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Topics Review Flashcards

(93 cards)

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1
Q

Cane use

A

Used on the stronger side to provide support on lower limb
Move cane forward 6-10 inches, then follow with the weaker leg.
Advance the stronger than after past the cane
Another method is having the client move the affected extremity and cane at the same time

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2
Q

Brachytherapy and radiation

A

Limit each staff member time in room to 30 minutes
Keep door to the room closed
Teach family members to stay at least 6 feet away from client
Use lead apron when providing care to reduce exposure to radiation
Wear a radiation film badge while in the clients room to monitor radiation exposure
Dispose of items removed from the room in appropriate containers

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3
Q

Airborne

A

MTV
Measles
Tuberculosis
Varicella

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4
Q

Airborne Interventions

A

Provide provide room with negative airflow
Keep door close
Nurse must be fit for N95 respirator
Apply small surgical mask to patient if leaving the room

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5
Q

Droplet

A

PIMP’N R
Pertussis
Influenza
Mumps
Pneumonia
neisseria meningitidis
Rubella

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6
Q

Droplet interventions

A

Private room
May cohort with client who has infection with same organism
Keep door closed
Mask is required when personnel is within 3 ft of the client

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7
Q

Contact

A

MRSA
E. Coli
Staph
Rotavirus
Salmonellosis
Shigellosis
Vancomycin resistant enterococci (VRE)

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8
Q

Contact Interventions

A

Private room preferred
Gloves and gown worn by caregivers and visitors
Dispose materials into non porous bag
Dedicated equipment for the client or disinfect after each use
Client to leave room only for essential clinical reasons

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9
Q

Protective isolation interventions

A

Follow standard
Sterile linings
Minimize exposure
Positive pressure room
Wear sterile gloves and gown mask when in contact with
Minimize exposure to microorganisms found on the outer layers of fresh flowers, fruits and vegetables

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10
Q

Class A fire extinguisher

A

paper wood cloth trash

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11
Q

Class B fire extinguisher

A

Flammable liquids and gases

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12
Q

Class C Fire extinguisher

A

Cords
Electrical fires

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13
Q

Class K Fire extinguisher

A

Kitchen fire such as stove

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14
Q

Hepatitis A

A

Standard and contact precautions
Reservoir: Feces
Can be spread up to 2 weeks before symptomatic

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15
Q

Hepatitis B

A

Standard Precaution
Reservoir: Blood and body fluids
Contact precaution for blood and body fluids; follow disinfection and sterilization guidelines for reusable equipment

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16
Q

Hepatitis C

A

Standard: additional precautions for hemodialysis unit
Reservoir: Blood and body fluids Contact
Contact precautions for blood and body fluids

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17
Q

Surgical asepsis

A

Use sterile gloves
Avoid coughing, laughing, or sneezing over sterile field
Do not reach over sterile field
Be low waist or above chest is contaminated
Keep non-waterproof drapes dry
*A 1-inch border of sterile drapes and packages is considered contaminated
*Open sterile packages by unfolding top flap away from your body first and toward you last

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18
Q

Kosher Diet

A

Orthodox Judaism forbid consumption of dairy-meat combinations. Only fish with scales and fins are allowed.
Permissible meats include those from animals that eat vegetables, have hoofs, and are ritually slaughtered.
Ex: broiled chicken with rice, vegetables, and mixed fruit is good.

The practice of someone remaining with the deceased body at all times

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19
Q

Health care associated infections (HAIs)

A

Common site HAIs causes
- E.coli
- Staph aureus
- Enterococci (VRE)
(All contact precautions)

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20
Q

NG tube insertion

A

Best way to check for placement is Chest X-ray
- cannot be done routinely before each use
Additional methods of verification
- pH monitoring (1-6)
- Withdraw gastric contents and inspection of color

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21
Q

Fecal impaction

A

A collection of hardened feces in the rectum that client cannot expel
- usually results from unrelieved constipation
Enemas are usually prescribed

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22
Q

Fecal incontinence

A

Inability to control passage of feces and gas from anus
Physically unable to avoid defecation

Nursing actions: assess for causes, medication, infection, or impactions.
Provide perineal care after each stool

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23
Q

Eye exam

A

Age 40 and under every 3 to 5 years
Ages 40 to 64 every 2 years
Ages 65 and older every year

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24
Q
A
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25
Colonoscopy
Every 10 years after the age of 50
26
Purpose of bladder irrigation
Promotes elimination This intervention is intended to prevent blood clots from forming in the bladder or remove any clots that may be present. Can be uncomfortable. **Pain is not an expected finding and should be reported immediately to the provider**
27
Infiltration
Occurs due to leakage of fluid in the surrounding tissue Ex: usually saline or meds **Taut skin and cool to the touch, pallor, swelling, damp dressing, slowed infusion **Nursing actions**: stop the infusion, remove catheter, elevate the extremity, and apply a warm moist compress or a cold compress.
28
Phlebitis
Occurs due to an inflammation of a vein from infection or irritation of the catheter **Warm skin, red streak, pain, edema, throbbing, erythema (redness), palpable band at the vein site, slowed infusion **Nursing treatment**: Stop infusion, remove catheter, apply moist warm compress
29
Extravasation
Occurs due to leakage of damaging medications into surrounding tissue **warm skin, edema, redness, pain **Nursing treatment**: discontinue iv, cool compress
30
Isotonic Fluid
Treatment of extracellular dehydration Due to maybe: blood loss, vomiting/diarrhea,surgery Examples: - Normal saline (0.9% NS) - Lactated Ringers (LR) - 5% dextrose in water (D5W) ** can become hypotonic solution once dextrose is fully metabolized.
31
Primary prevention
**Examples** Immunization programs Child car seat education Nutrition and fitness activities Health education programs
32
Secondary Prevention
**Examples** Communicable disease screening and case finding Early detection and treatment of hypertension Exercise programs for older adults who are frail
33
Tertiary prevention
**Examples** Prevention of pressure ulcers ad a complication of spinal cord injury Promoting independence for a client following stroke Rehabilitation services
34
Isotonic Fluids
Treatment of vascular system fluid deficit (Prevent fluid shift between compartments) Used for: Blood loss, vomiting/diarrhea, surgery Examples - Normal saline (0.9% NS) - Lactated Ringers (LR) - 5% Dextrose in water (D5W)
35
Hypotonic Fluid
36
Hypotonic Fluid
Treatment of intracellular dehydration For DKA, Hyperosmolar hypoglycemia, hypernatremia(SINCE SODIUM IS AN EXTRACELLULAR ELECTROLYTE TOO MUCH WATER IS BEING DRAWN OUT OF CELLS CAUSING CELLULAR DEHYDRATION) Examples: - 0.45% normal saline - 0.22% saline - 0.33% saline 2.5% dextrose in 0.0.45% saline
37
Hypertonic solution
Treatment when serum osmolality is low Used for: Hyponatremia, cerebral edema (to reduce brain swelling) Examples: - 10% dextrose is water - 50% dextrose in water 5% dextrose in normal saline - 5% dextrose in 0.45% saline - 5% dextrose in lactated ringers
38
Hypovolemia manifestations
Tachycardia Thready pulse Tachypnea (increased RR) Weight loss Dry mucous membranes Capillary refill less than 3 seconds Weakness, fatigue Orthostatic hypotension Poor skin turgor **LATE SIGNS” - Oliguria Decreased CVP Flatted neck veins *Lab values* - Bun: increased (norm 8-25) - Urine specific gravity: increased (1.010-1.030) - Hematocrit: increased (lowest 36% females highest 52% males)
39
Hypervolemia Manifestations
Cough, dyspnea, crackles Increased blood pressure Tachypnea and tachycardia Bounding pulse Weight can Jugular vein distention Increased CVP Pitting edema DECREASED DIAGNOSTIC PROCEDURES due to hemodilution BUN, creatinine, Hct, electrolytes
40
Intracellular electrolytes
Potassium Phosphorus Magnesium
41
Extracellular Electrolytes
Sodium Calcium Chloride Bicarbonate
42
Electrolyte values
Potassium: 3.5 to 5 mEq/L Sodium: 135 to 145 mEq/L Calcium: 9 to 10.5 mg/dL Magnesium: 1.3-2.1 mEq/L Phosphorus: 3.5 - 4.5 mg/dL Chloride: 98-106
43
Hypokalemia manifestations
Less than 3.5 mEq/L - Muscle weakness - cardiac arrhythmias - Constipation - Fatigue Less than 3 mEq/L (severe) - Respiratory paralysis - Paralytic ileum
44
Hypokalemia manifestations
Orthostatic hypotension Shallow respirations Parathesias Weak thready pulse Ascending bilateral muscle weakness with respiratory collapse and paralysis Fatigue **HYPOactive bowel sounds** Abdominal distention **Constipation** Vomiting Anorexia PVCs Bradycardia VTACH ST depression
45
Hyperkalemia manifestations
Muscle weakness Fatigue Parasthesia Ascending flaccid paralysis Nausea **HYPERactive bowel sounds** Increased gastric motility/ cramps **Diarrhea** Bradycardia Hypotension Widened PR and QRS complex Asystole possible
46
Hyponatremia manifestations
Hypothermia Headache Confusion Lethargic Seizures Coma Decreased deep tendon reflexes Muscle **Monitor the client for weakened respiratory effort** GI: increased motility, hyperactive bowel sounds, abdominal cramping, anorexia, nausea, vomiting
47
Hypernatremia manifestations
Hyperthermia Restless Fatigue Disorientation Irritability Muscle twitching Muscle weakness Seizures Decreased LOC Reduced to absent DTR Dry and swollen tongue that is red in color
48
Hypomagnesemia manifestations
Hyperactive deep tender reflexes Muscle cramps Numbness Tingling Muscle tetany (positive chvosteks and trousseaus signs) Seizures Insomnia Increased blood pressure Paralytic ileus
49
Hypermagnesemia manifestations
Diminished DTR **Muscle paralysis** Shallow respirations, Decreased respiratory rate Bradycardia, hypotension Cardiac arrest Dysrhythmias, prolonged PR interval Lethargy
50
Peripheral arterial disease (PAD)
**Intermittent claudication** - is ischemic pain that is precipitate by exercise, resolves with rest, and is reproducible. (FOUND IN EARLY STAGES) Risk factors: Diabetes mellitus LATE STAGE: - Dependent rubor - Rest pain, or a numbness (worse when food is elevated or foot is in elevated position) - Foot ulcers
51
Peripheral vascular disease (PVD)
52
Autonomic dysreflexia
Causes a sudden and severe rise in blood pressure, in addition to other symptoms. *occurs when the autonomic nervous system reacts to a stimulus below the level of spinal cord injury **Bladder, bowels, boils, bones, babies, and back passage** Intervention: first place client to sitting position to decrease hypertension
53
Diabetic ketoacidosis (DKA)
Increased urine output Weight loss Kussmaul respirations (deep, labored breathing) Blood glucose above 300 mg/dL
54
Diabetes insipidus
Condition causing extreme thirst and excessive urination due to the kidneys inability to conserve water. **Deficiency of ADH** -tachycardia (due to dehydration) - polyuria - polydipsia (extreme thirst) - fatigue Medications - Vasopressin - carbamazepine - demopressin acetate
55
Addison disease
*Caused by a lack of production of aldosterone by the adrenal gland. *Don’t produce enough cortisol Aldosterone- regulates fluid balance, blood pressure, and electrolyte (sodium and potassium in blood) levels. *Addisonian crisis* characterized by a drop in blood pressure - really low: can happen when body is under stress.
56
Diagnostic tests for myocardial infarction
Troponin I - myocardial muscle protein that is released when there is injury to cardiac muscle Troponin T - muscle protein that is also released when there is injury to cardiac muscle CPK - enzyme that is elevated in presence of muscle injury Myoglobin - elevation indicates myocardial injury Creatinine kinase- MB - isoenzyme. Elevated indicates myocardial injury
57
Three chamber closed chest tube system
Suction chamber Water seal chamber: - Tidaling in water chamber - Fluid level will rise with inspiration - Fluid level will fall with expiration - **Cessation of tidaling in water seal chamber indicates lung re-expansion or obstruction** - ** Continuous building indicates a leak** Collection chamber
58
Dehiscence vs eviseration
Dehiscence: a surgical would that begins to open up after surgery. - risk factors: poor nutrition, obesity, wound infection Evisceration: serious complication when internal organs, such as bowel, protrude through a dehisced wound. **medical emergency**
59
Evisceration nursing action
Call for help Cover the organs using a soaked sterilizer 0.9% sodium chloride dressing Secure Notify physician **do not attempt to reinsert organs**
60
Ventricular tachycardia nursing interventions
Defibrillation- if the client is unstable and unresponsive Elective cardioversion- priority intervention if the client is AWAKE and RESPONSIVE.
61
Nitroglycerin transdermal patch
Should instruct the client to be patch free 10-12 hrs a day Place the patch away from an area of skin folds and joints Rotate the patch site to prevent skin irritation These only offer ongoing prevention of angina attacks and are not used as an immediate relief
62
Normal absolute partial thromboplastin time (aPTT)
Between 25-35 seconds Heparin therapeutic range: 60-80 seconds >90 seconds —> bleeding precautions. Stop the infusion
63
Arterial ulcer
Experiences claudication (pain with walking, then relieved at rest) Location: toes, feet, heels Pain often worsens with elevation Rounded Shiny, hairless, cool, pale
64
Venous ulcer
Location: ankle, lower leg Moderate pain, relieved by elevation Irregular borders and shape Appear wet or weeping
65
66
Dilated cardiomyopathy
Heart muscle weakens and enlarges making it difficult for the heart to pump out blood effectively Myocardium (muscle of heart) becomes stretched and thinner Symptom can include dyspnea on exertion b/c of reduced cardiac output
67
Pulmonary edema
Adventitious breath sounds: occurs when there is fluid in the lungs
68
Hypocalcemia manifestations
**Muscle twitches and tetany** (muscle spasms or tremors) Tingling and numbness of the hands and feet Positive Chvosteks sign (tapping on the facial nerve triggering facial twitching) Positive Trousseaus sign (Hand finger spasms) Laryngospasms Hyperactive deep-tendon reflexes (DTR) **Cardiovascular** Weak, thready pulse, tachy or bradycardia **GI** Increases gastrointestinal motility **Can cause ECG changes, prolonged QT interval and ST segments**
69
Hypercalcemia manifestations
Decreased reflexes Bone pain Anorexia, nausea, vomiting, constipation Weakness, lethargy Personality change Shortened QT and ST intervals Increased risk for blood clot
70
Hyperglycemic- hyperosmolar state
Blood glucose above 600 mg/dL Serum pH will still be in the expected reference range
71
Long term corticoid steroid use complications
Osteoporosis Moon-shaped face Increased risk of infection
72
73
Hyperglycemia manifestations
Rapid, deep respirations Abdominal cramping Orthostatic hypotension
74
Hypoglycemia manifestations
Cool, clammy skin Nervousness Tachycardia Confusion Sweating Headache Blurred vision Seizures Coma **Glucagon for severe hypoglycemia** and if client is unable to swallow
75
Treatment for hyperkalemia
Diuretic (Furosemide) Sodium polystyrene sulfonate (kayexalate) Other meds: Calcium gluconate Albuterol Patiromer
76
Cardiac tamponade manifestations
Pulsus paradoxus (a decrease of 10mg or more in systolic blood pressure during inspiration), tachycardia, muffled heart sounds, and jugular vein distention *dizziness, dyspnea, restlessness* - can result from fluid accumulation in the pericardial sac
77
Diabetic foot care
Inspect feet daily Wash feet daily with mild soap and warm water (do not soak) Pat feet dry, especially in between toes and avoid lotion between toes Use mild foot powder (powder with cornstarch) on sweaty feet Do not use callus removals Consult podiatrist Avoid open-toe, open heal shoes. Leather shoes over plastic. Wear slippers with soles No heating pads to warm feet. Wear socks avoid prolonged sitting, standing, and crossing of legs Cleanse cuts with warm water and mild soap.
78
Ammonia levels
10-80 mcg/dL expected range Increase when hepatocellular injury (cirrhosis) prevents the conversion of ammonia to urea for excretion **Lactulose can be given to aid in excretion of ammonia** — draws water into the colon Expect two to three bowel movements per day
79
80
Cardiac catheterization (angiogram)
Evaluate the presence and degree of coronary artery blockage Involves the insertion of a catheter into a femoral vessel and threading it into left or right side of heart Coronary artery narrowing and occlusions are identified by the injection of contracts media under fluoroscopy. **client should be NPO 4-8 hr before procedure, assess for iodine/shellfish allergy (contrast media)**
81
Angina and MI expected findings
Anxiety Chest pain : reports of tight squeezing, crushing, aching pressure in chest - can radiate to neck, shoulder, or arm, or present as jaw pain (MI) - Weakness or numbness in arms Indigestion, nausea Dizziness Stable angina is relieved by rest or nitroglycerin, manifestations last less than 15 min Myocardial infarction can occur without cause, often in morning after rest and relieved only by opioids, manifestations last more than 30 min
82
Ulcerative colitis things to avoid and recommend
Dairy products should be avoided, because they are poorly tolerated in clients with ulcerative colitis Restrict intake of fiber Use progressive relaxation techniques to minimize stress Arrange activities to allow for frequent rest periods
83
Ulcerative colitis manifestations
Continuous inflammation
84
Crohns manifestations
Patch inflammation Cobblestone
85
Antacid
Aluminum hydroxide Calcium carbonate - antacid neutralizes gastric acid but does not inhibit its secretion
86
H2 receptor antagonist
Famotidine - inhibit the secretion of gastric acid
87
Total parental nutrition (TPN)
TPN tubing is changed every 24 depending on facility protocol, MUST be changed every 72 hours at a minimum Never run by gravity Central line only not peripheral Using multilumin central line to avoid mixing substances
88
Systemic lupus manifestations
Decreased urine output Butterfly rash Fever Joint inflammation — autoimmune disorder that affects the joints, kidneys, heart, lungs, brain, and skin. **Raynaud’s phenomenon commonly accompanies SLE and can cause painful vasoconstriction in the clients fingers when exposed to cold temperatures**
89
90
Lyme disease teachings
Test for 4-6 weeks after getting bit by a tick, testing earlier is not reliable Remove ticks with tweezers Should wear light colors so ticks on the body can be easily seen **should develop pain and stiffness in your joints you should see your doctor** *Manifestations* : influenza like; bulls eye rash, muscle and joint pain, and stiffness.
91
Borderline personality disorder
Emotionally unstable Troubled interpersonal relationships Often engage in harmful behaviors
92
Histrionic personality disorder
**Self centered behavior** Seductive behavior Exaggerated and emotional displays Gain approval or admiration from others
93

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