units 1 & 2 and exam questions Flashcards
(199 cards)
1
Q
pt on ventilator and hyperventilated is at risk for what?
A
- acid deficit
* respiratory alkalosis
2
Q
following assessment of pt w/ pneumonia, RN identifies ineffective airway clearance based on what?
A
•crackles and wheezing in lower lungs
3
Q
pt w/ pneumonia has temp that fluctuates w/ periods of diaphoresis. What intervention is a priority?
A
•provide fluids of at least 3L/day
4
Q
pt w/ asthma can’t take deep breaths…decreased sounds in base and no wheezes..what is RN priority?
A
•measure O2
5
Q
what is appropriate expected outcome of elderly recovering from pneumonia?
A
•ability to perform ADLs w/o dyspnea
6
Q
which breathing impaired patient is priority?
A
•HR of 120 bpm b/c trying to get more O2
7
Q
pt pulls out chest tube…what is appropriate RN action?
A
- notify MD
- prepare for reinsertion
- apply occlusive dressing
8
Q
pt fasting for 5 days…which acid/base imbalance is expected?
A
•metabolic acidosis
9
Q
3 day hx of N/V in ER… confused, irritable, shallow resp. RR of 6…blood gases are expected to reveal?
A
*losing stomach acid
•metabolic alkalosis
10
Q
taking magnesium hydroxide…which RN action most appropriate?
A
•check renal fxn
11
Q
how can RN help minimize pt’s s/s of GERD regards to lifestyle changes?
A
•provide resources for smoking cessation support group
12
Q
pt w/ larger burns is at risk to develop stress ulcer…stress ulcers are evidenced by…
A
•hemorrhage
13
Q
Pt has rigid abdomen, shallow breath, tachycardia…what is RN priority action?
A
*perforation
•keep pt NPO in prep for surgery
14
Q
pt diagnosed w/ ulcer asks RN what is next…how does RN respond?
A
•most ulcers treated w/ medication
15
Q
pt w/ fractured rib is at risk for what?
A
•respiratory acidosis b/c can’t take in breaths as efficiently
16
Q
pt has CT in place following surgery…what requires action?
A
•continuous bubbling in water-seal chamber
17
Q
RN should report what assessment finding in pt w/ emphysema?
A
- cyanotic lips
* would expect fatigue, crackles, and barrel shaped chest
18
Q
which outcome demonstrates effectiveness of peri-operative teaching
A
•client demonstrates correct use of incentive spirometer
19
Q
before nurse brings pt to OR, pt reports that site hasn’t been marked. What is priority action?
A
•call surgeon to mark site
20
Q
nurse assesses pt just brought to PACU. BP was 136/80, but now in PACU it’s 110/80; UOP was 20 mL/hr, but now it’s 10 mL/hr. What is priory intervention?
A
- kidney’s not perfused enough
- not enough circulating volume
- pt has FVD
- priority action is to increase IV as ordered to 100 mL/hr, then investigate what’s going on
- LOC is NOT priority for FVD
21
Q
adverse side effect of inhalation anesthetics
A
•malignant hyperthermia
22
Q
malignant hyperthermia
A
- acute, life-threatening complication of drugs (anesthetics)
- causes increased Ca2+ levels in muscles
- causes increased muscle metabolism
- leads to metabolic acidosis (not enough O2 to cells), cardiac dysrhythmias, high body temp
23
Q
s/sx malignant hyperthermia
A
- tachycardia/pnea
- elevated body temp
- muscle rigidity
- skin mottling
- cyanosis
- myobloinuria (muscle protein in urine)
- rise in tidal CO2 and decrease in O2 sat
24
Q
Which allergy is greatest concern during surgical procedure?
A
•kiwi b/c proteins similar to those in latex
25
For pt taking Lasix, what is the best way to detect adverse effect?
* intake and output
* Lasix is diuretic
* pt was in FVE, so now if give too much could become FVD
26
During hot summer day, elderly pt tells clinic nurse that he isn't drinking or voiding much. HR is 100 bpm. BP is 90/60. What action does nurse take first?
•worried about dehydration- inc. HR and dec. BP
•give pt a drink b/c not an emergency
*BEST way to rehydrate is PO
27
Physical assessment of client w/ cardiac dysrhythmia reveals hypoactive bowel sounds, dizziness, decreased DTRs, etc. Lab result consistent with this is...
•hypokalemia
28
b/c nurse is aware extracellular dehydration can occur in elderly w/ gastroenteritis (diarrhea/vomit), it's important to assess for...
```
*pt is FVD
•hyperthermia
•dec. UOP
•dec. diastolic BP
•furrowed tongue/confusion
•NOT tenting skin b/c elderly skin ALWAYS tents
```
29
Which nursing measure is most important to implement to decrease wound infection?
•change surgical dressing using sterile technique
| *asking for measure to take, not to assess
30
For pt w/ hypernatremia, nurse must implement...
•seizure precautions
31
Pt receiving .45% NS (hypotonic), if given in excess it could cause which effect on cells
* swell and lyse
| * dilute blood, so fluid goes into cells
32
Elder pt presents w/ decreased DTRs, which question by nurse helps eliminate possible cause?
•use of laxatives regularly
33
what food source highest in B12
* organ meat
* OJ
* spinach
* eggs
* milk products
* fortified cereals
34
what is evidence of cardiovascular dysfunction in anemic
* chronic fatigue
* pallor
* SOB
* hypotension
35
what indicates pulmonary embolism
•stabbing chest pain
36
pt admitted to ICU w/ 25% total body surface area burn...no medical hx. Which IV fluid is contraindicated to administer?
* in burns, develop systemic inflammatory response, which leads to capillary leak and third spacing
* intravascular volume goes down
* .45 % NS b/c it is hypotonic and would make third spacing worse
37
who is at most risk for FVD
* infants
| * elderly
38
single best indicator of fld. status
•daily weight
39
pt w/ aphasia presents w/ suspected CVA. Which finding indicates that it is a thrombotic stroke?
•two episodes of speech difficulty (indicates TIAs)
40
What is a predisposing factor for an embolic stroke?
* Afib
| * embolic stroke is sudden onset and often originates at heart
41
CN 10 (vagus) and CVA
* gag reflex
| * must put pt in high fowlers to promote safe swallowing
42
pt experiencing status epilepticus..what med does nurse admin
* Ativan
* stops unwanted ctx
* also give dilantin IV drip to prevent further seizures
43
hyperventilation causes
* cerebral vasoconstriction
| * might trigger seizure activity b/c leads to less cerebral perfusion (O2)
44
after blood transfusion nurse should...
•stay w/ pt for 10-15 min
45
what is hypersensitivity rxn
•transfusion rxn to blood type
46
pt receiving IV K+. It is important for nurse to...
* infuse faster than 24 hrs
* NOT admin diuretic also
* monitor IV site for s/s of extravasation
47
lab study helpful in dx of pernicious anmeia
•Schilling test
48
FVD subjective
* dizzy- poor perfusion to brain
* weak
* lethargic
* fatigue
49
FVD objective
* hyperthermia
* syncope
* tachycardia/pnea- compensate to maintain CO
* thready pulse- vasoconstriction in periphery
* hypotension
* oliguria
* confusion
* diminished cap. refill
50
FVD labs
* increased Hct
* increased serum osmolarity
* increased urine specific gravity and osmolarity
* hypernaturia
51
hypovolumetric shock
* decreased oxygen to organ/pressure to organ
* complication of FVD
* tx w/ O2, fluids, vasoconstrictors (increase central flow first)
52
FVE subjective
* confusion
* SOB
* lethargy
* muscle weakness
53
FVE objective
* tachycardia/pnea
* bounding pulse
* hypertension
* weight gain
* crackles
* edema
* JVD
54
FVE labs
* decreased Hct, serum osmolarity
* decreased BUN, creatinine, electrolytes
* respiratory alkalosis (dec. CO2/inc. pH)
* chest x-ray showing pulm. congestion
55
normal Na+
•135-145 mEq/L
| *imbalances manifested in neuro abnormalities
56
s/sx hyponatremia
* tachycardia
* hypothermia
* hypotension if r/t Na+ loss
* hypertension if r/t H2O excess
* headache
* confusion/lethargy
* weakness
* increased GI motility
57
s/sx hypernatremia
* tachycardia
* hyperthermia
* hypotension
* restlessness
* muscle twitch/weakness
* seizure
* coma
* thirst
* dry mucous membrane/skin
* increased GI motility
* edema
58
normal K+ level
•3.5-5 mEq/L
| *imbalances manifested in cardiac abnormalities
59
s/sx hypokalemia
* hypotension (ortho), weak irregular pulse, rep. distress
* weakness, cramping, hypoactive reflex, paresthesia
* confusion
* bradycardia, inverted T waves
* decreased GI motility (constipation)
* polyuria
60
s/sx hyperkalemia
* hypotension, weak irregular pulse
* weakness, restlessness, paresthesia
* confusion
* peaked T waves
* increased GI motility (diarrhea)
* headache
* palpitations
* malaise
* oliguria
* nausea
* inc. resp. rate
61
normal Ca2+ levels
•9-10.5 mg/dL
| *imbalances manifested in skeletal muscle abnormalities
62
s/sx hypocalcemia
* paresthesia
* muscle twitch/SPASM
* hyperactive DTRs
* positive Chvostek's/Trousseau's
* dec. HR, hypotension (dec. contractility)
* inc. GI- hyperactive bowel, diarrhea, cramping
63
s/sx hypercalcemia
```
•lethargy
•paresthesia
•muscle WEAKNESS
•faster clotting time
*high risk for DVT
```
64
phosphorus levels
•3.0 - 4.5 mg/dL
| *imbalances manifested in skeletal muscle abnormalities
65
s/sx hypophatemia
* same as hypercalcemia
* lethargy
* paresthesia
* muscle WEAKNESS
66
s/sx hyperphatemia
* same as hypocalcemia
* paresthesia
* muscle twitch/SPASM
* hyperactive DTRs
* positive Chvostek's/Trousseau's
* dec. HR, hypotension (dec. contractility)
* inc. GI- hyperactive bowel, diarrhea, cramping
67
Mg2+ levels
•1.3-2.1 mEq/L
| *imbalances manifested in skeletal muscles (DTRs)
68
s/sx hypomagnesemia
* occurs in conjunction w/ hypocalcemia
* HYPERACTIVE DTRs (spasm)
* tetany
* seizures
* psychosis
69
s/sx hypermanesemia
* renal dz
* lethargy
* HYPOACTIVE DTRs (weakness)
* coma
* bradycardia
* hypotension
70
electrolyte imbalances due to use of laxatives
* hypermagnesemia
| * hypokalemia
71
acute seizure tx
* lorazepan (Ativan)
| * diazepam (Valium)
72
long term seizure tx
* phenytoin (Dilantin)
| * also given during acute via IV to prevent progression into status epileptics
73
L hemispheric stroke consequences
* language, math, and analytic thinking
* expressive, receptive, global aphasia
* agnosia- inability to recognize objects
* alexia- reading diff.
* agraphia- writing diff.
* hemianopsia, hemiplegia, hemiparesis
74
R hemispheric stroke consequences
* abnormalities in spatial perception, proprioception, and judgment/impulse control
* hemianopsia, hemiplegia, hemiparesis
* depth perception- overestimate
75
recombinant tissue plasminogen activator (rtPA)
•thrombolytic NZ (Activase)
•can be used to reverse ischemic stroke (thrombolitic/embolitic) if given w/ 3-4.5 hrs of initial sx
*only used for clot in brain (not used for DVT)
76
normal Hgb levels
* m: 14-18 g/dL
| * f: 12-16 g/dL
77
Hgb levels in anemia
•mild: 10-14 g/dL
•moderate: 8-10 g/dL
•severe: < 8 g/dL
* < 10 g/dL when clinical manifestations show
78
normal Hct levels
* m: 50-57 ml/dL (50-54%)
| * f: 37-48 ml/dL (37-48%)
79
normal WBC levels
* 5,000-10,000/uL
* elevated evidence of infection
* decreased evidence of immunosuppression
80
folic acid food sources
* beans/legumes
* citrus fruits/juice
* fortified bread, cereals, pasta, etc
81
iron food sources
* red/organ meat
* leafy greens
* egg yolks
* almonds
* legumes
* dried fruit
82
fresh frozen plasma transfusion
* anti coagulated clear liquid portion of blood separated from whole blood by centrifugation
* used to reverse excessive anticoagulation
* clotting factor deficiencies associated w/ hemorrhagic tendency
83
packed RBC transfusion
* whole blood with ⅔ of plasma removed
* severe anemia
* moderate blood loss
* less danger of fluid overload
* transfusion of choice
* should not exceed 4 hrs transfusing
84
whole blood transfusion
* massive blood loss
| * pt needs O2-carrying capacity and vol. increase
85
normal pH
•7.35-7.45
86
normal PCO2
•35-45 mmHg
87
normal HCO3
•22-26 mEq/L
88
compensated
•pH normal
•acid/base components may be abnormal, but they are balanced
*most abnormal is reason
89
uncompensated
* pH and one other value abnormal
| * buffer/regulatory mechanisms have not begun to correct imbalance
90
partially compensated
* all values abnormal abnormal
* CO2 and HCO3 in same direction
* evidence buffer/regulatory mechanisms have begun to respond
91
partially compensated respiratory acidosis
* pH down
| * CO2 and HCO3 up
92
partially compensated respiratory alkalosis
* pH up
| * CO2 and HCO3 down
93
partially compensated metabolic acidosis
•all down
94
partially compensated metabolic alkalosis
•all up
95
respiratory acidosis labs
* pH < 7.35
* CO2 > 45
* HCO3 normal (22-26)
96
respiratory acidosis etiology
1. respiratory depression
2. inadequate chest expansion
3. airway obstruction
4. reduced alveolar capillary diffusion of gases
97
respiratory acidosis s/sx
* dyspnea, tachypenic
* anxiety/irritability/disorientation
* hypoventilation -> hypoxemia (b/c no where for O2 to bind)
* hypotension
* tachycardia
* headache
* hypERkalemia -> dysrhythmias
98
respiratory acidosis tx
•O2; patent airway; enhance gas exchange via...
- positioning
- breathing technique
- vent support
- bronchodilators
- mucolytics
99
respiratory alkalosis labs
* pH > 7.45
* PaCO2 < 35 mmHg
* HCO3 normal (22-26)
100
respiratory alkalosis etiology
```
•hypoxemia stimulated hyperventilation
-emphysema; pneumonia
•impaired lung expansion (ascites, scoliosis, preggo)
•Salicylates (aspirin) OD
•CNS trauma/tumor
•excessive exercise/stress/pain
•anxiety
•diabetes
```
101
respiratory alkalosis s/sx
* Tachypnea; hyperpnea, tachycardia
* Giddiness, dizziness, syncope, convulsions, or coma
* Weakness, paresthesias, tetany
* Hypokalemia
* Hypocalcemia
102
respiratory alkalosis tx
* O2 therapy
* anxiety interventions
* rebreathing techniques
103
metabolic acidosis labs
* pH < 7.35
* PaCO2 normal (35-45)
* HCO3 < 22
104
metabolic acidosis etiology
```
•renal failure
•DMKA
•lactic acidosis
•ingested toxins (aspirin, antifreeze)
•carbonic anhydrase inhibitors (Diamox)
*over-production/under-elimination of H+
*underproduction/over-elimation HCO3
```
105
metabolic acidosis s/sx
* Tachypnea (hyper) “Kussmaul’s”
* Hypotension- poor tissue perfusion as condition worsens
* Drowsiness,confusion, or coma
* Headache, dec. DTRs & muscle tone
* Altered GI: anorexia, N/V
* Hyperkalemia
106
metabolic acidosis tx
* DKA- admin insulin
* GI losses- admin antidiarrheals; rehydrate
* low serum HCO3- admin NaHCO3
107
metabolic alkalosis labs
* pH > 7.45
* PaCO2 normal (35-45)
* HCO3 > 26
108
metabolic alkalosis etiology
* hypokalemia (diuresis, steroids)
* gastric fluid loss
* overcorrection of acidosis w/ NaCO3
* massive transfusion w/ whole blood
* hyperaldosteronism
* licorice intoxication
109
metabolic alkalosis s/sx
* Tachycardia, Hypoventilation (compensatory)
* Dysrhythmias
* Paresthesias, muscle weakness, confusion
* Hypokalemia
* Hypocalcemia
110
metabolic alkalosis tx
* GI loses- antiemetics, fluids, electrolytes
| * K+ depletion- discontinue causative agent (diuretic)
111
hypoventilation
```
•not breathing enough (getting rid of enough CO2)
•rapid/shallow breaths
•vasodilation
•hypercapnia
*blood becomes ACIDIC
```
112
hyperventilation
```
•deep, labored, rapid breathing
•vasconstriction
•hypocapnia
•Kussmaul respirations
*blood becomes BASIC
```
113
diuretics and alkalosis
•diuretics cause loss of fluid not containing HCO3
114
normal PaO2
* 80-100 mmHg
| * amount of O2 dissolved in arterial blood
115
normal SaO2
* 96-100%
| * amnt O2 dissolved in blood
116
good indicator of metabolic acidosis during hyperventilation
•severe diarrhea
117
good indicator of respiratory alkalosis during hyperventilation
•anxiety
118
atelectasis
* alveolar collapse
| * causes a reduction in gas exchange b/c reduces surface area
119
thoracentesis
* surgical perforation of chest wall and pleural space w/ large-bore needle
* used to obtain specimens, admin meds, remove fld/air
* local (conscious) sedation
120
empyema
•infection in pleural space causing collection of pus
121
bubbling w/in CT system
* always occurs when CT is connected to continuous suction
* bubble w/ only water seal indicates air passing thru chamber w/ higher intrathoracic pressure (exhale, cough, sneeze)
* excessive bubbling may indicate leak
122
CT complications
* redness/swelling/purulence/bleeding
* tracheal deviation
* sudden/increased dyspnea
* SaO2 < 90%
* drainage > 70 mL/hr
* crepitus
* accidental disconnect (immediately submerge in sterile H2O or cover w/ vasoline gauze)
123
COPD complications
* hypoxemia
* hypercarbia
* respiratory acidosis
* respiratory infection
* dysrhythmias
* HF
* decrease resp. drive (NEVER give > 2 L)
124
indication of tension pneumothorax
•tracheal deviation to side opposite of pneumothorax
125
#1 preventable cause of prematures dz/death
•tobacco use
126
how does atelectasis reduce gas exchange
•reduced alveolar surface
127
pt w/ 2 chest tubes on R side; clients trachea is pointing toward L upper chest. What's RN's best action
•notify MD/rapid response team
128
elderly w/ pneumonia has symptoms of
* altered mental status
| * dehydration
129
which pathophysiological mechanisms of lung parenchyma allows pneumonia to develop?
•inflammation
130
atelectasis and brochiectasis indicate...
•collapse of a portion of the airway
131
what finding confirms diagnosis of asthma
•inspiratory and expiratory wheezing
132
7 y/o tachypneic, afebrile, RR=38, and nonproductive cough. PT most likely has
•acute asthma
133
19 y/o in ED w/ acute asthma attach; RR=44 bpm; acute resp. distress. Which action should RN take first
•nebulizer tx
134
79 y/o w/ bacterial pneumonia who is vegetarian and OCD about germs, What is predisposing factor for pneumonia?
•age
135
what data significant from pt w/ pneumonia
* quality of breath sounds
* chest pain
* color of nail beds
136
pt w/ bacterial pneumonia is to be started on IV abx. what must be completed first?
•sputum culture to determine which abx to use
137
what should be included in plan of care for pneumonia pt?
•frequent linen changes b/c likely diaphoretic and at risk for skin breakdown
138
pleuritic chest pain is...
•moderate pain that worsens on inspiration
139
which measure most likely to reduce pleuritic chest pain?
•teach pt to splint rib cage b/c talking about pain
140
what indicates presence of resp infection in pt w/ asthma
•cough productive of yellow sputum
141
30 y/o male w/ stab wound has CT inserted b/c...
•CT serve as method of draining blood/fld
142
what are expected findings of CT after thoractomy
* 50 mL drainage in chamber
| * drainage system below pt chest
143
continuous bubbling in suction control chamber requires...
•no action
144
antiacids
```
•increase pH of gastric contents
•deactivate pepsin
•buffer acids
•best given on empty stomach
•aluminum -> constipation
•magnesium -> diarrhea
*Sodium Bicarbonate, Maalox, Mylanta
```
145
histamine receptor antagonists
* antagonize (block) production of histamine
| * do not impact reflux as much as reduce acid production and promote healing of inflamed tissue
146
proton pump inhibitors
•primary tx for GERD
•long-acting inhibition of gastric acid by impacting proton pump of parietal cells in mucosa
•given IV to treat/prevent stress ulcers
*Prilosec, Zantac, Prevacid
147
prolonged use of proton pump inhibitors
* may mask symptoms
* may cause pneumonias and C-diff
* increase risk of hip fractures in elderly b/c of Ca2+ loss
148
Dumping syndrome
* vasomotor response to food ingestion due to stomach being no longer able hold contents and "dumping" mass amounts into small intestine
* reduced circulatory volume b/c trying to supply intestines
* s/s of tachycardia, hypotension, dizziness
* compilation of GERD and PUD
* high protein diet, avoiding wheat and dairy
149
perforation
* deep ulcer goes thru lining of stomach or duodenum
| * can cause peritonitis
150
s/sx perforation
```
•severe epigastric pain spreading across abdomen
•hypotension
•round, board-like abdomen
•hyperactive or diminished bowel sounds
•rebound tenderness
*surgical emergency
```
151
RN interventions for GI bleed
* ABCs
* vital signs (prevent hypovolemic shock)
* fld replacement
* NG tube lavage
* manage pain
* admin meds
152
NG tube gastric lavage
* NS instilled and then removed with blood
| * pt on L side to limit flow out of stomach
153
Why would a client with gastric ulcers need to be cautious about using OTC cold remedies?
* OTC medications may have aspirin in them
* OTC medications may contain NSAIDs
* Drug interactions may occur causing deepening of the stomach ulcers
154
why do NSAIDs cause bleeding
•inhibit prostaglandin production
•prostaglandins are responsible for providing mucosal layer of stomach
*nothing to protect stomach
155
chronic gastritis can cause
* Pernicious anemia
* Sickle cell anemia
* Gastric ulcers
* Electrolyte imbalance
* Cancer of the stomach
156
role of parietal cells
* intrinsic factor that helps absorb B12
* destroyed in chronic gastritis
* require B12 injection for life
* also secrete HCl (diminished in older adult)
157
GERD in elderly
•may not have s/s of reflux b/c diminished parietal cell HCl production
*more severe complications b/c immunocompromised
•atypical chest pain
•ENT infections; Barrett's esophagus
•pulmonary symptoms
•sleep apnea
•asthma
158
The danger of aspiration is increased if regurgitation occurs when the client
•lying down
159
dysphagia indicates ____; and assessment by RN should include ____
* stricture of the esophagus
| * when it occurs in pt
160
interventions for anti-acid admin
* give on empty stomach
* monitor for constipation
* don't give w/ other drugs
* assess pt for hx of HF or renal dz first
161
febrile nonhemolytic transfusion rxn
•most common
•fever w/in 2 hrs
•chills, headache, flushing, anxiety, muscle pain
*due to sensitization to blood products
162
septic transfusion rxn
•rapid onset of fever/chills
•hypotension
*due to contamination
163
acute hemolytic transfusion rxn
```
•fever/chills/anxiety immediately
•N/V
•dyspnea
•tachycardia/tachypnea
•hypotension
*due to incompatibility
```
164
allergic transfusion rxn
```
•flushing
•urticaria (hives)
•itching
•wheezing
*due to sensitivity
```
165
thrombocytopenia
* low platelet count
| * recipient of platelet transfusion
166
s/sx increased ICP
* widening of pulse pressure
| * decreased HR
167
preventing post-op DVT
•have pt. perform dorsal/plantar flexion qh
168
spirometer
* expands lungs during INHALATION
| * prevents respiratory acidosis
169
tx for tachycardia/hypotension
•IV fluid bolus
170
narcan
•reverses respiratory depression r/t OPIOIDS
171
A/B imbalance caused by aspirin OD
* respiratory alkalosis
| * metabolic acidosis
172
duodenal ulcer
* upper portion of duodenum
| * evening pain 1.5-3 hrs after meal
173
blood transfusion rate
•2 mL/min
174
CT drainage
•100-300 mL post insertion
•report > 70 mL/hr after 4 hrs post-op
*keep device below chest
175
s/sx hyperglycemia
```
•3 P's
•polyphagia
•polydispia
•polyuria
*hot and dry, sugar's high
```
176
s/sx hypoglycemia
```
•TIRED
•tachycardia
•irritability
•restless
•excessive hunger
•diaphoresis
*cold and clammy, need some candy
```
177
fiber and hypothyroidism
* encourage fiber rich foods, NOT laxatives
| * laxatives impede absorption of Synthroid
178
normal BP
•120/80 mmHg
179
pre-HTN
•121-139/81-89 mmHg
180
HTN
•140/90 mmHg (and above)
181
IVP
* intravenous pyelography
* used to diagnose calculi, tumors, cysts
* view of kidney, bladder, and tract
* requires bowel prep so view is not obstructed
182
concern about contrast dye
* nephrotoxic
* major concern for kidney failure in dehydrated or renal compromised pts
* pt's taking metformin at risk for lactic acidosis
183
pre-contrast dye procedures to prevent complications
* adequate hydration before/after
* IV hydration for renal insufficient pts
* diuretics after for renal insufficient
* discontinue metformin 48 hrs prior
* if have minor dye allergy can admin steroids/antihistamines prior
184
CAUTION (clinical manifestations of cancer)
* Change in bowel/bladder habits
* A sore that doesn't heal
* Unusual bleeding/discharge
* Thickening of lump presence
* Indigestion/dysphagia
* Obvious changes in warts/moles
* Nagging cough/hoarseness
185
peripheral neuropathy
* nerves that carry messages to the brain and spinal cord from the rest of the body are damaged or diseased
* s/sx: pain, impaired movement, paresthesias, weakness, diminished sensation
186
glycosylated hemoglobin (HgbA1c) levels
* 4%-6% in non-diabetic
* 6%-8.5% in diabetic (<7 target for diabetic)
* best indicator of avg blood glucose for pat 120 days
* used to evaluate effectiveness of tx
187
hyperkalemia etiology (MACHINE)
```
Meds (ACEI, steroids, beta blocker)
Acidosis
Cellular destruction
Hemolysis; hypoaldersteronism
Intake- excessive
Nephron failure
Excretion impaired
```
188
HTN tx (ABCD)
ACEIs
Beta blockers
CCBs
Diuretics
189
risk factors for primary
* no true known cause
* high Na+ and fat
* obesity
* stress
* etoh
* inactivity
* caffeine
* vit D deficiency
190
solutions to treat hypo volumetric shock
* 0.9% NaCl
| * lactated ringers
191
thyroid storm
```
•fever
•hypertension
•abdominal pain
•tachycardia
*exaggerated hyperthyroidism
```
192
priority intervention for calculi
•relieving pain
193
casts
* protein structures in renal tubules
| * presence in urine indicated kidney infection
194
gastric distention during NG suction indicates
•NG tube not patent
| *report to MD immediately
195
prior to an infusion, what prevents against blood group incompatibility AFTER blood has arrived
•comparing ID #s on blood and pt wristband
196
blood glucose during DKA
•increases
197
pt has high T3 and T4 and low TSH. What is RN priority intervention?
•monitor apical pulse
| -b/c once give Propanorol, the HR will decrease
198
renal calculi in L kidney...which assessment finding indicates development of complication
•pt reports severe pain at L CVA
199
hypothyroidism...which problem is a priority?
•depression and withdrawal
