H356 Biophysical Processes: Final Exam

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What is the ranking numbers for categories on FLACC scale?

0-2

Hypoglycemia by age: * Ages ___-____: < 100 * Ages ___-___: < 80 * Ages ____+: < 70

0-5, 6-12, 13

Short-acting insulin: onset

0.5-1 hour

Rapid-acting insulin: peak

0.5-3 hours

normal serum creatinine

0.6-1.3 mg/dL

Long-acting insulin: onset

0.8-4 hours

Hypertonic fluids include saline solutions greater than ______% (3% and 5%)

0.9

Only fluid that is compatible with blood products

0.9% NS

What IV fluid would you anticipate hanging for client who is crashing on a med-surg unit; BP is dropping rapidly; rapid response team has been called overhead

0.9% NS

What is in NS

0.9% NaCl

Severe, steady, excruciating pain from cholelithiasis may last up to ___ _______, and when it subsides, there is _________ __________ in the _______

1 hour, residual tenderness, RUQ

Treatment of Sepsis: Considerations - Probably more than ___ _______ _______ IV - Vasopressors increase BP by __________ blood vessels, which can decrease tissue _________ and increase __________ of the heart, inotropes help with this - We have to try ________ first -- vasopressors don't work well if there is no volume in the blood vessels

1 large bore, constricting, perfusion, resistance, fluids

how much iron is generally lost everyday

1 mg

A 13-year-old just returned from surgery for scoliosis. What nursing interventions are appropriate in the first 24 hours (Select all that apply)? 1. □ Assess for pain. 2. □ Check neurological status. 3. □ Get the teen up to the bathroom 12 hours after surgery. 4. □ Log roll to change positions. 5. □ Monitor blood pressure.

1, 2, 4, 5

Peritoneal Dialysis: Solutions & Concentrations - Available in ___ or ___ L plastic bags with ___________ concentrations of _____%, 2.5%, and _________% - ____________ composition is similar to __________ - Solution ___________ to ________ temperature

1, 2, glucose, 1.5, 4.25, electrolyte, plasma, warmed, body

Folic Acid Replacement Therapy - Folic acid ___ mg/day ___________ - Up to ___ mg/day for chronic alcoholism

1, orally, 5

Output Minimums - Infants: ___-____ mL/kg/hr - Child: _____ ml/kg/hr - Older child/adolescent: _____-____ ml/kg/hr

1-2, 1, 0.5-1

Obesity: Nutritional Therapy - Weight loss of ___-___ lbs per ________ may result from decreasing calories by ____-________ per day - Carefully supervise is diet contains ______ calories/day or less - Avoid _______ - Avoid ___________ and __________ beverages, which add calories but little/no ___________ - _______ usually lose weight faster than _____________

1-2, week, 500-1000, 800, fads, alcohol, sugary, nutrition, men, women

How long does the acute HIV infection last?

1-3 weeks

How long does the diuretic phase normally last

1-3 weeks

Toddler age

1-3 years

The diuretic phase begins with a gradual increase in daily urine output of ____-_____ L/day, but may reach ___-___ L or more. The ____________ are still not fully functional. The ___________ may still be severe, as reflected by low _____________ _____________, elevated _________ _________ and ________ levels, and persistent signs and symptoms.

1-3, 3-5, nephrons, uremia, creatine clearance, serum creatinine, BUN

How long does the oliguric phase last

1-7 days

newborn normal urine SG

1.001-1.020

adult normal urine SG

1.005-1.030

Intermediate-acting insulin: onset

1.5-4 hours

1/2NS purpose

1/2 moves into cells and 1/2 remains in ECF

ECF makes up ___ of TBW

1/3

Most obesity interventions will result in ______% weight loss

average age of acute appendicitis

normal IV infusion rate of furosemide

10 mg/min

Peak incidence of type 1 DM is between _____ and _____ years of age

10, 15

HIV & IV Drug Use - W/o intervention, each infected injecting drug user (IDU) transmits HIV to _____ other people - 1 in 23 IDU women and 1 in 36 IDU men will be diagnosed with HIV - Injecting drug users have a shorter ________ ___________ than those who contract the virus other ways - First ______________ ________ in country will be in San Fransisco, Seattle, Philadelphia, and Baltimore

10, life expectancy, injecting sites

Rapid-acting insulin: onset

10-30 minutes

Plaster takes _____-____ _________ to dry

10-72 hours

Daily Maintenance Fluid Requirements - 1-10 kg: _________ ml/kg - 11-20 kg: ___________ ml + _____ ml/kg for each kg > ______ kg >20: ___________ ml + ______ ml/kg for each kg > ______ kg

100, 1000, 50, 10, 1500, 20, 20

Prediabetes is defined as fasting plasma glucose levels higher than or equal to _______ mg/dL or less than ________ mg/dL

100, 126

What is hyperthermia after the first 2 days postop > than in F and C

100, 37.8

Hypoglycemia by age: * Ages 0-5: < _____ * Ages 6-12: < _____ * Ages 13+: < ______

100, 80, 70

What is mild hyperthermia > or = in F and C

100.4, 38

What is moderate hyperthermia > or in F and C

100.4, 38

24 hour urine creatinine clearance normal

107-139 mg/dL

Within ____ ________ after surgery, output should be increasing

12 hours

Best outcome for speech development for child with CP if repair is performed before

12 months

Hgb normal

12-15

Intermediate-acting insulin: duration

12-18 hours

oral SR (sustained release) is given every

12-24 hours

Norovirus - Symptoms begin ____-____ _____ after exposure - Last ___ _____ to _____ _______ - Common in __________, day cares, cruise ships - contaminated _____, water, raw shellfish, mishandled food - Destroyed by _____________ but not ______________

12-28 hrs, 1 day, 2 weeks, schools, ice, cooking, freezing

Normal BP: Systolic < _______ (and/or) diastolic <= ______

120 and 80

Severe hyponatremia

120 or less

Hypertension exists when systolic BP is greater than _______ mmHg or diastolic BP is greater than ______ mmHg for extended periods of time

120, 80

Prehypertension Systolic ______-______ (and/or) diastolic <= ______

120-129 and 80

Hypertensive Crisis A severe and abrupt elevation in BP arbitrarily defined as DBP >= ______-_______ mmHg

120-140

The nurse administered 15 U NPH insulin (Humulin N) at 0800. Hypoglycemia would be most likely to occur between _______ and _______ (answer in military time)

1200, 2000

Moderate hyponatremia

121-129

Normal GFR is

125 mL/min

The amount of blood filtered by the glomeruli in a given time is termed the GFR and is about

125 ml/min

Type II Diabetes is defined as FBS > _______ mg/dL

126

Type 1 DM: Treatment Multidisciplinary Approach Glucose monitoring; goal, near normal levels of < _____ mg/dL * 13-19 years: _____-_____ * 6-12 years: ______-______ * <6 years: _____-______ Laboratory measurement of ____________ ______, goals: * Under 19 yr: <= ______ % * Goal of ______% if no excessive hypoglycemia Insulin therapy - __________ control: decreases risk of long-term complications - Selection of appropriate insulin preparation

126, 90-130, 90-180, 100-180, hemoglobin A1C, 7.5, 7, glycemic

Adolescent age

13-18 years

Type 1 DM: Nutrition Total carbs: Minimum of _______ g/day (____-___ g/meal) Protein: ____-____% of total calories Fat: Limit saturated fat to <_____% TDI Meal planning should be based on the individual's usual food intake and balanced with insulin and exercise patterns

130, 45-60, 15-20, 7

Mild hyponatremia

130-135

Hypertension- Stage 1 Systolic _____-_____ (and/or) diastolic _____-_____

130-139 or 80-89

Sodium

135-145

Na normal lab

135-145 mEq/L

Stage II HTN Systolic > ______ (and/or) diastolic >= _____

140 or 90

Hyperglycemia is defined as BG above __________ mg/dL, and severe hyperglycemia is defined as BG above ________ mg/dL

140, 180

Prediabetes can be defined as 2-hr oral GTT between ______ and ______

140, 199

What is the level of the GFR to meet the criteria for dialysis for CKD?

15 ml/min or less

Chronic Renal Failure: ESRD - GFR < _______ ml/min - Neurological: weakness/fatigue/confusion - CV: ___________ BP, __________ and _____________ edema, increased CVP, pericarditis -Pulmonary: ______, depressed __________, thick __________ - GI: ____________ odor to breath, ____________ taste, mouth/gum ___________, anorexia/nausea/vomiting - Psychological: Withdrawn, ____________ changes - Hematological: ___________ - Skin: Dry and flaky, ____________, ____________, purpura - MS: Cramps, renal _______________, _________ pain

15, increased, pitting, periorbital, SOB, cough, sputum, ammonia, metallic, ulcerations, behavioral, anemia, pruritus, ecchymosis, osteodystrophy, bone

Rule of 15: - ______ g of ___________ carbohydrates - __________ blood sugar _____ _________ after treatment - ___________ treatment if blood sugar still under specified range for age - ___________ HCP if no significant improvement after ___-___ _________ - Avoid foods with _______ (decreases ___________ of sugar) - Do not _____________ - Follow up with __________ carb if more than ___ ________ until next meal

15, simple, recheck, 15 minutes, repeat, contact, 2-3 doses, fat, absorption, overtreat, starchy, 1 hour

Drain - ____-_____ ___________ long - May be facilitated by gently _____________ __________ or changing position

15-30 minutes, massaging abdomen

PLT ct normal

150-400

What is normal intake and output for an average adult every day?

1500 mL

Hypertensive Crisis: Treatment Goal: BP is ______/_____ or _______ over the next ____-____ _________ Interventions: ______ ______: (Nitropress), (Nipride), _____________ - BP and pulse taken every ____-____ __________ - __________ drug according to level of BP - __________ urinary _________ - ____________ - ______________ checks - Monitor cardiac, pulmonary, and __________ systems for decompensation

160/100, 110, 2-6 hours, IV meds, nitroglycerin, 2-3 minutes, titrate, hourly, output, bedrest, neurologic, renal

Long-acting insulin: duration

18-24 hours (24 +)

Normal weight BMI

18.5-24.9

Number of HIV infections peaked in

1999

Which has the highest risk for HIV transmission? 1st 2-6 months of infection OR 1 year after infection

1st 2-6 months

When is a cheiloplasty usually performed?

2-3 months (10-12 weeks)

When is CL surgery done

2-3 months of age

VUR: Additional Interventions - Urine cultures may be collected every ____-____ _______; ___ _______ most common - _________ more likely to get UTI due to __________ distance to bladder - Most babies that present to ED for a _________ with no other symptoms get in and out cathed for a ______________ and _________ to r/o _______

2-3 months, E. Coli, girls, shorter, fever, urinalysis, culture, UTI

How long does viremia from HIV typically last?

2-3 weeks

Neonatal healing period

2-3 weeks

Short-acting insulin: peak

2-5 hours

Pain from duodenal ulcers usually occurs

2-5 hours after a meal

ICF makes up how much of body fluid?

2/3

After IV administer of glucagon to an unconscious hypoglycemic patient, expect patient to regain consciousness in about ____ __________.

20 minutes

normal furosemide dose per day

20-80 mg

On average, _______ to ______ mL of urine in the bladder causes moderate distension - the urge to void/urinate

200, 250

AIDS occurs with presence of HIV and at least one of the following conditions: 1. CD4+ T cell count drops below _______ cells/uL 2. One of the following opportunistic infections: Fungal: ____________ Viral: _______________ disease other than liver, spleen, or nodes, herpes simplex w/chronic ulcers, varicella, herpes Protozoal: ______________ of the brain, isosporiasis Bacterial: ________________ _______________ 3. One of the following opportunistic cancers - Invasive cervical cancer, ___________ ___________, Burkitt's lymphoma, immunoblastic lymphoma, primary ____________ of the brain 4. ____________ ___________: loss of _____ or more of ideal body mass 5. _________ ____________ ___________ (Cognitive, motor, and behavioral impairments in 70% of AIDS clients)

200, candida, cytomegalovirus, toxoplasmosis, myobacterium tuberculosis, Kaposi Sarcoma, lymphoma, wasting syndrome, 10%, AIDS dementia complex

During the symptomatic infection stage, CD4 count is _____-______ and viral load is __________

200-500, increasing

What is the best indicator for renal function and can indicate if the clients kidney disease is worsening?

24 hour urine-creatinine clearance, closely approximates GFR

Fat Embolism Syndrome: Clinical Manifestations - Usually occurs ___-___ _____ after injury, may be in short hours if extreme - When emboli travel to _________, S/S are caused by poor O2 exchange - _________ pain - _____________, cyanosis - Dyspnea - Apprehension - Confusion - Changes in ______ - TACHYCARDIA - Decreased partial pressure of ____________ _________ - Diffuse _____________ (late) - ___________ __________ changes - Restlessness - Headache

24-48 hours, lungs, chest, tachypnea, LOC, arterial oxygen, crackles, mental status

What percent of Americans have MS

25%

Treatment of Mild Scoliosis - Up to a _____ degree curvature - ______ ______________ - Follow up every 4-6 months

25, no treatment

Treatment of Moderate Scoliosis - Between ____-____ degree curvature - _____________ & ____________

25-45, bracing, exercise

Hypotonic IV fluids have osmolality of less than _________ mOsm/L

270

FACES pain scale can be used as young as _____ years old

How long can it take for HIV antibody test to be positive

3 weeks to 3 months

Hypertonic IV Fluids Examples

3% NS, D5W 0.9NS, D10W

Pharmacological Pain Management: Mild & Low Moderate (<___ on a 0-10 scale) & (___-___) - ______________ - __________

3, 4-6, acetaminophen, NSAIDs

Screening for diabetes is recommended every ______ years for patients _____ years and older

3, 45

Diagnosing Metabolic Syndrome _____or more of these: - __________ __________: >= 40 in men, >= 35 in women - ______________: > ______ g/dL OR drug treatment for elevation - _______ cholesterol: <____ in men or <____ in women OR drug treatment for this problem - __________ ___________: >____ systolic OR >____ diastolic OR drug treatment for HTN - ___________ __________ ___________: > _____ g/dL OR drug treatment for elevated BG

3, waist circumference, triglycerides, 150, HDL, 40, 50, blood pressure, 130, 85, fasting blood glucose, 110

How long does AKI recovery phase normally last

3-12 months

When does wound infection usually occur

3-5 days post op

Rapid-acting insulin: duration

3-5 hours

Attacks of pain from cholelithiasis frequently occur ___-____ _______ after a _____-_____ _______ or when the patient _______ _________

3-6 hours, high-fat meal, lies down

Preschool age

3-6 years

Potassium

3.5-5.0

K normal lab

3.5-5.0 mEq/L

When are antacids taken

30 minutes before or 1-3 hours after meals

Obesity BMI

30-39.9

Hypertonic IV fluids have an osmolality greater than _______ mOsm/L

300

oral IR (immediate release) is given every

4 hours

Peak incidence of GER is in infants _____ __________ of age and generally resolves spontaneously around _____ ___________ of age

4 months, 12 months

Early childhood healing period

4 weeks

Who can use the FACES pain scale? _____ year-olds

Intermediate-acting insulin: peak

4-12 hours

anuria is urine output < ____ mL/day

Severe/morbid obesity BMI

40+

Average daily secretion of insulin in adults is ___-____ U daily

40-50

oliguria is a decrease in urinary output to < ________ ml/day

400

Treatment of Severe Scoliosis: Angle > ____ degree curvature - Surgical intervention with _________ __________ and ____________ ______________

45, spinal fusion, internal stabilization

When should pregnant patients stop taking glipizide?

48 hours before delivery

How long must a patient stop their metformin before getting a study done with contrast dye? How long after?

48 hours, 48 hours

CL and CP - Facial malformations that occur between the ______ and _____ week of _____________ development - May appear ___________ or __________

4th, 10th, embryonic, separately, together

Folic acid deficiency is characterized by serum folate < ____ ng/mL

D5 1/2NS composition

5% dextrose in 0.45 saline

D5NS Composition

5% dextrose in 0.9% saline

D5W composition

5% dextrose in water (2/3 enters cell and 1/3 remains in the ECF)

the numeric pain scale can be used as young as ____ years old but is normally used for children ___ and up

5, 8

Synthetic takes ___-____ ___________ to dry

5-20 minutes

Pharmacological Pain Management: Moderate to Severe - (___-___) to (>___) pain - _____________ - ___________-___________ ___________

5-6, 7, opioids, patient-controlled analgesia

Sublingual and buccal provides faster relief (__-___ __________) and lasts ___-___ _________

5-7 minutes, 2-5 hours

Short-acting insulin: duration

5-8 hours

Oral prednisone is used for clients with IBD who did not respond to

5-ASA

Prediabetes is defined as HbA1C from _______-_______%

5.7-6.4

Food allergy affects up to ___% of children 3 years and younger

Developmental and Biological Variances - Infants younger than _____ __________ do not produce _________ - Infant __________: sunken vs bulging - Infant ____________ on others to meet fluid needs - Infant has limited ability to __________ and ______________ urine

6 weeks, tears, fontanels, dependent, dilute, concentrate

When potassium levels exceed ____ mEq/L or ____________ are identified, treatment must be initiated immediately

6, dysrhythmias

Fear/Stressors: Infant - at about ____ months of age are acutely aware of absence of parent and become fearful of unfamiliar persons (____________ _________) - They can sense the _________ their parents are experiencing - Used to having basic needs met by _____________ - In some situations, constraints of hospitalization results in loss of _________ being met by __________, which could result in issues with __________ - ___________ __________: beginning in the older infant

6, stranger anxiety, anxiety, parents, needs, parents, attachment, separation anxiety

When is palatoschisis normally performed

6-12 months

School age

6-13 years

Normal BUN

6-20 or 10-20 mg/dL

Later childhood healing period

6-8 weeks

Diagnostic Evaluation: Type 1 DM - A1C >= ________% OR - ___-hour FBG level of > ______ mg/dL OR - Oral GTT of _______ or more in a ___-hour sample OR - Random blood glucose level of ________ mg/dL or more _________ by classic ________ of diabetes

6.5, 8, 126, 200, 2, 200, accompanied, signs

Metabolic syndrome is more prevalent in those over _____ ________ of age

60 years

PUD: Gerontological Considerations - Increased in patients > ____ ______ of age - Increased use of ___________ - First manifestation may be ________ ___________ ____________ or ___________ _____________ - treatment similar to younger adults - Emphasis placed on prevention of both ___________ and _______ __________

60 years, NSAIDs, frank gastric bleeding, decreased hematocrit, gastritis, peptic ulcers

Glycemic goal of treatment for diabetes: HbA1C of less than ____% Fasting blood glucose goal is _____-______ mg/dL

7, 70-126

Hypoglycemia occurs when blood glucose is less than ________ mg/dL and severe hypoglycemia occurs when BG is less than ________ mg/dL

70, 50

Euglycemia is _____-_______ mg/dL

70-140

Adolescence healing period

8-12 weeks

Calcium normal

8.6-10.2 mg/dL

Normal PaO2

80-100

Normal CD4 count

800-1200

Low output in the first 24 hrs (______-________ mL) may be normal expected

800-1500

Which percentage of hip fractures result from a fall?

90%

What is the goal term for HIV? (____% aware of HIV status, ____% on HIV treatment, _____% virally suppressed)

90, 90, 90

Chronic Renal Failure: Diminished Renal Reserve - Glomerular filtration rate - > or = ________ ml/min - Observation & control of ________ ____________ - _____ _______ __________ for ___________ _____________ to detect loss of renal reserve - Kidney damage with ___________ or _____________ GFR - Decreased urinary _____________ and _________________ - Treatment of ______________ conditions: diabetes, HTN, renal artery stenosis

90, blood pressure, 24 hr urine, creatinine clearance, normal, increased, concentration, nocturia, comorbid

What is hypothermia < or = in F and C

96.8, 36

What WHR is optimal

< 0.8

Underweight BMI

< 18.5

Acute Pain - ___ ____ months duration - ____________ heart rate, respiratory rate, blood pressure - ______________/pallor - ____________, agitation, confusion - Urine _____________ - Goal: Pain control with eventual _______________

< 3, increased, diaphoresis, anxiety, retention, elimination

What WHR indicates truncal fat

> 0.8

Chronic Pain - ___ ___ months duration - ______________ physical movement/activity - ______________ - _______________ from others and social interaction - Goal: control pain to the extent possible focusing on __________ ____ __________ and ____________

> 3, decreased, fatigue, withdrawal, quality of life, function

What waist circumference indicates obesity for a woman

>35 inches

What waist circumference indicates obesity for a man

>40 inches

A client has the following symptoms: urgent and frequent bowel movements of diarrhea that contains blood with pus and mucous, low hemoglobin/hematocrit, potassium level of 2.0. Based on the patient's signs and symptoms, which disease does this describe? A. Ulcerative Colitis B. Crohn's Disease C. Appendicitis D. Necrotizing enterocolitis

A client received 14 Units of regular insulin (Humulin R) before breakfast at 8 am. If the client doesn't eat any breakfast, what symptoms should the nurse assess for at 10 am. A. Profuse sweating and lethargy B. Fatigue and blurred vision C. Excessive amounts of urine D. Hunger and intense thirst

Cushing's or Addison's (C/A) Adrenal atrophy (autoimmune, infection, tumor metastasis)

Cushing's or Addison's (C/A) Bronze pigmentation of skin

Cushing's or Addison's (C/A) Constipation and diarrhea

Cushing's or Addison's (C/A) Dehydration/hypovolemia

Cushing's or Addison's (C/A) Hyperpigmentation

Cushing's or Addison's (C/A) Hypoglycemia

Cushing's or Addison's (C/A) Hyponatremia

Cushing's or Addison's (C/A) Hypotension

Cushing's or Addison's (C/A) Nausea and vomiting

Cushing's or Addison's (C/A) Orthostatic hypotension -- dizziness

Cushing's or Addison's (C/A) Salt cravings

Cushing's or Addison's (C/A) Unexplained hyperkalemia

Cushing's or Addison's (C/A) Weakness and fatigue

Cushing's or Addison's (C/A) Weight loss

If fluid therapy fails to restore an adequate BP, the first-line vasopressor is: A) Norepinephrine B) Epinephrine C) Solumedrol D) Dobutamine

In the chronic, asymptomatic phase of HIV infection, we expect to find: A) Low viral load, CD4 above 500, detectable antibodies. B) High viral load, CD4 150 C) Flu like symptoms, high viral load, normal CD4, positive HIV antibodies D) Slight decrease in CD4, Viral load rising, no detectable antibodies.

The client is admitted into the emergency department with diaphoresis, pale clammy skin, temp 36.5 C and BP of 90/70. They also have a urinary tract infection. Which intervention should the nurse implement first? A. Start an IV with an 18 gauge catheter B. Administer dopamine intravenous infusion C. Obtain arterial blood gases (ABGs) D. Insert and indwelling urinary catheter

The faster the onset of anaphylaxis symptoms, the more severe the allergic reaction. A.True B.False

The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes mellitus? A. A 48-year-old woman with a hemoglobin A1C of 8.4% B. A 58-year-old man with a fasting blood glucose of 111 mg/dL C. A 68-year-old woman with a random plasma glucose of 190 mg/dL D. A 78-year-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL

The nurse is teaching a 60-year-old woman with type 2 diabetes mellitus how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful? A. "I can help control my blood pressure by avoiding foods high in salt." B. "Smokeless tobacco products decrease the risk of kidney damage." C. "I should have yearly dilated eye examinations by an ophthalmologist." D. "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL."

The nurse teaches a 38-year-old man who was recently diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient requires an intervention by the nurse? A. "I will discard any insulin bottle that is cloudy in appearance." B. "The best injection site for insulin administration is in my abdomen." C. "I can wash the site with soap and water before insulin administration." D. "I may keep my insulin at room temperature (75 o F) for up to a month."

The nurse would expect serum protein levels of a child with MCNS to be: A. Low B. Normal C. High

When the nurse is caring for a client whose HIV status in unknown, which of these exposures is most likely to transmit HIV? A) Needle stick with a needle and syringe used to draw blood. B) Splash into the eyes when emptying a bedpan containing stool C) Contamination of open skin lesions with client vaginal secretions D) Exposure to sputum and saliva during tracheal suctioning

Which assessment information is most important for the nurse to obtain when evaluating whether treatment of a patient with anaphylactic reaction has been effective? A) Oxygen saturation B) Orientation C) Heart rate D) Blood pressure

Which laboratory finding, in conjunction with the presenting symptoms, indicates minimal-change nephrotic syndrome (MCNS)? A) Hypoalbuminemia B) Low specific gravity C) Decreased hematocrit D) Decreased hemoglobin

A nurse is assessing a client who is admitted for elective surgery and has a history of Addison's disease. Which of the following findings should the nurse expect? A. Hyperpigmentation B. Intention tremors C. Hirsutism D. Purple Striations

A (Addison's disease is an endocrine disorder that occurs when the adrenal glands do not produce enough of the hormone cortisol, and in some cases, the hormone aldosterone. The disease is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and hyperpigmentation (darkening) of the skin in both exposed and non-exposed parts of the body.)

A nurse is caring for a client with type 1 diabetes mellitus who reports feeling shaky and having palpitations. When the nurse finds the client's blood glucose to be 48 mg/dL on the glucometer, he should give the client which of the following? A. Graham crackers B. 1 tsp sugar C. 4 oz diet soda D. 4 oz skin milk

A (After establishing that the client has hypoglycemia, the nurse should give the client about 15 g of a rapid-acting, concentrated carbohydrate, such as 4 oz of fruit juice, 8 oz of skim milk, 3 tsp of sugar or honey, 3 graham crackers, or commercially prepared glucose tablets. The nurse should recheck the client's blood glucose level in 15 minutes. 1 tsp sugar does not contain enough carbohydrate to reverse hypoglycemia. The usual recommendation is 4 tsp of sugar or 1 tablespoon of honey. The client who has hypoglycemia requires treatment with15g of carbohydrates to raise the blood glucose level. Diet soda does not contain the required carbohydrates, but has artificial sweeteners. The nurse can administer 4 oz of regular soda, however. This does not contain enough carbohydrate to reverse hypoglycemia. The usual recommendation is 8 oz of skim milk in order to provide 15 g of carbohydrates.)

A client is admitted in a state of diabetic ketoacidosis. The Health Care Provider (HCP) prescribes insulin detemir 0.1 units/kg/hr to be administered via intravenous (IV) drip. What should the nurse do? A. Consult the prescriber STAT. B. Calculate the insulin dose and mix it with 100 mL of normal saline C. Calculate the insulin dose and infuse the solution prepared by the pharmacy. D. Calculate the insulin dose and mix it with 100 mL of D5W.

A (Insulin detemir is a long-acting or basal insulin. ONLY short or rapid-acting insulins can be administered via IV. Regular insulin is the most common insulin to be administered via an IV drip. Insulin apsart, insulin lispro, and insulin glulisine would also be acceptable to administer via IV as well, as they are all rapid-acting insulins.)

A client is admitted to the hospital with Cushing Syndrome. On the physical assessment of the client, what should the nurse expect to find? A. Hypertension, peripheral edema, and petechiae B. Weight loss, buffalo hump and, moon face with acne C. Abdominal and buttocks striae, truncal obesity, and hypotension D. Anorexia, signs of dehydration, and hyperpigmentation of the skin

A (The effects of Adenocorticotropic hormone (ACTH) excess, especially the glucorticoids-- leads to weight gain from accumulation and redistribution of adipose tissue.)

A nurse is caring for a child who has Addison's disease. Which of the following actions should the nurse take? A. Teach the parents about cortisol replacement therapy. B. Place the child on a low-sodium diet C. Monitor the child for fluid-volume excess D. Discuss the manifestations of hypoglycemia with the parents.

A (The nurse should plan to teach the child's parents about cortisol replacement therapy. Administration of glucocorticoids and mineralocorticoids is necessary because inadequate supplies or a sudden cessation of the medications can cause acute adrenal crisis.)

Five Years have passed. On a slow-ish Tuesday night you realize the next patient being worked up is you old friend, AD! He presents with nausea and vomiting. Abdomen is distended. Bowel sounds are present, slightly hyperactive. He has not had a bowel movement in 6 days. The physician suspects a bowel obstruction. What type of obstruction do you suspect? A. Mechanical due to surgical adhesions/scar tissue B. Non-Mechanical post operative ileus C. Mechanical - intussusception

A (Yes - with his history of abdominal surgeries, and presence of bowel sounds the most likely type of obstruction would be mechanical.)

High Intestinal Obstruction Onset: A. Acute B. Slow/insidious Pain: A: Less intensity, vague and mild or sharp and severe, depending on the cause B. Crampy pain, colicky, intermittent Vomiting: A. Late, feculent odor may be absent, but serious if noted B. Early, profuse, biliary Abdominal distension A. Greatly increased B. Increased Constipation: A. Absolute constipation with lack of flatus and some diarrhea B. +Feces for a short time? Electrolytes: A. Rapid loss of Cl, K, Na B. Late imbalance?

A, B, B, A, B, A

A child with bacterial pneumonia is prescribed antibiotics as well as supplemental oxygen. The child also requires sufficient fluids. In addition to this, the child has chest tube to remove air from the intrathoracic space. What should the nurse include in the plan of care of this child? Select all that apply. A) Carefully assess the respiratory status B) Monitor chest tube insertion site to ensure patency C) Monitor functions of chest tube and drainage device D) Prescribe medicine for fever and shallow respirations E) Administer a dose of pneumococcal conjugate vaccine

A, B, C

A child with bacterial pneumonia is prescribed antibiotics as well as supplemental oxygen. The child also requires sufficient fluids. In addition to this, the child has chest tube to remove air from the intrathoracic space. What should the nurse include in the plan of care of this child? Select all that apply. A. Carefully assess the respiratory status B. Monitor chest tube insertion site to ensure patency C. Monitor functions of chest tube and drainage device D. Prescribe medicine for fever and shallow respirations E. Administer a dose of pneumococcal conjugate vaccine

A, B, C

The nurse is teaching to a group of nursing trainees on food allergies of children. What are the points that the nurse should mention to the trainees? Select all that apply. A) "Educate the parents and teachers regarding symptoms of food allergies." B) "Educate people with known food allergies to avoid unknown foods and restaurants." C) "Educate mothers to breastfeed their infants to provide immunity against allergens." D) "Educate the parents to ignore the ingredient list on food that is sold commercially." E) "Educate the people to refuse admission to children in day care center with known food allergies."

A, B, C

A child with minimal-change nephrotic syndrome (MCNS) is prescribed steroid therapy. What information does the nurse provide to the family before starting the therapy? Select all that apply. A) The nurse emphasizes on the importance of long-term care. B) The nurse informs the family about the side effects of the therapy. C) The nurse emphasizes that dietary rules need to be followed strictly. D) The nurse instructs the family how to detect signs of relapse or complications. E) The nurse informs the family that the child may have to stop attending school.

A, B, C, D

Hypo-perfusion of the Gastrointestinal system in the septic patient can lead to.... (SELECT ALL THAT APPLY) A) Hypoactive bowel sounds. B) Paralytic ileus C) Gastric ulcers D) Bowel Ischemia

A, B, C, D

Clients with severe sepsis typically have...... (Select all that apply) A) Hypotension B) Tachycardia C) Anemia D) Respiratory Distress

A, B, D

Signs of sepsis include... (SELECT ALL THAT APPLY) A) Elevated Lactate level >1 mmol/L B) SBP<90 or >40 mmHg drop in systolic BP C) Hypertension D) Elevated WBCs (>12000)

A, B, D

You client is diagnosed with Hyperosmolar Hyperglycemic Syndrome (HHS). Which of the following lab results are consistent with this diagnosis (SELECT ALL THAT APPLY). A. Urine: large amount glucose (normal is 0) B. Blood Glucose: 880 mg/dL C. Urine: Positive for large amounts of ketones (normal is 0_ D. Potassium (K+): 2.8 mmoL/L

A, B, D (In the case of hyperglycemia that we see in HHS, we expect to see elevated glucose in the blood, as well as in the urine. The kidneys are trying to help flush out the excess glucose by way of urination. Although we thank the kidneys for their effort, this is often unsuccessful and leads to extreme dehydration in your patient. The will get better faster with some insulin! Blood HYPERglycemia is the problem here. The high blood glucose causes polyuria and extreme dehydration in these patients. Due to excessive urination the K+ may be low in these clients. Remember that they do have some insulin to draw K+ into the cells, as well. Each patient will be different -- we want you to remember that in these cases, K+ is going to change rapidly, so you need to make sure you have frequent labs to monitor this important electrolyte.)

A nurse is caring for a client who has Cushing's disease. The nurse should identify that clients who are at risk for which of the following? (Select all that apply). A. Infection B. Gastric ulcer C. Renal calculi D. Bone fractures

A, B, D (Suppression of the immune system places the client at risk for infection. Clients are at higher risk for bone fractures due to decrease calcium absorption which leads to osteoporosis. These clients are a risk for gastric ulcers due to the overproduction of cortisol inhibits the production of the protective lining in the stomach. Clients with Cushing's do not have a risk for the development of renal calculi.)

A nurse is assessing a client who has Cushing's syndrome. Which of the following interventions should the nurse expect to perform? (Select all that apply.) A. Assess blood glucose level B. Assess for neck vein distension C. Monitor for an irregular heart rate D. Monitor for postural hypotension E. Weight the client daily

A, B, E

A 78-year-old patient is admitted with a BP of 180/98 mm Hg. Which age-related physical changes may contribute to this patient's hypertension (select all that apply)? A. Decreased renal function B. Increased baroreceptor reflexes C. Increased peripheral vascular resistance D. Loss of elasticity in large arteries from arteriosclerosis E. Increased adrenergic receptor sensitivity

A, C, D (The age-related changes that contribute to hypertension include decreased renal function, increased peripheral vascular resistance, increased collagen and stiffness of the myocardium, and decreased elasticity in large arteries from arteriosclerosis.)

What are nonmodifiable risk factors for primary hypertension (select all that apply)? A. Age B. Obesity C. Gender D. Ethnicity E. Genetic link

A, C, D, E (Hypertension progresses with increasing age. It is more prevalent in men before early middle age and above the age of 64 years in women. Blacks have a higher incidence of hypertension than do whites. Children and siblings of patients with hypertension should be screened and taught about healthy lifestyles.)

A nurse is assessing a client who has Cushing's syndrome. Which of the following findings should the nurse expect? (Select all that apply): A. Alopecia B. Tremors C. Moon face D. Purple striations E. Buffalo hump

A, C, D, E (MY ANSWER Alopecia is correct. Clients who have Cushing's syndrome can develop hirsutism, which is excessive body hair. Women can also develop alopecia, in the form of male pattern baldness.Tremors is incorrect. Tremors are not a common manifestation of Cushing's syndrome.Moon face is correct. Moon face, which is manifested by a round, red, full face, is a common manifestation of Cushing's syndrome.Purple striations is correct. Purple striations on the skin of the abdomen, thighs, and breasts are common manifestations of Cushing's syndrome.Buffalo hump is correct. Buffalo hump, which is a collection of fat between the shoulder blades, is a common manifestation of Cushing's syndrome.)

Select the most common food allergies from this list. (There are 5). A) Eggs B) Spices C) Peanuts D) Nuts E) Soy F) Fish/shellfish G) Buckwheat H) Strawberries I) Citrus

A, C, D, E, F

After a few more days in the hospital, you are finally ready to discharge A.D. In his discharge instructions you will include: A. Eat small, soft, frequent meals B. Maintain a high carbohydrate, high protein diet C. Monitor incision for redness, swelling, or drainage. Notify health care provider if these occur. D. Report any increased nausea and/or vomiting, epigastric pain, bloody emesis, or tarry stools. E. Eliminate high concentrated sweets from the diet. F. Limit fluid intake to 1 quart a day. G. Avoid using NSAIDS for pain relief

A, C, D, E, G (A: eating smaller meals more frequently will decrease the risk of nausea and dumping syndrome. Softer foods will be better at first for his healing stomach. C. Signs of infection D. Would be a sign GI tract bleeding E: with removal of part of the stomach, he is at risk for dumping syndrome and post-prandial hypoglycemia, so less concentrated sweets will be best. G: We know AD is prone to ulcers, and since NSAIDs are linked to ulcer risk, he should avoid this category of medication.)

THE DIET OF A CHILD WITH MODERATE TO SEVERE EDEMA WITH MINIMAL CHANGE NEPHROTIC SYNDROME (MCNS) INCLUDES? (SELECT ALL THAT APPLY) A. HIGH PROTEIN. B. HIGH CARBOHYDRATE. C. LOW FAT. D. NO SALT ADDED. E. 700ML FLUID RESTRICTION.

A, D, E

Fat-soluble vitamins

A, D, E, K

Help relax your veins and arteries to lower your blood pressure. These medications prevent an enzyme in your body from producing angiotensin II, a substance that narrows your blood vessels. This narrowing can cause high blood pressure and force your heart to work harder.

ACE inhibitors

Which anti-hypertensives are prescribed to diabetic patients

ACE inhibitors (lisinopril), ARBs (losartan, Cozaar)

Most common cause of endogenous Cushing syndrome.

ACTH-secreting pituitary adenoma

Increases reabsorption of water by the tubules of the kidney

ADH

Blocks the action of angiotensin II so that veins and arteries dilate

ARBs (angiotensin II receptor blockers)

___________ ____________, as compared to other ethnic groups, have the highest prevalence of HTN in the world

African Americans

What are the five drug classes used to treat IBD

Aminosalicylates, corticosteroids, biologic therapies (immunomodulators), immunosuppressants, antibiotics

Secretes GH, prolactin, and other tropic hormones

Anterior pituitary

Treatment for H. Pylori

Antibiotics (clarithromycin, amoxicillin, etc.)

What type of medication scheduling is most effective for chronic and predictable pain?

Around the clock (ATC)

Gallbladder disease is more common in ___________ Americans and __________ Americans. There is an especially high incidence of gallbladder disease in the Native American population, particularly in the _________ and ______ tribes.

Asian, African, Navaho, Pima

How often should diabetic patient go through risk factor assessment for HTN, DLD, smoking, family history, CAD, and presence of macroalbuminuria and microalbuminuria

At least annually

may be used in the acute care setting, the outpatient dialysis center or the patient's home. It uses a cycling machine for dialysate inflow, dwell, and outflow according to present times and volumes.

Automated peritoneal dialysis (APD)

A child has a nasogastric (NG) tube after surgery for acute appendicitis. What is the purpose of the NG tube? A. To maintain electrolyte balance B. To prevent abdominal distention C. To prevent the spread of infection D. To maintain an accurate record of output

A client has the following signs and symptoms: abdominal cramping which is mainly located in the right lower side, ulcers in the mouth, bleeding anal fissure, and diarrhea. Based on the patient's signs and symptoms, which disease does this describe? A. Ulcerative Colitis B. Crohn's Disease

After teaching a client with HIV about starting anti-retroviral therapy, the nurse recognizes that further teaching is needed when the client says: A. "I should never skip doses, even if I develop side effects" B. If my viral load becomes undetectable, I will not be able to transmit HIV to others C. I should not use any OTC drugs without checking with my healthcare provider

Ephinephrine is appropriate to administer to a patient experiencing an anaphylactic reaction because it is a: A. Vasoconstrictor and Bronchoconstrictor B. Vasoconstrictor and Bronchodilator C. Vasodilator and Bronchoconstrictor D. Vasodilator and Bronchodilator

Food allergies are typically symptomatic: A.The first time the child eats the food B.The second time the child eats the food C.After several ingestions of the food D.When the child is in a house that the food is being prepared

One of the parents of a child calls the clinic and asks, "We want to visit a seafood joint on my child's birthday. I am allergic to shellfish. Is there a chance that my child will also be allergic to shellfish?'' What response does the nurse give the parent? A) "Your child has 100% chance of suffering from food allergy." B) "Your child has a 50% chance of suffering from shellfish allergy." C) "Your child will not be allergic to shellfish it is not transmitted from parents." D) "Your child will be allergic to shellfish if only your spouse suffers from allergy."

The client with sepsis weighs 250 pounds (lbs.). What volume of Normal Saline (NS 0.9%) does the nurse expect to give as a bolus? A) 7500 mL B) 3409 mL C) 1136 mL D) 250 mL

The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant's postoperative care include: A. Arm restraints, suctioning of drainage, and mouth irrigations. B. Cleansing of suture line, supine position, and arm restraints. C. Mouth irrigations, prone position, and cleansing of suture line. D. Supine and side-lying positions, suctioning of drainage, and arm restraints.

The nurse provides teaching to the parent of an 16 month old with a cow's milk allergy. The nurse knows the parent needs further education when she states: A) "I should watch for signs/symptoms of other food allergies." B) "This allergy is probably related to breastfeeding." C) "I will need to read ingredient labels carefully." D) "My child may outgrow this allergy."

To prevent gastric ulcers in the septic patient, the nurse anticipates an order for: A. Solumedrol (Solucortef) 125 mg. IV push BID B. Pantoprazole 40 mg. IV push BID C. Vancomycin 1.5 grams IV piggyback BID D. Metoprolol 5 mg. IV push BID

What does dark yellow and frothy urine indicate? A. Ketones and glucose B. Dehydration and proteinuria C. WBCs and dehydration D. RBCs and glucose

What is one of the most significant factors in determining when to start antiretroviral therapy in a patient with HIV? A. Whether the patient has high levels of HIV antibodies B. The patient's readiness to commit to a complex, lifelong, uncomfortable drug regimen C. Whether the patient has a support system to help manage the costs and side effects of the drugs.

Which type of bowel disease is most likely to cause severe malnourishment A. UC B. CD

Which type of obstruction will most often result in diminished or absent bowel sounds? A. Mechanical B. Non-Mechanical

A nurse is assessing four clients on a medical unit. The nurse should identify which of the following clients as exhibiting positive manifestations of hypercortisolism? A. A client who has a butterfly rash on his face B. Moon face C. A client who has a positive Chvostek's sign D. A client who has muscle hypertrophy

B (A client who has a moon face and fat pads on his neck, back and shoulders is exhibiting manifestations of hypercortisolism or Cushing's syndrome.)

A staff nurse is teaching a client who has Addison's disease about the disease process. The client asks the nurse what causes Addison's disease. Which of the following responses should the nurse make? A. "It is caused by the lack of production of insulin by the pancreas." B. "It is caused by the lack of production of aldosterone by the adrenal gland." C. "It is caused by the overproduction of growth hormone by the pituitary gland." D. "It is caused by the overproduction of PTH by the parathyroid gland."

B (Addison's disease is caused by a lack of production of the adrenocorticotropic hormones (cortisol and aldosterone) by the adrenal gland.)

What early manifestation(s) is the client with primary hypertension likely to report? A. Cardiac palpitations B. No symptoms C. Dizziness and vertigo D. Dyspnea on exertion

B (Hypertension is often asymptomatic, especially if it is mild or moderate, and has been called the silent killer. The absence of symptoms often leads to noncompliance with medical treatment and a lack of concern about the disease in patients. With severe hypertension, symptoms may include fatigue, palpitations, angina, dyspnea, and dizzines)

What does the nursing responsibility in the management of the patient with hypertensive urgency include? A. Monitoring hourly urine output for drug effectiveness B. Instructing the client to follow up with a health care provider within 24 hours after outpatient treatment C. Titrating IV drug dosages based on BP and HR measurements every 2 to 3 minutes D. Providing continuous electrocardiographic (ECG) monitoring to detect side effects of the drugs

B (Hypertensive urgencies are often treated with oral drugs on an outpatient basis, but it is important for the patient to be seen by a HCP within 24 hours to evaluate the effectiveness of the treatment.)

A nurse is teaching a client who has been taking prednisone to treat asthma and has a new prescription to discontinue the medication. The nurse should explain to the client to reduce the dose gradually to prevent which of the following adverse effects? A. Hyperglycemia B. Adrenocortical insufficiency C. Severe dehydration D. Rebound pulmonary congestion

B (Prednisone, a corticosteroid, is similar to cortisol, the glucocorticoid hormone produced by the adrenal glands. It relieves inflammation and is used to treat certain forms of arthritis, severe allergies, autoimmune disorders, and asthma. Administration of glucocorticoids can suppress production of glucocorticoids, and an abrupt withdrawal of the drug can lead to a syndrome of adrenal insufficiency.)

Which outcome is a priority for the client with Addison's disease? A. Adherence to a 2-gm sodium diet B. Maintenance of medication compliance C. Prevention of hypertensive episodes.

B (The maintenance of medical compliance is critical. Clients should never stop taking the prescribed medication without taking to their healthcare provider.)

What describes a primary difference in treatment for diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS)? A. DKA requires administration of bicarbonate to correct acidosis. B. HHS requires greater fluid replacement to correct dehydration. C. Administration of glucose is withheld in HHS until the blood glucose reaches a normal level. D. Potassium replacement is not necessary for the management of HHS.

B (The management of DKA is similar to that of HHS except HHS requires greater fluid replacement because of the severe hyperosmolar state. Bicarbonate is not usually given in DKA unless pH is <7.0 because administration of insulin will reverse the abnormal fat metabolism. Total body potassium deficit is possible in both conditions, requiring monitoring and possibly potassium administration, and in both conditions, glucose is added to IV fluids when blood glucose levels fall to 250 mg/dL.)

A nurse is providing dietary teaching for a client who has Cushing's disease. Which of the following recommendations should the nurse include in the teaching? A. Limit intake of potassium-rich foods B. Restrict sodium intake C. Increase carbohydrate intake D. Decrease protein intake

B (The nurse should recommend the client to restrict sodium intake to control fluid volume. This restriction can range from "no-added-salt" to table foods to a restriction of 2 g/day.)

A nurse is assessing a client who has Addison's disease and is at risk for Addisonian crisis. Which of the following actions should the nurse take? A. Provide a low-carbohydrate diet B. Weigh the client daily C. Administer oral corticosteroids D. Restrict fluid intake

B (Weigh the client daily. Addison's disease is an endocrine disorder that causes weight loss, muscle weakness, fatigue, low blood pressure, and hyperpigmentation (darkening) of the skin. Obtaining the client's daily weight will alert the nurse that dehydration is developing, which could indicate an impending crisis.)

The client with Cushing's disease needs to modify dietary intake to control symptoms. In addition to increasing protein. Which strategy would be most appropriate? A. Increase calories B. Restrict sodium C. Restrict potassium D. Reduce fat to 10%

B (restricting sodium thereby reduces fluid retention)

Water-soluble vitamins

B and C

Low Intestinal Obstruction Onset: A. Acute B. Slow/insidious Pain: A: Less intensity, vague and mild or sharp and severe, depending on the cause B. Crampy pain, colicky, intermittent Vomiting: A. Late, feculent odor may be absent, but serious if noted B. Early, profuse, biliary Abdominal distension A. Greatly increased B. Increased Constipation: A. Absolute constipation with lack of flatus and some diarrhea B. +Feces for a short time? Electrolytes: A. Rapid loss of Cl, K, Na B. Late imbalance?

B, A, A, B, A, B

Until A.D's obstruction resolves, you anticipate orders for: A. Jejunostomy/J-Tube B. IV Fluids or TPN C. Activity: Strict Bedrest D. NG tube to low continuous suction E. Strict I/O F. Activity: Up with assist G. Regular diet H. NPO I. Chloraseptic or lidocaine throat spray J. IV Proton Pump inhibitor (such as Pantoprazole) K. Ibuprofen (Advil/Motrin) PO for pain

B, D, E, F, H, I, J (B: We need to make sure AD doesn't become dehydrated/under-nourished D: With a bowel obstruction (mechanical or non-mechanical) the course of treatment is NG to suction to remove all gastric contents to "decompress" the GI tract to prevent N/V E. We must ensure AD is not become dehydrated and I/O measurements are critical for this F. We want to avoid further complications d/t immobility (weakness/pneumonia, etc) H. No bowel sounds/obstruction= NPO status I. This can be an effective treatment for the sore throat may pts have d/t large tube in their throat. If allowed, lozenges or ice chips can also help J: We know that AD has problems with ulcers, so a PPI IV push would be reasonable for this pt to reduce any further acid production and ulcers. Once he can take the PPI orally, that would be a good option)

A high value of this means your kidneys aren't working well, but can also mean - urinary tract obstruction - CHF or recent MI - GI bleeding - Dehydration - Shock - Severe burns - Certain meds, such as some antibiotics - A high-protein diet

BUN

This number represents an indirect measurement of renal function and the GFR. Measures the amount of urea nitrogen in the blood.

BUN

CKD Metabolic Disturbances Waste product accumulation - As GFR decreases, ______ and __________ __________ levels increase, indicating that kidney function is ____________

BUN, serum creatinine, declining

gastroduodenostomy name

Bilroth 1

the establishment of an anastomosis between the upper portion of the stomach and the duodenum

Bilroth 1

Common Causes of Fractures: Infancy - ________ ________ - Child ________/_____-____________ injury - Accident/Injury

Birth trauma, abuse, non-accidental

High blood glucose damages what?

Blood vessels, nerves

SEPSIS LAB FINDINGS: WBCS: (Increased/Decreased/Both) BUN & Creatinine: (Increased/Decreased) Lactate: (Increased/Decreased) PT, PTT: (Increased/Decreased) D-dimer: (Increased/Decreased) Platelets: (Increased/Decreased) Glucose: (Increased then decreased/Decreased then increased) Electrolytes: (Constant/Changing) Procalcitonin:(Increased/Present or Decreased/Not Present)

Both, Increased, Increased, Increased, Increased, Decreased, Increased then decreased, changing, Increased/present

Temporary immobilization and stabilization of fractured hips or fractures of femoral shaft

Buck's traction

used for injections, tricks CNS into not feeling pain by using vibration to disrupt pain receptors

Buzzy Bee

A 16 year old female has been diagnosed with possible appendicitis. What diagnostic testing would the nurse anticipate prior to an appendectomy? A. CT, urinalysis, basic metabolic panel B. X-ray, blood cultures C. CT, complete blood count, serum HCG, urinalysis D. Ultrasound, urine pregnancy

A 2-year-old is admitted in the pediatrics division with an edematous face and pruritus involving lips and tongue. The parents tell the nurse that the child has eaten pineapple for the first time. What does the nurse infer from the condition of the child? A) The child is suffering from marasmus. B) The child is suffering from kwashiorkor. C) The child is suffering from allergy syndrome. D) The child is suffering from immediate gastrointestinal hypersensitivity.

A child with nephrotic syndrome is being treated with corticosteroids. The child's parents tell the nurse that the child has suddenly gained weight and the child's face has become round. How does the nurse respond? A) "The child needs to be assessed for other viral infections." B) "You need to increase the child's fluid intake immediately." C) "These side effects will diminish after completing the therapy." D) "Have you made any dietary changes in the child's care plan?"

A college student is newly diagnosed with type 1 diabetes. She now has a headache, changes in her vision, and is anxious, but does not have her portable blood glucose monitor with her. Which action should the campus nurse advise her to take? A. Eat a piece of pizza. B. Drink some diet pop. C. Eat 15 g of simple carbohydrates. D. Take an extra dose of rapid-acting insulin.

A nurse is providing care to a child who has an allergy to eggs. The nurse should question a prescription for which of the following immunizations? A) Hepatitis B (HepB) B) Haemophilus influenza type b (Hib) C) Influenza, live attenuated (LAIV) D) Inactivated poliovirus (IPV)

A priority in the first 24 hours after a bilateral adrenalectomy is? A. Beginning oral nutrition B. Promoting self-care activities C. Preventing adrenal crisis D. Ambulating up and down the hallway

All of the following are signs of sepsis EXCEPT: a) Fever or feeling chilled b) Confusion/difficult to arouse c) Slow heart rate d) Extreme pain e) Rapid breathing

Cushing's or Addison's (C/A) Adrenal hyperplasia/tumor

Cushing's or Addison's (C/A) Bruising and petechiae (fragile blood vessels)

Cushing's or Addison's (C/A) Buffalo neck and fat deposition on abdomen

Cushing's or Addison's (C/A) Central obesity with protruding abdomen and thin extremities

Cushing's or Addison's (C/A) Diarrhea is more likely

Cushing's or Addison's (C/A) Easy bruising

Cushing's or Addison's (C/A) Emotional irritability/depression

Cushing's or Addison's (C/A) Evidence of decreased immune system: high risk for infections without fever --- poor wound healing

Cushing's or Addison's (C/A) Fluid retention (edema)

Cushing's or Addison's (C/A) Gastric upset/ulcers due to increase in hydrochloric acid

Cushing's or Addison's (C/A) Glucose intolerance (elevated BG)

Cushing's or Addison's (C/A) Gynecomastia in men

Cushing's or Addison's (C/A) Hirsutism and amenorrhea in women

Cushing's or Addison's (C/A) Hypernatremia

Cushing's or Addison's (C/A) Hypertension (Na and water retention, dependent edema)

Cushing's or Addison's (C/A) Hypervolemia

Cushing's or Addison's (C/A) Moon face

Cushing's or Addison's (C/A) Osteoporosis

Cushing's or Addison's (C/A) Severe acne

Cushing's or Addison's (C/A) Striae- reddened lines on abdomen

Cushing's or Addison's (C/A) Thin, fragile skin, thinning balding hair

Cushing's or Addison's (C/A) Unexplained hypokalemia

Cushing's or Addison's (C/A) Weakness, fatigue, sleep disturbances

Cushing's or Addison's (C/A) weight gain and increased appetite

THE NURSE IS CARING FOR A 3-YEAR-OLD CHILD WITH NEPHROTIC SYNDROME. WHAT UNEXPECTED FINDING WOULD THE NURSE REPORT? A. PROTEINURIA B. DISTENDED ABDOMEN C. BLOOD IN THE URINE D. ELEVATED SERUM LIPID LEVELS

The nurse is caring for a client diagnosed with sepsis. Which assessment data warrant immediate intervention by the nurse? A. Temp: 100.4F, Pulse 104, Respirations 26, BP 102/60 B. WBC 18,000/mm3 (normal: 5,000-10,000/mm3) C. Urinary output 90 ml in the last 4 hours D. The client complains of being thirsty

The nurse is caring for a client with a fractured left tibia and fibula. Which data should the nurse report to the health-care provider immediately? A. Localized edema and discoloration occurring hours after the injury. B. Generalized weakness and increasing sensitivity to touch. C. Dorsalis pedal pulse cannot be located with a Doppler and increasing pain. D. Pain relieved after taking four (4) mg. hydromorphone (Dilaudid), a narcotic analgesic.

The nurse is conducting an assessment on a 7 year old patient who is 36 hours post op following an appendectomy. The nurse does not hear any bowel sounds and the patient and parents denies flatus. Which of the following actions is most appropriate by the nurse? A. Encourage the patient to increase fluid intake to promote peristalsis B. Encourage the patient to increase solid food intake to promote peristalsis C. Withhold food and fluid intake until intestinal motility has returned D. Withhold food and encourage fluid intake to keep patient hydrated

The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action? A. 8:40 PM to 9:00 PM B. 9:00 PM to 11:30 PM C. 10:30 PM to 1:30 AM D. 12:30 AM to 8:30 AM

The school nurse is caring for a child with a peanut allergy who just ate trail mix containing nuts. The child's lips are swollen and the nurse hears wheezing. Select the correct sequence of interventions. A) 1. Notify the child's parents. 2. Administer IM Epinephrine. 3. Call 911 for EMS B) 1. Call 911 for EMS. 2. Administer IM Epinephrine. 3. Notify the child's parents. C) 1. Administer IM Epinephrine 2. Call 911 for EMS 3. Notify the child's parents D) 1. Call 911 for EMS. 2. Notify the child's parents. 3. Administer IM Epinephrine.

Which intervention should the nurse implement for a client with a fractured hip in Buck's traction? A. Assess the insertion sites for signs and symptoms of infection. B. Monitor for drainage or odor from under the plaster covering the pins. C. Check the condition of the skin beneath the Velcro boot frequently. D. Take weights off for one (1) hour every eight (8) hours and as needed.

Which of the following clinical manifestations should lead you to suspect that Maria's appendix has ruptured? A. Fever B. Localized Pain C. Sudden relief from pain. D. Increasing anorexia

C (A sudden relief of pain occurs following rupture of the appendix. This symptom is brief, followed by an increase in pain that is diffuse and accompanied by rigid guarding of the abdomen because of peritonitis.)

A nurse is caring for a client who has type 1 DM. Which of the following recommendations should the nurse make to the client for a sweetener? A. Corn syrup B. Natural honey C. Nonnutritive sugar substitute D. Guava nectar

C (Clients who have type 1 diabetes mellitus should limit carbohydrate intake. Corn syrup is high in carbohydrates and is not an appropriate choice to use as a sweetener. Clients who have type 1 diabetes mellitus should limit carbohydrate intake. Honey is high in carbohydrates and is not an appropriate choice to use as a sweetener. Clients who have type 1 diabetes mellitus should limit carbohydrate intake. Nonnutritive sugar substitutes allow the client to sweeten the taste of foods without increasing carbohydrate intake. Clients who have type 1 diabetes mellitus should limit carbohydrate intake. Guava nectar contains carbohydrates and is not an appropriate choice to use as a sweetener.)

A nurse is caring for a client who has diabetes mellitus who is prescribed regular insulin via a sliding scale. After administering the correct dose at 0715, the nurse should ensure the client receives breakfast at which of the following times? A. 0720 B. 0730 C. 0745 D. 0815

C (Five to ten minutes is the lag time suggested for rapid acting insulin, but regular insulin is the short acting type with an onset of 30 minutes. A fifteen minute interval between insulin administration and eating a meal is too short since the onset of regular insulin is 30 minutes. Regular insulin should be given 20 to 30 minutes before eating because the onset of action is 30 minutes. There are circumstances when this lag time guide can be adjusted. A one hour interval between insulin administration and eating a meal is too long since the onset of regular insulin is 30 minutes.)

The unit is very busy and short-staffed. What could the RN delegate to the unlicensed assistive personnel (UAP)? A. Check BP readings for the client receiving IV sodium nitroprusside B. Administer antihypertensive medications to stable clients. C. Obtain orthostatic BP readings of assigned clients D. Teach about BP monitoring and the use of automatic BP monitoring equipment

C (The UAP may check postural changes in BP as directed. The LPN may administer antihypertensive medications to stable patients. The RN must monitor the patient receiving IV sodium nitroprusside, as the patient is in a hypertensive crisis. The RN must also do the teaching related to home BP monitoring)

A client sustained a fractured femur in a motor-vehicle accident. Which data require immediate intervention by the nurse? Select all that apply. A. The client requests pain medication to sleep. B. The client has eupnea and normal sinus rhythm. C. The client has petechiae over the neck and chest. D. The client has a high arterial oxygen level. E. The client has yellow globules floating in the urine.

C, E

Fissures, strictures, abscesses, and fistulas are more common with (UC/CD)

Malnutrition and growth failure is more common with (UC/CD)

HIV binds to specific _______ and chemokine receptors to enter cell

CD4

_______ ____-________ play a critical role in the immune response characteristic of Celiac disease

CD4+ T-cells

What are loop diuretics used for?

CHF, renal disease, hypertensive crisis

He presents with nausea and vomiting. Abdomen is distended. Bowel sounds are present, slightly hyperactive. He has not had a bowel movement in 6 days. Consider AD's symptoms, and explain why the physician (and you!) would suspect a bowel obstruction rather than Cholelithiasis. Answer like this:: If it were cholelithiasis he would...... But instead, AD............ The way these are kind of similar.....

CHOLELITHIASIS SIGNS If it were cholelithiasis, AD would have more PAIN in the RUQ/back. More likely female. He would report fat intolerance and possibly be jaundiced. OBSTRUCTION SIGNS But instead AD...... He has not had a bowel movement in 6 days. No complaints of pain. SIMILAR. Nausea/vomiting. Abdominal distention.

(CL/CP) may elicit severe emotional reactions form parents

Associated Problems of CL/CP Feeding - Inability to form anterior seal (CL/CP) - Decreased ability to suck (CL/CP) _____________ Long-term considerations - __________/__________ - _________ - _____________ - Improper __________ of middle ear --> ________ __________

CL, CP, dental/orthodontic, speech, hearing, drainage, otitis media

Regulation of hormonal secretion Nervous system control - Initiated by ______ and implemented by ________ - Directly affects some __________ glands - ________, ______, and other stressors can stimulate the nervous system to modulate hormone secretion

CNS, SNS, endocrine, pain, fear

BP =

CO x PVR

Long-term Use of Corticosteroids - __________- relaxes smooth muscle in the lungs - _______-_______ COPD - _____________ diseases

COPD, end-stage, autoimmune

Intestinal Obstruction: - ______ scan and ___________ __________ - Sigmoidoscopy or ____________ - _______, ________, ________

CT, abdominal x-ray, colonoscopy, CBC, WBC, BUN

Main antibiotic used preoperatively

Cefazolin

Diagnostics for Cushing's syndrome

Checking serum levels of cortisol, 24-hour urine collection for free cortisol (increased levels --> Cushing's)

Three or more drugs from different groups are prescribed at full strength

Combination antiviral therapy

Includes fat wrapping, cobblestoning, fissures, and thickened wall of intestine

Crohn's disease

Caused by excessive corticosteroids, particularly glucocorticoids

Cushing's syndrome

A nurse is assessing a client who is taking oxacillin to treat an infection. The nurse should recognize which of the following findings is a manifestation of an allergic reaction? A. Diarrhea B. Fever C. Dark urine D. Pruritus

The school nurse is called to the cafeteria because a child "has eaten something he is allergic to." The child is in severe respiratory distress. What should the nurse do first? A) Determine what the child has eaten. B) Administer diphenhydramine. C) Move the child to the nurse's office or hallway. D) Have someone call for an ambulance/paramedic rescue squad.

WHAT WOULD THE NURSE RECOMMEND TO THE PARENTS OF A CHILD TO PREVENT A UTI? A. Voiding every three to four hours B. Adequate water intake C. Good perineal hygiene D. All of the above

WHY IS IV ALBUMIN BEING CONSIDERED FOR JOEY? WHAT CATEGORY OF SOLUTION IS IV ALBUMIN? A. CRYSTALLOID / HYPOTONIC B. CRYSTALLOID / HYPERTONIC C. CRYSTALLOID / ISOTONIC D .COLLOID / VOLUME EXPANDER

What finding supports the diagnosis of AIDS in the individual with HIV? A. Flu-like symptoms B. Oral hairy leukoplakia C. CD4/T Cells 200-500/uL D. Cytomegalovirus

Which of the following is the best way to explain sepsis to a client's family member? A) Sepsis is a bloodstream infection. B)Sepsis means that the blood pressure is dropping and we need to treat that quickly. C) Sepsis is the most serious infection possible. D) Sepsis happens when the body responds to an infection in an exaggerated way, causing body systems to start failing.

Your friend eats a shrimp dinner with you and later tells you that she is allergic to shellfish and has been itching. The priority medication to administer at this time is A) IM epinephrine B) IV corticosteroids C) Sublingual nitroglycerin D) PO Diphenhydramine

A nurse is assessing a client who has Cushing's syndrome. Which of the following findings should the nurse expect? A. Weight loss B. Hypotension C. Diaphoresis D. Hyperpigmentation

D (Hyperpigmentation, bruising, and striae or stretch marks, are manifestations of Cushing's syndrome.)

When a client in diabetic ketoacidosis exhibits Kussmaul respirations, their body is attempting to correct the....... A. Respiratory Acidosis B. Hyperglycemia C. Hypoglycemia D. Metabolic Acidosis

D (In DKA, the acidosis is a METABOLIC acidosis. So -- to get rid of the acid, the body attempts to "blow it off" by making the patient take a lot of deep breaths. Their breathing pattern will be tachypnic (fast) and labored/deep.)

Several diagnostic tests are ordered for the management of care of appendicitis. Appropriate nursing management in this preoperative period includes which of the following? A. Apply moist heat to the abdomen to relieve pain. B. Administer an enema to ensure total bowel evacuation preoperatively. C. Perform deep abdominal palpation to assess the level of pain. D. Ensure that diagnostic tests are administered as soon as possible to prevent delay in treatment.

D (Successful treatment of appendicitis is based on prompt recognition of the disorder; the primary nursing objective is to assist in establishing a diagnosis.)

What IV fluid would you anticipate hanging: Client with severe cellular dehydration; client admitted to the hospital with severe gastroenteritis

D5W 1/4 NS

Hypotonic IV Fluids Examples

D5W, 0.45% NS

What are the two main hypotonic IV fluids?

D5W, 1/2NS, 1/4NS

Isotonic IV Fluids Examples

D5W, NS, D5 1/4 NS, LR

DKA or HHS or both Acidosis/ketones

DKA

DKA or HHS or both Hyperglycemia, >300 mg/dL

DKA

DKA or HHS or both Kussmaul respirations, ketonuria

DKA

DKA or HHS or both Mortality rate 2-5%, up to 10%

DKA

DKA or HHS or both Type 1 DM

DKA

HIV Drug Therapy: ART -Nucleoside, non-nucleoside, and nucleotide reverse transcriptase inhibitors: Inhibit the ability of HIV to make a _________ __________ ________ in __________ - Protease Inhibitors: interfere with activity of _________ _________ - Fusion Inhibitors: Interfere with HIV ______-___________ ______ ____________ and ________ into cells

DNA copy early, replication, enzyme protease, CD4-receptor site binding, entry

a complex disorder of carbohydrate, fat, and protein metabolism resulting from the lack of insulin secretion by the beta cells of the pancreas or defects of the insulin receptors; it is commonly referred to simply as diabetes. There are two major types of diabetes: type 1 or type 2

Diabetes Mellitus

36 hours (1.5 days) after surgery, you are once again A.D's nurse A.D. reports that he feels slightly nauseated. His abdomen is soft and only tender at his incision site. You auscultate and hear no bowel sounds. At this time, you are concerned A.D. has developed a bowel obstruction. Which type of bowel obstruction would you expect? Explain WHY.

Due to the fact that A.D. has no bowel sounds, the most likely scenario is that he has a non-mechanical bowel obstruction. More specifically, a paralytic ileus caused by abdominal surgery. (Hopefully, this ileus will resolve on its own. Anesthesia and surgery on the abdomen can cause the GI system to "shut down" in response to this stress. For some patients, it can unfortunately take a while for the GI system to wake up again.)

Main complication of Roux-en-Y Gastric Bypass

Dumping syndrome

Postop complications PUD surgery

Dumping syndrome, postprandial hypoglycemia, bile reflux gastritis

The client with diabetes is brought into the emergency department by his family members, who say that he has had an infection, is not acting like himself, and is more tired than usual. Prioritize the following nursing actions in the order of priority for this client A. Check blood glucose B. Begin continuous regular insulin drip C. Establish time of last food and drink D. Administer 0.9% NaCl IV infusion E. Ensure patent airway F. Establish IV access

E, A, F, D, B, C (As with all clients, first, establish an airway. With a client with diabetes and abnormal behavior, the blood glucose must first be checked to determine if the symptoms are related to diabetes. In this case, the symptoms are related to hyperglycemia, so an IV must be started for fluid resuscitation and insulin administration. The last food intake and mediations may establish a cause for the hyperglycemia and aid in determining further treatment)

What is the most common pathogen causing UTI

E. Coli

Sodium plays a major role in: - __________ volume and concentration - ____________ and ___________ of __________ ________________ - ______________ ____________

ECF, generation, transmission, nerve impulses, muscle contractility

PUD: Perforation - _____________! - In ___________ __________ ulcers or those on __________ __________ of stomach - Symptoms: Acute __________, ________/___________ _____________, elevated ______

EMERGENCY, large duodenal, lesser curvature, pain, rigid/boardlike abdomen, WBCs

Sepsis is contagious: T/F

metformin can be used to treat type I DM (T/F)

Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic Syndrome (HHS) are linked to low blood glucose levels. (T/F)

F (both DKA and HHS are linked to very high blood glucose levels. What causes the patient's blood glucose to be high? As a nurse, we need to help figure this out! The most common causes are: - Patient is not taking their insulin or other glucose lowering agents as prescribed. Maybe they ran out and can't afford it....maybe it was their 21st birthday and they had a big party.... - Undiagnosed Diabetes (in other words, the patient didn't know they were diabetic, so they were not using any insulin or other glucose lowering drugs!) - Illness (in general, blood glucose levels rise when people have an underlying illness like urinary tract infection, pneumonia, etc.))

The adrenal medulla and cortex work together to perform the same functions (T/F)

F (each part has distinct functions, and they act independently of one another)

Cleft lip may only be unilateral (T/F)

F (may be unilateral or bilateral)

HHS is more common than DKA (T/F)

F (opposite)

Obesity: Exercise - Increases appetite (T/F) - Diminishes appetite (T/F) - ________ is best, if possible. _____-____ minutes per day. - Promotes and maintains weight loss - Improves ___________ of weight - Even if weight loss does not result, __________ __________ are improved in people who are more active

F, T, daily, 30-60, distribution, health outcomes

What are the three main assessment tools used to measure acute pain in children

FLACC, FACES, numerical rating scale

Bowel obstruction will always present with absent bowel sounds TRUE/FALSE

False

If your septic patient develops Disseminated Intravascular Coagulation (DIC), they need blood thinners, like heparin, right away. (True/False)

False

The transfer of gastric contents into the esophagus

GER

Mucosal damage caused by reflux (backflow) of stomach acid into the esophagus, causing irritation/esophagitis

GERD

What is Nissen fundoplication used for?

GERD

What is metoclopramide used for?

GERD, gastroparesis (diabetes)

End-stage renal disease (ESRD) occurs when

GFR <15 mL/min

The recovery phase begins when the _______ ___________, allowing the _______ and ________ ____________ levels to plateau and then ___________. Renal functions may take up to _____ _________ to stabilize.

GFR increases, BUN, serum creatinine, decrease, 12 months

Recovery Phase: S&S - Begins when ________ ____________ - BUN and creatinine levels ____________, then ____________

GFR increases, plateau, decrease

Uremia often occurs when

GFR is <15 mL/min

Treatment for neuropathy

Gabapentin/Neurontin (anti-seizure, Pregabilin, Lyrica), Cymbalta (antidepressant)

PUD COMPLICATION: Less common: result of edema, inflammation, pylorospasm, fibrous scar tissue formation Pain: worse at the end of the day - relief may be obtained by belching or self induced vomiting constipations occurs because of dehydration & decreased diet intake secondary to anorexia

Gastric outlet obstruction

What is a common surgical treatment for infants with GERD?

Gastric tube, jejunal tube, or both (G-tube, J-tube, G/J tube)

3 antacid examples

Gaviscon, Mylanta, Tums

Hypervolemia Clinical Manifestations - _____/Confusion (Altered _____) - ___________, Weakness - _________- feeling of impending doom - ____________ - dependent - ______________ upon auscultation (moist) - _______________ edema - Jugular vein ___________ - _____________ blood pressure - ______________ HR

HA, LOC, lethargy, SOB, edema, crackles, pulmonary, distension, increased, increased

When conservative therapy for CKD is no longer affective, ____, ____, and __________ are treatment options

HD, PD, transplantation

DKA or HHS or both Extremely severe fluid deficit

HHS

DKA or HHS or both Hyperglycemia, >600 mg/dL

HHS

DKA or HHS or both Mortality rate 10-15%

HHS

DKA or HHS or both Type 2 DM

HHS

DKA or HHS or both focal neurologic deficit (stroke-like) common

HHS

CO =

HR x SV

What are ACE inhibitors used for?

HTN

What are ARBs used for?

HTN (especially in clients who do not tolerate ACE inhibitors)

What are diuretics used for?

HTN, edema

Main question to ask for nursing assessment of patients who may be undernourished

Have you unintentionally lost weight in the last 6 months?

Nutritional status assessment component? Personal and family history Acute or chronic illnesses Current medications Herbs, supplements Depression Diet history

Health history

What are the four main preoperative lab/diagnostic tests?

Hgb, creatinine, height/weight, INR

Decreases HCl acid secretion by blocking action of histamine on H2 receptors

Histamine Receptor blockers

What are potassium-sparing diuretics used for?

Hypertension, hyperaldosteronism, edema, diuretic-induced hypokalemia

Type (I/II) Diabetes occurs when the pancreas fails to produce insulin or when the insulin is defective

Hypervolemia: Care Management - ____&____ - Monitor ____________ changes - Assess _____________ changes - ______________ changes - ____________ ___________: the best indicator of fluid balance - __________ assessment - Collaborative: ____________ per MD order

I&O, cardiovascular, respiratory, neurologic, daily weights, skin, diuretics

Pulmonary Edema Treatment/Prevention - Monitor and document _______ during and after surgery - Be aware of high-risk pt's and advocate for reasonable amounts of ________ - Assess for low ____ ______ and ___________ - Administer O2, ___________ if appropriate

I&O, fluids, O2 saturation, crackles, diuretics

Nursing Interventions for LUO or retention - Assess _______ - Assess __________ characteristics - Remove ____________ urinary catheter ASAP - Encourage _________ ____________ - ____________ _________ to determine volume of urine retained - _____________ if necessary (urine volume per scan > 300 mL) **prefer in/out cath and no indwelling

I&O, urine, indwelling, early ambulation, bladder scan, catheterize

HHS usually occurs with type (I/II) diabetes

Type (I/II) Diabetes occurs when insulin receptors on the cells fail to respond properly

Which route of administration is painful with unreliable absorption?

Which route of administration is the best for immediate analgesia?

Preoperative medications: Used to maintain fluid volume

IV fluids

Intestinal Obstruction: Nursing Implementation - ______ ________ as ordered (watch for fluid overload) - Maintain _____ _________ - _________ care - Skin care to ________ - Monitor _____________ - Education

IV fluids, NG tube, oral, nose, electrolytes

Pulmonary Edema Causes - Rapid administration and/or high volume of ____ ________ or _________ products. Also the body's __________ response causes fluid ___________ (ADH, ACTH)

IV fluids, blood, stress, retention

Treatment of Sepsis: GU/Renal - _______ ________ (30 mL/kg) - _____________ (furosemide/lasix) - ____________ - Monitor BUN, creatinine, & electrolytes

IV fluids, diuretics, dialysis

Hypernatremia Causes: Excessive sodium intake - Excessive ______ _________ i.e. __________ NaCl - ______________ tube feedings without ________ ________ supplements - Near- ____________ in salt water Inadequate water intake - ____________ or ____________ impaired individuals Excessive water loss (Increases sodium concentration)- dilutional effect - _____________ water loss as in profuse ____________ or high __________

IV fluids, hypertonic, hypertonic, free water, drowning, unconscious, cognitively, insensible, sweating, fever

Post-Operative Care - ____ _________ - Monitor for ___________ and bleeding - _______ _______ patient - Pain management - ______________ checks of ______________ - _____ tube - __________ ____________ - _______________ therapy - Active and passive _______

IV fluids, swelling, log roll, neurological, extremities, NG, foley catheter, physical, ROM

What is the treatment for Addisonian Crisis

IV hydrocortisone

Hypertonic saline is used with great caution and the limited doses need to be on an _____ ____________ _________

IV infusion pump

Ambulatory Surgery Discharge Criteria (Phase II or Extended Observation) - All Phase I criteria met - No _____ ____________ drugs for last 30 minutes - ____________ if appropriate to surgical procedure or orders - Able to ____________ if not contraindicated - Responsible adult present to accompany and drive pt home - Written ____________ instructions given and pt and caregiver understanding confirmed

IV opioid, voided, ambulate, discharge

In which form(s) can glucagon be given?

IV, IM, SQ

Adolescents Erikson Stage

Identity vs. Role Confusion

Health Risks Associated with Obesity (Increased/decreased) LDLs (Increased/decreased) triglycerides (Increased/decreased) HDLs - Liver _________ - Chole___________ - Chronic _________ disease - ________arthritis - Gout - GERD - HTN - ___________ veins (venous stasis) - _____________ irregularities in women - Infertility - Sexual dysfunction - Gynecomastia/hypogonadism - Sleep ________ - Asthma - Pulmonary HTN - Exercise intolerance - Obesity ____________ syndrome - Type 2 DM - ____________ syndrome - Polycystic ovary syndrome - Depression, low self-esteem, risk of suicide, social isolation - Cardiomyopathy - Atrial fibrillation

Increased, Increased, decreased, cirrhosis, lithiasis, kidney, osteo, varicose, menstrual, apnea, hypoventilation, metabolic

Hypertonic saline monitoring: Vital signs: __________ HR, BP, RR, dyspnea with exertion; _________ crackles, __________ respirations, full bounding peripheral _________, wt ________, ____________ veins

Increased, moist, shallow, pulse, gain, distended

School-age Erikson stage

Industry vs. Inferiority

Causesof elevation of temperature (> 100 F) after first 48 hrs (postop day 3 and later)

Infection

The third step in treating Type II DM

Insulin (when the above no longer provide glycemic control)

What secretes hormones into blood vessels in the pancreas

Islets of Langerhans

uses pressure to deliver vaccine to puncture the skin, reduces injury from needlestick

J-Tip Syringe

removes the colon and attaches the ileum to the rectum

J-pouch

Management of Care: Hyperkalemia - Eliminate oral and parenteral ____ __________ - Increase _____________ of K (__________, dialysis, ______________) - Force K from _____ to ______ by IV _____________ or _________ _____________ - IV insulin administration can be given to push K from the ECF to the ICF; it may be given with ____________ to prevent rebound hypoglycemia - In renal disease: _____________

K intake, elimination, diuretics, Kayexalate, ECF, ICF, insulin, sodium bicarbonate, glucose, dialysis

furosemide is not ______ ___________

K+ sparing

Pharmacologic Therapy: CKD Dyslipidemia: Goal - Lowering _______ below ________ mg/dL - Triglyceride level below _________ mg/dL

LDL, 100, 200

Hypertonic saline monitoring: Neurologic status: Altered _______, _____, __________ disturbances, skeletal muscle ____________, ______________

LOC, HA, visual, weakness, paresthesia

What IV fluids would you anticipate hanging for client with large amount blood loss (ECF volume deficit); post-surgery, or trauma

Lactated Ringer's

What are the two main treatments for MS

Lifestyle modification, medications

Stage II Hypertension interventions

Lifestyle modifications and two-drug combination for most (usually thiazide-type diuretic and ACE inhibitors, ARB, BB, or CCB)

Individual Risk Factors: Malnutrition - Genetics - _____________ - Inconsistent __________ patterns - Conditions affecting ________ intake - Conditions associated w/impaired __________ - Conditions associated with impaired __________ - _____________

Lifestyle, eating, oral, digestion, metabolism, medications

Is Tramadol an opioid agonist or a mixed agonist/antagonist (MAA)?

MAA

What are the three macrovascular effects of diabetes?

MI, stroke, peripheral vascular disease

What is the most commonly used oral drug for the treatment of type 2 DM

Metformin

Which medication is used for PUD if aspirin and/or NSAIDs cannot be discontinued

Misoprostol/Cytotec

3 antacid examples

Mylanta, Maalox, Tums

Gastric outlet obstruction treatment

NG tube to suction and fluid and electrolytes

PUD: Hemorrhage treatment - ______ ________ to ________ for ____-____ _________ - ____ ___________ and __________, ________ __________ if needed - Careful ________ monitoring - _______________

NG tube, suction, 24-48 hours, IV fluids, electrolytes, blood transfusion, I/O, endoscopy

Intermediate-acting insulin: name

NPH (Humulin N, Novolin N)

Nursing Care for ENDOSCOPY Prior: ______ for ___-___ ________ After: _____ until ____ _______ returns (__-___ ______) - Monitor for ______, ________, unusual difficulty ____________, elevated _________ - Minor throat discomfort: ___________, ________ gargle - _____________ until fully alert - Inform patient that they may experience some _________, belching, and ______________

NPO, 6-12 hours, NPO, gag reflex, 1-2 hours, pain, bleeding, swallowing, temperature, lozenges, saline, bedrest, bloating, flatulence

Nursing Care for Endoscopy - Prior: _______ for ______-_____ __________ - After: _______ until ______ _______ returns (1-2 hours) - Monitor for pain, bleeding, unusual difficulty __________, elevated __________ - Minor throat discomfort: __________, _______ gargle - ______ ________ until patient fully alert - Inform patient that they may experience some _________, belching, and _______________

NPO, 6-12 hours, NPO, gag reflex, swallowing, temperature, lozenges, saline, bed rest, bloating, flatulence

Pneumonia: Nursing Mgmt - Assess for respiratory distress - ________ if high RR - _____ _________ - ___________ as needed - Chest tube for pneumothorax - Chest ___________ - Postioning - Suction - Antipyretics - ________________

NPO, IV fluids, oxygen, percussion, antibiotics

Intestinal Obstruction: Collaborative Care - _______ - Inserting _______ ______ to __________ ________ - _____ _______ therapy - _______ control - _____________ -- last resort

NPO, NG tube, decompress bowel, IV fluid, pain, surgery

Cholecystitis: Collaborative Care -Pain control: ___________ and ___________ (these decrease secretions and counteract smooth muscle spasms) - Infection control: ____________ treatment or _____________ (to drain purulent material from the obstructed gallbladder) - Maintenance of F&E: _____ _________ with _________ __________ if severe nausea/vomiting Treatment is mainly supportive and symptomatic.

NSAIDs, anticholinergics, antibiotic, cholecystostomy, NG tube, gastic decompression

What is in Lactated Ringer's solution?

Na, Cl, K, Ca, lactate

What is in Ringer's solution?

Na, K, Ca

Treatment of DKA: - Rapid IV of _________ (dextrose added when BG level reaches 250-300 mg/dL) - Insulin IV: ________-_______ ONLY - Correct _____________ imbalances - Watch for lowering __________ because as insulin is provided more will enter the cells causing lowered levels of this electrolyte - Monitor electrolytes and for _______: If the BG falls too far or too fast before the brain has time to equilibrate, water is pulled form the blood to the CSF and the brain, causing _______________ ____________

NaCl, short-acting, electrolyte, potassium, ICP, cerebral edema

What is the treatment for opioid overdose?

Naloxone (narcan)

a surgical technique used to suture the fundus of the stomach around the esophagus to prevent reflux

Nissen fundoplication

What is the rule for dialysis pt who has access device?

No BP, blood draws, IVF, flushes in affected arm

Iron binds to

Treat/Prevent Atelectasis by... - Assess pt's _____ ___________ and breath __________ - ___________ __________ (if appropriate) - Frequent ____________ changes - ________, _________, _________ _________ - INCENTIVE SPIROMETER - Explain why (prevent pneumonia) - Teach ______________ technique - Administer _____ if necessary

O2 saturation, sounds, early ambulation, position, turn, cough, deep breathe, splinting, O2

Treatment of Sepsis - Supplemental ______ --> Mechanical ventilation - __________ (___ ml/kg) Crystalloid (NS/LR) - When the fluids don't work... _______________ like _____________ - OTHER DRUGS: Corticosteroids, albumin, inotropes to increase heart contractility (dobutamine) Monitor for effectiveness - O2 Sat, ABGs - BP - Urine output - Mental status - Peripheral pulses Goal: Mean arterial pressure (MAP) < _______

O2, FLUIDS, 30, VASOPRESSORS, norepinephrine, 65

Hypotension Nursing - Assess BP, I/O, urine output, and document - _____ - ________ ___________ - Monitor _____________ for bleeding

O2, IV fluids, incision

Pulmonary Embolism Treatment - ____ therapy - ______________

O2, anticoagulation

Which route is controlled by the patient and requires patient and family teaching?

PCA pump

UTI Nursing Assessment Subjective data 1. _____ 2. _____________ 3. Health patterns Objective data 1. _______, chills, ___________ 2. __________ (commonly atypical), loss of appetite, altered mental status, ABSENCE OF DYSURIA

PMH, SURGERIES, fever, dysuria, elderly

Oral rehydration therapy - Increase _____ fluids if diarrhea increases - Give PO fluids __________ if vomiting (pedialyte, gatorade)

PO, slowly

What are H2 receptor blockers used for?

PUD and GERD

What are PPIs used for?

PUD and GERD

What are antacids used for?

PUD and GERD

What is surgery for CP called

Palatoschisis

Secretes oxytocin and ADH (increases reabsorption of water by the tubules of the kidneys)

Posterior pituitary

Taken daily by high-risk individuals to reduce risk of contracting HIV

Pre-exposure prophylaxis (PREP)

Upon physical examination, someone with cholecystitis will exhibit

RUQ tenderness, abdominal rigidity

Two H2 receptor blocker examples

Ranitidine, famotidine

Short-acting insulin: name

Regular (Humulin R, Novolin R)

Bariatric surgery that involves stapling the stomach to decrease its size (gastric pouch) and then shortening the jejunum and connecting it to the small stomach pouch, causing the base of the duodenum leading from the nonfunctioning portion of the stomach to form a Y configuration, which decreases the pathway of food through the intestine, thus reducing the absorption of calories and fats

Roux-en-Y gastric bypass

Mild-Moderate Hypoglycemia Treatment (awake, hungry, irritable, shaky, weak) - (cold, clammy skin; pale; rapid pulse; rapid/shallow respirations; change in mood; drowsiness)

Rule of 15

Sepsis: Pathophysiology - Starts with some sort of infection, which kicks off an inflammatory response, called ___________. This can happen in other instances, as well as ____________ and can lead to __________ damage. - Technically __________ means that 2 or more organ systems are failing; homeostasis cannot be maintained without intervention, and often the patient requires ________ __________ (enteral/parenteral feedings, ventilation, dialysis, etc.)

SIRS, trauma, organ, MODS, life support

Pulmonary Embolism: S/S - ________ - anxiety - __________ __________

SOB, chest pain

Primarily used in hospital settings and ICUs. A score > or = 2 with a documented/suspected infection can indicate sepsis. A higher score = POOR PROGNOSIS

SOFA

Which route of administration has slow absorption and is not used for acute pain?

Caloric intake should be sufficienct, but tissue needs aren't met d/t disease process (cancers, RA, etc.)

Secondary/chronic disease-related PCM

HIV Modes of Transmission - ______ with infected partner - Exposure to infected ________ or ________ products - Pregnancy, ___________, or _________ ___________ **** HIV is very ___________ outside the body

Sex, blood, blood, delivery, breast feeding, fragile

main complication with CD surgery

Short Bowel syndrome

A child with type 1 diabetes is experiencing morning hyperglycemia and hypoglycemia between 2 am and 4am each night. The child may be experiencing ("Somogyi Effect"/"Dawn Phenomenon"). The nurse should expect ("a decreased evening insulin dose"/"an increased evening insulin dose") to be prescribed?

Somogyi Effect, a decreased evening insulin dose

neuropathy where it feels like they are wearing stockings/gloves all the time

Stocking-Glove Neuropathy

A person can have cholelithiasis without cholecystitis (T/F)

Always give insulin, even if child does not have appetite when they are sick (T/F)

Biguanides do not increase insulin secretion from the pancreas, therefore they do not cause hypoglycemia (T/F)

D5NS is maintenance fluid (T/F)

Somatic pain is usually responsive to nonopioid or opioid drugs (T/F)

There is no diagnostic test for sepsis (T/F)

When a diabetic patient is ill they should just follow their usual meal plan (T/F)

Crohn's Disease: Pathophysiology - _____-_________ ____ ____________ profile - Any part of _____ _________ from _________ to _________ -- mostly affects __________ __________ - ______ __________ of bowel in ______________ fashion - Ulcerations, ____________, __________, ____________ of bowel wall, ____________ formation, _____________

T-helper 1 cytokine, GI tract, mouth, anus, distal ileum, all layers, discontinuous, fibrosis, adhesions, stiffening, stricture, fistulas

Placed in the common bile duct to help drain bile from the liver. It is sometimes placed after a cholecystectomy, common bile duct (CBD) exploration or liver transplant. It will serve as a drain to drain excessive bile from the liver until the common bile duct is healed. (This helps until edema produced by the trauma of exploring and probing the duct has subsided, and allows drainage while the small intestine is adjusting to receiving a continuous flow of bile)

T-tube

In fact, it can be dangerous to treat hypertensive urgency or severe symptomatic hypertension in the same way as a true hypertensive emergency, because lowering blood pressure too rapidly can trigger _______ or ________ (because cerebral BP decreases too fast)

TIA, stroke

The client with pre-renal azotemia receives a fluid challenge. In evaluating a response to the therapy, which outcome indicates that the goal was met?

The production of urine after the initial bolus of furosemide (Lasix)

Which age group is most impacted by separation anxiety?

Toddler

Weak mu agonist, that also inhibits re-uptake or norepinephrine and serotonin

Tramadol (Ultram)

What is glucagon's therapeutic use?

Treats hypoglycemia from an insulin overdose

High cholesterol usually corrects itself going into remission, and anti-lipid agents are not safe for children, so the hypercholesterolemia is not normally treated. (true/false)

True

Many children will outgrow food allergies. (True/False)

True

The most common endocrine disorder of childhood

Type 1 DM

Diabetes Mellitus - Partial or complete deficiency of the hormone insulin (________ ____) OR - The body's inability to use insulin (__________ ______)

Type 1, Type 2

What types of diabetes does insulin treat?

Type I, Type II, gestational

Metformin treats (Type I/Type II) DM, and is usually prescribed to ____________ ____________ diabetics

Type II, newly diagnosed

Colorectal cancer is more common with (UC/CD)

Rectal bleeding/hemorrhage is more common with (UC/CD)

toxic megacolon is more common with (UC/CD)

What are the most second most common bacterial infection in women

UTIs

HHS precipitating factors

UTIs, pneumonia, sepsis, Acute illness, Newly diagnosed type 2 diabetes, Impaired thirst sensation and/or inability to replace fluids

What are the two diagnostic studies for cholecystitis?

Ultrasonography (Scope procedure), ERCP

____________ is the result of filtration, reabsorption, secretion, and excretion of water, electrolytes, and metabolic waste products

Urine

Primary Vesicoureteral reflux (VUR) is caused by

VUJ anomalies, faulty valve

Diabetes: Infection - Defective ______ ___________ - glucose feeds bacteria/fungi ---> __________ ____________ - Glucosuria ---> ___________ and ________ _________ ___________ Prevention - Recognize infections promptly and treat - Control BG - ____________

WBC mobilization, yeast infections, bladder, urinary tract infections, vaccinations

Appendicitis: Diagnostic Measures - CBC: Elevated ______ count - Urinalysis: R/O _______ - ____________ test - ______ ________ - Ultrasound

WBC, UTI, pregnancy, CT scan

Intussusception diagnosing tests (2)

X-ray, ultrasound

N&V - Antiemetics - __________ (ondansetron) - Compazine (Phenothaizine) - Reglan (Phenothaizine) - Vistaril (Antihistamine) - ______________ (Promethazine)

Zofran, phenergan

Sepsis can be treated if it's identified early. a) True b) False

Match the characteristic with the correct type of insulin. 1. Mealtime carb coverage, given as close to mealtime as possible. 2. Typically injected once per day 3. Usually given 2-3 times per day, peaks at about 4-12 hours a. Rapid/Short acting -- lispro (Humalog) or regular (Humulin R) b. Intermediate Acting -- NPH (Humulin N) c. Long Acting -- glargine (Lantus)

a, c, b

What is the fastest absorption sites for insulin in order

abdomen, arm, thigh, buttock

Causes of Paralytic Ileus: - ____________ _____________** - _____________ or other inflammatory process - ______________ abnormalities (HYPOKALEMIA) - ____________ ____________*

abdominal surgery, peritonitis, electrolyte, spinal fractures

Intestinal obstruction primary diagnostic tool

abdominal x-ray

What is the most common diagnostic test ordered to diagnose a bowel obstruction?

abdominal x-ray

Ulcerative Colitis: Expected Findings - _____________ pain/Cramping (______) - Anorexia/Weight ________ - _________**** - ____________ (___-____/day)*** - Stools may contain _________, ________, or _________ ****** - Abdominal distension w/____________ and/or ___________ upon palpation - _________-pitched bowel sounds - __________ ___________****

abdominal, LLQ, loss, fever, diarrhea, 15-20, blood, mucous, pus, firmness, tenderness, high, rectal bleeding

Crohn's Disease - ____________ pain/Cramping (______) - Anorexia/Weight _______ - ____________ (~___/day w/__________ or ______)** - Abdominal distension w/_____________ and/or _____________ upon palpation - _______-pitched bowel sounds - _____________**

abdominal, RLQ, loss, diarrhea, 5, mucous, pus, firmness, tenderness, high, steatorrhea

Paralytic ileus- Causes - ____________ surgery - _______________ injury - __________ pain meds during/after surgery

abdominal, peritoneal, opioid

During the asymptomatic chronic infection, CD4 count is __________ ______ and viral load is ______

above 500, low

In most cases, the joint ________ and _________ the injury is ________ to eliminate movement that may cause displacement at the fracture site

above, below, casted

Clinical manifestations of hypermagnesemia from CKD include: - ____________ of reflexes, decreased _________ _________, cardiac ______________, and ____________

absence, mental status, dysrhythmias, hypotension

Metformin decreases blood glucose in three ways: 1. Decrease ________________ of glucose from the ___________ 2. Decrease ______________ of glucose by the _____________ 3. Increase ____________ of insulin _______________ in the ____________

absorption, intestines, synthesis, liver, sensitivity, receptors, tissues

ARI Fluid & electrolyte balance is very important. Observing and recording ___________ __________ and _____________ and __________ ________ are essential

accurate intake, output, body weight

PUD: Etiology & Pathophysiology - __________ __________: An increase in acid in the gastric mucosa causes inflammation and histamine release, which leads to vasodilation, increased capillary permeability, and more secretion of acid and pepsin - ______________ ___________: bacterial infection - Medical-Induced Injury: __________ and __________ - Lifestyle factors: ___________, ________, psychologic _________, and __________

acid environment, helicobacter pylori, NSAIDs, aspirin, alcohol, coffee, stress, smoking

AEIOU: Who needs dialysis? A: ________-_______ problems E: _____________ problems I: ________________ O: ___________ of __________ U: ____________ symptoms

acid-base, electrolyte, intoxications, overload, fluids, uremic

Most common cause of emergent abdominal surgery in children

acute appendicitis

Burns, traumas, and major infections can cause this (in relation to nutrition)

acute disease/injury-related malnutrition

What are three things that may evoke a counter regulatory hormone response resulting in hyperglycemia

acute illness, injury, surgery

Renal failure is classified as

acute or chronic

Superficial erosion with minimal inflammation, short duration, and resolves quickly when cause is identified and removed

acute peptic ulcer

What are 3 causes of acute blood loss

acute trauma, ruptured aortic aneurysm, GI bleeding

Opioids have the potential for

addiction

Life-threatening condition caused by stressors, infection, post-adrenal surgery that can also produce acute adrenal insufficiency, or abrupt withdrawal of corticosteroids

addisonian crisis

Somogyi effect interventions

adjust evening insulin dose down or add a bedtime snack

Dawn phenomenon treatment

adjust timing of insulin (closer to bedtime) or possibly increase insulin

Neuropathic pain: Treatment - _____________ analgesis like ___________________, ______________ drugs, and _______ ____ __________ ____________

adjuvant, antidepressants, antiseizure, alpha 2 adrenergic agonists

What are two endogenous causes of Cushing's Syndrome that aren't iatrogenic admin of corticosteroids

adrenal carcinoma, congenital adrenal hyperplasia

What two parts make up the adrenal glands

adrenal medulla, adrenal cortex

Stimulates the adrenal cortex to secrete corticosteroids, secreted by anterior pituitary

adrenocorticotropic hormone (ACTH)

Risk Factors for Primary Hypertension - ___________ age - Alcohol - _____________ smoking - _____________ ____________ - Elevated serum __________ - Excess dietary ____________ - Gender (________ before age 50, _________ after age 50 d/t menopause) - Family history - _____________ - Ethnicity - _______________ lifestyle - Socioeconomic status - ___________

advanced, cigarette, diabetes mellitus, lipids, sodium, men, women, obesity, sedentary, stress

When does high fever after surgery normally occur?

after first 48 hours (postop day 3 and later)

Intussusception conservative treatment

air or barium contrast enema

Folic acid deficiency: Causes - Chronic ______________ - Chronic ___________________ - ______________ deficiency - ___________ interfering with absorption or use of folic acid - Malabsorption syndromes like ____________ disease, ___________ disease, or _________ __________ resection - Increased requirements: _____________

alcoholism, hemodialysis, dietary, drugs, celiac, crohn's, small bowel, pregnancy

Medicine indicated for edema d/t heart failure, hepatic cirrhosis, or nephrotic syndrome -- HTN, diuretic-induced hypokalemia (trade/generic)

aldactone/spironolactone

Regulates sodium and potassium balance, therefore regulates water balance

aldosterone

Works by blocking the action of aldosterone, a natural substance in the body that causes sodium and water retention, therefore raising blood pressure.

aldosterone antagonists

Short-term Use of Corticosteroids - ____________ reactions - Poison Ivy - __________ ________ response (i.e. pinched nerve, bursitis) - Reactive ___________ (asthma acute exacerbation)

allergic, acute inflammatory, airway

Immune reaction to a foreign substance such as pollen, bee venom, foods, pet dander

allergy

Obesity: Drug Therapy *** NOT TO BE USED __________ - Only for __________ with BMI _____ kg/m or greater with at least ______ _________-___________ ______________ - __________ ____________: (sympathomimetic, non-amphetamines) - ______________ _____________-___________: Blocks fat breakdown and absorption (Orlistat: Xenical, Alli) - ___________ __________: Works on the brain to decrease appetite, increase feelings satiety - _________ (Phenermine and Topiramate) Non-amphetamine & anti-seizure/migraine which may decrease appetite - Nurses need to know if patients are taking these drugs

alone, adults, 27, one weight-related condition, appetite suppressants, nutrient absorption-blocking, serotonin agonists, Qsymia

glucagon is released from the _________ cells of the pancreas

alpha

VTE Prevention - ______________ ASAP - Prophylactic ______________ (Heparin, Coumadin, Lovenox) - _________ - ___________ pumps

ambulation, anticoagulants, SCDs, ankle

Preoperative Teaching - General information, don't overwhelm - Early _____________ - ________ restrictions - Pain med administration - SCD boots - _________ will they go after procedure and what does the __________ want to know?

ambulation, food, where, patient

What are the potassium sparing diuretics?

amiloride, spironolactone, triamterene

5-asa's are also called

aminosalicylates

Risk of transmission via unprotected receptive ________ intercourse is 30 times greater than for unprotected receptive ___________ intercourse

anal, vaginal

UTI Pain Management - Urinary ______________ * _____________ (Pyridium), used in combination with ______________, provides soothing effect on urinary tract mucosa ** Stains urine ___________ _________ (can be mistaken for blood and may stain underclothing)

analgesic, phenazopyridine, antibiotics, reddish orange

Acute clinical syndrome resulting from the interaction of an allergen and a patient who is hypersensitive to that allergen

anaphylaxis

Which body shape poses risk for heart disease, diabetes, breast CA, endometrial CA, HTN, HLD

android

excess body fat that is placed predominantly within the abdomen and upper body, as opposed to the hips and thighs

android obesity

Hematologic disorders associated with ARI include __________ d/t impaired ____________ production and ____________ abnormalities leading to bleeding

anemia, erythropoietin, platelet

Surgery Gerontological Considerations - Physiological changes in aging may impact response to ______________ and F&E/________ imbalances - ________ perception may be altered - Skin: Decreased ___________, very fragile - Vision/hearing impairments may cause difficulty following instructions - Greater risk for ______________ (use warming blankets)

anesthesia, blood, pain, elasticity, hypothermia

Hypothermia up to 12 hr after surgery can be caused by: - Effects of _____________ - Body _______ _______ during surgical procedure

anesthesia, heat loss

Urine retention: Causes - _____________ - anticholinergics - ___________ (pain) - Prolonged _______________ - ___________ surgery

anesthesia, opioids, catheterization, pelvic

Nausea and Vomiting: Causes - Action of _______________ or ____________ - Delayed __________ _________/slowed peristalsis - Length and type of _____________

anesthetics, narcotics, gastric emptying, surgery

How often should diabetics test for nephropathy with albuminuria and serum creatinine screening

annually

Increase gastric pH by neutralizing acid

antacids

taken 30 minutes before/1-3 hours after meals to provide temporary relief (not for children)

antacids

Nutritional status assessment component? Height and weight, BMI, rate of weight change, amount of weight loss

anthropometric measurements (helps to assess nutritional status)

Can be used for treating the primary disease process of IBD (including luminal disease and fistulizing disease for CD and colitis in the case of UC), for treating bacterial overgrowth, or for treating septic complications of IBD, such as abscesses and post operative wound infections

antibiotics

Preoperative medications: Reduces risk of infection

antibiotics

During an allergic reaction, the immune system produces ____________ that identify a particular allergen as __________, even though it is not

antibodies, harmful

Testing for HIV - There are tests for __________ to the virus as well as the ________ itself - Most diagnostic tests are focused on _____________ - May take ___ _______ to ___ _______ for antibodies to build - __________ to __________ is almost ALWAYS necessary

antibodies, virus, antibodies, 3 weeks, 3 months, retesting, confirm

Preoperative medications: Decreases oral and respiratory secretions

anticholinergics

Preoperative medications: Used to decrease nausea and vomiting

antiemetics

Peritoneal Dialysis After catheter is inserted, skin is cleaned with ___________ solution and _________ dressing is applied. Catheter is connected to __________ ________ system and secured to the abdomen with __________, and it is _____________ immediately

antiseptic, sterile, sterile tubing, tape, irrigated

Once on dialysis and after a period of time on dialysis, it is not uncommon for patients to develop ___________

anuria

Urine output <40 mL per 24 hours

anuria

Older Adults are at risk for malnutrition d/t: - Decreased ____________ - ___________ - Limited or fixed _________ (choice between food and meds) - _____________ (secondary to stroke) - Gingivitis/missing ________ - Social __________ (living alone, lose desire to fix meals) - __________ can alter ________ of food or decreased ___________

appetite, depression, income, dysphagia, teeth, isolation, medications, taste, appetite

normal GFR

approximately 125 ml/min

Anastomosis of radial artery and basilic vein, shunting arterial blood into the vein

arteriovenous fistula

looped graft from brachial artery to antecubital vein

arteriovenous graft

How often should diabetic do exercise stress testing including ECG, stress echo, etc?

as needed based on risk factors

Nurse's role 1. _________ pain and communicate this info to other HCPs 2. Ensure the initiation and coordination of adequate _________ __________ ______________ 3. ___________ the effectiveness of these interventions 4. ____________ for people with pain

assess, pain relief measures, evaluate, advocate

ADPIE

assessment, diagnosis (identification of priority problems), planning, implementation, evaluation

DKA Treatment •Rapid ______________ •___________ Support •____________ ____________ •Obtain _____ ________ & Labs •_________ resuscitation •________ _________ ______

assessment, oxygen, cardiac monitor, IV access, fluid, regular insulin drip

Who is in OR? - Surgeon and _____________ (not always) - Circulating Nurse (sterile/non-sterile) - Scrub nurse (sterile/non-sterile) - ________________ provider - Any other surgery-specific roles perfusionist, etc.

assistant, non-sterile, sterile, anesthesia

Gastric & Duodenal ulcers: Both may be ___________ until complications occur

asymptomatic

Individuals with CKD are frequently _____________

asymptomatic

What usually occurs for the HIV infection during month 10 to about year 5

asymptomatic chronic infection

When CD4 count is above 500 and viral load is low, what is this normally considered?

asymptomatic chronic infection

HTN: Clinical Manifestations - Mainly _______________ Secondary Symptoms - Fatigue - Reduced ___________ tolerance - ____________ - _______________ - ___________ - ______________

asymptomatic, activity, dizziness, palpitations, angina, dyspnea

VUR: Clinical Manifestations - Many cases _____________ - ____________ ___________ ___________

asymptomatic, urinary tract infections

When should a person with type 2 diabetes have their vision checked through a dilated eye examination and then how often should they have exams thereafter?

at time of diagnosis, annually

Collapse of alveoli d/t mucous plugs

atelectasis

What is the main anticholinergic used preoperatively

atropine

Children with Special Needs Visual or hearing impairment - Provide material in ___________, __________, or ________ means to assist child

auditory, tactile, visual

What is the primary way for nurse to evaluate patency of AVF/AVG

auscultate for presence of bruit, feel for thrill

Primary causes of Addison's: - Idiopathic ____________ dysfunction - ____________ - ___________ectomy - ____________ of the abdomen

autoimmune, cancer, adrenal, radiation

Pathophysiology of celiac disease is believed to be ______________ with a ___________ ______________-

autoimmune, genetic predisposition

Neurons from the hypothalamus create a circuit to facilitate coordination of the endocrine system and the ___________ nervous system

autonomic

Toddler Erikson stage

autonomy vs. shame and doubt

Anaphylaxis: Prevention - _________ ___________ to allergen (history of exposure, family history, results of skin prick testing) - _________ parents, teachers, coaches, and daycare workers (________ and _________, what to do in an emergency)

avoid exposure, educate, signs, symptoms

PACU Discharge Criteria (Phase I) - Patient __________ (or baseline) - _________ _________ at baseline or stable - No excess __________ or drainage - O2 saturation > ______% - _________ controlled or acceptable - Minimal ____________ and ____________ - __________ given

awake, vital signs, bleeding, 90, pain, nausea, vomiting, report

A 4-year-old child is hospitalized with pneumonia. The nurse notes patient's pulse oximetry reading is 88 %. The priority nursing action for this child is? A.Obtain a blood sample to send to the lab B.Begin oxygen per nasal cannula C.Medicate the patient for pain D.Begin administration of IV Fluids

General signs of pneumonia include: a) clear breath sounds and brown sputum. b) cough, tachypnea, and retractions. c) nasal flaring and tympany with percussion. d) low fever and nausea.

John is recovering and ready for discharge home on oral antibiotics. John's parents ask how can this infection be prevented in the future. The nurse's best response is: a) "Keep him out of school during the winter months when infections are severe." b) "A pneumococcal vaccine is available, if he isn't up to date on his vaccines, he can get the pneumonia vaccine once he recovers from this illness." c) " Make sure he gets his flu shot every year in the fall."

When someone has severe sepsis, their chances of survival drop by as much as 8% for every ______ that goes by without treatment. a) Minute b) Hour c) Day d) None of the above

Cholelithiasis Develops when ___________ that keeps __________, _______ _______, and ___________ in solution is altered, leading to _________ *** _______ secreted by the ________ is ___________ with ___________

balance, cholesterol, bile salts, calcium, precipitation, bile, liver, supersaturated, cholesterol

Long-acting insulin is sometimes referred to as ____________ ____________ because it keeps blood glucose level consistent

basal insulin

____________-____________ insulin dosing is the preferred method of treatment for hospitalized patients with DM, because it mimics a healthy pancreas by delivery basal insulin constantly as a basal and then as needed as a ___________

basal-bolus, bolus

Nephrotic Syndrome: Pathophysiology - Disturbance to __________ _________ of __________ leads to increased ___________ ____________

basement membrane, glomeruli, protein permeability

Nephrotic Syndrome: Treatment - __________ - 1 g ______ diet - 500 mL ________ _____________ - _________ ________ - Meds: * ___________ 10 mg, 4x/day * ____________ 20 mg, 4x/day * KCl 10 mg, 2x/day * _____________:PRN for SBP > 140 -- Consider _____ ___________ if U/0 doesn't increase

bedrest, Na, fluid restriction, daily weight, prednisone, furosemide, hydralazine, IV albumin

E. Coli - Undercooked ________, or water - Petting zoo, animal exhibits, ___________ settings - Symptoms begin in ____-____ _______, usually lasts ___ __________ - _____________ not very effective - Can progress to _______

beef, daycare, 3-4 days, 1 week, antibiotics, HUS

Cobalamin Deficiency: Manifestations GI - Sore, red ___________ shiny tongue - ____________ - Nausea and vomiting - _____________ pain

beefy, anorexia, abdominal

Teach patients to ask for medication when?

before the pain gets unbearable

Pain Intensity- Types of Measures to assess child's pain - ___________ (distress actions) - Physiologic - _______-________ - _______________ - Assume pain present

behavioral, self-report, observation

Five common causes of postrenal AKI

benign prostatic hyperplasia, prostate cancer, calculi, trauma, tumors

Preoperative medications: Used to reduce anxiety, induce sedation, and for amnesia

benzodiazepines

insulin is released from the ________ cells of the pancreas

beta

Causes the heart to beat slower, with less force. It slows the heart mainly by blocking the action of epinephrine.

beta blockers

For the use of sulfonylureas, _______ _______ function must be present

beta cell

Type 2 DM: Etiology Pancreas - Defective ________ ________ secretion of insulin - Insulin _________ stimulates ___________ insulin secretion - Eventual __________ of beta cells Liver - Excess _________ production - Inappropriate __________ of ___________ production Adipose tissue - Decreased ____________ and increased _________ - Results in altered __________ and _____ _____________ Muscle - Defective ___________ __________ - Insulin resistance - Decreased __________ of glucose by cells resulting in hyperglycemia

beta cell, resistance, increased, exhaustion, glucose, regulation, glucose, adiponectin, leptin, glucose, fat metabolism, insulin receptors, uptake

Type 1 DM - Absolute insulin deficiency due to destruction of _________ __________ - Onset typically in ____________ and adolescence but can occur at any age - Most childhood cases of DM are _________ ____

beta cells, childhood, type 1

metformin: class

biguanide

Which oral agents: - Reduces glucose production by the liver - Enhances insulin sensitivity at tissues - Improves glucose transport into cells - May cause weight loss - Beneficial against plasma lipids - May damage kidneys

biguanides (metformin)

Complications of Gastric Surgery Prolonged contact of bile causes damage to gastric mucosa Administration of Questran relieves irritation

bile reflux gastritis

What is Questran used for

bile reflux gastritis

Spasms from stone movement produces severe pain, which is term _________ _________, even though the pain is rarely colicky; is it more often ________

biliary colic, steady

Hormones trigger release of fatty acids & neutral fats. Platelet aggregation & fat globule formation occurs.

biochemical/metabolic theory

Anti-TNF agents

biologic therapies (immunomodulators)

Celiac Disease: Diagnosis - _________ of __________ _________ - ___________ and ___________ testing

biopsy, small intestine, genetic, serologic

Infant age

birth to 1 year

what are three causes of chronic blood loss

bleeding duodenal ulcer, colorectal cancer, liver disease

NSAIDs like Ibuprofen/Advil/Motrin and Toradol/Ketorolac may cause (2)

bleeding, kidney damage

Heparin & Lovenox - Monitor site for __________, __________, bruising, or rash Labs: Heparin: ________ Lovenox: ________ Coumadin: ________

bleeding, petechiae, PT/PTT, none, INR

Effective oral anti-diabetic treatment involves: - Careful monitoring of __________ ___________ levels - Therapy with one or more _________ - Treatment of associated __________ conditions such as high cholesterol and high blood pressure

blood glucose, drugs, comorbid

The force exerted by the blood against the walls of the blood vessels

blood pressure

Which products are colloid/fluid volume expanders

blood products, albumin

Cortisol Functions - Regulation of _________ _________ - ___________ of inflammatory action - Support in response to __________ - Promotes ___________

blood sugar, inhibition, stress, metabolism

Diagnostic Testing: Endocrine - Labs: _________ and __________ provide direct measurement of the hormone level, or by evaluating blood or urine components affected by the hormone e.g. _____________

blood, urine, electrolytes

Sepsis is NOT just a

bloodstream infection

DKA or HHS or both Fluid deficit/fluids required

both

DKA or HHS or both Mental status changes

both

DKA or HHS or both Pre-renal azotemia (lots of urinating)

both

Because biguanides (metformin) decreases intestinal absorption of glucose, the patient will have an increased amount of _____________ _______________.

bowel movements (sometimes diarrhea)

Paralytic Ileus - Interventions - Assess ___________ ________; passing gas - _______ until ileus resolved - Maintain ___ tube - IV fluids for hydration and ________ - Early ______________

bowel sounds, NPO, NG, calories, ambulation

Intestinal Obstruction: Nursing Assessment - ________ ________ - Abdominal _________ - Signs of ___________ - _______ and _______ - __________ - Labs

bowel sounds, girth, tenderness, intake, output, pain

Allergy Prevention - ___________ infants ____________ until 4-6 months - Introduction of foods to infants by _____ __________ - ____________ of foods that cause reaction - Children with ______ allergy should not be given the influenza vaccine

breastfeeding, exclusively, 6 months, avoidance, egg

why are infants at risk for IDA

breastmilk low in iron

Post-Op: Complications - ___________ difficulties (with severe curvature) - ___________ or ________ damage - Lowered ________-_______ - Post-operative __________

breathing, spine, nerve, self-esteem, infection

Pneumonia: Manifestations - Obstruction of ____________ - Decreased ______ ___________ - Increased ___________ - Symptoms: Cough, fever, chills, ________cardia, ______pnea, _____pnea, pleural pain, malaise, respiratory distress, _________ breath sounds - ___________ cough: Yellow, bloodstreaked - __________ sputum = infection

bronchioles, gas exchange, exudate, tachy, tachy, dys, decreased, productive, rusty

Approximately how many people in the U.S. die each year because of sepsis? a) 45,000 b) 1,200,000 c) 258,0000 d) 10,000

John has been in the hospital receiving treatment for 2 days. Which assessment findings would indicate that John is responding to medical and nursing interventions? a) Cough productive of white sputum; temperature 37.5 degrees Celcius; SpO2 98% on 1 L O2 b) Complaints of dyspnea; Respiratory rate of 42 on 1 L O2; clear lung sounds c) Cough productive of yellow sputum; lung sounds clear; Spo2 96% on room air d) Coarse crackles in posterior lower lobes; Respiratory rate 28; no complaints of chills

Nursing Process: Which nursing intervention is appropriate for risk for deficient fluid volume? a. Assist John with incentive spirometry every hour b. Assist John to ambulate in the hall three times per day c. Monitor urine output to assess if meeting minimums d. Place John on isolation precautions

What is sepsis? a)An infection in the blood b)A local infection, such as cellulitis or appendicitis c)A toxic reaction to an infection d)A chronic disease

What must be present to activated vitamin D

calcium

lower your blood pressure by preventing calcium from entering the cells of your heart and arteries. Calcium causes the heart and arteries to contract more strongly. By blocking calcium, calcium channel blockers allow blood vessels to relax and open.

calcium channel blockers

What are the five main calculi types

calcium oxalate, calcium phosphate, struvite, uric acid, cystine

During the oliguric phase, a low serum _________ results from the inability of the kidneys to activate vitamin D; client may be on a ____________/__________ _____ supplement

calcium, calcium, vitamin D

Nephrolithiasis: Etiology - Metabolic Abnormalities that resulted in increase urine levels of __________, oxaluric acid, ________ ________, or citric acid ---- ______ pH levels

calcium, uric acid, low

What defines energy in terms of nutrition

calorie or kilocalorie

Interventions for Undernutrition - Therapeutic diets (High _________ and high _____) - Daily _________ _______/diet diary - Dietary ___________ (vitamins, ensure/promote) - __________ ________ meals - Appetite ___________ (Megace, Marinol) - Nutrition __________ - ___________ feedings (enteral) - Medical nutritional therapy (__________ ____________ nutrition)

calorie, fat, calorie count, supplements, multiple small, stimulants, consult, tube, total parenteral

What is the most common cause of mechanical colon obstruction

cancer

Common Causes of Fractures: Adults - accidental injury - _____________ (pathologic fracture) - ________________

cancer, osteoporosis

ACE inhibitor example

captopril (Capoten)

Provides a physically protective coating in patients with PUD and is used primarily as adjunct to other medications *interacts with digoxin , warfarin, and Dilantin

carafate/sulcrafate

Which drug interacts with digoxin warfarin and dilantin that is used for PUD?

carafate/sulcrafate

bolus dose of insulin to cover for carbs eaten, typically written as 1 unit divided by x grams of carbohydrates

carbohydrate coverage

CKD causes altered _______________ metabolism caused by impaired glucose metabolism from cellular ____________ to normal action of insulin

carbohydrate, insensitivity

main source of calories/energy

carbohydrates

What 3 main things does metabolic syndrome increase risk for

cardiovascular disease, stroke, diabetes

Used to immobilize the fracture until adequate callus formation

casts

Peritoneal Dialysis: - Peritoneal access is obtained by inserting a ___________ through the _________ wall - Technique for catheter placement varies, and is usually done via _____________

catheter, anterior, surgery

HTN Nursing - Assess BP I&O urine output and document - Treat the _________ - Administer _______-__________ as ordered

cause, anti-hypertensives

Acute episodes of watery diarrhea, infection, emotional disturbance

celiac crisis

What are the two ways of classifying anemia

cell morphology, etiology

Hypotonic IV fluids are used to prevent and treat ____________ ___________ by providing _______ _________ to the cells

cellular dehydration, free water

List three macrovascular complications of DM

cerebrovascular disease (risk of stroke), cardiovascular disease (risk of MI), peripheral vascular disease (risk of peripheral neuropathy)

Symptoms of hemorrhage from PUD (3)

change in vital signs (if lots of blood loss), blood in stool or NG output, low RBC counts

What is the repair for CL called

cheiloplasty

Commons Preop Labs/Diagnostic Tests - Urinalysis - ____________ x-ray - Blood studies: RBC, WBC, Hct, _______ - Electrolytes - ABGs, oximetry - Coagulation studies: PT/PTT, ________ - Blood glucose - Creatinine - _______ - EKG - Liver function tests - Type and crossmatch - ____________ test - Height/weight

chest, Hgb, INR, BUN, pregnancy

Dysrhythmias S/S - _____________ discomfort and ___________

chest, anxiety

Trained professional who plans therapeutic activities for hospitalized children.

child life specialist

Fracture are more common in ____________ (not ___________)

childhood, infancy

Intussusception is most common in

children younger than 2 years of age

Salmonella - Most common type of food poisoning in the US - High incidence in ____________ under ____ - Contaminated ________ - _______ - Turtles, baby _______, frogs, snails - ___________ and ___________ shorter duration, ___________ may persist up to ___-___ __________ - _______________ not recommended in uncomplicated cases, most cases clear up on own

children, 5, food, pets, chicks, nausea, vomiting, diarrhea, 2-3 weeks, antibiotics

What three populations are at risk for IDA d/t increased deman

children, adolescents, pregnant women

Inflammation of the gallbladder

cholecystitis

stone in the common bile duct

choledocholithiasis

Cholecystitis is usually associated with

cholelithiasis

Most common disorder of the biliary system

cholelithiasis

Stones in the gallbladder

cholelithiasis

____________ is the precursor for steroid hormone synthesis

cholesterol

IBD is a (acute/chronic) disease

chronic

What are the two types of blood loss that can cause anemia

chronic and acute

IBD is characterized by

chronic intestinal inflammation

Involves progressive, irreversible loss of kidney function

chronic kidney disease

Gerontological Considerations - _____________ _____________ pain Barriers - Believe that pain is _________ _______ ____ __________ - Inability to process information and _____________ pain Treatment: "Start _____, go _______" - Metabolize drugs more _________ - NSAIDS cause ____ ___________ - _____________ impairment - Incorporate ___________ and other nonpharmacologic interventions

chronic nonmalignant, normal part of aging, communication, low, slow, slowly, GI bleeding, cognitive, exercise

Long duration, eroding through the muscular wall with the formation of fibrous tissue, present continuously for many months or intermittently throughout the person's lifetime

chronic peptic ulcer

___________ exposure to some stressors can cause persistent elevation in heart rate and BP and changes in the endocrine system. This puts patients at risk for chronic diseases such as ______________ and cardiac disease.

chronic, hypertension

A common physiologic rhythm is ________ __________. It is a 24-hour rhythm that can be driven and altered by sleep-wake or dark-light 24 hour (____________) cycles

circadian rhythm, diurnal

Prerenal causes of ARI: Factors that reduce systemic ____________, causing reduction in renal _________ ________ and leading to _____________/_____________

circulation, blood flow, hypotension, hypovolemia

what are the 5 rights of delegation?

circumstance, task, person, direction and communication, supervision

What are the 4 C's of Communication

clear, concise, correct, complete

Failure of maxillary and median nasal processes to fuse

cleft lip

Fissure of palate from failure of 2 palatal processes to fuse

cleft palate

Results from failure of hard and soft palates to fuse because of failure of tongue to descend soon enough

cleft palate

An essential nutrient for hematopoiesis, folate metabolism, DNA and RNA production, and carbohydrate, fat, and protein metabolism

cobalamin

Which deficiency causes weakness, paresthesias, reduced vibratory and position senses, and impaired thought processes?

cobalamin

vitamin B12

cobalamin

This is found in fish, shellfish, meat, poultry, eggs, and fortified cereal

cobalamin (vitamin B12)

Begins in middle age or later and is more common in northern european ancestry

cobalamin deficiency

This commonly caused by pernicious anemia

cobalamin deficiency

Which type of anemia has neuromuscular manifestations

cobalamin deficiency

occurs when body does not produce enough intrinsic factor

cobalamin deficiency

Distraction, hypnosis, relaxation breathing, imagery, meditation, art and music therapy, and progressive muscle relaxation are examples of what type of pain management?

cognitive therapies

Sepsis: Integumentary Effects Decreased blood flow= - __________ & _________, later _________/__________ - Warm/flushed sometimes d/t vasodilation/increased temp but ultimately leads to above^^

cold, clammy, mottled/cyanotic

Intussusception in Adults: S/S RARE - Pain _________ and _______ - ___________ and __________ may occur - Causes: ___________, polyp or ________, __________, _________ disease

comes, goes, nausea, vomiting, surgery, tumor, adhesions, Crohn's

Parent Nursing Interventions - Tailor nursing care to family's needs/preferences - Maintain positive ____________ w/family - Ask for parent's ____________ in care - Explain all aspects of ___________, keep family "in the loop" - Provide information/teaching materials to family - Preparing for ___________ and home care

communication, participation, treatment, discharge

Condition in which swelling & increased pressure within a compartment presses on and compromises the function of blood vessels, nerves, and/or tendons that run through that compartment

compartment syndrome

GER becomes GERD when

complications develop

Chronic Renal Failure: Renal Insufficiency - Headaches - Decreased ability to ______________ - ____________ - Polyuria --> ___________ - increased ________ and ___________ ____________ - GFR: progressively decreases from ____ to ____ ml/min - Mild ____________ - Increased __________ ___________ - Weakness and fatigue

concentrate, edema, oliguria, BUN, serum creatinine, 90, 30, anemia, blood pressure

During hemodialysis, nurse should be alert to changes in __________ and perform __________ ________ every ____ to ____ ___________

condition, vital signs, 30, 60 minutes

Causes of urinary incontinence include ___________ or depression, ___________, atrophic vaginitis, urinary ____________, restricted __________, fecal ___________, or _________

confusion, infection, retention, mobility, impaction, drugs

What are the four early symptoms of hypoglycemia?

confusion, irritability, tremor, sweating

Sepsis: Neurologic Effects Poor perfusion of the brain leads to - Possible ___________, change in LOC, delirium, decreased _____________ Eventually - ____________, areflexia - Pupils _____________ Older adults become confused very quickly, younger adults/children may exhibit _____ mental status changes, until they become less responsive or lose consciousness

confusion, responsiveness, unresponsive, nonreactive, no

Hypotension S/S Hypoperfusion leads to: - ___________ - Decreased __________ ________ - Weakness/____________ - ____________ pain - _____________ SBP <90

confusion, urine output, fainting, chest, hypoxemia

Causes of moderate elevation (>100.4) in the first 48 hr post op: - Lung _____________ - _____________

congestion, dehydration

Gerontological Considerations: - Structural changes in kidneys decrease ability to __________ __________ - _____________ changes lead to increased risk of fluid and electrolyte imbalances - Loss of ______________ tissue leads to increased loss of _____________ - Reduced _________ mechanism results in decreased fluid intake - Functional changes affect ability to independently ___________ ____________

conserve water, hormonal, subcutaneous, moisture, thirst, obtain fluids

a gravity exchange process for peritoneal dialysis in which a bag of dialysis fluid is raised above the level of an abdominal catheter to fill the abdominal cavity and lowered below the level of the abdominal catheter to drain the fluid out

continuous ambulatory peritoneal dialysis

CAP

continuous antibiotic prophylaxis

Malignant Hyperthermia: Symptoms - Muscle _____________ - Hyperthermia - ____________ - Lactic ____________ - Hemodynamic/__________ changes

contracture, hypoxia, acidosis, cardiac

Fear/Stressors: School-Age - Loss of _________ - Fear of _______, bodily injury, and ________ - Loss of ___________ - Separation NOT as much of an issue as toddlers/preschoolers; may have already experienced when starting school - Want to know ___________ for procedures; like being __________ and want to make __________

control, pain, death, privacy, reason, involved, choices

Fear/Stressors- Adolescent - Loss of ____________; give some to avoid __________ ___________ - Loss of ___________ ** - Concerned with _________ ** (fear of altered _________ _________)* - Separation from _________ ________* (more important than separation from family) - May act as though not afraid when they really are

control, power struggle, privacy, appearance, body image, peer group

What is glucagon's expected pharmacological action?

converts glycogen in the liver into glucose (takes about 20 minutes)

HTN: Complications - ___________ ___________ __________ mainly due to __________ ___________ ___________ - Heart ____________ - _________________ disease - TIA's, stroke - _______________ vascular disease (one or more major pulses in the extremities are reduced or absent; intermittent claudication) - _____________________ - _____________ damage (hemorrhages or exudates, with or without papilledema, blurring of vision, loss of vision)

coronary artery disease, left ventricular hypertrophy, failure, cerebrovascular, peripheral, nephrosclerosis, retinal

bolus dose of insulin that takes into account insulin sensitivity factor & target blood glucose; number specific to each person and takes into account how sensitive individual is to insulin

corrective dose

What are the two ways of determining insulin dose for bolus dose

corrective dose and carbohydrate coverage

The adrenal ___________ is the outer part of the adrenal gland. It secretes several __________ hormones, including glucocorticoids, mineralocorticoids, and androgens

cortex, steroid

Hormones synthesized by the adrenal cortex excluding androgens

corticosteroids

These drugs stop, control or reduce the inflammatory response (local or systemic) in any part of the body by suppressing the immune system

corticosteroids

Used for moderate-to-severe UC and CD to achieve remission (class)

corticosteroids

_____________ antagonize hypoglycemic effects of insulin, resulting in elevated blood glucose

corticosteroids

What is the main glucocorticoid

cortisol

What is the most abundant and potent glucocorticoid that is necessary to maintain life

cortisol

What is the best indicator of renal function (how much of the kidney's nephrons are able to work- this number closely approximates the GFR)

creatinine clearance - 24 hour urine

Intussusception in children: S/S - Sudden, loud ___________ - Infants may pull ________ to _________ - Pain ________ and _____, usually every _____-______ __________ at first, then _________ - ________ mixed with ________ and _________ - ___________ - ________ in abdomen - Lethargy - ________________ - _____________

crying, knees, chest, comes, goes, 15-20 minutes, longer, stool, blood, mucus, vomiting, lump, diarrhea, fever

Calculi: Diagnostics - Urinalysis - Urine ___________ - _____________ - _______________ - IVP (intravenous pyelogram) - _____ scan - Pts who have recurrent stone formation may have ____ _______ ________ collections measuring calcium, phosphorus, magnesium, sodium, oxalate, citrate, sulfate, potassium, uric acid, and total volume

culture, ultrasound, cystoscopy, CT, 24 hour urine

a total proctocolectomy for UC is

curative

Drug therapy cannot _______ IBD. Medications are used to __________ and ___________ ____________ or treat complications

cure, induce, maintain remission

Caused by over-secretion of the corticosteroids (endogenous and exogenous)

cushing's syndrome

APD: - __________ delivers the _________ - Times and __________ fill, dwell, and drain

cycler, dialysate, controls

Inflammation of the bladder wall, and urinary system

cystitis

Nursing Process: Which nursing intervention is appropriate for the problem of impaired gas exchange? a) Monitor IV fluids hourly b) Place John on isolation precautions. c) Assist John to ambulate in the hall 3 times per day d) Administer O2 as prescribed to maintain sats greater than 92%

Who is at highest risk for developing sepsis? a) Newborn babies b) People with cancer c) People over 65 years old d) All of the above

Sepsis is more deadly than _____. a) Breast cancer b) AIDS c) Prostate cancer d) All of the above

d (258,000 people died each years in the U.S. from sepsis, more than prostate, breast cancer, and AIDS combined)

How often should a diabetic client inspect their feet?

daily

What are 4 things a diabetic person can do to help reduce risk of complications?

daily physical activity, eating a healthy diet, taking one's prescribed medication, lowering cholesterol and blood pressure

Best indicator of fluid balance

daily weight

What is the best indicator of fluid balance

daily weight

MCNS: Treatment Interventions - __________ _______ - Turning Q ____ ______/______ care - Diet (low sodium, fluid restriction, high protein) - Activity (bedrest) - Strict ___________ and __________ - Medications - Family support and home care

daily weights, 2 hrs, skin, intake, output

Chronic Kidney Disease Define as presence of - Kidney __________ Markers of damage: - _______, _______, _________ tests - Glomerular filtration rate (GFR) * < ______ ml/min for ____ __________ or longer

damage, blood, urine, imaging, 60, 3 months

Malignant Hyperthermia Treatment

dantrolene

slows metabolism, reduces muscle contraction and mediates the catabolic processes

dantrolene

Early morning glucose elevation produced by the release of growth hormone, which decreases peripheral uptake of glucose resulting in elevated morning glucose levels

dawn phenomenon

Hyperglycemia present upon waking that peaks in adolescent and young adulthood possibly d/t GH

dawn phenomenon

CKD disease staging is based on

decrease in the GFR

what are the four ways the body becomes iron deficienct

decreased intake (MOST COMMON CAUSE; infants- breastmilk is low in iron, vegetarians), decreased absorption, increased demand, increased loss

What is one gerontologic consideration r/t the kidneys? (3)

decreased number of functioning nephrons, aging kidney less able to compensate for changes in F&E imbalances, older adults more likely to have comorbid conditions

Undernutrition: Labs *prealbumin is best marker for malnutrition - Iron (increased/decreased) - RBCs (increased/decreased) - Albumin/pre-albumin** (increased/decreased) - Electrolytes - BUN and Creatinine - Liver enzymes - WBCS (increased/decreased)

decreased, decreased, decreased, decreased

Endocrine System: Gerontological Considerations- Normal aging results in: - _____________ hormone production and secretion - Altered hormone __________ and biologic activity - _____________ responsiveness of target tissues to hormones - Alterations in ____________ _________ - Subtle changes of aging often ________ manifestations of ____________ disorders, resulting in delayed treatment (fatigue, constipation, mental impairment)

decreased, metabolism, decreased, circadian rhythms, mimic, endocrine

AKI: Gerontological Considerations - Older adults have a ___________ number of functioning ____________ in the kidney - The aging kidney is less able to ______________ for changes in fluid and electrolyte ____________ - Older adults are more likely to have more ____________ __________

decreased, nephrons, compensate, imbalances, comorbid conditions

Causes of Compartment Syndrome - ___________ compartment size (_____________ __________, splints, _________) - Increased compartment _________ -- _________, bleeding, _______________ *** Usually within the first ____ _______ of injury when edema is at its peak)

decreased, restrictive dressings, casts, content, edema, inflammation, 48 hours

Sepsis: CVPV Effects - CO and BP are initially maintained d/t the kidneys maintaining vasoconstriction & fluid balance, but eventually... - _____________ CO and BP - ____________ - _________ peripheral pulses - ___________ (anasarca) Later - Tissue ___________ - ____________ ___________/infarction (MI)

decreased, tachycardia, weak, edema, ischemia, myocardial ischemia

Compartment Syndrome: Prevention/Care - Prevent by _____________ __________ - Regular _____________ of extremity and cast/immobilization device - Limit length of time that extremity is in a _____________ position - ______________ of operative extremity if ordered

decreasing edema, assessment, dependent, elevation

Nissen Fundoplication- Post Surgical Care - _________ ________, control n/v and _______ - Start on __________ diet and slowly advance to ________, then __________ - Side effects: Difficulty __________, __________ and increased __________

deep breathing, pain, liquid, soft, solids, swallowing, bloating, flatulence

Type II DM is caused by insulin _________ and insulin ________. Many tissues are resistant to insulin: Reduce number of insulin __________, or insulin receptors are less _____________

deficiency, resistant, receptors, responsive

What are three causes of decreased RBC production

deficient nutrients (iron, cobalamin, folic acid), decreased erythropoietin (kidney failure), decreased iron availability (liver disease)

A sterile, biodegradable gel used to treat vesicoureteral reflux (VUR). The ________ implant is injected into the bladder wall where the ureter enters the bladder, forming a bulge at the opening. The bulge reduces the size of the opening, to prevent urine from flowing backward into the ureter. The opening is still flexible so urine can flow into the bladder, as it should. It is gradually replaced by the body's own tissue, so the bulge remains.

deflux

Scoliosis can lead to: - ____________ - ______ - Alteration in ___________ - _______________ compromise - Altered ________ _________

deformity, pain, mobility, respiratory, body image

Separation and disruption of previously joined wound edges

dehiscence

Occurs whenever total output of fluid exceeds intake

dehydration

Management of Gastroenteritis - Assessment of ___________ - ___________ ____________ - Avoid fluids with high _____________ and low __________ values - Advance to __________ diet as tolerated - Nursing mothers should ____________ to breastfeed - Anti-diarrheal agents are ______________ - Protect ________ - _____ _____________ for severe dehydration

dehydration, oral rehydration, carbohydrate, electrolyte, normal, continue, discouraged, skin, IV therapy

Hypovolemia: Fluid Volume Deficit Manifestations - S/S of __________ - Restlessness, lethargy, ___________ - Confusion, altered ______ - Increased _______ - _____ skin, skin ____________ - _____________ neck veins - ____________ weight - _________ heart rate / _____________ BP - Decreased urine output (below _______ ml/day; can go into ___________)

dehydration, weakness, LOC, thirst, dry, tenting, flattened, decreased, increased, decreased, 500, shock

Infection __________ healing and may result in ____________ _______________

delays, chronic osteomyelitis

The transferring to a competent individual the authority to perform a selected nursing task in a selected situation

delegation

Fractures are more common in childhood, because: - Bones are less _________ and more _________ in young children - Children are more _________ than adults and have limited gross _________ _____________

dense, porous, active, motor coordination

Reddish/brown round/oval patches from diabetes

dermopathy

Which stage of separation anxiety? Child becomes inactive, withdrawn, lacks interest in environment, apathetic Sadness, depression Withdrawal or complaint behavior Crying when parents appear

despair

Which stage of separation anxiety? - Lack of protest when parents leave - Increased interest in surroundings - Interacts w/strangers or familiar caregivers - Forms new but superficial relationships - If parents reappear, child may ignore

detachment

When taking corticosteroids, there is normally a slow ____________ of the body. Trade off is treatment with a steroid in a chronic or autoimmune disorder will usually keep the body healthier than if the ___________ process was left unchecked

deterioration, inflammatory

External Fixation - __________ (pins, rods, screws, etc.) are ___________ to the body - Used to apply __________ - _____________ - Holds fracture fragments together to promote ___________

devices, external, traction, immobilization, healing

Internal Fixation - ____________ (pins, rods, screws, etc.) are ____________ the body - Holds fracture fragments __________ to promote ___________ - Often ____________

devices, inside, together, healing, permanent

What is the leading cause of kidney disease

diabetes

What are the two leading causes of chronic kidney disease (state more prevalent cause first)

diabetes (50%), hypertension (25%)

Name the two main comorbid conditions that can put clients at higher risk for CKD

diabetes, hypertension

A severe metabolic complication of uncontrolled diabetes that, if untreated, leads to diabetic coma and death.

diabetic ketoacidosis

The major complication associated with Type I Diabetes is

diabetic ketoacidosis

Compartment Syndrome: Collaborative Care/Treatment - Prompt, accurate _____________ is critical - ____________ recognition is key - Do not apply ______ or _________ above ________ level if suspected - ___________/loosen the bandage and bivalve the cast - Traction weight ____________ - Surgical ______________ (_________________)

diagnosis, early, ice, elevate, heart, remove, reduction, decompression, fasciotomy

Movement of fluid/molecules across a semipermeable membrane from one compartment to another

dialysis

long plastic cartridge that contains thousands of parallel hollow tubes or fibers that are the semipermeable membrane

dialyzer

What provides the filter for hemodialysis

dialyzers

Physiologic signs - Skin flushing/___________ - Vital sign changes: ____, _____, _____ - _____ _____________, restlessness - __________ changes

diaphoresis, BP, RR, HR, O2 saturation, pupil

Rotavirus - Most common cause of ___________ in children <____ years - Infants ___-____ months most vulnerable - Symptoms usually begin ___-____ ______ after exposure - Diarrhea can be severe and last ___-___ _________ - _____________ available

diarrhea, 5, 6-12, 2-3 days, 3-9 days, vaccine

Hyponatremia Causes: Excessive sodium loss - GI losses: ____________, vomiting, ___________, NG ____________ Renal losses: ___________, endocrine (_____________ insufficiency) - Inadequate sodium intake - ____________ diets Excessive water gain (decrease in sodium concentration) - Excessive ____________ IV fluids

diarrhea, fistulas, suction, diuretics, adrenal, fasting, hypotonic

Mild cases of hypoglycemia can be treated with ________- higher intake of __________ and lower intake of _____________- to prevent rebound postprandial hypoglycemia

diet, proteins, carbohydrates

Celiac Disease: Therapeutic Management - Primarily ___________ - ____-______ or _________-_____ diet - _________ and ________ become substitute grain foods - Possible _____________ restrictions

dietary, low-gluten, gluten-free, corn, rice, lactose

Dwell - ___________ and __________ occur between patients _________ and ___________ _____________ - Duration of time varies, depending on method

diffusion, osmosis, blood, peritoneal cavity

What are the three main principles of dialysis

diffusion, osmosis, ultrafiltration

Malabsorption can be due to: - Decreased ___________ _________ - _______ side effects - Decreased _________ __________ _________

digestive enzymes, drug, bowel surface area

What are the two most common medications with PCA pump?

dilaudid, fentanyl

Management of Care- Hypokalemia - Potassium chloride supplements orally or IV - Always __________ IV KCl - ____________ give KCl via IV ________ or as a ___________ - Should not exceed ________ mEq/hr to prevent ______________ and ____________ ___________

dilute, never, push, bolus, 10, hyperkalemia, cardiac arrest

UTI Dx - _________ for leukocyte estrace and nitrates - ____________ culture and sensitivity - Increased risk in _________ ________

dipstick, urinalysis, older adults

Intrarenal causes: Conditions that cause __________ _________ to the renal tissues, resulting in impaired ___________ function

direct damage, nephron

Dehiscence may be preceded by sudden ____________ of brown, pink, or clear _____________

discharge, drainage

Metformin will NEED to be ___________ if the patient is to undergo studies with _____________ _______ because of possible __________ effects; check with prescriber

discontinued, contrast dye, renal

Sepsis: Hematologic Effects _______________ ______________ _____________ - Thrombin clots in microcirculation - Platelets are consumed making unnecessary small clots, so they are not available to help clot where needed --> bleeding - __________ and __________ at the same time. - Where do we see the bleeding? _________, _____ tract, _______ (later), puncture sites

disseminated intravascular coagulation (DIC), clotting, bleeding, skin, GI, lungs

Non-Pharmacologic Pain Management: Pediatric Patients - ______________ - Relaxation - Guided __________ - ____________ stimulation - Containment and ___________ - ____________ __________ - ____________ care

distraction, imagery, cutaneous, swaddling, nonnutritive sucking, kangaroo

what are the 6 main classes of antihypertensives?

diuretics, beta blockers, calcium channel blockers, ACE inhibitors, ARBs, Aldosterone Antagonists

Allergy Diagnostic Testing - _________-_________, ________-__________ _________ ________= gold standard - Not be used alone for diagnosis.... may be used as an adjunct with ______ ________ test and _________ ____ measurements - _________ __________ diet

double-blind, placebo-controlled food challenge, skin prick, serum IgE, trial elimination

Opioids may cause (3)

drowsiness, respiratory depression, constipation

Dialysis can also be used to treat

drug overdoses

Undernutrition: Clinical Manifestations - ______ scaly skin, rashes; __________/ulcerations around the mouth - _______ hair/loss - __________ nails - ____________ eyes - _____________ body temperature - ____________ muscle mass - ___________ _________ changes, difficulty concentrating, irritable, confused - Delayed _________ ___________ - Susceptible to ______________

dry, crusting, thin, brittle, sunken, decreased, decreased, mental status, wound healing, infection

Why can PUD cause hemorrhage

due to erosion

Complications of Gastric Surgery Associated with meals having a hyperosmolar composition: S/S generalized weakness, sweating, palpitations, and dizziness

dumping syndrome

Gastric contents empty too rapidly into the small intestines causing decreased absorption, N/V, weakness, and diarrhea

dumping syndrome

Which type of ulcer has burning or cramp-like pain

duodenal

Which type of ulcer is associated with other diseases, such as COPD, pulmonary disease, pancreatic disease, hyperparathyroidism, Zollinger-Ellison Syndrome, and chronic renal failure

duodenal

Which type of ulcer makes mid-epigastric pain beneath xiphoid process or back pain

duodenal

Which type of ulcers are found more in men?

duodenal

Which type of ulcers are more related to alcohol ingestion and heavy smoking habits and stress

duodenal

Which type of ulcers occur at age 35-45

duodenal

Which ulcers may be relieved with food

duodenal

H. Pylori accounts for 90-95% of

duodenal ulcers

What is carafate used for?

duodenal ulcers

Which type of ulcers are more common (80%)

duodenal ulcers

What is a common collaborative problem related to both hyper and hypokalemia

dysrhythmias

Which type of infection can lead to sepsis? a) Bacterial b) Viral c) Fungal d) Parasitic e) All of the above

Hyperthermia: Treatment - Careful assessment and monitoring - ___________ ______________ - __________ ____________ exercises - Notify HCP for possible ______________, work-up

early ambulation, deep breathing, antibiotics

Prevention & Treatment of VTE - __________ ___________ *** - _____________ ____________ _________ - Heparin (SQ or IV) - Lovenox/Enoxaparin (SQ) - Coumadin (PO)

early ambulation, sequential compression devices

Allergies & Anaphylaxis: Therapeutic Management - ___________ __________ and treatment is the goal - Mild reaction: (Only one system(s) affected and no ____________ or _________ involvement): ____________ such as ________________ or certirzine - Moderate or severe reaction (More than one system or ___________/__________ involvement) * First ___________ ___________ * _______________ * ________

early recognition, respiratory, cardiac, antihistamine, diphenhydramine, cardiac, respiratory, establish airway, epinephrine, fluids

N&V- Prevention/Treatment - No _____________ until pt is fully awake - No eating until passing ______ or return of _________ __________ - _______-__________ - Start _________ and small- advance from clear liquids to solids gradually - Continue _____ ________ until tolerating oral liquid/food

eating, gas, bowel sounds, anti-emetics, slow, IV fluids

Dilutional hyponatremia can cause (3)

edema, hypertension, heart failure

S/S of Fractures - __________ - __________ and tenderness (localized to the point of injury) - Muscle ___________ - Decreased or loss of ____________ - Inability to ________ _________ or use - ___________ against movement - ________________, contusion - May or may not have _____________

edema, pain, spasms, function, bear weight, guard, ecchymosis, deformity

The dose amount and duration of use of corticosteroids dictate the extent of dependency and damage to the body. Watch for _________, _________ _______, _________ wound healing, _____________, and infections

edema, peptic ulcers, delayed, osteoporosis

Pre-Op Checklist Day of Surgery - Preoperative __________ completed - _____________ _________ signed - _______ - bowel prep - _________ prep (shower or bathe in antimicrobial soap) - Documentation/Checklist of ____________ - ___________ prior to transfer - Pre op ________ - given and charted - ________ ________ up after pre op bed in low position - Hospital gown - ___________ and ID band - Dentures, eyeglasses, hearing aids, contacts, left in place or removed - ___________ __________ before transfer - Pre Op ______ work on chart, surgeon notified of abnormal values - ______________: history, MAR on chart, EHR/EMR up-to-date, high alert meds noted

education, informed consent, NPO, skin, valuables, voided, meds, side rails, allergy, vital signs, labs, medications

HTN: Gerontologic Considerations - Loss of ____________ in the large arteries --- _______________ - Increased ___________ and ___________ of the ____________ - Increased ___________ _________ ________ - Decreased _________ function

elasticity, atherosclerosis, collagen, stiffness, myocardium, peripheral vascular resistance, renal

Hypervolemia: Treatment - Remove fluid without changing ___________ _________ or __________ of _______

electrolyte composition, osmolality, ECF

In CKD, ______________ magnesium levels are not a problem unless the pt ingests magnesium containing products (e.g. milk of magnesia, magnesium citrate, antacids containing magnesium)

elevated

CKD can lead to _____________ ______________ d/t an alteration in lipid metabolism

elevated triglycerides

Patient & Family Teaching for Femoral Head Prosthesis/Hip Replacement DO - Use ____________ toilet seat - Use a shower __________ - NO __________ - Use _________ between legs for first ____ weeks after surgery when lying on "_______" side or when ______________ - Keep hip in _________, _________ position when sitting, walking, or lying - Notify surgeon if severe _______, ___________, or loss of __________ occurs - Inform ____________ of presence of prosthesis before dental work so that ______________ ___________ can be given

elevated, chair, BATHS, pillow, 8, good, supine, neutral, straight, pain, deformity, function, dentist, prophylactic antibiotics

In CKD, sodium may be __________, ____________, or _________ Because of impaired ______________, ____________ along with water is retained, and ____________ _____________ may occur

elevated, normal, low, excretion, sodium, dilutional hyponatremia

Complications with ESRD Pharmacologic Therapy: Drug Toxicity - Delayed and decreased __________ lead to ___________ of drugs and the potential for drug toxicity. Drug doses and frequency of administration must be adjusted on the basis of the ___________ of the kidney disease

elimination, accumulation, severity

Main cause of vascular obstruction

emboli and atherosclerosis of the mesenteric arteries

Hypertensive crisis can lead to either hypertensive urgency or hypertensive ___________, the latter of which can lead to hypertensive ______________

emergency, encephalopathy

A mixture of equal quantities of lidocaine and prilocaine used as a local anesthetic.

emla cream

Intervention for normal BP

encourage lifestyle modification

Chronic complications of diabetes are primarily those of ________-__________ ______________ from damage to blood vessels (______________) secondary to chronic ______________

end-organ disease, angiopathy, hyperglycemia

Diabetic nephropathy is the leading cause of what in the US?

end-stage renal disease

What does PCA requires monitoring of?

end-tidal CO2

Produce and release chemical messengers called hormones (hypothalamus, pituitary, thyroid, parathyroid glands, adrenals, pancreas, ovaries, testes, pineal gland)

endocrine glands

What is the MAIN diagnostic study for cholecystitis?

endoscopic retrograde cholangiopancreatography

What is the main diagnostic test for peptic ulcers

endoscopy

Peptic Ulcer: Diagnostic Studies - _____________ with or w/o biopsy - Tests for ___ _________ - __________ ________ studies - ___________ analysis - Labs: ________, __________ ________ studies, and ________ examination

endoscopy, H pylori, barium contrast, gastric, CBC, liver enzyme, stool

Hypertensive Crisis Rising BP triggers ____________ ___________ --> Release of _____________ substances --> ________ _________ _________

endothelial damage, vasoconstrictor, end organ damage

Treatment of Sepsis: GI - _________ or _________ if needed - ____________ may help stimulate the GI tract & prevent ileus, maintain mucosa - _________ _________ _________ to decrease risk of ulcers (pantoprazole, esomeprazole, lansoprazole) - Sepsis often causes ____________, so pts will most likely need supplemental nutrition

enteral, parenteral, enteral, proton pump inhibitors, hypermetabolism

Other routes other than PO for pain management

epidural, transdermal

Anaphylaxis: Emergency Care at Home - Administer ____________ via Auto-Injector immediately if S/S present (Auvi-Q, EpiPen, Generic Epinephrine Auto-Injector, Impax Epinephrine Auto-Injector)

epinephrine

The major hormones secreted in the adrenal medulla are

epinephrine, norepinephrine, dopamine

What med might the pt receive if the Hgb and Hct are low? (2)

epogen, procrit (erythropoietic drugs to stimulate RBC production)

Children with Special Needs Psychomotor difficulties Provide ____________ to meet their needs

equipment

Autonomic Neuropathy: Reproductive Effects - ___________ ___________ - Decreased _________ - ____________ and nonspecific __________

erectile dysfunction, libido, candidal, vaginitis

Anemia - Deficiency in number of _____________ - _____________ quantity of quality - ______________volume

erythrocytes, hemoglobin, hematocrit

Two PPI examples

esomeprazole (Nexium), pantoprazole (Protonix)

GER/GERD Complications - ______________ (irritation of the lining of the esophagus) - _______________ __________ (resulting from scar tissue) - ____________ esophagus (precancerous lesions) - ______________ - ______________ (pneumonia) - Bronchospasms - Laryngospasms - _____________ of esophagus - Upper _____ ____________ - ___________ erosion

esophagitis, esophageal strictures, barrett's, bronchitis, aspiration, ulceration, GI bleeding, dental

How often should you test BG for someone with diabetes who is ill?

every 3-4 hours

Organ protruding through incision/opening in pt's skin

evisceration

Hypertensive Crisis: Causes - ______________ of chronic HTN - ____________ or _____________ - ________ (cocaine, amphetamines) - ____________ ________ (KNOW) - __________ injury (trauma) - Acute __________ __________

exacerbation, preeclampsia, eclampsia, drugs, rebound HTN, head, aortic dissection

A systemic inflammatory response to an infection where the body's response to the microorganisms is __________ causes sepsis

exaggerated

What are the three phases of PD cycle collectively called?

exchange

Glucagon-Like Peptide-1 Receptor Agonists (2 examples)

exenatide (byetta, 2x/day), liraglutide (victoza 1x/day)

What is a physical pain relief strategy, non-medication that significantly helps with chronic pain?

exercise

Therapeutic Management Type 1 DM - Nutrition - ___________ - ____________ measurement for ____________ - Illness management - Management of acute complications - Prevent or prolong time before long-term complications occur

exercise, morning, hyperglycemia

Do not inject insulin in site to be

exercised (example stay away from arms and legs day of tennis match)

What is one complication of peritoneal dialysis?

exit site infection, peritonitis, hernias, lower back problems, bleeding, pulmonary complications

Peritoneal Dialysis Complications - _______ ________ infection - _____________ - Hernias - ________ ________ problems - Bleeding - ______________ complications

exit site, peritonitis, lower back, pulmonary

These secrete their substances into ducts that then empty into a body cavity or onto a surface

exocrine glands

Patients affected with Type I DM need ______________ __________

exogenous insulin

Isotonic IV fluids are used to __________ ________ _________ and provide ______ ______ ________

expand plasma volume, no free water

Obesity: Geriatric Considerations - Decreased energy ____________ increases body _______ - _____________ age-related problems - ________ventilation - ______________ - _________________ problems Decreases ________ _________ by ____-____ _________ Decreases __________ of life

expenditure, fat, exacerbates, hypo, incontinence, cardiovascular, life expectancy, 6-7 years, quality

Gerontological Considerations: PreOp Phase - Medical history may be more ______________ - Assessment: Be aware of any ____________ deficits - Risks associated with _____________ and surgery are ____________ - Planning for _____________ at the time of admission -- looking ahead to recovery/coordination of care/caregiver support

extensive, sensory, anesthesia, increased, discharge

Fractures of the Hip: Clinical Manifestations - ____________ rotation - Muscle ___________ - _____________ of the affected extremity - ___________ ________ and tenderness in the region of the fracture site

external, spasm, shortening, severe pain

Kidneys: Primary Functions - Regulate the volume/composition of _____________ _________ - Excrete _________ - Control __________ ____________ - Produce _____________ - Activate _____________ ______ - Regulate ________-________ balance

extracellular fluid, waste, blood pressure, erythropoietin, vitamin d, acid-base

Cholelithiasis: Collaborative Care - _________________ _______-_______ ___________ ***If stones cannot be removed via ___________ - High-energy shock waves ___________ stones - Takes ___-___ _________ - Used in conjunction with ________ ________

extracorporeal shock-wave lithotripsy, endoscope, disintegrate, 1-2 hours, bile acids

FLACC

face, legs, activity, cry, consolability

Delirium/Confusion Interventions - safety, _________ prevention - Try to identify cause and treat it

fall

Scoliosis: Risk Factors - _____________ __________ - Age - ______ - Conditions such as * ____________ dystrophy * ____________ palsy * __________ bifida

familial inheritance, sex, muscular, cerebral, spina

Nephrolithiasis: Etiology- Genetic factors?

family history

Nursing Assessment for CKD: - Complete history of any existing renal disease, _________ __________ - _______-_______ health problems - ___________ habits

family history, long-term, dietary

Name three causes of nephrolithiasis

family history, sedentary lifestyle, diet

What is the main H2 receptor antagonist used preoperatively?

famotidine

Sepsis: Respiratory System Effects - Initially, decreased blood supply & increased metabolic rate causes _______ breathing --> _______________ & ______________- - With inflammation and increased capillary permeability, we see _________ leaking from the vasculature, causing __________, alveolar __________, and ___________ which eventually leads to respiratory failure.

fast, hyperventilation, tachypnea, fluid, infiltrates, edema, crackles

Insulin has a direct effect on_______ metabolism: stimulates lipogenesis and inhibits lipolysis and the release of fatty acids from adipose tissue

fat

Provides satiety and other energy source

fat

The presence of fat globules in tissues and organs after a traumatic skeletal injury

fat embolism syndrome

What are the four symptoms associated with chronic cholecystitis?

fat intolerance, dyspepsia, heartburn, flatulence

Obesity Causes: 1. Increase in _______ _________ 2. Increased _________, which contribute to _________ resistance and atherosclerosis, and disrupt _________ function and predispose to certain ___________)

fat mass, adipokines, insulin, immune, cancers

In DKA, the ketoacidosis is caused by breakdown of _______ and __________ due to a lack of ___________

fat, muscle, insulin

During the oliguric phase, examples of neurologic changes include - ______________ - Difficulty ____________ - Possible __________ - Stupor - Coma - Possible ____________

fatigue, concentrating, seizures, death

What are 4 common symptoms that may occur during the asymptomatic chronic infection stage of HIV that increase moving into the symptomatic infection stage?

fatigue, headaches, low-grade fever, night sweats

Most common psychologic factors before surgery are (3)

fear, anxiety, hope

Gallbladder Disease: Risk Factors - Gender (male/female) - (Nulliparity/Multiparity) - Age older than ____ years - __________ therapy - ______________ lifestyle - Genetics/ethnicity - ___________

female, multiparity, 40, estrogen, sedentary, obesity

What are the two main preoperative opioids?

fentanyl, dilaudid

Pneumonia: Symptoms - High _________ and _______ Respiratory - Cough (nonproductive to productive) --> _________ sputum - ________pnea - ___________ or fine crackles w/decreased breath sounds - ___________ with percussion - __________ pain; abdominal pain w/lower lobe involement - Retractions - Nasal __________ - Pallor to _____________ _____________ seen on X-ray -Irritable, restless, lethargic, malaise - Nausea, vomiting, diarrhea, or abdominal pain

fever, chills, whitish, tachy, rhonchi, dullness, chest, flaring, cyanosis, infiltrates

Inflammation of cholecystitis produces the symptoms:

fever, leukocytosis

HIV Acute Infection: Symptoms - ____________, swollen ________ nodes, sore throat, headache, malaise, and _________/joint pain, diarrhea, or a diffuse _______

fever, lymph, muscle, rash

what is the semipermeable membrane of dialyzers

fibers

The primary overall function of the kidneys is to __________ the ___________ and maintain the body's internal ________________

filter, blood, homeostasis

The long-term convalescence of 3-12 months may cause psychosocial and __________ hardships for the family, and appropriate ___________, social work, and psychiatrist/psychologist referrals are made as needed. If the kidneys do not recover, the pt will eventually need ___________

financial, counseling, dialysis

Safety Considerations - Room ready - all necessary equipment available - Risk of _______ - Prevent ____________ (warming blankets) - ____________ technique & skin prep - Safe patient transfer - ________ __________! - Proper pt _____________ (critical for success of surgery and pt safety. The pt will probably not be able to tell you if they are in painful or restrictive position so be vigilant about ensuring ______________ and __________, and alleviating ___________)

fire, hypothermia, aseptic, lock wheels, positioning, circulation, alignment, pressure

When does mild hyperthermia normally occur

first 48 hr post op

What is metformin used for?

first line of defense for type II diabetes

Normal distribution of fluid in ICF and ECF

first spacing

Pre-procedure verification before the start of the procedure = _________ and _________ __________ which is documented

first, second time out

Scoliosis: S/S - Difficulty ________ _______ - Uneven _________ _________ - Protruding ____________ or _____ - Unequal ______ length

fitting clothes, shoulder blades, scapula, hip, leg

Hypokalemia- Clinical Manifestations - Fatigue - Muscle weakness, leg cramps - Soft, ________ muscles - Paresthesia, _____________ _________ - _____________, ____________, ___________ __________ - Shallow respirations - Weak, irregular pulse - ________ __________ - Unexplained _______________

flabby, decreased reflexes, constipation, nausea, paralytic ileus, EKG changes, hyperglycemia

What are the main clinical manifestations of renal calculi (5)

flank pain, fever, chills, nausea, vomiting

Pyelonephritis: Manifestations - _________ pain - ____uria - Pain at _____________ ________ - Same S&S as cystitis

flank, dys, costovertebral angle

Patient & Family Teaching for Femoral Head Prosthesis/Hip Replacement DO NOT - ________ hip greater than _____ degrees - ___________ the hip - ____________ rotate the hip - __________ legs - Put on own _______ until ___ weeks after surgery - Sit on chairs ___________ _______ to aid rising to a standing position

flex, 90, adduct, internally, cross, shoes, 8, without arms

IV Fluid Replacement if Continued Vomiting/Diarrhea - ________ _________ given if child has moderate to severe hydration - ___________ fluids ONLY for IV fluid bolus (______ or ______) - Start _____________ IV fluids after bolus complete (______ or _________) - ______________ is added to IV fluids only after child has ___________

fluid bolus, isotonic, NS, LR, maintenance, D5 1/2NS, D5 1/4 NS, potassium, voided

Name one nursing diagnosis for CKD clients (4)

fluid imbalance, electrolyte imbalance, impaired nutritional status, difficulty coping

Management of Care: Hyponatremia Caused by water excess: ____________ __________ is needed Severe symptoms (seizures): Give small amount of IV _____________ __________ solution (______ NaCl)

fluid restriction, hypertonic saline, 3%

In the oliguric phase of AKI, the nurse should assess the client for

fluid volume overload (pulmonary edema)

Before hemodialysis, nurse should complete assessment of _________ status, condition of _________, ____________ and ______ condition

fluid, access, temperature, skin

If a patient is experiencing N&V from glucagon, monitor _________ and __________ intake, and turn _________________ patients on their sides to prevent ______________ from vomiting

fluid, carbohydrate, unconscious, aspiration

Intervention for HHS: ___________ replacement, correction of _______________ _______________, _____________ administration Fluid replacement: Watch the ____________ for fluid volume excess

fluid, electrolyte imbalances, insulin, elderly

Dialysis is used to correct ________ and __________ ___________ and to remove __________ products in renal failure

fluid, electrolyte imbalances, waste

Urinary Incontinence: Management Strategies Lifestyle interventions such as an - Adequate volume of __________ and reduction or elimination of __________ __________ from the diet - ___________ treatments such as _________ __________ regimens (timed voiding, habit training, prompted voiding), bladder ___________, and ________ __________ ___________ training

fluids, bladder irritants, behavioral, scheduled voiding, retraining, pelvic floor muscle

In an ill diabetic patient, encourage _________ to aid in clearing of _____________. Need to have an increase in intake of ____-________ ________, such as broth, water, diet gelatin, and other decaffeinated beverages

fluids, ketones, non-caloric fluids

Management of HHS •__________ (______ than dka) •_________ (usually ___ infusion) •___________ __________ •Follow electrolytes carefully •Check blood glucose every _______ •Strict I/O •__________ assessments (know the baseline)

fluids, more, insulin, IV, cardiac monitor, hour, neurologic

Maintenance IV fluids are useful for daily maintenance of body ________ and ________, and for _________________

fluids, nutrition, rehydration

Encourage ________ and ________ in ill diabetic patient

fluids, rest

Different types of Catheters - __________ catheter - ____________ catheter - ______________ tubes - ______________ catheterization

foley, suprapubic, nephrostomy, intermittent

Green leafy vegetables, enriched grain products, breakfast cereals, orange juice, peanuts, and avocados are all high in

folic acid

What is used for DNA synthesis and RBC formation and maturation

folic acid (folate)

What should be provided to patient's after they take glucagon and regain consciousness from an episode of hypoglycemia

food

Specific components of food, such as protein, are recognized by allergy-specific immune cells that produce an immune response with characteristic symptoms

food allergy

Type 2 Diabetes: Risk factors - Too much _________ with too much _________ ______ - Not enough ________ - _________ that cause greater insulin _________ and/or make you _________ LEADS TO - ___________: need extra insulin as body becomes resistant - ___________ deposits in __________ cause even more damage - Other set of genes inherited from parents make _______ _______ in pancreas wear out early; cannot make enough insulin RESULTS IN - Body needs more __________ but cannot __________ it TYPE 2 DIABETES

food, animal fat, exercise, genes, resistance, hungry, overweight, fatty, pancreas, islet cells, insulin, produce

Nursing Assessment: Malnutrition - _________ history for last week/day - ________ care; teeth intact? - Ability to __________ - Height/Weight, ______ - ___/_____ calculations - ________ signs - ________________ _____________ - ___________ circumference - ________________ strength

food, oral, swallow, BMI, In/out, vital, skinfold thickness, midarm, musculoskeletal

Break in a bone when more stress is placed on the bone than that bone can withstand

fracture

Cystitis: Manifestations - ___________ or ___________ - ______________ pain - _____uria - __________uria - Fever - ___________ in older adults

frequency, urgency, suprapubic, dys, hemat, confusion

IBD is characterized by: - GI Symptoms: __________ _________, __________ __________ pain - Extra intestinal and systemic _____________ responses - _______________ and ____________ without complete ____________ - ___________ failure

frequent stools, crampy abdominal, inflammatory, exacerbations, remissions, growth

Girls should wipe from

front to back

Potassium sources - ___________ and _____________ (bananas and oranges) - _________ substitutes - Potassium ____________ - __________ _________

fruits, vegetables, salt, medications, stored blood

Nutritional status assessment component? Ability to perform ADLs, handgrip strength, performance test (timed walk test), chewing and swallowing ability

functional status

Non-K+ sparing diuretic

furosemide

What med is commonly used during the oliguric phase

furosemide

loop (non k-sparing) diuretic example

furosemide

Loop diuretic

furosemide (Lasix)

Hypernatremia in normal or hypervolemic client - Restlessness, agitation, twitching, seizures, coma - Intense thirst, flushed skin - Weight _________, peripheral and pulmonary _________, ____________ BP

gain, edema, increased

Nephrotic Syndrome: Other Manifestations - Weight _________ - __________ edema progressing to severe generalized edema (ascites, labial or scrotal swelling, intestinal mucosa, ankles and legs) - ____________ volume of urine - ________ urine specific gravity - _________ and __________ urine - Pallor - Irritability - Susceptibility to ___________

gain, facial, decreased, high, dark, frothy, infections

Corticosteroids: Side Effects - Weight ________ - __________ of the face - Decreased ___________ - ___________ changes - __________-_________ adverse effects

gain, rounding, appetite, behavior, long-term

Hormonal factors during pregnancy may cause delayed emptying of the ___________, resulting in _______ of bile

gallbladder, stasis

What are the two most common complications of cholecystitis in older patients and those with diabetes

gangrenous cholecystitis, bile peritonitis

Cholecystitis: Complications - ______________ cholecystitis - _____________ ____________ - ____________titis - __________itis - ______________ ___________ - ____________ - _____________ ___________ --> _____________

gangrenous, subphrenic abscess, pancrea, cholang, biliary cirrhosis, fistulas, gallbladder rupture, peritonitis

Intestinal Obstruction: Pathophysiology - Fluid, ______, and intestinal contents accumulate - __________ ___________ collapses - As the bowel becomes ___________, __________ bowel _________ rises - Increased ______________: Fluid cannot get ___________ properly (it is not reaching most of the intestine) --> Increased capillary _____________ and _____________ of fluids and electrolytes into the ____________ cavity - ______________ and _____________ _________ - May cause __________ bowel, or bowel ____________

gas, distal bowel, distended, intralumenal, pressure, pressure, absorbed, permeability, extravasation, peritoneal, hypotension, hypovolemic shock, necrotic, perforation

What three conditions/processes might put a person at risk for decreased absorption of iron

gastrectomy, inflammatory bowel disease, celiac disease

Which type of ulcer causes pain in the left epigastrum, back, and upper abdomen

gastric

Which type of ulcer has burning/gaseous pain

gastric

Which type of ulcers are found more in women?

gastric

Which type of ulcers are increased with incompetent pyloric sphincter and bile reflux

gastric

Which type of ulcers are more related to NSAID use?

gastric

Which type of ulcers occur at age 50-60

gastric

Which ulcers may be worse when eating

gastric

Which ulcers have higher mortality

gastric (d/t increased age of incidence)

a surgical procedure to treat obesity that involves removing a large part of the stomach so the remainder resembles a tube or sleeve in order to limit the volume that the stomach can hold

gastric sleeve surgery

What is used to treat gastroparesis in autonomic neuropathy

gastric stimulant like metoclopramide

Ulcers found on the lesser curvature of the stomach

gastric ulcers

Inflammation of the stomach and intestines

gastroenteritis

What is the main complication from glucagon

gastrointestinal effects (nausea and vomiting)

stimulate the smooth muscle of the GI tract and increases the rate of gastric emptying

gastrointestinal stimulants

Metformin primarily affects the _____________ ____________: abdominal ___________, nausea, cramping, diarrhea, feeling of ______________

gastrointestinal tract, bloating, fullness

What are the four main systems affected by autonomic neuropathy?

gastrointestinal, cardiovascular, reproductive, urinary

creation of an artificial opening between the stomach and jejunum

gastrojejunostomy

Autonomic Neuropathy: GI Effects Mainly caused by _____________ (delayed gastric emptying) - __________ - ___________ & __________ - Gastroesophageal ________ - Persistent feelings of __________ - ______________

gastroparesis, anorexia, nausea, vomiting, reflux, fullness, hypoglycemia

Provides long-term nutritional support but poses risk for aspiration and skin breakdown

gastrostomy tube

What a nurse can delegate - __________ of data- provide to RN for development of plan of care; nurse may validate some findings - _____________ of teaching - Tasks or activities that a ________, PCA, or UAP has been trained to perform. Competency is up to date

gathering, reinforcement, tech

Anesthesia Mechanical ventilation via endotracheal tube or laryngeal mask airway ; IV and inhaled meds render pt unconscious

general anesthesia

Nissen Fundoplication Complications - ____________ __________ complications - ____________ - Tearing of the ____________ - ___________ of the _________

general anesthesia, bleeding, esophagus, slippage, wrap

Diabetes that develops during pregnancy. It may resolve after pregnancy but may also be a precursor of type 2 diabetes in later life.

gestational diabetes

Gastric bypass surgery decreases the amount of

ghrelin

What is the treatment for someone suffering from hypoglycemia after being administered glipizide?

give 15-20g of carbs (if conscious: oral in pill form or as food. If unconscious: IV glucose if available, or 1 mg glucagon SQ or IM)

Long-acting insulin: name

glargine, detemir

Which drug stimulates insulin secretion from the beta cells of the pancreas, thus increasing insulin levels?

glipizide

Which med (not insulin) CAN cause hypoglycemia, as it makes the pancreas work harder

glipizide

what drug increases the number and sensitivity of insulin receptors?

glipizide

What represents the amount of blood filtered each minute by the glomeruli

glomerular filtration rate

Nephrotic syndrome increases ______________ ______________ to __________, especially ____________

glomerular permeability, protein, albumin

Blood is filtered in the

glomerulus

When the person is unable to remain conscious, ____________ is given SQ, IM, or IV for emergency replacement

glucagon

a hormone produced by the alpha cells in the islets of Langerhans that stimulates the conversion of glycogen to glucose in the liver

glucagon

OUTPATIENT- SEVERE hypoglycemia treatment - Administer ___________ _____ or ____ - _______ patient on _______ after administration-- danger of ___________ - Notify PCP immediately, and follow orders - If still unconscious, ______ ______ or transport to ______ - After recovery, have patient _________ a __________ __________

glucagon IM, SQ, turn, side, vomiting, call 911, ED, ingest, complex carbohydrate

Increase insulin synthesis/release from the pancreas, inhibit glucagon secretion, decrease gastric emptying, increase feelings of satiety

glucagon-like peptide receptor agonists

Named for the effects on glucose metabolism. They inhibit the inflammatory response and are considered anti-inflammatory.

glucocorticoids

Adrenal Gland Hormones - Sugar (______________) - Salt (_______________) - Sex (_____________)

glucocorticoids, mineralocorticoids, androgens

one of the simple sugars that serves as a major source of energy. It is found in foods (e.g., refined sweets) and also is the final breakdown product of complex carbohydrate metabolism in the body; it is commonly referred to as dextrose

glucose

Obesity Diagnostic tests (for comorbidities) - ___________ and ___________/triglycerides - _____________ function tests - ___________ x-ray: ___________ __________

glucose, cholesterol, liver, chest, enlarged heart

Be aware that for severe hypoglycemia, IV _____________ is the treatment of choice because it acts faster than ______________

glucose, glucagon

Celiac Disease: Dietary Management - Many processed foods contain __________ as a __________ or __________; so always read all labels for gluten

gluten, filler, thickener

Celiac disease is intestinal tolerance to dietary protein _______ that produces ____________ __________-

gluten, mucosal lesions

CD is also called "________-_________ ___________" or gluten-sensitive enteropathy or "celiac _______"

gluten-induced enteropathy, sprue

a polysaccharide that is the major carbohydrate stored in animal cells

glycogen

breakdown of glycogen into glucose

glycogenolysis

Lifestyle Modifications for Infants with GER - Infants who are __________ with no ___________ complications do not need modifications - Change to _______ formula - Frequent ____________ - ___________ more __________ feedings - ____________ feedings with _______ ________ - ___________ monitoring

growing, respiratory, soy, burping, smaller, frequent, thicken, rice cereal, weight

Long-term use of corticosteroids leads to SEs such as _____________ suppression, weight _______, and decreased bone _________

growth, gain, density

Which body shape poses risk for osteoporosis, varicose veins, and cellulitis

gynoid

obesity pattern seen in people who store fat primarily around the hips and thighs

gynoid obesity

HTN S/S Occasionally ______________

headache

Hypertensive Emergency --> Hypertensive Encephalopathy Hypertensive emergency may be manifested as hypertensive encephalopathy, a syndrome in which a sudden rise in BP is associated with - ____________ - ____________ & ____________ - _____________ - Confusion - ___________ - __________ - ____________ vision - Transient ____________

headache, nausea, vomiting, seizures, stupor, coma, blurred, blindness

PreOp Assessment - Past _________ and __________ history, especially regarding things like problems with ___________ Medications - _____________ - Narcotics - Antidepressants - _________ __________ meds - Herbs - ____________ meds ---------------------- _____________ (like to anesthesia) Illicit Drugs Labs/Diagnostic Tests Pregnancy Review of Systems

health, family, anesthesia, anticoagulants, blood pressure, diabetes, allergies

Even if the pt appears to be asleep, talk to them through your assessment since ___________ is often the first sense to return

hearing

Pulmonary Edema risk factors - _____________ _________ - ________ patients - Patients with pre-existing ___________ - ___________ failure

heart failure, older, infections, renal

Hypervolemia- Fluid Volume Excess Causes - ___________ or _________ failure - Long-term use of ______________ which causes retained fluid - Excessive use of ____________ or ____________ fluids

heart, renal, corticosteroids, isotonic, hypotonic

Pediatric focuses S/S (GER): Children - _____________ - ________________ pain - Non-cardiac _________ pain - Chronic ________ - Dysphagia - ______________ asthma - Recurrent ________________

heartburn, abdominal, chest, cough, nocturnal, pneumonia

GERD S&S: Adult - ____________ (pyrosis) - _____________ - ____________/wheezing - _____pnea - Postprandial _________ - Belching - Early __________ - __________________ - Hypersalivation - Nausea & vomiting - Feeling of _________ in throat or food stopping - Dys__________ - Sore throat

heartburn, dyspepsia, coughing, dys, bloating, satiety, regurgitation, lump, phagia

Parental Reactions - Overall sense of ____________ - _____________ the skills of the staff - Accepting the ___________ of hospitalization - Dealing with fear, coping with uncertainty, seeking _____________

helplessness, questioning, reality, reassurance

Hemoglobin molecules bound to glucose molecules; blood levels of hemoglobin A1C are used as a diagnostic measure of average daily blood glucose levels in the monitoring and diagnosing of diabetes; it is also called glycosylated hemoglobin and most commonly referred to as A1C.

hemoglobin a1c

Iron increased ____________ production and therefore ____-______________ capacity

hemoglobin, O2-carrying

IDA: Diagnosis - Decreased _____________, MW, iron, ferritin - Increased _______, RBC distribution width, RDW - Peripheral blood smear: _____________, ____________ RBCs

hemoglobin, TIB (total amount of unbound transferrin), microcytic, hypochromic

What is increased RBC destruction called

hemolysis

What is the most common complication from PUD

hemorrhage

What is a major complication from a kidney biopsy for CKD?

hemorrhage (check labs-coags)

What are the three main complications of PUD

hemorrhage, perforation, gastric outlet obstruction

____________ impacts the development of allergies

heredity

Protrusion of a loop of an organ or tissue through an abnormal opening (mechanical obstruction)

hernia

Client need is life-threatening

high priority

What is the general trend for CD4+ cell count for HIV patients without treatment?

high with initial dip in first 2-3 weeks, stays high for about 5 years, then drops off gradually until year 10, then dramatically decreases and AIDS occurs

Prevention of ARI is primarily directed toward identifying and monitoring ______-_______ ____________, controlling exposure to ______________ drugs and industrial ___________, and preventing prolonged episodes of ____________ and ____________

high-risk populations, nephrotoxic, chemicals, hypotension, hypovolemia

HIV Nursing Management/Interventions - Identify ______-______ individuals and encourage ________ - Initiate and monitor drug regimens - Prevention of __________ - Prevent ______________ infections - Encourage health lifestyle - Ongoing ___________, including family planning - Supportive relationships - GOALS: Decrease __________ _________, prevent transmission, raise ______ counts, delay symptoms/____________

high-risk, testing, transmission, opportunistic, education, viral load, CD4, infections

What does the % mean in the possible dextrose concentration bags

higher % means more fluid and waste products removed

the style of cast that is applied to the trunk , around the affecting leg, and around half of the unaffected leg

hip spica

Anti-secretory agents to decrease the secretion of HCl acid by the stomach (GER/GERD)

histamine 2 receptor antagonists

Preoperative medications: Which medications are used to reduce stomach acid?

histamine H2 receptor antagonists

Ulcerative Colitis: Diagnosis/Evaluation - ___________ and physical exam - Labs: _____, _____, _____, _________ samples; __________ _________ to differentiate from CD - _______________ or ____________ w/biopsy - ___________ ___________ - _________ and/or _______

history, CBC, ESR, CRP, stool, serologic panel, sigmoidoscopy, colonoscopy, barium enema, MRI, CT

Crohn's Disease: Diagnosis/Evaluation - ___________ and physical exam - Labs: _____, _____, _____, _________ samples, ________ _________, _________, _________ levels; __________ _________ to differentiate from UC - ___________ ________________ and ____________ w/biopsy - ___________ ___________ - _________, _____, and/or _______

history, CBC, ESR, CRP, stool, total protein, albumin, vitamin, serologic panel, upper endoscopy, colonoscopy, barium enema, MRI, CT, US

GER/GERD Diagnosis - __________ of symptoms - ____________ ___________ - _______________ - Esophageal ___________ - Gastric ____________/24 hour ____ _________ - _____________ (gastric emptying study)

history, barium swallow, endoscopy, biopsy, secretions, ph study, scintiscan

Populations at Risk for Malnutrition - All ____________ individuals are potentially at risk - Low ____________ status - Race - Ethnicity - Populations are greatest risk are: * _________ __________ ________ and _________ __________

hospitalized, socioeconomic, very young children, elderly adults

Acute Renal Failure/Acute Renal Injury usually develops over _________ or ________ with progressive elevations of ________ and ___________ ____________. It is characterized by a rapid loss of renal function with progressive _____________.

hours, day, BUN, serum creatinine, azotemia

Hypertensive URGENCY - Develops over _______ to ______ - BP is severely elevated but there is ______ __________ __________ of __________ ___________ ____________ - Situation does ______ ________ ______ meds; oral antihypertensive medications (yes/no) - Client may not required to be hospitalized but requires frequent _________-_____ - Allow patient to _____ for _____-_____ ____________ in a ________ environment; may significantly reduce BP

hours, days, no clinical evidence, target organ damage, not require IV, yes, follow-up, sit, 10-20 minutes, quiet

Hypertensive EMERGENCY - Develops over _______ to _______ - A clients' BP is severely elevated _____ ___________ of ______ _________ ________ ________ especially to the _______ (>______/______) Can precipitate: - _______________** - Acute ________ ___________ failure with pulmonary ________ - MI - __________ failure - __________ ___________ ____________ - Intracranial or subarachnoid _____________ - __________pathy

hours, days, with evidence, acute target organ damage, CNS, 180/120, encephalopathy, left ventricular, edema, renal, dissecting aortic aneurysm, hemorrhage, retino

Ulcerative Colitis: Pathophysiology - ___________ response mediated by ___-___________ ____ cells - Inflammation typically limited to __________ and ____________ - ____________ and ____________ ___________ along the bowel (varying degrees of ulceration, ____________ and __________)

humoral, T-helper 2, colon, rectum, mucosa, submucosa continuously, bleeding, edema

Gastroenteritis Nursing Interventions - Assess child's ______________ status - Strict __________ and ________ - Daily ___________ - Hourly monitoring of _____ _________ and site of infusion - INCREASE FLUIDS IF INCREASE IN VOMITING/DIARRHEA - DECREASE FLUIDS WHEN TAKING PO FLUIDS OR SIGNS OF __________

hydration, intake, output, weights, IV rate, edema

Diuretic of choice for hypertension

hydrochlorothiazide (Microzide)

Urinary Tract Infection: Possible Causes - Poor _________ practices - _______________ - ___________ ____________ e.g. stone/tumor - __________ impairment e.g. neurogenic bladder - _________ impairment - ____________ in women can be a factor d/t the changes in the vaginal pH

hygiene, catheterization, intrinsic obstruction, urinary, renal, menopause

CKD can cause ________magnesemia

hyper

DKA: - ________glycemia - _____________ in the serum - _________osis - _____________ - ______________ imbalances

hyper, ketones, acid, dehydration, electrolyte

Signs and symptoms of ____________: - Polyuria - Polydipsia - Dehydration - Fatigue - Fruit odor to breath - Kussmaul breathing - Weight loss - Hunger - Poor wound healing

hyperglycemia

a fasting blood glucose level of 126 mg/dL or higher or a non-fasting blood glucose level of 200 mg/dL or higher

hyperglycemia

Pathophysiology: Type 1 DM With a deficiency of insulin, glucose in unable to enter the cell and remains in the blood. High levels of glucose in the bloodstream is called: _____________ - Liver and muscle cells store glucose in the form of ____________ Cells break down protein for conversion to glucose by the liver, _________________, this glucose then contributes to hyperglycemia - Elevated blood glucose leads to ___________ __________; this urinary fluid loss leads to ____________ Protein and fat breakdown lead to _________ ________ (the body is actually in a state of starvation) which leads to ______________ - Cells also break fat into ___________, which is converted to ___________ by the liver Accumulation of ketones causes a drop in pH (____________ __________) Acetone is blown off giving breath a fruity odor (__________ _________)

hyperglycemia, glycogen, glyconeogenesis, osmotic diuresis, polydipsia, weight loss, polyphagia, glycerol, acetone, metabolic acidosis, acetone breath

Somogyi Effect - ___________ present upon waking - ____________ effect in which an ________ of insulin causes _________ between ___-___ am - ____________ _________ hormones released resulting in rebound ____________ in the am & ketosis - S/S: _________, night ________, __________ - Check BG levels between ___-___ am if suspected

hyperglycemia, rebound, overdose, hypoglycemia, 2-4, counter regulatory, hyperglycemia, headache, sweats, nightmares, 2-4

DKA: hyperkalemia or hypokalemia

hyperkalemia (•no insulin to draw the K into the cells)

CKD can cause ______________ when serum potassium level reaches ____-____ mEq/L, which is the ________ serious electrolyte disorder in kidney disease that can cause ___________ _______________

hyperkalemia, 7-8, most, fatal dysrhythmias

Extreme hyperglycemia that occurs without ketosis or acidosis

hyperosmolar hyperglycemic state

a metabolic complication of uncontrolled type 2 diabetes, similar in severity to diabetic ketoacidosis but without ketosis and acidosis

hyperosmolar hyperglycemic syndrome

What are some modifiable risk factors someone with diabetes can change to help prevent vascular complications

hypertension, dyslipidemia, smoking

Term used to indicate either hypertensive urgency or emergency

hypertensive crisis

_______________ solutions are used to treat very specific problems and are administered in carefully controlled, limited doses in order to avoid vascular volume overload and cell dehydration

hypertonic

Clinical indications for ____________ saline use is when the serum Na is dangerously low (< or = _______ mg/dl)

hypertonic, 115

Dextrose solutions (10% dextrose & 50% dextrose) are considered ____________ solutions that are used on a limited basis to treat client with __________________

hypertonic, hypoglycemia

Oliguric phase can result in ______natremia, ______kalemia, _______phosphatemia and ________calcemia

hypo, hyper, hyper, hypo

During the oliguric phase, _____________ occurs, the parathyroid gland secretes ________, which stimulates bone ______________, thereby releasing ___________ from the bones

hypocalcemia, PTH, demineralization, calcium

Signs and symptoms of _____________: - Reduced cognition - Tremors - Diaphoresis - Weakness - Hunger - Headache - Irritability - Seizure

hypoglycemia

a blood glucose level of less than 70 mg/dL or above 50 mg/dL with signs and symptoms of hypoglycemia

hypoglycemia

What are the three main complications of insulin?

hypoglycemia, hypokalemia, lipohypertrophy

HHS: hyperkalemia or hypokalemia

hypokalemia

Signs of ___________: irritability, confusion, arrhythmias, ECG changes, severe muscle weakness, diarrhea

hypokalemia

In the diuretic phase of AKI, nurses must monitor for what important electrolyte abnormalities? (2)

hypokalemia, hyponatremia

During the oliguric phase, uncontrolled ___________ or water ___________ can lead to _____________ ___________, so fluid _________ must be closely monitored

hyponatremia, excess, cerebral edema, intake

What is the main sign of sepsis

hypotension (SBP <90 or <40 mmHg drop in SBP)

what 3 items does the qSOFA entail?

hypotension (systolic <100), altered mental status, tachypnea (RR > 22/min)

What is important to monitor clients for after receiving HD? (2)

hypotension, orthostatic hypotension

Hemodialysis Complications: Muscle Cramps - Factors associated with the development of muscle cramps include _________, hypovolemia, high ___________ ________ (large interdialytic weight gain) and use _____-________ dialysis solution

hypotension, ultrafiltration rate, low-sodium

____________ that occurs during HD primarily results from rapid removal of vascular __________ (hypovolemia), decreased ___________ ___________, and decreased systemic intravascular __________

hypotension, volume, cardiac output, resistance

The hormones secreted by the posterior pituitary are produced in the

hypothalamus

Contributors to Obesity - ____________ imbalance --> Overeating - __________ _________(appetite suppressant that increases fat metabolism) - __________ ___________: This is in the gut and inhibits leptin which can lead to overeating.

hypothalamus, leptin deficiency, ghrelin excess

Often resolves in time as anesthesia wears off; warm blankets/bear hugger

hypothermia

What are the four late symptoms of hypoglycemia?

hypothermia, seizures, coma, death

Which fluids are used to prevent and treat cellular dehydration by providing free water to cells?

hypotonic

Which type of fluid treats gastroenteritis

hypotonic

D5 1/2NS and D5 1/4 NS purpose (3)

hypotonic effect, water to cells, calories (170)

Post-Op Problems: Respiratory _________________ caused by anesthesia agents or pain meds; treat with reversal agents if severe

hypoventilation

Atelectasis Risk Factors: - _______________ - Constant ___________ Position - Ineffective ___________ - History of ____________ - ___________ adults - Intubation/____________ anesthesia - _____________ surgery - _______________/bedrest

hypoventilation, recumbent, coughing, smoking, older, general, thorax, immobility

WHAT ARE TWO EXAMPLES OF CLINICAL MANIFESTATIONS THAT MEET THE CRITERIA OF A PRE-RENAL CAUSE OF AKI?

hypovolemia, dehydration

Post-Op Problems: Respiratory _______________- caused by atelectasis, pneumonia, sedation with decreased respirations, pulmonary embolism, pulmonary edema, bronchospasm, aspiration

hypoxemia

Delirium/Confusion Causes - Fluid and electrolyte imbalances - _____________ - _______ effects (anesthesia/opioids) - ___________ deprivation - ___________ alteration, deprivation, or overload

hypoxemia, drug, sleep, sensory

decreased hemoglobin causes decreased O2 which causes

hypoxia

Several conditions can cause Cushing syndrome. The most common cause is ____________ _____________ of _____________ ______________ (e.g., prednisone). About 85% of the cases of endogenous Cushing syndrome are due to an ________-_____________ __________ ___________ (__________ ________). Less common causes include adrenal tumors and ectopic ACTH production by tumors (usually of the lung or pancreas) outside of the hypothalamic-pituitary-adrenal axis. Cushing disease and primary adrenal tumors are more common in __________ in the ____- to ____-year-old age group. Ectopic ACTH production is more common in ______.

iatrogenic administration exogenous corticosteroids, ACTH-secreting pituitary adenoma, Cushing disease, women, 20, 40, men

What is the most common cause of Cushing's Syndrome

iatrogenic administration of exogenous corticosteroids

Many cases of nephrotic syndrome are ____________. We think it is an __________ process that occurs ____-_____ _________ after a _________ ____________.

idiopathic, autoimmune, 4-8 days, viral infection

When do you give Narcan?

if respirations are less than 8

Protruding abdominal stoma, isolated ileal segment with ureters implanted in posterior portion of segment

ileal loop (ileal conduit)

A total proctocolectomy can be with _______ ______/_______ __________ OR with ___________ _____________

ileal pouch/anal anastomosis, permanent ileostomy

The patient with ARI is critically _____ and suffers not only from the effects of ___________ __________ but also from the effects of comorbid diseases or conditions (______, ___________ diseases)

ill, renal disease, dM, cardiovascular

Recovery - Highly variable, and depends on the underlying ___________, general __________ and ______ of the patient, the length of the ____________ phase, and severity of __________ __________

illness, condition, age, oliguric, nephron damage

DKA is precipitated by (6)

illness, infection, inadequate insulin, undiagnosed Type 1 DM, poor self-management, neglect

Food Allergies: Clinical Manifestations - Classified as __________ (within minutes to hours) or ____________ (2-48 hours) - Systemic: ___________, _________ failure - GI: ____________ pain, vomiting, diarrhea, ____________ - Respiratory: ________, _________, rhinitis, infiltrates - Cutaneous: _____________, __________, atopic dermatitis

immediate, delayed, anaphylaxis, growth, abdominal, cramping, cough, wheezing, urticaria, rash

______________ if you suspect fracture!!!

immobilize

FES Prevention/Treatment - _____________ fracture ASAP and maintain it! - Supplemental ___/___________ support - Correction of _____________ - ___ _________

immobilize, O2, respiratory, acidosis, IV fluids

Traction Purposes: - ____________ a joint or part of the body - Prevent ________ and __________ _______ associated with injury - __________ a fracture or dislocation - May help correct ______________ (extremities that are bent/locked, rarely)

immobilize, pain, muscle spasms, reduce, contractures

What HIV does... - ___________ dysfunction mostly from destruction of _______ T cells - Normal T cell life span is 100 days, whereas infected cells only live ___ _____ - Viral activity destroys ____ __________ T cells daily - Immune problems start when CD4+ T cell counts drop below _______ cells/uL - Nomral CD4 range is ______-_______ cells/uL

immune, CD4+, 2 days, 1 billion, 500, 800-1200

Infliximab (Remicade) and adalimumab (Humira) are both

immunomodulators

Use of these meds must be watched closely for infusion reaction or allergic reaction

immunomodulators

Used with IBD to regulate inflammatory and anti-inflammatory cytokines (suppresses immune response)

immunomodulators (biologic therapies)

methotrexate is an example of an

immunosuppressant

Has many side effects and require close monitoring (IBD class)

immunosuppressants

Used for children with IBD who are steroid resistant or steroid dependent

immunosuppressants

What is a risk factor for hypoglycemia in patients taking glipizide?

impaired liver or kidney function

Diuretic Phase: S&S - Gradual ___________ in urine output, ____-____ L/day; may reach ___-___ L/day - _________volemia, __________ - _____________ - BUN and creatinine levels begin to ____________

increase, 1-3, 3-5, hypo, dehydration, hypotension, normalize

There will be (increased/decreased) BUN with DKA

increased

Symptoms of gastric outlet obstruction from PUD

increased gastric residual volume, vomiting, constipation

Examples of __________ ________ of iron occurs with chronic slow bleeding, frequent or heavy menstruation, bleeding gastric ulcers, elderly men with colon cancer (bleeding tumor), h. pylori, and hookworms

increased loss

HHS Neurologic symptoms occur due to

increased serum osmolality

In sepsis, 1st glucose is __________ d/t sympathetic nervous system response and cortisol. Then glycogen stores _________ and liver is failing, so glucose is ___________

increased, deplete, decreased

Children in PICU/NICU - Child and parent's stress is __________ - ______________ needs of family must be met - Parents need ____________ - Critically ill child becomes _________ of their parent's lives

increased, emotional, information, focus

S/S Severe Dehydration - ___________ pulse - irritable to ___________ - _______ mucous membranes - ___________ _________ - Very delayed ______ __________ - _____________ to __________ - _______ weight loss in infants, _____ in older children

increased, lethargic, dry, sunken eyes, cap refill, oliguria, anuria, 10%, 6%

Teaching/Parent Instruction Need to follow up if: - Diarrhea or vomiting __________ - No ___________ seen in hydration status - Child appears __________ or will not take ___________ - No ___________ ___________

increases, improvement, worse, fluids, urine output

Cholecystitis: Manifestations In addition to pain: - ________________ - __________ - _______________ - ____________ & ___________ - Restlessness - _______________

indigestion, fever (leukocytosis), jaundice, nausea, vomiting, diaphoresis

Cobalamin Deficiency: Management - Increasing dietary intake is _____________ in pernicious anemia - ______________ _______________ - ______________ _______________ _______ (1000 mcg/day IM X 2wks, then weekly until levels normalize, then monthly for life; cyanocobalamin, hydroxocobalamin)

ineffective, intranasal cyanocobalamin, parenteral vitamin B12

Which age group is most impacted by stranger anxiety?

infants (6 months or older)

which two populations are at risk for iron deficiency anemia due to decreased intake

infants, vegetarians

Inflammation of the urinary tract may be attributable to a variety of disorders, but ___________ is the most common

infection

More common in open fractures and soft tissue injuries

infection

Addisonian Crisis: Causes - Stress, __________ - Post _________ _________ - __________ _________ of __________

infection, adrenal surgery, abrupt withdrawal, corticosteroids

Additional Manifestations of CKD - _______________ d/t altered immune response and function Respiratory System - Pleural ____________ - Predisposition to _____________ __________ - _____________ - Pulmonary __________

infection, effusion, respiratory infection, dyspnea, edema

Complications of Compartment Syndrome - ____________ from necrotic tissue - Persistent ____________ __________ in the affected extremity is NOT reversible - ______________ (Volkmann's contracture of the forearm, can begin within 12 hrs of increased pressure) - _________________ ___________ failure - ________________ in extreme cases

infection, motor weakness, contracture, myoglobinuric renal, amputation

Name one of the leading causes of death in CKD? (2 total)

infection, respiratory complications

What are the two leading causes of death in ARI?

infection, respiratory complications

Renal Calculi: Risk Factors - ____________ - Urinary ___________ & __________ - Immobility - _____________ - Increased _________ acid or urinary ____________

infection, stasis, retention, dehydration, uric, oxalate

Sepsis is caused by ____________, like: - pneumonia - peritonitis - UTI - Procedures - Indwelling devices

infections

Neuropathic pain: causes - Trauma - _____________ - ______________ disease (DM) - _______________ - Infections of the ___________ system - Tumors

inflammation, metabolic, alcoholism, nervous

Urethritis - __________ of the ___________ - Etiology: __________ or ________ - Treatment: Similar to ______/_____________

inflammation, urethra, bacterial, viral, UTI, pyelonephritis

What is the cause of mild elevation in post-op days 1 and 2 - _____________ response to surgical stress

inflammatory

What are the three phases of peritoneal dialysis

inflow (fill), dwell (equilibration), drain

What are the 3 steps called in a manual process of PD?

inflow, dwell, drain

Sibling Nursing Interventions - ___________ siblings about their brother's/sister's condition (using _____-_________ language and concepts at their developmental level) - Encourage siblings to __________ (as appropriate)

inform, age-appropriate, visit

ERCP: Nursing Implementation Pre-Op - Check __________ ________ - _________ after _________ and day of test Post-Op - Assessment for ______________ - ______________ for several hours - _______ until return of _____ _________ - Patient teaching - follow-up if stent needs removed or changed Complications include pancreatitis, perforation, infection, and bleeding

informed consent, NPO midnight, complications, bedrest, NPO, gag reflex

Legal Preparation for Surgery - ____________ __________ (adequate disclosure, understanding and comprehension, give consent voluntarily) Nursing role: ____________ and _________ patient's understanding - Nursing Role = __________ Witness (often if guardian signing), verify pt's ability to understand, verify pt's understanding - Consent for __________ ____________

informed consent, witness, verify, advocate, blood transfusion

What are the four stages of ARI

initiating, oliguric, diuretic, recovery

Preschool Erikson Stage

initiative vs. guilt

Hypovolemia: Causes - __________ water _____ or perspiration (high fever, heatstroke) - ______________ - _____ losses: NV, NG _________, diarrhea, fistula ____________ - Overuse of ____________ - Inadequate fluid __________ - ________-________ fluid _________ e.g. severe burns

insensible, loss, hemorrhage, GI, suction, drainage diuretics, intake, third-space, shift

Dehydration: Causes - ____________ fluid loss - Increased _______ _________ - GI tract ___________ (vomiting, diarrhea) - ______________ - _________

insensible, renal excretion, dysfunction, ketoacidosis, burns

Cobalamin as (acute/insidious) onset

insidious

Chronic Use of Corticosteroids can lead to: - Adrenal _____________ - ___________ - Risk for _____________ - Glucose ____________ - F&E Disturbances - _______________ disturbances

insufficiency, osteoporosis, infection, intolerance, psychological

A naturally occurring hormone secreted by the beta cells of the islets of Langerhans in the pancreas in response to increased levels of glucose in the blood.

insulin

Released continuously into bloodstream in small increments with larger amounts released after food intake

insulin

portable device that contains a pre-filled cartridge of insulin

insulin pen

Delivers a basal rate of regular or rapid-acting insulin AND/OR Program to deliver a bolus dose with each meal **Some models also continuously monitor blood glucose levels

insulin pump

Sulfonylureas (glipizide) increases the number and sensitivity of

insulin receptors

Metabolic Syndrome Pathway OBESITY can lead to __________ __________ which can lead to 1. Impaired ___________ _________ (leads to type 2 DM) 2. (increased/decreased) coagulation and (increased/decreased) fibrinolysis 3. _______________ 4. Hyper_____________ 5. Increased ____________ and decreased HDL All of which leads to: _____________ ____________

insulin resistance, glucose tolerance, increased, decreased, hypertension, insulinemia, triglycerides, cardiovascular disease

Type I diabetes is treated with

insulin therapy

Type 1 DM: Nutrition Management - Maintaining near-normal blood glucose by balancing food intake with ___________ and __________ - Achieving optimal ________ ________ levels - Providing appropriate ___________ for normal growth and development - Preventing and treating acute and long-term complications - Concentrated __________ are ____________ - Improving overall health through optimal nutrition

insulin, activity, serum lipid, calories, sweets, discouraged

Pharmacologic Therapy: CKD Hyperkalemia - IV _____________ with IV glucose to manage ______________ - K+ moves ________ the cells when insulin is given - IV glucose is given concurrently to prevent hypoglycemia - When effects of insulin diminish, K+ shift back ______ ____ cells

insulin, hypoglycemia, into, out of

Enough ___________ is present with HHS to prevent the breakdown of fats for energy, thus preventing _____________

insulin, ketosis

Victoza® works in 3 ways like the hormone GLP-1 (7-37)b to help control blood sugar. -GLP-1 is normally released from your small intestine when you eat. It helps your pancreas produce more _______ - It helps keep your ________ from making too much ________. -GLP-1 also ______ _______ the process of food leaving your stomach, which helps control your blood sugar levels after meals.

insulin, liver, glucose, slows down

Nursing Management of Dehydration - __________/___________ by weighing ___________; at home, monitor ____ of _________ and degree of __________ - Vital signs - Daily ___________ - Assessment of skin, mucous membranes, ____________

intake, output, diapers, #, diapers, wetness, weights, fontanel

Fluid volume excess (hypervolemia) - Excessive _________ of fluids, abnormal __________ of fluids, or _____________-____-___________ _________ _________

intake, retention, interstitial-to-plasma fluid shift

Name two body systems affected by kidney failure and a clinical manifestation of each

integumentary-dry scaly skin, hematologic - anemia, GI- anorexia nausea and vomiting

Client need is non-life-threatening, does not require immediate action

intermediate priority (middle)

Which type of insulin is a sterile suspension of zinc insulin crystals that is cloudy or opaque

intermediate-acting

Hip Fracture: Surgical Repair - ____________ _________ - Partial or total ______ ___________ **** Permits early _____________ of the pt and decreases the risk of __________ ______________

internal fixation, hip replacement, mobilization, major complications

space between the cells

interstitial

What is the reserve fluid that replaces fluid either in the blood vessels of the cells, depending on the need?

interstitial fluid

Occurs when intestinal contents cannot pass through the GI tract (small intestine or large intestine, partial or complete)

intestinal obstruction

Conditions that cause direct damage to the renal tissues, resulting in impaired nephron function

intrarenal

The exact cause is unknown but in most cases, it is preceded by a virus that produces swelling of the lining of the intestine, which then slips into the intestine below (telescoping)

intussusception

Pharmacologic Therapy: CKD Anemia - _________ supplements - Another side effect of EPO therapy is the development of ___________ _____________ from the increased demand for iron to support _______________ Side Effects: ___________ irritation, ___________, may make stool _______ in color

iron, iron deficiency, erythropoiesis, gastric, constipation, dark

Hyperkalemia- Clinical Manifestations - Fatigue, ___________ - Muscle weakness, cramps - Loss of muscle ________ - ______________, ______________ __________ - Abdominal cramping, ______________, vomiting - Confusion - _____________ pulse - Tetany - ________ ____________

irritability, tone, paresthesia, decreased reflexes, diarrhea, irregular, EKG changes

When given IV, K may cause _____________ and ________ at the IV site. __________ lines are the preferred site for IV administration

irritation, pain, central

________ ________ _____________ will determine if this is autoimmune type 1 diabetes or some other form of diabetes

islet cell autoantibody

areas of pancreatic cells that produce insulin and glucagon

islets of Langerhans

____________ IV fluids have the same osmolality as normal blood plasma

isotonic

______________ IV fluids are used to expand plasma volume and provide no free water

isotonic

D5W is ___________ in the bag and ______________ in the body

isotonic, hypotonic

Types of Dehydration - _____________- water and salt are lost in equal amounts. THIS IS THE PRIMARY FORM OF DEHYDRATION IN CHILDREN - ______________- electrolyte deficit exceed water deficit - ______________- water loss exceeds electrolyte deficit

isotonic, hypotonic, hypertonic

Cholelithiasis: Total Obstruction Symptoms - ____________ (lack of bile flow into duodenum) - _________ ________ urine (soluble bilirubin in urine) - __________-__________ stools (no bilirubin reaching small intestine to be converted to urobilinogen) - _________ (deposition of bile salts on skin) - Intolerance of _________ _________ (nausea, sensation of fullness, anorexia; no bile in small intestine) - _____________ tendencies (d/t lack of/decreased absorption of vitamin K) - _________________ (no bile salts in duodenum for fat emulsion/digestion)

jaundice, dark amber, clay-colored, pruritus, fatty foods, bleeding, steatorrhea

Provides long-term nutritional support, but has decreased absorption of meds and feedings and poses risk of skin breakdown, however, decreases risk of aspiration

jejunostomy tube

Fast-Acting Carbs - 1/2 c ________ or _______ - 5 lifesavers - 1 fruit roll up - 3 ______ glucose tabs -4 _______ glucose tabs - 4 starburst - 1 airhead - 15 skittles (1 fun bag size)

juice, soda, BD, Dex4

Indicated for hyperkalemia

kayexalate

Med that exchanges sodium ions for potassium ions in the intestine

kayexalate

S/S of this med include: Gastric irritation, N/V, hypokalemia, hypocalcemia, hypomagnesemia, sodium retention

kayexalate

Organic chemical compounds produced through the oxidation of secondary alcohols (e.g., fat molecules), including dietary carbohydrates.

ketones

You should check urine for _________ with _______ voiding for an ill diabetic patient. They should report high levels to HCP

ketones, each

1 out of 4 diabetics will experience

kidney failure

Excretion of insulin is dependent on

kidneys

Potassium is regulated by the

kidneys

Hypokalemia caused by 1- Increased loss of K+ via the ___________ or ____ __________ 2- Increased ________ of K+ from _______ to ______ 3- ___________ k+ __________ (rare)

kidneys, GI tract, shift, shift, ECF, ICF, dietary, deficiency

Hypokalemia Causes: - Increased loss of K+ via the ___________, GI, _______, and _____________ GI- diarrhea, vomiting, fistulas, NG suction, ____________ drainage Renal- ____________, dialysis Skin- ______________ Increased shift of K+ from ECF to ICF (out of cells) - __________ ________ release, _________ therapy with DKA Dietary K+ deficiency (rare) - ____________, diet low in potassium

kidneys, skin, dialysis, ileostomy, diuretics, diaphoresis, increased insulin, insulin, starvation

Nursing Interventions: School Age - __________ of hospitalization - Include the child in __________ - Gain ____________ and give _________ ___________ - Include in __________-_________ - Encourage active ____________ - Maintain clear and consistent ___________ - Allow for _____________

knowledge, education, cooperation, positive feedback, decision-making, participation, limits, privacy

Nursing Interventions: Adolescent - Assess ____________ - Encourage ____________ - Involve in ___________-_________ - _______________ - Give ___________ _____________ - Provide ___________ for care - Encourage to wear __________ ____________ and perform normal grooming

knowledge, questions, decision-making, regression, positive reinforcement, privacy, street clothes

Hyperventilation characteristic of metabolic acidosis, resulting from the respiratory system's attempt to eliminate excess CO2 by increasing depth and rate of respirations.

kussmaul respirations

What do women with renal calculi often complain of

labial pain

Nutritional status assessment component? Glucose, electrolytes, lipid profile, BUN

laboratory data

Surviving Sepsis Campaign Bundles TO BE COMPLETED WITHIN 3 HOURS 1. Measure __________ level 2. Obtain ________ _________ prior to administration of antibiotics 3 Administer ________ _________ antibiotics 4. Administer ______ ml/kg crystalloid for ___________ or lactate > or = ____ mmol/L TO BE COMPLETED WITHIN 6 HOURS 5. Apply _____________ (for hypotension that doesn't respond to initial fluid resuscitation) to maintain a mean arterial pressure of > or = ______ mmHg 6. In the event of persistent arterial hypotension, despite fluid volume resuscitation (septic shock) or initial lactate > =4 mmol/L (36 mg/dL): Measure _______ and _______ 7. ____________ lactate if initial lactate was elevated

lactate, blood cultures, broad spectrum, 30, hypotension, 4, vasopressors, 65, CVP, SCVO2, Remeasure

_________ ________ rise when the body is deprived of O2 and resorts to anaerobic cell metabolism. This is also the byproduct of muscle/cell death. _____________ also --- a biomarker of bacterial infections (SEPSIS)

lactic acid, procalcitonin

If untreated, Celiac disease can lead to... - ___________ __________ - ____________ deficiencies - Impaired ___________ - ________________ - ______-_______ ______________-

lactose intolerance, vitamin, growth, osteomalacia, non-Hodgkin's lymphoma

Not Permanent, can be removed if needed Reduces size of stomach to feel full

lap band surgery

Scoliosis A complex spinal deformity usually involving a __________ curvature of the spine, spinal __________, and ___________ _____________. Most cases are _____________.

lateral, rotation, thoracic hypokyphosis, idiopathic

Gastric Ulcers: Manifestations - Pain in _______ ___________, ________, and _________ _____________ - "___________", "___________" pain - ____-____ _______ _______ a meal - If the ulcer is through the __________, pain is worse when ________

left epigastrium, back, upper abdomen, burning, gaseous, 1-2 hour after, mucosa, when eating

Patients with diabetes who develop uremia may require _________ _________ than before the onset of CKD

less insulin

Cholecystitis: Manifestations - Fever & __________ - _____________ - ___________ & ___________ - _________ - Abdominal ___________ - Feeling of __________ - ______ ______________ - __________! * Located in __________ _________ ________ or ________ _________; may radiate to __________, increases with ________ ________

leukocytosis, jaundice, nausea, vomiting, anorexia, distension, fullness, fat intolerance, pain, right upper quadrant, right shoulder, back, deep breaths

The first step in treating Type II Diabetes is

lifestyle changes (wt loss, diet changes, smoking cessation)

What is the treatment options for GER/GERD in the order that they are prescribed? 1. 2. 3.

lifestyle changes, medications, surgery

prehypertension interventions

lifestyle modifications and no drugs unless indicated

Stage I hypertension interventions

lifestyle modifications and thiazide-type drugs for most; may consider ACE inhibitors, ARB, BB, CCB, or combination

Children in Isolation Precautions - Added stressor of hospitalization - _____________ in child's understanding - Dealing with child's __________ - Potential for ____________ ___________ - _______________ changes

limitations, fears, sensory deprivation, environmental

Which medications can be used for metabolic syndrome

lipid-lowering (statins), anti-hypertensives (diuretics, BBs, CCBs, ARBs, ACEs), metformin

Nutrition after laparoscopic cholecystectomy - __________ first day - _______ _________ for several ________

liquid, light meals, days

Nutrition after incisional cholecystectomy - Progress from __________ to a __________ diet once _______ _________ have returned - The amount of _____ in the postoperative diet depends on the patient's ____________. - A _____-____ diet may be helpful if the flow of _______ is reduced (usually only in the early postoperative period) or if the patient is _____________ - Sometimes, the patient is instructed to restrict fats for ___-___ __________ - Otherwise, no special dietary instructions are needed other than to eat nutritious meals and to avoid excessive fat intake

liquids, regular, bowel sounds, fat, tolerance, low-fat, bile, overweight, 4-6 weeks

Rapid-acting insulin: names

lispro, glulisine, aspart

If the blockage of the gallbladder occurs in the cystic duct, the bile can continue to flow into the duodenum directly from the __________. However, when the bile in the gallbladder cannot escape, this stasis of bile may lead to _______________.

liver, cholecystitis

Tylenol/Acetaminophen can harm the __________ in _________ ________

liver, large doses

Common conditions that occur during the symptomatic infection stage include: ____________ infections, _______________, oral hairy ____________, shingles, etc.

localized, lymphadenopathy, leukoplakia

Intestinal Obstruction: Clinical manifestations vary depending on ____________ Early S/S - __________ __________ _________ - ___________ and __________ - __________ ___________

location, colicky abdominal pain, nausea, vomiting, abdominal distension

VUR: Medical Management - _____-term ____ ____ ____________, considered prophylaxis (_______), usually _____ normal dose - Annual _________ to assess the status of reflux - ______________ _____________ to keep bladder empty - Possible to ____________ as the ureter elongates with age and function of valve improves - Potential need for ___________ to correct ureter and prevent refluxing (__________ or ___________ ____-____________)

long, low dose antibiotics, CAP, 1/4, VCUG, intermittent catheterization, outgrow, surgery, deflux, ureteral re-implant

It is a colorless solution with a pH of 4.0; once it is injected into the SQ tissue at physiologic pH, it forms micro-precipitates that are slowly absorbed over the next 24 hours

long-acting insulin

Pre-diabetes - ________-________ damage already occurring d/t glucose levels (heart, blood vessles) - Usually present with _____ ____________

long-term, no symptoms

ARB example

losartan (Cozaar)

4 actions with pre-diabetes to prevent the development of type 2 DM

lose weight, exercise, monitor a1c, eat healthy

Sensory Neuropathy symptoms a. _________ of sensation/________ sensations (feeling of walking on pillows, ____________) b. ________ (burning, cramping, crushing, tearing, worse at __________) c. ______________ (tingling, burning, itching) d. ______________ (Increased sensitivity of senses) e. Complete or partial loss of ____________ to __________ and _____________

loss, abnormal, numbness, pain, night, paresthesia, hyperesthesia, sensitivity, touch, temperature

ECG volume deficit (hypovolemia) - Abnormal ______ of normal body fluids - Inadequate ________ - ________-____-___________ _________ ______ (fluid shifts to where it is needed the most)

loss, intake, plasma-to-interstitial fluid shift

A client need that is not directly related to client's illness or prognosis

low priority

Cobalamin Deficiency: Diagnosis - (high/low) serum cobalamin (normal = 200-900) - (high/low) serum methylmalonic acid - (high/low) serum homocysteine (also occurs with folic acid deficiency) - serum test for _______-___ ___________

low, high, high, anti-IF antibodies

IBD: Nutrition - Well-balanced, ____ residue, _______-________, _____-______ diet with vitamin and mineral supplements recommended if symptoms don't inhibit oral intake - _____ ____________ ________ foods to avoid (clients are encouraged to avoid foods that exacerbate symptoms; high _______, ______ foods, and high-_____ foods may trigger diarrhea) - MVI, _____, and ________ acid supplements often needed - ____________ formula (either orally or by tube) may be required; this may improve nutritional status and induce ____________

low, high-protein, high-calorie, no universal trigger, fiber, cold, fat, iron, folic, elemental, remission

bladder to the urethra is a _________ tract infection

lower

GER/GERD Predisposing Conditions - Incompetent _____________ ____________ _____________ (certain medications & foods exacerbate this) - Decreased esophageal ____________ - Decreased ___________ ___________ - Increased _________________ _________ (obesity, hiatal hernia)

lower esophageal sphincter, clearance, gastric emptying, intraabdominal pressure

Veins in the ___________ extremities are highly susceptible to ___________ formation after __________, especially ____ fractures

lower, thrombus, fractures, hip

Cobalamin (vitamin B12) deficiency, folic acid deficiency, liver disease are associated with which type of anemia

macrocytic (megaloblastic), normochromic

When giving a pt with CKD medicine for constipation, what element/electrolyte should not be given?

magnesium (no anatacids w/magnesium)

A severely hydrated child will need more than _____________ after _______ _______ complete (1.5-2 times maintenance) ***Adding potassium to IV solution (Never add in cases of ____________/_____________)

maintenance, fluid bolus, oliguria, anuria

Which has the highest risk for HIV transmission? - Male to male or female-to-male intercourse?

male to male

Renal Calculi: Overview - Increased incidence in (males/females) - Nausea and ____________ - Agonizing _________ pain that may radiate to _________, testicles, or ____________ area - _________, sudden, _________ pain (may be intermittent depending on stone ____________) - _________uria - _____uria - Urinary _____________

males, vomiting, flank, groin, abdominal, sharp, severe, movement, hemat, dys, frequency

Deficit, excess, or imbalance of essential nutrients

malnutrition

CAPD is a

manual exchange

MCH

mean corpuscular hemoglobin

MCV

mean corpuscular volume

Detectable occlusion of the intestinal lumen

mechanical obstruction

Postrenal causes involve _____________ ___________ of urinary ______________

mechanical obstruction, outflow

Release of fat globules from the bone marrow into the venous circulation

mechanical theory

Acute urinary retention is a ___________ __________ that requires prompt ____________ and __________ _____________

medical emergency, recognition, bladder drainage

play with real medical equipment and often dolls, which allows children a non-threatening way to learn about and familiarize themselves with medical procedures, equipment, hospitals, doctors and nurses; it gives voice to fears and misconceptions about their hospital experience that they may be unable to express verbally. It is an invaluable tool to help kids of all ages, but should always be done with adult supervision and feedback.

medical play

What are the three main components of treatment for IBD?

medications (to induce remission and maintain remission), nutritional support, surgical treatment

Common allergens associated with anaphylaxis: - _____________ - __________ - Foods - Venom (______ or _________) - Biologic agents (_________ products, hormones, enzymes)

medications, latex, bees, snakes, blood

Surgery for UC and CD is used when _____________ and __________ therapy fail to prevent complications

medications, nutrition

The adrenal _________ secretes catecholamines that are involved in the stress response and prolong effects of SNS

medulla

Folic acid (B9) deficiency causes ______________ anemia

megaloblastic

Other oral agents that increase insulin production from the pancreas (not sulfonylureas)

meglitinides (repaglinide, nateglinide)

Ectopic ACTH production by tumors outside the hypothalamic-pituitary-adrenal axis (usually of the lung or pancreas) is most common in _____.

men

Who is the most affected population with HIV

men who have sex with men (MSM)

Reduces inflammation in the intestinal mucosa (med name)

mesalamine

Used for both mild-moderate UC and CD when the colon is involved; induced and maintains remission (med name)

mesalamine

What is the main 5-ASA used for IBD

mesalamine

Effective in the induction AND maintenance of remission in MILD-MODERATE ULCERATIVE COLITIS; also first-line therapy for Crohn's disease when the COLON IS INVOLVED (med name and class)

mesalamine, aminosalicylate

Additional Manifestations of CKD - ______________ ___________ which results from the kidney's impaired ability to excrete excess acid (primarily ___________) - ____________ due to decrease production of erythropoietin - _____________ tendencies d/t defect in PLT function

metabolic acidosis, ammonia, anemia, bleeding

Collection of risk factors that increase an individual's chance of developing cardiovascular disease, stroke, and diabetes

metabolic syndrome

Several Co-morbidities of Type 2 Diabetes Mellitus are known collectively as __________ ___________: - Abdominal obesity - Hypertriglyceridemia - Coronary artery disease - Dyslipidemia - Hypertension - Increased risk for thombrotic events

metabolic syndrome

Insulins restore the diabetic patient's ability to: - _______________ carbohydrates, fats, and proteins - Store ____________ in the __________ - Convert _____________ to ______ stores - Does not ____________ defects in insulin receptor _____________

metabolize, glucose, liver, glycogen, fat, reverse, sensitivity

Complications of ________________: - Nausea, diarrhea, and anorexia - Vitamin deficiencies (B12, folic acid) - Lactic acidosis (rare but potentially fatal)

metformin

Which medication (not glucagon) does NOT cause hypoglycemia?

metformin

decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization.

metformin

Which opioid is most often used for chronic pain

methadone

Immunosuppressant used for IBD (example)

methotrexate

What are five examples of corticosteroids

methylprednisolone (Solu-Medrol), dexamethasone (Decadron), prednisone (Deltasone), hydrocortisone, cortisone

What is the main gastrointestinal stimulant (generic)?

metoclopramide (Reglan)

Beta-blocker example

metoprolol (Toprol)

UTI Tx - Anti-____________ - Increased _________ ________ - Prevention

microbials, fluid intake

Iron-deficiency anemia, vitamin B6 deficiency, copper deficiency, thalassemia, and lead poisoning are associated with which type of anemia?

microcytic, hypochromic

Main benzodiazepine before surgery (both names0

midazolam, Versed

Awake, hungry, irritable, shaky, weak, headache

mild hypoglycemia

Non-opioids are used for?

mild pain

Initial exposure to allergen may product _________ reaction, repeated exposure may lead to a _________ ___________ reaction

mild, more serious

GERD is defined as _______ symptoms more than _________ per week or _________ symptoms ________ per week

mild, twice, severe, once

Rule of 15 is used for

mild-moderate hypoglycemia

Cleft palate may be __________ or ____________

mildine, bilateral

Starchy Carbs - 1 c _______ - 6 saltines w/ _____ or ________ - 1/2 c __________ ________ - 1 slice _______ w/ _____

milk, PB, cheese, chocolate milk, bread, PB

Musculoskeletal Manifestations of CKD - CKD ___________ and ________ disorder: Systemic disorder of metabolism - Decrease in Vit D --> Decrease in Ca absorbed from intestine therefore decrease serum calcium, which must be present to activate Vit D

mineral, bone

Steroid hormones essential for maintaining fluid and electrolyte balance.

mineralocorticoids

Some of these are electrolytes, includes Ca, Cl, Mg, Ph, K, Na, S, zinc, iron, and others

minerals

What are the two main causes of intracapsular fractures?

minor trauma, osteoporosis

For GASTRIC ulcers only

misoprostol/Cytotec

Synthetic prostaglandin that decreases acid secretion in the parietal cells of the stomach and provides some physical protection *Used primarily as adjunct to other medications

misoprostol/Cytotec

Nalbuphine and Butorphanol are examples of?

mixed agonist/antagonists

cold clammy skin, pale, rapid pulse, rapid/shallow respirations, change in mood, drowsiness

moderate hypoglycemia

Anesthesia Patient is responsive, but relaxed. Breathing independently.

moderate sedation

Opioids are used for?

moderate to severe pain

What is the most important nursing intervention for glipizide?

monitor for signs of hypoglycemia (diaphoresis, tachycardia, fatigue, excessive hunger, tremors)

Anesthesia Less responsive, may need airway support

monitored anesthesia care

Prevention of Foot Ulcers/Amputation - Annual _____________ test - Carefully choose ________ that fit properly - Inspect feet _________ - No ___________ or ____/_____ extremes - Clean, _________, ________ socks - Skin hygiene and nail care, including ____________ - Report problems ____________

monofilament, shoes, daily, barefoot, hot, cold, cotton, white, moisturizing, immediately

Serum creatinine (24-hour urine creatinine clearance) determinations (calculated glomerular filtration rate) are considered ________ accurate indicators of kidney function than BUN

Sepsis: GI Effects Decreased blood flow leads to - Impaired ___________/___________ - _____________ bowel sounds - Risk for __________! - __________, bleeding, impaired absorption - ____________ gut, necrosis

motility, peristalsis, hypoactive, ileus, ulcers, ischemic

____________ is key to weight loss, and ___________ and encouragement are critical

motivation, coaching

Common Causes of Fractures: Childhood - _________ _________ ________ - _________ or play - _______________ deficiency

motor vehicle accident, sports, nutritional

Provides temporary nutrition and is used for suction and decompression of the abdomen. It provides good absorption of meds and tube feedings. Poses the risk for aspiration and skin breakdown.

nasogastric tube

Provides temporary nutrition and the end of the tube is past the stomach which poses less risk for aspiration. It cannot be used for suction and provides poor absorption of meds and tube feedings. Poses a risk of skin breakdown.

nasojejunal or nasoduodenal tube

___________ and ___________ Americans as well as _____________ are at an increased risk for Type 2 Diabetes

native, african, hispanic

After giving glucagon, nurses must monitor for persistent

nausea and vomiting

Gastroenteritis S/S - ___________ and ____________ - Abdominal __________ - ______________

nausea, vomiting, cramping, diarrhea

Hyponatremia Clinical Manifestations - Tiredness, lethargy, weakness - ___________ and _________ - ____________ - Decreased _______ - Diarrhea - Abd ___________ - Muscle ___________ - ____________ - _________

nausea, vomiting, headache, LOC, cramps, spasms, seizures, coma

4 big symptoms of dumping syndrome

nausea, vomiting, weakness, diarrhea

With ____________ _________, the gland responds by increasing or decreasing the secretion of hormones based on feedback of various factors

negative feedback

Bilateral tubes inserted into renal pelvis, catheters exit through an incision on each flank, or there may just be one kidney

nephrostomy

Potassium: 3.5-5.0 Necessary for: - Transmission and conduction of __________ and _________ impulses - Cellular ________ - ____________ of ____________ ____________

nerve, muscle, growth, maintenance, cardiac rhythms

Which system regulates hormonal secretion

nervous system

Autonomic Neuropathy: Urinary Effects - ____________ __________ - Urinary __________ - ___________ or difficulty voiding - _________ stream of urine

neurogenic bladder, retention, infrequent, weak

During the oliguric phase, ____________ changes can occur as the ______________ waste products increase

neurologic, nitrogenous

Non-mechanical obstructions can result from _____________ or ____________ disorders

neuromuscular, vascular

Abnormal processing of sensory input by the PNS or CNS

neuropathic pain

Adjuvant drugs are used for?

neuropathic pain

Pain that is described as numbing, hot, burning, shooting, stabbing, sharp, or electric shock-like

neuropathic pain

Care of the Pt with Surgery or Traction - ____________ checks (___ ____) - Circle any ___________ noted on cast/dressing - _________ control - Edema = ______ to area for first _____ ________ after ___________ - Pulmonary function (______, ________, _________ __________) - _______________/alignment - Teach/reinforce use of ___________ devices - Plan to minimize complications d/t ____________ - Careful _____ care

neurovascular, 6 ps, drainage, pain, ice, 24 hours, surgery, turn, cough, deep breathe, positioning, assistive, immobility, pin

Type 1 DM: Exercise - Important for normal G&D - Encouraged and ___________ ___________ - Enhances ____________ ____________ - __________ blood glucose levels * Eat a _________ __________ exercising or exercise _________ a meal - Insulin adjustment if needed - Check BG _________, ___________, and __________ activity

never restricted, insulin absorption, lowers, snack before, after, before, during, after

Neurologic Manifestations of CKD Neurologic system begins to deteriorate when the ___________ waste products increase, which can cause: - ______________ _______ syndrome - Muscle ____________ - Irritability - Decreased ability to _____________ - _____________ ____________ - Altered mental __________ - Seizures - ___________

nitrogenous, restless leg, twitching, concentrate, peripheral neuropathy, ability, coma

Can children take antacids?

is thiazide diuretic k-sparing

The physiologic process by which info about tissue is communicated to the CNS

nociception

Obstruction that results from a neuromuscular or vascular disorder

non-mechanical

What are the three main types of drug therapy for pain?

non-opioids, opioids, adjuvant drugs

Closed Reduction - _______-___________, __________ realignment of bone fragments - Usually with _______________ ___________, sometimes anesthesia - Example- setting a cast

non-surgical, manual, conscious sedation

Long-acting insulin: peak

none

GER may be considered __________ for some children and adults after meals

normal

What are the three main isotonic IV fluids?

normal saline (0.9% NaCl), Ringer's (Na, K, Ca), Lactated Ringer's (Na, Cl, K, Ca, and lactate, typically used post surgery)

Acute blood loss, hemolysis, chronic kidney disease, chronic disease, cancers, endocrine disorders, starvation, aplastic anemia, sickle cell anemia, and pregnancy are associated with which type of anemia?

normocytic, normochromic

Surgery for CD is _____ ___________; __________ of ____________ segments with resection and re-_____________ of remaining intestine

not curative, removal, diseased, anastomosis

PUD: Perforation treatment - _______ ACP Immediately! - ______ ________ to _________ - _____________ - ___ __________ --- usually __________ ____________ - Prepare for ____________ __________

notify, NG tube, suction, antibiotics, IV fluids, Lactated Ringer's, emergency surgery

Use for pt's 8 years of age or older, if developmentally able

numeric pain scale

The ________ retains the accountability for the delegation

nurse

You may not delegate anything to do with the

nursing process (assessment, planning, implementation, evaluation, teaching)

The science of optimal cellular metabolism and its impact on health and disease; the sum of processes by which on takes in and utilizes nutrients

nutrition

Good __________, _______ and ___________ are necessary for recovery from ARI. Nutrition restrictions/requirements should be regulated in accordance with renal function.

nutrition, rest, activity

Calculi: Collaborative Care - ____________ therapy - Strict ________ - __________ all urine - ______________ - ____________ therapy e.g. cystoscopy

nutritional, I&O, strain, lithotripsy, surgical

Wound Infection/Impaired Wound Healing Risks - Preexisting _____________ deficiencies - _____________, ulcerative colitis, alcoholism, malnourished/obesity - ___________ adult - ___________________ - Prolonged hospital stay - Lengthy surgical procedure

nutritional, diabetes, older, immunosuppression

Celiac Disease: Foods NOT allowed (4)

oats, wheat, barley, rye

Excessively high amount of body fat or adipose tissue

obesity

What is a Roux-en-Y gastric bypass used for?

obesity

What is gastric sleeve used for?

obesity

What is lap band surgery used for?

obesity

Two examples of things that can cause intraabdominal pressure

obesity, hiatal hernia

If patient can self-report, do NOT change to __________ scale while __________

observational, asleep

Post-Op Problems: Respiratory _______________: - Usually the tongue, happens most often in very sedated patients TREAT WITH: _________ ________ _______ _________

obstruction, head tilt chin lift

Appendicitis: Pathophysiology - __________ of the _________ of the appendix by hardened stool, swollen lymphoid tissue, or possible parasites - Obstruction prevent __________ outflow, which increases lumenal _____________ and compresses blood vessels - _____________ causes ulceration of epithelial lining and bacterial invasion

obstruction, lumen, mucous, pressure, ischemia

Treatment of sepsis: antibiotics - Try to _________ _________ first - ___________ _________ first, then _________ (vancomycin)

obtain cultures, broad spectrum, targeted

Hip fractures are common in the

older adult

Remember that _________ _________ will take longer to heal from fractures

older adults

Clients at the Most Risk for Fluid and Electrolyte Imbalances - _________ ___________ - Clients with CRF, ___________ disorders - Clients who are ____________ impaired - Clients who are taking ________ that alter fluid and electrolyte balance

older adults, endocrine, cognitively, drugs

The prevalence of incontinence is higher among ___________ men and women, but it is _______ a ___________ of aging

older, not, consequence

ARF is often associated with ____________

oliguria

Decrease of urine output 300-500 mL/day

oliguria

Occurs as CKD worsens

oliguria

Oliguric Phase S&S - ____________ : <400 mL/day; occurs within ____-___ days of kidney injury - Urinalysis: _______, RBCs, WBCs, sp gr fixated at __________ - ____________ ___________ - _____kalemia and _______natremia - ____________ BUN & creatinine - Fatigue and malaise

oliguria, 1-7, casts, 1.010, metabolic acidosis, hyper, hypo, elevated

During the _________ phase, the serum potassium levels increase because the ability of the kidneys to excrete potassium is impaired

oliguric

Phase resulting in F&E abnormalities, hyponatremia, hyperkalemia uremia, and possible cerebral edema

oliguric

3 PPIs (generic name)

omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix)

PPIs aside from ___________ as well as _____________ are safe to use during pregnancy for treatment of GERD

omeprazole, metoclopramide

How often are H2 receptor antagonists and PPIs taken?

once daily

Glipizide is taken _________ daily, ______ _________ __________ the ________ meal of the day

once, 30 minutes before, first

What is the primary antiemetic used preoperatively (both names)

ondansetron, Zofran

Surgical procedure resulting in internal fixation

open reduction internal fixation (ORIF)

Fentanyl, Dilaudid, Morphine, Oxycodone, Hydrocodone, Percocet, Norco are all types of

opioids

Preoperative medications: Which is used to relieve discomfort during pre op procedures and sedate?

opioids

Route of administration when pt has functioning GI system

oral

What are two classes of drugs that can cause secondary hypertension?

oral contraceptives, corticosteroids

The second step in treating Type II DM

oral drug therapy

IDA: Management - Address cause - ________ _________ ___________: Ferrous sulfate - Take with _______ __________ (acidic and helps with absorption) - Ferrous sulfate may cause __________, ___________, and/or _____________

oral iron supplements, orange juice, nausea, diarrhea, constipation

Type 2 is most often treated with _______ and ______-_______ ________ agents to work on 4 defects of type 2 diabetes: - Increase ____________ _________ - Decrease ___________ __________ by the liver - Decrease ___________ _________ - Help with ___________ of insulin

oral, non-insulin injectable, insulin production, glucose production, adipose tissue, absorption

How and when should you give glipizide?

orally 30 minutes before selected meals

Management of Care- Hypernatremia - Treat underlying cause - Primary water deficit- Replace fluid __________ or IV with ___________ or ____________ fluids - Excess sodium: dilute with _________-_________ IV fluids and promote excretion with ____________ - Monitor carefully S/S of hypernatremia

orally, isotonic, hypotonic, sodium-free, diuretics

What are the 5 exogenous causes of cushing's (not steroid use)

organ transplant, chemotherapy, autoimmune diseases, severe allergies, chronic inflammatory condition

Obesity Assessment Be sensitive and nonjudgemental - Rule out "__________" causes of obesity (___________ syndrome, hypothyroidism, polycystic ovary syndrome, hypothalamus tumor, etc.) - Vital signs - Respiratory and _____________ assessments - ________, ____________ ______________ - Mobility - Gynecomastia and ______________ (in men) - _________ use - _______________ list

organic, Cushing's, cardiovascular, BMI, waist circumference, hypogonadism, drug, medication

Most non-opioids can be found

over the counter

ESRD: Conservative Therapy - Correction of ECF fluid volume ___________ or __________ - ____________ and _____________ therapy - _____________ supplementation, phosphate ___________ - _______-____________ therapy - Measures to lower ____________ - Adjustment of drug dosages to degree of ___________ ___________

overload, deficit, nutritional, erythropoietin, calcium, binders, anti-hypertensive, potassium, renal function

Dysrhythmias: Causes - Hyp________, Hyper_______ - Fluid and electrolyte imbalance - Preexisting conditions - _____________

oxemia, capnia, anesthesia

A complex, multidimensional experience and one of major reasons that people seek healthcare

pain

What is the most important assessment in the pt with renal calculi?

pain

What are the 6 Ps for neurovascular checks?

pain (and point of tenderness), pulses, pallor, paresthesia (sensation distal to the fracture site), paralysis (movement distal to fracture site), pressure

PostOperative Nursing Care: Appendectomy - _______ control - _____ _________ - _____________ - ______ ____________ until bowel sounds return - Wound care, possible drain care - Psychosocial support

pain, IV fluids, antibiotics, NG decompression

Preoperative Nursing Care: Appendicitis - ________ control - _____ __________ - ___________ - NG ____________ with rupture - Psychosocial support - Teaching about appendectomy

pain, IV fluids, antibiotics, decompression

Hypertension: Causes - ________, anxiety, bladder distension (SNS) - Body's response to ________ often encourages _________ __________ - Preexisting _____

pain, stress, fluid retention, HTN

IDA: Symptoms - ____________ - _________________ - Shortness of breath - Easily ________________ - Koilonychia (spoon nails_ - Hair loss (____________) - ____________ - Plummer-Vinson syndrome - Glossitis** - Esophageal _________

pallor, palpitations, fatiguability, alopecia, pica, webs

Presenting Symptoms: Type 1 Diabetes Long pre-clinical period, manifestations develop once ________ can no longer produce __________ and then ________ ________ of symptoms, often present to ER with ________________ * ____________: elevated BG leads to osmotic diuresis * ____________: attempt to relieve dehydration * ____________: Attempt to compensate for lost calories - Hyperglycemia (Glucose in bloodstream) - ____________ - Weight _________ + Typical hyperglycemia symptoms

pancreas, insulin, rapid onset, ketoacidosis, polyuria, polydipsia, polyphagia, glycosuria, loss

Type 1 DM: New(er) Treatments - _____________ transplant * Usually with ___________ transplant in kidney failure patients * For patients with __________ difficulty controlling diabetes with ___________ * Downsides: Lifelong ____________; does not complete remove long-term renal & neurological _____________ - _________ _________ transplant * Islet cells from ____ or more pancreas donors are infused into the _________ _______ of the liver * Still experimental in the US * ______________ is a problem

pancreas, kidney, severe, insulin, immunosuppression, complications, islet cell, 2, portal vein, rejection

GLPRA Risks/SE - ____________ - ___________ problems with _________ - Delayed ___________ __________ may change absorption of oral meds - ___________

pancreatitis, kidney, byetta, gastric emptying, diarrhea

Decrease/absence of intestinal persistalsis

paralytic ileus

The most common cause of non-mechanical obstruction

paralytic ileus

characterized by lack of intestinal peristalsis and bowel sounds

paralytic ileus

Acute/Chronic Pyelonephritis Acute: Inflammation of the renal ____________ and ___________ system Chronic: Kidneys have become _______, _________, and lost _________ d/t scarring or fibrotic tissue. Pre-existing condition cause -- ____________ _________ issues with chronic UTIs

parenchyma, collecting, small, atrophied, function, vesicoureteral reflux

Pneumonia: Inflammation of the pulmonary __________ caused by accumulation of _______ or _______ in the ____________ which results in poor ____________ and air __________. Types: Lobar, bronchopneumonia, interstitial

parenchyma, fluid, blood, alveoli, oxygenation, exchange

Additional Nursing Considerations During Hospitalization - Preventing or minimizing __________ __________ - Minimizing loss of _____________ - Promoting freedom of _________ - Maintaining a child's ____________ - Encouraging _____________ and industry - Preventing or minimizing fear of ___________ _________ - Providing developmentally appropriate activities like ____________ activities, expressive activities, and toys - Involve _________ __________

parental absence, control, movement, routine, independence, bodily injury, diversional, child life

Nursing Interventions: Infant - ___________ __________ - _________ care - _________ measures - Avoid _____________ - Appropriate ________ - ____________ _____________

parental involvement, bundle, comfort, overstimulation, play, nonnutritive sucking

Nursing Interventions: Preschool - ____________ _________ - ACKNOWLEDGE __________ - _________ to hospital - Spend time with child to build ________ - Provide _________ - ____________ activities

parental involvement, fears, orient, trust, play, divisional

Nursing Interventions: Toddler - ____________ _____________ *** - ___________ objects - PLAY - Set _________, give _________ on simple decisions - Promote __________ behavior for bedtime - _____________!

parental involvement, security, limits, choices, ritualistic, safety

For communicatively impaired children, ____________ are an excellent source of information

parents (caregivers)

Compartment Syndrome: Clinical Manifestations Six Ps

paresthesia, pain, pressure, pallor, paralysis, pulselessness

Cobalamin Deficiency: Manifestations NM - Weakness - ______________ of feet and hands - Reduced _____________ and __________ senses - Impaired _________ ___________

paresthesia, vibratory, position, thought process

Anemia is not a disease, but an indication of a

pathologic process

Who can hit the PCA pump button?

patient only

Blood in the urine. Cloudy urine. Foul or strong urine odor. Frequent or urgent need to urinate. General ill feeling (malaise) Pain or burning with urination. Pressure or pain in the lower pelvis or lower back. Wetting problems after the child has been toilet trained.

pediatric UTI symptoms

Erosion of the GI mucosa due to digestive action of HCl acid and pepsin

peptic ulcers

What are Bilroth 1 and 2 used for?

peptic ulcers

Endoscopy: Potential Complications - ___________ of the esophagus, stomach, and/or duodenum - ____________ from a biopsy site - ____________ ___________ of gastric contents - Over-_______________ from the medication during test - _____________ induced by the sedative - Local IV ___________ reaction to the injection of _____________ sedative medication

perforation, bleeding, pulmonary aspiration, sedation, hypotension, phlebitic, sclerosing

What are the two methods of dialysis

peritoneal and hemodialysis

A Tenckhoff catheter is placed into

peritoneal cavity

lack of mature erythrocytes caused by inability to absorb vitamin B12 into the bloodstream

pernicious anemia

PUD Surgery: Postoperative care - Post-surgical patient is at risk for ___________ __________ - Maintain ____ _______ until fluid can be tolerated; ____ ________ before then - Careful GI assessment and incision care - ___________ portions of ________ and ________ daily (small, frequent meals) - ______ _____________ - Restricted _________ with meals - ___________ amounts of _________ and _______ - ___ ___________ of ________ after each meal

pernicious anemia, NG tube, IV fluids, small, fluid, food, low carbohydrates, sugar, moderate, protein, fat, 30 minutes, rest

Psychological Manifestations of CKD - _______________ and ___________ changes - Decreased emotional _________ - Withdrawal - ______________

personality, behavioral, ability, depression

When kidneys fail, _______________ builds up in the blood, which leads to severe musculoskeletal disorders

phosphate

During the oliguric phase, ____________ is released from the bones after PTH production, leading to elevated serum _____________ levels, and client may need __________ ___________

phosphate, phosphate, phosphate binders

massage, exercise, TENS, PENS, acupuncture, and heat/cold therapy are examples of what type of pain management?

physical

Nutritional status assessment component? Physical appearance, muscle mass, and strength, dental or oral health, cognitive status

physical examination (helps to assess nutritional status)

Should be used as adjunct to self-report and behavioral observation to assess pain

physiologic measures

What are Maslow's hierarchy of needs from most important to least important?

physiological, safety, love and belonging, esteem, self-actualization

Addison's D/C Teaching - Client lacks endogenous corticosteroids which leads to an inability of __________ reaction to _____________ - ____________ replacement therapy required - Must wear ________ _________ ________ or have ID card - Short-term use of steroids is ___________ until body produces its own again

physiological, stressors, lifetime, medic alert bracelet, tapered

Hypertonic saline monitoring: Skin and mucous membrane changes: ____________ edema in dependent areas, skin _______ and _______ to touch, GI changes: __________ motility, __________ liver

pitting, pale, cool, increased, enlarged

The hypothalamus and ___________ gland integrate communication between the nervous and endocrine system

pituitary

Casts can be _________ or more commonly __________

plaster, synthetic

For DIC in sepsis, ____________ _________ may be needed

platelet transfusion

_________ is the work of children and is critical in their _____________

play, development

Pneumonia: Complications - ___________: increased air in the pleural space which increases interpleural pressure and prevents the lung from expanding fully. - _____________ ___________: excessive accumulation of fluid in the pleural space - ___________: Collection of pus in the pleural space - _________ ________ with closed drainage system may be inserted into the pleural space to drain air or fluid

pneumothorax, pleural effusion, empyema, chest tube

Chronic excessive intake of water; it is a common symptom of uncontrolled diabetes.

polydipsia

Excessive eating; it is a common symptom of uncontrolled diabetes.

polyphagia

increased frequency or volume of urinary output; it is a common symptom of diabetes

polyuria

What are the three P's of Type I DM

polyuria, polydipsia, polyphagia

In the case of possible exposure (sexual assault, needle-stick injury) HAART will be started to reduce the risk of infection and protect the patient until testing is confirmed

post-exposure prophylaxis

When is LR normally used?

post-surgery

Complications of Gastric Surgery A bolus of fluid high in carbs goes into small intestine causing excessive amounts of insulin into circulation (S/S sweating, weakness, mental confusion, palpitations, tachycardia, and anxiety)

postprandial hypoglycemia

Causes involve mechanical obstruction of urinary outflow

postrenal

Autonomic Neuropathy: CV Effects - _____________ ____________ - Resting _____________ - Painless ___________ _____________

postural hypotension, tachycardia, myocardial infarction

Main distinguishing factors for hyponatremia in hypovolemic client

postural hypotension, weight loss, increased pulse, decreased BP

During the oliguric phase, the serum ___________ levels increase because the ability of the kidneys to excrete ___________ is impaired

potassium, potassium

Truvada

pre-exposure prophylaxis

Anaphylaxis: Manifestations Immediate or delayed - Neurologic: (can _________ reaction): restless, irritable, __________, headache, dizziness, _______________, disorientation - Cutaneous: ___________, urticaria, ____________ - Respiratory: ______________, pulmonary ________, ____________ - Cardiac: ______________, hypotension, impaired cardiac output, poor perfusion

precede, anxiety, paresthesia, flushing, angioedema, bronchoconstriction, edema, hemorrhage, vasodilation

blood glucose is higher than normal, but not high enough to be considered diabetes

prediabetes

First-line therapy for nephrotic syndrome

prednisone

Reduces inflammation and pain for UC and CD (med name)

prednisone

Used for moderate-to-severe UC AND CD to achieve remission (med name)

prednisone

What is the main corticosteroid for IBD

prednisone

MCNS: Medications - Corticosteroids: _____________ - ______________: if not responding well to corticosteroids - ____________ - IV ____________ 25%

prednisone, immunosuppressant, diuretics, albumin

Major contraindication Cytotec

pregnancy

What are the three contraindications for glipizide?

pregnancy, lactation, diabetic ketoacidosis

What to think about with Procedural Pain - ____________ - Environment/__________ - ___________ positioning - __________ agents - _____________* - _______________ role

preparation, location, comfort, topical, distraction, parental

Factors that reduce systemic circulation, causing reduction in renal blood flow and leading to hypotension/hypovolemia

prerenal

Which age group is most impacted by regression?

preschool

Inflow - _____________ amount of ___________ infused through established catheter over about ____ ___________ - After solution infused, _______ ________ closed to prevent _______ from entering tubing

prescribed, solution, 10 minutes, inflow clamp, air

VUR: Nursing Interventions Education - _____________ of _______ - _______________ administration Post-op - ________ control (Analgesics and ___________ ____________) - _________ ____________ - Possible _________ and _________ - ___________ care/dressing changes

prevention, UTIs, antibiotic, pain, muscle relaxants, foley catheter, stents, drains, incision

Primary or secondary cause of Addison's? Idiopathic autoimmune dysfunction, cancer, adrenalectomy, radiation of the abdomen

primary

Which type of HTN is essential or idiopathic and accounts for 90-95% of all cases

primary

Types of Nephrotic Syndrome - ___________ _________: Also known as idiopathic nephrosis, childhood nephrosis, or minimal change nephrotic syndrome (MCNS) - _____________ nephrotic syndrome: In association with glomerular damage - ______________ nephrotic syndrome: Autosomal recessive disorder

primary disease, secondary, congenital

More prevalent type of obesity that results from excess calorie intake over expenditure for the body's metabolic demand

primary obesity

Pneumonia: Classifications - __________ or secondary illness - Viral - ____________ - Atypical - _____________ - Medical Equipment Associated (_____)

primary, bacterial, aspiration, VAP

Chronic starvation, no inflammation (anorexia nervosa, no access to food)

primary/starvation-related PCM

A biomarker released with bacterial infection

procalcitonin

Child life specialists can help prep for _____________ using _________ positions and ____________ involvement

procedures, comfort, parental

DKA is caused by

profound deficiency of insulin

GERD/GER Pregnancy - Increased ______________ in pregnancy causes decreased tone and motility of smooth muscles, resulting in GER, slower __________ _________, and reverse ___________, which may cause acid indigestion or pyrosis.

progesterone, gastric emptying, peristalsis

Two examples of intrarenal causes of AKI

prolonged ischemia, nephrotoxic drugs

Tissue growth, repair, maintenance, and energy

protein

MCNS: Treatment Goals - To decrease urinary __________ loss - Controlling __________ - Balance ____________ - Prevent or treat any __________ - Minimize complications of treatment

protein, edema, nutrition, infection

Insulin stimulates ____________ synthesis and promotes intracellular shift of _______________ and _______________ into the cells

protein, potassium, magnesium

Nephrolithiasis: Etiology- Diet - Large intake of dietary __________ that increases _________ _________ excretion - A diet low in __________ decreases the risk of high levels of uric acid in the urine - Excessive amounts of _______ or _________ juices increases risk of calculi - Low ________ intake increases urinary concentration

protein, uric acid, purines, tea, fruit, fluid

Which stage of separation anxiety? Screaming, crying, inconsolable, clinging to parents, pleading for parents to stay, agitated, temper tantrums, refuse to comply with care, resists caregivers

protest

INPATIENT- Severe hypoglycemia - Follow hospital specific ___________ (practice in your activity binder) - Pediatrics typically treated __________ - Adults are typically treated with ______ _________ _____ ________ - _________ if patient unable to swallow and no IV access

protocol, orally, 50% dextrose IV push, glucagon

Decrease stomach HCl acid secretions by inhibiting the proton pump mechanism responsible for secreting H ions (GER/GERD)

proton pump inhibitors

Decreases HCl acid secretion by blocking enzyme that is important for the secretion of HCl acid

proton pump inhibitors

D5NS purpose

provides free water to cells, provides calories

Integumentary Clinical Manifestations of CKD -______________: the main cause is multifactorial and includes _______ skin, ___________-__________ deposition on the skin, and sensory _____________ This may be so intense that it can lead to ___________ or _________ secondary to scratching. - ___________ __________: rare but occurs in end stages of CKD

pruritus, dry, calcium-phosphate, neuropathy, bleeding, infection, uremic frost

Accumulation of extravascular fluid in lung tissue and alveoli

pulmonary edema

LASIX indications - Acute _____________ _________, __________, and ____________ (and ascites)

pulmonary edema, edema, HTN

A blockage of a pulmonary artery by a thrombus

pulmonary embolism

Calculi: Nutritional Therapy - ________: High: sardines, herring, mussels, liver, kidney, goose, venison. Moderate: chicken, salmon, crab, veal, bacon, pork, beef, ham - ____________: High: milk, cheese, ice cream, yogurt, all beans, lentils, fish, dried fruits, nuts, chocolate - ____________: High: dark roughage, spinach, rhubarb, asparagus, cabbage, tomatoes, beets, celery, parsley, chocolate, instant coffee, tea

purine, calcium, oxalate

What class of foods should be avoided in pt with history of nephrolithiasis - high levels of uric acid?

purines (sardines, herring, mussels, liver, bacon)

Inflammation d/t infection of the renal parenchyma and collecting system

pyelonephritis

Diagnosis of Fractures - _____________ - __________ taking - Suspicion of fracture in a young child you refuses to ________ or _________ _________

radiographs, history, walk, bear weight

What are 3 examples of H2 receptor antagonists (generic name)

ranitidine (Zantac), Famotidine (Pepcid), Nizatidine (Axid)

Bone healing and remodeling is typically _________ in children

rapid

Fat Embolism: How do I Know? - __________ onset of symptoms with traumatic injury/surgery - ____________ to neck, anterior chest wall, axilla, buccal membrane, conjunctiva - _________ _____-____ showing white out - ______ cells in blood/urine specimen (maybe)

rapid, petechiae, chest x-ray, fat

The response of ___________-__________ insulin is like that of the endogenous insulin produced by the pancreas in response to a meal (often used within ____ minutes of mealtime)

rapid-acting, 15

Malignant Hyperthermia - _______ disorder characterized by hyperthermia with __________ of __________ __________ that can result in death - ______________ determined to some extent - _________________ of skeletal muscle resulting from altered control of intracellular __________ - Usually occurs during general anesthesia with ____________ and inhaled agent (may occur ______-operatively as well)

rare, rigidity, skeletal muscles, genetically, hypermetabolism, calcium, Succinylcholine, post

Cardiac Output: Influencing Factors - Heart _________ - ______________ - Conductivity - ____________-___________-___________ system - ______________ peptides

rate, contractility, renin-angiotensin-aldosterone, natriuretic

This occurs when blood pressure rises after you stop taking or lower the dose of a drug (typically a medicine to lower high blood pressure).

rebound hypertension

In some situations, the client does not _________ from ARF, and ____________ ___________ ___________ results, eventually requiring __________ or a kidney ______________

recover, chronic kidney disease, dialysis, transplant

Consequences of Untreated Pain - Suffering - Physical and psychosocial dysfunction - Impaired ___________ from acute illness/surgery - ________________ - __________ disturbances

recovery, immunosuppression, sleep

Good route for those you cannot swallow, and absorption may vary

rectal

Wound Infection Manifestations - ___________ from hyperemia from vasodilation - ___________ from increased metabolism at inflammatory site - ___________ from nerve stimulation by chemicals, pressure, and fluid exudate - ___________ from fluid shift to interstitial spaces; fluid exudate accumulation - Loss of ____________ from swelling and pain

redness, heat, pain, swelling, function

Benzodiazepines are used for which 3 main things?

reduce anxiety, induce sedation, amnesia

What is the cause in AKI of elevated serum creatinine and BUN?

reduced renal blood flow

skeletal traction ________ fractures and __________/stabilizes fractures

reduces, immobilizes

Goals of Fracture Management - ____________ and __________ - Restoring ___________ - Preventing further injury and ____________

reduction, immobilization, function, deformity

Patients with Substance Abuse Problems - Assess for substance abuse of possible diversion of opioids - Consider ____________ to pain clinic/specialist - Right to receive ___________ pain management - Opioids may be used effectively and __________ - Consider complications of ______________

referral, effective, safely, withdrawal

Anesthesia No loss of consciousness, site is numbed via nerve block or topical/subcutaneous medication

regional/local

Fears/Stressors: Preschooler - ____________*** (highest age risk) - _____________ ___________ and fear of abandonment, generally less than toddler - Inability to distinguish _______ from _________ - Unable to understand _________ for hospitalization - Loss of _______-________ - Fear of _______ and _________ _________

regression, separation anxiety, fact, fiction, reason, self-control, dark, bodily injury

intermediate-acting insulin is usually combined with ______________ insulin to reduce the number of insulin ________________ per day

regular, injections

When drawing up two types of insulin in one syringe, always withdraw the ____________ or ___________-________ insulin before the ______ insulin

regular, rapid-acting, NPH

Name one primary function of the kidneys? (6)

regulate volume and composition of ECF, control blood pressure, excrete waste, produce erythropoietin, activate vitamin D, regulate acid-base balance

Kids who do not respond to corticosteroids for MCNS are more likely to

relapse

Cholecystitis: Surgical Therapy Laparoscopic cholecystectomy (90% of cases) ***TREATMENT OF CHOICE - ___________ of___________ through ____ to ___ ________ _________ - ____________ postoperative pain - Resume normal activities, including work, within ___ __________ - _____ complications; main complication is _________ to the common bile duct - The few contraindications to laparoscopic cholecystectomy include peritonitis, cholangitis, gangrene or perforation of the gallbladder, portal HTN, and serious bleeding disorders

removal, gallbladder, 1, 4, puncture holes, minimal, 1 week, few, injury

Cholecystitis: Surgical Therapy Open (incisional) cholecystectomy - _____________ of __________ through ________ ________ ___________ - ___-_________ inserted into ________ ________ _________ to ensure _________ of ________ and to allow ________ ________ to __________

removal, gallbladder, right subcostal incision, T-tube, common bile duct, patency, duct, excess bile, drain

Transdermal: _____________ previous patch __________ applying new

remove, before

If bathing/repositioning pt in traction, remember to __________ the __________ before moving the pt. When finished and returned to positioning, slowly, gently, ___________ the weight.

remove, weight, lower

What is the best diagnostic study for CKD

renal biopsy

Health Promotion: Risk Factors for CKD - History of _________ _______ - ____________ - ___________ ____________ - Repeated _______ Regular checkups and changes in urinary ___________, frequency, and ___________ should be reported

renal disease, hypertension, diabetes mellitus, UTIs, appearance, volume

Hyperkalemia Causes: High serum potassium caused by: Impaired ___________ ____________ SHIFT FROM ______ to _______ - Most common in ________ _________ - Excess potassium __________ - Excessive or rapid parenteral administration - Potassium-containing drugs/supplements

renal excretion, ICF, ECF, renal failure, intake

The partial or complete impairment of kidney function resulting in an inability to excrete metabolic waste products and water

renal failure

What are the four main diagnostic studies for CKD

renal ultrasound, renal biopsy, renal scan, CT scan

Secondary HTN- Possible Causes - ___________ disease - _____________ disorders (i.e. thyroid disease, neurologic disorders like brain tumors) - _____________-induced HTN - ___________-induced (e.g. oral contraceptives, corticosteroids) - ______________ - narrowing of the aorta

renal, endocrine, pregnancy, drug, congenital

Hypertensive Encephalopathy: Manifestations - ____________ insufficiency (_________ impairment to complete _____________) - ____________ _________________ (Ranging from _________ angina to __________ and pulmonary __________) - ___________ ____________ (excruciating chest and back pain with diaphoresis and ________ of _________ in ____________)

renal, minor, shutdown, cardiac decompensation, unstable, infarction, edema, aortic dissection, loss, pulses, extremity

Sepsis: Renal Effects - Decreased perfusion --> _______ ____________ system activated which causes ______________ - Angiotensin II --> Aldosterone --> Na & Water ___________ and ADH< which helps maintain _________ _________ and BP. This helps support BP but eventually causes - ___________ urine output - ____________ BUN & creatinine - Need for _____________ - Ultimately, the kidneys need hydration and blood flow, so if the BP remains low and fluid continues to seep into interstitial areas, the kidneys will ultimately fail.

renin angiotensin, reabsorption, cardiac output, decreased, increased, dialysis

ECF volume deficit (hypovolemia) treatment

replace water and electrolytes with balanced IV solutions

___________ of HIV occurs fast, so there are often ___________, making treatment even more difficult

replication, mutations

PACU - Receive _________ - Maintain safety of pt - Perform ____________ - Treat/address any complications - Give __________ to receiving unit or __________ pt to home

report, assessments, report, discharge

Challenges to HIV Drug Therapy - Treatment regimen must be closely adhered to, otherwise ___________ occurs. Patients must be ___________, financially and emotionally, to begin the regimen. - Some combinations require meds many times throughout the day - Side effects: _________, peripheral ____________, pain, N/V, fatigue, __________ resistance, _______ disease, _______________ disease

resistance, ready, diarrhea, neuropathy, insulin, bone, cardiovascular

Mixed agonists/antagonists like nalbuphine and butorphanol produce less ____________ ____________ but may precipitate ______________

respiratory depression, withdrawal

Post-Operative Gerontological Considerations - Decreased _____________ function: Coughing and deep breathing --- increased risk for ___________/pneumonia - Decreased ability to ___________ drugs --- drug ___________ - Increased __________ of fully coming out of _____________ - Often (not always) more underlying health problems that may contribute to more post-operative complications

respiratory, atelectasis, eliminate, toxicity, time, anesthesia

Palatoschisis: Post-Op - Watch for ___________ difficulties - __________ ___________ - No _______ or ________ objects in mouth - Monitor _________ _______ - ___________ modifications: __________ feeding

respiratory, elbow immobilizers, hard, sharp, suture line, feeding, syringe

PUD: Conservative Therapy - Adequate _______ - ______________ modification - Cessation of ______________ and ____________ - Drug therapy: __________, ____ ___________ __________, __________ __________ ______________ - STOP ____________ and __________ if possible (switch to __________-_________) - __________ reduction - Long-term care and _________-_____

rest, dietary, smoking, alcohol, antacids, H2 receptor blockers, proton pump inhibitors, NSAIDs, aspirin, enteric-coated, stress, follow-up

Clinical Manifestations of CKD begin to present as a result of: ___________ _____________ left in the bloodstream that are not able to be excreted via the kidneys: - _________ - ______________ - Hormones - Electrolytes - Water - Other substances

retained substances, urea, creatinine

Micro-hemorrhages and aneurysms that affect the retina & ultimately macula, more prone to cataracts and glaucoma

retinopathy

What are the three main microvascular complications with DM?

retinopathy, nephropathy, neuropathy

What are the three microvascular complications from diabetes?

retinopathy, neuropathy, nephropathy

Anesthesia Meds - Anesthesia agents - ___________ agents - Same list from medications in preop section - Anesthesia provider gives doses necessary to maintain pt's necessary __________ and safe __________

reversal, sedation, recovery

ARI is potentially __________, the primary goals of treatment are to eliminate the ___________, manage the ___________, and prevent ______________ while the kidneys recover

reversible, cause, symptoms, complications

Dysrhythmias: Treatment - Assess cardiac __________ - ______ - Administer _______-___________ if ordered

rhythm, O2, anti-arrhythmic

Celiac Disease: Foods ALLOWED - ________ - _________ - Soy - Potato - Eggs - Millet - Buckwheat - _______ flours

rice, corn, nut

Appendicits: Clinical Manifestations - Pain in _______ _______ quadrant - ____________ tenderness at McBurney's point - ___________ - Elevated ______ count - __________ abdomen - Decreased or absent _________ _________ - Vomiting - Constipation/diarrhea - Anorexia - ____________ and tachypnea - Pallor - Lethargy - Irritability - ______________ posture

right lower, rebound, fever, WBC, rigid, bowel sounds, tachycardia, stooped

Hemodialysis Complications: Blood loss - May result from blood not being completely __________ from the _________, accidental __________ of blood ________, dialysis membrane __________, or bleeding after the removal of ____________ at the end of dialysis

rinsed, dialyzer, separation, tubing, rupture, needles

Cortisol, produced by the adrenal cortex, __________ early in the day, _________ toward the evening, and _________ again toward the end of sleep to _________ by morning

rises, declines, rises, peak

__________ vials between hands instead of ___________ them to mix insulin suspensions

roll, shaking

Store insulin at

room temperature

What should the nurse do to prevent lipohypertrophy?

rotate injection sites

Most common cause of diarrhea in children <5 years

rotavirus

Prevention of Diarrhea - Two _____________ vaccines are available - Teach _________ ___________ - Clean _________ supply/protect from _____________ - Teach careful food ____________ - Encourage _________ washing

rotavirus, personal hygiene, water, contamination, preparation, hand

Appendicitis: Complications - ___________: Sudden relief of pain - ___________: Fecal and bacterial contamination after rupture - ____________: Inflammation inhibits small bowel motility

rupture, peritonitis, ileus

Most common type of food poisoning in the US

salmonella

Gastroenteritis: Predisposing Factors - Poor _____________ - Improper handling of _________ - ____________ - _______________ - Presence of other _____________ processes

sanitation, food, daycare, antibiotics, infectious

Macroscopic features of Celiac Disease/Villous Atrophy detected with Endoscopy - ____________ of mucosa on circular folds - ___________ of the mucosa - __________ pattern

scalloping, fissuring, mosaic

Which age group is most impacted by fear of bodily injury?

school-age

A complex spinal deformity usually involving a lateral curvature of the spine, spinal rotation, and thoracic hypokyphosis

scoliosis

8 Supervisory Commandments for Nurses 1. Know the ________ of practice of those under your supervision 2. Know the _________ and opportunities for growth of those under your supervision 3. _________ regularly to verify the status of assigned tasks/activities 4. Take ________________ of your decisions/actions 5. _____________ for staff 6. Always be _____________ on the unit- unless otherwise communicated 7. Provide ____________ and make some time to __________ with your team 8. _______________

scope, strengths, inspect, responsibility, resource, accessible, feedback, debrief, communication

Abnormal accumulation of interstitial fluid (edema)

second spacing

Primary or secondary cause of Addison's? Suppression of the adrenal gland to produce endogenous cortisol due to long-term administration of exogenous corticosteroids; abrupt steroid withdrawal; hypophysectomy

secondary

Which type of HTN accounts for 3-10% of HTN in adults and is related to an underlying cause?

secondary

intact and healthy ureters are overwhelmed by raised vesicular pressures associated w/ obstruction, which distorts the ureterovesical junction. Underlying causes include neurogenic bladder and chronic, recurrent UTIs

secondary VUR

occurs as a result of an acquired condition (UTI or obstruction); neuropathic bladder dysfunction; obstruction due to renal stones, strictures, tumors; children who "hold" their urine (dysfunctional voiding)

secondary VUR

Less common type of obesity d/t chromosomal/congenital anomalies, metabolic problems, CNS lesions/disorders

secondary obesity

Nephrolithiasis: Etiology; Lifestyle - ____________ occupation, ______________

sedentary, immobility

Tramadol may potential

seizures

Hypernatremia with hypovolemia: Clinical Manifestations - Restlessness, agitation, lethargy, ___________, _________ - Intense __________, dry swollen __________, ___________ mucous membranes - _____________ ___________, ____________ in BP, weight ________, __________ pulse - _______________, muscle __________

seizures, coma, thirst, tongue, sticky, postural hypotension, decrease, loss, increased, weakness, cramps

Intervention for urinary retention autonomic neuropathy and what risk does it impose

self-catheterization, infection

Obesity: Behavior Modification - _______-__________: "Food Diary" - ___________ __________: Does the patient know their "eating cues" and learn to try to avoid them - _____________: Incentives for weight loss - __________ _________ help

self-monitoring, stimulus control, rewards, support groups

What is the gold standard for assessment of acute pain in child who is developmentally able

self-report

What type of scale is the FACES pain scale?

self-report

Cobalamin Deficiency: Management - Reduce risk for ____________ d/t decreased ____________ to _________ and pain (falls, burns, trauma) - ____________ _______________ for neuromuscular complications

sensitivity, heat, physical therapy

Foot ulcers/amputations Due to __________ deprivation, peripheral _________ damage, and increased risk of __________ as well as ____-__________ ________ & stepping on foreign objects

sensory, vascular, infection, ill-fitting shoes

Fears/Stressors: Toddler - _____________ __________ ** - Loss of ______-________ - Fear of ________ and pain - ___________ behavior - Issues can arise with disruption of __________ and __________ from ___________

separation anxiety, self-control, injury, regressive, routine, separation, parents

A systemic inflammatory response to a documented or suspected infection

sepsis

Score of > or = 2 on qSOFA along with a documented/suspected infection, this suggests

sepsis

life-threatening organ dysfunction caused by a dysregulated host response to infection

sepsis

What does SOFA stand for

sequential organ failure assessment

What is the best indicator of renal failure (how much irreversible damage has been done)

serum creatinine

What is the best indicator of renal failure? (How much irreversible damage)

serum creatinine level

HIV Diagnostic Studies - HIV ________ detection of _______________ - Progression monitored by ______ _________ and ________ __________ - Normal CD4: ______-______ - The __________ the viral load... the better - WBCs: _____________ - Platelets: _____________ - RBCs- ___________ ^^^ (d/t disease process and treatment0

serum, antibodies, CD4 counts, viral load, 800-1200, lower, neutropenia, thrombocytopenia, anemia

Celiac Disease: Clinical Manifestations - Typically noticed _________ _________ after induction of gluten in diet - Clinical Manifestations typically are noticed between ____ and _____ ________ of age S/S - Impaired _____ absorption: __________ and _____________ - General ____________ including: ___________ __________, ___________, ___________ - _____________ _____________

several months, 1, 5 years, fat, diarrhea, steatorrhea, malnutrition, muscle wasting, anemia, anorexia, abdominal distension

HTN: Diagnostic Studies - ____________ elevated BP readings over ____________ ____________ - UA, BUN, Cr, CBC - Serum electrolytes - ECG - Serum lipid profile

several, several weeks

Two examples of prerenal causes of AKI

severe dehydration, heart failure

Unable to swallow, unconscious, convulsing

severe hypoglycemia

What are the two main causes of an extracapsular fracture?

severe trauma, fall

Cholecystitis: Clinical Manifestations Vary from _________ to _______ at all - Pain more severe when ________ ________ or ______________ Pain is ___________ and __________ - _________cardia - ___________ - Prostration - May be referred to __________/________ - Residual tenderness in _______ - Occur ___-___ ______ after _____-___ meal or when patient ______ _____

severe, none, stones moving, obstructing, steady, excruciating, tachy, diaphoresis, shoulder/scapula, RUQ, 3-6 hours, high-fat, lies down

Which type of insulin can be given IV?

short-acting (regular)

__________-________ insulin is given IV or SQ and is often used with ______________ ___________________

short-acting, diabetic ketoacidosis

what are four causes of hemolysis

sickle cell anemia, medications (methyldopa, aldomet), incompatible blood, trauma (i.e. cardiopulmonary bypass)

TIME OUT - Verify the person, ________, and procedure - _________ the procedure site - Always check pt history, consent, radiological studies needed, implants and protheses required, and patient ____________ ______ - Time out for the team: Correct _________, procedure, side/______, and agreement that we are set to go

site, mark, identification band, patient, site

Reduces fractures (holds the broken bones together) and immobilizes/stabilizes fractures

skeletal traction

ARI: Collaborative Management ___________ ____________ measures are important to prevent pressure ulcers because of _________ and decreased _________ ___________. Mouth care is important to prevent _____________.

skin care, edema, muscle tone, stomatitis

Cast and Brace Care - Ensure ________ and _____________ integrity - Check the _____________ tissue every ____-____ _________ - _____________ checks (check for compartment syndrome) - Keep extremity ___________ (at/above level of heart) - Keep cast/brace __________ and ________ (allow adequate air circulation for plaster cast to dry) - Mark any ___________ noted - Do not put anything down __________ the cast - Keep non-casted joints __________

skin, neurovascular, surrounding, 1-2 hours, neurovascular, elevated, clean, dry, drainage, inside, mobile

S/S Mild-Moderate Dehydration - Dry ________ and mucous membranes - Poor skin ___________ - ____________ anterior fontanel - __________ in color - ______________ pulse - ____________ (kidneys try to retain body fluid) - VS may still be ___________ - Decreased __________ - irritability

skin, turgor, sunken, pale, increased, oliguria, normal, tears

Preventing Hypoglycemia - Don't ______ or _________ meals or snacks (if you take insulin or oral diabetes meds be consistent with amount eaten and timing) - __________ your ______ ______ (may check and record BG several times a week or day) - __________ medication carefully and take it ____ _______ - ________ your medication or eat ________ snacks if you increase physical ________ - Eat a meal or snack with ___________ - ________ your low glucose __________ (This can help health care team to see patterns contributing to hypoglycemia) - ________ some form of diabetes ____ so that in emergency others will know you have diabetes)

skip, delay, monitor, blood sugar, measure, on time, adjust, additional, activity, alcohol, record, reactions, carry, ID

Growth hormone (GH), thyroid-stimulating hormone (TSH), and prolactin levels peak during

sleep

Signs of Opioid Overdose - ________ or ___________ respirations - _______-_____________ - ______________

slow, shallow, over-sedation, confusion

Most mechanical obstructions occur in the

small intestine

GER/GERD Lifestyle Modifications- Adults - _______, ___________ meals (4-6 per day) - Drink adequate _________ _______ ________ to aide food passage - Eat ___________ and ______ well to add saliva to the food - Avoid extremely _____ or ______ foods, ________, fats, alcohol, coffee, chocolate, and citrus - Avoid eating and drinking for _____ ________ before __________ to prevent ____________ ____________ - _____________ the head of the bed - Lose ________ if overweight to decrease the gastroesophageal ____________ gradient - Avoid _____________ and salicylates

small, frequent, fluids with meals, slowly, chew, hot, cold, spices, 3 hours, retiring, nocturnal reflux, elevate, weight, pressure, tobacco

Nutritional Therapy: Prevention of Cholelithiasis - People have fewer problems if they eat ___________ more _________ meals with some _____ each meal to promote gallbladder _____________ - The diet should be low in __________ ______ (e.g. butter, shortening, lard) and high in __________ and __________ - If obesity is a problem, a ___________-________ diet is indicated - ___________ __________ __________ should be avoided because it can promote gallstone formation

smaller, frequent, fat, emptying, saturated fats, fiber, calcium, reduced-calorie, rapid weight loss

Utilize ________ ________ ______ and group _________ for nursing implementation of weight loss interventions

smart phone apps, therapy

VTE Risks - _________ - _________ adults - Bedrest/_____________ - _____________ or malnutrition - High dose ____________ therapy - Surgical patients (__________) - History of DVT - Trauma - Obesity - History of a-fib or other dysrhythmia

smokers, older, immobility, dehydration, estrogen, ortho

Obesity: Psychosocial Factors Eating habits are related to: - Marketing - ___________ environment - Family ___________ - ________ or ___________ - Availability of food - _____________ - Level of _____________

social, traditions, stress, depression, association, activity

furosemide inhibits ___________ and ___________ reabsorption at the proximal and distal tubules and ascending loop of henle

sodium, chloride

CKD: Nutrition Therapy - __________ restriction: Diets vary from 2-4 g, depending on degree of edema and HTN - ___________ restriction: 2-3 g, foods high in this should be avoided - _____________ restriction: (Dairy products), 1000 mg/day - ____________ restriction: waste product accumulation - ____________ restrictions: intake depends on daily urine output

sodium, potassium, phosphate, protein, water

Primary HTN: Contributing Factors - Increased __________ intake - Increased _______________ nervous system activity - Greater than __________ _________ _______ - Excessive _____________ consumption - _____________ use

sodium, sympathetic, ideal body weight, alcohol, tobacco

Pain that arises from bone, joint, muscle, skin, or CT

somatic pain

Surgical incision or broken bones are types of

somatic pain

Which type of pain is usually aching or throbbing in quality?

somatic pain

Rebound hyperglycemia upon waking d/t hypoglycemia between 2-4 a.m d/t overdose of insulin before bed

somogyi effect

Causes of Undernutrition - Inadequate food _________ - _________ _________ (burns, fevers, hospitalization) - _________ __________ (diabetes) - "____________" issues (chewing/swallowing) - Residents of __________ ________/rehabs - ___________ due to *decreased digestive enzymes *Drug side effects *Decreased bowel surface area

sources, acute illness, chronic illness, mechanical, nursing homes, malabsorption

When a stone is lodged in the ducts or when stones are moving through the ducts, what may result?

spasms

Hypertonic solutions are used to treat very _________ problems and are administered in carefully controlled, _________ doses in order to avoid _____________ _____________ __________ and cell _______________.

specific, limited, vascular volume overload, dehydration

Antagonizes aldosterone in the distal tubules to increase sodium and water excretion (generic)

spironolactone

Can help with rales "wet" sounds in lungs as well as lower extremity edema; risk for hyponatremia and hyperkalemia

spironolactone

K-sparing diuretic (generic)

spironolactone

K-sparing diuretics

spironolactone

S/S of this med: H/A drowsiness, lethargy, confusion, hyponatremia (generic)

spironolactone

aldosterone antagonist examples (2)

spironolactone (Aldactone), eplerenone (Inspra)

Pediatric focused S/S (GER): Infants - __________ up, vomiting - __________/irritability with _________ of _______ - Weight ______, failure to ____________ - Gagging, __________ at the end of feedings - Respiratory problems (____________) - Apnea or _________

spitting, crying, arching, back, loss, thrive, choking, aspiration, ALTE

In some children, GER may resolve ____________ as their esophageal sphincter grows ____________ over the first year of life

spontaneously, stronger

HIV/AIDS: Prevention of Transmission in Health Care Setting - Maintain ______________ _____________ - ________ washing/hygiene - Protective barriers: ___________, __________, eye shield, gown - Do NOT _______ needles/syringes - Clean up spills of ________ and ________ fluids immediately using germicidal solution - Consider ______ _________ ___________ to be contaminated - Avoid contaminating the __________ of specimen containers during collection - Cleanse work surface areas with appropriate ____________

standard precautions, hand, gloves, mask, recap, blood, body, all body fluids, outside, germicide

Cholelithiasis: Etiology & Pathophysiology - _______ of ______- --> Supersaturation and changes in composition of bile (________ ___________) - ___________, __________, and ____________ or _________ lesions of biliary system decrease bile _______ - Stones may ________ in gallbladder or _________ to _______ or ________ ______ duct - Cause ________ as they pass through ducts; may _________ in ducts and produce ___________

stasis, bile, biliary sludge, immobility, pregnancy, inflammatory, obstructive, flow, remain, migrate, cystic, common bile, pain, lodge, obstruction

What is prescribed to diabetics to prevent heart attack and stroke

statins (lipid-lowering agents, atorvastatin, Lipitor)

glipizide: pharmacological action?

stimulate release of insulin related to blood glucose level (pt must have functioning pancreas)

Folic Acid Deficiency: Manifestations - ____________ - Cheilosis - Dysphagia - Flatulence - Diarrhea - ____________ - Irritability - ____________ - __________, _________ tongue

stomatitis, pallor, fatigue, smooth, tender

CHOLECYSTITIS: Etiology & Pathophysiology - Most commonly associated with obstruction from ________ or ________ - _____________ ____________: Can occur in older adults and critically ill Inflammation - Confined to ___________ ________ or _______ ________ - Gallbladder is ___________ and __________ - May be _________ with ______ or _____ - _________ duct may become occluded - _____________ and __________ after attack

stones, sludge, acalculous cholecystitis, mucous lining, entire wall, edematous, hyperemic, distended, bile, pus, cystic, scarring, fibrosis

What are the three most important nursing interventions in the mgmt of care for a client with renal calculi

strain all urine, strict I&O, force fluids unless contraindicated

_____________ response to surgery may intensify in the older adult

stress

Low urine output causes - __________ response (ADH, aldosterone) - _________ ___________ before surgery - Loss of _________ during surgery - _______________ - _______________

stress, fluid restriction, fluids, diaphoresis, drainage

Good route for pt's who cannot swallow; provides faster relief and lasts longer

sublingual, buccal

Bariatric Surgery Proven to have __________, _________ impact on weight loss Criteria: 1. BMI _____ kg/m2 or greater OR 2. BMI ______ kg/m2 with ______ or more ___________, __________-_________ medical complications AND 3. _____________ ___________ to ensure the patient can commit to a ____________ ____________ __________ and to screen for __________ and/or ______________ AND 4. No advanced ____________, ___________ and __________ disease and ______________ disease

successful, lasting, 40, 35, one, severe, obesity-related, psychological screening, lifelong behavioral change, depression, addiction, cancers, liver, kidney, cardiopulmonary

PUD: Gastric Outlet Obstruction - __________ onset of ___________ of _________ due to _______, _________, or ______ tissue

sudden, narrowing, pylorus, edema, inflammation, scar

glipizide: class

sulfonylurea

Oral agents that increase insulin production from pancreatic beta cells, poses risk for weight gain

sulfonylureas

glyburide and glimepiride are both

sulfonylureas

Bacterial agents are more common in _____________ while viral agents are more common in _____________

summer, winter

GER/GERD Teaching/Patient Education - Sleeping position (__________ for infants) - Feeding routines, _________ formula - Play times (limit to at least _____ ________ after __________) - Keep infants _________ during feeding to prevent regurgitation (aspiration) - _______ training

supine, thicken, 30 minutes, eating, upright, CPR

How is mesalamine normally administered

suppository or enema

Secondary causes of Addison's - _____________ of the adrenal gland production of endogenous cortisol due to _______-________ administration of _____________ ____________ - Abrupt steroid ____________ - _________________

suppression, long-term, exogenous corticosteroids, withdrawal, hypophysectomy

Open Reduction - ____________ usually with ___________ - Risk of ___________ - ____________ recovery - Example- surgical insertion of screws to re-attach pieces of ulna bone together

surgery, anesthesia, infection, longer

Most common cause of mechanical obstruction

surgical adhesion

Mechanical Obstruction: Causes (5)

surgical adhesions, cancer, hernias, volvulus, intussusception

Infection: Collaborative Care - Open fractures require aggressive ____________ _____________ - ____ ____________ followed by course of _________ ______________ - Meticulous _____ _________

surgical debridement, IV antibiotics, oral antibiotics, pin care

ORIF - ____________ procedure resulting in __________ fixation - The broken bone is __________ or put back into place - An ____________ fixation device is placed on the ________ - Screws, plates, rods, pins

surgical internal, reduced, internal, bone

Cheiloplasty: Post-Op - Cleansing of ________ ________ - Keep _______ (vaseline) - __________ ____________ - _________ control - Resume feeds as tolerated - Avoid ________ objects or _________ in the oral cavity - Home within ____ ________

suture line, moist, elbow immobilizers, pain, hard, suction, 24 hours

VTE S/S 3 main ones

swelling, redness, calf tenderness

When CD4 count is 200-500 and viral load is increasing, what occurs?

symptomatic infection

UTI: Nursing Goals - _____________ relief - Teaching and prevention * ____________ better than baths * ____________ cleansing (front-to-back) * ____________ after intercourse * Anti-microbial therapy * No scented toilet paper * No perfumes etc. to perineal area * _________ bladder regularly

symptomatic, showers, perineal, voiding, empty

Nephrotic Syndrome: Diagnostic Evaluation - Based on history of ____________ and clinical manifestations - 4 MAIN CLINICAL MANIFESTATIONS ARE: 1. Massive ____________ 2. __________ 3. __________________ 4. ________________________ - ________ _________ provides information regarding glomerular status

symptoms, proteinuria, edema, hypoalbuminemia, hypercholesterolemia, renal biopsy

Harmful Effects of Unrelieved Pain - ______________ - Increased ____________ - ____________ breathing, decreased __________ _________ - _______________ - Urinary and bowel ____________ - Anorexia - Weakness/fatigue - Impaired muscle ______________ - Disorganized thought processes

tachycardia, clotting, shallow, tidal volume, pneumonia, retention, coordination

Hypoglycemia TIRED acronym

tachycardia, irritability, restlessness, excessive hunger, diaphoresis

Hormones exert their effects on

target tissue

Buck's Traction - ___________ immobilization and stabilization of fractured _______ or fractures of __________ shaft - Correct _______ and ______ joint contractures (not fractures) - Reduces ___________ __________

temporary, hip, femoral, knee, hip, muscle spasms

truvada is also called

tenofovir

CL & CP: Risk factors - ____________: __________, _________, anticonvulsants, steroids, retinoids during pregnancy - ____________ ____________ during pregnancy - ___________ __________ - Having _____________ or __________ during pregnancy - _______ are more likely to have cleft lip with or without cleft palate - Clef palate without cleft lip is more common in __________ - In US, most common in __________ Americans and least common in _________ Americans

teratogens, smoking, alcohol, folate deficiency, family history, diabetes, obesity, males, females, Native, African

SQ rapid-acting (lispro) or short-acting (regular) insulin are adjusted according to blood glucose ________ results (several times a day, before meals and at bedtime)

test

PCA are programmed to give a dose of medication every time

the patient hits the button

Other oral agents, improve insulin sensitivity so no hypoglycemia concerns but linked to cardiovascular problems so rarely used

thiazolidinediones (pioglitazone, rosiglitazone)

Fluid accumulation in part of body where it is not easily exchanged with ECF (ascites)

third spacing

Combination antiviral therapy: _________ or ________ drugs from _________ groups are prescribed at __________ strength to attack viral ___________ in _______ ways, and helps to reduce ________ _____________

three, more, different, full, replication, many, drug resistance

What is the best way to reduce risk for vascular complications in diabetic patients

tight or intensive therapy

Diagnostic Testing: Endocrine Important to put ________ on the lab slip and sample with hormones that fluctuate with ____________ ____________

time, circadian rhythm

Anemia can lead to

tissue hypoxia

The goal of ___________ is to use the smallest dose of analgesic that provides effective pain control with the fewest side effects

titration

What are histamine H2 receptor antagonists used for preoperatively?

to reduce stomach acid

Non-opioids do not produce

tolerance or addiction

Barriers to Effective Pain Management - _____________ - Fear of physical _____________ - _____________ - Fear of ____________ __________ by administering analgesics

tolerance, dependence, addiction, hastening death

block sensation of pain by numbing the skin layers and mucous membranes

topical anesthetics

Surgery for UC

total proctocolectomy

A complication more common with UC that involves widening of the large intestine

toxic megacolon

fluid in specialized cavities

transcellular

Which route of administration takes 12-17 hours to reach full effect?

transdermal

What are the four steps of nociception?

transduction, transmission, perception, modulation

HIV Risk Factors - Received blood __________ or _________ factors before _________ - Shared _________, _________, or other injection equipment - ____________ active, inconsistent/no __________ with _________ partners - ___________ of mothers who have HIV/AIDS

transfusion, clotting, 1985, needles, syringes, sexually, protection, multiple, babies

What are 8 most common food allergens?

tree nuts, eggs, wheat, peanuts, fish, shellfish, soy, milk

Several hormones secreted by the anterior pituitary are referred to as __________ hormones, including TSH, ACTH, FSH, LH, ICSH

tropic

What is infant Erikson's stage?

trust vs. mistrust

During the oliguric phase, damaged ____________ cannot conserve _________, resulting in normal or below-normal levels of serum __________

tubules, sodium, sodium

Hemodialysis: Procedure - _______ needles placed in fistula or graft - Needle closer to __________ or ____ catheter lumen pulls _________ from the pt and sends to the _____________ - Blood is returned from the ___________ to pt through second needle or ________ catheter - Dialyzer/blood lines primed with _________ solution to eliminate ______ - Terminated by flushing dialyzer with ________ to remove all __________ - Needles removed and ______ _________ applied

two, fistula, red, blood, dialyzer, dialyzer, blue, saline, air, saline, blood, firm pressure

Diabetes mellitus that is a genetically determined autoimmune disorder characterized by a complete or nearly complete lack of insulin production; it most commonly arises in children or adolescents.

type 1 diabetes mellitus

a type of diabetes mellitus that most commonly presents in adults and is becoming more common in children and adolescents due to inactivity and weight gain. The disease may be controlled by lifestyle modifications, oral drug therapy, and/or insulin, but patients are not necessarily dependent on insulin therapy

type 2 diabetes mellitus

Diabetes: Risk factors for amputation - Foot ____________ - ___________ neuropathy** - ____________ artery disease - ___________ abnormalities - Impaired __________ function - _____________ neuropathy

ulcerations, sensory, peripheral, clotting, immune, autonomic

Includes ulcerations, surviving mucosa (pseudopolyps), loss of haustra, crypt distortion

ulcerative colitis

It is important to cope with stress and emotions to avoid exacerbations of

ulcerative colitis

Total proctocolectomy w/ileal pouch/anal anastomosis or permanent ileostomy is used for

ulcerative colitis

Two forms of IBD

ulcerative colitis, Crohn's disease

Renal Calculi: Diagnosis - _____________ - IVP - Renal stone ___________ - KUB (__________) --kidney, ureter, and bladder - Serum: __________ ___________ and ________ ___________

ultrasound, analysis, X-ray, calcium oxalate, uric acid

During the asymptomatic chronic infection stage, most are ____________ of infected status and may _____________ _________ the virus for years

unaware, unknowingly spread

Pain Behaviors - Crying, grimacing, moaning, aggressiveness, restless, being ____________, rubbing or __________, GUARDING - Changes in __________ or _________ patterns

uncooperative, massaging, sleeping, eating

CKD is _______________ and untreated d/t it's asymptomatic nature in some patients

underdiagnosed

Cause of Cholelithiasis

unknown

Common Stressors/Response to Hospitalization - Fear of the __________ - ___________ or _________ anxiety - Fear of pain or __________ - Loss of _________ - Anger - Guilt - ____________

unknown, separation, stranger, mutilation, control, regression

Hypotension: Causes - _______________ fluid/blood loss - ____________ dysfunction

unreplaced, cardiac

When does hypothermia normally occur?

up to 12 hr post op

Kidney to bladder is an _________ tract infection

upper

Feeding the Child with CL/CP - Hold infant ____________ during feeding - ________ ________ feeder - _________ bottle - ________-_________ ________ ________ nurser - _________________, especially with (CL/CP) - __________- molded device from OT or ST; closes opening in mouth during feeding - ______________ frequently d/t increased air being swallowed

upright, special needs, pigeon, mead-johnson cleft palate, breastfeeding, CL, obturator, burping

GI Issues in CKD Every part of GI is affected due to excessive __________ - Mucosal ____________ - ____________ (mouth ulcerations) - __________ _________ (urinous odor of breath) - GI _____________ - ____________, N&V

urea, ulcerations, stomatitis, uremic fetor, bleeding, anorexia

Patients with diabetes who develop _________ may require less insulin than before the onset of CKD

uremia

Syndrome in which kidney function declines to the point that symptoms occur in multiple body systems

uremia

Dialysis is begun when the pt's __________ can no longer be adequately managed conservatively or initiated when GFR is less than ______ ml/min

uremia, 15

During the oliguric phase, F&E abnormalities and __________ occur. The kidneys cannot excrete _________ products of _____________.

uremia, acid, metabolism

a surgery to fix the tubes that connect the bladder to the kidneys. The surgery changes the position of the tubes at the point where they join the bladder to stop urine from backing up into the kidneys. ... This surgery takes several hours to complete.

ureteral reimplantation

Isolated ileal segment with ureters implanted in posterior portion of segment: Ileal segment anastomosed to sigmoid colon

ureteroileosigmoidostomy

Left ureter anastomosed to right ureter

ureterostomy

Inflammation of the urethra

urethritis

The inability to empty the bladder

urinary retention

What value reflects GFR

urine creatinine clearance

No urine or incomplete bladder emptying

urine retention

A UTI that has spread into the systemic circulation - life-threatening emergency

urosepsis

What are the best ways to prevent pneumonia

vaccinations and care bundles (VAP)

cutting of certain branches of the vagus nerve, performed with gastric surgery to reduce the amount of gastric acid produced and thus reduce the recurrence of ulcers

vagotomy

surgery that reduces acid production

vagotomy

Which has the highest risk for HIV transmission? Hollow bore needle for vascular access OR used for IM injection

vascular access

Obstruction that results from an interference with blood supply to a portion of the intestines

vascular obstruction

Hemodialysis: Obtaining ___________ access is one of the most difficult problems Types of access include: - ____________ __________ and _________ - _____________ vascular access

vascular, arteriovenous fistulae, grafts, temporary

The adrenal glands are small, paired, highly ____________ glands located on the _________ portion of each ____________

vascularized, upper, kidney

How does the body prioritize blood flow to the heart and brain?

vasoconstriction elsewhere

Systemic Vascular Resistance: Influencing Factors SNS - a1 and a1-adrenergic receptors (____________) - B2-adrenergic receptors (______________) Neurohormonal - Vasoconstrictors: ____________ and _____________ Local Regulation - Vasodilators: __________, __________ __________ - Vasoconstrictors: ____________

vasoconstriction, vasodilation, angiotensin, norepinephrine, prostaglandins, nitric oxide, endothelin

ADH is a potent

vasoconstrictor

Sepsis causes ____________ and _________ ___________ of blood flow, and ______________ increases

vasodilation, capillary permeability, coagulation

VTE Diagnostics - __________ __________ determines venous flow in deep femoral, popliteal, and posterior tibial veins

venous doppler

VTE Precipitating Factors - ___________ ____________ caused by incorrectly applied casts/traction - __________ _________on a vein - _____________

venous stasis, local pressure, immobility

Calcium channel blocker example

verapamil (Calan)

SE of Lasix - CNS: __________, HA, dizziness, weakness, ____________ - CV: ____________ __________ - GI: ___/___

vertigo, restlessness, orthostatic hypotension, N/V

Abnormal retrograde flow of bladder urine into the ureters

vesicoureteral reflux

What is the name of the non-insulin injectable?

victoza (1x/day)

Celiac Disease: Pathophysiology - Characterized by __________ _________ in the _______ _________ in response to protein gluten, specifically the _________ component of gluten. LEADS TO _______________

villous atrophy, small bowel, gliadin, malabsorption

Transmission is more likely in the initial infection because

viral load is high

What is large viral levels in the blood called

viremia

What is the initial infection with HIV called?

viremia

Pain that arises from organs, such as the GI tract and bladder

visceral

can be well-localized or poorly localized pain

visceral

- ERCP allows for _____________ of the gallbladder, cystic duct, common hepatic duct, and common bile duct. -_______ taken during ERCP is sent for _______ to identify potential infecting organisms. - Percutaneous transhepatic cholangiography is the insertion of a _____________ directly into the gallbladder _________, followed by injection of ________ materials. It is generally done after _____________ indicates a bile duct blockage

visualization, bile, culture, needle, duct, contrast, ultrasonography

Clients receiving hypertonic saline solutions require frequent monitoring of (3)

vital signs, neurological status, skin and mucous membranes

Intrinsic factor binds to ____________ _______ and is absorbed in the ___________ and used for ______ ____________ which eventually leads to _____ _____________

vitamin B12, intestines, DNA synthesis, RBC production

Mechanisms of Chronic Kidney Disease- Mineral & Bone Disorder (CKD-MBD) Decrease in __________ _______ --> Impaired ____ ___________ from the gut --> Decrease in __________ ________ ---> increase in _________ (osteitis fibrosa), --> Bone ______________ (osteomalacia) --> Increase in ____________ _____ and ______ (vascular and soft tissue _____________)

vitamin D, ca absorption, serum ca, PTH, demineralization, serum Ca, PO4, calcifications

CKD causes a decrease in the active form of __________ _______, which causes a decrease in ____________ absorbed from the intestine, and therefore ___________ ___________ ____________ levels

vitamin D, calcium, decreased serum calcium

Responsible for metabolism of amino acids, fats, carbohydrates

vitamins

Potassium is added to IV fluids only after child has

voided

What are the two main diagnostic tools for VUR

voiding cystourethrogram (VCUG), abdominal ultrasound

Common indications for dialysis in ARI/ARF are: (1): ______________ __________ (2): Elevated _____ levels with _______ changes (3): Significant change in __________ __________

volume overload, K+, ECG, mental status

twisting of the bowel on itself, causing mechanical obstruction

volvulus

Diabetes Illness Management Notify HCP if: - ___________ - ___________ odor to breathe - _____________ __________ - Decreasing level of ___________

vomiting, fruity, Kussmaul respirations, consciousness

Nephrolithiasis: Etiology- Climate - _________ climates that cause increased fluid loss - _____ urine volume - _______________ solute concentration of urine

warm, low, increased

CKD: Protein restriction - Although protein is a necessary nutrient, when protein is ingested, protein ________ ___________ are created. Healthy kidneys have millions of nephrons to filter this. It's then removed in the urine - Unhealthy kidneys lose the ability to remove protein waste and it starts to build up in the ___________. Dietary protein intake for patients with CKD is based on the __________ of kidney disease, __________ status, and body __________.

waste products, blood, stage, nutritional, size

Why are growth plate (physeal) fractures common

weakest part of long bones

Main distinguishing factors for hyponatremia in hypervolemic client (2)

weight gain, increased BP

Health Promotion: Acute Intervention for CKD - Daily _________ and ______ - ID s/s of fluid ______________ - ID s/s of __________________ - Strict ___________ adherence - Medication education - Motivate pts in mgmt of disease

weight, BPs, overload, hyperkalemia, dietary

Pharmacologic Therapy: CKD HTN - _________ loss - Lifestyle changes - ___________ recommendations - ____________ and _______ restriction - ____________ drugs - _____________ like Lasix

weight, diet, sodium, fluid, antihypertensive, diuretics

Nursing Mgmt of CKD: Evaluation of Care - Maintenance of ideal body __________ - Acceptance of chronic disease - No ___________ or _________ - ___________, ___________, and serum ___________ levels in acceptable range

weight, infection, edema, hematocrit, hemoglobin, albumin

HTN: Lifestyle Modifications - ___________ reduction - ____________ therapy (_________) - Dietary __________ reduction - Modification in ____________ consumption - Regular ___________ physical activity - Avoidance of ___________ products - __________ management A major problem in the long-term management of the patient with HTN is poor _____________ with treatment plan

weight, nutritional, DASH, sodium, alcohol, aerobic, tobacco, stress, compliance

When do you used D10W

when TPN has expired and waiting on a new bag from pharamacy

Pain from gastric ulcers usually occurs

when eating or 1-2 hours after a meal

Cholecystitis: Laboratory Tests (ALL INCREASED) - ________ _______ _______ count - Serum ____________ level - ________ ____________ level (if obstructive process if present) - __________ _________ levels - Serum ____________ level (if pancreatic involvement)

white blood cell, bilirubin, urinary bilirubin, liver enzyme, amylase

Give metformin _______ or ________ _______ main meals

with, shortly after

When should a person with type 1 diabetes have a dilated eye exam and then how often should they have exams thereafter?

within 5 years of onset of diabetes, annually

Adrenal tumors are most common in __________, ____ to ____ years of age.

women, 20, 40

Signs/Symptoms of Pain - _____________ of face or brow - ___________ fists - Moaning - Diaphoresis - ______________ pulse rate - Verbal complaints - Restlessness - _____________ body posture - Facial ______________ - Irritability - _____________ blood glucose - ______________ respiratory rate - Muscle ____________ - Decreased GI ____________ - Urine ____________ - Pallor - Anxiety/agitation

wrinkling, clenched, increased, guarded, grimacing, increased, increased, tension, motility, retention

Clinical Manifestations: Type 2 DM - May go _________ with ___________ hyperglycemia - May have typical ________ ___ symptoms - Typically ____________ - Chronic hyperglycemia - Fatigue, recurrent __________, vaginal yeast infections or candida infections, ______________ wound healing, _________ changes - Often diagnosed during routine physical

years, undetected, type 1, overweight, infections, prolonged, vision

Sepsis: High Risk Individuals - __________ (under 10) or _______ (over 65) - Patients with _________ diseases (diabetes, kidney/liver disease, cancer) - Recent __________ - Severe _______/wounds - Patients on ____________ therapy - Patients who are ____________ - ________-__________

young, old, chronic, surgery, burns, immunosuppressive, malnourished, post-partum

Sibling reactions - Experiencing many changes and being too __________ to __________ them - Being cared for by ____________ or outside of the home - Receiving little ___________ about the ill sibling - Perceiving that parents will treat the sick child _____________

young, understand, nonrelatives, information, differently

Shigella - ___________ _________ most vulnerable - ______-________, contaminated food/water, touching object contaminated with bacteria - Usually lasts ____-____ ________

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