Part 2 Flashcards
(126 cards)
1
Q
Three treatments for hyperthyroidism
A
-radiative iodine (pt should be alone for 24 hours and after that must be careful w urine hazardous)
- PTU prumble thiouracil (Puts Thyroid Under) also a cancer drug knocks down WBC so monitor
-thyroidectomy can be total (need lifelong therapy and may have low calcium) or sub
2
Q
Three treatments for hyperthyroidism
A
-radiative iodine (pt should be alone for 24 hours and after that must be careful w urine hazardous)
- PTU prumble thiouracil (Puts Thyroid Under) also a cancer drug knocks down WBC so monitor
-thyroidectomy can be total (need lifelong therapy and may have low calcium) or sub
3
Q
for signs of thyroid storm
A
-very high temps
-very high BP (210/180)
- severe tachycardia
-psychotic delirium
very dangerous can harm brain bc hypoxic
4
Q
How to treat thyroid storm
A
Temp down
O2 up
5
Q
Concern for 12-48 after total or sub thyroidectomy
A
-totals get tetany (due to low Calcium, can close off airway)
-subs get storm
6
Q
Never pick infection as an answer unless it is
A
Past 72 hours postop
7
Q
Use caution when withholding thyroid preop (NPO) because
A
-any sedation could potentially kill them
8
Q
Adrenal cortex disorder start with either
A
A or C
9
Q
Addisons Disease is
A
Undersecretion of adrenal cortex
-hyperpigmented (tan)
- don’t adapt to stress (during stress glucose and BP go down and they do into shock)
-give steroids (add a sone addisons)
10
Q
Cushing’s syndrome is ________ of the adrenal cortex
A
-oversecretion (cushy= more)
11
Q
S/s of Cushing’s syndrome (also s/s of steroids)
A
-moon face
-hirsutism (increase body hair)
-water and sodium retention (losses potassium)
-gynecomastia (man boobs)
-Buffalo hump
-central obesity (small skinny limbs)
-decrease bone density
-easy bruising
- irritability
-immunosuppression
-HIGH GLUCOSE
-IM MAD I HAVE AN INFECTION
12
Q
Treatment for Cushing syndrome
A
-adrenalectomy (then has to go on steroid therapy causing them to turn to moon man)
13
Q
No small toys for children under
A
4 years
14
Q
No metal toys for a child receiving
A
-oxygen
15
Q
BEWARE OF FOMITES
A
Nonliving object that harbors microorganisms
16
Q
Play for a 6-9 month old
A
-object permanence teaching
-jack in the box, peak a boo
17
Q
When can a child have purposeful play
A
-9 months
-DO NOT PICK IF CHILD UNDER 9 months and HAS ANY OF THESE WORDS; build, sort, stack, make, construct
18
Q
Good book for 6, 9 and 12 month olds
A
6 months: soft
6-9: window books (peak a boo)
-9-12: talking books
19
Q
Toddler (1-2 y/o) toys
A
-push pull toys (mower)
-gross motor skills (running, jumping)
-no colored pencils, scissors
-parallel play
20
Q
Preschoolers
A
-finger dexterity
-work on balance
-cooperative play
-pretend play
21
Q
School age
A
-creative (let them do it)
-legos are great
22
Q
What’s the reason for a Laminectomy
A
-to relieve nerve root compression
23
Q
What’s the reason for a Laminectomy
A
-to relieve nerve root compression
24
Q
3 s/s of nerve root compression
A
-pain
-paresthesia (numbness and tingling)
-paresis (muscle weakness)
25
3 s/s of nerve root compression
-pain
-paresthesia (numbness and tingling)
-paresis (muscle weakness)
26
3 locations for laminectomy
-cervical (neck)
- thoracic (upper back)
-Lumbar (lower back)
27
3 locations for laminectomy
-cervical
- thoracic
-Lumbar
28
Cervical spinal cord effects
Diaphragm and arms
29
Cervical spinal cord effects and considerations
Diaphragm and arms
-1st breathing then arms and hand function
30
Thoracic laminectomy effects and considerations
-cough mechanism and bowels
31
Lumbar laminectomy effects and considerations
-bladder and legs
-when have they last voided (bladder distended?) and then function of the arms and legs
32
Post Op laminectomy pts should not
-sit on side of bed with feet on the ground dangling
-not allowed to sit for longer then 30 mins
-may walk stand lie down without restrictions
33
When you don’t know a restriction what answer should you pick
6 weeks
34
Surgical laminectomy pt should NEVER again
Left something above their head
35
When is a high creatinine reportable?
When pt is to have a procedure with dye
36
INR levels above blank is a high priority
4
37
INR levels above blank is a high priority
4
38
Nursing actions for Low pH
Get a set of vitals and call the doctor
39
Defining characteristics for respiratory failure
-CO2 in the 60s
-02 in the 60s
-prepare to intubate and ventilate
40
BNP is the best indicator of
Congestive heart failure
-Should be under 100
41
Definitive indicator that HIV has converted to aids
CD4 count below 200
42
What do you do if ANC is below 500
-critical immuno suppressed
-neutropenic precautions
43
All psych drugs cause
Low BP
and
Weight changes (mostly weight gain, prozac can cause loss and gain)
44
All psych drugs cause
Low BP
and
Weight changes (mostly weight gain, prozac can cause loss and gain)
-
45
PHENOTHIAZINES
- all end in ZINES!!
-1st gen/typical anti-psychotics
-zines for the zany ( antipsychotics)
- in small doses they are antiemetics
-considered major tranquilizers
46
Side effects of major tranquilizers
A- anticholingeric (dry mouth)
B- blurred visions
C- constipation
D- drowsiness
E- extrapyramidal syndromes (Parkinson’s like)
F- photosensitivity
G- aGranulocytosis (low WBC, immunosuppressive)
47
Decanoate
-long acting IM form given to non-compliant clients
-court ordered
-can be shortened as D
48
Tricyclic Antidepressants
-NSSRI
- elavil, tofranil, aventyl, desyrel
-side effects ABCD
-E is euphoria
49
BENZODIAZEPINES
-minor tranquilizers
- ALWAYS have zep in name
-also used preop to induce anesthesia, as a muscle relaxants, good for alcohol withdraw, seizures, help ppl fighting ventilator
50
If you want to put someone to sleep use the Zs
Zeps and zines and zapines (tranquilizers)
51
Names of MAOIs and s/s
-spot of beginning of the name
-MARplan, NARdil, PARnate
-side effects ABCD
52
Considerations for MAOIs
-Tyramine can cause a hypertensive crisis
- no aged cheese (can have mozzarella and cottage cheese), yogurt, cured/preserved/organ meats, alcohol, caffeine, chocolate, fermented foods, bananas, avocados (guacamole), and I need dried fruit)
-Also no OTC meds went on an MAOI
53
Lithium is unique from other psych drugs, because
-it does not stabilize, nerve cell membranes, but rather acts more like an electrolyte
- Three Ps: peeing, pooping and parenthesia (earliest sign of electrolyte imbalance)
54
What are the signs of toxic affects of lithium requiring the nurse to call the MD and hold medication
-tremors
-Metallic taste
-Severe diarrhea
55
Relationship of sodium to lithium
-Low sodium makes lithium more toxic
-High sodium makes lithium ineffective
56
PROZAC SSRIS
- same side effects as NSRI
-causes INSOMNIA give early in day
57
Haldol
- has decanoate form
-side effects ABCDEFaG
-1st gen/typical antipsychotic like the zines
-NEUROLEPTIC MALIGNANT SYNDROME may be evident in elderly, young, and schizophrenic pts w overdose
58
NMS neuroleptic malignant syndrome
- potentially fatal hyperpyrexia (fever)
-could reach 106 to 108 degrees (definitely over 105)
-Dosage for elderly patients should be half the adult dose
-also has anxiety and tremors (distinguish between EPS bc NMS has fever)
59
Clozapine (clozaril)
-2nd gen/atypical anti-psychotic
-these drugs generally end in ZAPINE
-slight minor side effects similar to zines (decrease in ABCDEF)
- DOES HAVE AGRANULOCYTOSIS side effect (low WBCs)
-Geodon (ziprasidone) has black box warning bc it can prolong the QT interval causing sudden cardiac arrest (avoid in cardiac pts)
60
Sertraline (Zoloft)
-SSRIs
-causes insomnia but can give at nighttime
-increases toxicities of other drugs bc they are not getting metabolized (adding to pts regime will require lower dosages of other meds)
-NO ST JOHNS WORT will cause serotonin syndrome
-INTERACTIONS W WARFARIN COUMADIN pt will bleed out if dose not lowered
61
Serotonin Syndrome
-potentially life-threatening
-Looks like the MAOIs patient that eat tyramine
-SAD Head= sweaty, apprehensive (sense of doom) dizzy and headache
62
Total weight gain for pregnancy
28lbs +/- 3
63
Weight gain in 1st trimester
1 lb/month (total 3 lbs)
64
Weight gain in 2nd+ 3rd Trimester
1 lb/week
-if you take the week and subtract 9 that is the weight that should be gained
-over by 1-2 lbs okay, 3 lbs need assessment, 4 lbs could be trouble
65
Fundal not palpable until
Week 12 (after 1st treatment)
66
When is the Fundus at the umbilicus
-20-22 weeks
-important to know for date of viability and know trimester the PT is in
67
4 positive signs of pregnancy
-fetal skeleton on x-ray
-Fetal presents on ultrasound
-Auscultation of fetal heart rate (starts beating at five weeks but you can hear it between 8 to 12 weeks)
-One examiner, palpates, fetal movement/outline but not when mom just feels it (quickening)
68
3 different ways to select a maternity question
when would you first = pick the earliest part of the range
When is it most likely? = pick the middle part of the range.
When should you … by? = pick the end of the range
69
When is Quickening
-16-20 weeks
-first feels 16 weeks
-most likely feels by 18 weeks
-when should you feel by 20 weeks
70
Order of Chadwick’s , Goodells and Hegars
-alphabetical order
71
Hegars signs
-uterine softening
72
Prenatal care educating
-once a month until week 28
-then once every 2 weeks until week 36
-finally once very week until delivery or week 42
73
Hemoglobin in pregnancy
-Will fall
-We don’t worry about it unless it gets really low
-gets lower and lower closer to birth
-acceptably low can be as low as 9
74
Pregnancy urinary incontinence
-1st and 3rd T problem
-treat by voiding every 2 hours (do from start of pregnancy to 6 weeks after delivery)
75
Treatment for difficulty breathing in pregnancy
-2nd-3rd T problem
-tripod position
76
How to treat back pain in pregnancy
-2nd and 3rd T problem
-gets worse and worse
-treat w pelvic tilt exercises
77
Effacement
Thinning of cervix
78
Station
-relationship of the fetal presenting part to moms ischial spines (the smallest diameter through which the baby has to fit for a vaginal birth, narrowest part of pelvis)
-negative station= head/presenting part is above the tight squeeze
- Positive station= presenting part has made it past the Tight squeeze
79
Engagement
Station 0
80
Lie
-relationship of the spine of the mother and the spine of the baby
-longitudinal lie= good! Parallel spines
-transverse lie= Bad, spines perpendicular
Olique lie= baby is diagonal to moms hip
81
Presentation
-the part of the baby that enters the births canals first
-when in doubt pick ROA (this first) or LOA
82
1st stage of labor
-1.Latent (LAT is order), 2. Active, 3. Transition
83
2nd Stage of Labor
-push baby out
84
Third stage of labor
-Push placenta out
85
Fourth stage of labor
-Stop bleeding by contracting the uterus
- 2 hours after delivery of placenta (then postpartum begins)
86
Contraction should not be longer than or closer than
-90 seconds
-Every two minutes
-If so, could indicate trouble in labor
-indicative of uterine tetany , uterine hyperstimulation, parameters to stop Pitocin
87
Active phase of labor
-contractions frequency= every 3-5 minutes
-Contraction duration = 30 to 60 seconds
-Contraction intensity= moderate
88
Frequency of contractions
-Beginning of one contraction to beginning of the next
89
How should a woman measure her intensity of a contraction
-teacher to palpate with one hand over the fundus with the pads of the fingers (fingertips)
-use other hand to time it
90
Painful Back Labour
- Occiput Posterior (OP = Oh Pain)
-position and push
- (knee to chest)
-take fist and push it into her sacrum (applies counter pressure to relieve pain)
91
Prolapsed Cord
- HIGH PRIORITY EMERGENCY
-push-position
-push head off cord (DONT touch cord)
-Position knee chest to take compression off cord
-usually emergency C section
92
Interventions for ALL other complications in Labor and birth (uterine atony, uterine hypoTension, vena cava syndrome, uterine tetany etc(
-LION
-L turn on left side
-I increase IV
-O oxygenate
-N notify dr
93
Pitocin running in OB crisis
-STOP IT
-would be first before positioning
94
Pain meds in labor
Don’t administer pain meds to woman in labor if baby likely to be born when med peaks
-
95
Low fetal heart rate
This is bad
Do lion and if pit was running, stop it
96
High fetal heart rate
-Not a big deal document and take Mom’s temperature because it could be due to a fever
97
Low baseline variability
-when the fetal heart rate stays the same and does not change (this can be high low or in the middle)
-LION
98
High baseline variability
-good document it
99
Late decelerations
-heart rate slows down near the end or after a contraction
BAD do LION
100
Early Decelerations
-baby’s heart slows before or at the beginning of a contraction
-fine
101
Fetal Heart monitoring pattern
-3 bad start w L do LION
-1 variable do push and position
102
VEAL CHOP
V- variable = C- core compression
E- early Dec =H- head compression
A- acceleration= O-okay
L- late Dec = P-placental insufficiency
103
Stage 2 Delivery order
1. Deliver head
2. Suction mouth first and then nose
3. Check for nuchal cord (around the neck)
4. Deliver shoulders and body
BABY MUST HAVE ID BAND BEFORE LEAVING DELIVERY AREA
104
Stage 3 order
Delivery of the placenta
1. Make sure it’s all there
2. Check for 3 vessel cord
AVA
-2 arteries
-1 vein
105
Stage 4 of labor
-first 2 hours after delivery of placenta
-4 things you do 4 times an hour in the 4th stage
-vital signs (checking for signs of shock BP down, rates up cold and clammy)
-check Fundus (boggy then massage), if displaced then Catherize
-check pads (100% saturated in 15 mins bad)
-roll her over (check bleeding underneath her, can also assess perineal area)
106
Postpartum Uterine assessment
- firm, midline, height= day postpartum (1 cm/day)
107
Lochia (rubra, serosa, alba)
Rubra- 1st red (rubbing turns something red)
Serosa- pink (rosa rosey pink)
Alba- albinos are white yellowish
108
Postpartum Extremity Check
-thrombophlebitis
-via bilateral calf circumference measuring
-homans not very reliable
109
Milia
-distended sebaceous glands which appear as tiny white spots on babies face
110
Epstein pearls
-small white epithelial cyst on babies gums
111
Mongolian spots
-bluish black macules appearing over the buttocks and or size of a darker skin neonate
112
Erythema toxicum neonatorum
-red papular rash on babies torso, which is benign and disappears after a few days
113
Hemangiomas
-benign tumor of capillaries
114
Cephalohematoma
-swelling caused by bleeding between the ostium and periosteum of the skull the swelling does not cross suture lines
115
Capital succedaneum
-edematous swelling on scalp caused by pressure during birth. The swelling may cross suture line that usually disappears in a few days
-C.S may Cross Sutures, Cap is symmetrical
116
Vernix caseosa
-Caseus= cheese
-whitish she’s like substance which appears intermittently over the first 7 to 10 days
117
1.Nevus/nevi
2. Nevus flammeus
3. Telangiectatic nevi
1. Generic term for birthmark.
2. Non-blanchable port wine stain.
3. Blanchable pink stork bites
118
Physiologic Jaundice
-appears after 24 hours of age and disappears at about one week
119
Tocolytics
- causes maternal tachycardia
-stops labor (used for premature labor)
120
Magnesium Sulphate
-stop labors
- high magnesium (opposite) makes everything go down (HR, BP, REFLEXES, RR and LOC goes down)
-
121
Methergine
-oxytocics stimulates contractions
-can cause high BP bc of vasoconstriction
122
Betamethasone
-steroid
- mom gets it IM
-given before baby is born
123
Survanta (surfactant)
-baby gets it
-given transtracheal
-after baby is born
124
What precautions must be taken for a client receiving radiation treatment?
-Private room in a bathroom
-Limit visitors, rotate nursing staff who provide care. Place sign at door and bedside.
125
What additional precautions must be taken for clients receiving sealed internal radiation?
-all bodily fluids are radioactive, use hazardous clean up gloves and gown
126
If a client sealed internal implant falls out, what should you do?
-pick it up with long handled forceps and put it in a lead container
