants and children
Infants:
Spitting up or forceful VOMITING, irritability, excessive crying, hemoptysis, arching of back, stiffening
Respiratory problems
FTT
Apnea
Children: Heartburn, abdominal pain, chronic cough, dysphagia, noncardiac chest pain
340
expected findings of Meckel's diverticulum
Rectal bleeding, usually painless
Abdominal pain
Bloody, mucus stools
341
expected findings of Intussusception
sudden ab pain with screaming and knee-chest
sausage-shape mass
red currant jelly
vomiting
fever
342
Hirschsprung’s Disease expected findings in newborns, infants and and children
all: constipation, diarrhea, abdominal distension
babies: vomiting bile, FTT
newborn- failure to pass meconium within 1-2 days after birth, refusal to eat
infants- all
children: malnourished, visible peristalsis, palpable fecal mass, RIBBON-like stool
343
Hypertrophic Pyloric Stenosis
s/s
vomiting following feedings- PROJECTILE
nonbilious vomiting that can be bloody
constant hunger
OLIVE- shaped mass in RUQ
peristaltic waver from L toR when supine
failure to gain weight and manifestations of dehydration
344
what are some complications of GER in children
Recurrent pneumonia, weight loss, and failure to thrive
Repeated reflux of stomach contents can lead to erosion of the esophagus or pneumonia if stomach contents are aspirated.
345
What is the expected temp level of a 3-6 month old?
37.5˚ C (99.5˚ F)
346
what are some s/s of juvenile idiopathic arthritis?
Joint swelling, stiffness (tend to be worse in morning or after inactivity)
Mobility limitations
Fever
Rash
Gait with a limp
Delayed growth
347
medications for JIA
Ibuprofen, naproxen, diclofenac, indomethacin, and tolmetin control pain and inflammation
DMARDS like methotrexate
Biologic DMARDS like etanercept
348
What are some early signs of disequilibrium syndrome?
nausea, vomiting, headache
349
What should the diet of a dialysis pt be like?
Eat well-balanced meals to include foods high in folate (beans, green vegetables), and take supplements. Each exchange during dialysis depletes protein, requiring the client to increase protein intake over predialysis limitations, but it still might require some restriction.
350
What are some ways to take care of an arm with hemodialysis
Avoid lifting heavy objects with the access-site arm.
Avoid carrying objects that compress or constrict the extremity.
Avoid sleeping on top of the extremity with the vascular access.
Perform hand exercises that promote fistula maturation.
351
what cause Disequilibrium syndrome?
Results from too rapid a decrease of BUN and circulating fluid volume. It can result in cerebral edema and increased intracranial pressure.
352
how to recognize and take care of disequilibrium syndrome?
Early recognition of disequilibrium syndrome is essential. Manifestations: n/v, ALOC, seizures, and agitation.
Advanced age is a risk factor b/c hypotension due to rapid changes in fluid and electrolytes
Slow dialysis exchange rate, especially for older adults and first-time hemodialysis.
anticonvulsants or barbiturates if needed
353
3 different types of peritoneal dialysis
Continuous ambulatory peritoneal dialysis (CAPD) -7 days/week for 4 to 8 hr. can continue normal activities during.
Continuous-cycle peritoneal dialysis (CCPD) -24-hr dialysis. The exchange occurs at night while sleeping. The final exchange is left to dwell during the day.
Automated peritoneal dialysis (APD)- 30-min exchange repeated over 8 to 10 hr while sleeping.
354
which is medical and which is surgical asepsis?
peritoneal- surgical asepsis
hemodialysis- medical asepsis
355
Some complications of peritoneal dialysis
peritonitis-Cloudy or opaque effluent
protein loss- monitor blood albumin
hyperglycemia and hyperlipidemia- take antihypertensive and insulin
poor dialysate inflow or outlfow- milk or strip the tubing, use stool softeners.
356
which hepatitis infections can be treated with antivirals?
hep B and C
357
BUN levels for fluid volume deficit
increased BUN levels
358
What are some finding of overhydration?
v/s: tachycardia, bounding pulse, htn, tachypnea,
neuro: confusion, muscle weakness, seizures, ALOC
GI: increased motility, ascites
respiratory: dyspnea, orthopnea, crackles
osmolarity less than 280 mOsm/kg
359
What are some nutrition considerations for uric acid?
Decrease intake of purine sources: organ meats, poultry, fish, gravies, red wine, and sardines.
Lemon or orange juice can be consumed to alkalinize the urine (vit C)
360
What are some post op expectations for the client after ESWL
bruising at site
hematuria
position in a flat position
361
DKA nursing actions
rapid isotonic fluid (0.9% sodium chloride) replacement to maintain perfusion
blood glucose levels approach 250 mg/dL, add glucose to IV fluids in order to maintain 120 to 240 mg/dL blood glucose levels. Administer regular insulin continuously through an IV infusion at 0.1 unit/kg/hr.
admin potassium via IV
admin sodium bicarbonate IV for severe acidosis
362
What are some s/s of malignant hyperthermia?
Increased carbon dioxide level, decreased oxygen saturation level, and tachycardia occur first,
2nd:dysrhythmias, muscle rigidity, hypotension, tachypnea, skin mottling, cyanosis, and muscle-cell protein in the urine (myoglobinuria)
late: extreemely elevated temp
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nursing actions for malignant hyperthermia
stop surgery
dantrolene IV
100% o2
obtain specimens
iced IV 0.9%
cooling blanket
catheter to monitor output and myoglobinuria
cardiac rhythm monitoring and dysrhthmia
ICU
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Autonomic dysreflexia occurs with a spinal cord injury above level what?
T6
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s/s of autonomic dysreflexia
severely increased BP
lowe HR, confusion, anxiety, stroke
cardia carrest
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Why does cirrhosis cause decreased sodium?
Sodium decreases after decreased albumin results in decreased intravascular osmotic pressure. The kidneys perceive this as love volume and retain water, causing dilutional hyponatremia
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What are some findings of pericarditis?
chest pressure/pain aggravated by breathing (mainly inspiration),
coughing, and swallowing, SOB
pericardial friction rub auscultated at left lower sternal border
relief of pain when sitting and leaning forward.
elevated cardiac enzymes
paradoxical pulse (a decrease of 10 mm Hg or more in systolic blood pressure during inspiration)
tachycardia
hypotension
decreased CO
