Exam 1, Exam 2, Exam 3 final

Hypovolemic shock description

Loss of blood or volume from the vascular space. Low circulating volume Decreased circulating volume results in decreased preload

Idealism vs. realism

Loss of idealism is a major source of burnout and nurses leaving the profession Nursing classes - we nurture idealism Daily challenges of nursing forces us into realism

Hypoxemic definition

Low arterial blood o2 levels

Shock neuro s/s

Restless, anxiety, lethargy, confusion

Speech parkinsons s/s

Soft low pitched voice, dysarthria slurred speech, echolalia repetition of words, hypophonia soft voice

Beta blockers for Graves name? For?

-lol for supportive therapy ie diaphoresis, anxiety, tachycardia, palpitations but don't inhibit thyroid hormone

Corticosteroids names? Define? SE?

-one drugs. Antiinflammatory. SE: fluid/Na retention, hypertension, cushingoid state, gastric distress, adrenal suppression, psychosis, osteoporosis, susceptibility to infection

Goiter classes

0: none visible, 1:mass not visible but is palpated, 3:mass visible and easily palpated

Anaphylactic shock example

76 y.o. same-day -surgery client admitted to your unit a few minutes ago from PACU followi ng a left hip hemi-arthroplasty. His second dose of cefazolin IV was started 5 minutes ago. Client now c/o itching and SOB. He is extremely restless, anxious, and gasping. VS: T 100, P 130 irregular, R 40 dyspneic, stridor, wheezing BP 60 by Doppler only, skin warm, generalized edema.

7 tips of QRS in 6 second strip

7x10=70bpm

PaO2

80-100. Decreased: anaerobic metabolism

Healthy adult CD4 count? In HIV/AIDs?

800-1000, lower in HIV/AIDs

What is MAP when BP is 83/50

83+2(5) then divide answer by 3. Answer 61 which is normal 60-70

Glasgow scale score 8 means?

8= intubate, lower the worst

Calcium normal? Hypofunction of adrenal? Hyperfunction?

9-10.5 total or 4.5-5.6 ionized if older slightly decreased. Increased, decreased

BG normal? Early sepsis? Late? Septic shock

<110, 110-120, 120-150, >150

Serum lactate normal? Early sepsis? Late sepsis? Septic shock?

<2, normal/slightly increased, 2-4, >4

What K level for supplements

<4

Bradycardia

<60bpm

Massive hemothorax

>1.5 L of blood drained from pleural space upon chest tube insertion or >200cc/hour in 1st 4 hours

Tachycardia

>100 bpm

Sepsis w/ systemic inflammatory response syndrome criteria

>100.4 or <96.8 temp, >90HR, >20RR or PaCO2 <32, >12000 WBC. Sepsis present if >2 SIRS s/s present w/ infection + hypotension, u/o less, + fluid balance, decreased cap refill, hyperglycemia >120, unexplained changed LOC, or rising creatinine level

Sinus tachycardia s/s

>100bpm, fatigue, weakness, SOB, orthopnea, decreased O2 sat, decreased BP, restlessness, anxiety, decreased UO, angina pain, palpitations, T wave inversion, ST seg elevation

ST elevation: ST segment is what elevation? Associated w/?

>1mm elevation. Associated with MI

ESR that indicates chronic inflammation/infection

>20/mm

You want CD count to be what for immunocompromised

>200

Droplet precautions define? Ex?

>3 feet, private room, mask if w/in 3 ft of patient, transport w/ mask Ex: flu, mumps, pertussis, meningitis, flu type b, diphtheria, pharyngitis, pneumonia, rubella

Osteoarthritis : onset age? Gender affected? Risk factors/cause? Disease process? Disease pattern? Lab findings? Common drug therapy?

>60yr female. Aging, genetics, obesity, trauma, occupation. Degenerative. Can be unilateral weight bearing joints/hands/spine, nonsystemic. Elevated ESR. NSAIDs, acetaminophen, other analgesics

MAP WE WANT what

>65

ECG define? Captured by? ___ of cells?

A graphic representation, or picture, of cardiac electrical activity. Captured by conductive gel on adhesive pads. Positive or negative deflection from the isoelectric baseline Depolarization and repolarization of cells

Vaxes available for hepatitis

A+B

Rn dx from coagulation issues/varices

Activity Intolerance Decreased Cardiac Output Risk for Injury Pain

Rn dx from portal hypertension

Activity Intolerance Fluid Volume Excess Pain Altered Tissue Perfusion

Rn dx for cirrhosis

Activity intolerance Imbalanced nutrition Impaired skin integrity Fluid volume excess Risk for injury Body image disturbance Disturbed thought pattern Collaborative problem: hemorrhage

Assessment for Addison's

Activity level changes Lethargic, fatigue, muscle weakness, salt cravings, anorexia, n/v, diarrhea, ab pain, impotenence or amenorrhea Depressed Confused Psychotic Bronze pigment of skin, changes in distribution of hair, GI issue, weakness, hypoglycemia, postural hypotension, weight loss

Documentation should never be completed before it

Actually takes place

Acute on chronic s/s

Acute change in respiratory status in a chronic respiratory failure patient

Liver transplant complications

Acute graft rejection, infection which can lead to organ failure w/ encephalopathy

Assessment for high altitude ilnesses: acute? High altitude cerebral? Pulmonary?

Acute mountain: headache, anorexia, n/v, chilled, irritable, VS variable. High altitude cerebral edema: no ADLs, apathy, ataxia, changed LOC, confusion, seizures, stupor, coma, death. High altitude pulmonary edema: poor exercise tolerance, prolonged recovery time, fatigue, weakness, dry cough, cyanosis of lips/nails, tachycardia/tachypnea, crackles, pink sputum, alkalosis, hypoxemia, pnuemonia

Acute respiratory distress syndrome ARDS

Acute respiratory failure w/: hypoxemia even w/ 100% O2, decreased pulmonary compliance, dyspnea, non-cardiac associated bilateral pulmonary edema, dense pulmonary infiltrates on Xray aka ground glass appearance

Peripheral organs of immune system

Adenoids, tonsils, lymph nodes/vessels, spleen

What is most common method used to secure ET/NG tubes

Adhesive tape but it can irritate and tear skin, possible fungal infection.

Sinus bradycardia treatment

Adjust medication Treat the cause Anticholinergics- Atropine IV fluids/O2 Pacing

Sinus tachycardia treatment

Adjust medication Treat the cause Antipyretics Hydration

<15% EF

Advanced HF, severe activity and exercise intolerance

2 years you are

Advanced beginner

Level 4 trauma center

Advanced life support in rural/remote settings w/ no access to higher level trauma center

MG management

Affects symptoms w/out influencing the course of disease like anticholinesterases/cholinergics. Inducing remission via immunosuppressants, corticosteroids, plasmapheresis, thymectomy, don't allow in hot temps

First aid/prehospital care for heat stroke

After ensuring patent airway, effective breathing, circulation: rapid cooling is 1st. No food/liquid, ensure patent airway, remove from environment, remove clothing, pour/spray water, fan patient, ice packs, emerge in water

ACE inhibitors reduce

Afterload but dry hacking cough common

Contraindications for TIPS

Age over 65 Heart Failure Grade III or IV Hepatic Encephalopathy INR >5 Severe thrombocytopenia Moderate to severe Pulmonary HTN Uncontrolled infection

Escalating behaviors indicating violence

Agitation, inappropriate communication, hostility, physical violence

Hyperaldosteronism: aka? Increased? Causing? From?

Aka Conn's syndrome, Increased secretion of aldosterone from one or both adrenal glands resulting in mineralocorticoid excess causing Na retention w/ K/H excretion causing metabolic alkalosis+raised BP. From adrenal adenoma, high renin from kidney hypoxemia/thiazides

Amyotrophic lateral sclerosis aka? Define?

Aka Lou Gehrigs. Is progressive until entire body involved causing weakness, atrophy and then death.

Class 4 LHF from MI

Aka cardiogenic shock. Tachycardia, hypotension, BP <90, U/O <30, cold/clammy, poor pulse, agitation/confusion, pulmonary congestion, tachypnea, chest discomfort. Managed via drugs, intra-aortic balloon pump, percutaneous ventricular assist device, immediate reperfusion

Depolarization aka? Define?

Aka contraction.High potassium inside cell Exchange of potassium & sodium Action potential occurs

Type 4 hypersensitivity aka? Results in? Ex?

Aka delayed. Results in inflammation. Ex: Poson ivy, graft rejection, positive TB skin test, latex allergy, sarcoidosis

Neupogen aka? Function?

Aka filgrastim. Decreased incidence of infection in patients who are neutropenic from chemotherapy or other causes.

Repolarization aka? Define

Aka relaxation. Higher potassium in blood Exchange of potassium & sodium Resting potential occurs

Syndrome of inappropriate antiduretic hormone SIADH: aka? Definition?

Aka schwartz-barter. Hypersecretion of ADH resulting in inability to excrete appropriate amount of urine developing fluid retention/overload and dilutional hyponatremia

Fatty liver aka? Caused from? S/s?

Aka steatosis. Caused from alcohol, DM< obesity, elevated lipids. WEight loss, glucose control, lipid lowering agents are recommended

Viral load testing aka? Measures? Type?

Aka viral burden testing. Measures presence of HIV material in patient's blood. Type: quantitative RNA assay

Stage 4 severe Parkinson's

Akinesia, rigidity

AST vs ALT which is better for assessing liver

ALT more specific to liver

Hypothalamus

ANS controlling temp and cognition

Black widows cause? affect?

Abdominal pain, and neurotransmitters

Nerve 6

Abducens eye movement

Contractility

Ability of muscle to shorten and contract when stimulated

Excitability

Ability of non pacemaker cells to respond to impulse and depolarize

Conductivity

Ability to send an electrical stimulus from cell membrane to cell membrane and as result excitable cells depolarize aka P QRS

Conductivity

Ability to send electrical stimulus from cell to cell causing depolarization in succession from cell to cell causing P and QRS

Late signs of increased ICP

Abnormal posturing. Extension aka decerbrate rigidity or abnormal flexion aka decorticate rigidity

Dysrhythmia define

Abnormal rhythm of electrical stimulation

Ventilatory failure problem defined by PaCO2 level

Above 45 in patients w/ otherwise healthy lungs

Expected outcomes for HIV

Absence of chills and fever Absence of diarrhea Maintenance of WBC within patients normal range Absence of s/s of infection

Categories of HF

Acaute, chronic, left aka systolic or diastolic, right side, high output

ARDS 1st s/s? The rest of s/s?

Accessory muscles use are the first signs Dyspnea tachypnea, low blood O2 level Restlessness tachycardia sweating low blood pressure organ failure confusion Other S/S depend on the cause

Nerve 11

Accessory. Muscles of pharynx, larynx, sternocleidomastoid, trapezius

Sandostatin action? Indications? SE? Patient education? Contraindications?

Action: Blocks the production of hormone secreting tumors, reduces the loss of body fluids and minerals in severe diarrhea Indications: Vasoactive Intestinal Peptide (VIP)- secreting tumors of liver and GI tract, bleeding varicosities in esophagus Side Effects: loose/oily stools, dizziness, headache, increased liver pain, jaundice, unexplained weight gain, cold intolerance, bardycardia, DIB, irregular heartbeat Patient Education: Can increase pregnancy chance due to changes in hormones, inject precise dosage, alternate sites, refrigerate Contraindications: children, pregnancy. Use with caution in patient with Vit B12 deficiency

Furesomide action? SE? Patient education? If taking sucralfate?

Action: Loop diuretic that prevents the body from absorbing too much salt Indications: Edema, Hepatic Ascites, hypertension Side Effects: Ringing in the ears, confusion, jaundice, fever, chills, sore throat, dry mouth, blurred vision Patient Education: Avoid sudden, quick movements, no alcohol use, If taking Sucralfate, take 2 hours before or after Lasix

Vasopressin action? SE? Patient education? Contraindications?

Action: Man made form of "anti diuretic" hormone. Shifts sodium at the cell level Indication: Hyponatremia in patients with end stage liver disease, cirrhosis, and portal hypertension, severe ascites Side Effects: weakness, lightheaded, DIB, angioedemia, C/P, skin changes and discoloration, rapid weight gain Patient Education: No alcohol Contraindications: Use with caution in patients with kidney disease, asthma, HF, seizures, migraines

Hyperthyroidism s/s

Bulging eyes, finger clubbing, tremors, diarrhea, amenorrhea, heat intolerance, fine/straight hair, raised irritability, goiter, tachycardia, raised BP, dyspnea, weight loss, muscle wasting, localized edema

Acute coronary syndrome ACS

CAD- Coronary Artery Disease Results when the heart muscle no longer is able to receive needed perfusion Can be stable or unstable- pain is described as angina The loss of perfusion can result in the cardiac injury leading to ischemia and if no intervention cardiac muscle death. AKA MI

To assess leukocytes

CBC w/ differential that checks neutrophils, lymphocytes, etc. Normal WBC 4500-11000, Normal neutrophils 6300 or 40-70%, normal lymphocytes 4100 or 20-40%

AIDS immunologic manifestations

CD4/CD8 ration <2, CD4 <200, hypergammaglobulinemia, opportunistic infections, lymphadenopathy, fatigue

Thalamus

CNS

Corticosteroid SE

CNS changes like euphoria/insomnia/psychosis, CV changes like edema/hypertension, GI effects like irritation/ulcers/increased appetite/weight gain, hyperglycemia, muscle weakness, delayed wound healing, bone density loss, body fat redistribution

High output HF

CO remains normal/above normal unlike left/right HF and caused by increased metabolic needs or hyperkinetic conditions

Conditions that affect the flow of air in and out of the lungs that can lead to respiratory failure

COPD, cystic fibrosis, bronchitis

ARDS treatment

CPAP, BiPAP, mechnical ventilation, conservative fluid therapy w/ IV+diuretics, antibiotics if infection, corticosteroid solumedrol/prednisone

Calculating cerebral perfusion pressure CPP

CPP= MAP-ICP x MAP= SBP + 2 (DBP) then divide by 33

Asystole treatment? No?

CPR unless DNR, check another lead to ensure not fine VF(which requires defib) then epinephrine/atropine, oxygen, treat cause, follow advanced cardiac life support. Allow family presence. No shocks for asystole

Sodium affects

Cardiac activity/action potential

Patients who are severely hypothermic are at high risk for

Cardiac arrest so avoid external rewarming

Common threats to circulation

Cardiac arrest, myocardial dysfunction, hemorrhage

Digoxin

Cardiac glycoside for chronic HF w/ sinus rhythm and a fib. Increases contractility, reduces HR, inhibits sympathetic activity

Medulla brainstem

Cardiac slowing, respiratory center, Cranial nerves 9, 10, 11, 12

Obstructive shock specific cause/risk factors

Cardiac tamponade, arterial stenosis, PE, pulmonary hypertension, constrictive pericarditis, thoracic tumors, tension pneumothorax

Types of shock

Cardiogenic Obstructive Hypovolemic Distributive(includes septic, neurogenic, anaphylactic)

Emergent examples

Cardiopulmonary arrest Shock/hemorrhage Chest pain w/ diaphoresis Unstable VS Injury at T6 and above can lead to neurogenic shock Severe respiratory distress Myocardial infarction Major burns or trauma Uncontrolled bleeding Coma Status epilepticus Penetrating injury to the eye

Heart transplant procedure

Cardiopulmonary bypass, heart removed, posterior walls of left/right atria left intact, left atrium of donor is anastomosed to recipients atria and great vessels joined

If light pulse and awake

Cardioversion/defib

Foundation of ED rn

Assessment

Autonomic dysreflexia associated w/? Causes?

Associated w/ upper SCI. Causes severe hypertension, bradycardia, headache, nasal stuffiness, flushing, blurred vision from distended bladder/constipation.

Neural-induced/neurogenic distributive shock

Associated with cervical spine injuries Spinal cord injury, spinal anesthesia, epidural block, severe pain, decreased vasomotor center function Degenerative spine changes that interfere with blood flow to the spinal cord

Best practice for patient safety for those at risk for infection

Asssess fo s/s, monitor cultures/WBC, screen all visitors for infection, inspect skin/mucus membranes for redness/heat/pain/swelling/drainage, promote nutrition esp. protein, fluids for fever, education

First aid/prehospital care of snake bite

Assume poisonous if you don't know. Move to safe area first, encourage rest, remove jewelry/clothing, immobilize affected extremity, maintain extremity at level of heart, keep person warm, no alcohol, don't incise/suck wound/ice/tourniquet, elastic bandage to impede lymphatic flow but not super tight

Neuro findings of cirrhosis

Asterixis, paresthesias of feet, peripheral nerve degeneration, portal systemic encephalopathy, reversal of sleep wake pattern, sensory disturbances

Esophageal varices are often? Large scale?

Asymptomatic and sudden, 1st sign loss oc consciousness. Large scale blood loss

Premature ventricular complexes s/s? Treatment?

Asymptomatic of palpitations, chest discomfort, diminished/absent peripheral pulses w/ PVC. Treatment usually by eliminitating cause , O2 and amiodarone/Cordarone for ischemia/MI. K if hypokalemia, or beta blockers

Defibrillation define? Steps?

Asynchronous countershock. Clear, resume CPR after for 5 cycles/2 minutes then assess rhythm, if VF or pulseless VT continues 2nd shock, resume CPR

CD4 and HIV at first? Then?

At first normal and HIV load low then progressively CD4 cell counts fall and viral load rises

Stabilizing the tube

At mouth/nose, possible bite block if oral and after verify presence of bilateral/equal breath sounds and level of tube

TBI fluids

At risk for DI if pituitary injury

MI usually from

Atherosclerosis, or clot

A. Fibrillation caused by

Atrial fibrosis from old age, weight, white, alcohol, stroke, DM, mitral valve disease, heart diseases like hypertension, heart failrure, coronary artery disease

Premature atrial complexes? What wave? May not be visible due to?

Atrial tissue irritable and ectopic focus fires premature impulse. Premature P wave may not be visible from stress, fatigue, anxiety, inflammation, infection, caffeine/nicotine/alcohol/epinephrine/digitalis or myocardial ischemia, electrolyte issues, atrial stretch from heat failure

For tensilon test make sure

Atropine at bedside since antidote. Differentiated between myasthenic crisis which will see improvement like MG and cholinergic crisis where it will get worse/no change

Meds for intubation

Atropine, lidocaine, sedatives, paralytic agent succinylcholine/-nium meds

Parkinson's outcomes

Attains improved nutritional status Strives toward improved mobility Progresses toward self-care Maintains bowel function Achieves a method of communication Copes with effects of Parkinson's disease

Increased ICP evaluations

Attains optimal breathing pattern Demonstrates optimal cerebral tissue perfusion Attains desired fluid balance Has no signs or symptoms of infection Absence of complications

Shock requires immediate?

Attention to prevent organ dysfunction

When WBC low interventions

Avoid crowds, don't share toilet articles, bathe daily, clean tooth brush weakly, wash hangs before eating/drinking/touching pet/shaking hands/coming home, no raw foods, no liquids standing out >1hour, don't reuse dishes, don't change litter boxes, no reptiles, temp q day, report s/s of infection, take drugs, don't work in garden, wear condoms

S/s of inadequate organ perfusion r/t HF

Change in LOC, U/O <30ml/hr, cool/clammy, absent/decreased pulses, fatigue, recurrent chest pain

The indicator that patients may be in beginning of severe sepsis

Change in affect or behavior, can be less patient, restless, fidgety

Autoregulation

Changes diameter of vessel to maintain cerebral blood flow

ICP s/s

Changes in LOC 1st Pupillary changes Slow/slurred speech and delay in response N/v Cushing's triad Hypertension, bradycardia, posturing Restlessness, lethargy, and drowsiness Hypercapnia/hypoxemia Stupor---> Coma

Early assessment of increased ICP

Changes in Level of Consciousness (LOC) includes: Disorientation, restlessness, & confusion Pupillary changes in size, shape, and reaction to light as pressure is exerted on cranial nerve III Weakness Headache Projectile vomiting (not preceded by nausea)

Nonprogressive/compensatory stage for shock

Clinically apparent. Hormone/kidney response causing renin, ADH, aldosterone, epinephrine MAP decreases by 10-15 from baseline Decreased U/O, increased Na, b.vessel constriction, thirst anxiety, tachycardia, ^ RR, falling BP, cool/clammy, O2 decrease Tissue hypoxia in non-vital organs Acidosis and hyperkalemia Attempts at overcoming consequences of anaerobic metabolism and maintaining homeostasis

Hypovolemic shock labs/dx tests

Clotting studies Urinalysis ↑Specific gravity Pregnancy test (childbearing age women) X-ray, CT, ultrasound of suspected site of blood loss ECG Endoscopy Type and Screen for possible blood replacement High lactic acid, CDC/H&H/K, renal/liver function

Stage 4 of hepatic encephalopathy

Comatose:Unresponsive, leads to death in most patients Seizures, obtunded, muscle rigidity, + Babinski

Managing pain for HIV

Comfort measures w/ pressure relieving mattress/warm bath/massage/change positions, drugs, complementary therapies like guided imagery/distraction/relaxation/biofeedback

Rn management of cirrhosis

Comfort, activity, positioning, nutritional support, drugs like diuretics+laxatives+anti-infectives+vasopressin, parencentesis, surgery, psychosocial support

The surviving sepsis campaign

Committed to reducing mortality from severe sepsis and septic shock worldwide initiated in 2002 Enormous potential to save lives Could save 400,000 lives if we treat only half of the eligible patients with the Surviving Sepsis Campaign Bundles

Splenomegaly common in what type of cirrhosis

Common in nonalcoholic causes of cirrhosis

Chronic thyroiditis hasimotos disease affects who more? Define? Thyroid? S/s?

Common type of hypothyroidism affecting more women. Autoimmune disorder triggered by bacterial or viral infection. Thyroid destroyed by anitbodies leading to TH being low and TSH increased. S/s:dysphagia, painless enlargement of thyroid.

Cardiogenic shock risk factors

DM, cardiomyopathies

Chronic steroid therapy can result in

DM, infection, fluid/electrolyte imbalance, hypertension, osteroporosis, glaucoma

Autoantigens for: systemic lupus? RA? Scleroderma/systemic sclerosis? Mixed connective tissue disease? Sjogren syndrome?

DNA proteins. IgG possibly cartilage. DNA proteins. DNA proteins. Salivary gland cells, vaginal mucous cells, lacrimal gland cells

Most accurate way to document fluid retention

Daily weights, most reliable indicator of fluid gain/loss

Barotrauma

Damage to lungs by positive pressure

Volutrauma

Damage to the lung by excess volume delivered to one lung over the other

Complete spinal cord lesion injury define? Types?

Damage where all innervation below injury is damaged Paraplegia-paralysis of the lower body Tetraplegia (formerly quadriplegia)-paralysis of all four extremities

Passive vs. active immunity

Days/months and natural or transplacental or via artificial injection of antibodies aka immunoglobulin vs. lasts for years and from natural infection or via artificially w/ vaccines

Cirrhosis: death is caused by? Fatal w/o?

Death is caused by progressive liver failure, GI bleeding, sepsis, renal failure and hepatocellular carcinoma. Fatal without transplant

Posturing types and define each

Decorticating where arms, wrists, fingers flexed w/ internal rotation and plantar flexion of legs for spine. Decerebration via extension of arms/legs, pronation of arms, plantar flexion, opisthotonos body spasm for brainstem.

Cardiogenic shock description

Decrease in cardiac output and perfusion due to decrease in mechanical function of the myocardial muscle. Direct pump failure, fluid volume not affected

Aspirin MI

Decrease platelet aggregation and vasoconstriction

Nutrition therapy to reduce preload

Decrease sodium and water retention to decrease workload of heart Heart healthy diet (low fat/cholesterol, low sodium, high fiber) NAS/ sodium intake less than 2 grams daily Fluid restriction 1-2 liters daily Dietary collaboration 1 kg weight gain or loss = 1 liter of retained or lost fluid Same scale, clothes, time daily (before breakfast) Avoid salt substitutes containing K+ (drug interactions)

Changes of endocrine system r/t aging

Decreased ADH causing dehydration risk+dilute urine. Decreased estrogen decreasing bone density, dry skin. Decreased glucose tolerance causing increased weight +slow wound healing+yeast infection+polydipsia+polyuria. Decreased metabolism

Metabolic manifestations of hypothyroidism

Decreased BMR, decreased body temp, cold intolerance

Late neuro s/s of shock

Decreased CNS aka lethargy/coma, generalized muscle weakness, diminished/absent deep tendon reflexes, sluggish pupil response to light

Left sided HF manifestations r/t

Decreased CO Pulmonary Congestion Ineffective pump of left ventricle Usually caused by heart disease Pulmonary congestion due to blood back up Impaired activity and exercise tolerance

Cardiovascular key features of of shock

Decreased CO, increased HR, thready pulse, decreased BP, narrow pulse pressure, postural hypotension, low central venous pressure, flat neck/hand veins in dependent positions, slow cap refill, diminished peripheral pulses

Managing RHF from MI

Decreased CO, paradoxical pulse, clear lungs, JVD @ semi-fowlers. Sufficient fluids, monitor pulmonary artery wedge pressure keeping >15-20

Disability across room assessment

Decreased LOC or interaction with environment Irritable Doesn't recognize family members Inappropriate reactions to painful stimuli Flaccid/hyperactive muscle tone

S/s of hypercapnic respiratory failure

Decreased LOC, headache, lethargy, seizures

Patho of hypovolemic shock

Decreased MAP (decreases blood flow resulting in decreased tissue perfusion) Loss of oxygen-carrying capacity from the loss of circulating RBCs Lead to cellular anaerobic conditions Abnormal cellular metabolism

Kidney and urinary changes for hypovolemic shock

Decreased U/O for early, possibly progressing to none, possible kidney failure

Kidney s/s of shock

Decreased U/O, increased specific gravity, sugar/acetone in urine

Malnutrition on immunity

Decreased WBC+neutrophils

Radiation therapy on immunity

Decreased WBC, damage to 1st line barriers

Psychological manifestations of hyperthyroidism

Decreased attention span, restlessness, irritability, emotional lability, manic behavior

Coagulation deficits w/ cirrhosis

Decreased bile production prevents the absorption of Vitamin K. Vitamin K is needed for the production of clotting factors. This increases the risk of bleeding. Decreased production of prothrombin and fibrinogen. (think clotting cascade)

Growth hormone deficiency s/s?

Decreased bone density, pathological fractures, decreased muscle strength, increased serum cholesterol levels

Innate immune response changes of aging

Decreased hematopoietic cells, decreased phagocytic capacity, decreased cells, increased dendritic cells

Aging immune system

Decreased immune function causing increased infections. Increased production of autoantibodies causing increased autoimmune disorders. Decline in immune response causing increased cancer incidence

GI s/s of shock

Decreased motility, diminished/absent bowel sounds, n//v, constipation

Adrenocorticotropic hormone ACTH deficiency s/s?

Decreased serum cortisol, pale sallow complexion, malaise/lethargy, anorexia, postural hypotension, headache, hypoglycemia, hyponatremia, decreased axillary/pube hair

GONA complications of HIV

Decreased testosterone: reduced libido, fatigue, reduced fertility, decreased muscles, weight low. Decreased estrogen: reduced libido, premature menopause, decreased muscles

Adaptive immune response changes of aging

Decreased thymus size, decrease t cells, decreased b lymphocytes, decreased antibody response

TSH /throtropin deficiency s/s?

Decreased thyroid hormones, weight gain, cold intolerance, scalp alopecia, hirsutism, menstrual abnormalities, decreased libido, slowed cognition, lethargy

What indicates left ventricular failure

Decreased tissue perfusion from poor CO and pulmonary congestion from increased pressure in pulmonary vessels

S/s of pneumothorax

Decreased/absent breath sounds, respiratory distress, hypotension, JVD, tracheal deviation and if unrelieved mediastinal shift, CV collapse, death

HIV mouth wash does what

Decreases sores

Radioactive Iodine therapy function? Given how? Takes how long after therapy for symptom release?

Decreases vasculartity, inhibits release of thyroid hormones, given through straw to prevent teeth staining.. Takes 6-8 weeks after therapy for symptom relief due to stores

Asystole don't

Defib

If patient in VF or pulseless VT immediate priority is to? The earlier the?

Defibrillated after CPR and continue until defib time. The earlier the greater chance of survival

Glucocorticoids aka? Affects? Stimulated by?

Cortisol which affects metabolism, stress responses, emotions, immune function. Stimulated by corticotropin releasing hormone from hypothalamus that stimulates anterior pituitary ACTH which causes release.

Addison's drugs aka? Take w/? Cortex? Prednisone? Florine?

Cortisone, hydrocortisone/cortex, prednisone, fludrocortisone/Florinef. Take w/ meals. Cortex Report weight gain/round face/fluid retention since can be cushing's. Prednisone report d/n/v fever. Florine monitor BP wight gain/edema since possible hypertension

Pneumonia interventions? drugs?

Cough, deep breathing, bronchodilators, antibiotics Avelox, Levaquin, Zosyn, Vancomycin, Augmentin,

S/s pneumonia

Cough, fever, chills, tachycardia, tachypnea, dyspnea, pleural pain, malaise, respiratory distress, low breath sounds, productive cough

If mobilization not possible what other interventions for reducing risk for injection/injury

Coughing and deep-breathing exercises Chest PT Frequent position changes Position to facilitate breathing HOB up 30 degrees (depending on BP) Nutritional support (TF, TPN) NGT or PEG feedings (monitor protein and albumin levels Keep HOB ↑ to avoid aspiration

Pulmonary edema key features

Crackles, dypnea at rest, disorientation/confusion esp in elders as early s/s, tachycardia, hyper/hypotension, reduced U/O, pink frothy cough, premature ventricular contractions, dysrhythmia, anxiety, restlessness, lethargy

If after all interventions and still increased ICP

Craniotomy to remove tissue/hemaotomas

Atrioventricular node define? Rate?

Created slight delay in electrical impulses. Intrinsic rate 40-50bpm

Interventions w/ liver transplantation

Cyclosporine immunosuppressant. Vaccinations, prophylactic antibiotics

Immunosuppressive drugs

Cyclosporine/sandiummune/Neoral , mycophenolate mofetil/cellcept, azothriprine/imuran

Preventing or managing hepatic encephalopathy from cirrhosis due to ammonia/protein

Dietary limitations and drugs to reduce bacterial breakdown

Liver functions

Digestion, nutrition, metabolism

Bowel training

Digital stimulation of the anal sphincter Performed at regular intervals, after meals and when convenient Not appropriate if cord lesion involves the sacral segment or nerve roots Contraindicated if there is spasticity of the anal sphincter

Elective cardioversion: digoxin? If for a.flutter/fib? Make sure? Mode?do what before? Do what during?

Digoxin withheld 48 horus before, if for atrial flutter/fibrillation anticoagulants for 4-6 weeks before. Emergency equipment available, consent form, sedation. Synchronized mode. Turn o2 off away from patient, shout clear before. Maintain airway, o2, VS/LOC, drugs, monitor, assess for burns, support, document.

Assessment findings from portal hypertension

Dilated abdominal find vessels Enlarged spleen Bruits heard over the upper abdominal area due to esophageal and gastric varices

Types of cardiomyopathy

Dilated cardiomyopathy, nonobstructed, obstructed, restrictive

Distributive shock risk factors

Diminished immune response, reduced skin integrity, cancer, peripheral neuropathy, strokes, institutionalizations, malnutrition, anemia

Contact transmission

Direct via physical contact aka person to person or indirect from source to host via passive transmission from contaminated object

Beta blockers and MI

Decrease size infarct, dysrhythmias

Glasgow used for? Categories and points for each?

Describing LOC. Eye opening(4), motor response(6), verbal response(5)

Sinus dysrhythmia examples

Sinus tachycardia, sinus bradycardia, premature atrial complexes

Magnesium sulfate for

VT, VF and life threatening VT called torsades de pointed from antidysrhymics like amiodarone

Researcher

conduct research to increase knowledge thus improving patient care

Testing CSF

+ halo, + glucose

Sepsis= ?

2 or more SIRS criteria+known source of infection

Type 5 stimulated hypersensitivity aka? Ex?

Aka stimulated. Ex: Grave's, B-Cell gmamopathies

H/H used to IF HF resulting from

Anemia

GI manifestations of hypothyroidism

Anorexia, weight gain, constipation, abdominal distention

Thyroditis types?

Types: acute from bacteria, subacute/granulomatous from virus, or chronic aka hashmiotos

Dx for cirrhosis

US first, then biopsy, possible liver scan, xray, MRI, CT

Sepsis erythema, swelling, pain=?

Cellulitis

Communications

USE OF EFFECTIVE INTERPERSONAL AND THERAPEUTIC COMMUNICATIONS SKILLS BUILD RELATIONSHIPS IN ALL AGES

K

3.5-5. Increased: dehydration, acidosis

Sepsis dysuria, frequency=?

UTI

Hemothorax treatment

Chest tube

Asterixis

Coarse tremor characterized by rapid, nonrhythmic extensions/flexions in wrists and fingers

Collaborator

facilitate the functions of other health care team members as they provide care

Types of injuries

Deceleration and accleration

W/ HF focus on? Only cure is?

Focus symptom management Only "cure" is heart transplant

HIV endocrine issues

Gonadal dysfunction, body shape changes, adrenal insufficiency, DM, elevated triglycerides/cholesterol, change in libido

All old people are considered

Immunosupressed

Sepsis: HA+fever=?

Meningitis

Thyroid location

Neck

BNP <100

Normal/no HF

AV block treatment

O2, drugs, pacing, pacemakers

Skin shock s/s

Pale, clammy, cool

Glycoprotein inhibitors

Reduce platelet aggregation

Liver diseases often found during

Routine physical exam/lab test

Infarction

Tissue death that occurs over several hours

Scoring for reflexes

0-4, 2 normal

1 kg weight gain = how much water?

1 L fluid restriction

What labs can indicate hypovolemia

Elevated BUN, decreased proteins, increased hematocrit

Impairment of renal function resulting from inadequate perfusion causes

Elevated BUN/serum creatinine

Best possible score for intubated

11t

Hyper secretion of thyrotropin/TSH s/s

Elevated THS+T3/t4, weight loss, tachycardia, dysrhythmias, heat intolerance, increased GI motility, tremors

Acuity scales/triage 2 standardized systems that are most reliable

Emergency severity index ESI and canadian triage acuity scale CTAS

23-year old women with severe abdominal pain; positive home pregnancy test; BP 90/50 mm Hg.

Emergent

Big block method for regular rhythm define? If little blocks left over?

Count number of large blocks between R waves and divide it into 300, if little blocks left over count each as 0.2 and add to big blocks then divid into 300

Glasgow lowest score

3 which means unresponsive

Nursing assessment for shock

ABCs Focused assessment of tissue perfusion:VS, Peripheral pulses, LOC, Capillary refill, Skin (e.g., temperature, color, moisture), UO. Allergies

Determining HR on ECG

Count tips and x by 10

Bicarbonate normal? Hypofunction of adrenal? Hyperfunction?

23-30. Increased, decreased

CO norm? Early sepsis? Late sepsis? Septic shock?

3-5L, decreased, increased, greatly decreased

Lactic acid norm

3-7mg or 0.3-0.8 mmol. Increased: anaerobic metabolism with buildup of metabolites

Addison's disease aka? Primary cause? Secondary cause?

Aka adrenal insufficiency so not enough cortisol/aldosterone. Primary cause: idiopathic/autoimmune, TB, cancer, AIDs, hemorrhage, gram - sepsis, adrenalectomy, radiation, mitotane/toxins. Secondary: pituitary tumors/necrosis, hypophysectomy, radiation, sudden stop of long term glucocorticoid therapy

Hypersensitivity aka? Define? Types?

Aka allergy or increased/excess response to presence of antigen to which has been previously exposed. Types: 1 immediate, 2 cytotoxic, 3 immune complex mediated, 4 delayed, 5 stimulated

Cardiac resychronization therapy CRT for HF

Aka biventricular pacing. Permanent pacemaker or combo w/ cardioverter/defib

Type 2 hypersensitivity aka? Ex?

Aka cytotoxic. Ex: transfusion reaction, Autoimmune hemolytic anemia, goodpasture's syndrome, myasthenia gravis

Limbic lobe

Emotions, survival, learning/memory

Assess of multiple sclerosis

Fatigue Weakness aka ataxia Spasticity/hyperactive DTR, +babinski Visual impairment Incontinence Disorders of swallowing and speech

K normal? Hypofunction of adrenal? Hyperfunction?

3.5-5. Increased, decreased

RA age onset? Gender? Risk factors? Disease process? Disease pattern? Lab findings? Common drug therapy?

35-45 yr female. Autoimmune, genetic, emotional stress triggers, environment. Inflammator. Bilateral symmetric joints, systemic. Elevated rheumatoid factor, antinuclear antibody, ESR. NSAIDs, methotrexate, corticosteroids, BRMs, immunosuppressives.

Oxytocin from? Targets? Functions?

From posterior pituitary and targets uterus and mammary glands to stimulate contractions and ejection of milk

Nerve 9

Glossopharyngeal, pain and temp from ear, taste of 1/3rd of tongue, throat muscles, parotid glands

PEEP usually set to

5-15 cm H2O

MAP average

60-70 to maintain perfusion to organs

If anxiety from shock

Ativan

P wave

Atrial depolarization

ARDS often occurs after

Acute lung injury, sepsis, PE, shock, aspiration, inhalation injury, transfusion of plasma products like RBCs, platelets, plasma. Burns, DIC, shock, trauma, nervous system injury, pancreatitis, fat/amniotic fluid emboli, pulmonary infection, inhalation of toxic gases like smoke/O2, pulmonary aspiration esp. of gastric contents, drug ingestion/opioids/aspirin/heroin, hemolytic disorders, cardiopulmonary bypass, submersion of water w/ water aspiration

Endogenous secretion aka Cushing's disease conditions that increase cortisol secretion

Adrenal hyperplasia, pituitary adenoma increasing ACTH, malignancies/carcinomas, adrenal adenomas/carcinomas

Surgical interventions for cushing's

Adrenalectromy, transsphenoidal adenomectomy to remove tumor, hypophysectomy to remove pituitary, radiation of pituitary

HF-4

Adult smoking cessation advice/counseling

AST/ALT ratio >2 means

Alcoholic liver disease usually

PaCo2 alkalosis? Acidosis

Alkalosis -40- Acidosis 35 - 45

ACS all patients

All patients do not present the same; Some may have ST elevation (STEMI) or non-ST elevation (NSTEMI) or Unstable angina Risk

Monitoring for CSF leak after hypophysectomy? Treatment?

Halo w/ light yellow color at edge and clear plus positive for glucose. Persistent severe headaches. Tx: bedrest, spinal tap

Assessment for cirrhosis

Any exposure to chemicals, toxins, drugs, or alcohol (specifics such as amount, type) Sexual history, body fluid exposure, tattoos Abdominal assessment (palpation of liver) Skin, bruising, petechiae, fruity/musty breath odor Mental status/psychosoical assessment Cognitive issues, behavior changes, sleep pattern disturbances, labile emotions

Sinoatrial node

Conduction begins with this aka primary pacemaker. 60-100bpm

Glucose of Cushing's

BG are high b/c liver stimulated and insulin receptors are less sensitive

Purpose of med management in hyperthyroidism ? Priorities focus on?

Decreased effect ofthyroid hormone on cardiac function and reduce secretion. Priorities focus on monitoring, reducing stimulation, promoting comfort, teaching

For disability/neuro evaluate need for

CT scan, BG check, ABG, alcohol level

Imaging assessment for HF

CXR for left since cardiomegaly, radionuclide studies w/ thallium to indicate presence/cause of HF

The nurse is caring for a patient with a BP of 130/45 and an ICP of 25 mm HG. Calculate the MAP Calculate the CPP What do numbers indicate

Calculate the MAP=73 Calculate the CPP=48 Numbers indicate impaired blood flow to brain

Post ictal phase patient can

Can wake up violent

General assessment and tools for spinal injury

Detailed neurological exam Diagnostic x-rays (lateral cervical spine x-rays) CT scan MRI

AIDS wasting syndrome

Diarrhea, malabsorption, aneorexia, oral/esophageal lesions causing weight loss

GI manifestations of AIDS

Diarrhea, weight loss, n/v

Conventional HF therapy

Diuretics, vasodilators, inotropics

CD-4 <200 is?

Dx of AIDS

Gynecomastia

Enlarged breasts

Anterior pituitary disorder hypo? Hyper?

GH hypo:dwarfism/cretinism, hyper:gigantism/acromegaly

Liver transplantation used for

Hep C, primary liver tumor, acute/chronic liver disease

Causes of left side ventricular HF

Hypertension, CAD, valvular disease

Tracheostomy considered for

If artificaial airway needed for longer than 10-14 days to reduce tracheal and vocal cord damage

Heart failure

Inability of heart to work effectively as pump

Immune system issues of cirrhosis

Increased infection, leukopenia

ST elevation it does what

It evolves over time

Chronic HF

Long term presence of the disease Focus on symptom management Cannot completely eradicate

Sepsis management bundle

Low dose steroids, insulin, mechanical ventilation

Remeron aka? Function?

Mertazipine. tetracyclic antidepressants

BNP 300-599

Mild HF

MAP is better indicator of

Perfusion to organs than systolic blood pressure

Systolic HF aka?

Pumping problem. "Relaxes but can't contract" Heart muscle has lost strength Ventricles can fill

Change in LOC is

The first indication that neuro status has declined

If patient is agitated, restless, has widely fluctuating inspiratory pressure reading, or has other signs of air hunger

The flow rate may be set too low. Increasing the flow should be tried before using chemical restraints.

Thyroid hormones

Triiodothyronine T3, thyroxine T4, calcitonin

44-year-old man with dislocated elbow.

Urgent

QRS

Ventricular depolarization

S/s of worsening encephalopathy

change in LOC/orientation, asterixis/liver flap, fetor hepaticus/liver breath

A high CVP indicates

hypervolemia or poor right ventricular contraction.

Parathyroid hormones

parathyroid hormone

Cardiomyopathy

Disease of the cardiac muscle Unknown Cause

Trauma impact on immunity

Disruption of barrier defenses, contamination from soil/water/objects

Surgery impact on immunity

Disruption of normal flora+barrier, reduced neutrophils

Class 2 and 3 LHF from MI interventions

Diuresis, nitroprusside/nitroglycerin, beta blockers, ACE/ARBs, inotropes like dobutamine

Drugs for hyperparathyroidism

Diuretic Lasix to promote Ca excretion, Calcimetics/oral phosphates, Cinacalet/Sensipar that decreases Ca. For patient who doesn't respond to Sensipar, IV phosphates given to prevent bone resorption/Ca absorption. Ca chelators mithramycin

Drug therapy for fluids for cirrhosis

Diuretic, quinolones like norflaxacin/noroxin for spontaneous bacterial pertionitis

Drugs for cirrhosis

Diuretics Aldactone, Lasix Laxatives Lactulose Anti-infectives Neomycin Vasopressin

Drug Interventions for HF that reduce preload raising SV

Diuretics and vasodilators like nitrates, morphine for anxiety

Med therapy for SIADH

Diuretics if Na WNL +HF present, Vasopressin antagonists to excrete water w/out Na loss like Tolyaptan/Samsca, Conivaptan/Vaprisol

Hypovolemic shock risk factors

Diuretics, diminished thirst reflex, immobility, aspirin, use of complimentary therapies, anticoagulants

To prevent bacterial contamination for ventilator

Do not allow moisture and water in ventilator tubing to enter humidifier

Nitroglycerin for MI

Do not give if patent is on sildenafil, tadalafil, vardenfil)- vasodilator- increase blood supply to coronary muscle

Ancillary staff who had hands on care w/ patient should

Document

Technology doesn't?

Does not change patient's rights to privacy of health information. Whether documentation is paper-based, electronic or in any other format, maintaining confidentiality of all information in a health record is essential, and relates to access, storage, retrieval and transmission of a client's information

With oxygenation failure applying 100% o2

Doesn't correct the problem

Sinoatrial node define? Rate?

Dominant pacemaker. intrinsic rate 60-100bpm

Nonabsorbable antibiotics: dont ? Names? Function? SE? Contraindications? Patient education?

Don't give w/ lactulose. Neomycin, metronidazole/flagyl, ridaximin/xifaxan. Kills normal flora diminishing protein breakdown thus decreasing ammonia. SE:dizziness, headache, loss of appetite, metallic taste, seizures, sudden vision changes, trouble speaking and neurologic changes Contraindications: Over the counter medications such as cough syrup that contain alcohol Patient Education: Take with food, may turn urine a dark color, no alcohol

Preparing body for viewing if trauma death, suspected homicide, or abuse

Don't remove IV/tubes or clean skin instead cover body w/ sheet while leaving face exposed and dimming lights

Meds for acromegaly

Dopamine agonists:bromocriptine mesylate (parlodel), Cabergoline (Dostinex) stimulate dopamine receptors and inhibit the release of GH and prolactin (PRL). Reduces the size of pituitary gland to normal or near normal size Octreotide (Sandostatin)- inhibits GH release

Babinski sign

Dorsiflexion of great toe and fanning of the other toes positive is abnormal

Testing motor function for SCI for cervical spine

Downward pressure when shrugging, resistance when pulling up arms, resistance when straightening flexed arms, grasp an object forming fist

Reality shock

- the stress, surprise, and disequilibrium experienced when shifting from a familiar culture into one whose values, rewards, and sanctions are different

Non glasgow motor scoring? Do what?

0 no movment 5 being normal against full resistance. Flex extend elbows, elevate arms, flex extend wrists and fingers and touch each finger to thumb

Normal creatinine? BUN?

0.5-1.2, 7-18. Elevated can indicate fluid deficiency and kidney issue. Determines kidney function

Acute rejection begins when? What happens? Dx? Doesn't?

1 week-3 months after. Either antibody mediated leading to vasculitis aka vessel necrosis or can be cellular causing lysis of organ cells. Dx: labs. Doesn't automatically mean they will lose organ

Rn dx of cirrhosis

1. Activity intolerance 2. Imbalanced nutrition 3. Impaired skin integrity 4. Fluid volume excess 5. Risk for injury 6. Body image disturbance 7. Disturbed thought pattern 8. Collaborative problem: hemorrhage

Protein goal for ARDS/respiratory failyure

1.5-2g/kg

1 kg of weight gain/loss equals how much retained/lost fluid

1kg=1L

Drugs for anaphylaxis

1st line synpathomimetics: epinephrine/adrenalin, isoproterenol/isuprel, ephedrine/vatronol. 2nd line antihistamines:diphenhydramine benadryl, corticosteroids: -one drugs. Support drugs:vasopressors norepinephrine/levophed, dopamine/inotropin

Epinephrine for? Aka?

1st line went for cardiac arrests aka adrenaline

Hospital care for heat stroke

1st priority monitor/support airway, breathing, circulation, o2, IV NS, catheter, no aspirin/antipyretic S, cooling blankets, ice packs, iced gastric/bladder lavage, continuous core temp monitoring, if shivering benzos like diazepam/valium chlorpromazine/thorazine

Prehospital care providers

1st to see patient before ED by ambulance ex. Emergency medical services EMS, emergency medical technicians EMTs for BLS like o2, wound care, splinting, spine immobilization, monitoring VS, paramedics for ALS that can include cardiac monitoring, advanced airway management, intubation, IV access, admin of drugs

CV changes for hypovolemic shock

1st: ^HR, difficult to palpate pulse progressing to absent, low BP

Noninvasive temporary pacing NTP: define? Used to? For? VS done on which side if NTP placed?

2 large external electrodes. To stimulate ventricular depolarization. For emergency bradycardia/asystole until invasive can be used or returns to normal. One over upper right chest, one over apex. VS on right side.

Patient identification for safety

2 unique identifiers before intervention and meds: DOB, identification #, telephone number, address, SS #

Communication must be

2 way process

Normal levels of CPAP ? If no pressure set?

5-15cm H2O. No positive pressure given thus being used as t-piece with alarms.

Fluid restrictions for SIADH interventions

500-1000mL/day, dilute tube feedings w/ saline, use saline to irrigate GI tubes, mix drugs w/ saline, measure I/O/weight, oral rinsing to keep moist mouth

For heart transplant if everything good when do you ambulate

6 hours after, bed sitting in chair

Cortisol normal from 6-9am? 4-6PM? Hypofunction of adrenal? Hyperfunction?

6-8AM 5-23mcg or 138-635 SI. 4-6PM 3-13mcg or 83-359 SI. Decreased, increased.

Normal rate? Bradycardia? Tachycardia?

60-100, <60 bradycardia, >100 tachycardia

Issues w/ cardiovascular for SCI if above

6th thoracic which can lead to bradycardia, hypotension, hypothermia, dysrhythmia

Comatose glasgow

7

PH

7.35-7.45 decreased: insufficient tissue oxygenation causing anaerobic metabolism and acidosis

Glucose normal? Hypofunction of adrenal? Hyperfunction?

70-115 but older adults can be increased. Normal to decreased, normal to increased.

Normal CPP range

70=100mmHg

ARDS dx

A low PaO2 < 60mmHg Progressive need for higher levels of Oxygen Patient does not respond to increased Oxygen Chest x-ray shows diffuse haziness or (ground glass) appearance of lungs Rule out cardiac pulmonary edema

What can increase variceal bleeding

A nominal pressure like heavy lifting, vigorous exercise, chest trauma, dry/hard food in esophagus

Avoiding

A person may recognize that a conflict exists and want to withdraw from it or suppress it, avoiding included trying to just ignore a conflict and avoiding others w/ whom you disagree

Acute respiratory failure cause is associated with

A physiological lung problem, a neuro problem, or musculoskeletal problems

Hepatorenal syndrome HRS s/s? Often occurs? Poor?

A sudden decrease in urinary flow, < 500ml/24 hours (oliguria). Elevated BUN and creatinine levels with abnormally decreased urine sodium excretion Increased urine osmolarity. Often occurs after clinical deterioration. Poor prognostic sign, often cause of death in these patients.

Examples of medical conditions that may cause respiratory failure

A. Asthma B. COPD: Emphysema, Chronic bronchitis C. Pneumonia • Aspiration pneumonia • Ventilator associated pneumonia • Community acquired pneumonia • Hospital/health-care associated pneumonia D. Tuberculosis E. Pulmonary Embolism

Diagnosis of ARF

A. History and physical exam B. Labs C. X-ray D. Pulmonary function tests

Treatment of respiratory failure/ARDS

A. Oxygen B. Positioning C. Fluids D. Medications E. Diet F. Exercise

TBI interventions

ABC, treat as if SCI until xray, assess for cushing's triad, neuro assessment/LOC/glasgow, prevent ICP, drugs fluids, nutrition , surgery

Initial assessment for SCI

ABCs, assess for hemorrage like hypotension/tachycardia/weak pulse, use glasgow to assess LOC, assess motor/sensory status

Dx of respiratory failure

ABGs look for hypoxemia+hypercarbia, CXR, urine+sputum cultures, pulmonary function test

ACE inhibitors/ARBs

ACE: -il drugs+vasotec, ARBs: -tan drugs. 1st choice. Suppress renin-angiotensin causing dilation and prevent aldosterone preventing Na and water retention

Automatic external defibrillation aka? Needs? Steps?

AEDs. Needs firm/dry surface. Stop CPR, clear, analyze pressed, shock for VF or pulseless VT, then CPR until instruction to stop

Lymphocytes in AIDs aka?

AIDS WBC <3500 aka leukopenic

Sepsis progression

ARDS (lungs usually first to fail) Fever/tachycardia Altered Mental Status Myocardial failure (hypotension) Death

Conditions that affect gas exchange in alveoli leading to respiratory failure

ARDS, pneumonia

Labs of cirrhosis

AST, ALT, LDH elevated but as liver detoriates AST/ALT can be normal, bilirubin usually elevated in blood and urine(urinobilogen), serum protein/albumin low in chronic, pt/inr prolonged, platelets low, anemia, WBC can be low, ammonia increased if chronic/advanced, possible hypnatremia if ascites, decreased hematocrit/hemoglobin

GI finding sof cirrhosis

Ab pain, anorexia, ascites, clay colored stool, diarrhea, varices, femoral hepaticus, gallstones, gastritis, GI bleeding, hemorrhoidal varices, hepatomegaly, hiatal hernia, hypersplenism, malnutrition, nausea, small nodular liver, vomiting

S/s of hepatitis

Ab pain, changes in skin/sclera aka icterus, arthralgia/joint pain or myalgia/muscle pain, diarrhea, constipation, changes in color or uurine/stool, fever, lethargy, malaise, n/v, pruritus/itching, RUQ liver tendernderness, jaundice, dark urine/clay stool

Urgent triage examples

Abdominal pain Non-cardiac chest pain Multiple fractures or lacerations w/o major hemorrhage Displaced/multiple fractures/dislocations Temps >101 Renal calculi Decrease level of consciousness Overdose that is conscious Chemical exposure to the eye New onset respiratory infection Acute psychosis Pneumonia w/o respiratory failure Complex/multiple soft

Fluid/electrolyte managagement interventions of cirrhosis

Accurate I/O, Daily weights, monitor trends Monitor S/S of fluid retention Monitor electrolytes Maintain sodium restricted diet

HF-3

Ace Inhibitors (ACE) or ARB for left ventricular systolic dysfunction (LVSD)

High altitude hospital care/treatment for AMS

Acetazolamide/Diamox/anhydrase to prevent/treat by inducing acidosis take 24 hours before and during trip, dexamethasone/decadron to treat to reduce edema to relieve sysmteoms.

Other increased ICP rn interventions

Achieving an Adequate Breathing Pattern Optimizing Cerebral Tissue Perfusion Maintaining Negative Fluid Balance (Strict I/O's) Preventing Infection Monitoring and Managing Potential Complications Detecting Early and Later Indications of Increased ICP

Ph acidosis? Alkalosis? Acidosis? Alkalosis?

Acidosis -7.40- Alkalosis 7.35 - 7.45 pH < 7.40 -Acidosis pH > 7.40 -Alkalosis

HCO3 acidosis? Alkalosis>

Acidosis 22 - 26 Alkalosis

Neomycin action? Indication? SE? Patient education? Contraindications?

Action: Aminoglycoside-stops the production of proteins that bacteria need to survive Indications: Hepatic encephalopathy Side Effects: hearing loss, ringing in ears, dizziness, tingling or numbness of skin, muscle twitching, seizures Patient Education: Patients need to follow low protein diet, obtain proteins from vegetables and dairy products, eat whole grain products Contraindications: Anticoagulants, vancomycin, keflex, PCN, lanoxin methotrexate

Quinolones action? SE? Patient education? Contraindications?

Action: Antimicrobial, antiviral properties Indications: Hepatitis C, Consistent elevated liver enzymes, Pre-transplantation prophalaxysis Side Effects: Bursitis, peripheral neuropathy, n/v/d, alterations in sensation Patient Education: Take on empty stomach, take with full glass of water, avoid alcohol Contraindications: Pregnancy, breast feeding

Propranol action? SE? Patient education? Contraindications?

Action: Inhibits renin secretion decreasing the tendency of ascites Indication: Portal hypertension, Liver dz, Ascites Side Effects: Black, tarry stools, blood in urine, blurred or loss of vision, body aches, crying, extreme fatigue, hair loss, anxiety Patient Education: No alcohol, do not skip doses or double up on doses, move slowly when standing Contraindications: Depression, asthma, Wolf-Parkinson White Syndrome (WPW)

Parathyroid hormone function on kidneys?

Activates vitamin D, increased reabsorption of Ca+Mg, increase phosphorus/bicarbonate/Na excretion all to increase serum Ca

Management of Addisons? Important to monitor?

Adrenocorticoid replacement : Hydrocortisone/Cortef Prednisone/Deltasone Cortisone/Cortisone Acetate Solu-medrol/methylprenisolone Important to monitor blood glucose levels

Interventions for hyperaldosteronism

Adrenolectomy of one or both glands, spironolactone to increase K, low Na diet, monitor BP, monitor labs, replace K if needed, I/O, meds

Interventions for HF that reduce preload raising SV

Aimed to decrease volume/pressure in left ventricle, increase ventricular muscle stretch+contraction. Good for HF w/ congestion w/ Na+H2o overload. Nutrition, drugs

Intrapulmonary causes of ventilatory failure

Airway disease:COPD/asthma, v/Q aka ventilation perfusion mismatch: PE, pneumothorax, acute respiratory distress syndrom ARDS, amyloidosis, PE, interstitial fibrosis

Triage nurse across room assessment

Airway, breathing, circulation, disability. Always scanning and look for clue that you need to be on alert.

Shock lung

Aka ARDS

Acute adrenal insufficiency aka? Define? Na and K? Severe?

Aka Addisonian crisis. Life threatening low cortisol and aldosterone due to stress from surgery/trauma/infection. Na falls and K raises, severe hypotension

Vasopressin aka? Function? Monitor? No more than?

Aka Pitressin. Parenteral ADH replacement. Monitor for water intoxication aka drowsiness/confusion/headache/anuria/weight gain >2lbs/24 hours. No more than 3L fluids/day

Gout aka? Patho? Types?

Aka gouty arthritis, systemic urate crystals deposit in joints/tissue causing inglammation. Types: primary from purine metabolism issue, secondary hyperuricemia aka uric acid in blood from crash diets, chemo,

Antibody mediate immunity aka? Types?

Aka humoral, antigen-antibody reaction. Types: adaptive from foreign organism either naturally artificially and can be active or natural. Passive is when you are given artifical antibodies from injection/mom

Acromegaly aka? Definition? Onset may be? Changes in?

Aka hyperpituitarism. Overproduction of Growth Hormone (GH) Onset may be gradual with slow progression. Changes in size of skeletal bones and soft tissues, skeletal thickness, hypertrophy of skin, organ enlargement, bone thinning, cartilage degerneration, hypertrophy of ligaments/vocal cords, peripheral neuropathy, hyperglycemia

Type 1 immediate hypersensitivity aka? Results in? Ex?

Aka immediate. Results in release of mediators especially histamine. Ex: hay fever/allergic rhinitis, classic allergy signs, allergic asthma, anaphylaxis, pollen, bee, peanuts, shellfish, drugs, inhaled/ingested/injected/contacted

Type 3 hypersensitivity aka? Results in? Ex?

Aka immune complex-mediated. Results in inflmmation. Ex: Serum sickness, vasculitis, systemic lupus, RA, scleroderma

Inflammation aka? Function?

Aka natural/innate immunity and provides immediate protection

Parkinson care

Allow tim, meds for pain/tingling, physical/occupational therapy, prevent complications of constipation/ulcers/contractures, schedule activities late in morning, alternate communication methods, monitor food intake, high protein/calorie foods

Hepatic encephalopathy aka? Define? S/s?

Also called Portal-systemic Encephalopathy (PSE) Cognitive Syndrome resulting from liver failure or cirrhosis Sleep and mood disturbances Change in mental status Speech problems Reversible with early intervention

After load

Also known as systemic vascular resistance (SVR) Amount of tension that the ventricle must overcome to open the aortic valve and eject blood into the systemic circulation Normal is 700-1500 dy/sec/cm

Reproductive manifestations of hyperthyroidism

Amenorrhea, decreased menstrual flow, increased libido

Antifungals for immunocompromised

Amphotericin B

Chemical-induced distributive shock

Anaphylaxis Wide spread reaction that occurs in response to contact with a substance to which the person has a severe allergy (antigen) Septic Shock Capillary leak syndrome

Hematologic findings of cirrhosis

Anemia, DIC, impaired coagulation, splenomegaly, thrombocytopenia

CV manifestations of addison's

Anemia, hypotension, hyponatremia, hyperkalemia, hypercalcemia

Bone marrow suppression from chemo SE

Anemia, thrombocytopenia, neutropenia increasing risk for infection/bleeding, hypoxia, fatigue

Coronary artery bypass drafting define

Aneruysm that causes ventricular tachydysrthmia respected via balloon in ventricles to eliminate irritable focus

Drugs for patients w/ systolic HF

Angiotensin-converting ACE inhibitor or angiotensin receptor blockers ARBs, high ceiling or K sparing duretics, human B type natriuretic peptides, nitrates, intropics beta andrenergic/phoshodiesterase/Ca sensiztizer/Digoxin/lanoxin, beta andrenergic blocker

What can stop digoxin absorption

Antacids

Drugs for GI issues from ventilation

Antacids, sulcralfate, histamine blockers, proton pump inhibitors

D if unresponsive anticipate

Anticipate cat scan

Preventing infection for HIV

Antiretroviral therapy, prophylaxis/active treatment of opportunistic infections, avoid infection, drugs

Low circulating volume hypovolemic shock s/s

Anxiety (hypoxia) Tachypnea Decrease in CO ↑Heart rate (compensatory) Decrease in stroke volume, PAWP, urinary output

Premature contraction rn dx

Anxiety, ineffective coping, impaired comfort

Early neuro s/s of shock

Anxiety, restlessness, increased thirst.

Endoscopic variceal ligation EVL banding

Application of small "O" bands around the base of the varices to decrease the supply

Testing motor function for SCI for S1

Apply resistance when plantar flexing feet

SBAR is? Define?

Approach to hand-off communication S = Situation B = Background A = Assessment R = Response

MS GI/GU s/s

Areflexic bladder or frequency/urgency/nocturia, constipation, incontinence, impotence

Fluid/electrolyte findings of cirrhosis

Ascites, decreased effective blood volume, dilutional hyponatremia or hyperatremia, hypocalcemia, hypokalemia, peripheral edema, water retention

Low exhaled volume/low pressure alarm sounds from leak in ventilator circuit preventing breath sounds from being delivered

Assess all connections and all ventilator tubings for disconnection

Preventing pulmonary edema

Assess for early signs Crackles in bases Dyspnea at rest, disorientation, confusion High Fowler's position

Artifact or ventricular tachycardia first thing to do

Assess or check leads

Nursing care for ET tube

Assess placement, cuff leak, breath sounds, chest wall movement, prevent pulling/tugging on tube to prevent slipping, check pilot ballon to ensure inflated, suctioning/coughing/speaking can cause dislodgement, neck flexion/head rotation/mouth secretions/tongue movements moves tube, possible soft wrist restraints and then sedation if other measures fail

Care of patient w/ mechanical ventilation

Assess respiratory status/VS/color/chest expansion/placement/pulse ox, ABGs, HOB raised, check venilator settings, check alarms, if PEEP observe peak airway pressure, check display for tidal volume, empty tubing if moisture, ensure humidity via air temp at body temp, cuff inflated, assculate lungs, check for suctioning q 2 hours, assess mouth for pressure ulcers, mouth care q 2 hrs, change tape as needed, trach care, check for GI distress, I/Os, turn q 2 hours, get out of bed as prescribed, rest,

The nurse is notified by the telemetry monitor technician about a patient's heart rate. Which method does the nurse use to confirm the technician's report?

Assess the heart rate directly by taking an apical pulse

If high pressure alarm sounds from obstruction in tubing b/c patient lying on the tubing or there is water or a kink in tubing

Assess the system, moving from artificial airway towards ventilator

Care of ET/Trach tube

Assess tube position q 2 hours, position ventilator tubing in a way that patient can move without pullin on tube. Mouth care q 8 hours

Ventricular tachycardia assessment

Assessment Palpitations Dizziness/ lightheadedness. Shortness of breath. Chest pain/ pressure. Near-fainting or fainting (syncope). Weak pulse or no pulse

Steps of delegation

Assessment+planning, communication, surveillance/supervision, evaluation+feedback

Victims of abuse

Assessment/documentation, communication, education

Respiratory MG

Assisted cough, keep ambulance bad and intubation equipment tat bedside, bipap

With ventilator what does nurse do

Assists in connecting patient to ventilator and monitoring settings

When to have liquids for ARDS/failure

At end of meal

Burn wound infection occurs through

Auto-contamination where patient's own flora overgrows or cross contamination from others

Myasthenia gravis

Autoimmune disease w/ remissions exacerbations. Progressive weakness that improves w/ rest, poor posture, ocular palsieas, ptosis, weak eye closure, diplopia, respiratory compromise, loss of GU/Gi control, fatifure, achiness, paresthesias, decreased smell/taste

Examples of commmon disorders and therapies leading to immunocompromise

Autoimmune disorders, Burns, Malnutrition, Cancer, Drugs, AIDS, Diabetes

Multiple sclerosis s/s

Autoimmune usually familial, tinnitus, lowered hearing, nystagmus, diplobia, blurred vision, dysarthria, dysphagia, onset 20s-40s, weakness that can progess to paralysis, muscle spasticity, ataxia, vertigo, urinary retention, spastic bladder, constipation

MAP

Average pressure in patient's arteries during one cardiac cycle. Influenced by total blood volume, CO, size of vascular bed

Education for hepatitis

Avoid all meds/OTCs, avoid all alcohol, rest frequently, eat small frequent meals w/ high carbs+moderate fat/protein, avoid sex until antibody testing -

Prevention of infection for neutropenic

Avoid crowds, don't share toilet items, bathe daily esp. armpits groin genitals anus, clean toothbrush, wash hands before eating after pet touching after shaking hands after getting home, avoid raw foods, don't drink liquids standing >1hr, don't reuse dishes, don't change litter box, take temp q day, report s/s of infection

Patient fam education for immunocompromised

Avoid large crowds, Bathe daily, Perianal care after each BM. Avoid fresh fruits and vegetables. Cooked meats only. No fresh flowers. Avoid Gardening

How to prevent those at risk for vasovagal attacks causing bradydysrhythmia

Avoid raising arms above head, pressure over carotid artery, pressure on eyes, bearing own/straining for BM, stimulating gag reflex

To prevent vagal stimulation

Avoid tracheal suctioning, enemas, rectal temp, BM straining, vomitting, gagging, tight collars, raising arms above head

Type 1 interventions

Avoidance therapy, decongestants, antihistamines, corticosteroids, alternative therapy, desensitization therapy aka allergy shots

Patient described as alert is? Can be alert but?

Awake and responsive. Can be alert but not oriented to person, place, or time

Skin findings of cirrhosis

Axillary/pube hair changes, caput medusae, eccymosis, increased skin pigmentation, jaundice, palmar erythema, pruritis, spider angiomas

Chronic rejection what happens? Occurs? Cure?

B.vessel muscle overgrows and occludes vessels and organ tissue replaced w/ fibrotic scar tissue reducing transplant organ function occurring continuously due to chronic ischemia. Occurs to some degree w/ all. No cure.

If DM and shock

BG can go up

Nitrates monitor

BP . Headache normal fixed w/ acetaminophen

3rd stage progressive

BP drops, MAP low, may say they will die, hypoxia, anxiety, tachycardia or possible bradycardia

For breathing both apneic patients and those w/ poor ventilators effort need

BVM ventilation until endotracheal intubation and mechanical ventilator used

Band aka? Mature is?

Baby neutrophil, mature is segment

Promoting mobility for MS

Baclofen/lioresal to lessen muscle spacisticy, paresthesia via antidepressants, amatadine/symmetrel for fatigue, antispasmodics, antieleptics. ROM, stretching

Antibiotics for immunocompromised

Bactrim, vancomycin

Dysrhythmia vs. arrhymias

Bad, pain, difficult, abnormal vs. no not without

patient is brought to the ED by a friends who report " he probably overdosed on downers". What type of airway management does the nurse expect this patient to receive? decreased level of consciousness deceased gag reflex Emesis to face and chest sonorous respirations pulse oxygen is 87%.

Based on clients ventilator effectiveness and physical abnormalities client requires airway management with an endotracheal tube. The use of the bag-valve-mask may be used for ventilation for support until endotracheal intubation is performed but does not serve as effective management for his client.

Artifact focus on

Baseline for p and t's, if nothing distinguishable artifact, see slide 34

Primary survey before engaging? Define?

Before engaging making sure safe w/ standard precautions/ PPE then the initial assessment: Airway/cervical spine, breathing, circulation, disability, exposure

Stage 4 of conflict

Behavior: this is a stage where conflict becomes visible

EF 40-50%

Below normal

Cause of hyperaldosteronism? Results in?

Benign adrenal adenoma, results in mineralocorticoids excess

Echocardiogram is

Best tool to dx HF(valve changes, pericardial effusion, chamber enlargement, ventricle hypertrophy, EF) and non invasive. Assesses EF, valvular changes, chamber enlargement, pericardial effusion, blood clots, cardiac wall motion.

Meds that help management HF+hypertension

Beta Blockers "lols" Angiotensin converting enzyme (ACE) inhibitors "prils" Angiotensin II receptor blockers (ARBs) "tan"

Drugs for preventing bleeding for cirrhosis

Beta blockers like propranolol/inderal, antibiotics , vasoactive vasopressins like terlipressin/somatostatin

Drugs for esophageal varices

Beta-blocking agents Propanolol/Inderal, Nadolol/Corgard

Stage 2 mild parkinsons

Bilateral limb involvement, maskike face, slow shuffling gate

Portal hypertension from liver dysfunction

Blood backs up and you get hemroids and umbilicus gets visible veins, you get splenomegaly, esophageal bleeding

Acute respiratory failure classified by? Further defined as?

Blood gas abnormalities. Further defined as ventilators, oxygenation, combination of both failures

Hemothorax

Blood loss into chest cavity

Expected outcomes for hyperaldosteronism

Blood pressure remains normal Fluid and electrolyte balance is maintained Decrease in aldosterone levels Client verbalizes understanding of condition Client verbalizes understanding of dietary recommendations

Hep C from? S/s? Recovery?

Blood to blood. S/s asymptomatic. Usually don't recover and chronic infection develops

Dx of cushings

Blood/salivary/urine Cortisol levels high, ACTH high if pituitary Cushings or very low if adrenal Cushing's or when chronic steroid use Dextramethasone suppression testing Incread BG, decreased lymphocytes, increased Na, decreased Ca+K MRI CT scan X- Ray

Types of trauma

Blunt or penetrating

MS visual issues

Blurred vision, diplopia aka double vision, decreased, scotomas aka peripheral vision change, nystagmus aka involvuntary REM

Neuro manifestations of hyperthyroidism

Blurred/double vision changes usually earlier s/s, eye fatigue, dry eyes, corneal ulcers/infections, increased tears, njected/red conjunctiva, photophobia, eyelid retraction/lag, globe lag, hyperactive DTR, tremors, insomnia

Trauma definition

Bodily injury

Congenital/primary immune deficiencies

Born w/ defect. Like selective immunoglobulin A deficiency which is treated by treating infections, or Bruton's agammaglobulinemia treated w/ antibody replacement

CV manifestations of hypothyroidism

Bradycardia, dysrhythmia, enlarged heart, decreased activity tolerance, hypotension

Atropine for

Bradydysrhythmia

Hypothalamus + pituitary location

Brain

Rapid deceleration/acceleration can cause

Brain damage through impact w/ hard skull aka coup-countercoup injury

Managing airway/breathing for SCI

Breath sounds/VS q 2-4 hours, if tetraplegic cough assist via placing hand on rib cage/ab and cough, incentive spirometer, monitor for pneumonia/PE/atelectasis

Ventilator rate

Breaths/min

CAD

Broad term including chronic stable angina and acute coronary syndromes like unstable angina, MI and affects arteries for myocardium causing ischemia and infarction

Asthma drugs

Bronchodilators, cholinergic Antagonist, long acting beta agonist Albuterol, atrovent, combivent, Advair, Singular, Prednisone

Examples of venomous arthropods

Brown recluse, black widow, scorpions, bees, wasps

Contusion

Bruising of brain aka coup if at site or contrecoup if injury at opposite

Clinical manifestations of cushing's

Buffalo hump on back, unusual behavior, facial features, fat/truncal obesity, ACTH/cortisol increase, loss of muscle mass on limbs, thin overextended skin, hypertension/hyperglycemia/hypernatremia/hyperpigmentation, urinary cortisol increased, menstrual irregularities, porosity of bones, weight gain, moon face, loss of bone density, purple striae, acne

Burnout: shares? If reality shock is not handled? S/s?

Burnout shares common characteristics with reality shock If reality shock is not handled in a healthy way - progress to full-fledge burnout Symptoms: depression, sadness, grief, and mourning

Bloodwork for dx of respiratory failure

CBC, chemistries(CMP, BMP)

Sepsis cv s/s

CO/BP low in early+septic shock. CO/HR/BP high in severe sepsis. With progression DIC causing hypoxia/ischemia.

Hypercapnic respiratory failure examples

COPD, asthma, neuromuscular disease, drug overdose, chest wall abnormalities

If no pulse and not awake

CPR

Ventricular tachycardia: rate? Rhythm? P wave? QRS?

Can be intermittent/nonsustained or sustained Rate- 100-200 bpm Rhythm- regular or irregular P wave- none or not associated with QRS QRS- wide, bizarre appearance

With fluid volume excess hematocrit Hct

Can be low from hemodilution

Fungal opportunistic infections

Candida causing candidiasis, stomatitis, esophagitis leading to altered taste, mouth pain, difficult swallowing, retrosternal pain, cottage cheese in mouth. Cryptococcosis meningitis causing fever, headache, blurred vision, n/v, nuchal rigidity/stiff neck, confusion, altered LOC, malaise, seizures. Histoplasmosis causing dyspnea, fever, cough, weight loss, enlarged lymph nodes

Tests verifying perfusion

Cap refill, MAP, skin color, temp

Complications of surgical interventions for MI

Cardiac Tamponade - fluid compresses the heart muscle reducing cardiac output Mediastinitis- infection of the mediastinum

Pons brainstem

Cardiac acceleration/vasoconstriction, controls RR and pattern, cranial nerves 5, 6, 7, 8

Immunocompromised

Care of patients with secondary immunodeficiency

Nursing roles

Caregiver, communicator, teacher/educator, counselor, leader, researcher, advocate, collaborator

Pheochromocytoma patho?

Catecholamine producing tumor in adrenal medulla which store/release epinephrine and norepinephrine. Excess of those mimic sympathetic division of ANS

Adrenal medulla hormones? Release stimulated by?

Catecholamines:epinephrine, norepinephrine. Release stimulated by activation of sympathetic nervous system from stress aka fight or flight

Central venous catheterCVP

Catheter inserted through subclavaian vein to superior vena cava to heart to right atrium. Measure central venous pressure. Lets you know of volume in right heart for HF. Trends up or down is most important

Atrioventricular node

Cause impulses to slow down before proceeding to ventricles aka PR allowing atria to contract and ventricles to fill

Cirrhosis caused by? Develops? Results in?

Caused by chronic reaction to hepatic inflammation or necrosis Develops slowly, results in end stage liver disease

In som VT causes? Assess? Treatment if stable?

Causes cardiac arrest. Assess ABC, LOC, O2 sat. If stable w/ sustained VT o2 and ECG then amiodarone, lidocaine, or mag sulfate

Drowning assessment fresh water

Causes surfactant to wash out which destabilizes alveoli to increase airway resistance

Education for pacemaker generator

Cell phones >6 inches away from generator, handset on ear opposite of generator, avoid electromagnetic fields like magnets/TV/radio transmitters/MRI. Carry ID card/bracelet. Don't apply pressure to generator, don't operate electrical appliances over/make sure grounded. If beeps move away and notify

Spinal cord injuries: incomplete spinal cord lesions

Central, anterior, posterior, brown-sequard. Cord damaged where some function/movement below level of injury

History assessment for Addison's

Changes in activity level:fatigue, muscle weakness, lethargy GI disturbances:nausea, vomiting, anorexia, diarrhea, abdominal pain Sexual disturbances in women:menstrual cycle changes r/t weight loss, men may experience impotence

Physical assessment of cushing's

Changes in fat distribution Muscle wasting and weakness Skin changes Hirsutism in women Male pattern baldness Edema Fluid and electrolyte imbalance GI issues like ulcer formation from raised HCl and decreased gastric mucus

reproductive manifestations of hypothyroidism in women? Men?

Changes in menses like amenorrhea or prolonged period/annovulation/decreased libido vs. men: decreased libido/impotence

Abdominal assessment of cirrhosis

Check for distended abdomen/umbilicus+veins/caput medusae+Problems w/ balance/posture+inguinal/umbilical hernias, right upper quad for heptamegaly by advanced RN, measure girth, take weight for most reliable indicator of fluid retention

MOI types

Chemical, lack of oxidation, smoke, electricity, heat, mechanical energy

Exposure to energy examples

Chemicals Lack of Oxidation Smoke Electricity Heat Mechanical Energy

Dx of hyperaldosteronism? K/renin? Na? Specific gravity?

Chemistry labs MRI, X-rays, CT scan Aldosterone levels, low K/renin, high Na, low specific gravity

Radiation induced immune deficiencies

Chemo more immmunosuppressive than radiation/radio therapy

Cancer treatments that can cause bone marrow suppression causing immunosuppression

Chemotherapy, biotherapy both lead to neutropenia/myelosuppression causing high risk for sepsis

Pneumothorax define

Chest injury that allows air to enter pleural space and results in lung collapse

MI pain

Chest, radiates to left arm, jaw/back/shoulder/ab pain, in morning, lasting 30 min>, n/v, diaphoresis, dyspnea, impending doom, palpitations, dizziness,

Protecting skin

Clean dry skin, mobility to decrease shearing forces, routine turning

Cardiac transplantation

Clients with ESRD, severe COPD, clotting disorders and infections are not candidates Immunosuppressive therapy usually begins in operating room

Stage 2 of conflict

Cognition/personalization: Conflict must be perceived by the parties to it whether or not conflict exists is a perception issue. If no one away of conflict then generally agreed that no conflict exists. Place where parties decide on what conflict is about.

Clinical reasoning focuses on

Collection of FACTUAL DATA Process information Understand problems/situation Plan & implement intervention Evaluate outcomes Reflect & learn from the process

Perceptions by new nurses

Colliding expectations - expected workplace to be more like nursing school High patient-to-nurse ratios were a particularly dominant source of stress The need for speed - felt there should be more time to transition to carrying full responsibility for patient care You want too much - complaints about heavy workload, with little time to do it and little time to spend with patients How dare you - feeling mistreated by nurse and physician colleagues and management Change is on the horizon - despite the complaints, still felt hopeful

To est. brain death

Coma of known cause, norma/near core body temp, normal BP, at least 1 neuro exam

Effects of liver cell failure

Coma, retro hepaticus aka bad breath, spider nevi, gynecomastia, jaundice, ascities, loss of sex hair, testicular atrophy, liver flap aka coarse hand tremor, bleeding tendency due to decreased prothrombin, anemia/iron deficiency, ankle edema

Stage 4

Comatose: unresponsiveness leading to death, unarousable, obtunded, no response to pain, no esterixis, + babinski, muscle rigidity, femoral hepaticus aka musty sweet breath, seizures

What should RNs document

Communication Quality Improvement/Assurance and Risk Management Continuity of Care Establishes Professional Accountability Legal Reasons All Aspects of the Nursing Process As a general rule, any information that is clinically significant should be documented. Plan of Care Admission, Transfer, Transport and Discharge Information Client Education

Level 2 trauma center

Community hospitals that may not be able to meet resource needs of patients w/ complex injury

3-4 years you are

Competent

Five conflict handling intentions

Competing, collaborating, avoiding, acommadating/cooperative, compromising, smoothing

Stage 5 complete parkinsons

Complete ADL dependence

HF core mreasures

Component of the Joint Commission initiative Accreditation process Standardized Evidenced based measures Importance of measuring the processes and outcomes Developed by panels of clinical experts and key stakeholders

Micropressor ventilators

Computer managed positive pressure ventilator. Computer allos ongoing monitoring of ventilation, alarms, patient condititions. Ventilators more responsive w/ severe lung disease who need prolonged weaning.

Western blot

Confirms HIV when ELISA is + and detects serum antibodies to 4 specific major HIV antigens

CNS manifestations of AIDS

Confusion, dementia, headache, fever, visual changes, memory loss, personality changes, pain, seizures

Nursing assessment of HIV client

Continuous assessment of opportunistic infections: Fungal infections- Pneumocystis Carinii Pneumonia, Oral or Vaginal Candidiasis, Mycobacterium Avium Complex- Herpes Simplex Virus Varicella-zoster virus Malignancies-Kaposi's Sarcoma skin lesions or oral lesions, Hodgkins lymphoma, Burkett's lymphoma

QRS complex define

Contraction/depolarization of bundle of his/Q and ventricles/RS

Hypothalamus considered the

Control center

Functions of thyroid hormones: controls? Promotes? Regulates? Affects? Increased? Increase? Decreased? What antagonist?

Control metabolism, promote pituitary secretion of GH+gonadotropins, regulate protein/carb/fat, affects HR, increased RBC production, increase bone formation and decrease bone resorption of calcium. Insulin antagonist

Reducing metabolic demands for increased ICP

Controlling body temp via treating fevers and not allowing shivering

Mineralocorticoids controls? Aka and what it does? Stimulated via? Hypo?

Controls Na and K. Aldosterone maintains extracellular fluid volume promoting Na+H2O reabsorption and K excretion. Stimulated via renin-angiotensin release, raised K, ACTH. Hypo: hyperkalemia, hyponatremia, hypovolemia, acidosis

Skin manifestations of hypothyroidism

Cool pale or yellowish dry coarse scaly skin, thick/brittle nails, dry/coarse/brittle hair, decreased hair growth w/ loss of eyebrow hair, poor wound healing

Skin changes for hypovolemic shock

Cool, moist, pallor/cyanosis, mottled/gray or blue if light/darker if dark, slow cap refill

Integumentary s/s of shock

Cool/cold, pale/mottled/cyanotic, moist/clammy, mouth dry/pastelike

Cerebellum

Coordination/movement, equilibrium, overshooting target, predict distance/speed

Preop care for Cushings

Correct electrolyte/glucose imbalances. Cardiac monitoring. Decrease fall risk, high calorie/protein diet. Glucocorticoid preps given.

Hyperfunction of adrenal glands: Cortex? Medulla?

Cortex:Cushing's Disease Excess cortisol (glucocorticoid), hyperaldosteronism excess mincerlocorticoid, or excess androgens. Medulla: pheochromocytoma/tumor causes excess catecholamines epinephrine/norepinephrine

Hyperfunction of adrenal gland: Cortex? Medulla?

Cortex:Cushing's syndrome aka excess cortisol. Conn's syndrome aka excess aldosterone. Adrenal virilizing syndrome aka excess androgens. Medulla:Pheochromocytoma aka tumor.

AIDS respirator manifestations

Cough SOB

ARB example

Cozaar, diovan

Scorpion s/s

Cranial nerve and/or skeletal muscle involvement, pain, possible fever, hypertension, GI issues, tachycardia, cardiac dysfunction, pulmonary edema, paresthesia

Common disorders associated with arthritis

Crohn's, ulcerative colitis, TB, hemophilia, whipple's, intestinal bypass, hyperparathyroidism, hyperthyroidism, DM, sickle cell crisis, psoriasis, infection

Interleukin 1 IL-1

Cytokines that induces fever, stimulates prostaglandin, increases growth of CD4 T cells

Viral opportunistic infections

Cytomegalovirus in eye, respiratory/GI tract/CNS. Herpes simplex virus HSV in perirectal/oral/genital area. Varicella /shingles

Vasopressin aka ADH deficiency aka? S/s?

DI: increased UO, low specific gravity <1.005, hypovolemia, hypotension, dehydration, increased plasma osmolarity, increased thirst, output doesn't decrease when fluid intake decreased

Renal disease on immunity

Decreased neutrophils+immunoglobulin

Hepatic disease impact on immunity

Decreased neutrophils+phagocyt+immunoglobulin

Priority problems for hypothyroidism

Decreased oxygenation, hypotension, altered cognitive functioning, potential for myxedema coma which can cause respiratory failure

Hypoesthesia vs. hyperesthesia

Decreased sensation vs. increased sensation

Pulmonary diseases on immunity

Decreased ueutrophils

Advanced beginner characteristics

Demonstrates marginally acceptable performance, gaining experience w/ real situations to note meaningful patterns and attributes or have them pointed out by preceptor, can formulate guidelines for actions in terms of patterns and attributes, difficulty identifying important aspects, treat all attributes as equally important, can note recurrent meaningful situational comments but not prioritize between them

Depth markings? Tube cuff?

Depth markings show how far the tube has been inserted, (how many cm at teeth or lips) Tube cuff is inflated-minimal air can pass around cuff to the vocal cords, nose or mouth.

First aid/prehospital care for high altitude illnesses

Descend to lower altitude, if mild rest/acclimate, o2 admin

High altitude hospital care/treatment for HACE/HAPE

Descent, o2, dexamehasone/decadron for HACE. Phosphodiesterase/tdalafil/cialis. HAPE: sildenafil/viagra to prevent HAPE since vasodilation, o2, bedrest warmth, calcium channel blocker nifedipine/Procardia to decrease vascular resistance if.

Labs for HF primary goal

Determine and treat underlying cause

Chronic respiratory failure s/s

Develops over days or longer Slight changes in ABG's

Acute respiratory failure s/s

Develops rapidly, life threatening Change in ABG and acid/base balance

Dexamethasone suppression testing

Dexamethasone given and 24 hour urine collection follows if urinary corticosteroid excretion and cortisol levels suppresses Cushing's disease not present

S/s of cardiogenic shock

Diaphoresis Pale, cool skin Rapid respirations Rapid weak thready pulse Low BP (systolic < 90 mm Hg for 30 minutes) Confusion or loss of ability to concentrate Unresponsiveness

ARDS interventions

Drugs, fluids, nutrition, case management

Assessment of parkinson's

Dysarthria Tremor, rigidity, bradykinesia, & postural instability Excessive and uncontrolled sweating Paroxysmal flushing Orthostatic hypotension Gastric and urinary retention, constipation Sexual dysfunction Depression, dementia Sleep disturbances, hallucinations Personality changes Psychosis, dementia, & acute confusion

Obstructive shock s/s

Dyspnea Tachycardia Cyanosis Pleuritic pain Hemoptysis, Pulsus paradoxus >10 mm Hg decrease in systolic BP on inspiration Distant muffled heart sounds pericardial tamponade

The hallmark s/s for respiratory failure

Dyspnea aka difficulty breathing

Orthopnea

Dyspnea in recumbent/lying flat position. Check pillows when sleeping, paroxysmal nocturanal dyspnea

Respiratory failure s/s

Dyspnea, dyspnea on exertion/lying down, orthopnea aka easier to breath upright, RR or pattern change, change in lung sounds, hypoxemia s/s(pallor, cyanosis, increased HR, restlessness, confusion), hypercarbia, decreased O2 sat

Pulmonary findings of cirrhosis

Dyspnea, hydrothorax, hyperventilation, hypoxemia, orthopnea

To assess inflammation

ESR, c-reactive protein aka CRP

BP for shock

Elevate feed, keep head flat/elevated 30 degrees all to increase perfusion to brain

Pulmonary artery pressure PAP and pulmonary wedge pressure PAWP are

Elevated in left HF b/c volume and pressure is increased in left ventricle

Common risk factors for CAD

Elevated lips, tobacco, limited physical activity, hypertension, DM, obesity, excess alcohol, stress

Liver cancer dx

Elevated serum alpha-fetoprotein AFP, increased phosphatase, xray, CT, US, biopsy

Classifications of triage

Emergent, urgent, non urgent

If high pressure alarm sounds from patient anxious or fights ventilator

Emotional support, increase flow rate, explain procedures, sedate/paralyze as ordered

Psychosocial interventions for acromegaly

Encourage to express concerns about altered appearance, help indentify strengths, reassure that treatment may reverse some problems

Patho of endocrine system: endocrine glands? Hormones? There is no? Uses what to transport hormones to target tissues?

Endocrine glands secrete hormones Hormones exert their effects on specific tissues or target tissues There is no direct connection between the target tissues and the endocrine gland (Ductless glands). Uses the circulatory system to transport the hormones to the target tissues.

Parathyroid hormone function on GI

Enhances absorption of Ca and phosphorus from gut via activated vitamin D to increase serum Ca

Splenomegaly define? What does this cause?

Enlargement of the spleen as a result of the inability of the veins that drain the spleen to empty into a congested portal system from portal HTN. The enlarged spleen takes up and holds/destroys formed elements of the blood causing thrombocytopenia and anemia increasing bleeding risk.

6 second strip how many blocks?

Enough info to define rhythm, all test questions. 30 blocks

Hemorrhage after TBI

Epidural, subdural, intercerebral

Paracentesis interventions

Explain procedure, obtain VS/weight, void before procedure to prevent bladder injury, HOB elevated, measure/record drainage, decribe fluid, send fluid to lab for analysis, after removal apply dressing, maintain bedrest per protocol, weight after

Preop for hypophysectomy

Explained that body changes, organ enlargement, visual changes not reversibl, nasal packing present for 2-3 days after so will be necessary to breath via mouth, not to brush teeth/cough/sneeze/blow nose/bend forward after surgery since can increase ICP delaying healing or causing bleeding for up to 2 months

Cirrhosis definition

Extensive, irreversible scarring of liver

Acceleration vs. deceleration injury

External force contacting head putting head in motion vs. moving head suddenly stopped

Invasive temporary pacemaker define? Safety?

External generator and leads that are inserted. Safety: when not attached to generator insulate wire ends, all electrical equipment grounded, wear rubber gloves when touching wire to prevent static electricity

Causes of ventilatory failure

Extrapulmonary involving nonpulmonary tissues or intrapulmonary aka disorder of respiratory tract

Hemoglobin

F:12-16, M:14-18. Increased: fluid shift, dehydration. Decreased:hemorrhage

Hematocrit

Female 37-47%, M: 42-52%. Increased: fluid shift, dehydration. Decreased: hemorrhage

Acute hemolytic reaction s/s?

Fever, heat sensation, lumbar pain, chills, hypotension, bleeding, increased HR, chest pain, hemoglobinuria, hyperbilirubinemia

Manifestations of acute HIV infection

Fever, night sweats, chills, headache, muscle aches, rash, sore throat

Early s/s of sepsis

Fever, u/o less than intake, lightheadedness

Diastolic HF aka?

Filling problem. "Contracts but can't relax" Inadequate relaxation or "stiffening" LV cannot relax adequately during diastole

Most important question to ask for shock

Fluid i/o during past 24 hours. U/O reduced during first stages when fluid intake normal

Diuresis at risk

Fluid in peripheral tissue is mobilized and excreted and patient describes awakening at night to urinate

Acute and rehab phases: spinal shock intervention

Foley catheter insertion, NG tube insertion

Neutropenic precautions

For AIDS only:No fresh flowers in room, no fresh food, no one in the room that is sick.

CXR of HF?

For LHF, cardiomegaly, hypertrophy, vascular engorgement, pleural effusions

Beta adrenergic agonists/inotrope

For acute HF. aka dobutamine/dobutrex for short term acute HF. Improves contractility

Digoxin/lanoxin for? Do what?

For atrial fibrillation. Apical pulse taken

Azothioprine/imuran

For autoimmune hepatitis+RA by disrupting DNA/RNA synthesis resulting in decreased B+T cells

Calcitonin from? Function? Opposite of? Low Ca? Elevated Ca?

From thyroid and lower Ca and phosphorus by reducing bone resorption/breakdown. Opposite of parathyroid hormone. Low Ca suppress, elevated increase secretion

Stimulation of sympathetic nervous system w/ HF

From tissue hypoxia. 1st mechanism. Causes increase in HR/BP from vasoconstriction, resulting in immediate increase in CO/SV but then eventually goes dow causing pulmonary edema

Hypovolemic shock from hemorrhage cause or risk factor

From trauma, GI ulcer, surgery, inadequate clotting from hemophilia, liver disease, malnutrition, bone marrow suppression, cancer, anticoagulants

Hypovolemic shock from dehydration case/risk factors

From vomiting, diarrhea, heavy diaphoresis, diuretic therapy, NG suction, DI, hyperglycemia

Late signs of advanced cirrhosis aka end stage liver failure

GI bleeding, jaundice, ascites, spontaneous bruising

Antiviral for immunocompromised

Ganciclovir

5 foods to boost liver function

Garlic, lemons, broccoli, turmeric, organic protein

Nurse thyself

Get organized Breaks Avoid OVER TIME trap REST & RELAXATION Personal habits diet exercise BALANCE Enjoy your patients - Customer Service Keep a sense of humor - Laugh at yourself

TPA

Gets rid of all clots. So you cannot give anything else until it wears off

For epipen have patient

Give return demo

Prevent escalating violence

Give time, give attention, if someone has threat body language notify security ahead that they might get called, be calm, listen, be respectful, specify specific limits like 1013/1014, offer food/tv, admin meds if needed like ativan haldol g med

If tachycardic CO will

Go down since you don't have volume since no volume to fill

Hepatic encephalopathy goal? treatment?

Goal is to reduce ammonia load. Nonabsorbable disaccharides (carbohydrate):Lactulose- Also can be given as an enema. Nonabsorbable antibiotics : Neomycin (GI upset), Rifaximin (better tolerated) , Flagyl

Other manifestations of hyperthyroidism

Goiter+bruits over goiter, wide eyed/startled appearance aka exophthalmos, decreased WBC, enlarged spleen

BNP is used to

Golden standard. Dx HF part of body's response to decreased CO from ventricles having ^ pressure. amino acid secreted by the body as a natural response to help correct the sequela of a HF exacerbation. BNP causes the blood vessels to dilate resulting in increased cardiac output. Measures severity of HF

Sepsis patho

Gram positive/negative bacteremia Can also be virus or fungal Inflammatory response activated Release of macrophages and lymphocytes produce fever leukocytosis, hypotension, vasodilatation and myocardial depression

Electrocardiogram

Graphic representation of cardiac electrical activity

Best practice for immunocompromised

Hand Washing/Hand Rub for all patients/caregivers, No visitors with s/s of respiratory infections, Environmental interventions such as keeping windows closed+negative pressure rooms+HEPA filters. Contact Precautions for patients known to be colonized/infected w/ resistant organisms, Avoid fresh/dried flowers/plants, Avoid contact w/ animal feces, saliva, urine or litter boxes. Wear masks when moving/transporting to different areas in the hospital. Avoid uncooked meats, seafood, and eggs. Wash fruits and vegetables

joint commission guidelines to prevent infection

Hand cleaning Prevent infection of the blood from central lines Prevent infection after surgery Prevent infections of the urinary tract that are caused by catheters

Best ways to prevent infection

Hand hygiene >15 seconds, PPE, adequate staffing, disinfection/sterilization, patient placement/transport

Standard precautions define?

Hand hygiene, PPE:gloves for fluids/nonintact skin, gown, mask/eye/shield when splash possible like suction,

Prevention of injury for thrombocytopenia

Handle gently, avoid IM, use small needle, firm pressure q 10 min or no longer bleeds, ice areas of trauma, test urine/stool for blood, observe IV q 4 hours for bleeding, avoid enema/suppository, measure ab girth daily, electric shaver, soft toothbrush, don't blow nose, keep walkways clear

Preventing infection for Cushing's

Handwashing, anyone w/ upper respiratory tract infection must wear ask, continuous assessment, WBC check, inspect mouth/lungs/urine, skin care, pulmonary hygeine

Measures for prevent hep A

Handwashing, avoid contaminated food/water, immunoglobulin w/in 14 days if exposed to virus, HAV vax before traveling to Mexico/Caribbean, vax if living/working in enclosed areas

Tests for glucose

HcA1c glycosylated hemoglobin reveals average blood glucose over 2-3 months

Secondary survey

Head-to-Toe assessment Reassess all interventions

Sodium potassium pump responsible for

Heart contractions

Surgical management of HF

Heart transplantation, VADs/ventricular assistive device

What doesn't tolerate hypoxia and only a few minutes w/out O2 resulting in damage and cell death

Heart, brain, liver, pancreas

Skin manifestations of hyperthyroidism

Heat intolerance, Diaphroesis, fine/soft body hair, smooth/warm/moist skin, thinning of scalp hair

Sex hormone binding globulin function? So liver dysfunction can mean?

Helps body macrophage sex hormones. So liver dysfunction can mean too many sex hormones leading to gynecomastia and spider angiomas(classic sign)

Assessment findings from coagulation issues

Hematemesis Melena (black tarry stools) Can be spontaneous with no precipitating factors Decreased H&H, Increased ammonia level Confusion Ascites

Esophageal varices bleeding s/s can either be

Hematemesis aka vomiting blood or melena black tarry stools

SE of chemo

Hemorrhagic cystitis, cardiac muscle damage, loss of bone density, anemia, neutropenia aka decreased WBC, thrombocytopenia, n/v, hairloss/alopecia, mucositis, anxiety, sleep issues, change in cognition, bone marrow suppression, peripheral neuropathy

Most common cause of cirrhosis

Hep. C, alcoholism, biliary obstruction

Pulmonary embolus drugs

Heparin, fibrinolytics, lovenox

Immune system infection risk factors

Hepatic disease, malnutrition, pulmonary disease, radiation, renal disease, splenectomy, surgery, trauma

Felty's syndrome from RA

Hepatosplenomegaly and leukopenia occur

Hypercarbia

High arterial blood levels of CO2

Parkinsons diet

High calorie, soft dieat, thickened fluids, small frequent meals

Usual diet for cirrhosis if no encephalopathy

High carbs, moderate fat, high protein

What diuretics are most effective for treating fluid volume overload

High ceiling/loops like furosemide/lasix, torsemide/demadex, bumetanide/bumex

Factors that can lead to hepatic encephalopathy w/ cirrhosis

High protein diet, infections, hypovolemia, hypokalemia, constipation, GI bleeding, drugs like sedatives/diuretics

AF interventions

High risk for PE, antidysrhythmics, beta blockers, anticoagulants. Cardioversion, ablation, or pacing

Diffuse axon also injury

High speed acceleration/deceleration

Most common environmental factors causing heat related illness like heat exhaustion/heat stroke

High temp and high humidity

Preload higher blood volume? Lower blood volume?

Higher blood volume-higher CVP Lower blood volume-lower CVP

Sepsis community based care

Home care management Teaching for self-management Good handwashing Good hygiene Balance diet Rest and exercise Skin care Mouth care How to take temperature

Community based care for cardiomyopathy

Home care management Teaching for self-management Health care resources

Reality shock phases

Honeymoon, shock/rejection, recovery, resolution

Expected outcomes for hyperthyroidism

Hormone level return to normal Improved nutritional status Verbalizes understanding of lifelong treatment Effective coping measures

Expected outcomes for SIADH

Hormone level return to normal range Lab values return to normal (sodium, potassium, urine osmolality, urine specific gravity)

Laundry for HIV

Hot water, bleach, keep soiled clothes in plastic bag

Metabolic processes that can affect disability/neuro

Hypoglycemia, hypoxia, neuro injury, drugs

Physical assessment of hyperaldosteronism

Hypokalemia Hypertension Headache Fatigue Nocturia, stamina loss Muscle weakness Dehydration Polydipsia Polyuria Numbness and tingling Fluid and electrolyte imbalance

Sepsis= 2 or more SIRS criteria+known source of infection and one or more of the following clinical manifestations may also be present

Hypotension ↓U/O Positive fluid balance Decreased capillary refill BG > 120 (without DM) Unexplained change in mental status Rising serum creatinine (without kidney problems

Cardiac problems from ventilation

Hypotension if dehydrated or need high PIP: avpod valsalva maneuver fluid retention so monitor fluid I/O, weight, hydration, signs of hypovolemia

Neural-induced neurogenic distributive shock s/s? Greatest risk when?

Hypotension, bradycardia. Greatest risk in 1st 14 hours after injury

Indicators of hypovolemic shock

Hypotension, tachycardia, tachypnea, pallor, diaphoresis, cool/clammy ski/, confusion

Hypofunction of thyroid: disorders?

Hypothyroidism: autoimmune thyroiditis aka hashimoto's disease, myxedema coma

Pulmonary manifestations of hypothyroidism

Hypoventilation, pleasurable effusion, dyspnea

A low CVP indicates

Hypovolemia

Warfarin education

INR, no high K, avoid herbs like ginger

If patient develops respiratory distress during mechanical ventilation

Imeediately remove ventilator and provide ventilation with bag valve mask to allow quick determination of whether problem is w/ ventilator or patient

Unstable dysrhythmia treatment

Immediate defibrillation, follow advanced cardiac life support, treat cause

Ventricular fibrillation treatment

Immediate defibrillation, then CPR, airway, epinephrine/vasopressin/amiodarone/lidocain/mag sulfate, oxygen, then defib, after stable treat cause

Spinal shock syndrome immediately? Complete? Not?

Immediately after injury, complete temporary loss of motor/sensory/reflex/autonomic function for <48 hours but function if cervical/high thoracic injuries comes back once resolved. Not abnormal for all this to be absent immediately after

If you suspect anaphylaxis

Immediately call rapid response tesam

Preventing further SCI after SCI

Immobilize fracture via fixation/traction/surgery, assess LOC/VS/pulse ox/pain

Multiple sclerosis define? Types?

Immune-mediated, progressive demyelinating disease of the CNS has remission and exacerbation. 4 types: releasing/remitting, primary, secondary, progressive/relapsing

RN dx priority

Impaired gas exchange, ineffective breathing pattern, risk for decrease CO

Parkinson's rn dx

Impaired verbal communication related to decreased speech volume, slowness of speech, inability to move facial muscles Impaired physical mobility related to muscle rigidity and motor weakness Imbalanced nutrition, less than body requirements, related to tremor, slowness in eating, difficulty in chewing and swallowing

Stages 2 of hepatic encephalopathy

Impending:Continuing mental changes, mental confusion Asterixis-hand flapping Disorientation to time, place, person

Stage 2 portal systemic hepatic encephalopathy

Impending:Mental confusion, disorientation to time/place/person, asterixis aka hand flapping

Anaphylaxis interventions

Important to get history of all allergens and discontinue Keep a list of all allergens, tell all healthcare providers Immediately assess respiratory status and airway Epinephrine and diphenhydramine (IV) Treat anxiety as patient will be anxious Teach automatic epinephrine injector Return demonstration/Epi-Pen Manifestations of allergic reaction and when to call health care provider D/C IV medications, keep fluids, change tubing

Purpose of mechanical ventilation

Improve gas exchange, decrease work needed for effective breathing until lungs adequate or acute episode has passed

Multiple sclerosis outcomes

Improves physical mobility Reports no injury Attains or maintains control of bladder and bowel patterns Participates in strategies to improve speech and swallowing Compensates for altered thought processes Demonstrates effective coping strategies Adheres to plan for home maintenance management

Reduced immunity and blood producing functions of cancer

Increased risk for infection, anemia, thrombocytopenia putting them at risk for bleeding

HIV malignancies

Increased risk for kaposi's sarcoma, lymphoma, cervical cancer, lung cancer, GI cancers, anal cancer

Immune manifestations of Cushing's

Increased risk of infection, decreased immune function, decreased WBCs+antibodies, decreased inflammator response, decreased cytokines+histamine+prostaglandins, manifestations of infection/inflammation may be masked

<35% EF

Increased risk of sudden cardiac death and life threatening arrhythmia

Causes of the high pressure alarm sound

Increased secretions or mucus plug in airway, coughs/gags/bites tube, anxious/fights ventilator, airway size decreases r/t wheeze/bronchospasm, pneumothorax, artificial airway displaced/tube in r. Mainstem bronchus, obstruction in tubing from lying on tube/water or kick in tube, increased PIP from sigh, decrease compliance from gradual trend up in PIP

Teaching for early s/s of shock

Increased thirst, decreased u/o, lightheadness, sense of apprehension

Cardiac transplant complications

Infection is primary complication Other Acute rejection (1st year) Malignancy (lymphoma) Coronary artery vasculopathy cause of death after first year

Acute spontaneous bacterial peritonitis SBP define? Identified how?

Infection of ascetic fluid resulting from bacteria. Identifies when positive ascetic fluid bacterial culture.

Complication for transphenoidal surgery for Acromegaly

Infection, bleeding, increased ICP, transient diabetes insipidus, increased chance of CSF leak/nose bleed(look for halo)

Systemic sclerosis s/s

Inflamed, fibrotic, sclerotic, edamtous, renal failure, myocardial fibrosis, raynaud's, pulmonary hypertension, esophagitis, ulcers, joint inflammation, myositis, fever, fatigue, anorexia, vasculitis, calcinosis, esophageal dysmotility, sclerodactyly of digits, telangiectasis aka spider hemangiomasm hand/arm symmetric pitting edema

Liver disease

Inflammation leads to the destruction of hepatocytes (liver cells).

Hepatitis definition? From what cuases? Results in?

Inflammation of liver. Viral most common but can also be from chemicals, drugs, herbs causing edema in liver's bile channels resulting in jaundice

3 decisions of immunity that make immunocompetence

Inflammation, antibody mediated immunity, cell mediated immunity

Hypersecretion of prolactin secreting tumors/adenoma causes what? Resulting in?

Inhibits gonadotropins and sex hormones resulting in galactorrhea/breast milk production, amenorrhea, infertility, hypogonadism aka loss of secondary sex characteristics, increased body fat

Antiretroviral therapy function? Multiple?

Inhibits viral replication. Multiple drugs used together aka highly active antiretroviral therapy HAART

Trauma define

Injury to living tissue.

Doutamine teaching

Instruct client or caregiver to report: Signs of worsening HF (shortness of breath, orthopnea, decreased exercise tolerance), Abdominal pain Nausea or vomiting Explain to patient the rationale for instituting this medication and the need for frequent monitoring. Chest pain Instruct client to notify nurse immediately of pain or discomfort at the site of administration.

Acute respiratory failure causes what

Insufficient oxygenation of the blood may lead to hypoxemia Hypoxia is inadequate oxygen to tissues

Cerebrum

Intelligence, creativity, memory. Right controls left, left controls right

MS cerebellar issues

Intention tremor during activity, dysmetria aka inability to direct/limit movement, dysdiadochokinesia aka inability to stop motor impulse, clumsiness

Stage 3 of conflict

Intentions: are decisions to act in given way intentions intervene betwee people's perception/emotions and their overt behavior

Drugs for Cushing's interferes w/? Names?

Interferes w/ ACTH or adrenals. Amino/elipten, metyrapone/metopirone affect cortisol, cyproheptadine/periactin for lowering ACTH

Multiple sclerosis disease modifying therapy

Interferon beta-1a Interferon beta-1b Glatiramer acetate Methylprednisolone Baclofen Imuran

Pheochromocytoma s/s

Intermittent hypertension w/ severe headaches, palpitations, diaphoresis, apprehension, impending doom, chest/ab pain w/ n/v, increased defecation

ICP monitoring devices

Intraventricular catheter, subarachnoid bolt/screw, subdural/epidural catheter or sensor, fiberoptic transducer tipped catheter

With ARDS usually patients require

Intubation

ARDS often needs

Intubation and conventional mechanical ventilation w/ positive end-expiratory pressure PEEP or continuous positive airway pressure CPAP

Radio frequency catheter ablation define?

Invasive to destroy irritable focus causing supraventricular or ventricular tachydysrthmia.

Lugol's solution: what containing? Definition? Admin when? Check for? Can be given w/? Used when?

Iodine containing, Saturated solution of potassium iodine. Admin 1 hr after thionamide, check for fever/rash/mouth sores/sore throat/gi distress since manifestation of iodism Can be given with orange juice or milk due to bitter metallic taste Used prior to thyroidectomy

Breathing across room assessment

Irregular breathing patterns-tachypnea, bradypnea, apnea Cyanosis or dusky skin tone Tripod position Retractions Use of accessory muscles Flaring of nares

CPP <50mmHg=

Irreversible neurological damage

Cirrhosis define? Develops how?

Irreversible scarring of liver usually from chronic reaction to necrosis. Develops slowly and has progressive prolonged course resulting in end stage liver disease and without transplant fatal

S/s of hypoxic respiratory failure

Irritability, restlessness, confusion & tachycardia

Airway assessment

Is airway patent? Clear of secretions/debrit C-spine immobilization C3, C4, C5 innervates the diaphragm Jaw-thrust, if needed to establish airway Intubation/O2 Masks

Too rapid correction of NA replacement

Is bad and can cause brain damage, pulmonary edema, or death/HF, must do it gradually

Jaw thrust chin lift for ?

Is suspected spine issue and need to see if patent airway

Hypertonic/isotopic IV fluids and ICP

Keeps CPP 60-70, SBP >90 and to maintain colloid osmotic pressure

Baclofen aka? Function

Kemstro. Helps muscle spasms

Black widow spider s/s

Latrodectism/neutransmitter release, ab pain, muscle rigidity, spasm, hypertension, n/v, facial edema, ptosis, diaphoresis, weakness, salivation, respiratory difficulty, fasciculations/twitching, parethesia

For continuous ECG leads are where and why

Leads on trunk to reduce motion artifact

Causes of right HF

Left HF, right ventricular MI, pulmonary hypertension

Diastolic HF

Left ventricle cannot relax during diastole preventing from filling to ensure CO causing less compliance

Pulmonary edema patho

Left ventricle fails and pressure rises causing fluid to leak across pulmonary capillaries into lungs

Important content for good documentation

Legible, complete, accurate, reflects nursing process

Who should document

Legislation and Standards of Practice of the profession require nurses to document the care they provide demonstrating accountability for their actions and decisions. First hand knowledge means the professional who is doing the recording is the same individual who provided the care. Students it is important that the RN record the care s/he provided in all relevant documents.

High alititude illness/disease/sickness

Less o2 available, hypoxia , increased RR leading to hypocapnia+resp. Alkalosis, REM impaired, excess HCO2 to increase RR/HR/BP/CO, erythropoietin leading to polycythemia

Teaching for hypothyroidism

Lifelong drugs, wear bracelet, periodic blood tests, no OTC drugs, adequate fiber diet but no supplement, take drug on empty stomach, if pt. Has more sleep and is consitpated dose may need to be increased or if difficulty sleeping and more bowel movements dose may need to decrease

Endoscopic therapies for esophageal varices

Ligation/banding w/ O bands on base of varices to decrease blood supply or sclerotherapy via injection

Neutropenic patient w/ infection

Limited manifestations, but consider any temp elevation in neutropenic as sign of infection

EF of 30% what meds to order

Linopril/zestril, digoxin/lanoxin, furosemide/lasix. Have to have diuretic, ACE, and ARB together

Jaundice: patho? Can cause?

Liver cells can not excrete bilirubin Fibrosis or scarring of the hepatic bile channels and ducts interferes with normal bile and bilirubin excretion Elevated serum bilirubin levels Can cause itching/pruritus

Labs for cirrhosis

Liver enzymes, total serum protein, albumin, PT/INR, platelet count, CBC, ammonia level, sodium, fecal occult blood, kidney function

Compensated vs. decompensated cirrhosis

Liver scarred but can perform essential functions w/out major symptoms vs. obvious manifestations

Infection path to sepsis

Local infection, then systemic infection/early sepsis, systemic inflammatory response syndrome, organ failure/severe, MODS/septic shock, then death

Remote vs. recall vs. immediate memory

Long term vs. recent vs. new

Splectomy on immunity

Loss of bacteria recognition

Nutrition therapy for fluids from cirrhosis

Low sodium diet aka 1-2g Na restriction. Read labels, table salt completely excluded, alternative flavoring via lemons etc. If late stage vitamin supplements like thiamine if alcoholic, folate etc.

Metabolism shock s/s

Low temp, thirst, acidosis, low urine output

iN ARDS the pulmonary capillary wedge pressure is

Low to normal vs. in cardiac induced pulmonary edema PCWP is >18

Kidney/urinary s/s of sepsis

Low u/o compared to intake. Kidney function decreases and creatinine increases

Labs of HIV

Low white blood cells counts CD4+ count CBC PPD Vital Signs Cough Nutritional Status GI Status

With PEEP it's important to

Lower FiO2 delivered whenever possible b/c prolonged use of high FiO2 can damage lungs from toxic effects of O2

Lasix and ICP

Lowers CSF production

Hyperventilation and increased ICP

Lowers PaCO2 causing vasoconstriction

Barbiturate coma and ICP

Lowers by lowering metabolic process/o2 consumption/CO2 production

Indications for mechnical ventilation

Maintain a patent airway, support and maintain gas exchange Reduce the work of breathing and reduce cardiac workload in heart failure Control the level of CO2 elimination & provide adequate ventilation and oxygen Serves as prophylaxis for patients at high risk of respiratory failure or an inability to breathe adequately

Until parameters other than a skin test come back negative for TB in patient w/ aids who also has TB s/s

Maintain airborne precautions

Planning for HIV

Maintain and Support Immune Function with Antiretrovirals Prophylactic and treatment of opportunistic infections

Interventions for Addisons

Maintain fluid balance to prevent dehydration via weight daily+I/O Monitor glucose levels Monitor electrolytes Hormone Replacement Therapy w/ cortisol/aldosterone or hydrocortisone for glucocorticoids or cortisol via prednisone

Purpose of intubation

Maintain patent airway, provide means to remove secretions, provide ventilation/oxygen

Goal in hypovolemic shock

Maintain tissue oxygenation, increase vascular volume to normal range, support compensatory mechanisms Lie flat with lower ext. elevated 12 inches (modified Trendelenburg) to facilitate venous return to central circulation

Management of transplant rejection: maintenance therapy

Maintenance therapy w/ continuous immunosuppression like cyclosporine+corticosteroids like prednisone

E exposure make sure

Make sure no issues and prepare for secondary survey

E of ABCDE if cold?

Makes them cold so make sure they are warmed back up via internal fluid warmers or external

Conditions predisposing to sepsis and septic shock

Malnutrition, immunosupression, large open wounds, mucus membrane fissures, GI ischemia, invasive procedures, malignancy, >80 y/o, infection, chemo, alcoholism, DM, chronic kidney disease, transplant, hepatitis, HIV/AIDs

For patient who has undergone liver transplantation monitor for

Manifestations of rejection like tachycardia, fever, RUQ/flank pain, decreased bile pigment, increased jaundice, elevated bilirubin/ALT/AST/phosphatase/PT/INR

TBI drugs

Mannitol diuretic for cerebral edema which lowers ICP, fever drug

Treatment of increased ICP

Mannitol, lasix, hypertonic/isotonic IV, steroids, anticonvulsants, hyperventilation, sedatives, barbiturate coma, coagulation, hypertensive therapy, hypotensive therapy

Altered GI structure and function of cancer

Many have anorexia, cachexia aka body wasting/malnutrition develops, diet high in protein and carbs for weight

To detect changes in tube position

Mark where the tube touches patient's teeth or nose

Monitoring for Graves

Measure apical, BP, temp q 4 hours. Repot any palpitations, dyspnea, vertigo, chest pain. Increase in temp can indicate thyroid storm

Sepsis resuscitation bundle

Measure lactate, blood cultures before antibiotics, broad spectrum, if hypotension or high lactate IV then vasopressor, if hypotension persists monitor CVP

Afterload measured w/? Lower the SVR the? Higher the SVR the?

Measured with a pulmonary artery catheter Lower the SVR the higher the CO Higher the SVR the lower the CO

HIV antibody tests measures?

Measures response to virus aka ELISA/western blot for antibodies

Interventions of hepatitis: what are the goals

Measures to rest liver, promote regeneration, prevent complications

History assessment for hypothyroidsm

Medication history- lithium, sodium or potassium perchlorate (blocks iodine uptake), amiodarone (damaging effects to thyroid) Fatigue, weakness Slowed mentation

Parasympathetic nerves

Medulla Vagus (10th cranial) Releases Acetylcholine Decreased heart rate Decreased contractility Heart can rest and conserve

Megace aka? Function?

Megesterol, Treatment of anorexia, weight loss, and cachexia associated with AIDS

TBI key features

Memory loss, headache, dizziness, seizure, loss of consciousness, sleepiness, restlessness, confusion, bruising, personality changes, diplopia, gait changes, pupil changes, bradycardia, papilledema, high BP, hypotension/tacycardia if hypovolemic shock, nuchal rigidty if CSF leak

Sepsis respiratory s/s

Metabolic acidosis, RR increases, ARDs can occur

S/s of coral snake

Mild pain, no swelling, difficult to find marks, n/v, headache, pallor, ab pain, paresthesias, numbness, altered LOC, flaccid paralysis, difficulty talking/swallowing/breathing

Eye/vision problems for grave's interventions

Mild s/s:elevate HOb at night+artificial tears. If photophobia dark glasses/eye patch. If cannot close eyelids tape lids at night. Possible short term steroid therapy for swelling like prenisone or diuretics for edema in eye

Adrenal cortex hormones

Mineralocorticoids aka aldosterone salt, androgens sex, glucocorticoids aka cortisol sugar.

Balloon tamponade for varices: definition? Placed how? Usually?

Minnesota/sengstaken-blakemore tube to control bleeding, but can cause aspiration/asphyxia/perforation. Tube placed through nose to stomach and balloon inflated to apply pressure to bleeding spot. Usually intubated w/ mechanical ventilation if they cannot do second endoscopy or TIPS

BNP 600-899

Moderate HF

Nutrition therapy for hepatic encephalopathy from cirrhosis

Moderate amount of protein, fat foods, simple carbs

When giving netrecor

Monitor BP and pulse because can lower BP. Can be asymptomatic. Give on separate IV line

Psychosocial assessment of cushing's

Mood changes Laughing or crying Irritability Confusion Depression Sleep disturbances

Urine tests for hormones accuracy? Procedure?

More accurate. Start by emptying bladder first and don't save. At end empty bladder and save. Make sure if needed preservative added first.

Shift to left define? Shows?

More baby band neutrophils than segment. Shows infection

As you get older you build up

More coronary arteries so MI they have more collateral to not loose o2 like younger people.

Ventricular dysrhythmias

More life threatening. Premature ventricular complexes, ventricular tachycardia, ventricular fibrillation, ventricular asystole

MI treatment

Morphine Oxygen Nitrates Aspirin Rest Angioplasty repair

Morphine MI

Morphine - Control patient pain and anxiety- decrease demand on heart

Management of acute MI

Morphine, O2, nitroglycerin, aspirin aka MONA. Transfer to facilities designated to intervene for MI

MI remember MONA

Morphine, oxygen, nitrates, aspirin

Dilated cardiomyopathy

Most common fibrosis of myocardium

End stage of sepsis and SIRS

Multiple organ failure evident uncontrolled bleeding occurs Death rate for patients in this stage exceeds 60% Manifestations resemble late stage of hypovolemic shock

Musculoskeletal manifestations of hypothyroidism

Muscle aches/pains, delayed contraction and relaxation of muscles

Musculoskeletal manifestations of Cushing's

Muscle atrophy most apparent in extremities, osteoporosis aka bone density loss which leads to fractures+decreased height+aseptic necrosis of femur+slow/poor healing of bone fractures

Long term complications for SCI

Muscle wasting, contractures, skin issues, heterotopic ossification causing decreased ROM and swelling/redness/warmth

Sudden stop in steroid therapy causes

Muscle weakness, Hypoglycemia, Fever, Malaise, N/v, Hypotension, dizziness

Conditions that affect nerves and muscles that control breathing and lead to respiratory failure

Muscular dystrophy, ALS, spinal cord injury

Pneumothorax treatment

Needle decompression, chest tube

Radial cardiac catheterization

Needs positive allens test, femoral is more restrictive

For lungs you want what pressure

Negative for the lungs to be expanded

Hyperthyroidism s/s?

Negative nitogen balance, hyperglycemia, decreased body fat, increased appetite

Hypotensive therapy and increased ICP

Neosynephrine, levophed, vasopressin

Lasix has what negative effect

Neprhotoxic

Human B type natriuretic peptide

Nesiritide/natrecor for acute HF. Causes nitruresis aka loss of Na in kidneys as well as vasodilation lowering pulmonary capillary wedge pressure PCWP and improves glomerular filtration.

Distributive shock cause/risk factors

Neural induced causing systemic vasodilation: pain, anesthesia, stress, SCI, head trauma. Chemical induced: anaphylaxis, sepsis, capillary leak from burns/trauma/liver issue/hypoproteinemia

2 types of distributive shock

Neural-induced distributive shock Chemical-induced distributive shock

Disability assessment

Neuro: AVPU: alert, responsive to voice, responsive to pain, unresponsive Level of consciousness? Glasgow Coma Scale (score 3-15) Eye opening Verbal response Motor response

Extrapulmonary causes of ventilatory failure

Neuromuscular disorders:MG, Guillain-barre, poliomyelitis. SCI, CNS dysfunction from stroke/^ ICP, meningitis, chemical depression, kyphoscoliosis, obesity, sleep apnea, external obstruction/constriction

Segs vs. bands

Neutrophils that are mature and capable of phagocytosis are segmented the higher the better protection from infection, neutrophils that are less mature are called bands

Hypertensive therapy and increased ICP

Nipride, nicardipine, labetalol, metoprolol

Bigeminy vs. trigeminy vs. quadrigeminy

Normal then premature vs. 2 normal then premature vs. 3 normal followed by premature

R. Atrial pressure in left HF

Normal/elevated and elevated in right HF

CSF lumbar puncture

Not for increased ICP

Heat exhaustion not? Define? S/s?

Not medical emergency. Syndrome resulting primarily from dehydration. S/s life flu w/ headache, weakness, n/v, orthostatic hypotension, tachycardia, confusion

Mr. Stella's has history of alcoholism and admitted w/ cirrhosis has average 24 hour UO of 1000mL and today had 486 mL UO in last 24 hours. Elevated BUN+creatinine and urine Na of 6, not orietented to place or time. WHat are priorities

Notifying primary care provider, preventing infection, monitoring for fever/chills/abpain which indicate infection and continued mental status monitoring. Indicates heptaorenal syndrome

First 2 years you are

Novice

Benner's novice to expert

Novice Advanced beginner Competent Proficient Expert

Documentation

Nursing documentation must provide an accurate and honest account of what and when events occurred, as well as identify who provided the care

Shock/rejection phase

Nursing is not what you expected Loss of balance between idealism and realism Ready to quit Anger, frustration, disappointment, negativism Excessive fatigue

Interventions that reduce preload

Nutrition therapy to decrease volume and pressure in left ventricle increasing muscle stretch and contraction. appropriate for HF accompanied by congestion with total body sodium and water overload.

Nursing implications for ascites? Low grade fever could be?

Nutrition therapy, low sodium diet Drug therapy-Lasix, Aldactone Paracentesis- Monitor vital signs Respiratory Support Monitor VS- Low grade fever could be a sign of peritonitis

Respiatory failure treatment: always consider

O2

respiratory changes for hypovolemic shock

O2 90-95% for nonpreogressive and 75-80% progressive stage >70% refractory stage. RR increases, once lactic acidosis pressure depth increases

Hospital care for drowning

O2 admin, intubation, cpr, defib, gastric decompression via NG tube to prevent aspiration,

FiO2 fraction inspired o2

O2 level delivered to patient(21-100%)

Substances that can pass blood brain barrier

O2, glucose, CO2, alcohol, anesthetics, water

Best motor response

Obeys 6, localizes 5, withdraws/flexion 4, abnormal flexion posturing 3, extension posturing 2, none 1

Pneumonia patho

Obstruction of bronchioles leading to low gas exchange and high exudate

The nurse is caring for a patient with a spinal cord injury. The patient is complaining of a headache rated 10/10. On assessment the nurse notices a BP=155/78, HR=52 and abdominal distention. The patient's sitter reports that the patient has not had a BM for 2 weeks.

Obtain an order for NG tube placement

Hep D from?

Occurs only w/ hep B. Blood to blood and sex

DIC

One of the most common complication of sepsis. Patient bleeds out. Too much clotting leads to too much bleeding. Clotting factors depleted so much bleeding

You may benefit from VAD if

One or both ventricles don't work well b/c of HF

Siadh vs. DI

Opposite high fluid and low UO w/ fluid volume excess/edema/high BP vs. low fluid high UO and fluid volume deficit+low BP

Expected outcomes for hypothyroidism

Optimal tissue perfusion and cardiac functioning BP and HR are within normal limits Verbalizes understanding of lifelong therapy Clear communication

Heat stroke complications

Organ dysfunction, renal impairment, electrolyte imbalance, coagulopathy, pulmonary edema, cerebral edema

Verbal response

Oriented 5, confused/disoriented 4, inappropriate words 3, incomprehensible sounds 2, none 1

Autonomic parkinsons s/s

Orthostatic hypotension, perspiration, seborrhea, flushing, blepharospasm eyelid spasm

Systemic s/s of RA

Osteoporosis, severe fatigue, anemia, weight loss, nodules, peripheral neuropathy, vasculitis, pericarditis, fibrotic lung, sjogren's syndrome aka dry eyes/mouth/vag, renal disease, felty's syndrome

Stage 5

Outcomes: conflict is constructive when it improves the quality of decisions and dysfunctional when uncontrolled opposition breeds discontent

Classic heat stroke

Over period of time as result of chronic exposure to hot humid environment

Anaphylaxis treatment

Oxygen Antihistamine such as diphenhydramine (Benadryl) Epinephrine Corticosteroids to reduce allergic response H2 blocker Medical alert bracelet Prevent cardiac/respiratory arrest due to anoxia Adequate airway/O2 if needed Monitor VS and levels of activity as indicators of oxygen saturation IV access Latex free

Med therapy for HF

Oxygen as necessary to keep O2 saturation at prescribed levels Diuretics (loop, thiazide, potassium sparing) ACE inhibitors (captopril, lisinopril, prinivil, zestril, accupril) ARB-(Diovan, Cozaar) Beta-Blockers (coreg, lopressor) Vasodilators (hydralazine, morphine) Human B-type natriuretic peptides

ACS/MI assessment

Pain onset, location, and duration Pain intensity, precipitating factors, relieving factors Patient History Vital Signs

Assessment findings of cirrhosis

Pain, fever, GI symptoms, fatigue

Compartment syndrome s/s

Pain, paresthesias, pallor, no pulse, weakness

Brown recluse bite s/s

Painless/stinging, pruritus, vesicle surrounded by edema, erythema, bluish purple, necrosis, eschar, red/white/blue, ulcer, possibly systemic w/ rash, fever, chills, n/v, malaise, joint pain, renal failure, pulmonary edema, hemolytic anemia, thrombocytopenia, DIC, death

Circulatory across room assessment

Pale or mottled skin tone Flushed Diaphoresis Obvious and uncontrolled bleeding

Hypoxemia s/s

Pallor, cyanosis, increased HR, restlessness, confusion

In resuscitation situation BP can quickly be estimated before cuff by

Palpating for presence of peripheral/central pulses. If radial present BP at least 80, if femoral present at least 70, if carotid present at least 60

Care w/ SVT: assessment

Palpitations Chest pain Weakness Fatigue Shortness of breath Nervousness Anxiety Hypotension syncope

Sustained s/s of sinus dysrhythmia

Palpitations, chest discomfort from myocardia ischemia, restlessness, anxiety, pale/cool skin, syncope from hypotension, SOB, weakness

Tachydysrthmia additional s/s

Palpitations, chest discomfort/pressure/pain, pale/cool skin, syncope from hypotension, heart failure causing dyspnea, crackles JVD, weakness. >100bpm

CV manifestations of hyperthyroidism

Palpitations, chest pain, increased BP, widened pulse pressure, tachycardia, dysrhythmia

Spinal cord injury s/s

Paralysis below level of injury. above C4 paralysis of respiratory muscles and quadriplegia(all 4).

Tetraplegia/quadriparesis vs. paraplegics/paraparesis

Paralysis in all fours, weakness frin cervial/upper thoracic vs. paralysis/weakness in lower extremities like in lower thoraci/lumbar injury

GI/GU if SCI

Paralytic ileus, lowered peristalsis, distention, areflexis/neurogenic bladder aka no bladder contraction causing urinate retention

Left sided HF s/s

Paroxysmal nocturnal dyspnea, elevated pulmonary capillary wedge pressure, pulmonary congestion(dry cough at night, crackles, wheezes, blood-tinged sputum, tachypnea), restless, confusion, orthopnea, tachycardia, exertional dyspnea, fatigue, cyanosis, gallup, pulmonary edema, pleural effusion, displaced apical pulse

Surgical treatment for hyperparathyroidism? Post op?

Partial para thyroidectomy to remove glands affected by tumor leaving the remaining glands intact. Total parathyroidectomy where all 4 glands are removed. Ca decreased preop. Postop Ca checked, also assessed for tingling/twitching/+ Trousseaus?/+Chvostek's which can indicate tetany

Transition to practive model from base to tip

Pass NCLEX, workforce orientation, transition modules including patient centered care/communication and teamwork/evidence based practice/quality improvement, informatics, orgoing institutional support, license renewal

Deep tendon reflexes

Patellar, brachioradialis, achilles, biceps, triceps, achilles tendon

Emergency care for thyroid storm/crisis

Patent airway, antithroids -azole/PTU, sodium iodide admin, propranolol given, glucocorticoids hydrocortisone/prednisone/dexamethasone , monitor for dysrhythmia/VS, cooling blanket/comfort, antipyretics, NS IV

Emergency care for myxedema coma

Patent airway, replace fluids w/ IV, levothyroxine IV, glucose IV, corticosteroids, check temp, monitor BP, cover w/ warm blankets, monitor for changes in mental status, turn q 2 hrs, aspiration precautions

Hypovolemic shock interventions at beginning

Patent airway, start/maintain IV, admin O2, elevate feet, head flat/elevated <30 degrees, examine for bleeding, if bleeding direct pressure, admin drugs, increase IV fluids, don't leave patient

Pathogenic vs opportunistic infection

Pathogenic infection caused via virulent organisms vs. infection caused by organisms present as part of normal environment

Patient safety examples

Patient Identification Fall Prevention Skin Integrity Medication Error Prevention Infection Prevention

Synchronous intermittent mandatory ventilation weaning method

Patient breaths between preset breaths/min, machine set to 12 breaths/min, RR of patient will be combo of patient and ventilator breaths, as weaning ensues gradual decrease in SIMV rate usually 1-2 breaths/min

Expected outcomes for ADH deficiency

Patient experiences normal fluid volume Absence of thirst, normal lab values, and stable weight Verbalizes understanding of Diabetes Insipidus and medication regime

T-piece technique weaning method

Patient teacher off ventilator for short periods 5-10 min to breath spontaneously, ventilator replaced w/ t-piece or CPAP, prescribed FiO2 may be higher on T-piece than on ventilator, weaning progressives, nighttime weaning not attempted until spontaneous breaths most of the day

More recently further specified as the quality and safety education for nursing (QSEN), competencies

Patient-centered care Teamwork and collaboration Quality improvement Safety Evidence-based practice (EBP) Informatics

Confidentialtiy: patients have? Healthcare professionals should? HIPAA?

Patients have a right to protection of their privacy with respect to the access, storage, retrieval and transmittal of their records . Healthcare professionals should view security of Patient's documentation as a serious issue. Health insurance portability and accountability act (HIPAA) is maintained at all times - no exceptions.

Combined ventilatory and oxygenation failure caused by

Patients w/ abnormal lungs like chronic bronchitis, emphysema, asthma attach. Cardiac failure w/ respiratory failure

ICP monitoring

Patients who have intracranial pressure need to be monitored closely to determine if cerebral perfusion is adequate Catheter is inserted

High pressure alarm sounds when

Peak inspiratory pressure reaches alarm limit(10-20 above patient's baseline PIP)

Surgical intervention for MI

Percutaneous Coronary stents to open Intervention Atherectomy Coronary Bypass Graft Surgery

Other manifestations of hypothyroidism

Periorbital edema, facial puffiness, nonpitting edema of hands/feet hoarseness, goiter, thick tongue, increased sensitivity to opioids, weakness/fatigue, decreased UO, anemia, easy bruising, iron deficiency, folate deficiency, vitamin B 12 deficiency

Neuro issues from HIV

Peripheral neuropathies, myopathies, reduced sensory, pain, gait changes leg weakness, ataxia, muscle pain

Surgical management of dysrhythmias

Permanent pacemaker, coronary artery bypass grafting, implantable cardioverter/defibrillator

Surgical management for life threatening dysrhythmia

Permanent pacing, coronary artery bypass grafting, aneurysmectomy, implantable vardioverter/defibrillator, open chest cardiac massage

PEEP used when

Persistent hypoxemia that doesn't improve w/ acceptable o2 delivery level. Or added when PaO2remains low w/ FiO2 50-70%

Autoimmunity define? Example? Cure?

Person develops inappropriate immune response against healthy normal cells. Ex: systemic lupus, polyarteritis, rheumatoid arthritis, rheumatic fever, type 1 DM. No cure just anti-inflammatory and immunosuppressive drugs

Cushing's syndrome s/s

Personality changes, mooon face, increased infection risk, males: gynecomastia, females:amenorrhea/hirsutism, fat deposits on face/back of shoulders, osteoporosis, hyperglycemia, CNS irritability, NA/fluid retention causing edema, thin extremities, GI distress from high acid, thin skin, purple striae, easy bruises/petechiae, poor wound healing

Adrenal medulla disorder

Pheochromocytoma

Ventilatory failure results from

Physical problem of lungs/chest, defect in respiatory control center in brain, poor function of respiatory muscles esp. diaphragm

Discharge determined by

Physician

Vagal maneuver done by

Physician

When a client dies

Physician is responsible for family notification Evaluate if it is safe/appropriate for a family member to be present during resuscitation Prepare body for viewing

ACCLIMATIZATION

Physiologic changes that help body adapt to less o2

2 families of poisonous snakes

Pit viper like rattlesnakes, copperheads, cottonmouths and coral snakes

Pit viper characteristics

Pit, triangular head, 2 fangs, 3 sets of replacement fangs

Cutaneous/superficial reflexes

Plantar flexion of all toes

Guillain-barre interventions

Plasmapheresis aka plasma exchange, immunoglobulin, ABC, mobility/immobility, manage pain, promote communication, psychosocial support, keep intubation stuff at bedside, skin care, PE prevention

Antineoplastics for immunocompromised

Platinum/cisplatin, methotrexate

Complications of HF

Pleural effusion Atrial fibrillation High risk fatal dysrhythmias (EF < 35% Renal insufficiency or failure Pulmonary edema

Protozoan opportunistic infections

Pneumocystis PCP causing dyspnea, tachypnea, dry cough, fever, fatigue, weight loss, crackles. Toxoplasmosis encephalitis from cats/undercooked meats causing changed LOC, headaches, fever, speech/gait/vision issues, seizures, lethargy, confusion. Cryptosporidiosis causing diarrhea

Pneumonia organisms

Pneumocystitis carinii pneumonia/PCP, mycobacterium MAC

Sepsis productive cough/yellow sputum+fever=?

Pneumonia

Artifact can be caused by

Poor electrical contact, loose electrode, patient movement or broken wire so always assess first to make sure it's artifact and not an actual lethal rhythm

Nutrition therapy for Cushing's

Possible fluid/Na restrictions like no salt added or 3-4g/day, teach to check labels and daily record for Na

Sinus bradycardia s/s

Possibly asymptomatic, syncope, dizziness/weakness, confusion, hypotension, diaphoresis, SOB, chest pain

Honeymoon phase

Post graduation Excited about being a nurse Idealistic Enthusiastic "Big things poppin'"

ADH deficiency patho

Posterior pituitary doesn't produce enough vasopressin aka ADH and causes diabetes insipidus

Cirrhosis types

Postnecrotic from hepatitis/drugs/toxins, laennec's/alcoholic, biliary aka cholestatic from chronic biliary obstruction/autoimmune disease

Stage 3 moderate Parkinson's

Postural instability, increased gait disturbance

Nursing priority for HIV client

Potential for Infection Inadequate oxygenation Pain Inadequate nutrition Impaired Skin Integrity Confusion

Stage 1 of conflict

Potential opposition/incompatibility: presence on conditions that create opportunities for conflict to develop

Determinants of contractility include

Preload and afterload Ventricular musculature Neural control Physiological depressants Drug therapy Electrolytes

Atrial dysrhythmia examples

Premature atrial complexes, supraventricular tachycardia,

Atrial dysrhythmias include? What wave affected

Premature atrial complexes, supraventricular tachycardia, atrial fibrillation. Altered P wave shape

If premature p wave

Premature atrial contraction

What are common heart rhythms w/ HF

Premature atrial contractions, premature ventricular contractions, atrial fibrillation

Apical and radial pulse irregularity can occur w/

Premature beats, AF, heart blocks

Ventricular dysrhymias

Premature ventricular complexes, ventricular tachycardia, ventricular fibrillation, ventricular asystole

Wide QRS and no T wave means? Won't?

Premature ventricular won't feel it on pulse but will see it on EKG

Immunosuppressants

Prenisone, cyclosporine

If glasgow <8 or risk for airway compromise

Prepare for intubation and mechanical ventilation

Inspiration is cycled in what major ways

Pressure cycled, time cycled, volume cycled

Peak airway inspiratory pressure PIP

Pressure used by ventilator to deliver set tidal volume at given lung compliance. Highest pressure reached during inspiration. Trends reflect changes in resistance of lungs and resistance in ventilator. Upper pressure limit set to prevent barotrauma which can sound alarm and prevent volume

HOB >30 degrees when supine to

Prevent aspiration and ventilator associated pneumonia

ACI inhibitors for Mi

Prevent development of HF

Physical assessment for endocrine: examine for?

Prominent forehead/jaw Round/puffy face Dull/flat expression Exophthalmos, Vitiligo, Striae, Hirsutism

Four broad aims of nursing practice identified in the definition of nursing:

Promote heath, prevent illness, restore health, to facilitate coping w/ disability/death

Turning and positioning does

Promotes comfort, prevents skin breakdown, improves gas exchange, prevents pneumonia and atelectasis

Lactulose/lactitol function? SE?

Promotes excretion of ammonia in stool, cleanses bowels, increases osmotic pressure to draw fluid into colon preventing ammonia absorption thus decreasing confusion/encephalopathy. SE: intestinal bloating/cramps, hypokalemia, dehydration, skin breakdown from stools, burping, n/v

Multiple sclerosis interventions

Promoting Physical Mobility Minimizing Spasticity and Contractures Activity and Rest Minimizing Effects of Immobility Preventing Injury Enhancing Bladder and Bowel Control Enhancing Communication and Managing Swallowing Difficulties Cognition and Emotional Responses Teaching Patients Self-Care

Bilateral equa breath sounds to ensure

Proper ET tube placement

Beta adreneric blockers examples? For?

Propranolol/inderal for supraventricular and ventricular premature beats and tachydysrthmias

Androgen therapy avoided in men w/

Prostate cancer

Structures important to HIV

Protease and reverse transcriptase. CD4 t lymphocyte receptors

Priority nursing interventions for patient w/ neutropenia

Protecting from infection, teaching how to reduce infection, total patient assessment including IV sites q 8 hours

Very cold water and drowning

Protective effect by reducing metabolic rate and diving reflex to asphyxia causing bradycardia, vasoconstriction to reduce o2 use and enhance blood flow

Bi-level positive airway pressure BiPAP

Provides positive pressure ventilation

Interventions for acromegaly

Psychosocial, meds, radiation for removal of hypophysis/pituitary gland, surgery via hypophysectomy

Interventions for LHF r/t MI

Pulmonary complications.

Obstructive shock caused by

Pulmonary embolism large blood clot blocks the pulmonary artery. Immobility Blunt chest trauma Tension pneumothorax History of clotting Cardiovascular disease Hypertension CAD-arterial plaque Large tumor Pericarditis

Obstructive shock risk factors

Pulmonary hypertension, cancer

Right sided HF in absence of left sided HF usually from

Pulmonary issues like COPD or pulmonary hypertension, ARDS

Education for pacemakers

Pulse 1 full minute same time each day and record in diary, take pulse if you feel pacemaker failure, inform other docs of pacemaker, don't lean over electric/gas motors, anti theft devices in stores can cause malfunction, inform airport before metal detector, stay away from welding equipment, safe to operate microwave oven unless old/defective. Notify if SOB, dizziness, fainting, chest pain, weight gain, prolonged hiccuping.

If apical pulse differs from radial

Pulse deficit suggests the heart not pumping adequately to perfume body

2nd stage of shock nonprogressive

Pulse ox on forehead/ear, cool/clammy skin

Dysrhytmia affects? Can be?

Pumps oxygenation of blood in body, perfusion/oxygenation, impairs organs+electrolytes. Can be life threatening

PERRLA

Pupils equal, round, react to light, accommodate to assess cranial nerve 3

Nutrition for varices

Puréed or soft diet, low protein high fiber

Pressure cycled ventilators

Push air into lungs until preset airway pressure reached. Tidal volumes+inspiratory time vary. Used for short time like post op or respiratory therapy. AKA Bi-Pap but can also expiratory pressure similar to PEEP

Volume cycled ventilators

Push air into lungs until preset volume delivered, constant tidal volume delivered regardless of pressure needed to deliver tidal volume. Set pressure limit prevents excessive pressure from being exerted on lungs. Advantage: constant tidal volume delivered regardless of changes in lung/chest wall compliance or in airway resistance

Time-cycled ventilators

Push air into the lungs until a preset time has elapsed. Tidal volume and pressure depends on needs of patient and type of ventilator

Sepsis flank pain+fever=?

Pyelonephritis

Thionamides: aka? Function? Response? PTU? Meth can cause? Both?

Pylthiouracil PTU and methimazole/Tapazole. Blocks thyroid hormone production by preventing iodine binging. Response delayed b/c patient may have amounts stored to continue to release. PTU can cause liver issues like jaundice/dark urine/clay stool, meth can caus ebirth defects. Both avoid crowds/ill b/c increased infection risk, check weight gain+slow HR+cold intolerance which can indicate hypothyroidism.

Premature ventricular complexes

QRS has repetitive rhythm but can be different shapes. Frequency increases w/ age. Can be from MI, heart failure, COPD, anemia, hypokalemia, hypomagnesemia, stress, nicotine, caffeine, alcohol, infection, surgery

Documentation: quality documentation is? It reflects?

Quality documentation is an integral part of professional RN practice. It reflects the application of nursing knowledge, skills and judgment, the clients' perspective and interdisciplinary communications.

First aid emergency care for bee/wasp

Quick removal of stinger, ice, ABC, determine if allergic and has EPI kit, then antihistamine

Nutrition therapy for cirrhosis

R/t vitamin and mineral deficiency 4-7 small meals/day, low sodium 12g/day, low ammonia Protein restriction 1.2-1.5g/kg is for patients with episodic hepatic encephalopathy who do not respond to standard treatment. Veg protein better, consider TPN/enteral

Assessment/planning of delegation is

RNs responsibility

For freezing gait and postural instability w/ parkinsons

ROM, stretching, remind to avoid concentration on feet when walkin, encourage participation in ADLs

Lowered CPP =?

Raised ICP+poor autoregulation

Increase in blood volume or CO

Raises MAP. Increase in vascular bed=lower MAP or small bed=higher MAP

Implantable cardioverter/defibrillator ICD for? Activated/deactivated via?

Random episodes of sustained ventricular tachycardia or ventricular fibrillation not caused by MI. Activated/deactivated via magnet

Respiratory shock s/s

Rapid breathing, shallow respiration

Hospital care for frostbite

Rapid rewarming via water bath, hot towels, IV opiates/rehydration, no dry heat/massage, elevate, splints, assess q hr for compartment syndrome, tetanus prophylaxis, loose sterile dressing, no compression, antibiotics, antiprostaglandin ibuprofen, possible debridement/amputation

Myexedma coma define? Decreased metabolism causes?

Rare serous complication of untreated/poorly treated hypothyroidism. Decreased metabolism causes heart muscle to become flabby resulting in low CO+decreased perfusion resulting in organ failure

Restrictive cardiomyopathy

Rare, characterized by stiff ventricles that prevent filling

Nonurgent examples

Rash, chronic headache, sprains/strains, colds, head injury but alert no vomitting and no altered LOC, simple fractures

Ventricular fibrillation rate? Rhythm? P wave? QRS?

Rate- indeterminate Rhythm- chaotic P wave- none QRS- none

Recovery phase

Realize there is more than one perspective within the nursing profession Begins to "see a light and the end of the tunnel" A renewed enthusiasm for nursing

For premature contractions

Really random usually so probably no long term effects

Physical assessment for SIADH

Recent head trauma Past and current medication use Weight gain GI disturbances - nausea, vomiting, poor appetite, Hyponatremia Serum level < 115 can cause changes in mental status

First aid/prehospital care for for frostbite

Recognize early for white/waxy appearance, seek shelter, body heat to warm via hands over area

Teach patient and caregiver to do what for which s/s that can indicate worsening/recurrent heart failure

Report imeediately s/s: rapid weight gain >3lb in a week, decrease in exercise tolerance, cold symptoms >3-5days, wakening to urinate at night, dyspnea/angina at rest or worsening, increased swelling in feet/ankles/hands

Rigidity define

Resistance to passive movement. Cogwheel rhythmic interruption of muscle, plastic mildly restrictive, lead pipe total resistance

Testing motor function for SCI for lumbar spine

Resistance when lifting legs, resistance when dorsiflexing feet

Patient w/ cervical SCI at risk for

Respiratory compromise b/c C3-5 innervation the diaphram

Ascites excess fluid volume can cause

Respiratory issues

Hypovolemic shock : resposne to

Response to acute volume loss depends on Extent of injury or insult Age General state of health

During acute hepatitis interventions

Rest periods, diet high in carbs/calories w/ moderate fat/protein, small/frequent meals, drugs used sparingly, if B or C antivirals given

Decreasing fatigue and weakness for HF

Rest, ambulate according to activity tolerance and increase

Dx of RA

Rheumatoid factor +, ANA +, elevated ESR

Paroxysmal supraventricular tachycardia

Rhythm intermittent from premature atrial complex

D-diner and c protein for sepsis

Rise

Preventing injury for hyperparathyroidism

Risk for fractures teach to handle carefully, use lift sheet to reposition, help w/ ambulation

Severe sepsis

S

ARDS intervention:assessment

S/E of PEEP=pneumothorax so assess lung sounds, suction, repositioning, prone

Cardiac conduction pathway

SA node fires, spreads through atria causing depolarization/P wave, AV node fires, spreads down AV bundle of his causing PR delay, purkinje fibers distribute through ventricles causing depolarization QRS

Cardiac conduction from

SA node, AV once, ventricular muscle cells

MAP formula

SBP+2(DBP)/3

Bromocriptine/parlodel SE? Give how? Notify if?

SE: orthostatic hypotension, GI irritation, nausea, heachaed, cramps, constipation/ Give w/ meal, treatment start low and gradually increased. Notify if chest pain, dizziness, watery nasal discharge because might be dysrhythmia, coronary artery spasm, or CSF leak

Pulmonary manifestations of hyperthyroidism

SOB w/ or w/out exertion, dyspnea, rapid/shallow respirations, decreased vital capacity

First aid/emergency care for drowning

Safe rescue first, spine stabilization if spine trauma risk, airway clearance, ventilators support, if hypothermia concern handle gently to prevent ventricular fib, ab/chest thrusts if airway obstruction

Restoring fluid volume balance for Cushing's

Safety, drugs, nutrition, monitoring, radiation, surgery

Obstructed cardiomyopathy

Same as nonobstructed except left ventricle outflow is obstructed

Beta blocker/digoxin therapy education

Same time of day to take, no antacids/cathartics/laxatives w/ dig, take pulse before and notify if change +fatigue/weakness/confusion/loss of apetite aka toxicity s/s for dig, report for lab tests

Antiretroviral for immunocompromised

Saquinavir, delavirdine

A client is brought to the ED by the family because he has verbally threatened others and attempted to stab the neighbor's dog. What does the nurse do in order to ensure the safety of the patient and others?

Search belongings and secure personal effects, remove dangerous equipment from room like sharps container or portable instrument, instruct nursing students to avoid wearing stethoscope around necks

If rebleeding occurs for esophageal varices

Second endoscopic procedure, balloon tamponade via minnesota/sengstaken-blakemore tube if they cannot do endoscopy or TIPS, esophageal stents, shunts

ARDS also can need

Sedation and paralysis for adequate ventilation and to reduce tissue needs

Left shift

Seg neutrophils are no longer the most numerous type of circulating neutrophil and instead bands are more numerous

MAOI-B example? Avoid?

Selegiline/Deprenyl. Avoid foods/drinks w/ tryamine in cheeses/smoked or aged or cured meats and sausage and wine /beer which can cause hypertension

Innate/natural/nonspecific immunity aka? Define? Types?

Self vs. nonself. 1st line defense like barriers/skin+biochemical barriers+mechanical barriers. 2nd line defense aka inflammation: inflammatory response to acuteacellular injury causing vasdilation aka redness/heat, increased permeability causing edema, cellular infiltration causing pus, thrombosis, pain, phagocytosis/cleanup, interferons, complement

Parietal lobe

Sensation, spatial, singing/instruments, processing visual experiences, perception of body parts/position

Severe sepsis

Sepsis and acute organ dysfunction Progression of sepsis with greater inflammatory response All tissues involved and hypoxic Microthrombi formation DIC Disseminated intravascular coagulation Often missed Looks better Rapid progression to Septic Shock

ARDS common causes

Shock, trauma, sepsis , pancreatitis, CABG, pulmonary infections , inhalation of toxic gases, pulmonary aspiration, multiple blood transfusions, near- drowning , burns

Treatment of esophageal varices

Short term esophagogastric ballooon tamponade, endoscopic variceal ligation, endoscopic sclerotherapy

Community acquired pneumonia

Shouldn't have been hospitalized w/in 14 days prior to s/s or has been hospitalized less than 4 days prior to onset of s/s

Bladder training education

Signs and symptoms of Urinary Tract Infection Adequate fluid intake Frequent bladder emptying Personal hygiene and cleanliness Skin creams and barrier ointments

Thyroid scan function? Procedure? IF hypersecretion? Ask?

Size, position, functioning of thyroid. Radioactive iodine given by mouth and up take by thyroid measured, if hypersecretion it's increased if normal it's 5-35%. Ask if procedures done w/ iodine die like renography before or drugs w/ iodine.

Preventing injury for Cushing's

Skin assessment/protection, turn q 2 hours, pad prominences, avoid activities w/ skin trauma, reduce tissue injury via soft toothbrush/electric razor, keep skin clean/dry, use lift sheet, call for help when ambulating, walkers/canes, gait belt, high calorie/calcium/vit D diet, no caffeine/alcohol, antacids, H2 receptors like tagamet or ranitidine/zantac, pepcid. No smoking/NSAIDS

Dx of acromegaly

Skull xray, CT scan, MRI

If ET tube moves it can

Slip into right mainstem bronchus

Neuro manifestations of hypothyroidism

Slowing of intellectual functions aka slowness/slurring of speech+impaired memory+inattentiveness, lethargy/somnolence, confusion, hearing loss, paresthesia, decreased tendon reflexes

Hypothermia complications

Slows drug metabolism, causes vasoconstriction that makes venous/arterial access more difficult, causes coagulopathies that increases bleeding risk

Airborne

Small particles enter host, suspended in air for long time. Ex: tuberculosis, varciella. Requires special ventilation systems, N95

Kaposi's sarcoma

Small purplish brown raised lesions not painful/itchy anywhere on body including membranes, lymph nodes, mouth/throat, lungs

Critical access hospitals

Small rural ED facility

Preventing CAD

Smoke, less fats/cholesterol/sodium, cholesterol checks, physical activity, manage DM, BP checks, prevent obesity

Mucositis define? Interferes w/? Interventions?

Sores in mucous membranes often developing in GI tract and mouth aka stomatitis from chemo/radiation. Interferes w/ eating, avoid alcohol mouthwashes, use good oral hygiene w/ soft brush, magic mouthwash

Temporal lobe

Sound, complicated memory, wernicke's area for processing words into thought

For pacemaker

Spike

Peripheral nervous system

Spinal nerves, cranial nerves, ANS

Eye opening

Spontaneous 4, to loud voice 3, to pain 2, none 1

Non rebreather best for? Bag valve mask best for? Endotracheal tube?

Spontaneous breathing. Ventilation assistance during resuscitation. Impaired consciousness and mechanical ventilation

Pneumonia dx

Sputum culture, CXR, ABGs

Ventricular tachycardia treatment if stable? If unstable?

Stable- Elective cardioversion Oral antiarrhythmics- Sotalol, Amiodarone Treat the cause Unstable VT w/out pulse: treat as VF

If not breathing do what

Start CPR then reassess and if still not breathing mechanical bag or if that doesn't work mechanical breathing

Performing glasgow start with?

Start with least noxious/pressure than advance. Normal voice then loud then shaking, then pain via supraorbital/trapezius/mandibular/sternal pressure

Surgical management of parkinsons

Stereotactic pallidotomy, thalamotomy via scar tissue to area to stop tremors. Deep brain stimulation where electrode connected to pacemaker.

Medical/surgical interventions that can impair normal immune response

Steroid therapy, chemo, antirejection drugs, catheters, trach tubes, synthetic implants, surgery, trauma, radiation therapy, burns, skin breakdown, adrenal insufficiency,infants

Testing for pituitary hypofunction

Stimulation testing via insulin injection and positive if GH+ACTH doesn't increase

Stimulation tests for hormones define? Ex?

Stimulation: stimulus provided to see if able to produce hormones normally and failure of hormone level to rise indicates hypofunction. Ex: insulin should result in GH and ACTH to rise but if it doesn't hypofunction

For anaphylactic shock priorities

Stop drug, Epi first via IM or SQ never IV for anaphylaxis if code situation IV, Benadryl/solumedrol, pepcid h2 blocker

Heat exhaustion interventions

Stop physical activity, cool place, cold packs, cool water, fanning, spraying water, remove clothing, oral rehydration, monitor VS, NS IV

Stage 3

Stuporous: mental confusion, stuporous/drowsy but arousable, abnormal ECG, muscle twitching, hyperreflexia, asterixis

Stage 3 of hepatic encephalopathy

Stuporous:Marked mental confusion Muscle twitching, hyperreflexia, Stuporous, drowsy but arousable

Patho of hepatic encephalopathy

Substances absorbed by intestines not broken down leading to elevated serum ammonia and GABA

Psychosocial assessment of cirrhosis

Subtle/obvious personality, cognitive, behavior changes possible, sleep pattern disturbances possible to emotional lability aka fluctuations in emotions

If high pressure alarm sounds from increased secretions or mucus plug in airway

Suction

Maintaining patent airway for trach/ET tube

Suctioning when these are present: secretions, increased peak airway/inspiratory pressure PIP, rhonchi/wheezes, decreased breath sounds. Also proper care of ET/trach tube

Acute HF

Sudden HF s/s

Exwertional heat stroke

Sudden onset from physical activity in hot condition

BNP 101-299

Suggest HF present

Blunt force more is? Penetrating is?

Superficial things like skin integrity vs. penetrating is more underlying structures

4th refractory/irreversible shock

Support patient , ventilator, pressors, epinephrine to keep HR up

Sudden cessation of long term glucocorticoid therapy leading to Addison's function? Must be?

Suppresses glucocorticoid production through negative feedback causing adrenal atrophy. Must be withdrawn gradually to allow pituitary production of ACTH and activation of adrenal to make cortisol

AV blocks define? 1st degree? 2nd degree? 3rd degree?

Supraventricular impulses delayed/blocked. 1st degree: sinuses impulse enventually reaches ventricle vs. 2nd some sinus impulses reach but others don't vs. complete and no impulses to ventricles. P wave there but QRS delayed/blocked

Pheochromocytoma interventions

Surgery, don't smoke drink caffeine, change position slowly, don't palpate abdomen, hydration, calm/restful environment, limit activity

Inteventions for liver cancer

Surgical resection and liver transplantation, radiation, hepatic artery embolization, ablation, chemo

Main trigger leading to hypovolemic shock

Sustained decrease in MAP of 5-10 below baseline resulting from decreased circulating blood volume, compensatory mechisms go into place and if MAP still decreased anaerobic increases lactic acid cause electrolyte/acid-base issues leading to MODS

Immunocompromised patient you may need to do what for IV

Switch sites more. Use ports under skin

Novice preceptor implications

Teach rule to guide action that can be recognized without situational experience, must be backed up by competent nurse

SIRS/systemic inflammatory response syndrome criteria

Temperature > 100.4 ° or < 96.8 ° F HR > 90 RR > 20 or PCO2 < 32 Abnormal WBC

Cushing's triad seen in?

Terminal stages of acute head injury and indicates imminent herniation and occlusion of cerebral blood flow

Testes hormones

Testosterone

Drug therapy for infection prevention

Tetanus toxoid given IM when admitted or tetanus immune globulin when history of tetanus immunization not known. Antibiotics

Systems that must be in place for perfusion

The "pump" (the heart) The pipes (the blood vessels) The fluid (the blood)

Ventricular tachycardia the arches?

The arches have a pattern

Reaching the best outcome w/ reality shock

The best outcome of reality shock is bicultural adaptation Blending of the value systems of school and work

Etiology of shock

The different types of shock can be traced back to one of the three components of the heart. The "pump" (the heart) The pipes (the blood vessels) The fluid (the blood)

Functions of endocrine system

The endocrine system controls overall body function and regulation, including: metabolism, temperature, fluid+electrolyte balance, growth, reproduction, elimination

The provider comes to examine Mr. Stellas and performs a paracentesis. The nurse is talking with family members who state that they are worried that Mr. Stellas is "not going to make it through this hospitalization." What types of nursing responses are appropriate?

The nurse should engage in active listening, therapeutic use of silence, exploration, and making clarifying statements. Rationale: The nurse should allow family members to express their feelings and provide a nonjudgmental acceptance of their concerns. Utilizing appropriate therapeutic communication techniques provides family members with a safe environment in which to express concerns and feelings

Ventilator tidal volume

The volume of air the patient receives with each breath (7-10 ml/kg)

Modes of ventilation

The way patient receives breaths from ventilator: assist control/AC, synchronized intermittent mandatory ventilation SIMV, bilevel positive airway pressure, other modes

Conditions causing increased cortisol secretion: exogenous admin aka Cushing's syndrome

Therapeutic use of ACTH or glucocorticoids most commonly for treatment of: asthma, autoimmune disorders, organ transplant, chemo, allergies, fibrosis

Low exhaled volume/ low pressure alarm sounds when

There is a disconnect or leak in ventilator circuit or a leak in the patient's aritifical airway cuff

Multiple sclerosis system management can cause?

These medications can cause depression and thoughts of suicide, photosensitivity, dizziness, constipation and change in blood count, and liver profile.

Shivering can indicate

They are being cooled too quickly

Left ventricular assist device

They have bags from tubes. Patients will be on blood thinners for whole life, they have to carry batteries. Last about 4 hours, cannot let them die. Make sure fam support. Ensure complicance, keep site clean

S/s of acromegaly

Thickened lips, scalp skin folding, voice deepening, fingertip tufting, kyphosis, backache, excess sweat Coarse facial features Increasing head size Lower jaw protrusion Enlarged hands and feet Joint pain, body pains due to growth Barrel Shaped Chest/breathing issues Hyperglycemia Sleep apnea Enlarged heart, lungs, and liver Broad rounded nose

Skin manifestations of Cushing's

Thinning skin or paper-like appearance especially on back of hands, striae, increased pigmentation w/ ACTH

Preventing acute adrenal insufficiency those most at risk? Low ACTH causes?

Those most at risk: Cushings from glucocorticoid therapy. Low ACTh causes adrenal atrophy and patient completely depends on drug and if drug stopped not enough glucocorticoids causing this which is life threatening

Drugs that improve SV for HF

Those that reduce afterloa, reduce preload, and improve cardiac muscle contractility

A. Fib can lead to

Thrombus formation leading to stroke or embolic events or PE or venous thromboembolism VTEfrom blood pooling

Central organs of immune system

Thymus, peyer's patches aka s. Intestine mucosa, bone marrow

Levothyroxine/synthroid definition? Started how?

Thyroid replacement. Started in low dose and gradually increased since can cause severe hypertension

Morning care develops SOB, fatigue, tachycardia what is interpretation? Interventions

Tired from activity, reduce morning care, cluster interventions, if doesn't resolve RRT/notify dr. If they do better you respiratory, physical therapy, nutritionist

Frostbite vs. frostnip

Tissue freezes and can be superficial, partial, full thickness vs. superficial injury that can cause pain, numbness, pallor but relieved by warmth w/ no tissue damage

Injury

Tissue injured but not necrotic

Ischemia

Tissue that is oxygen deprived

Mean arterial pressure function? Target number?

To maintain blood flow through coronary arteries >60, to maintain perfusion of organs 60-70

Vagal maneuver to treat? Includes? Can cause?

To treat supraventricular tachydysrthmia and includes carotid sinus massage can cause rebound tachycardia or severe bradycardia

Drugs for SIADH

Tolvaptan/samsca or conivaptan/vaprisol promoting water excretion w/out Na loss and should only be administered in hospital to monitor Na, diuretics if Na normal and no HF, hypertonic saline if Na low

Hospital care for brown recluse

Topical antiseptic, sterile dressing, antibiotics, possible debridement/skin graft, tetanus prophylaxis, hydration, is systemic blood transfusion

Hypovolemic shock

Total body fluid decreased decreasing MAP. From hemorrhage like surgery, trauma or from fluid loss like d/v, burns, dehydration. Both lead to low venous return/CO which leads to poor perfusion causing shock

Surgical management of hyperthyroidism

Total thyroidectomy to remove all and daily hormone treatment required to replace function. Partial thyroidectomy where may return to normal functioning

Normal serum Ca? Normal serum phosphate? If older?

Total: 9-10.5 mg/dl. 3-4.5 mg/dL but if older can be lower

Other hyperthyroidism types

Toxic multinodular goiter that is more mild an no exopthalmos/edema. Exogenous hyperthyroidism from excess thyroid replacement hormones

For ARDS/ respiratory failure transition to what diet upon removal from mechanical ventilation

Transition to a high-calorie and high protein diet upon removal from Mechanical Ventilation and improved respiratory/mental status

If med management fails to control ascites

Transjugular intrahepatic portal shunt TIPS used to control ascites and reduce variceal bleeding

Pain and temp

Transmitted by same nerves so if one intact the other can be assumed to be intact

Surgical management of acromegaly? Procedure?

Transsphenoidal Hypophysectomy - removal of the pituitary gland Entry through the sphenoid sinus in nose muscle Grady then taken from thigh and used to support and prevent CSF leak. Nasal packing then inserted Minimally invasive approach

Brain tissue expansion/pressure examples

Trauma to head, tumors, abscesses aneurysms, edema

Premature contraction treatment

Treat the cause Beta blockers Antiarrhythmics Teach education : Manage stress Avoid caffeine/ alcohol/ tobacco

Cardiogenic shock treatment

Treat underlying problem (MI, HF etc.) Fluid resuscitation is limited due to concern with fluid overload. Vasopressors are begun earlier than in other shock states Norepinephrine Vasopressin

Pre thyroidectomy treated with? What's controlled? Diet? Educate?

Treated with iodine therapy+antithyroids to decrease the thyroid size and vascularity. Hypertension, dysrhythmias, tachycardia must be controlled. Possible high protein+carb diet. Educate on supporting neck when coughing to reduce strain on suture, hoarseness may be present after

Mechanism of injury determines

Treatment and care

Surviving sepsis bundles treatment protocols

Treatment for first 3-6 hours 30ml/kg Respiratory support/ventilation Identify/remove source Central Venous Access IV fluids/vasopressors Lactic acid levels (3-23 mg/dl) you want it to drop after 3 hours Broad spectrum antibiotics

Nerve 5

Trigeminal sensation of face, scalp, mouth, nose

Nerve 4

Trochlear eye movement

Labs for MI

Troponin and creatinine kinase, myoglobin.

If abdomen distended

Tube in stomach and must be decompressed via NG tube

Hyperparathyroidism caused by

Tumor or renal disease. Loss of calcium from the bones to the serum Hypercalcemia Hypophosphatemia, vitamin D deficiency, kidney disease, carcinoma, neck trauma/radiation

Imaging for cirrhosis

Ultrasound is often the first assessment. Detects ascites, hepato-megally, spleenomegally, bile duct obstruction. An x-ray, CT scan or MRI may also be ordered.

High output HF is

Uncommon. Cardiac output remains normal or above normal Caused by increased metabolic needs Anemia Septicemia High fever Hyperthyroidism Hyperkinetic-unusually increased movement in muscle (spasms

Stage 1 initial Parkinson's

Unilateral limb involvement, minimal weakness, hand/arm trembling

Positive vs. negative deflections vs. isoelectric baseline

Up lines vs. down lines representing depolarization/repolarization. Line in middle when no current flow after depolarization/repolarization is isoelectric baseline

S/s of diabetes insipidus

Up to 20L urine/day, polyuria, dry skin/mucuouslow specific gravity 1.010-1.030, low osmolarity, hypovolemia, high thirst, tachycardia low BP, elevated NA, K decreased

Eyes of graves: eyelid retraction/lag vs. globe/eyeball lag? Ask patient to?

Upper eyelid fails to descend when patient gazes downward vs. upper eyelid pulls back faster than the eyeball when patient gazes up. Ask pt. To look down then up

10-year-old girl with vomiting, diarrhea, and abdominal pain onset 4 hours after eating fish.

Urgent

56-year old man with severe unilateral back pan and previous history of kidney stones.

Urgent

Proficient preceptor implications

Use complex case studies for learning, good preceptor for competent nurse

For skin irritation and pruritus associated w/ jaundice from cirrhosis

Use cool rather than warm water on skin, don't use excessive soap, Use lotion to soothe skin, assess for open skin areas from scratching

If TBI personality/behavior problems

Use structured consisten environment

High levels of androgens usually in? S/s?

Usually in cushing's causes acne, hirsutism aka increased hair, and clitoral hypertrophy, decreases estrogen and progesterone, oligomenorrhea aka scant/infrequent menses can occur

For patients w/ diastolic HF drug therapy

Usually not effective

Interventions for hyperthyroidism/graves

VS, monitor weight, rest periods, calm environment, comfort measures, cool temps/water, high calor/protein diet, small frequent feedings if hypermotility present

Hospital care for black widow

VS, opioids, muscle relaxant diazepam/valium, tetanus prophylaxis, possible antihypertensives, antivenom

Spider angioma define? AKA?

Vascular lesion w/ red center+radiating branches on nose, cheeks, upper thorax, shoulders in cirrhosis. AKA telangiectases

Catecholamine norepinephrine effects on Blood vessels? GI? Bladder? Skin? Liver? Pancreas? Eyes?

Vasoconstriction. Increased sphincter tone, sphincter contractions. Increased sweating. Increased gluconeogenesis and glycogenolysis. Decreased glucagon and insulin release. Dilation of pupils

Vasopressors do what

Vasoconstricts

Drugs that reduce afterload to improve SV for HF

Vasodilator: ACE inhibitor, ARBs, human B-type natriuretic peptide

Posterior pituitary hormones

Vasopressin aka ADH, oxytocin

Blood through heart

Vena cava, right atrium, tricuspid right ventricle, pulmonic valve, pulmonic arter, pulmonic vein, left atrium. Mitral valve, left ventricle, aortic valve, aorta

Nitrates

Venous vasodilator for persistent dyspnea. Benefits by returning venous vasculature capacity, decreases volume of blood return to heart, improves left ventricle function

If cause of ventilator alarm cannot be determined

Ventilate manually w/ resuscitation bad until problem corect by another healthcare pro

T

Ventricular repolarization

Sudden death very important to say?

Very important to say patient died, no passed away/expired, say they died

Dig toxicity s/s

Very irregular heart rate Vomiting Dizziness Vision changes (blurred vision or yellow, green or white halo) Confusion

Nerve 8

Vestibulocochlear hearing, equilibrium

Subacute/granulomatous thyroiditis caused how? S/s?

Viral after cold or upper respiratory infection. S/s: fever, chills, dysphagia, muscle/joint pain that can radiate to ears/jaw, hard enlarged thyroid

Esophagogastroduodenoscopy

Visualize upper GI to detect varices

What is most common ventilator

Volume cycled ventilator, Phsyician prescribes rsettings

Gonadotropin LH+FSH deficiency for women? Men?Both?

W: amenorrhea, anovulation, low estrogen, breast atrophy, loss of bone density, decreased pubic/axillary hair, decreased libido, dyspareunia/painful intercourse. M: decreased facial hair, decreased ejaculate volume, reduced muscle mass, loss of bone density, decreased body hair, decreased libido, impotence. Both: secondary sex characteristics

Minor head injury education

Wake q 3-4 hours for first 2 days if sleeping, expect headache/n/dizziness for @ least 24 hours, tylenol for headache, no sedatives/alcohol/sleeping for at least 24 hours, no strenuous activity for at least 48 hours, no nose blowing/ear cleaning for 48 hours. Take back to ED for: blurred vision, drainage from ear/nose, weakness, slurred speech, progressive sleepiness, vomiting, worsening headache, unequal pupil size

Systolic HF/systolic ventricular dysfunction

When heart cannot contract enough during systole to eject enough blood into circulation leading to decreased perfusion and blood to accumulate in pulmonary vessels leading to congestion. CO decreased

Suppression tests for hormones define? Ex?

When hormone levels high. Failure of suppression of hormone production indicates hyperfunction. Ex: glucose should suppress GH

ET tube cuff

When inflated cannot talk

Hand hygiene when?

When soiled, before direct contact, before sterile gloves, after intact skin contact/body fluids, after removing gloves, after contact w/ inanimate objects in contact w/ patient

Liver trauma? Observe for?

When upper abdominal or lower chest trauma sustained. Observe for hypovolemic shock, RUQ pain, distention/rigidity, guarding

Disposition define? Depends on?

Where client goes next like discharge home, observation, inpatient, transfer, rehab etc. Depends on extent of injury and situation

Sepsis define

Widespread infection that triggers a whole body inflammatory response Infection enters bloodstream If not treated, cell death will occur and patient will die

Loop /high ceiling diuretics continue to

Work even after excess fluid is removed and as result some can become dehydrated so assess for s/s like confusion, decreased U/O, dizziness

ET tube placement verified via

Xray and checking end tidal CO2 levels are most accurate. Assessing for breath sounds, symmetric chest rise until verified and air emerging from tube

Productive cough of pneumonia

Yellow, bloodstreaked, rusty sputum= infection

Does caregiver have appropriate knowledge, skills, abilities to accept delegation? Are there organizational policies/procedures in place for task, is RN supervision available?

Yes delegate, no don't delegate

Delegation: has there been asssessment of the patient's needs by RN?

Yes go on, no: assess needs and procee to consideration of delegation

Is task w/in delegating RN SOP? Are statues/regulations in place supporting delegation? Does organization permit delegation? Is delegating RN competent to delegate? Is task w/in rang of function? Frequently refunds? Is perfomed according to steps? Involves little/no modification ? May be performed w/ predictable outcomes?doesn't inherently involve ongoing assessment/decision making? Does not endanger healthcare?

Yes keep going, no: don't delegate

Clinical reasoning

ability to reason as a clinical situation changes, taking into account the context and concerns of the patient and family

ACS- MI occurs when the tissue of heart is

abruptly or severely deprived of oxygen

All members of healthcare team require

accurate information about clients to ensure the development of an organized comprehensive care plan.

ARBS-ACE inhibitors

act by preventing the formation of angiotensin II rather than by blocking the binding of angiotensin II to on blood vessels. Angiotensin II is a very potent chemical that causes muscles surrounding blood vessels to contract, thereby narrowing blood vessels-increasing BP Block the action of angiotensin II by preventing angiotensin II from binding to angiotensin II receptors on blood vessels Blocks the binding of angiotensin II receptors on blood vessels Blood vessels enlarge (dilate) and blood pressure is reduced Reduced blood pressure makes it easier for the heart to pump blood and can improve heart failure. Persistent cough, elevated K+

Systemic sclerosis aka? Define? S/s?

aka scleroderma chronic inflammatory autoimmune connective tissue disease. Hardening of skin

Hepatic encephalopathy late signs? It may be?

altered LOC, impaired thinking and neuromuscular problems It may be acute and reversible it treated early

Methimazole/Tapazole aka? Avoid? Monitor?

antithyroid medication Avoid in pregnant women Avoid large crowds (decrease in WBC's) Monitor heart rate, weight gain, and cold intolerance (signs of hypothyroidism)

Good test to evaluate whether documentation is satisfactory

ask the following question: "If another RN had to step in and take over this assignment, does the record provide sufficient information for the seamless delivery of safe, competent and ethical care?"

As cirrhosis develops the tissue? These do what?

becomes nodular. These nodules block bile ducts and normal blood flow thru the liver

The risk of inaccurate/incomplete documentation is

care that is fragmented, tasks that are repeated and therapies which could be delayed or omitted

Cardiac catheterization

catheter is put into a blood vessel in your arm, groin (upper thigh), or neck and threaded to your heart. Through the catheter, your doctor can do diagnostic tests and treatments on your heart. Gets xray to see blood flow/blocks aka coronary angiography

AIDS dementia complex causes?

causes cognitive , motor, behavioral impairment rangng from barely noticeable to severe dementia

Chronic HF results in

changes to the ventricular size, shape, and dimension. This process is called ventricular remodeling.

S/s of tension pneumothorax

decreased or absent breath sounds on affected side respiratory distress hypotension JVD Uneven chest movements Tracheal deviation (late)

Treatment for respiratory failure

depends on whether the condition is acute (short-term) or chronic (ongoing) and its severity. O2 and treating underlying cause

Implantable cardioverter defibrillator ICD

device that's placed in the chest or abdomen. Doctors use the device to help treat irregular heartbeats called arrhythmias An ICD uses electrical pulses or shocks to help control life-threatening arrhythmias, especially those that can cause sudden cardiac arrest (SCA).

The result of acute respiratory failure: either? PaO2? PaCO2? Ph? These can?

either a low oxygen level and/or a high carbon dioxide level in the blood. PaO2/ partial pressure of arterial oxygen <60mmHg PaCO2/ partial pressure arterial carbon dioxide >45mmHg Acidosis pH <7.35 These can occur at the same time.

VAD can help which stages of HF

end stage, earlier stage

To meet aims the nurse uses

four blended competencies; Cognitive, Technical, Interpersonal, and Ethical/legal.

When ventricular remodeling occurs from chronic HD

heart tries to compensate for the fall in stroke volume by dilating the ventricular chamber to increase intraventricular volume. The increase in volume does initially increase cardiac output, but at the cost of increasing ventricular filling pressures and wall stress, which leads to further remodeling and worsening heart failure. (Hypertrophy)

Hypofunction of adrenal gland s/s? Aka? From? If acute?

hyperkalemia, hyponatremia, hypovolemia, acidosis. Addison's disease aka insufficient cortisol or aldosterone. From inadequate ACTH, hypothalamus/pituitary issues, or adrena issue. If acute adrenal crisis and life threatening

CV manifestations of DI

hypotension, decreased pulse pressure, tachycardia, weak peripheral pulses, hemoconcentration aka increased hemoglobin/hematocrit/BUN

PEEP positive end expiratory pressure

is positive pressure exerted during expiration. PEEP improves oxygenation by preventing alveoli from collapsing. This promotes gas exchange and prevents atelectasis. It is used to treat hypoxemia. (5-15 cm H2O

One of main goals of treating respiratory failure

is to get oxygen to your lungs and other organs and remove carbon dioxide from your body

Anabolic effects of insulin: liver? muscle? Fat?

liver: promotes glycogen synthesis/storage, inhibits glycogenolysis/gluconeogenesis/ketogenesis, increases triglycerides. Muscle: promotes protein and glycogenesis. Fat: increases fat synthesis, promotes triglyceride storage, decreases lipolysis

When stridor, dypsnea, or other s/s of obstruction appear after thyroid surgery

notify rapid response

ACS unstable angina

occurs with increase physical activity or exertion, resolved with rest

PH compensated? Uncompensated?

pH 7.35-7.45-Compensated pH < 7.35 -Uncompensated pH > 7.45 -Uncompensated

Hypovolemic shock ABGs

pH ↓decrease tissue oxygenation→ acidosis pO2 ↓ anaerobic metabolism pCO2 ↑

Earliest manifestation of shock

raised HR, use changes in pulse as main indicator of shock and progression. Change in mental status/behavior can also be early s/s

Corticosteroids for ARDS: name? Function? Effectiveness?

solumedrol/prednisone Reduce inflammation, Stabilize capillary membranes, Decrease WBC movement Effectiveness has not been proven

The guidelines of documentation will

support RN's to contribute to the development of agency policy and promote evidence-informed practice, which enables RNs to meet the Standards of Practice for Registered Nurses every day in client care

Clear, complete and accurate documentation in a health record ensures

that all those involved in a client's care, including the client, have access to information upon which to plan and evaluate their interventions.

Perfusion defined

the act of pouring over or through, especially the passage of a fluid through the vessels of a specific organ.

If supplemental o2 doesn't maintain adequate o2

then consider mechanical ventilation, either invasive or non-invasive. Consider positive pressure ventilation CPAP or BiPaP ventilation

Liver biopsy

to obtain a tissue sample to assess pathology. Increased risk due to bleeding risk.

When blood vessels dilate

total blood volume remains the same Blood pressure decreases Blood flow slower

How to eat for ARDS/failure

•Eat while sitting upright •Use pursed-lip breathing •Liquids may be easier to consume. •Limit empty calorie foods •Accept meal prep help, MOW, freeze extra portions, rest before eating

Treatment of hypovolemic shock

Keep patient warm to avoid hypothermia Apply direct pressure to sites of obvious bleeding Start one or two large-bore intravenous access for fluid and blood replacement Always start IV fluids before administering medications (vasoconstrictors) dopamine (Epinephrine) norepinephrine (Levophed) Immobilize any obvious fractures Get a good history

Adrenal glands location

Kidneys

Normal creatinine

Know

A. Fib

Know difference between that and artifact

Preventing dysrhytmia for those at risk for potassium imbalance

Know s/s of decreased K like weakness/cardiac irregularity, eat K like tomatoes/beans/prunes/avocados/bananas/strawberries/lettuce, take K supplements

Airborne precautions define? Equipment? Ex?

Known/suspected from infection suspended in air for prolonged periods. Negative airflow used, private room, n95, transport wearing mask. Ex:tuberculosis, measles/rubeola, varicella

Neuro for TBI

LOC most important and early sign is behavior change, PERLLA, cranial nerves, glasgow, motor, posture, ears/nose for CSF leaks, nuchal rigidity aka stiff neck, hyperventilate if suctioning

Psychosocial parkinsons s/s

Labile, depressed, paranoid, upset easily, mood swings, cognitive impairment, dementia, delayed reaction, sleep issues

Labs for ARDS/respiratory failure

Laboratory indices: Sodium levels 135-145 Hypernatremia may indicate fluid deficiency; hyponatremia may indicate fluid overload. BUN/creatinine ratio: Elevated BUN may indicate fluid deficiency

Dx of Graves

Labs T3, T4 are increased, TRH stimulation test w/ no response, TSH low EKG -assess cardiac status Ultrasound, thyroid scan (size, position, and functioning of the thyroid gland)

Best for assessing for bleeding**

Labs for liver clotting factors:PT, PTT, INR

Drug therapy for hepatic encephalopathy from cirrhosis

Lactulose, lactitol, nonabsorbably antibotics, thiamine supplement+benzos if alcohol withdraw

Types of cirrhosis

Laennec's alcohol induced, Postnecrotic viral hepatitis/drugs, Biliary chronic biliary obstruction and infection

Decerebrate/decorticate posturing as well as pinpoint/dilated and nonreactive pupils is

Late mental deterioration sign so notify immediately

Cushing's triad

Late sign of increased ICP: severe hypertension, widened pulse pressure, bradycardia

HF -2

Left ventricular function assessment (LVF < 40%)

Lemon glycerin swabs

Lemon swabs as well as mouthwashes/swabs with alcohol base to them are contraindicated in care of compromised patients. They serve to dry out the mucosal membranes. In many patients, they contribute to mucositis. Swabs in ice water can be as refreshing as lemon based ones. Cancer patients typically rinse with NS (ocasionally with Baking Soda if needed to buffer it).

Patients who are less than alert are

Lethargic aka drowsy/sleepy but easily awakened, stuporous if aroused only via vigorous/painful stimuli, or comatose if cannot be aroused/unconscious

Rapid neuro assessment

Level of consciousness, orientation movement of arms/legs, pupil size/reaction to light

How to measure ab girth

Lie flat while RN pulls tape around largest diameter usually over umbilicus of abdomen. Girth measured at end of exhalation, mark the skin to ensure same placement on subsequent readings

Ventricular fibrillation assessment

Life threatening Immediate loss of consciousness Pulseless Seizures Apneic No BP or heart sounds Pupils fixed and dilated Skin cold and mottled Death will result without immediate intervention

Hypercalcemic crisis is what? Ca level? Interventions?

Life threatening Calcium level > 15mg/dl (level greater than 12 can lead to psychosis, coma and death) Calcitonin, IVF, Phospate therapy, Observe for signs of hypocalcemia

Insufficient adrenocortical steroids causes

Loss of aldosterone and cortisol decreasing gluconeogenesis, hypoglycemia, reduced urea nitrogen excretion causing anorexia/weight loss

Distributive shock cause

Loss of sympathetic tone Loss of vascular tone Pooling of blood in venous and capillary beds Capillary leak

Clinical manifestations of HIV

Low CD4+ count, Opportunistic Infections, Lymphadenopathy, Fatigue, Dry Skin, Poor Wound Healing, Skin lesions, Night Sweats, Cough, SOB, Diarrhea, Weight Loss, N/V, Diarrhea, Change in Mental Status, Fungal/bacterial/viral infections, Cancer

Diagnosis ARDS

Low PaO2 via ABG, sputum culture via bronchoscopy/transtracheal aspiration, chest xray for whited out ground glass appearance of lung, ECG ruling out cardiac issues, hemodynamic monitoring w/ pulmonary artery catheter.

Causes of oxygenation failure

Low atmospheric o2:altitudes, closed spaces, smoke inhalation, carbon monoxide poisoning, pneumonia congestive HF w/ PE, PE, ARDS, interstitial pneumonitis-fibrosis, abnormal hemoglobin, hypovolemic shock, hypoventilation, nitroprusside therapy:thyocyanate toxicity, methemoglobinemia

Examples of positive/negative feedback control via hypothalamus

Low cortisol from adrenal cortex stimulates secretion of corticotropic releasing hormone from hypothalamus which stimulates anterior pituitary to secrete ACTH that then triggers release of cortisol from adrenal cortex and rising cortisol inhibits CRH release from hypothalamus

Dx of Addisons: cortisol? BG? Na? K? BUN? ACTH? Other labs?

Low cortisol levels Low fasting blood glucose Low sodium Increased potassium Increased BUN Adenocorticotropic hormone (ACTH) stimulation test most definitive via ACTH given and in primary cortisol absent/decreased or secondary it's increased Imaging MRI, CT scan pituitary gland or adrenal gland hypertropy

Spontaneous bacterial peritonitis s/s

Low fever, loss of appetite, ab pain, change in mental staus

Lactic acid=

Low o2

Clinical manifestations of severe sepsis

Low o2, high RR, decreased/absent u/o, change in LOC.

Steroids and ICP

Lowers inflammation

Sedatives and increased ICP

Lowers metabolic rate of brain

Anticonvulsant and ICP

Lowers seizure risk

Major parts of immune system

Lymph nodes, thymus, spleen, bone marrow

Poor CD4 t cell function as result of HIV leads to

Lymphocytopenia, increased incomplete and nonfunctional antibodies, abnormal macrophages leading to bacterial, final, viral infections, opportunistic infections

Creatinine normal? Early sepsis? Late? Septic shock

M:0.6-1.2, W:0.5-1.1, normal to increased

HF self-management health teaching

MAWDS: medications like regime and no NSAIDs, activity like limits/carry convo during exercise, weight each day at same time on same scale, diet limiting Na 2-3g/day+limiting fluids to 2L, symptoms to notify

Esophageal varices are? Caused by? Blood loss can lead to?

MED EMERGENCY. Portal HTN causes blood to back up from the liver into the esophageal veins. Fragile, thin-walled esophageal veins become distended from increased pressure, they can rupture.Blood loss can lead to shock from hypovolemia

If MAP decreases too much with hypovolemic shock

MODS occurs

If chest pain from MI+cardiogenic shock and EKG pain meds to use

MONA, 12 lead, thrombolytics, surgery

When cardiac output is insufficient to meet body's demands, these temporary mechanisms operate to increase cardiac output

Major types Sympathetic nervous system stimulation release of norepinephrine and epinephrine Renin-angiotensin-aldosterone system activation ADH secreted by posterior pituitary - total body fluid increased Chemical responses (BNP) Myocardial hypertrophy Blood is shunted from skin and less vital organs Anaerobic metabolism

HAART make sure?

Make sure not missed, delayed, admined in lower than prescribed doses to maintain effectiveness of drugs.

What is high priority for ET tube

Making sure not dislodged then Protect skin

Distributive shock

Maldistribution of adequate circulating blood volume

SIADH caused by?

Malignancies like cancers, pulmonary disorders like pneumonia/abscess/TB/pneumothorax/chronic lung disease/positive press. Ventilation, CNS issues like trauma/infection/tumor/stroke/lupus, drugs like ADH, chlopropramide, opioids, antidepressants

Immmunocompetent definition

Max protection against infection

Therapeutic paracentesis may? Up to? Risk of? This can lead to? Use what to replace volume?

May also provide diagnostic information Up to 5 Liters of ascitic fluid can be removed at one time (careful monitoring required) Risk of hypovolemia, circulatory dysfunction and renal impairment. This can lead to HRS. Use albumin to replace volume.

Mechanical ventilation can be what or what? Insertion of?

May be Invasive or non-invasive Insertion of an artificial airway endotracheal (ET) tube or tracheostomy; Oral (preferred) or nasal site for ET tube

Violent clients

May be under the influence of drugs/alcohol Preexisting psychiatric disorders Ineffective communication

EF <40%

May confirm dx of HF, ventricular failure

Person w/ TB and CD4 <200

May not have positive TB skin test because inability to mount immune response aka anergy so confirmed via gamma assay blood test

Treatment for SVT

May stop on its own Vagal Maneuver by qualified personnel If hypotensive or unstable, immediate cardioversion with sedation Antiarrhythmics- Adenosine Cardiac catheter ablation Treat cause

If CPR becomes necessary for breathing

Mechanical ventilator disconnected and manually ventilated via BVM

Positive pressure ventilators are classified by

Mechanism that ends inspiration and starts expiration

Health promo/maintenance for anaphylaxis

Medical ID bracelet, epipen, ask about drug allergies

Management of valve disease

Medical Management Balloon Valvuloplasty Transcatheter aortic valve replacement Valve Replacement using synthetic and tissue valves Keep BP down

History assessment of cushing's

Medical history Medication history (use of glucocorticoids) Weight gain, increased appetite Menstrual history (oligomennorrhea)

Medical treatment of parkinsons

Medication Review Anti-Parkinsonian Meds: Levodopa, Carbidopa Anticholinergic Therapy: Cogentin, Akineton, Artane Dopamine Agonists: Requip, Parlodel, Mirapex Monoamine Oxidase Inhibitors: Eldepryl, Azilect Catechol-O-methyltransferase Inhibitors: Comtan Antidepressants Antihistamines

Key points of HF med management

Medication adherence is an essential part of management of heart failure. Medications should be reviewed with the patient on every doctor's visit or hospitalization Review drug-to-drug, food-to-drug reactions, and allergies Check Pulse and BP before medications administered and monitor closely during therapy Best practice: apical pulse for one full minute

SCI drugs

Methylprednisolone for inflammation, baclofen/lioresal pumped in CSF for muscle relaxation

Immunocompromised Client Secondary to Cancer Rn assessment: monitor? Monitor? Inspect? Inspect? Monitor?

Monitor CBC results, cultures (urine, blood, sputum, central line, wounds) Monitor VS q4h Inspect mouth q8h Inspect skin, mucous membranes, peri-rectal area for fissures, abscesses Monitor IV sites for infection

Carotid sinus massage monitor? Complications? What's needed?

Monitor ECG/VS/LOC, complications include bradydysrhythmia, asystole, VF, cerebral damage. Defibrillator and resuscitation equipment needed at bed

ADH deficiency interventions

Monitor I&O Daily weight Monitor labs (urine specific gravity) Patient Education (I&O, lifelong therapy, medication teaching) Administration of desmopressin acetate (DDAVP) a synthetic form of ADH given orally, intranasally, SQ, or IV.

Neuro interventions for cirrhosis

Monitor LOC, orientation, mental status Memory status Monitor for behavioral changes Ask about sleep pattern disturbances, personality changes Monitor/assess ammonia, liver function tests

Interventions for hypothyroidism

Monitor VS Medication therapy (synthroid) Patient Education

Interventions for immunocompromised

Monitor VS Monitor WBC, neutrophils, Patient-Family Education

After extubation

Monitor VS q 5 min and assess ventilatory pattern for respiratory distress/obstruction. Sore/hoarse throat common. Semi-fowlers Deep breaths q 30 min, incentive spirometer q 2hours, limit speaking to help gas exchange, decrease laryngeal edema, reduce vocal coward irritation

Key points med management of HF: monitor? Low K can cause? Know the cumulative? Inquire about?

Monitor applicable lab especially electrolytes Low potassium levels can cause arrhythmias especially in HF patients. Know the cumulative effects of taking medications that may have similar actions Inquire about non-prescription medications

Bleeding precautions for cirrhosis

Monitor for S/S of bleeding:stool, urine, bruising Monitor coagulation studies (PT, INR, Platelet count, PTT) Avoid injections (IV, IM or SQ), keep nails trimmed/smooth Monitor orthostatic vital signs, Use soft toothbrush, use electric razor

Post surgical for cushing's: monitor? If adrenal removed? If unilateral adrenalectomy?

Monitor for adrenal insufficiency, shock(hypotension, rapid/weak pulse, low UO), life long glucocorticoid and mineralocorticoid replacement if adrenal removed, if unilateral adrenalectomy hormone replacement until other gland increases, slowly taper corticosteroid therapy

Neurogenic shock SCI

Monitor for bradycardia/warm skin/hypotension and notify if occurs+give fluids, hydration via IV

Preventing hypotension for hypothyroidism

Monitor for changes like shock, prevent complications. Lifelong thyroid hormone replacement like levothyroxine/synthroid

Post thyroidectomy interventions

Monitor for complications most important. Use pillows/sandbags to support head and neck, semi fowlers, avoid neck extension, humidify air, cough/deep breath, suction, Monitor for hemorrhage Monitor for respiratory distress, keep equipment at bed side w/ o2+suctioning

Ascites interventions: monitor? Kee? Provide? Elevate? Encourage?

Monitor for dyspnea, O2 saturation Keep HOB elevated 30 degrees or more Provide oxygen if needed Elevate feet to decrease pedal edema Encourage OOB to chair

Providing safe environment for SIADH

Monitor for fluid overload/pulmonary edema like bounding pulse, neck veins distended, crackles, edema, reduced UP. If Na <120 neuro changes so seizure risk, reduce environment noise/lighting

Interventions for cushing's

Monitor for infection, protect from accidents/falls, assess nutrition, monitor/treat hyperglycemia, assess BP/heart rhythm

Rn care for diabetes insipidus

Monitor pulse, replace fluids, check neuro/VS/mucous membranes, drugs if not severe oral chlorpropamide/Diabinese or if severe Desmopressive DDAVP, weigh patient

Improving oxygenation for hypothyroidism

Monitor respiratory, possible ventilatory support or o2, don't/reduce sedation

Rn interventions for SIADH

Monitor response to treatment Fluid restriction (500- 1,000mL/day) despite patient being thirsty Slowly replace lost sodium Monitor I & O Observe for S/S hyponatremia and fluid volume excess Assess for other problems that may cause fluid retention Weigh daily (report > 2lbs/day) VS, LOC Safe Environment Monitor mental status frequently; initiate seizure precautions

HF management

Monitor vital signs closely Elevated heart rate may be first sign of HF (compensatory) Semi-fowler's position to degrease preload (volume return to the heart) Organize activities to provide adequate rest for patients who are decompensated Appropriate delegation of duties

The rn priorities in care for patient during mechnical ventilation

Monitoring and evaluating patient responses, managing the ventilator system safely, and preventing complications

Surveillance/supervision is

Monitoring performance of task/function and assures compliance w/ standard of practice+policies+procedures. Frequency/level of monitoring vary w/ needs of patient and experience of LPN/NAP

Monitoring fluid status for ARDS/ respiratory failure

Monitory daily, overload may result in pulmonary edema

Ascites: most? Define? Can cause? Triggers? Leads to? Increases? Causing?

Most common complication from portal hypertension Collection of free fluid within the peritoneal cavity (abdominal distention) causing third spacing where fluid shifts to abodmen Can cause renal vasoconstricton Triggers the renin-angiotensin system Leads to sodium and water retention Increases hydrostatic pressure and vascular volume Causing more ascites.

Prevalence of graves

Most often women between 20-40

Frontal lobe or cerebral cortex

Motor cortex for voluntary/eye movement, broca's speech formation, memory, behavior/judgement, reasoning/abstraction

Fall prevention for safety

Move slowly, siderails up/locked, call light within reach, fall risk communicated, bed lowest, if older assess mental status for delirium and think of sitter to reorient

Addison's neuromuscular and skin manifestations

Muscle weakness, fatigue, joint/muscle pain, vitiligo or hyperpigmentation

Skeletal muscle changes for hypovolemic shock

Muscle weakness, pain, deep tendon reflexes decreased/absent

Musculoskeletal manifestations of hyperthyroidism

Muscle weakness/wasting

Pleuritic pain

Muscular achy chest pain

MG issues with chholinesterase inhibitors/anticholinesterase

Myasthenic crisis via increased pulse/RR/BP, incontinence fixed via drugs gradually . Cholinergic crisis n/v/d/cramps/blurred vision/twitching fixed via atropine

Bacterial opportunistic infections

Mycobacterium causing fever, debility, weight loss, mailuse, swollen lymph glands. TB causing cough, dyspnea, chest pain, fever, weight loss.

Asystole caused from

Myocardial hypoxia, advanced heart failure, hyperkalemia, acidosis

Cardiogenic shock: most common cause? Impaired? Any type?

Myocardial infarction most common cause Impaired pumping of heart muscle Any type of pump failure with decreased CO. Cardiac arrest, ventricular dysrhythmia, cardiac amyloidosis, cardiomyopathies myocardial degeneration

Other interventions for bleeding w/ cirrhosis

NG tube inserted to detect bleeding, packed RBC, fresh plasma, dextran, albumin, plateleyts, monitor VS/PT/PTT/platelets/INR

Secondary survey includes

NGT insertion for decompression to prevent vomiting/aspiration Foley insertion Labs Diagnostic studies Pain Medical history

Transplant rejection definition? Types?

NK+t cells destroy cells from animals/people. Types: hyperacute, acute, chronic rejection

Resolution phase

NURSES Begin to make conscious decisions about their future in nursing Adapt to current job or leave for another position May quit nursing altogether Go back to school

Treatment of cirrhosis for excess fluid volume

Na restriction 2g/24 hours, spironolactone/lasix diuretics, paracentesis

Reducing stimulation for Grave's

Noisy/stressful environment can increase hyperthyroidism+cardiac issues. Encourage rest, keep environment quiet by closing door to room, limit visitors, postponing/eliminating nonessential care

Asystole rate? Rhythm? P wave? QRS?

None for all possible p waves but usually not

When breathing ineffective interventions

Nonrebreather mask Bag-Valve-Mask ventilation Prepare for intubation Prepare for needle thoracentesis Prepare for chest tube placement

Hypokalemia s/s

Nonspecific neuro and muscular symptoms like generalized weakness, depressed reflexes, irregular HR. Can be fixed w/ K sparing diuretic like spironolactone/aldactone

Temporary pacing define? For? Modes? Types?

Nonsurgical w/ timed stimulus when impulse or conduction is defective. For symptomatic bradydysrhythmia, heart block or asystole. Modes: synchronous/demand and asynchronous/fixed. Types: noninvasive/external or invasive

6 -year-old with a temperature of 101 F and flu-like symptoms

Nonurgent

65-year-old woman with redness and swelling on forearm associated with bee sting.

Nonurgent

When can mechanical ventilation be discontinued

Normal O2, normal ventilation, respiratory muscle strength are achieved

Respiratory failure interventions

O2 for acute hypoxemia to keep PaO2 >60 while treating cause. If O2 doesn't maintain PaO2 mechanical ventilation. Upright position, relaxation/diversion/guided imagery ti decrease anxiety, energy conserving measures like minimal self care/no unnecessary procedures. Systemic or MDI drugs , deep breathing

For patient w/ hepatopulmonary syndrome monitor

O2 sat w/ pulse ox, if needed o2 therapy to ease breathing, elevate HOB >30 degrees, feet elevated to decrease dependent ankle edema all to relieve dyspnea

Nonsurgical interventions for shock

O2 therapy, IV crystalloid NS/LR colloids like blood/plasma/expanders, vasoconstrictors dopamine/inotropin+norepinephrine/levophed, intropics like dobutamine/dobutrex, milrinone/primacor, drugs for coronary perfusion like nitroprusside/nitropress, monitoring VS(pulse, BP, pulse press, central venous press, RR, skin color, o2, LOC, U/O)

Hospital care of snake bite

O2, 2 large bore IV w/ NS or RL, continuous monitoring, opioids, tetanus prophylaxis, wound care, labs, ECG, history, measure circumference of bitten extemity q 15-30 min, antivenom CroFab if pit viper w/in 6 hours or Micrurus/Wyeth for Coral snake. Keep epinephrine, antihistamines, steroids at bed side for anaphylactic response to antivenom

Hospital care for bees/wasp

O2, continuous monitoring, IV w/ NS, epinephrine IM, albuterol for bronchospasm, antihistamines, corticosteroids

Sepsis interventions

O2, drugs, IV antibiotics, corticosteroids for adrenal support, insulin, heparin, synthetic activated protein C drotrecogin/xigris to prevent clots, blood replacement if hemorrhage

Other physical assessment of cirrhosis

Observe vomit/stool for blood via frank blood or + fecal occult blood test, assess breath for retro hepaticus aka fruity/musty odor, amenorrhea, continuous mental function

Increased blood flow/pressure examples

Obstruction of venous outflow, acidosis from high arterial PaCO2, increased right atrial pressure, Duran sinus thrombosis

Obstructive shock description

Obstructive shock is a ↓ in blood flow Caused by a physical obstruction in the heart or neighboring blood vessels Tissues begin to die because they don't receive essential oxygen and nutrients

Special notes on diuretics

Obtain baseline BP and P Potassium deficiency ACE inhibitors or ARBs + diuretics may not experience hypokalemia Monitor kidney function Creatinine > 1.8 mg/dl Notify healthcare provider Hypovolemia Furosemide- hearing loss Be aware of cumulative effect if taking diuretics and antihypertensive medications

Clinical criteria 2 anaphylaxis

Onset minutes-hours of 2 or more of these s/s after exposed to allergen: skin/mucous membrane problems involving swollen lips, tongue, soft palace, uvula, hives, pruritis, flushing. Respiratory distress r/t dyspnea, bronchospasms, wheezes, stridor, hypoxia, cyanosis. Hypotension r/t loss of consciousness, incontinence, hypotonia, absent DTR. Gi issues like n/v, cramping, ab pain

Clinical criteria 3 anaphylaxis

Onset minutes-hours of hypotension w/ systolic BP <90 or 30% lower than baseline pressure

Clinical criteria 1 anaphylaxis

Onset minutes-hours of skin/mucous membrane problems involving swollen lips, tongue, soft palate, uvula, hives, pruritis, flushing, respiratory distress causing dyspnea, bronchospasm, wheezes, stridor, hypoxia, cyanosis. Hypotension causing loss of consciousness, incontinence, hypotonia, absent DTR

Immunocompromise secondary to cancer

Open Wounds Active Infection Mucositis

Cranial nerve 2

Optic, vision

Therapy induced immune deficiencies

Organ transplant, treatment of autoimmune disorder, complication of chemo, cytotoxic drugs for cancer/autoimmune disorder, corticosteroids for autoimmune diseases/neoplasms/endocrine issues for inflammation and immunosuppression, cyclosporine for RA, disease modifiers for RA/psoriasis like alefacept/infliximab/remicade

Basics of triage

Organized system of sorting Prioritization based upon severity (including MOI) Highest acuity receives quickest evaluation and treatment

Supporting cognition for hypothyroidism

Orient to person, place, time, explain all procedures slowly, provide safe environment, encourage fam to accept mood changes and mental slowness and remind them that problem should improve

Fraction of nspired o2 FiO2

Oxygen level delivered to patient, based on ABG and condition, range is 21-100% o2

Managing pulmonary edema

Oxygen therapy Nitroglycerin Rapid-acting diuretics IV morphine sulfate Continual assessment

Interventions for sepsis/SIRS

Oxygen therapy Poor perfusion and oxygenation More likely mechanical ventilation Drug therapy Enhance CO and restore vascular volume Antibiotics (gram negative) Adrenal insufficiency (hydrocortisone) Hyperglycemia Clotting problems (heparin) Blood replacement therapy

What is appropriate for any patient who has acute hypoxemia(respiratory failure)? It's to keep PaO2 at what level?

Oxygen therapy is appropriate for any patient who has acute hypoxemia. To keep PaO2 level about 60mmHg

Conditions that affects the flow of blood into the lungs leading to respiratory failure

PE causing lung damage

Labs for shock

PH low, PaO2 decreases, PaCO2 increases. Hematocrit/hemoglobin decrease if due to hemorrhage, if dehydration H/H raised

Caregiver

PROVISION OF CARE MEETING PHYSICAL, EMOTIONAL, INTELLECTUAL, SOCIOCULTURAL, AND SPIRITUAL NEEDS

Pressure support ventilation weaning

PSV allows respiratory effort to be augmented by predetermined pressure assist from ventilator, as weaning starts amount of pressure applied to inspiration gradually decreased. Another method is to maintain pressure but gradually decreasing preset breaths/min

Adenosine used for?

PSVT, WPW. Causes asystole then bradycardia and hypotension

Hypoxic respiratory failure: PaO2? SaO2? Usually? Most? Involves?

Pa O2 < 60 mmHg, SaO2 < 90 Usually a normal or low Pa CO2. Most common form of respiratory failure Involves fluid filling or collapse of alveoli

Hypercapnic respiratory failure: PaCO2? PH? PH depends on? What's common?

PaCO2 >45mm HG Acidosis- pH < 7.30, pH depends on the level of bicarbonate, which is dependent on the duration of the hypercapnia ( think Renal) Hypoxemia is common w/o supplemental O2

Critical values of acute respiratory failure: PaO2? SaO2? PaCO2? PH?

PaO2 <60, SaO2 ,<90, PaCO2 >50 occurring w/ academia pH <7.30,

Automaticity

Pacing function from SA node. If myocardial ischemia, electrolyte imbalance, hypoxia, drugs, infarction any cell can produce impulses causing dysrhythmias

Automaticity

Pacing function, the ability of cardiac cells to generate an electrical impulse spontaneously and repetitively

Premature contractions assessment

Palpitations/skipping of heartbeat Difficulty catching their breath Faintness Dizziness Loss of consciousness

Ejection fraction EF

Percentage of blood ejected from the heart during systole Normal adult range 50%-70%

Diabetes insipidus patho? Primary? Secondary? Can also be from?

Pituitary gland doesn't make enough ADH so kidneys make a lot of urine/polyuria and dehydration, increasing plasma osmlatrity, increasing thirst from nephrotic aka inherited, primary aka defect of hypothalamus/pituitary, or secondary aka head injury, pituitary tumor, infection, hypophysectomy, or craniotomy. Can also be from drugs like lithium

Circulatory treatment

Place 2 large-bore 16 gauge IV catheters (IV, IO, or CVL) in antecubital of elbow Crystalloid fluids Normal Saline or Ringer's lactate Warmed blood IV fluids to prevent hypothermia Rapid infusers Blood products (O negative) CPR Hemorrage control Manual pressure if external hemorrhage or tourniquet

Examples of hypoxic respiratory failure

Pneumonia, pulmonary edema(cardiac or non-cardiac), pulmonary hemorrhage

ADH deficiency assessment: s/s? Na? BP? HR? Specific gravity? Urine osmolarity?

Polydipsia Polyuria (4 to 30 L per day) Dehydration Hypernatremia Hypotension Tachycardia Specific gravity decreased < 1.005 Urine osmolarity decreased < 300 mOsm/kg

Other connective tissue diseases

Polymyositits/dermatomyositis, systemic necrotizing vasculitis, polymalgia rheumatica/temporal arthritis, ankylosis spondylitis, reiter's, ma fan, lyme disease, psoriatic arthrisis, fibromyalgia syndrom

Complications of cirrhosis

Portal Hypertension, Ascites, Jaundice, Nutritional deficiencies, Coagulation deficits, Bleeding esophageal varices, Hepatic encephalopathy, Hepatorenal syndrome, Biliary obstruction

Mr. Stellas is a 54-year-old man with a known history of alcoholism. He has been admitted numerous times to the hospital. Today he is again admitted with complications of cirrhosis. What assessment findings should the nurse anticipate?

Portal hypertension, splenomegaly, esophageal varices, hematemesis, melena, jaundice

Treatment goals for ARDS/respiratory failure: positioning? Provide? Conserve? Use what to promote gas exchange?

Position the patient in an upright position Provide relaxation techniques, diversion and guided imagery to assist with dyspnea Conserve the patient's energy, minimal self care and cluster activity, allow for rest Bronchodilators to promote gas exchange

Continuous positive airway pressure CPAP

Positive airway pressure throughout the entire respiratory cycle for spontaneously breathing patients. Keep alveoli open during inspiration and expiration improving gas exchange and o2

Mechnical ventilation

Positive end-expiratory pressure (PEEP) is positive pressure exerted during the expiratory phase of ventilation. Improves oxygenation by enhancing gas exchange and preventing atelectasis and alveoli from collapsing Used to treat persistent hypoxemia that does not improve with acceptable oxygen delivery. Which results in an increase in arterial blood oxygen

ET tube/tracheostomy used for

Positive pressure and during inspiration pressure generated that pushes air into lungs and expands chest

Positive end expiratory pressure PEEP

Positive pressure exerted during expiration. Enhances gas exchange and prevents atelectasis via preventing alveoli from collapsing b/c lungs kept partially inflated so gas exchange promoted throughout cycle.

Most problems are caused by which ventilator

Positive pressure from ventilator

Care/use of rip injector

Practice assembly, keep at all times, inject in top thigh, can inject through pants, use when any s/s of anaphylaxis and call 911, go to hospital 4-6hrs after injection, have at least 2 drug filled devices, protect from light, room temp,

Expert characteristics

Practices holistic rather than fractionated, grasp situation intuitively and correctly identifies solutions w/out wasting time, extraordinary management of clinical problems, considered an expert by others, has intuitive grasp of situation and zeros in on accurate region of problem

Strategies to decrease reality shock

Preceptor program-structured Mentor - an experienced nurse that is not evaluating your job performance Support groups - not complaining - positive and uplifting

Steps to securing oral/nasal ET tube

Prepare skin via shaving, protect skin via benzoin, then apply duroderm, tape tube to upper lip or nose

Interventions for cirrhosis: potential for hemorrhage? These all function to do what?

Prevent bleeding in patients with varices IV Sandostain or Vasopressin is used for acute hemorrhage Constricts blood vessels to stop bleeding Nonselective beta blocker Propranolol (inderal), nadolol (corgard) Decrease heart rate, decrease hepatic venous pressure, reducing the chance of bleeding

Preventing hypovolemic shock

Prevent dehydration, prevent trauma/hemorrhage via safety. Secondary prevention via assessing by assessing for occult bleeding via comparing baseline to current pulse, U/O, VS, LOC, anxiety, thirst, impending doom. Aspiring, NSAIDs, diuretics can lead to it

Safety intervention for violent

Prevent escalating, de-escalation, mitigating violence

Functions of glucocorticoids

Prevent hypoglycemia by increasing gluconeogenesis in liver, maintains cardiac muscle, increase lipolysis, increases protein catabolism, degrades collagen, increase mature neutrophils, anti-inflammatory, maintain behavior/cognitive function

Patient safety interventions for Cushing's

Preventing/monitoring fluid overload via bounding pulse/vein distention/crackles/edema/low UO. Skin breakdown risk so pressure reducing mattress, assess pressure areas, O2 mask/cannula, change positions q 2 hours

With diastolic HF prevents? Blood? EF?

Prevents ventricles from filling with sufficient blood to ensure adequate cardiac output, causes ventricles to be less compliant causing more pressure needed to move same amount of blood Blood backs up (pulmonary) Normal EF (>40%)

TBI types

Primary: open aka fractured/penetrating and closed aka blunt trauma which includes contusion/concussion. Secondary occurs after initially injury and worsen outcome

Hypothyroidism primary caused by? Secondary?

Primary:Secondary to surgery or radiation of thyroid for hyperthyroidism/cancer Autoimmune (Hashimoto's) Congenital Cancer Iodide/tyrosine deficiency, lithium, excess exposure to iodine. Secondary to pituitary/hypothalamic tumors/trauma causing inadequate TSH

During hospitalization, Mr. Stellas has had an average 24-hour urinary output of 1000 mL. Today, the nurse notes that he has had 486 mL of urinary output in the last 24 hours. Laboratory results indicate elevation in BUN and creatinine levels, and a urine sodium level of 6 mEq/L. He is oriented occasionally to person; he is not oriented to place or time. What priorities of care should the nurse identify?

Priorities of care should include notifying the primary care provider; preventing infection (e.g., due to spontaneous bacterial peritonitis); monitoring for fever, chills, and abdominal pain (signs of infection); and continued monitoring of mental status. Rationale: A sudden decrease in urinary flow, elevated BUN and creatinine levels, abnormally decreased urine sodium level, and worsening encephalopathy are indicators of hepatorenal syndrome (HRS). The nurse should prioritize care by notifying the primary care provider, preventing infection; these patients are prone to develop acute spontaneous bacterial peritonitis and are also susceptible to other types of infection, thought to be the result of low concentration of proteins.

Health promotion/maintenance of ARDS

Priority: early recognition of those at high risk, closely assess tube feedings/impaired swallowing+gag reflexes. Infection control guidelines like hand washing, invasive catheter/wound care, contact precauses

Contact precautions equipment? Ex?

Private room, gloves, wash hands before leaving, wear gown, dedicate items to patient. Ex: Multidrug resistant organisms like MRSA, VRE, pediculosis/lice, scabies, respiratory synctial virus/RSV, c.diff, ebola

Hospitalized care of immunocompromised

Private room, handwashing, clean room 1x/day, dedicated items in their room and don't share equipment w/ other pts., limit people working w/ pt., inspect mouth q 8 hours, inspect skin/mucus membranes q 8hrs, inspect IV sites q 4 hrs, wound care daily, cough/deep breath, limit visitors to healthy adults, strict aseptic, avoid indwelling caths, no fresh flowers, no raw foods

Care of patient w/ myelosuppression and neutropenia

Private room, handwashing, no supplies from common areas keep a set of patient equipment in their room, limit personnel, inspect mouth q 8hrs, inspect skin/membranes q 8hrs, assess IV q 4 hrs, change dressings, coughing/deep breathing, limit visitors to healthy adults, avoid indwelling caths, avoid raw foods

Ventilators failure

Problem in o2 intake/ventilation and blood delivery/perfusion that causes ventilation perfusion mismatch where perfusion normal but ventilation inadequate. Chest perssure doesn't change enough for air movment and as result too little o2 reaches alveoli and CO2 retained.

Stage 1 portal systemic hepatic encephalopathy

Prodromal: subtle s/s, personality/behavior changes, emotional lability aka euphoria/depression, impaired thinking, inability to concentrate, fatigue/drowsiness, slurred/slowed speech, sleep pattern disturbances

Stage 1 of hepatic encephalopathy

Prodromal:Subtle personality, behavioral and emotional changes

Adrenal crisis in Addison's

Profound fatigue, dehydration, vascular collapse, low BP, renal shut down, low Na, high K

Patho of cirrhosis

Progression of liver disease results in widespread irreversible scarring (fibrous bands of connective tissue). Excessive fibrous tissue causes compression leading to impairments in blood and lymph flow.

Guillain-barre syndrome define? Starts in?

Progressive demyelinating polyneuropathy causing moron weakness and sensory abnormalities. Starts in legs and spreads up aka ascending paralysis snf then recovers from top to bottom

Albumin function? If you have liver dysfunction?

Protein in interstitial space to form oncotic pressure. If you have liver dysfunction water cannot go in interstitial space leading to ascites/pitting edema+you will have high albumin at first then low

Hepatocyte function

Protein synthesis & storage Transformation of carbohydrates Synthesis of cholesterol+bile salts & phospholipids Detoxification, modification, and excretion of substances Initiates formation and secretion of bile.

Urine analysis of HF

Proteinuria and high specific grav, microalbuminuria is early indicator of decreased compliance before BNP rises and s/s

Helping fam w/ sudden death

Provide a private place Talk with the family with everyone together Reassure that all possible efforts were taken Keep comments factual Use concrete words such as "died" or "death": Avoid confusing words such as "expired" or "passed away" Encourage and allow time for family to support each other Encourage viewing of the body Spend time with the family Allow the family to talk about their loved one Avoid unnecessary information (drunk, high, etc.)

Supporting self esteem for HIV

Provide acceptance, allow for privacy but dont avoid/isolate, encourage self care/independence, guided imagery

VAD can help support your heart how

During or after surgery, until your heart recovers. While you're waiting for a heart transplant. If you're not eligible for a heart transplant. (A VAD can be a long-term solution to help your heart work better.)

S/s of respiratory failure

Dyspnea/Dyspnea on exertion, Orthopnea, Change in RR/pattern, Change in lungs sounds, Pallor, confusion, cyanosis, increase HR, restlessness , anxiety, lethargy, bradycardia (which can occur early or late), Hypercarbia-high arterial blood levels of carbon dioxide.

CV findings of cirrhosis

Dysrhythmia, collateral circulation, fatigue, hyperkinetic circulation, peripheral edema, portal hypertension, spider angiomas

RN following progress of client being treated for hypothyroidism which finding indicates thyroid replacement has been inadequate? Which findings indicates too much has been given

ECG changes, low temp, bradycardia. body is in a hypo-metabolic state. Tachycardia, nervousness, and dry mouth are all signs of hyperthyroidism and would indicate the client has received an excessive dose of thyroid hormone.

Advanced life support ACLS steps

ECG, CPR, airway inserted, manual bag w/ mask w/ o2, head tilt or chin lift, 2 large IV lines, suction setup, check pulses/BP/pupils, intubation, emergency drugs, possible external pacing, chest compressions until pulses or stopped by dr., if return of circulation for VF/VT pulses/asystole therapeutic hypothermia to protect brain

ACS/MI dx

EKG - ST depression, T wave inversion, ST Elevation Troponin levels- serial every 8 hours Chest X-ray (rule out aortic dissection Cardiac Catherization

Graph of EKG each wave has?

Each wave has a definition and based on numbers/measurement

Hypovolemic shock prevention/screening

Early ID and tx of the cause of fluid volume loss Early control of bleeding Monitoring of fluid volume status and early replacement of fluids

Reducing risk for infection and injury

Early and frequent patient mobilization to improve circulation and help prevent pneumonia

Premature contractions/complexes define

Early rhythm complexes when cells/cell groups other than SA node fire impulse before SA node aka ectopic focus

Managing fluids for cirrhosis interventions

Early stages aimed at preventing acculumulation via nutrition, drugs, paracentesis, respiratory support

Sepsis skin s/s

Early/septic shock pallor/cyanosis/mottling, severe sepsis skin warm/no cyanosis. If DIC petechia, ecchymoses. Blood can ooze from sites

S/s of airway obstruction

Early: dyspnea, coughin, inability to clear secretions. Late:stridor. Requires prompt attention and epinephrine give

Manifestations of SIADH: early?

Early: loss of appetite, n/v. Weight gain, hyponatremia, fluid shifts, lethargy, headaches, hostility, disorientation, change in LOC, seizures, coma, decreased DTR's, bounding pulse, hypothermia, elevated urine Na/specific gravity

Whats best for diagnosis HF

Echocardiogram which can detect valve changes, pericardial effusion, chamber enlargement, ventricular hypertrophy

Clinical observations for ARDS/failure

Edema, skin turgor, mucus membranes, I/Os, monitor for weight changes

Forensic nurse examiners RN-FNEs

Educated to obtain history, collect forensic evidence, offer counseling/follow up for rape/abuse

Responding to feelings of isolation

Education about modes of infection

Jane is seasoned nurse w/ 30 years experiences and is on 15 bed unit and she is just rehabilitating from knee surgery, how would you respond to the situation when other nurses complain unnecessarily that Jane's assignment has all of the patients in the front hall and with patient acuity scores of 1

Effective communication

Drop in creatinine is good indicator of

Effective treatment of therapy

Risk factors for sepsis

Elderly persons and children Postoperative patients 10 times more likely to die from sepsis than from MI or CVA Chronic illnesses DM CVD Immunosuppressive disease HIV/AIDS Use of long term immunosuppressive therapy Chemotherapy Poor nutrition Debilitation

Considerations for older adults and ventilation

Elders especially smokers/COPD at risk for dependence and failure to wean.

Preventing injury/bleeding

Electric shaver, soft brush, no aspirin, no contact spots, ice trauma sit, avoid hard foods, eat warm/cool/cold foods, check skin/mouth family, no anal sex, stool softener, no enemas/suppositories, don't bend at waste, loose clothes/shoes, no blowing nose or don't block both passages, no music instruments

Pacemakers

Electrical Stimulus to the heart muscle to depolarize cells to start muscle contraction Pacemakers can be temporary or permanent -Temporary: Used in patients with symptomatic bradycardia Transcutaneous- apply the electrodes to the chest wall Transvenous - external battery operated pulse generator flows with lead wire to stimulate the heart

Labs for HF

Electrolytes* + cardiac enzymes Creatinine* good indicator for renal perfusion magnesium CBC- hemoglobin and hematocrit B-type natriuretic peptide (BNP)* Urinalysis ABGs Coagulation studies Renal and hepatic function tests Thyroid function

Labs for HF

Electrolytes, possible raised BUN/creatinine, H&H to see if anemia, BNP/natriuretic peptide to dx HF w/ acute dyspnea, proteinuria, high specific gravity, microalbuminuria, ABG

Labs of hepatitis

Elevated ALT/AST, elevated phosphatase, bilirubin elevated, liver biopsy

ACS risk factors

Elevated Cholesterol Smoking HTN, DM, Obesity Increasing age, Family history, Premenopausal women, Race

35-year-old man with chest pain and diaphoresis

Emergent

85-year-old man with new onset of confusion; BP elevated compared to his usual reading.

Emergent

Psychosocial for cushing's

Emotionional instability, don't feel like themselves, mood swings, irritability, confusion, depression, crying/laughing inappropriately, sleep difficulties, fatigue

If high pressure alarm sound from increased PIP associated w/ deliverance of a sigh

Empty water from ventilator tubing, remove any kinks, coordinate w/ respiratory therapist or physician to adjust the pressure alarm

Conditions causing increased cortisol secretion

Endogenous secretion aka cushing's disease or exogenous admin aka cushing's syndrome

Endoscopic retrograde cholanggiopancreatogaphy ERCP

Endoscope to inject contrast to view biliary tract for stone removal, biopsy, stent placement

ERCP

Endoscopic retrograde cholangiopancreatography use a scope to inject contrast material to view the biliary tract.

Increased ICP rn interventions: maintaining patent airway

Endotracheal Intubation & mechanical ventilation if indicated Careful mouth care and suctioning as needed HOB 30-45°

What is most common type of airway for short term basis

Endotracheal tube and passes through mouth/nose and into trachea and rests 2cm above carina before bronchi

Penetrating trauma define? Skin integrity? Surrounding tissue?

Energy to body tissue from a moving or sharp object Skin integrity is interrupted Surrounding tissue deformation results

All patients w/ cirrhosis should be screened for

Esophageal varices by endoscopy to detect early before bleeding

Effects of portal hypertension w/ liver damage

Esophageal varices causing hematemesis, gastropathy, and melena. Splenomegaly, dilated abdominal veins aka caput medusae, ascites, rectal varices aka hemorrhoids

EGD

Esophagogastroduodenoscopy to directly visualize the upper GI tract

Maintaining social contact for HIV

Establish therapeutic relationship, don't isolate, spend time with them

Ovary hormones

Estrogen, progesterone

Sedatives for intubation

Etomidate, ketamine, propofol, midazolam, fentanyl, morphine

Health promotion and maintenance for sepsis

Evaluate all patients for risk factors (older adults) Aseptic technique Remove indwelling urinary catheters ASAP Remove and IV access lines ASAP Early detection of sepsis Hallmark of sepsis is rising lactate level normal or low WBC Teach patient and family manifestations of infection When to contact health care provider Take ALL antibiotics as prescribed

Low exhaled volume/low pressure alarm sounds from a cuff leak occurring in the ET or tracheostomy tube

Evaluate for cuff leak, Cuff leak suspected when patient can talk/airway escapes from mouth or when pilot balloon on artificial airway is flat

Low exhaled volume/low pressure alarm sounds from the patient stopping spontaneous breathing in the SIMV or CPAP mode or on pressure support ventilation

Evaluate patient's tolerance of the mode

If high pressure alarm sounds from decreased compliance of lung, a trend of gradually increased PIP

Evaluate reasons for decreased compliance, increased PIP occurs in ARDS, pneumonia, worsening of pulmonary disease

Evaluation and feedback

Evaluation is often the forgotten step in delegation

Although causes and initial manifestations associated w/ different types of shock vary

Eventually the effects of hypotension and anaerobic cellular metabolism result in key features of shock

Mouth care for mucositis

Examine mouth q 4 hours, if present notify, soft brush q 8 hrs/before meals, rinse mouth q 12 hrs, avoid alcohol mouthwash, rinse mouth 4x/day, drink 2L+ water, antimicrobial drugs, topical analgesics, swish and spit water, water based moisturizer, artificial saliza, no tobacco, no spicy/salty/acidic/dry/rough/hard food, cool liquids

Cushing's patho

Excess glucocorticoids causes slow turnover of fats causing total body fat increases, increases in tissue breakdown leading to increased urine N resulting in decreased muscle mass/strength+thin skin+fragile capillaries all leading to bone density loss

Hyperparathyroidism patho

Excess secretion of parathyroid hormone Increased serum calcium aka hypercalcemia and decreased serum phosphorus levels aka hypophosphatemia causing bone resorption/loss of Ca+reduced bone density

ADH excess? Causes what?

Excess secretion of vasopressin (ADH) Causes Syndrome of Inappropriate Antidiuretic Hormone

Cushing's : a group of abnormalities that result from?

Excessive levels of hormones produced by the outer layer of the adrenal glands Taking steroid hormones Excess production of adrenocorticotrophic (ACTH) may result from a pituitary gland tumor or a tumor associated with other organs Widespread symptoms

Functions of liver

Excretory, synthesis, storage, metabolism, detoxification. Clothing factors, sex hormone binding globulin aka SHBG, albumin

MODS multiple organ dysfunction syndrome

Exhaustion of metabolic reserves leads to failure and acidosis Oxygen supply/demand imbalance leads to acidosis Impaired myocardial function leads to decreased cardiac function and tissue hypoxia Microvascular thrombi leads to DIC and insufficient blood supply to multiple organs/systems

Common assessment findings for immunocompromised

Recurrent infections, diarrhea, fatigue, anemia

Preparing for intubation

Explain procedure, if emergency bring code/crash cart/airway equipment box/suction to bedside, maintain patent airway via positioning+oral/nasopharyngeal airway until intubated, monitor VS, s/s of hypoxia/hypoxemia, dysrhythmia, aspiration

Malnutrition is

Extreme issue fro patients and main reason for failure to wear from ventilator

Rn performing admission assessment on client dx w/ diabetes insipidus which findings does rn anticipate during assessment

Extreme polyuria, low specific gravity, excess thirst

Glasgow coma scale for head injury

Eye opening up to 4 points, verbal response up to 5 points, best motor response up to 6

Nerve 7

Facial pain, temp from ear, deep sensation of face, taste

Lupus erythematosus define

Facial rash systemic if chronic progressive autoimmune

Most heart failure begins w/

Failure of left ventricle and progresses to both ventricles

Fulminant hepatitis define? Results in?

Failure of liver cells to regenerate results in acute hepatitis

Major contributing factor for pression to septic shock

Failure to recognize/intervene

Coral snake characteristics

Red on yellow can kill a fellow

Systemic lupus s/s

Red rash, lesions, nephritis, pericarditis, raynaud's phenomenon, pleural effusion, CNS lupus, ab pain, joint inflammation, myositis, fever, fatigue, anorexia, vasculitis, muscle atrophy, pneumonia

Nutrition Interventions for HF that reduce preload raising SV

Reduce Na and water retention. Restricted Na to 2-3 g/day, possible fluid restriction to 2 L/day, weight daily

Goals for cushing's

Reduce cortisol levels, remove tumors, restoration of normal/acceptable body appearance

Diuretics

Reduce fluid volume. Vasodilators reduce preload and/or afterload, inotropics increase contractility

Promoting comfort for Graves

Reduce room temp, make sure fresh pitcher of ice water, change bed linen when wet from diaphoresis,suggest cool shower/bath, artificial tears for eyes, taping eyelids closed for sleep

Renin-angiotensin system activation w/ HF

Reduced blood flow to kidneys activates. Vasoconstriction and aldosterone causes sodium and wate rentention causing peripheral edema

Pancreas complications of HIV

Reduced exocrine function: fatty food intolerance, cholelithiasis, pancreatitis. Reduced endocrine function: DM, hyperlipidemia

CD4 in HIV is? Leading to?

Reduced leading to lymphocytopenia, increased production of incomplete antibodies, abnormal macrophages

Compensatory mechanism to improve increased ICP

Reduction of CSF volume by contraction of ventricles Reduction of blood volume in the cranium Hypoventilation PCO2 causing vasodilation Cushing's reflex Displacement of brain matter (herniation)

Expected outcomes for cushing's

Reduction of cortisol levels Removal of tumors Restoration of normal body appearance Maintain fluid and electrolyte balance

Warning signs of primary immune deficiency

Fam history of immune deficiency, drugs that cause it, RA Frequent/unusual infections or unusual complication. 8+ infections w/in 1 yr, 2+ sinus infections w/in 1 yr, 2+ months on antibiotics w/ little/no effect, 2+ pneumonias w/in 1 yr, failures of infant to gain weight/grow, recurrent deep skin/organ abscesses, persistent thrush after 1 y/o, need for IV antibiotics for infection, 2+ deep seated infections

Assessment for hyperpituitarism

Fam history, hat/glove/ring/shoe size change, fatigue lethargy, backache, arthralgias/joint pain, headaches, vision changes. Initially lip/nose size increase

S/s of pit viper envenomation

Fang marks, swelling, a lot of pain n/v, parathesia, hypotension, ecchymosis, necrosis, hypovolemic shock, pulmonary edema, renal failure, DIC, minty/metallic taste, tingling/paresthesia of scalp/face/lips, fasciculations/twitching, seizures

Amyotrophic lateral sclerosis s/s

Fasciculations/face twitching, dysarthria/slurred speech, dysphagia,, fatigue, muscle atrophy/weakness

Oral vs. nasal route

Fast/easy for emergency vs. facial/oral traumas/surgeries when oral not possible but not for blood clotting issue

General appearance of Cushing's

Fat redistribution: moon face, buffalo hump, truncal obesity. weight gain, ace, fine coating of hair over face/body, male pattern balding in women

Symptoms r/t decreased CO

Fatigue Weakness/Activity intolerance Oliguria during day (nocturia during night) Angina Confusion, restlessness Dizziness Tachycardia, palpitations Pallor Weak peripheral pulses Cool extremities

Early manifestations of cirrhosis

Fatigue, change in weight, GI s/s like anorexia/vomiting/ab pain/liver tenderness

Right sided HF aka for pulmonale

Fatigue, high peripheral venous pressure, ascites, enlarged liver/spleen, may be secondary to chronic pulmonary problems, distended jugular veins, anorexia/GI distress, weight gain, dependent edema

Left sided heart failure key features of decreased CO

Fatigue, weakness, oliguria during day, nocturia at night, angina, confusion/restless, dizziness, tachycardia, palpitations, pallor, weak pulses, cool extremities

Stages of liver damage

Fatty aka fat deposits, fibrosis aka scar tissue, cirrhosis aka cell damage

For cerebellar function test

Fine coordination test via running heel of foot down shin, hands palm up then palm down on each thigh, arms out at the side and fingers to nose, gait and equilibrium

ACE

First choice treatment for HF Lowers BP and reduce progression of heart damage from HF Inhibit angiotensin-converting enzyme (ACE) from activating the hormone angiotensin. Angiotensin signals the body to constrict blood vessels-raising BP Decrease the resistance to blood flow in vessels Dilates arteries Common side effect- dry cough, altered taste

Ventricular fib first thing to do?

First thing to do assess, immediate defib/cpr if leads correct

Assessment of anaphylaxis

First uneasiness, apprehension, weakness, impending doom, anxious, frightened. Then itching, urticaria/hives, erythema, angioedema of eyes/lips/tongue. Then histamine causing bronchoconstriction, excess mucus causing confession/wheezing/crackles/stridor, hypotension, hypoxemia

Bladder training

Reflex bladder treated with medications, neuromodulation, bladder surgery, or indwelling catheter. Infection control, utilizing proper techniques to prevent UTI Nonreflex bladder requires the uses of condom catheters for men and pads/waterproof undergarments for women. Skin breakdown and external infections are a major concern

Level 1 trauma center

Regional capable of total care for every aspect of injury

HF management: exercise? Drugs? Vax? Monitor? Focus on?

Regular exercise (unless decompensated) Smoking cessation No drugs Influenza and pneumonia vaccines Monitor daily weights (plan of action if weight increases by 2-3 lbs.) Focus on control of risk factors for other underlying/aggravating diseases (such as DM, ischemic heart disease)

Points oc transition to practice model

Regulation(providing new graduates w/ info on SOP, Nurse practice act, maintaining license), practice(provides link that will provide new graduates w/ planned practice experiences w/ qualified nurses to mentor), education(experts in curriculum design)

To increase ability with ADLs for ards/respiratory failure

Reinforce O2

Nutrition/exercise for respiratory failure/ARDS

Frequent small meals and medical food supplements •supplementations for 7 -12 days. Medical food supplements for outpatients: low BMI, weight loss patients at nutritional risk benefit especially when combined with exercise. •Osteoporosis:Calcium & vitamin D, avoid tobacco/ETOH intake •Vitamins:diet w/ adequate intake (AI) vitamins A/C/E. . No studies to show needs >RDA, •Omega-3 Fatty Acids •Milk and Mucus: •Limit empty calorie foods •Accept meal prep help, MOW, freeze extra portions, rest before eating Tube Feeding Consider Takes the pressure off of the child to Eat more than they would like. Night time feedings Daytime boluses Formula

Coagulation intracranial hemorrhage from anticoagulation increased ICP

Fresh frozen plasma, vitamin K, platelets

Cardiogenic shock

From MI, arrhythmia, valvular heart disease, HF leading to low venous return/CO leading to poor o2 perfusion causing shock

Hepatitis B from? S/s? Recovery?

From Sex, needles, blood, hemodialysis, maternal-fetal route, person-to-person contact by open cut/sores, if immunnosuppressed. S/s: anorexia, n/v, fever, fatigue, RUQ pain, dark urine, light stool, joint pain jaundice, no symptoms. Can recover

Adrenocorticotropic hormone ACTH from? Targets? Stimulates?

From anterior pituitary and targets adrenal cortex. Stimulates corticosteroids and adrenocortical growth

Growth hormone from? Targets? Function?

From anterior pituitary and targets bone/soft tissue to promote growth via lipolysis, protein anabolism, and insulin antagonism

Leuteinizing hormone from? Targets?function?

From anterior pituitary and targets ovaries and testes to stimulate ovulation/progesterones and testosterone secretion

Follicle stimulating hormone from? Targets? Function?

From anterior pituitary and targets ovary/testes to stimulate estrogen+follicle maturation or spermatogenesis

Acute thyroiditis from? Causes what?

From bacteria causes pain, neck tenderness, malaise, fever, dysphagia and fixed w/ antibiotics

Hepatopulmonary syndrome from? Aka? Monitor?

From cirrhosis aka breathing issues from ascites pressure. Listen for crackles

Chronic hepatitis from? Usually leading to?

From hep B or C usually leading to cirrhosis and liver cancer

Hyperpituitarism from? Leading to?

From hypothalamus hyper functioning, tumors, tissue hyperplasia, adenoma/benign tumor leading to endocrine symptoms, visual changes, headache, increased ICP

Brain herniation

From increased ICP tissue shifts and herniated down causing pressure on nerves causing eye/LOC/cheyen stokes issues

Right sided/ventricular failure

From left HF, right ventricular MI, or pulmonary hypertension. Right ventricle cannot empty and increased volume/pressure develop in venous system causing edema

Distributive shock

From neural induced, spinal injury, chemical induced, anaphylactic, sepsis. All lead to peripheral dilation lowering venous return/CO/MAP leading to poor perfusion causing shock. Fluid shifted from central vascular space, body fluid volume normal/increased

Obstructive shock

From pericarditis, cardiac tamponade, extended immobility leading to low venous return/CO causing poor o2 perfusion leading to shock. Cardiac function decreased from noncardiac factor, central volume decreased but total fluid no affected

Adenocorticotropic hormone ACTH from what? Affects what? Hyper?

From pituitary and affects adrenal cortex. Hyper: excess glucocorticoids, mineralcorticoids, androgens leading to Cushing's disease

Portal hypertension gastrophy

From portal hypertension, slow gastric mucosal bleeding occurs resulting in chronic slow blood loss, occult positive stools, anemia

Preventing myxedema coma r/t hypothyroidism

From stress like illness, surgery, chemo, discontinuing thyroid replacement+sedatives/opioids. Coma, respiratory failure, hypotension, hyponatremia, hypothermia, hypoglycemia, shock, organ damage/failure can all occur due to this. Monitor for and report change in LOC

Androgen/steroid/testosterone therapy SE:

Gynecomastia, acne, baldness, prostate enlargement

Restoring skin integrity for HIV

HAART/radiation/chemo for kaposi's sarcoma, analgesics/comfort, clean/dressed, skin care

Cardiomyopathy leads to

HF so treat as HF. Usually gets LVAD or transplant. Treated via treating symptoms.

dx of AIDS requires? Once AIDs diagnosis?

HIV + and have either CD4 count <200 or an opportunistic infection or 2 or more episodes of pneumonia in 1 year. Once AIDS diagnosis even if CD4 goes up or infection treated they will still have AIDS

How to prevent ventilator associated pneumonia

HOB at least 30-45 degrees(reduce reflux/aspiration) Assess need for suctioning(oral, nasal, tracheal)Q2 Oral Care Q2-4 hours (reduce dental plaque and infection) Stress Ulcer prophylaxis (Protonix, Pepcid) Hand Hygiene/ gloves when providing care Turn/position Q2 hours ("GOOD LUNG DOWN") Assess readiness to wean off ventilator daily with spontaneous breathing trials (SBT) Daily Spontaneous Awakening Trials (SAT)

CO=?

HR x SV(preload, afterload, contractility)

CO equation

HR x SV(volume of blood ejected w/ contraction 60-70)

Activity intolerance s/s

HR/BP change >20, fatigue, chest pain,dyspnea

Normal sinus them

HR:60-100, P, QRS, present

Left sided heart failure key features of pulmonary congestion

Hacking cough worse at night, dyspnea, breathless, crackles/wheezes, frothy/pink sputum, tachypnea, heart Gallup/extra sound

Complications of thyroidectomy

Hemorrhage, respiratory distress from tracheal compression/nerve damage/tetany, parathyroid injury causing hypocalcemia/tetany, nerve damage, thyroid storm

Common joint deformities in RA

Herberden's and Bouchard' nodes affecting fingers

Expected outcomes of acromegaly

Hormone levels return to normal or near normal Reduce or eliminate headache and visual disturbances Reverse body changes if possible

Interventions for pituitary hypofunction? If gonadotropins steroids/testosterone given via IM? For women what's given?

Hormone replacement. If gonadotropins steroids/testosterone given via IM w/ high dose first and continued until virilization aka presence of male secondary sex characteristics is achieved. For women estrogen/progesterone given

Skin and skeletal muscles can tolerate low O2 for how long without dying/damaged

Hours

Flow rate is

How fast each breath delivered and usually set to 40 L/min

Mechanism of injury define

How patient's traumatic event occurred

Risk factors for cardiogenic shock

Hx CAD PVD DM Hypertension High cholesterol and triglycerides Tobacco and alcohol use Hx heart attack or CAD Obesity

Increased CSF examples

Hydrocephalus, pseudotumor cerebri

Thiazide diuretics

Hydrochlorothiazide or metolazone/zaroxolyn. Longer acting. Dehydration not common like loops

Lupus inteventions

Hydroxychloroquine/palquenil, chronic steroid therapy, immmunosuppressant methotrexate, protect skin from sun, no perfume, lotion, no drying agents like alcohol

MS sensory issues

Hypalgesia aka diminished pain sensitivity, paresthesia, facial pain, decreased temp. Sensation, numbness, tingling, burning

If no perfusion and DM

Hyper or hypglycemia possible with HF. If RHF anorexia which can affect meds and diet

Calcium: hyper? Hypo?

Hyper- blocks conduction pathways Hypo- decreased myocardial contraction

Magnesium: hyper? Hypo?

Hyper- causes delayed impulse conduction Hypo- irregular ventricular contraction

Potassium: hyper? Hypo?

Hyper- decreased cardiac conduction, life threatening rhythm Hypo- myocardial hyper excitability, ECG changes

Cushing's aka? From? Affects?

Hypercortisolism. From problem w/ adrenal cortex, problem w/ anterior pituitary, or problem w/ hypothalamus, or glucocorticoid therapy. Affects metabolism and all body systems

1st degree vs. 2nd degree vs. 3rd degree vs. 4th degree frostbite

Hyperemia and edema vs. blisters w/ partial thickness necrosis vs. dark blisters no blanching, full thickness necrosis w/ debridement vs. no blisters/edema, bloodless, necrosis to muscle/bone, gangrene w/ amputation

Primary mechanisms that can result in SCI

Hyperflexion, hyperextension, axial loading/vertical compression, excess rotation

Insufficiency of adrenocortical steroids aka Addison's can result in

Hyperkalemia - excretion is decreased Poor glucose regulation - hypoglycemia Fluid and electrolyte imbalance, increased sodium and water excretion causing hyponatremia and hypovolemia Decrease in body, axillary, and pubic hair, particularly in women

Monitoring kidneys for K

Hyperkalemia if kidneys not functioning well, review creatinine and if >1.8 notify before admin of K

CV manifestations of Cushing's

Hypertension, increased risk for thombolic events, frequent dependent edema, capillary fragility leading to bruising+petechiae, hypervolemia

SE of women gonadotropin hormone replacement? What's given to induce ovulation?

Hypertension, thrombosis increased esp. if they smoke. Clomid given to induce ovulation

Acute and rehab phases: autonomic dysreflexia assessment

Hypertensive emergency S/S include pounding HA, diaphoresis, nasal congestion, piloerection, bradycardia, and HTN

Grave's aka? Definition? Leads to? Occurs w/?

Hyperthyroid aka toxic diffuse goiter. Autoimmune disorder leading to goiter, exopthlamos aka abnormal eye protrusion, pretibial myxedema aka dry/waxy swelling of lower legs. Occurs w/ DM, vitiligo, arthritis

Hyperfunction of thyroid: disorders

Hyperthyroidism aka thyrotoxicosis/grave's disease, thyroid storm, goiter

Drowning assessment salt water

Hypertonic fluid draws protein fluid into alveoli causing pulmonary edema

Nonobstructed cardiomyopathy

Hypertrophy of all walls and septum

Posterior pituitary disorders hypo? Hyper?

Hypo: diabetes insipidus. Hyper: syndrome of inappropriate antidiuretic hormone SIAH, oxytocin

Growth hormone disorders: hypo? Hyper?

Hypo: dwarfism, cretinism. Hyper: gigantism, acromegaly

Adrenal cortex disorders hypo? Hyper?

Hypo:Addison's aka insufficient cortisol, hyper:Cushing's excess cortisol, Conn's excess aldosterone, Adrenal virilizing syndrome aka excess androgens

Parathyroid disorders hypo? Hyper?

Hypo:hypocalcemia, elevated phosphate. Hyper: hypercalcemia, hypercalcemia crisis

Thyroid gland disorders hypo? Hyper?

Hypo:hypothyroidism, autoimmune thyroiditis/hashimotos, myxedema coma. Hyper: hyperthyroidism, Grave's/thyrotoxicosis, goiter, thyroid storm

Hypo-parathyroid disorder define? From? Fixed how? diet?

Hypocalcemia, elevated phosphate. From surgery that removed parathyroid, autoimmune, or hypomagnesemia, radiation. Fixed via IV calciium, calcitriol, mag sulfate replacement. Test to eat high Ca lo phosphorus foods no milk/yogurt/cheeses

Nerve 12

Hypoglossal muscle of tongue

Combined ventilatory and oxygenation failure

Hypoventilation. Impaired gas exchange at alveoli resulting in poor diffusion of o2 into blood and CO2 retention and may/may not include poor lung perfusion. When lung perfusion not adequate V/Q mismatch and both ventilation and perfusion inadequate

Unstable dysrhythmias H and T's?

Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypo/ hyperkalemia Hypoglycemia Hypothermia Toxins Tamponade, cardiac Tension pneumothorax Thrombosis (coronary or pulmonary) Trauma

ARDS indicated by

Hypoxemia that persist (despite 100% oxygen) Decreased pulmonary compliance (elasticity) Dyspnea Non-cardiac related bilateral pulmonary edema Chronic pulmonary fibrosis which can lead to a systemic inflammatory response syndrome (SIRS)

Mechanical ventilation most used for

Hypoxemia, or progressive alveolar hypoventilation w/ respiratory acidosis, surgery, those who expend too much energy w/ breathing, those who have general anesthesia/heavy sedation

Whatever the underlying problem patient in ARF is always

Hypoxemic aka has low arterial blood oxygen levels

Types of respiratory failure

Hypoxic respiratory failure, hypercapnic respiratory failure,

Teacher/educator

INDIVIDUALED TEACHING PLANS TO MEET LEARNING NEEDS OF PATIENTS AND THEIR FAMILIES THROUGH COMMUNICATION

ER care of patient w/ acute adrenal insufficiency

IV NS/dextrose, Hormone replacements H2 blocker for ulcer prevention. Hyperkalemia:Insulin w/ dextrose/NS, Kayexalate for K binding/excreting resin, loop/thiazide diuretics, K restriction, I/O, monitor ECG for slow HR/block/fibrillation. Hypoglycemia: IV glucose, glucagon, monitor BG

Acute spontaneous bacterial peritonitis treatment

IV antibiotics-Quinolones: Norfloxacin, Bactrim if patient has an allergy.

Interventions for hyperparathyroidism

IV fluids, drugs, monitor Ca levels, EKG/cardiac monitor, I/O, prevent injury from bone density loss, encourage low Ca/Vitamin D diet, strain urine, furosemide/lasix+IV saline for Ca excretion, prevent injury

Class 1 LHF from MI interventions

IV nitrates and diuretics, monitor u/o+VS hourly, monitor K

Precautionary measures if an agent must be used despite history of allergic reaction

IV solution, intubation equipment/trach set at bedside, premeditated w/ diphenhydramine aka benadryl or corticosteroid and started slowly

Sores in mouth for HIV interventions

Ice and cold stuff to decrease pain

First aid/prehospital care for black widow

Ice first, monitory for systemic toxicity and if systemic ABC then ED

First aid/prehospital care for brown recluse

Ice, no heat, elevation, wound care, rest

Health promotion for hypovolemic shock

Identify patients at risk Elderly Debilitating illness (avoid overload) Immunocompromised Surgical or accidental trauma patients Cultural and religious attributes (blood products Length of time of hypo-perfusion can impact outcome despite appropriate intervention

If adrenal issue due to pituitary increased ACTH? If from adrenal tumor?

If Adrenal issue due to pituitary increased ACTH removal of pituitary adenoma or hypophysectomy via transphenoidal or transfrontal rout. If from adrenal tumor a partial or complete adrenalectomy.

Neuro manifestations of hypopituitarism if from tumor?

If from tumor changes in vision first, temporal headaches, diplopia/double vision, ocular muscle paralysis limiting eye movement

How to prevent dysrhythmia for ischemic heart disease? If not relieved or gets worse?

If having angina attack treat w/ rest and nitroglycerin, if not relieved/gets worse/sweating/n/weakness/palpitations seek medical help

Stress test

If no chest pain, walks on treadmill to see how well squeeze of heart is for HF

Hypopituitarism if one hormone affected know as? If all hormones? Caused by?

If one hormone affected known as selective, if all hormones decreased called panhypopituitarism. Caused by tumors, malnutrition, rapid loss of body fat, shock, severe hypotension, head trauma, infection, radiation, surgery, AIDs, postpartum hemorrhage

Hypocalcemia/tetany after thyroid surgery: if what happened? Monitor for?

If parathyroid removed/damaged. Monitor for tingling around mouth/toes/fingers, assessor muscle twitching if Ca definiciency

Compensatory stage of shock

If perfusion deficit corrected during or before nonprogressive/compensatory, patient recovers with no residual sequelae If deficit not corrected, patient enters progressive stage

Teach that minor head injury that what can occur

If they have concussion post concussion syndrom can happen. S/S: personality changes, irritability , headaches, dizziness, restlessness, nervousness, insomnia, memory loss, de[presson

Expected outcomes of hyperparathyroidism

If total surgical removal of parathyroid glands, pt verbalizes requirement for lifelong therapy. Hormone levels return to normal Remains free of injury

To assesss humoral immunity

Immunoglobulin Ig levels: IgA, IgG should be 75%, IgM 15%. Presence of circulating B cells

Disease modifying antirheymatics + biological response modifiers

Immunosuppressant decreasing WBCs+platelets avoid large crowds/ill, avoid alcohol,

How ascites develops

Impaired albumin production Serum osmotic pressure decreases, reducing the return of fluid to the blood from the tissues Fluid shifts from the vascular system into the abdomen, a form of "third spacing".

HF impaired? Heart unable to? Characteristic

Impaired cardiac pumping/filling Heart unable to produce adequate cardiac output (CO) to meet metabolic needs Chronic and progressive

Left sided HF assessment

Impaired perfusion, anaerobic metabolism, unusual fatigue. Ask about ADLs, chest discomfort/palpitations/slipped beats, nonproductive cough usually at night, later possible pink frothy sputum if pulmonary edema, dyspnea, exertions dyspnea, orthopnea

Whats characteristic from left ventricular failure

Impaired tissue perfusion, pulmonary congestion, edema, decreased CO

Multiple sclerosis rn dx

Impaired verbal communication and risk for aspiration related to cranial nerve involvement Impaired physical mobility related to weakness, muscle paresis, spasticity Risk for injury related to sensory and visual impairment Impaired urinary and bowel elimination (urgency, frequency, incontinence, constipation) related to nervous system dysfunction Disturbed thought processes (loss of memory, dementia, euphoria) related to cerebral dysfunction

CPAP for HF

Improves sleep apnea which is directly correlated w/ CAD as result of diminished o2 to heart

Parkinson's interventions

Improving Mobility Enhancing Self-Care Activities Improving Bowel Elimination Improving Nutrition Enhancing Swallowing Encouraging the Use of Assistive Devices Improving Communication Promoting Home and Community-Based Care Teaching Patients Self-Care

Priority problems of HF

Improving gas exchange, improving CO, decreasing fatigue/weakness, preventing/managing pulmonary edema

In ventilatory failure what leads to hypoxemia

Inadequate o2 intake or CO2 retention

Hypoxia

Inadequate o2 to tissues

Shock is? Insufficient?

Inadequate tissue perfusion+o2 to maintain function Insufficient oxygen delivery, uptake and utilization to meet the metabolic demands of cells and organs.

Hydrocephalus

Increase in CSF from TBI

Maximal effects of sex steroid replacement w/ androgen/testosterone replacement

Increase in penis size, libido, muscle mass, bone size, bone strength, hair growth, voice deepens, improved self esteem/body image

Cushing's response/reflex triad

Increase in the systolic blood pressure with a widening of the pulse pressure (Hypertension) Cardiac slowing (Bradycardia) Change in respiratory pattern (Bradypnea)

Metabolic manifestations of hyperthyroidism

Increased BMR, heat intolerance, low fever, fatigue

Catecholamine epinephrine effects on heart? Blood vessels? GI? Kidneys? Bronchioles? Bladder? Fat? Pancreas?

Increased HR. Vasodilation. Decreased motility. Increased renin release. Relaxation/dilation. Relaxation. Increased lipolysis. Increased glucagon and insulin released.

Respiratory key features of shock

Increased RR, shallow depth, increased PaCO2, decreased PaO2, cyanosis esp. around lips/nails

Kidney/urinary + skin manifestations of DI

Increased U/O: low specific gravity/dilute urine, hypo-osmolar, poor turbot, dry mucous membranes

Increased PIP means

Increased airway resistance in patient or ventilator tubing aka bronchospasm or pinched tubing, increased secretions, pulmonary edema, decreased pulmonary compliance(lungs stiffer to inflate)

Endocrine findings of cirrhosis

Increased aldosterone/ADH/estrogen/glucocorticoids, gynecomastia

What labs indicate cirrhosis from biliary obstruction

Increased alkaline phosphatase and gamma-glutamyl GGT decreased fecal urinobilinogen, light/clay colored stool, high AMA and ANA titers and elevated immunoglobulin

ARDS: increased? Diffuse? Poorly?

Increased alveolar capillary membrane permeability Diffuse alveolar inflammation and damage is a defining feature of ARDS, appearing as dense bilateral pulmonary infiltrates on chest radiography which significantly reduce lung compliance. Poorly inflated alveoli receive blood but cannot exchange gases therefore a (V/Q) mismatch and hypoxemia results.

Which manifestations are most often seen in general hyperthyroidism

Increased appetite, eyelid retraction, insomnia, palpitations, tremors

Adrenal cortex complications of HIV

Increased cortisol: fat redistribution, decreased muscle. Decreased cortisol: adrenal insufficiency, hypoglycemia, hyperkalemia, hypotension, fatigue, weight loss

In infection WBC differential count usually shows

Increased number of immature nutriophils aka shift to the left

Portal hypertension from cirrhosis define? This leads to? Blood seeks? The hepatocytes have? Leads to?

Increased resistance to or obstruction of the flow of blood thru the portal vein and its branches. This leads to an increase pressure within the portal vein. Blood seeks an alternative path around the increased pressure. The hepatocytes have less access to blood impairing their ability to perform. Leads to esophageal, gastric, and hemorrhoidal varices

Neuro manifestations of DI

Increased thirst, irritability, decreased cognition, hyperthermia, lethargy-coma, ataxia all b/c of dehydration

Renal findings of cirrhosis

Increased urine bilirubin, hepatorenal syndrome

Right sided HF r/t

Increased volume and pressure develops in the venous return Ineffective pump of right ventricle Cannot empty completely Usually caused by lung disease or left HF Weight gain and edema due to systemic blood flow back up Impaired activity and exercise tolerance

S/s of ARDS

Increased work of breathing/hyperpnea, noisy respiration, cyanosis, pallor, intercostal/substernal retractions, sweating, respiratory effort, altered LOC, hypotension, tachycardia, dysrhythmia

Erythropoietin vs. thrombopoietin

Increases RBCs vs. platelets

Megace does what

Increases appetite

Parathyroid hormone function on bone

Increases release of Ca+phosphorus from bone into extracellular fluid aka bone resorption, decreased bone formation, increased bone breakdown all to increase serum Ca

Histamine activity? Symptoms produced?

Increases vascular permeability, constricts smooth muscle, increases gastric acid secretion. Edema of airway, bronchial constriction, urticaria, angioedema, pruritus, n/v/d, shock

Hallmark of sepsis is

Increasing serum lactate, normal/low WBC, decreasing segmented nutrophil w/ rising band nutrophil aka left shift

Dyspnea assessment guide

Indicate amount of SOB you are having by marking the line. Left side of line is no SOB and right side is SOB as bad as can be

Droplet

Indirect transmission w/ infected secretions. Stay at least 3 ft away. Ex: flu

Rn dx for increased ICP

Ineffective airway clearance related to diminished protective reflexes (cough, gag) Ineffective cerebral tissue perfusion related to the effects of increased ICP Risk for infection related to ICP monitoring system (fiberoptic or intraventricular catheter)

Rn dx for shock

Ineffective tissue perfusion; renal, cerebral, cardiopulmonary, gastrointestinal, hepatic, and peripheral related to decreased perfusion to vital organs as evidenced by low heart rate/decreased blood pressure/cool clammy skin etc. Fear and anxiety related to potential for death as evidenced by restlessness Potential complication for organ ischemia/dysfunction related to decreased perfusion as evidenced by abnormal vital signs

Initial assessment is?

Initial assessment for who to see first, not secondary stuff

Basic stages of shock: common to all types of shock

Initial stage (early shock) Non-progressive (compensatory) stage Progressive (intermediate) stage -life threatening emergency Refractory (irreversible) stage MODS/multi organ dysfunction syndrome

Drug therapy for hyperthyroidism/graves

Initial treatment. Iodine, lugol's solution, thionamides like PTU/uracil+methimazole/tapazole, lithium, bea blockers -lol, radioactive iodine therapy

ARDS patho

Injury causes lung fluid increases w/ more protein. Surfactant reduced causing unstable alveoli, edema forms, then hypoxemia and ventilation-perfusion V/Q mismatch result

Secondary mechanisms that can result in SCI

Injury that worsens primary injury: hemorrage, ischemia/lack of blood flow, hypovolemia, neurogenic shock

Trauma definition? Mechanisms? Multi? What results

Injury to living tissue Mechanism of injury (MOI) : Intentional, Unintentional Multisystem affect Injury results

Blunt trauma define? Extent of injury? Transfer energy?

Injury without interruption of skin integrity from impact forces like MVA, fall, blast effect from bomb, acceleration-deceleration forces Extent of the injury may be masked Transfer energy causing tissue deformation trauma to bones, vessels, tissue

Drugs that enhance contractility Interventions for HF raising SV

Inotropics , vasodilators, beta blockers. If chronic low dose beta blockers. Digoxin for symptoms decreasing dyspnea

If high presssure alarm sounds from coughing/gagging/biting ET tube

Insert oral airway to prevent biting

If you cannot get vein via IV or catheter

Intraosseous access

Terlipressin and somatostatin can cause? So observe?

Ischemic complications and dysrhythmia so observe heart rhythm, apical pulse, BP, assess for stroke

Ventricular tachycardia caused by

Ischemic heart disease, MI, cardiomyopathy, hypokalemia, hypomagnesemia, valvular disease, heart failure, drugs, hypotension, ventricular aneurysm, common the initial rhythm before ventricular fibrillation/arrest

Pancreas hormones patho?

Islets have alpha cells for glucagon to raise glucose and beta cells for insulin to lower glucose and delta cells for somatostatin to inhibit glucagon/insulin

If no p

Issue with ventricle

Issues w/ brainstem, thalamus, cortex result in? Cerebellar issues?

Issues w/ opposite side of body. Same sside

Dysrhymias are abnormal rhymes of heart's electrical system how does this affect heart function

It cannot effectively pump oxygenated blood throughout the body

If a person has a positive test result for HIV antibodies

It doesn't mean they ave AIDS only that they are infected w/ virus

Late assessment findings of cirrhosis

Jaundice- (skin and sclera), edema Deterioration of mental function /memory Ascites, hepatosplenomegaly,esophageal varices, Spider angiomas on nose, cheeks, shoulders, veins on abs, palmar arethyma Gynecomastia, hirsutism, peripheral neuropathy Bleeding tendencies and hemorrhage, varices/hemorrhoids, anemia, thrombocytopenia Weakness/wasting R/T anemia & malnutrition RUQ firm, nontender

Late manifestations of RA

Joint deformities, moderate/sever pain, morning stiffness and systemic s/s

Early manifestations of RA

Joint inflmmation, systemic: low fever, fatigue, weakness, anorexia, paresthesias

Acute gout s/s

Joint inglammation, pain, swollen, usually pain in great toe aka podagra, ESR increased, serum uric acid >6.5, urinary uric acid >750

If taking lasix at home they are probably taking what else

K supplement

To prevent VAP/ventilator acquired pneumonia

Keep HOB >30 degrees

Patient fluid restriction teaching should include

Keep a fluid log to record their daily fluid intake Patient to weigh daily. A rapid change in weight can be the result of fluid gain or loss Be aware of how much fluid is in each cup or glass regularly used To determine this, fill each with water. Then, pour the water into a measuring cup To reduce thirst and to decrease dry mouth: Maintain a diet low in sodium Chew on ice cubes/chips. Remember, this fluid needs to be counted in daily fluid intake Suck on sugar-free hard candy Chew gum

Diastole vs. systole

Relaxation/filling vs. contraction and emptying

Extubation

Removal of ET tube. Explain procedure, O2/emergency intubation equipment at bedside. Hyperoxygenate and suction tube/mouth then deflate cuff and remove tube at peak inspiration. Instruct to cough, O2 via facemask/nasal cannula

Obstructive shock treatment

Removal of obstruction CT or needle decompression to remove trapped air pneumothorax Needle pericardiocentesis remove blood pericardial sac Surgical embolectomy Surgical repair aneurysm Anticoagulant therapy (PE)

Exposure interventions

Remove all clothing via scissors if rapid access/possible further injury/fabrics melt into skin. Consider forensics using paper bag for clothing/gloves. Warm client

Acute and rehab phases: autonomic dysreflexia interventions

Remove triggering stimulus Place pt in high fowlers position to ↓BP Identify and Treat the Cause Urinary catheter insertion Fecal decompaction Administration of ganglionic blocking agent (hydralazine) IV Patient education Skin assessment for irritants (wrinkle sheets, food crumbs...)

Preventing hypothermia

Remove wet clothing/sheets Cover client Infuse warm (Invasive) solutions/blood products Increase room temperature Warm/Warming blankets Heat lamps

Minimizing confusion for HIV

Reorient to person/time/place, simple directions, simple language, bring familiar items from home, calendars/clocks, safety, assess for increased ICP and change in LOC

Dx of MG

Repetitive nerve stimulation, electrolyography, tensilon testing

51 y/o in hospital w/ recurrent HF. 237lb, IV in left arm, on O2 2L via nasal cannula. Sitting on side of bed, SOB, returned from bathroom, sweating, nasal cannula on bedside table, what should you do first

Replace nasal cannula ABCDE

Patients w/ HF may experience increased

Thirst and drink excess fluid from sodium retention

CNS changes for hypovolemic shock

Thirst, initial/nonprogressive restless/agitated/anxious/impending doom, progresses to confusion/lethargy then somnolence/loss of consciousness

Control of metabolism via thyroid gland occurs through? Controlled by? What's needed for t4/t3?

Thyroxine T4 and triiodothyronine T3 which increase metabolism/BMR Controlled by hypothalamus thrytropin releasing hormone which trigggers anterior pituary TSH which stimulates T3/T4. Protein and iodine needed for t4/t3.

Emergent triage time to RN/MD? Reassess when? Condition exists that?

Time to RN/MD is immediate, reassess continually. Condition exists that Potawatomi immediate threat to life or limb

Urgent triage time to intervention? Reassess? Define?

Time to intervention 1-2 hours, reassess q 30 minutes or less. Immediate threat to life doesn't exist

Urgent Define? Reassess how often? Examples?

Time to intervention 1-2 hours, reassess q. 30 minutes or more. Suicide or mental issues

Nonurgent triage time to intervention? Reassess?

Time to intervention is several hours, reassess q 1-2 hours

When should RNs document

Timely Chronologically Frequently Late, Delayed or Lost entries

Hypocalcemic crisis s/s

Tingling and twitching of facial muscles and extremities Tetany - muscle spasms as a result of calcium deficiency

Hypoparathyroidism s/s

Tingling, numbness, muscle tentany, severe cramps, spasms, seizures, irritability, psychosis, inappropriate muscle contractions(which can indicate tentative), + Chnosteks/Trousseaus indicate tetany

MS cranial nerves s/s

Tinnitus, vertigo, hearing loss, facial weakness, dysphagia, dysarthria aka slurred speech, dysphagia

Refractory/irreversible stage of shock

Too little oxygen reaches tissues Cell death and tissue damage result causing MOD Body cannot respond effectively to interventions Rapid loss of consciousness Non-palpable pulse Cold, dusky extremities Slow, shallow respirations Immeasurable oxygen saturation

Overal goals of management of shock

Treatment of cause if known Restoration of oxygen delivery to the tissues Reduce oxygen consumption

Mannitol and increased ICP

Treatment of choice, osmotic diuretic, keeps serum osmolarity higher which dehydrated brain. High is dry, low is overload

Thyroid storm/crisis: triggered by? Event that occurs w/? Report? UAP? If temp increased?

Triggered by stressors like trauma, infection, ketoacidosis, pregnancy, iodine. Life threatening event that occurs w/ uncontrolled hyperthyroidism and characterized by high fever and hypertension, tachycardia, ab pain, n/vm diarrhea, anxiousness, tremors, restless, confused, seizures, coma, death. Report any temp increase even of 1 degree F. UAP reports temp as soon as obtained. If temp increased immediately assess cardiac

Tests for HF/MI and could progress to cardiogenic shock

Troponin, EKG, electrolytes, d-diner to test blood clots in lungs, xray.

Heat stroke true? Types? S/s?

True emergency. Types: exertional, classic. Temp >104, hot/dry skin, mental status changes, hypotension, tachycardia, tachypnea, electrolyte imbalances, decreased renal function aka oliguria, coagulopathy abnormal clotting, pulmonary edema aka crackles

If breath sounds and chest wall movement are absent on left side

Tube may be in right mainstem bronchus so reposition tube

Anaphylaxis define? S/S?

Type 1 hypersensitivity that stimulates histamine release. All blood vessels dilated, decreased CO, bronchoconstiction, edema of airway, angioedema, bronchial constriction, urticaria, pruritus, n/v/d, shock within seconds to minutes after allergen exposure

Chronic gout s/s

Urate kidney stone formation, skin tophi aka Na urate crystals on skin, changes in UO

Safety precautions for radioactive iodine therapy: do what? If urine spills? Use what if urinary incontinence? If women incontinence? on 2-3rd day after? Wear? Wash? Avoid? Don't?

Use toilet not used by others for 2 weeks after, sit to urinate, flush 3 times after, if urine pills use paper towel to clean up, bag in sealable bag and take to hospital radiation therapy department, use condom cath if urinary incontinence, use facial tissue layers to cath urine if women incontence, use laxative on 2nd-3rd day after, wear only machine washable clothing and wash separately, wash on empty after using washing machine, avoid close contact w/ pregnant/infants/young, don't share toothbrush/paste,disposable plates/utensils

Drugs and failing liver used? Especially?

Used sparingly since difficult to metabolize. Especially opioids, sedatives, barbiturates, fat soluble vitamins/minerals, excessive iron supplements, niacin, NSAIDs, all OTC drugs and should be restricted

Common causes and risk factors for heart failure

Usually Hypertension, MI, CAD, cardiomyopathy, drugs, valvular disease/stenosis, congenital defects, cardiac infection, dysrhythmia, DM, smoking, fam history, obesity, lung disease, sleep apnea, hyperkinetic conditions(hyperthyroidism), long term NSAIDs/thiazolidinediones for diabetics

High levels of corticosteroids usually in? S/s?

Usually in cushing's Kill WBCs and shrink organs like spleen and lymph nodes

Initial stage of shock

Usually not clinically apparent Metabolism changes from aerobic to anaerobic Lactic acid accumulates and must be removed by blood and broken down by liver

Those w/ minor or moderate TBI

Usually recover at home after discharge

Scorpion interventions

VS first, possible intubation, o2, IV, ice, analgesics/sedatives w/ caution, acetaminophen/tylenol, cooling blanket, tetanus prophylaxis, wound care

Care for dysrhythmias

VS q 4 hours, monitor, evaluate response, notify if chest pain, assess pain/perheral circulation, antidysrhythmic therapy via drugs, cardioversion or defib. Monitor labs and activity tolerance, rest periods, observe respiratory difficulty, promote stress reduction, spiritual support

Home care assessment for HF

VS, poor tissue perfusio(fatigue, angina, activity intolerance, LOC change, pallor/cyanosis, cool extremities), congestion, functional ability, nutrition, home environment, adherence/understanding

Lidocaine for?

VT, VF treatment, ventricular premature beats

Digoxin toxicity

Vague nonspecific including anorexia, fatigue, blurred vision, changes in LOC, dysrhythmia. Early signs of toxicity: bradycardia and loss of P wave. Monitor apical and rhythm. Hypokalemia potentiates toxicity

Nerve 10

Vagus pain and temp from ear, sensation of pharynx/larynx/thoracic/abs, muscles of soft palate/larynx/pharynx, secretory BG lands, cardiac/smooth muscle innervation

Managing urinary/bowel elimination for SCI

Valsalva manuever or tightening abs or catheter for UI. Stool softeners, fluid intake, high fiver diet, consistent time for elimination

Manifestations for addison's if primary ACTH and MSH elevated? If primary autoimmune?

Varies depending. If primary ACTH and MSH elevated increasing pigmentation. If primary autoimmune decreased pigmentation patches and low body hair.

S/s of hemothorax

Varies, respiratory distress, decreased breath sounds

Improving gas exchange HF

Ventilation assistant,monitor RR/rhythm/quality q 1-4 hours, ascultate breath sounds, Supplemental o2 to maintain sat >90%. If dyspea high fowlers w/ pillows under arm, repositioning/coughing/deep breathing q 2 hours to improve oxygenation/prevent atelectasis

Infections from ventilator

Ventilator associated pneumonia from aspiration. Prevented via handwashing and care of tube, oral care, pulmonary hygiene/chest physiotherapy, postural drainage, and turning/position

Blood gas problems from ventilation can be corrected by

Ventilator changes and adjustment of fluid and electrolyte imbalance

Disadvantage of assist control/AC ventilation

Ventilator continues to deliver preset tidal volume even if breathing rate increases which can cause hyperventilation and respiratory alkalosis. If that happens from pain, anxiety, acid/base imbalance correct cause

Surgical management for HF

Ventricular assist deviceventriculectomy, cardioplasty, acorn cardiac support device, myosplint

When cardiac arrest occurs underlying rhythm usually? Then whats initiated?

Ventricular tachycardia VT, ventricular fibrillation VF, or asystole no pulse and unconscious and then CPR must be initiated

CPR for

Ventricular tachycardia, ventricular fibrillation, asystole

Tidal volume Vt is

Volume of air patient receives w/ each breath, as measured on inspiration or expertion. Average prescribed range: 7-10mg/kg

Cardiac output

Volume of blood ejected by the heart each minute Normal adult range 4.8 liters

No one is dead unless

Warm and dead

O2 delivered is

Warmed to body temp, 98.6 and humidified 100% to prevent mucosal damage

Health care associated pneumonia

Was hospitalized >2 of last 90 days, resided in long term care facility in last 90 days, received outpatient infusion or wound care in last 30 days, attended clinic or hemodialysis in last 30 days, has fam member w/ MDRP

Hep E from? Recovery?

Waterborne in India/Asia/Africa/Middle East/Mexico/Central+South America. Fecal contamination. Can recover

Ventilator mode

Way in which the patient receives breaths from the ventilator Assist Control(AC): breathing for the patient Synchronized intermittent mandatory ventilation (SIMV): mandatory breaths are patient-triggered

Muscle deconditioning from ventilator

Weakness from immobility. Get out of bed, ambulate, help w/ exercises

CPAP used commonly for

Weaning. No ventilator breaths delivered, just delivers o2 and provides monitoring and alarm system.

Diuretic interventions

Weigh daily, i/o, measure ab girth, document edema, assess electrolytes since loops like furosemide/lasix can cause hypokalemia or spironolactone conserves it

UAP can

Weigh patient and get I/Os

HF=1 discharge instructions

Weigh yourself daily Take your medication as prescribed Follow your diet and fluid restrictions Follow your activity program Know when to get help (symptoms worsening) Keep your follow up appointments Strongly advised to take influenza and pneumonia vaccines

S/s for Graves

Weight loss Increased appetite Diarrhea Sweating Dyspnea Exophthalamus Thinning hair Vision changes, Irritability Insomnia Fatigue Amenorrhea Increased libido Chest palpitations Hypertension Tachycardia Dysrhythmias

GI manifestations of hyperthyroidism

Weight loss, increased appetite, increased stools, hypoproteinemia

Guillain-barre s/s

Wekness, paralysis, DTR decreased/absent, RR compromise, loss of GUI/GI, ataxia, paresthesia, pain, dysphagia, diplopia, dysrhythmias, tachycardia

Competing

When 1 person seeks to satisfy own interests regardless of the impact on the other parties to the conflict he is competing

Synchronous/demand temporary pacing: how it works

When HR above rate on generator it doesn't fire, when HR less than setting provides impulses

Goal for intervention's for Cushing's

When caused by adrenal or pituitary issue cure possible, when caused by drug therapy for other health problem focus is to prevent complications

Shock: whole? Any problem? More than one?

Whole-body" response "syndrome" Any problem impairing oxygen delivery to tissues and organs can start shock, lead to life-threatening emergency More than one shock state can exist at a time

Masklike face

Wide open fixed staring eyes

Cirrhosis patho? Inflammation? Early on?

Widespread scarred/fibrotic tissue that changes normal makeup. Inflammation from toxins/disease causes degeneration as it develops tissue becomes nodular blocking ducts/blood. Early on enlarged/firm/hard but shrinks

If a person has unprotected sex w/ HIV + person one night and comes in for testing week later the ELISA

Will be - even though the patient may have active HIV since the body hasn't had enough time to form antibodies

Accommodating/cooperating

Willingness of one partying to a conflict top lace the opponent's interest above his/her own

Housekeeping for HIV

Wipe up body fluids w/ soap/water and disinfect w/ bleach wearing gloves

With rhythms you can have?

You can have a mix of more than one

Once doctor tells fam death you can

You can reiterate what doc has said

History for hypovolemic shock

Younger most common, trauma, procedures, GI ulcers, hemophilia, liver disorders, prolonged n/v/d, aspiring, NSAIDs, diuretics

Intervention to increase intake for nutrition for HIV

Zofran 30 min prior to meals, if mouth sores magic mouth wash with lidocaine

Assist control ventilation

Resting mode. Takes over work of breathing. TIdal volume/ventilatory rate preset. If no spontaneous breaths ventilatory pattern established by ventilator. Programmed to respond to inspiratory effort if breathing which then ventilator delivers preset tidal volume while allowing patient to control breathing rate

Beta adrenergic blockers

Reverses catecholamines. Started slowly in chronic HF. Carvedilol/coreg, metoprolol/lopressor. AAssess for bradycardia/hypotension. Weight daily

Hypovolemic shock interventions focus on

Reversing shock, restoring fluid volume, preventing complications

Sinus arrhythmia difference from normal sinus rhythm

Same as normal sinus rhythm except HR increases during inspiration and decreases during exhalation causing PP/RR intervals to vary is normal and can be from digitalis or morphine

Ventricular fib can look like

Seizure

Standard for sepsis treatment

Sepsis rescucitation bundle

Distributive shock septic shock

Septic Shock = Presence of sepsis with hypotension despite fluid resuscitation Presence of tissue perfusion abnormalities Stage of sepsis/SIRS when MOD evident and uncontrolled bleeding. Severe hypovolemic shock and hypodynamic cardiac function present.

Hyperkinetic conditions causing high output HF

Septicemia, high fever, anemia, hyperthyroidism

Close sepsis

Serious emergency. Common in the US > 750,000 cases annually > 200,000 deaths Management improved but Increased drug resistant organism Early discharges "quicker and sicker"

Dx of hyperparathyroidism

Serum PTH levels X rays (kidney stones, calcium deposits, and bone lesions)

Dx for SIADH

Serum sodium, potassium, chloride, and bicarbonate Plasma osmolality Serum creatinine Blood urea nitrogen Blood glucose Urine osmolality Serum uric acid Serum cortisol Thyroid-stimulating hormone CT scan, MRI

Managing ventilator system

Settings prescribed and checked. Check water and temp. Remove condensation in tubing by draining into receptacles and empty. Assess/care for et/trach tube to maintain patency

BNP >900

Severe HF

Pulmonary edema causes by

Severe HF w/ fluid overload, acute MI, valve disease, dysrhytmia

Sepsis can progress to?

Severe sepsis occurs when a patient with documented sepsis goes on to develop acute organ dysfunction and tissue hypoxemia Most commonly affected organs are the kidney, lungs, heart and blood vessels

HIV transmission

Sexual w/ mucous membrane to infected sectretions, parenteral w/ needles/equipment w/ blood, perinatal from placenta or maternal blood/fluids/milk

Waste disposal for HIV

Sharps in puncture proof container like coffee can, standard precations, bleach,

Hypothermia first aid/prehospital care

Shelter, remove wet clothing, passive rewarming via warm clothing/blankets, active rewarming via heating blankets, warm packs, heaters. Warm high carb liquids w/ no caffeine/alcohol

Advanced beginner preceptor implications

Shift from teaching rules to guidelines, help to recognize patterns and their meanings, assist in prioritizing, must be backed up by competent nurse

ECG and HF

Shows hypertrophy dysrhythmias, MI, not helpful determining extent/presence of HF

Surgical treatment for cirrhosis? Who is surgical risk?

Shunt- Diverts fluid away from the liver. Correction of:electrolyte imbalances, abnormal coagulation (FFP, vitamin K, and PRBCs) Patients with ascites are poor surgical risks.

Levodopa-carbidopa aka? Function? SE? Take when

Sinemet. Less expensive and better for motor function. SE: long term use leads to dyskinesia. Take before meals

For MS w/ cognitive impairment

Single date calendar, written lists, recorded messages, organized environment, frequently used items in familiar places

Sinus dysrhythmias include

Sinus tachycardia or bradycardia

Pulmonary cather/Swans catheter

Sits in pulmonary artery for pressure. Enters through jugular vein into right atrium

Compromising

Situation in which each party to conflict is willing to give up something

Collaborating

Situation in which the parties to a conflict each desire to satisfy fully the concerns of all the parties. In collaborating the intention to the parties are to solve the problem by clarifying differences rather than by accommodating various points of view

Smoothing

Situation where an effort to compliment the other part and focus on agreement. original conflict rarely resolved

ED handoff to inpatient info to give

Situation, brief history, assessment/diagnostic findings, transmission precautions needed,interventions, response to interventions AKA SBAR

Calcium channel blockers function? Examples? For?

Slow HR. Verapamil/calan and diltiazem/cardizem for supraventricular tachycardia, atrial flutter, atrial fibrillation

Parkinson's disease define? Can be?

Slowly progressing neurologic movement disorder that eventually leads to disability characterized by tremor, rigidity, bradykinesia/akinesia slow or no movment, postural instability due to dopamine loss and reduced sympathetic nervous system. Can be primary idiopathic or secondary from tumors/drugs

ACEI and ARDs are started

Slowly, 1st dose can rapidly drop BP. Those at risk: BP already <100, >75y/o, Na <135, or are volume depleted. Monitor bP and immediately notify if BP < 90, if BP <90 lay flat to increase cerebral perfusion

Romberg sign

Stand w/ arms at sides and eye open w/ no swaying then w/ eyes close and sways proprioceptive issue if swaying for both eyes closed+open cerebellar

Staff safety examples

Standard Precautions PPE Negative pressure rooms for tuberculosis etc. Domestic violence Follow security plan for violent clients look for escape/de-escalation

Direct home care for HIV

Standard precautions, good handwashing, don't share razors/toothbrushes

Prevniting hepatitis in healthcare

Standard precautions, needless systems, hep B vax, immunoglobulin w/in 14 days, adequate sanitation/hygiene, wash hands, drink treated water, don't share bed linen/towels/utensils/glasses, don't share needles/razors/nail clippers/toothbrush/waterpiks, condoms, bandages over cuts/sores

Treatment goals for ARDS/respiratory failure: use what to reduce inflammation? Maintain? Provide adequate? Provide what as necessary?

Steroids to reduce inflammation Maintain an appropriate fluid balance, considering underlying conditions, conservative fluid management has been linked to improved outcomes in ARDS. Provide adequate nutrition: consider enteral or parenteral nutrition. Provide hemodynamic support as necessary.

One of the most important aspects of ongoing care for patient w/ cirrhosis is to

Stress avoiding alcohol/illicit drugs to prevent further fibrosis, allow it to heal, prevent GI irritation, reduce bleeding

GI and nutrition issue from ventilation

Stress ulcers decreasing nutrition and increasing risk for infection Fixed via drugs. Paralytic ileum requiring PTN Malnutrition causing weakness

Preload

Stretching of the muscle fibers in the ventricle Called central venous pressure Measured in the right atria Normal CVP 0-8mm Hg The larger the volume the greater the stretch Affected by venous return

Airway across room assessment

Stridor or wheezing Grunting Sniffing position Can't speak Drooling/can't control secretions

Conditions that affect areas of the brain that control breathing that can lead to respiratory failure

Stroke, drug/alcohol OD

Distributive shock anaphylactic shock

Swelling of the lips and tongue, angioedema Wheezing, stridor Flushing, pruritus, urticaria Respiratory distress and circulatory failure Anxiety, confusion, dizziness Sense of impending doom Chest pain Incontinence

Bees/wasps s/s

Swelling, systemic effects like edema, n/v, diarrhea, renal failure, liver injury, dysrhythmias. If allergic urticaria/hives, pruritus/itching, swelling of lips/tongue. Anaphylaxis shown via respiratory distress bronchospasm, laryngeal edema, hypotension, altered LOC

Amatadine aka? Function

Symmetrel antiviral for parkinsons

Sinus tachycardia

Sympathetic stimulation or vagal/parasympathetic inhibition causing increased SA node discharge >100bpm from activity, anxiety, pain, stress, fear, fever, anemia, hypoxemia, hyperthyroidism, pulmonary embolism, epinephrine, atropine, caffeine, alcohol, nicotine, aminphylline, thyroid meds, hypovolemic shock, MI, infection, heart failure

Compensatory mechanisms for HF

Sympathetic system stimulation, renin-angiotensin system activation, other chemical responses, myocardia hypertrophy

Cardiomyopathy assessment

Symptoms are dependent on the structural and functional abnormalities of the heart muscle These patients tend to have right or left side heart failure

Early assessment findings for cirrhosis

Symptoms are vague and nonspecific. Fatigue, anorexia, abdominal pain edema of ankles, epistaxis, bleeding gums, itching and significant weight change. .

Bowel training education

Symptoms of impaction Diet with sufficient fluid intake and fiber

Physical assessment for Addison's

Symptoms r/t hypoglycemia:sweating, tachycardia, tremors Dehydration Hyperpigmentation r/t increased melanocyte stimulating hormone (MSH)

Cardioversion define? For?

Synchronized countershock for emergency unstable ventricular or supraventricular tachydysrthmias or elective for stable tachydysrthmia and resistant to meds

Health promotion for cold

Synthetic clothing since stays dry, no cotton. Layer clothing, inner layer of polyester fleece, outer wind/waterproof layer , hat, facemask, sunscreen, glasses

Right sided HF assessment

Systemic congestion, fluid retained, pressure builds, edema in lower legs progressing up, ask about weight gain, nausea, anorexia from liver resulting in fluid retention, advanced HF ascites and increased ab girth, diuresis at risk

Right sided heart failure key features

Systemic congestion: jugular vein distention, enlarged liver/spleen, anorexia/nausea, dependent edema of legs/sacrum, distended abdomen, swollen hands/fingers, polyuria at night, weight gain, increased BP from excess volume or decreased BP from failure, increased ab girth, ascites

Systemic sclerosis interventions

Systemic steroids, immunosuppressants, skin protection, warmth, no stress/drugs, HOB elevated, small/frequent meals, semisoft foods, no caffeine/pepper

Whats characteristics from right ventricular failure

Systemic venous congestion, peripheral edema

Sympathetic nerves

T1-4 Releases Noradrenaline Cardiopulmonary splanchnic nerve Increase heart rate Increase contractility Cell can meet oxygen demand

Treatment for portal hypertension

TIPS transjugular intrahepatic portosystemic shunt

Synchronized intermittent mandatory venilation SIMV

TIdal volume and ventilatory rate preset. if patient doesn't breath ventilatory pattern established by ventilator, allows spontaneous breathing at patient's own rate and tidal volume between ventilator breaths. Ventilatory and weaning mode.

Thombolytic therapy for MI

TPA, retaplase

Anterior pituitary hormones

TSH aka thyrotropin, adrenocorticotropic ACTH, lerutinizing hormone, follicle stimulating, prolactin, growth hormone, melanocytes stimulating

Desmopressin DDAVP: forms? Function? Dont? Do what? Notify if?

Tabs, nasal spray, parenteral. ADH replacement. Don't drink >3L fluids/day. Weigh daily. Notify if >2lbs/day gained or persistent headache/confusion since can indicate water toxicity

1st stage of shock early

Tachycardia, fever, tachypnea, CO2 retention

Cardiovascular shock s/s

Tachycardia, thready pulse, low CO/BP

Distributive shock/septic shock s/s

Tachypnea/hyperventilation Temperature dysregulation ↓ urine output Altered neurologic status GI dysfunction Respiratory failure is common

Education for cortisol replacement therapy

Take in divided doses in morning and 2nd at 4-6PM, take w/ meals, weight daily, increase dosage as directed for stress, never skip dose, wear alert bracelet, know how to give IM hydrocortisone

How to prevent premature beats and ectopic rhythms

Take meds, stop smoking/caffeine/alcohol, manage stress, don't get too tired

When counting regular rhythm aka small box method

Take number of small 0.2 boxes between 1 R wave and another R wave and divide by 1500.

RN is caring for client being discharged after thyroidectomy, what discharge instructions should be appropriate

Take thyroid replacement meds as ordered, watch for body changes like lethargy/restlessness/sensitivity to cold/dryer skin and report to Dr.

Rn management for mechanically ventilated

emergency equipment available Have a patent IV access/IV fluids, IV flush and medications available if needed Notify and/or partner with Respiratory therapist Educate patient/family regarding immediate post intubation process (CXR, ABG, IV drips, restraints, communication, etc.) Ensure patient safety and comfort and a method of communication Monitor cardiac/respiratory function Monitor vent alarms/response to therapy Assess mouth around ETT for pressure ulcers Insert/maintain indwelling urinary catheter, nasal/oral gastric tube Prevent complications of immobility, i.e. DVT

RN's provide a wide range of client education on a daily basis. Accurate documentation of this education is essential to

enable communication and continuity of what has been taught. Lack of documentation about client education diminishes this important aspect of care.

Clinical competency

encompasses the ability to observe and gather information, recognize deviations from expected patterns, prioritize data, make sense of data, maintain a professional response demeanor, provide clear communication, execute effective interventions, perform nursing skills correctly, evaluate nursing interventions, and self reflect for performance improvement within a culture of safety

Vasopressin antagonists function? Names? Only?

excrete water without sodium loss Tolvaptan (Samsca), Conivaptan IV (Vaprisol) used in hospitalized patients. Only given in the hospital setting allowing close monitoring for the development of hypernatremia.

5 important characteristics for good documentation

factual, accurate, complete, current (timely), organized, compliant with standards These core principles of nursing documentation apply to every type of documentation in every practice setting.

Acute spontaneous bacterial peritonitis SBP s/s

fever, chills, abdominal pain and tenderness, anorexia, change in mental status

COPD drugs

includes meds for asthma) and corticosteroids, mucolytic, positioning Symbicort, Spiriva, flovent

Beta blockers

lols" Widely prescribed classes of drugs to treat Hypertension (high blood pressure) Heart failure Long-term use of beta-blockers helps manage chronic heart failure Action Beta-blockers work by blocking the effects of epinephrine (adrenaline) and slowing the heart's rate Decreasing the heart's demand for oxygen Decreases force of contractions Worsen asthma, impotence, hallucinations (elderly)

COPD patients may have

lower levels that are acceptable PaO2 of <60 mmHg or a SaO2 of <90% or a PaCO2 of >50 mmHg as their normal.

Ventricular assist device VAD is

mechanical pump that's used to support heart function and blood flow in people who have weakened hearts. The device takes blood from a lower chamber of the heart and helps pump it to the body and vital organs, just as a healthy heart would.

Hepatitis A s/s? Route? Rocovery?

mild, flu like. Fecal oral route from people or consuming contaminated food/water like shellfish. Can recover

Patient after hypophysectomy

monitor neuro q 1 hour 1st 24 hrs, monitor IO since DI possible, deep breathing, don't cough/blow nose/sneeze, don't brush teeth instead floss/mouth rinse, avoid bending at waist, monitor nasal drip for halo since CSF, monitor bowels to prevent straining, teach self admin of hormones+vasopressin

Normal pH? PaCO2? HCO3?

pH: 7.35 - 7.45 7.40 PaCO2: 35 - 45 40 HCO3: 22 - 26

Advocate

protection of human or legal rights; patients have the right to make informed decisions about their own care

COUNsELOR

provide appropriate information to help patients and their families facilitate problem-solving and decision-making

CD4/CD8 ratio? CD4 count of AIDS?

ratio <2, count <200/mm3

ABGs of HF

reveal hypoxemia oxygen does not diffuse easily through fluid filled alveoli. Respiratory alkalosis - hyperventilation, resp acidosis- CO2 retention, met acidosis - accumulation of lactic acid

Patients who are not considered candidates for transplantation

severe CV instability w/ cardiac disease, severe respiratory disease, metastic tumors, inability to follow instructions

Autonomic dysreflexia interventions

sitting position first, notify, loosen clothes, check catheter for kinks, catheter if not already, check for fecal impaction, check roll temp to make sure not cold, measure BP q 10-15 minutes, nitrates/hydralazine

Prednisone aka? Function? SE?

anti-inflammatories (steroidal) (intermediate acting) immune modifiers. Suppresses adrenal function at chronic doses of 5 mg/day. Replaces endogenous cortisol in deficiency states.acne, ↓ wound healing, ecchymoses, fragility, hirsutism, petechiae, adrenal suppression, hyperglycemia, cushingoid appearance, increased infection, muscle wasting, osteoporosis, hypertension, depression, euphoria, edema

Methyl prednisolone aka? Function?

anti-inflammatories (steroidal) immunosuppressants, corticosteroids Replacement therapy in adrenal insufficiency., SE just like prenisone

Propylthiuracil PTU aka? Do what? May affect? SE?

antithyroid drug Avoid large crowds (decrease WBC's) May affect liver functioning Slow heart rate, weight gain, and cold intolerance

Decompensated cirrhosis

the development of ascites, jaundice, hepatic encephalopathy or variceal bleeding (metabolic abnormalities occur

In physiology perfusion is

the process of a body delivering blood to a capillary bed

Magic mouthwash: used when? Compounded how? The most common ingredients are?

used 30 min prior to eating to prevent or treat oral mucositis. compounded by a pharmacy and most often contains anticholinergic agents such as diphenhydramine (Benadryl); an anesthetic, such as viscous lidocaine; and an antacid or mucosal coating agent, such as magnesium or aluminum hydroxide, kaolin, or sucralfate. may also contain an antibiotic and/or an antifungal medication such as nystatin, and a corticosteroid. The most common ingredients are diphenhydramine, viscous lidocaine, antacid, nystatin, and corticosteroids

Echocardiography aka echo is

uses sound waves to create moving pictures of your heart. The pictures show the size and shape of your heart. They also show how well your heart's chambers and valves are working. Echo also can pinpoint areas of heart muscle that aren't contracting well because of poor blood flow or injury from a previous heart attack. A type of echo called Doppler ultrasound shows how well blood flows through your heart's chambers and valves. Echo can detect possible blood clots inside the heart, fluid buildup in the pericardium (the sac around the heart), and problems with the aorta. The aorta is the main artery that carries oxygen-rich blood from your heart to your body.

Short term esophagogastric balloons tamponade

using a Minnesota or Blakemore tube. Difficult process for patient.

Endoscopic sclerotherapy

varices are injected with a sclerosing agent. Many complications, EVL is preferred

Acute respiratory failure can occur as a result of

ventilatory (air movement) or oxygenation (gas exchange) failure or a combination of both

The pressure in right atrium is indicator of

circulating blood volume and right ventricle pumping strength. Normal CVP readings are between 2-8 mm Hg.

Clinical competency focuses on

clinical nursing skills: Technical skills Patient care Cultural competency communication

Gout interventions

colchicine+NSAID for acute if chronic allopurinol, low purine diet, no ogran meats+fish+shellfish

Electrolyte imbalance can occur from

complications of HF or as SE of drug therapy, esp diuretic.

S/s of pulmonary edema

crackles/dyspnea/disorientation/confusion. Acute: anxious, tachycardia. Late sides: moist productive frothy blood tinged sputum+cold/clammy/cyanotic

If 17 small boxes between 2 R waves

1500/17=88.23 or 88 bpm

Phases of case management of ARDS

1: early dyspnea/tachypnea via supporting/O2, 2: patchy infiltrates increasing pulmonary edema and supported via mechanical ventilation/preventing complications, 3: hypoxemia and supported via O2, preventing complications, supporting lungs, 4: irreversible pulmonary fibrosis and supported via preventing sepsis, pneumonia, multiple organ dysfunction syndrome, weaning from ventilator

Goals for management of ARDS phase 1? 2? 3? 4?

1: give o2, support. 2: prevent complications from PE/ventilation. 3: support lungs, give O2, prevent complications r/t hypoxemia. 4: irreversible lung damage, prevent sepsis, organ failure, wean from ventilator, long term care/rehab

Classification/staging of HF

1: high risk, cardiac structural abnormalities. 2/3: current/prior s/s of HF. 4:end stage HF

Stages of conflicts

1: potentional opposition/incompatibility, 2: cognition and personalization, 3:intentions, 4:behavior, 5:outcomes

Stages of hepatic encephalopathy

1: prodromal, 2:impending, 3: stuporous, 4:comatose

Hypothermia hospital care for? Do what?

For moderate/severe. Handle gently, supine position, ABC, drugs w/ caution and/or spaced longer, drugs can accumulate w/out effect and once warmed can lead to toxicity, withhold IV drugs until core >86, CPR if w/out spontaneous circulation, defib can be ineffective until >86, active external and core warming, trunk warmed before extremities, warm IV fluids/O2, heated peritoneal/pleural/gastric/bladder lavage. Cardiac bypass, hemodialysis, venous rewarming via catheter

Thyroxine/T4 and TSH

For older than 65, a.fib, or evidence of thyroid disease since HF can be caused by or aggravated

Dopamine agonists function? Example? SE?

For parkinsons. Lowers dyskinesia. Ex: ropinirole/requip. SE: postural hypotension, hallucinations, sleepiness.

Cyclosporine/sandimmune/neoral

For psoriasis, RA, MS, MG, scleroderma, lupus, organ transplant rejection. Blocks helper t cells

Iodine preparations used for? Can result in?

For short term therapy before surgery to decrease thyroid blood flow reducing thyroid hormone for 2 weeks. Can result in hypothyroidism

If high pressure alarm sounds from airway size decreased r/t wheezing/bronchospasm

Ascultate breath sounds

If high pressure alarm sounds from pneumothorax

Ascultate breath sounds, Alert doc or rapid response about bronchospasm or decreased breath sounds or unequal chest excursion

Neurogenic shock example

30 year old client comes to ER after a diving injury. He and some of his friends were swinging from a rope into a creek below when his head struck the bottom of the creek resulting in a cervical fracture and paralysis from his neck down. He is alert and oriented vital signs T -99.6 BP 110/68, MAP 82 , HR-72, Resp-22. He is placed on a ventilator due to suspected cervical injury. His neck is immobilized in a cervical collar. 30 minutes later you enter his room because the ventilator alarms are going off. VS: 99.8, 60 and bounding, BP 82/62, MAP 68, R 28 bucking the ventilator. Capillary refill >2, client is anxious, extremely restless.

PaCO2

35-45. Increased: anaerobic metabolism

Adaptive immunity aka? Define?

3rd line defense. Passive vs. active immunity. Cellular T cell mediated or humoral B cell mediated

Nonsurgical management for burn wound infection

Asepsis, safe environment, monitoring for early infection, drugs, isolation, environmental infection, no plants, no raw foods

Remember with SBAR

Ask clarifying questions

Med management for MI

Aspirin, glycoproteins inhibitors, beta blockers, ACE inhibitors, thrombolytic therapy

Leader

Assertive, self-confident practice, effecting change and teamwork

For test remember to

Assess

Assessing level of spinal injury

Assess ABC's Respiratory dysfunction is related to level of injury Pons in the Brainstem is the respiratory center Abdominals and intercostal muscles (T1-T11) Diaphragm (C4) ARF leading cause of death in high cervical cord injury CV dysfunction common in acute spinal cord injuries Cont. ECG monitoring for bradycardia, asystole, & other arrhythmias

Emergency care of anaphylaxis

Assess ABC, call RRT, intubation/tracheotomy equipment at bed, O2, discontinue IV by changing tubing w/ NS, start IV if no IV w/ NS, prepare epinephrine, HOB elevated 10 degrees if hypotension if normal BP 45 for ventilation, raise feet/legs, stay w/ patient, reassure

Monitoring patient response to ventilator

Assess VS, breath sounds, pulse ox, ABGs, breathing pattern, et/trach site

Because other dysrhythmias besides PVCs can cause widened QRS

Assess carotid, brachial, or federal arteries against monitor or auscultation apical pulse. PVCs can indicate ventricular tachycardia or fibrillation

BUN normal? Hypofunction of adrena? Hyperfunction?

10-20 but in older can be higher. Increased, normal.

Ventricular muscle cells rate

10-20bpm

Sinus tachycardia vs. supraventricular tacycardia

100-149 vs. 150-250bpm

Normal sodium? Hypernatremia can indicate? Hyponatremia can indicate?

135-145, fluid deficiency, fluid overload

Na normal? Hypofunction of adrenal? Hyperfunction?

136-145. Decreased, increased

Normal glasgow

15

If 10 small boxes between 2 R waves

1500/10 = 150 bpm

12 lead ekg how many leads

10 stickers on but actually captures 12 views

THe fraction of inspired O2 aka FiO2 is usually prescribed at what than the level used while ET tube in place

10% higher

Normal ICP range

10-15mmHg

If high pressure alarm sounds from artificial airway being displaced/ ET tube slipped into right mainstem bronchus

Assess chest for unequal breath sounds and chest excursion. Obtain CXR as ordered after proper position verified, tape securely in place

Preventing or managing pulmonary edema w/ HF

Assess for early s/s: Document crackle location, if not hypotensive sitting high fowlers w/ legs down. Priority admin O2 via facemask or nonrebreather. Pulse ox >90. If not better notify respiratory therapy for BiPAP/CPAP. If BP >100 nitroglycerin q 5 minutes 3x. Lasix/bumex, if BP good morphine, if severe ultrafiltration

Physical assessment of hyperparathyroidism

Assess for recent bone fractures Weightless, psychological distress, waxy pallor of skin, bone deformities, GI issues like anorexia/n/v/pain/constipation, peptic ulcers, fatigue, lethargy, psychosis, entail confusion, coma Arthritis Recent radiation treatment to the head or neck Renal stones Confusion

Assessment: targeted history dx of respiratory failure

Assess for underlying conditions that lead to respiratory failure. Focused respiratory assessment

Transjugular intrahepatic portal systemic shunt TIPS: for those? Procedure? Usually discharged when? Requires?

For those who don't respond to other treatment for hemorrhage or long term ascites. Sheath through jugular and needle guided through liver into portal vein and balloon enlarges and stent keeps it open. Usually discharged in 1-2days and requires 1 yr follow up US

Rescue therapy for transplant rejection used for? What is used?

For treating acute rejection. Globulin or muromonab

Psychosocial assessment of Graves

Assess mood swings Irritability Decreased attention span Manic behavior

Increased ICP inteventions

No extreme neck/hip flexion, no suctioning, avoid low o2, don't cluster activities, quiet environment, low lights, no high temp/fever

AIDs dietary limits

No fresh/raw or rare

Compensated cirrhosis

No obvious symptoms, may be unaware of disease, stable

V. Fib no? Can be from?

No recognizable deflections, no CO or pulse. Can be from CAD, MI, hypokalemia, hypomagnesemia, hemorrhage, antidysrhythmics, SVT, shock, surgery, trauma

Assessment for acromegaly

Assess patient's age, gender, and family history Changes in hat size, glove, ring, or shoe size Presence of fatigue Headache Joint pain Increase in lip, nose, hands, feet, Prominent brow ridge Visual disturbances

Snakebit prevention

No venomous snakes as pets, protective attire, walking sticks/poles, inspect areas before placing hands/feet in them, don't harass snakes, don't transport snake w/ victim unless in sealed container

Normal ratio of CD4 to CD8? In HIV/AIDS?

2:1, in HIV and AIDS because of low CD4 ratio is low and associated with increased manifestation of disease

Sepsis can usually be? Avoid? Secondary prevention? Patient?

Can usually be prevented Avoid trauma and hemorrhage Proper safety equipment Seat belts Awareness of hazards in home/workplace Secondary prevention Assess for early manifestations Patient teaching

Hypothermia s/s for mild, moderate, severe

Core <95, Mild: shivering, dysarthria/slurred speech, decreased coordination, impaired cognition, diuresis. Moderate: weakness, acute confusion, apathy, incoherence, stupor, decreased clotting/thrombocytopenia. Severe: bradycardia, hypotension, decreased RR, dysrhythmia, decreased neuro reflexes, acid/base imbalance

Drug and fluid therapy for ARDS

Corticosteroids to reduce inflammation, antibiotic is infection, conservative fluid therapy w/ diuretics

Hypothalamus hormones

Corticotropin releasing, thyrotropin-releasing, gonadotropin releasing, growth hormone releasing, growth hormone inhibiting, prolactin inhibiting, melanocytes inhibiting

ECG paper

30 boxes in 6 second strip, big box=0.2 seconds and little box = 0.04seconds

Ensure each intubation attempt lasts no longer than

30 seconds, preferably <15 seconds then. After give O2 and suction if needed

Deceleration vs. acceleration

Flying off motor cycle and due to gravity being slowed down across gravel slowly vs. acceleration ejected off motor cycle and hitting a tree ie they are going fast and stopped abruptly and organs keep going and hit the inner body

Competent preceptor implications

Focus on improving decision-making skills and ways to improve coordination of multiple/complicated care needs of patient assignments, food preceptor for novice nurse

Pronator drift

For cerebral/brainstem motor issue if patient closes eyes and hold arms up w/ palms up for 15-30 seconds the arm on weak side will fall/drift with palm pronating turning inward

Level 3 trauma center

For communities w/out level 1-2 centers, primary focus is stabilization and transfer

Ventricular assist devices

For end stage. Mechanical pump implanted for short term awaiting heart transplant or long term

Assessment of sensory function for? Includes?

For guillain barre syndrome. Includes pain, superficial/deep sensation, light touch, proprioception

Barbiturate coma define? Complications?

For increased ICP using pentobarbital/nembutal or thiorpentone. Has mechanical ventilation. Complications: decreased GI motility, dysrhythmia, hypokalemia, hypotension

Parkinson's s/s

Onset gradual, after 50 y/o, mask like blank expression, stooped posture, pill rolling tremors in hands/arms/diaphragm/tongue/lips/jaw, shuffling gait, rare in black people, muscle rigidity, depression, mental deterioration, bradykinesia aka loss of normal arm swing/lowered eye blinking/loss of slawllowing/difficulty initiating movement

Immune history assessment

Allergies, meds that have immmune SE like antibiotics/anti-inflammatory/immunosuppressive agents/antimetabolites/ antineoplastics/thyroid suppressive therapy. Fam history, infection history, immunizations, autoimmune disorders, cancer

Common rn dx for immunocompromised

Altered Nutrition:Nutrition meets metabolic needs Altered Protection:Resolution of signs of altered protection Impaired Skin Integrity:Signs of impaired skin integrity resolving Activity Intolerance:Resolution of signs of activity tolerance Knowledge Deficit: Client demonstrates or verbalizes understanding Risk for infection:Absence of infection or risk for infection decreased

Use of halo

Alters balance, loose clothing, bathe in bathtub, wash under vest, support head w/ pillow when sleeping, stay active, don't drive, straws for drinking, cut food in small pieces, wrap pins w/ cloth if cold temp, pin care, observe pins daily, increase fluids/fibers

Target cell concept-interlocking puzzle

Although many different hormones circulate throughout the bloodstream, each one affects only the cells that are genetically programmed to receive and respond to its message.

Safety is

Always first

Nonurgents are

Ankle sprain and cold or broken toe or flu like

Addison's GI manifestations

Anorexia, n/v, ab pain, bowel changes either constipation or diarrhea, weight loss, salt craving

Managing fever

Anti-infectives, antipyretics like acetaminophen/tylenol, increase fluid intake, external cooling w/ hypothermia blankets/ice, sponging w/ tepid water, cool compress, no fans

Common agents that cuase anaphylaxis

Antibiotics, ACTH, insulin, opioids, local anesthetics, ACE inhibitors, chemo, radiocontrast, foods, pollen, mold, latex, bee, wasp, fire ants, hornets

Benzotropine type? Aka? SE?

Anticholinergic aka congentin. SE: confusion, urinary retention, constipation, dry mouth, blurred vision

Minimizing diarrhea for HIV

Antidiarrheals, less fat/spicy/sweet foods, no alcohol/caffeine

Meds for hyperaldosteronism

Antihypertensive medications Potassium sparing diuretics: Aldactone, Spirono Eplerenone (Inspra) blocks action of adolsterone

Circulation assessment

Any obvious bleeding. Use direct/firm/manual pressure, tourniquet last resort or w/ traumatic amputation. Assess peripheral/central pulses, HR, BP, perfusion

Shock caused by

Any problem that impairs o2 delivery to tissues and organs leading to life threatening emergency, usually from cardiovascular problems and changes

Valvular heart disease

Aortic Valve Stenosis/ Regurgitation Mitral Valve Stenosis/Regurgitation Endocarditis

Psychological manifestations of hypothyroidism

Apathy, depression, paranoia, withdrawal

Breathing

Are ventilatory efforts effective? Spontaneous breathing/chest expansion Respiratory rate and/or effort Auscultate breath sounds Chest wall integrity Lung compliance via ventilating w/ BVM Signs and symptoms of pneumothorax or hemothorax Intubation masks or chest decompression via needles/chest tube if pneumothorax

Acute& rehab phases spinal shock assessment

Areflexia below the level of injury Spinal cord segment below is without sensation, paralyzed, flaccid, & reflexes are depressed Reflexes initiating bladder & bowel function are affected leading to bowel distention & paralytic ileus

After heart transplant

Arrthymias are possible. The younger the donor heart the better the outcome

Common meds for immunocompromised and function of each

Bactrim- To prevent pneumocystis carinii pneumonia Antifungal drugs to prevent oral candidiasis Antibacterial prophylaxis (levaquin) Antiviral drugs-Acyclovir to prevent Hep B, CMV, Herpes

Bands normal %+ /mm3? Lymphocytes % + /MM3

Bands 5% or 500/mm3. Lymphocytes 28% or 2800 /mm3

Cause of tension pneumothorax

Barotrauma from BVM or ventilation, blunt/penetrating chest trauma, progression of simple pneumothorax

Lung problems from ventilation

Barotrauma: pneumothorax, emphysema, pneumomediastinum from airflow limitation, blebs/bullae, PEEP, hyperinflation, or high pressure to ventilate like ARDS Volutrauma Acid base imbalance

Hyperacute rejection begins when? What happens? Those at risk? Treatment?

Beginning immediately. Antibody mediated triggering blood clotting leading to necrosis, inflammation. At risk: received donated organs of ABO different from their own, have received multiple transfusions before, have history of multiple pregnancies, or have received previous transplant. Tx: removal of organ

Competent characteristics

Begins to see his/her actions in terms of long term goals or overall plan, begins to distinguish between relevant and irrelevant attributes, feels the ability to cope/manage unforeseen events, lacks the speed and flexibility of a proficient nurse, begins to unsterstand actions in terms of long range goals

Progressive stage of shock

Begins when compensatory mechanisms fails Aggressive interventions to prevent multiple organ dysfunction syndrome

Biliary obstruction

Bile production decreased preventing absorption of fat soluble vitamins like K which causes insufficient clotting factors causing bleeding/bruising risk

Infection risk from chemo managed w/

Biological response modifiers, growth factors to stimulate immunity or if already sick drugs for that organism

After assessing patient you document, JVD, edema, swollen hands, distended abs, bibasilar crackes, productive cough that is pink what is interpretation

Biventricular failure

Artificact

Bizarre irregular deflections in baseline of ECG, NOT a. Fib

Patho of portal hypertension

Blockage of blood through portal vein seeks collateral/alternative venous channels and backs up into spleen causing splenomegaly, dilated veins, ascites, esophageal varices, prominent ab veins aka caput medusae, and hemorrhoids, portal hypertensive gastrophy

When blood vessels constrict and total blood volume remains the same

Blood pressure increases Blood flow faster

Physical assessment for hypothyroidism

Bradycardia, goiter Hypotension Hair loss Constipation Weight gain Facial edema aka myxedema+nonpitting edema everywhere Decreased T3 and T4 levels

Motor parkinsons s/s

Bradykinesia slow movement, rigidity, akinesia, tremors, pill rolling, maskline face, difficulty chewing/swallowing, uncontrolled drooling, fatigue, reduced arm swinging, microphagia aka change in writing

ICP increased by

Brain tissue expansion/pressure, increased CSF, increased blood flow/pressure

C3/c4/c5 can cause? Urgency?

Breathing issues and emergent

Priority issues w/ SCI

Breathing, neurogenic shock, further SCI, impaired mobility, bladder/bowel, impaired adjustment

Rate of ventilator

Breaths/min number of breaths delivered by ventilator. Rate usually 10-14 breaths/min

Treatment for atrial dysrhythmia

Calcium channel blockers Antiarrhythmics Digitalis glycoside Beta blockers Anticoagulants Cardioversion Ablation Patient education: Monitor HR s/s Stroke Decrease stress

Initial stage of shock: do what? Baseline MAP? HR/RR? Adaptive?

Call for help/RRT, Baseline MAP decreased by 5-10 mm Hg, Cardiac response Heart and respiratory rate increased from baseline Adaptive responses of vascular constriction, increased heart rate. HR/RR increasing from baseline may be only s/s

When stridor or other manifestations of obstruction after extubation

Call rapid response team before airway become completely obstructed

Proficient characteristics

Can discern situations as wholes rather than single pieces, uses past experiences rather than rules to guide practice, can recognize when the expected normal picture is absent, considers fewer p[topms and hones in on accurate elements of problems, perceives situations as whole rather than in aspects

Systolic HF: can not? Reduced? Blood? Hallmark finding?

Can not contract forcefully enough during systole to eject adequate amounts of blood into circulation Reduced left ventricular ejection Blood backs up (pulmonary) Hallmark finding: Ejection fraction below 40%

Hypovolemic shock etiology

Can occur with 20% (~ 1 liter) of volume loss. Hemorrhage (external):trauma, Surgery. Hemorrhage (internal):Blunt trauma, GI ulcers/Liver disease, Overuse of NSAIDS/ASA, Poor control of surgical bleeding. Dehydration, decreased fluid intake, increased fluid loss, DI, conditions reducing clotting

MI assessment

Chest pain unrelieved with rest Diaphoresis Mottled skin Nausea Anxiety Shortness of breath Palpitations Elevated Troponin

Oxygenation failure

Chest pressure normal but doesn't oxygenate blood sufficiently. V/Q mismatch in which air movement and O2 intake/ventilation normal but lung blood flow/perfusion is decreased.

Conditions causing respiratory failure

Condition that affects the flow of blood into the lungs, affect the nerves and muscles that control breathing, that affect the areas of the brain that control breathing, that affect the flow of air in and out of th lungs, that affect gas exchange in alveoli

CPR steps

Confirm unresponsiveness, call 911/response team then CPR: chest compression 100 per minute, patent airway, ventilate/breathing w/ mouth to mask 10-12 breaths/min

Left sided HF aka? Types of left HF?

Congestive heart failure. 2 types: systolic HF and diastolic HF

Rheumatoid arthritis define?

Connective tissue disease destructive to bilateral joints and chronic progressive systemic autoimmune disease leading to bony ankylosis, calcification, bone density loss, secondary osteoporosis

Preparing body for viewing

Consider Forensic/coroner requirements, cultural requirements

After o2 replaced and rested no SOB but o2 sat is 96% do what next

Continue assessment as 96% is considered acceptable

Interventions for cardiomyopathy

Drug therapy to help increase cardiac output Antidsyrhythmic medications Implantable cardiac defibrillators

Enhancing nutrition for HIV

Drugs like ketoconazole/fluconazole/amphotericin, mouth care, ice chips, no unpleasant odors, antiemetics, monitor weight+I/O, high calorie/protein low fat, small frequent meals, supplements, TPN

Enhancing oxygenation for HIV

Drugs like trimethoprim/sulf/bactrim/pentamidine for PCP bronchodilators/steroids, respiratory support w/ O2/suctioning/chest physical therapy, maintenance, comfort, rest

ICD education

Drugs still, sit/lie down if shock and notify, if someone else touching shock not harmful, avoid electromagnetic fields/electric generators/radio or TV transmitters /metal detectors/welding equipment/motors which can inhibit tachydysrthmia detection or cause shocks, cell phones >6 in away from generator and held opposite ear of ICD, wear ID card/bracelet, no swimming/driving/dangerous equipment

Improving CO w/ HF nonsurgical

Drugs, CPAP, cardiac resychronization therapy CRT, investigative gene therapy

Nursing implications for esophageal varices

Drugs, Monitor- PT, PTT, fibrinogen, platelet count, INR, and ammonia levels, monitor black tarry stools

Environmental factors that increase infection

Drugs, chemicals, vitamin definiciences, malnutrition esp. protein malnutrition, DM, older adults

Preventing/managing hemorrhage interventions

Drugs, endoscopic therapies, rescue therapies like 2nd endoscope/ballon/stents/shunts, TIPS

Nonsurgical management for dysrhythmias

Drugs, vagal maneuver, pacing, CPR, ACLS, cardioversion, defibrillation, catheter ablation

Managing inflammation/pain from RA

Drugs: immunosuppressive DMARDs like methotrexate, lefluomide/arava, hydroxychloroquine/plaquenil, NSAIDs, BRMs, glucorticoid prednisone, rest, positioning, ice/heat, hot shower, alternative therapies for pain, assistive devices, managing fatigue, promoting rest

ACE SE

Dry cough, hyperkalemia, orthostatic hypotension, confusion, reduced U/O

Skin changes for HIV

Dry, itchy, irritated, rashes, folliculitis, eczema, psoriasis, peteciae, bleeding gums, poor wound healing, lesions, night sweats

Acute spontaneous bacterial peritonitis

Due to low concentrations of plasma proteins causing fever, chills, ab pain, tenderness

Common quinolones

Floxin Levofloxacin Ciproflaxacin Moxifloxacin (Avelox) Gatifloxican (Tequin)

Expected outcomes of Addisons

Fluid and electrolyte balance is maintained Nutritional Status is maintained Verbalizes understanding of Adrenal Insufficiency Hormone levels return to normal or near normal

Priority problem for Cushing's

Fluid overload, risk for injury r/t thin skin/poor healing/bone loss, potential for infection, potential for acute adrenal insufficiency

Most important s/s of AIDS

Night sweats, diarrhea, weight loss, n/v, opportunistic infections like pneumocystis jiroveci aka carinini pneumonia, cytomegalovirus CMG, shingles/varicella. Malignancies like kaposi's sarcoma, invasive cervical carcinoma

Ventricular fibrillation

No CO, no pulse. Defibrillate then CPR, o2, drugs like epinephrine

Ventricular asystole

No CO, no pulse. Manage airway, O2, epinephrine, atropine, CPR after notifying, check leads. NO SHOCK

Assessment for asystole

No CO, no pulse/BP/RR full cardiac arrest

Heat related illness prevention

No alcohol/caffeine, sunscreen, breaks, light weight light colored loose clothing, cool baths/showers, indoors, ask neighbor/friend to check at least q 2x a day during heat wave

C of ABC make sure

No bleeding, pulse and color

Novice characteristic

No experience, inability to use discretionary judgement, use of context free rules for actions, no rule about which tasks are most relevant in a real world situation or when an exception to the rule is necessary, has no profession experience

Deceleration define? The more distance involved? Example?

Occurs as energy that is dispensed from the moving object. The overall result is deceleration over distance. The more distance involved, the better the outcome. Ex.- A body slides across pavement through friction

Septic shock/chemical induced distributive shock

Occurs secondary to infection Develops from volume loss in the core circulation and poor circulatory support Life threatening blood pressure drop Reduced U/O Body temperature changes Skin is warm Late signs of inadequate tissue oxygenation

Acceleration define? Example?

Occurs when the body is abruptly set in motion for a position of rest. Ex.- A body coming to a sudden stop but the internal organ continue to move forward

Hepatic encephalopathy Occcurs when?

Occurs when the liver fails to breakdown toxins properly and the toxins buildup in the bloodstream aka elevated ammonia levels. These toxins can cause damage to organs and nerves.

Nerve 3

Oculomotor eye movement and pupil constriction

Expert preceptor implications

Often not possible to recapture mental processes, encourage exemplars and descriptions of excellent practice, good preceptor for competent nurse

Cranial nerve 1

Olfactory, smell

Pulmonary artery

Only artery w/ deoxygenated and goes to lungs for oxygenation and goes back in pulmonary vein to left vatrium throu mitral valve to aorta

Paroxysmal nocturnal dyspnea

Sudden awakening with a feeling of breathlessness 2-5 hours after falling asleep. Sitting upright, dangling the feet, walking usually relieves the condition

Testing for hyperpituitarism

Suppression testing of negative feedback control mechanism. High BG suppress GH. If GH levels don't fall below 5 it's positive/abnormal

Progressive stage of shock: MAP? Organs? Life? Conditions causing?

Sustained decrease in MAP of >20 mm Hg from baseline Vital organs develop hypoxia, ischemia Life-threatening emergency, impending doom Conditions causing shock must be corrected within 1 hour of progressive stage onset Rapid weak pulse, low BP, pallor/cyanosis, cool moist skin, anuria, decreased O2 w/ rising lactic acid/K

Sinus bradycardia

Excess vagal/parasympathetic stimulated causing decreased SA node <60bpm from sinus massage, vomiting, suctioning, valsalva manuever aka bearing down for BM/gagging, hypoxia, MI, beta adrenergic blockers or calcium channel blockers or digitalis, athletes

Dysrhythmia issues

Alteration in perfusion, abnormal rhythm and can lead to organ failure, electrolyte imbalances, morbidity

Drowning better in what temp? Since? Do what first?

Better in cold water since slows metabolism and HR. Get them warm first.

Fresh vs. salt water drowning which is better and why

Better to be in salt water since cells shrink/dehydrate which is better then them bursting in fresh

Assessment of atrial dysrhythmia

Dizziness Weakness/ fatigue Shortness of breath Chest discomfort/ pain Hypotension Asymptomatic

Initial assessment for sinus dysrhythmia

Dizziness, weakness, confusion, hypoxia diaphoresis, SOB, chest pain

T wave

Ventricular repolarization

A. Fib s/s

Fatigue, weakness, SOB, dizziness, anxiety, syncope, palpitations, chest discomfort/pain, hypotension, possibly asymptomatic, thrombi formation

4 steps to interpretation

Whats rate, is it regular, is ther 1 p wave per QRS, does QRS appear normal

If after using valve bag mask and absent sound in certain area

Xray, tube

Is it regular

Yes is R to R interval regular or <3 small not big blocks between and same shape for ventricles, P to P w/ same shapes/regular timing <3 small blocks for atrium or no irregular

Does QRS appear normal

Yes- duration consistent/similar normal conduction through AV nodes. No-ventricular in origin.

Is ther 1 p wave per qrs

Yes- sinus rhythm, no-pacemaker not sinus node

Diabetic urinated on floor do what first? Then

Is scene safe FIRST then A via jaw thrust due to fall, B via chest rise/fall sounds if weak assist w/ breathing via o2 or mask, then reassess after intervention,

Prevent escalating for violence and psych issue

Keep in area to minimize chaos like if psych issue take them out of waiting room/get away from others

Renal calculi define? Urgency?

Kidney stones are urgent due to pain level being high

Emergent define? Examples ?

Life threatening and needs to be addressed right then. All team needed. Ex: codes like strokes, heart attack

P wave means? Formed as?

Means atrium working and depolarized(contracted/positive charge). Formed as impulses originate in SA node/pacemaker passes through atrium.

Graph paper measures? How many boxes for 3 seconds? 1 box=?

Measures voltage against time. 15 boxes= 3 seconds. 1 box=.20 seconds

Degree of trauma affected by? Types?

Mechanism of injury(MOI): intentional, unintentional

If you fix something for ABCDE etc then! You cannot?

Then reassess. You cannot move on until you address A or whatever the issue is

Q wave isn't always? Still called? In MI? In normal person?

There and visible. Still called QRS though if you cannot say. Still can be present in Q wave MI. Normal person usually don't see Q

Premature atrial complexes s/s and treatment

Usually no s/s except palpitation. No intervention except for causes like heart failure, stress management, avoiding substances like caffeine/alcohol

Tachydysrthmia/bradydysrhythmia s/s

chest discomfort/pain that can radiate to jaw/back/arm, anxiety, restless, confusion, dizziness, syncope, changes in pulse, pulse deficit, SOB/dyspnea, tachypnea, crackles, orthopnea, extra heart sounds, JVD, weakness, pale/cool skin, n/v, decreased UO, delayed cap refil, hypotension

Bradydysrhythmia additional s/s

If BP normal possibly no s/s, if BP no adequate myocardial ischemia, infarction, dysrhytmia, hypotension, heart failure

Sinus dysrhythmia can be

Bradycardia or tachycardia

Big block example: 4 blocks between Rs?

4 blocks between R's = 300/4=75bpm

Lead placement? Right leg? Right arm? Left leg? Left arm? Can be placed by?

4 leads on limbs, 6 leads on chest. Right leg is ground, right arm negative, left leg positive, left arm is positive or negative. Can be placed by UAP but placement verified via RN

Very old and very young

Are more at risk for decompensation so can be urgent or emergent usually

Extrinsic factors of heart contraction

Autonomic nervous system: parasympathetic vs. sympathetic fight or fight

Atrial fibrillation treatment

Calcium channel blockers like diltiazem/cardizem, amiodarone/cordarone, drondarone/multaq, cardioversion. Beta blockers like metoprolol/Toprol, esmolol/brevibloc. Digoxin/lanoxin if heart failure. Anticoagulants like heparin, enoxaparin/lovenox, warfarin/coumadin or antiplatelets like aspirin or clopidogrel/plavix. Cardioversion, catheter ablation, pacers, maze procedure w/ bypass

If rate to slow vs. high

If slow might be AV issue since slower if high maybe SA issue

Supraventricular tachycardia s/s

If sustained palpitations, chest pain, weakness, fatigue, SOB, nervousness, anxiety, hypotension, syncope and if BP not sustained angina, heart failure, cardiogenic shock. If nonsustained possibly asymptomatic

Rn dx. For atrial dysrhythmia

Impaired gas exchange Decreased cardiac output Ineffective tissue perfusion

If quality of breathing not good what's anticipated

Non rebreather and if still bad use valve bag mask and anticipate intubation

Supraventricular tachycardia rate? Rhythm? P wave? QRS?

Rate - 150-250 bpm Rhythm - Regular P wave- buried in T wave QRS: narrow but can be wide

Atrial flutter rate: atrial? Ventricular? Rhythm? P wave? QRS?

Rate - Atrial - 250-350 bpm Ventricular - variable Rhythm - Atrial-regular, Ventricular-variable P wave - saw-tooth pattern QRS - Narrow

Atrial fibrillation rate? Rhythm? P wave? QRS?

Rate - Atrial - > 350 bpm Ventricular - Variable Rhythm - Irregular P wave Chaotic not clear QRS Normal

Normal sinus rhythm rate? Thythm? P wave? QRS?

Rate 60-100bpm, rhythm regular, p wave 1 per QRS that is consistent, QRS narrow<0.10 sec and constant

Low BG s/scan seem like

Stroke

If alcoholic assume

They have a brain injury

Nonurgent define? Reassess how often?

Time to intervention several hours. Reassess q 1-2 hours to make sure no change in status

Counting irregular rhythms aka 6 second strip method

Tip of R aka QRS numbers(aka just count the number of tips of QRS) in 6 second strip and multiply by 10