NCLEX Flashcards
(562 cards)
1
Q
Hemoglobin
A
Female 123-157
Male 140-174
Responsible for transporting O2
2
Q
Hematocrit
A
Female 37-47%
Male 42-52%
Concentration of RBC in the body
3
Q
RBC
A
4.5-5.5 million
4
Q
WBC
A
5000-10000
5
Q
Platelets
A
150000-400000
Help clot and stop bleeding
6
Q
Partial thrombin time (PTT)
A
20-30 seconds
7
Q
PTT on heparin
A
rate should be 1.5-2.5x patients normal
8
Q
Prothrombin time (PT)
A
10-12 seconds
9
Q
International normalized ratio (INR)
A
0.9-1.2
10
Q
INR on warfarin
A
therapeutic INR 2-3
11
Q
sodium normal
A
135-145
12
Q
potassium normal
A
3.5-5.0
13
Q
calcium normal
A
9-10.5
14
Q
magnesium normal
A
1.5-2.5
15
Q
chloride normal
A
98-106
16
Q
phosphorous normal
A
2.5-4.5
17
Q
BUN
A
10-20
*increases when kidneys do not filter urea waste
18
Q
creatinine
A
0.6-1.2
19
Q
troponin
A
0-0.4
20
Q
BNP
A
<100
*when fluid retention is present, the heart senses the need to pump harder and release BNP
21
Q
total cholesterol
A
<200
22
Q
HDL normal
A
> 55
*responsible for cleaning out arteries and reduces plaque / build up
23
Q
LDL normal
A
<130
*clogs arteries
24
Q
Triglycerides (very LDL)
A
<160
25
urine specific gravity
- 1.005-1.030
- increased ; dehydration
- decreased ; diluted urine
26
urine osmolarity
- 300-900
- number of particles in urine
- increased ; dehydration
- decreased ; diluted urine
27
urine WBC
0-4
*increased; inflammation, UTI
28
protein in urine
should be negative
*if positive; kidney disease, preeclampsia
29
ABG normals
pH normal ; (acidosis) 7.35 – 7.45 (alkalosis)
HC03 normal ; (acidosis) 22-28 (alkalosis)
CO2 normal ; (alkalosis) 35-45 (acidosis)
*fully compensated if pH is normal
30
causes of hypernatremia (HINT: models)
- medications
- osmotic diuretics
- diabetes
- excessive water loss
- low water intake
- sodium intake too high
31
signs and symptoms of hypernatremia (HINT: fried and salted)
- fever
- restlessness and agitation
- increased fluid retention
- edema
- dry mouth
- skin flushed
- altered LOC
- low urinary output
- thirst
- elevated BP
- decreased energy
32
causes of hyponatremia (HINT: mobs fail)
- meds – diuretics
- oral gastric tube suctioning
- burns
- SIADH
- Failure of kidney, heart, liver
33
signs and symptoms of hyponatremia (HINT: low sodium)
- LOC altered
- orthostatic hypoTNS
- weak muscles
- seizures
- osmolarity low (serum)
- diarrhea
- increased ICP
- urine osmolarity high
- more bowel sounds
34
causes of hyperchloremia
- dehydration
- vomiting
- sweating
- excess steroids cause chloride retention
35
causes of hypochloremia
- CHF
- water intoxication
- salt losses (burns, sweating, v&d)
36
cause of hyperkalemia
- medication
- acidosis
- cellular destruction
- hypoaldosteronism
- intake
- nephrons – renal failure
- excretion impaired
37
causes of hypokalemia
- drugs
- inadequate K+ intake
- too much water
- Cushing’s disease
- heavy fluid loss
38
causes of hypercalcemia
- malignancy
- diuretics
- steroids
- parathyroid
- immobilization
- endocrine
- D vitamin
39
causes of hypocalcemia
- celiac, chrons disease (malabsorption)
- hypoparathyroidism
- alcoholism
- malnutrition
- pancreatitis
- renal failure
40
causes of hyperphosphatemia
- hypocalcemia
- tumor lysis
- renal faliure
41
causes of hypophosphatemia
- malnutrition
- alcoholism
- TPN
- hypercalcemia
42
foods high in vitamin C
- citrus fruits
- strawberries
43
foods high in vitamin D
- fortified milk and cereal
44
foods high in vitamin K
- leafy greens
45
foods high in vitamin B12
- protein
- dairy
- eggs
46
foods high in folic acid
- dark green veggies
- legumes
- nuts
47
foods high in iron
- meats
- eggs
- leafy greens
48
foods high in potassium
- avocados
- oranges
- yogurt
- milk
- salmon
- bananas
49
foods high in calcium
- cheese
- leafy greens
- milk
- salmon
- almonds
- tofu
- yogurt
50
foods high in phosphorus
- dairy
- chocolate
- cola
- nuts
- beans
- meats
- grains and seeds
51
foods high in sodium
- soy sauce
- condiments
- canned food
- processed meat
- popcorn
52
renal diet
- fluid restriction
- low electrolytes
- low protein
- high calcium
53
grapefruit juice and medication contraindication
*inhibits enzyme in liver needed to metabolize these meds
- nifedipine
- verapamil
- statins
- midazolam
- SSRIs
54
acetaminophen antidote
acetylcysteine
55
benzodiazepine antidote
flumazenil
56
heparin and enoxaparin antidote
protamine sulfate
57
warfarin antidote
phytonadione (vitamin K)
58
local anesthetics
*END IN -CAINE
- indicated for painful procedures and localized pain and discomfort
59
opioid agonists
*END IN -INE OR -ONE
*example; morphine, oxycodone, fentanyl
*MONITOR FOR RESP. DEPRESSION
- indicated for moderate to severe pain relief
60
opioid antagonist
*END IN -ONE
*exmaples; naloxone, methynaltrexone
- indicated for opioid overdose
61
NSAIDs
*examples; naproxen, ibuprofen, ASA, ketorolac
- indicated for inflammation, pain, fever
62
acetaminophen
- no anti-inflammatory properties
- indicated for pain and fever
- taking with alc. can cause major liver damage
- max dose is 4000 mg daily
63
COX-inhibitors
*RISK FOR
- renal impairment
- vasoconstriction
- bleeding
- gastric ulcers
64
ACE inhibitors
*END IN -PRIL
- indicated for HTN, CHF
- blocks conversion of angiotensin I to II
65
ARBs
*END IN -SARTAN
- indicated for HTN, DM neuropathy, CHF
- inhibits angiotensin II
66
Calcium channel blockers for heart and bv
*END IN -MIL
- indicated for HTN, angina, afib/flutter
- block calcium channels in BV (vasodilation) and heart (slow HR and decrease contraction force)
67
calcium channel blockers bv only
*END IN -DIPINE
*WILL NOT CAUSE CONSTIPATION
*INTERACTS WITH GRAPEFRUIT
- indicated for HTN, angina
- block calcium channels in BV (vasodilation)
68
sodium channel blockers
*PROCAINAMIDE, LIDOCAINE
- indicated for dysrhythmias
- slow impulse conduction and delays repolarization
69
beta blockers
*END IN -LOL
- indicated for HTN, angina, arrhythmias, MI, anxiety, alc. Withdrawal
- block beta 1 and 2 adrenergic receptors to slow HR
70
potassium channel blockers
*AMIODARONE, IBUTILIDE
- indicated for dysrhythmias
- block potassium currents to prevent repolarization, interfering with excitatory pathways
71
atropine
- indicated for excessive secretions, sinus bradycardia, heart block
72
digoxin
- cardiac glycoside
- indicated for HF, afib, a flutter, CHF, cardiogenic chock
- increases heart contractility and decreases the rate
73
adenosine
*GIVE IV PUSH CLOSE TO HEART AND QUICK
*WARN PT IT WILL FEEL LIKE A KICK TO THE CHEST
- indication for SVT
- interrupts re-entry pathways through AV node, restoring sinus rhythm
74
H1 antagonists
*END IN -INE
- indicated for allergy, anaphylaxis, sedation
- blocks H1 receptors, decreases flushing, edema, secretions, itching, pain
75
glucocorticoids
*END IN -IDE, -ONE
*INHALE CAN CAUSE THRUSH
*DO NOT USE ORAL FOR MORE THAN 10 DAYS
- indicated for asthma, COPD, allergies
- decreases inflammatory mediators, infiltration of inflammatory cells, and vascular permeability
76
Leukotriene receptor antagonists
*END IN -KAST
- indicated for asthma, COPD, allergies
- - suppress leukotrienes to decrease smooth muscle constriction / edema
77
monoclonal antibodies
*END IN -ZUMAB
*ANAPHYLAXIS MAY OCCUR IF AMNIN SQ
- indicated for asthma, COPD, allergies
- reduce amount of IgE in blood to limit trigger of an inflammatory reaction
78
B2-adrenergic agonists
*END IN -OL
*USE SHORT ACTING THEN LONG IN 1 MIN INTERVALS
- bind to beta2 receptors in airway leading to relaxation of smooth muscles
79
Methylxanthines
*END IN -LINE
*NARROW THERAPEUTIC WINDOW
- relaxes bronchial smooth muscle
80
Anticholinergics
*END IN -IUM, -BROMIDE
- block muscarinic receptors in bronchi causing less bronchoconstriction
81
Guaifenesin
- indicated for excess mucus
- stimulates flow of respiratory tract secretions making a more productive cough
82
Mucolytics
*HYPERTONIC SALINE, ACETYLCYSTEINE
- indicated for excess mucus
- reacts with mucus to make it more watery
83
decongestants
*PHENYLEPHRINE, PSEUDOEPHEDRINE
- activates alpha 1 adrenergic receptors on nasal blood vessels causing vasoconstriction
84
alpha adrenergic agonists
*EPINEPHRINE, NOREPINEPHRINE, EPHEDRINE, PHENYLEPHRINE
- indicated for cardiac arrest, shock, control bleeding anaphylaxis
- activates alpha receptors resulting in vasoconstriction and pupil constriction
85
beta adrenergic agonists
*EPINEPHRINE, NOREPINEPHRINE, DOPAMINE, DOBUTAMINE, ISOPROTERENOL
- indicated for AV block, cardiac arrest, shock, HF, preterm labor
- activates beta receptors causing SNS stimulation resulting in increased HR (B1), bronchodilation (B2), uterine relaxation (B2)
*SIDE EFFECTS; tachycardia, HTN, CNS overstimulation
86
alpha adrenergic antagonists
*END IN -ZOSIN
- block activation of alpha receptors in SNS causing vasodilation, decreased BP
87
beta adrenergic antagonists
*END IN OLOL
- block activation of B1/B2 in SNS
88
cholinergic medications
*END IN -STIGMINE
- cause REST AND DIGEST; increase GI secretions and motility, increase urination, pupil constriction, decrease HR
89
anticholinergic medications
- block acetylcholine in PNS thereby blocking REST AND DIGEST
90
anti-parkinson's medication
*LEVODOPA
- increases dopamine synthesis and can decrease motor symptoms
91
cholinesterase inhibitors
*DONEPEZIL, RIVASTIGMINE, GALANTAMINE
- indicated for Alzheimer’s, dementia
- prevents acetylcholine breakdown which resulting in improved memory
92
long term anticonvulsants
*PHENYTONIN, PHENOBARBITAL, VALPROIC ACID
- selectively inhibit sodium channels, suppressing action potentials in hyperactive neuros
93
rapid acting anticonvulsants
*LORAZEPAM, DIAZEPAM
- causes CNS depression
94
H2 antagonists
*END IN -IDINE
- block release of histamine which blocks acid secretions
95
Proton pump inhibitor
*END IN -ZOLE
- prevent the transport of H ions into gastric lumen to decrease gastric acid production
96
GI protecetant
*SUCRALFATE
- promotes healing of ulcers by providing barrier over them
97
Loop diuretics
*END IN -IDE
- indicated for low urinary output, edema, CHF, BP management
98
thiazide diuretics
*END IN -THIAZIDE
- indicated for HTN, edema
99
potassium sparing diuretics
*END IN -ONE
- indicated for HTN, edema, HF
100
steroids
*END IN -SONE
- indicated for Addison’s disease, inflammation, allergy, autoimmune disorders
- suppresses inflammation in immune system
101
thyroid hormone replacements
*LEVOTHYROXINE
- take every day, same time, empty stomach, separate from other medications
102
anti-thyroid medications
*IODINE, RADIOACTIVE IODINE, METHIMAZOLE
- reduces size and vascularity of thyroid gland or kills thyroid cells
103
ADH (antidiuretic hromone)
*VASOPRESSIN, DESMOPRESSIN
- indicated for DI, shock
- causes body to retain water, increasing blood volume, decreasing UOP and increasing BP
104
thrombolytics
*END IN -ASE
- enzyme that converts plasminogen to plasmin, plasmin destroys a clot
105
penicillins
*END IN -CILLIN
- antibiotic
106
cephalosporin
*STARTS WITH CEP-
- antibiotic
107
carapenems
*END IN -PENEM
- antibiotic
108
tetracyclines
*END IN -CYCLINES
- antibiotic
109
macrolides
*END IN -MYCIN
- antibiotic
110
aminoglycosides
*END IN -CIN
- antibiotic
111
sulfonamide
*START WITH SULF-
- antibiotic
112
anti-tuberculosis agents
*ISONIAZID - kills mycobacteria that are actively dividing
*RIFAMPIN - bactericidal
113
amphotericin
- for systemic fungal infections
114
azoles
*END IN -AZOLE
- for systemic or topical fungal infections
115
fungins
*END IN -FUNGIN
- antifungal medications
116
Benzodiazepines
*END IN -LAM, -PAM
- indicated for anxiety
- avoid alc., monitor for resp. depression
117
SSRIs
*END IN -INE
- antidepressant
- prevent reuptake of serotonin increasing availability
*MONITOR FOR SEROTONIN SYNDROME - HTN, confusion, anxiety, tremors, ataxia, sweating
*MONITOR FOR SUICIDE FOR 2-3 WEEKS
118
TCAs
*END IN -PTYLINE
- antidepressant
- prevent reuptake of serotonin / norepinephrine
*SIDE EFFECTS; tachycardia, cardiac effects, anticholinergic effects, sedation
119
MAOIs
*ISOCARBOXAZID, PHENELZINE
- antidepressant
- block enzymes to increase ALL neurotransmitters
*NO FOOD WITH TYRAMINE (aged cheese, wine, pickled meat). will cause HTN crisis
120
Lithium
- mood stabilizer indicated for mania
- inhibits excitatory neurotransmitters and promotes GABA
*DO NOT admin with NSAIDs
*THERAPEUTIC RANGE; 0.6-1.2
121
first generation antipsychotics
*HALOPERIDOL
- indicated for schizophrenia, mania, aggression, agitation
- inhibits dopamine
*MONITOR FOR tardive dyskinesia, slurred speech, tremors, neuroleptic malignant syndrome (high fever) prolonged QT wave
122
second generation antipsychotics
*END IN -APINE
123
tocolytics
*TERBUTALINE, MAGNEIUM SULFATE
- binds to beta 2 adrenergic receptors to slow contractions
*SIDE EFFECTS; CNS overstimulation (terb.), hypermagnesemia (mag.)
124
oxytotics
*OXYTOCIN
- stimulate contractions in labor or PPH
125
prostaglandin E1
*MISOPROSTOL
- ripen cervix
126
prostaglandin E2
*DINOPROSTONE
- ripen cervix
127
nitrous oxide
- gas mixed with O2
- reduces anxiety, causes feeling of well-being
128
narcotics used in labor
- meperidine
- butorphanol
- morphine
- nalbuphine
*CAN CROSS PLACENTA so monitor for resp. depression
129
epidural
- regional anethesia
- small catheter placed into lower spine and pain medication is given
130
spinal block
- indicated for pain control during C-section
- injected directly into fluid of the spinal cord and will block pain for a few hours
131
drugs to avoid in children
- ASA (reye's syndrome)
- Ibuprofen before 6 mo. (immature liver)
- tetracycline (tooth discolouration)
- oseltamivir (hallucinations)
132
inotropes
- go directly to the heart to increase myocardial contractility force
133
vasopressors
- mimic SNS to cause vasoconstriction
- indicated for MI, hypoTNS, shock
134
medication for septic shock
1st; dopa or norepi
2nd; epi or phenylephrine
3rd; vasopressin
135
milrione
- indicated for cardiogenic chock, decreased CO, heart defects
- causes systemic vasodilation decreasing after load and increasing contractility
- inhibits phosphodiesterase
136
cardiac output formula
CO = stroke volume X heart rate
137
PICC
needed when several weeks of infusions are needed (chemo, antibiotics, TPN)
138
139
ECG normal findings
- 1 P wave for every QRS
- PR interval between 0.12-0.20
- QRS less than 0.12 seconds
- Rate between 60 and 100
- Regular rhythm
*LITTLE BOXES 0.04
140
first degree heart block ECG
PR interval >0.20
141
second degree heart block (type 1) ECG
PR normal, then longer, then longer, then drops
142
second degree heart block (type 2) ECG
No P wave for every QRS
143
third degree heart block ECG
variable PR wave
144
tall peaked T waves indicate ...
hyperkalemia
145
shallow / inverted T waves & U wave indicate ….
hypokalemia
146
tall, unpeaked T waves indicate …
Hypermagnesemia
147
beneficence
doing good
148
nonmaleficence
do no harm
149
accountability
accepting responsibility for your actions and accepting consequences
150
fidelity
keep your promises and be faithful
151
autonomy
encourage patient to make their own decisions without judgement or coercion
152
veracity
tell the truth and not withholding any part of the truth
153
orthodox jewish
*KOSHER DIET
- no shellfish
- no pork
- do not combine meats / dairy in same meal
*PT NEEDS WRAPPED PLASTIC UTENSILS / PREP THEIR OWN MEAL
154
Halal diet
- no alc.
- no pork
- meat must be slaughtered religiously
155
seventh-day adventisit church
- no alcohol
- no caffeine
- lacto-ovo vegetarians
- no meat / pork
156
hinduism diet
- no eggs
- dairy ok
- no meat - esp. beef
157
where are steroids produced
produced by adrenal cortex
158
glucocorticoids effects
- mood
- immunosuppression
- break down fat and proteins
- inhibit insulin
159
mineralcorticoids effects
- retain sodium and water
- excrete potassium
(example; aldosterone)
160
where are catecholamines from
secreted by adrenal medulla
161
antidiuretic hormone
- secreted from pituitary gland
- retains water but not sodium
- medication replacement ends in -PRESSIN
162
thyroid hormone
- provide energy for metabolism
- TSH controls release of T3/T4
- low T3/T4 cause high TSH
- levothyroxine is T4 med. replacement
163
thyroid hormone negative feedback loop
- blood has low T3/T4 levels
- hypothalamus increases TRH
- pituitary increased TSH
- thyroid increases T3/T4
164
parathyroid hormone (PTH)
controls calcium levels by pulling from bones into blood
165
calcitonin
- released when serum calcium levels increase
- inhibit osteoclasts
166
metformin nursing considerations
- do not give in renal and hepatic impairment
- monitor BUN, Cr
- take with food
- hold 24hrs before and 48hrs after IV contrast studies
167
addison's disease
- TOO little steroids
- low cortisol; fatigue, wt loss, hypoglycemia
- low aldosterone; low sodium and water, potassium retention, hypoTNS
168
cushing's disease
- TOO much steroids
- high cortisol; immunosuppression, mood alteration, fat redistribution
- high aldosterone; fluid and sodium retention, potassium excretion
*remember moon face, buffalo hump, weight in abdomen
169
conn's disease
too much aldosterone
170
pheochromocytoma
- too much catcholamines due to tumour on adrenal gland
- s&s; tachycardia, palpitations, HTN, diaphoresis
*DO NOT PALPATE ABDOMEN IF SUSPECTED DT RISK OF RUPTURING TUMOUR
171
diabetes insipidus
- not enough ADH in the body
- s&s; drying effects, tachycardia, hypoTNS
- decreased USG
- increased Na, HCT, serum osmolarity
172
what to monitor after parathyroidectomy
- monitor for hypocalcemia
173
crackles
- sounds like wood burning in a fire place, popping
- air moving through mucous, fluid
174
rhonchi
- low-pitched, snoring
- secretions in airway
175
wheezes
- high pitched musical sound
- airway constriction
176
diminished
- quiet
- shallow or restricted breathing
177
stridor
- high pitched inspiratory sound
- upper airway obstruction
178
HIGH ventilator alarms
*HIGH PRESSURE
caused by;
- coughing
- gagging
- bronchospasm
- fighting ventilator
- ETT occlusion
- kink in tubing
- increased secretions
- thick secretions
- water in ventilator circuit
179
LOW ventilator alarms
*LOW PRESSURE
caused by;
- disconnected tubing
- loose connections
- leak
- extubation
- cuffed ETT or trach is deflated
- poorly fitted mask
180
why would a client need a chest tube?
- pneumothorax
- euffusions
- abscess
- cancer
- hemothorax
181
drainage collection chamber (chest tube)
- connected to patient
- air, fluid, blood drains into here
- no tidaling / bubbling
182
water seal chamber (chest tube)
- tidaling (up when pt breaths in)
- intermittent bubbling
- ensures suction is a closed system
183
suction control chamber (chest tube)
- connected to suction
- no tidaling
- gentle bubbling
- replace with sterile water PRN
184
montelukast
- leukotriene modifier
- managed allergic rhinitis, allergies, asthma
- long term to prevent attacks
- regulate mass cells
185
guaifenesin
- expectorant to loosen mucus and stimulate cough
186
assessment findings for COPD
- barrel chest dt hyper-inflated lungs
- accessory muscle use
- congestion
- diminished, crackles, wheezes
- acidotic
- hypercarbic
- hypoxic
187
pneumonia diagnosis
- CXR; patchy infiltrates
- sputum culture identifies bacterial source
188
air embolism positioning
left lateral trendelenburg (durant's maneuver)
189
pulmonary embolism positioning
high fowlers
190
cranial nerve I
olfactory - smell
191
cranial nerve II
optic - vision
192
cranial nerve III
oculomotor - pupil contriction
193
cranial nerve IV
trochlear - downward eye movement
194
cranial nerve V
trigeminal - jaw movement, sensation of face and neck
195
cranial nerve VI
abducens - lateral eye movement
196
cranial nerve VII
facial - facial movement, taste of 2/3 of tongue
197
cranial nerve VIII
vestibulocochlear - hearing and balance
198
cranial nerve IX
glossopharyngeal - swallowing, taste on posterior 1/3
199
cranial nerve X
vagus - swallowing, speaking
200
cranial nerve XI
spinal/accessory - flextion and rotation of head
201
cranial nerve XII
hypoglossal - tongue movements
202
normal ICP
5-15
203
ICP symptoms
- vomiting
- headache
- mental status changes; LOC, confusion
- eyes; pupillary changes, nystagmus
- speech; slurring, pressured
- cushing's triad; increased systolic BP, decreased HR, altered respirations
204
decorticate posturing
- abnormal flextion
- arms pulled toward center
- clenched fists
- damage to midbrain
205
aphagia
inability to swallow
205
dysphagia
difficulty swallowing
205
aspirin and children
- can cause Reye's syndrome if pt has viral infection
- commonly used in Kawasaki disease
205
decerebrate posturing
- abnormal extension
- arms and legs straight out
- toes pointed downwards with arched back
- damage to deep brain structures;pons
205
dysphasia / aphasia
impairment in comprehension or production of language
- receptive; damange to wernicke's
- expressive; damage to broca's
206
basilar skull fracture
- battle's sign; bruising over mastoid process
- raccoon eyes; periorbital bruising
- cerebralspinal rhinorrhea; halo test positive and positive for glucose on glucometer
*NEVER PUT ANYTHING IN NOSE AS IT CAN GO INTO BRAIN
207
epidural hematoma
- dura peeled off skull
- rapid expansion or blood between dura mater and skull
208
subdural hematoma
- dura attached to skull
- slow expansion of venous blood between arachnoid matter and dura matter
209
hypertensive crisis treatment
- sit client up to lower BP
- administer antihypertensives
- tx underlying cause (ex. full bladder - cath, constipated - disimpact, pressure injury - reposition)
210
hemorrhagic stroke
- vessel ruptures and bleeds into brain
- increases ICP
- "worst headache of my life"
- tx; control bleeding, craniotomy
211
ishemic stroke
- clot blocks blood flow to brain
- thrombotic; in brain artery
- embolic; clogs blood vessel leading to brain
- tx; permissive HTN (ensures brain perfusion), antithrombotics (tPA), surgical removal
212
stroke symptoms
- balance; dizziness, headache
- eyes; blurry vision, unequal
- face; unilateral drooping
- arms; arm/leg weakness
- speech; difficulty
213
menengitis assessment findings
- nuchal (Neck) rigidity
- photophobia
- fever
- kernig's sign; pt supine, bend leg up, INTENSE PAIN
- brudzinski's sign; pt supine, passive neck flexion causes involuntary flexion of knees and hips
214
multiple sclerosis
- autoimmune disorder
- CNS inflammation
- damages mylein sheath
215
guillain-barré
- antibody immunologic response precipitated by viral or bacterial illness
- causes ascending weakness and paralysis
- 2 week peak, slow recovery
- tx underlying illness
216
neuropathy
weakness, numbness and pain from nerve damage
217
botulism
- toxin released by bacteria found in soil, dust, honey
- after 1 year you can digest better
- inhibits acetylcholine release
- descending paralysis
- tx antitoxin
218
myasthenia gravis
- autoimmune disorder where communication between nerves and muscle are destroyed
- diagnosed via TENSILON TEST
219
parkinsons
- progressive
- caused by degeneration of dopamine neurons
- symptoms; tremor, rigidity, akinesia / ataxia, postural instability
220
T cells
coordinate attack and/or directly kill pathogens
221
B cells
produce antibodies
222
memory cells
circulate to patrol of repeat threats
223
monocytes
when activated become macrophages which "eat" antigen presenting cells
224
antigen
- protein marker on outside of cell
- marks "self" vs. "other"
225
antibody
- locks on to antigen on cell
- marks cell for destruction
226
antivirals
* END IN -VIR
227
antifungals
*END IN -ZOLE
*nystatin is topical cream / powder. common med for thrush
228
aminoglycosides - antibitoic
* END IN -MYCIN
- gram negative
- inhibit bacterial protein synthesis
*monitor for tinnitus
*vancomycin mostly used for sepsis. can get red-man syndrome so GIVE SLOW
229
fluroquinolones - antibiotic
*END IN -FLOXACIN
- for UTI, resp. infections, etc.
- inhibit bacterial protein synthesis
*monitor for prolonged QT, tendon rupture
230
penicillins - antibiotic
* END IN -CILLIN
- indicated for infections
- inhibits synthesis of bacterial cell wall
231
immunosuppressants
* TACROLIMUS, SIROLIMUS
- indicated for autoimmune disorders and transplant recipients
232
inactivated vaccines
- hep A
- flu
- polio
- rabies
233
live-attenuated vaccines
- MMR
- rotavirus
- smallpox
- chicken pox
- yellow fever
234
immune globulins
* IVIG, RhoGAM
- indicated for immunodeficiency, autoimmune disorders
*high risk for sensitivity reaction so start LOW AND SLOW
*can pre medicate with acetaminophen and diphenhydramine
235
airborne precaution infections
- TB
- rubeola (measles)
- varicella (chickenpox)
- SARS
- small pox
236
droplet precaution infections
- influenza
- pretussis
- mumps
- rhinovirus
- adenovirus
- meningitis
- streptococcus aureus
- rubella
- diptheria
237
contact precaution infections
- MRSA
- VRE
- norovirus
- rotavirus
- conjunctivitis
- herpes
- lice
- scabies
- poliomyelitis
238
sepsis
- infection spread in bloodstream
causes;
- increased capillary membrane permeability
- massive vasodilation
- BP is not high enough to perfuse tissues
239
signs and symptoms of sepsis
- shiver, fever, very cold
- extreme pain or general discomfort
- pale or discoloured skin
- sleepy, difficult to rouse
- "i feel like i might die"
- SOB
- elevated lactic acid level
- metabolic acidosis
- tachycardia
- tachypnea
240
sepsis tx
- blood culture
- broad spectrum IV ABX within 1 hour
- IV fluids
- vasopressors
241
systemic lupus erythematosus
- immune system attacks joints, skin, brain, lungs, kidneys, blood vessels
- flare ups and remissions
symptoms management;
- immunosuppressants
- steroids
- hydroxychloroquine
242
rheumatoid arthritis
- chronic systemic inflammatory disease
- destruction of connective tissue and synovial membrane in joints
243
psoriasis
- T-cell mediated inflammatory skin disease
- thickening of epidermis and dermis
symptom management;
- light therapy
- folic acid
- retinoids
- infliximab
244
topical antimicrobials
applied directly to the skin to tx bacterial, fungal, or viral infections
245
topical corticosteroids
reduce inflammation, redness, itching
246
primary lesion
direct result of a disease process
247
secondary lesion
developed as a consequence of the client's activities
248
stage 1 pressure ulcer
- non blanchable
- skin intact
249
stage 2 pressure ulcer
- PARTIAL THICKNESS
- dermis exposed
250
stage 3 pressure ulcer
- FULL THICKNESS
- exposed hypodermis
- granulation tissue, eschar, necrotic
- tunneling
251
stage 4 pressure ulcer
- through all hypodermis and exposes muscle, bone, cartilage
252
unstageable pressure ulcer
- too much eschar and cannot see base of wound
253
dermatitis
- inflammation of the dermis
- contact; hypersensitivity when exposed to allergen
- atopic (eczema); intense itching, flare ups
254
stevens-johnson syndrome
- cytotoxic t-cell drug reaction
- keratinocyte cell death
- causes extensive blistering
255
bacterial skin infections
- cellulitis; red, warm, swollen
- impetigo; bullous, ulcerative
- MRSA
256
viral skin infections
- HSV; type 1 (mouth), type 2 (genital). vesicles turn into pustules, rupture, and form crusts
- herpes zoster; grouped lesions with weeping and crusting
257
fungal skin infections
- tinea; classified by location. annular patches with elevated borders and scaling
- candidiasis; yeast infection causing burning and itching
258
squamous cell carcinoma
- very top layer of epidermis grow out of control
- tx; remove
259
basal cell carcinoma
- most common
- start in bottom layer of epidermis
- tx; remove
260
melanoma
- melanocytes grow out of control
- less common but more dangerous
- appearance; dark brown or black
- mostly on trunk / legs
- tx; immunotherapy, chemo, radiation
261
1st degree burn
- superficial
- skin remains intact
- redness, no blisters
262
2nd degree burn
- partial thickness
- blisters
- moist and red skin
263
3rd degree burn
- full thickness
- destroy nerve endings
- red, tan or black
- dry, leathery, eschar
264
4th degree burn
- involves bone and muscle underneath skin
- dry and dull
265
emergent burn phase
- first 24-48 hours
- high risk for hypovolemic shock, electrolyte imbalance, renal failure
- PRIORITY FLUIDS
266
rule of 9s for burn
- entire head is 9%
- front of chest is 9%
- front of abdomen is 9%
- back of chest is 9%
- back of abdomen is 9%
- front of EACH leg is 9%
- back of EACH leg is 9%
- front of EACH arm is 4.5%
- back of EACH arm is 4.5%
- groin area is 1%
267
burn complications
- hypovolemic shock
- renal failure
- hyperkalemia
- hyponatremia
268
burn fluid replacement
- crucial in first 24 hours
- LR
*want to output 30mL per hour
269
parkland burn formula
4mL x % body surface area burned x body weight (kg)
*give first half of the solution over the first 8 hours
*second half over the next 16 hours
270
pH of stomach
1.5-3.5
271
functions of the liver
- produce bile, albumin, cholesterol
- converts glucose to glycogen
- converts ammonia to urea
- metabolizes bilirubin, drugs
272
function of gallbladder
- stores bile
- releases bile into small intestine
273
what is bile
- green/yellow substance
- alkaline
- emulsifies lipids so they can be absorbed
274
functions of the pancreas
produce and releases digestive enzymes into duodenum
275
trypsin enzyme
break down proteins
276
amylase enzyme
break down carbohydrates
277
lipase enzyme
break down fats
278
TPN contents
- dextrose
- amino acids
- electrolytes
279
TPN complications
- infection (scrub the hub, change bag and tubing q24h)
- fluid overload
- hyper or hypoglycemia
- embolism
280
antiulcer agents
- H2 receptor blockers (*END IN -INE). blocks acid secretion
- PPI (*END IN -OLE). prevent H ion transport
- antacids
- GI protectant (sucralfate). provides barrier
281
gastric residual
greater than 500mL, stop feed and notify provider
282
blakemore tube
- 3 ports
- balloon is esophagus to stop bleeding varices
*KEEP SCISSORS AT BEDSIDE.
283
esophageal varices
- dilated veins in esophagus
- can burst
- dt liver disease, alcoholism
284
GERD
- acid refluxes from stomach into esophagus
- tx; sit upright after meals, small frequent meals, H2, PPI
285
gastric ulcer symptoms
- pain 1-2 hrs after meal
- pain aggravated by eating
- vomiting
- wt loss
- hematemesis
286
duodenal ulcer symptoms
- pain 2-4 hrs
- food may relieve pain
- wt gain
- melena
287
chron's disease
inflammation and erosion of the ileum anywhere along GI tract
288
ulcerative colitis
- inflammation of large intestine
- causes ulceration
- common in 20-40 and those of jewish descent
289
diverticular disease
- diverticula; herniation of mucosa through colon wall
- diverticulosis; asymptomatic
- diverticulitis; symptomatic
290
tx chrons, ulcerative colitis, diverticular disease
- low fiber
- avoid cold and hot foods
- no smoking
- antidiarrheals
- antibiotics
- steroids
- may need surgical removal of affected portion
291
appendicitis
- most common at 10 yrs
pain path;
- dull, steady pain
- over 4-6 hours pain progresses in RLQ
- sudden relief = rupture
292
McBurney's sign
- indicated in appendicitis
- significant pain when palpating 2/3 way from umbilicus in RLQ
293
pancreatitis
digestive enzymes activate inside the pancreas causing auto-digestion
294
pancreatitis assessment
- cullen's sign (c shape bruising above umbilicus)
- grey turner's sign
- abdominal distention
- ascites
- rigid abdomen
- jaundice
- hypotension
295
cholelithiasis
- gallstones
- hardened deposits of bile in gallbladder
- dt hyperlipidemia/bilirubinemia
296
cholelithiasis assessment
- sudden, sharp RUQ pain
- radiates to back and between shoulder blades
- worse after fatty meal / at night
297
cholecystitis
- gallbladder inflammation
- dt infection, blocked bile duct
298
hepatitis
- inflammation of liver
- different types dt different viruses
299
hepatitis A
- transmitted via food or water
- prevent by vaccine
- tx; supportive
300
hepatitis B
- transmitted via contact with bodily fluids
- prevent by vaccine, blood screening, improved hygiene
- acute; supportive
- chronic; antiviral therapy
301
hepatitis C
- transmitted via contact with bodily fluids
- prevent by blood screening, sterile needles
- tx; antivirals
302
hepatitis D
- transmitted via contact with bodily fluids (only if already infected with HBV)
- prevent by
blood screening, sterile needles
303
hepatitis E
- transmitted via food or water
- prevent by improved hygiene
- tx; supportive
304
hepatic encephalopathy
protein in diet is broken down into ammonia but dt liver inflammation, it is not converted into urea
305
how to decrease ammonia
- lactulose; binds to ammonia - antibiotics (neomycin or rifaximin); reduces bacterial ammonia production
- decrease protein in diet
306
aldosterone effects on the body
- sodium retained
- water retained
- potassium excreted
307
glomerulonephritis
- inflammation of kidney
- dt antibodies lodged in glomerulus causing decreased filtering ability
308
glomerulonephritis symptoms
- sore throat
- malaise
- flank pain
- HTN
- edema
- decreased UOP
- sediment / blood in urine
- increased BUN and Cr
309
nephrotic syndrome
kidney disorder causing body to pass too much protein in the urine
causes;
- infection
- NSAIDs
- cancer
- lupus
- diabetes
- strep
- inflammation
310
renal diet
LOW protein
LOW sodium
LOW phosphorus
*EXCEPT IN nephrotic syndrome, you want high protein
*AVOID DARK COLAS AND CHOCOLATE (high in phosphorus)
311
anasarca
edema that starts in the face and spreads to the whole body
312
pre renal failure
blood cannot get to the kidneys
313
intra renal failure
damage inside the kidney
314
post renal failure
something is blocking the urine from leaving the kidneys
315
acute kidney injury
- occurs suddenly
- cause a build up of waste products in the blood
316
chronic kidney disease
damage accumulates over time and the kidneys can no longer filter waste properly
317
phases of acute injury
- onset; UO decreases
- oliguric; fluid overload
- diuretic; can excrete waste but unable to concentrate urine
- recovery
318
diabetic nephropathy
chronic high blood glucose levels causes thickening of renal arterial wall and sclerosis of nephrons
319
stages of chronic kindey disease
lower the GFR, more damage there is
320
lab value in chronic kidney disease
- increased BUN / Cr
- metabolic acidosis
- HIGH potassium and phosphorus
- LOW calcium
321
hemodialysis
- client has fistula that is connected to machine to filter waste products
- rapid fluid shift; monitor BP/electrolytes
- must anticoagulant
322
characteristics of a good hemodialysis fistula
- palpate a thrill
- auscultate a bruit
323
peritoneal dialysis process
- dialysate is infused into peritoneal cavity
- dwells for 6 hrs
- fluid is drained along with toxins
324
peritoneal dialysis drainage
- should be clear
- ensure all comes out - turn to side if decreased fluid return
325
BPH
prostate and surrounding tissue grow excessively and squeeze urethra
326
BPH symptoms
- dribbling after urination
- excessive nocturnal urination
- frequency
- sense of incomplete bladder emptying
- incontinence
327
BPH diagnosis
- digital rectal exam
- urine test
- blood test
- PSA blood test
328
BPH tx
- alpha blockers; relax muscle fibers in prostate
- 5-alpha reductase inhibitors; shrink prostate
- tadalafil; relaxes smooth muscle
329
gynecoid pelvic shape
- normal
- rounded or blunt
330
anthropoid pelvic shape
- oval
- adequate outlet, narrow pubic arch
331
android pelvic shape
- angulated or heart shaped
- not favorable for birth or labor
332
platypelloid pelvic shape
- flat with coal inlet
- makes birth and labor difficult
333
ovarian hormones
*FSH, LH
- released by anterior pituitary gland
- control menstrual cycle (28 days)
334
estrogen
- female
- from ovaries
- stimulates female secondary sex characteristics
- repair uterus wall
- control ovulation
335
progesterone
- female
- from ovaries, placenta
- prevents uterine wall breakdown
336
testosterone
- male
- from testes
- stimulates male secondary sex characteristics
337
oral contraceptives
- stop ovulation, prevent implantation
- contain estrogen and progesterone
- higher clotting risk
338
education for cervix health
- PAP
- HPV vaccination
- quit smoking
- healthy eating
- low stress
339
endometriosis
- tissue that lines uterus grows outside
- pain in lower abdomen, back, pelvis, rectum, vagina
340
toxic shock syndrome
- accumulation of toxins that are produced by staph aureus
- risks; tampons, cervical caps
341
risk factors for STDs
- multiple sex partners
- breaks in skin
- inadequate condom use
- severity of partner infection
342
gonorrhea
transmission; oral, anal, vaginal, mom to baby
testing; urine, secretions, blood
tx; abx (doxycycline)
343
syphillis
- 3 stages (most infectious 1/2)
transmission; direct contact with lesions, mom to baby
testing; secretions, blood
tx; abx (penicillin)
344
chlamydia
transmission; oral, anal, vaginal, mom to baby
testing; urine, secretions
tx; abx (azithromycin, doxycycline)
345
herpes
- type 1; cold sores
- type 2; genital
transmission; sex, mom to baby
testing; physical, confirmed with labs
tx; antivirals
346
TORCH syndrome
infectious agents that can cause serious harm to developing fetus
- toxoplasmosis
- other agents
- rubella
- cytomegalovirus
- herpes
347
TORCH syndrome symptoms
- fever
- difficulty feeding
- hepatomegaly
- splenomegaly
- jaundice
- hearing impairment
- eye abnormalities
348
DMARD
*METHOTREXATE
indicated for RA
action; reduce joint destruction and slow disease progression by interfering in immune response
349
hypouricemic agent
*ALLOPURINOL
indicated for gout
action; inhibits xanthine oxidase to prevent uric acid from forming
*AVOID food high in purine (beer, wine, cheese, beans, cream)
350
bisphosphonate
*ALENDRONATE
indicated for osteoporosis
action; decrease bone resorption by osteoclasts
351
centrally acting muscle relaxers
*BACLOFEN
indications; muscle spasticity, MS, CP, SCI
action; suppresses hyperactive reflexes involved in muscle movement regulation
352
fracture treatment
- rest
- ice
- compression
- elevation
- immobilization; cast, splint, etc
- traction; temp. proper alignment
353
osteoporosis
- bone demineralization
- bone resorption accelerates and bone formation slows
354
osteoporosis risk factors
- women
- caucasian
- early / post-menopause
- smoking
- family hx
- excessive ETOH
- thing, small frame
- increased age
355
rheumatoid arthritis
- autoimmune disease
- destruction of connective tissue and synovial joints
- leads to dislocation and deformity
- pannus forms causing necrosis
- flares occur during fatigue and stress
356
RA assessment findings
- pain in morning
- visible joint deformities
- spongy, soft, boggy feeling joints
- warm / reddened joints
- elevated ESR
- positive rheumatoid factor
357
RA tx
NSAIDS, glucocorticoids, DMARD
358
osteoarthritis
- age related
- cartilage decreases and bones become sclerosed causing bone spurs
359
osteoarthritis assessment findings
- outgrowths; heberdens (close to fingernail), bouchards (middle finger joint)
- morning stiffness
- hard, bony, tender joints
- crepitus
- pain with activity
- no inflammation, redness, fever, fatigue
360
gout
- body cannot control uric acid production or exertion
- acid crystallizes and deposits in connective tissues
- inflammation and destruction of joints
361
gout assessment
- pain getting worse as day goes
- inflammation
- decreased mobility
- tophi (white/yellow)
- high uric acid levels
362
gout tx
- alternate cold and warm compress
- allopurinol, NSAIDS, corticosteroids
- avoid high purine foods
363
foods high in purine
- organ meats
- red meats
- anchovies
- sardines
- scallops
364
contractures
permanent muscle shortening caused by muscle spasticity
365
myopathy
- muscle weakness and atrophy
- decreased muscle strength and tone
- dt drugs, ETOH, idiopathic
366
rhabdomyolysis
severe injury to skeletal muscle causing the release of their intracelluar contents that can become toxic in circulation
367
rhabdomyolysis assesment
- dark urine (coca cola coloured)
- vomiting
- bruising
- fatigue
- muscle weakness
368
rhabdomyolysis tx
- fluids to protect kidneys
- diuretics
- bed rest
- monitor electrolytes and CK
369
fracture complications
- avascular necrosi
- compartment syndrome
- fat embolism
- infection
- osteomyelitis
- PE
370
compartment syndrome
- increased pressure in confined space
- increased pressure compromises circulation
- distal tissue becomes ischemic
371
fat embolism symptoms
- hypoxia
- dyspnea
- tachypnea
- confusion
- altered LOC
- petechial rash
372
anticoagulants
- heparin
- antiplatelet drugs
- warfarin
- factor Xa inhibitors
373
heparin
- thrombin inhibitor
- PREVENTS clots
- monitor aPTT
374
heparin induced thrombocytopenia and thrombosis (HITT)
- heparin complication
- 5-10 days after exposure
- platelet count drops
CM;
- skin lesions at injection sites
- chills
- fever
- chest pain
- DVT
375
low molecular weight heparins
*END IN -PARIN
- PREVENT clots
- dose based on body size
- always SC
- can be given in pregnancy
376
warfarin
- disrupts liver synthesis of clotting factors
- monitor PT and INR
- avoid foods high in vitamin K (leafy greens)
377
aspirin; acetylsalicylic acid
- decreases platelet aggregation
- don't administer with other anticoags
- d/c 5-7 days before surgery
378
salicylism
- ASA toxicity
CM;
- nausea
- tinnitus
- headache
- delirium
- hyperventilation
- pulmonary edema
- respiratory acidosis
379
fibrinolytcis/thrombolytics
* END IN -ASE
- break up clots
- converts plasminogen to plasmin
- must be given ASAP
380
coagulants
- stop bleeding by forming clot
- vitamain K
- protamine sulfate
- thrombin
381
blood administration
- 2 RN check
- filtered blood tubing
- large gauge IV (20, 18)
- can only give with NS
- vitals before, 30 min in, and end
382
febrile transfusion reaction symptoms
- fever
- chills
- tachycardia
- tachypnea
- hypoTNS
383
hemolytic transfusion reaction symptoms
- mild; fever, chills, headache
- chest pain
- tachycardia
- tachypnea
- hypoTNS
- hemoglobinuria
- apprehension
- severe; DIC, circulatory collapse
384
allergic transfusion reaction symptoms
- rash
- itching
- bronchospams
385
polycythemia vera
- excessive erythrocytes, leukocytes and thrombocytes
- hyper viscous blood causing poor perfusion
386
iron deficiency anemia
dt;
- iron deficient diet
- chronic ETOH
- malabsorption
- rapid metabolic activity; pregnancy, adolescence, infection
386
387
vitamin B12 deficiency anemia
dt;
- dietary deficiency
- malabsorption
388
aplastic anemia
- body stops producing enough new blood cells
- dt damage to bone marrow
389
anemia assessment findings
- tachycardia
- orthostatic hypoTNS
- dyspnea on exertion
- fatigue
- pallor
- cool skin
- mottled
- delayed cap refill
- unable to tolerate cold
390
sickle cell anemia
- disorder causing RBC to "sickle" and break down
- autosomal recessive
391
sickle cell crisis
- decreased blood flow to tissues leads to hypoxia, ischemia, infarction
- severe joint pain
- splenomegaly and tenderness
dt;
- hypoxia
- exercise
- high altitude
- fever
392
sickle cell crisis tx
- IV fluids; decreased sickled cell concentration
- blood transfusion; provides normal RBC
- oxygen; increase oxygenation
- pain medications
- hydroxyurea; increases production of fetal hemoglobin to reduce crises
393
disseminated intravascular coagulation (DIC)
proteins that control blood clotting become overactive
394
disseminated intravascular coagulation (DIC) cascade
- precipitating event activates coagulation cascade
- causes excess thrombin = excess clotting
- too mich plasminogen turning into plasmin causing fibrinolysis and excess bleeding
395
disseminated intravascular coagulation (DIC) cascade triggers
- blood transfusion
- cancer
- pancreatitis
- liver disease
- severe tissue injury
- pregnancy complication
- sepsis
396
disseminated intravascular coagulation (DIC) cascade lab findings
LOW
- platelet count
- fibrinogen
HIGH
- PT
- INR
- PTT
- D-dimer
397
cancer stage 1
- early stage
- small, invasive mass or tumor
398
cancer stage 2
- localized stage
- tumor spread to nearby tissue
- mass grown in size
- spreads to nodes near mass
399
cancer stage 3
- regional spread
- affects more of surrounding tissues
- spreads to nodes away from mass
400
stage 4 cancer
- distant spread
- spread to other tissues/organs beyond initial location
401
cancers classic warning signs
- change in bowel or bladder habits
- sore that does not heal
- unusual bleeding or discharge
- thickening or lump on skin
- indigestion
- obvious change in wart or mole
- nagging cough or hoarseness
402
chemotherapy
stops cancer cell growth and from metastasizing
403
chemotherapy side effects
- anemia
- thrombocytopenia
- neutropenia
- GI upset
404
chemotherapy precautions
- wash hands before and after medication and wear gloves while handling
- handle bodily fluids with care
405
radiation
- shrink and kill cancer cells
- external or internal
406
external radiation precautions
- less time near source
- stay behind shield when near the source
407
internal radiation precautions
- was laundry separately
- flush toilet twice
- use separate utensils, towels
- drink lots of fluid
- no kissing or sexual contact (1 week)
- avoid infants, pregnant women, pets, public transportation, work, school
408
neutropenic precautions
for those who are immunocompromised
- private room with closed doors
- no fresh fruits, veggies, flowers in room
- no live vaccines
- limit visitation
409
leukemia
bone marrow produces increased numbers of immature leukocytes which suppress the production of normal blood cells
409
leukemia assessment
- wt loss
- fatigue
- bleeding
- fever
- pallor
- bruising
- arthralgia (joint stiffness)
410
leukemia management
- neutropenic precaution
- antibiotics (IV)
- antiemetics
- enteral nutrition
- blood product administration
411
hodgkin's lymphoma
- localized, single node
- reed-sternberg cells present
412
non- hodgkin's lymphoma
- multiple nodes involved
413
lymphoma assessment
- painless swelling of lymph nodes
- night sweats
- fatigue
- fever
- infections
- wt loss
- enlarged liver of spleen
414
lung cancer symptoms
- wheezing
- hemoptysis (coughing blood)
- cough
- SOB
- difficulty swallowing
415
esophagus cancer
dt reflux and long term exposure or irritants (ETOH, tobacco)
cm; chest pain, dysphagia
416
stomach cancer
dt H.pylori infection, high salt intake, nitrates in pickled or salted food, low fruit and veggies intake, ETOH, tobacco
417
breast cancer predisposing factors
- female
- 55+ yrs
- menopause
- BRCA1 and BRCA2 genes
418
breast self exam
- done monthly on SAME day
- 3-7 days after period ends
419
prostate cancer predisposing factors
- african american males
- 60+ yrs
- family hx
- ETOH abuse
- high fat diet
- farmers
- painters
420
prostate cancer screening
- blood test for PSA
- digital rectal exam (DRE) to feel prostate
421
wilms tumor
- most common childhood kidney tumor
- nephroblastoma
422
wilms tumor assessment
- swelling or palpable mass in abdomen
- abdominal pain
- hematuria, anemia, HTN
423
tumor lysis syndrom
many cancer cells die in short period of time and contents are released into bloodstream
causes;
- hyperkalemia (EKG changes)
- hyperuricemia (kindey damage)
- hyperphosphatemia (kidney damage)
- hypocalcemia (seizures, tremors)
424
true or false; calcium has a sedating effects
TRUE
425
facial plethora
edematous, shiny, pink face dt superior vena cave syndrome (blood stuck in upper extremity)
426
APGAR assessment
- appearance
- pulse
- grimace
- activity
- respiration
*10 IS HIGHEST
* 7 OR ABOVE IS IDEAL
*DONE AT 1 AND 5 MIN
427
newborn reflexes
- rooting - could remain for 1yr
- palmar grasp - diminish 3-4mo
- babinksi (positive when toes fan out) - gone at 1yr
- moro (startle) - gone at 6mo
428
normal integumentary findings on a newborn
- lanugo
- milia
- vernix caseosa
429
meconium aspiration assessment
- intense work of breathing
- grunting
- nasal flaring
- tachypnea that can lead to bradypnea
430
newborn physiological jaundice
- appears on day 2-3 of life
- expected
431
newborn pathological jaundice
- occurs within first 24 hrs
- not expected
- possible liver issue or ABO incombatibility
432
kernicterus
- brain damage resulting from high levels of bilirubin in the blood
- tx; phototherapy (helps break down bilirubin). DO NOT EXPOSE EYES AND PRIVATE PARTS
433
foramen ovale
opening between right and left atrium present in fetal circulation
434
ductus arteriosis
opening between pulmonary artery and aorta present in fetal circulation
435
risk factors for congenital heart defect in newborns
- maternal viral infections
- maternal diabetes
- drug and ETOH use
- advanced maternal age
436
PDA
- failure of ductus arteriosus to close
- machine like murmur
437
alprostadil
keeps suctus arteriosus open to allow blood to get out to newborn body when it otherwise couldn't
438
arterial septal defect
- open between atria
- more blood flow out to lungs
- often asymptomatic until late childhood
- murmur
439
ventricular septal defect
- opening between ventricles
- too much blood to lungs
- signs begin 2-8 weeks
- loud murmur, pale, sweaty
440
atrioventricular canal defect
- opening between atria and ventricles
- heart failure & failure to thrive
- murmur
441
tetralogy of fallot
- large VSD
- pulmonary stenosis
- right ventricle hypertrophy
- overriding aorta
- sends deoxygenated blood out to body
cm; cyanosis, dyspnea, poor feeding, wt gain, tet spells
*KEEP BABY CALM - CRYING CAUSING TET SPELLS
442
tricuspid atresia
- tricuspid valve does not grow
- deoxygenated blood out to body
443
transposition of the great arteries
- aorta and pulmonary artery are switched
- oxygenated blood continuously circulating through pulmonary circuit. deoxygenated blood through systemic
444
hypoplastic left heart syndrome
- left sided structures are small
- blood flows through ASD back to right side
- when hole closes, very little blood gets out to body
*PUT ON PROSTAGLANDINS TO KEEP HOLE OPEN
445
4 D's of epiglottitis
- dysphagia
- dysphonia
- drooling
- distress
446
meningocele
- closed spina bifida
- protrusion of spinal fluid-filled meninges through vertebral defect
447
myelomeningocele
- open spina bifida
- protrusion of spinal fluid-filled meninges AND spinal cord through vertebral defect
448
microcephaly
small head size
cm;
- impaired cognitive development
- delayed motor function and speech
- facial distortion
- dwarfism
- hyperactivity
- seizures
449
cleft lip / palate management
- surgical corrected
- lip first at 3-6 mo
- palate 6-24 mo
- feed with specialized bottles
- elbow restraints so they don't pull sutures
- prone positioning to drain secretions
- nothing in mouth
450
esophageal atresia
- part of esophagus does not form
- cannot swallow food
- surgical repair
451
pyloric stenosis
pylorus is narrow but food cannot pass from stomach through intestines
- olive shaped mass
452
omphalocele
abdominal contents protrude through the umbilicus while remaining in peritoneal sac
453
intussusception
part of intestine slips inside the other intestine
cm;
- red currant jelly stools
- lots of pain
- green, bilious emesis
- sausage shaped mass in abdomen
454
hirschsprung's
absence of neurons in rectum and/or colon which leads to NO peristalsis and stool build up
cm;
- ribbon like stool
- swollen belly
- constipation
- gas
- irritation
- vomiting green or brown
455
kawasaki disease
infectious agent triggers T cells to overproduce cytokines which cause activation of leukocytes to adhere to vascular walls and damage blood vessel lining
cm;
- strawberry tongue
- bilateral conjunctivitis
- red, swollen hands
- high fever
- elevated CRP, ESR, WBC, platelets
*ONLY TIME CAN GIVE ASPIRIN IN KIDS
456
phenylketonuria
body is unable to break down phenylalainne cause damage to CNS
- screening 24-48 hrs
- heel stick
- avoid foods high in protein, dairy products, aspartame
457
rickets
softening and weakening of bones due to lack of vitamin D
- bow legs
- weakness
- spine, pelvis, leg pain
458
impetigo
- bacterial disease in children
- honey coloured crust forms
459
burns in children
TBSA burned; lund and browder chart
fluid replacement;
3mL x TBSA x kg = LR in 24 hrs
OU;
at least 0.5 mL/kg/hr
460
infants developmental stage
erkison; trust vs. mistrust (birth to 18 mo)
piaget; sensorimotor (birth to 2 yrs)
461
3 mo. infant milestones
- cooing sounds
- smile at people
- distinct cries
- recognize voices
- hold head up in tummy time
462
6 mo. infant milestones
- babble
- gurgling sounds
- giggle, laugh
- voice to express pleasure
- growing 1/2-1 inch per month
- gain 5-7 oz per week
- BIRTH WT SHOULD BE DOUBLE
463
9 mo. infant milestones
- sit without support
- imitate speech, sounds
- recognize own name
- gaze shift to objects being spoken about
464
12 mo. infant milestone
- communicate with 1-2 words
- recognize familiar words
- standing
- answer simple questions nonverbally
- BIRTH WT SHOULD BE TRIPLED
465
18 mo. infant milestone
- walk
- anterior fontanelle close
- speak 18+ words
- repeat overheard words
- point to familiar objects
- can follow simple commands
466
toddler developmental stage
erikson; autonomy vs. shame and doubt (18mo - 3yrs)
piaget; preoperational (beings at 2yrs)
467
2yr milestone
- 2 word phrases
- 2 step direction
- 50+ words
- speak well enough to be understood
- can run and kick a ball
- can go forward facing in car seat
- parallel play
468
preschooler developmental stage
erikson; initiative vs guilt (3-5yrs)
piaget; preoperational (until 7yrs)
469
3yr milestone
- 200+ words
- use phrases
- understand spatial concepts
- use plurals
- dress themselves
- use forks
470
4yr milestone
- understand and ask "why and how"
- identify colours
- express own feelings and ideas
- group objects together (ie food, animals)
- catch balls
- undo buttons
471
school age developmental stage
erikson; industry vs. inferiority (5-13yrs)
piaget; concrete operational (7-11yrs)
472
adolescent developmental stage
erikson; identity vs role confusion (13-21yrs)
piaget; formal operation stage (12+ yrs)
473
young adult developmental stage
erikson; intimacy vs isolation (21-39 yrs)
474
middle adults developmental stage
erikson; generativity vs stagnation (40-65yrs)
475
old adults developmental stage
erikson; integrity vs despair (65+yrs)
476
presumptive signs of pregnancy
- amenorrhea (no period 3 mo)
- really tired
- enlarged breasts
- sore breasts
- urination frequency
- movement perceived (quickening 16-20 weeks)
- emesis and nausea
477
probable signs of pregnancy
- positive pregnancy test
- return of fetus when tapped (ballottement)
- outline of fetus palpable
- braxton hicks
- softening of cervix (goodell's sign)
- bluish cervix (chadwick's sign)
- lower uterine segment softens (hegar's signs)
- enlarged uterus
478
positive signs of pregnancy
- fetal movement seen/felt by HCP
- electronic device detects fetal heart sounds
- delivery of fetus
- ultrasound detects fetus
479
naegele's rule
1st day of last period + 7 days - 3 months + 1 year = estimated due date
480
first trimester
1 mo; fertilized egg, amniotic sac, primitive face, heart tubes
2 mo; neural tubes, HR at 6 weeks via ultrasound
3 mo; extremities fully developed, fully formed organs
481
second trimester
4 mo; HR audible with doppler at 10 weeks, functional nervous system
5 mo; muscle development, hair, vernix caseosa
6 mo; eyelids open, movement response, may survive premature at 23 weeks
7 mo; body fat, hearing fully developed, respond to stimuli, likely survive premature
482
third trimester
8 mo; kicking, see and hear
9 mo; lungs fully developed, coordinated reflexes
10 mo; labor can happen anytime, movement decreases
483
pregnancy nutritional needs
- proteins; lean, white meat
- complex carbs; starchy veg, beans
- fiber; plant foods, legumes
- healthy fat; avocados, nuts, seed
484
caloric needs during pregnancy
additional 300 calories a day if within normal BMI
*if lower BMI, maybe 500 calories
485
additional supplements in pregnancy
- folate / folic acid
- calcium
- vitamin D
- iron
- DHA (omega 3 fatty acid)
- iodine
486
foods to avoid in pregnancy
- fish high in mercury
- cold deli meats
- hot dogs
- raw meat and eggs
- unpasteurized dairy products
- pate, liver
- unwashed produce
- alcohol
- caffeine (no more than 200mg / 12 oz)
487
drugs to avoid in prgnancy
- NSAIDS; aspirin, ibuprofen, advil, motrin
- ACE inhibitors
- sulfonamide/fluoroquinolone antibiotics
- warfarin
- benzodiazepines
- castor and mineral oils
- chloramphenicol
- isotretinoin (acutane)
488
routine pregnancy exams
- blood type/Rh factor
- STI testing
- glucose challenge
- urinalysis
- anatomy ultrasound
- non-stress test
- group B strep
- kick counts
489
oral glucose tolerance test in pregnancy
- at 28 weeks
- mom drinks 50g of oral glucose
- 1 hour later blood sugar is checked
- >140, 3 hours glucose test is performed
490
3 hour glucose tolerance test in pregnancy
- mom cannot eat or drink 8 hours before
- fasting sugar checked
- mom drinks 100g of oral glucose
- sugar checked at 1, 2 and 3 hours
- fails = gestational diabetes
491
non-stress test in pregnancy
baby should have 2 accelerations in 20 min (reactive). not reactive can indicate baby may not tolerate labour
492
FHR patterns and causes "VEAL CHOP"
- variable deceleration = cord compression
- early deceleration = head compression
- accelerations = Okay!
- late decelerations = placental insufficiency
492
non reassuring FHR nursing interventions
- lay mother on left side
- increase IV fluids
- oxygen
- notify PCHP
- discontinue oxytocin
493
GTPAL
- gravidity; number of pregnancies
- term; number of pregnancies carried to 37 weeks
- preterm; births between 20 and 36+6 weeks
- abortions; pregnancy ends before 20 weeks
- living children; number of alive children
*twins only count ONCE except L
494
skin changes in pregnancy
- melasma
- dark spots
- pregnancy glow
- acne
- linea nigra
- stretch marks
- PUPPP (puritic uticarial papules and plaques of preg.)
- skin tags
495
hyperemesis gravidarum
- lasts entire pregnancy
- cannot keep food or water down
- wt loss, dehydration, electrolyte imbalances
- tx; promethazine, TPN, IVF
496
preeclampsia s&s
- >20 weeks
- BP >140/90 2 times, 4hrs apart
- protein in urine
- facial puffiness
- pedal edema
- wt gain
497
eclampsia
BP so high seizures can occur
498
preeclampsia risk factors
- multiple fetuses
- chronic HTN
- gestational HTN
- obesity
- increased age
- african american
- DM
- use of in vitro fertilization
- kidney disease
499
HELLP syndrome
hemolysis, elevated liver enzymes and low platelet count
tx; corticosteroids, antihypertensives, blood products, delivery
500
risk factors of gestational diabetes
- overweight / obese
- prediabetes hx
- hx of baby wt greater than 9lbs
- black, hispanic, american indian, asian
501
cholestasis in pregnancy
- bile acids enter bloodstream
- causes itching in soles and palms
- compromises fetal safety
502
ectopic pregnancy
- egg implants outside the uterine cavity
- cm; dizziness, n&v, abdominal/pelvic pain, loss of appetite
- tx; methotrexate (aborts fetus), surgical removal
503
variability in FHR
- absent; not good
- marked; expected in labour otherwise a concern
- moderate; good
504
FHR normal
110-160
505
FHR accelerations
FHR increases when a contraction occurs
- want 15 bpm increase for 15 secs
506
early decelerations in FHR
when contraction occurs, FHR goes down.
*indicates head compression
*U shape on monitor
*not good or bad
507
variable decelerations in FHR
when contraction occurs, FHR plummets and then spikes back up.
*indicates cord compression
*sharp V shape on monitor
508
late decelerations in FHR
FHR drops after contraction occurs.
*placental insufficiency (baby not getting enough oxygen)
509
true labor contractions
- regular, interval getting shorter
- contractions continue even with mother movement
- increased intensity
- start lower back and move to front of abdomen
510
tocolytics
*TERBUTALINE, MAGNESIUM-SULFATE
- slow contractions
511
baby position lettering
- L for if back is on mother's left side
- R for if back is on right side
- O for occiput comes through birth canal first (head)
- M for mentis (chin down)
- S for sacral (butt down)
- A for if back is anterior
- P for if back is posterior
- T for if back is directly towards one hip or the other (transverse)
*WILL HAVE 3 LETTERS
*L/R, O/M/S, A/P/T
512
first stage of labor
- cervical dilation to 10cm
- latent; 0-6cm
- active; 6-10cm
513
second stage of labor
- ends when fetus is delivered
- 7 cardinal movements
- pushing stage for 2-3 hours
514
third stage of labor
- ends when placenta is delivered
515
signs of separation of placenta from uterine wall
- gush of blood
- umbilical cord lengthening
- globular shape fundus
516
fourth stage of labor
- first 1-2 hrs after delivery
- monitor for hemorrhage, infection
517
placenta previa
- placenta over birth canal
- painless bright red bleeding
518
abruptio placenta
- placenta tears away from uterine wall
- PAINFUL
- partial; abdomen will feel hard has a board dt internal bleeding
- complete; massive external bleeding
519
prolapsed cord
- elevate presenting part of fetus off the cord
- knee to chest or trendelenburg
- administer o2
- emergency c-section
520
shoulder dystocia
- 1 min since head delivery with no shoulders
- turtle's sign; head delivered then pulls back
521
shoulder dystocia interventions
- call for help
- evaluate for episiotomy
- mcrobert's maneuver; thighs to abdomen
- supra pubic pressure
- enter maneuvers
- remove posterior arm
- gasket maneuver; roll onto hands and knees
- stop pushing
522
chorioamnionitis
membranes around fetus are infected by bacteria
523
risk factors for PPH
- twins
- macrosomic
- preeclampsia
- prolonged or precipitous labor
- forceps or vaccuum
- excessive amniotic fluid (polyhrdramnios)
524
electroconvulsive therapy
- 6 to 12 initial tx
- maintenance tx
- NPO night before
- reorient pt when awake
- cannot drive home
525
purging via vomiting signs
- esophageal varices
- tooth enamel breakdown
- russell's sign on knuckles
526
BMI formula
weight (kg) / height squared (m2)
527
BMI weights
- <18.5 = underweight
- 18.5-24.9 = normal
- 25.0-29.9 = overweight
- >30 = obese
528
total client care model
RN is responsible for all aspects of care during a shift
529
primary nursing model
RN is responsible for caseload of clients and provides care for same clients during their hospital stay
530
team nursing
team members provide care under supervision of RN leader (1 nurse meds, 1 nurse bed baths, 1 nurse wound care, etc.)
531
standard precauction
- hand hygiene
- PPE if you expect bodily fluid exposure
- disinfect equipment
- safe injection practices
532
contact precautions
- hand hygiene
- gown
- gloves
- disposable equipment
- private room or cohort
*FOR
- MRSA
- VRE
- diphtheria
- RSV
- herpes
- pediculosis
- scabies
- c. diff
- noro/rota virus
533
droplet precaustions
- hand hygiene
- mask
- private room or cohort
*FOR
- flu
- mumps
- pertussis
- rubella
- bacterial meningitis
- epiglottitis
- parvo
- diphtheria
- penumonia
534
airborne precuations
- hand hygiene
- N95
- private, negative pressure room
- closed door
- gown
- gloves
*FOR
- TB
- measles
- varicella
- SARS
- Smallpox
- VZV
535
donning PPE
*GROUND UP
- gown
- mask
- goggles
- gloves
536
doffing PPE
- gloves
- goggles
- gown
- mask
537
normal age changes
*DECREASED
- vision
- hearing
- liver and kidney function
- skin turgor and elasticity
- decalcification of bones
538
primary prevention
- intervene before individual has health issue
*Includes;
- education
- immunizations
- modifying risk behaviour
539
secondary prevention
- early disease identifications
*Includes;
- screenings
- health fair
- regular BP checks
540
tertiary prevention
- tx disease and prevent complications
*Includes;
- nutritional education for chronic illness
- outpatient therapy
- support groups
541
birth immunization
hep B
542
2 and 6 mo. immunizations
- DTaP
- Rotavirus
- IPV
- PCV13
- Hib
- Hep B
543
4 mo. immunizations
- DTaP
- Rotavirus
- IPV
- PCV13
- Hib
544
12 mo. immunizations
- Varicella
- Hep A
- MMR
- PCV13
- Hib
545
4-6 yr immunizations
- MMR
- IPV
- DTaP
- varicella
546
resonance percussion
- hallow
- over air filled space
- ex. lung
547
flatness percussion
- loud boom
- over solid things
- ex. bone, muscle
548
tympany percussion
- drum like
- over fluid
- ex. abdomen
549
wheeze
high pitched whistle caused by airway narrowing
ex. asthma, COPD
550
stridor
high pitched INSPIRATORY wheeze dt blockage of airflow in trachea
ex. epiglottitis, foreign body, edema
551
crackles
coarse rattling sounds caused by airway secretions
ex, pneumonia, edema, bronchitis
552
rales
fine crackles that sound like bubbling, rattling, small clicking
ex. when air opens alveoli
553
S3 heart sound
sloshing noise after S2 dt fluid overload
ex; CHF, pregnancy
sounds like "ken-tuck-y"
554
S4 heart sound
extra beat before S1 due to stiff, failing, hypertrophic LV
ex; HTN, aortic stenosis, cardiomyopathy
sounds like "ten-ess-ee"
555
medications that increase cardiac output
- ACE Inhibitors
- ARBs
- Nitrates
- Inotropes
