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Nsg 101 > Test 3 > Flashcards

Test 3 Flashcards

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0
Q

Secondary wound healing process

A

Open wound, granulation fills in wound bed, epithelial cells finish the job.

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1
Q

Primary wound healing process

A

Surgical, allows epithelial cells to migrate and repair tissue. Superficial.

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2
Q

Tertiary wound healing process

A

Open a while before it closes. This occurs to get rid of infection. Allow to heal from secondary first.

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3
Q

Phases of healing of wound

A

Hemostasis.
Inflammatory.
Proliferation.
Maturation.

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4
Q

Hemostasis phase of healing

A

Platelet helps clot blood. Vasoconstriction.

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5
Q

Inflammatory phase of wound

A

Vasodilation. Swelling, increased pain around tissue, increased WBC to fight infection.

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6
Q

Maceration of a wound

A

Water logged edges

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7
Q

Tunneling of wound

A

Passageway under intact skin with an end point

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8
Q

Undermining of a wound

A

Extends under skin or superficial tissue

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9
Q

Stage 1 pressure ulcer/wound

A

Skin in tact but doesn’t Blanche

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10
Q

Stage 2 pressure ulcer/wound

A

Partial thickness. It opens here, blister

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11
Q

Stage 3 pressure ulcer/wound

A

Full thickness skin loss, goes into dermis

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12
Q

Stage 4 pressure ulcer/wound

A

Full thickness, tissue loss. May see bone or muscle.

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13
Q

Stage 5 pressure ulcer/wound

A

Unstageable. Can’t determine depth.

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14
Q

Stage 6 pressure ulcer/wound

A

Deep bruising. The skin is intact so u can’t see how far it goes

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15
Q

4 phases of wound healing

A

Hemostasis
Inflammatory
Proliferation
Remodeling

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16
Q

Hemostasis phase of wound healing

A

Platelets clot blood due to vasoconstriction

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17
Q

Inflammatory phase if wound healing

A

Swelling, increased pain around tissue, elevated WBC to fight infection. Vasodilation

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18
Q

Proliferation phase of wound healing

A

Surface wound-epithelial

Deeper-granulation then epithelial

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19
Q

3 processes of wound healing

A

Primary
Secondary
Tertiary

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20
Q

Primary process of wound healing

A

Surgical, allow epithelial cells to repair superficial tissue

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21
Q

Secondary process of wound healing

A

Open wound, granulation tissue fills in, then epithelial

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22
Q

Tertiary process of wound healing

A

Wound is open a while before it closes to get rid of infection

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23
Q

Lab tests for nutrition

A

Hbg
Prealbumin
Esr
Crp

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24
Esr lab shows what for nutrition
Response to treatment
25
Crp lab shows what for nutrition
Inflammation, levels should decrease if levels are improving
26
Mg values
1.3-2.3
27
Ca levels
8-10
28
K+ levels
3-5
29
NA+ levels
135-145
30
pH levels
7.35-7.45
31
Causes of metabolic acidosis
Dka Severe diarrhea Renal failure Shock
32
Causes of metabolic alkalosis
Severe vomiting Excessive gi auctioning Diuretic Excessive NaHCO3
33
Causes of respiratory acidosis
Problems with exhaling: | Copd, anesthesia, pneumonia, atelextasis, lung injury
34
Causes of respiratory alkalosis
Hyperventilation: | Anxiety. Fear
35
Cardiovascular problems with immobility
Decreased cardiac capacity. Ortho static hypotension Thrombus formation
36
Respiratory symptoms for immobility
Decreased lung expansion, gas exchange | Pooling of secretions
37
Musculoskeletal symptoms of immobility
Decreased muscle mass Atrophy Contractures
38
Integumentary symptoms for immobility
Tissue hypoexmia | Pressure ulcers
39
Urinary symptoms for immobility
Infection | Urinary stasis
40
Negative nitrogen balance symptoms of immobility
Wt loss | Decreased muscle mass
41
Gi symptoms of immobility
Constipation | Decreased peristalsis
42
Psychologic symptoms of immobility
Mood disturbances
43
Metabolic interventions for immobility
Increase protein, calories | Supplement with B and C vit's
44
Respiratory interventions for immobility
Expand lungs | Mobilize secretions
45
Cardiovascular interventions for immobility
Prevent thrombus formation Increase fluids Change positions Decrease cardiac workload
46
Musculoskeletal interventions for immobility
Exercise | Passive/active rom
47
Integumentary interventions of immobility
Change positions Skin care Trochanter roll
48
Fat soluble vitamins
A D E K
49
Water soluble vitamins
B | C complex
50
Reasons for npo
Rest gi tract Prevent aspiration Treat n/v Let gi function normally after sx
51
Interventions for pt with dysphasia
Rest prior to eating | HOB 90 degrees
52
Normal oral intake
1100-1400 ml
53
Normal output
2200-2700 ml
54
How much i/o is needed to maintain f/e
2600 ml
55
Obligatory urine output and amount
What u need to rid body of toxins | 400-600 ml
56
Output exceeds intake/absorption in these conditions
Hypernatremia | Hypokalemia
57
Output is less than intake ith these conditions
Hyponatremia | Hypercalcemia
58
Colloid pressure
Push fluid into compartments
59
Hydrostatic pressure
Push fluid out of compartment
60
Osmolality causes what mechanism to react
Thirst
61
Increased Hypernatremia cause cells to
Shrivel
62
Hyponatremia cause cells to
Cells swell
63
Which hormone goes with which electrolyte Aldosterone Aldosterone/natriuretic peptides ADH
Increased K+ excretion Regulate Na+ excretion H2O excretion
64
Hyponatremia | How to fix
Na+ with NS/LR Lower diuretic dose Fluid restriction 800 ml-hr
65
Hypernatremia fix
Nutrition. | Increase water decrease salt
66
Hypokalemia fix
K+ replacement | Increase meats veggies fruits
67
Hyperkalemia fix
KayeXalate to increase K+ excretion
68
Hyponatremia symptoms If hypovolemia Hypervolemia
Mental changes Combative Hypovolemia=tachy Hyper=Brady
69
Hypovolemia
Dehydrated
70
Hypervolemia
Fluid overload
71
Hypernatremia symptoms
Mental changes
72
Hypocalcemia fix
Calcium replacement with V-D | D5W fluids
73
Hypercalcemia fix
NS with LASIK
74
Hypokalemia symptoms
Prolonged QT waves Dysthymias At risk for paralytic ileus
75
Hyperkalemia symptoms
Peaked T waves

Nsg 101 (4 decks)

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