NUR-345 Final Exam Flashcards
(172 cards)
1
Q
What are the two types of megaloblastic anemias?
A
Cobalamin (Vitamin B12) deficiency and folic acid deficiency
2
Q
What causes a cobalamin (Vitamin B12) deficiency?
A
- dietary deficiency
- intestinal malabsorption
- chronic alcholism
- a lack of intrinsic factor
3
Q
How is cobalamin (Vitamin B12) deficiency treated?
A
Parenteral (IM injections [cyanocobalamin or hydroxocobalamin]) or intranasal (Nascobal, CaloMist) for life
4
Q
How is folic acid deficiency treated?
A
1-5 mg/day PO
5
Q
What is the normal aPTT time?
A
25-35 seconds
6
Q
What is the normal PT time?
A
11-16 seconds
7
Q
How is neutropenia diagnosed?
A
<1000 and <500 is LIFE threatening!
8
Q
What is neutropenic isolation?
A
- strict handwashing
- private room w/ HEPA (reverse isolation)
- no flowers or plants
- no raw fruits or veggies
- assess visitors prior to entry
9
Q
What are the symptoms of Hodgkin’s lymphoma?
A
insidious onset w/ enlarged, movable, non-tender cervical/axillary/inguinal lymph nodes
other sx:
- weight loss
- fatigue
- weakness
- fever
- chills
- tachycardia
- night sweats
- generalized pruritis
10
Q
What electrolyte should be monitored with multiple myeloma?
A
calcium d/t increased uptake by bone
11
Q
What is the nursing management in a pt with MLL who has hypercalcemia?
A
high fluid intake; urine output monitoring to prevent kidney stone formation
12
Q
What should the nurse do if abnormal VS (like increased temperature) are obtained before starting a blood transfusion?
A
call MD w/ abnormal VS
13
Q
What is a febrile, nonhemolytic reaction?
A
the sensitization to donor WBCs, platelets, or plasma proteins
14
Q
What are the clinical manifestations of a febrile, nonhemolytic reaction?
A
sudden chills and fever (rise in temp of > 1 degree C), HA, flushing, anxiety, vomiting, muscle pain
15
Q
What is the nursing management for a febrile, nonhemolytic reaction?
A
give antipyretics as prescribed–avoid aspirin in thrombocytopenic pts and DO NOT RESTART transfusion unless ordered my MD
16
Q
How do you prevent a febrile, nonhemolytic reaction?
A
consider leukocyte-poor blood products (filtered, washed, or frozen) for pts w/ a hx of two or more such reactions
17
Q
What are the manifestations of left sided heart failure?
A
- weakness
- fatigue
- increased HR
- anxiety, depression
- dyspnea
- shallow respirations (32-40/min)
- paroxysmal nocturnal dyspnea (reabsorption of fluid from dependent body areas, pt feels suffocated)
- orthopnea, dry, hacking cough
- nocturia
- frothy, pink-tinged sputum
18
Q
What are the manifestations of right sided heart failure?
A
- fatigue
- increased HR
- anxiety, depression
- dependent, bilateral edema w/ wt gain
- ascites/anasarca
- cachexia
- RUQ pain
- anorexia and GI bloating
- nausea
- dusky > brown > brawny skin coloration
- lower extremity shiny w/ decrease hair growth
- confusion
19
Q
What are the symptoms of a DVT?
A
- extremity pain
- edema
- increase in calf circumference
- (+) Homan’s sign
20
Q
What are the complications of a DVT?
A
pulmonary embolism
21
Q
What is the nursing care given to a patient with a venous leg ulcer?
A
- moist dressings
- high protein diet
- vit. A, vit. C, and zinc acid aid in wound healing
- compression of the leg is essential to healing
- elastic wraps
- unna boot
22
Q
What are the common SE of Lasix?
A
- dehydration
- hypocalcemia
- hypocholoremia
- hypokalemia
- hypomagnesemia
- hyponatremia
- hypovolemia
23
Q
What are the sx of hypocalcemia?
A
- anxiety, irritability
- tetany, abdominal cramps
- (+) Chvostek’s and Trousseau’s signs
- convulsions, bone fracture
- tingling, numbness
24
Q
What is HbA1c?
A
shows the amount of glucose attached to hemoglobin molecules over RBC life span (approximately 120 days)
25
What is the normal value of HbA1c?
\<7%
26
What does a normal HbA1c reduce?
the risk of retinopathy, nephropathy, and neuropathy associated with DM
27
What does HbA1c measure?
the amount of glycoslated hemoglobin as a percentage of total hemoglobin
28
What type of insulin is Novolog?
rapid-acting insulin
29
What type of insulin is NPH?
intermediate-acting
30
What is the onset, peak, and duration of Novolog?
Onset: 15 min
Peak: 60-90 min
Duration: 3-4 hours
31
What is the onset, peak, and duration of NPH?
Onset: 2-4 hours
Peak: 4-10 hours
Duration: 10-16 hours
32
What are the storage instructions for insulin?
* Do not heat/freeze
* In-use vials may be left at room temperature up to 4 weeks
* Extra insulin should be refrigerated
* Avoid exposure to direct sunlight
* Insulin can be stored in a thermos or cooler to keep it cool (not frozen) if the patient is traveling in hot climates
* Prefilled syringes are stable up to 1 week when stored in the refrigerator
33
When is a subtotal thyroidectomy indicated?
* Ig goiter causing compression
* Unresponsive to antithyroid meds
* Thyroid cancer
34
What are the instructions prior to receiving a subtotal thyroidectomy?
anti-thyroid meds are taken 4-6 weeks prior to get to Euthryroid state
35
What are the possible complications of a subtotal thyroidectomy?
* hypothyroidism
* hypoparathyroidism
* hypocalcemia (tetany)
* hemorrhage
* damage to laryngeal nerve
* infection
* thyrotoxic crisis
* airway obstruction
36
What is a thyroid storm?
A life threating condition with a high mortality rate. It occurs when there is a large "dumping" of thyroid hormone into the system.
37
What are the manifestations of a Thyroid Storm?
* increased BMR
* fever
* HTN
* tachycardia
* arrhythmia
38
What are the nursing responsibilities in caring for a patient experiencing a thyroid storm?
* assess for the clinical manifestations
* treat with tylenol
* sponge bath
* Inderal (propranolol)
* IV fluids
39
What are the nursing responibilities for a patient post-subtotal thyroidectomy?
* teach pt turning techniques to avoid stress on suture lines; have O2, suction, tracheostomy tray all in pt's room post-op
1. airway
2. respiratory status
3. laryngeal damage
* assess q2h for VS, hemorrhage (feel behind neck), neck swelling, frequent swallowing, choking
* keep pt in semi-fowler's position with only a small pillow to avoid pillow to avoid neck flexion
* assess for tetany (d/t accidental parathyroid removal): tingling, muscle twitching, Trousseau & Chvostek signs
40
What are the nursing responsibilities post-transphenoidal hypophysectomy?
* HOB elevated 30 degrees
* oral care q2h (no tooth brush) with floss/rinsing mouth (continue for 2 weeks)
* assess nasal drainage for CSF --\> if positive for glucose, there is a CSF leak
* monitor and correct electrolytes and glucose levels
* Monitor ECG
* Protect from infection
* assess for presence of halo sign (yellow on the edge and clear in the middle) as it indicates CSF
* assess nuero conidtion every hour for the first 24 hours and then q4h
* administer stool softeners to prevent straining
* breathe through mouth
* NO bending over/coughing/blowing nose/sneezing
41
What is the treatment for an Addison's crisis?
* IV hydrocortisone
* IV replace fluid loss
* reverse hyperkalemia (Kayexalate)
* monitor BP
* ECG
* monitor VS closely
42
What is the treatment for Addison's disease?
* lifelong replacement of corticosteroids (Prednisone) and mineralcorticoids (Florinef)
* Na+ replacement during excess heat
* avoid using alcohol or caffeine
* monitor sx for gastric bleeding or hypoglycemia
43
What is the normal value range for BUN?
6-20 mg/dL
44
How is a UTI prevented?
* complete entire antibiotic rx
* maintain daily fluid intake of half their body weight in ounces (150 --\> 75 oz/day)
* good peri-care habits
* empty bladder frequently/completely
* urinate before/after intercourse
* avoid bath salts, vaginal deodarant sprays, bubble baths, bath oils, hot tubs
* fluids/foods to avoid d/t being potential bladder irritant: caffeine, alcohol, citrus juices, chocolate, highly spicey foods
45
What foods should be avoid in a pt with calcium oxalate kidney stone?
* black tea
* spinach
* rhubarb
* cocoa/chocolate
* beets
* pecans
* peanuts
* okra
* wheat germ
* lime peel
* swiss chard
46
What foods should be avoid in a pt with a uric acid kidney stone?
* organ meats
* poultry
* fish
* sardines
* red wine
47
What foods should be avoid in a pt with a calcium phosphate kidney stone?
high animal protein consumption
48
What foods should be avoid in a pt with a struvite stone (magnesium ammonium phosphate) kidney stone?
* dairy
* red & organ meats
* whole grains
49
What are the risk factors for bladder cancer?
* cigarrette smoking
* chronic recurrent renal calculi
* chronic lower UTI's
* long-term indwelling catheter
50
What are the symptoms of bladder cancer?
painless hematuria
51
When and where is a nephrostomy tube inserted?
directly into kidney d/t complete ureteral obstruction
52
What are the nursing repsonsibilities in a pt with a nephrostomy tube?
* assess for kinking or compression
* NEVER clamp tube
* Possible Irrigation: STRICT sterile technique w/ NSS 5 mL @ a time
* If more than 1 drainage tube, record output separately
53
What are the nursing responsibilities post-nephrostomy tube incision?
* muscle aches from hyper-extension during surgery
* respiratory status: IS, splinting, CDB
* Abd. distention: bowel is manipulated during surgery --\> decreased peristalsis --\> NPO until BS return
* early ambulation
* daily weight
* Urine output: check q1-2hr; total output should be at least 30-50 mL/hr; check color, consistency, mucus, blood, sediment
54
What are the complications of GERD?
* esophagitis --\> ulcerations --\> scar tissue --\> esophageal stricture --\> dysphagia
* Respiratory: sore throat, wheezing, coughing, dyspnea, hoarseness
* disturbed sleep patterns
* dental erosion
* Barrett's esophagus: pre-cancerous; change in type of cell to another; flat cells in esophagus change to columnar
55
What are the lifestyle modifications for GERD?
* wt loss
* no ASA/NSAIDs
* HOB elevated
* small frequent feedings
* NO smoking
56
What is the nutritional therapy for GERD?
* high protein
* low fat
* NO alcohol/spicy foods
* NO milk @ HS --\> leads to increase gastric secretions
* avoid coffee, cola, wine
* take fluids between meals
57
How is Pepcid classified?
H2 Histamine Receptor Blockers
58
What is the rx for chronic gastritis?
* bland diet: 6 small meals
* antacids: 1 & 3 hours AFTER
* avoid alcohol, caffeine, ASA, smoking
* antibiotics for H. pylori (PPI, Byaxin, vancomycin)
* Proton Pump inhibitors
* monitor for bleeding
* tx for anemia
59
What are the symptoms of a gastric ulcer?
* dyspepsia (heartburn, bloating, N/V, pain)
* occurs 1-2 hours after meals
* rare at NOC
* worsens w/ food intake
* H. pylori
* NSAIDs, ASA, steroids, SSRIs
* severe stress
* smoking
* wt loss
60
What are the symptoms of a duodenal ulcer?
* burning/cramping, heartburn, bloating, nausea, feeling of fullness
* 2-5 hours after meals
* most sx occur @ NOC
* food relieves pain
* H. pylori
* NSAIDs, ASA, alcohol use
* severe stress
* smoking
* wt loss
61
What are the complications of peptic ulcer disease?
* hemorrahge
* perforation
* gastric outlet obstruction
62
What are the sx of perforation d/t PUD?
Sudden, severe upper abd pain that spreads throughout abdomen and is not relieved by food/antacids
63
How is PUD diagnosed?
* endoscopy w/ bx
* urea breat test
* other lab work
64
What medications treat PUD?
* Histamine (H2) receptor blockers & PPi
* Antibiotic therapy
* Antacids --\> Carafate before meals
65
What are the nursing responsibilties post-bilroth surgery?
* I/O
* NG w/ gentle NSS irrigations to maintain patency
* frequent position changes
* splinting for CDB
* BS assess
66
What are the complications of surgery for PUD?
* Dumping syndrome
* Post-prandial hypoglycemia
* Bile reflux gastritis
67
What is Dumping Syndrome?
Ig bolus of gastric chyme entering the smlal intestine w/ meals. Draws fluids into bowel --\> results in decrease in plasma volume, bowel distention, increased intestinal transit --\> diarrhea/cramping
68
What are the sx of dumping syndrome?
occurs within 30 minutes of eating. pt c/o weakness, sweating, palpitations, dizziness, abd crmaps, borborygmi (audible BS), need to defecate.
69
How is dumping syndrome prevented?
* eat 6 small meals/day
* DO NOT drink fluids w/ meals
* fluids 30-45 min before/after meals
* avoid concentrated sweeds
* increase proteins/fats to meet energy needs and tissue repair, while decreasing carbohydrates post surgery
* lay down/recline after eating to prevent rapid dumping of food into intestine by gravity pull
70
What is post-prandial hypoglycemia?
occurs w/ dumping syndrome which increases insulin release which lowers BS (but food passes through GI too fast for complete absorption to occur)
71
What is bile reflux gastritis?
associated w/ pylorus reconstruction --\> leads to epigastric distress and is treated w/ Questran
72
What are the sx of C. diff?
* watery diarrhea
* fevor
* anorexia
* nausea
* abd. pain
73
What antibiotics are given to treat C. diff.?
Flagyl and Vancomycin
74
What is the nursing care for a pt w/ C. diff?
* gloves/gown
* NO sharing equipment
* 10% bleach to kill
* contact isolation
75
What is the medical management of Crohn's disease?
Goal:
* rest bowel (NPO)
* control inflammation
* treat infection
* correct malnutrition
* alleviate stress
* symptomatic relief
* improve quality of life
76
What are the surgical procedures available for a patient with inflammatory bowel disease?
Crohn's diesease: structureplasty
Ulcerative colitis: prctocolectomy w/ ileoanal reservoir
77
What are the risk factors for colorectal cancer?
* family hx of colorectal cancer (first-degree relative)
* personal hx of inflammatory bowel disease
* personal hx of colorectal cancer
* family or personal hx of adenomatous polyposis (FAP)
* family or personal hx of hereditary nonpolyposis colorectal cancer (HNPCC) syndrome
* obesity (BMI \> 30 kg/m2)
* red meat (\>7 servings/week)
* cigarette use
* alcohol (\>4 drinks/week)
78
What are the manifestations of chronic hepatitis?
* malaise
* easy fatiguability
* hepatomegaly
* myalgias and/or arthralgias
* elevated liver enymes (AST & ALT)
79
What is the normal reference range for lipase?
0-160 units/L
80
What is the normal reference range for amylase?
30-220 units/L
81
What is the normal reference range for ALT?
4-36 international units
82
What is the normal reference range for AST?
0-35 units/L
83
What is the treatment for chronic hepatitis?
* Goals: decrease viral load and decrease liver enzyme levels
* antivirals (Interferon)--can cause leukemia
* slow rate of disease progression: cirrhosis, liver failure, cancer
84
How do you prevent viral hepatitis?
* hand washing
* proper personal hygiene
* environment sanitation
* control and screening of food handlers
* avoid sharing toothbrushes and razors
85
What teaching should be provided to the patient?
* avoid alcohol/ASA/NSAIDs
* avoid spicy/rough foods
* avoid straining with stool, coughing, sneezing, retching, and vomiting
* good oral hygiene--soft toothbrush
* small frequent meals--low Na+
* strict I/O, daily weights, measure abd girth
86
What are the complications of acute pancreatitis?
* pulmonary effusion, atelectasis, pneumonia
* hypotension
* tetany (hypocalcemia)
87
What does CAUTION stand for?
**C**hange in bowel or bladder habits
**A** sore that does not heal
**U**nusual bleeding or discharge from any body orifice
**T**hickening or a lump in the breast or elsewhere
**I**ndigestion or difficulty swallowing
**O**bvious change in a wart or mole
**N**agging cough or hoarseness
88
What are the SE of Isoniazid and Rifampin?
nonviral hepatitis
89
When can isolation precautions be discontinued in a patient with TB?
When 3 sputum cultures have returned negative.
90
What are the 3 chambers for a chest tube?
collection, water seal, suction chamber
91
What is the collection chamber of a chest tube?
air/fluid from pt
92
What is the water seal chamber of a chest tube?
2 cm H2O that acts as a 1 way valve preventing air backflow to pt
93
What is the suction chamber of a chest tube?
H2O vented to atmosphere; fill w/ 20 cm H2O hooked to LCS to cause GENTLE bubbling
* Bubbling in water seal chamber occurs during exhalation, coughing, sneezing. There should be normal tidaling observed.
94
What is the nursing responsibilities for a pt with a chest tube?
* assess/palpate around dressing to assess for air leakage
* prepare pt for frequent chest x-ray
* never clamp unless ordered
* keep collection unit BELOW level of lungs
* do not empy collection chamber and mark level for I/O
95
What do you do if there is accidental removal of a chest tube?
Immediately apply occlusive dressing and if drainage tube become disconnected from chest tube, stick in sterile H2O or per agency policy
96
What are the nursing responsibilities in a planned removal of a chest tube?
* offer pain med to pt 30-60 min prior
* suture removal kit for MD
* pt is instructed to take break
* exhale
* hold breath and do valsalva
* tube is pulled and occlusive dressin plased then DSD
* monitor VS and respiratory status frequently
97
What is transudate?
clear, pale yellow fluid that collects when there are fluid shifts in the body
98
What is exudate?
results from increased capillary permeability d/t inflammation that causes a cloudy fluid w/ cells and proteins d/t malignancy or disease like TB
99
What is the purpose of traction?
* to prevent or reduce pain & muslce spasm
* to immobilize
* to reduce fx
* to expand joint space
100
What are the nursing responsibilities for a patient in traction?
* maintain proper body alignment
* assess pressure points every 2 hours
* traction is to be maintained continuously
* keep weights off floor and hanging freely
* make sure ropes are in pulleys correctly
101
What is compartment syndrome?
reduction of blood supply that can occur from too tight a cast or nonexpansive muscle fascia
102
What are the symptoms of compartment syndrome?
* sweeling and increase pressure press on & compromise function of bloody vessels, nerves, tendons
* decreased movement
* severe pain
* loss of sensation
* vascular compromise
* alteration in 6 P's--pain, pallor, pulse, parasthesia, paralysis, pressure
103
What may be assessed in a pt post-op hip surgery?
severe pain, lump in buttock, limb shortening, external rotation as may indicate prosthesis dislocation and notify surgeon immediately!
104
What care is given to a pt post-op amputation?
Wound drainage system
* sterile technique for dressing changes
* wound drainage system to minimize swelling
Flexion contractures
* most common w/ hip flexion
* avoid by not sitting in chair \> 1 hour or keeping residual limb elevated after the 1st post-op day
* if able, have pt lie prone 30 inches 3-4x/day
Phantom limb sensation
* pt still feels amputated limb
* subsides 'some' but often chronic
* opioids, TENS
* tx varies depending on degree of tolerability by pt. MEDICATE! pain is real.
Wrapping residual limb
* fosters shaping and molding for eventual prosthesis
* taken off and reapplied several times per day
105
What are the nursing responsibilities for a pt post-op amputation?
* inspect residual limb daily for signs of irritation and s/sx of infection
* d/c prosthesis if irritation develops
* wash limb thoroughly; rinse and pat dry, keep exposed to air for 20 minutes after washing
* no lotions/alcohols/powders/oils unless rx by MD
* residual limb sock: change daily and wash in mild soap and lay flat to dry
* pain management
* ROM daily of upper/lower
* do not elevate the residual limb on pillow
* lay prone if possible 3-4x/day
106
How is lyme disease prevented?
* avoid walking through tall grass and low brush
* mow grass
* move woodpiles and bird feeders away form house
* wear long pants or tightly woven nylon tights
* tuck pants into boots or long socks, wear long sleeved shirt and closed shoes when hiking
* check for ticks
* spray insect repellent containing DEET
107
How do you treat systemic erythamatous lupus?
* NSAIDs
* anti-malarials
* immunosupressive drugs
* corticosteroids
108
What is the nursing responsibilities in a pt with lymphedema following a mastectomy?
* teach nonrestrictive clothing
* NO venipunctures/injections in affected arm
* NO BP in affected arm
* do not keep arm in dependent position
* compression dressing/sleeves
* massaging
* compression bandages
* intermittent pneumatic compression sleeve
* ROM
* elevation
109
What needs to be assessed in a patient receiving radiation?
careful assessment of skin
110
What are the symptoms of a tension headache?
* no prodrome, no N/V
* possible light and sound sensitivity
* bilateral location
* constant/dull/band-like
111
What are the symptoms of a migraine?
* recurring
* uni-/bi- lateral
* family hx increases risk
* may/may not have precipitating events--stress, foods, smells, fatigue
* often there is a prodrome
* "steady/throbbing"
112
What are common food triggers of a migraine?
chocolate, cheese, oranges, tomatoes, onions, MSG, aspartame, alcohol, vinegar, caffeine, nicotine, nitrites
113
What are the symptoms of a cluster headache?
* sharp/stabbing pain around eye
* uniterlateral edema, tearing, ptosis
* attacks occur in clusters: same time each day, same season of year. usually at night
114
What is the treatment of a cluster headache?
100% O2 @ 6-8L as it causes casoconstriction & increases serotonin in CNS
115
What is decorticate?
internal rotation & adduction of arms w/ flexion of elbows, wrists, and fingers
116
What is decerebrate?
arms are stiffly extended and adducted and hyperpronated as well as hyperextension of the legs w/ plantar flexion of feet
117
What information should the nurse be aware of when giving anti-seizure medicaitons?
* Common SE: diplopia, drowsiness, sluggishness, gingival hyperplasia (Dilantin)
* no abrupt withdrawal
* weaning under MD guidance after have been seizure free for a period of time and have normal EEG
118
What are the nursing responsibilities during a seizure?
* initiate seizure precautions
* airway--do not restrain and ease to floor if in chair
* protect from injury (head), turn to side, nothing in mouth, loosen restrictive clothing
* note start, progression, areas of body involved
* timing
* post-ictal: stay with pt, orient, O2 prn, suction prn, LOC
* teach: meds, medic alert bracelet, avoid alcohol/fatigue, proper nutrition
119
How is seizure activity charted?
* precipitating factors: identify & eliminate/reduce
* how long dideach phase last? what occurred in each phase?
* which body part affected 1st progression
* LOC, tongue biting, stiffening/jerking, total lack of muscle tone
* dilated pupils, excessive slaivation, altered breathing, cyanosis, flushing, diaphoresis, incontinence, posturing (decorticate/decerebrate)
* post-ictal state (VS, pupils, memory, etc.)
120
How is trigeminal neuralgia treated?
* antiseizure meds
* analgesics & opioids
* nerve blocks
* surgical
* glycerol rhizotomy
121
How is trigeminal neuralgia managed?
* avoid temperature extremes
* do not neglect orla hygiene--soft toothbrush and assess oral cavity
* soft diet w/ lukewarm foods
122
What are the symptoms of neurogenic shock?
* hypotension
* bradycardia
* usually w/ cervical or high thoracic injury
* d/t loss of sympathetic NS innervation causing vasodilation
123
Why is an ERCP used?
* provides direct visualization of a body structure through a lighted fiberoptic instrument
* pancreatic, hepatic, and common biliary ducts
* evaluates juandice patients and pts w/ unexplained upper abdominal pain
* can diagnosis obstruction and provide characteristics of the lesions visualized
124
What should be assessed in a pt prior to receiving an abd CT scan?
* allergy to iodine
* claustrophobia
* NPO for 4 hours
125
What should be encouraged following an abd. CT scan?
drinking plenty of fluids
126
How often should a pt have a colonoscopy?
every 10 years
127
What medication should be withheld prior to receiving a pulmonary function test?
no inhaled bronchodialators for @ least 6 hours prior to procedure
128
What should be done prior to a parencentesis?
* explain the procedure
* does not need to fast
* written consent
* urinate
* labs
* baseline VS w/ abd girth
* positioning
129
Who should accompany a pt to a knee arthroscopy?
someone over 18 who can drive them home and be with them for at least 24 hours
130
What post-op care should be provided to a pt following a knee artheroplasty?
* sterile dressing
* wound should be clean and dry
* ice and elevate for first 24-28 hours
* pain and anti-nausea meds prn
131
What should a MD be notified following a knee atheroplasty?
* swelling, tingling, pain or numbness in the toes that is not relieved after elevation above hear for 1 hour
* drainage that is foul smelling, green or yellow, or new presence of drainage
132
What patient care should be given following a thoracentesis?
* site is covered by bandage
* check VS and s/sx of hypoxia, pneumothorax, hemotysis
* check lung sounds
* turn pt on unaffected side for 1 hour
* normal activity can resume after 1 hour
* encourage CDB
* send specimens to lab
133
What are some complications of a thoracentesis?
* pneumothorax
* intraplural bleeding
* hemoptysis
* reflex bradycardia
* hypotension
* pulmonary edema
* emphysema d/t infection
134
What is another name for a lung scan?
V/Q scan
135
Why is a lung scan used?
* dx of pulmonary embolism
* identifies defects in blood perfusion
136
What is done after a bronchoscopy?
* NPO until gag reflex returns (about 2 hours)
* check sputum for bleeding
* signs of impared respirations or laryngospasm
* post-bronchoscopy fever
* warm saline gargles and/or lozenges for sore throat
137
What are complications of a broncjoscopy?
* fever
* bronchospasm
* hemorrhage
* hypoxemia
* pneumothorax
* infection
* laryngospasm
* aspiration
* cardiac arrest
138
Why is a MRI better than a CT?
* better contrast
* no obscuring bone artifacts
* shows blood flow
* observe more planes
139
What is done after an EEG?`
remove electrode paste with acetone and have pt shampoo hair
140
What is the pt prep for a PET scan?
* explain it
* fast 4 hours before test
* no alcohol, caffeine, or tobacco for 24 hrs before test
* no sedatives
* void before test
* should not experience any discomfort
141
How long does it take for BRCA 1/BRCA 2 results to available?
several weeks
142
What are the limitations to a mammogram?
it is not a definitive diagnosis for breast cancer
143
What pt care is given post-lumbar puncture?
* hold dressing with adhesive at puncture site
* prone position with pillow under abdomen
* rehydrate with fluids using a straw
* remain in reclining position for up to 12 hours--no elevation of head
144
What should be taught to a pt prior to a cardiac stress test?
* fast 2-4 hours before
* avoid alcohol, tobacco, and caffeine
* wear comfortable shoes and clothing
* verbalize any symptoms
* takes about 45 minutes
145
What is done before a cardiac stress test?
* informed consent
* pretest EKG
* baseline VS
* apply and secure EKG electrodes
146
What is done after a coronary angiogram?
* assess circulation
* check pulses, color, and sensation in extremity every 15 min for 1 hour
* assess hypotension/HTN, abnormal HR, dysrhythmia, and signs of pulmonary emboli
147
What should be done after a bone marrow biopsy?
* apply pressure at puncture site
* bandage/ice packs
* assess for signs of shock, hemorrhage, & infection
* bed rest 30-60 min after test
* tenderness @ site for several days
* mild analgesic
148
Why is a venous doppler used?
evaluate pt's circulation and blood flow, patency of veins, and looks for DVT, arteriosclerosis, venous insufficiency, and blood clots
149
What is the purpose of a hyperbaric chamber in a pt with a wound that won't heal?
It increases the amount of O2 that the blood can carry which then temporarily restores normal levels of blood gases and tissue funciton to promote healing and fight infection.
150
How is a creatinine clearance test performed?
urine collected for 24 hours
151
What needs to be taught in a pt receiving a creatinine clearance test?
* little risk with blood draw
* void and discard first urine specimen
* show where to store urine
* keep urine refrigerated
* post the hours
* no toilet paper
* collect last specimen at end of 24 hours
* take to lab
152
What is important to assess for a pt before receiving a pyelography?
shellfish/idodine allergy
153
What is contraindicated in a pt receiving a pyleography?
* shellfish allergies
* iodine allergies
* renal insufficiencies
* multiple myeloma
* pregnancy
154
What is an oral glucose tolerance test?
measure the body's ability to use glucose, the body's main source of energy
155
When is OGTT used?
to dx gestational diabetes, prediabetes, and diabetes
156
What pre-op care is given to a patient for an esophagogastroduodenoscopy?
* explain procedure
* NPO for 8 hours
* may be mildly uncomfortable
* throat is anesthetized to depress gag reflex
* pt sedated during procedure
* will not speak during test
157
What is the urea breath test?
used to detect H. pylori and if the bacteria is present, urea is converted to CO2 which is delivered from the stomach to lung and then exhaled
158
What are the side effects of a barium enema?
* white stools
* may cause constipation --\> increase fluids
159
What is the care given post-myelogram?
* encourage fluid intake
* voids within 8 hours post procedure
* administer meds as prescribed
* remain lying for hours after with HOB elevated
* resume diet if there is no N/V
160
What are the benefits of peak flow monitoring?
* helps determine what makes asthma worse or better
* whether treatment is working
* when to add/stop medications
161
What lab test/s would the nurse anticipate being drawn on a pt scheduled for a liver biopsy?
* PT/INR
* aPTT
162
What is the normal RBC range?
M: 4.2-5.4 x 106/uL
F: 3.6-5.0 x 106/uL
163
What is the normal Hct?
M: 40-50%
F: 37-47%
164
What is the normal Hb?
M: 14.0-16.5 g/dL
F: 12.0-15.0 g/dL
165
What is the normal platelet count?
150-400 x 106/uL
166
What is the normal WBC count?
4.8-10.8 x 106/uL
167
What is the normal bicarbonate?
24-31 mEq/L
168
What is the normal calcium level?
8.5-10.5 mg/dL
169
What is the normal chloride level?
98-106 mEq/L
170
What is the normal magnesium level?
1.3-2.1 mg/dL
171
What is the normal potassium level?
3.5-5.0 mEq/L
172
What is the normal sodium level?
135-145 mEq/L
