SG 24; vascular surgery, SG 23; shock, Chest tubes, SG 22; pituitary, SG 21; thoracic, SG 20 - PTSD, anger, substance abuse, SG 19 - Adrenal, SG 18 - cardiac surgeries, SG 17 - MI, SG 16 cardiac disorders, SG 15 suicide, mass disasters, SG 14 pancrea...
assessment of bubbling, when does this occur intermittently?
based on pt's breathing, is ok due to air leaking chest cavity
what to watch for with post op in neurosurgical patients
be alert for large outputs - 500 mL in 2 hrs
why does enzyme levels become elevated in the body when a pt has pancreatitis
because of pancreatic cell damage
nursing interventions for acute HF
bedrest, fluid restriction, open airway, diuretics
how often is chest x-rays done
before chest tube, everyday they have it, and after chest tube taken out
gigantism
before epiphyses close, excess growth of skeleton and soft tissues, common in young children
When should pancreatic enzymes be given?
before or with meals
when should blood gases be taken?
before venting the patient, 20 min after venting or 20 min after each change made in settings
ST segment
beginning of ventricular repolarization, from the end of S wave to beginning of T wave
post traumatic stress disorder
behavior demonstrated by someone who experienced, witnessed or was confronted with a traumatic event
treatment for OCD
behavior therapy SSRI (fluvoxamine, sertraline) SNRI (venlafaxine)
t/x of OCD
behavior therapy: expose to what they avoid response prevention; focus on delaying rituals
treatment for asystole
being CPR, place IV or IO, epinephrine 1 mg every 3-5 min, search for H&H - no defibrillation
where should tubes and bottles be kept
below chest level at all times
causes of pheochromocytoma
benign tumor in adrenal medulla
t/x of delirium tremors
benzo
Flumazenil (Romazicon) use
benzo overdose
what should be given for DTs?
benzodiazepines
treatment for controlling rhythm of a fib
beta blocker, if not working then cardioversion
what should be given if you can't lower BP and HR?
beta blockers (olol) - metoprolol most common
treatment of symptomatic more than 1 PVC
beta blockers, antiarrhythmias (amioderone)
causes of most first degree blocks
beta blockers, calcium channel blockers, digoxin
what are most first degree blocks from?
beta blockers, calcium channel blockers, digoxin
Medications for cirrhosis
beta-blockers (to decrease venous pressure) diuretics (for ascites) albumin (for ascites and increase urinary output) vitamin K
meds for cirrhosis
beta-blockers(corgard) with Imdur, diuretics for ascites, albumin, vitamins, paracentesis
schizotypal charactersitics
bizarre fantasies, and preoccupations, suspicious and hypersentive
risk factors for total laryngectomy
bleeding, TE fistula, respiratory tract infection
risk of partial/hemi laryngectomy
bleeding, aspiration, SQ emphysema, infection
cardiac tamponade can occur surgical from
bleeding, oozing
s/s of carotid rupture
bleeding/pulsation at site, change in color, sternal or high epigastric distress
carotid rupture s/s
bleeding/pulsation at site, change in color, sternal or high epigastric distress - apply direct pressure
s/s of sensory conversion disorder
blindess, aphonia, anosmia, numbness, deafness
lithium
blocks ADH
Hep C transmission
blood
transmission of hep C
blood (90-95% blood transfusions)
transmission of hep B
blood and body fluids
treatment of sepsis
blood cultures, lactic acid above 2, broad spectrum IV antibiotics, IV fluids
what should be done for endocarditis?
blood cultures, temp, anti-inflammatories, antibiotics, assess decreased organ system perfusion
glucocorticoids increase what
blood glucose, and protein catabolism - peak release in a.m.
urine amylase reflects what
blood levels
ace inhibitors decrease what
blood pressure
what do ARB's decrease?
blood pressure
hep b
blood, blood products, hepatovax, can lead to liver cancer and chronic hep b
injuried pneumothorax
blunt trauma, puncture, high pressure ventilator
toxicity associated with digitalis
blurred vision
exhaustion stage
body responded negatively to anxiety, stores are depleted
reason for ventilation-perfusion mismatch
both air and blood flow impairment - pulmonary embolism
Body disturbance disorder
botox
body disturbance disorder
botox
hypertensive crisis symptoms
bp >180/>120, headache, n/v, chills, sweating, restlessness, dilated pupils, fever, motor agitation
Amylase
breaks down carbs
amylase
breaks down carbs
lipase
breaks down fat
Lipase
breaks down fats
trypsin
breaks down protein
Trypsin
breaks down proteins
what must a pt be able to do before they can be extubated?
breathe spontaneously, clear secretions, maintain satisfactory ABG's
use of epinephrine (adrenalin)
bronchodilating effects in anaphylaxis, asthma, and cardiac arrest (opens airways)
med used to keep airway clear
bronchodilators (nebulizer)
Cullin's sign
bruising around umbilicus
Cullins sign
bruising around umbilicus
factors that increase intra-thoracic pressure
bucking, ETT migration into R bronchus, bronchospasm, barotrauma, decreased compliance
what med is used IVP to reduce pulmonary congestion?
bumex (lasix), loop diuretics' used too
4 loop diuretics
bumex, furosemide, torsemide, ethacrynic acid
bundle branch block
bunny ears
characteristics of bundle branch block
bunny ears
med treatment for GAD
buspirone, SSRI
undoing
buying gifts to fix things
why is vascular surgery performed
bypass blockages, repair damaged areas, remove emboli, open occluded vessels to increase blood flow
what effects theophylline?
caffeine
causes of sinus tach
caffeine, stress, fever, dehydration, drugs
what does alkalosis lower?
calcium and potassium
Fatty stage of cirrhosis
can be reversible/get better with lifestyle changes cell degeneration increased liver size increased WBC
Desmopressin acetate
can cause bed wetting
inotropes
can cause feelings of anxiety - dopamine, dobutamine, isoproteneol
tartive dyskinesia
can not be reversed
what can not be done with asystole?
can not shock
what can not be done in torsade de point
can not shock - must defibrillate
what does succinylcholine do related to anxiety?
can produce anxiety - does not relieve pain
caput medusase
can see vascular through the belly skin becomes translucent
Asystole
cardiac arrest without obvious electrical activity
what can both low calcium and potassium lead to?
cardiac arrhythmias
Premature complexes (PAC)
cardiac cell other than the SA node is firing before the next sinus impulse
symptoms of severe toxic reactions related to theophylline
cardiac dysrhythmias, v-fib, cardiac arrest, convulsions
gigantism complications
cardiac failure
dobutamine is used for which shock
cardiogenic
vasodilators are used for which shock
cardiogenic
t/x of vtach with pulse
cardioversion
treatment for unstable atrial flutter
cardioversion
treatment with pulse and Vtach
cardioversion
Cardioversion vs Defibrillation
cardioversion - with pt R wave defibrillation - high shock to heart to terminate VF
transcatheter aortic valve replacement (TAVR)
catheter implants new valve within diseased valve
Decreased vitamin k synthesis
causes a prolonged PT (longer than 12.5 seconds)
fatty stage of alcoholic cirrhosis s/s
cell degeneration, increase liver size and increase WBC
first sign of cyanosis
central (lips)
what must TPN be administered through?
central line, PICC, or port
s/s of poor toleration
change in pulse rate or rhythm, poor color, restless, confusion, diaphoresis, change in BP
what should you do if tubing is occluded by prolapsed cuff?
change the tubing
what to do if tube occluded by prolapsed cuff
change tubing
ventricular fibrillation
chaotic waves
purpose of perfusion lung scan
check blood flow with injected radioactive dye
pre-procedure check for endoscopic retrograde cholangiopancreatography
check for allergy to dye
post op microsurgery
check s/s of cerebral edema, decrease HR, increase BP, pupil change, HOB 30 degrees, low dose pain meds, no coughing or sneezing, test and clear fluid from nose
common compulsions
checking rituals, counting rituals, washing, praying, touching, arranging
what needs to be done if a patient with dementia is taking antipsychotics?
chemical restraint - must be taken off or given lower dose to know if they still need the psychotic
angina s/s
chest pain longer than 10-20 min, dyspnea, diaphoresis, cool skin, tachycardia, hypotension
s/s of 3rd degree block
chest pain, SOB, decreased LOC, hypotension, slow HR, pulmonary congestion, CHF
treatment of pleural effusion complication
chest tube
symptoms appropriate for an EKG
chest: pain, discomfort, pressure, or tightness, difficulty breathing, recent drug use, prior cardiac disease (MI)
bile acid sequestrate meds
cholestyramine, colestipol, colesevelam
prognosis of hep D
chronic hep, cirrhosis, fulminant hep
Large cell carcinoma
cigarette smoking and environmental carcinogens, early metastasis, surgical resection
small cell carcinoma
cigarette smoking, enviromental carcinogens, aggressive tumor, poorest prognosis, less than 1 yr
squamos cell carcinoma
cigarette smoking, exposure to environmental carcinogens, local invasion- surgical resection
what technique is used for suctioning when stoma has healed?
clean technique
antisocial treatment approach
clear about expectations and the consequences, matter-of-fact approach, expect pt to refuse to cooperate
treatment for schizioid
close human connect, but easily overwhelmed - be patient
fibrinolytic therapy
clot busters - not blood thinners tPA, alteplase
Hep D transmission
co infection with Hep B blood and blood products
treatments for panic disorders
cognitive behavioral techniques, benzos, SSRI, tricyclic antidepressants, antihypertensives clonidine (catapres), propranolol (inderal)
therapy treatment for anxious people
cognitive-behavioral therapy - teaches different way of thinking
treatment for personality disorders
cognitive-behavioral therapy, dialectical behavior, case management
pharmacological treatment for hypovolemic shock
colloids, albumin, dextran
stage 4
coma
administration implication when giving theophylline to consider?
compatibility - need for 2nd IV
percutaneous transluminal angioplasty
compresses plaque and enlarges lumen
oniomania
compulsive buying
antisocial characteristics
conflict with society, theft, vandalism, fighting, delinquency, truancy, unable to sustain consistent work
Serotonin syndrome symptoms
confusion, agitation, muscle rigidity, weakness, shivering tremors, tachycardia, tachypnea, diaphoresis, hypersalivation
what other symptoms may be assessed with panic disorder?
confusion, disorientation, self-blaming, avoidance, sleeping or eating changes
Causes of Right Bundle Branch Block
congenital heart abnormality, heart attack, myocarditis, pulmonary hypertension, pulmonary embolism
psychosomatic
connection between mind (psyche) and body (soma)
what is needed with synchronized cardioversion?
consent needed
Manifestations of acute pancreatitis
constant mild to severe pain that worsens after a fatty meal or alcohol consumption LUQ or mid epigastric pain
ART line
continous BP, no air in line, zero q4h, start of shift and after change
Sustained ventricular tachycardia
continous at least 30 seconds of Vtach
what does nitroprusside require
continuous BP monitoring with arterial line
CPAP
continuous positive airway pressure
Oxytocin
contractions of uterus in labor
collateral circulation
coronary arteries gradually narrow, small branches may enlarge or new branches may form in order to bring more blood to myocardium
best way to clear secretions and keep airway clear
coughing and deep breathing
where is CPR done with duck bill speech
cover nose and mouth for CPR - bag via stoma
CPR with total laryngectomy
cover nose and mouth, bag via stoma
bioprosthetic valve and main advantage
cow (bovine) or pig (porcine) tissue - no need for life long blood thinners
Viral hepatitis causes
decreased protein and fat synthesis decreased carb metabolism decreased/impaired detoxification decreased vitamin k synthesis
symptoms of decreased cardiac output
decreased urine output, edema, hypotension, EKG changes, fatigue, dizziness, cold clammy skin, altered mental status
Neomycin for hepatic encephalopathy
decreases the number of flora and ammonia production in the bowel PO and rectal installations the drug is ototoxic, nephrotoxic, and neurotoxic monitor hearing and kidney function
vfib t/x
defib, CPR, epi, amiodarone
pulseless vtach treatment
defibrillation
treatment with no pulse and vtach
defibrillation
would a trach cuff be inflated or deflated for eating/drinking?
deflated if pt can handle secretions
s/e of radiation for cancer t/x
delays healing - used for early glottic or intrinsic cancer
Synchronized Cardioversion
delivers electrical shock synchronized with patients R waves/heartbeat
pain relief in acute pancreatitis
demerol, morphine, diluadid must report poor pain relief
bipolar 2
depressed longer, hypomanic
when schizophrenia occurs later in life, what is usually associated?
depression or dementia
related disorders to anger, hostility, or aggression
depressive disorder, PTSD, Alzheimer's disease, personality or psychotic disorders
self soothing behaviors
deramtillomania - skin picking onychophagia - nail biting trichotillomania - hair pulling
body identity integrity disorder
desire to become an amputee
pyromania
desire to set fire
kleptomania
desire to steal
purpose of mediastinoscopy
detect lung metastasis and explore/biopsy mediastinal lymph nodes
what critical thing keeps a patient from going home/being hospitalized?
determination if patient would be a harm to themselves or others if they were at home
what part of system actually sets suctioning
dial in bottom - not wall suction
antispasmodic/anticholinergics given for pancreatitis
dicyclomine (bentyl)
Causes of PVCs
diet, fatigue, stress, heart failure, drugs, trauma, acute MI
What is stroke volume?
difference between end end-diastolic volume and end-systolic volume
Stage 3: Stuporous
difficult to arose, sleeping most of time, incoherent but become noisy and abusive when aroused, increased deep tendon reflexes, rigidity of extremities, babinski
Stage 3: stuporous
difficult to arouse incoherent but becomes abusive when aroused increased deep tendon reflexes rigidity of extremities positive Babinski
Proximal nocturnal dyspnea
difficulty breathing at night due to lying flat
what should be observed for post op of bronchoscopy
difficulty breathing or excessive amount of blood
Hypomania symptoms
difficulty focusing, increased sexual energy, increased talkative, increased activity, reckless episodes, decreased need for sleep, increased sociability - not as low depressive episode
Cardiac Glycosides meds
digatoxin, digoxin
Positive inotropes meds
digoxin
first choice pain med for pain relief of pancreatitis
dilaudid - can use morphine or demerol
teaching for total laryngectomy
diminished taste and smell, need a smoke detector
nursing responsibilities for 24 hr urine
discard first void, collect over 24 hr, any loss must restart, often kept on ice
panic disorder
discrete episodes of panic, 15-30 min of rapid, intense escalating anxiety
what causes cardiomegaly?
disease of heart muscle, heart valves, HTN, pulm hypertension, arrhythmias
cardiomyopathy
disease of the heart muscle
when coping fails, what does a pt experience?
disequilibrium and significant distress
moderate anxiety
display being nervous/agitated - physically displayed
characteristics of dissociative disorder
disruption in integration of consciousness, memory, identity, environmental process
findings associated with somatic disorders
disrupts daily life, preoccupation with symptoms, anxiety about symptoms, remissions and exacerbations, probable alcohol or substance abuse, overmedicated, symptoms longer than 6 months
three types of dissociative disorder
dissociative amnesia, dissociative identity disorder (multiple personality disorder), depersonalization
fibrioloytics
dissolve blood clots
Schizophrenia
distorted or bizarre thoughts, perceptions, emotions, movements, and behaviors
DIG FAST mania acronym
distractibility, indiscretion, grandiosity, flight of ideas, activity increase, sleep deficit, talkativeness
bipolar s/s DIG FAST
distractibility, indiscretion, graniosity, flight of ideas, activity increase, sleep decreased, talkativeness
Paranoid Characteristics
distrust and suspiciousness, cold and unemotional - common in men
treatment for pulmonary edema
diuretics
Symptoms of decreased cardiac output
dizziness, syncope, restlessness, anxiety, fatigue, weakness, tachypnea, dyspnea, weight gain
what do antidepressants do for an anxious person?
don't cure but can relieve symptoms
purpose of ventilation scan
done after perfusion, deep breathe O2 and radioactive gas, read as match or mismatch - DONE FOR PE's
modified radial neck dissection
done with another surgery, lymph nodes removed
Cluster B personality disorders
dramatic, emotional, erratic antisocial, borderline, histrionic, narcissistic
when are ABG's drawn with t-pieces
drawn before trial and 20 min after
caution with first gen medications
drink plenty, postural hypotension
agents that lead toxic hepatitis
drugs (acetaminophen), alcohol, industrial toxins
vasopressors
drugs used to increase blood pressure
causes of dilated cardiomyopathy
drugs, alcohol, pregnancy
causes of premature junctional contractions (PJC)
drugs, anxiety, caffeine, tobacco, alcohol
what are some causes of dysrthymias?
drugs, electrolyte imbalances, marked thermal changes, disease, trauma, stress
assess trach infection
dry dressing, sterile technique when suctioning new, clean tech when healed
how should dressing be around stoma?
dry dressings - assess for infection every shift
thoracic descending AA symptom
dsypnea, dysphagia
Common issues after Roux-en-Y surgery
dumping syndrome excoriation of the anus from frequent irritating stools
symptoms of depressive episode
dysphoric, depressive, despairing, decrease interest, fatigue, decrease appetite, suicidal
manifestations of hypoxemia
dyspnea, cyanosis, restlessness, apprehension, confusion, increased HR and BP, metabolic acidosis
manifestations of hypercapnia (high CO2)
dyspnea, headache, papilledema, tachycardia, hypertension, drowsiness, coma, vasodilation, respiratory acidosis
complications associated with MI
dysrhythmias, pump failure, cardiogenic shock, infarct extension, structural defects, pericarditis
schizotypical treatment
easily overwhelmed by stress, give plenty of time to make decisions
Gray Turner's sign
ecchymosis in the flank
What measures ejection fraction?
echocardiogram
S/S of water intoxication
edema of eyes, fingers, ankles, sacrum, cerebral edema with convulsions
if the graft is taken from the leg, what may occur
edema of leg
atypical antipsychotics
effexor, pristiq, cymbalta, wellbutrin, serzone, remeron, viibryd
tricyclic antidepressants
elavil, tofranil, asendin, norpramin, pamelor, sinequan, amitriptyline
Electrocardiogram
electrical recording of the hearts activity
synchronized cardioversion
electrical shock that is synchronized with pts heartbeat (R wave)
what is the first thing you should do when a patient is having difficulty breathing?
elevate HOB
paracentesis
elevate HOB, monitor BP and HR
what does diabetes do when an MI occurs?
elevate blood sugar, increase MI risk
myoglobin
elevated if muscle if affected
complications of grafting
embolism, contrast dye sensitivity, dysrhythmias, reocclusion of treated vessel, vessel perfusion, hematoma at insertion site
schiziod characterisitics
emotionally cold and aloof, does not express strong emotions
what should you do if tubing is occluded by water in vent tubing?
empty the water into a reservoir bag
what to do if tube occluded by water in vent tubing
empty water into reservoir bag
pseudocyst
encapsulated fluid; in the pancreas or abd cavity may rupture causing peritonitis tx: drainage
cardiomegaly
enlargement of the heart
pancrelipase (viokace)
enzyme replacement, give before or with meal, do not crush or chew, track progress by maintaining weight
Acinar cells secrete
enzymes for digestion
what is secrete by acinar cells
enzymes for digestion
abscess
epigastric mass with tenderness increased WBC, fever tx: ATB and drainage
what should be administered if wheezing or stridor is noted?
epinephrine and glucocorticoids, may need reintubated
Prinzmetal angina
episodic chest pain unrelated to exertion
Hemorrhage complication
esophageal bleeding may be caused by cough or vomiting tx with balloon tamponade
what is used first - succinylocholine or etomidate
etomidate first, date before you succ
quadrigeminy
every 4th beat is a PVC/PAC
how often should mouth care be done?
every hr
Bigeminy
every other beat is a PVC/PAC
trigeminy
every third beat is a PVC/PAC
Why is a bronchoscopy performed?
examine tissue, biopsy, identify bleeding, determine tumor resection, clear secretions
SIADH (syndrome of inappropriate antidiuretic hormone), schwart-barter
excessive water retention in the body, hyponatremia occurs due to retention
what will a 24 hr urine show with cushing disease?
excretion of cortisol, K+, Ca, glucose
use of balloon tamponade for bleeding esophageal varices
exerts pressure directly
level 2
exhibit some loss of ability to function, experience with alternative methods of coping
pre op teaching total laryngectomy
expect physical changes, provide support - expect fear of suffocation and choking
traumatic events or stressors
experiences that are extraordinary in intensity or severity
Premature Atrial Contraction (PAC)
extra beat
premature ventricular contraction (PVC)
extra beat, QRS >0.12 and bizarre
premature ventricular contraction (PVC) characteristics
extra beat, irregular rhythm, no P wave, wide QRS
inadequate characteristics
fail in emotional, economic, occupational, social adjustments, lack perseverance to work toward goals
Third degree AV block (complete heart block)
failure of AV node to conduct impulses
s/s of fulminant hepatitis
failure of liver, necrosis beyond repair, death, HBV with concurrent HDV
supraglottic/extrinsic cancer involves what part of larynx
false cords, epiglottis
pseudocyesis
false pregnancy
supraglottic cancer is what part of larynx
false vocal cords, epiglottis
symptoms of brady dysrhythmias
fatigue, dizziness, lethargic, fainting, confusion, difficulty with exercise, SOB, decreased perfusion
agoraphobia
fear of leaving home
phobia
fear or an object or social situation that causes distress or interferes with normal functioning
Hep E transmission
fecal oral
transmission of hep A
fecal-oral
transmission of hep E
fecal-oral
Hep A
fecal-oral - food/water workers commonly get this, havrix
Hep A transmission
fecal-oral route
hep e
fecal-oral, no vax, severe in preg women
diagnosing generalized anxiety disorder
feeling excessively or highly anxious at least 50% of the time for longer than 6 months
splitting
feels as things are all good or all bad
risk factors of anxiety disorders
female, younger than 45, divorced or separated, poverty
three changes that occur with chronic pancreatitis
formation of protein plug in ducts, decreased acinar cells leads to pickling, fibrosis of pancreatic tissue
Changes during chronic pancreatitis
formation of protein plugs decreased acinar cells fibrosis of pancreatic tissue
pulmocare and nutrivent
formulas with higher fat and low CHO content
FIO2
fraction of inspired oxygen, vent may deliver 21%-100%
Side effects of loop diuretics
frequent urination, blurry vision, headache, constipation, diarrhea
complications of chronic active hepatitis
from B or C, cirrhosis, primary liver cancer
complications of chronic persistent hepatitis
from B or C, damage does not progress, often asymptomatic, labs normal with mild AST or ALP for 1 year
seizure prevention med
gabapentin
level 3
general adaptation syndrome - fight, flight, panic
etiology of schizophrenia
genetics, neuroanatomic/neurochemical factors (altered dopamine and serotonin), immunologic viruses
inspiration and expiration with chest tube
inspiration move toward pt, expiration moves away from pt
2 endocrine substances produced in the pancreas are
insulin glucagon
control of chronic pain and exocrine and endocrine insufficency
insulin or oral agent, enzymes, TPN, H2 blockers, proton pump inhibitors
pleural effusion
leakage of pancreatic enzymes shows increased levels of amylase tx: if it does not stop; chest tube
cognitive therapy - assertiveness training
learn to negotiate interpersonal situations
d/c teaching for CABG that there will be:
no further drainage, a mild fever and extreme fatigue for serve weeks,
atrial fibrillation
no identifiable P wave, RVR >100
characteristics of atrial fibrillation
no identifiable P wave, irregular R - quivering tissues
voice quality of transoral cordectomy
no problems
if there is no PQRST during sinus arrest, what does that mean?
no pulse
pre-op pulm prep
no smoking, sternal splint, IC, explain ET tube
diseases that can progress to dementia
parkinsons, head trauma, prion disease, huntington's, pick's, vascular dementia, korsakoff syndrome
transsphenoidal hypophysectomy
partial/total removal of pituitary
treatment approach for obsessive compulsive
participate in his own treatment plan, avoid informality - professional approach
dependent characteristics
passively allows others to assume responsibility for major areas of their lives
assist/control ventilation (ACMV or AC)
patient can trigger breath, but the vent is in control
treatment of acute coronary syndrome/unstable angina
percutaneous coronary revascularization, coronary artery bypass grafting
schizotypal personality disorder
problems with self and interpersonal relationships, not as severe
use of iced saline lavage for bleeding esophageal varices
produces vasoconstriction
exudate
product from bacteria or tumors
coronary atherosclerosis
progressive disease characterized by plaque formation
LTH
prolactin (milk production)
use of injection sclerotherapy for bleeding esophageal varices
promotes thrombosis and sclerosis of bleeding
nursing care - surgical procedure
prophylactic antibiotics, heparinized before clamping
Antidote for succinylcholine chloride (anectine)
prostigmine
succinylocholine antidote
prostigmine
what should be decrease in the diet if a pt has a high ammonia level
protein
decreased albumin is related to
protein synthesis
what does decreased albumin levels show?
protein synthesis
what is used to prevent GI issues?
proton pump inhibitors
social anxiety
provoked by certain social performances
social phobia
provoked by certain social/performance situations
treatment for somatic disorders
prozac, paxal, zoloft (antidepressants) assess symptoms and suicidal thoughts, encourage physical activity,
common SSRIs
prozac, zoloft, paxil, celexa, lexapro, luvox, viibryd
long term outcome of schizophrenia
psychosis decreases over time, most unable to live full independent life
what should be observed for post op of a laryngoscopy
respiratory difficulties, pain or swelling in throat or chest, apprehension, expectorating blood
manifestations of pneumo
respiratory distress, tachycardia, chest pain, decreased breath sounds, decreased expansion on affected side, cyanosis
position post procedure of bronchoscopy
semi-fowlers, no ice chips or drink until gag reflex present
dopamine is used for which shock
septic shock
s/s of addisons crisis
severe hypotension, high K+, low Na, confusion, low BS, dehydration, shock, dysrhythmia, fever, headache
addisons crisis
severe hypotension, high K, low BS, NA, dehydration
prognosis of hep E
severe in pregnant women
aortic dissection s/s
severe pain in back, chest, or abdomen, cardiac tamponade if dissection progresses
SSRI s/e
sexual dysfunction
common s/e of SSRIs
sexual dysfunction
S/S of Delirium Tremens (DTs)
shaking, vomiting, sweating, increased pulse, insomnia
tumor of lungs etiology
smoking or secondhand, inhaled carcinogens, hereditary predisposition, pre-existing chronic pulm disease
modifiable risk factors for CAD
smoking, diet, exercise, HTN, obesity
what does early intervention prevent?
social stagnation or decline, delay of progression to psychosis
where does a central venous pressure sit?
superior vena cava or right atrium
Management of chronic pancreatitis
supplemental enzymes TPN, 4-6000cal/day insulin/oral agents H2 antagonists/PPI
use of intra-aortic balloon pump
supports hemodynamics, allows perfusion of coronary arteries, decreases afterload which decreases oxygen demand
negative anger
suppressed or expressed inappropriately
who explains surgery when pt has questions?
surgeons responsibility
gigantism/acromegaly treatment
surgery, hypophysectomy, life long replacement of hormone stimulation by anterior pituitary, growth inhibitors, irreversible skeletal changes
tx of pheochromocytoma
surgical removal of tumor
how must pancreatic enzyme pills be taken?
swallow, do not chew
barriers related to reading EKG's
sweating, muscle tremors, tension, parkinsons, seizures, chest hair, implantable neurostimulators
S/S of hemorrhage
swelling, tight trach ties, bright blood up to 8hr post-op, serosanguinous 2-3 days
trach hemorrhage s/s
swelling, trach ties getting tighter, active bleeding is bright red blood being suctioned
which vent is great for weaning
synchronized IMV
which vent is great for weaning, synchronized IMV or assist/control vent?
synchronized IMV is great for weaning
treatment for pt that has a pulse but is unstable
synchronized cardioversion
what would a pt experience with right ventricular failure?
systemic issues - HTN, weight gain 2 lbs over 24 hrs
Example of fibrinolytic drug
tPA, ateplase
s/s of shock
tachy, fever, low BP, cool, clammy
Aggression management: escalation phase
take control, provide direction, let know unacceptable, if ineffective obtain help
what do ventilation-perfusion, impaired diffusion, and impaired ventilation all have in common?
they are always hypoxemic
hypertrophic cardiomyopathy
thickening of ventricles
abnormal laryoscope findings
thickening or deformity, irregular mucous membrane, fixation of normally mobile laryngeal structures
prevention of encephalopathy med
vitamin B1
early symptom of glottic cancer
voice change - if progresses or persists more than 2 weeks, see HCP
done before cardiac surgery
stop smoking, treat infection, treat CHF, optimize renal function, blood sugar management, pulm function test, vascular mapping
SQ use of epi
stops bleeding temporarily
approach for paranoid pts
straightforward and candid manner
hypertension can occur from
stress - affects sutures
common s/e of a fib
stroke
complications of pheochromocytoma
stroke, blindness, cardiac failure, sudden death
causes of PAC's
strong emotions, excessive alcohol, tobacco, caffeine, hypokalemia
dissociation
subconscious defense mechanism used to prevent recognition of a horrific or traumatic event - detachment from reality
when air travels into subcutaneous tissue, what may occur?
subcutaneous emphysema or crepitus
what may occur with barotrauma
subq emphysema or crepitus and eventually tension pneumothorax
what do you do if tube is occluded by secretions
suction
what should you do if tubing is occluded by secretions?
suction
how do we keep secretions thin and prevent airway obstructions?
suction as often as needed, warm humidification, hydration
use of synchronized cardioversion
treat unstable SVT, unstable afib/flutter, V tach with a pulse
methadone use
treatment of opioid withdrawal
use of nicotinic acid
treats hypercholestrol
diagnosis tests
troponin, myoglobin, CK, CBC, ABG, EKG
severe anxiety
trouble thinking/reasoning, muscle tightening, increased VS
severe anxiety
trouble thinking/reasoning, muscles tight, vital signs increase
what part of the larynx is glottic cancer?
true vocal cords - most common
glottic cancer
true vocal cords, early symptom is voice change, slow metastasize
what should you do if there is a leak in the tubing?
try to inflate, check the pressure, change if needed
if suction from wall is turned off, what must happen
tubing must be disconnected from chest tube device
laser surgery
tumor reduced or destroyed by laser beam
if bottle turns over, what should you do
turn system upright, have pt cough and deep breath
cognitive-therapy - positive reframing
turning negative messages into positive ones
crisis
turning point in an individuals life that produces an overwhelming emotional response
Typical dose of aspirin
typical dose of cardiac cases around 75-100 mg daily, can be increased to as high as 325 mg
what should be avoided with MAOI's
tyrimine foods (aged foods)
s/s of laryngeal cancer
voice change, painful swallowing, dyspnea, foul breath, lump in neck, weight loss, ear pain
what should be avoided with MAOIs?
tyrimine rich foods - aged foods like cheese, picked, sauced, soybeans, fruit, alcohol, yeast
situational crisis
unanticipated or sudden events that threaten the individual's integrity - physical emotional illness, death, divorce, fired from job
what 3 things do you need that without them shock can occur?
uncompromised vascular system, volume of blood, tissues are able to deliver oxygen
respiratory acidosis is due to over or under ventilation?
under ventilation
when is hypertrophic cardiomyopathy usually diagnosed?
undiagnosed until exertion like sports
assessing facial nerve
unequal drooping, assess smile
treatment for adrenal tumors related to cushing syndrome
unilateral or bilateral adrenalectomy - if bilateral will require lifetime hormone replacement
what should you do if tubing is occluded by a kink in the vent tubing?
unkink
what should you do if tubing is occluded by kinked ET tubing?
unkink
interventions for impaired verbal communication
unplug phone (can not use anyway), give bell, know patient can not answer verbally
prinzmetal's angina
unrelated to activity, occurs unpredictably
interventions to prevent constipation
use of bulk fiber and stool softeners, hydration
theophylline
used for COPD, caffeine affects drug, never IVP
implanted cardioverter defibrillator (ICD)
used for anti-arrhythmic pacing, cardioversion, and defibrillation - intensive shock with arrhythmias
adenosine
used for antiarrhythmias
atropine
used for bradycardia
Etomidate
used for intubation
use of etomidate
used for intubation, short acting sedative
Single lumen (cannula)
used for long neck
median sternotomy
used for open hearts, middle of chest, least painful especially when splinted
SIMV (Syncronized intermittent Mandatory Ventilation)
used for pt who have needed ventilation assistance support for a longer time period (weeks or months) - IMV rate gradually decreased allowing pt to breath, goes back and forth
t-piece trial
used for short period of intubation - 2 days
bronchodilators
used to open up airway
Dobutamine
used to raise blood pressure
ascites
usually d/t chronic leakage of pseudocyst s/s: increased amylase, increased abdominal girth tx: paracentesis
preventative measures/post exposure of hep A
vaccine - havrix immune globulin therapy, twinrix
preventative measures/post exposure of hep B
vaccine hepatovax-B or recombivax B, three injections over 6 months, HBIG post exposure
algoria
vague response
effects on body - skin, temp, thirst
vasoconstriction, skin color changes, cool, moist, edematous, decrease body temp
nitrates
vasodilation - nitroglycerin, isosorbide
S/S of fluid deficit
vasodilation, increase permeability, 3rd spacing, shock
Pharmacologic agents to treat esophageal varices
vasopressin (can be given as an IV infusion) propranolol somatostatin
meds used for management of bleeding esophageal varices
vasopressin and pantopranolol decrease portal pressure
ADH
vasopressin antidiuretic hormone (reduces urinary volume)
disadvantage of assist/control vent
vent can not change with the patient needs
T wave created by
ventricles relaxation
QRS complex
ventricular depolarization
phonation
voice production
hostility
verbal aggression, usually when feeling threatened or powerless
what should be used instead of propofol if BP is too low?
versaid
if pt has low BP what anesthetic should be used
versed, instead of propofol
electronic larynx
vibration placed against neck to talk, sounds like robot
causes of myocarditis
viral, bacterial, or parasitic infection
s/s of carotid endarterectomy
visual disturbances, weakness, numbness, aphasia, intermittent confusion
voice quality of partial/hemi laryngectomy
voice returns after 2-3 days, can have a normal convo
causes of sinus bradycardia
vomiting, valsalva maneuvers, syncope, medications, hypothyroidism, hypothermal, digoxin
treatment of asymptomatic with 1 PVC
watch and monitor
factors inhibiting ADH release and promoting diuresis
water load or blood volume, cold, alcohol, diabetes insipidus, CO2 inhalation
factors simulating ADH release and conserving water
water loss, blood loss, acute infection, morphine, anesthetics, barituates, pain, trauma, surgery, emotional stress
role of ADH
water regulation
what should be assessed prior to surgery
pt ability to see, hear, write, and read - plan way to communicate, consult speech therapy prior to surgery, need for good oral care to reduce infection risk
what is not possible unless a TE fistula is present?
pt can not aspirate
"bucking"
pt is out of sync with the ventilator
what is done at night with SIMV
pt is placed back on vent at night to rest
important part of thoracentesis
pt must remain immobile
synchronized IMV (SIMV)
pt runs this with their own spontaneous breathing - if they fail to breath, a minimum # of breathes is given
borderline treatment approach
pt take responsibility for themselves, done attempt to rescue from consequences, consistent here and now approach
esophageal speech
pt takes air into upper esophagus and expels vibration occurs in a portion of the gullet
assist/control vent
pt triggers, but vent is in control
who experiences proximal noctural dyspnea
pt with cardiomyopathy
when can PEEP not be used
pts with highly compliant lungs - COPD, hypovolemia, low cardiac output
what patients may develop signs of cyanosis much later?
pts with low hemoglobin
nutrition for intubated pts
pulmocare and nutrivent used with J tube for less risk of aspiration
what would a pt experience with left ventricular failure?
pulmonary congestion
s/s of vessel erosion
pulsating trach tube
empyema
pus in the pleural cavity
what do you do if chest tube becomes disconnected from bottle or comes apart at connection
put end of chest tube in saline or water cup (reestablish water seal), 3 corner dressing if tube comes out from pt, clamp for short amount of time
post op positioning pleurodesis
q15m turning, very painful initially
how often should tube feeding residuals be checked to monitor aspiration?
q4hrs
Antidysrhythmic Drug
quinidine sulfate
how fast does supraglottic/extrinsic cancer metastasize?
rapidly
how quickly does supraglottic cancer metastasize
rapidly
prognosis of hep A
rarely fatal, no carrier state
idoventricular rhythm
rate 20-40
characteristics of junctional rhythms
rate 40-60, no P wave or inverted, PR greater than 0.12
ventrical tachycardia
rate >170
characteristics of idoventricular rhythm
rate; 20-40 bpm, wide QRS
I-E ratio
ratio of inspiratory time to expiratory time, usually 1:2 or 1:1.5 - COPD pt is longer
what should be nearby and ready when etomidate is used?
ready to intubate
biome-fome cuff
red port ALWAYS left open
bivona fome-cuff trach tube
red port ALWAYS left open after insertion
Tx of hepatic encephalopathy
reduce ammonia - eliminate protein reduce ammonia forming bacteria
treatment for encephalopathy
reduce ammonia, eliminate protein then gradually increase, neomycin, lactulose, laxatives
statins
reduce risk of heart attack/stroke
vasodilators
reduces blood pressure
use of portal- systemic shunts for bleeding esophageal varices
reduces portal hypotension by diverting blood flow
Vasopressin to treat esophageal varices
reduces portal pressure by constricting splanchnic arteries
EKG of sick sinus syndrome
regular QRS and HR, pause, faster HR
normal sinus rhythm characteristics
regular rhythm, HR 60-100, normal P, PR, and QRS
what does mineralcorticoids regulate?
regulates sodium and electrolyte balance
Antispasmodics
relieves smooth muscle spasms pavabid, cerespan dicyclomine (bentyl)
ALP
remain elevated after ALT and AST return to normal
total laryngectomy with radical neck dissection
removal of SQ and soft tissue, sternocleidomastoid muscle, jugular vein, spinal accessory muscle
segmental resection
removal of a small section of lobe
lobectomy
removal of half a lobe
total laryngectomy
removal of larynx, hyoid, pre-epiglottic, strap muscle, 1 or more trach rings - pharyngeal opening sutured shut
pneumonectomy
removal of one entire lung, space fills with pleural fluid
treatment and management of hemorrhage/esophageal bleeding
balloon tamponade
how should a pt be suctioned?
insert, rotate, slowly pull out
how should a pt be laying for an EKG?
laying flat, with arms down, and legs uncrossed
third degree heart block
no P to QRS relationship
how to reverse fatty stage
no alcohol and better nutrition
treatment for cirrhosis
no alcohol, 2500-3000 cal/day, sodium restriction if ascites, fluid restriction if decrease sodium
Cluster A personality disorders (odd/eccentric)
paranoid, schizoid, schizotypal
benefit of PEEP
prevents atelectasis and reinflates collapsed alveoli
causes of atrial flutter
previous MI, HTN, valve issue, thyroid problems
what does it mean if T waves are inverted
previous cardiac ischemia
5 ACE inhibitor meds
pril - lisinopril, captopril, benzaepril, enalapril, ramipril
complications of mechanical ventilation
barotrauma, subcutaneous emphysema, crepitus, tension pneumothorax
What do beta blockers do in relation to blood pressure in heart rate?
Beta blockers lower BOTH blood pressure and heart rate
diagnosing angina
based on PMH, echo, EKG, angiography
Side effects of fibrinolytic therapy
Bleeding, bruising, pulmonary edema, arterial embolism, DVT
what should be done with an ART line?
"0" at start of shift, q4h, and when change is done
treatment of SIADH
0.9%, 0.45%, increase sodium diet, 3%, 5% NaCl, diuretics, K+ replacement
how many seconds is a big EKG box
0.20
how long is 1 large square?
0.20 seconds
dialectical behavior therapy
for those that exhibit self-injurious behavior
anhendonia
inability to experience pleasure
maintenance lithium level
0.6-1.2
What do ARBs treat?
Block the action of angiotensin II, pharmacologic effect is similar to ACE's
Hep B transmission
Blood and blood products
transmission of hep D
Blood and body fluids, related to hep B
5 questions for P waves
- are P waves there - are P waves occurring regularly? - is there one P wave for every QRS interval? - are the P waves smooth, rounded, and upright in appearance or inverted? - do all of the P waves look similar?
Isoelectric line
- flat line - above line: positive charge - below line: negative charge
six-step approach
- heart rate - heart rhythm - P wave - PR interval - QRS complex - identify rhythm
malingering vs factitious disorder
- malingering occurs when an individual is trying to avoid a situation such as military service, criminal prosecution, work, or to obtain financial compensation. - factitious disorder produces physical symptoms on themselves or another to take on the "sick Role"
beta-blockers
-olol used to decrease HR and arrhythmias
calcium channel blockers
-pine used for hypertension and arrhythmias
calcium channel blockers
-pine - decrease BP EXCEPT diltiazem and verapamil lower BP and HR
ACE inhibitors
-pril used for hypertension
ARB meds
-sartan, losartan, valsartan, candesartan, eprosartan, olmesartan
how many seconds is a little EKG box
0.04
how long is 1 small square?
0.04 seconds
normal QRS interval
0.06 - 0.10 sec 1 1/2- 3 small boxes
range for PR interval
0.06-0.12
range for P wave
0.12-0.2
normal PR interval
0.12-0.20 seconds (3-5 small boxes)
Normal PR interval
0.12-0.20 seconds (3-5 small squares)
PVC t/x
1 - monitor symptomic/more than 1 - beta blockers, antiarrhythmics
how is tubing clamped
1 clamp one way, 1 clamp the opposite way
duration of brief psychotic disorder
1 day to 1 month
supraglottic laryngectomy
1 week temp trach, tube feeding 2-3 weeks
how long are labs done for after they return to normal
1 year
A client who had an MI asks the nurse why he is receiving morphine. Which benefits of morphine should the nurse explain to this client? (SELECT ALL THAT APPLY). 1.) Sedation 2.) Pain relief 3.) Diminished anxiety 4.) ↓ myocardial oxygen demand 5.) Vasoconstriction of peripheral vessels 6.) ↑ urinary output
1, 2, 3, 4. Morphine is to ↓ pain, myocardial O2 demand, and anxiety while causing sedation. Vasodilation and urinary retention are associated with the administration of morphine.
The nurse is caring for a patient with a digoxin level of 2.3 ng/dl. What symptoms should the nurse expect? (SELECT ALL THAT APPLY). 1.) Nausea 2.) Drowsiness 3.) Photophobia 4.) ↑ appetite 5.) ↑ energy level 6.) Seeing halos around bright objects.
1, 2, 3, 6. Digoxin is a cardiac glycoside used to manage & Tx heart failure. The therapeutic range is 0.8 ng/dl - 2.0 ng/dl. Signs of toxicity are GI disturbances, neurological abnormalities, facial pain, personality changes, and visual disturbances.
The nurse admits a client with a diagnosis of chronic adrenal insufficiency. Which assessment findings confirm this diagnosis? (SELECT ALL THAT APPLY). 1.) Hyponatremia 2.) Hyperkalemia 3.) Hyperglycemia 4.) Hypercalcemia 5.) Hypocalcemia
1, 2, 4. Adrenal insufficiency is manifested by hyponatremia, hyperkalemia, hypoglycemia, and hypercalcemia. BUN is generally increased.
A client is started on steroid therapy after an adrenalectomy. Which information is MOST important to share with this client? (SELECT ALL THAT APPLY) 1.) Take the prescribed dose daily, and do not miss a dose 2.) Notify your healthcare provider if you experience increased urination 3.) Discontinue steroid therapy after two weeks 4.) Take this medication for the rest of your life 5.) Take two doses if you miss a dose
1, 2, 4. Steroid therapy following an adrenalectomy will continue for the rest of the client's life. It is important to take the dose daily, and not miss a dose. The client should be warned about the potential side effects such as hyperglycemia, which could manifest as symptoms such as increased urination. Clients should take the medication as soon as they remember missed dose, but not double the dose the next day.
Which statements are true regarding lung cancer tumor staging? (Select all that apply) 1.) Staging describes the severity of the cancer 2.) Staging helps the health care provider plan appropriate treatment 3.) Staging systems don't change over time 4.) Surgical biopsy with cytologic cell examination is the only data collection method used to perform staging 5.) Staging helps to determine whether the cancer has spread to distant areas of the body
1, 2, 5, staging describes the extent and severity of the cancer, and helps the health care provider determine the most appropriate therapy. Staging systems continue to improve as cancer is better understood. Multiple data collections methods such as laboratory results, physical examinations, and imaging results are used to determine the stage of cancer.
The nurse is admitting a client suspected of having Addison's disease. An initial serum chemistry test is done. What findings should the nurse expect to find? 1.) Hyponatremia and Hyperkalemia 2.) Hypernatremia and Hypokalemia 3.) Hyperglycemia and Hypernatremia 4.) Hypercalcemia and Hyperglycemia
1, Addison's disease is characterized by hyponatremia, hyperkalemia, hypoglycemia. Serum calcium is is not usually affected to a significant degree.
Side effects of digoxin
Bradycardia, anorexia, n/v, fatigue, ARRHYTHMIAS
bubbling in 1-5 water system indicates what
1-2 is normal, 4-5 not good indicates leaking
preicteric phase
1-3 weeks before jaundice, GI symptoms, anorexia, n/v, mild RUQ pain
duration before jaundice during preicteric
1-3 weeks before onset of jaundice
how long does shcizophreniform disorder last
1-6 months
Which condition would place a client at the greatest risk for cardiogenic shock? 1.) Acute MI 2.) CAD 3.) Decreased Hgb level 4.) Hypotension
1. 15% of clients with Acute MI will also experience cardiogenic shock. CAD causes MI. Decreased Hgb level is a result of bleeding. Hypotension is a result of reduced CO from cardiogenic shock.
Which class of drug is most commonly prescribed to increase CO? 1.) Beta-adrenergic agonist 2.) Angiotensin-converting enzyme inhibitor 3.) Loop diuretic 4.) Beta blocker
1. A beta-adrenergic agonist such as dobutamine is a direct-acting inotropic agent that primarily increases CO. Angiotensin-converting enzyme inhibitor directly ↓BP, Loop diuretics don't have an effect on contractility or tissue perfusion. BB ↓HR & BP
The nurse is caring for a client admitted with Addisonian Crisis. Which outcome is the priority? 1.) Preventing irreversible shock 2.) Preventing infection 3.) Relieving anxiety 4.) Lowering blood pressure
1. A client with Addisonian crisis has an uncontrolled loss of Na in the urine, and impaired mineralocorticoid function, which results in loss of extracellular fluid, low blood volume, and possible irreversible shock. Infection is not a priority in this life threatening scenario. Relieving anxiety is appropriate for after the client has been stabilized. The Client would have hypotension with Addisonian crisis so we would not want to lower the blood pressure we want to raise it.
The nurse understands that the most common symptom in a client w/ AAA is? 1.) Abdominal pain 2.) Diaphoresis 3.) Headache 4.) Upper back pain
1. Abdominal pain in a client with an AAA results from the disruption of normal circulation in the abdominal region. Diaphoresis and headache are not associated with an AAA. Lower back pain usually signifies expansion & impending rupture of the aneurysm.
The nurse is caring for a client admitted with joint pain and weakness the client describes a gradual coarsening of facial features and enlargement of hands and feet over the past year what assessment is appropriate for this client? 1.) Growth hormone levels 2.) cortisol levels 3.) Thyroid hormones 4.) insulin levels
1. Acromegaly is marked by the coarsening of facial features and soft tissue and swelling of hands and feet. The cause is overproduction of growth hormones. cortisol levels are increased in Cushing syndrome which causes thin extremities truffle obesity and moon face. Thyroid hormones are not related to these symptoms. Insulin changes do not produce this client's symptoms.
3 stages of General Adaptation Syndrome (GAS)
1. Alarm 2. Resistance 3. Exhaustion
What should the nurse assess in a female client with anterior pituitary hypofunction? 1.) Date of last menstrual period 2.) weight gain 3.) changes in urinary output 4.) chest pain
1. Amenorrhea is a sign of decreased FSH which is one of the anterior pituitary hormones. Weight gain is associated with Cushing's syndrome. Urinary output is related to posterior pituitary function. And chest pain is not related to hormone levels.
A client who was involved in an MVA is admitted to the hospital with the diagnosis of pneumothorax. A chest tube is inserted and attached to chest drainage system. The nurse notes almost constant bubbling the water seal chamber. Converse is aware that the bubbling is most likely the result of: 1.) Air leaks 2.) Adequate suction 3.) Inadequate suction 4.) Kinked chest tubes
1. Bubbling in the water seal Chamber of a chest drainage system stems from an air leak. In pneumothorax, an air leak can occur as air is pulled from the pleural space. Bubbling doesn't normally occur with either adequate or inadequate suction. Kinked chest tube can stop the suction and any pre-existing bubbling in the water seal chamber.
treatment for pulseless electrical activity (PEA)
1. CPR - NO defib 2. place IV/IO 3. epinephrine 1 mg every 3-5 min - search for H&T's
While palpating a client's abdomen, the nurse notes a pulsating abdominal mass. How should the nurse interpret this assessment? 1.) Abdominal aortic aneurysm 2.) Enlarged spleen 3.) Gastric distention 4.) Gastritis
1. The presence of a pulsating mass in the abdomen is an abnormal finding, and usually indicates an outpouching in a weakened vessel. However, can be a normal finding on a thin person. Enlarged spleen, Gastric distention, Gastritis do not cause pulsation.
treatment for major depressive disorder
ECT (electroconvulsant therapy)
With a client diagnosed with Cushing's syndrome what is the priority nursing assessment? 1.) Serum Glucose 2.) Daily wt. 3.) Urinary output 4.) Abdominal girth
1. Cushing's syndrome results in an ↑ secretion of of cortisol from the adrenal cortex. Glucose metabolism is profoundly affected by hypercortisolism.
treatment for a pt that has a pulse and is stable
1. EKG 2. Adenosine 3. Procainamide 4. amiodarone 5. cardioversion 6. potassium channel blocker 7. expert consultation 8. repeated episodes - ICD
The nurse is admitting a client newly diagnosed with Cushing's syndrome. The nurse expects to find what S/Sx in the initial assessment? 1.) "Moon face" & truncal obesity 2.) Wt. loss & heat intolerance 3.) Changes in skin texture & low body heat 4.) Polyuria & dehydration
1. Overproduction of adrenocortical hormone results in redistribution of fat, resulting in the manifestations of "moon face", truncal Obesity, "buffalo hump".
A nurse reinforces the teaching plan for a client who has recently been diagnosed with squamous cell carcinoma of the left lung. What is the most appropriate information for the nurse to give this client? 1.) you have a slow growing cancer that rarely spreads 2.) in terms of prognosis you may only have a few months to live 3.) squamous cell cancer is very rapid growing cancer 4.) the cancer has generally metastasized by the time diagnosis is made
1. squamous cell carcinoma is a slow growing rarely metastasizing type of cancer. It has the most optimistic prognosis of all lung cancer types.
OCD t/x meds
1. SSRI (fluvoamine) 2. SNRI (venlafaxine) 3. second gen antipsychotic (risperidone, olanzepine)
treatment for no pulse
1. start CPR 2. call for help 3. AED/defibrillator/shock 4. epinephrine 5. amiodarone
The nurse notes an order to change the client's chest drainage system from suction to gravity drainage. What is the most appropriate action by the nurse? 1.) Detached to from the suction port to provide a vent 2.) Clamp the client's drainage tube 3.) Question the health care provider's order 4.) Turn off the suction source and leave the tubing connected
1. When the suction source is turned off, the drainage system should be open to the atmosphere so intrapleural air can escape from the system. Detaching the tube from the suction port provides an exit vent for air and reduces the risk of tension pneumothorax.
general adaptive system (GAS)
1. alarm 2. resistance 3. exhaustion
what steps should be taken if a pt with pulmonary edema experiences trouble breathing?
1. assess pt 2. elevate HOB 3. apply oxygen
4 C's of addiction
1. compulsive behavior 2. cravings 3. chronic, relapsing behavior 4. cognitive impairment
treatment for vfib
1. defib 2. CPR 3. epi 4. amiodarone
3 major events of PTSD
1. dreams or intrusive thoughts of trauma 2. emotional numbing 3. hyperarousal
three hormone groups of adrenal cortex
1. mineral 2. gluco 3. sex
treatment steps for brady cardia
1. monitor if stable 2. atropine 1 mg, every 3-5 min - up to 3 mg 3. external transcutaneous pacing 4. epinephrine 5. dopamine
A client who underwent femoral-popliteal bypass surgery, is scheduled to return from the PAC unit. Which staff member should receive this client? 1.) RN w/ 1 year of experience 2.) LPN w/ 5 years of experience 3.) Nursing assistant w/ 15 years of experience 4.) Charge nurse w/ 10 years of experience
1. this is because the client requires, frequent neurovascular assessments, so a RN should receive them. AN LPN does not have the education to complete this action. The Nursing assistant does not have the necessary assessment skills. The Charge needs to be able to direct the care of other pts.
treatment for SVT
1. valselva manuvear 2. adenosine - 6 mg IVP, then 12 IVP 3. cardioversion w/ consent
Hemoglobin level needed to promote adequate oxygen delivery
10 g/dl
duration of ET tubes
10-14 days - trach placed if needed longer
HR for sinus tach
100-150
A client with pneumonia is ordered azithromycin 500mg IV daily. The medication is premixed by the pharmacy in a 50ml bag of solution to be infused over 30min. The IV delivers at 15gtts/ml. What drip rate should the infusion pump be set at? (Round to a whole number) _____________gtts/min
15gtts 50ml -------- X --------- = 25gtts/min 1 ml 30min
The nurse is assessing a patient with substernal chest pain. Which symptoms reported support a Dx of stable angina pectoris rather than a possible MI? (SELECT ALL THAT APPLY) 1.) "The pain began while I was watching tv." 2.) "The pain goes up and down my left arm." 3.) "The pain lasts less than 5 minutes." 4.) "The pain started when I ate breakfast and continued all morning." 5.)" One nitroglycerine relieved the pain."
2, 3, 5. Stable angina pectoris is a temporary imbalance of supply and demand of oxygen for cardiac muscle. Substernal pain may radiate to the arm, it is precipitated by stress, is relieved by rest or nitroglycerine and lasts 2-5 minutes
A client is experiencing the classic S/Sx of acute coronary artery disease. What is the nurse's priority intervention? 1.) Remain with the client to reduce anxiety 2.) Apply supplemental oxygen 3.) Administer sublingual nitroglycerine 4.) Educate the client about his symptoms
2, Enhancing myocardial oxygenation is the priority when a client exhibits S/Sx of cardiac compromise. Without adequate oxygen, the myocardium suffers damage.
Which potential complication should the nurse instruct a client with Cushing's syndrome about? 1.) Dehydration 2.) Infections 3.) Breathing difficulty 4.) Acute pain
2, High levels of corticosteroids cause reduced inflammatory and immune response., putting the client at an increased risk of infections. Na & H2O is retained with Cushing's syndrome resulting in fluid overload. Breathing difficulty & Acute pain are not generally associated with Cushing's syndrome.
Which findings should the nurse expect to find in a patient with Addison's disease? 1.) Weight gain & loss of skin pigment 2.) Fatigue & muscle weakness 3.) Hypertension & hyponatremia 4.) Increased appetite & hypokalemia
2, Manifestations of adrenal insufficiency or Addison's disease include fatigue, muscle weakness, weight loss, hyperpigmentation, hyperkalemia, hyponatremia, decreased appetite and hypotension.
duration of post-icteric phase
2-12 weeks
when must a percutanoues transluminal coronary angioplasty be done within s/s?
2-3 hours
Central Venous Pressure (CVP)
2-6 mmHg norm
duration of jaundice for icteric
2-6 weeks
icteric phase
2-6 weeks, jaundice, increased RUQ pain, pruritus, brown foamy urine, light brown stool, assess sclera and skin
When auscultating the abdomen of a client with an AAA, the nurse hears a bruit. How should the nurse interpret this finding? 1.) Normal finding 2.) Reflects a partial arterial occlusion 3.) Indicates a collection of fluid in the lungs 4.) Shows an inflammation of the pericardial surface
2. A bruit is a vascular sound that reflects partial arterial occlusion. This is not a normal finding. Fluid in the lungs is called crackles. Inflammation of the pericardial surface causes friction rub.
A client is at risk of developing cardiogenic shock. Which is a presenting symptom of this condition? 1.) ↓ HR 2.) ↓ Cardiac index 3.) ↓ BP 4.) ↓ Cerebral blood flow
2. A client's Cardiac index is used to identify if their CO is meeting the client's needs. Cardiac index, BP, and Cerebral blood flow are less useful in determining the risk of cardiogenic shock.
A nurse teaches a client with acute coronary syndrome about coronary blood flow. Which statement, made by the nurse is correct? 1.) Most of the blood flow to the coronary arteries is supplied during inspiration 2.) Most of the blood to the coronary arteries is supplied during diastole 3.) Blood flow to the coronary arteries is related to breathing patterns 4.) coronary arteries receive most of their blood flow from systole
2. Although the coronary arteries receive a minute portion of blood from systole, most of the blood flow is supplied to the coronary arteries during diastole.
A client is scheduled for testing to Dx an AAA. What is the most definitive test for this condition? 1.) Abdominal x-ray 2.) Aortogram 3.) CT scan 4.) Ultrasound
2. An aortogram accurately and directly depicts the vasculature, and clearly delineates the vessels and abnormalities. An X-ray will only show the AAA if it is calcified. CT scan and ultrasound don't give a direct view of the vessels therefor don't yield as an accurate Dx.
The nurse is performing an admission assessment with an AAA. For which comorbidity should the nurse assess? 1.) Diabetes Mellitus 2.) HTN 3.) Peripheral vascular disease 4.) Syphilis
2. HTN causes continuous pressure on vessel wall --> weakened walls --> an aneurysm. DM is not directly related. Peripheral vascular disease is loosely linked to aneurysms. Only 1% of clients with syphilis experience an aneurysm.
The nurse is caring for client with DI. What is the nurse's priority intervention? 1.) Watching for signs and symptoms of septic shock 2.) Maintaining adequate hydration 3.) Checking weight every three days 4.) Monitoring urine for specific gravity over 1.030
2. Maintaining fluid intake is essential and the client with DI. The client is at risk for developing hypovolemic shock because of increased urine output. Weight should be measured daily to monitor fluid balance. Urine specific gravity should be monitored for low osmolarity generally less than 1.005, due to the body's inability to concentrate urine.
A client is involved in an MVA. Upon admission to the emergency department, the client's heart rate was 130 BPM, with shallow respirations of 32 breaths/min, a blood pressure of 90/60 mmHg. The breath sounds were diminished on the right side, and paradoxical chest wall movement appears on the right side. A chest X-ray reveals in pneumothorax with multiple rib fractures. What diagnosis would the nurse anticipate for this client? 1.) Tension Pneumothorax 2.) Flail chest 3.) Ruptured diaphragm 4.) Massive hemothorax
2. Next for bed fractures in paradoxical chest pain comment would confirm a diagnosis of flail chest. Diaphragm shift would have bowel sounds in the middle chest. Tension pneumothorax would have severe respiratory distress. A massive hemothorax would have signs and symptoms of shock.
The nurse is caring for a AAA Pre-Op client. The nurse understands that this client is most at risk for? 1.) HTN 2.) Aneurysm rupture 3.) Cardiac arrhythmias 4.) Diminished pedal pulses
2. Rupture of the aneurysm is a life-threatening emergency and is the greatest concern for this client. HTN should be avoided because it can ---> to rupture. Cardiac arrhythmias are not directly linked to an aneurysm. Diminished pedal pulses are a sign of poor circulation to the lower extremities, and are associated with an aneurysm but are not life-threatening.
The nurse assessing a client with an AAA is most concerned when the client presents with: 1.) Lower back pain, ↑BP, ↓ RBCs, ↑WBCs 2.) Severe lower back pain, ↓BP, ↓RBCs, ↑WBCs 3.) Severe lower back pain, ↓BP, ↓RBCs, ↓WBCs 4.) Intermittent lower back pain, ↓BP, ↓RBCs, ↑WBCs
2. Severe lower back pain indicates a rupture, secondary to pressure being applied within the abdominal cavity. When there is a rupture, the pain will continue until the rupture is fixed. BP & RBCs are decreased because from the blood loss d/t aneurysm rupture. WBCs increases because they migrate to the site of the injury.
The nurse is planning care for a patient with Addison's disease. What outcome is appropriate for the nurse to include in this patients care plan? 1.) Fluid intake of less than 1000ml a day 2.) Participating in daily relaxation techniques 3.) Ambulating in the hall 5-6 times per day 4.) Choosing low sodium foods
2. Stress can precipitate an Hypotensive crisis w/ a patient w/ Addison's disease. So therefore a client has to learn ways to identify and cope with stressors.
cardiac workup
EKG, locate ischemia, echo, cardiac enzymes, cardiac cath
The nurse is preparing a client for chest tube insertion in the upper right chest. What is the priority role of the nurse? 1.) A nurse isn't required. 2.) Preparing the chest tube drainage system. 3.) Bringing the chest X-ray to the client's room. 4.) Inserting the chest tube
2. The nurse must anticipate that a drainage system will be required, and the system readied prior to chest tube for immediate connection following insertion. The chest X-ray need not be brought into the client's room. A train provider will insert the chest tube.
A patient who experienced an MI tells the nurse that he is fearful of dying. Which statement by the nurse will help to validate this patient's feelings? 1.) "Tell me more about your fear of dying." 2.) "It must be very frightening to be told that you have had an MI." 3.) "Facing death would certainly be a frightening experience for me." 4.) "Please be assured that we are doing everything possible to prevent you from dying."
2. The nurse should validate this patient's feelings by acknowledging his fear. This provides the patient with a sense of being understood, and demonstrates empathy.
Which information should the nurse include in the teaching plan of a patient diagnosed with Cushing's syndrome? 1.) ↑ dietary sodium 2.) Physical changes are disease related 3.) ↑ fluid intake is important 4.) Restrict dietary protein
2. The patient may have disturbed body image related to fat redistribution, "moon face", truncal Obesity, "buffalo hump", acne, striae, hirsutism. So explaining theses physical changes can help to address theses feelings. Patients w/ Cushing's syndrome should ↑ protein, ↓ sodium intake, and fluids are often restricted.
A client, scheduled to have a ventilation-perfusion scan, asks good nurse to explain the tests. The nurse tells the client that the test will help diagnose a pulmonary embolism and provide information about: 1.) Amount of pleural surface and oxygenation present 2.) Extent of occlusion in amount of perfusion loss 3.) Location and size of pulmonary embolism 4.) Presence of perfusion and atelectasis abnormalities
2. The ventilation perfusion scan will provide information on the extent of occlusion caused by the pulmonary embolism in the amount of column tissue involved in an area not refused. It does not address the amount of coral surface and oxygenation present, the size of pulmonary emboli, or the presence of perfusion and atelectasis abnormalities.
AST
20-100 x the normal value
range for bundle branch/purkinjie fibers
20-40
idoventricular rhythm
20-40 bpm
Sinus Bradycardia
HR <60
Sinus Tachycardia
HR >100
HCO3 normal range
21-28
HCO3
22-26, metabolic
diagnosis of addison's disease
24 hour urine and lab work
what is the peak time for DTs?
24-48 hours after no alcohol
max cuff pressure
25
treatment for positive and negative schizophrenia
2nd gen - risperidone, clozapine
beta blockers decrease what
HR and blood pressure
non sustained vtach
3 beats - 30 seconds
non-sustained ventricular tachycardia
3 beats to less than 30 seconds
acute stress disorder length vs. PTSD
3 days to 4 weeks after event, PTSD over 3 months
A client with reports of acute chest pain radiating down the left arm was admitted to the telemetry unit. Which lab studies should the nurse order to evaluate myocardial damage? (SELECT ALL THAT APPLY) 1.) Hgb & Hct 2.) Serum glucose 3.) Creatinine phosphokinase (CK-MB) 4.) Troponin T & troponin I 5.) Myoglobin 6.) BUN
3, 4, 5. Levels of CK-MB, troponin T, and troponin I rise because of cellular damage. Myoglobin elevation is an early indicator of myocardial damage.
A nurse is monitoring a client for manifestations of cardiac tamponade. Which finding would support this dx? (SELECT ALL THAT APPLY). 1.) Bradycardia 2.) Hypertension 3.) Restlessness 4.) Muffled heart sounds 5.) Widened pulse pressure 6.) Distended neck veins
3, 4, 6. Cardiac tamponade is a medical emergency. Symptoms of cardiac tamponade include elevated venous pressure, distended neck veins, Kussmaul's sign, hypotension, narrowed pulse pressure, tachycardia, dyspnea, anxiety, cyanosis of the lips & nails, and muffled heart sounds.
A client diagnosed with Addison's disease is concerned about dark areas of skin around his knees and elbows. The nurse's best response would be: 1.) "This finding is not related to Addison's disease. I will refer you to a dermatologist." 2.) "This skin change is related to your medication therapy, and should subside in a few weeks." 3.) "This is related to hormonal changes caused by Addison's disease." 4.) "This change is related to sun exposure and should not be a concern."
3, Addison's disease causes melanin stimulating hormone (MSH) levels to elevate as the pituitary gland is stimulated. This results in areas of increased pigmentation. There is no damage to the skin so therefore there is no reason to see a dermatologist.
when is depression most intense
3-4th day post op, promote self-care
A client with a Hx of cardiac problems is concerned that he may incur a MI. What sign would alert the nurse that this client may be developing this acute condition? 1.) Hoarseness 2.) Pink, foamy sputum 3.) Indigestion 4.) Swelling of the feet and ankles
3. A sensation, often described as heartburn, is commonly associated with an impending MI.
A client, scheduled for a pneumonectomy asked the nurse how the thoracic cavity will be filled. What is the nurse's best response: 1.) The space remains filled with air only 2.) The surgeon fills the space with a gel 3.) Serous fluid fills the space and consolidate the region 4.) The lung tissue from the remaining lung grows in this space
3. And then immediate postoperative period air and serous fluid fill the space. Eventually the area consolidates, preventing extensive mediastinal shift of the heart and remaining lung. Air can't be left in the space. There's gel that can be placed in the pleural space. The tissue from the other lung can't cross the mediastinum, although it temporary mediastinal shift exists until the space is filled.
A client who is 48hr post MI is most at risk for developing? 1.) Cardiogenic shock 2.) Heart failure 3.) Arrhythmias 4.) Pericarditis
3. Arrhythmias, caused by oxygen deprivation to the myocardium, is the most common complication of MI.
A client with an AAA is admitted to a step-down unit. The nurse should intervene Immediately if this client experiences: 1.) A migraine-like headache 2.) Cramping in the legs 3.) Sudden, severe back pain 4.) Diaphoresis
3. If expansion and impending of an AAA is suspected, the nurse should assess for acute & severe pain in the back or lower abdomen, which may radiate to the groin. No other options indicate a change in client's status.
The nurse is asking auscultating the lungs of a client following chest tube insertion. What assessment finding would indicate correct chest tube placement? 1.) Bronchial sounds heard at both bases 2.) Vesicular sounds heard over the upper lung fields 3.) Bronchovesicular sounds heard over both lung fields 4.) Crackles heard on the affected side
3. If the tube is inserted correctly, normal bronchovesicular breath sounds should be heard in the client's oxygenation status should improve. A chest X-ray should be done to ensure re-expansion and all other sounds are abnormal.
Bradydysrhythmias
HR below 60
A client's BP is 126/80mmHg. How would the nurse interpret this client's MAP and organ perfusion? 1.) Organs are in danger of ischemia and perfusion pressure is critically low 2.) Organs are at risk of insufficient perfusion and perfusion pressure is borderline low 3.) Perfusion pressure is adequate to meet organs' perfusion needs 4.) Perfusion pressure minimally meets the organ's
3. MAP= 126mmHg + 2(80 mmHg) ----------------------------- 3 286mmHg ----------- = 95mmHg 3 Normal MAP is 70-110, therefore the organs are being adequately perfused
The nurse is educating a patient about the long-term management of CAD. What information should the nurse include? 1.) The need to have cardiac cath. done every year 2.) The use of coronary artery bypass surgery as a preventative measure 3.) Daily PO aspirin to prevent blood clots 4.) The need to have a percutaneous coronary intervention with routine cardiac cath.
3. PO aspirin would be the initial long-term Tx for CAD to prevent coronary blood clots.
A nurse is providing education to a patient with Addison's disease. What should be included in the nurse's teaching? 1.) Low-sodium diet 2.) Decrease fluid intake 3.) Wear a Medic-Alert bracelet 4.) Taking daily cortisone on an empty stomach
3. Patients with Addison's disease should wear an aler bracelet to inform health care providers of possible Addisonian crisis.
A nurse is caring for a client with hypovolemic shock. Which findings should the nurse expect to assess? 1.) BP 132/85, HR 116, Urinary Output of 45ml/hr, and warm skin 2.) BP 149/92, HR 59, Urinary Output of 57ml/hr, and cold skin 3.) BP 87/58, HR 123, Urinary Output of 20ml/hr, and clammy skin 4.) BP 91/62, HR 99, Urinary Output of 35ml/hr, and pale skin
3. S/Sx of hypovolemic shock would include altered LOC, oliguria, hypotension, tachycardia, tachypnea, cool, pale, and clammy skin.
The nurse is assessing the abdomen of a client with a possible abdominal aneurysm. Where should the nurse palpate to determine this condition? 1.) Right upper quadrant 2.) Directly over the umbilicus 3.) Middle lower abdomen to the left of the midline 4.) Middle lower abdomen to the right of the midline
3. The aorta lies directly left of the umbilicus therefore, the rest of the locations are inappropriate for palpation.
The nurse anticipates that the priority Tx for a client with a spontaneous pneumothorax is: 1.) Antibiotics 2.) Bronchodilators 3.) Chest tube insertion 4.) Hyperbaric chamber
3. The only way to re expand a lung is to place a chest tube so air in the pleural space can be removed in the long re expanded. And I biotics and bronchodilators would have no effect on lung reexpansion, nor would placing the client in a hyperbaric chamber.
A client's ABG results are pH: 7.16, PaCO2: 80mmHg, HCO3: 24 mEq/L, and SaO2: 81%. Based on these values this client is showing signs of? 1.) Metabolic Acidosis 2.) Metabolic Alkalosis 3.) Respiratory Acidosis 4.) Respiratory Alkalosis
3. pH= Acid 7.35-7.45 Alk PaCO2 = Alk 35-45 Acid HCO3 = Acid 22-26 Alk SaO2= 80-100
A client tells the nurse that his chest tube has been accidentally. What is the most appropriate action by the nurse? 1.) position the client on the left side 2.) Position the client on the right side 3.) Apply in occlusive dressing over the site 4.) Reinsert the chest tube that fell out
3. to prevent this client from sucking air into the pleural space and causing a pneumothorax and occlusive dressing should be applied over the hole. The health care provider should be called, and the client checked for signs of respiratory distress. Positioning the client on either the left or right side won't make a difference. The old tube should not be reinserted because it's not sterile.
normal and severe serum albumin levels
3.5-5 - severe malnutrition below 2.5
how long should the HOB be elevated after eating and drinking?
30 min
peak lithium time
30 min - 4 hours
Cushing syndrome is most common in
30-50 y.o. female=male
Nutrition with hepatitis
3000 cal/day low fat diet monitor fluid retention with daily weight and abdominal girth
PaCO2 normal range
35-45
PaCO2
35-45, respiratory
A client w/ symptoms of acute asthma is ordered IV aminophylline 350mg in 100ml to be administered over 30min. The nurse has vials of the medications are labeled 250mg/5ml. How many ml of fluid was the ordered dose? (Round to a whole number) ________ml
350mg 5ml -------- X --------- = 7ml 1 250mg
how long do you have to be off warfarin for surgery
4 days
what do you have to physical have to be considered panic disorder
4 or more - palpations, sweating, tremors, SOB, chest pain, nausea, sense of suffocation, dizziness, hot flashes, chills, paresthesia, abdominal distress
What is an appropriate treatment measure for a client with Addisonian Crisis? 1.) IV fluid replacement 2.) IV corticosteroids 3.) Blood glucose management 4.) All and the above
4, All of these answers are first-line treatment measures during Addisonian Crisis
how long does crisis last?
4-6 weeks, resolved by returning to pre-crisis function
A client with SOB has decreased to absent breath sounds from the apex to the base of the lung on the right side. How would the nurse interpret this finding? 1.) Acute asthma 2.) Chronic bronchitis 3.) Pneumonia 4.) Spontaneous pneumothorax
4. A Spontaneous pneumothorax occurs when the client's lung collapses causing an acute decrease in lung function. A sudden collapse will cause chest pain and SOB. Wheezes will be heard with asthma. Ronchi will be heard with bronchitis. Pneumonia will have bronchial breath sounds.
A nurse is planning care of a client with cardiogenic shock. What is the priority outcome for this client? 1.) Correct hypoxia 2.) Prevent infraction 3.) Correct metabolic acidosis 4.) Increase myocardial O2 supply
4. A balance between O2 supply and demand must be maintained. The demand for O2 increases during shock therefore requiring more oxygen. Without more O2 the effects of shock will increase. Increasing O2 will correct metabolic acidosis, and hypoxia. Infraction normally causes the shock state, therefore preventing isn't appropriate.
The nurse is caring for a post operative client who has undergone surgical removal of the pituitary gland and has now developed diabetes insipidus. The nurse should assess for: 1.) hypertension and bradycardia 2.) Glucosuria and weight gain 3.) Fluid overload and hyponatremia 4.) Severe dehydration and hypernatremia
4. A client with diabetes insipidus excretes high volumes of urine, even without fluid replacement. Limiting fluid intake will cause severe dehydration and hypernatremia. A client undergoing a fluid deprivation test may experience tachycardia and hypotension. Weight loss, and normal urine glucose levels are common in client w/ DI. Fluid overload and hypernatremia are signs and of syndrome inappropriate antidiuretic hormone (SIADH).
The nurse is assessing a client that was given an opioid analgesic. What ABG value would indicate that this client is at risk for respiratory failure. 1.) PaCO2 15 mmHg 2.) PaCO2 30 mmHg 3.) PaCO2 40 mmHg 4.) PaCO2 80 mmHg
4. An ABG of 80 mmHg would indicate retained CO2. To have Respiratory arrest there is an inefficient ventilation and the retention of CO2.
A patient was just admitted to the ED for evaluation of a possible MI. Which diagnostic intervention would be the nurse's priority intervention? 1.) Cardiac catheterization 2.) Cardiac enzymes 3.) Echocardiogram 4.) Electrocardiogram (ECG)
4. An ECG is the quickest, most accurate, and most widely used tool to determine the location of MI.
The nurse is aware that a client with Cushing's syndrome is at risk for: 1.) Hypoglycemia& dehydration 2.) Hypotension & hyperkalemia & hyperglycemia 3.) Hyponatremia & dehydration 4.) Hypertension & heart failure
4. An ↑ mineralocorticoid activity w/ Cushing's syndrome results in a retention of NA & H2O, which commonly contributes to HTN and heart failure.
A nurse is teaching a client about lung cancer. The nurse determines that teaching was effective when the client states that which is the primary cause of lung cancer? 1.) genetics 2.) occupational exposures 3.) pipe smoking 4.) cigarette smoking
4. As many as 90% of clients feeling sated with one cancer smoke cigarettes. Cigarette smoke contains several organ-specific carcinogens. There may be a genetic predisposition for the development of lung cancer. Occupational hazards, such as pollutants, can cause cancer. Pipe smokers inhale less often than cigarette smokers and 10 to develop cancers of the lip and mouth.
A nurse is caring for a client diagnosed with diabetes insipidus. Which laboratory value is the most important for the nurse to monitor? 1.) Glucose 2.) Hemoglobin 3.) Creatinine 4.) Sodium
4. Diabetes insipidus occurs as a result of decreased release of ADH, which disturbs fluid and electrolyte balance, especially sodium. Twice daily posting Meyer for hypernatremia
A client receives midazolam, 2mg IV, as sedation before bronchoscopy. 5 minutes after administration his respiratory rate drops to 4 breaths/minute. What is the nurse's most appropriate action? 1.) Administer naloxone 2.) Administer protamine sulfate 3.) Administer phentolamine 4.) Administer flumazenil
4. Flumazenil reverses the effects of benzodiazepines such as midazolam. Naloxone is used to reverse opioids such as morphine. Protamine sulfate reverses the effects of heparin. Vital told me is injected into the tissues to reverse the damage effects of dopamine infiltration.
The nurse is caring for a client who has had a chest tube inserted for the treatment of pneumothorax. Which assessment finding best indicates to the nurse that the chest tube is no longer needed? 1.) There's minimal damage from the chest tube 2.) ABG results are within normal range 3.) the client states he is not experiencing dyspnea 4.) no fluctuation in the water seal chamber occurs when no suction is applied
4. One indication of lung re-expansion is the cessation of fluctuation in the water seal chamber when suction isn't applied. Drainage should be minimal before chest tube is removed. An ABG analysis may be done to ensure proper oxygenation but isn't necessary if other clinical assessment criteria are met. A chest tube isn't removed until the client's lung has adequately free expanded and remains expanded.
What is the nurse's most important tool for monitoring the severity of the shock state? 1.) ART line 2.) Indwelling urinary catheter 3.) ECG monitor 4.) Pulmonary artery catheter
4. Pulmonary artery catheter will give accurate pressure measurements within the heart, that help determine the course of Tx. ART line, Indwelling urinary catheter, and ECG monitor will provide valuable information related to the shock state but aren't the most important tools.
A nurse is obtaining assessment data from a client with possible lung cancer. The nurse is most concerned if the client exhibits which symptom? 1.) Dizziness 2.) generalized weakness 3.) hypotension 4.) recurrent plural effusions
4. Recurring episodes of pleural effusions can be caused by a tumor and should be investigated. Dizziness, generalized weakness, and hypotension art typically considered warning signs, but may occur in advanced stages of cancer.
A nurse is caring for a client who has just returned to the unit following a lobectomy here during assessment, the nurse is aware that the lobectomy site: 1.) remains empty. 2.) Is filled with gel by the surgeon 3.) Is filled with serous fluid 4.) Is filled by overexpansion of the remaining lobes
4. The remaining load or lobes over expand slightly to fill the space previously occupied by the tissue that has been remove. The diaphragm is carried higher on the operative side to further reduce the empty space. The surgeon doesn't use gel to fill the space. Serous fluid overproduction would compress the remaining lobes and diminish their function possibly causing a mediastinal shift.
A client, diagnosed with a large benign lung tumor asked the nurse how it will be treated. What is the nurse's best response: 1.) The tumor is treated with only radiation therapy 2.) The tumor is treated with chemotherapy only 3.) The tumor is left alone unless symptoms are present 4.) The tumor is removed with the least possible amount of tissue
4. The tumor is removed to prevent further compression of lung tissue as the benign tumor grows. If the tumor can't be removed, then radiation or chemotherapy may be used to reduce the size of the growth.
Following a motor vehicle collision, a client has a chest tube inserted in the left upper chest. The two begins to drain dark red fluid. What does the nurse determine? 1.) The chest tube was inserted improperly 2.) This is an expected result for this client 3.) An artery was nicked when the chest tube was placed 4.) The client is experiencing a hemothorax
4. This client has a hemothorax, in which blood collection causes a lung to collapse. The placement of a chest tube will drain blood from the space and re expand the lung. And intercostal artery can be next during chest tube insertion, but the risk is minimal if the provider placing the tube is specifically trained. The initial chest X-ray would confirm the presence of blood, or air in the pleural space.
A client displays signs associated with a possible aneurysm rupture. What is the priority nursing intervention? 1.) Administer prescribed Antihypertensives 2.) Prepare the client for an aortogram 3.) Administered Beta-adrenergic blockers 4.) Prepare client for surgical intervention
4. When the vessel ruptures, prompt surgery is required for its repair. Antihypertensives & Beta-adrenergic Blockers can help prevent aneurysm rupture by controlling HTN. An aortogram is used for the Dx of an aneurysm.
pH
7.35-7.45
pH normal range
7.35-7.45
A client's ABG analysis reveals a pH: 7.81, PaCO2: 73mmHg, PaO2 of 82mmHg, HCO3 of 24 mEq/L. How would the nurse interpret these values? 1.) Metabolic acidosis 2.) respiratory alkalosis 3.) metabolic alkalosis 4.) respiratory acidosis
4. pH= Acid 7.35-7.45 Alk PaCO2 = Alk 35-45 Acid HCO3 = Acid 22-26 Alk SaO2= 80-100
The nurse is admitting a client newly diagnosed with Cushing's syndrome. What Lab values would the nurse expect to find? 1.) ↓ sodium & ↓ glucose 2.) ↓ cortisol & ↓ glucose 3.) ↑ cortisol & ↓ sodium 4.) ↑ cortisol & ↑ sodium
4. ↑ glucose, sodium, and cortisol are found with patients who have Cushing's syndrome.
The nurse is assessing a client who is displaying the earliest sign of shock. What is the finding that the nurse would report? 1.) Cyanosis 2.) ↓ Urine output 3.) Heart sound present at S4 4.) Altered LOC
4. ↓ CO --> ↓ cerebral blood flow --> restlessness, agitation, confusion. Cyanosis, S4 heart sound, and ↓ urinary output are all later signs of shock.
range for AV node
40-60
range for bundle of his
40-60
Junctional Rhythm
40-60 bpm - no p wave or inverted
how long does narcan last?
45 min
major depressive disorder s/s
5 or more symptoms within 2 week period - inability to problem solve, weight change, sleep change, eating change
how long does it take for lithium to start working?
5-14 days
how long does wash out take between medications when switching?
5-6 weeks to wash out
how long should you wait between switching antidepressants and why
5-6 weeks to wash out, can cause serotonin syndrome
how early should antiplatlet inhibitors (aspirin, plavix) be stopped before surgery
5-7 days before surgery
Partial/hemi laryngectomy
50% of larynx removed, localized tumor/remove tumor and surrounding tissue
What is a normal ejection fraction?
50-70%
normal ejection fraction
50-70%
How long is every strip
6 seconds long
how long is antibiotic treatment for lung abscess
6-12 weeks
complications of fulminant hepatitis
6-8 weeks after symptom onset, occurs when you have hep B with hep D
range for SA node
60-100
Fulminant hepatitis
75% mortality the liver fails to regenerate, necrosis beyond repair coexistance of hep B and D requires a liver transplant
PaO2 normal range
80-100
hep c
90-95% blood transfusions, no vax, liver cancer, cirrhosis
adventitious crisis
911, missing child, rape, murder
SaO2 normal range
95-100%
Normal QT
= or < 1/2 R-R
prolonged QT
> 1/2 R-R
how long does delusional disorder last
>1 month
altered ALT- alanine aminotransferase
>1000 u/L
ALT
>1000u/L
diagnosis of schizophrenia
>6 months of psychotic thinking or behaviors, increased positive symptoms
s/s of pheochromocytoma
BP 300/200 or higher, palpitations, visual disturbances, sweating, headache
ABCCC cardiac failure
A; airway B; breathing C; circulation C; cervical spine C; consciousness
2 posterior hormones
ADH and oxytocin
what level remains elevated when ALT and AST return to normal?
ALP - alkaline phosphatase
Q wave created by
AV node
Side effects of fibrates
Abdominal pain, headache, nausea, constipation, CK elevates, abnormal LFT's
Pancreatic complications
Abscess pseudocyst ascites pleural effusion
adrenocortical insufficiency
Addison's disease
How to administer loop diuretics
Administer furosemide IVP slowly and watch for signs of ototoxicity. Do not admin concurrently with aminoglycoside antibiotics
Examples of potassium sparing diuretics
Amiloride, spironolactone, triamterene
Examples of calcium channel blockers that lower blood pressure only
Amlodipine, felodipine, isradipine, nicardipine, nifedipine
paroxysmal supraventricular tachycardia (SVT)
HR greater than 150
Post-op pheochromocytoma
BP fluctuations, arrhythmias, give corticosteroids, tendency for hemorrhagic problems
brady dysrhythmia characteristic
HR less than 60, regular PR and QRS
What is cardiac output?
HR x SV
Medications for acute pancreatitis
Antacids H2 antagonists PPI antispasmodics analgesics
amiodarone
Antiarrhythmic
lidocaine
Antiarrhythmic
Cluster C personality disorders
Anxious, fearful, insecurity, and inadequacy avoidant, dependent, obsessive compulsive
causes of ventricular tachycardia
CAD, MI, structural heart disease, HTN, RHD, cardiomyopathy, scar tissue
Causes of third degree AV block
CAD, inferior wall MI, electrolyte disturbances
when can PEEP not be used?
CAN NOT BE USED in patients with highly compliant lungs - COPD, hypovolemia, low cardiac output
pt can not do what with total laryngectomy
CAN NOT TALK
where is CPR done with larynectomy
CPR via stoma, medical alert bracelet
asystole t/x
CPR, IV/IO, epi 1 mg every 3-5 min, H&T's
cardiac output
HR x SV
Examples of bile acid sequestrants
Cholestyramine, colestipol, colesevelam
suppression
Consciously and intentionally pushing unpleasant feelings out of one's mind
Side effects of calcium channel blockers
Constipation, dizziness, palpitations, fatigue, headache, nausea, rash, flushing, swelling in feet and lower legs
What constitutes one heartbeat
Contraction and relaxation of the heart
what should be done if an NG tube accidentally become misplaced
DO NOT reinsert, notify physcian
How is major depressive disorder diagnosed?
DSM, 5 or more symptoms within a 2 week period
self soothing behaviors
Dermatillomania (skin-picking) Onychophagia (nail biting) Trichotillomania (hair pulling)
maturational crisis
Developmental events requiring role change - wedding, birth, retirement
Examples of positive inotropes
Digoxin
Cardiac Glycosides
Digoxin increase force of the heart
Examples of calcium channel blockers that lower blood pressure and heart rate
Diltiazem and verapamil
Side effects of nitrates
Dizziness, headache, flushing/redness of face and neck, n/v, hypotension, arrhythmia
Parameters for digoxin
Do not give if hr is below 60
Side effects of ARB's
Dry cough, dizziness, fatigue, upset stomach, headache, edema, diarrhea
Side effects of ACE inhibitors
Dry cough, dizziness, headache, fatigue, stomach upset, angioedema
how is adenosine pushed?
FAST
Side effects of beta blockers
Fatigue, weight gain, cold hands and feet, dizziness, depression, nausea, hypotension, trouble sleeping
Example of fibrates
Fenofibrate
Side effects of nicotinic acid
Flushing/redness of the skin on the face and neck, itching, headache, dizziness, diarrhea
Side effects of thiazide diuretics
Frequent urination, diarrhea, loss of appetite, headache, hair loss, muscle spasms, constipation
Examples of loop diuretics
Furosemide, torsemide, ethacrynic acid, bumetanide
treatment of esophageal fistula
G-tube, J-tube, small bore feeding tube used, monitor for healing
Risk factors for hepatic encephalopathy
GI bleeding High protein diet electrolyte imbalance
symptoms of preicteric phase
GI symptoms, wt loss, malaise, arthralgia, "flu-like" symptoms, mild RUQ pain
preventative measures/post exposure of hep D
HBIG vaccine - hep B therapy
what will myocarditis lead to?
HF and arrhythmias
what should happen if a leak occurs post op microsurgery
HOB elevated, bedrest 72 hours, antibiotics
what do we watch when suctioning?
HR
vtach
HR 170 or higher
Side effects of potassium sparing diuretics
Headache, heartburn, loss of appetite, n/v, diarrhea
Side effects of bile acid sequestrants
Heartburn, gas and bloating, diarrhea, nausea, muscle aches and pain
Hep A prevention
Hep A vaccine Immune globulin therapy for post-exposure
Hep B prevention
Hep B vaccine Immune globulin therapy for post-exposure
Hep D prevention
Hep B vaccine Immune globulin therapy for post-exposure
Examples of thiazide diuretics
Hydrochlorothiazide, metolazone chlorothiazide
What do statins treat?
Hypercholesterolemia and hypertriglyceridemia. prevention of heart attacks and strokes.
causes of torsades de pointes
Hypokalemia, hypomagnesemia, tricyclic antidepressant drug overdose, use of antidysrhythmic drugs
H & T's
Hypovolemia Hypoxia Hypo/Hyperkalemia Hypothermia Hydrogen Ion (acidosis) Toxin Tamponade Tension pneumo Thrombosis
nursing care SIADH
I&O, frequent neuro checks, HOB no more than 10 elevation, declomycin, lithium
second degree AV block - mobitz 2
If the P's don't get through - secondary to a disease involving the His-purkinje system
Endocrine disturbances cirrhosis
inability to inactivate hormones
word salad
Incoherent mixture of words, phrases, and sentences
Use of positive inotropes
Increase contractility of the heart
Pulmonary hypertension
Increase in blood pressure in pulmonary arteries
T wave
Indicated repolarization of the ventricular myocardial cells
Malingering Disorder
Intentionally pretending to be sick or injured to avoid work or responsibility
What do ACE inhibitors treat?
Interfere with production of angiotensin 2 resulting is vasodilation, reduced blood volume, and prevention of its effects in the heart and blood vessels. In HF they reduce afterload and improve cardiac output and renal blood flow.
which tube provides least risk for aspiration?
J tubes, bypass the stomach
when are CABG's done?
L main coronary artery 70% stenosis, 50% of all 3 vessels, severe ventricular dysfunction, diabetes
7 anterior hormones secreted
LTH, GH, TSH, FSH, LH, ACTH, MSH
Follow up with hepatitis
Labs are continued for a year after they return to normal
Examples of ACE inhibitors
Lisinopril, captopril, benazepril, enalapril, ramipril
HDL levels
Low: <40 High: >60
compensatory stage
MAP falls 10-15 mmHg, circulating blood volume decreases 1000 mL, compensatory mechanism maintain BP
intermediate or progressive shock
MAP falls 20 or more, compensation does not work, low pH, excessive lactic acid production, decrease CO, AMS, decrease urine output, if not treated rapidly, prognosis is poor
Early, reversible and compensatory stages of shock
MAP less than 10 mmHg of normal levels, increase HR = increase C.O, if minor injury- arterial pressure usually maintained
if the BP of a patient with brady dysthymias is not adequate, what can it lead to?
MI, ischemia, or infection
causes of cardiogenic shock
MI, restrictive pericarditis, cardiac surgery complications
cocaine and amphetamines withdrawal s/s
MI, stroke, coma, death, dilated pupils
what MUST be ready before succinylcholine chloride (anectine) is administered?
MUST be ready to intubate, clarify they are ready before administering
MAOIs
Marplan, Nardil, Parnate
Fibrinolytic therapy
Medications are used to break us a clot that could be dangerous/life threatening.
Examples of beta blockers
Metoprolol, carvedilol, propranolol
R & S wave created by
Purkinje fibers
What do bile acid sequestrants do?
Reduce LDL cholesterol levels. Prevents cardiac events.
symptoms of major depressive disorder
inability to problem solve, weight loss/gain, hypersomnia/insomnia, etc
precaution for theophylline
NEVER given IVP, dilute and give slow
total laryngectomy nutrition
NG tube (do not resinsert if misplace), oral feeding 10-14 days, thick fluids, good oral care, monitor weight, no swallowing
what can not be done with torsades de point?
NO cardioversion - must defibrillate
Pre-op ERCP (endoscopic retrograde cholangiopancreatography)
NPO and check for allergy to dye
What meds may be used before or during bronchoscopy?
NPO to prevent aspiration, sedative (versed, fentyl), atropine (dry secretions), xylocaine (gag reflex, suppress cough)
Post-op ERCP (endoscopic retrograde cholangiopancreatography)
NPO until gag reflex is present observe for abdominal pain, fever, chills, hypotension, tachycardia, & n/v
post procedure checks for endoscopic retrograde cholangiopancreatography
NPO until gag reflex present, observe for abdominal pain, fever, chills, hypotension, tachycardia
post op laryngoscope
NPO until gag reflex returns (1-2 hr), observe for resp difficulties, pain, swelling, apprehension, expectorating blood
post op for direct laryngoscopy
NPO until positive gag reflex, vitals every 15 min, must have a driver
How to decrease pancreatic stimulation and rest the organ
NPO with/without NG suction when allowed, advance diet as tolerated (low fat high carb)
diet for pancreatitis
NPO, advance diet as tolerated - clear, full, low fat, high CHO
pancreatitis diet
NPO, then clear, full, low fat, high CHO
crystalloid solutions
NS, LR, D5
GI symptoms of pancreatitis
NV, guarding/rigidity w/rebound tenderness jaundice foul smelling, oily stool hypoactive bowels
Side effects of aspirin
Nausea, vomiting, stomach pain, heartburn
Examples of nitrates
Nitroglycerin, isosorbide dinitrate, isosorbide mononitrate
Hep C prevention
No vaccine available
Hep E prevention
No vaccine or post-exposure med available
Atrial rate
Number of P waves seen
Ventricular rate
Number of R waves seen
Obessions vs Compulsions
Obsessions - intrusive, persistent uncontrollable thoughts, urges or images Compulsions- impulse to repeat certain behaviors or mental acts to avoid distress (what gives temp relief)
steps for pt with MI
Oxygen Nitrates Aspirin Morphine
second degree heart block mobitz 1 wenckebach
P gets further and further from QRS
junctional rhythm
P wave inverted, rate 40-60
Premature Junctional Contraction (PJC)
P wave inverted, rate usually <100
PAC vs. PJC vs. PVC
PAC: extra firing in atrium, has P wave PJC: extra firing around AV, inverted P wave PVC: extra firing in ventricle, no P wave
what will tell you if a patient is in first degree heart block?
PR interval above 0.2 - usually asymptomatic
what disease is chronic in nature with periods of exacerbations during increased stress?
PTSD
indications of respiratory failure - level of PaO2, PaCO2, pulse ox
PaO2 below 50, PaCO2 above 45, pulse ox below 85%
Nursing care with hepatitis
Pain medications used cautiously to not worsen cirrhosis
sinus arrest
Pause in EKG
What does it mean if the T waves are greater than 1/2 the height of QRS complex
Peaked
Use of aspirin
Platelet aggregation inhibitor, also can treat acute coronary syndrome, acute thromboembolic stroke
What do potassium sparing diuretics do?
Prevent sodium reabsorption, prevents excretion of potassium and decreased retention of water preventing hypokalemia. Used in the management and treatment of hypertension and HF
P wave created by
SA node
what is the pacemaker of the heart?
SA node
causes of sick sinus syndrome
SA node disease or dysfunction
manifestations of large pleural effusion
SOB, absent breath sounds over fluid area
criteria for placing a pt back on a vent
SOB, coughing, inability to exacerbate secretions, vital signs
What does elevation of ST mean?
STEMI
anaphylactic shock
Severe allergic reaction
SADPERSONS
Sex Age Depression Previous attempt Ethanol abuse Rational thinking loss Single, divorced, widowed Organized plan No spouse Stated future
agnosia
inability to recognize objects
What is the ejection fraction?
Stroke volume divided by end-diastolic volume
method of choice for patients ventilated for a short period of time (<2 days)
T-piece trials
Administration of bile acid sequestrants
Take with meals, high fiber diet, and plenty of water.
obstructive shock
Tension Pneumo, Cardiac Tamponade, arterial tumor or clot, abdominal distention
What do fibrates treat?
They treat hypertriglyceridemia and hypercholesteremia by inhibiting triglyceride synthesis.
What do beta blockers treat?
Treat hypertension, angina, heart failure, and cardiovascular event prevention/protection.
What do calcium channel blockers treat?
Treat hypertension, heart failure, and angina by inhibiting calcium ion reflux into vascular smooth muscle and myocardium
What does nicotinic acid treat?
Treats hypercholesterolemia, hypertriglyceridemia, and high-density lipoprotein deficiency by activating the nicotinic acid receptor.
situational crisis
Unanticipated Death, divorce, termination of a job, illness
What do loop diuretics treat?
Used in the management and treatment of fluid overload conditions such as HF, nephrotic syndrome, or cirrhosis, and hypertension. Promote potassium excretio
What do thiazide diuretics treat
Used in the management and treatment of hypertension and heart failure. Promote potassium excretion
What do nitrates treat?
Vasodilator used to treat and manage angina and other cardiovascular diseases
Pruritus
a build-up of bile salts that causes severe itching
hemothorax
a collection of blood in the pleural cavity
early signs of supraglottic or extrinsic cancer
a lump in throat, pain or burning while drinking hot liquids or orange juice
dysthymic disorder
a mood disorder involving a pattern of comparatively mild depression that lasts for at least two years
obsession
a recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses
Peritonitis symptoms
abdominal tenderness rigidity on palpation
s/s of peritonitis
abdominal tenderness with rigidity on palpitation
What is automaticity?
ability of pacemaker cells to put electrical impulses
wide QRS
above 0.12
what should systolic BP be to promote good cardiac output?
above 90 (MAP 65)
how does schizophrenia appear?
abrupt or insidious
risk factors of conversion disorders
abuse, acute stressful event, female, comorbid psychiatric disorder, first degree relative
conversion disorder risk factors
abuse, recent stressful event, female, comorbid psychiatric disorders
encephalopathy stage 3 stuporous
abusive when aroused, difficult to arouse, rigidity
delirium
acute altered mental statue, can be reversed, caused by underlying condition
use of albuterol
acute asthmatic attacks
medication s/e
acute dystonic reactions, akathisia, Parkinsonism, tardive dyskinesia, seizures, neuroleptic malignant syndrome
Hepatitis
acute inflammation of the liver caused by viruses, toxins, or bacteria
delirium
acute, can be reversed, treat underlying cause - ativan and haldol to sedate if causing harm
what do you do if tube is occluded by pt bitting ET tube
add bite block
how should hallucinations be addressed?
address directly, but dont agree
how to address hallucinations
address directly, do not agree, assess for paranoia
if all treatments fail for possible causes to assess for, what should you do?
administer neuromuscular blockers such as propofol and versaid
causes of cushing syndrome
adrenal tumor, prolonged cortisone therapy, ectopic ACTH
ACTH
adrenocorticotropic hormone (stimulates secretion of adrenal cortical hormones)
teaching to avoid
aerosols, boating, swimming, sitting in water
cardiomyopathy
affect heart muscle itself, acquired or hereditary
when is IV administered narcan most effective?
after 2-5 min
acromegaly
after epiphyses closes, adults, increase connective tissue, cartilage, growth and thickening of hands, feet, face with visual hallucinations
When does neuroleptic malignant syndrome occur
after first dose of medication or shortly after starting meds
coronary artery bypass grafting considerations before surgery
age, co-morbities, pulm function
Nonmodifiable risk factors for CAD
age, gender, familly, history
immediate treatment of cardiac failure
aggressive resuscitation, oxygen support, restore fluid volume, seal chest with 3 corner taping, drain fluids in pleural cavity
encephalopathy stage 2 impending
agitation, asterixis, fetor hepaticus (smell of old urine)
3 categories of phobias
agoraphobia, specific, social
tension pneumothorax
air accumulation in pleural cavity producing increased pressure - tx with chest tube
risks for total laryngectomy with radical neck dissection
airway obstruction, carotid artery rupture, skin flap and graft necrosis
reasons for impaired ventilation
airway obstruction, respiratory disease, neurological disorder, chest wall injury
Antabuse use
alcohol
Pancreatitis is caused by
alcohol abuse gallstones (biliary tract related is most common) post-op complications bacterial infections
etiology of acute pancreatitis
alcohol abuse, cholecystitis (gallstones), post op complications, bacterial infections
Naltrexone use
alcohol and opioid dependence
Treatment of cirrhosis
alcohol cessation increase protein and carbs, low fats medication paracentesis
Acamprosate use
alcohol use disorder
delirium tremors
alcohol withdraw, shaking, vomiting, increase pulse, sweating, AMS (need to be hospliatized), 24-48 hr peak after no alcohol
Etiology of acute pancreatitis
alcohol, cholecystitis (gallstones), post op complications
3 types of cirrhosis
alcohol, post hepatic, biliary
stressors predisposing to laryngeal cancer
alcohol, tobacco, poor nutrition, HPV, occupational pollutants
catharsis
alleviate or increase feeling of anger
synchronized IMV
allows for spontaneous breathing by pt, but if pt fails, minimum # of breathes are given
what should always be available when a pt is intubated?
ambu bag and mask
what should be kept in sight with trach
ambu bag and mask
green, low priority triage
ambulatory patients, isolated abrasions, contusions, sprains
treatment for controlling rate of a fib
amioderon
Hepatic encephalopathy
ammonia intoxication the liver is unable to convert blood ammonia to urea to detoxify
patho of hepatic encephalopathy
ammonia intoxication, liver unable to convert blood ammonia, brain is highly sensitive
aphasia
inability to speak
tidal volume
amount of air delivered with each breath (add a zero to pt KG weight)
what is measured on the vertical line?
amplitude (voltage)
Dx of acute pancreatitis
amylase > 500 after 12-24 hours lipase elevated after 48 hours
Abnormal lab values in acute pancreatitis
amylase >500 high serum lipase increased glucose low calcium high bilirubin high WBC high AST
What labs increase with pancreatitis
amylase, lipase, WBC, bilirubin, glucose
Dx of chronic pancreatitis
amylase/lipase multiple specialized tests to challenge gland function ERCP
what is given before shock with a synchronized cardioversion?
analgesia
Spleen damage causes
anemia (decreased platelets) leukopenia thrombocytopenia
indications for ET tubes
anesthesia, O2, short term mech vent, allows for deep suctioning
thoracic ascending AA symptom
angina pain
meds used for anxious people
anixolytics - xanax, Valium, Librium, clozapine
aspirin
anti-platelet aggression inhibitor - not a blood thinner
Diazepam use
antianxiety, hypnotic, used to sedate, induce sleep, and decrease anxiety
nursing care for lung abscess
antibiotic compliance, high protein and calorie diet, coughing and deep breathing, mouth care 2-3 hrs
treatment of empyema
antibiotic, drain fluid (thoracentesis, chest tube, thoracotomy), cough and deep breath to prevent fibrothorax
treatment for abscess complication
antibiotics, drain
treatment for preventing stroke in a fib
anticoagulant
meds for personality disorders
antidepressants, anxiolytics, antipsychotic, mood stabilizers
Cluster B personality disorders (dramatic, emotional, erratic)
antisocial, borderline, histrionic, narcissistic
Use of Benzodiazepines
anxiety
level 1
anxiety, use one or more psychological ego defense mechanisms
t/x generalized anxiety disorder
anxious longer than 6 months - buspirone, SSRI
heart block
any interference or delay in passage of impulses from SA node through the purkinje fibers
how are thoracic aneurysms diagnosised
aortogram, ultrasonography, CT, chest xray, transesophogeal echocardiographs
anomie or anomy characteristics
apathy, alienation, anxiety, personal disorientation and distress resulting from loss of social norms and goals previously valued
3 A's of dementia
aphasia, apraxia, agnosia
what should you do if tubing is occluded by pt is biting on ET tube?
apply a bite block
what should be done if a patient experiences bleeding post op
apply continuous direct pressure
Cluster C personality disorders (anxious, fearful)
avoidant, dependent, obsessive-compulsive
s/s of symptomatic aortic aneurysm
back pain, flank pain, abdominal pain, pulsating mass, GI bleeding, decreased/absent peripheral pulses
aggression management; trigger phase
approach in nonthreatening, convey empathy, move to quiet area, PRN med, suggest physical activity
main question to consider with hypercapnia
are they easy to arouse?
5 p wave questions
are they there? occurring regularly? one p for every QRS? are they smooth, round, and upright? do they all look similar?
fibrothorax
area of empyema walled off by fibrous tissue - encapsulating. if whole cavity involved and chronic, fibrous peel forms over visceral pleura and prevents lung expansion
risk for supraglottic/conservation laryngectomy
aspiration or bleeding
pre op surgery
assess and mark pulses, correct F&E imbalances, H&H, clotting, never vigorously palpate abdomen
post op care for arteriography, embolectomy, angioplasty
assess circulation, fluids given, do not remove dressing, pressure dressing at site, HOB slightly elevated, may feel knot under skin for 5-7 days
post op - surgical procedures
assess for hemodynamic instability, decreased circulation to lower extremities, renal dysfunction, GI, dysfunction, F&E imbalances, lungs, wound infection, decrease CO, log roll, no crossing legs,
how would you know if an ET tube slips down into one bronchus?
assess lungs bilaterally for diminished lung sounds, get a chest x-ray
nursing role of 12-lead
assess patient, identify lethal rhythms
when an alarm sounds, what is your top priority action?
assess- start simple first
hep d
associated with hep b, HBIG vax, chronic hep, cirrhosis, fulminant hep
where should an ET tube be?
at the lipline, and stay at the same measurement
what can under ventilation or respiratory acidosis lead to?
atelectasis
statin meds for CAD
atorvastatin, simvastatin, pravastatin, lovastatin, rosuvastatin
Examples of statins
atorvastatin, simvastatin, rosuvastatin, pravastatin, and lovastatin
what rhythm puts a patient at risk for a blood clot and stroke?
atrial fibrillation
causes of addisons disease
atrophy of gland, tumors, surgical removal, chemo, trauma, anticoags, open heart
treatment for slow rhythm junctional rhythms
atropine and pacing
serotonin syndrome s/s
autonomic instability, hypertension, diarrhea, agitation
post op femoral popliteal or femorotibibial graft
avoid flexion of knees or hips, avoid elevation of legs above heart, check pulses, walking program 4-6x a day, 7P's, no crossing legs, anticoag therapy
d/c instructions for pneumo
avoid increase pressure in lungs, valsalva, excessive activity
what does humidification prevent
crustation
what MUST be done if a speaking valve is attached to a cuffed trach?
cuff must be deflated - no room for air to escape
if a pt needs mechanical ventilation, what must be used
cuffed tube
what type of tube must be used if mechanical ventilation is needed?
cuffed tube - CAN NOT USED CUFFLESS WITH MECH VENT
metal tube
cuffless double lumen - permanent trach
adrenal cortex
cushing's disease
trouble breathing with sengstaken-blakemore
cut balloon ports and pull out
if a pt is having trouble breathing with a balloon tamponade (sengstaken-blakemore) , what should you do
cut the balloon parts and pull the tube out
Alcoholic (Laennec's) Cirrhosis
d/t having 1 or more pints of liquor or 12 pack per day along with malnutrition
Post hepatic cirrhosis
d/t massive necrosis of toxins the liver is large and nodular then decreases in size and function
patch graft
dacron or vein is sewed to edges of artery that has been split open
how should fluid retention be monitored
daily weight and abdominal girth
nursing care for cushings
daily wt, assess for edema
who is likely to develop hep A
day care workers, water treatment employers, people in 3rd world countries
when is digoxin held
day of
how long can manic/depressive episodes occur?
days, weeks, months - not duration, different for everyone
black, no triage
dead, those with minimal chance of surviving, massive head injuries, 95% coverage of third degree burns
s/s of diabetes insipidus
decrease BP, increase HR, increase thirst, poor skin tugar, low urine gravity
S/S of anaphylactic shock
decrease BP, resp. distress, abdominal cramps, constriction of smooth muscle, bladder, uterus, bronchioles
vasodilators
decrease CO, decrease oxygen need, amniorone, nitro
Use of Bile Acid Sequestrants
decrease LDL
hypovolemic shock causes
decrease circulating blood volume, decrease diastolic filling, dehydration, acute pancreatitis, burns, nasogastric suctioning, vomiting, diarrhea, pleural effusions, diabetes
hypotension can occur from
decrease fluid volume, blood loss, meds
H2 antagonists
decrease hydrochloric acid stimulation famotidine (Pepcid) ranitidine (Zantac)
PPI
decrease hydrochloric acid stimulation pantoprazole (Protonix) omeprazole (prilosec) esomeprazole (Nexium)
effects on body - respiratory
decrease oxygen levels, increase carbon dioxide, respiratory acidosis, ARDS, increased resp rate
When ammonia is high in the blood
decrease protein in the diet
high amonia = what type of diet
decrease pts protein in diet
measures to help prevent development of cancer of the laryx
decrease smoking, alcohol, fume exposure, voice abuse, and voice use with chronic laryngitis
effects on body - renal
decrease urine output, renal failure, renal hypoperfusion, decrease GFR
indications the lung has reexpanded
decreased fluctuation for some time before; chest x-ray, good bilateral breath sounds, fluid often rises in tube with no tidaling
Hematologic disorders
decreased production of clotting factors (prothrombin and vit K) bleeding tendencies prolonged PT time (normally 12.5)
hematologic disorders lead to what
decreased production of clotting factors - bleeding tendencies and prolonged PT - anemia, leukopenia, thrombocytopenia
Huntington's disease
inherited, dementia eventually
s/s of rheumatic heart disease
fever, chest pain, heart murmur, WBC increase, joint pain, skin lesions
Neuroleptic Malignant Syndrome s/s
fever, muscle rigidity, AMS, autonomic dysfunction, seen after 1st dose or shortly after starting meds
Neuroleptic Malignant Syndrome
fever, muscle rigidity, altered mental status
s/s of neuroleptic malignant syndrome
fever, muscular rigidity, altered mental status, and autonomic dysfunction
manifestations of lung abscess
fever, weakness, productive cough with foul smelling breath, dyspnea, weight loss, anorexia
resistance stage
fight or flight
panic anxiety
fight, flight, or freeze - adrenaline surge, pupils widen
panic anxiety
fight, flight, or freeze response; pupils dilate
transudate
filtrate of plasma, occurs normally, usually reabsorbed, normal biproduct with altered reabsorption
communication with pt that have personality disorder
firm, supportive, limit setting, assertive
risk factors or somatic disorders
first degree relative, decreased serotonin or endorphins, depressive disorder, personality or anxiety disorder, childhood trauma, female 16-25
treatment for positive schizophrenia
first gen - halodol (po,IM) prolixin (IM,SQ), depot shot every 4 weeks
Q wave
first negative deflection
S wave
first negative deflection after R wave
R wave
first positive deflection
somatic disorder risk factors
first relative, decreased serotonin or endorphins, depressive personality or anxiety disorder, childhood trauma. abuse/neglect, female 16-25
radiation treatment for cancer of larynx
first treatment choice for early cancer, used for early glottic or intrinsic cancer affecting one cord
Gray Turner's sign
flank bruising
negative symptoms - normally present with schizophrenia
flat affect, algoria (mumbled response), anergia (no energy), anhedonia (lack of joy), avolition (lack of motivation)
negative symptoms (normal) schizophrenia
flat affect, algoria, anergia, anhedonia, avolition
alterations in speech - flight of ideas, neoglisms, echolalia
flight of ideas - each sentence is different neoglisms - made up words echolalia - repeating words
replacement of aldosterone (mineral corticoid)
florinef - 3xwk
treatments of hypovolemic shock
fluid blood replacement, O2, mechanical ventiliation, dopamine, legs elevated, control bleeding
pulmonary edema
fluid in the lungs
pleural effusion
fluid in the pleural space usually secondary to another problem
high central venous pressure indicates
fluid overload, vasoconstriction, cardiac tamponade
if hypotensive, post aortic dissection what should be done
fluid resuscitation and immediate surgery
Treatment of Diabetes Insipidus
fluids, I&O equal, monitor urine specific gravity and serum osmolarity
treatment of aortic dissection
focus is pain control, reducing BP, decrease left ventricular ejection velocity, morphine IV, nitroprusside, verapamil, diltiazem
FSH
follicle-stimulating hormone (ovarian follicles and spermatogenesis)
Prevention of toxic hepatitis
follow chemical instructions monitor liver functions on certain drugs avoid wild mushrooms
treatment for tracheal malacia
fome cuff
s/s of tracheal, esophageal fistula
food being suctioned up
overproduction of growth hormone can lead to
gigantism and acromegaly
histrionic treatment
give choices in care, incorporate wishes, approach formally
treatment approach for passive-aggressive and dependent personalities
give pt explicit directives rather than ask, encourage to make easy decisions
vasopressin
given at end of water deprivation test, causes reduced urine output and increased urine osmolality
BIG sign of suicide
giving their things away
2 endocrine substances secreted in pancreas
glucagon and insulin
regression
going back to a safe time
what prevents nosocomial pneumonia?
good trach care and suctioning
bypass graft
grafts attatched above and below blockage
s/s of pancreatitis
grey turners (flank bruise), cullings sign (belly bruise), 3rd spacing
GH
growth hormone or somatotropin (growth of all tissue and protein synthesis)
what should be assess with schizophrenia
h/s of schizophrenia, suicidal ideations, current support system, their perception of the current situation
assessment for OCD
h/s, thought process, self-concept, roles, self-care considerations
Trichotillomania
hair pulling
positive symptoms (not normal) schizophrenia
hallucinations, delusions, altered speech, bizarre behavior
positive symptoms - not normally present with schizophrenia
hallucinations, delusions, altered speech, bizarre behavior
first generation antipsychotics for positive symptoms
haloperidol, prolixin, depot injection q4weeks
antipsychotic drug and s/e
haloperidol, s/e; muscle rigidity and parkinsonian
unstable angina/acute coronary syndrome
happens at rest, over 10 min, can lead to inverted T waves, at risk of MI
stable angina
happens on excertion, less than 10 min
stable angina
happens on exertion, less than 10 min
what should you do if a patient extubates themselves?
have a bag prepared and nearby - reintubate
what should be asked before administering nitro?
have they taken viagra?
s/s of panic disorder
have to have 4 or more, palpations, sweating, tremors, SOB, chest pain, nausea, sense of suffocation, dizziness, hot flashes, paresthesia, abdominal distress
risk factors of SIADH
head injury, brain tumor, encephalitis, meningitis, chemo, small cell lung cancer, anesthesia, acute infections
Injection sclerotherapy to treat esophageal varices
injection of a sclerosing agent into the esophageal varices to promote thrombosis
Causes of Left Bundle Branch Block
heart attack, cardiomyopathy, myocarditis, hypertension
rheumatic heart disease
heart disease caused by rheumatic fever (infection)
Digoxin use
heart failure, atrial fibrillation
atrial flutter/fib RVR
heart rate above 100
what may be effected by albuterol that should be check before administering?
heart rate/pulse
Sodium Bicarbonate
heartburn, indigestion
atypical antipsychotics
help with aggressive and impulsive behaviors - olanzapine, ziprasidone
bleeding s/s total laryngectomy
hemopytsis, neck swelling, expectoration of blood, excessive JP drainage
carotid endarterectomy post op concerns
hemorrhage, resp distress, cranial nerve damage, hyper/hypotension
cardiac tamponade can occur medical from
hep reversal, coagulopathy, hypothermia
Viral hepatitis
hepatocyte damage d/t inflammation altered cell function inflammation impaired bile flow can lead to jaundice
Causes of viral hepatitis
hepatocyte damage, altered cell function, inflammation, impaired bile function - jaundice due to inflammation
K+, BS, Na, and Cl for addison's disease
high potassium low BS, Na, Cl
Diet for Addison's disease
high protein, high salt, high complex carbs - avoid fast sugar
what is the high risk of using PEEP with patients where it is contraindicated?
high risk of barotrauma (ruptured lung)
whats the risk of putting a pt on peep with highly compliant lungs
high risk of barotrauma (ruptured lung)
bp with underdamping
high sys/low dia
voice quality of laser surgery
hoaresness
assess laryngeal nerve
hoarseness, difficulty swallowing and speech
thoracic transverse AA symptom
hoarseness, dysphagia
3 thiazide meds
hydrochlorothiazide, metolazone, chlorothiazide
t/x of vessel erosion
hyper inflate cuff, prepare for surgery, check VS
hyperactive adrenal cortex
hyperfunction increased BS, NA, BP, WBC decreased potassium, Ca truncal obesity, thin extremities, osteoporosis, fat deposits, bruises, petechiae
s/s of cushing syndrome
hyperglycemia, irritability, moon face, Na and fluid retention, thin extremities, gynecomastia, fat deposits, GI distress, thin skin, striae, bruises, petechiae, osteoporosis, buffalo hump, increase infection risk, high BS
treatment for vessel erosion
hyperinflate cuff, maintain VS, prepare for surgery, notify HCP
what do peaked T waves mean?
hyperkalemia or new ischemia
effects on body - cardio
hyperkalemia, weak thready pulse, dysrhythmias
adverse effect of epi
hypertension
Causes of aneurysms
hypertension, arteriosclerosis, atherosclerosis, trauma
preventing hypoxemia
hyperventilate them with 3 breathes or 100%, limit suction to 10-12 sec, keep suction pressure 80-100, NO NS prior to suctioning
addisons disease
hypofunction increase potassium low NA, BS, BP, Cl weight loss, body hair changes, weakness, dehydration
paradoxical movement
injured portion moves opposite of normal - pulls in with inspiration, pushes out with expiration
s/s of SIADH
hyponatremia, anorexia, n/v, abd cramps, finger print edema, input higher than output, sudden wt gain without edema, lethargy, seizures, dilute blood, concentrated urine
diabetes insipidus
hyposecretion of ADH
adverse effect of propofol
hypotension
s/s of decreased CO
hypotension, fatigue/weakness, EKG changes, edema, dizziness, reduced urine output, cold clammy skin, AMS
causes of second degree heart block - mobitz 1 wenckeback
hypotension, shock, pulmonary congestion, CHF, angina
alarm stage
hypothalamus to adrenals release adrenalin
H - factors to pulseless arrest (PEA, asystole, VT, VF)
hypovolemia, hypoxia, hydrogen ion, hypo/hyperkalemia, hypothermia
H - factors to pulseless arrest
hypovolemia, hypoxia, hypothermia, hypo/hyperkalemia, hydrogen ion
low central venous pressure indicates
hypovolemic shock
Treatment of cardiogenic shock
if MI, intra-aortic balloon pump, dopamine, thrombolytic therapy
decortication
if fibrothorax occurs, decortication done. lung is freed by blunt dissection of fibrous peel
when can a trach tube be deflated?
if no mechanical ventilation is needed, cuff can be deflated for eating/drinking
treatment for wenckeback
if symptomatic - 1. monitor if stable 2. atropine 1 mg, every 3-5 min - up to 3 mg 3. external transcutaneous pacing 4. epinephrine 5. dopamine
characteristics of 3rd degree block
if the P's and Q's don't agree - more P waves than QRS, PR varies, QRS normal, no P-Q relationship
when is a patient hospitalized for DTs?
if the withdraw causes altered mental status
what does serum bilirubin levels show impairment of?
impaired bile flow
Apraxia
impaired motor function
apraxia
impaired motor functioning
Prolonged PT is associated with
impaired vitamin K
what does prolonged PT impair?
impaired vitamin K
teaching for at home
importance of smoke detector d/t diminished taste and smell, watch for s/s of recurrent coughing, hemoptysis, dyspnea
epinephrine
improve breathing, stimulate heart, raise BP
use of digitalis
improve pumping action of the heart
where should clamps be kept
in plain sight
what is refractoriness?
inability of cardiac cells to respond to stimuli - pause between lub and dub
Anhedonia
inability to experience pleasure
anterolateral thoracotomy
incision below breast
S/S of septic shock
increase HR and resp rate, decrease systolic BP, AMS, fever, SOB, infection
digitalis
increase blood pressure
Fluid resuscitation
increase cardiac output and organ perfusion
what does epinephrine do in the body?
increase heart rate and blood pressure
diagnosis of gigantism/acromegaly
increase in glove, ring, hat size, growth hormone, glucose levels, CT, MRI
causes of sinus arrhythmia
increase in vagal tone, digitalis toxicity, morphine
vasoconstrictions
increase perfusion and CO - epi, norepi, vasopressin
treatment for inadequate minute volume
increase rate/volume
altered AST - aspartate aminotransferase
increased 20-100x normal
s/s a patient is having difficulty breathing
increased HR, nasal flaring, gasping, anxiety, using accessory muscles
pancreatitis complication -abscess s/s
increased WBC, fever,
s/s of ascites
increased abdominal girth, increase serum amylase without pain
serum lipase
increased after 48 hrs, remain elevated for 7-14 days
Altered viral hepatitis labs
increased bilirubin increased ESR decreased albumin levels (low protein synthesis)
a/e and considerations that occur with glucosteroids
increased blood sugar, insomnia - do not stop abruptly
Stage 2 (impending)
increased drowsiness disorientation inappropriate behavior mood swings asterixis (uncontrolled hand movement) fetor hepaticus (breath smells of old urine) sleeps a lot, but easily aroused
stage 2 - impending
increased drowsiness, disorientation, inappropriate behavior, mood swings, agitation, asterixis, fetor hepaticus (foul urine smell), sleep most of the time
s/s of tension pneumo
increased dyspnea, cyanosis, tachycardia, JVD, asymmetrical chest movement, decreased breath sounds
hyperthermia can occur from
increased metabolism and oxygen need
s/s of tracheal malacia
increased need for larger amount of air to seal cuff
what can low calcium cause?
increased neuromuscular irritability possibly leading to seizures
how to keep airway clear with vents
increased secretions are normal when new, clean every shift, use fluids/humidification to keep secretions thin
isuprel
increases heart rate
decrease in autonomic hyperactivity med
inderal
medication considerations for treating panic disorder
individualized based on patients, start with lowest dose for older adults, never stop meds abruptly, must have follow up care
SIRS risk factors
infections, immunocompromised
acromegaly complications
infertility, diabetes, increased lipid levels, cardiac disease, increased BP
what does erythrocyte sedimentation rate show?
inflammation
endocarditis
inflammation of middle of heart, t/x antibiotics
myocarditis
inflammation of the heart muscle
endocarditis
inflammation of the middle of the heart
pericarditis
inflammation of the outer layer of the heart
increased WBC is due to what
inflammatory process
would a trach cuff be inflated or deflated for absent swallowing reflex?
inflated
would a trach cuff be inflated or deflated for mechanical ventilation?
inflated
intra-aortic balloon pump
inflates during systole, deflates during diastole, done before CABAG, decreases afterload, myocardial oxygen demand
intra-aortic balloon pump
inflates when the heart is receiving blood, deflates when blood pumped out
aggression management; crisis phase
inform pt is out of control, staff taking control, use restraints
where is the inner cannula of an ET tube placed?
into outer cannula
where is the outer cannula of an ET tube pplaced?
into stoma
curiass, pulmowrap, iron wrap negative-pressure vents
intubation not required, fit tightly around thorax and abdomen specific to pts body
specific phobia
irrational fear of a particular object or situation
s/s of ventricular fibrillation (V-fib)
irregular rhythm, LOC, no pulse, BP, or heart sounds, cyanotic
blocks below the bundle of his may be due to?
ischemia or scarring
yellow, medium priority triage
isolated simple femur fracture
key manifestation of biliary cirrhosis
jaundice
s/s of post-icteric phase
jaundice subsides, malaise continues for 9 months to 1 yr, stool, urine, appetite, and labs improve
s/s icteric phase
jaundice, increased RUQ pain, pruritus, brown foamy urine, light brown or clay stool, assess sclera and skin
nursing interventions for laryngectomy
keep airway clear, elevated HOB, suctioning, deep breathing, q2h turn, avoid coughing, no respiratory depressant meds, humidification use, watch for s/s of decrease O2
Lactulose for hepatic encephalopathy
keeps ammonia in an ionized state acidifies feces and discourages bacterial growth cathartic - increases bowel movements (diarrhea)
nephrogenic diabetes insipidus
kidneys do not respond to ADH - cannot resorb water
reward seeking behavior
kleptomania (stealing) oniomania (buying) hoarding pyromania (fire setting)
reward-seeking behaviors
kleptomania - compulsive stealing oniomania - compulsive buying hoarding pyromania - fire setting
anergia
lack of energy
avolition
lack of motivation
encephalopathy t/x
lactulose, eliminate protein
what should be observe for with extubation
laryngeal spasms - wheezing
what should be observed for after extubation?
laryngeal spasms -wheezing or stridor
Post OP total Laryngectomy
laryngectomy tube, suctioning need, NG tube, avoid swallowing, deep breathing, avoid coughing
TIA
last less than 24 hours
sustained vtach
lasting more than 30 seconds
post icteric phase
lasts 2-12 weeks, jaundice subsides, malaise and weakness continues for 9 month - 1 yr, stool, urine, appetite, labs improve
Pre-icteric
lasts for 1-3 weeks before the onset of jaundice GI symptoms, anorexia, NV, weight loss, malaise, arthralgia weakness, flu-like symptoms mild RUQ pain
Post-icteric
lasts for 2-12 weeks jaundice subsides malaise is always present stool and urine return to normal appetite improves labs improve
Icteric
lasts for 2-6 weeks jaundice, RUQ pain pruritus, brown foamy urine light brown or clay stools grayish/white in appearance
hypopopituitarism
lesion or destructive process in or near pituitary
narrow QRS
less than 0.06
LDL levels
less than 100, diabetic less than 70
triglyceride levels
less than 150 mg/dL
cholestrol level
less than 200
addisons disease is most common in
less than 60 y.o. females
s/s of hypopopituitarism
lethargy, fatigue, apathy, intolerance to cold, weakness, loss of libido, impotence, infertility
where should an ART line be in level with?
level of the heart
procaimade
life threatening arrhythmias
treatment of hypopopituitarism
lifelong replacement with adrenal cortoids and thyroid hormones, sex and growth hormones
symptoms of ventricular tachycardia
lightheadness, palpations, chest pain
mood stabilizer drug
lithium
prognosis of hep C
liver cancer and cirrhosis
prognosis of hep B
liver cancer, chronic hep B
Chronic active hepatitis (CAH)
liver destruction continues with hep B or C can develop cirrhosis increased risk of liver cancer
diagnosis test for portal hypotension
liver function test and biopsy
diagnosis of cirrhosis
liver function test, liver biopsy
carotid artery angioplasty
local sedation, stent in carotid, neuro and cardio monitored
3 beta blocker meds
lol - metoprolol, carvedilol, propranolol
first degree block
long PR interval
First degree AV block
long PR interval >0.20 sec
tx of addison's disease
long term use of cortisone/hydrocortisone (done by 4pm), NEVER run out, always keep on person
avoidant treatment approach
look for signs of depression, trusting relationship, make them known of upcoming procedures, inform pt when and when not you will be available
PAC characteristics
looks like an extra beat, irregular rhythm, comes right after T wave and starts another P
neurogenic shock s/s
loss of vasomotor control, increase CO, hypotension, slow pulse, decrease urine output, decrease body temp
disadvantages of trach
loss of warming and humidification, ineffective coughing and increased risk of infection
support groups for total laryngectomy
lost chord club or new voice club
symptoms of manic episode
loud rapid speech - can be vulgar, decrease need for sleep, delusions, irritable
K+, BS, Na, Ca, WBC for cushing disease
low K+, Ca high Na, BS, WBC
cushing disease diet
low sodium, high potassium, low calorie, high protein, high vitamin
bp with overdamping
low sys/high dia
use of statins
lower cholesterol, CAD
use of fibrates
lower cholestrol
first sign of supraglottic cancer
lump in throat, pain/burning while drinking
adenocarcinoma
lung scarring and chronic interstitial fibrosies, mets to CNS, skeleton, adrenal glands, surgical resection
mitral valve issues backup into where
lungs
pendulum air
lungs can not expand fully (atelectasis)
LH
luteinizing hormone (ovulation and spermatogenesis)
Neoglism
made up words
top priority nursing goal for trach tubes
maintain airway
how to prevent sella turcica
no bending forward, no sneezing, coughing, brushing teeth, blowing, picking nose, no straw or valsalva
impaired diffusion
no blood flow - alveolar disorders (COPD), pulmonary edema (HF)
cognitive therapy - decatastrophizing
making more realistic appraisal of situation
revia (naltrexone) use
management of opioid/alcohol dependence
bipolar 1
manic longer, not as depressed
bipolar 1
manic longer, not as much depression
epi causes vasoconstriction, what should be done because of this? SQ and IM
massage after
epi
massage after, causes vasoconstriction leading to hypertensive crisis
hypovolemia
massive fluid loss from great vessels, cardiac rupture
red, high priority triage
massive hemorrhage, pneumothorax
post hepatic cirrhosis
massive necrosis from toxins, viral hep, or autoimmune liver larger and nodular, decrease functioning
assessment of bubbling, when does this occur continuous bubbling?
may be an air leak in system, must be found and corrected, may have a pleural source in lung
who is potentially at harm with paranoia?
may be harmful to others
Stage 4: coma
may not respond to painful stimuli absence of deep tendon reflex decerebrate posture EEG abnormal
clang association
meaningless rhyming of words
what should be done to monitor fluid status?
measure abdominal girth at same spot every time, I&O, hourly outputs
tx of mediastinal flutter
mechanical ventilation with PEEP (correct acidosis, stablizes chest wall), analgesic for pain control, avoid fluid overload
declomycin
med causing excessive urination
mediastinal flutter
mediastinum shifts back and forth, coughing impossible, atelectasis
pulmonary edema
medical emergency of excess fluid in lungs
cardiac tamponade
medical emergency of rapid collection of fluid in pericardial sac
if a patient is causing harm to themselves or others, what can be done?
medicate - Ativan or haladol
MSH
melanocyte-stimulating hormone
electroconvulsive therapy (ECT) s/e
memory loss
s/e of ECT
memory loss
effects on body - GI/hepatic
metabolic acidosis, bacterial/toxins enter abdominal cavity, ulcers may hemorrhage, paralytic ileus, increase glucose first then hypoglycemia
acute pancreatitis s/s
mild-severe constant pain, 24-48 hrs after meal or alcohol, LUQ pain, generalized jaundice, abnormal bulky foul smelling fatty stool, hypoactive bowel sounds, peritonitis
if chest tube becomes obstructed, what should you do
milking or stripping the tube
heimlich valve
mini chest tube
miteral valve repair
mitral valve access with thin tube that is guided through vein in leg to reach heart, small clip placed to help close
which second degree block has a higher risk of progressing to complete heart block?
mobitz 2
Post op paracentesis
monitor BP, HR and for S/S of shock monitor injection site nurse gets specimen to lab the disadvantage is that it removes electrolytes and proteins
post procedure paracentesis
monitor BP, HR, s/s of shock
treatment for pseudocyst complication
monitor and watch or drain via endoscopy or surgically
nursing care hepititis
monitor possible bleeding - bruising, bleeding, check H&H
what should not be done with rib fractures
no chest binding, 3-6 weeks to heal
what can not be done with an ET tube?
no eating or drinking
Types of Dysthymias for wide QRS
monomorphic VT, polymorphic VT, SVT with aberrancy
deeper the inhalation, _______ flucculation you'll see
more
characteristics of mobitz 2
more P waves than QRS, PR consistent, ORS normal
characteristics of 2nd degree block - mobitz 1 wenckeback
more P waves that get further than QRS , PR increases progressively (longer, longer, longer, drop)
advantages of trach
more comfortable, can swallow, eat, talk, drink
advantages of nasotracheal tubes
more comfortable, easily secured, unable to bite down, better oral care
flail chest
most critical injuries, automobile accidents - 3 or more ribs floating causing paradoxical movement
posterolateral thoracotomy
most painful, incision under arm to back shoulder blade
mild anxiety
motivates
fluctuating fluid level "tidaling"
movement of fluid coming out of chest
hysteria
multiple physical complaints with no organic basis
Algoria
mumbled or vague response
Side effects of statins
muscle pain and damage, liver damage, increased blood sugar or diaberes, neurological side effects
what must be ready if succinylcholine is used
must be ready to intubate
criteria for using a t-piece trial
must be stable, awake and alert, breathing without difficulty
What is excitability?
myocardial cells to respond to stimuli
what is contractility?
myocardial fibers to shorten due to stimuli
cause of idoventricular rhythm
myocardial ischemia
symptoms of mild toxicity related to theophylline
n/v, diarrhea, insomnia, restless, tachycardia
narcotic withdrawal s/s
n/v, sweating, diarrhea, insomnia, constricted pupils
manifestations of chronic pancreatitis
n/v, weight loss, diarrhea/flatus, steatorrhea, diabetes, stones in ducts
onychophagia
nail biting
revia use
narcotic addiction
carotid endarterectomy
neck artery cleaned, decreased blood supply to brain suggests transient stroke
what occurs when a cuffed tube is inflated too much?
necrosis of tissues in trachea, TE fistulas, strictures
considerations for bagging with pts that have metal tube traches
need adapter to attach ambu bag or take out metal trach and place a plastic one
what should be done to monitor increased intracranial pressure?
neuro checks every 4 hours
Post op Carotid Endarterectomy
neuro status, equal strength, speech, pupil size, assess bleeding, hypo/hypertension, HOB 30 degrees
what should never be done on long term cortisone therapy?
never stop abruptly
treatment of angina
nitrates, beta blockers, calcium channel blockers, aspirin
third degree AV block
no P to QRS relationship
treatment for PAC's
no treatment - stop underlying causes
Refractory/Irreversible stage of shock
no treatment to reverse damage, cellular damage cannot sustain life
preventative measures/post exposure of hep C
no vaccine
preventative measures/post exposure of hep E
no vaccine available, no post exposure therapy
Supraventricular Tachycardia (SVT)
no visible P wave, rate 150-260
is there an early sign of subglottic cancer?
no, most asymptotic until growth affects airway
if you have an open capsule, what should it be mixed with?
non-protein food/drink - applesauce, jello, or fruit-juice
causes of addisons crisis
noncomplient cortisone use, complications of surgery, stress on chronic addison's disease, shock, infection, dehydration
levophed
norepinephrine treat low blood pressure
normal and severe prealbumin levels
normal >15, severe malnutrition below 5
Stage 1 (prodromal)
normal LOC with periods of lethargy reversal of day & night slight tremor yawning
encephalopathy stage 1 prodromal
normal LOC, periods of lethargy
Stage 1: prodromal signs
normal LOC, periods of lethargy, euphoria, reversed day and night sleep, slight tremor, yawning
contraindications to intra- aortic balloon pump
not able to receive blood thinners, peripheral artery disease, sepsis, aortic dissection or insufficiency, L ventricle problems
When is Narcan not useful?
not effective for respiratory depression caused by hypnotics and anesthetics
U wave
not normally seen, repolarization of purkinje fibers, most commonly seen in hypokalemia
if fluctuation stops in first 24 hrs, what can this mean?
notify HCP, may have clot or blockage, lung may need reinflated
s/s of bleeding post op
observe for hemoptysis, swelling of neck, expectoration of blood, excessive drainage in JP
increased billirubin is due to what
obstruction
biliary cirrhosis
obstruction of bile duct and scarring from inflammation or severe CHF bile stasis of liver, fibrosis, jaundice
Biliary cirrhosis
obstruction of bile duct d/t scarring and inflammation bile stasis in liver causing fibrosis and liver damage jaundice
what part of an ET tube is only used for insertion?
obturator
post op thoracentesis
occlusive dressing applied, bedrest, lay on unaffected side for 1 hr, chest xray
s/s of ecchymosis
occur in 3-6 days, gray turner's sign, cullins sign, anemia, increased WBC
fine ventricular fibrillation
occurs after more prolonged arrest, more difficult to convert
coarse ventricular fibrillation
occurs immediately after cardiac arrest, better prognosis with defib
Pulseless Electrical Activity (PEA)
occurs when any heart rhythm is observed one monitor, but no pulse
when does high pressure airway occur with airway pressure?
occurs with anything that impedes air flow
when does low pressure airway occur with airway pressure?
occurs with leaks in tubing or detachment
cluster A personality disorders
odd/eccentric paranoid, schizoid, schizotypal
removal of tube
pain meds 30 min before, suture removal kit, have Vaseline gauze ready to cover hole, pt does valsalva when tube removed, air tight dressing, check SOB
key features related to anxiety disorders
panic without reason, unwarranted fear of objects, unexplained/overwhelming worry
s/s of motor conversion disorder
paralysis, seizure like movement, gait issues
mild level of anxiety
often motivates people, helps focus
people commonly seen with polymorphic ventricular tachycardia (Torsades de Pointes)
often seen in alcoholics or eating disorders
common age range for sick sinus syndrome
older adults
medication considerations
older adults start with lowest dose, do not stop abruptly, follow up care if important
how often is a full tube change done?
once a month
short term outcome of schizophrenia
ongoing, never fully recover or episodes of complete recovery
obturator
only used for insertion of trach
open pneumothorax
opening in chest wall, lung collapses
thoracotomy
opening of chest cavity
suboxone use
opioid dependence
narcan
opioid reversal, IV most effective, last 2-5 min then pt can experience decreased resp again
interventions for altered nutrition
oral feeding begins 10-14 days, check for TE, mouth care and teeth brushing, monitor weight, thick fluids, flex head forward to swallow
treatment for underproduction of gonadotropins
oral replacement
best positioning for patients with difficulty breathing
orthopneic position - edge of bed leaning over bedside table
cyclic antidepressant s/e
orthostatic hypotension and cardiac dysrhythmias
SE of tricyclic antidepressants
orthostatic hypotension, cardiac dysrhythmias - can not give with MAOI's
etiology aortic aneurysm
over 60, >3cm aneurysm, increased BP, diabetes, trauma, can read 10-12 before found
obsessive compulsive characteristics
over meticulous and perfectionistic, concerned with conformity
respiratory alkalosis is due to over or under ventilation?
over ventilation
Histrionic characteristics
overly dramatic and reactive, responds intensely, attention seeking, irrational outbursts
brady treatment
oxygen, atropine, pacing, dopamine, epi
t/x for MI
oxygen, nitrate, aspirin, morphine
Second Degree Heart Block (Mobitz II)
p wave but not QRS
second degree AV block, mobitz type 1 wenckenbach
p wave gets further from QRS until no QRS
criteria for ventilation (Pa02, FI02, PaC02, pH, resp)
pH below 7.25 PaO2: below 50, PaCO2: above 50, FIO2: above 60, resp rate above 35
levels of PaO2, PaCO2, SaO2, and ph that show acute respiratory failure
pH: below 7.3, PaO2: below 60, PaCO2; above 50, SaO2: below 90- most pt are acidotic
first treatment for third degree block
pacemaker
what should be focus with rib fractures?
pain and respiratory complications, want them C&DB
most common complication of pericarditis
pericardial effusion
causes of cardiac tamponade
pericardial effusion, trauma, cardiac rupture, hemorrhage
etiology of cardiac tamponade
pericardial effusion, trauma, cardiac rupture, hemorrhage
late sign of cyanosis
peripheral (nailbeds)
what does fluid and electrolyte imbalances cause
peripheral edema, ascites, muscle wasting due to lack of protein
Post OP total Laryngectomy
permanent trach, loss of normal speech and airway, change in smell, drainage tube
stent graft
permanent, non-collapisble tube placed in the artery after angioplasty to keep the vessel open
tumor of lungs s/s
persistent or changing cough, hemoptysis, pleural effusion, wt loss, anorexia, anemia
avoidant characteristics
pervasive and hypersensitive to rejection
moderate anxiety
physcial display
resection and replacement graft
pieces of saphenous vein, cephalic or basilic arm veins and synthetic material like teflon or dacron
Cooper Rand Electronic speech aid is
pipes sound into the mouth through small plastic tube held in corner of mouth
causes of secondary adrenocortical deficiency
pituitary disease/hypothalamus disease, long term cortisone therapy
what occurs with underproduction of growth hormone
pituitary dwarfism
how is PE drained if fluid continues to accumulate
pleurodesis
complication of bronchoscopy
pneumothorax from perforation, may complain of sore throat
how can you tell poor perfusion on a lung scan
poor uptake or cold spots
what part of the larynx is subglottic cancer?
portion below vocal cords
subglottic cancer
portion below vocal cords, mostly asymptomic until growth affects airway
positive end-expiratory pressure (PEEP)
positive pressure is maintained in the lungs at end of exhalation
problems associated with balloon tamponade(sengstaken-blakemore)
possible ulcerations or necrosis, gastric balloon rupture (asphyxiation), aspiration,
Fenestrated tracheostomy tube
precut hole in trach, pt can talk - used for weaning
maturation crisis
predictable event in the course of life - weddings, births, retirements
When is lithium contraindicated?
pregnancy - can cross placenta
lithium is dangerous for who
pregnant women, crosses placenta - stop when pregnant or breast feeding
three phases of viral hepatitis
preicteric, icteric, post-icteric
Frank-Starling Mechanism
pressure heart is under during preload
Peak Inspiratory Pressure (PIP)
pressure needed by the ventilator to deliver a set tidal volume
use of positive end-expiratory pressure (PEEP)
prevent atelectasis and reinflate collapsed alveoli
IV antiplatelet drugs
prevent blood clots
why are chest tubes placed?
remove air, fluid, or instill medication
supraglottic laryngectomy or conservation laryngectomy
remove epiglottis, hypoid bone, and false vocal cords
purpose of thoracentesis
remove fluid or air, diagnostic aspiration of pleural fluid, pleural biopsy, instill medication
aggression management; postcrisis phase
remove restraints, discuss behavior, focus on appropriate expression
Paracentesis
removes fluid from the abdomen done to relieve dyspnea and abdominal pressure sitting position
disadvantages of paracentesis
removes protein and electrolytes
complications of pancreatitis
renal failure within 24 hrs after onset, ARDS 3-7 days after onset, diabetes
decreased cardiac function leads to decreased what
renal function causing increased BUN, creatinine
if a patient is pleasantly confused, what should be done?
reorient
treatment for pleasantly confused delirium pt
reorient if not causing harm
interventions major depressive disorder
repeat what they say as a question, ask direct questions, safety first
echolalia
repeating words that are heard
what should you do if trach expulsion occurs?
replace if old - if new bad and call for help, may need to open forceps
treatment for herniation
replace tube cuff
factitious disorder (munchausen)
report physcial or psychological s/s for attention
factitious disorder (munchausen)
report physical or psychological s/s for attention
how often should the tubing be moved from side to side?
repositioned every 24 hours
postive pressure ventilation - what is require?
require intubation or trach - vent used for pt who make no respiratory efforts
tracheoesophageal puncture with blom-singer voice prosthesis "duck bill"
requires TE puncture, diverts air into oral-pharynx for speech production
passive-aggressive characteristics
resists demands for adequate functioning through indirect methods such as stubbornness
what can occur with underventiliation
resp acidosis
what can occur with overventiliation
resp alkalosis leading to low calcium and potassium producing cardiac arrhythmias and neuromuscular irritability
narcissistic treatment
respond positively to patients sense of entitlement
Medical management of hepatitis
rest the body! stop drinking, no change in diet, stop hepatotoxic drugs
what should be started after a patient is defibrillated?
restart CPR
effects on body - neurlogical
restless in early stage, altered level of consciousness
s/s of hypercapnia (increased CO2)
restless, headache, increased BP, irritable, slurred speech
treatment of addisons crisis
restore fluid volume, Na, and glucose RAPIDLY
restrictive-rare cardiomyopathy
restricts heart from stretching - stiffness
cognitive behavioral therapy
restructuring thinking
treatments for MI
revascularization procedures, intra-aortic balloon pump, ventricular assist devices, cardiac rehab
revex (nalmefene) use
reversal of opioid effects
Naloxone Hydrochloride (Narcan) use
reverse effects of opioids
RIND
reversible ischemic neurologic deficit, may last up to 1 week
most dangerous rib fractures
ribs 1-3
rib fractures with risk of liver or spleen lacerations
ribs 10-12
most common rib fracutures
ribs 5-9
Administration of pancreatic enzymes
right before or with meals do not chew wipe lips and drink after do not mix with protein-containing foods can be sprinkled on food sit up after evaluated by reduction of steatorrhea
serum amylase
rises 12-24 hrs after onset, remains elevated 3-4 days
second gen antipsychotics t/x for postive and negative symptoms
risperidone, clozapine
compulsion
ritualistic or repetitive behaviors that a person carries out continuously in an attempt to decrease anxiety, provides temporary relief
what needs to be done to monitor lithium levels?
routine blood draws every 1-3 days
spontaneous pneumothorax
rupture of blebs in COPD, weakened area of lung with exertion
interventions for major depressive disorder
safety first - ask directly if they want to hurt themselves, do they have a plan?, promote ADL's, getting up everyday, therapeutic communication
general interventions
safety, privacy, therapeutic communication, deep breathing, client and family education
monomorphic ventricular tachycardia
same waves
femoral popliteal or femorotibibial bypass graft
saphenous autograft preferred, no constrictive clothing or laying on graft side
atrial flutter
saw tooth pattern, RVR >100
atrial flutter characteristics
saw tooth wave, HR 110-150, R-R is regular, HR 60-100, P wave not identifiable, PR not measurable
Late stage cirrhosis
scar tissue fibrosis necrotic tissue decreases in size ascites appears
later stage of alcoholic cirrhosis s/s
scar tissue, fibrosis, necrosis, decrease liver size and nodular in nature
atherectomy graft
scraps the surfaces of the vessel to remove plaque, risk of stroke
main purpose of 12 - lead EKG
screen patients for possible cardiac ischemia
cuffed trach tube
seals airway, prevents aspiration
cuffed tube
seals airway, prevents aspiration
treatment for resistant OCD
second gen antipsychotics - risperidone, quetiapine, olanzapine
lithium use
sedation
use of propofol
sedation with mechanical ventilation
what should be encouraged with schizophrenia?
self care, med compliance, incorporating family
what 3 unmet needs having care result in greater sense of well-being and improved health?
self care, sexual expression, budgeting
reason for overdamping
shock absorbed, kinks, blood clots, compliance tubing
t/x of anxiety
short term anxiolytics (xanax, valum, liprium, clonipine), cognitive behavorial therapy
use of succinylcholine chloride (anectine)
short-acting paralysis used for intubating
ET tube movement
should be at lipline, if moved, can make diminished lung sounds - want chest xray, assess breath sounds
change occurring with radical neck dissection
shoulder droop
post op for total laryngectomy with radical neck dissection
shoulder droop, has drains, split thickness skin, graft over carotid artery, check graft circulation
what ability does a pt lose with a radical neck dissection
shoulder shrugging
how are pancreatic enzymes evaluated to see if they are affective?
shown by improved nutritional status, maintaining weight, and normalized stools
Surgical tx of esophageal varices
shunts tie off of varices
Manifestations of chronic pancreatitis
similar s/s to acute hx of n/v, weight loss, anorexia, decreased appetite, steatorrhea diarrhea diabetes calcification of pancreas
what puts a patient more at risk of major depressive disorder?
single, divorced people, age 15-45
what is hering breuer reflex associated with?
sinus arrhythmia
types of dysrhythmias for narrow QRS
sinus tach, a fib, a flutter, AV nodal reentry
Dermatillomania
skin picking
what is done to minimize postop infection risk
skin prep, prophylactic antibiotics, timely removal of tubes
goals for HF
slow progression, decrease workload, increase cardiac function, control fluid retention
treatment for stable atrial flutter
slow the HR (olol), treat underlying cause
true aneurysm
slow weakening of the arterial wall due to long term problems fusiform - spindle shaped, circumferential - entire diameter of vessel
how quickly does glottic cancer metastasize
slowly
rheumatic heart disease
slowly progressive valvular deformity
sodium channel blockers
slows HR
treatment of pneumo
small - monitor, large - O2 and chest xray
transoral cordectomy
small lesion on one cord removed, resection done via laryngoscope
small the #, _____ the chest tube
smaller
disadvantages of nasotracheal tubes
smaller airway, epistaxis, sinitus can develop
biggest risk factors of laryngeal cancer
smokers, 50-70 yr old males, non caucasian population
Fluid and electrolyte balance
sodium and water are retained leads to edema ascites muscle wasting
s/s of addisons disease
sodium loss, potassium retention, dehydration, hypotension, hypoglycemia, skin pigmentation, weight loss, weakness, body hair changes
meds used in COPD exacerbations- glucosteroids
solu-cortef, solu-medrol
treatment of dwarfism
somatrem and humatrope
assess hypoglossal nerve
speech difficulty, biting tongue, assess by sticking tongue out
S/S of endocrine disturbances
spider angiomas testicular atrophy/impotence gynecomastia (men with breasts) pectoral and axillary alopecia palmar erythema
cirrhosis s/s
spider angiomas, testicular atrophy, gynecomastia, pectoral or axillary alopecia, palmar erhythema
s/s of cirrhosis
spider angiomas, testicular atrophy, gynecomastia, pectoral or axillary alopecia, palmar erythema (red hands or soles of feet)
3 potassium sparing diuretics
spiralactone, triamterene, amiloride
Manifestations of portal hypertension
splenomegaly esophageal varices caput medusae (cluster of swollen veins) ascites
portal hypotension causes
splenomegaly, esophageal varices, caput medusae (veins on abdominal wall), ascites
portal hypotension
splenomegaly, esophageal varies, caput medusae, ascites
borderline characteristics
splitty, projection, denial, impulsive and unpredictable, unstable moods, inappropriate display of temper
when is nutrition started after a pt is intubated?
started around 48 hours after intubation
ventricular tachycardia
starts in lower chambers, rate 170 or higher
what technique is used for suctioning when stoma is new?
sterile technique
interventions for wound infection
sterile technique, suture line care, assess lack of circulation, good mouth care
reasons for underdamping
stiff tubing, artifact, tachycardia
thyroid disease with MI
stimulates cardiac system
vasopressin tannate
stimulates peristalsis, increase doses may cause angina, increase BP, MI
pulmonary prep
stop smoking, cough and deep breath, sternal splinting, incentive spirometry, explain ET tube and vent
preparing pt for cardiac surgery
stop smoking, treat infection and CHF, optimize renal function, blood sugar management, ABG's, vascular leg mapping
how long does it take for gag reflex to return after laryngoscope and how do you test it?
takes 1-2 hours, check by assessing swallowing or ability to gag
CK
takes longer to peak
aggression management; recovery phase
talk about situation, help relax, explore alternatives, document injuries, debrief staff
s/e of neuroleptic malignant sydrome
tardive dyskinesia - can not be reversed
use of pigtail and pilot balloon
tells if cuff is inflated
SIRS criteria
temp >100.9 <96.8, HR above 90, resp above 20, PaCO2 <32, WBC above 12 or below 4 - have to have 2 or more to meet criteria and have to have infection
post op for partial/hemi laryngectomy
temp trach 2-3 days, regain full voice, normal speech and airway after healed
post op for supraglottic laryngectomy or conservation laryngectomy
temp trach for 1 week, difficulty swallowing, coughing, expectorating secretions, tube feeding 2-3 weeks
hypothermia can occur from
temp, coagulophathy, shivering,
left ventricular assist device/LVAD
temporary, diverts blood from atrium to descending aorta to allow ventricle rest, prevent pulm edema
what is common for pts with schizoid and schizotypal patients to do that should be respected?
tend to isolate
agnosia
the inability to recognize familiar objects
if fluctuation stops in 2-3 days, what can this mean?
the lung has reexpanded
who is potentially at harm for commanding hallucinations?
the patient to themselves
Digestion is started by
the stimulation of the vagus nerve by seeing or smelling food
somatization
the transference of mental experiences and states into bodily symptoms
repression
the unconscious blocking of unacceptable thoughts, feelings and impulses
major criteria for weaning a pt
their clinical status, RR - extent of dyspnea, stable ABG's, stable VS
meds used for COPD exacerbation-xanthine derivative
theophylline (aminophylline)
therapeutic and toxic level of theophylline
therapeutic; 10-20 toxic; above 20 (severe reactions occur at 30)
how is large PE drained
thoracentesis
tx of hemothorax
thoracotomy to ligate bleeding source
TSH
thyroid stimulating hormone
use of surgical ligation for bleeding esophageal varices
ties off blood vessels
what is measures on the horizontal line?
time (rate)
PR interval
time it takes for the sinus impulse to travel to the AV node and into the purkinje fibers
wedge resection
tissue removed in section of wedge for localized lesion
how are epinephrine and dopamine titrated?
to patients response
tardive dyskinesia
tongue rolling, smacking tongue
QT interval
total time for ventricular depolarization and repolarization
T - factors to pulseless arrest
toxins, tamponade, tension pneumothorax, thrombosis
T - factors to pulseless arrest (PEA, asystole, VT, VF)
toxins, tamponade, tension pneumothorax, thrombosis
What is conductivity?
transmit impulses from cell to cell, when 1 cell is stimulated the impulse will start
contraindications of ET tubes
trauma, edema, burns of face or throat., obstruction or spasm in larynx
false aneurysm
traumatic are caused by some traumatic break ni the vessel wall versus a weakening saccular/berry - small outpouchings dissection - develops from break or tear
Magnesium Sulfate
treat and prevent low magnesium
nitrates
treat angina
potassium channel blockers
treat antiarrhytmias
dopamine
treat low BP, low cardiac output, and improve kidney flow
Colloid solutions
treat patients with shock
tachy t/x
treat underlying cause
treatment of sinus tach
treat underlying cause
PAC t/x
treat underlying causes
cautions with 2nd gen medications
weight gain, sedation, sleep disturbances, agranulocytosis
s/s of herniation
wheezing, high pressure alarm sounding
preload
when heart is filling with blood
when should a pt be suctioned with a cuffed tube?
when the cuff is deflated
when is suctioning ineffective?
when the patient is coughing, suctioning is ineffective
when cant a percutanoues transluminal coronary angioplasty be done?
when there is a 100% block
what can develop with rheumatic heart disease if heart is unable to supply enough oxygen?
will develop HF
what will occur is abscess ruptures in the lung
will develop empyema
what should be explain to expect as post-op procedures
will have laryngectomy tube, suctioning themselves, NG tube presence, avoid swallowing by suctioning or spitting, deep breath every hours, avoid coughing
what should the client due to prevent skin irritation and breakdown when taking enzymes
wipe lips
Chronic persistent hepatitis (CPH)
with hep B or C liver damage does not progress often asymptomatic but labs are abnormal
what will occur immediately with narcan?
withdrawal symptoms such as n/v, changes in heart rhythm - watch for in addicts
Water deprivation test
withheld 8-12 hrs or until 3-5% wt lost
s/s of underproduction of gonadotropines (FSH, LH)
women - infertility, decreased libido, menstral irregularity men - delayed puberty, testicular atrophy, decrease sperm count, loss of lobido
risk factor anxiety
women, younger than 45, divorced or separated, poverty
chronic pancreatitis s/s
wt loss, n/v, anorexia, diarrhea, steattorrhea
can dilated cardiomyopathy be reversed?
yes
is it normal for fluid retention to occur in patients that are vented?
yes, common in first 48-72 hours, use diuretics and check neuro exams
is it normal to have increased secretions when a tube is first placed?
yes, it is a foreign body, will slow after 4-5 days
S/S of cardiogenic shock
↑ HR, ↑ RR, ↓ BP, ↓ urinary output, restless, diaphoretic, cool/clammy skin change in mental status
