Adult 3 Final

When does the ST segment vary

when trouble with the myocardium

Medical management of altered LOC

- patent Airway (epiglottis & tongue may relax occluding airway) -Breathing (monitor resp & lung sounds) -Circulation -Nutrition (possible calorie counts needed, supplements, asst w/ feeding, TPN, gtube)

What is disparity

- unequal, as in age, rank, or degree - gaps in the quality of health & health care across racial, ethnic, sexual orientation and socioeconomic groups

Criteria for predicting severity of pancreatitis (Ransons criteria)

---Admission Age > 55, WBC > 16,000, glucose > 200, LDH > 350, AST > 250 ---w/in 48 hrs of admission Fall in Hct > 10%, BUN increase > 5, Ca+ <8, Base deficit >4, fluid shift > 6L, PO2 < 60 **add those up --the more factors the more the mortality rate (more than 6 = death)

when assessing traumatic brain injury - what s/s should RN be alert for (chart 63-2)

-Altered LOC -confusion -pupil abn (changes in size, shape & light response) -altered or absent gag reflex -absent corneal reflex -sudden onset of neuro deficits -changes in VS -vision or hearing impairment -sensory dysfunction -HA & sz

RN dx for pt having hysterectomy

-Anxiety - r/t dx of cancer, fear of pain, perception of loss of feminity -Disturbed body image r/t altered fertility & fears about sex & r'ships w/ partner -Acute pain r/t surgery -Deficient knowledge of periop aspects & post op self care

What are fomites?

-Any object or substance capable of carrying infectious organisms & transfer them from one individual to another. - Germs or parasites - Skin cells, hair, clothing, & bedding are common hospital fomites

How to protect PD cath?

-Aseptic -Sterile gloves -mask for all in room -shut door -sign on door

Bowel pattern interventions for AIDS/HIV

-Assess bowel pattern factors that may worsen diarrhea -Avoid foods that irritate - raw fruits & vegs, carbonated beverages, spicy foods, extreme temps -small freq meals

complications of cerebral angiogram (ATI)

-Bleeding -ck distal to puncture site for adequate circulation (color, temp, cap refill, pulses)

Complications of increased ICP

-Brain stem herniation -watch for cushings triad -diabetes insipidus -SIADH

What are some benign breast disorders

-Breast pain (usually based on cycle r/t hormone fluctuations) -Cysts -Fibroadenomas -Benign proliferative disease (atypical hyperplasia or LCIS)

Medical mgmt of cardiogenic shock?

-Correct underlying problem -Reduce further demands on heart -Improve oxygenation -Restore tissue perfusion

Effects of C7-C8 injury

-Full elbow extension, some finger control -Independent dressing, eating, elimination,

Nutrition for pt w/ cirrhosis (ATI)

-High carb - high protein - moderate fat - low sodium -vitamins supplement

Mgmt of cerebral aneurysm

-Prevent bleeding of unruptured aneurysm or bleeding (surgery to reinforce artery on either side - sleeve or band over aneurysm to keep from expanding or from dissection -the thinner they get, the more increased risk for rupture -hypothermia

Nursing mgmt for cardiogenic shock

-Prevent cardiogenic shock = oxygenation, decrease workload, promptly relieve angina, preserve pt energy - Frequent assessment = monitor for adventitious lung sounds & hourly I&O - Monitor cardiac rhythm - Monitor hemodynamic parameters - Monitor fluid status = prevent fluid overload & pulm edema - Titrate med drips - Continuous eval of therapy **goal is to decrease workload of heart

Nursing mgmt for ARF

-Prevent infection (avoid indwell cath, asepsis w/ invasive lines, wash hands) -Provide skin care (moisturize, treat pruritus, watch for uremic frost) -Provide emotional support (provide info, support fam, treat anxiety)

Care of the hospitalized dialysis pt

-Protect access -Precautions w/ meds & fluids (ck HR,BP & BS & fluids before meds) - insulin may need to be adjusted -Cardiac/resp complications (edema) -Uremia -Elyte levels (esp K+) -Diet -Tx pain -Pscyh suppport

Nursing care of pt getting radiation tx

-Pt & family education (limit visitors 30min - no kids - no preg visitors or RN) -Restrictions & precautions -Nutrition -Skin care -Oral care -Protection of caregivers -Safety (badges on caregivers)

What happens during dialysis

-Pt blood leaves and enters body thru 2 needles inserted into the pts access site -blood then pushed thru blood compartment of dialyzer -after blood is in dialyzer, excess fluids & toxins are pulled out and into dialysate compartment -at the same time, elytes & other chemicals in the dialysate solution move from dialysate into bloodstream

How is SVC syndrome treated

-Radiation to shrink tumor size -Chemo -Anticoags for intraluminal thrombosis -stent placement to reopen occluded SVC -surgery (less common) for vena cava bypass -supportive = O2, steroids, diuretics

Other causes of chronic renal failure

-Renal injury -Pyelonephritis -Glomerulonephritis (inflammed glomeruli) -UT obstruction (prolonged / repeated) -Polycystic kidney disease

RN care for pt w/ urinary diversion

-Routine post op care -Ostomy nurse -Infection prevention -Body image

Ways to improve oxygenation in cardiogenic shock

-in early stages, O2 administered nasal cannula at 2-6L/min to achieve O2 sat exceeding 90% -monitor ABG and pulse ox to determine if pt needs more aggressive method of O2

Nursing dx impaired skin r/t radiation therapy reactions

-in erythematous areas avoid soap, cosmetics, perfumes, powders, lotions -lukewarm water to bathe -avoid rubbin or scratching -avoid shaving area w/ strait razor -avoid heating pads, ice packs & tape -avoid exposure to sun or cold weather - avoid tight clothing -apply vitamin A and D to area

Respiratory status for pt w/ cirrhosis (ATI)

-monitor O2 sats & distress -position pt for easy respiration -sit in chair or elevate HOB

Care after a renal angiography

-monitor VS until stable -monitor for hematoma, hemorrhage, swelling -peripheral pulses, color & temp of involved extremity -cold compresses at injection site to decrease edema & pain -bedrest -good seal on artery

Fluid balance for pt w/ cirrhosis (ATI)

-monitor for fluid excess -strict I&O -daily weights -assess ascites & edema -restrict fluids and Na+ if needed

Clinical manifestations of ARF

-pt appears ill & lethargic -dry mucous membranes -CNS depression (drowsy, lethargic, HA, twitches, sz) --as ARF continues, pt more ill until underlying conditions treated --effects almost every system of the body

RN interventions after liver bx (ATI)

-pt to right side lying position for several hours -monitor VS -assess for abd pain -assess for bleeding from puncture site

What factors put older adults at risk for HIV

-sexually active but don't use condoms (view only as birth control) -don't consider themselves as high risk -older gay men starting relationship w/ younger men -older adults that are IV drug users -may have recieved transfusions before 1985 (when just starting testing donated blood) -normal age related changes r/t reduced immune system function

High risk behaviors for HIV

-sharing infected injection equipments (needles) -Having sex w/ infected people

Procedure for irrigation of colostomy

-sit in chair by toilet -500-1500mL tap water is hung 15-20 in above stoma (shoulder height) -remove pouch -apply sleeve to stoma - place end in commode - allow solution to flow thru tube & cath - lubricate irrigating cone and insert into stoma - allow water to flow slowly while advancing cath - replace dressin

What is the tx for HIV

-they are continually evolving b/c the virus evolves so much -antiretroviral agents

What is normal INR

0.8 - 1.2

Sensory tests

1 Tactile sensation - cotton to differ parts of body w/ eyes closed and name 2 Superficial pain - paperclip unfolded - touch w/ round part and sharp part - pt should know/feel difference 3 Vibration - tuning fork 4 Position sense - proprioception - rotate ankle w/ eyes closed and ask which way is it pointing

500 mL of fluid is equal to how much in a persons weight?

1 lb.

What are the 3 categories of laryngeal cancer

1. Supraglottic - above cords - 1/3 2. Glottic - true vocal cords - seldom mets b/c few SLN or LN in area - 2/3 3. Subglottic (less than 1%)

What is normal specific gravity

1.010 - 1.025

Creatinine levels in pt with chronic renal disease?

1.5 - 3.0 **CRF is over 3.0

How much can the stomach store?

1.5L

When do vasomotor s/s of dumping syndrome occur

10-90 minutes after eating --pallor, sweat, palpitations, HA, warmth, dizzy, drowsy --could also eventually cause steatorrhea (prevents adequate mixing of panc & biliary secretions)

What is normal triglycerides

100-200

What is normal BUN to creatinine ratio

10:1 or 20:1

What is normal PT (not on blood thinners)

11 - 13 seconds

How many lobes does the liver have

4

What are the 4 pairs of paranasal sinuses

4 pairs of bony cavities lined w/ nasal mucosa -named by location -frontal, ethmoidal, sphenoidal, maxillary -major function to serve as resonating chamber of speech -common site of infection

What is normal cerebral perfusion pressure (CPP)?

60-100 mm Hg -it goes down as ICP goes up **if < 50 = life threatening -causes necrosis of brain cells

What is normal BUN

7-18

What is normal pH

7.35 - 7.45

How long is the SI

70 meters

What is normal CD4 count

700 - 1000

What is the window for prophylaxis after exposure or needle stick

72 hours

What is normal Ca+

8.5 - 10.5 total calcium

What is the portal vein rich in

80% nutrients -blood picks up nutrients from SI & LI goes to portal vein -gets first shot of energy & vitamins (and bacteria) -cooper cells attack bacteria

What is the portal vein

80% of the blood supply to the liver comes from the portal vein --drains the GI tract --rich in nutrients / lacks O2

How much glucose does the brain use

80% of the glucose in the body because it never stops

What is the survival rate after heart tx

85-90 % the first year 50-70% after 10 years

What is a community?

A group of people & institutions that share geographic, civic, or social parameters

Best dx test to determine lung function (and if arterial blood is getting O2)

ABG

What is sono used for

Adjunct to a mammo to distinguish fluid filled cysts from other lesions -can't r/o malignant -microcals not seen on sono - only on mammo

Where is the ST segment

After QRS and before the T wave -beginning of ventricle repolarization -should be flat

Elevation of bilirubin

Altered liver function, bile duct obstruction or other hepotbiliary disorder -norm = 0.1 - 1.0

What is the most common effect of radiation

Altered skin integrity -alopecia -erythema & flaking of skin -moist desquamation (dermis exposed w/ skin oozing serous fluid) -ulceration

Bacteria in the intestine can create what ?

Ammonia

What is tidal volume

Amount of air inhaled and exhaled with each breath -500 mL

What is cardiac output?

Amount or volume of blood ejected or pumped in 1 minute

What is genetic profiling

Analysis for presence of mutations in genes found in tumors or body tissues --assists in dx, tx selection, prediction of response to therapy, & risk of progression or recur **breast, lung, kidney, ovarian, brain, leukemia, lymphoma

When does filtration occur

As blood flows thru the glomerulus from an afferent arteriole --this filtrate is then sent to the tubules

What does the SI open up to

Ascending or cecal portion of LI at the ileocecal valve

After care for renal bx

Assess site for bleeding and infection --sandbags for pressure

Function of the lower esophagus sphinctor

At the top of the stomach and prevents reflux

What are the causes of bradycardia

Athlete, sleep, vagal stimulation (vomit/strain), MI, meds (beta blockers)

What is the antidote for bradycardia

Atropine rapid IVP if symptomatic (increases HR by increasing firing action of SA node & conduction thru the AV node)

How to avoid pancreatitis (ATI)

Avoid etoh Eat low fat diet

Where do bladder tumors usually arise ?

Base of bladder & involve ureteral orifices & bladder neck

Leukotriene modifiers

Blocks inflammatory response -COPD and asthma **singulair

What happens to blood flow after we eat

Blood shunts to the GI

Peak force expiratory pressure

Blow out as fast as can and see how long it takes to empty the lungs - a PFT

What does the dura mater cover

Brain & spinal cord

How is cerebral aneurysm dx

CT - will show the bleed & aneurysm if not ruptured Cerebral angiogram

S/S of infection / peritonitis for PD cath pt

Cloudy dialysate - abd pain - rebound tenderness - shock

SE of calcium & albumin

Constipation

What is Karposi's sarcoma

Cutaneous lesions but can involve multiple organ systems -mets to liver is common --lesions cause discomfort - disfigurement - ulceration - potential for infection

What is the patho cause of cardiogenic shock (notes)

Decrease in pumping ability of myocardium -decreased CO w/ decreased perfusion to kidneys -causes chain of effect that makes things worse -when BP drops, kidneys produce more fluid, causing heart to work harder (increase in preload, fluid accumulates in lungs) -tissue perfusion decreases causing more damage to heart

What is staging

Determines the size of the tumor - local invasion - & distant metastasis

What is active immunity

Develops when person has been exposed to infectious agent & develops OWN ANTIBODIES -thru exposure or artifically thru immunization

S/S of right sided colon lesion/ cancer

Dull abd pain Melena stools Ascending colon

First segment of the SI

Duodenum --common bile duct empties into allowing passage of bile & panc secretions for digestion --must have those to break down food & digest

When do most prenatal infections occur

During delivery

When are coronary arteries perfused?

During diastole

complications of mild acute pancreatitis

During illness - potential for hypovolemic shock, sepsis, elyte imbalances

Late s/s of laryngeal cancer

Dysphagia - dyspnea - foul breath

Dx of chronic pancreatits

ERCP CT Xray MRI Sono Labs of fecal fat Increased amylase

Who should wear a mask during a PD dialysis?

EVERYONE IN THE ROOM

What is secondary prevention?

Early detection & tx of disease w/ goal to limit severity & minimize impact of lifestyle & ADL's -screenings, health risk appraisal, health fairs, cholesterol and BP checks, mammograms, TB screen

What is category A bioterrorism

Easily transmitted & high mortality rates -smallpox, botulism, anthrax, plague, tularemia, eboli

What is category C bioterrorism

Easy to produce & have HIGH morbidity/mortality -hantavirus

Nursing mgmt for ovarian ca

Emotional support Comfort measures Info Attentiveness & caring

What is the #1 indication for heart transplant

End stage cardiomyopathy -hearts inability to pump sufficient blood to meet metabolic demands of the body -causes left ventricular hypertrophy (stretched out and decreased contractility) -very low CO

What is external respiration

Exchange of CO2 and O2 in the LUNG

What is the sympathetic NS?

Excitatory responses -fight or flight -when under stress = increase in heart, dilate bronchioles, heart contracts stronger & faster, arteries to heart dilate carrying more blood to organs, skin cool but shunts blood to essential organs when peripheral b. vessels constrict, peristalsis slows, liver releases glucose for quick energy, sweat increases

What can decrease or help lymphedema

Exercises prescribed - elevating arm above heart several times per day - gentle muscle pumping (fist and release fist)

What does somatostatin do

Exerts hypoglycemic effect by releasing growth hormone and glucagon to increase glucose levels

What is cirrhosis (ATI)

Extensive scarring of liver caused by necrotic injury or chronic reaction to inflammation over prolonged time --normal liver tissue is replaced w/ fibrotic tissue that lacks function

What increases risk for breast ca

Fam hx -period started less than 12 y/o -delay in menopause (after 50) -first childbirth after age 30 -no kids

What is lipodystrophy

Fat redistribution --rolls of fat in odd places

S/S of dialyzer disequilibrium syndrome

HA - N/V - restless - decreased LOC - sz **may be seen in ARF or BUN over 150

S/S of inhaled anthrax (ATI)

HA - fever - muscle aches - chest discomfort - severe dyspnea - shock ***treat w/ IV cipro prophylactically - abx don't stop progression

What happens to VQ with pulmonary embolism

HIGH VQ (because low perfusion)

What is ELISA test

HIV antibody test (enzyme immunoassay) that allows for early detection before onset of s/s

What are the side effects of postexposure prophylaxis meds

HIV becomes resistant to the meds to treat it Cost is $500-$1000

What is the 3rd HIV stage

HIV symptomatic -number of CD4+ Tcells gradually fall (200-499) -pt develops s/s related to the HIV infection -opportunistic infections start (non life threaten) - candidias - shingles, nausea, GI infections, flu, colds

What is the 2nd stage of HIV

HIV symptomatic -virus starts to take over -CD4+ T cells is still over 500 -upon reaching viral set point, chronic asymptomatic state begins -Body has sufficient immune response to defend against pathogens **viral load is > antibody load

Describe sinus bradycardia on EKG

Heartrate is less than 60 bpm Rate = regular Pwave = 1 per QRS

Saliva substitutes

Help in conditions that result in dry mouth (i.e. chemo pt) -not absorbed **mouthkotee - salivart**

What is the function of the pons

Helps regulate respirations

How is ovarian ca prevented (protective barriers)

Hysterectomy - Pregnancy - Oral contraceptives - Breastfeeding

When is CABG indicated

If all other less invasive cardiac procedures don't work or not applicable

Tx for cervical carcinoma in situ before childbearing years

If invasion is less than 1mm = conizatoin

What is PTCA used for

If stenosis or occlusion of coronary artery due to CAD -restores blood flow without open heart surgery

What is pulse deficit

If take apical w/ radial - periperal cant be greater than apical - apical can be = deficit

S/S of diffuse axonal injury

Immediate coma - decort/decer posturing - recovery depends on severity -survival low or if they do = veg state -normally caused by falling from high place

Treatment for V fib

Immediate defibrillation - epinephrine (increases HR and constricts blood vessels) - CPR

What is azathioprine or Imuran

Immunosuppressant often used

What is hypertrophy

Increase SIZE of existing cells i/e - prostate hypertrophy (benign)

What is only way to get to the diuresis phase

Interventions and intervene

How should stoma be cared for until healed?

Irrigate stoma w/ 5-10mL sterile saline --with order

S/S of hyperkalemia

Irritability - abd cramping - diarrhea - paresthesia - generalized muscle weakness

Second segment of SI

Jejunum

What is uremic frost

Kidnesy can't filter urea -crystals of urea -crystal thru skin = causing severe itching **benadryl and atarax -clip nails, washcloth

All blood circulates through what?

Kidney

What is stage 5 kidney damage (GFR)

Kidney failure (ESRD) **Less than 15 --need dialysis or transplant

What is a KUB test

Kidneys - ureters - bladder xray -shows adrenal glands and position of kidneys & size / shape

What are CD8 cells

Killer T cells

What is the host (ATI)

LIVING BEING that is AFFECTED by the AGENT

S/S of contusions

LOC assoc w/ stupor and confusion -altered consciousness -hemorrhage or edema (peaks 18-36hrs after) -temporal lobe contusion = greater risk of swelling & rapid deterioration & brain herniation **watch of weak thready pulse, shallow resp, decrease BP and temp, involve bowel/bladder, abn eye mvmt

Later indications of ICP

LOC continues to deteriorate -pulse and resp decrease or erratic -pulse pressure widens -alterd resp patterns -projectile vomiting -hemiplegia or decorticate

What is normal total cholesterol

Less than 200

What is the goal in CBI

Light pink tinged urine

Pathophys of hepatic encephalopathy

Liver cells unable to convert ammonia to urea -causes brain dysfunction and damage

What can PET scans detect

Lung, colon, liver, panc, head & neck, Hodgkin & NHL, melanoma -with use of tracer to image the biologic activity of an area rather than it's structure

What makes up the lower resp tract

Lungs -pleura -lobes -mediastinum -bronchi & bronchioles -alveoli

What is the most common way cancer cells spread

Lymphatic

Potential complications after breast surgery

Lymphedema Hematoma / seroma Infection

What is normal RBC

M = 4.7 - 6.1 F = 4.2 - 5.4

What medication decreases cerebral edema

MANNITOL (osmotic diuretic) --decreases circulating volume to head

What is specific gravity

Measures density of a solution compared to density of water --depends largely on hydration status *evaluates ability of kidneys to concentrate solutes in urine

Gastric analysis

Measures hydrochloric acid and pepsin content for eval of aggressive gastric & duodenal disorders **2 types -basal gastric secretion -gastric acid stimulation test

What is OKT3

Med used to fight acute rejection

Autonomic NS effects of secretions of stomach, panc, intestine

P = increased S = no direct effect

What is prophylactic surgery

Removal of nonvital tissues / organs that are increased risk for cancer

What is the T wave

Ventricular repolarization

What is dry weight

Weight after dialysis -pt is weighed pre and post dialysis

Who is at higher risk for cirrhosis

Weomen who drink age 40-60

What test is used to confirm ELISA test

Western blot

What is renin-angiotensin II system activated?

When pressure in renal arterioles falls below normal levels --shock, dehydration, decreased Na+ to tubules

How do kidneys regulate RBC production

When they detect decrease in O2 tension in renal blood flow -they release erythropoietin --this stimulates bone marrow to make RBC's that carry O2 thru body

What is the function of the trachea

Windpipe -serves as passage from larynx to bronchi

Reconstruction for neck dissections

With flap & vasculature -cutaneous flap with skin & subq tissue -myocutaneous flap with subq tissue, mucle & skin - more freq used

Primary prevention of cervical ca

Women aged 18+ -pap test 3 years after start of intercourse but no later than 21y -pap q 2 years

Are kidney transplant recipients at risk for cancer?

YES 500X greater chance of various cancers

What lies on top of each kidney

adrenal gland

Patho of ARDS

inflammatory trigger that causes alveoli to collapse --low VQ --problem w/ ventilation -small airways are narrowed due to interstitial fluid & bronch obstruction -decreased lung compliance and decrease in functional residual capacity

What causes ARDS

insult to lungs (most common is mechanical insult) -triggers inflammatory response - increase in permeability in blood vessels causing fluid to leak or seep int lungs

If ostomy at descending colon - stools are

semi soft to soft

What comes up in a urine analysis if not clean catch or midstream

"amorphous debris"

Efferent

"away from" carry FROM CNS to effectors like muscles or glands -starts in brain to cord to nerves to peripheral to stimulate muscle (to move an organ)

Afferent

"towards a center' carry sensory nerve impulses from receptors TOWARDS CNS -pain, heat

S/S of bladder cancer

#1 - Visible painless hematuria -changes in voiding pattern/frequency/stream (r/t blockage & irritation of urethra) -changes in urine clarity (urine may be darker b4 blood can be seen) --chronic UTI, urgency & dysuria, pelvic pain w/ mets

Risk factors for lung ca

#1 Smoking - radiation - exposure (chronic) to inhaled irritants like pollutin, asbestos - radon (natural gas in earth crust)

What is the main bypass graft site?

#1 is greater saphenous vein -has to maintain alot of pressure so has to be good and long/big

Early s/s of laryngeal cancer

#1 is hoarseness (greater than 2 wks) -raspy voice (greater than 2 wks) -burning in throat (esp w/ hot liquids or citrus juices)

Neuro effects of ARDS

#1 mental status changes -poor cerebral perfusion -not enough O2 to brain -LOC decreases rapidly down to confusion then coma

How much does Medicare spend per year for immunosuppressant drugs?

$17,000 per year for meds for kidney tx recipient --compared to $70,000 for 1 year of dialysis --transplant costs more than $100,000

Assessment of sympthetic NS functions

(adrenergic responses) Increases pulse and BP Dilated pupils Decreased peristalsis Increased perspiration

Assessment of parasympathetic NS

(cholinergic responses) Decreased BP and HR Constricted pupils Increased salivation and peristalsis Dilated blood vessels Bladder contraction

RN dx for brain mets

(focus on comfort & quality of life) --self care deficit --nutrition --pain --anxiety / fear

What is neurogenic shock

(more serious & can lead to cardiogenic shock) -result of loss of autonomic NS below level of lesion **effects vital organs **decrease BP, HR & CO = pulm edema, right HF, venous pool in extremities - heat loss due to peripheral dilation *monitor for abrupt onset of fever

How is bladder cancer diagnosed

** #1 Cystoscopy (can scrape cells for bx) CT Bx

What causes esophageal varices

** almost always caused by portal HTN -Cirrhosis --the worse the portal HTN, the higher it can go -esophagus not designed to swell & shrink so stay swollen **hemorrhage easy and quick --if liver disorder and vomit = emergent b/c weakens vessel walls

Nutrition for ARDS

***35 - 45 kcal per kg to maintain -TPN or NG depending on severity of illness and amt of time on ventilator

What is acute renal failure

***hallmark sign is SUDDEN ONSET -almost complete loss of kidney function -kidney fails & can no longer excrete waste - maintain elyte & fluid balance

Variable O2 delivery

**Cannula (up to 6L) **Simple mask (6-8L) **partial rebreather (8-11L) **non rebreather (up to 12L)

Medical management of pericarditis

**Determine cause --Rule out MI first -if CO is impaired - pt on bedrest until fever, chest pain and rub have subsided -Analgesics and NSAIDS for pain -Corticosteroids = if inflammation doesn't respond to NSAIDS -Pericardiocentesis = as dx analysis of fluid ore emergent tx for tamponade -percardial window = square cut out of pericardium and fluid allowed to collect in mediastinum & drain into lymph system **avoid anticoags because of risk of tamponade

What are the risks of immunosuppressants

**Infection -nephrotoxicity -HTN -hyperlipidemia -increased blood glucose and leads to DM -increased risk of cancer -cataracts, blood dyscrasias, tremors, hirsutism

Complications of gastric surgery

**Short term -anastomosis leak - blood clots - bowel obstruction **Long term -B12 deficient - esophagitis (constant GERD) - osteoporosis - dumping syndrome

What are the s/s of pericarditis (notes)

**Substernal chest pain (most common symptom) -improves w/ sitting or leaning forward - can radiate to neck or left shoulder/arm -constant pain (worsen on inspiration or laying down) **pericardial friction rub (most common sign) -scratchy high pitched on auscultation -around Erbs point (4th ICS, LSB) -heard best when pt is sitting/leaning forward -mild fever, dyspnea, nausea, anorexia, anxiety -non productive cough/hiccup, increased WBC, c-reactive protein and ESR

Dx tests indicative of pancreatitis

**elevated labs -amylase, lipase, WBC, decreased Ca+ **xrays of abd & chest to r/o other causes **CT to eval size of panc, check for cysts, cancer, abscess, pseudocysts **H&H to monitor bleeding **paracentesis to examine fluid for enzymes

Assessment for transplant rejection

**oliguria -edema -fever -HTN -weight gain -swelling/tenderness over transplanted kidney or graft site

Meds to treat pancreatitis

**opioid pain meds -fentanyl, morphine, dilaudid **histamine 2 antagonists to decrease panc activity by blocking gastric acid -tagament, zantac **PPI if H2s aren't tolerated -protonix **antiemetics

Pre op teaching by nurse prior to transplant

**pt is on call & must be available when kidney becomes available -pulm hygiene (cough/deep breathe) -pain mgmt (don't let get out of control) -dietary restrictions -IV / arterial line -Urinary cath (HOURLY OUTPUTS) -NG tube (until bowel function resumes) -Early ambulation -Teach s/s of rejection

What should RN always do with blunt chest trauma

**secondary assessment -likely have trauma elsewhere as well don't forget about other possible injuries (head, bleeding out, etc)

What is the medical mgmt of ARF?

**treat the underlying causes -pt may require dialysis until renal function returns

Maintainance of O2 to manage ICP

*ABG's - want partial O2 on high end and CO2 on low end (to cause vasoconstrict in brain) -put on ventilator to control resp & manipulate ABG *pulse ox

What are other complications post heart tx

*Accelerated atherosclerosis & CAD *Osteoporosis - monitor Ca level and supplement w/ calcium and Vit D *Melanoma (r/t immunosupp.) *Wt gain, glucose intolerance and hyperlipidemia assoc w/ corticosteroid use

What are the 3 PD dialysis types?

*Acute Intermittent (AIPD) *Continuous Ambulatory (CAPD) *Continuous cyclic

Types of vehicle transmission

*Airborne (dust or droplets > 1 meter) -- ckn pox, TB, anthrax *Waterborne (streams, pools) -- cholera, diarrhea *Foodborne (poultry, seafood, meat) -- botulism, staph, Hep A, tapeworm, typhoid fever

What are 2 other types of surgery for gastric cancer

*Biliroth I - pylorus is removed and the proximal stomach is connected to the duodenum *Biliroth II - (gastrojejunostomy) - the greater curvature of the stomach is connected to the jejunum in a side-to-side manner.

What are the s/s of chronic renal failure?

*CV - most s/s are CV - HTN, CHF, PE, pericarditis *Derm - severe puritis, uremic frost *GI - anorexia, N/V, hiccups *Neuro - altered LOC, confusion, difficult concentrate, muscle twitches, agitation, sz, peripheral neuropathy, restless leg *GU - uremic odor to urine (ammonia)

What are the major causes of renal failure

*DM I or II *HTN --primary cause is DM

Types of contact transmission

*Direct (hand shake, kiss, bites) -- STD, warts, staph *Indirect (drinking glass, toothbrush, toy, puncture) --Cold, influenza, pneumonia, tetnus *Droplet (sneezing) -- strep, whooping cough

Causes of acute pancreatitis

*Etoh abuse & biliary tract disease (gallstones) -instrumentation on the duct (ERCP) -surgery on or near the duct & abd -duodenitis, bacteria / viral infection (mumps), trauma, peptic ulcer disease, drugs, idiopathic

What are the neurologic manifestations of HIV/AIDS

*HIV encephalopathy (pretty common) -progressive cognitive, behavioral & motor decline -probably directly r/t HIV infection *Cryptococcus neoformans *peripheral neuropathy *depression

Risk factors for CRF

*HTN *DM -obesity - fam hx of kidney disease - smoking (decreases circulation) - elevated cholesterol (plaque - decreased circulation) - age 65 or over - native american - AA - asian american - hispanic

During the 1st tx of hemodialysis - what complication can you expect?

*Hypotension (N/V, tachycardia, diaphoresis) *Cramping (d/t rapid fluid & elyte shifts)

What are some other tx for cardiogenic shock

*IABP - intraaortic balloon pump - balloon inserted into descending thoracic aorta and inflates during diastole - causes increased pressure to hyperperfuse the coronary artery -deflates during systole to decrease afterload -short term & important to synch with heart *Ventricular assist devices -external pacemaker, used as bridge therapy to recovery or heart tx *Surgery -PCI, CABG

Dx of esophageal varices

*Immediate EGD --identify cause and site of bleeding *Portal system pressures

What are the s/s of ovarian ca

*Increased abd girth *Pelvic pressure *Bloating *Back & abd pain & leg pain & pelvic pain -Constipation -urinary urgency *indigestion & flatulence -increased waist size

Classification of brain tumors (chart 65-1)

*Intracerebral -gliomas = most common, infiltrate any portion of brain --astro - stage 1 or 2 --gliobastoma - stage 3 or 4 --also oligodendrocytoma, ependymoma, medulloblastoma *Arising from supporting structures -meningiomas - neuromas - pituitary adenomas *Developmental tumors -Angiomas - dermoid - epidermoid - teroma - craniopharyngioma *metastatic lesions

Vector transmission types

*Mechanical (bodies of flies or roaches) -- E coli diarrhea, salmonella) *Biological (lice, mosquitos, ticks, mites) -- lymes, malaria, plague, rocky mountain fever, typhus fever, yellow fever

How can invasion occur

*Mechanical pressure - rapid proliferation forces fingerlike projections *Malignant cells less adherant & break off from tumor & invade *Enzymes - certain enzymes destroy surrounding tissue like vascular membranes

How is cerebral function assessed

*Mental status - behavior, posture, groom,dress, hygiene, gestures, facial express *Intellectual function *Thought content - clear, natural, coherent *Emotional status - effect, pattern change *Perception - alterations *Motor ability - get up and go test (test gait) *Language - appropriately answer questions - read *Impact on lifestyle - roles in society, etc

What are the 3 functions of the SI

*Movement - 3-10 hours to move chyme thru *Digestion - intestinal enzymes *Absorption - intestinal villa help move and absorb, increase surface area to 7000cm, major organ of absorption

Chart 63-1 - multisystem assess for pt w/ brain injury

*Neuro = monitor for s/s of ICP, calculate CPP, monitor antisz med blood levels *Skin = assess skin integrity *Musculoskeletal = ROM - posturing *GI = bowel sounds & distended abd and decreased hgb - constipation *GU = I&O, *Metabolic = fluid & elyte balance - hct - weight *Resp = breath sounds, RR, cough reflex, ABG, CBC, cxr, O2 sats *CV = VS, DVT, dysrhythmia, ekg, elytes, blood coags, glucose levels, urine sp gravity

What is pericardial effusion / cardiac tamponade

*Pericardial effusion - accumulation of fluid in the pericardial sac *Cardiac tamponade - when accumulation of that fluid compresses the heart

Complications of peritoneal dialysis?

*Peritonitis *Leakage *bleeding *Long term

Medical mgmt of ascites

*Potassium sparing diuretics (spironolactone) -decrease ascites -minimize fluid and elyte imbalances compared to other diuretics **anti-inflammatories *COLCHICINE (gout meds) -may increase survival in mild-moderate cirrhosis

What is pituitary adenoma

*Pressure effects = HA, visual dysfunction, hypothalmic disorders (sleep d/o, appetite, temp, emotions) , increased ICP *Hormonal effects = prolactin (lactate when not preg) - growth hormone - ACTH (cause cushings disease if too much or little ACTH)

What is the key to dialyzer disequilibrium syndrome

*Prevention --slow dialysis -for severe fluid overload - do ultrafiltration only to remove fluid only but leave urea alone --also give mannitol or dilantin

What diet restrictions should pt with CKD be on?

*Protein restriction *Sodium restriction *Fluid restriction varies *Potassium restriction

How is a double lumen cuffed catheter used?

*Red adapter = attached to blood line where blood is pumped from pt to dialyzer *Blue adapter = after blood passes thru dialyzer - returns to pt thru blue adapter --more permanent than double lumen large bore cath

complications of altered LOC

*Resp failure (assoc w/ ineffective airway clearance) -shallow resp = leads to atelectasis & pneumonia *Pneumonia *Pressure ulcers (turn Q2H) *Aspiration (HOB increase at least 20 degress if in coma)

How is metabolic acidosis in ARF treated

*Sodium bicarb --to increase pH --K+ back into cells

Medical mgmt s/p total laryngectomy

*Speech -esophageal speech = before and after speech tx -electric speech = put to side of neck and buzzing noise and mouth consanants and vowels -tracheosesophageal puncture -most used now - speech more normal - cut fistula at closure of trach into esophagus - when healed put prosthetic voice box so air can go thru to talk

What are some causes of pre renal ARF?

*Volume depletion r/t -hemorrhage - severe n/v - dehydration - cdiff - crohns - UC - diuretics *Impaired cardiac r/t -CHF - MI - cardiogenic shock - dysrhythmias *Vasodiation r/t -sepsis - anaphylaxis - too high dose of antiHTN

What are some complications of pericarditis that the RN should monitor for

*cardiac tamponade -excess fluid in pericardial sac that interferes with heart filling and function -JVD w/ clear lungs -Elevated CVP -Narrowing pulse pressure -Decreased CO -Muffled heart sounds -Tachycardia, tachypnea -Hypotension

What are the s/s of infective endocarditis (notes)

*heart murmur at apex of heart CNS - dizziness *fever - spiking fever w/ acute - fever of unknown origin w/ subacute Clusters of petechiae, osler nodes, janeway lesions, roths spots, splinter hemorrhage

Function of the medulla

*most important in brainstem **autonomic NS - controls temperature - respiration - heartrate - BP - cough - vomit - swallowing - sneezing

Goals of SCI med mgmt

*prevent secondary injury *prevent further SCI *steriods *resp *skeletal fx reduction & traction

Med mgment of SCI

*rapid assess = s/s of progressive neuro deficits *immobilize *extrication *stabilize *transport

Describe atrial flutter on EKG

*rare has a saw tooth look - multiple Pwaves per QRS - regular rhythm **atria beats 200-250 bpm -- ventricle beats 75-150 bpm

How are patients screened for heart tx

- Age (not ideal for elderly - not best possible outcomes) - Pulmonary status - pt w/ COPD, DM or CKD not ideal - can't oxygenate the blood - Psych status - support?, non compliance hx w/ meds, stable job, insurance, transplant psychosis, antidepressants after tx - Infectious processes - HIV, hepatitis - they will be on immunosuppressants for rest of life - Hx of other tx - Body size - Blood typing - Geographic location (distant btwn donor & recip - must be less than 4 hrs)

What are the treatments of dysrhythmias

- Cardioversion - Debrillation

What meds are used to tx cardiogenic shock

- Loop diuretics (Lasix) - Vasodilators - Positive inotropes - Vasopressors - IV morphine - antiarrhythmics

What are the 3 categories of ARF?

- Pre renal - Intra renal - Post renal

Specific indications for CABG

- Uncontrolled, unstable angina (at rest) - Left main coronary artery stenosis - Multivessel disease : if get in and see more than 1 - Prevent/treat MI, dysrhythmia, heart failure (#1 reason is MI) -Complications from unsuccessful PCI

How should RN convey culture sensitivity (ATI)

-Address pt by last name unless given other permisison by pt -Introduce self and position -Be authentic & honest about what RN knows /not know about culture of pt -use culture sensitive language -Find out what pt knows about health prob & tx -Incorporate pt preferences & practices into care -DON"T make assumptions -Encourage pt to ask about anything they don't understand -Respect pt beliefs, values, practices & show respect for their support systems

What is the non surgical tx for bladder ca

--IV therapy - chemo --PO chemo --Topical BCG (given intravesicular = instilled into bladder = causes local inflammation killing cancer cells

What are the 2 major consequences of portal HTN

--ascites --varices

What is the anatomy of the spinal cord

-18 inches long -Thick as your pinky finger -Continuous with the medulla- -Extends from the foramen magnum at base of skull to lower border to first lumber vertebar

Who was Margaret Sanger?

-1920's was a teacher -Influenced to become a nurse by her mother's death from "consumption" after bearing 11 children. -Became an advocate of occupational health -Promoter for public access to birth control and set up the first women's health clinic which provided diaphragms. (The clinic was closed after 10 days by police and she and her sister were jailed)

Assessment and dx findings of cervical ca

-Abnormal pap -Biopsy - shows severe dsyplasia (CIN III) or high grade squamous intraepithelial lesions (HGSIL) or carcinoma in situ -Staging -Tests (colposcopy, CT, MRI, D&C)

Who was Lavina Dock?

-Active in women's suffrage -Early author of nursing textbooks -Very politically active for nursing rights and regulation

Diet for ARF patient

-Adequate calories -TPN or tube feedings -May need K+ restricted

How to prevent pre-renal ARF?

-Adequate hydration -Monitor labs for pts on diuretics -Monitor BP / P -Monitor urine output

Tx for CRF/CKD

-Aimed at treating underlying causes & slowing disease process -Meds and diet changes, lifestyle changes -

RN mgmt for s/p total laryngectomy

-Airway - monitor for aspiratoin -Breathing -Circulation - arteries or veins cut? - s/s of internal bleeding (tachy, hypoTN, sweat, impending doom, sweat, sz, coma) -communication (none for about 2 wks post op)

What should health care provider or RN do for postexposure prophylaxis

-Alert supervisor -Identify the source patient -Report quickly to employee health -Give consent for baseline testing -Get postexposure prophylaxis meds & start within 2 hours (monitor for toxicity -Continue meds for 4 weeks

What are some of the meds used s/p transplant

-Cyclosporine -Tacrolimus -Mycophenalate -Sirolimus **give to patient on their schedule

Lab tests indicating DIC (ATI)

-Decreased Hgb -Decreased platelets -Decreased fibrinogen -Increased Pt and Ptt -Increased D Dimer

Who was Mabel Staupers?

-Developed wide range of services that improved the health care of the citizens of Harlem. -During WW II, as Executive Secretary of the National Association of Colored Graduate Nurses, she led the movement to gain full integration of Black nurses into the armed forces and the professional nursing organizations. -First African American director of nursing

Medical mgmt of ascites

-Diet - decrease protein -Diuretics - pull fluid off -Bedrest -Paracentesis - to pull fluid off -Transjugular intrahepatic portosystemic shunt (TIPS)

What is the purpose of the GI tract

-Digest food = to meet nutritional & energy needs of the body -Eliminate waste

What are other complications of hemodialysis?

-Disequilibrium (dialyzer disequilibrium syndrome) -Chest pain (angina d/t hypotension, CAD or anemia) -Bleeding (d/t being on heparin to prevent clotting or coumadin) -Access clotting (heparin is sued) -Ulcers (found in duodenum or gastric) -infection -Exsanguination (life threatening)

Complications of PTCA, stents and atherectomy?

-Dissection: split of artery (i.e. aneurysm) -Perforation: as push agnst artery wall can perforate -Abrupt closure: piece of plaque breaks off and causes closure -Vasospasm of coronary artery: not life threatening and doesn't last long -Acute MI : Because manipulation of heart -Cardiac arrest

Types of pain in renal cancer

-Dull pain = in back from pressure of compression of ureter, tumor in perineal area or hemorrhage into kidney tissue -Colicky pain = if clot or mass of tumor cells passes down the ureter (like kidney stones)

Late s/s of gastric ca

-Dyspepsia -early satiety (full earlier) b/c tumor taking up space -wt loss -abd pain above umbilicus **anemia = late s/s

RN dx of anticipatory grief

-Encourage verbilization of fears & feelings -successful coping -allow for periods of crying, sadness, venting of hostility and anger

Assessment & dx for ovarian ca

-Enlarged ovary should be assessed asap -75% have mets by dx - 60% have spread outside the pelvis

Other risk factors for uterine cancer

-Estrogen w/o use of progesterone -Early menarche -Late menopause (after age 52) -Nulliparity -Anovulation -Post menopause bleeding -Obesity ( --infertility, DM, tamoxifen

RN education for pericarditis

-Explain inflammatory process to reduce anxiety -Take food, milk, or antacids w/ anti-inflammatory meds to reduce gastric distress -Report s/s of pericarditis b/c there is risk of repeated episodes

How can you check flow of AV fistula

-Feel thrill - hear bruit **if don't hear/feel vibrate or cold hand = could be clotted = get to ED STAT

S/S of pericardial effusion / cardiac tamponade

-Feeling of chest fullness - pressure in chest - distended JVD - SOB (position for comfort, high fowlers, sitting or side lying) - labile - low BP

Risk factors for breast ca

-Female -Increasing Age -Personal hx breast ca -Family hx breast ca (having 1st degree relatives) -early start of period (before age 12) -late menopause (after age 55) -nulliparity (no full term preg) -late age at first full term preg (after age 30) -hormone therapy - exposure to radiation during child or teen years -hx of hyperplasia or in situ -obesity -high fat diet and etoh intake (2-5 drinks per week increases risk 1.5 times)

What are the early stage of renal disease?

-Few or no s/s -Often no s/s until damage to 90% of the kidneys -Needs aggressive tx

Functions of the kidneys

-Form urine -Excrete wastes -Regulate elytes & acid base balance -Control of H20 balance & BP -Renal clearance -Regulates RBC production -Synthesis of Vit D -Secretes prostaglandins -Regulate Ca & phosphorus balance

Who was Mary Breckinridge?

-Founded Frontier Nursing Services in Appalachia which made home visits to poor Appalachian families. -Introduced midwives and established the first school of Nursing in Appalachia. -She entered nursing after being widowed, remarrying, losing a premature daughter and then her son to appendicitis, and divorcing. -Divorced woman in her era & able to deliver healthcare on horseback all over Appalachia? Insanity. -The FNS is still widely acclaimed, a nursing school has blossomed & there is a hospital and home health service that thrives today because of it.

Post cardiac procedure for nurse (s/p cardiac cath)

-Frequent VS and check distal pulses -effected leg should be kept strait for 4-6hrs -sandbags on site -if d/c'd - pt should call 911 if bleeding at site

Effects of C5 injury

-Full head and neck control - shoulder strength + - elbow flexion + -independent dressing and eating w/ assist - maximal asst w/ elimination, needs transfer asst

Effects of C6 injury

-Fully innervated shoulder - wrist extension/dorsiflexion -independent dress & eat & elimination w/ minimal assist

What is the PD dialysis procedure?

-Gather materials (dialysate fluid, tubing, sterile gloves) -Prepare / clean area (NO PETS IN ROOM)

Colonoscopy

-Gold standard for colorectal cancer screening & surveillance & monitor pt w/ hx colon ca or polyps --allows for bx --eval of pt w/ diarrhea of unknown origin, occult bleeding or anemia, further to examine abn barium studies --clarifies & determines extent of IBD

Effects of C4 injury

-Good head & neck sensory and motor control -some + shoulder elevation -diaphragm movement + --dependent dressing, eating, limited mobility to voice, mouth, head, chin or shoulder

What are the characteristics of vag d/c in advanced cervical ca

-Gradually increases -becomes watery & then dark & foul smellling from necrosis & infection of the tumor

Effects of C2-C3 injury

-Head & neck sensation +, some neck control *can go w/o ventilation for short periods --dependent for dressing, eating, elimination

Body image for pt after urinary diversion

-Help pt develop a new normal -Teach & asst to become comfortable w/ new tasks associated with this surgery -Address sexuality -Anxiety and coping

Assessment & dx of cardiogenic shock

-Hemodynamic monitoring (ICU) -Increased pulm artery wedge pressure (PAWP) --(left ventricle function) -Decreased CO -Increased systemic vascular resistance (SVR) -Activation of renin-angiotensin-aldosterone system -Increased lactic acid level -Metabolic acidosis -Multi organ failure -EKG (monitor for ischemic changes) -Cardiac enzymes elevated (CK MB, troponin)

When is acute dialysis indicated?

-High & increasing level of K+ -Fluid overload -Impending PE -Increasing acidosis -Pericarditis -Severe confusion -To remove toxins or meds -Hepatic coma, hyperkalemia, hypercalcemia, HTN, uremia

Severe acute pancreatitis characteristics

-High levles of inflammation -damage to panc from autodigestion (primarily trypsin) **prognosis = 10-30% mortality

What does C1 injury effect/cause

-Little / no sensation or control of head & neck -No diaphragm control *requires continuous ventilation --dependent for dressing, eating, elimination - limited mobility

How long after a kidney transplant does the transplanted kidney start to function

-Living = immediatley - less chance of rejection / more successful -Cadaver = may require dialysis 2-3 weeks before function begins

Patients have the right to

-Make own decisions about healthcare -Expect a relationship w/ RN based on trust, respect & collaboration -Privacy -Access to services that meet their health needs -Responsible for their own health

Risk factors for renal cancer

-Men -Obesity -Tobacco use -Occupational exposure to petroleum products, heavy metals, asbestos -Unapposed estrogen therapy -Polycystic kidney disease

What is removed in a radical cystectomy

-Men = bladder, prostate, seminal vesicles, perivesicular tissues -Women = bladder, lower ureters, TAH, anterior vagina, urethra, pelvic LN

What are the late s/s of pancreatic ca

-Mets to other organs -S/s of obstruction **Pain, jaundice & weight loss are classic s/s -ascites from cancer cells in the peritoneum

Nursing care of patient post TURP w/ CBI

-Monitor I&O -Urine w/ CBI should be at least what putting in plus UO & pink -Clots should be smaller than quarter -Watch for plugs/blocks in catheter -Maintain flow (clamp regulates flow) -Accurate I&O

How to prevent infection after transplant

-Monitor WBC & platelets - they are depressed by immune suppressive drugs -Assess for clinical s/s = shaking, chills, fever, tachycardia, tachypnea, rise or fall of WBC -Assess sources of infection = resp, surg site, IV site, central lines, arterial line, dialysis cath, urinary cath, URINARY TRACT

Nursing mgmt of ARF?

-Monitor fluid & elyte balance (esp K+) **weigh same time each day on same scale -Reduce metabolic reate **tx infections (they increase rate) & temp, encourage rest, cough & deep breathe -Promote pulmonary function (IS)

Nursing actions for SIADH (ATI)

-Monitor for hyponatremia -Lasix, 0.9% sodium chloride IV, or hypertonic sodium chloride as prescribed for severe -

What are the 4 tissue layers that surround the GI tract

-Mucosa - innermost layer made of thin smooth muscles -Submucosa - connective tissue -Muscularis - circular & longitudal muscles -Serosa - connective tissue

Gastric acid stimulation test

-NG left in place -drug given to stimulate gastric secretions -specimens collected Q 15 min for 1 hour -depressed levels suggest gastric cancer -increased levels = duodenal ulcers & zollinger-ellison

Preprocedure for cerebral angiogram (ATI)

-NPO 4-6 H prior -allergy to iodine or shellfish -hx of bleeding or taking anticoags -BUN and cr prior -no jewelry -mild sedative occasionally -monitor VS continuously

EGD

-NPO 8 hrs prior -Requires sedation (versed) -monitor O2 sats -mouth guard to prevent biting the scope -leave pt in lateral position

Basal gastric secretion analysis

-NPO for 12 hrs -Avoid etoh, tobacco, drugs that effect gastric secretion for 24h -NG tube inserted -Gastric residual contents are aspirated & discarded -NG tube is attached to suctioning for collection of contents Q 15 min for 1 hour

What does CKD lead to?

-Na+ & H2O retention -Metabolic acidosis -Anemia -Ca/Phosphorus imbalances -Low Vitamin D levels

What cancers can MRI detect

-Neurologic, pelvic, abd, thoracic, breast -magnetic fields to create sectioned images

What cancers can CT scans detect

-Neurologic, pelvic, abd, thoracic, breast -narrow beam xray to can layers of tissue for cross section view

Where is a PD cath placed

-OR -3-5 cm below umbilicus -made for long term use and are radio-opaque (to ck placement) and made of silicone

S/S of renal cancer

-Often asymptomatic **Painless hematuria #1 s/s -Triad of s/s in 10% (hematuria, pain, flank mass)

Nursing mgmt for pericarditis

-Pain mgmt = morphine is drug of choice -Positioning = high fowlers, sitting, side lying or tripod stance to expand mediastinum -Limit activity to decrease cardiac workload -Psych support -Monitor for complications -Educate

What are the other s/s of transplant rejection?

-Pain/tenderness over surgical site after healed -Fever **decrease in urine output -HTN -elevated creatinine -cloudy urine -drainage from wound

What are some oncologic emergencies

-Superior vena cava syndrome -spinal cord compression -pericardial effusion / cardiac tamponade -DIC -SIADH -tumor lysis syndrome

S/S of decompensated cirrhosis

-ascites -jaundice -weakness -muscle wasting -weight loss -continuous mild fever -clubbing of fingers -purpura (b/c decreased platelet count) -spontaneous bruising -epistaxis -hypoTN -sparse body hair -white nails -gonadal atrophy

Maintaining though process interventions for HIV/AIDS

-assess mental & neuro status -clear, simple language if mental status is altered -establish & maintain daily routine -orientation -ensure pt safety -maintain & improve functional ability

Assessment for HIV/AID patient

-assess physical and psych status -identify potential risk factors (IV drug use, risky sex practices) -immune system function (CBC, CD4, CD8, viral load) -nutritional status (albumin, prealbumin) -skin integrity -resp status - neuro status - fluid & elyte status - knowledge level

Hand and arm care after ALND

-avoid BP, injections & blood draws in effected extremity -use sunscreen -avoid bug bites (use repellant) -cooking mitt when cooking -avoid cutting cuticles - push them back -electric razor for shaving axilla -avoid lifting over 5-10 lbs

What are the pros of a kidney tx

-avoid dialysis -improved quality of life

Nursing dx of impaired oral mucosa

-avoid mouthwashes -NS mouth rinses Q2H -water soluable lip lubricant -avoid spicy foods, extreme temps, citrus

What are the hematopoietic side effects of chemo

-can cause myelosuppression (depression of bone marrow function -pancytopenia = risk of infection & bleeding

What does Angiotensin II cause

-cardiac & vascular hypertrophy -systemic vasoconstriction -thirst & increased blood volume -Na+ & fluid retention

When is surgery indicated for SCI

-compression of cord -injury results in fragmented or unstable verterbal body -injury involves wound that penetrates the cord -bony fragments are in the spinal canal -pt neuro status is deteriorating

Function of the midbrain

-connects pons and and cerebellum w/ cerebral hemispheres -has sensory & motor pathways -center for auditory & visual responses

Purpose of irrigating colostomy

-control odor and allow feces & H2O to flow into commode -painful cramps caused by too rapid flow or too much solution

S/S of oral SCC

-crusted scaly area on skin w/ red inflammed base -persistent non healing ulcerated bump or thickened skin on lower lip -wart like growth or plaque -red scaly patches or bumps

What is a renal & ureteral brush bx

-cystocope exam first -ureteral cath followed by bx brush passed thru the catheter -suspected lesion is brushed back & forth to obtain cells **shows stone vs tumor vs artifact --IVF after to clear kidneys & prevent clot formation - urine may contain blood 24-48hrs after

Tertiary prevention of communicable disease (ATI)

-decrease complications & disabilities thru tx & rehab -monitor tx compliance -identify & link pts to needed community resources

What is PET fusion

-detects same as PET -use PET and CT in one machine to provide an image combining anatomic detail, spatial resolution, & functional metabolic abn

Risk factors for gastric ca

-diet high in smoked meat, pickled & salted food -men and > 55 years old -smoking -obesity -porr drinking

Anticholinergics

-dilate bronchi **atrovent, spireva -can't pee, can't see, can't sit, can't poop

Nutrition for s/p gastric surgery

-eat small freq meals -avoid drinking fluids w/ meals -low sugar intake **high fat and protein for calories

Care post ERCP

-ensure gag reflex has returned prior to giving foods, fluids -monitor for complications ---cholangitis, perforation, sepsis, pancreatitis

Bronchodilators

-facilitate respirations by dilating airways -symptomatic relief & prevent bronchospasms -PO, inhaled, nebulizer **#1 albuterol

Examples of primary prevention

-family planning, genetic counseling, sex ed, smoking, communicable disease education, health & hygiene education, safety ed, immunizations

Ways to correct underlying problem in cardiogenic shock

-first treat oxygenation needs of heart muscle -pt may require thrombolytic therapy, PCI (percutaneous coronary intervention), CABG, surgery, or combo of these --replace cardiac valve, correct dysrhythmia, correct acidosis and elyte imbalance

RN considerations r/t intracavity radiation

-foley catheter -BEDREST and position restrictions -hygiene -monitor pt -SE of therapy -emotional support -address potential for isolation

Skin integrity interventions for AIDS/HIV pt

-freq routine assessment of skin & mucosa -maintain balance btwn rest & activity -reposition q2h -pressure reduction devices -avoid scratching -gentle, nondrying soaps -avoid tape -perianal skin care

What are the s/s of dumping syndrome

-full sensation - weak - faintness - dizzy - palpitations - sweating - cramping pains - diarrhea --resolve after intestine has been evacuated --later = rapid elevation of BS & increased insulin secretion = reactive hypoglycemia

Circulatory support for ARDS

-give vasopressors to keep BP up (d/t cardiogenic shock) -monitor CVP -give IV abx when fluid in lungs -massive corticosteroids to decrease inflamm response -sedatives to decrease anxiety -surfactant

How to assess for nerve injury s/p neck dissection

-have pt smile, frown, move jaw -can they swallow?

What does renal clearance depend on

-how quick substance is filtered across glomerulus -how much substance is reabsorbed in tubules -how much substance is secreted

What can nurses do about disparity & risk

-identify disparity (risk factor) -Advocate for better care / more needed care -Strive to fix -Educate ourselves and others -Protect others from harm -Evidenced based research -Open access -Change policy in politics, hospitals, health orgs

What is secondary prevention of cancer

-identify high risk -cancer screening -health education & health maintenance programs

Nursing for SVC syndrome

-identify pts at risk -monitor cardiopul & neuro status -avoid UE venipuncture & BP measurement -facilitate breathing w/ position -energy conservation (minimize SOB) -monitor fluid volume

RN dx for HIV/AIDS

-impaired skin integrity -diarrhea -risk for infection -activity intolerance -disturbed thought process -ineffective airway -pain -imbalanced nutrition -social isolation -anticipatory grieving

Stool tests in GI disorders

-includes inspection of consistency, color and occult, fecal fat, cdiff, nitrogen --fecal occult blood --multisampling test annually --fecal immunochemical test

Major goals of planning for pt w/ breast cancer & surgery

-increase knowledge of disease and tx -reduction of pre-op and post op fear and anxiety -improvement of decision making ability -improve coping skills -improve sex function -absence of complications

S/S of ascites

-increased abdominal girth -rapid weight gain DX -percussion -flanks bulge when in supine position -fluid wave

RN diagnosis for altered LOC

-ineffective airway - risk of injury - deficient fluid volume - impaired oral mucus - risk for impaired skin integrity - impaired tissue integrity of cornea r/t absent cornea reflex - ineffective thermoregulation r/t damaged hypothal - impaired urinary elimination - bowel incontinence

RN dx for brain injury

-ineffective airway clear & impaired gas exchange -ineffective cerebral perfusion -deficient fluid volume -imbalanced nutrition -risk for injury and impaired skin integrity

RN dx for altered LOC

-ineffective airway clearance -risk of injury -deficient fluid volume -impaired oral mucus -risk for impaired skin integrity -ineffective thermoregulation -impaired urinary elimination -bowel incontinence

RN diagnosis for ICP

-ineffective breathing patterns (r/t brain stem compression) -ineffective cerebral perfusion -deficient fluid volume -risk for infection

RN diagnosis for intracranial surgery

-ineffective cerebral tissue perfusion -potential for impaired gas exchange -disturbed sensory perception -body image disturbance

Post op interventions after breast surgery

-inform pt regarding post op sensations -maintain privacy -bra w/ breast form -provide info -support coping and adjustment -counseling and referral -monitor for potential complications

S/S of compensated cirrhosis

-intermittent mild fever -vascular spiders -reddened palms (palmar erythema) -unexplained epistaxis -ankle edema -vague morning indigestion -flatulent dyspepsia -abd pain -firm, enlarged liver -enlarged spleen

Where is a pacemaker implanted?

-lead enters external jugular vein -tunnelled subq btwn pacemaker & external jugular -beneath skin in pectoral region -tip of lead lodged in apex of right ventricle

cardiac age related changes?

-left ventricluar hypertrophy -valves thicken -rigid AV valves -murmurs at mitral and aortic valve (create turbulence in blood) -conduction not as well so higher risk for dysrhythmia (afib #1 in elderly, tachy, brady) -arteries lose compliance - cause isolated systolic HTN -barorecptor response decreases (so higher risk for falls or orthostatic HTN) -kyphosis (so decreased space in thoracic cavity and lungs - compress heart)

RN interventions for dumping syndrome (ATI)

-lie down when vasomotor manifestations occur -sandostatin -bentyl (antispasmodic med) -I&O - labs values - weight --lie down after meal to slow movement of food - limit fluid ingested - no liquids w/ meals for 1 hr before and after meals - high protein, low fat, low fiber, low to moderate carb - avoid milk,sweets, or surgars - small freq meals

Indications for gastric surgery

-life threaten hemorrhage -obstruction -penetrations -gastric cancer -trauma -ulcerations that are not responsive to meds or EGD tx

Sclerotherapy and band ligation for esophageal varices (ATI)

-ligating bands or injected sclerotherapy for active bleeding ONLY --sclerotherapy higher risk for hemorrhage

What are the s/s of spinal cord compression

-local edema, venous stasis, impaired blood supply -local or radicular back or neck pain -pain worse w/ movement, supine position, cough, sneeze, valsalva -neuro dysfunction & related motor & sensory deficits (numb, tingle, coldness in effected areas, loss of positional sense) -bladder / bowel dysfunction depending on level

RN interventions for altered LOC

-maintain airway -suction -padded siderails -IV fluids slowly -mouth care -cleanse eyes w/cotton balls moistened w/ sterile NS -regulate temp -prevent urinary retention & promote bowel functio

Activity intolerance interventions for AIDS/HIV

-maintain balance btwn activity & rest -energy conservation techniques -relaxation measures

Planning for pt w/ HIV/AIDS pt

-maintain skin integrity - regular bowel patterns - absence of infection - improved activity tolerance - improved thought process - improved airway clearance - increased comfort & nutritional status - increased socialization - expression of grief - absence of complications

1 Liter of fluid is equal to how much kilograms?

1 kg or 2.2 lbs --if pt has 3 liters taken off = should be a 6.6 lb weight drop

What is pagets disease

1% of breast ca -scaly, red, itchy lesion of the nipple -usually DCIS of nipple but can have invasive component

Who is at higher risk for uterine cancer

2x more for caucasion women -70% are obese - increases morbidity & mortality in this disease

How many branches does the left coronay artery have?

3 - left main CA - left anterior descending - circumflex artery

How many sections does a PD cath have?

3 sections -Intraperitoneal = numerous openings along cath & tip -Subq = tunnels thru fatty tissue -External = hangs out and connects to dialysate tubing

How long does medicaid/medicare pay for immunosuppressants?

3 years post tx --most pts can't afford, so back into renal failure - back onto dialysis -poss loss of disability as well

What is normal WBC

3,500 - 10,500

How is motor response rated/assessed on GCS

6 = commands followed 5 = local reaction to pain 4 = general withdrawal to pain 3 = decorticate position present 2 = decerbrate position present 1 = no motor response

Is there a link btwn mental illness and homelessness

6% population has severe mental illness -20-25% of the homeless have a severe mental illness

What happens during initiation of malignant cell transformation

Carcinogens alter the genetic structure of cell DNA causing permanent cell mutations

What are the 4 portions of the stomach

Cardia (entrance) Fundus Body Pylorus (outlet)

What does a sternal fx have potential for

Cardiac contusion -#1 problem of this is pericardial effusion (start building fluid in pericardial sac - leading to cardiac tamponade)

What should you evaluate for with rib fx

Cardiac injury -CT scan - Echo (look for cardiac tamponade) - EKG (r/o dysrhythmia) - continuous pulse ox - ABG

What is the primary cause of death in ESRD or CKD?

Cardiovascular disease

What is an ICP monitor (ATI)

Device inserted into the cranial cavity that records pressure -connected to a montor that shows a picture of the pressure waveform -more precise than vague clinical s/s

Conditions that cause decreased specific gravity

Diabetes insipidus - glomerulonephritis - severe renal damage

Endocrine portion of the pancreas

Diabetic -secretion of insulin, glucogen & somatastatin into blood stream --islets of langerhans

How is cancer diagnosed

Diagnostic tests that: -determine presence of tumor & involvement -identify mets & invasion -evaluate function of involved/uninvolved organs / systems -collect tissue & cells for analysis = tumor stage & grade

Transplants have greater success if they are done before what?

Dialysis

SE of magnesium

Diarrhea

What is pulse pressure

Difference between systolic and diastolic

What is dysplasia

Different transformation of cell where it doesn't look like/not common -malignant, more aggressive -expansion of immature cells -cell maturation & differentiation are delayed (so not well differentiated cells = bad)

S/S of botulism (ATI)

Difficult swallow - progressive weakness - N/V - abd cramps - difficulty breathing ***treat w/ airway mgmt, antitoxin, eliminate toxin, supportive care (nutrition, fluids, prevent complications)

Diffusion in dialysis

Diffusion - causes the movement of toxins and wastes out of blood thrr HIGHER (blood) to LOWER concentration (dialysate)

What does the stomach secrete

Digestive fluids highly acidic in response to food or anticipation of eating --secretes up to 2.4L of highly acidic fluid

Function of the SI

Digests & secretes -by folding back and forth over itself

What is a cerebral aneurysm

Dilatation of the walls of a cerebral artery -develops as result of weakness of arterial wall -if pressure builds - increases bulging (balloon) of wall

What are esophageal varices

Dilated tortuous veins found in the submucosa of lower esophagus -develop from elevated pressure in the veins that drain into the portal system -prone to rupture & source of massive GI bleed

What are carbs broken down into

Disacchyrides or monosacchyrides

What are advanced s/s of cervical cancer

Discharge - irregular bleeding - pain or bleeding after sex - leg pain - dysuria - rectal bleeding - edema in extremities

Definition of cancer

Disease process that starts when abnormal cell is transformed by genetic mutation of cell DNA -cell forms a clone & proliferates abnormally -ignores growth regulating signals surrounding cell

What are the side effects of antiretroviral agents

Dislipidemia (so on statins too) Hyperglycemia Peripheral neuropathy Myopathy Pancreatitis Liver problems Pain Lipodystrophy

What is the decorticate position

Adduction of arms, flexion of elbows & wrists -arms / wrists towards body **deCOR = TOWARDS

What is the most common kind of gastric ca

Adenocarcinoma --86% occur in stomach lining

What does efficient filtration depend on

Adequate blood flow that maintains a constant pressure --alterations that cause this: hypoTN, decreased oncotic pressure in blood, increased pressure in tubules caused by obstruction

How is pericarditis classified

Adhesive Exudative Noneffusive

What is internal - intracavity irradiation for cervical ca

After anesthesia & pelvic exam -specially prepared applicators are inserted into the endometrial cavity & vag -they aren't loaded w/ radioactive material until pt returns to their room -Loads applicators w/ radioactive material (called afterloading) --pt remains isolated in private room until application is complete

What is tissue expander recons

After mastectomy -expander placed under pec muscle & gradually filled w/ saline to stretch skin to accept implant

When is the best time for a BSE

After menses - day 5-7 counting the first day as day 1

Where does the PR interval start

After the P wave and before QRS - its when the AV node delays so ventricles can fill

What is the QRS complex

After the PR interval --the small down, large up, small down on EKG --Depolarization of ventricles --triggers main pumping contractions

What is antilymphocyte globulin

After transplant - med used to help prevent acute rejection

Causes for atrial fibrillation

Age, valvular disease, CAD, open heart surgery

What is chemotherapy

Agents used to destroy tumor cells by interfering with cellular function & replication -cure, control or palliative -trying to target cells during mitosis (cells most susceptible)

Where is the circumflex artery located?

Arises from left main CA and circles around to the lateral left wall of the heart

Where does the left anterior descending CA located?

Arises from left main CA and goes down the anterior wall of the heart

What is the most common type of renal cancer

Arises from the renal epithelium -accounts for 85% of all kidney tumors

What is the arterial part of AV fistula used for

Arterial blood flow to dialyzer

Key characteristics of ARDS

Arterial hypoxemia despite high FiO2 - bilateral lung infiltrates - onset is 12-48 hrs after insult - severe dyspnea - retractions - crackles - chest pain - decreased pulm compliance -

What is the type of fluid of ascites

As a result of liver damage - large amounts of albumin-rich fluid, 15L or more, may accumulate in the peritoneal cavity as ascites

What is dialyzer disequilibrium syndrome

As we filter small particle solutes (urea i.e.) - water shifts into brain causing cerebral edema -most common in children

Which body tissues are most effected in radiation and chemo

Body tissues that proliferate rapidly -skin, epithelial lining of GI tract, oral cavity, bone marrow

Effects of radiation on bone marrow

Bone marrow cells proliferate rapidly -long bones -pancytopenia (decreased RBC, WBC & platelets) --increased risk of infection & bleeding

What can nuc med imaging detect

Bone, liver, kidney,spleen, brain, thyroid -IV inject or ingestion of radioisotope followed by imaging of tissues that have concentrated the isotopes

What is the pt w/ DIC at risk for (ATI)

Both internal & external bleeding -and damage to organs resulting from ischemia caused by microclots

What is internal radiation

Brachytherapy -delivers high dose of radiation to localized area -radioisotope is implanted by needles, seeds, beads or catheters in body cavities or --high does for short period or low dose for extended periods

Treatment for invasive cervical ca

Brachytherapy Surgery

What 3 main components does the cranial vault contain

Brain - blood - CSF -if one of those increases in volume, at least one of the other 2 must decrease in volume or pressure increases --blood flow decreases as ICP increases

What is cerebral circulation

Brain does not store nutrients & requires constant O2 -those needs met thru cerebral circulation -brain receives 750 mL per minute of blood flow (15% of the cardiac output thur the carotid artery)

What is a linear or simple skull fx

Break in the continuity of the bone

Positive BRCA 1 gene mutation increases risk for what cancers?

Breast - ovarian

What type of cancer does ovarian cancer increase a risk for

Breast ca -by 3 to 4 fold

Surgical tx of breast ca

Breast conservation Total mastectomy Modified radical mastectomy SLN bx & ALND Breast reconst

What is postnecrotic cirrhosis

Broad bands of scar tissue -late result of a previous bout of acute viral hepatitis

What cancers can endoscopy detect

Bronchial & GI -allows tissue bx, fluid aspiration, & excision of small tumors

What are the most common lung cancers

Bronchogenic - arising from the bronchial epithelium -these are the small cell cancers -found earlier and tx - arise from bronchial tree

What are the s/s of a basilar fx

Bruise over mastoid bone (behind or front of ear) CSF escapes from ears and nose --halo sign (CSF drains on white linen_

What is battles sign

Brusing over mastoid bone -seen in basilar fx

Why does chronic renal failure cause N/V?

Build up of toxins

Why does CRF cause mental status changes?

Build up of toxins / ammonia

Laxatives

Bulk stimulant --rapid acting, increase motility by increasing fluid in intestine --saltless osmotic laxative pulls fluid out of venous system into lumen of SI **worry about elyte reabsorption (K+) --used to also rid high ammonia levels (lactulose)

What is a renal bx

Bx of kidney to help dx & eval kidney disease --small part of renal cortex is obtained thru perc bx (needle) or open by thru small flank incision

How is HIV transmitted

By body fluids containing HIV or infected CD4 lymphocytes -blood, seminal fluid, vag secretions, amniotic fluid, breast milk -breaks in skin or mucosa increase risk

What CDC category is the 2nd HIV stage (HIV asympomatic)

CDC Category A

What CDC category is the 3rd HIV stage (symptomatic HIV)

CDC Category B

What CDC category is AIDS

CDC Category C

What CDC category is the primary stage of HIV

CDC category A

Examples of tumor specific antigens

CEA = colorectal BRCA 1 & 2 = breast / ovarian PSA = prostate

What is cirrhosis

CHRONIC disease characterized by replacement of normal liver tissue w/ diffuse fibrosis that disrupts structure & function of liver ---scarring of liver

What are the cardiac markers

CKMB myoglobin troponin

What is the blood brain barrier

CNS is inaccessible to many substances that circulate in blood because of this barrier -barrier formed by endothelial cells of brains capillaries -they form continuous tight junctions creating a barrier to MACROMOLECULES -can be altered by trauma, cerebral edema & cerebral hypoxemia

What is internal respiration

CO2 exchange from tissue into blood and O2 from blood into tissue -at capillary beds

What is the respiratory drive

CO2 levels in the blood -stimulate the medulla in brain

What happens to resp drive if there is long term high CO2 levels in blood

COPD/emphysema -drive to breath regulated by O2 -start with low O2 rate and titrate up

What is the formula for cerebral perfusion pressure

CPP = MAP - ICP

What does the arachnoid space contain

CSF in the space below it (subarachnoid space) -has arachnoid villi that absorbs CSF into the venous system

Complications of LP (ATI)

CSF leakage -if clotting doesn't occur to seal puncture site - CSF may leak = headache and increase risk for infection -prepare pt for epidural blood patch to seal off hole if headache persists

Other dx scans for PE

CT D Dimer - shows risk for DVT Venous dpx Echo - look at heart valves and any cardio clots (afib) EKG - rule out MI (onset could mimic MI)

Dx of pancreatic cancer

CT (85-90% accurate) MRI ERCP Bx Paracentesis Endoscopic US Gi xray (just shows malformation) CA 19-9, CEA, DU-PAN-tumor markers non specific for panc ca but used to mark progession

Dx tests for brain tumor

CT = shows number, size & density of lesions & extent of 2ndary edema MRI = most valuable for brain tumors - esp smaller tumors and where bone is thick (pit gland & brain stem) PET EEG CSF studies

Lab test showing pneumothorax

CXR -Hypoxemia on ABG's (PaO2 less than 80)

What is the parasympathetic NS?

Calms - inhibitory response -dominant controleer for visceral effectors

What is an AV graft

Can be created subq by interposing a biologic or synthetic graft material btwn artery & vein -used when pt not candidate for AV fistula

Causes of atrial flutter

Can cause SOA - CP - and decreased BP --caused by age, valvular disease, CAD, open heart sx

What do nitrates do

Can decrease BP significantly M orphine O 2 N itrate A sa

Chronic subdural hematoma

Can develop from minor head injuries & seen most freq in elderly -time between injury and onset of s/s can be 3w to months = so actual injury may be forgotten

What is post infarction syndrome

Can happen after renal artery embolization -pain, fever, GI s/s - must be dealt w/ for 2-3 days with IV and PO meds (tylenol for fever, narcs for pain, antiemetics, restrict oral intake, IV fluids)

Where can cervical cancer metastasize to

Can invade tissues outside the cervix - including LN anterior to the sacrum -1/3 can involve the fundus -nerves can be effected causing bad back and leg pain relieved only by large doses of opiates

What if SVC syndrome is untreated

Can lead to cerebral anoxia - laryngeal edema - bronch obstruction - death

Nerve injury s/p neck dissection

Can occur if cervical plexus or spinal accessory nerve is severed --can cause lower facial paralysis -if laryngeal nerve is severed = problems swallowing

What is CA-125

Cancer antigen level -elevated levels are significant predictor of extrauterine disease or mets (also ovarian ca)

What is bladder cancer

Cancer that forms in tissues of the bladder -most are transitional cells -starts in cells that normally make up the lining of the bladder

What types of diseasesd does hysterectomy treat

Cancer, dysfunctional uterine bleeding, endometreosis, non malignant growths, persistent pain, pelvic relaxation & prolapse & previous injury to uterus

Define oral cancer

Cancers involving any part of the mouth, tongue, gums, pharynx, lips --curable if found early (most of the time not found early)

What is the #1 opportunistic infection in HIV symptomatic stage?

Candidias

What are nitrates for?

Nitroglycerin - vasodilator to treat angina - decreases BP as well (significantly)

Will patients receiving cyclosporine display usual s/s of rejection (book)

No -usually asymptomatic rise in serum creatinine -more than 20% rise is considered acute rejection

In florence nightengale era, was nursing acceptable

No - next to prostitution -because dealing with unclean people and sick people and only people that didnt' have anything better to do with their lives went into nursing -believed pts needed human contact

What protein restriction diet for CRF?

No protein diet -Less than 60 gm / day to reduce urea production *3oz beef = 25gm - 1 egg = 8gm

S/S of the first stage of HIV

No s/s to flu like symptoms in the primary stage

Palliative care for gastric cancer

No successfult tx other than removal of tumor -if unable to remove tumor = do chemo

What is a spontaneous pneumothorax

No trauma -small bleb on lung ruptures and air enters pleura space

What are the fast growing lung ca

Non small cell - almost always assoc w/ smoking

Will lung ca s/s have cough with or without sputum

Non small cell = no sputum Small cell = sputum

What is c-reactive protein

Non specific indication of inflammation - if increased and no other s/s of inflammation = inflammation of coronary arteries

What are fibrocystic breast changes

Non specific term to describe many benign findings -don't necessarily indicate a cyst

Breast cancers with favorable prognosis

Noninvasive tumors or less than 1cm Neg LN ER/PR positive Well differentiated Low Her2/neu No vascular or lymph invasion

What neurotransmitter effects mood and overall activity

Norepinephrine -excitatory

What is the main neurotransmitter of the sympathetic NS

Norepinephrine (noradrenaline) - same as if body was injected adrenalin

What is central venous pressure (CVP)?

Normal = 4-8 mm/Hg -measures pressure in right atrium for hypo or hypervolemia -determines preload (filling) -manage fluid volume -draw from infuse IV meds and fluids - common complications: infection, pneumothorax, air embolism

BUN / creatinine ratio in ARF

Normal is 10:1 or 20:1 --if ratio is high = indicates cause is pre-renal (dehydration) --if ratio is low = indicates cause is intra-renal

How much is pancreas enzyme secretion

Normally 1.5 - 2.5L per day

Ammonia in GI disorders

Normally used to rebuild amino acids or converted to urea for excretion

What does the upper resp tract include

Nose Paranasal sinuses Turbinate Bones (Conchae) Pharynx, Tonsils, Adenoids Larynx Trachea

What happens to reabsorbtion in the LI when pt has diarrhea

Not enough time to reabsorb elytes like K+ & fluids from LI --hypokalemia seen to happen with laxative and lactulose

Is CEA detected in healthy person

Not normally -indicates presences of cancer but not the type of cancer -its a protein

What should be noted in CBI

Note time bag put up -keep close eye to make sure IN is EXCEEDED by OUT -if we run too slow we clot off catheter & there will be bladder filling and overexpanding w/ irrigant

What is ejection fraction?

Number associated with average % of blood ejected with each contraction

Guidelines for ethical behavior for nurses

Nurse Practice Act Patient bill of rights Standards of practice Personal values Company policy

What is a community health nurse?

Nurse who practices in the community -usually have a facility they work from but are not limited to hospital nursing practice

Examples of tertiary prevention

Nutrition counseling the obese, exercise rehab, case mgt, shelters, support groups, PT, OT, rehab

How are regional LN (N) classified in staging

Nx - nodes cannot be assessed N0 - no LN mets N1, 2, 3 - Increasing involvement of nodes

ICP with hypoxemia

O2 sats decreased --causes vasodilation -CO2 keep down b/c causes vasodilation -possible ventilator to control this

RN care for PE

O2 therapy to relieve dyspnea & hypoxemia - high fowlers - IV access - meds - anxiety control - LOC monitor

What does the left anterior descending coronary artery provide to the heart

O2 to the left ventricle --stenosis in LAD termed the "widow maker"

What is the biggest s/s of rejection s/p kidney transplant

OLIGURIA (<500 mL UO in 24 hours)

Pathophys of ascites

Obstruction Increased capillary pressure Fluid shift into intraperitoneal space

What is renal artery embolization

Occlusion of renal artery to occlude blood supply to the tumor thus killing the tumor cells -also stimulates an immune system response

Assess & dx of colon ca

Occult blood Colonoscopy Labs (CEA)

What is a depressed skull fx?

Occur when the bones of the skull are forcefully displaced downward -can vary from slight depression to bones being splintered & embedded within brain tissue

What is hyperacute rejection

Occurs a few minutes after transplant -if the antigens are completely unmatched *tissue must be removed asap so recip doesn't die *seen when recip is given wrong type of blood

What is an acute rejection

Occurs any time from 1st week to 3 mths after -everyone has some type of rejection

What is gastric cancer

Occurs anywhere in the stomach --pylorus (40%) --Body (40%) --Cardia (15%) --Multiple (10%) --tumors can infiltrate surrounding areas

What are the characteristics of vag bleeding in advanced cervical ca

Occurs irregular intervals -between periods (metorrhagia) -after menopause -may be slight and usually after trauma or pressure (sex, douching, or bearing down after BM)

Fat metabolism in the liver

Occurs when glucose is low (as in starvation or uncontrolled DM) -fatty acids are broken down for energy & ketone bodies enter blood & provide energy

What is cardiogenic shock (book)

Occurs when hearts ability to contract & pump blood is impaired -supply of O2 is inadequate for heart & tissue

What is the treatment for diarrhea related to HIV

Octretide acetate (sandostatin)

What is the most common sign of ovarian ca

Often silent but -enlargement of abdomen from accumulation of fluid

What is the #1 cause of afib

Old age

Risk factors for bladder cancer

Older than 55 Men Caucasions Tobacco use Exposure to environmental carcinogens (dyes, rubber, leather, ink, paint) Recurrent bacterial infections (chronic UTI) Bladder stones High urinary pH High cholesterol intake, high soda & caffeine intake

Who can receive medicare?

Older than 65 Receive social security Disable for 2 yrs Have ALS w/ disabilty benefits or kidney failure w/ maintenance dialysis or had transplant

What is the 2nd phase of ARF?

Oliguria --LESS THAN 400mL UO in 24 hrs (about 17mL / hr) -normal UO is 720 mL in 24 hrs **Increased BUN, creatinine first - then elytes imbalance - K+ increases - uric acid - Mg-

What does a fixed and dilated pupil indicate

Ominous sign of brain stem herniation is imminent

What is lung cancer

One of the most leading causes of cancer related deaths

What is the triad of s/s for renal ca

Only in 10% of patients -Hematuria -Pain -Flank mass (by now, usually mets)

What does nipple inversion indicate

Only significant if recent change -ulceration, rashes, and spontaneous nipple d/c needs evaluation

What is a craniotomy

Open skull for access -small portion or skull incision -suture back -relieves ICP, evac blood clot or hemorrhage

What drugs does the liver detox

Opiates, barbiturates, neutralizes etoh

What is the most common GI clinical manifestations of AIDS

Oral candidiasis -may progress to esophagus & stomach -diarrhea -HIV wasting syndrome

Dx of oral ca

Oral exam Cervical LN assessment CT head/neck Bx any lesion that doesn't heal in 2 weeks

Florence nightengale developed ______ _______

Organized nursing -known in England -1854 went to Turkey during war to help in the hospital with dying soldiers (no air flow, bad food, dirty water, dirty dressings) -kept track of what she did (evidence based - first statitician)

What is the most common type of transplant

Orthotopic - replace only the ventricles and keep atria and great vessels

What removes the excess water from pts fluid volume during dialysis?

Osmosis & ultrafiltration --osmosis = H2O moves from lower (blood) to higher concentration (dialysate)

How much of the filtrate is reabsorbed into the blood stream

Out of the 180L / day of filtrate produced - 99% is reabsorbed into bloodstream --result is formation of 1-2L urine / day

What is normal GFR?

Over 125 mL

What is the #1 function of the lungs

Oxygenate the blood #2 - acid base balance (lungs and kidneys)

Autonomic NS effects on b vessels in heart muscle

P = Constricted S = Dilated

Autonomic NS effects on bronchioles

P = Constricted S = Dilated

Autonomic NS effects on BP

P = Decreased S = Increased

Autonomic NS effects on HR and force of heart

P = Decreased S = Increased

Autonomic NS effects on RR

P = Decreased S = Increased

Autonomic NS effects on peristalsis

P = Increased S = Decreased

Autonomic NS effects on pupils

P = constricted S = dilated

Autonomic NS effects on urinary

P = contract muscle walls & relax sphincters S = relax muscle walls & contract sphincters

Autonomic NS effects on abd viscera & skin

P = no direct effect S = Constricted

Autonomic NS effects on skeletal muscle

P = no direct effect S = Dilated

Autonomic NS effects of liver convertion glycogen to glucose

P = no direct effect S = increased

Autonomic NS effects on sweat

P = no direct effect S = increased

Autonomic NS effects on adrenal medulla

P = no direct effect S = secretion of epinephrine & norepinephrine

Autonomic NS effects on sphincters of GI

P = relaxed S = contracted

Autonomic NS effects of saliva

P = thin & watery S = thick

Causes of high VQ

PE, pulm infarction, cardiogenic shock #1 cause is pulmonary embolism

Prognosis of lung cancer

POOR b/c often dx in advanced stage

Is sympathetic nervous system positive or negative in relation to HR and contractility?

POSITIVE -Chronotropy - dromotropy - inotropy

What is head/brain/sp injury all about

PREVENTION

What is the 1st level of cardiac procedures

PTCA percutaneous transluminal coronary angioplasty

how can you protect pt with altered LOC

Padded side rails - 2 side rails up -

Post op nursing dx for pt getting breast surgery

Pain Disturbed sensory perception Disturbed body image Self care deficit Risk for sexual dysfunction Deficient knowledge (drains, arm exercises, hand & arm care)

S/S of colorectal ca

Pain LLQ Ineffective, painful straining due to obstruction Tenesmus (constant feeling of need to pass stools) Rectal pain Feeling of incomplete evacuation Alternate w/ diarrhea & constipation Frank bloody stools

S/S of partial obstruction

Pain and thin pencil stools

What causes sinus tachycardia?

Pain, anxious, acute blood loss, hypovolemia, heart failure, (speed kill) - causes decreased cardiac output

other risk factors for laryngeal cancer

Paint or wood fumes - voice strain - chronic laryngitis - deficient riboflavin - african american and men - decreased immune system

What is the goal of tx in lung ca

Palliative or tx geared towards relieving symptoms

How are portal HTN measured

Palpable enlarged spleen and ascites may be present -can be measured indirect or direct

Elevation of lipase

Pancreatitis Norm = 0-110

Elevation of amylase

Pancreatitis Norm is 56-90

In early stages of cervical ca how is it found

Pap smear

What causes peristalsis

Parasympathetic stimulation causes peristalsis & increases secretory actions -causes sphincters to open & let food & nutrients & waste pass thru

If a pt has bilateral renal tumors or cancer of a single functioning kidney - what can be done

Partial nephrectomy can be done

Complications of colon ca

Partial or complete obstruction Hemorrhage (tumor invades surrounding vessels)

What is the purpose of the nose

Passage for air to pass to and from lungs -filters impurities & humidifies & warms the air as inhaled

What is the #1 concern s/p neck dissection

Patent airway #2 = hemorrhage

Goals for pt w/ brain injury

Patent airway Adequate CPP Fluid & elyte balance **prevent 2ndary injury adequate nutrition Normal body temp Improve cognitive function Effective family coping

Who is the nurses primary commitment to

Patient -practice without regards to socio-economic, personal issues or where/how disease was contracted

What are the s/s of the HIV asymptomatic stage

Patients feel well and have few s/s -CD4+ T cell levels remain high enough to preserve immune defense responses

Where is the gallbladder

Pear shaped -underneath the liver -drained by the cystic duct

How is cervical cancer prevented

Pelvic exams & PAP - for early detection Education - for abstaining and safe sex Smoking cessation HPV vaccine

In later stages of cervical ca - how is it found

Pelvic exams that reveal a large, reddish growth or deep ulcerating lesion with spotting or bloody discharge

What do the chief cells in stomach secrete

Pepsinogen --precursor to pepsin which is a major factor in digesting protein

How is spinal cord compression dx

Percussion tenderness @ compression level - MRI - abn reflexes - sensory & motor abn - spine xrays - bone scans - CT scans - CT guided myelogram

What is incisional bx

Performed if tumor mass is too large to be removed -wedge of tissue is removed for analysis -negative results does not guarantee absence of cancer

Actual blood flow thru pulm circulation

Perfusion

If there is a problem with the blood flow around the alveoli sacs, there is a problem with?

Perfusion =HIGH VQ (low perfusion)

What moves food forward in the stomach

Peristalsis -if food particles too large - will wave back to stomach for more breaking down

What is the movement of urine from renal pelvis - to ureter - to bladder caused by?

Peristaltic contraction of the muscles in the ureter wall

What is between the 2 pleuras and how much

Pleural space -has 15 mL of pleural fluid to keep them from rubbing together (lubricant)

What is a epidural monitor

Pneumatic flow sensor to detect ICP -low incidence of infection & complications -

What is the most common respiratory clinical manifestation of AIDS

Pneumocystic carini pneumonia - PCP -others include mycobacterium avium complex & TB

What is directly related to esophagus varices

Portal HTN

What 2 things are directly linked to liver disease

Portal HTN Ascites

Primary risk factor for esophageal varices (ATI)

Portal hypertension

What is a continent urinary diversion

Portion of the intestine is used to create a new reservoir for urine -attached to abd wall -pt cath's themselves to empty the reservoir

Prevention and risk for pulmonary embolism

Post op early ambulation - fluids - SCDs - TED hose - passive ROM

What arteries branch off of the right CA>

Posterior descending artery - sends blood to the posterior wall of the heart

Where is the esophagus

Posterior to trachea - anterior to spine --10 inches long & passes thru the diaphragm

How thick should the endometrium be

Postmenopausal women should have very thin endometrium r/t low levels of estrogen - if thicker needs further assess

What are the 3 types of cirrhosis (ATI)

Postnecrotic Laennecs Biliary --stay current on vaccines --avoid etoh

What elyte should you monitor if giving pt lactulose (ATI)

Potassium -can cause hypokalemia w/ increased stools from lactulose`

What is ammonia

Potential toxin -pt w/ liver issues (portal encephalopathy) placed on protein restriction do help decrease ammonia in blood

What makes pts at risk

Poverty - age - illiteracy - homeless - isolation - rural or inner city - mental ill - working poor -

Nursing mgmt for colon ca surgery

Pre op = bowel prep Post op = monitor for anastomosis leakage - prolapse stoma - perforation - stoma retraction - fecal impaction - skin irritation Nutrition = TPN or IVF until bowel function returns - slow advance diet - healthy diet

What decreases risk of ovarian ca

Pregnancy & use of oral contraceptives

What is pneumothorax

Presence of air or gas in pleural space that causes lung collapse

Modified radical neck dissection

Preserves one or more of the nonlymph structures -used more often -selective neck dissection -preserves 1 or more LN groups, internal jugular, muscle and nerves

What is diabetes insipidus

Pressure of ICP on pituitary gland (behind sinuses) -DILUTE urine output (huge amounts of UO like water) -increases Na+ up to 150-160 (as dehydration continues) **replace fluid loss **DI goes away after ICP fixed

Anemia mgmt for CRF?

Prevent & tx **Erythropoietin 3 times / week with dialysis or subq (if not on dialysis) **Titrate to keep Hgb over 12 (if over 12 = hold) -iron supplements IV or PO - IV w/ dialysis is best to reduce fluid overload

What is tertiary prevention

Prevent disease progression, maximize recovery, minimize suffering **Treatment

Ethical considerations include what ? (ATI)

Preventing harm, doing no harm, promoting good, respecting both pt and community rights, preventing disease

*What is primary prevention?

Prevention of initial occurrence of disease or injury -Nutrition education, family planning, sex ed, smoking cessation, communicable disease education, health & hygiene, safety, prenatal classes, immunizations, hearing screenings, f/u bilirubin in infants, childhood screenings in school

Histamine 2 antagonists

Prevents gastrin from stimulating release of hydrochloric acid **zantac - tagament - pepsid - axid** --cimetadine, famotidine, nizatadine, ranitidine **"dine" - histaMINE

Oral BCC

Primarily on lips -ulcer with raised pearly border -non healing/masses/bleed easy --lesion that is nonhealing for 2 weeks to mth = need to see dr

What is the 1st stage of HIV

Primary (aka acute HIV) -the period from infection w/ HIV to development of the HIV specific antibody --rapid viral replication & dissemination thru the body) **window period - HIV + person tests negative (lack of antibodies) -viral set point

What are the causes of hepatic dysfunction

Primary liver disease - acute/chronic cirrhosis Obstruction of bile flow - gallstones Derangements of hepatic circulation - portal hypertension

What if you can see pulpulsion wave of peristalsis outside the intestine?

Probably blockage somewhere

What is chronic renal failure / chronic kidney disease?

Progressive & irreversible deterioration of kidney function over time

What are the s/s of SVC syndrome

Progressive SOB - cough - hoarse - chest pain - facial edema -edema of neck, arms, hands, thorax - skin tightness feeling -difficult swallow -engorged & distended jugular, temporal & arm veins -increased ICP, HA, altered MS

Chronic pancreatitis (ATI)

Progressive, destructive disease w/ development of calcifications & necrosis -possible result in hemorrhage pancreatitis -mortality as high as 50%

What is LCIS

Proliferation of cells in the breast lobules -found incidentally on path b/c not seen on mammo and no palpable mass -marker for increased risk of breast ca (increases risk 8-10x)

What is neoplasia

Proliferation of cells that don't belong there -formation of new abnormal tissue growth -creates a neoplasm / mass

How is cancer controlled

Prolong survival & contain cancer cell growth

How is DIC dx

Prolonged PT (prothrombin) Prolonged PTT (partial thromboplastin) Decrease fibrinogen Decreased platelet Decreased H & H Decreased clotting factors Positive protamine sulfate Elevated D Dimer Prolonged INR

Nursing management for ascites and cirrhosis

Promote rest Nutrition Skin care Decrease risk of injury Monitor for potential complications (bleeding, hemorrhage, hepatic encephalopathy, fluid volume excess)

What is CA 19-9

Protein -exists on surface of certain cells and is shed by tumor cells to use as tumor marker to follow the course of cancer --elevated in most pts w/ advanced panc cancer

Pepsin aids in

Protein digestion

What are tumor specific antigens

Proteins on cancer cell membranes -distinguish malignant cells from benign cells of the same type of tissue -useful in measuring extent of disease & tracking course of illness during tx --cell markers identifyed by the immune system to identify cancer cells before cancer

What is a home health nurse ATI

Provide health care services to pts where they reside -nursing homes, asst living, traditional homes -function as educator, provider of skilled nursing & coordinator of care

What is a staff nurse / field nurse / visit nurse?

Provide nursing care -you are the healthcare provider in the home & your assessment skills are vital -you have to communicate your findings -assess, communicate, triage, & treat -must have good critical thinking skills -draw blood, give resp tx, manage ventilators, tube feedings, etc & develop ability to know how the home is supposed to smell, look and sound.

Potassium restriction for CRF

Provide pt w/ list of foods high in K+ -poultry, bananas, OJ, tomatoes, potatoes, avocado, chard, citrus fruits, juices (grapefruit & tomato), dried lentils, green leafy, milk, nuts, parsnips, dried peaches, raisins, sardines, spinach, whole grain cereals

What is triceps reflex

Pt arm flexed at elbow and position in front of chest -support pt arm and palpate tricep tendon 1-2 inches above elbow -direct blow on tendon will cause triceps to contract and elbow to extend *tests nerve roots C6-C8

What is brachioradialis reflex

Pt forearm resting on lap or across abdomen -gentle strike 1-2 in above wrist *flexion & supination of forearm *tests nerve roots C5-C6

When can right to privacy be broken

Pt is or has threatened harm to self or others

What is brudinski sign

Pt lay flat and flex neck forward -normal = no pain or resistance -abn = pain & resistance, hip & knee flexion in response = indicates meningitis

What is kernigs sign

Pt lie flat and flex one knee & hip on same side -normal = no pain or resistance -abnormal = pain and resistance = indicates meningitis

How does cmmty health nurse play the role of advocate??

Pt's are either entering or exiting acute care quickly & unprepared -or never seeing acute care environment for their needs -advocate to get them the care they need -inform, support, mediate -place priority on pt's values & willingness to progress thru chain of command for resolution

How does the cmmty health nurse play the role of case manager?

Pt's in community have many needs -mulitiple fields working towards goal of better health for this person -coordinate the care - cut the cost - simplify the routine so pt can thrive in it

Who is PD dialysis used for

Pts unable to tolerate rapid shifts in fluid, elyte & metabolic changes **severe HF pts, severe HTN, pulm edema

When is breast MRI most useful

Pts w/ proven cancer when assessing for mulitfocal disease (more than one tumor in same quadrant of breast -or multicentric (more than one tumor in other quadrants)

What are other causes of cardiogenic shock (notes)

Pulm congestion, hypoxia - inadequate circulation - high mortality - #1 cause is MI (ischemia causes decreased contractility), valve dysfunction - *cardiomyopathy (esp left side of heart) - trauma to heart - cardiac tamponade - dysrhythmias --similar to heart failure but happens really fast (minutes to hrs)

What does ARDS cause

Pulm edema, increasing bilat infiltrates on CXR, refractory hypoxemia, loss of lung compliance

what can blunt chest trauma cause

Pulm or cardiac contusions, broken ribs, possibly life threatening -A B C's

Cardiopulmonary side effects of chemo

Pulmonary edema Capillary leak syndrome Pericarditis HF (r/t pulmonary edema)

When does the ACS recommend women at average risk undergo clinical breast exam

Q 3 years in their 20 & 30's and then annually

Does the HIV virus mutate slow or quick

QUICK

Describe v tach on EKG

R waves (HR) are pointed downward (below line) - No pwave - HR / R waves = greater than 150 bpm **life threatening and normally goes into v fib

On an EKG - what waves are counted to get HR?

R waves (and multiply by 10 on a 6 second strip)

Describe a normal sinus rhythm EKG

R waves = HR = 60-100 bpm Rate = regular 1 P wave per QRS complex

Function of the liver

REMOVE WASTE FROM BLOOD - secretes them into bile --important in regulating metabolism of glucose & protein --drug metabolism --produces prothrombin --cleans & clears our blood

What type of isolation should a transplant patient be on

REVERSE isolation **no mixing of clean & isolation patients for nurse caring for tx patient

Nonsurgical mgmt of breast ca

Rad therapy (external beam or brachytherapy) -chemo -hormonal (tamoxifen, aromatase inhibitors (anastrazole, letrozole, exemestane) -targeted therapy

Other treatments of renal cancer

Radiation Chemo Hormone therapy -may be used adjunct w/ surgery

Medical mgmt for laryngeal ca

Radiation - for stages 1 and 2 to eradicate tumor and decrease size Chemo - attacks all cells that reproduce quickly - collateral damage to cells that have quick mitosis (mucus, blood, hair, etc)

what does increased fluid in the pericardial sac do?

Raises pressure in the heart and compresses the heart - can progress to cardiac tamponade

What is acute renal failure (ARF)

Rapid loss of renal function due to damage to the kidneys --can be life threatening --can cause metabolic acidosis & fluid / elyte imbalances

What is cytosarcoma phyllodes

Rare lesion that grows rapidly -rarely malignant & tx surgically -if malignant - mastectomy poss but no LN removal

S/S of graft vs host disease

Rash - progress to blister & leaking serous fluids (like 2nd degree burns) - mucosal shedding w/ diarrhea (may exceed 2L per day) - biliary stasis w/ abd pain - enlarged liver - elevated liver enzymes

Describe afib on EKG

Rate - irregularly irregular (no pattern) *SA node dysfunction and fires @ 300x per minute -atria quivers - ventricles fire whenever **danger = blood pools in atria forming clots -left clot goes to brain -right clot goes to lungs

The level of blood glucose regulates what?

Rate of insulin the pancreas produces

What is osmolarity

Ratio of solute to water

What is passive immunity

Received thru injection of immune factors from another source -or mother to infant thru colostrum or placenta in utero -if RN gets needlestick - give immunoglobulin or IgG

Contraindications to recieving a kidney transplant

Recent cancer - active/chronic infection - severe irreversible extrarenal disease (inoperable cardiac disease, chronic lung disease, PVD) - active HIV, Hep B & C - morbid obesity - current substance abuse - hx of non compliance w/ meds - inable to consent

What is the 4th phase of ARF

Recovery -Improve renal function -May take 3-12 mths -urinary functions improve & elyte levels improve

What is renal glycosuria

Recurring or persistent excretion of glucose in the urine -occurs if amt of glucose in blood and glomerular filtrate exceeds the amount that the tubules are able to reabsorb --occurs in DM

S/S of chronic pancreatitis

Recurring severe abd & back pain Vomiting Pain is chronic & severe & unrelieved by large doses of opioids Poss opioid dependence Weight loss d/t decreased intake r/t anorexia or fear of eating Malabsorption & protein & fats stop absorbing -then pt gets steatorrhea (freq, frothy, foul smell stools)

What is another management of ICP

Reduce CSF and intracranial blood volume -burr hole & evacuate blood from brain (if on /by surface of brain) -ventricolostomy drain or VP shunt -hyperventilate = vasoconstriction

Goals for nursing s/p gastric surgery

Reduce anxiety Nutrition Maintain weight Relieve pain Prevent infection

How does kayexelate work

Reduce elevated K+ levels by exchanging sodium for potassium ions in the intestinal tract

PPI's (ATI)

Reduce gastric acid by inhibiting the cellular pump necessary for gastric acid secretion --capsules can be sprinkled on food or applesauce for pt w/ swallow difficulty **protonix - prilosec - nexium** (p-zole or pizole / fazolis)

Primary prevention of cancer

Reduce risks thru health promotion & EDUCATION -avoid carcinogens, make good dietary changes, lifestyle changes

Histamine receptor antagonists (ATI)

Reduce secretion of acid - onset longer than antacids but last longer --take w/meals and at bedtime **zantac - pepcid - axid** (histaMINE & drug ends in dine)

What is cancer grading

Refers to classification of tumor cells -define the type of tissue where tumor originated & degree that the tumor cells retain characteristics of original tissue (differentiation of cells)

What is invasion

Refers to the growth of primary tumor into surrounding host tissues

What is neurological level in SCI

Refers to the lowest level at which sensory and motor are normal --below neuro level there is total sensory & motor paralysis, loss of bladder & bowel control, loss of sweat & vasomotor tone & marked reduction of BP

How are DTR's tested

Reflex hammer -handle held loosely btwn thumb & index finger to allow full swing motion -wrist is similar to percussion use -position extremity so tendon slightly stretched -strick tendon briskly and compare sides for symmetry

What is major factor to control EC volume & serum/urine osmolarity

Regulation of salt and water

What is hyperacute rejection

Rejection & failure w/in 24 hours

What is acute rejection

Rejection w/in 3-14 days -rejection can also occur after many years

What is post renal ARF

Related to kidney obstruction -stones / strictures that obstruct urine outflow -BPH or urinary retention causing hydronephrosis (back up of urine into kidney)

epidemiological triangle (ATI)

Relationship among agent, host & environment -interaction btwn determines development & cessation of communicable diseases - form web of casuality that increase or decreases risk

Xanthines

Relax smooth muscle PO not used as much anymore **theonophylline

What is palliative treatment of cancer

Relief of s/s associated with the disease -pain control -improve quality of life

What is a radical neck dissection

Removal of all cervical LN -from mandible to clavicle & removal of sternocleidomastoid muscle, internal jugular vein, & spinal accessory nerve

What is total mastectomy

Removal of breast and nipple/areola but not including ALND -for DCIS -for BRCA 1/2 positive -may do w/ a SLN bx

What is radical trachelectomy

Removal of cervix and selected nodes to preserve childbearing capacity

What is a total gastrectomy

Removal of entire stomach, duodenum, LN & mesentary, lower part of esophagus -connect esophagus to jejunum

What is pelvic exenteration

Removal of pelvic organs, including bladder or rectum, pelvic LN, and construction of diversional conduit, colostomy & vagina

What is bilateral pelvic lymphadenectomy

Removal of the common iliac, external iliac, hypogastric & obturator lymph vessels and nodes

What is a radical nephrectomy

Removal of tumor, kidney, adrenal gland, surrounding perinephritic fat, gerota's fascia & LN

What is a total hysterectomy

Removal of uterus, cervix & ovaries

What is radical hysterectomy

Removal of uterus, ovaries, fallopian tubes, proximal vag, bilateral LN thru abd incision

What is conization

Removing a cone shaped portion of the cervix -used when bx shows CINIII or HGSIL and in situ

Dietary restrictions after transplant

Renal diet 1st --then Low salt - Low fat diet

Once the urine leaves this area - the composition or amount of urine does not change

Renal pelvis --no changes to pH, concentration, amount, volume, etc

After urine is formed in the nephron - where does it flow

Renal pelvis - then into the ureters

The collecting ducts connect to what?

Renal pyramids -triangular -each kidney has 8-18 pyramids

Where do the 2nd & 3rd steps of urine formation occur

Renal tubules

What controls levels of Angiotensin II

Renin -an enzyme released by cells in kidney

What happens if vasa recta detects a decrease in BP

Renin is secreted --renin converts to angiotensin I --then that converts to angiotensin II = causes increase in BP --then aldosterone is secreted in response to poor perfusion or increase in osmolarity = increase in BP

What happens during promotion stage of cancer cell transformation

Repeated exposure to carcinogens cause abn genetic info -cells have on and off switches for cell growth -when suppressor cancer genes lose ability to turn off growth, they are allowed to reproduce

Pancreatic enzymes

Replace pancreatic enzymes to aid digestion & absorption of fats, proteins, carbs **creon - pancrease** --take with food but not hot foods --helps food digest properly

Skin care for cirrhosis

Requires moisturizers and antipuritic agents (benadryl & atarax) - itchiness r/t ammonia

S/S of pulmonary embolism

Resp go up to 35-45 - rapid onset of chest pain - tachycardia - anxiety - apprehension - pain on inspiration (ATI)

Nursing care for cirrhosis (ATI)

Resp status Skin integrity Fluid balance VS Neuro status Nutrition GI status Pain status

Bile is secreted in response to what

Response to gastrin, secretin & cholecystokinin

Pathophys of dumping syndrome (ATI)

Response to sudden influx of hypertonic fluid - SI pulls fluid from EC space to convert hypertonic to isotonic fluid --fluid shift causes decrease in circulating volume - resuls in vasomotor s/s

Nursing care for pancreatitis (ATI)

Rest the pancreas -NPO until pain free -TPN -when diet resumed = bland, low fat, no stimulants, small freq meals -antiemetic -NG for gastric decompression -no etoh or smoking - limit stress - pain mgmt -position for comfort - fetal, side lying, HOB elevated, sitting up or leaning forward)

Tertiary prevention for occupational health nurse

Restoration of health thru rehab

Diffuse axonal injury

Results from widespr\ead shearing & rotational forces -damage thru brain to the axon -injured areas may be diffuse w/ no identifiable lesion -assoc w/ prolonged traumatic coma - assoc w/ poor prognosis

What happens to sodium and water in CKD?

Retention -kidney is unable to concentrate or dilute urine correctly **leads to edema, HTN and HF

What type of virus is HIV

Retrovirus -carry their genetic material in the form of RNA

What are the kidneys protected by

Ribs & abd muscles & back muscles

Is the left or right ureter longer?

Right

What side (R or L) of the bronchi aspirate easier?

Right -bronchs are straighter and larger so more easy to aspirate

What is the O2 transport

Right atrium - tricuspid valve - right ventricle - pulmonary valve - pulmonary artery - to lungs - drop off CO2 & pick up O2 - pulm vein - left atrium - mitral valve - left ventricle - aortic valve - aortic arch - to system to arteries - arterioles - cap beds where gas exchange occurs

What side of the bronchus or lungs aspirate more often?

Right side -straighter and longer since right lung has more lobes

RN dx for DIC

Risk for deficient fluid volume r/t bleeding Risk for impaired skin integrity r/t ischemia or bleeding Risk for imbalanced fluid r/t excessive blood/factor replacement Ineffective tissue perfusion Death anxiety

Morals

Rules of conduct -Right vs wrong

Ethics

Rules of conduct or standards governing the conduct of a person or group of people

What is autonomic dysreflexia

S/S = pounding HA, profuse sweat, nasal congestion, goose bumps (piloerection), BRADYcardia, HTN --acute emergent --r/t loss of ANS response overwhelming response to stimuli **main cause is bowel bladder distention **make sure bowel/bladder emptied (patent cath, strait cath, DRE to check for impaction, high fowlers unles contraindicated) **assess skin - rash can cause

What are the s/s of impaired cerebral circulation

S/S of hypoxia -restless - confusion - dyspnea - hypotension - cyanosis

What are the s/s of hemorrhage s/p neck dissection

S/S shock (hypoTN, tachycardia) -saturated dressings

What causes the start of depolarization

SA node causes this in the atria

What is the environment (ATI)

SETTING or SURROUNDING that SUSTAINS the HOST

What is partial laryngectomy for

STAGE 1 (also may just need chemo and rad and not surgery) -cancer limited to 1 vocal cord

When is supraglottic laryngectomy used for tx

STAGE 1 or 2

What are the s/s of cerebral aneurysm

SUDDEN - SEVERE HA and sudden LOC -if just balloons may not cause LOC but will cause HA & -pain/rigid back of neck or spine -visual disturbance, tinnitus, dizzy

How is cardiac output figured?

SV x HR = CO

What is the epidemiological process for the nurse (ATI)

Same as nursing process -Assess nature, extent & significance of problem (collect info) -Use info to formulate poss theory (explore poss explanation) -Gather info to narrow down possibilities -Make plan *focus on breaking cycle of disease (break chain of transmission and control spread of disease -Put plan into action - implement -Evaluate plan (gather info to determine success of plan) -Report & follow up

What is coronary artery stent placement?

Same procedure as PTCA - but put mesh around balloon - mesh is more permanent and it holds the plaque to the arterial wall -last longer and is smooth on inside

What are needle bx

Sample suspicious masses that are easily accessible -breast, thyroid, lung, liver, kidney -sometimes sono, CT or MRI guided

How are DTRs graded

Scale 0 - 4+ 0 = no response 1+ = diminished (hypoactive) 2+ = normal 3+ = increased (may be interpreted as normal) 4+ = hyperactive (hyperreflexia)

What is alcoholic cirrhosis

Scar tissue normally surrounds the portal areas -most frequently caused by chronic alcoholism

What is biliary cirrhosis

Scarring occurs in liver around bile ducts -results from chronic biliary obstruction & infection --least common of the types of cirrhosis

Examples of secondary prevention

Screenings (HTN, cholesterol, DM, vision, lead exposure, TB

What is the intrinsic factor

Secreted by gastric mucosa --vital for absorption of V B12 in ileum of SI --w/o B12 & intrinsic factor = pernicious anemia

Functions of the GI tract

Secretion Digestion Absorption of nutrients Motility Elimination

What type of organ is the stomach

Secretory & muscular

Objective s/s of pancreatitis (ATI)

Seepage of blood exudates into tissue from panc enzyme actions -ecchymoses on flanks (turners sign) -bluish gray periumbilical discolor (cullens sign) -jaundice -absent or decreased BS - possible ileus -ascites -warm, moist skin - fruity breath (hyperglycemia) -tetany -increase WBC, bilirubin, glucose, amylase, enzymes -decreased platelets, calcium, magnesium

What are the 2 kinds of movement in the SI

Segmental contractions - mixing waves or churning Peristalsis - forward pulpulsion

What is cultural awareness

Self awareness of RN's own cultural background & differences

Incomplete spinal cored lesions

Sensory or motor fibers - or both - are preserved below the lesion

What did Lillian Wald do in 1902 to help children being barred from school

Sent a district nurse from her Henry House Project into public school system for month free -absences were reduced signficantly -12 nurses were hired for the district

Risk factors for DIC 2ndary to other complications (ATI)

Septicemia Cardiopulmonary arrest Hemorrhage

What neurotransmitter helps control mood & sleep and inhibits pain

Serotonin -inhibitory

What is an important part of community disaster planning (ATI)

Setting up communication protocol -provide access to emergency agencies (Red cross)

Classic presentation of acute pancreatitis (ATI)

Severe - constant - knife like pain (LUQ, mid epigastric and /or radiating to back) - unrelieved by N/V

What is stage 4 kidney damage (GFR)

Severe decrease in GFR **15-29

Less than 8 on glascow is associated with what? (ATI)

Severe head injury and coma --less than 8 intubate

S/S of ICP (ATI)

Severe headache - decreasing LOC - restlessness - irritability - dilated/pinpoint pupils - slow to react - altered breathing pattern (cheyne stokes or apnea or centeral neuro hyperventilation) - decreased motor function - abn posturing (decorticate, decerbrate, flaccidity)

What if pulse pressure is less than 30?

Severe loss of cardiac output

S/S rib fx

Severe pain - point of tenderness - muscle spasms

Complications of severe acute pancreatitis

Shock, anoxia, hypoTN, fluid & elyte imbalance, necrosis to panc, peritonitis, organ failure

Complications of radical neck dissection

Shoulder drop - poor cosmetic (visible neck depression)

What is a renal ultrasound

Shows fluid accumulation - masses - congenital malformation - organ size changes - obstructions

What is echo?

Shows size and shape of heart, motion of myocardium, valves, blood flow *TEE (transesophageal) - like hi def TV and used with conscious sedation (ck gag reflex after)

What if carcinoma in situ of cervix is found after childbearing years

Simple hysterectomy -removal of uterus only

How is the choice of type of bx decided

Size & location of tumor - type of treatment anticipated - need for surgery & general anesthesia

Services home health nurse provides ATI

Skilled assessment - wound care - lab draws - med education & administration - parenteral nutrition - IVF & meds - central line care - urinary cath insertion & maintenance - coordination of other health care participants

Where is the AV node

Slows the electrical impulse so atrium can have time to contract & fill ventricles (atrial kick) -between the right atrium and ventricle superior to the triscuspid valve

What is a LP / spinal tap (ATI)

Small amount of CSF withdrawn from spinal canal and analyzed

Treatment of pericardial effusion & cardiac tamponade

Small effusions that are asymptomatic - no tx req (poss steroid & diuretics) -monitor for s/s of increasing fluid -Pericardiocentasis -windows in pericardium surgically -rad or chemo tx

Risk factors for oral cancer

Smokeless tobacco - smoking - excessive etoh - over 50 - AA man --combined use of tobacco and etoh due to synergistic carcinogen effect

What forms the pyloric sphincter

Smooth muscle in the wall of the pylorus (outlet of the stomach) --this is the door to the SI

What is the structure of the trachea

Smooth muscle w/ C shaped rings of cartilage - prevent trachea from collapsing -smooth muscle assists in peristalsis

What are some of the things filtered, reabsorbed & excreted in urine?

Sodium - chloride - bicarb - potassium - glucose - urea - creatinine - uric acid

What happens if common bile duct gets blocked by stones

Spasms - GB issues - pancreatitis (depends on location of blockage)

what does positive chronotropy do?

Speed up the HEART RATE

What other injuries are lower rib fx (5-9) assoc with

Spleen - causing major internal bleeding b/c spleen is where blood is stored Liver - lacerations to this is worse

What is a comminuted skull fx

Splintered or multiple fracture line or multi bone fragments

What is S4?

Splittinf of S1 (lub) - sounds like "tennessee" - associated with HTN crisis

what is S3

Splitting of S2 (dub) - sounds like "kentucky" - associated with heart failure

What is metastasis

Spread from primary tumor to distant sites by direct spread of cells to body cavities or lymph & blood circulation

Stage 1 of bladder cancer

Spread to bladder walls

What is hematogenous spread of cancer

Spread via blood stream -directly related to vasculature of tumor -few ca cells can survive the turbulence of the arterial circulation

How do antiarrhythmics tx cardiogenic shock

Stabilizes heart rate

What are the stages of ovarian ca

Stage 1 - contained in within ovary(s) Stage 2 - Cancer in one or both ovaries & involves other organs (bladder, uterus, f tubes, colon, rectum) Stage 3 - Involves one/both ovaries and has 1 or both of: mets beyond pelvis to abd lining and/or spread to LN Stage 4 - In one/both ovaries, distant mets to liver, lungs, or other organs outside the pelvic cavity

Where is the bundle of his

Starts at AV node and branches off into left and right -The bundle of His branches into the left and the right bundle branches, which run along the interventricular septum

What is the electrical impulse of the heart

Starts at SA node along myocardium of atria - cause electrical stimulation and contraction of atria - then AV node (in right atrial wall near tricuspid) - AV node coordinates incoming impulses and delays them to allow atria contraction and ventricle to fill up - then relays to bundle of his - then divides into right bundle branch (to right ventricle) and left bundle branch (left ventricle) - left bundle branch divides into left posterior and anterior bundle brances to reach the purkinje fibers - these fibers rapidly conduct impulses thru thick walls of ventricle to cause contraction

Stage 0 of bladder cancer?

Stays inside the inner lining of the cells

Complications of AV graft

Stenosis - infection - thrombosis

Meds for chronic pancreatitis

Steriods w/ food PPI on empty stomach H2 antagonists prior to meals Panc enzymes w/ food Insulin

What is the stick man test

Stick figure used to record muscle strength for each part of extremity -using 5 point scale

Effect of histamine on digestion (table 34-2)

Stimulated by substances in food (unclear) --targets: gastric glands --effects: increased gastric acid production

Biliroth 1 is better for what?

Stomach function

Functions of the liver

Storage Protection Metabolism

Storage function of the liver

Stores fat soluble vitamins (only place that stores them) - A, D, E, K -stores B complexes (iron & copper) -stores B12 and small amounts of Vit C -stores Mg- --stores nutrients for later use in the chemicals it produces for metabolic needs

Function of the stomach

Stores food -then secretes gastric juices -muscular agent that pushes partially digested food (chyme) on to the next step = small intestine

Thrombolytics

Streptokinase (streptase) and alteplase (activase)

Causes of sinus tachycardia

Stress, blood loss, anemia, anxiety, exercise, caffeine, etoh, smoking, drugs (cocaine, ectasy)

What is the biceps reflex

Strike biceps tendon over slight flexed elbow -support forearm and place thumb against pt tendon then strike thumb **normal is flexion at elbow and contract biceps *tests nerve roots C5, C6

What is patellar reflex

Strike patellary tendon below patella -pt can sit or lie down **quads contract & knee extension *tests L2-L3

What is the babinski reflex

Stroke lateral aspect of sole of foot CNS disease - toes fan out and draw back --normal in newborns

What is epidemiology (ATI)

Study of health related trends in the community -purpose of disease prevention, health maintenance & protection -relies on statistical evidence to determine rate of spread of disease & people effected -broad understanding of spread, transmission & incidence of disease and injury

What does epidemiology involve (ATI)

Study of relationships among an agent - host - and environment ***aka epidemiological triangle

What happens in tubular secretion

Substance moves from peritubular capillaries - or vasa recta - into tubular filtrate --concentrates and becomes urine

S/S of O2 toxicity

Substernal pain - fatigue - restlessness

What are disacchyrides?

Sucrose, maltose, galacctose --become fuel after broken down

Sulfonamides

Sulfasalazine (azulfadine) --release the aminosalycylic acid in the colon --has direct anti inflammatory effect of the asa

Portal venous system includes what

Superior mesenteric Inferior mesenteric Gastric, splenic, cystic -terminate hepatic vein - inferior vena cava

What do the right coronary arteries do?

Supplie right side of heart with blood - leads to the inferior wall of the heart

What does the superior mesenteric supply

Supplies intestine w/ nutrients & O2

What does the gastric artery supply

Supplies stomach w/ nutrients & O2

What does the inferior mesenteric supply

Supplies the intestine w/ nutrients & O2

What is the function of the coronary arteries?

Supply the heart muscle with oxygenated blood - adjust blood flow according to metabolic needs

Medical mgmt of post renal ARF?

Supportive -Remove obstruction -Treat infection ureterolithiasis (cystoscopy or lithotripsy)

What should RN recommend for breast pain

Supportive bra - decrease salt & caffiene - take advil - Vitamin E or primrose oil

Medical mgmt of hepatic encephalopathy

Supportive tx -lactulose = promote excretion of ammonia - titrate so pt has 2-3 soft bowels/day -neomycin = suppress GI bacteria that produces ammonia -elytes -serum ammonia -avoid sedatives, tranq, analgesics -small freq meals and low protein diet

Antitussive

Suppress cough reflex in medulla #1 = codeine

Oral SCC

Surface of epithelium -slow growing dysplasia - non painful - crusted/scaly lesions that won't heal

What is the preferred tx for renal cancer

Surgery -if the tumor can be removed **radical nephrectomy

Medical mgmt for gastric ca

Surgery (total gastrectomy) Tumor resection Dx laparoscopy Palliative care

Tx of reproductive malignancies

Surgery - chemo - radiation - or combo -may be curative or palliative -care of the surgery patient is similar to care of pt w/ other abd surgeries

Tx for depressed brain injury

Surgery w/ elevation of the skull and debridement -usually within 24 hrs of injury

Treatment for pancreatic ca

Surgical resection / whipple or pancreaticoduodenectomy Chemo Rad Palliative

Medical mgmt for ovarian ca

Surgical staging Exploration Reduction of tumor mass Chemo --surgical removal is the tx of choice

Esophageal varices (ATI)

Swollen, fragile blood vessels in esophagus --medical emergency if hemorrhage

What is the autonomic nervous system

Sympathetic and parasympathetic nervous system -regulates activities of internal organs like heart, lungs, blood vessels, digestive organs, glands **maintenance& restoration of internal homeostasis

Where are neurotransmitters made / stored

Synaptic vessels

S/S of dumping syndrome (ATI)

Syncope - palpitations - dizzy - HA

What is SIADH

Syndrome of inappropriate antidiuretic hormone --more insidious and harder to fix than DI -CONCENTRATED urine w/ very little UO -Na+ tanks (down to 115) = high risk for sz **fluid restriction **bolus hypersaline (3% NS) to diurese of H2O

Protein metabolism in liver

Synthesis of plasma proteins, albumin, globulins, blood clotting factors, transport proteins & plasma lipoproteins

Formula to figure MAP?

Systolic + (Diastolic x2) ------------------------------- 3

What do the letters in staging cancer mean

T = primary TUMOR N = regional lymph NODES M = METS

What is graft vs host disease

T lymphocytes from transplanted marrow activate an immune response against patients tissues (skin, GI, liver) -they view the patient's tissue as foreign

what SCI is a halo vest used for

T spine or C spine

What level of SCI effects respiratory function

T1-T11 = muscles that contribute to resp (abd & intercostals) C4 = diaphragm muscles --acute resp failure is leading cause of death in high cervical cord injuries

What is the most frequent sign of pulmonary embolism

TACHYPNEA

Primary prevention for occupational health nurse

TEACH good nutrtion & knowledge of health hazards -provide info on vaccines -use of protective equip

How is cervical cancer staged

TNM system mostly T = extent of primary tumor N = LN involvement M = Mets

People who smoke are twice as likely to develop bladder cancer as non smokers. T or F?

TRUE

When is hemilaryngecotmy used for tx

TUMORS > 1cm

Signs of pneumothorax

Tachy, hypoxia, cyanosis, dyspnea, accessory muscles (all s/s of resp distress) -tracheal deviation to unaffected side (tension pneumothorax) -reduced or absent breath sounds on affected side -asymmetrical chest movement

Physical assess findings for pulm embolism

Tachycardia - hypotension - tachypnea - crackles and cougn - diaphoresis - decreased O2 sats - petechiae - pleural effusion (fluid)

What area of the breast extends into the axilla

Tail of spence

What is chronic rejection

Takes place over many years -body's constant immune response against new organ slowly damages transplanted tissues or organ

What cells does HIV target

Targets cells with CD4 receptors -these are expressed on the surface of T lymphocytes

What is cervical carcinoma in situ

Technically severe dysplasia & defined as cancer that's extended thru the full thickness of the epithelium of the cervix but not beyond -usually preinvasive cancer

S/S of full or complete bowel obstruction

Telescope bowels - death of bowel tissue

What does the vasa recta do?

Tells to make more renin --if we lose that - we get HTN

Concussion

Temp loss of neurologic function w/ no apparent structural damage -usually from blunt trauma from acceleration-deceleration force, direct blow or blast injury

What type of cath are used for PD caths/

Tenckhoff Swan Cruz

What are the common capillary beds

Terminal branches of the hepatic artery and portal vein -mixture of venous & arterial blood bathes the liver cells

Main s/s of hypocalcemia

Tetany

How does CKD cause low Vit D level?

The active metabolite of Vit D is made in the kidney

If kidney is functioning normally - the volume of elytes is equal to what

The amount ingested

What happens if the patient does not use immunosuppressants?

The body will launch an immune response and destroy the foreign tissue

Why are immunosuppressant drugs doses constantly changed?

The drugs have a narrow therapeutic window --require frequent labs to adjust doses & monitor for SE & nephrotoxicity

What is cardiac tamponade?

The effects of accumulated fluid/pressure (blood or fluid in pericardium) - can be deadly

What is a primary head injury

The initial damage to the brain that results from the traumatic event -contusions, lacerations, torn b vessels or foreign object penetration

What are the s/s of cirrhosis (child pugh scale)

The more of these s/s the poorer the outcome -ascites (absent 1 - slight 2 - moderate 3) -bilirubin (+ to or < 2 is a 1 - 2-3 is a 2 - moderate >3 is a 3) -albumin (>3.5 is a 1 - 2.8-3.5 is a 2 - < 2.8 is a 3) -pt (1-3 is a 1 - 4-6 is a 2 - >6 is a 3) -encephalopathy (None is 1 - gradet 1-2 is a 2 - grade 3-4 is a 3)

Waste products are what?

The pollution we excrete

What is afterload

The resistance in the left ventricle during ejection - the load against that the heart contracts to eject blood

What happens to the smaller molecules in GI tract that are broken down by enzymes

They are absorbed thru the walls of the SI & into the blood streatm -vitamins & minerals go unchanged but we change fats, proteins & carbs to smaller molecules for use

Why do well differentiated cells grow slower

They are encapsulated

Why is ovarian cancer difficult to dx

They are usually deep in the pelvis -no early screening at this time -Transvag US & CA-125 testing for those at high risk

Why can early signs of brain tumors be overlooked in elderly

They can mimic s/s of dementia

What is EMG

Thin electrodes into the muscle -electric current thru muscle to check neuromuscular deficit (nerve or muscle problem)

What is definitive test of pneumothorax

Thoracentesis

Diagnostic surgery for cancer?

Through biopsy -excisional -incisional -needle ---obtain tissue sample for analysis of cells

What is hemilaryngecotmy

Thyroid cartilage of larynx split in the midline of neck -portion of cord removed w/ tumor, aryenoid cartilage and 1/2 thyroid removed **airway and swallow preserved **trach x 2wks with gtube or TPN for nutrition **weak rough raspy voice with decreased projection

What is cardioversion?

Timed electrical current - synchronized using a dose of electrical current to the heart at a specific time in the cardiac cycle (pharmacologic cardioversion uses antiarrhythmic meds instead of shock) -converts heart w/ abn fast (tachy) or in arrhythmia into normal sinus rhythm **i. e. use in afib

Why are so many meds used to treat HIV

To attack the virus during different cycles since it mutates so quickly

What do we use GI enzymes & secretions for

To break food down into smaller molecules so body can use them

What is balloon tamponade

To control hemorrhage in esophageal varices -pressure is exerted on the cardia (upper orifice of stomach) -tube has 4 openings for gastric aspiration, esophageal aspiration, gastric & esophageal balloon inflation -compression of bleeding varices by inflation of balloon -gastric & esophageal outlets allow nurse to aspirate secretions

When is radiation tx used

To cure, control, or for palliative care

What is the main function of the kidney

To filter waste and excess fluid from the blood stream

What is the main goal of surgery in breast ca

To gain local control

Indications for EEG (ATI)

To identify and determine sz activity -useful for sleep disorders & behavioral changes

why are drains used in neck dissections

To prevent collection of fluid subq -between 80-120 mL of serosanguineous may drain for 1st 24H --excess drainage could mean hemorrhage or chyle fistula

Why are diuretics used to treat cardiogenic shock

To remove excess fluid

What is the venous part of AV fistula used for

To return cleaned blood to the body

How should pt be positioned for LP (ATI)

To stretch the spinal cana -pt assume cannonball position while on one side by having pt strecth over table

What is the #1 risk factor for laryngeal ca

Tobacco (or any carcinogen) -combined with etoh causes chronic irritation

What type of surgery for ovarian ca

Total abd hysterectomy w/ removal of fallopian tubes & ovaries and possibly the omentum -tumor debulk -para-aortic & pelvic LN sampling -diaphragmatic bx - peritoneal bx & cytologic washings

What is complete spinal cord lesion

Total loss of sensation and voluntary muscle control below the lesion -result in paraplegia or tetraplegia

What is a fiberoptic monitor

Transducer tipped cath inserted into ventricle, subarach space, subdural space or under bone flap

What is metaplasia

Transformation of one type of cell into another -adult cell of that tissue to form abnormal cell for that tissue

What are the ureters made of

Transitional cell epithelium = called UROTHELIUM --prevents reabsorption of urine

Is living or deceased kidney transplants more successful

Transplant from well matched living donors are slightly more successful

What does a kidney tx involve

Transplanting a kidney from a living or deceased donor to a recipient who no longer has renal function

Barriers to care for people w/ chronic disability or disease

Transportation, money for meds and treatment

What is TRAM reconstruction

Transverse Rectus Abdominal Myocutaneous -breast mound created by tunneling abd skin, fat & muscle to mastectomy site

What are phosphate binder?

Treat ARF --aluminum or calcium acetate (PhosLo) ***always give PhosLo with food

What is modified radical mastectomy

Treat invasive breast ca -removal of entire breast tissue, including nipple and the ALND -chest muscles are left intact (in radical mast all muscles are removed)

Medical mgmt of cirrhosis

Treat s/s and slow disease progress -eliminate etoh -Meds (PPI, H2 blockers, antacids) -Nutrition (low protein, high calorie

Main treatment of ARF

Treat underlying cause & fix underlying cause

What are the advantages of internal radiation

Treatment time is shorter - reduced exposure to personnel - can be outpatient

Flagyl and vancomycin

Treats Cdiff

What is the TIPS procedure

Treats ascites -cannula threaded into portal vein by transjugular route --to reduce portal HTN, stent is placed to serve as intrahepatic shunt between portal circulation & hepatic vein -tx of choice for refractive ascites --decreases Na+ retention & prevents recur of fluid accumulation

The higher the dextrose concentration in the dialysate the more fluid is removed? T or F

Trued -because the osmotic gradient is increased

What are the pancreatic enzymes

Trypsan - protein Amylase - starches Lipase - fats

Balloon tamponade (ATI)

Tube / gastric balloons used to compress blood vessels -traction applied after balloons inflated to desired pressure -when bleeding stops - traction released - pressure in balloon reduced --for pt w/ unsuccessful TIPS

How does lymph mets occur

Tumor emboli enter lymph by interstitial fluid (which communicates w/ lymph fluid) -malignant cells can lodge in LN or pass btwn lymph or venous circulation

Surgical procedurs to treat cervical ca

Tumor invasion less than 3mm = hysterectomy Invasion more than 3mm = radical hysterectomy w/ pelvic node dissection and aortic node assessment

What protein does the cell membrane of cancer cells contain

Tumor specific antigens

What is BRCA 1 and 2?

Tumor suppressor genes -mutations of those are responsible for majority of hereditary breast ca -BRCA1 = 65-87% risk -BRCA2 = 45-87% risk --also increases risk for ovarian ca

How does mets occur

Tumors growing in or penetrating body cavities can shed cells or emboli that travel within body cavity & seed surfaces of other organs

How does corticosteriod decrease cerebral edema

Turns off immune response -decrases inflammation -need massive amount

How is the primary tumor (T) classified in staging

Tx - tumor cannot be assessed T0 - No evidence of primary tumor Tis - Carcinoma in situ T1, 2, 3, or 4 - Increasing size and/or local extent of tumor

CA 19-9 or CEA

Used to dx GI cancer (and colon cancer) -monitor success of cancer therapy -assess for recurrence -can be elevated in benign conditions

What is palliative radiation therapy

Used to relieve s/s of mets disease e -especially with brain, bone or soft tissue mets ---treat emergencies like superior vena cava, bronch airway obstruction, spinal cord compression

What is LEEP?

Used to remove abn cells -thin wire loop with laser is used to cut away a thin layer of cervical tissue -outpatient, in office, local given prior -allows path to examine removed tissue to determine if borders are disease free

Indications for ICP monitoring (ATI_

Useful for early identification & tx of ICP -pts who are comatose or have GCS scores of 8

What is continuous cyclic peritoneal dialysis (CCPD)

Uses a cycler -programmed w/ how much fluid to use, how many exchanges, fill time, dwell time, drain time, etc --a last fill is instilled to dwell during day for the night --pt can sleep thru this

Ammonia conversion

Uses amino acids from protein & creates ammonia as a waste product -converts it to urea

What is traditional CABG?

Uses cardiopulmonary bypass (CPB)

What is peritoneal dialsys?

Uses peritoneal membrane that lines abd wall as semipermeable membrane for dialysis

What is the GCS calculated by?

Using appropriate stimuli and assessing pt response in 3 areas

Where does recurrent uterine ca occur

Usually in the vaginal vault or upper vagina -mets usually in LN or ovary

What is a primary brain tumor

Usually occupied by healthy tissue that takes up most of the nutrients -can grow spherical but infiltrates tissue -30-40% originate from other ca mets

What is the most freuq occur gyn ca in US

Uterine

What is the 4th most common cancer in women

Uterine -after breast, colorectal and lung

What is perfusion / ventilation ratio

VQ ratio -should be equal or 1:1 -there is enough ventilation to supply the blood w/ O2 and just enough blood to take all O2

Nursing for pt with DIC

VS - I &O - assess skin color & temp, heart sounds, lung sounds, bowel sounds - chest pain - abd tenderness - inspect all body orifices for bleeding - minimize physical activity - prevent bleeding - turn, cough, deep breathe

What is radical vaginal hysterectomy

Vaginal removal of the uterus, f tubes, and proximal vag

Activities that precipitate bleeding of esophageal varices (ATI)

Valsalva - lifting heavy objects - coughing - sneezing - etoh

What are some other causes of afib

Valvular disease, CAD, open heart surgery, binge drinking (high etoh in blood)

What does CT w/ contrast show

Vasculature -hold metformin before day of scan (reacts to dye & cause kidney problems) -creatinine and BUN check prior -allergy to contrast or shellfish? -increase fluids after to get rid of contrast

First line of tx for esophageal varices

Vasopressin -for people W/O CAD -produces constriction of preportal splanchnic arterioles & decreases portal pressurs

How do vasocontrictors tx esophageal varices (ATI)

Vasopressin & somatostatin --most effective to increase portal inflow ---vasopression not for pt w/ CAD

What is venous occlusive disease

Veins in the liver are occluded -leads to portal HTN, liver disease - liver failure -can't treat w/ immunosuppress.`

What happens as AV fistula matures

Venous part dilates due to increased blood flow coming directly from artery -after dilated enough, it will accommodate 2 large bore (14-16 gauge) needles inserted for dialysis

If there is a problem with the air - there is a problem with the?

Ventilation =LOW VQ (low ventilation)

What is a ventriculostomy

Ventricular cath monitoring device is placed -cath placed into ventricle of brain and connects to a fluid filled system to a transducer -transducer records pressure as electricle impulse -also allows CSF to drain during acute increases in ICP

how is ICP managed

Ventriculostomy Subarachnoid bolt Epidural monitor Fiberoptic monitor

What is the most accurate and reliable O2 delivery system for COPD pt

Venturi mask (holds 4-6L)

Exocrine portion of pancreas

Very alkaline pancreatic enzymes -into GI thry panc duct --amylase on carbs - lipase on fats - trypsan on proteins

What is the remaining amount of virus in the body after the initial immune response?

Viral set point -results in a steady state of infection that lasts for years (8-10)

What are the 2 pleura

Visceral Parietal

What does the occipital lobe control

Visual and memory

S/S of occipital lobe tumor

Visual loss in 1/2 of the visual field on opposite side of tumor & visual hallucinations

What is a cerebral angiogram (ATI)

Visualization of cerebral blood vessels -subracts bones and tissues form images leaving only vessels -detects defects, narrowing, obstruction of arteries or b vessels in brain

Problems of gastrectomy

Without stomach - there is no secretion of intrinsic factor -intrinsic needed for absorption of V B12 to prevent pernicious anemia

Risk factors for cholecystitis

Women - older than 40 - multiple babies - oral contraceptives - weight loss yoyo diets - native american - hispanic - CF

Primary prevention of breast cancer

Women 20 y/o and over -BSE -clinical breast exam q 3 years (for aged 40+ yearly) -mammos starting at age 40

In the late 1700's and prior - who took care of illnesses?

Women in the family -neighbors, family, and religious groups for anything formal -if in dire need = a bonesetter/surgeon was called

What was the 1st formal nursing school

Womens hospital of philadelphia *1872

Contusion

Worse than concussion -moderate to severe injury where brain is bruised and damaged in specific area r/t acceleration-deceleration force or blunt trauma -impact leads to contusion

What is a myelography

Xray of the spinal cord & subarachnoid space -pt lay in bed for hours to decrease CSF leakage -if severe HA = CSF leak -if oil base / lay flat 6-8H -if H2O base / HOB 30 degrees 6-8 H

Is the pt in the primary stage of HIV infectious

YES because the viral load is very high

When are mammograms recommended

Yearly starting at age 40

Do certain birth control increase risk of HIV

Yes -estrogen in oral contraceptives can increase women's risk of HIV -when used in HIV+ woman = increases shedding of HIV in vag & cervical secretions

Does inspiration require energy

Yes -expiration does not (but in resp diseases like COPD it does)

Do people with renal ca have mets at the time of dx?

Yes 25%

Can pre renal ARF effect if renal cells live or die?

Yes - and can cause ischemia -then turns into intra renal ARF

In 1900's were children barred from school

Yes - no reason required and no tx provided

Risk factors for SCI

Young age - men - etoh and drug use

Who is at risk for communicable disease (ATI)

Young children - elderly - immunosuppressed - high risk lifestyle - international travelers - health care workers

What is an atherectomy

a minimally invasive surgical method of removing atherosclerosis from a large blood vessel within the body -uses a roboblator and other end has suction cath to suck after shaving -

The renal artery arises from what

abdominal aorta --then divides into smaller & smaller vessels forming AFFERENT arterioles

What is a silent unit

absence of both V & Q -causes pneumothorax and ARDS

Cipro

abx used to treat crohns

What are the 6 major neurotransmitters

acetylcholine serotonin dopamine norepinephrine GABA endorphin/enkephalin

What does built up ammonia cause

confusion - hepatic coma - -protein restricted diet **give lactulose to release ammonia in stools (want 3-4 stools) -explain the goal of stool amount to the patient

age related changes of resp system

decrease ability to move air rapidly in and out of lungs b/c of loss of compliance, loss of elasticity, decreased muscle mass

What does negative dromotropy do

decreases CONDUCTION from AV node

Surfactant

decreases surface tension -keeps alveoli open

what is the electrical stimulation of the heart

depolarization (contraction)

what is the mechanical relaxation of the heart

diastole

What is disseminated intravascular coagulation (DIC)

disorder of coags or destruction of clots resulting in bleeding -clotting cascade consume clotting factors faster than the body can replace them -fibrinolysis occurs - breaking down clots & increasing circulating levels of anticoags placing pt at risk for hemorrhage

Effect of ARDS on renal

due to decreased cardiac output - not perfusing kidneys -BUN and CR rises as kidneys shut down -UO starts to fall

obstacles to good nutrition s/p gastric surgery

dumping syndrome and reflux

What is BNP

dx test for CHF -hormone in stretch receptors in myocardium - stretch as CO decreases (*starlans law) **activated when heart stretches - send message to kidney "help" - turn off renin aldosterone - lasix should drop BNP

What is mild acute pancreatitis characteristics

edema - inflammation - minimal organ dysfunction **prognosis = return to norm w/in 6 mths

S/S of frontal lobe tumor

emotional state & behavior, apathetic mental attitude -pt becomes untidy & careless, obscene language

What is the hypthalamus

endocrine system regulation - site of hunger - sleep & wake cycle - BP - aggressive & sexual behavior - emotional responses (blushing, rage, depression) --controls the autonomic NS

What is amylase

enzyme secreted by pancreas & intestine mucosa -turns starch into dextrin - maltose - glucose

Most common cause of cirrhosis

etoh consumption -reduced protein intake contributes as well

What causes SIADH

excessive release of ADH

S/S of chronic DIC

few s/s - easy bruising - prolonged bleeding from venipuncture & injection sites - bleeding of gums - slow GI bleeding

What is gynecomastia

firm enlargement of glandular tissue beneath and surrounding areola of male

What is asterixis

flapping tremor, or liver flap - tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings --sign of hepatic encephalopathy due to high ammonia levels

What are breast cysts

fluid filled sacs that develop as breast ducts dilate -usually in ages 30-55

what is hypertrophy

increased SIZE of cell

Risk factors for lymphedema

increased age, obesity, presence of extensive axillary disease, rad tx, infection or injury to extremity

When does cyanosis occur

late - appears gray in pt w/ dark skin

What is fluid wave

lay flat - hand at umbilical and tap rt or lt side - watch fluid "wave"

What are the duodenal secretions

lipase and bile

If pt has ostomy at ascending colon - stools are

liquid

What is the stool like in the cecum

liquid

If ostomy at transverse colon - stools are

liquid to semi soft

What sounds does bell hear

low bitch --murmurs

Mast cell stablizers

mast cells release histamine = initiates inflammatory response *antihistamines -they have anticholinergic SE

What is vital lung capacity

maximum volume of air exhaled from point of maximum inspiration -decrease w/ ALS, fatigue, atelectasis, COPD, pul edema

What is a transcranial doppler

measures the velocity of blood flow through the brain's blood vessels -diagnosis of emboli, stenosis, vasospasm from a subarachnoid hemorrhage (bleeding from a ruptured aneurysm), etc

Where is thoroscopy done

mediastinum -laparoscopically

S/S of esophageal varices (ATI)

melena and hematemesis

RN mgmt of ARDS

monitor EKG and resp status -if fighting ventilator - call dr so can give hypnotics and angiolytics to calm -PEEP levels UP -neuromuscular blocking agents to cause paralysis to decrease O2 demands of body

Causes of low VQ

more blood around alveoli that there is air -tumors, obstruction, pneumonia, mucus plug

What is ventilation

movement of air in and out of lungs

What is peripheral cyanosis

nails, toes, earlobes

Describe asystole on EKG

no waves - no HR- nothing

What is EEG used for

non invasive -assesses the electrical activity of the brain to determine if abn in brain wave patterns

Systemic effects of radiation

not many -fatigue, general malaise, anorexia - usually temporary

Pulmonary embolism

obstruction of pulm artery or one of its branches by a thrombus

Tx for epidural hemorrhage

openings in skull (burr holes) to decrease ICP emergently - remove clot - control bleeding -craniotomy -drain placed after to prevent reaccumulation of blood

What is metabolic acidosis

pH is less than 7.35 HCO3 is less than 22

What is resp alkalosis

pH is more than 7.45 HCO2 is less than 35

What is metabolic alkalosis

pH is more than 7.45 HCO2 is more than 26

What is resp acidosis

pH less than 7.35 HCO2 is high (higher than 45)

Paraplegia

paralysis of lower body

What is s/s of hyponatremia

personality changes - irritability - nausea - anorexia - vomit - weight gain - fatigue - muscle pain - HA - lethargy - confusion Na+ = neuro

WHat is the Romberg test

screening test for balance -pt stand w/ feet together & arms at side -eyes open and then closed for 20-30 seconds -stand close to pt in case balance is lost

what causes altered LOC

secondary to another condition -UTI, hepatic dx, metabolic problem (lactic acidosis), DKA, disruption of neurotransmitters, or anatomic structures

Pharyngeal lipase

secreted by pharynx --turns triglycerides into fatty acids

What are the triggers for DIC

sepsis, trauma, cancer, shock, abruptio placenta, toxins, allergic reactions

Care for drains after breast surgery

show how to empty and measure fluid show how to milk clots thru tubing teach observations that need attention (color drain change - sudden stop of drainage - s/s of infection inform when drain is ready to be pulled (<30mL for 24H)

what is stacy stermotitis

skin turns purple leather (PVD)

What are ketones

small compounds that enter the bloodstream and provide energy

End ostomy - stools are

solie

How to keep pt hypothermic with ICP

they are usually hyper thermic so bring temp down -antipyretics -cooling blanket -careful because shivering and febrile will increase ICP too

Why is vitamin K required by the liver

to make prothrombin

What is central cyanosis

tongue / pupils

What is SIADH

uncontrolled release of ADH leading to increased extracellular fluid volume & hyponatremia

What does the draining fluid look like

urine --if cloudy = infection --if blood = call physician - possible peritonitis (unless new catheter or pt on period)

Fecal immunologic tests (FIT)

use antibodies to detect globin protein in human hemoglobin --drugs and foods do not influence the testing

Causes of cerebral aneurysm

usually unknown -may be due to atherosclerosis, HTN vascular disease - head trauma - advanced age - cong defect of vessel wall

What are the types of dialysis?

hemodialysis - CRRT - PD

S/S of acute DIC

hemorrhage - infarction -

What sounds does diaphragm jhear?

high pitch

What does an open lung sound on percussion

hollow Fluids = dull sounds Liver = dull Bowel = hollow

what is the isoelectric line?

homeostatic

What is hemodynamic monitoring

in ICU arterial line inserted and continuous monitoring of real time BP -also has port to get frequent arterial blood samples

Medical mgmt of PE

in emergent = treat hypotension w/ dopamine -EKG - ABG - pain control - thrombolytics - heparin

where is B12 and bile absorbed

in the ileum of the SI

What is ataxia

incoordination of voluntary muscles -walking, reaching, tremors at rest or during movement (tremors = prob in balance & coordination)

what is hyperplasia

increase NUMBER or proliferation of cells -precancer

How is carafate prepared

Dissolve in med cup --take 1 hour AC or not enough time to coat the stomach --forms instant bandage over stomach --used for pt at risk for ulcers or taking alot of NSAIDS --dont take w/ large amount of H2O or will be too diluted

What is the 3rd phase of ARF

Diuresis --gradual increase in UO (=glomerular filtration has started to recover) **BUN & creatinine start decreasing - elytes start decreasing (better but still abn) **monitor for dehydration during this phase

Meds for cirrhosis (ATI)

Diuretics - decrease fluid build up / ascites Beta blocker - for pt w/ varices to prevent bleeding Lactulose - to promote excretion of ammonia thru stool Abx

What is the purpose of a urinary diversion

Divert urine from bladder to new exit site - usually thru a surgically created opening (stoma)

S/S of cerebellar tumor

Dizzy, ataxia or staggering gait, tendency to fall toward side of lesion, muscle incoordination, nystamus (involuntary rhythmic eye mvmts),

What is the allen test

Done before every artery stick for ABG -make sure radial artery is patent -make fist and blanche palm then occlude radial artery -open hand with artery still occluded and hand should still pink up

What is topical BCG

Done in conjunction w/ transurethral resection -use cystoscopy -put in cath -mytomycin **enhances body immune response to cancer --BCG is the live strain of mycobacterium (causative agent in TB)

What neurotransmitter effects behavior, attention, emotions and fine movement

Dopamine -inhibitory

S/S of chyle fistula

Drainage of "milky white" or clear fluid - Drainage ranges from low output (< 500 mL/day) to more than 3 L /day -excess drainage that has a 3% fat content and sp gravity of 1.012 or more

What causes end stage cardiomyopathy

Drug use - HTN - cardiac defect (long term foramen ovale patent causing mixed circulating blood)

Examples of agents

Drugs - Fumes (asthma) - Toxins - Genetic issues - Trauma - Temperature - Viruses (HIV, flu, rubeola) - Fungi - Bacteria

What are the reversible causes of ARF

Due to -hypovolemia - severly low BP - low CO - HF - obstruction of kidney or lower urinary tract - diminished blood supply to kidneys r/t injury/trauma

Why does cirrhosis cause difficult thinking or confusion (ATI)

Due to buildup of waste products in blood and brain that liver is unable to rid of

What is the NON oliguric renal failure phase

Due to intrarenal causes such as nephrotoxic agents, burns, trauma --this has all s/s except has a normal output

Why does cirrhosis cause hobnail appearance

Due to islands of normal tissue and regenerating liver tissue

Why is the right kidney lower than the left?

Due to the liver

What happens in flail chest

During inspiration the chest wall goes in rather than expands and compresses the lung (b/c ribs aren't connected to anything) --upon exhale rib cage should get smaller but it pushes out and can't get all of air out -compresses lung = no ventilation

What is galactography

Dx procedure -inject less than 1 mL of radiopaque thru cannula into a ductal opening on areola followed by a mammo -to eval abn within a duct if pt has blood nipple d/c with expression or spontaneous

Most frequent s/s of PE

Dyspnea and tachypnea -Resp go up to 35-45, rapid onset of chest pain, anxiety, apprehension, tachycardia

How is pericardial effusion & cardiac tamponade dx

ECG for pericardial effusion - CXR (will show water bottle heart in large effusions - CT - narrow pulse pressure - SOB & tachypnea

1/3 cancer could be prevented worldwide through what?

EDUCATION

Assess & dx of gastric cancer

EGD w/ bx & cytology (**study of choice) Stools for occult blood CBC - ck for anemia --gastric tumors not palpable until advanced stages --monitor for CEA's for recurrence Q6m forever

What are the early s/s of cervical cancer

Early cancer rarely produces s/s -can present as watery discharge after intercourse or douching

Neurologic side effects of chemo

Effects the CNS -peripheral neuropathy -acoustic nerve sensitive so possible hearing loss -encephalopathy

What does erythema (redness) indicate in breast

Either benign local inflammation -or superficial lymphatic invasion of ca

What is portal hypertension (ATI)

Elevated BP in veins that carry blood from intestines to liver

Amylase and lipase

Elevations indicate pancreatitis -not elelvated in presence of extensive pancreatic necrosis d/t destruction of panc cells that make the enzymes

What can peristent chyle fistula lead to

Elyte disturbance, hypovolemia, hypoalbuminemia, coagulopathy, immunosuppression, chylothorax, and peripheral edema, wound infection and local skin breakdown. ---Prolonged chyle leak can lead to mortality

Where does community health nursing happen?

Health Depts - Community & free clinics (CVS, Walgreens) - Home Health - Hospice centers - LTC centers - schools - urgent cares - short stay centers - occupational health

What are the components of community health nursing?

Health promotion Disease prevention Treatment Rehab Evaluation Research

How should you irrigate a colostomy

Helps schedule bowel movements Supports body image Monitor and manage complications

S/S of esophageal varices (book)

Hematemesis Melena *rapid decrease in mental / physical status Often hx of etoh abuse S/S of shock could be present

What is bone marrow transplant used for

Hematologic cancers or solid tumors

Complications of renal angiography

Hematoma - thrombosis - altered renal function

What is the most common form of dialysis?

Hemodialysis --cleans the blood of waste products **done 3 x per week for 3-4 hours (sometimes up to 5hrs)

What is acute intermittent peritoneal dialysis (AIPD) used for?

Hemodynamic unstable pt with uremic symptoms *N/V, fatigue, altered LOC -also w/ hyperkalemia, acidosis & fluid overload

Meds to tx DIC (ATI)

Heparin -to decrease microclots from forming & using up clotting factors

*What are the sources of perfusion to the liver

Hepatic artery Portal vein -terminal branches join to form the capillary beds

What can build up of ammonia causee

Hepatic coma --significant confusion --no vitamin K = no prothrombin

Decreased albumin

Hepatic disease --norm is 3.5 - 5.0

Elevation of AST indicates

Hepatitis or cirrhosis --norm is 5-40

Elevation of ALT

Hepatitis or cirrhosis --norm is 8-20

S/S of smallpox (ATI)

High fever - fatigue - severe HA - rash (start on face/tongue quickly spread to trunk & extremities) - vomit ***treat (no cure) - supportive care - prevent w/ vaccine

Treatment of superior vena cava syndrome (ATI)

High fowler position - radiation tx

Primary HIV infection is characterized by what?

High levels of viral replication & destruction of CD4+ T cells --causes dramatic drop in CD4 cells

Primary prevention of uterine ca

High risk w/ women at time of menopause -educate on s/s and report any unexpected bleeding or spotting

Long term complications of peritoneal dialysis

High triglycerides - abd hernia at cath site - low back pain - clots in cath

Category A biological agents (ATI)

Highest priority agents -pose risk to national security **easily transmitted & high mortality rates ---smallpox, botulism, anthrax, tularemia, hemorrhagic viral fevers, plague

Effects of T11-L5 injury

Hip flexors, hib abductors, knee extension & flexion, ankle dorsiflexion -independent dress, feed, elimination -short distance to full ambulation w/ assist

Why does CRF cause peripheral edema

Hold fluid and Na+

What is pleura

Holds lungs together -the two pleura and the space/fluid between them lubricate the thorax and lungs -permit smooth motion of the lungs in the thoracic cavity with each breath

What is a subarachnoid bolt

Hollow device inserted thru skull and dura mater into subarachnoid space -screw is attached to transducer to record output *complications = infection, block of screw by clot or brain tissue

What is a subarachnoid screw / bolt (ATI)

Hollow threaded screw or bolt placed in the subarachnoid space thru twist drill burr hole in the front of the skull behind hairline -bolt is connected by fluid filled tubing to transducer leveled at approx location of lateral venrtricles

Who are vulnerable aggregates

Homeless - mentally ill - incarcerated - chronically ill - seasonal workers

Effect of secretin on digestion (table 34-2)

Hormone - stimulated by pH of chyme in duodenum below 4-5 --targets: stomach to inhibit gastric secretion & stomach contractions & pancreas to incrase bicarb panc juice

Effect of gastrin on digestion (table 34-2)

Hormone - stimulated by stomach distention w/ food --targets: gastric glands --effect: INCREASED gastric juice rich in HCI --motility effects: INCREASED motility of stomach - DECREASED time req for gastric emptying - relaxes ileocecal sphinctor - excitation of colon - CONTRICTS gastroesophageal sphinctor

Effect of cholecystokinin on digestion (table 34-2)

Hormone - stumulated by fat in duodenum --targets: gallbladder to release bile into duodenum & pancreas to release panc enzymes & stomach to inhibit gastric secretions

What is gastric motility controlled by

Hormones

Metabolism fuction of the liver

Huge function of the liver -after eating glucose is taken from portal veins & converted into glycagen the converted back and goes back into blood stream --turns ammonia into urea to be rid of by kidneys (takes a toxin, uses it in protein metabolism, then sends to kidneys to rid)

When pt presents w/ a breast problem, what does the nurse assess

Hx of medical disorders - surgical hx - fam hx - gyn & OB hx - meds - hormonal contraceptives use - hormone replacement used - fertility treatments - smoking/etoh use - onset of disorder - pain w/ mass? - redness, nipple d/c or skin changes

Where does stomach get its acidity

Hydrochloric acid --function is to break down food into more absorbable & aids in destruction of ingested bacteria

What do the parietal cells in stomach secrete

Hydrochloric acid Intrinsic factor (absorbs B12)

RN dx for SCI

Ineffective breathing patterns Ineffective airway clearance Impaired bed & physical mobility Disturbed sensory perception Risk for impair skin integrity Impaired urinary elimination Constipation Acute pain

S/S of rectal lesions

Ineffective painful straining upon BM

Potential complications of transplant

Infection Rejection PE Hemorrhage / GI bleeds (r/t immunosuppressants) Fungal infections (r/t meds) C diff (r/t abx) Wound infection UTI

What is the #1 complication of post heart tx

Infection & Rejection - pt is on immunosuppressants which increases risk of infection (but decreases risk of rejection)

Complications of ICP monitor placement (ATI)

Infection & bleeding -strict aseptic technique -sterile dressing changes -keep drainage systems closed -limit monitoring to 3-5 days -irrigate system only PRN to maintain patency

What does HIV do to CD4 cells

Infiltrate them and cause genetic mutation so they don't work and the body won't know a foreign invader

What is the most common type of breast ca

Infiltrating ductal -about 80% of cases -tumors arise from the duct system & invade surrounding tissues -solid irregular mass

How does pelvic radiation increase risk of bladder ca

Inflames tissues & causes changes at the cellular level

What is pericarditis

Inflammation of the pericardium -normally there is 20mL of lubricating fluid in the space

what does causing trauma to brain during intracranial surgery cause

Inflammation process = increased blood flow & edema -will increase ICP

What is chronic pancreatitis

Inflammatory disorder characterized by PROGRESSIVE destruction of pancreas --caused by repeat episodes of pancreatitis -cells that should secrete no longer can & pressure inside panc increases as scarring occurs -panc and common bile ducts obstruct

Acute pancreatitis (ATI)

Inflammatory process due to activated panc enyzmes autodigesting the pancreas --severity varies but overall mortality is 10-20%

What is the pathophys of pericarditis (book)

Inflammatory process may lead to accumulation of fluid in the pericardial sac & increased pressure on the heart

What happens in DIC

Inflammatory response generated by underlying disease initiates coagulation -fibrinolytic systemm is suppressed so massive tiny clots form in the microcirculation -clotting time normal at first -As platelets & clotting facters are consumed to form microthrombi - coagulation fails -result of excess clotting is bleeding

Prostaglandins

Inhibit the secretion of gastrin & INCREASE secretion of mucus lining of stomach = providing buffer --used to protect lining of the stomach in situations that may lead to GI complications **misoprostol or Cytotec**

Nephrons are responsible for what

Initial formation of urine

What are the s/s of PCP

Initially may be nonspecific -non productive cough, fever, chills, dyspnea, chest pain, respiratory distress -if left untreated = progresses to pulmonary impairment & resp failure

What will the patient have to manage s/p pancreaticoduodenectomy

Intake of fat and carbs post op -may require panc enzymes added to their meds

Antacids

Interact with acids to neutralize them **MOM - Tums - Pepto - malox - mylanta - aluminum - calcium salts - magaldrate - mag salts - sodium bicarb** --if renal pt = dont take antacid w/ magnesium

Where is bile secreted to

Into small ducts of the Spincter of Oddi --diverted to the GB when sphincter is closed

What is IORT

Intra-Op Radiation Therapy -during excision of tumor & radiate surrounding tissues -decreases collateral damage

What causes increase in BUN to creatinine ratio

Intrinsic renal disease or dehydration --hypovolemia increases this

Stage 3 of bladder cancer

Invaded fatty tissue surrounding bladder

Stage 2 of bladder cancer

Invaded muscle

What does epidemiology investigate (notes)?

Investigates -cause & effect of disease -disease trends in populations -collect statisics -relationship btwn host, agent, environment -gives us info about disease, where they happen, who is ill, other factors

What are the 2 common surgical approaches for cancer tx

Local excision Wide local or radical excision

What are the adenoids function

Located in roof of nasopharynx - lymph tissue and part of lymph system

What is an axon

Long projection that carries impulses AWAY from cell body

Risk factors for pulm embolism

Long term immobility - oral contraceptive - hormone replacement - pregnancy - smoking - hypercoag - obesity - surgery - heart failure or afib - sickle cell - long bone fractures - advance age

What is radiation burn

Look like sunburn - then 2nd degree (blistering) - then sloughing of tissue

What does the Medulla of the kidney contain

Loops of Henle, vasca recta & collecting ducts of the nephrons

Fecal occult blood test

Most commonly used -for screening or early cancer detection --dont perform if hemorrhoid bleeding --asa, red meats, NSAIDS, turnips and horseradish avoided 72hrs prior -Vit C foods can show false negative

Type of oral cancers

Mostly SCC also BCC

What does the parietal lobe control

Mostly sensory -analyze sensory info - relays to thalamus - pt awareness of body in space,- size & shape - right & left orientation

What type of cancer is cancer of the cervix

Mostly squamous cell -others are adenocarcinoma and mixed adenosquamous

How is chemo administered?

Mostly thru IV -some PO -prefer central line

What is the LI's main job

Move gastric contents thru - absorb H2O & elytes - eliminate waste

How does a kidney tx effect lovenox injections

Move to opposite side if pt has had kidney tx --also no contact sports now

3 main functions of the LI

Movement Absorption Elimination

What does ventilation require

Movement of the walls of the thoracic cage & of its floor (the diaphragm)

How does albuterol treat hyperkalemia in ARF

Moves K+ back into cells -short term fix until dialysis -by nebulizer for

How is the motor system assessed

Muscle strength Balance & coordination

Function of the esophagus

Muscular tube that moves food & fluid from mouth to stomach

How is metastatis (M) classified in staging

Mx - mets cannot be assessed M0 - no distant mets M1 - Distant mets

What is oral candidiasis treated with

Mycelex or nystatin

what if the ST segment is BELOW the isoelectric line

Myocardia ischemia

What if the ST segment is ABOVE the isoelectric line

Myocardium infarction (has, had, or is having)

S/s of dig tox?

N/V , anorexia,, halo around lights

What are the GI side effects of chemo?

N/V/D (can be delayed for a week following) Fluid & elyte imbalance

What type of fluid balance should a patient with ICP have

NEGATIVE fluid balance

Is parasympathetic nervous system positive or negative in relation to HR and contractility?

NEGATIVe

What post op care should be done for pt s/p urinary diversion

NG tube care & assessment IV fluids Monitor I&O, IV site Nephrostomy tubes to divert urine out of body

Should you feed a patietn getting hemodialysis?

NO -order early tray & give meds accordingly -check BS & may need insulin

Are the recipients kidneys removed in a transplant?

NO -the kidney is placed in the iliac fossa to allow for easier access to blood supply needed to perfuse it

What is a new med used for post transplant patients

NULOJIX -given thru 30 minute IV infusion Q month (without needing the additional 30 pills of immunosuppressants) -inhibits the activation of Tcells (they are key to triggering immune system response to perceived foreign invader)

What causes sinus bradycardia?

Narcotics, decreased metabolic needs, vasovagal stimulation - if marathon runner or exercise alot = normal

What causes airway resistance

Narrowing of bronchial tree creating air resistance -asthma, bronchitis, COPD

Side effects of progestin therapy (used for uterine ca)

Nausea - depression - rash - mild fluid retention

S/S of pericardial effusion & cardiac tamponade

Neck vein distention during inspiration - Pulsus paradoxus (systolic BP decreases 10 mmHg during inspiration & pulse stronger on expiration) - distant heart sounds - rubs & gallops - tachycardia

Where is thoracentesis done

Needle in btwn visceral and parietal space to remove fluid -at bedside in tripod position and go in thru the back -bx done if bronchiogenic

Direct measurement of portal HTN

Needle into spleen during laparotomy -manometer greater than 20mL is abnormal -another method is to insert cath into portal vein or its branches

What does digoxin (Digitalis) do?

Negative chronotropic and Positive isotropic --don't give if HR is < 60 bpm --watch for toxicity

What is the functional unit of the kidney

Nephron --1 million per kidney --so we can survive on one kidney

Causes of intra renal ARF

Nephrotoxic agents (30%) - meds/drugs such as -aminoglycoside abx (genatmicin) - contrast agents - heavy metals (lead, mercury) - arsenic - NSAIDS - ACE inhibitors *also acute kidney infections or acute glomerulonephritis - transfusion reactions **Ischemia main cause (50%) r/t decreased renal perfusion

What is placed after a ileal conduit

Neprhostomy tube -b/c don't want urine pressure at stoma until healed -to avoid peritonitis

What does the Glascow coma scale assess (ATI)

Neuro function and LOC

intracranial surgery pre op RN management

Neuro status assessment -LOC -motor strength (upper and LE) -neuro deficits -educate (fam & pt needs to know poss risks & benefits) -shave head - urinary cath

The basic functional unit of the brain

Neuron

Who puts in an ICP monitor (ATI)

Neurosurgeon in the OR, ED, or CCU -Rarely used unless pt is comatose so minimal need for pain meds

Antacids (ATI)

Neutralize excess gastric acid --take when acid secretion is highest (1-3 hr after eating & bedtime) --separate from other meds by 1 hour **mylanta

When was the World Health Organization established?

1948

When was Medicare and Medicaid established?

1965

When was WIC established?

1972

What is the hepatic artery

20% blood supply to the liver -rich in O2

What is a sign of acute rejection (in regards to creatinine levels)?

20% increase in creatinine **1.0 to 1.2 **3.0 to 3.6 --those are both 20% increases

How much blood supply is in the GI tract at any given time

20% total CO circulating around GI

How much cardiac output does the kidney recieve

20-25% --all blood circulates thru kidney 12x per hour

What is normal bicarb HCO3

22-26

How long is the GI tract

23-26 feet long --hollow food tube surrounded by 4 layers -ribbon like

What is the primary test of renal clearance

24 hour urine -evaluates how well kidney performs this excretory function

If a patient gains 5 lbs, how much fluid have the added?

2500 mL

Sodium for CRF pt should be restricted to what?

2G

Category B biological agents (ATI)

2nd highest priority agents **moderately easy to spread & high morbidity & low mortality ---typhus, cholera

What occurs on the opposite side of a closed brain injury

2ndary injury at opposite side due to rebound

What is the thalamus

relay for all sensation but NOT SMELL -in cerebrum

what is the electrical relaxation of the heart

repolarization (relaxation)

What is peripheral vascular resistance

resistance to flow that must be overcome to push blood through the circulatory system

Early signs of ICP (LOC changes)

restless - disoriented - increase resp effort -papillary changes, impaired EOM, unilateral extremity weakness, constant HA

Nursing mgmt after pacemaker placement

- assess HR after implant - assess site for infection - assess breath sounds (poss pneumothorax) - teach: no magnets, elec motors, electromagnetic fields

What is a cardiac stress test

- can use exercise or chemical - mostly chemical - use a CA dilator and stimulate symptoms w/ IV push and can push antidote if heart is stressed

Nursing dx risk of infection for pt w/ cancer

-Assess for s/s of infection -ck VS Q 4 hr - monitor WBC - report fever > 100.4, chills, sweat, heat, pain, exudate on body surfaces, MS change --private room if WBC less than 1,000 --avoid fresh fruit & veggies, fish, raw meat, fresh flowers & potted plants if WBC < 1000

Why is a psych eval needed prior to transplant

-Assess pt's ability to adjust to transplant & coping styles -Social hx -Social support available -Financial resources (for meds) -Hx of psych illness (often those are aggravated by the steriods needed for immunosuppression)

What else did Lillian Wald do?

-Believed nursing agencies should be independent of physicians and religious groups. S -Coined the name "public health nurse." -Started the Henry Street Settlement in NY which eventually became the VNA. -Politically active for increased rights for women and children

Techniques in traditional CABG (notes)

-Blood bypasses heart and lungs -Circulated, with a pump, outside body where it is filtered, oxygenated and cooled or warmed -Heart stopped w/ potassium-rich cardioplegia solution -heparin used to prevent clotting -Protamine sulfate to reverse heparin -Room is cold to maintain hypothermia (less than 50 degrees) and slows basal metabolic rate and decreases demand for O2

How does dialysis work

-Blood from body enters machine and flows past one side of membrane -Membrane is barrier that keeps blood & dialysate from mixing but lets waste thru -Dialysate is special fluid that pulls waste from body -Waste, xtra fluid & chemicals move thru the membrane into dialysate -clean, filtered blood goes back into body

What is the pathophysiology of head injury

-Brain suffers injury -Brain swelling or bleeding increases intracranial volume -Rigid cranium has no room for expansin so ICP continues to increase -Pressure on b vessels within brain causes blood flow to brain to slow -cerebral hypoxia & ischemia occur -ICP continues to rise - brain may herniate -Cerebral blood flow ceases

RN assess for SCI

-Breating pattern & strength of cough - lungs auscultated -monitor for changes in sensory & motor damage (motor = spread fingers, squeeze RN hand -- sensory = gently pinch skin or touch w/ tongue blade w/ both eyes closed) -assess for spinal shock, s/s of overdistended bowel/bladder -monitor temp

Preop management of intracranial surgery

-CT & MRI for baseline (where & why surgery) -cerebral angiogram (ck for altered blood flow) -transcranial dplx (ck for altered blood flow) -antiseizure meds (dilantin, cerebryx) - high risk for sz if manipulating brain tissue -corticosteriods (dexamethasone) - to decrease swelling assoc w/ surgery -fluid restriction (mannitol, lasix) -abx -anxiolytic (valium

Mgment of brain injury

-CT / MRI = to see damage -always assume cervical spine injury too until proven otherwise -monitor ICP - ventilator support - prevent DI and secondary brain injury -Sz precautions and dilantin -Pain and anxiety mgmt/prevention (valium, xanax, ativan) -serial GCS

Post op intracranial mgmt

-CVP monitor (in RA) -arterial line (cont BP monitor) -reduce cerebral edema -relieve pain -prevent sz -monitor ICP **montior for #1 sign LOC changes - cushings triad **pt always in ICU

Medical mgmt of intra-renal ARF

-Cause usually glomerulonephritis or pylenephritis = TX INFECTION

How is blood flow/perfusion assessed?

-Cerebral perfusion (decrease in cardiac output = 1st organ effected is brain) -BP -Pulses -Skin (pallor or cyanosis or turgor) -JVD (in right CHF) - should be at 45 degrees to check -Auscultation (listen all 4 cardiac landmarks with bell & diaphragm) -Extremities (edema, cap refill, vasc changes, absence of hair)

Medical mgmt of brain tumors

-Chemo - before surg to decrease size of tumor -Rad - decrease size of tumor and pressure (palliative) -Brachytherapy - surg implant of radiation to deliver high doses at short distance -BMT - from long bones-harvest-radiate whole body - infuse back -steroids - decrease tumor size

Antipeptic agents

-Coats injured area in stomach to prevent further injury from acid --protects eroded ulcer sites in GI tract from further damage by acid & digestive enzymes **sulcrafate (carafate)

What is the medication mgmt post transplant

-Combo of glucocorticoids & meds to specifically affect action of lymphocytes *Immunosuppressants (combo of drugs) -doses tapered to the lowest effective doses -will still take as long as they have transplanted kidney -average of 30 pills per day

Medical management pre transplant

-Complete physical -Tissue typing -Blood typing -Antibody screening -Lower urinary tract studied to assess bladder neck function -Eval if pt needs dialysis prior to surgery **MUST BE INFECTION FREE PRIOR TO SURGERY (can't have any increase in WBC, fever, cough, etc) -psych eval

Pharm tx for SCI

-Corticosteriods = high dose or IV in 1st 24-48hrs

Who is Lillian Wald

-Created Visiting Nurses -Convinced Met Life to hire nurses to decrease mortality rate -She believed nursing was autonomous & independent -Started the school of nursing in 1902, statistics, & Nat'l Org of Public Health Nurses

How to assess/dx pericarditis

-Hx = recent endocarditis, CABG, bloodborne pathogen, open heart surgery -S/S = chest pain and pericardial rub -Echo = inflammation, pericardial effusion or tamponade, heart failure -TEE -CT = size, shape, location of pericardial effusions -MRI = detection of inflammation & adhesions -CXR = enlarged heart

Complications of chronic renal failure / CKD

-Hyperkalemia -Pericarditis, pericardial effusion, pericardial tamponade (d/t uremic build up) -HTN -Anemia/GI bleed (d/t decreased RBC) -bone disease, mets, & vascular d/t low calcium, low Vit D, elevated aluminum

Nursing mgmt for liver disorders and ascites

-I&O -Abd girth measurement -Daily weights -Labs -Frequent rest periods -Small freq meals

Treatment for peritonitis/infeciton for pt w/ PD cath

-IV or intraperitoneal abx (or both) -Cath removal if needed (pt will need 1 mth of abx before new cath is placed)

Dx tests for renal cancer

-IV urography (see structures & blood vessels) -Cystoscopic exam (can pass thru ureter into kidney pelvis & take tissue samples) -CT scan (eval tumor and mets) **repeat studies to watch for growth (grows FAST even in 1wk)

Nursing diagnosis for patients with cancer

-Impaired oral mucosa -Impaired tissue integrity -Imbalanced nutrition -Chronic pain -Fatigue -Disturbed body image -coping & anticipatory grief -Risk for infection

Medical mgmt of pre-renal ARF?

-Improve renal blood flow -Improve cardiac output -Treat hypotension & shock

Other interventions for HIV/AIDS

-Improving airway clearance = high fowlers or fowlers - pulm therapy - cough * deep breathe - percussion - drainage - vibration - adequate rest --Pain = meds, skin & perianal care

Secondary prevention of communcable disease (ATI)

-Increase early detection thru screening -refer suspected cases for dx confirmation -provide postexposure prophylaxis (hep A, rabies) -quarantine when necessary

What age group is at high risk for ovarian ca

-Increased risk after age 40 -Peaks in early 70's -Median age is 63

What are the risk factors for pancreatic cancer

-Increasing age (peaks 70-80) -Males -Smoking -Chemical exposures -Diet high in fat/or meat -DM, chronic pancreatitis, hereditary

Risk factors for ovarian ca

-Industrialized countries -Nulliparity -Infertility -High fat intake -Fam hx -Breast ca -Older age -Talc in perineal area

What are the 3 basic types of ICP monitors (ATI)

-Intraventricular cath (ventriculostomy) -Subarachnoid screw or bolt -Epidural or subdural sensor

Why is AV fistula the gold standard for dialysis

-It's natural -We don't reject our own tissue -Less chance of infection -Lasts longer than grafts

Common s/s of liver disease

-Jaundice -Hemolytic (RBC destruction) -Hepatocellular (bili levels up due to damaged liver cells) -Obstructive (gallstones, tumors, pressures from enlarged organs) -Hereditary hyperbilirubinemia (increasing bili w/o liver damage)

Pharmacology to treat hyperkalemia in ARF?

-Kayexalate -IV dextrose / insulin (titrate together) -Calcium gluconate -Albuterol

What happens during the kidney transplant

-Kidney placed in iliac fossa -Donor ureter is connected to recip bladder -Donor kidney artery & vein are attached to recipient femoral artery and vein (bladder will have 3 ureters)

What is decompensated cirrhosis

-Late disease -Result from failure to synthesize proteins, clotting factors other manisfestations of portal HTN

Who was Florence Nightengale?

-Lead nurse in caring for the British & allied soldiers in Turkey -Believed her calling was to alleviate suffering -Believed in fresh air, nutrition & cleanliness -She addressed patient's need for psychological health by encouraging the writing of letters home and entertainment for the mind. -Founder of EBP, she kept statistics on her patients

What is compensated cirrhosis

-Less severe -vague s/s -early disease -discovered secondary at a routine physical exam

Surgical management of bladder ca

-Partial bladder removal in early stages -Transurethral resection (remove cancer tissue) -Transurethral fulguration (laser/burn cancer tissue out) -Radical cystectomy (total remove of bladder & surrounding structures)

RN interventions for ICP

-Patent airway -Suction of secretions -Monitor for resp irregularities -Proper position (head midline & elevate 30-45 degrees) -Prevent valsalva maneuver (will increase ICP) - no BM straining - stool softener -Maintain neg fluid balance

Medical mgmt of pericardial effusion

-Pericardiocentesis = aspirate fluid from pericardial sac -Pericardioectomy = pericardial window -Prophylactic abx -Telemetry EKG to monitor for dysrhythmias

How does CKD cause calcium / phosphorous imbalance?

-Phosphorous is retained d/t decreased glomerular filtration -as phos increase = calcium decreases -calcium then leached out of bones to maintain blood levels **End result = bone disease, calcification of major b vessels

Mgmt of chronic pancreatitis

-Prevent & manage attacks -Treat pain - try antioxidants, lifestyle changes, yoga, mediation -Treat DM resulting from panc islet cell dysfunction -Correct malabsorption w/ panc enzyme replacements WITH MEALS -endoscopy to remove stones, correct strictures & drain cyst -teach to avoid high fat & high protein meals

RN interventions s/p neck dissection

-Put in fowlers or high fowlers - to facilitate breathing and drainage of lymph fluid and blood, swallowing (never flat = blood can pool/clot) -call light in reach -pain control -wound/flap care -nutrition -mobility -assess for nerve injury -coping

Problems associated w/ gastric ca

-Pyloric obstruction -Bleeding and **anemia**+ -Severe pain -Gastric perforation -peritonitis

What does hospice focus upon

-Quality of life -Palliation of symptoms -Psych & spiritual care

Treatment for spinal cord compression

-Rad therapy to decrease tumor size -steroid to decrease inflammation -surgery to debulk tumor -vertebroplasty to stabilize vertebrae -chemo

What are the complications of altered LOC

-Respiratory failure (assoc w/ ineffective airway clearance) shallow resp = leads to atelectasis & pneumonia -Pneumonia -Pressure ulcers (turn Q2H) -Aspiration (always issue in altered LOC) **elevate HOB at least 20 degrees if comatose

What causes altered LOC?

-Results from another condition (UTI in elderly - lactic acidosis - DKA) -Disruption of anatomic structures -Disruption of neurotransmitters (r/o everything w/ dx test)

What is the conduction flow in the heart

-SA node thru atria to stimulate conduction -to AV node to slow conduction and stimulate atria to contract -to the bundle of his -to right and left bundle branches -to purkinje fibers

Risk factors for cervical cancer

-Sex - multiple partners, early age (younger than 20) -Sex w/ uncircumcised males -Sexual contact w/ males whose partners have had cervical ca -Early childbearing -Exposure to HPV (16 & 18 types) -HIV infection & other causes of immunodeficiency -Smoking & 2nd hand smoke -Exposure to DES in utero -Fam hx -Low socioeconomic status -Nutrition deficiency (folate, beta-carotene & Vit C) -Chronic cervical infection -Overweight

What are the effects of radiation in oral mucosa

-Stomatitis (inflammation of oral tissues) -xerostomia (dryness of mouth) -change & loss of taste -decreased saliva

What should RN do if extravasation is suspected?

-Stop administration of med -may try to aspirate any remaining drug fro the site -cold pack to site -inject buffer / neutralizer under skin to buffer the alkaline solution

Psych concern after transplant

-Stress & coping (no support group esp if no more dialysis) -Anxiolytics -Antidepressants -Counseling -Med regimen compliance

Standard tx of oral ca

-Surgery to remove and clear margins -Radiation - to shrink - sometimes preop to make margins easier to clear w/o deforming (sometimes implanted into tongue) -Chemo

Medical mgmt of uterine ca

-Total or radical hysterectomy & bilateral removal of ovaries and fallopian tubes w/ node sampling (TAH-BSO) -Monitor CA-125 -Chemo and radiation -Progestin therapy

How to prevent intra-renal ARF

-Treat hypoTN STAT (don't just hold HTN meds, but may need fluid bolus) -Prevent infection / treat asap -Monitor drug effects on kidney function (&labs)

More medical mgmt of ARF

-Treat metabolic acidosis -Phosphate Binders -Avoid magnesium products

What is acoustic neuroma

-Tumor of 8th cranial nerve (internal auditory meatus) -may grow slow but can become large before dx -Compresses facial nerve (CN5 if too large - so unilateral face burn/twitch) S/S = tinnitus, loss of hear, vertigo, staggering gait

Avoiding hemorrhage s/p neck dissection

-VS Q 1-2 H - then Q4H after stabilized -avoid valsalva -high epigastric pain = impending rupture signs -assess dressings for excessive bleeding

Post ERCP nursing care (ATI)

-VS and resp status -Notify doc of bleeding abd or chest pain, s/s infection -withhold fluids until return of gag reflux

What are the early s/s of pancreatic ca

-Vague - non specific -Vague pain, epigastric may radiate to the back = increases w/ food -rarely dx at this time

What other s/s should alert a nurse that a pt should be assessed for ovarian ca?

-Vague, undiagnosed, persistent GI s/s -Palpable ovary in woman after menopause (b/c ovaries should shrink after menopause)

How to prevent post-renal ARF

-Watch for urinary retention -Bladder scans / BVI -Investigate retention causes asap & resolve them

GI status for pt w/ cirrhosis (ATI)

-abd girth measured daily if pt has ascites -mark location w/ tape for consistency

What are the indications or s/s of extravasation

-absence of blood return from IV -resistant to flow of IV fluid (IV pump beeping?) -burning, swelling, redness @ site

Assessment & dx findings of uterine ca

-annual gyn checkups -irregular bleeding should be checked immediately -Endometrial bx = menopausal woman w/ bleeding - to r/o hyperplasia -Sonogram - measure thickness of endometrium -Bx or aspiration

Postprocdure for ICP monitor placement (ATI)

-maintain system integrity (serious risk of infection) -inspect insertion site Q24H for redness, swelling, drainage -change dressing per protocol -Observe ICP waveforms -assess pt clinical status & monitor routine & neuro VS QH PRN

Neuro status monitoring for pt w/ cirrhosis (ATI)

-monitor for deteriorating mental status & dementia consistent w/ hepatic encephalopathy --lactulose may be needed do decrease ammonia

Skin integrity for pt w/ cirrhosis (ATI)

-monitor for skin breakdown -prevent pressure ulcers -pruritus (assoc w/ jaundice) will cause itching - encourage washing w/ cold water & apply lotion

Nutrition interventions for HIV/AIDS

-monitor weight, I&O, dietary intake, factors that interfere w/ nutrition -dietary consult -antiemetics -oral hygiene -tx oral discomfort -dietary supplements -may req enteral feedings or TPN

What is a glioma

-most common type of brain tumor -can infiltrate any portion of brain -usually spread by infiltrating into surrounding neural connective tissue -cannot be completely removed w/o causing major damage to vital structures **not capsulated - have tentacles that attack surrounding tissue and start new tumor

What is excisional bx

-most freq used for easily accessible tumors of skin, breast, and upper/lower GI and upper resp -surgeon can sometimes remove all tumor & surrounding margins -

Pathophys of pericarditis (notes)

-normally 20mL in space to lubricate -increased permeability to blood vessels & immobilization of platelets, WBC, etc -causes pericardial effusion & fluid trapped in the sac leading to cardiac tamponade w/ compression of heart

Post colonoscopy nursing care (ATI)

-notify dr of severe pain (poss perforation) or s/s hemorrhage -monitor for rectal bleeding -monitor VS and resp status -resume normal diet as prescribed -encourage increased fluid -may be increased gas r/t air instillation during procedure

How is head/brain/sp injury prevented

-obey traffic laws -seat belt -no ride in back of pick up truck -helmets -water safety (no shallow diving, with etoh and H2O activities) -firearm protection, safety, education -fall prevention (esp elderly) -protective devices for athletes -prevent violence & suicide (GSW) -no speeding, driving under influence

SIADH is an oncologic emergency. What is SIADH (ATI)

-occurs when excessive levels of ADH are produced -ADH helps kidneys & body to conserve correct amt of h2o -SIADH causes body to retain H2O -this results in dilution of Na+ in blood -s/s = N/V (early), lethargy, hostility, sz, coma

Potential complications of HIV/AIDS

-opportunistic infections -impaired breathing or resp failure assoc w/ PCP -wasting syndrome -fluid & elyte imbalance -adverse reaction to meds

Cancer is stronger in who?

-over 60 years old -higher in men -higher in industrialized countries (r/t environment exposures to carcinogens) -AA men

Pathophys of pancreatitis

-pancreatic duct obstructs (temp) -pancreas hypersecretes enzymes -enzymes enter bile duct activated & combine w/ bile then reflux back into panc -panc becomes inflammed as being autodigested by enzymes **severely painful in abd & back

Intraprocedure for cerebral angiogram (ATI)

-place pt on table with head secured -cath put into artery (groin or neck usually) - inject dye -when done, cath removed & closure device or pressure over artery **post procedure - monitor that clotting occured over artery

What does the hemodialysis circuit have?

-plastic blood tubing -2 compartment filter (dialyzer) or aka artificial kidney -dialysis machine (monitors & maintains blood flow & administers dialysate)

Hand and arm care after breast surgery

-potential for lymphedema after ALND -pt education -prevention is vital - follow guidelines for lifetime -no BP, inj or blood draws in effected arm -ROM exercises 3x day for 20 m to increase circulation, prevent stiffness, increase muscle strength -mild analgesic or warm shower can help prior to exercise -initial limit of lifting and activity

primary prevention of communicable disease (ATI)

-prevent occurrence of infectious disease -educate public re: need of vaccines -counsel pts traveling to other countries -educate public re: prevention, eliminating risk factors, hand hygiene, universal precautions, proper food handling & storage, condoms

Decreasing isolation interventions for HIV/AIDS

-promote atmosphere of acceptance & understanding -assess social interactions & monitor behaviors -allow pt to express feelings -address psych feelings -provide info r/t spread of infection -educate fam, partners

What does the WHO do?

-provides daily info regarding occurance of international diseases -establishes world standards for abx and vaccines -primary focus is on health care workforce & education, environment, sanitation, infectious disease, maternal & child health, primary care

Nursing process for care of pt undergoing breast ca - assessment

-pt response to dx -coping mechanisms -psych or emotional support does she have/use -partner or fam member to assist in making tx choices -educational needs of pt -any discomfort

What is portal systemic encephalopathy (ATI)

-pt unable to convert ammonia to urea -those products are carried to the brain & cause neuro s/s -treat w/ lactulose -reduce protein intake if

Inflammatory breast ca

-rapid spread -chemo, rad and surgery

Treatment & management of pancreatitis

-relieve s/s & prevent complications --pain control (morphine unless looking at Oddi of sphincter) -IVF -nutritional support (TPN, jtube, PPN) or NPO -I & O -Ng -ciprofloxacin prophylactic -O2 saturation monitoring -blood transfusions to keep HGB > 10

What are wide or radical excisions

-removal of tumor, LN, adjacent involved structures, & surrouding tissues high risk for tumor spread

How to reduce fever in pt with altered LOC

-remove all bedding except for light sheet or towel -tylenol -cool sponge bath with electric fan -hypothermia blanket -freq temp monitoring

Tx of tumor lysis syndrome

-restore elyte balance -aggressive fluid hydration 24-48 before and after cytotoxic tx -loop diuretic -IV sodium bicarb or hypertonic dextrose -poss dialysis

What is superior vena cava syndrome (ATI)

-result form obstruction (mets of breast/lung ca) of venous return & engorgement of vessels from head and upper body -s/s = periorbital & facial edema - dyspnea - nose bleed - erythema of upper body

Breast surgery pre op interventions

-review & reinforce info on tx options -prepare pt what to expect before, during and after surgery -inform pt re surgical drain, arm & shoulder mobility, & ROM -open communication -realistic expectations -support coping -provide info for supportive services & resources -support pt decisions

Complications s/p neck dissection

-risk for swelling of posterior pharynx --temporary trach -chyle fistula -hemorrhage -nerve depression -impaired airway

What are the causes of acute pericarditis

-secondary to another infection (endocarditis, myocarditis) -viral infection -post MI * 10days to 2mths after -cancers, trauma, uremia -radiation tx of chest -connective tissue or endocrine disease -hypersensitivity states -chest trauma, heart surgery, TB, malignant tumors -chronic causes thickening of pericardium & restricts diastolic filling (s/s heart failure)

S/S or assessment of pancreatitis

-severe knife like abd pain -severe back pain -often pain is 24-48 hrs after large meal or drinking etoh -pain most severe after meals -antacids & emesis don't help -decreased peristalsis -abd distention -peri umbilical bruises or bruising of the flanks -guarding -N/V (emesis could be bile colored) -fever - jaundice - confusioin - agitation

What cancers can fluoroscopy detect

-skeletal, lung, GI -use of xrays that identify contrasts in body tissue densities sometimes using contast

S/S of oral BCC

-slow growing -raised border -pearly -can have ulceration -bleed when disturbed -translucency -depression in the center and can ooze

Complications of SCI

-spinal or neurogenic shock -DVT -respiratory -autonomic dysreflexia

How is HIV prevented

-standard universal precautions -safer sex (abstain from sharing sex fluids - reduce # of partners to 1 - always use latex condoms) -don't share needles -blood screening & tx of blood productes

Discharge planning s/p transplant

-starts prior to transplant -wear ID bracelet -Med schedule (be precise about time of meds) -lifelong med therapy -teach s/s of rejection -join Amer Assoc of Kidney patients -Diet low sodium, low fat -Fluids -avoid contact sports, daily wts (call 2lb or more in 1 day)

What happens during peritoneal dialysis?

-sterile dialysate introduced thru abdomen thru abd cath & allowed to dwell -while dwelling, urea & creatinine begin to be cleared from body -diffusion and osmosis as wastes move from blood to dialysate -ultrafiltration by using dialysate w/ higher glucose concentration

How does acetycholine effect digestion (table 34-2)

-stimulated by sight/smell/chewing of food & stomach distention --targets: gastric glands & muscles & intestinal muscles --effect: INCREASES GASTRIC ACID --motility effects: INCREASED with decreased sphinctor tone

Effect of norepinephrine on digestion (table 34-2)

-stimulated: by stress or other stimuli --targets: secretory glands, gastric & intestinal muscles --effect: INHIBITORY --motility effects: DECREASED w/ increased sphinctor tone

Neuro gerontologic changes

-structural = atrophy of brain, -motor = atrophy of muscles, shuffled gait, decreased agility and reaction times -sensory = visual & hearing loss -temp/pain = decreased sensations -taste / smell = decreases (eat less) - weight loss -tactile/visual = decreased -mental status = be sensitive to dementia or delirium / don't go into REM or stage 4 sleep, decreased pupil response

Subjective s/s of pancreatitis (ATI)

-sudden onset of severe pain -epigastric, radiating to back, left flank or shoulder pain -worse when lying down or eating -worse after etoh or high fat foods -not releived w/ vomiting -pain somewhat releived by fetal position -N/V weight loss

How is ARDS treated

-supportive care and let lungs heal -treat underlying condition -if aspirated, then buffer (suction and buffer) -incubate and ventilator support in ICU -decrease O2 demands to let lungs heal themselves **PEEP (high) -higher the PEEP the lower the % of O2 we can get by with to reduce risk of O2 toxicity

What is an AV fistula

-surgically created in forearm by joining an arter to a vein -either side to side or end to side -Needles are inserted into the vessel to obtain blood flow adequate to pass thru dialyzer

How is EEG performed (ATI)

-takes bout 1 hr -pt resting in chair or bed put small electrodes on scalp -electrical signals produced by brain are recorded in form of wavy lines -lines document brain activity -notations are made when stimuli are presented or sleep occurs -flash of light or pics used to initiate stimuli

What can increased ICP cause?

-there is a fixed amount of space designed to hold certain amount of stuff -more stuff = higher pressure in that space -causes pressure on all other structures in brain (= sz, coma, death) -only outlet from brain is foramen magnum

How are caregivers protected when pt getting internal rad tx

-these pts emit radiation while implant is in place -limit time and distance and use sheilding -private room, badges, no preg health members, no kids, 30 min time limit for visitors, visitors ft distance

Indications for renal bx

-unexplained acute renal failure -persistent proteinuria or hematuria -transplant rejection -glomerulopathies

What is local excision

-used when mass is small -removal of mass & small margin around that is easily accessible

Early s/s of gastric cancer

-usually asymptomatic -pain releived w/ antacids

What are some carcinogen agents & factors

-viruses/bacterias (not that aggressive but main is epstein barr virus) -physical factors (sunlight, smoking, radiation, UV light b/c chronic irritation of skin) -chemical agents (#1 tobacco - 30% ca deaths) -genetic factors -diet -hormones -immune system

Small bowel capsule endoscopy

-visualize entire bowel -improve eval of small bowel -8 lead sensors applied, held in place w/ abd binder, pt performs normal activities, test lasts 8 hrs -NPO except H2O for 8-10 hrs prior -can eat after 4 hrs

RN assess for brain injury

-when did injury occur -what caused injury -direction & force of blow -hx of LOC or amnesia & how long? -could pt be aroused during LOC (arouse QH)

gender related differences in the heart

-women smaller hearts & coronary arteries so increased risk of emboli creating occlusion -estrogen decreases = atherosclerosis -women better lipid profile -women DVT more often

Motor and sensory function

...

What are BNP levels

0 - 100 = normal > 100 = CHF **80 year old may have 3-500 and still be normal

What is normal ICP amount

0-10 mm Hg

what is normal creatinine

0.5 - 1.5

What is normal creatinine

0.6 - 1.2 --increased in renal disease

What are the 5 functions of a pacemaker

1 - depends on which chambers are being paced (A, V, or D = dual) 2 - which chambers are being sensored 3 - type of response (trigger, inhibit or both) 4 - program/reset from outside? 5 - defib

What are the 3 types of uterine ca

1 - majority - estrogen related - occurs in younger, obese, perimenopausal - low grade endometrioid 2 - 10% - high grade - older women & AA 3 - 10% - hereditary & genetic - r/t Lynch II syndrome

What are the stages of HIV

1 - primary 2 - HIV asymptomatic 3 - HIV symptomatic 4 - AIDS

why isn't laryngeal cancer found early

1 - self medicate the sore throat 2 - denial

Cancer staging

1 - small and no mets 2 - differentiation of cells (poor = bad and good =good) 3 - mets into LN (local) 4 - mets to other locations

How is afib treated?

1 Decrease rate with dig or CC blocker 2 Coumadin or ablate line from SA & AV node and pace ventricles

What are the 3 steps of malignant transformation

1 Intitiation 2 Promotion 3 Progression

Complications of CABG

1 cardiac - dysrhythmia (#1 afib) 2 pulmonary - heart failure, pulm congestion - lasix to tx 3 fluid volume - excess or deficit - monitor by using CVP in rt atrium 4 neurologic - mitral emboli - monitor LOC - neuro assess pre and post op 5 renal - decrease in CO

What is the marine hospital?

1798 developed by congress -later became the Public Health Service -established with the signing by Presiden t John Adams of an act for the relief of sick and disabled seamen.

When did the first Nursing School in US open?

1872 -Nurse Training School of Women's Hospital of Philadelphia opens as the first formal nursing school in the United States

What pH should stomach acid be

1-4 -highly corrosive & will burn throat when vomit

4 indications for O2 therapy

1. Change in resp rate or pattern -hypoxemia 2. Circulatory hypoxia -O2 sats <90 3. Histotoxic hypoxia -CO2 poisoning 4. Anemic hypoxia

What are the 3 layers of the meninges

1. Dura mater = outer tough layer, gray, thick 2. Arachnoid = mid layer, thin, spiderweb like 3. Pia mater = thin, inner, transparent layer - hugs brain and holds all the brain tissue together

Pre op management for CABG

1. H&P - hx of infection, trauma, hepatitis, HIV, anything that will cause compromise 2. tests - CXR, CBC, CMP, EKG 3. health assessment - include neuro and mental baseline 4. pscyhosocial assess - hx of non compliance w/ meds, support sys, social service 5. monitor / manage potential complications 6. pt teaching - meds, diet exercise

What are the 4 phases of ARF?

1. Initiation 2. Oliguria 3. Diuresis 4. Recovery

What is HIV wasting syndrome

10% weight loss & chronic diarrhea or chronic weakness & fever w/ absence of other cause -protein energy malnutrition ---anorexia, diarrhea, GI malabsorption, lack of nutrition may contribute to this

How long should nebulized albuterol be given?

10-20 mg over 15 minutes --effective & rapid tx for HYPERKALEMIA **don't give to pt w/ tachycardia or CAD

What is normal HGB

12 - 16 female 14 - 18 male

How long for waste products from meal to reach the rectum

12 hrs can be 3 days until excretion

What is normal HGB

12-16 female 14-18 male

Each breast contains what kinds of lobes

12-20 cone shaped lobes made of glandular elements (lobules & ducts) -separated by fat and fibrous tissue that binds the lobes together -milk produced in the lobules then carried thru ducts to nipples

What is the normal blood flow thru the kidney

1200 mL per minute

What is normal Na+

135-145

What is the best possible score on glascow coma scale?

15

What is normal ICP (ATI)

15 mm Hg -persistant ICP decreases cerebral circulation = brain death if not tx urgently

What is normal platelets

150 - 350,000

What is normal platelets

150,000 - 400,000 --risk for bleeding when 50k to 100k (mild risk)

How much blood flows thru liver every minute

1500 mL

How long is the SI

16-19 feet long -7,000 cm of surface area for absorption & secretion

When was the first med school in US established?

1765 -University of Pennsylvania -Dr's visited patients at home

When was the World Health Organization (WHO) formed

1948

How many Pwaves per QRS are normal?

1:1 ratio

When should you follow up with post exposure testing

1month 3months 6months 1year

What are the most rare rib fx

1st 3 ribs - b/c they are strongest and largest and most well attached -if broken = high mortality rate r/t lacerations of subclavian arteries -monitor for internal bleeding

How much does the risk for breast ca increase with family hx

1st degree relative (mom, sister, daughter) = increases 2 fold -if 2 1st degree relatives = five fold -if father or brother had breast ca = high risk -if BRCA 1 or 2 + = inherited cases

What is the initiation phase of ARF?

1st phase -starts w/ initial insult or trauma to the kidney --until oliguria phase begins

How may cuffs does PD cath have

2 dacron polyester cuffs that are soft & flexible -to stabilize cath, limit movement & prevent leaks --also bacteria barriers

How many lobes and hemispheres does the cerebrum have

2 hemisphers 4 lobes

Assessment of ransons criteria

2 or fewer signs = 1% mortality 3-4 signs = 15% mortality 5-6 signs = 40% mortality >6 signs = 100% mortality

How do the kidneys control pH or acid-base balance

2 ways --reabsorb & return to circulation any bicarb from the urine filtrate --& to excrete acid in the urine

What is continuous ambulatory periotneal dialysis (CAPD)

2nd most common type of dialysis -done at home by pt -exchanges fluid 4-5x per day 7 days per week w/ varying dwelling times **the longer the dwell, the more urea is removed -once equilibrium is reached - dialysate no longer pulls off toxins or fluids

When does bleeding after placement of PD cath normally resolve

2-3 days --during menses - dialysate draws blood from uterus

How long does AV fistula need to mature

2-3 mths before it can be used -encourage hand exercises (squeeze rubber ball) to accomodate large bore needles

What is therapeutic levels of INR

2.0 - 3.0 higher for afib dose coumadin by this only

What is normal PO4

2.5 - 4.5

Blood supply from the hepatic artery is rich in what

20% O2

What is normal RBC

3.5 - 5.5

What is normal K+

3.5-4.5

Normal urine osmolality

300-900

How long does food stay in stomach

30m to several hours

How many spinal nerves are there

31

What is normal PCO2

35-45

What is normal HDL

35-70 -HDL transports cholesterol away from the tissue and cells of the arterial wall to liver for excretion

What is normal hct

36 - 46% female 41 - 53% male

How long does PD take?

36-48hrs to do what hemodialysis does in 6-8 hrs

What is continuous bladder irrigation

3L bags of fluid per bag -IV pole hang 2 bags w/ 3 way tubing into 3 way urinary cath -fluid into cath to keep bladder from filling w/ clots post op

Category C biological agents (ATI)

3rd highest priority -comprimising emerging pathogens can be engineered for mass spreading **easy to produce, &/or have potential for high morbidity & mortality ---hantavirus

How is eye response rated/assessed on GCS?

4 = eye opening spontaneously 3 = eye opening secondary to voice 2 = eye opening secondary to pain 1 = no eye opening

When does collateral circulation usually develoop after mastectomy

4 weeks -arm exercises help facilitate this

What is the capacity of the bladder

400-500 mL

What is the EF of the right ventricle?

42%

What is normal BUN

5 - 25

How is verbal response rated/assessed on GCS?

5 = conversation coherent & oriented 4 = conversation incoherent & disoriented 3 = words spoken but inappropriately 2 = sounds made but no words 1 = no vocalization

What is the 5 point scale to test muscle strength

5 = full ROM against gravity & resistance 4 = full ROM against gravity & moderate against resistance 3 = full ROM against gravity only 2 = full ROM when gravity is eliminated 1 = weak muscle contraction when palpated but no movement 0 = complete paralysis

What is normal WBC

5,000 - 10,000

How large is the large intestine

5-6 ft

What is normal urine pH

5-9 -depending on diet -alkaline pH is bad

One pound of weight equals how many mL of fluid?

500 mL --so weight change of 1 lb could suggest fluid gain / loss of 500 mL

How much CSF is produced per day

500 mL -the ventricles and subarachnoid space contains approx 150mL

What is the EF of the left ventricle?

52%

What age does uterine cancer mostly occur

55-64 years of age

what is the average cardiac output?

5L for adults

What type of cancer is most bladder cancer

90% is transitional cell -they occur at the margin where cell types change and begin in the cells that normally make up the inner lining of bladder

What is normal Chloride

95 -1 05

Pathyphys of colon ca

95% are adenocarcinoma -rising from lining of colon -usually starts as polyp - transforms to malignancy - invades, destroys normal tissues

What are the other types bladder cancer

< than 10% are -squamous cell (begins in thin, flat cells) -adenocarcinoma (begins in cells that make & release mucus & other fluids)

What is capillary leak syndrome?

= Cells that line the capillaries separate allowing for a leakage of fluid from the circulatory system to the interstitial space, -results in a dangerous hypotension, hemoconcentration, and hypoalbuminemia. I -Life-threatening because each tim has potential to cause damage or failure of, vital organs due to limited perfusion.

Nurse is doing admission assessment of pt w/ acute pancreatitis. What is the priority to be reported to the dr (ATI)?

A - Hx of cholelithiasis B - Amylase levels 3x greater than expected C - Severe pain radiating to back rated at 8 D - Hand spasms when BP is checked ***D*** indicative of hypocalcemia = risk for cardiac dysrhythmia

Nurse teaching nutrition to pt w/ pancreatitis. What indicates pt needs further teaching (ATI)?

A - I will eat small, freq meals B - I will eat easy to digest foods w/ limited spice C - I will use skim milk when cooking D - I will drink regular cola **D**Caffeine free beverages are recommended

Nurse assessing pt w/ pancreatitis on admission. What is expected finding (ATI)?

A - Pain in RUQ radiating to right shoulder B - Pain worse when sitting upright C - Pain relieved w/ defecation D - Epigastric pain radiating to left shoulder **D**

What is the ASIA Impairment scale

A = Complete - no motor or sensory function is preserved in S4-S5 B = Incomplete - sensory but not motor is perserved below neurogenic level & includes S4-S5 C = Incomplete - Motor is preserved below neurogenic level & more than 1/2 of key muscles have muscle grade <3 D = Incomplete - Motor is preserved below neuro level and at least 1/2 of key muscles below neuro level have muscle grade 3 or greater E = Normal - motor and sensory function are normal

RN mgmt of pulmonary embolism

A B C -suppportive = give meds on time, monotir labs (ptt), heparin drip, d/c education re: INR checks, bleeding precautions, no contact sports

Nurse caring for pt w/ traumatic brain injury has ICP cath. What complication should she monitor for?

A headache B infection C Aphasia D HTN answer = infection

Nurse admits pt w/ bleeding esophageal varices - she should anticipate Rx for what med (ATI)?

A propranolol (Inderal) B Metoclopramide (Reglan) C Rantidine (zantac) D Terlipressin (vasopressin) **D - constricts blood vessels

What happens in tubular reabsorption

A substance moves from filtrate back into peritubular capillaries or vasa recta

Low K+ foods are:

Apples - blueberries - green beans - iceberg lettuce - cabbage - cucumbers

Med mgmt of pulmonary contusions

ABC - O2 supplement - IV fluids - ET tube - severe = high PEEP --always abx to prevent pneumonia (due to the fluid in lungs caused by the inflammatory response assoc w/ trauma)

What is the decerbrate position

ABduction of arms, extended elbows and wrists

If pt drinks alot of H2O - what happens to ADH

ADH decreases - urine output increases

When is total laryngectomy used for tx

ADVANCED CA

If pt is HTN and taking anti HTN meds, should those be given before or after dialysis

AFTER -check BP first

What is the 4th stage of HIV

AIDS -CD4+ T cell count is less than 200 -as levels drop below 100 - the immune system is significantly impaired --life threaten infections take over (candidias in lungs & esophagus - cervical ca - lymphoma - karposi sarcoma mets to liver, brain & PCP)

What is ADH

Antidiuretic hormone **vasopressin --hormone secreted by pituitary gland in response to osmolarity of blood ---conserves water

What is a dialyzer?

AKA artifical kidney -replaces actions of glomeruli & tubules -hollow fiber devices w/ thousands of tiny straw like porous tubes carry blood thru dialyzer -tubes allow toxins, fluids,e lytes to pass from blood into solution

What is the gold standard fistula used for dialysis

AV fistula

What cancers can US detect

Abd & pelvic -assess tissues deep in body

Assess for ascites

Abd girth measurements Watch respirations - causes pressure on diaphragm Vasodilation, H2O & Na+ retention

Effects of T6-T10 injury

Abd muscle control +, partial to good balance w/ trunk muscles -independent dress, feed, elimination

S/S of left sided colon lesion/cancer

Abd pain Cramping Ribbon stools Feeling of incomplete evacuation Constipation & abd distention Blood in stool Descending colong - near colorectal area

What is renal clearance?

Ability of the kidneys to clear solutes from the plasma

What is atypical hyperplasia

Abn increase in ductal or lobular cells in the breast -increases chance of breast ca by 4-5 times

Examples of scalp injuries

Abrasion Contusion Laceration Hematoma

Calicum to dx GI disorders

Absorbed in GI tract May detect malabsorption

Sodium & potassium to dx GI disorders

Absorbed in GI tract Vomit & diarrhea can cause depletion

Sources of ammonia

Absorption from GI tract Kidney cells Muscle cells

How is HIV wasting syndrome treated

Abx - steroids - marinol (appetite stimulant)

Social environments (ATI)

Access to health care High risk working conditions Poverty

What is hepatic encephalopathy / portal systemic encephalopathy

Accumulation of ammonia & toxic metabolites in blood and brain -portal hypertension -poor marker for survival

What is jaundice caused by

Accumulation of bilirubin in the boold that the liver is unable to breakdown

What is pericardial effusion

Accumulation of fluid beyond 50mL in the pericardial sac - normal is 20 mL

Primary neurotransmitter for parasympathetic NS

Acetylcholine -during quiet nonstress - cholinergic impulses predominate

what neurotransmitter effects inhibitory

Acetylcholine -excitatory

What if pH is low

Acidosis

What is primary prevention

Activites that prevent disease or injury -education **prevent

What is secondary prevention

Activities for early detection & treatment **screening

What is intra renal ARF

Actual damage to the glomeruli or tubules

What are the leading cause of communicable disease deaths (ATI)

Acute resp infections (pneumonia & influenza) - AIDS - diarrheal diseases - TB - malaria - measles

What is tension pneumothorax

Air enters pleural space during inspiration thru a one way valve and not able to exit during expiration -trapped air causes pressure on heart and lung -increase in pressure compressess blood vessels and limits venous return leading to decrease cardiac output --can cause death -air and pressure continue to rise and cause a mediastinal shift

Medical management of altered LOC

Airway (patent) Breathing (monitor resp & lung sounds) Circulation Nutrition (possible calorie counts needed, supplements, asst w/ feeding, gtube, TPN)

2 categories of SCI

Aischemia, hypoxia, edema & hemrrhage - result of inflammatory process & severe compression of spinal cord (irreversible if treated timely)

What is adhesive pericarditis

Aka constrictive -because layers of the pericardium become attached to each other and restrict ventricular filling or by what accumulates in the sac (serum, pus, calcium deposits, clotting proteins, blood)

What is the most common type of cirrhosis

Alcoholic --effects circulation & nutrients & O2 of portal area

Cirrhosis types

Alcoholic (Laennec's) Post necrotic Biliary Cryptogenic

The regulation of sodiume volume secreted depends on what?

Aldosterone --aldosterone increases reabsorption of Na+

Are the pancreatic enzymes acidic or alkaline

Alkaline (high in pH) r/t high concentrations of bicarb to help neutralize stomach acid

What is total laryngectomy

All laryngeal structures removed (hyoid bone, epiglottis, cricoid cartilage, 2 or 3 rings of trachea) ***permanent trach **voice loss permanent, mucus production decreases, swallow preserved

What are the types of BMT

Allogenic (from unknown donor or related after cross & type) Autologous (using pt's own BM) Syngeneic (from identical twin)

RN interventions for anxiety (for pt w/ hysterectomy)

Allow pt to express feelings Explain physical preps and procedures Emotional support

After warming dialysate fluid, what should you do prior to attaching PD cath tubing

Allow tubing to fill w/ dialysate prior to attaching to abd tubing -takes 5-10 min to fill 2-3L of fluid -then clamp tube -allow for dwell time -after dwell time, unclamp tube & drain solution by gravity thru closed system over 10-20 min -after drained, weigh bag to ensure all fluid has drained

What does insulin do

Allows entry of glucose into cells of liver, muscle & other tissues --stored as glycogen or used as energy --when insulin is absent - glucose only excreted in urine = raising BS = DM --stored fats & proteins are used for energy rather than glucose and body mass decreases (wt loss

What genetic factors increase risk for cancer

Almost all cancer runs in families -cancer in 2 or more 1st or 2nd degree with the same type, early onset in age or 1 or more types of cancer in one person

What are non susceptible hosts

Already have immunity to the disease by either vaccine or already having it --antibodies

What is the progession stage of cancer cell tranformation

Altered cells exhibit increased malignant behavior --cells/tumors invade & create distant sites for growth

Urine tests in GI disorders

Amylase Urobilinogen

What is a vector

An organism, typically a biting insect or tick, that transmits a disease or parasite from one animal or plant to another

What are the only sphincters in the GI under voluntary control

Anal sphincter Sphincter of upper esophagus

What is tumor marker identification

Analysis of substances found in the body -tissues, blood, or other body fluids that are made by the tumor or by the body in response to the tumor **breast, colon, lung, ovarian, testicle, prostate cancers

Why does CRF cause weakness & fatigue?

Anemia & elyte imbalance

What controls the release of aldosterne

Angiotensin II

What is the most powerful vasoconstrictor

Angiotensin II

What is the agent in (ATI)

Animate or inanimate object that CAUSES the DISEASE

What are the effects of radiation in GI system

Anorexia - nausea - vomit - diarrhea - esophageal irritation - dysphagia -high risk for elyte imbalance

What is cellcept

Another immunosuppressant used with Cyclosporine

Symptoms of pneumothorax

Anxiety - pleura pain

What is attached to the cecum

Appendix -function unknown

S/S sternal fx

Anterior chest pain - bruising around sternum

What is Prednisone

Anti inflammatory steroid used w/ other immunosuppressants

What meds should be given prior to chemo

Antidiarrhea and antiemetics (prophylactically)

Four sections of the LI

Ascending (right side of abd) Transverse (right to left) Descending (left side) Sigmoid, rectum, anus

Women with increased risk for breast ca should start mammo when?

Ask dr - usually 10 years prior

Intraop nursing for CABG

Assess Explain procedures Assist with procedures Comfort and safety

Post op nursing for CABG

Assess (CV and pulm) #1 complication = dysrhythmia (afib) Monitor for complications Home and community care

Indications for cerebral angiogram (ATI)

Assess blood flow to and within brain -identify aneurysms -vascularity of tumors for surgical planning -therapy to inject meds that tx blood clots or infuse chemo

What is included in clinical breast exam

Assess for symmetry & size - skin assess for color, venous pattern, thickening, edema

What is pulmonary artery pressure PAP?

Assess left ventricle function (cardiac output) -PAWP pulmonary artery wedge pressure measures left ventricl filling pressure (preload) - critically ill req higher left ventricle preload to maintain CO - common complications: infection, pulm artery rupture, pulm infarction, air embolism, dysrhythmias

Acute and subacute subdural hematoma

Assoc with major head injury w/ contusion or laceration -s/s develop over 24-48 hrs **S/S = changes in LOC, pupillary signs, hemiparesis, coma, increase BP, decreased HR and RR = rapidly expanding hematoma **emergent

Causes of vtach?

Associated w/ MI - CO decreases significantly - normally pulseless - no filling time - unresponsive and need a defibrillator

S/S of left sided colon lesions

Associated with obstruction

What are the types of gliomas

Astrocytoma = most common - Stage 1 or 2 glioma (more sensitive to chemo) Gliablastoma = multiform - stage 3 or 4 = hospice

If there is fluid in the lungs where can it be auscultated

At bottom (gravity)

Where is the T wave

At the end - after QRS = ventricles repolarize

What are the 2 most common benign proliferative breast disease?

Atypical hyperplasia Lobular carcinoma in situ --increases risk of breast ca

What does the temporal lobe control

Auditory -hearing & understanding of language & music

Pancreatitis (ATI)

Autodigestion of pancreas by panc digestive enzymes that activate prematurely before reaching the intestiness --results in inflammation, necrosis, hemorrhage

What does prealbumin tell us?

Average albumin over last 3 months

What is the peritonitis rate for PD cath patients

Average is Q4 years --staph and strep most common

CKD is present when the GFR is what?

BELOW 60 mL/minute for more than 3 mths -or when albumin to creatinine ratio is over 30 for each g of creatinine

Interventions for pt w/ DIC

Avoid procedures that increase ICP (cough, strain to BM) Monitor VS & neuro checks (UO, abd girth, hemodynamics) Avoid meds that interfere w/ platelets (NSAIDS) Avoid rectal probes & meds Avoid IM injections Monitor dressing and saturations, assess suction output

Definitive dx or s/s of ARDS

BILATERAL lung infiltrates - refractory hypoxemia

What do ARB's do?

BLock receptor sites of angiotensin 2 **sartins

What is the tx of PCP

Bactrim (TMP-SMZ) or pentamidine or prophylactic --isolation --1 tab BID for acute PCP -- 1 tab QD for prophylactic

What is the viral set point

Balance btwn amount of HIV and the immune response -during primary stage

Other medical mgmt for esophageal varices

Balloon tamponade Endoscopy - sclerotherapy & variceal banding

What is a closed brain injury

Blunt injury -head accelerates & then rapidly decelerates or collides w/ another object AND -brain tissue is damaged but no opening thru skull or dura

Why does increased ICP cause cushings triad

B/C putting pressure on brain stem

What is the only nonfat soluble vitamin that can stay in the liver for long time

B12

How to reduce metabolic demands to manage ICP

Barbiturates (phentobarbital) = to keep pt calm Paralyzing agents (pavulon) Sedation (diprivan) = to keep sedated Fentanyl = to keep out of pain --anxiety & pain will increase ICP -promote BM so don't strain -prevent urine retention (bladder spasms = increased ICP)

What is the pre op work up for ovarian ca

Barium enema or colonoscopy Upper GI series MRI Sono CXR IV urography CT - r/o intra-abd mets Staging the tumor with TNM method

Renal side effects of chemo

Because chemo is excreted thru the kidneys -and accumulate end products after cell lysis -decrease dose if BUN and creatinine are elevated

Post op sensations after breast surgery

Because nerves are cut -tenderness, pulling, numbness, tightening, twinges -can occur along chest wall, axilla and inside upper arm -phantom pain or sensations - feel like breast and nipple still there -diminish but can last months or years

Why should you take calcium and phosphorus binders with food

Because they bind with food --Ca binds w/ phosphorus - inactivates it - pass thru GI --must be given w/ food to be effective

After liver bx, how should patient be positioned

Bedrest - lay on side of bx to seal ck for bleeding

Nursing care for pt getting brachytherapy

Bedrest - logroll - foley cath to keep bladder empty - low residue diet - antidiarrhea so seed isn't displaced

What should a stoma look like

Beefy red or hot pink

Where does systole occur on EKG

Before the P wave (P to T)

What are adenocarcinomas of the cervix

Begin in mucus producing glands and often due to HPV infections

What is the mouth/

Beginning of GI system

What is the renal pelvis

Beginning of the collecting syste -made of structures designed to collect & transport urine

What is culture

Beliefs, values, & assumptions about life - widely held among a group of people - transmitted across generations

What is the CD4 count of HIV+ pt

Below 500

Antidote for sinus tachycardia

Beta blockers - catheter ablation

What is the PR interval

Between P wave and QRS complex --delay of AV node to allow filling of ventricles

What is the ST segment

Between S in the QRS complex and the T wave --Beginning of the ventricle repolarization (relax) --should be flat

What does VQ scan show when have PE

Big chunk out of side of lung -no perfusion HIGH VQ

Right and left hepatic ducts transport ________

Bile away from the liver

How is bile EXCRETED

Bilirubin forms when blood cells are destroyed -liver modifies and excretes it in bile into duodenum to leave body in feces -small amount will reabsorb & filter thru liver & excrete again in bile

What does high cholesterol intake promote

Bladder stones

S/S of DIC

Bleeding from mucus membranes, venipuncture sites and GI and urinary tracts -multiple organ dysfunction - renal failure - pulm infarctions -progressive decrease in platelets

Intracerebral hematoma/hemorrhage

Bleeding into the substance of the brain -usually seen in GSW or stab wounds -onset may be insidious starting with neuro deficits then HA

Contraindications for renal bx

Bleeding tendencies, uncontrolled HTN, solitary kidney, morbid obesity

What do calcium channel blockers do?

Block calcium across the cell membrane and cause arterial relaxation --negative dromotrine --reduce conduction of the heart

What causes atrial flutter

Block in the AV node sends the impulse back to SA node -has 2, 3, or 4 (not alot like afib - not as dangerous as afib) - don't treat - just note

What do beta blockers do?

Block the sympathetic nervous sysem - decrease HR and BP - if non selective they cause bronchospasm - so don't give to asthma, COPD, etc **olol

Proton pump inhibitor

Blocks final step of acid production lowering the acid level in the stomach --big ones **Prevacid (lanzoprazole) - Prilosec (omeprazole) - Nexium (esomeprazole) - Protonix (pantoprazole) - Aciphex (rabeprazole) ***P zole or pizzole**

Epidural hemorrhage / hematoma

Blood collects between skull and dura mater -can result from skull fx causing rupture or laceration to middle meningeal artery -LOC at time of inury w/ lucid interval after -S/s caused by expanding hematoma -after lucid interval-pt restless, agitated, confused

What is BUN

Blood urea nitrogen --evaluates hydration status

Causes for V tach

CAD - elyte imbalance

Causes for ventricular fibrillation

CAD - elyte imbalance

What if a patient is cyanotic - what should you do

CALL A CODE

How is PTCA done

Catheter with balloon on tip is threaded up (normally thru femoral artery) to the narrowed coronary artery -balloon then inflated to compress the plaque against the arterial wall to open lumen -lasts as long as pt maintains healthy life **post op = leg extension 4-6hrs, distal pulses, watch for bleeding

What should you find out after chest trauma

Cause - level of responsiveness - estimated blood loss - recent drug or etoh use that led to it - pre hosp tx (what did they do in field (steroids or other drugs)

How do vasopressors tx cardiogenic shock

Cause vasoconstriction of great arteries, increasing pressure around the heart

What is biliary cirrhosis (ATI)

Caused by biliary obstruction or autoimmune disease

What is Laennec's cirrhosis (ATI)

Caused by chronic etoh

What is postnecrotic cirrhosis (ATI)

Caused by viral hepatitis or certain meds or toxins

What are some immunosuppressants

Cellcept, Prograf, Imuran, Cyclosporine

What is anaplasia

Cells that differ from parent cells with minor or major difference -differ in shape, origin, etc -not as bad as dysplasia -abnormal lack of differentiation

What is cerebral angiography

Cerebral circulation -av malformation, aneurysm

S/S of cardiogenic shock

Cerebral hypoxia - *decreased BP - *chest pain - rapid & weak pulse - cold & clammy skin - tachypnea - crackles - decreased UO - dysrhythmias

What is CSF

Cerebrospinal fluid -produced in 4 ventricles of the brain -cushion and nutrients to the brain - takes waste away from brain -important in immune & metabolic function

What is the 3 areas the brain is divided into

Cerebrum Brain stem Cerebellum

*What is the earliest sign of increasing ICP?

Change in LOC

S/S of colon cancer

Change in bowel habits (#1) - blood in stools - unexplained anemia - anorexia - wt loss - fatigue

What is the 1st sign of brain tumor

Change in personality or mild neuro dysfunction (stumble, face twitch, hand twitch)

Indications for GCS (ATI)

Changes in LOC esp in pt with head injury, lesions, cerebral infarctions, encephalitis

What do the tubules do

Changes to filtrate (H2O & elytes) --last place this happens

What are the quality of pulses?

Check bilaterally - are they equal? 0 = absent 1 = weak 2 = thready 3 = normal 4 = bounding

Nursing interventions after cardiac cath

Check distal pulses - bedrest for 6 hrs with leg in extension - if bleeding at site call 911

If pt w/ CBI is in pain

Check to see if flow is good

What is a dialysate?

Chemical bath used to draw waste products out of the blood

How is DIC treated

Chemo or surgery to treat underlying ca -abx for sepsis -anticoags (heparin) -transfusion of fresh frozen plasma (contain clotting factors)

Risk factors for pneumothorax

Chest trauma (blunt) - penetrating chest wounds - closed/occluded chest tube

What happens during expiration

Chest wall and diaphragm return to previous position - lungs recoil and force air out thru the bronchi & trachea

How is pericardial effusion dx

Chest xray (cardiomegaly) Echocardiogram to confirm

S/s of AIDS (ATI)

Chills - rash - anorexia - nausea - wt loss - weakness - fatigue - HA - sore throat - night sweats

What kills the new kidney

Chronic attack by the immune system

S/s of lung ca

Chronic cough - chronic dyspnea - persistent cough w/ or w/o blood - hoarseness - dyspnea - unilateral wheezing - chest wall pain and masses - muffled heart sounds - clubbing - weight loss or anorexia ***cough, change in cough or voice, dry persistent cough with no sputum (lecture)

What does hemodialysis involve?

Circulating the pt's blood outsie the body thru a dialysis circuit

What is preload?

Circulating volume that stretches the heart to recieve blood prior to contraction

How is SVC syndrome dx?

Clinical findings - CXR - CT scan - MRI - thrombus of port dx by venogram

Med mgmt for closed and non depressed brain injury

Close observation

Function of the upper esophagus sphinctor

Closes at rest & prevents air from entering stomach

What is S1

Closing of the mitral and tricuspid valves (atria)

What is S2

Closing of the pulmonary and aortic valves (ventricles)

Objective data for cirrhosis (ATI)

Cognitive changes - altered sleep/wake pattern - depression, euphoria, lability - GI bleed - ascites - jaundice - petechiae - ecchymosis - nosebleeds - melena - hematemesis - palmar erythema - peripheral edema - asterixis - fetor hepaticus

What happens after a vein is removed for bypass graft

Collateral circulation

What is an intracranial hemorrhage

Collection of blood -most serious brain injury --immediate increased ICP and pressure on surrounding brain tissue --s/s delayed until disorientation & increased ICP (after 48H)

Subdural hemorrhage / hematoma

Collection of blood inside the dura - btwn dura and brain -most common cause is trauma but can be aneurysm -chronic/acute/subacute -more variable than epidural hematoma -caused by rupture in small vessels (venous) that bridge the subdural space

What does the GB do

Collects - concentrates - stores bile -released when fat is present in duodenum

What does a lab analysis of CSF indicate

Color - clear Specific gravity - 1.007 is norm Protein count WBC Glucose Elytes --normal CSF has minimal WBC and no RBC

What is a meningioma

Common benign encapsulated tumors of arachnoid cells on the meninges -slow growing -s/s = result from compression rather than invasion -complete removal or parital dissection is standard tx

What do neurotransmitters do

Communicate messages from neuron to neuron or to a specific target

What is CBC and what is it used for in GI

Complete blood count -will dx anemia & infection (RBC & WBC) --GI bleed most common cause of anemia in adults --Cancer, inflammatory bowel disease

How is cancer cured

Complete eradication of disease -if excise all primary tumor and not LN+ = guaranteed a cure -if SLN or LN +, remove LN & work up for mets (w/ PET scan)

What is hospice

Comprehensive multidisciplinary approach to the care of the patients with terminal illness and their families

What is spinal cord compression

Compression of cord and nerve roots from tumor, lymphomas, interruption of blood supply -prognosis depends on severity & rapid of onset (70% at thoracic - 20% in lumbar - 10% in cervical)

What is the hilum

Concave portion of kidney where renal artery enters & ureters & renal vein exit

What is homelessness

Condition of not having a regular, safe, secure place to rely on staying overnight

What are some of the causes of ARF

Conditions that reduce blood flow to the kidneys impairing renal function -hypovolemia -hypoTN -reduced CO and HF -obstruction of kidney or lower urinary tract by tumor, blood clot, or k. stone -bilateral obstruction of renal arteries or veins

S/S of hepatic encephalopathy

Confusion Unkept Mood changes Impaired sleep pattern Somnolence Asterixis

Medical mgmt for rib fx

Conservative with pain control -avoid excess activity -most heal in 3-6 weeks

Things to consider for prophylactic surgery

Consider the following: -fam hx & genetics -presence or absence of s/s -potential risks vs benefits -abililty for early detection -pt's acceptance of post op outcome

Low flow O2 system

Contribute O2 to inspired room air -unreliable if not used correctly

What supports the breast to the chest wall

Coopers ligaments

What is the cerebellum

Coordination of movement - fine motor - balance - postural space - proprioception -below occipital lobe

What type of transplants are not rejected

Cornea transplants (b/c cornea has no blood supply) Identical twin transplants

What is superficial reflexes

Corneal, palpebral, gag, upper/lower abd, plantar, perianal -corneal, gag and plantar normally only tested -corneal = clean wisp of cotton on outer corner of eye - should blink (stroke or brain injury may cause loss of reflex) -gag = gently touch back of throat w/ cotton tip applicator (absent in stroke,etc) -plantar = stroke sole of foot (toe flexion)

#1 clincal manifestation of lung ca

Cough or change in chronic cough or voice

What does edema & pitting of breast indicate

Could be cancer blocking lymph drainage giving skin orange peel appearance **classic s/s of advanced breast ca (inflammatory breast ca)

Antidote for a fib

Coumadin, diltiazem (cardizem - CC blocker that relaxes blood vessels so heart doesn't work as hard) - pacemaker

What is the visceral pleura

Covers the lungs

What is the parietal pleura

Covers the thorax - lines the mediastinum

Epiglottis

Covers trachea when we swallow to prevent aspiration -stroke pt has paralysis of epiglottis - increasing risk for aspiration --if choke/gag/cough alot while eating needs further assess

What is the peripheral nervous system

Cranial nerves - spinal nerves - autonomic nervous system

Individual & family disaster preparedness (ATI_

Create action plan - alternative methods of communication - highlight poss evacuation routes - identify local meeting places - disaster kit

How does kayexalate treat hyperkaleima in ARF?-

Creates BM --if that doesn't work - laxative

Is creatinine or BUN a more sensitive indicator of renal function

Creatinine

How to monitor urea for dialysis pts

Creatinine BUN **will increase -watch for urea crystal deposits on skin

What is a good measure of the GFR?

Creatinine clearance --calculated by 24 hour urine collection

What are prostaglandins used for what diseases

Crohns or UC -

Treatment for precursor or preinvasive lesions cervical ca

Cryotherapy Loop electrocautery excision procedure (LEEP) Conization

How is cancer managed?

Cure Control Palliative

What are the 2 types of urinary diversions

Cutaneous (w/ ostomy device) Continent urinary diversion

What type of urinary diversion is an ileal conduit

Cutaneous urinary diversion -ureters are diverted to an opening in the abd wall

How is the lower urinary tract studied prior to transplant

Cystoscopy or IVP -make sure outflow is working to support the new kidney

How does renal artery embolization stimulate an immune system response

D/t infarction of renal cell carcinoma releases tumor-associated antigens that enhance the pt's response to metastatic lesions -can cause post infarction syndrome

Conditions that cause increased specific gravity

DM - nephritis - fluid deficit

Risk factors for pulmonary embolism

DM, COPD, heart disease, heart failure, HRT, constrictive clothing

What is the most frequent symptom of pulmonary embolism

DYSPNEA

What should RN measure to measure the kidney excretion of fluid

Daily weights & I&O

RN mgmt for dialysis pt

Daily weights - I&O - VS - think before you medicate (BP meds may need to hold prior to dialysis) - protect access

What is a chyle fistula

Damage or cutting of lymph duct system in the neck during dissection -damage to thoracic duct in surgery

Hepatic dysfunction occurs when?

Damage to hepatocytes / liver cells

What is extravasation?

Damage to soft tissue if leak from a vein -can cause tissue necrosis & damage to underlying tendons, nerves & b. vessels

New SE of PPI's

Decrease acid level so much we let the bacteria that stomach acid normally kills get thru - linked to Cdiff --important for pt immobile as acid will just sit in stomach, we get anxious = production of more acid = increase risk of ulcer

How do vasodilators tx cardiogenic shock

Decrease afterload and preload of the heart **nitroglycerins (vasodilator in veins and in higher doses - in arteries)

What is one way ICP is managed

Decrease cerebral edema -osmotic diuretic **mannitol -corticosteriods (dexamethasone) -fluid restriction -hypothermia

How do beta blockers treat esophageal varices (ATI)

Decrease heart trate and reduce hepatic venous pressure -used prophylactically not for emergent hemorrhage

What happens to urine output as tumor in bladder cancer grows?

Decrease in UO Increase in frequency & urgency

Purpose of bicarb in LI

Decrease pH in your LI because sits there for a while and bicarb makes it less acidic so doesnt burn your LI

Palliative care for gastric surgery

Decrease pain Chemo Radiation - for pt w/ obstruction r/t tumor, GI bleeding, severe pain Surgery - bypass the tumor

What do ACE inhibitors do?

Decrease preload and afterload **prils

Biliroth 2 is better for what?

Decrease recurrence

What is pancytopenia

Decreased RBC (anemia) Decreased WBC (leukopenia) Decreased platelets (thrombocytopenia)

What are the s/s of altered LOC

Decreased alertness - decreased consciousness (on GSC) - change in pupils / eye opening / verbal & motor responses - subtle behavior changes (stops eating, talk to people that aren't there)

S/S of altered LOC

Decreased alertness - decreased consciousness - change in pupils/eye opening/motor responses - subtle behavior changes (stop eating, talk to people not there, etc)

Effect on hepatic system of ARDS

Decreased pressurs and perfusion in the liver = liver starts to fail - can't process wastes and foods (fat,protein,carbs,lipids)

What is cushings triad

Decreased pulse Decreased respirations Increase systolic BP (diastolic stays same) = widening pulse pressure

How is SIADH dx

Decreased sodium Increased urine osmolarity (more concentrated) Decreased BUN & creatinine 2ndary to dilution

What are the s/s of SIADH

Decreased urine output -Sodium levels lower than 125

What is the glomerular filtration rate in ARF?

Decreases --based on age & sex, so varies

What is the pH in ARF?

Decreases --more acidic --4.5 or less

What does negative isotropy do

Decreases FORCE of myocardial CONTRACTION

What does negative chronotropy do?

Decreases HEART RATE

How does IV dextrose / insulin treat hyperkalemia in ARF?

Decreases K+ by causing K+ to SHIFT BACK INTO CELLS -follow with Dextrose 5% -monitor for hypoglycemia (insulin chases K+ into cells)

Steroids

Decreases inflammation **prednisone = PO **Methylprednisolone (medrol) = IV, IM, PO --causes decrease in immune system so high risk of infection --taper, don't stop abruptly, watch BS (will increase)

What does removal of tumor margins in an exc bx do?

Decreases the possibility for residual microscopic diseased cells can lead to recur

What are the cardinal s/s of cardiac tamponade

Decreasing systolic BP and increased diastolic - narrowing pulse pressure less than 30 mm Hg - Increased JVD - Distant or muffled heart sounds - pulsus paradoxus (greater than 10 mm Hg between inspiration and expiration, noticed with handheld BP device)

Treatment for V tach

Defibrillation (if symptomatic) - lidocaine rapid IVP (antiarrhythmic) - CPR

Nursing process for care of pt getting breast surgery - pre op dx

Deficient knowledge Anxiety Fear Risk of ineffective coping Decisional conflict

What is osmolality

Degree of dilution or concetration of urine (or solution)

What are seasonal workers at risk for

Dehydration, sun exposure, decreased nutrition, extreme temps, pesticides

High flow O2 system

Delivery total amount of inspired air -specific O2 delivery (trach collar = up to 4L) and face tent (8-10L)

How is bladder cancer tx

Depends on grade of tumor, stage of tumor, pt's age & physical health, emotional & mental health --usually surgery

What is the long term survival of a transplanted kidney

Depends on how well it matches the recip & how well body's immune response is controlled

Medical mgmt for flail chest

Depends on severity -pain control and decrease anxiety --severe = emergent surgery with plates and screws in ribs

Medical mgmt of laryngeal ca

Depends on size, location and stage -surgery

Medical mgmt of colon ca

Depends on stage -surgery #1 choice -radiation -chemo

What are s/s of tumor lysis syndrome

Depends on the extent -Neuro = fatigue, weak, memory loss, altered MS, muscle cramps, numb/tingle, sz -Cardio = elevated BP, dysrhythmia -GI = anorexia, N/V, abd cramp, diarrhea, hyperactive BS -Renal = flank pain, oliguria, anuria, renal fail, acidic urine pH --gout, malaise, pruritis

What are the s/s of a skull fx?

Depends on the location and severity -persistant & localized pain, welling,

How is invasive cervical ca tx

Depends on the stage of the lesion, pt age, health, & physician -surgery and radiation mostly used

Indications for a LP (ATI)

Detect presence of diseases (MS - syphilis - meningitis), infection, malignancies -also used to decrease CSFf pressure, instill contrast media, meds, or chemo directly to CSF

Why promote rest for cirrhosis

End state has fatigue, poor exercise tolerance - need rest periods

What type of organ is pancreas

Endocrine and exocrine

What are the islets of langerhans

Endocrine part of pancreas --collection of cells embedded in the pancreas **BETA = make hormone insulin **ALPHA = make glucagon **DELTA = somatostatin

What neurotransmitter effects pleasure sensation, inhibits pain

Endorphin -excitatory

ERCP

Endoscopic retrograde cholangiopancreatography -allows visualization of the common bile duct & panc ducts -allows removal of gallstones, placement of stents and biopsies

What is an ERCP

Endoscopic retrograde cholangiopancreatography -scope entered thru esophagus into duodenum where panc duct system is -into common bile duct to remove stones

What would indicate removal of recipients "old" kidney

Enlarged, malignant, harmful, or polycystic

What is maltase

Enzyme secreted by intestinal mucosa -maltose into glucose

What is lactase

Enzyme secreted by intestinal mucosa -turns lactose into glucose, galactose

What is sucrase

Enzyme secreted by intestine mucosa -turns sucrose into glucose, fructose

Trypsin

Enzyme secreted by pancreas --breaks down protein (into polypeptides) into amino acids

What is amylase

Enzyme secreted by salivary gland -breaks down carbs to dextrin - maltose - then glucose -thinking about food starts the enzyme secretion

AST and ALT

Enzymes found in liver --elevated in liver disease

Why did doctors look at the germ theory

Epidemics of cholera, diphtheria, influenza, TB, yellow fever... -led to the development of Dept of Health to deal with unsanitary conditions & social issues in the cities

What are the types of intracranial hemorrhage

Epidural Subdural Intracerebral

What is included in the larynx

Epiglottis - hypoid bone - thyroid cartilage

Why does a pt with CKD get anemia?

Erythropoietin production decreases -causes RBC production to decrease **leads to fatigue, SOA, angina

What nurse was huge advocate for african american nurses?

Esp in mlitary **Mabel Staupers

What is the major risk factor for uterine cancer

Estrogen exposure

How do we resolve ethical dilemmas

Ethics committee Company policy Pt's right to choose

General cultural assessment parameters (ATI)

Ethnic background - religous preferences - family structure - language - communication needs - education - cultural values - food patterns - health practices

Risk factors for cirrhosis (ATI)

Etoh - chronic hepatitis - autoimmune hepatitis - steatohepatitis (fatty liver disease causing chronic inflammation) - damage to liver by drugs, toxins, infections - chronic biliary cirrhosis - cardiac cirrhosis caused by rt side HF

AWhat are neuro assessment and dx procedures used for (ATI)

Eval neuro function by testing indicators like -mental status -motor function -electrical activity -ICP

What is a diagnostic laparoscopy

Evaluate gastric tumor and take tissue bx and look for mets

What is a secondary head injury

Evolves over hours or days after initial injury -results from inadequate delivery of nutrients & O2 to cells -swelling, edema, increased ICP

What is a colposcopy (ATI)

Examination of the tissues of the vagina and cervix using electric microscope -bx often done at the same time

What do prostaglandins do

Have a vasodilation effect -important to maintain renal blood flow

What are the health and wellness problems of the homeless

Exposure - Mental illness (PTSD, depression, schizo, bipolar) - lack of access to meds - lack of hygiene, lack of appropriate food - substance / etoh abuse - physical issues r/t to being homeless

What is a cone bx (ATI)

Extensive surgical bx -dr excises a cone shaped sample of tissue to remove potentially harmful cells -sometimes w/ anesthesia -may destroy cells using a scalpel, cryosurgery (extreme cold to freeze tissues) or lasers

What is the nose composed of

External - supported by bones & cartilage Internal - hollow cavity separated into right & left by septum

Risks / side effects of chemo

Extravasion (when IV administered) Fluid / elyte imbalance Risk for infection (pancytopenia) Risk for bleeding (thrombocytopenia) Protection of caregivers (preg sould not handle chemo pt - they have toxic body fluids / urine)

What 3 areas does the GCS assess a response in?

Eye opening (range is 4 to 1) Verbal (range 5 to 1) Motor (range 6 to 1)

What should you watch for with rib fx

FLAIL CHEST

Subjective data for cirrhosis (ATI)

Fatigue - wt loss - pruritus (severe itching) - confusion or difficult thinking - mental / personality changes

What diet can increase carcinogen factors

Fats, etoh, salt, smoked meats, red processed meats, nitrates, high calories, obesity

S/S that hepatic encephalopathy is worsening (ATI)

Fecor hepaticus (liver breath) Asterixis (flapping of hands)

S/S of ebola (ATI)

Fever - hemorrhage - V/D - cough - jaundice - shock **treat (no cure) - airway - dialysis - supportive care - prevention (avoid contaminated items/animals)

Why does CCPD have a lower infection rate

Fewer accesses made to connection sites

What is a epidural or subdural sensor (ATI_

Fiber optic sensor inserted into epidural space thru burr hole -device measures changes in the amount of light reflected from pressure sensitive diaphragm in the cath tip -cable is connected to precaliberated monitor that displays # value of ICP -noninvasive b/c device does NOT penetrate the dura

What is the renal capsule?

Fibrous connective tissue (kidneys are suspended from the abd wall by this renal fascia) - blood vessels - lymph structures are the renal capsule

what are the meninges

Fibrous connective tissues that cover the brain & spinal cord -provide protection, support & nourishment

What are rugae

Fingerlike projections that help move food around

complications of O2

Fire Condensation & bacteria in tubing **Any more than 2L of O2 needs to be humidified

What are fibroadenomas

Firm - round - movable - benign tumos -nontender -sometimes removed for definite dx

What is the P wave

First "hump" in EKG --depolarization of atria in response of SA node trigger (contract atria)

How is muscle strength assessed

Flex / extend extremities against resistance 0 = flaccid (paralysis) 3 = enought to overcome gravity 5 = full power against resistance

What is the #1 cause of increased ICP

Head injury Other causes: #2 is brain tumors subarachnoid hemorrhage toxic & viral encephalopathies --ICP usually a s/s of something else

Flexible fiberoptic sigmoidoscopy

Flexible fiberoptic sigmoidoscopy allows visualizatoin of 16-20 inches from anus -regular rigid sigmoidoscopy allows 10 inches from anus -allows for documentation via photos or video & bx sampling -no sedation required -pt lay on left side w/ right leg bent

Inhaled steriods

Flovent , beclovent ***rinse mouth afterwards to prevent yeast infection

What is an intraventricular catheter (ATI)?

Fluid filled cath inserted into lateral ventricles (usually on right side) thru a burr hole -cath is connected to a sterile drainage system w/ 3 way stopcock -stop cock allows simultaneous monitoring of pressures by transducer connected to bedside monitor & drainage of CSF

Why does CRF cause difficulty breathing?

Fluid overload

What does LI reabsorb

Fluids and elytes --particularly K+

S/S of brain tumors

Focal = poss visual, hear, mental deficit Generalized = reflect increased ICP --HA, vomit not assoc w/ food, edema of optic nerve = decreased acquity, diplopia, sz (unilat/Jacksonian if motor cortex tumor)

What is community based nursing?

Focus is on the health of individuals, families, & groups in the community -Client/patient is the individual, family or group -Nursing actions are to provide direct care to the client --VNA, schools, prisons, camps

Nursing care for DIC (ATI)

Focus on assessing for and correcting underlying cause (septic, hemorrhage) -prevent organ damage and replace clotting factors (fresh, frozen plasma) -avoid NSAID, avoid valsalva, bleeding precautions, monitor VS, oliguria, & decreased LOC

What are hospice nurses ATI

Focus on enhancing quality of life thru provision of palliative care, support pt & fam thru dying process, bereavement support to fam after pt death

What is community oriented nursing?

Focus on the health of the community as a whole -the client / patient is the community -public health

What if the pyloric sphincter dysfunctions?

Food doesn't leave stomach properly -Food passages slower -or bacteria from SI goes back into stomach

What is achilles reflex

Foot is dorsiflexed at ankle and hammer strikes stretched achilles tendon *plantar flexion *tests nerve roots S1-S2

What is transsphenoidal brain surgery

For access to pituitary gland for adenoma -go thru nose and/or mouth thru sinus

What is sclerotherapy

For esophageal varices -sclerosing agent injected thru endoscope into bleeding varices to promote thrombosis & sclerosis -treat acute GI bleed but NOT prevention and subsequent variceal bleeding

What is a skull fracture

Forceful trauma causing a break in continuity in skull -may occur with or without damage to the brain

What 3 step process is urine formed?

Formed in the nephrons 1. Glomerular filtration 2. Tubular reabsorption 3. Tubular secretion

What is a basilar skull fx

Fracture of the base of the skull (or at the side of the auditory canal)

What is cryotherapy

Freezin w/ nitrous oxide

What can pericarditis cause

Frequent prolonged episodes can lead to thickening & decreased elasticity of pericardium - scarring can fuse the visceral and parietal pericardium - both conditions can restrict hearts ability to fill with blood (constrictive pericarditis) - can also become calcified and further restricting ventricle expansion

What was the district health of nursing

From England -later developed into our public health system -came to US 1886 -aka visiting or home health nurses (particularly the poor - dr;s wouldn't see the poor but nurses would)

Where is the left main CA located?

From point of origin (aortic valve) to 1st major branch

Where do the coronary arteries originate

From the aorta just above the aorta valve leaflets

What is the largest lobe of the cerebrum

Frontal

S/S of concussion

Frontal lobe = bizzare irrational behavior Temporal lobe = temp amnesia or disorientation -Sz, HA, dizzy, irritable, fatigue, poor concentration -if bizarre behavior, vomiting, unaroused = ED

Food is what?

Fuel

Effects of T1-T5 injury

Full hand and finger control - use of intercostal & thoracic muscles -independent dress, feed, elimination

Effects of S1-S5 injury

Full leg & ankle control - innervation of perineal muscles for bowel, bladder & sex -independent dress, feed, normal to impaired bowel/bladder, -ambulate independent w/ or w/o assist

What skull fx would cause raccoon eyes

Fx of occipital area

What is stage 1 kidney damage (GFR)

GFR is greater or equal to 90 mL/minute (but less than 125)

Most common cause of anemia in adults

GI bleed

Indications for fecal occult blood test (ATI)

GI bleed or unexplained diarrhea

When should blood transfusions be given if pt is on dialysis?

GIVE WITH DIALYSIS IF POSSIBLE --allows pt to get the benefit of transfusion w/o excess fluid --also pt may require lasix between units

Preprocedure for ICP monitor (ATI)

Head is shaved Wash site w/ antibacterial solution

Where does 70% of pancreatic ca occur?

Head of the pancreas

What is intra arterial blood pressure

GOes in thru wrist (radial artery) on left side - direct & continuous measurement of BP - can obtain ABG's and blood samples from this line - no fluids or IVP meds can go thru - monitor for infection, distal ischemia, pain, arteriospasm

Risk factors for pancreatitis (ATI)

Gallstones Etoh -- primary cause ERCP GI surgery Kidney failure Trauma Genetics Ulcers Meds / drug toxicity

Arterial system of the GI

Gastric artery Superior mesenteric Inferior mesenteric

What surgery poses greatest risk for dumping syndrome (ATI)

Gastrojejunostomy (billroth II) --reduced stomach has less ability to control amount & rate of chyme that enters SI after meal

What is myopathy

General muscle weakness & pain -esp cardiac muscle weakens

Physical environments (ATI)

Geography Water/food supply Presence of reservoirs/vectors

What are growing medical problems in prison

Geriatric problems - organ failure - communicable diseases (TB exposure) -increasing population that have never been immunized

What part of the kidney does the filtration

Glomerulus

Each afferent arteriole branches to form what?

Glomerulus --the capillary bed responsible for glomerular filtration

What 2 basic components are the nephrons made of

Glomerulus - filtering made of capillary network Tubule

Amino acids and glucose are filtered where?

Glomerulus and reabsorbed -so neither are excreted in the urine

What may be added to PD?

Glucose in the solution may increase BS so regular insulin may be added to dialysate *also K+, abx, heparin

Dextrose in PD may increase what/

Glucose levels Infection or peritonitis (bacteria loves sugar/dextrose)

What are monosacchyrides

Glucose, fructose --become fuel after broken down

When is surgery the primary approace for cancer tx?

Goal is to remove entire tumor or as much as feasible (aka debulking) - any surrounding involved tissue - & LN

surgical mgmt of brain tumors

Goal is to remove or destroy the entire tumor w/o increasing neuro deficit or relieve s/s by partial removal

Preop (transplant) managment (book)

Goals -bring metabolic state to level as close to normal as possible -infection free -prepare patient for surgery & post op course

What is troponin 1 & 2

Gold standard marker for MI - increases in 3-4hrs after MI - stays increased for up to 1-3 weeks after MI

How is cancer grading classified?

Grade 1 - well differentiated (good) Grade 4 - poorly differentiated or undifferentiated (bad)

What are the complications of BMT

Graft vs host disease Venous occlusive disease

Assessing incision s/p neck dissection for infection

Grafts should be pale pink and warm to the touch -watch incisions for pus and malodorous drainage -aseptic technique to clean around incision

Why were nurses suddenly without jobs in the 1930's?

Great Depression -nurses who had previously been employed as private duty nurses in the home were without jobs as their patients were suddenly impoverished.

What is the creatinine in acute renal failure

Greater than 1.2

What is the BUN in acute renal failure?

Greater than 18

What is K+ in acute renal failure

Greater than or equal to 5

What is dumping syndrome (ATI)

Group of manifestations that occur after eating -shift of fluid to abd is triggered by rapid gastric empty or HIGH CARB ingestion

What is an aggregate

Group of people that share a common need

What is an aggregate?

Group of people with similar needs -children, community, etc

RN assessment for pt having hysterectomy

H & P Pelvic exam Psych & emotional responses Pt knowledge D/c blood thinners (asa, NSAIDS, Vit E) prior to surgery Prophylactic abx prior to surgery and d/c the next day Prevent thrombus w/ heparin and SCDS

What is bile made of

H2O - K+ - Ca+ - Cl- and bicarb, fatty acids, cholesterol, bilirubin and bile salts

What does the filtrate normally consist of

H2O - elytes - other small molecules --larger molecules stay in the bloodstream

Describe sinus tachycardia

HR is greater than 100 bpm - (not concerning unless sustained > 130 HR and/or with cardiac hx) - Rate = regular - Pwave - 1 per QRS

What activates the renin-aldosterone axis?

HTN -causing H2O & Na+ retention =increased edema, HTN, HF, metabolic acidosis

What is a major SE of Mycophenalate

Increases risk for CMV

What is supraglottic laryngectomy

Hyoid bone, glottis, false cords removed with tumor **airway preserved **swallow preserved (still hoarse voice) **trach for one week to maintain patent airway then removed and stoma closes by itself --difficult swallow for about 1 week --speech therapy needed

What is clonus

Hyperactive -bouncing effect or hyperreflex -assoc w/ CNS disease (hepatic encephalopathy from ammonia level

What are the 3 types of transplant rejection

Hyperacute Acute Chronic

What fluid balance are HIV pt's at risk for

Hypo AND hyper but mostly hypo fluid balance -elyte imbalance r/t D/V

Objective data for bleeding esophageal varices (ATI)

HypoTN Tachycardia Hgb & Hct (indicating anemia)

Potential complications of pancreatitis

Hypocalcemia - HYPERglycemia - hypoxemia - fluid shift - ileus - DIC - infection - pseudocysts - necrosis - hemorrhage

Patho of increased ICP

ICP -causes decreased cerebral perfusion -pressure in heart goes up so harder to get blood up there (decreased O2 and increased CO2) -stimulates further edema -herniation

Where should the pt getting balloon tamponade remain

ICU b/c of risk of complications -monitor close and continuouss -no more than 24 hrs

Third segment of SI

ILEUM --fluid and nutrients are absorbed here --when resect portions of SI = high risk for malnutrition

Treatment for severe acute pancreatitis

IV hydration - FFP - Pressors - IV abx - ERCP - surgery - calcium glucongate

Ways to reduce workload of heart in cardiogenic shock

IV morphine (it also dilates the blood vessels) - this reduces workload of heart by decreasing preload and afterload

Prevention / or tx of sz in CRF?

IV valium or ativan - maintenance keppra - tegretol - dilantin

Secondary prevention for occupational health nurse

Identify workplace hazards Early detection thru health surveillance & screening Prompt treatment Counseling & referral

What causes lymphedema

If functioning lymph channels are inadequate to ensure return flow of lymph fluid to general circulation -after LND - collateral circulation must assume function -transient edema can occur until collateral circulation occurs

What is a renal angiography

Images of renal arteries -pierce femoral artery w/ needle - then cath threaded into aorta or renal artery -contrast injected **evaluates blood flow, differs cysts from tumors, eval HTN

What are susceptible hosts

Immunocompromised Age (elderly & children) Gender Genetics Ethnicity Occupation Physiological state Pregnant, chemo pt, HIV

What is given to pt's getting a allogenic BMT

Immunosuppressants -to decrease chance of graft vs host disease

What is pre renal ARF?

Impaired blood flow to kidneys -60-70% of ARF (hypoperfusion of kidney & decrease in GFR)

What causes portal HTN (ATI)

Impaired circulation of blood thru liver --collateral circulation develops creating varices in upper stomach and esophagus

What do pulmonary contusions cause

Impaired gas exchange - hypoxemia - CO2 retention by causing infiltrates in the pleural sac

What are values

Important & lasting beliefs or ideas about GOOD or BAD -generally shared within person's culture

What does the activationof the renin-angiotensin system do?

Increases the retention of water - expands intravascular fluid volume

Risk factors for colon cancer

Increasing age - fam hx of colon ca or polyps - previous colon ca or adenomatous polyps - high etoh - smoking - obesity - hx of gastrectomy - history of IBD - high fat & protein and low fiber diet - genital cancers

What is a common type of continent ileal urinary reservoir

Indiana Pouch -Ureters attach to pouch made of a segment of the ileum & cecum -drain by catheter placed into stoma -use SI & LI segments to form a false bladder -pt strait caths themselves 4x per day **risk for hydronephrosis if not drained

What is CKMB

Indicates muscle break down if elevated - goes back 24 hours - not cardiac specific

What is the leading COD r/t cancer for women

In order of frequency Lung Breast Colorectal

What is the leading COD r/t cancer for men

In order of frequency Lung Prostate Colorectal

Explain the viral set point

In primary infection stage -host responds to HIV thru CD4+ T cell response that causes other immune cells (CD8) to increase their killing of infected cells -body produces antibody molecules to contain the free HIV particles & assist in their removal

Where does the P wave start

In the SA node thru atria =atrial depolarization in response to SA trigger

Where is a pacemaker

In the heart - with leads to the ventricles and one set to send pulse to chambers/atria

The cells that form SCC and adenocarcinoma of the bladder develop how?

In the inner lining of the bladder as a result of chronic irritation and inflammation

Where is the purkinje fibers

In the inner ventricular walls

What are the turbinate bones

In the nose - aka conchae - because of their curves they increase the mucous membrane surface of the nasal passages & slightly obstruct air flowing thru them -filters and warms

When getting past the mouth & esophagus - where are the rest of the GI organs

In the peritoneal cavity

When are patients more receptive to learning

In their own home

What is transplant psychosis

Inability to accept that there is another persons heart inside their chest - incidence of suicide is higher

Dilute urine w/ specific gravity (1.010) or fixed osmolality indicates what?

Inability to concentrate and dilute urine --common early sign of kidney disease

Barriers to health care (ATI)

Inadequate insurance - inability to pay - language - cultural - lack of providers in community - geographic isolation - social isolation - lack of communication (phones) - lack of transportation - attitudes of healthcare personnel towards low socio pts - eligibility requirements for asst programs

What prevents atelectasis

Incentive spirometry

If urine is darker, what should the flow in CBI be?

Increase -decrease if urine is clearer

how do inotropes tx cardiogenic shock

Increase contractility and cardiac output (by increasing strength of myocardial activity) **Dobutamine

What is hyperplasia

Increase in NUMBER of cells -increase in proliferation of cells that don't belong there (bad)

What can brain tumors cause

Increased ICP - cerebral edema - sz - hydroencephalus - altered pituitary function

What does prominent venous pattern indicate in a breast

Increased blood supply required by a tumor

What if DCIS is untreated

Increased likelihood will turn into invasive cancer

What is portal hypertension

Increased pressure thru the portal venous system -caused by obstruction of blood flow thru the damaged liver

If pt is dehydrated - what happens to their ADH

Increases -so body holds onto H2O and Na+ --blood osmolality increases so stimulates release of ADH to reabsorb H2O

When fluid intake decreases - what happens to specific gravity

Increases (more concentrated)

What does positive dromotropy do

Increases CONDUCTION of the AV node

What does positive isotropy do?

Increases FORCE of myocardial CONTRACTION

What happens to respirations when CO2 goes up

Increases depth and rate of respirations

Reglan (ATI)

Increases motility of esophagus & stomach

What are indications for heart transplant

Ischemic heart disease - valvular heart disease - rejection of previous tx - heart defect - severe s/s that are uncontrolled by meds - no other surgical options - prognosis less than 2 year survival

What is a scalp injury

Isolated scalp trauma -usually minor but high risk for infection -because the many blood vessels in head constrict poorly - scalp bleeds profusely when injured -large tearing away (avulsion) of scalp is life threaten emergency -area is irrigated before suture -sugaleal hematomas usually reabsorb

How does the immune system effect cancer

It can detect development of cancer cells and destroy them before cell growth is uncontrolled -when fails to identify & stop the growth of ca cells - cancer develops

As stroke volume decreases - what happens to the HR?

It increases to compensate and maintain CO

Portal HTN is a result of what

It is the increased pressure thru the portal venous system that results from obstruction of blood flow thru the damaged liver

Why is alkaline pH of urine bad

It promotes bacteria growth and encourages kidney stone formation

Where is the SA node

Its the electrical impulse / pacemaker - near superior vena cava in right atrium

What are the oncologic manifestations of HIV

Kaposis sarcoma B cell lymphoma

Why is heparin used in diaysis?

Keep blood from clotting in the circuit

Urine is formed by the

Kidney

Why does pt w/ ARF need avoid magnesium

Kidneys can't dialyze it -Mag oxide - magnesium containing laxatives (mag citrate)

Nursing responsibilities in disaster preparedness

Know the plan - participate in drills & mock disasters - know where your response site is - maintain communication capability (stay off landlines) - assess risk groups (chronically ill, immobile, wheelchair) - assess supplies

Cultural competence

Knowing, appreciating, considering another person's culture in problem resolution

Protection function of the liver

Kupffer cells engulf bacteria (phagocytes) -engulf anemic RBC -detoxifies drugs, chemicals & etoh

What kind of condoms decrease risk of sexually transmitted HIV

LATEX -non latex made of lambskin do not protect against HIV infection but should still be used as barrier to fluids

How is SIADH treated

LIMIT FLUID INTAKE (to 50-100 mL / day) to increase sodium level and decrease fluid overload -poss IV sodium replacement -diuretics

Dx tests for cirrhosis

Labs Sono CT MRI radioisotope liver scan liver bx

The number of cycles and exchanges of peritoneal dialysis is based on what?

Labs & uremic symptoms -dextrose level is based on pt fluid status as measured by weight

Dx of hepatic encephalopathy

Labs (ammonia level) EEG - show generalized slowing Fetor hepaticus - sweet slightly fecal odor to breath

What should the home health nurse evaluate ATI

Living environment for: -safety -nonsecure rugs, electrical outlets, extension cords _O2 use -safety devices in bathroom -food, help w/ household activities, live alone, support system, access to healthcare, set up & dispense med capability of pt

What is a reservoir

Living or non-living sources of disease agents, - include sick or recovering pts, asymptomatic carriers, animals, and environmental sources (soil or water)

What surgery is done for SCI causing compression

Laminectomy

What is craniectomy

Large craniostomy -removes section of cranium -tumor removal -might leave open but suture back skin -store piece of cranium into abd cavity to keep viable (for 6m to 1y)

Where is the liver

Largest gland and organ in the body --in the RUQ behind the ribs --has 4 lobes that are small functional units

What is latissimus dorsi flap reconstruction

Latissimus dorsi muscle with some skin is rotated from the back to the mastectomy site -because flap isn't bulky enough to provide a breast mound, and implant is alow required

What nurse was an early author of nurse textbooks

Lavinia Dock

What are the 2 main coronary arteries?

Left and right coronary arteries

Stage 4 bladder cancer

Left bladder & mets to abdomen, or adjacent organs (prostate)

With increased aldosterone in the blood - what happens to Na+

Less sodium is excreted in urine --because aldosterone fosters renal reabsorption of sodium

What is normal LDL

Less than 160 --if DM or CAD then less than 70 is goal

What is oliguria

Less than 500 mL of urine in 24 hours

Fluid restrictions for pt with CRF?

Let pt have some control -save some fluids for the night **1500 mL for 24hrs - sometimes titrated to urine output + 500mL --so of pt has 300mL UO in 24hrs - total fluid restriction would be 800 mL

What does the ileocecal valve do

Lets digested material pass into cecum and stops reflux of bacteria into SI

What is the purpose of mucus in the LI

Lets passing thru without sticking to the walls of the LI

What is DIC (ATI)

Life threatening coagulopathy when clotting and anticlotting mechanisms occur at the same time

What is V fib?

Like a fib but related to the ventricles - HR is > 300 bpm - next to flat line - Need CPR but no defib - irregular rhythm, no atrial pulse - CA and death imminent

Who convinced MET life to hire more nurses to decrease mortality rates

Lillian Wald

Who created VNA

Lillian Wald

Who founded Nat'l Org of Public Health Nurses

Lillian Wald

What is a disability

Limitation that prevents a person from performing ADL's easily

What is breast conservation tx

Limited surgery (lumpectomy) followed by radiation -tamoxifen can reduce local recur rates after surgery & rad (usually take for 5 years)

How are skull fractures classified?

Linear (or simple) Comminuted Depressed Basilar

Where is the visceral pleura

Lines the lung itself and hold lungs together

Where is the parietal pleura

Lines the mediastinum

Most common sites for oral cancer

Lips - lateral tongue - floor of mouth

Expectorants

Liquefy secretions and reduce viscosity -robitussin

RN interventions for body image (hysterectomy)

Listen & address concerns Provide appropriate reassurance Address sexual issues Approach & evaluate each pt individually

Most lung ca spread where

Liver Brain Bone Adrenal gland

Most definitive test for cirrhosis (ATI)

Liver bx

Pathophys of cirrhosis

Liver cells necrose Destroyed cells replaced by scar tissue Eventually more scar tissue than functioning tissue Hobnail appearance -

Glucose metabolism in liver & regulation of glucose concentration

Liver converts glucose to glycogen in blood -stored until needed -when needed - converts back to glucose & released in blood --also makes more when hypoglycemic - liver breaks down amino acids from proteins or lactate by exercised muscles

Ammonia elevated

Liver disease --norm is 15-110

What is spinal shock

Loss of all neurological activity at level below injury **Associated w/ loss of bowel & bladder function (reflexes) -bowel distention & ileus caused by depression of reflexes and loss of innervation to bowels & tx w/ NG tube to decompress GI --paralysis, flaccid, reflexes absent

What is refractory hypoxemia

Low O2 sats or O2 in blood even when on O2 therapy

Improving nutrition for cirrhosis

Low protein - fruits - vegs - lean proteins - vitamins - small freq meals

Who can recieve medicaid

Low socioeconomic status & children -based on household size & income -priority to pregnant, children, disabled -provides inpt & outpt hosp care, vaccines for kids, family planning, prenatal care, early screening & dx & tx for those younger than 21

2 types of concussion

MILD - may lead to period of observed or self reported transient confusion, disorientation, impaired consciousness -memory lapse at time of injury & LOC for less than 30 min CLASSIC - results in LOC for less than 6h accompanied by degree of amnesia

what MUST you do to O2 when moving up in systems

MUST INCREASE FLOW (i.e. cannula to simple mask) --if not you could suffocate the pt

What nurse improved healthcare of Harlem

Mabel Staupers

Who was the first african american director of nursing

Mabel Staupers

Burr hole surgery

Made w/ drill into cranium -evacuate hematoma & relieve ICP -small holes into skull

Primary purpose of renal & urinary systems

Maintain body's homeostasis by regulating fluid & elytes - removing wastes

How else is ICP managed

Maintain cerebral perfusion --maintain cerebral perfusion pressure

Planning for pt w/ DIC

Maintain hemodynamic status Maintain intact skin & oral mucosa Maintain fluid balance Maintain tissue perfusion Enhanced coping Abscence of complications

RN interventions for intracranial surgery

Maintain tissue perfusion (lower CO2 and increase O2) -temp/BP maintain - monitor for s/s increased ICP

What is the buffer system in dialysis

Maintained using dialysate bath made of bicarb or acetate

Major goals of the RN for planning care for pt having hysterectomy

Major goals are relief of anxiety, acceptance of loss of uterus, abscence of pain or discomfort, increased knowledge of self care needs, and absence of complications

Post op care for hysterectomy

Major risks are infection & hemorrhage -b/c incision is close to bladder, void problems may occur -edema or nerve trauma may caus temp loss of bladder tone and may need indwelling cath

What else are fatty acids used for

Make cholesterol

Positive BRCA 2 gene mutation increases risk for what cancers

Male / female breast cancer - ovarian cancer

What are lower jaw fx?

Mandibular fractures -- wired shut -if nausea = fix asap! (risk of aspiration) **take wire cutters everywhere w/ pt and have bedside always -eating thru straw -exposed wires - put wax on ends or bend wire -oral suction if needed

What is an angiogram

Manipulate artery w/ balloon -right side go thru vein -left side go thru artery

What happens if pt s/p TURP w/ CBI gets clots

Manually remove w/ 60cc syringe -turn off irrigant & pull -then flush w/ fluid --continue

What nurse was big on birth control, womens health, and occupational health?

Margaret Sanger

Which nurse set up a free womens' health clinic?

Margaret Sanger -then went to jail

What are brain angiomas

Masses composed of largely abn blood vessels -usually on or in surface of brain -increased risk for CVA -83% occur in cerebellum

What is tertiary prevention?

Maximization of recovery after injury / illness -minimize deterioration & improve quality of life --Rehab, case mgmt, PT, OT, support groups

What are the s/s of pericarditis (book)

May be asymptomatic **chest pain or pain beneath clavicle, in neck or left scapula region -fairly constant pain, worsen w/ deep inspiration and when lying down -may be relieved when leaning forward **most characteristic sign is creaky or scratchy friction rub most clearly heartd at left lower sternal border - mild fever, increased WBC, anemia, elevated ESR or C-reactive protein, nonproductive cough or hiccup

How does tamoxifen increase risk for uterine ca

May cause proliferation of the uterine lining

What is a major SE of Sirolimus

May have anti-neoplastic effects

What is prothrombin time and how is it used to dx GI disorders

Measures rate that prothromb is coverted to thrombin (clotting time) --LIVER - site of all proteins involved in coagulation --Process depends on Vitamin K = associated clotting factors --Severe or acute liver disease leads to ELEVATED PROTHROMBIN TIME

What is lactobacillus

Med may be used s/p transplant as prophylactic to restore normal flora of GI

RN knows that as a result of tension pneumothorax, air continues to accumulate and intrapleural pressure rises causing....(ATI)...

Mediastinum to shift away from affected side and decrease venous return

What is a mental illness

Medical condition that disrupts a person's thinking, feeling, mood, ability to relate to others & daily functioning -often result in diminished capacity for coping

What is the inner portion of the kidney

Medulla

Primary prevention for colorectal cancer

Men & women aged 50+ -fecal blood test (annually) or colonoscopy (q 10 years) or BE (q 5 years)

Primary prevention of prostate ca

Men aged 50 + -DRE and PSA annually starting at age 50

Who are the "at risk" populations we must advocate for?

Mentally ill - Homeless - Impoverished working classes - Single parents - Chronically ill - Incarcerated

What is acculturation

Merging with or adopting the traits of a different culture

Complications of ARF

Metabolic acidosis (b/c no bicarb being produced) Elyte & fluid imbalance (esp K+)

Cerebral metastases

Metastatic lesions to brain account for most common neuro complication -tx focuses on palliative care -rad, chemo, surg used for therapeutic reasons

What is used for large skin grafts in reconstruction for neck dissection

Microvascular free flap -involves transfer of muscle, skin, or bone w/ artery or vein

What is in the brainstem

Midbrain Pons Medulla Cranial nerves

What is stage 2 kidney damage (GFR)

Mild decrease in GFR **60-89

S/S of pulmonary contusions

Mild to severe tachycardia - chest pain - hypoxemia - hemoptysis --Severe: crackles, frank blood in sputum, severe hypoxemia, resp acidosis, coma, death

What does a nephrostomy tube do

Minimizes chances for urine to leak into abd cavity causing peritonitis/infection/sepsis (after urinary diversion)

What do the renal pyramids drain into

Minor calices - that drain in to major calices - that open into the renal pelvis

What is stage 3 kidney damage (GFR)

Moderate decrease in GFR **30-59

What does 9-12 on glascow indicate (ATI)?

Moderate head injury

What is category B bioterrorism

Moderatly easy to spread & moderate morbidity / low mortality -typhoid, cholera

How is the nurse going to monitor urinary function after a transplant?

Monitor & record --hourly urine output w/ urometer attached to drainage bag to allow for small amouts of urine to be measured (up to 250mL) then dumped into primary bag --daily weights to monitor fluid balance --daily labs off of central line before/after dialysis

Prevention of infection after urinary diversion

Monitor VS - WBC - report temps - blood cultures as ordered - assess suture lines & drainage -abx as ordered

How many people are dx with breast can in US

More than 215,000 women 1450 men --more than 40,000 die annually

What is urine osmolality

Most accurate measurement of kidney ability to dilute & concentrate urine --concentrating ability is lost early in kidney disease

Indirect measurement of portal HTN

Most common -requires inserted cath w/ balloon into antecubital or femoral vein -advance to hepatic vein -fluid infused to inflate balloon -wedge pressure taken by occluding blood flow and measure unoccluded vessel

What are kupffer cells

Most common phagocytes in body --main job to engulf bacteria that enter the liver thru the portal blood supply

What is external radiation

Most common used -invisible beam of high charged electrons penetrate the body & target the tumor w/ pinpoint accuracy **try to minimize collateral damage

What is TIPS (ATI)

Under sedation - cath passed into liver via jugular vein -stent placed btween portal & hepatic veins bypassing the liver --portal HTN relieved --monitor VS and elevate HOB

What is DIC (notes)

Underlying disorder (not disease) -causes massive clotting in microcirculation -s/s r/t tissue ischemia & bleeding

Mentally ill are at high risk for what

Unemployment - homelessness - commission of violent acts both against and by them

What is the major means of HIV transmission

Unprotected sex & sharing of injection equipment -especially health providers handling needles

S/S of DIC (ATI)

Unusual spontaneous bleed from gums & nose - ooze & trickle or flow of blood from incisions or lacerations - petechiae & ecchymoses - bleeding from inject sites or IV sites - tachycardia - hypoTN - diaphoresis

Where is the stomach

Upper portion of abdomen - on the left - under left lobe of liver & diaphragm

Why should a pt w/ ascites be placed on bedrest

Upright posture is assoc w/ activation of renin-angiotensin-aldosterone system -causes reduced glomerular filtration & Na+ excretion and decreased response to diuretics

What is the major waste product of protein metabolism

Urea --must be excreted in urine or it accumulates in body tissues

What else is transplanted with a kidney?

Ureter of new kidney is transplanted into the bladder or ureter of the recipient

What is a ureterosigmoidostomy

Ureters are attached to sigmoid colon -advantage = no external device --Disadvantage = retrain anal sphincter, urine & BM from rectum, pt has to defecate every few hrs to release urine --wear pad, learn to recognize urine in colon, leakage, pressure from flatus or sneeze or cough causes incontinence

What is a major source of infection after transplant

Urinary tract -pt will have cath in place to monitor hourly UO -also exposed to reflux of urine from bag being held above bladder

What is a cutaneous urinary diversion

Urine drains thru an opening created in the abd wall and skin

What is an important indicator of success of transplant

Urine production after anastomosis of ureter from new kidney

How is CABG done without CPB (off pump CABG)?

Use of - beta blockers - take HR down to 40-50 - myocardial stabilization device (suction cup for either side of artery) --less invasive, not bloodless or beatless, HR low enough surgeon can sew between beats

What is SLN bx

Use of injectable dye to identify the SLN or LN that the primary tumor & surrounding tissue drains to --melanoma and breast

What are sugar tongs

Used for bedrest patients with C spine injuries -burr holes drilled and tongs into holes to provide traction and keep bones apart

What is pancreaticoduodenectomy

Used for resection of head of pancreas when thought to be only site of cancer -GB removed, part of stomach, duodenum, proximal jejunum & head of panc & common bile duct are removed -rest of panc connected to jejunum along w/ stomach -allows bile to flow into jejunum

What is defibrillation?

Used in emergencies - unsynchronized (used in v fib) - defib w pads and zap - like AED - This depolarizes a critical mass of the heart muscle, terminates the dysrhythmia, and allows normal sinus rhythm to be reestablished by the SA node

What will a pt w/ total gastrectomy need for the rest of their life

Vitamin B12 injections

What happens if not enough bile in digestive system

Vitamins A, D, E, K (fat soluable) don't dissolve right or absorb correctly

What is they larynx

Voice box (la-la-la) -cartilage/epithelium lined -connects pharynx and trachea -major function is vocalization & it protects lower airway from foreign substances -facilitates coughing

What is total lung capacity

Volume of air in lungs on max inspiration -max volume lungs can be expanded w/ greatest possible inspiratory effort -5800mL

Prior to attaching PD cath tubing - what should you do?

Warm the fluid --either in warming cabinets, incubator or heating pad **NEVER MICROWAVE OR OVEN OR BATH --if using cycler it will prewarm

What is intraductal papilloma

Wartlike growth that involves large milk ducts near nipple causing bloody d/c from nipple

What is bile

Waste product (bilirubin) aids in digestion of fat thru emulsification --stored in the gall bladder

What is creatinine

Waste product of skeletal muscle --filtered at the glomerulus --passed thru tubules w/ minimal change --excreted in urine

What happens in ultrafiltration

Water moves under high pressure to an area of low pressure --by applying negative pressure (suction force) to diaylsis membrance

S/S of cardiac tamponade

Weakness - chest pain - orthopnea - anxiety - diaphoresis - lethargy - altered LOC - decreased cerebral perfusion

What is flail chest

When 3 or more adjacent ribs are fx at 2 or more sights

When is genetic testing indicated for ovarian ca

When 3 or more cases of close related fam members have pre menopausal breast or ovarian ca

How is radiation used to control ca

When a tumor cannot be removed surgically or when LN mets is present -neoadj w/ or w/o chemo to decrease size of tumor to enable surgical resection

What is an open brain injury

When an object penetrates skull and damages soft tissue in its path -opens skull, scalp, and dura to expose the brain

What happens to the lungs during inspiration

When capacityy of chest is increased - air enters trachea (inhale) because of the lowered pressure within and inflates lungs

What is herd immunity

When majority of group of people is immunized against infectious disease (influenza)

What is an ethical dilemma

When personal values and beliefs dont match well with your pt's values and beliefs -euthanasia, experimental drugs, stem cell, abortion, sex selection, marijuana as a med, legalization of drugs, antimilitary and applying at VA

What is cardiopulmonary bypass?

With use of machine - blood bypasses heart and lungs - out of RA thru system to O2 blood and pull off CO2 - into heat exchanger - into aortic arch **so surgeon can work in bloodless field and heart no bumping/beating around --heparin used to prevent clot (very high risk) --protamine sulfate - to reverse heparin

Antidote for atrial flutter

adenosine or cardioversion

What is lucid interval

after LOC at injury - seem to get better -because absorbs CSF to compensate and allow more room for expansion -afterwards deteriorates rapidly -dilate/fixed pupil **ominous for rapid deterioration

Where does QRS complex start

after P wave and PR interval =ventricular depolarization =triggers main pumping contraction

Where does diastole occur on the EKG

after the t wave (T to P )

teteraplegia

aka - quadriplegia -paralysis of all 4 extremities

What if pH is high

alkalosis

What is homocysteine

amino acid in the body - increased is linked to atherosclerosis - but not dependent predictor (risk for CVA, PVD, CAD) **should be < 10

Where does leakage normally occur in PD cath

around insertion site -can last months or years **tx w/ smaller volumes of around 500mL then gradual increased to normal 2-3L

where does pulmonary circulation take place

around the bronchioles -blood up against semipermeable membrane -O2 diffuses out of alveolar sac into the blood and the CO2 from the blood diffuses into the alveolar sac for expelling during expiration (thru concentration gradients)

#1 cause of ARDS

aspiration -mechanical is #2 -other causes are sepsis and pneumonia,aspiration of gastric secretions, hydrocarbons, drowning, prolong inhalation of high concentration of O2, smoke, corrosive, shock,trauma, embolisms

Where does cerebral aneursym mostly occur

at circle of willis in brain -base of brain where arteries go up -too much pressure in short amount of space to perfuse

Why does pt w/ ARF get metabolic acidosis

because retaining acids, ammonia and phosphates

What is myoglobin

better than CKMB

Risk factors for DIC

blood transfusion reactions cancers - esp leukemia pancreatitis sepsis liver disease preg complications recent surgery or anesthesia sever tissue injury (brain or burns)

What is a dendrite

branch type structure for receiving messages

Mucolytics

break down mucus and aid expectorant **mucinex

What is laryngeal cancer

cancer of the larynx or voice box -can be curable if found early -not normally found early

Barretts esophagus and esophageal cancer (ATI)

caused by reflux of gastric fluids -if chronic = body continues to heal inflamed tissue and eventually replaces normal esophagus epithelium w/ premalignant (barretts) tissue or malignant tissue

Cardiovascular effects of ARDS

causes pulm congestion then cardiogenic shock -increased pulm infiltrates causes right side heart to get blood to lungs so right heart starts to fail = cor pulmonale***

What is suppressed ventilation (COPD)

chronic high levels of CO2 with low sensitivity sensors of CO2 -brain says there is high O2 so stop breathing -start low and slow on O2

What is partially digested food

chyme

What are the 4 types of incomplete spinal cord lesions

classified to area of spinal cord damage Central Lateral Anterior Peripheral

What should CSF look like

clear and colorless

What is the gold standard to dx colon cancer

colonoscopy

Once blood gets to liver, it forms its own circulatory system

common capillary bed --bathes our liver cells w/ O2 & nutrients then empty into hepatic vein that empties into vena cava

What is superior vena cava syndrome

compression of or invasion of SVC by tumor, enlarged LN, intraluminal thrombus that obstructs circulation -assoc w/ lung but can happen in breast ca, kaposi's sarcoma, lymphoma & mediastinal mets

What pts would require AV graft over fistula?

compromised vascular systems (DM) -their native vessels aren't suitable for fistula creation

What does the frontal lobe control

concentration - abstract thought - memory - motor functin - affect - speech - judgement - personality - inhibition

Water balance is regulated by the kidneys & results in what

formation of urine

what is the cardiac conduction system

generates and transmits electrical impulses that stimulate contraction of the myocardium

RN planning & goals for altered LOC

goals = maintain patent airway - protect from injury - fluid balance - etc (see RN dx)

What is EEG

gold standard for death pronouncing -brain activity -angiolytic 1st if allowed -reassure pt -wash hair after and no stimulants prior

What is angiogenesis

growth of new capillaries from host tissue by release of growth factors & enzymes -they stimulate form of new blood vessels that help cancer cells get needed nutrition & O2

What do CD4 cells do

hang out in blood stream & recognize foreign proteins (invaders) -take them to B lymphocytes in the LN -flood system w/ antiboides -mark cell for destruction (this is cell mediated immunity)

What is partial laryngectomy

portion of larynx removed with one vocal cord and tumor -all other structures remain **swallow preserved **voice quality is hoarse but preserved -best case scenario and least invasive

What is tumor lysis syndrome

potential fatal complication assoc with radiation or chemo -dumping cell debris in blood so overwhelms kidneys & they shut down **release of intracellular contents from tumor cells lead to elyte imbalances

What alters specific gravity

presence of blood, protein & casts in urine

Effect on blood of ARDS

probs with DIC = micro clots thru body - depletes all of coag proteins causing pt to bleed in all orifices (no clotting factors) --treat w/ multi infusions of fresh frozen plasma and whole blood

What is diffusion

process by which CO2 and O2 are exchanged at the air and blood interface -internal = tissue level -external = alveolar sac

What is DCIS

proliferation of malignant cells inside the milk ducts w/o invasion into surrounding tissue -usually on mammo with microcals -stage 0

what effects BUN

protein intake - tissue breakdown - fluid volume changes

What is an occupational nurse (ATI)

provide cost effective & high quality -works toward health and safety of workers -assess for work related illness & injury -plan & deliver health & safety services leading to more productive work force -facilitate health promotion activities

frontal tissue brain injury can cause what s/s?

pt exhibit bizzare or irrational behavior

What can rib fx cause?

pulm contusions = bleeding and fluid leaking into pleural space causing pleural effusions

Secretin of the pancreas

stimulates high bicarb nature of the exocrine function

Reglen

stimulates motility of upper GI

Decongestants

sudafed - afrin (Nasal spray) --can cause rebound congestion if used long term

What is blunt chest trauma

sudden compression or positive pressure #1 cause is MVA

S/S of ARDS

sudden onset of pulm edema (lungs fill w/ fluid) - increase bilat lung infiltrates - hypoxemia - refractory to supplement O2

what is the 1st choice to treat lung ca

surgery - to remove tumor or lobe of lung

What is the mechanical stimulation of the heart called

systole

What happens if Na+ gets lower than 115

sz - abn reflex & gait - papilledema - coma - death

temporal tissue brain injury can cause what s/s

temporary amnesia or disorientation -gait and balance disturbances

What is bioterrorism

terrorism involving the release of toxic biological agents

What is SLN bx

the SLN is the first node in the lymph basin that recieves drainage from the primary tumor in the breast -identified by injection of isotope -surgeon follows path of drainage, removes node and sends to path using frozen section -if + - can remove ALND immediately while pt under anesthesia still

The higher the viral set point...

the poorer the prognosis

What vessels in the kidneys constantly monitor BP

vasta recta --regulation of BP important function of kidney

Oral tumors that are > 4 cm =

will come back

What does low Vit D cause?

worsens bone loss & bone disease