Nclex Flashcards
(289 cards)
1
Q
Glucose
Normal Value
A
70-110 mg/dL
2
Q
Glucose
Effects of Imbalance
A
High glucose: 3 p’s (polydipsia: thirst, polyuria, polyphagia: increase hungry)
Low glucose: confusion, irritability, diaphoresis - sympathetic response.
If no tx for either then trajectory is seizure, coma and death.
3
Q
NA+
Normal Value
A
135-145 mEq/L
4
Q
NA+
Effects of Imbalance
A
High or Low sodium = confusion (change in neuro status) - affected by fluid balance
5
Q
K+
A
3.5-5 mEq/L
6
Q
K+
Effect
A
High or low dysrhythmia
High: diarrhea, cramping - acidotic states Think: alot of bananas= loose stools
Low: constipation, leg cramps - alkalotic states
7
Q
Ca+
Lab
A
8.5-10.5
8
Q
Ca+
Effects
A
High: constipation, slowed reflexes, kidney stones
Think: C for constipation= everything is slow Low: tetany, increased reflexes, Chvosteks & trousseau, diarrhea
9
Q
BUN
Lab
A
10-20 mg/dL
10
Q
BUN
Effect
A
affected by fluid balance and diet (protein intake - if eat a lot of protein then high if little protein intake then low.) Kidney function but not specific
10-20 is therapeutic drug range for dilantin (phenytoin and theophylline)
11
Q
Creatinine
Lab
A
0.5-1.5 mg/dL
12
Q
Creatinine
Effect
A
Specific to kidney function (based on muscle mass)
Level is the same for therapeutic range digoxin and lithium
13
Q
WBC
Lab
A
5-10K mm3
14
Q
WBC
Effects
A
if extremely low then sepsis (overwhelming will see immature bands or blasts - mature cells have died in the war).
filgrastim increases WBC
15
Q
Platelets
Lab
A
150-450K
16
Q
Platelets
A
High: clotting (anticoagulants, antiplatelets, hydration, therapeutic phlebotomy)
Low: bleeding (oprelvekin synthetic colony stimulating factor, soft toothbrush, electric razor, fall precautions)
17
Q
Hgb
Lab
A
> 10 g/dL (10-15)
More
18
Q
Hgb
Effect
A
Low: anemia (sob, lethargic, pallor), pace activities
can give CSF epogen to increase H&H
19
Q
HCT
Lab
A
35% or > up 48%
20
Q
HCT
Effect
A
Low: anemia - see above High: clotting
affected by fluid balance
21
Q
Bilirubin
Lab
A
<1
Less than
22
Q
Bilirubin
Effect
A
High: , icterus, abdominal pain, clay stools, , increased risk of bleeding
23
Q
MRI
Pre
A
Make sure there is no metal in the
e.g. welders may have fragments in their eyes and not know it, older pace-makers, rods, etc. Also, are they claustrophobic? May need a benzo before the procedure. If MRA,
Hold glucophage the day of the
procedure and hold for 48 hours after the procedure
24
Q
MRI
Post
A
It depends if it’s just a MRI (don’t need to do anything); a MRA (angiography which requires dye) need to increase fluids to flush out the dye or can cause renal dysfunction None
25
CT with contrast
| Pre
check for allergies for shellfish or
Hold glucophage the day of the procedure and 48 hours
after
26
CT with contrast
| Pre
check for allergies for shellfish or
Hold glucophage the day of the procedure and 48 hours
after
27
CT with contrast
| Post
Hold glucophage 48hrs after
| Increase hydration to excrete dye
28
Electroencephalogram (EEG)
| Pre
No lCNS stimulants or depressants
Before EEG e.g. no coffee/ tea: chocolate
hold the client’s seizure
meds (which would depress CNS). May sleep deprive them to increase likelihood of seizure
29
Electroencephalogram (EEG)
Nothing really post procedure
| None
30
Arterial Blood Gas
| Pre
Allen’s test, check bleeding profile
| PT/INR, PTT, Liver function) what meds are they on anticoagulants, antiplatelets or any bleeding disorders
31
Arterial Blood Gas
| Post
Hold pressure for 5 minutes
| or even longer if on meds that cause bleeding.
32
Endoscopy
| Pre
NPO 4-6 hours before to prevent
| aspiration
33
Endoscopy
| Post
Gag reflex before anything
| PO
34
Cardiac Catheterization
| Pre
NPO 4-6 hours prior, check
allergies, shellfish, iodine,
consent. Do not shave site, we only trim it
35
Cardiac Catheterization
| Post
HOB less 30 degrees.
Depends on closure device, maintain pressure, check site q15 minutes and distant pulses, bp/hr for internal bleeding. Hydration to remove dye from body,
36
Thoracentesis
| Pre
remain still, assess their lungs, vital signs prior consent, bleeding time, meds that may increase risk. of bleeding
37
Thoracentesis
| Post
CXR immediately after, assessment of lungs signs immediately, could
cause a pneumothorax, vital could
38
Nasal Cannula
0.5-6L, tissue damage around ears and nares, humidify if 3-4L or higher
39
Simple Face Mask
Cannot have less than 5-6 Liters or the client will rebreath their C02 and will have respiratory acidosis and have to be intubated
40
100% Nonrebreather
fill the reservoir bag with oxygen first before applying to client or will rebreath c02 and become acidotic
41
Respiratory
Complication
atelectasis, pneumonia
42
atelectasis
collapsed alveoli
43
Respiratory
TCDB q2h, ISE 10x hour while awake, pickle or accapella (blow into to loosen secretions), ambulate or at least sit up in chair, chest physiotherapy, hydration to thin secretions
44
Cardiac
Complication
DVT, PE, orthostatic
| hypotension
45
Cardiac
Interventions to Prevent
ambulation, heparin sq or lovenox, sequentials, TEDS, fluids, change positions slowly
46
GI
| Complication
ileus, constipation, N/V
47
GI
Interventions to Prevent
ambulation, nasogastric tube if vomiting or ileus - NPO until bowel sounds return
GU
48
GU
Complication
urinary retention, stones if they stay in bed too long, Catheter associated UTI (CAUTI)
49
GU
| Interventions to Prevent
Get them OOB - Gravity, lots of fluids
50
Integumentary
Complication
pressure ulcers, eviscerate,
| dehiscence, wound infection
51
Integumentary
Interventions to Prevent
Turn q2hs, ambulate, use binder, splint when coughing sterile dressing changes
52
State 2 differences between an ileostomy and colostomy?
a. Consistency: Ileostomy watery, continuous output. Colostomy is more formed- not continuous
b. Location: ileocecal (right lower quadrant - ileostomy); colostomy ascending, transverse, descending can irrigate colostomy but not ileostomy.
53
How often should an ostomy pouch/wafer be changed?
3-10 days or prn if there is a leak. Bag emptied? 2/3rd full
54
A client calls the clinic stating they have not had any output from their ileostomy for 2hrs. What is the best response by the nurse? State at least 2 things the nurse should tell the client.
a. hot liquids, knee chest, ambulate, change the wafer, warm shower, massage around it - if nothing needs to be seen = blockage
55
State 3 reasons a nurse would clamp a chest tube?
Looking for leak (intermittently), changing the drainage container, or getting ready to remove it.
56
TPN
Equipment/Lines/Tubes required to administer
filtered tubing, central line
57
```
TPN
Nursing considerations (need to knows to prevent harm)
```
daily labs, 2 nurses, monitor infection, check glucose levels, must change tubing q24hrs. Run out of TPN? dextrose 10-20% at same rate to prevent hypoglycemia, Monitor fluid balance
58
Tube Feedings
Equipment/Lines/Tubes required to administer
tubing set, formula, NGT, GT, JT
59
```
Tube Feedings
Nursing considerations (need to knows to prevent harm)
```
```
NGT placement CXR before using.
check blood glucose q6h
check residuals q4h
change the set q24h
make sure enough free water
Head of the bed 30 degrees or higher to prevent aspiration
```
60
State 3 factors that increase a client’s risk for falls
Age, medication, previous fall, uses equipment to ambulate (cane, walker), lines
61
How are crutches measured?
2-3 fingerbreadths below axillary, 20 degree angle wrist pressure on wrists not axillary
62
A client is being discharged home after hip surgery, what “hip precaution” teaching will you provide?
do not cross legs, do not bend over 90 degrees, chair height (upside down stop light), raised toilet seat. chairs with arms
63
What do nurses need to know about traction e.g. bucks or cervical?
continuous never release, never change weights
64
State 2 nursing considerations when communicating with a client who is hearing impaired
quiet environment, face them, lighting, hearing aids in if they have them, set aside enough time to speak with client
65
A nurse is discharging home a client with a visual deficit. State 3 home safety interventions
no chairs with wheels, no extension cords, or small animals, good lighting, no scatter rugs, paint edges of stairs bright colors
66
What can be delegated to an LPN?
Anything the nurse cannot EAT (Evaluate, assess or teach), only have stable patients, chronic conditions.
67
State 3 nursing ethical principles
autonomy, veracity (telling truth), fidelity (doing what you say you will do, keep your word), beneficence (doing good); nonmaleficence (not doing harm)
68
A client has a nasogastric tube for decompression. The nurse will set the suction gauge at 40-60 mmHg
What is the gold standard for NTG placement?
CXR
69
A client is at risk for aspiration (difficulty swallowing) what should the nurse instruct the CNA to do when feeding the client?
90 degrees, chin tuck, no straws, speech and swallow
70
Metoprolol
beta blocker
71
Metoprolol
Action/Side Adverse
blocks beta 1 receptor on the heart to slow heart rate and decrease blood pressure (blocks sympathetic response)
72
Metoprolol
Heart rate <60 & BP (SBP<90)
People with respiratory disorders because it affects beta 2 receptors causing bronchoconstriction
Diabetics - check blood glucose more frequently - masks hypoglycemia
change positions slowly, do not stop abruptly, do not overheat yourself
73
Accupril
Ace inhibitor -pril
74
Accupril
Action/Side Adverse Effects
interferes with the Renin-Angiotensin - Aldosterone system
75
Accupril
Check BP and Potassium levels (could be high because hold onto K+); Umbrella BP protocols ; S/E: hacking cough; Adverse reaction : angioedema
76
Warfarin
anticoagulant
77
Warfarin
Action/Side Adverse Effects
interferes with clotting cascade
78
Warfarin
Nursing Considerations
Parameters/Effectiveness, etc.
careful with NSAIDS increased risk of bleeding. Antidote: Vitamin K or Aquamephyton, Fresh Frozen Plasma (FFP). Teaching: Do not drastically change your diet; soft toothbrush, electric razor, no contact sports, report excessive bleeding or bruising. Lab: PT/INR if A-fib 2-3, if mechanical valve 2.5-3.5 or 4
79
Digoxin
Classification
Cardiac glycoside
| or positive inotrope (increases contractility), negative chronotropic (decreases heart rate)
80
Digoxin
Action/Side Adverse Effects
increases ventricular contractility to improve cardiac output
81
Digoxin
Nursing Considerations
Parameters/Effectiveness, etc.
Therapeutic range: 0.5-1.5 (if near 2 then patient will have symptoms of toxicity) visual disturbances green/yellow halos,
N/V Check at the bedside: Apical pulse for 1 minute if <60 hold
Also check potassium - if low can cause toxicity. How do you determine effectiveness? clearer lungs, decreased edema, no SOB or improved breathing, energy.
82
Furosemide
loop diuretic
83
Furosemide
Action/Side Adverse Effects
increase urine output and potassium (waster)
84
Furosemide
```
Check BP, Potassium, fluid balance
check weights (daily), effective if ease of breathing, clearer lungs, decreased edema, lowered BP monitor urine output.
```
85
Aspirin
antiplatelet, antipyretic, NSAID
86
Aspirin
Anti-platelet - makes them less sticky - effects the platelet for the life of the platelet which is 10 days
87
Aspirin
No one under 18 or Reye syndrome (liver failure)
Take with food - gastric distress and ulcers
Toxicity: tinnitus - ringing in the ears
88
Phenytoin
anti-seizure/
| anti-epileptic
89
Phenytoin
Action/Side Adverse Effects
seizure threshold - increase to prevent seizures
90
Phenytoin
Therapeutic range: 10-20
Causes birth defects
Decreases effectiveness of oral contraceptives - use barrier
Gingival hyperplasia, good oral care
pink urine is normal, Tube feedings hold 1 hour before and after
If given IV no dextrose or it will crystallize
91
Dexamethasone
steroids (-asone or one)
92
Dexamethasone
antiinflammatory
93
Dexamethasone
Do not stop abruptly or cause an adrenal crisis. Must taper the drug.
Long term: Moon Face, truncal obesity, thin extremities, buffalo hump, cataracts, osteoporosis, hirsutism, weight gain, fluid retention
As soon as take the medication - early signs: hyperglycemia, risk for infection, slow wound healing.
94
Cardizem
calcium channel blocker
95
Cardizem
ion influx
96
Cardizem
At bedside check: Heart Rate & Blood Pressure, prolong QT interval on ECG
Umbrella for drugs that lower BP
97
Simvastatin
anti cholesterol medications
98
Simvastatin
works directly on the liver to slow production of cholesterol
99
Simvastatin
Given night because the liver is more active at night.
LFT before starting medication and monitor LFTs
Adverse reaction: rhabdomyolysis
Do not ingest grapefruit juice.
Report abdominal pain, jaundice, icterus, dark urine, clay stools
Monitor cholesterol: Total = <200
HDL>60
LDL<100
100
Lorazepam
benzodiazepine
101
Lorazepam
works on CNS
102
Lorazepam
works on CNS
103
Lorazepam
```
antidote: flumazenil or romazicon
monitor respiratory rate
safety precautions
highly addictive
tolerance and withdrawal
```
104
Morphine sulfate
Opioid pain medication
105
Morphine sulfate
CNS
106
Morphine sulfate
Antidote: naloxone/narcan
monitor Respirations hold if <12
tolerance/dependence
107
What is the maximum score on the Glasgow Coma Scale?
15 (lowest is 3)
108
Which nerve is affected in Bell’s Palsy?
CN VII (know all CN and how they are tested)
109
What is Cushing's triad?
IICP widened pulse pressure, bradycardia, irregular respirations
110
Where is a ventriculostomy drain leveled to?
forman monroe, tragus of the ear
111
Which eye disorder has a loss of central vision?
macular degeneration no treatment (retinal detachment - curtain; glaucoma= loss peripheral only one that causes pain treated with medications; cataracts opaque vision)
112
Which type of cerebrovascular bleed requires immediate surgery (lucid then deteriorates quickly)?
Epidural bleed
113
What part of the brain controls balance?
cerebellum (C for coordination); frontal (Be Expressive - personality , expressive aphasia - Brocas); temporal (hearing, receptive aphasia, wernickes); parietal is sensation; occipital is vision
114
State 2 interventions you would do if clear drainage was observed draining from the nares of a client with a basilar skull fracture? (state 2)
1. halo test; mustache dressing. High risk for CNS infection = nuchal rigidity
115
What are the cardinal signs of Parkinson’s Disease?
TRAPI
| Tremors, rigidity, akinesia (bradykinesia slow movement), Postural instability
116
How is autonomic dysreflexia treated? Who is at risk?
T6 spinal injury or above, high bp caused by a stimulus below the injury usually bladder distention or constipation or tight clothing. Sit them up, look for the problem. If SBP >170 give BP medication
117
State 2 things a nurse needs to know about traction (Gardner wells or Bucks)
1. continuous traction and 2. do not change weights
118
State 2 vasopressors
a. epinephrine, norepinephrine, dopamine, dobutamine, vasopressin
vasodilators: Nitroglycerin, nitroprusside
119
Where is the phlebostatic axis located?
right atrium (4th ICS mid axillary)
120
What is it?
VTach___________________Treatment: __Check for pulse if have one then cardiovert; if pulseless treat as VFib - defibrillate ASAP, CPR until defibrillator is obtained.
121
What is it?
SVT__Treatment: vagal maneuvers (stimulate parasympathetic system) bear down, cough, blow through a straw, put face in ice water; doctor can carotid massage; adenosine 6, 12, 12 = 30 mg rapid iv push followed 20 mL of saline
122
What are signs and symptoms of pericarditis?
friction rub, pain relieved if leaning forward, and NSAIDS
123
Which type of valve replacement requires life-long anticoagulants?
mechanical (biological do not, but need to get a new biological every 8-10 years whereas mechanical is for life)
124
arterial ulcer
In arterial disease there is not enough blood, blood is warm and it carries all the nutrients. So decreased blood flow to lower extremities will not have edema, will be cool (lack of the warm blood), scarce hair and thick toenails because lack of nutrients, wounds are deep and edges are well circumscribed, weak pulses
125
venous ulcer
Venous insufficiency is just the opposite, no problem getting to the feet but blood pools in the feet due to incompetent valves make it difficult for the blood to return to the right side of the heart so edema, warm feet, good pulses, toenails are fine and hair is not patchy. Wounds are shallow with irregular borders
126
What medication(s) would you use to lower systemic vascular resistance?
vasodilators, antihypertensives
127
Interpret the following ABG:
pH 7.20, pC02 32, Hc03 18, Pa02 70
Metabolic Acidosis, partial compensation, hypoxemia
128
What would cause a low pressure alarm on a ventilator?
disconnected, pneumothorax, leak, tracheostomy cuff is down.
| High pressure alarm: stiff non compliant lungs, increased secretions in tube, biting the tube, kink in the tube
129
What is the cardinal sign of ARDs?
refractory hypoxemia needs mechanical ventilation and high PEEP
130
Bronchitis
Causes/
Physiology
smoking, pollution
131
Bronchitis
S&S
Blue bloater
increased H&H d/t constant release of erythropoietin
eventually right-sided HF (Cor Pulmonale)
02 sats 88-91%
132
Bronchitis
Tests/ Procedures/
Treatment
```
pulmonary function tests
inhalers (beta 2 agonists - terol; anticholinergics - tropium; and inhaled steroids - cort or asone)
mucolytics
low dose steroids
low oxygen via NC
```
133
Bronchitis
Education
stop smoking
teach about medications: what order to take inhalers,
do not stop steroids abruptly (if they are taking them)
Pursed lip breathing (helps keep alveoli open longer for better gas exchange)
134
Emphysema
Causes/
Physiology
smoking, pollution or genetic (do not have alpha 1 antitrypsin)
135
Emphysema
| S&S
Pink puffer - able to oxygenate themselves but using accessory muscles
02 sats 88-91%
136
Emphysema
Tests/ Procedures/
Treatment
Pulmonary function tests
inhalers (same as bronchitis above)
low dose steroids
low oxygen via NC
137
Emphysema
| Education
Same as above for Bronchitis
| Also, diaphragmatic breathing (largest muscle- less 02 use when using diaphragm instead of accessory muscle to breath)
138
Asthma
Causes/
Physiology
allergens
| genetic
139
Asthma
S&S
wheezing due to
| bronchoconstriction
140
Asthma
wheezing due to
| bronchoconstriction
141
Asthma
Peak flow meter
Green is good
yellow need to change med regime
red take rescue inhaler and call 911
142
Asthma
take medications as prescribed, how to use the peak flow meter, should be used everyday, try to avoid triggers
143
Tuberculosis
underdeveloped populations, crowded living conditions, immunocompromised
144
Tuberculosis
S&S
Night sweats, weight loss, hemoptysis
145
Tuberculosis
Tests/ Procedures/
Treatment
Positive sputum culture Acid Fast Bacilli, CXR
146
Tuberculosis
| Education
Must wear surgical mask when out in public or around people, take meds as prescribed (ethambutol, INH, Rifampin or Streptomycin) after 3 negative sputum cultures then they can stop taking the meds
147
Pneumothorax
Causes/
Physiology
Tall thin young males are at high risk for spontaneous pneumothorax, pple with COPD have blebs on their lungs puts them at risk, a client on a ventilator that has noncompliant lungs or trauma
148
Pneumothorax
S&S
absent or dim lung sounds (if small); tracheal shift to the unaffected side if large
149
Pneumothorax
Tests/ Procedures/
Treatment
Chest tube needs to be placed to restore negative pressure and re-expansion of the lung
150
Pneumothorax
Education
Pain control with PCA, about chest tube - when ambulating etc.
TCDB (pulmonary toileting)
151
Hyperglycemia
insulin
152
Hypoglycemia
15’s (15 grams of simple carbohydrate, recheck blood glucose in 15 min, another 15 grams of simple carbs if not in range but if in range then 7.5 g of complex carbohydrate so blood sugar does not plummet)
if confused or not conscious then give glucagon sq or IM or Dextrose 50% IVP if they have an IV - never give PO if not fully conscious - will aspirate
153
Rapid (Lispro, Aspartate) (-logs)
Onset
5-15min
154
Rapid (Lispro, Aspartate) (-logs)
Peak
1.5 (1-2)
155
Regular Insulin (-lin)
Onset
30
156
Regular Insulin (-lin)
Peak
3 (2-4)
157
NPH
Onset
60
158
NPH
Peak
6 (4-8)
159
Long acting
60
160
Long acting
Peak
No peak - basal rate
161
State the 2 differences between HHNKS and DKA:
a. Hyperglycemia hyperosmotic nonketotic syndrome - no acidosis, no ketones - type II diabetics (Blood glucose 600-1000)
b. DKA acidosis, ketones, Type I 400-600
162
What labs would the nurse expect for a client admitted with adrenal crisis?
```
adrenal cortex (think of the hormones aldosterone, cortisol and sex hormones):
aldosterone: holds onto NA & water gets rid of potassium - so what if no aldosterone?
get rid of NA+ and water and hold onto K+= hyponatremia, hypotension, hyperkalemia
```
Cortisol: if present have increase in glucose; if don’t have cortisol = hypoglycemia
Adrenal crisis= hyperkalemic, hyponatremic, hypotension, hypoglycemic
163
What are the complications (emergency) of hypothyroid and hyperthyroid?
a. Hypothyroid emergency/complication:_myxedema coma - give synthroid (thyroid hormone)
b. Hyperthyroid emergency/complication: thyroid storm - treat symptoms High BP, High temperature-
164
Using the rule of nines and Parkland formula calculate fluid resuscitation for first 8 hours:
Burns to the face, entire right arm, entire chest and abdomen, entire right leg and groin. Client weighs 68kg
face: 4.5, 9, 18, 18 1= 50.5 x 4mL x 68= 13,736/2 = 6868 first 8hrs (has to be infused within 8hrs of the when the burn occurred e.g. if burned at 1000, then it must be infused by 1800) then the rest over the next 16 hours
6868/8= 858.5
165
Hepatitis
Risk Factors
```
Know ABC
Immunoglobulins
vaccinations
body fluids
contaminated water/feces
```
166
Hepatitis
| S&S
liver dysfunction
167
Hepatitis
Treatment
immunoglobulin
| vaccinations
168
Cholecystitis
Risk Factors
female, fair fat, forty and fertile
169
Cholecystitis
S&S
right up quad/shoulder/back pain after fatty/spicy meal, N/V
170
Cholecystitis
Treatment
diet, cholecystectomy
171
Acute Pancreatitis
Risk Factors
alcoholism or stone is lodged in common bile duct, smoke
172
Acute Pancreatitis
S&S
acute abdominal pain, n/v , increased lipase and amylase
173
Acute Pancreatitis
Treatment
rest the stomach, nasogastric tube, stop drinking and smoking
or removal of the stone
174
Compare and contrast Glomerulonephritis and Nephrotic Syndrome - how are they similar and how are they different?
strep infection undetected/not treated - damaged kidneys, more permeable losing large cells albumin and red blood cells. Low albumin look like pillsbury dough boy (edema) frothy coca cola urine (frothy album and coca cola is red blood cells) ; red blood cells anemic. - treat glomerulonephritis antibiotic, go slow with replacing albumin.
If glomerulonephritis is not treated properly then they will develop nephrotic syndrome - irreversible chronic renal failure - go ahead and replace albumin.
175
What are the 3 phases of acute renal failure?
1) anuric/oliguric, 2) diuresis 3) recovery
176
What are 3 types (causes) of acute renal failure?
pre-renal (volume); intrarenal (drugs aminoglycoside); post-renal (enlarged prostate or stone)
177
Hemodialysis
3 days a week for few hours
| hypotension
178
Hemodialysis
Complications that might occur
hypotension
disequilibrium syndrome (too fast removal of BUN) slow the rate
use heparin= so risk of bleeding
179
Peritoneal Dialysis
several exchanges a day
| with dwell times
180
Peritoneal Dialysis
Complications that might occur
peritonitis
| fluid overload
181
Rheumatoid Arthritis
```
symmetrical joint destruction/deformities
swan neck, boutonniere
Rheumatoid factor (RF), ANA (antinuclear antigen)
stiff when joints not used e.g. waking up in the morning - feel better with movement
```
182
Rheumatoid Arthritis
```
DMARDs
Disease modifying antirheumatic drugs
plaquenil
steroids
methotrexate
```
183
Osteoarthritis
unilateral
wear and tear
pain occurs with use of the joints
184
Osteoarthritis
unilateral
wear and tear
pain occurs with use of the joints
185
Osteoarthritis
Treatment
steroids
surgery
OTC: chondroitin
186
Gout
build up of uric acid in the small joints can be in fingers and toes
(usually great toe)
very painful inflamed
Exacerbated by dehydration
187
Gout
prophylactic use of
Probenecid (helps excrete (pee) out the uric acid)
Allopurinol (decreases the production of uric acid
Colchicine for acute episodes
Indomethacin
188
PPN
Equipment Needed
peripheral line
189
PPN
| Complications
hyperglycemia
| fluid overload
190
PPN
Nursing
Interventions to
Prevent
Complications
```
daily labs
glucose checks
change tubing/bag
q24
dedicated lines
D10-D20% if no
feeding on hand
```
191
Isotonic
volume to increase BP
192
Hypotonic
cellular dehydration- never give this to
someone with a cerebral edema will
worsen it.
193
Hypertonic
brain swelling
194
Lumbar puncture
| Pre
contraindicated
for lICP, consent, labs,
keep patient still, calm
195
Lumbar puncture
```
dark room, hydrate,
supine position to
prevent spinal ha, but if
develop a spinal ha then
blood patch
```
196
Computed
Tomography
Angiography
dye allergy,
metformin hold
metallic taste
197
Computed
Tomography
Angiography
hydrate to clear dye
198
Barium enema
instill enema
do enema
before barium swallow
nothing specific
199
Barium enema
fluids, laxatives
200
Tracheostomy mask
always humidified
201
24hr urine collection
pt void then start time
202
24hr urine collection
if tissue or feces gets in or miss a void, start over Keep on ice
203
24hr urine collection
add last void, return to lab
204
Pyelography
| Pre
allergies to
iodine/shellfish.
metformin hold
205
Pyelography
| Post/
hydrate to clear dye
206
Sickle Cell
| Pre
african american,
hemoglobin S
carrier
207
Sickle Cell
| During
```
pain, extremities,
chest due to poor
perfusion (sickling
blocks off small
capillaries)
```
208
Sickle Cell
| Post
fluids, oxygen,
morphine,
hydroxyurea
prophylactically
209
Pernicious
| Pre
gastric bypass
210
Tell me about the chain of infection.
microorganism present, portal of entry, susceptible host
211
What is the difference between medical asepsis and surgical asepsis?
MEDICAL ASEPSIS REDUCES THE AMOUNT OF MICROORGANISMS (CLEAN TECHNIQUE) AND SURGICAL ASEPSIS REMOVES ALL MICROORGANISMS (STERILE)
212
State 3 interventions a nurse can do to improve pulmonary function.
turn, cough, deep breath, ambulate, incentive spirometry, hydrate
213
Tell me about 3 therapeutic communication techniques.
```
active listening
no why questions
offering self
CLARIFYING/RESTATING
OPEN-ENDED
CLOSE-ENDED
```
214
Foley Catheter
neurogenic bladder, surgery,
irritation
infection prevention, aseptic
technique
215
Straight catheter
no void after 6 hrs
infection prevention
216
Ostomy
bladder cancer
sterile technique, infection
prevention
217
Nephrostomy
blockage below kidney
infection prevention
218
What teaching would you provide to a client who has just been prescribed 3 inhalers (Ipratropium, Salmeterol and Azmacort)
-Terol first a beta 2 agonist, -tropium next and inhaled anticholinergic, steroids are last - rinse mouth and mouth piece to prevent thrush after using steroid inhalers. If you develop thrush use Nystatin swish and swallow - swish as long as you can in your mouth then swallow because thrush will travel through the entire GI tract
219
State 3 reasons a nurse would clamp a chest tube?
a. checking for leaks (start at the patient) b. changing the drainage container c. to determine if the chest tube is ready to be removed.
b. If the chest tube becomes disconnected from the drainage container. - take the end of the tube and put in sterile water/saline - in the room should clamps, sterile saline/water, gauze dressing and an occlusive vaseline dressing.
c. The chest tube is pulled out of the patient - it was newly placed - use gauze and tape 3 sides
d. if it was a chest tube that was pulled out and it was ready to come out - put vaseline occlusive
dressing on the incision site.
220
What should a stoma look like?
pink, beefy red - not blue, pale or black. Shrinks after surgery
221
A client calls the clinic stating they have not had any output from their ileostomy for 2hrs. What is the best response by the nurse?
VERY CONCERNING! Means there is a blockage. Knee to chest, drink warm fluids, prune juice, take warm shower, ambulate, massage around the site, replace the wafer - go to ER or clinic immediately.
222
Diltiazem
Class
Calcium Channel Blocker
223
Diltiazem Action
slows heart rate and decreases blood pressure
224
Diltiazem Parameters
HR <60 & SBP <90
225
Diltiazem Side/Adverse Effects
Hypotension, bradycardia, dizziness
226
Diltiazem Client Teaching
Change positions slowly, do not discontinue abruptly, do not over heat yourself
227
Digoxin Class
Cardiac Glycoside/Positive Inotropic
228
Digoxin Action
Increases contractility of the ventricles
229
Digoxin Parameters
Apical Pulse for 1 minute <60
230
Digoxin Side/Adverse Effects:
Bradycardia, green/yellow halos, n/v
Increased risk of toxicity if low K+
•Therapeutic range: 0.5-1.5
231
enalapril Class
ACE inhibitor
232
enalapril Action
works on Renin-Angiotension Aldosterone System blocks angiotensin 2 and prevents release of aldosterone
233
enalapril Parameters
Fluid balance, BP, and Potassium
234
enalapril Side/Adverse Effects:
hypotension, hyperkalemia, angioedema, hacking cough, birth defects/morbidity/mortality
235
enalapril Client Teaching
Monitor fluid balance, weight, daily same scale, cloths, time, edema, BP, change positions slowly, don’t overheat yourself, report difficulty swallowing, tongue
236
Heme
Oprelvikin
Filgrastim
Epogen
237
Oprelvikin Class
Colony stimulating factor
238
Oprelvikin action
increase platelet count
239
Oprelvikin Parameters
monitor platelet count (150-450K)
240
Oprelvikin Side/Adverse Effects
could develop clots if too many platelets, increased blood pressure. Bone pain is side-effect
241
Oprelvikin Client Teaching
Take Tylenol for bone pain
242
Filgrastim Class
Colony Stimulating Factor
243
Filgrastim Action
Increases WBC
244
Filgrastim Parameters
Monitor WBC
245
Filgrastim Side/Adverse Effects:
leukocytosis (too many WBC), bone pain
246
Filgrastim Client Teaching
bone pain is common, take Tylenol. Avoid people with infections.
247
Epogen Class
Colony stimulating factor
248
Epogen Action
Increase RBC count
249
Epogen Parameters
monitor H&H
250
Epogen Side/Adverse Effects
too many RBC increase BP and increased risk of clots.
251
Epogen Client Teaching
Bone pain is common s/e take Tylenol. Improvement in s&s of anemia
252
Heparin class
parenteral anticoagulant
253
Heparin Action
prevent clots from forming or extending
254
Heparin Parameters
aPTT (Heparin IV drip 50 to 70 seconds) q6h we’re gonna draw an aPTT
255
Heparin Antidote
Protamine Sulfate
256
Heparin Side/Adverse Effects
Bleeding (VS: HR and BP), HIT (Heparin Induced Thrombocytopenia)
Complete Blood Cell Count (CBC): H&H, Platelets.
257
Heparin Client Teaching
electric razor, soft tooth brush, report excessive bruising or bleeding, report dizziness.
258
Methotrexate Class
Chemotherapeutic
259
Methotrexate Action
Cancer
260
Methotrexate Parameters
suppresses cancer metastases/improvement, decreased
261
Methotrexate Side/Adverse Effects
Monitor CBC – causes pancytopenia (decrease blood cell count – RBC, WBC and Platelets)
•RBC < anemia (sob, lethargy, pallor)
•WBC < at risk for infection
•Platelets < risk for bleeding
•Stomatitis, alopecia
•GI issues (NVD)
262
Methotrexate
•Client Teaching: do not take colony stimulating factors before chemotherapy, take it after chemo. Talk about alopecia, stomatitis, GI (diarrhea, nausea and vomiting)
•Antidote: leucovarin
263
Infiltration
Remove. Elevate. apply warm compress
264
Air embolus
Left lateral trendelenberg
265
Extravasation
Aspirate drug, inject antidote
266
Hematoma
Apply light pressure
267
Phlebitis
Remove apply warm/cool compress
268
Acetaminophen antidote
N- acetylcysteine (mucomyst)
269
Benzodiazepine
Flumazenil (romazicon)
270
Cyanide poisoning
Methylene blue
271
Digitalis
Digoxin immune FAB (digibind
272
Heparin/enoxaparin
Protamine sulfate
273
Iron
deferoxamine
274
Lead
succimer
275
Magnesium sulfate
Calcium gluconate
276
Narcotics
naloxone
277
Warfarin
Phytonadione (vitamin k, aquamethyton, fresh frozen plasma)
worksheet
278
Gingko
treating blood disorders and memory issues
279
Ginkgo people should not take
Blood thinner
280
saw palmetto
saw palmetto
281
saw palmetto
headache, nausea, diarrhea, and dizziness
282
Who should not take saw palmetto
taken by children, during pregnancy or breastfeeding, or by those with hormone-sensitive cancers.
283
St. John’s Wort
for depression, menopausal symptoms, attention-deficit hyperactivity disorder (ADHD), somatic symptom disorder
284
Who should avoid St John's wort?
major depression because increase mania
285
Who should avoid St John's wort?
286
HEAD TRAUMA
Strokes/Bleeds:
o Thrombotic/embolic (clot/blockage) thrombolytics (protocol <3hrs) or
anticoags
o Hemorrhagic (broken vessel)
▪ fast=epidural (meningeal artery/awake, alert then suddenly
declines- EMERGENCY) or slow=subdural (venous bleed)
▪ NO thrombolytics/anticoags!
287
Ventricular tachycardia
Medication to treat
antiarrhythmic medication
288
Duodenal ulcer happens after
2-3 hours after meal
And night
Relieved by eating
289
Gastric ulcers
Occurs 30 minutes after eating
