ATI Study Guide Comp Predictor
WBC normal values
(for infection) 4,000-10,000
BUN/Creatinine normal values
(for kidney function) 7-20/0.8-1.4
Use the following communication tips when answering questions on NCLEX:
* If the client is anxious or depressed - use open-ended, supportive statements * If the client is suicidal - use direct, yes or no questions to assess suicide risk * If the client is panicked - use gentle guidance and direction * If the client is confused - provide reality orientation * If the client has delusions / hallucinations / paranoia - acknowledge these, but don't reinforce * If the client has obsessive / compulsive behavior - communicate AFTER the compulsive behavior * If the client has a personality or cognitive disorder - be calm and matter-of-fact
Ileostomy care and education
*-Empty pouch: 1/3 to 1/2 full. -Clean pouch 1-2 times daily. -Pouch change every 4-6 weeks. -Wafer size 1/8 to 1/4 larger than stoma -Avoid high fiber foods to prevent blockage.
Levothyroxine (Synthroid) -Signs of Toxicity
*Cardiac: anxiety, chest pain, tachy, htn.
Sinus Bradycardia Treatment
-Atropine -Avoid Valsalva -Hold Rate Slowing Drugs (Digoxin, Beta Blockers)
Pressure Ulcer Strategies -Reposition time (bed/chair) -Incontinent Pt.
-Bed every 2hr, chair every hour. -Apply barrier cream and moisture absorbing pad.
Contraction Stress Test (CST). Description, Purpose, normal range.
-Brush palm across nipple for 2-3min to release natural oxytocin that produce contractions. -Determine how fetus will tolerate stress of labor. -3 contractions, 10 min period, duration 40-60 secs.
Circumcision post op care: cleaning
-Change diaper every 4 hrs. -Clean penis with each change. -Apply petroleum jelly for at least 24 hrs after circumcision (prevent adhering). -Fan fold diaper (prevent pressure). -Avoid wrapping penis (impairs circulation) -Washing: trickle warm water over penis. -Do not clean yellowish mucus that appears by day 2. -Do not use moistened towelettes. -Healing: a couple of weeks.
Chest tube
-Continuous bubling in the water seal champers indicates an air leak. If this is observed, the nurse should attempt to located the source of the air leak and intervene accordingly (tighten the connections, replace drainage system)
Cystic Fibrosis (Respiratory Disorder) -Diagnostic Test -Possible Medication Administration
-DNA mutant gene identification. -Open capsule sprinkle on food (Enzyme: Pancrease).
Acute Mania Interventions
-Decrease stimuli and one to one observation if necessary.
Arthroplasty pt education -How to avoid contractures, dislocations; prevent DVT's. -Non-pharmalogical treatment
-Do not bend at waist. -Use abductor pillow in between legs. -Perform Continuous Passive Motion -Ice pack
Atrial Flutter Treatment
-Give anticoagulants (faster the HR, more risk for thrombus) -treat underlying cause -digoxin (slows rate by enhancing AV block) -Quinidine (supresses atrial ectopic block) -Amiodarone -Calcium Channel Blockers (Cardizem)/Beta Blockers (-olol) -consider cardioversion
COPD -conservative measurements -Rapid relief med
-High Fowler position -Increase fluids to liquify mucous -Albuterol
Buck's Traction -Goal -Following conservative measurements -Skin integrity/Neuro
-Immobilization -Follow RX orders: type of traction, weights, whether it can be removed. -Reposition every 2 hrs, provide pin care, neuro checks
Cholecystitis (inflammation of gallbladder) Diet
-Increase fruits, vegetables, whole grains. Ex: Melon -Avoid greasy/fatty foods
Ileostomy what pt expect on appearance.
-Initial drainage: dark green, odorless. -Some initial bleeding normal -Pink or red stoma color normal -Initial swelling; decreases 2-3 weeks later
Ventilator Alarms -Low Pressure -High Pressure
-Low: disconnection -High: suction for possible secretions, kinks.
Sinus Tachycardia Treatment
-May resolve with treatment of underlying cause -Digoxin, Beta Blockers (-olol), Verapamil -Vagal Maneuver
Diabetic Foot Care
-Nailcare: Podiatrist, cut nail straight across. -Wear Clean Cotton Socks/Closed Shoes -Do not soak feet or wear ointments
Discomforts During Pregnancy
-Nausea -Fatigue -Backache -Constipation -Varicose Veins -Hemoroids -Heartburn -Nasal stuffiness -Dyspnea -Leg Cramps -Edema lower extremities
Blood donation: universal donor and universal recipient?
-O negative universal donor. -AB universal recipient.
what is the difference between objective symptoms and subjective symptoms?
-Objective is what you observe -Subjective is what the patient tells you
Junctional Rhythms
-Occurs when the AV node takes over as the primary pacemaker in the heart rather than the SA node. AV node takes over when is moves faster than SA node. Rate: 40-60 bpm; Accelerated Junctional: 60-100 bpm; Junctional Tachycardia: 100 bpm or greater P Wave: If before QRS, P wave will be inverted. P Wave can also be hidden within the QRS complex. P Wave is usually <.12 seconds QRS: <.12 seconds
Patient education for Amniocentesis.
-Position: supine or rolled towel under right hip -Continue breathing normally when inserting needle -Rest 30 mins after procedure. -Increase fluids for next 24 hrs.
MMR contraindication
-Pregnancy, recent blood transfusion....
Risks for the patient with leukemia. Why is there a risk for hemorrhage for some leukemia patients?
-Risk for infection. -ineffective coping, related to diagnosis and disease process. -Thrombocytopenia induced hemorrhage.
Chlorpromazine (med for psychoses) -Adverse Effects and given treatment
-Severe Spasms/Tremors Tx: benzotropine (Cogentin), diphenhydramine (Benadryl).
Position for suppository or enema administration.
-Sim's/left lateral/Rt. knee to chest
Type Stomas: Appearance -Single -Loop -Divided -Double-Barrel
-Single (one stoma); brought through onto anterior abd wall. -Loop (two openings); proximal (active) and distal (inactive). -Divided (two separate stomas); proximal (digestive) and distal (secretes mucus). -Double-Barrel (distal and proximal sutured together are both brought up onto abd wall).
Moro Reflex (one of many reflexes present at birth)
-Startled (arms out sideways, palms up, thumb flexed). Ex: strike surface next to newborn.
Hyperglycemia
-Test urines for ketones and report if outside the expected reference range
Indications of Fluid Volume Depletion (Hypovolemia)
-Thready pulse/Hypotensive -Tachy -Increased Respiration -Cool, Clammy, Diaphoretic -Decreased Urine Output -Thirst
Levothyroxine (Synthroid) -What is it? -What patients should use this medication with caution? -Best way to take?
-Thyroid hormone; treats hypothyroidism. -Cardiac pts; aggrevates tachy and anxiety -Take in the morning, on empty stomach
Ferrous Sulfate (Feosol) -Purpose -Reporting symptoms -Administration -How to monitor effectiveness
-Treats iron deficiency -GI distress: nausea, constipation, heartburn. -Take on empty stomach, drink with straw and rinse to prevent staining. - Increase Hgb of 2g/dL, Hct
Contraindicated Immunizations During Pregnancy
-Varicella -Zoster -MMR
Stroke eating precautions
-check gag reflex -thickened fluids/puree -Sit upright/flexed neck forward
Types of Decelerations: <120 fhr -early -late -variable
-early: head compression -late: uteroplacental insufficiency -variable: cord compression
MRSA Contact Precautions
-keep distance within 3 ft of client -Private room or share with someone with similar infection (wound infection, herpes simplex) -double bag dressing gauze. -PPE: Gloves and Gowns.
Verapamil interactions
-lol may increase med, may potentiate carbamazapine and digoxin, may cause heart failure; may cause OH- report edema or SOB
TB precautions and care
-private room/negative pressure -N95 masks -pt wear mask when transported out of room or in any public place. -Medications: may be taking up to 4 meds at a time; up to 6-12 months -Test exposed family members -Sputum culture every 2-3 weeks; 3 negatives results in noninfectious.
Dehydration S&S (hypovolemia)
-pulse; weak and thready. hypotension -tachy -confused -decreased urine output -skin and mucous membranes dry Urine Specificity increased
How to calculate due date: LMP 8/2/15
-subtract 8-3=5 -add 7 + 2= 9 May 9, 2016
Second and subsequent defibrillations for pediatric patients should occur at:
.4 J/kg
Conjugated direct Bilirubin level
0.0-0.2 mg/dl
Standard ECG paper is divided into 1-mm blocks and moves past the stylus of the ECG at 25 mm per second. Each small block represents:
0.04 second
The duration of the QRS complex should be _____ second.
0.08 to 0.10
Each small square of graph paper represents _____ mV.
0.1
_____ seconds is/are measured in each large box on ECG graph paper?
0.20
Creatinine females
0.5-1.1
Digoxin
0.5-2.0
Creatinine males
0.6-1.2
Normal INR=
0.7-1.8 (Therapeutic INR 2-3)
Lithium
0.8-1.4
Each square on ECG paper is _____ mm in height and width.
1
When performing CPR on an adult, you would compress the chest to a depth of _____ inches.
1 1/2 to 2
pediatric Hematocrit levels
1 day --> 48-69% 2 day --> 48-75% 3 day --> 44-72 % 2 month --> 28-42 % 6- 12 year --> 37-49% 12- 18 year Male --> 37-49% 12-18 year Female --> 36-46%
Ideal time to do pre-op teaching if possible?
1-2 days before surgery
Rhythms for cardioversion
1. A-Fib 2. A-Flutter 3. SVT
Sign of mag sulfate toxicity (4)
1. Absent deep tendon reflexes 2.Resp rate < 12 3. Urine output < 30 4.Mag levels above 8
Sinus Bradycardia: Example: Your pt is pale, c/o dizziness and fatigue; pulse 56, BP 86/60. How would you follow protocol according to ACLS?
1. Airway 2. Oxygen 3. ECG, BP, Oximetry 4. IV Access 5. If s/s of perfusion, altered mental status, CP, hypotension, signs of shock: a. prepare for transcutaneous placing b. atropine 0.5mg IV while waiting for pacer (may repeat for total of 3mg IV) c. epi or dopamine drip while waiting pacer
Atrial Fibrillation Treatment
1. Amiodarone 2. Calcium Channel Blockers, Beta Blockers, digoxin 3. Synchronized cardioversion if unstable 4. radio frequency catheter ablation 5. anti-coagulation therapy 6. Cardizem
Premature Ventricular Contraction Clinical Signs
1. Depends on frequency 2. short diastolic filling time, decreased cardiac output 3. sensation of palpitations, skipped beats 4. Bigeminy (pvc every other beat) 5. Trigeminy (pvc every 3rd beat)
Correct method for walking upstairs with crutches
1. Hold to rail with one hand and crutches with the other hand. 2. Push down on the stair rail and the crutches and step up with the "unaffected" leg. 3. If not allowed to place weight on the "affected" leg, hop up with the "unaffected" leg. 4. Bring the "affected" leg and the crutches up beside the "unaffected" leg. 5.Remember, the "unaffected" leg goes up first and the crutches move with the "affected" leg.
Premature Ventricular Contraction Etiology
1. Hypoxia 2. Digoxin Toxicity 3. Mechanical Stimulation 4. Electrolyte Imbalance (potassium) 5. MI
Ventricular Fib Treatment
1. IMMEDIATE DEFIBRILLATION X3 2. CPR 3. SURVIVAL IS <10% FOR EVERY MINUTE THE PT REMAINS IN V-FIB
Ventricular Fib (Etiology, Clinical Signs)
1. Same as VT, PVC 2. Surgical Manipulation of heart 3. Failed cardioversion 1. Same as cardiac arrest 2. EKG is disorganized rhythm
SCREAM (acronym) for VFib and VTach
1. Shock Q2min 2. CPR after shock (compressions followed by resp 30:2) for 2min 3. Rhythm check after 2 min of CPR and shock again if indicated 4. Epinephrine or vasopressin 5. Antiarrythmic medications: Amiodarone/Lidocaine 6. Magnesium Sulfate
Education on meds for Kidney Disease 1.Digoxin (Lanoxin) 2.Sodium plystyrene (Kayexalate) 3.Epoetin alfa (Epogen) 4.Ferrous sulfate (Feosol) 5.Aluminum hydroxide gel (Amphojel) 6.Furosemide (Lasix)
1. Take within 2 hrs of meal, monitor signs of toxicity, apical pulse for 1 min. 2. Monitor hypokalemia, restrict sodium intake. 3. blood twice a week, monitor HTN. 4. administer following dialysis with stool softner, take with food. 5. avoid pts with GI disorders, take 2 hrs before or after Digoxin. 6. Monitor I&O, bp, weight. Report thirst, cough.
Ventricular Arrythmias Treatment
1. VT w/ a pulse: cardiovert 2. monitor more closely 3. prepare cardioversion (oxygen, lidocaine, treat cause) 4. VT w/o a pulse: defibrillate (call code)
Premature Ventricular Contraction Treatment
1. treat impaired hemodynamics 2. antiarrythmics 3. oxygen 4. monitor for PVC on T-Wave
Paroxysmal SVT Treatment
1. treat underlying cause 2. adenosine, beta blockers, digoxin, quinidine, MS 3. Carotid/Vagal Maeuver 4. Synchronized cardioversion if unstable
Magnesium
1.3-2.1
Synchronous cardioversion delivers energy:
10 ms after the peak of the R wave
What is the average length of time between infection with HIV (the Human Immunodeficiency Virus) and the onset of AIDS (Acquired Immune Deficiency Syndrome)?
10-14 years Contaminated blood transfusion or dirty needle 1-2 years
BUN
10-20
Dilantin
10-20
Theophylline
10-20
Normal PT=
11-12.5 seconds
Hemoglobin women
12-16
A paramedic places 10 leads: 4 on the limbs and 6 on the chest. The paramedic is preparing for viewing a:
12-lead ECG
Normal Fetal HR
120-160
Sodium
136-144
Sodium
136-145
Hemoglobin men
14-18
Platelet
150,000-400,000
Atrial tachycardia (SVT) atrial rate
150-250/min
The initial pediatric defibrillation should occur at:
2 J/kg
Teaching of controlled beep breathing and coughing?
2-3 deep breaths then cough from as deep down as possible
The intrinsic rate for a ventricular pacemaker is _____ beats per minute.
20 to 40
HC03
21-26
kicks a ball: developmental stage
24 months
Taking in phase
24-48 hours after birth: dependent, passive; focuses on own needs; excited, talkative
Atrial flutter (SVT) atrial rate
250-350/min
2 - Hyperglycemia Administer sliding scale insulin or plan for insulin to be added to the TPN solution. Monitor blood glucose
3 - Hypoglycemia Inform the provider and plan to give additional dextrose. Monitor frequent blood glucose.
HPV vaccination doses
3 doses
Phosphorus
3.0-4.5
Potassium
3.5-5
Potassium
3.5-5.5
Normal PTT=
30-40 seconds (Therapeutic PTT 1.5-2 x normal or control values)
pC02
35-45
Hematocrit women
37-47
RBC women
4.2-5.4 millin/mm3
RBC men
4.7-6.1 million/mm3
Hematocrit men
42-52
WBC
5,000-10000
first synchronous cardioversion for patients in PSVT should be at:
50 J
pH
7.35-7.45
Pacemakers are usually set to a rate of _____ beats per minute beginning with _____ amps.
70 to 80; 50
Glucose
70-105
p02
80-100
Total Calcium
9.0-10.5
Chloride
96-106
HcbA1c
<6.5%
pediatric Digoxin toxic concentration
> 2.5 ng/ml
Atrial fibrillation (SVT) atrial rate
> 350/min and multifocal
pediatric acetaminophen levels
>200 mcg/ml
In a left bundle-branch block:
A Q wave is seen instead of an R wave in MCL1
Depressive disorders
A classic symptom of depression is change in sleep patterns, indecisiveness, decreased concentration, or change in body weight. Any client who shows these signs or symptoms should be asked if they have suicidal ideation. Teach clients to never discontinue anti-depressants suddenly.
Neutropenia is a neutrophil count of less than 2,000/mm3. Neutropenia occurs in clients who are immunocompromised, are undergoing chemotherapy, or have a process that reduces the production of neutrophils.
A client who has neutropenia is at an increased risk for infection.
Parasympathetic stimulation of the heart causes:
A decreased heart rate
Older adult clients may not be able to drive to the provider's office, grocery store, or pharmacy. Assess support systems available for older adult clients.
A fixed income may mean that there are limited funds for buying diabetic supplies, wound care supplies, insulin, and medications. This may result in complications.
When verifying NG tube placement, the pH of aspirated gastric fluid should
A good indication of appropriate placement is obtaining gastric contents with a pH between 0 and 4.
Diverticulosis and Diverticulitis:
A high-fiber diet may prevent diverticulosis and diverticulitis by producing stools that are easily passed and thus decreasing pressure within the colon. During acute diverticulitis, a low-fiber diet is prescribed in order to reduce bowel stimulation. Avoid foods with seeds or husks. Clients require instruction regarding diet adjustment based on the need for an acute intervention or preventive approach.
Which of the following is typically found on an ECG with a bundle-branch block?
A notched QRS complex (rabbit ears)
Troponin I
A positive Troponin I indicates damage to cardiac tissues and level are no longer evident in the blood after 7 days.
A cataract is an opacity in the lens of an eye that impairs vision. There are three types of cataracts:
A subcapsular cataract - back of the lens. A nuclear cataract - center (nucleus) of the lens. A cortical cataract - lens cortex and extends from the outside of the lens to the center.
HELLP syndrome
A variant of gestational hypertension where hematologic conditions coexist with severe preeclampsia and hepatic dysfunction.
Which of the following is true of abdominal aortic aneurysm (AAA)?
AAA may be asymptomatic as long as it is stable
First priority for the nurse in admitting the patient to a med-surg bed after transfer from the PACU?
ABC's
ACE inhibitors
ACE inhibitors block the production ofangiotensin II which results in vasodilation, sodium and water excretion, and potassium retention. Drugs in this class are used for treating heart failure, hypertension, myocardial infarction, and diabetic or nondiabetic nephropathy. Clients taking captopril (Capoten) should be instructed to take med at least 1 hour before meals; all other ACE inhibitors are not affected by food. The generic names of ACE inhibitors end in "pril": · Capto pril (Capoten) · Enala pril (Vasotec) · Fosino pril (Monopril) · Lisino pril (Prinivil) · Rami pril (Altace) Side/adverse effects include: · Orthostatic hypotension with first dose · Instruct client to monitor BP for at least 2 hours after first dose · Cough, rash or altered or distorted taste (dysgeusia) · Instruct client to notify health care provider · Angioedema · Treated with epinephrine and symptoms will resolve once medication is stopped · Neutropenia is rare but serious with captopril (Capoten) · Instruct client to report signs of infection Hyperkalemia can be life-threatening Monitor potassium levels to maintain normal range of 3.5-5.0 mEq/L Medication/food interactions: · Concurrent use with diuretics can lead to first-dose orthostatic hypotension · Concurrent use with other antihypertensives can lead to increase effect resulting in hypotension · Concurrent use with potassium supplements or potassium-sparing diuretics increases the risk of hyperkalemia · Concurrent use with lithium can increase serum lithium levels, leading to lithium toxicity · Concurrent use with NSAIDs can decrease the therapeutic effects of the ACE inhibitor
Adverse effect of ACE inhibitor (pril's)
ACE inhibitors, such as captopril, increase potassium levels (hyperkalemia)
Diabetic Screening: risk factors - obesity, hypertension, inactivity, hyperlipidemia, cigarette smoking, genetic history, elevated C-reactive protein (CRP), ethnic group, and women who have delivered infants weighing more than 9 lb
ADA - recommends screening a client who has a BMI greater than 24 and age greater than 45 years, or if a child is overweight and has additional risk factors.
Airborne precautions:
AIRBORNE: "My Chicken Hez TB" -Measles -Chicken pox -Herpes zoster -TB Management: neg. pressure room, private room, mask, n-95 for TB. -A private room -Masks or respiratory protection devices for caregivers and visitors. -An N95 or high-efficiency particulate air (HEPA) respirator is used if the client is known or suspected to have TB. -Negative pressure airflow exchange in the room of at least six exchanges per hour.
Acute Renal Failure (ARF):
ARF is an abrupt, rapid decline in renal function. It is usually caused by trauma, sepsis, poor perfusion, or medications. ARF can cause hyponatremia, hyperkalemia, hypocalcemia, and hyperphosphatemia. Diet therapy for ARF is dependent upon the phase of ARF and its underlying cause.
Which of the following cardiac pacemakers has an intrinsic rate of 40 to 60 beats per minute?
AV junction
You are treating a 65-year-old man who is complaining of chest pain and difficulty breathing. On ECG examination, you note that his ventricular heart rate is 56, and there are more P waves than QRS complexes. The PR interval is constant when a QRS follows a P wave. The QRS complexes are normal and narrow. This type of block occurs when the impulse is not conducted through the:
AV node
Oral contraceptives: Signs of potential problems—"ACHES"
Abdominal pain (possible liver or gallbladder problem) Chest pain or shortness of breath (possible pulmonary embolus) Headache (possible hypertension, brain attack) Eye problems (possible hypertension or vascular accident) Severe leg pain (possible thromboembolic process)
The triplicate method of determining heart rate is:
Accurate when the heart rate is normal and greater than 50 beats per minute
Acetazolamide (Diamox - oral medication)
Acetazolamide is administered preoperatively to reduce IOP, to dilate pupils, and to create eye paralysis to prevent lens movement.
The major neurotransmitter for the parasympathetic system is:
Acetylcholine
Clients Who Require Dialysis: AEIOU (The Vowels)
Acid base imbalance Electrolyte imbalances Intoxication Overload of fluids Uremic symptoms
A patient in left ventricular failure is expected to have:
Activation of the renin-angiotensin-aldosterone system
Blood Transfusion - Types of reactions and onset
Acute hemolytic - immediate Febrile - 30 min to 6 hr after transfusion Mild allergic - During or up to 24 hr after transfusion Anaphylactic - immediate
Most myocardial infarctions are caused by:
Acute thrombotic occlusion
Which of the followinYou are called to evaluate a 64-year-old woman who complains of palpitations, weakness, and dizziness. Her heart rate is 160 beats per minute, her blood pressure is 118/ 80 and her respiratory rate is 28. The ECG tracing shows narrow QRS complexes and no identifiable P waves. Which of the following drugs is a class I (recommended) drug for this patient?
Adenosine
Intermediate-acting insulin NPH insulin (Humulin N), detemir insulin (Levemir). Administered for glycemic control between meals and at night.
Administer NPH insulin subcutaneous only and as the only insulin to mix with short-acting insulin.
If a patient with cardiac tamponade becomes hypotensive in the field, you should:
Administer a fluid bolus
You are transporting a patient to a cardiac center after a suspected myocardial infarction. The patient's vital signs are stable. ECG shows sinus rhythm with elevated ST segments. Fibrinolytic therapy for this patient will be most effective if:
Administered within 12 hours after the onset of symptoms
Considerations for the pregnant client
Admittance of a pregnant client to a medical-surgical unit: You may have a pregnant client admitted with a diagnosis unrelated to her pregnancy and, therefore, she may be admitted to a general medical-surgical floor. A mnemonic to assist you in performing important assessment elements for these clients is FETUS. * F: Document fetal heart tones every shift. To assess fetal heart tones, use a handheld Doppler ultrasound and place it in an area corresponding to uterine height. For example, for a client who's less than 20 weeks' pregnant, the most likely area to find fetal heart tones is at the pubic hairline or the symphysis pubis. For a client whose pregnancy is more advanced, such as at 24 weeks, the fetal heart rate can most probably be heard midline between the symphysis pubis and the umbilicus. As the pregnancy advances in weeks, fetal heart tones can be heard closer to and possibly above the umbilicus. * E: Provide emotional support. Pregnant women who are experiencing unexpected medical conditions are at a high level of anxiety related to how the current medical problem may affect the fetus. You should take extra care to alleviate and reduce your client's anxiety by explaining all medications and treatments. Additionally, be prepared to listen for fetal heart tones anytime the client requests it to further reduce her worry of the fetus' well being. * T: Measure maternal temperature. Because your client's core body temperature is higher than you can detect through oral or tympanic thermometers, be alert to the presence of a fever. A high maternal temperature can lead to fetal tachycardia and distress. An order for antipyretics on admission to ensure their quick availability will be a prudent request you should make to the admitting physician. * U: Ask about uterine activity or contractions. Make it a normal part of your routine to ask about any type of uterine pain, tightening, or discomfort throughout your shift. Be aware that early contractions often present as lower back pain. Don't attribute complaints of lower back pain to the hospital bed. If your client reports any unusual activity, take care to softly palpate the lower abdomen for periods of greater than 2 minutes while conversing with her. Watch for subtle changes of facial expression while simultaneously detecting a change in uterine tone. If contractions are suspected, your client will need to be monitored with continuous fetal monitoring in the labor and delivery unit. * S: Assess for the presence of and changes in sensations of fetal movement. After 20 weeks' gestation, all women should be able to report feeling the fetus move. This is an important assessment to perform and document at least every shift, easily accomplished by asking "How often are you feeling the baby move?" By asking this as an open-ended question, you'll receive more information about the quantity of fetal movement such as, "I haven't felt the baby move as much as usual today."
Asthma Management: ASTHMA
Adrenergics: Albuterol and other bronchodilators Steroids Theophylline Hydration: intravenous fluids Mask: oxygen therapy Antibiotics (for associated respiratory infections)
Juvenile hypothyroidism - Juvenile hypothyroidism is most often caused by chronic autoimmune thyroiditis and affects the growth and sexual maturation of the child. Clinical manifestations are similar to adult hypothyroidism, and the treatment reverses most of the clinical manifestations of the disease.
Adult hypothyroidism: Because older adult clients who have hypothyroidism may have manifestations that mimic the aging process, hypothyroidism is often undiagnosed in older adult clients, which can lead to potentially serious adverse effects from medications (sedatives, opiates, anesthetics)
Teach the client that thyroid replacement therapy is usually lifelong. - Therapeutic Use Levothyroxine replaces T4 and is used as thyroid hormone replacement therapy. Replacement of T4 also raises T3 levels, because some T4 is converted into T3.
Adverse effects are essentially the same as manifestations of hyperthyroidism: cardiac symptoms, such as hypertension and angina pectoris; insomnia, anxiety; weight loss; heat intolerance; increased body temperature; tremors; and menstrual irregularities
Instruct client how to inject exenatide subcutaneously. Teach client to take exenatide within 60 min before the morning and evening meal but not following the meal.
Advise client to withhold exenatide and notify the provider for severe abdominal pain. Teach the client how to recognize and treat hypoglycemia.
Wear clothing that is washable, wash clothing separate from clothing of others, and run the washing machine for a full cycle after washing contaminated clothing.
Advise the client to avoid infants or small children for 2 to 4 days after the procedure. Avoid contamination from saliva, do not share a toothbrush, and use disposable food service items (paper plates).
Nursing Interventions/Client Education Watch the client for decreased immune function. Monitor for hyperglycemia. Omalizumab can cause anaphylaxis.
Advise the client to report black, tarry stools. Observe the client for fluid retention and weight gain. This can be common. Monitor the client's throat and mouth for aphthous lesions (cold sores).
Emergency care for a bundle-branch block is:
Aimed at the cause of the block if it is identifiable
Shortness of Breath (SOB) Causes: 4 As+4Ps
Airway obstruction Angina Anxiety Asthma Pneumonia Pneumothorax Pulmonary Edema Pulmonary Embolus
Short-acting beta2 agonists, such as albuterol (Proventil, Ventolin), provide rapid relief of acute symptoms and prevent exercise-induced asthma.
Albuterol - Watch the client for tremors and tachycardia.
Characteristics of the 4 major types of cirrhosis?
Alcoholic, postnecrotic, biliary, lanex
Mental Status Exam
All clients should have a Mental Status Exam, which includes: Level of consciousness Physical appearance Behavior Cognitive and intellectual abilities The nurse conducts the MSE as part of his or her routine and ongoing assessment of the client. Changes in Mental Status should be investigated further and the provider notified. There are two types of mental health hospitalizations: Voluntary commitment and involuntary or civil commitment. Involuntary commitment is against the client's will. Despite that, unless proven otherwise, clients are still considered competent and have the right to refuse treatment.
Nursing assessment prior to the administration of contrast medium?
Allergies to iodine, shellfish
Characteristics of patient controlled analgesia?
Allows patient to control, inject whenever pain comes, it locks you out
Instruct the client to avoid the use of damaging hair-care measures, such as electric rollers and curling irons, hair dye, and permanent waves. Use of a soft hair brush or wide-tooth comb for grooming is preferred. ☐ Suggest that the client cut her hair short before treatment to decrease weight on the hair follicle. ☐ After hair loss, the client should protect the scalp from sun exposure and use a diaper rash ointment/cream for itching.
Alopecia is an adverse effect of certain chemotherapeutic medications related to their interference with the life cycle of rapidly proliferating cells. ■ Nursing Actions ☐ Discuss the impact of alopecia on self-image. Discuss options such as hats, turbans, and wigs to deal with hair loss. ☐ Recommend soliciting information from the American Cancer Society regarding products for clients experiencing alopecia. ☐ Inform client that hair loss occurs 7 to 10 days after treatment begins (select agents). Encourage client to select hairpiece before treatment starts. ☐ Reinforce that alopecia is temporary, and hair should return when chemotherapy is discontinued
Osteoarthritis
Alternate: Heat Therapy for Pain and Cold Therapy for Inflammation -Use assistive devices (raised toilet to help not straining)
Aluminum hydroxide gel - Avoid administering if client has gastrointestinal disorders; administer a stool softener with this medication
Aluminum hydroxide gel - Instruct the client to report constipation to the provider and to take 2 hr before or after receiving digoxin.
Documentation for Ostomy Care (Stool)
Amount Consistency Color
Antiparkinsonian
An antiparkinson, or antiparkinsonian medications are used for clients diagnosed with Parkinson's Disease. These medications increase dopamine activity or reduce acetylcholine activity in the brain. They do not halt the progression of the disease. These medications offer symptomatic relief. Anti-Parkinsonian Drugs include: A Cat Does Like Milk! A nticholinergic Agents C OMT Inhibitors (catechol-O-methyltransferase); An enzyme involved in degrading neurotransmitters. D opamine Agonists L evodopa M AO-B Inhibitors
You are treating a 70-year-old male patient with atrial fibrillation. The patient's ventricular heart rate is 180 beats per minute, the blood pressure is 90/60, and the patient complains of chest pain. The hallmark of atrial fibrillation is:
An irregularly irregular rhythm
Loss of central vision: Blindness: Consume foods high in antioxidants, carotene, vitamin E, and B12. Provider may prescribe daily supplement high in carotene + vitamin E.
An ophthalmoscope is used to examine the back part of the eyeball (fundus), including the retina, optic disc, macula, and blood vessels.
In the event of a coronary artery blockage, the muscle of the heart can receive blood from the:
Anastomoses that provide collateral circulation
Objective Data - SLE ◯ Physical Assessment Findings Fever (also a major manifestation of exacerbation) Pericarditis (cardiac or pleural friction rub may be present)
Anemia Lymphadenopathy Raynaud's phenomenon (arteriolar vasospasm in response to cold/stress) Findings consistent with organ involvement (kidney, heart, lungs and vasculature) Butterfly rash on face
Leukemia Signs and Symptoms: ANT
Anemia and decreased hemoglobin Neutropenia and increased risk of infection Thrombocytopenia and increased risk of bleeding
Fontella Closing on Newborn (Anterior and Posterior)
Anterior: 12-18 months Posterior: 1-2 months
Treatment for an ulcer caused by Heliobacter Pylori?
Antibiotic therapy
Stool softeners such as docusate sodium (Colace) are used for constipation
Anticholinergics such as propantheline are used for bladder dysfunction.
Immunomodulators such as interferon beta (Betaseron) are used to prevent and treat relapses
Anticonvulsants such as carbamazepine (Tegretol) are used for paresthesia.
Antidotes
Antidotes are agents given to counteract the effects of poisoning related to toxicity of certain drugs or substances. Antidotes are extremely valuable, however most drugs do not have a specific antidote. Atropine--> is the antidote for muscarinic agnostic and cholinesterase inhibitors: Bethanechol (Urecholine), Neostigmine (Prostigmin) Phyosostigmine (Antillirium)--> is the antidote for anticholinergic drugs, atropine. Digoxin immune Fab (Digibind)--> is the antidote for digoxin, digitoxin Vitamin K--> is the antidote for Warfarin (Coumadin) Protamine sulfate--> is the antidote for Heparin Glucagon--> is the antidote for insulin-induced hypoglycemia Acetylcysteine (Mucomyst)--> is the antidote for acetaminophen (tylenol)
Antineoplastics
Antineoplastics are used combat cancerous cells. There are many kinds of anti-cancer drugs with a variety of actions. But in simple terms this category of drugs attack cells that multiply and divide. This very action which can kill cancer cells can also do the same to healthy dividing cells. This is especially true of cells that need a steady supply of new cells such as skin, hair and nails. There are over 90 different kinds of chemotherapy agents and different drugs cause different side effects Chemotherapy is associated with a variety of side effects: § Nausea and vomiting § Diarrhea and or constipation § Alopecia § Anorexia § Fatigue and exhaustion § Mouth sores § Easy bruising Medications Fluorouracil (5-fluorouracil, 5-FU) Warning - Hazardous drug! 5-FUis one of the oldest chemotherapy drugs and is used against a variety of cancers. Following are some of the most common and important ill effects: · Soreness of the mouth, difficulty swallowing · Diarrhea · Stomach pain · Low platelets · Anemia · Sensitive skin (to sun exposure) · Excessive tear formation from the eyes Nursing Hints: Be aware of the importance of leucovorin rescue with fluorouracil therapy, if prescribed. · The best treatment for extravasation is prevention. · Extravasation can cause pain, reddening, or irritation on the arm with the infusion needle. In severe cases in can lead to tissue necrosis and even loss of an extremity. · Check infusion site frequently · Stop infusion immediately if suspected · Slowly aspirate back blood back from the arm · Elevate arm and rest in elevated position · Check institution policies on how to remove catheter
Blood Transfusion Reaction - Medications
Antipyretics (acetaminophen [Tylenol]) - febrile Antihistamines (diphenhydramine [Benadryl]) - mild allergic Antihistamines, corticosteroids, vasopressors - anaphylactic
Corticosteroids such as prednisone - Increased risk for infection, hypervolemia, hypernatremia, hypokalemia, GI bleeding, and personality changes.
Antispasmodics such as dantrolene (Dantrium), tizanidine (Zanaflex), baclofen (Lioresal) and diazepam (Valium) are used to treat muscle spasticity.
Antithyroid Medications (hyperthyroidism)
Antithyroid medications are used to block (anti) the thyroid hormones. Antithyroid medications block (anti) the conversion of T4 into T3. Used to treat clients with Graves Disease, thyro toxicosis. Antithryoid medications are prescribed for clients who have an overactive thyroid or hyperthyroidism. In hyperthyroidism....everything is HIGHHHHHHH(HYPERRRRRRRRR) Clients that are prescribed this medication need to take radioactivity precautions. Common Antithyroid Medications: Propylthiouracil (PTU)
Anxiety disorders
Anxiety disorders are common mental health disorders. Generalized Anxiety Disorder, Panic Disorder, Phobias, Obsessive Compulsive Disorder, and Posttraumatic stress disorder (PTSD) are all considered types of anxiety disorders. Assess the client for risk factors, triggers and responses.
Possible effects of unrelieved pain?
Anxiety, slows recovery, reduces trust
On ECG, pulseless electrical activity looks like:
Any electrical activity other than ventricular fibrillation or ventricular tachycardia
Heart Sounds: All People Enjoy the Movies
Aortic: 2nd right intercostal space Pulmonic: 2nd left intercostal space Erb's Point: 3rd left intercostal space Tricuspid: 4th left intercostal space Mitral or Apex: 5th left intercostal space
Newborn assessment components—"APGAR"
Appearance Pulse Grimace Activity Respiratory effort
To help reduce impedance to electrical current:
Apply 25 pounds of pressure with the paddles against the chest wall
Nursing Care for Engorgement
Apply moist heat for 5 min before breastfeeding. Ice compresses after feeding to reduce discomfort and swelling.
Amputation -Patient education
Apply prosthetic before ambulating.
Nursing Care for Boggy Uterus
Ask pt to void; if still boggy massage top of fundus with fingers and reassess every 15 mins.
Compare and contrast the use of acetaminophen and aspirin for the patient with arthritis?
Aspirin-upsides:anti inflammatory downside: GI upset Tylenol- upside: analgesic downside: non anti inflammatory, less irritating to the stomach but in high doses is hepatotoxic If it is a autoimmune, think about NSAIDS because there is no inflammation process
Thyroid-Radioactive Iodine (hyperthyroidism)
At high doses, thyroid radioactive iodine destroys thyroid cells. This drug is used for clients who have thyroid cancer and an over active thyroid (hyperthyroidism).
Aneurysms are most commonly the result of:
Atherosclerotic disease
Atypical antidepressants
Atypical antidepressants. Bupropion (Wellbutrin) is the most common example. Appetite suppression is a common side-effect. Headache and dry mouth may be severe and client should notify the provider if this occurs. Atypical antidepressants should not be used with clients with seizure disorders.
◯ Client Education: ■ Avoid UV and sun exposure. ■ Use mild protein shampoo and avoid harsh hair treatments. ■ Use steroid creams for skin rash. ■ Report peripheral and periorbital edema promptly / signs of infection related to immunosuppression.
Avoid crowds and individuals who are sick, because illness can precipitate an exacerbation. ■ Educate client of childbearing age regarding risks of pregnancy with lupus and treatment medications.
Permanent pacemaker teaching: Follow activity restrictions as prescribed, including no contact sports or heavy lifting for 2 months.
Avoid direct blows or injury to the generator site. Resume sexual activity as desired, avoiding positions that put stress on the incision site.
Limit activities. Avoid tilting the head back to wash hair. Limit cooking and housekeeping.
Avoid rapid, jerky movements, such as vacuuming. Avoid driving and operating machinery. Avoid sports.
Nine-point Postpartum Assessment...BUBBLEHER
B- Breasts U- Uterus B- Bladder B- Bowel function L- Lochia E- Episiotomy H- Hemorrhoids E- Emotional Status R- Respiratory System
What are the five vital signs?
BP, Temp, Resp., Pulse, Pain
ALS - Medication : Riluzole (Rilutek) is a glutamate antagonist that can slow the deterioration of motor neurons by decreasing the release of glutamic acid
Baclofen (Lioresal), dantrolene sodium (Dantrium), diazepam (Valium) ■ Antispasmodics are used to decrease spasticity.
Hep B contraindication
Baker's yeast
Bathing Newborn technique
Bathe from cleanest to dirtiest -Eyes -Face -Head -Chest -Arms -Legs -Groin (last)
The PR interval represents the time it takes an electrical impulse to:
Be conducted through the atria and the AV node
You are treating a patient who has a damaged SA node that is no longer pacing the heart. You would expect the patient's heart to:
Beat more slowly
Appropriate nursing response to the patient's complaint of pain?
Believe what the patient says
Isoproterenol raises the heart rate by functioning as a:
Beta agonist
Timolol (Timoptic - ophthalmic solution) and acetazolamide (Diamox - oral medication)
Beta-blockers (timolol) and carbonic anhydrase inhibitors (acetazolamide) decrease IOP by reducing aqueous humor production.
A bone marrow
Biopsy is commonly performed to diagnose causes of blood disorders, such as anemia or thrombocytopenia, or to rule-out diseases, such as leukemia and other cancers, and infection
Bipolar disorders
Bipolar disorders are mood disorders with periods of depression and mania. Clients have a high risk for injury during the manic phase related to decreased sleep, feelings of grandiosity and impulsivity. Hospitalization is often required and nurses should provide for client safety.
Assessment: Decreased visual acuity (prescription changes, reduced night vision)
Blurred vision; Diplopia - double vision Glare and light sensitivity - photo sensitivity; Halo around lights
Profile of the patient with polycythemia Vera: nature of the condition, how the patient appears?
Bone marrow abnormality, excessive production of RBC, WBC and platelets Looks erythemic.
Priority for Panic Disorder
Breathing Technique
Bronchodilators
Bronchodilators are used to treat the symptoms of asthma that result from inflammation of the bronchial passages, but they do not treat the inflammation. Therefore, most clients with asthma take an inhaled glucocorticoid concurrently to provide the best outcomes. The two most common classes of bronchodilators are beta2-adrenergicagonists and methylxanthines. Beta2-adrenergic agonists : act upon the beta2-receptors in the bronchial smooth muscle to provide bronchodilation and relieve spasm of the bronchial tubes, inhibit release of histamines and increase motility of bronchial cilia. These short-acting preparations provide short-term relief during an asthma exacerbation, while the long-acting preparations provide long-term control of asthma symptoms. The generic names for the inhaled form of these drugs end in"terol" = " T aking E ases R espiratory distress o r L abored breathing" · Albu terol (Proventil, Ventolin) · Formo terol (Foradil Aerolizer) · Salme terol (Serevent) The brand names of some drugs in this class provide a hint as well because they contain the words "vent " or " breth " referring to ventilation or breathing: · Albuterol (Pro vent il, Vent olin) · Salmeterol (Sere vent ) · Terbutaline ( Breth ine) Nursing interventions and client education: · Short-acting inhaled preparations of albuterol (Proventil, Ventolin) can cause systemic effects of tachycardia, angina, and tremors. · Monitor client's pulse rate before, during, and after nebulizer or inhaler treatments · Long-acting inhaled preparations can increase the risk of severe asthma or asthma-related death if used incorrectly—mainly if used without concurrent inhaled glucocorticoid use · Oral preparations can cause angina pectoris or tachydysrhythmias with excessive use · Instruct clients to report chest pain or changes in heart rate/rhythm to primary care provider · Client should be taught proper procedure when using metered dose inhaler (MDI) and spacer · If taking beta2-agonist and inhaled glucocorticoid concurrently, take the beta2-agonist first to promote bronchodilation which will enhance absorption of the glucocorticoid · Advise client not to exceed prescribed doses · Advise client to observe for signs of impending asthma attacks and keep log of frequency and intensity of attacks · Instruct to notify primary care provider if there is an increase in frequency or intensity of asthma attacks Methylxanthines: cause bronchial smooth muscle relaxation resulting in bronchodilation. Theophylline (Theolair) is the prototype medication and is used for long-term control of chronic asthma Nursing interventions: · Monitor serum levels for toxicity at levels >20 mcg/mL · Mild toxicity can cause GI distress and restlessness · Moderate to severe toxicity can cause dysrhythmias and seizures · Educated client regarding potential medication and food interactions that can affect serum theophylline levels · Caffeine, cimetidine (Tagamet), and ciprofloxacin (Cipro) can increase levels · Phenobarbital and phenytoin can decrease levels
The AV junction is formed by the AV node and the:
Bundle of His
Subjective Data: SLE ◯ Fatigue/malaise ◯ Alopecia ◯ Blurred vision ◯ Malaise ◯ Pleuritic pain ◯ Anorexia/weight loss ◯ Depression ◯ Joint pain, swelling, tenderness
Butterfly Rash › Raynaud's Syndrome
You are transporting a patient to a cardiac center after a suspected myocardial infarction. The patient's vital signs are stable. ECG shows sinus rhythm with elevated ST segments. When you analyze the ECG, ST segment elevation is determined when the ST segment is elevated:
By more than 1.0 mV in at least two leads
Cane Walking
C-cane O-opposite A-affected L-leg
Cancer antigen important in the diagnosis of gynecologic cancer?
CA-125
Laboratory finding that indicates progression for HIV infection to the onset of AIDS?
CD4 count less than or equal to 200
lidocaine complications
CNS effects, give phenytoin to control seizures, respiratory arrest: contraindicated in stokes-adams, wolf-parkinson syndrome, severe heart block, liver and renal dysfunction, sinus bradycardia and heart failure
Contact precautions
CONTACT: "MRS WEE" -MRSA -RSV -Skin infections (herpes zoster, cutaneous diphtheria, impetigo, pediculosis, scabies, and staph) -Wound infections -Enteric infections (C-Diff) -Eye infections (conjunctivitis) Management: gown, gloves, goggles, private room VRSA - contact and airborne precautions (private room, door closed, negative pressure) -A private room or a room with other clients with the same infection. -Gloves and gowns worn by the caregivers and visitors.
Be ready to administer ____ for Magnesium sulfate toxicity
Calcium gluconate
Deep and symmetrically inverted T waves may be indicative of:
Cardiac ischemia
The group of nerves that innervates the atria and ventricles is known as the:
Cardiac plexus
Blindness is a potential consequence of undiagnosed and untreated glaucoma. Encourage adults 40 or older to have an annual examination, including a measurement of IOP.
Care after Discharge: Set up services such as community outreach programs, meals on wheels, and services for the blind.
Characteristics and functions of hemoglobin with reference to oxygen and carbon dioxide?
Carries oxygen from the lungs to the cells and Carbon Dioxide carries away from the cells to the lungs.
Permanent pacemaker discharge teaching Permanent pacemaker teaching:
Carry a pacemaker identification card at all times.
macular degeneration
Central loss of vision
Cervical Tongs
Cervical tongs are applied after drilling holes in the client's skull under local anesthesia. Weights are attached to the tongs, which exert pulling pressure on the longitudinal axis of the cervical spine. Serial x-rays of the cervical spine are taken, with weights being added gradually until the x-ray reveals that the vertebral column is realigned. After that, weights may be reduced gradually to a point that maintains alignment. The client with cervical tongs is placed on a Stryker frame or Roto-Rest bed. The nurse ensures that weights hang freely, and the amount of weight matches the current prescription. The nurse also inspects the integrity and position of the ropes and pulleys. The nurse does not remove the weights to administer care.
Cancer Early Warning Signs: CAUTION UP
Change in bowel or bladder A lesion that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty swallowing Obvious changes in wart or mole Nagging cough or persistent hoarseness Unexplained weight loss Pernicious Anemia
89% oxygen postoperative: what to do...
Change oxygen to another finger
What to do before bolus feeding or administration of medication
Check for residuals (60 mL syringe)
Cholecystitis
Cholecystitis is characterized by inflammation of the gallbladder. The gallbladder stores and releases bile that aids in the digestion of fats. Fat intake should be limited to reduce stimulation of the gallbladder. Other foods that may cause problems include coffee, broccoli, cauliflower, Brussels sprouts, cabbage, onions, legumes, and highly seasoned foods. Otherwise, the diet is individualized to the client's needs and tolerance.
Common disease's manifestations
Cholecystitis--> Murphy's sign Pancreatitis--> Turner's sign Peptic Ulcer Disease--> Upper epigastric pain 1-2 hours after meals Appendicits--> Pain at McBurney's point
CHOLINERGIC CRISIS: Overmedication Muscle twitching to the point of respiratory muscle weakness - mechanical ventilation › Cholinergic manifestations - hypersecretions (nausea, diarrhea, respiratory secretions) and hypermotility (abdominal cramps)
Cholinergic manifestations - hypersecretions (nausea, diarrhea, respiratory secretions) and hypermotility (abdominal cramps)
Blood Transfusion - Potential Complications
Circulatory overload: Administer oxygen. Monitor vital signs. Slow the infusion rate. Administer diuretics as prescribed. Notify the provider immediately
Teaching for a patient who will do daily dressing changes at home?
Clean from least sterile to most sterile, hand hygiene, keep sterile technique, teach signs of infection (pus, dead skin cells, erythema, inflammation, heat
Apply local anesthetic to skin if indicated. Palpate skin to locate the port body septum to ensure proper insertion of the needle
Clean the skin with alcohol for at least 3. Apply local anesthetic to skin if indicated. Palpate skin to locate the port body septum to ensure proper insertion of the needle. seconds and allow to dry prior to insertion of the needle. Access with a noncoring (Huber) needle.
Complications: Infection; Bleeding: Bleeding is a potential risk several days following surgery.
Client Education Clients should immediately report any sudden change in visual acuity or an increase in pain.
Postoperative - Client Education: Wear sunglasses while outside or in brightly lit areas. Report signs of infection:
Client should report include yellow or green drainage, increased redness or pain, reduction in visual acuity, increased tear production, and photophobia.
Laser trabeculectomy - Post OP Clients should not lie on the operative side and should report severe pain or nausea , possible hemorrhage.
Clients should report if any changes occur, such as lid swelling, decreased vision, bleeding or discharge, a sharp, sudden pain in the eye and/or flashes of light or floating shapes.
Shock Signs and Symptoms: CHORD ITEM
Cold, clammy skin Hypotension Oliguria Rapid, shallow breathing Drowsiness, confusion Irritability Tachycardia Elevated or reduced central venous pressure Multi-organ damage
For Insuline Overdose
Common medication for insulin overdose: Gluc agon (see the form of glucose in the drug name?) Glucagon (or glucose) is needed to increase blood glucose or blood sugar.
Special assessment required for a patient after a gastrectom?
Concerned about pernicious anemia (vitamin B12 taken in form of ability to metabolize which is injection or sublingual) and dumping syndrome (rapid gastric emptying)
Hypothyroidism
Condition in which there is an inadequate amount of circulating thyroid hormones triiodothyronine (T3) and thyroxine (T4), causing a decrease in metabolic rate that affects all body systems.
You are transporting a patient to a cardiac center after a suspected myocardial infarction. The patient's vital signs are stable. ECG shows sinus rhythm with elevated ST segments. The ST segment is elevated because the damaged muscle is:
Constantly depolarized
Dealing with Constipation
Constipation is difficult or infrequent passage of stools, which may be hard and dry. Causes include: irregular bowel habits, psychogenic factors, inactivity, chronic laxative use or abuse, obstruction, medications, and inadequate consumption of fiber and fluid. Encouraging exercise and a diet high in fiber and promoting adequate fluid intake may help alleviate symptoms.
Nursing Care for Mastitis
Continue breastfeeding and take antibiotics as prescribed.
Routine of offering post-operative analgesia to a patient in her second post-op day?
Continue with every 4 hours around the clock
Hypocalcaemia Signs and Symptoms: CATS
Convulsions Arrhythmias Tetany Stridor and spasms
pediatric chloride level
Cord --> 96-104 Newborn --> 97-110 Child --> 98-106
What is most likely to happen during variable deceleration?
Cord compression
Prinzmetal angina occurs when:
Coronary arteries spasm
Hypertension Complications: The 4 C's
Coronary artery disease (CAD) Congestive heart failure (CHF) Chronic renal failure (CRF) Cardiovascular accident (CVA): Brain attack or stroke
The right atrium receives blood from the systemic circulation and the:
Coronary veins
Varicella contraindication
Corticosteroids
Hypothyroidism is also classified by age of onset.
Cretinism - Cretinism is a state of severe hypothyroidism found in infants. When infants do not produce normal amounts of thyroid hormones, central nervous system development and skeletal maturation are altered, resulting in retardation of cognitive development, physical growth, or both.
Cleft lip: nursing care plan (postoperative)—"CLEFT LIP"
Crying, minimize Logan bow Elbow restraints Feed with Brecht feeder Teach feeding techniques; two months of age (average age at repair) Liquid (sterile water), rinse after feeding Impaired feeding (no sucking) Position—never on abdomen
Droplet precautions
DROPLET: "SPIDERMAn" -Sepsis -Scarlet Fever -Strep -Pertussis -Pneumonia -Parvovirus -Influenza -Diphtheria -Epiglottitis -Rubella -Mumps -Adenovirus Management: Private room/mask -A private room a rom with other clients with the same infectious disease. -Masks for providers and visitors
Immunization: booster every 10 years
DTP
Hypertension Care: DIURETIC
Daily weight Intake and Output Urine output Response of blood pressure Electrolytes Take pulse Ischemic episodes or TIAs Complications: CVA, CAD, CHR, CRF
adenosine
Decrease electrical conduction through AV node used w/ Paroxysmal SVT, Wolff-Parkinson-White syndrome
digoxin
Decrease electrical conduction through AV node, Increase myocardial contraction used w/ H, atrial fibrillation and flutter, paroxysmal SVT
class IV meds: verapamil, diltiazem
Decrease force of contraction, Decrease heart rate, Slow rate of conduction through the SA and AV nodes: Atrial fibrillation and flutter, SVT, Hypertension, Angina pectoris
What to do when pt complains of cramping during tube feeding?
Decrease infusion rate
class III meds: Amiodarone, Dofetilide, Ibutilide, Sotalol
Decrease rate of repolarization, Decrease electrical conduction, Decrease contractility, Decrease automaticity: used w/ Conversion of atrial fibrillation -oral route, Recurrent ventricular fibrillation, Recurrent ventricular tachycardia
Addison's disease
Decreased aldosterone and renin
Signs and symptoms of the sudden development of a pneumothorax?
Decreased breath sounds, air hunger (gasping), unequal rise and fall of the chest
Urine Specific Normal Values and Significance
Decreased hypervolemia. Increased hypovolemia. 1.001-1.029
Objective Data: Physical Assessment Findings; Impaired respiratory status (difficulty managing secretions, decreased respiratory effort); Decreased swallowing ability
Decreased muscle strength, especially of the face, eyes, and proximal portion of major muscle groups Incontinence Drooping eyelids - unilateral or bilateral
Hypothyroidism
Decreased triiodothyronine (T3) and thyroxine
Diabetes Insipidus (DI)
Decreased urine specific gravity
An increase in peripheral vascular resistance:
Decreases stroke volume
Acetylcholine affects the heart by:
Decreasing heart rate
Nursing measures to assist a patient to prevent post-operative pulmonary complications?
Deep breathing, coughing, incentive spirometer
You are called to the local airport to evaluate a 40-year-old obese woman who is complaining of pain in her left lower leg. She has just completed a 12-hour flight, and the pain developed as she got off the plane. Her leg is warm, swollen, and painful. You suspect:
Deep-vein thrombosis
If the paddle positions are switched (if the apex paddle is applied to the sternum and the sternum paddle to the apex) during defibrillation:
Defibrillation will occur as usual
Teaching a patient about her newly diagnosed osteoarthritis?
Degenerative disorder, exercise must be joint sparing (swimming)
Transient incontinence Causes: DIAPERS
Delirium Infection Atrophic urethra Pharmaceuticals and psychological Excess urine output Restricted mobility Stool impaction
Contraindication During Alcohol Withdrawal
Delirium, accompanied by hallucinations.
The three characteristics of Wolff-Parkinson-White syndrome are a short PR interval, QRS widening, and a(n):
Delta wave
Patient education regarding the use of condoms in the prevention of sexually acquired diseases?
Demonstrate how to use and give them information
Relaxation of the heart is referred to as:
Diastole
Chronic renal failure
Diet: low-protein, low-potassium, and high-carbohydrate, as well as low-sodium and low-phosphate
Digoxin - Take apical pulse for 1 min, and monitor laboratory levels for signs of toxicity.
Digoxin - Instruct the client not to take medication within 2 hr of eating, and teach client how to take an apical pulse for 1 min.
Nursing diagnosis for the patient who has experienced surgery for cancer involving the removal of breast, limb, or surgery that results in an ileostomy or a colostomy. How best to address this concern?
Disturbed body image related to surgical removals
IV mannitol (Osmitrol) ■ IV mannitol is an osmotic
Diuretic used in the emergency treatment for angle-closure glaucoma to quickly decrease IOP.
Crutch walking
Do not alter after crutches after fitting Support body weight at the hand grips, with elbows flexed at 30 degrees, position the crutches on the unaffected side when sitting or rising from a chair.
Teaching a patient about lifestyle changes to assist the patient with the management of GRED (Gastroesophageal Reflux Disease).
Do not each 3 hours before bed, sit two hours after meals, small frequent meals, reduce intake of caffeine and alcohol preferably to zero
Client Education: Advise the client that the effects of the therapy may not be evident for 6 to 8 weeks. Advise the client to take medication as directed. Advise female clients to avoid becoming pregnant for 6 months.
Do not use same toilet as others for 2 weeks, sit down to urinate, and flush toilet three times. Take a laxative 2 to 3 days after treatment to rid the body of stool contaminated with radiation.
A drug that may improve the symptoms of cardiogenic shock patients in the field is:
Dopamine
Characteristics of tuberculosis including it mode of transmission and infective potential?
Droplet nuclei, isolation, negative pressure, spores forming phase, not highly contagious but you should take appropriate precautions
What is wrong with the script? gentamicin 50 mg po every 4 hours #30
Drug name: Gentamicin (capital G)
Hypothyroidism: - Late findings: Bradycardia, hypotension, dysrhythmias; Slow thought process and speech; Hypoventilation, pleural effusion Thickening of the skin; Thinning of hair on the eyebrows;
Dry, flaky skin; Swelling in face, hands, and feet (myxedema [non-pitting, mucinous edema]); Decreased acuity of taste and smell; Hoarse, raspy speech; Abnormal menstrual periods (menorrhagia/amenorrhea) and decreased libido;
Variant angina (Prinzmetal's angina)
Due to a coronary artery spasm, oftening occurring during periods of rest.
Dumping Syndrome
Dumping Syndrome occurs as a complication of gastric surgeries that inhibit the ability of the pyloric sphincter to control the movement of food into the small intestine. This "dumping" results in nausea, distention, cramping pains, and diarrhea within 15 min after eating. Weakness, dizziness, a rapid heartbeat, and hypoglycemia may occur. Small, frequent meals are indicated. Consumption of protein and fat at each meal is indicated. Avoid concentrated sugars. Restrict lactose intake. Consume liquids 1 hr before or after eating instead of with meals (a dry diet)
Dealing with Dysphagia:
Dysphagia is an alteration in the client's ability to swallow. Causes include: Obstruction Inflammation Edema Certain neurological disorders Modifying the texture of foods and the consistency of liquids may enable the client to achieve proper nutrition. Clients with dysphagia are at an increased risk of aspiration. Place the client in an upright or high-Fowler's position to facilitate swallowing. Provide oral care prior to eating to enhance the client's sense of taste. Allow adequate time for eating, utilize adaptive eating devices, and encourage small bites and thorough chewing. Avoid thin liquids and sticky foods.
Measures to encouraging peristalsis in a post-operative patient?
Early ambulation
Hypothyroidism - S/S: Early findings; Fatigue, lethargy, irritabilily Intolerance to cold Constipation ; Weight gain without an increase; in caloric intake; Pale skin; Thin, brittle fingernails; Depression; Thinning hair; Joint and/or muscle pain;
Early findings Fatigue, lethargy, irritabilily Intolerance to cold Constipation Weight gain without an increase in caloric intake Pale skin Thin, brittle fingernails Depression Thinning hair Joint and/or muscle pain
Phase I of the action potential represents the period of:
Early rapid repolarization
The ST segment reflects the:
Early repolarization of the ventricles
CataractsTeach clients to wear sunglasses while outside.
Educate clients to wear protective eyewear while performing hazardous activities, such as welding and yard work. Encourage annual eye examinations and good eye health, in adults > 40 yr.
Therapeutic communication to reassure a patient who is about to undergo surgery?
Educate them about nursing care postoperatively. Monitor closely, give pain medications
Characteristics of Transcutaneous Electric Nerve Stimulation?
Electrical current that is attached to your body that stimulates a nerve locally that blocks transmission of pain sensation using gate theory
Anorexia Nervosa
Electrolytes increasing: Sodium, Potassium, Chloride, BUN, Liver function, Cholesterol.
Cushing's disease
Elevated cortisol
Diabetes melitus
Elevated glycosylated hemoglobin (HbA1c)
ASTHMA- Encourage the client to drink plenty of fluids to promote hydration. Encourage the client to take prednisone with food. Advise client to use this medication to prevent asthma, not for the onset of an attack.
Encourage client to avoid persons with respiratory infections. Use good mouth care. Do not stop the use of this type of medication suddenly.
Apply a lubricating eye drop during the day and ointment at night if the client is unable to completely close his eyes. The client may also need to patch or tape his eyes shut at night to prevent damage to the cornea.
Encourage the client to wear a medical identification wristband or necklace at all times. Administer medications as prescribed and at specified times
End Stage Renal Disease (ESRD):
End Stage Renal Disease (ESRD): ESRD, or chronic renal failure, occurs when the glomerular filtration rate (GFR) is less than 25 mL/min, the serum creatinine level steadily rises, or dialysis or transplantation is required. The goal of nutritional therapy is to maintain appropriate fluid status, blood pressure, and blood chemistries. A high-protein, low-phosphorus, low-potassium, low-sodium, fluid restricted diet is recommended. Calcium and vitamin D are nutrients of concern. Protein needs increase once dialysis is begun because protein and amino acids are lost in the dialysate. Fifty percent of protein intake should come from biologic sources (eggs, milk, meat, fish, poultry, soy). Adequate calories (35 cal/kg of body weight) should be consumed to maintain body protein stores. Phosphorus must be restricted. The high protein requirement leads to an increase in phosphorus intake. Phosphate binders must be taken with all meals and snacks. Vitamin D deficiency occurs because the kidneys are unable to convert it to its active form. This alters the metabolism of calcium, phosphorus, and magnesium and leads to hyperphosphatemia, hypocalcemia, and hypermagnesemia. Calcium supplements will likely be required because foods high in phosphorus (which are restricted) are also high in calcium. Potassium intake is dependent upon the client's laboratory values, which should be closely monitored. Sodium and fluid allowances are determined by blood pressure, weight, serum electrolyte levels, and urine output. Achieving a well-balanced diet based on the above guidelines is a difficult task. The National Renal Diet provides clients with a list of appropriate food choices.
A compensatory mechanism of the heart in the presence of chronic hypertension is to:
Enlarge the muscle mass of the heart
Venturi Mask
Ensure reservoir bag 2/3 full during inspiration and expiration.
Non-Rebreather Mask
Ensure two "flaps" open during exhalation/close during inhalation.
Emergency medication for a patient experiencing an anaphylactic reaction?
Epinephrine
Epoetin alfa - Instruct the client about having blood tests twice a week and how to take blood pressure.
Epoetin alfa - Administer by subcutaneous route, and monitor for hypertension.
Atrial Fibrillation Etiology/Causes
Etiology: -Advanced Age -Valve Disorders -cardiomyopathy Causes: -chocolate (theobromine-stimulant) -sleep apnea -athletes -tall athletes -aging heart -men more than women
Sinus Tachycardia Etiology/Clinical Signs
Etiology: -Physiologic demand for oxygen -Sympathomimetric Drugs -Fever -Pain Clinical Signs: -increased HR; increased oxygen demand
Atrial Flutter Etiology/ Clinical Signs
Etiology: -occurs w/ heart disease -CAD -Valve Disorders Clinical Signs: -may cause thrombus -"saw tooth" -250-400 bpm
Sinus Bradycardia Etiology/Clinical Signs
Etiology: -response to myocardial ischemia -vagal stimulation -electrolyte imbalance -drugs -increased intracranial pressure -highly trained athlete Clinical Signs: -decreased CO if body can't compensate; improved CO due to diastolic filling time
Terminal Phase
Evaluation (evaluate goals, experience, feelings)
Frequency of nursing assessments for new post-operative patients?
Every 15 minutes x4 Every 30 minutes x4 Every hour x4
Priority nursing problems for a patient with a new ileostomy?
Excoriation of skin (impaired skin integrity) , disturbed body image
Exenatide is prescribed along with an oral antidiabetic medication, such as metformin or a sulfonylurea medication, for clients who have type 2 diabetes mellitus to improve diabetes control.
Exenatide improves insulin secretion by the pancreas, decreases secretion of glucagon, and slows gastric emptying
Angina Precipitating Factors: 4 E's
Exertion: physical activity and exercise Eating Emotional distress Extreme temperatures: hot or cold weather
The resting membrane potential is determined primarily by the difference between the intracellular potassium ion level and the
Extracellular potassium ion level
3rd Degree Heart Block Signs & Symptoms
Extreme Dizziness, Hypotension, Syncope, Decrease CO, Altered Mental Status
Stroke Signs: FAST
Face Arms Speech Time
Vagal maneuvers for SVT include:
Facial immersion in ice water
The most common cause of death following myocardial infarction is:
Fatal dysrhythmia
Ferrous sulfate - Instruct the client to take medication with food and that stools will be dark in color.
Ferrous sulfate - Administer following dialysis and with a stool softener
What is most likely to happen during early deceleration?
Fetal Head Compression
Drawing up Insulin? Regular vs. NPH
First Regular (clear), then NPH (cloudy)
Pacemaker
Fixed rate (asynchronous) - Fires at a constant rate without regard for the heart's electrical activity.
Appropriate nursing measures to prevent/treat constipation?
Fluids, high fiber, DSS (Colace), stool softeners
Letting go phase
Focuses on family and individual roles
Permanent pacemaker teaching: Report signs of dizziness, fainting, fatigue, weakness, chest pain, hiccupping, or palpitations.
For clients with pacemaker-defibrillators, when the device delivers a shock, anyone touching the client will feel a slight electrical impulse, but the impulse will not harm the person.
violent clients
For the aggressive or violent client, setting boundaries and limits on behavior are important. The nurse should maintain a calm approach and use short, simple sentences.
Characteristics of the spleen including its location in the body?
Found in the left upper quadrant. Serves a reservoir for blood (up to 500 cc), forms lymphocytes monocytes and plasma cells, destroys worn out RBC, removes bacteria from phagocytosis.
Stage III pressure ulcer
Full-thickness tissue loss with damage to or necrosis of subcutaneous tissue. The ulcer may extend down to, but not through, underlying fascia. The ulcer appears as a deep crater with or without undermining of adjacent tissue and without exposed muscle or bone. Drainage and infection are common.
Stage IV pressure ulcer
Full-thickness tissue loss with destruction, tissue necrosis, or damage to muscle, bone, or supporting structures. There may be sinus tracts, deep pockets of infection, tunneling, undermining, eschar (black scab-like material), or slough (tan, yellow, or green scab-like material)
Furosemide - Monitor intake and output and blood pressure.
Furosemide - Instruct the client to weigh self each morning and to notify provider of light - headedness, excess thirst, and unusual coughing
Gastroesophageal Reflux Disease (GERD)
GERD leads to indigestion and heartburn from the backflow of acidic gastric juices onto the mucosa of the lower esophagus. Encourage weight loss for overweight clients. Avoid large meals and bedtime snacks. Avoid trigger foods such as citrus fruits and juices, spicy foods, and carbonated beverages. Avoid items that reduce lower esophageal sphincter (LES) pressure, such as alcohol, caffeine, chocolate, fatty foods, peppermint and spearmint flavors and cigarette smoking.
fibrates: gemfibrozil, fenofibrate: increase HDL
GI distress, gallstones, myopathy, heaptotoxicity, increases risk of bleeding w/ warfarin, use w/ statins increase myopathy
Nicotinic acid, niacin: lower LDL, raise HDL
GI distress- take w/ food, facial flushing- take aspirin 30 minutes before each dose, hyperglycemia, hepatotoxicity, hyperuricemia,
good nurse sets these when she works
GOALS
The four types of anesthesia. When and how are they administered?
General(IV immediately before surgery), regional(epidural or spinal) conscious sedation(30 minutes prior to procedure) local(immediately before procedure)
Long-acting insulin Glargine insulin (Lantus) Administered once daily, anytime during the day but always at the same time each day.
Glargine insulin forms microprecipitates that dissolves slowly over 24 hr and maintains a steady blood sugar level with no peaks or troughs.
Favored alternative supplement for patient with a chronic musculoskeletal disorder?
Glucosamine
Antigout Medications - What is gout?
Gout is a type of arthritis. In healthy people the body breaks down dietary purines and produces uric acid. The uric acid dissolves and is excreted via the kidneys. In individuals affected with gout the body either produces too much uric acid or is unable to excrete enough uric acid and it builds up. High uric acid levels results in urate crystals which can now collect in joints or tissues. This causes severe pain, inflammation and swelling. Treatment is both lifestyle adjustment and medication. Medications First Line: NSAIDs and prednisone (Deltasone) Purpose: Used as a first line defense to treat the pain and inflammation of gout attacks. Colchicine (Colgout): Purpose: Treat the inflammation and pain associated with gout. Just like NSAIDs, these meds can lead to GI distress and should be taken with foods. HINT: The word gout is right in the name Colgout. Allopurinol (Zyloprim): Purpose: This is the only medical preventative treatment for gout. Allopurinal prevents uric acid production. This can be an effective means of preventing gout attacks when diet alone is not effective. HINT: Examine the name allopurinol and you can see the word PURINE in the middle of the name. Note: There are many drug and food interactions associated with allopurinol: Potential serious interactions with the use of saliscylates, loop diuretics, phenylbutazamines and alcohol and potential for drug interactions with Warfarin (Coumadin). Teach client with gout to avoid the following: · Anchovies, sardine in oil, fish roe, herring · Yeast · Organ meat (liver, kidneys, sweetbreads) · Legumes (dried beans and peas) · Meathextracts (gravies and consommé) · Mushrooms, spinach, asparagus, cauliflower
Patient teaching about how a patient who has been receiving opioids for a few months should discontinue the medication.
Gradually drop the dose so the patient does not go through withdrawals
Obstetric (maternity) history—"GTPAL"
Gravida Term Preterm Abortions (SAB, TAB) Living children
contraindication w/oral contraceptives
HTN
You are transporting a patient to a cardiac center after a suspected myocardial infarction. The patient's vital signs are stable. ECG shows sinus rhythm with elevated ST segments. Fibrinolytic therapy is contraindicated for this patient if he:
Had laser eye surgery 3 weeks ago
Ideal location for drainage bag of catheters
Hang on bedframe below level of the bladder.
While assessing a patient you identify a carotid bruit. This leads you to believe that the patient:
Has atherosclerosis
How does atropine affect the ventricular rate of third-degree heart block?
Has no effect on the rate
MG - Atropine
Have atropine available, which is the antidote for edrophonium (bradycardia, sweating, and abdominal cramps).
Provide small, frequent, high-calorie meals and schedule at times when medication is peaking.
Have the client sit upright when eating, and use thickener in liquids as necessary.
A patient asks you about his risk of cardiovascular disease. He is 50-years old and has diabetes, is overweight and smokes cigarettes. You advise him that:
He can modify his risk for cardiovascular disease by losing weight and not smoking
Avoid activities that increase IOP. Bending over at the waist Sneezing; Coughing; Straining;
Head hyperflexion; Restrictive clothing, such as tight shirt collars; Sexual intercourse
Normal Sinus Rhythm
Heart Rate: 60-100 bpm Regularity: Regular PRI: .12-.20 seconds QRS: <.12 seconds
Normal Sinus Arrhythmia
Heart Rate: 60-100 bpm; can be <60 Regularity: Irregular PRI: .12-.20 seconds QRS: <.12 seconds
Normal Sinus Bradycardia
Heart Rate: <60 bpm Regularity: Regular PRI: .12-.20 seconds QRS: <.12 seconds
Normal Sinus Tachycardia
Heart Rate: >100 bpm Regularity: Regular PRI: .12-.20 seconds QRS: <.12 seconds
Premature Atrial Contraction (PAC)
Heart Rate: Depends on underlying rhythm Regularity: Interrupts the regularity of underlying rhythm P-Wave: can be flattened, notched, or unusual. May be hidden within the T wave PRI: measures between .12-.20 seconds and can be prolonged; can be different from other complexes QRS: <.12 seconds
Identification of bundle branch blocks is:
Helpful in identifying patients at risk for third-degree heart block
Complication of severe preeclampsia—"HELLP" syndrome
Hemolysis Elevated Liver enzymes Low Platelet count
Priority nursing concern for the patient with severely decreased platelet count?
Hemorrhage
Immunization is recommended for postexposure protection
Hep A (fecal route)
Most common types of hepatitis in the united states?
Hepatitis A
Hepatitis disease transmissions
Hepatitis A--> Ingestions o contaminated food/water Hepatitis B--> Unprotected sexual contact Nonviral Hepatits--> Drug toxicity
Restrictions on the use of digoxin?
Hold if the apical pulse is less than 60 bpm
Dementia Living Coordination
Home health Agency>Assisted Living>Nursing Home
How to splint a patient for deep breathing and coughing who has an incision in his lower left abdomen?
Hug a pillow over the whole low abdomen
DTAP contraindication
Hx of inconsolable crying
Interaction between SSRI (e.g. fluoxetine) and St. John's Worts
Hypertension and Increased HR; may be life-threatening.
Mild preeclampsia
Hypertension beginning after the 20th week of pregnancy with 1 to 2+ proteinuria and a weight gain of more than 2 kg per week in the second and third trimesters.
Gestational hypertension
Hypertension beginning after the 20th week of pregnancy with no proteinuria.
You are treating a patient with blood pressure of 200 over 140. The patient initially complained of headache and nausea. During your 3-hour transport, the patient began to seize and is now unresponsive to any stimulus. You suspect the patient has:
Hypertensive encephalopathy
Exenatide A/E: GI effects, such as nausea and vomiting Pancreatitis manifested by acute abdominal pain and possibly severe vomiting
Hypoglycemia, especially when taken concurrently with a sulfonylurea medication, such as glipizide
Cardiogenic shock is defined by shock symptoms after:
Hypovolemia and dysrhythmias have been corrected
Hallucination
I understand you are scared
Order of Assessment
I-inspection P-palpation P-percussion A-auscultation Except with abdomen it is IAPP-inspect, auscultate, percuss and palpate.
Angle-closure glaucoma - less common form of glaucoma.
IOP rises suddenly. With angle-closure glaucoma, the angle between the iris and the sclera suddenly closes, causing a corresponding increase in IOP.
Preferred route of administration of different types of pain relievers for different types of pain?
IV (opioid agonist), PO
Torsades De Pointes Treatment
IV Magnesium
never give K+ in
IV push or bolus
During the test, various radiolabeled allergens are exposed to the client's blood, and the amount of the client's immunoglobulin E (IgE) that is attracted to each specific allergen is measured according to standardized values.
If an allergen is not attracted, this is considered a negative result. If a client's IgE is attracted to an allergen, the amount is measure on a scale of 0 to 5, with the higher number indicating a higher level from sensitivity.
Asthma - Combination agents (bronchodilator and anti-inflammatory) Ipratropium and albuterol (Combivent) Fluticasone and salmeterol (Advair)
If prescribed separately for inhalation administration at the same time, administer the bronchodilator first in order to increase the absorption of the anti-inflammatory agent
Combination agents (bronchodilator and anti-inflammatory) Ipratropium and albuterol (Combivent) Fluticasone and salmeterol (Advair)
If prescribed separately for inhalation administration at the same time, administer the bronchodilator first in order to increase the absorption of the anti-inflammatory agent
How can one use an ECG to differentiate between supraventricular and ventricular tachycardia?
If the QRS complex is narrow (<3 small boxes) - SVT. If the QRS complex is wide (>3 small boxes) - VT.
Circumstances that could prevent from validly signing his informed consent document?
If the patient is sedated, major tranquilizers, major pain medication
First priority for the patient after completing barium swallow examination?
Immediate access to restroom
Best time to perform bladder scan.
Immediate after void
Medication - MS
Immunosuppressive agents such as azathioprine (Imuran) and cyclosporine (Sandimmune) - Long-term effects include increased risk for infection, hypertension, and kidney dysfunction.
Gestational diabetes mellitus
Impaired tolerance to glucose with the first onset or recognition during pregnancy
If you see the outline of a small box implanted under skin in the left upper abdomen, you would suspect the patient has a(n):
Implantable cardioverter-defibrillator
Synchronized cardioversion is acceptable for patients with ventricular tachycardia:
In all cases
Systemic lupus erythematosus (SLE) is an autoimmune disorder in which an atypical immune response results in chronic inflammation and destruction of healthy tissue.
In autoimmune disorders, small antigens may bond with healthy tissue. The body then produces antibodies that attack the healthy tissue. This may be triggered by toxins, medications, bacteria, and/or viruses.
Antagonists
In order to understand how antagonist drugs work, you need to understand how agonist drugs produce therapeutic effects. Agonists are simply drugs that allow the body's neurotransmitters, hormones, and other regulators to perform the jobs they are supposed to perform. Morphine sulfate, codeine, and meperidine (Demerol) are opioids agonists that act on the mu receptors to produce analgesia, respiratory depression, euphoria, and sedation. These drugs also work on kappa receptors, resulting in pain control, sedation and decreased GI motility. Antagonists, on the other hand, are drugs that prevent the body from performing a function that it would normally perform. To quote William Shakespeare & the US Army, these drug classes allow the body's functions "to be or not to be...all that they can be". Common uses of antagonists: · Treatment of opioids overdose, reversal of effects of opioids, or reversal of respiratory depression in an infant · Example: a post-operative client receiving morphine sulfate for pain control experiences respiratory depression and is treated with naloxone (Narcan) Nursing Interventions for antagonists: · Monitor for side/adverse effects · Tachycardia and tachypnea · Abstinence syndrome in clients who are physically dependent on opioids agonists · Monitor for symptoms to include cramping, hypertension, and vomiting · Administer naloxone by IV, IM or subcutaneous routes, not orally · Be prepared to address client's pain because naloxone will immediately stop the analgesia effect of the opioid the client had taken · When used for respiratory depression, monitor for return to normal respiratory rate (16-20/min for adults; 40-60/min for newborns)
Dissections of the aorta are typically found:
In the ascending aorta
missing birth control pills...
In the event of a client missing a dose the nurse should instruct the client that if one pill is missed to take as soon as possible. If two or three pills are missed the client should follow the manufacturer's instructions and use an alternative form of contraception.
Presentation
Includes cephalic, breech and shoulder.
To increase cardiac output, you can:
Increase both heart rate and stroke volume
First signs and symptoms of hemorrhage?
Increase pulse, increase respiration, decrease BP, pallor to ashy grey skin, decreased urine output, bright red blood, upper GI coffee ground emesis, lower GI black tarry stool
An undesirable side effect of atropine is:
Increased myocardial oxygen demand
Syndrome of Inappropriate Secretion of Antidiuretic Hormone
Increased urine osmolality
Nephrolithiasis (Kidney Stones)
Increasing fluid consumption is the primary intervention for the treatment and prevention of the formation of renal calculi. Excessive intake of protein, sodium, calcium, and oxalates (rhubarb, spinach, beets) may increase the risk of stone formation.
Implanted port :a 1 year or more. Description - Port is comprised of a small reservoir covered by a thick septum.
Indications - Long-term (a year or more) need for vascular access; commonly used for chemotherapy.
Peripherally inserted central catheter - PICC
Indications - administration of blood, long-term administration of chemotherapeutic agents, antibiotics, and total parenteral nutrition
Characteristics of the patient with agranulocytosis, including primary risk for the patient?
Infection
Leads II and III are:
Inferior leads
After you administer nitroglycerine 0.4 mg SL to a patient with chest pain who has ST-segment elevation in leads II, III and AVF, his blood pressure drops to 78/50 mmHg. You anticipated this side effect in this patient because his ECG changes indicate damage to the:
Inferior wall which increases the dependence on preload
You are transporting a patient to a cardiac center after a suspected myocardial infarction. The patient's vital signs are stable. ECG shows sinus rhythm with elevated ST segments. The patient's ST segment elevation is seen in leads II, III, and aVF, leading you to suspect:
Inferior-wall MI
Infiltration and Extravasation
Infiltration is fluid leaking into surrounding subcutaneous tissue, and extravasation is unintentional infiltration of a vesicant medication that causes tissue damage
Characteristics of Crohn's Disease?
Inflammation of segments of the GI tract, malabsorption, diarrhea frequently
An elevated ST segment suggests:
Injury
Vasodilators (nitroglycerin, sodium nitroprusside) decrease preload and afterload.
Inotropic agents, such as digoxin (Lanoxin) and dobutamine (Dobutrex), improve cardiac output.
Need for Sterile Gloves
Inserting Catheter
Tunneled percutaneous central catheter For long-term use. Indications - Frequent and long-term need for vascular access
Insertion location - A portion of the catheter lies in a subcutaneous tunnel separating the point where the catheter enters the vein from where it enters the skin with a cuff. Tissue granulates into the cuff to provide a mechanical barrier to organisms and an anchoring for the catheter.
Peripherally inserted central catheter Description - 40 to 65 cm with single or multiple lumens Length of use - up to 12 months
Insertion location - basilic or cephalic vein at least one finger's breadth below or above the antecubital fossa; the catheter should be advanced until the tip is positioned in the lower one-third of the superior vena cava.
Nontunneled percutaneous central catheter: Description - 15 to 20 cm in length with one to three lumens Length of use - short-term use only
Insertion location - subclavian vein, jugular vein; tip in the distal third of the superior venacava Indications - administration of blood, long-term administration of chemotherapeutic agents, antibiotics, and total parenteral nutrition
Insulin glargine
Insulin glargine, a long-acting insulin, does not have a peak effect time, but is fairly stable in effect after metabolized
Insulin lispro
Insulin lispro has a peak effect around 30 min to 2.5 hr following administration
Stage I pressure ulcer
Intact skin with an area of persistent, nonblanchable redness, typically over a bony prominence, that may feel warmer or cooler than the adjacent tissue. The tissue is swollen and has congestion, with possible discomfort at the site. With darker skin tones, the ulcer may appear blue or purple.
A bone marrow Pre Ensure that the client has signed the informed consent form. Position the client in a prone or side-lying position.
Intra Administer sedative medication. Assist with the procedure. Apply pressure to the biopsy site. Place a sterile dressing over the biopsy site.
Which of the following may cause sinus bradycardia?
Intrinsic sinus node disease
Orientation Phase
Introduce, Discuss confidentiality, Set goals
Ipratropium - Advise the client to suck on hard candies to help relieve dry mouth; increase fluid intake; and report headache, blurred vision, or palpitations, which may indicate toxicity of ipratropium.
Ipratropium - Observe the client for dry mouth. Monitor the client's heart rate
Chest pain associated with MI:
Is constant
Defibrillation of patients in asystole:
Is not recommended
Wolff-Parkinson-White syndrome is of little clinical importance unless the patient:
Is tachycardic
A depressed ST segment suggests:
Ischemia
T wave inversion suggests:
Ischemia
Uses and characteristics of conscious sedation?
It decompressed the central nervous system. Sedated sufficiently so that there is no anxiety, no apprehension of fear, and little or no pain
Myasthenia gravis (MG)
It is caused by antibodies that interfere with the transmission of acetylcholine at the neuromuscular junction
Myasthenia gravis (MG) is a progressive autoimmune disease that produces severe muscular weakness.
It is characterized by periods of exacerbation and remission. Muscle weakness improves with rest and worsens with increased activity.
An ECG strip shows a rhythm with a rate of 45, a QRS of 0.08, and a P wave that appears after the QRS. You suspect that this dysrhythmia is most likely:
Junctional
Nursing care for a patient with a radioactive implant?
Keep distance as much as possible, minimize time in room (implant does not make urine or stool radioactive)
Insulate pacemaker terminals and leads with nonconductive material when not in use (rubber gloves).
Keep spare generator, leads, and batteries at the client's bedside.
The organ(s) most at risk in a hypertensive crisis include the:
Kidneys
You are treating a patient with blood pressure of 200 over 140. The patient initially complained of headache and nausea. During your 3-hour transport, the patient began to seize and is now unresponsive to any stimulus. ment for this condition includes:
Labetalol
Diagnostic Procedures
Laboratory Tests: Cerebrospinal fluid analysis. Diagnostic Procedures: MRI of the brain and spine
Lactose intolerance
Lactose intolerance results from an inadequate supply of lactase, the enzyme that digests lactose. Symptoms include distention, cramps, flatus, and diarrhea. Clients should be encouraged to avoid or limit their intake of foods high in lactose such as: milk, sour cream, cheese, cream soups, coffee creamer, chocolate, ice cream, and puddings.
Gonioscopy ☐ Gonioscopy is used to determine the drainage angle of the anterior chamber of the eyes.
Laser trabeculectomy, iridotomy, or the placement of a shunt are procedures used to improve the flow of the aqueous humor by opening a channel out of the anterior chamber of the eye.
Lead I looks at the heart from what view?
Lateral
A lead used for routinely monitoring dysrhythmias is:
Lead II
Which of the following is a bipolar lead?
Lead II
The circumflex branch of the left coronary artery mainly supplies blood to the:
Left atrium
You are evaluating an ECG tracing that shows wide QRS complexes that were produced by supraventricular activity. On MCL1 you see a QS pattern. You suspect:
Left bundle-branch block
The circumflex artery is a branch of the:
Left coronary artery
In lead II ECG placement, the positive lead is located on the:
Left leg
The majority of acute myocardial infarctions involve the:
Left ventricle
Right ventricular failure most often results from:
Left ventricular failure
Lead Placement
Left: Smoke (Black) over Fire (Red) Right: Snow (White) over Grass (Green) Center: Chocolate (place a little off center for possible CPR)
Hypokalemia Signs and Symptoms: 6 L's
Lethargy Leg cramps Limp muscles Low, shallow respirations Lethal cardiac dysrhythmias Lots of urine (polyuria)
Leukopenia is a total WBC count of less than 4,500/mm3. It may indicate a compromised inflammatory response or viral infection.
Leukocytosis- WBC count of greater than 10,000/mm3. It may indicate an inflammatory response to a pathogen or a disease process
Vaginal discharge during early pregnancy
Leukorrhea
Common Thyroid Medications
Levo thyro xine (Syn thro id,Levo thro id) Lio thyro nien (Cytomel) Liotrix ( Thyro lar) Thyroid ( Thryoid USP)
Which of the following may be a lethal treatment for a patient with a ventricular escape rhythm?
Lidocaine
Nursing measures to assist the patient with comfort and pain control?
Lift patient, reposition patient, use other methods for pain before medication
Therapeutic communication between a nurse and a patient who is expressing that he does not think he will ever adjust to his new colostomy?
Listen, open needed questions, encourage to express feelings
An accessory organ of digestion, the largest glandular organ in the body?
Liver
Acarbose can cause liver toxicity when taken long-term.
Liver function tests should be monitored periodically while the client takes this medication
Open-angle galucoma
Loss of peripheral vision
Appropriate foods for the patient newly recovered from acute pancreatitis?
Low fat, high complex carbs
Interactions of adrenergic agonists
MAOIs with epi, TCAs with epi, general anesthetics w/ epi, alpha and beta adrengergic blockers and diuretics block dopamine
MAOIs
MAOIs: Monoamine Oxidase Inhibitors. Phenelzine (Nardil) is an example. Hypertensive crisis may occur with tyramine food ingestion, so care must be taken to avoid these substances. Educate the client to avoid all medications until discussed with provider.
Complications: ● Myasthenic crisis and cholinergic crisis; Myasthenic crisis occurs when the client is experiencing a stressor that causes an exacerbation of
MG, such as infection, or is taking inadequate amounts of cholinesterase inhibitor. Cholinergic crisis occurs when the client has taken too much cholinesterase inhibitor.
Blood Transfusion - Sepsis and septic shock
Maintain patent airway. Administer oxygen. Administer antibiotics as prescribed. Obtain blood samples for culture. Administer vasopressors in late phase. Elevate client's feet. Assess for disseminated intravascular coagulation.
POST -OP: Maintain the client's safety. Ensure that all electrical equipment has grounded connections. Remove any electrical equipment that is damaged.
Make sure all equipment is grounded with a three-pronged plug. Wear gloves when handling pacemaker leads.
1st Degree Heart Block Causes
May be normal variant; inferior wall MI; drugs: verapamil or digoxin
Amiodarone
May cause liver, lung damage, and worsening of arrhythmias. Pt to report SOB, wheezing, jaundice, palpitations, lightheadedness
Tensilon testing: Baseline assessment of the cranial muscle strength is done. Edrophonium (Tensilon) is administered
Medication inhibits the breakdown of acetylcholine, making it available for use at the neuromuscular junction.
Which of the following home medicines would indicate that your patient has a strong risk factor for heart disease?
Metformin
2nd Degree Heart Block Treatment
Monitor HR, Atropine, Temp Pacemaker, Avoid meds that decrease conductivity
Diabetic neuropathy Caused from damage to sensory nerve fibers resulting in numbness and pain. Is progressive, may affect every aspect of the body, and can lead to ischemia and infection.
Monitor blood glucose levels to keep within an acceptable range to slow progression. ■ Provide foot care.
Nursing Considerations:
Monitor liver function tests - hepatotoxic risk. Assess for dizziness, vertigo, and somnolence.
Nursing Care: ◯ Apply heat or cold to the affected areas as indicated based on client response. ■ Morning stiffness (hot shower) ■ Pain in hands/fingers (heated paraffin) ■ Edema (cold therapy)
Monitor the client for indications of fatigue. ◯ Teach the client measures to ■ Maximize functional activity ■ Minimize pain ■ Monitor skin closely ■ Conserve energy (space out activities, take rest periods, ask for additional assistance when needed) ■ Promote coping strategies ■ Encourage routine health screenings
1st Degree Heart Block Treatment
Monitor; Observe for symptoms
Congestive Heart Failure Treatment: MADD DOG
Morphine Aminophylline Digoxin Dopamine Diuretics Oxygen Gasses: Monitor arterial blood gasses
Rapid-acting diuretics, such as furosemide (Lasix) and bumetanide (Bumex), promote fluid excretion.
Morphine decreases sympathetic nervous system response and anxiety and promotes mild vasodilation.
Understanding Rh. Administration of antibody and time.
Mother Rh negative. Fetus Rh positive. Rhogam at 28 weeks, then 72 hrs after birth.
Signs of cardiac tamponade include:
Muffled heart tones
Laboratory Tests - Increased creatine kinase (CK-BB) level Diagnostic Procedures Electromyogram (EMG) - Reduction in number of functioning motor units of peripheral nerves
Muscle biopsy - Reduction in number of motor units of peripheral nerves and atrophic muscle fibers
Administration of IM analgesia to a patient before controlled deep breathing and coughing?
Must correctly demonstrate it back to you, give analgesia attest 30 minutes before exercises postoperatively
MYASTHENIC CRISIS Undermedication: Respiratory muscle weakness - mechanical ventilation
Myasthenic findings (weakness, incontinence, fatigue) › Hypertension; › Temporary decrease of findings with administration of Tensilon;
Stroke volume depends on preload, afterload, and:
Myocardial contractility
The Starling law states that:
Myocardial fibers contract more forcefully when they are stretched
NPH
NPH insulin has a peak effect around 6 to 14 hr following administration.
Patient teaching for a patient who is about to undergo an esophagogastroduedenoscopy?
NPO after midnight, down the esophagus into stomach and into duodenum. No pain during procedure. Will carefully monitor before food or drinks. Make sure gag reflexes are active
Sjögren's syndrome (triad of symptoms - dry eyes, dry mouth, and dry vagina) ◯ Caused by obstruction of secretory ducts and glands ■
NSG CARE: Provide the client with eye drops and artificial saliva, and recommend vaginal lubricants as needed. ■ Provide fluids with meals.
Electrolytes
Na - 136-145 K - 3.5-5 Ca - 9-10.5 Mg - 1.3-2.1 P - 3-4.5 Cl - 98-106
Used Opioid overdose
Naloxone (Narcan)
Narcotic antidote
Naloxone (narcan)
Medication to reverse the effects of an opiate?
Narcan
Characteristics of the electromyogram?
Needle electrode into the skeletal muscles so that electrical activity can be heard
A right axis shift of the ECG is noted when the QRS deflection is:
Negative in lead I, negative or positive in lead II, and positive in lead III
Nephrotic Syndrome
Nephrotic syndrome results in serum proteins leaking into the urine. The goals of nutritional therapy are to minimize edema, replace lost nutrients, and minimize permanent renal damage. Dietary recommendations indicate sufficient protein and low-sodium intake.
pediatric Glucose (Serum)
Newborn, 1 day --> 40 to 60 Newborn, > 1 day --> 50 to 90 Child --> 60 to 100
Asystole
No electrical activity; only a straight line
While evaluating a 22-year-old female runner who called 911 because she fell and twisted her ankle, you apply an ECG monitor. Her heart rate is 46, P waves are normal and upright, the PR interval is 0.16 second, and the QRS complex looks normal. There is a QRS complex following each P wave. Treatment for this patient's heart rate should include:
No treatment at this time
After delivering five shocks, an implantable cardioverter-defibrillator will:
Not deliver more shocks until a slower rate is restored for 30 seconds
Latex Allergies
Note that clients allergic to bananas, apricots, cherries, grapes, kiwis, passion fruit, avocados, chestnuts, tomatoes, and/or peaches may experience latex allergies as well.
Occlusion is a blockage in the access device that impedes flow.
Nursing Actions Flush the line at least every 12 hr (3 mL for peripheral, 10 mL for central lines) to maintain patency
Diabetic nephropathy Damage to the kidneys from prolonged elevated blood glucose levels and dehydration
Nursing Actions Monitor hydration and kidney function (I&O, serum creatinine). Report an hourly output of less than 30 mL/hr.
Complications: ALS: Respiratory failure may necessitate mechanical ventilation.
Nursing Actions - Assess respiratory status and be prepared to provide ventilatory support as needed per the client's advance directives.
Complications: ALS: Pneumonia can be caused by respiratory muscle weakness and paralysis contributing to ineffective airway exchange.
Nursing Actions - Assess respiratory status routinely and administer antimicrobial therapy as indicated.
Medications: ◯ NSAIDs ◯ Corticosteroids (prednisone [Deltasone]) ■ Immunosuppressant agents - methotrexate and azathioprine (Imuran) ■
Nursing Considerations - Monitor for fluid retention, hypertension, and renal dysfunction. ■ Client Education - Do not stop taking steroids or decrease the dose abruptly. ◯ Immunosuppressant agents - methotrexate and azathioprine (Imuran)
verapamil, diltiazem
OH and peripheral edema, constipation, cardiac suppression, dysrhtymias, acute toxicity , increase digoxin, don't use w/ beta blockers, avoid grapefruit juice
Therapeutic communication between the nurse and the spouse of a dying patient?
OPEN ENDED QUESTIONS, LISTEN
Junctional escape rhythms:
Occur when the SA node fails to fire
Stable angina
Occurs with exercise or emotional stress and is relieved by rest or nitroglycerin (Nitrostat).
Unstable angina
Occurs with exercise or emotional stress, but it increases in occurrence, severity, and duration over time.
Nursing education for a patient who is undergoing a stool test for ova and parasites?
Once a day for three consecutive days
Rapid-acting insulin Lispro insulin (Humalog), aspart insulin (Novolog), glulisine insulin (Apidra). Administer before meals to control postprandial rise in blood glucose.
Onset is rapid, 10 to 30 min depending on which insulin is administered. Administer in conjunction with intermediate- or long-acting insulin to provide glycemic control between meals and at night.
Opthalmic
Ophthalmic medications are drugs used for the eye. These medications are typically prescribed for clients who have Glaucoma, Macular Degeneration. Other ophthalmic medications are used to treat allergic conjunctivitis, inflammatory disorders, dyes to visualize the eye, and to treat infections or viruses. Beta-Adrenergic Blocking Agents Prescribed for clients who have open-angle glaucoma. These agents decrease the production of aqueous humor. Block beta 1and beta 2 receptors. Common Beta-Adrenergic Ophthalmic Blocking Agents: beta xolos ( Bet optic ) (see the form of beta in the drug names?) See optic in Betoptic? Opthalmic medication. levo beta xolol ( Beta xon) (see the form of beta in the drug names?) levobunolol ( Beta gan) (see the form of beta in the drug name?) timolol ( Bet imol) (see the form of beta in the drug name?) Prostaglandin Analogs First line treatment for glaucoma. Fewer side effects and just as effective as the beta-adrenergic Ophthalmic blocking agents. These drugs lower IOP by facilitating aqueous humor outflow by relaxing the ciliary muscle. Common Prostaglandin Analogs: latanoprost (Xal atan ) (see the suffix atan in this drug and the drug below, they are the same) Travoprost (trav atan ) (see the suffix atan in this drug and the drug above; they are the same) Alpha2-Adrenergic Agonists These drugs lower IOP by reducing aqueous humor production and by increasing outflow. Also delays optic nerve degeneration and protects retinal neurons from death. Common Alpha2-Adrenergic Agonists: Brimon idine (Alphagan) (see the similarities with idine in the name of the drug) Apraclon idine (Iop idine ) (see the similarities with idine in both of the names of the drug) Direct Acting Cholinergic Agonist/Muscarinic Agonist (parasympathomimetic agent) These drugs stimulate the cholinergic receptors in the eye, constricts the pupil (miosis), and contraction of the ciliary muscle. IOP is reduced by the tension generated by contracting the ciliary muscle and promotes widening of the spaces within the trabecular meshwork, thereby facilitating outflow of aqueous humor. Common Direct Acting Cholinergic Agonist Agents: Pilocarpine Key points of ophthalmic medications: · Cylo plegics are drugs that cause paralysis of the ciliary muscle...plegic-like paraplegic, paralysis · Mydriatics are drugs that dilate the pupil. · Drug therapy for glaucoma is directed at reducing elevated IOP, by increasing aqueous humor outflow or decreasing aqueous humor production. · Oculus Dexter: OD (right eye) · Oculus Sinister: OS (left eye) · Oculus Uterque: OU (both eyes) Remember BAD POCC: Ophthalmic Medication Classes for treatment of Glaucoma B -beta adrenergic blocking agents A -Alpha-Adrenergic Agonists D -Direct Acting Cholinergic Agonists P -Prostaglandin Analogs O -Osmotic Agents C -Carbonic Anhydrase Inhibitors C -Cholinesterase Inhibitor; An indirect acting Cholinergic Agonist Remember BAD POCC for key points or side effects of Opthalmic Medications: B -Blurred vision A -Angle closure glaucoma (medications are used for this kind of glaucoma) D -Dry eyes P -Photophobia O -Ocular pressure (used to treat OP from glaucoma) C -Can Cause systemic effects C -Ciliary muscle constriction
3rd Degree Heart Block Causes
Organic Heart Disease, MI, Drugs, Electrolyte Imbalance, Excess Vagal Tone
Polyphagia (excessive hunger and eating) caused from inability of cells to receive glucose (cells are starving); Client may display weight loss. Metabolic acidosis. Kussmaul respirations -
Other: acetone/fruity breath odor ; headache, nausea, vomiting, abdominal pain, inability to concentrate, decreased level of consciousness, and seizures leading to coma.
Patient is having a hysterectomy and states, "I can possibly plan a pregnancy". What needs to be reinforced?
Outcome
Characteristics of DIC (disseminated intravascular coagulation)?
Overstimulation of clotting in anticlotting process.
The first medication a paramedic should administer to a patient with angina is:
Oxygen
The first upward deflection on an ECG tracing is the:
P wave
TPN provides a nutritionally complete solution. It can be used when caloric needs are very high, when the anticipated duration of therapy is greater than 7 days, or when the solution to be administered is hypertonic (composed of greater than 10% dextrose). It can only be administered in a central vein.
PPN can provide a nutritionally complete solution. However, it is administered into a peripheral vein, resulting in a limited nutritional value. It is indicated for clients who require short-term nutritional support with fewer calories per day. The solution must be isotonic and contain no more than 10% dextrose and 5% amino acids
Peptic Ulcer Disease (PUD)
PUD is characterized by an erosion of the mucosal layer of the stomach or duodenum. This may be caused by a bacterial infection with Helicobacter pylori or the chronic use of non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. Avoid eating frequent meals and snacks, as they promote increased gastric acid secretion. Avoid alcohol, cigarette smoking, aspirin and other NSAIDs, coffee, black pepper, spicy foods, and caffeine.
3rd Degree Heart Block Treatment
Pacemaker (temporary or permanent)
Demand mode (synchronous) - Detects the heart's electrical impulses and fires at a preset rate only if the heart's intrinsic rate is below a certain level. Pacemaker response modes include the following:
Pacemaker activity is **inhibited/does not fire. Pacemaker activity is **triggered/fires when intrinsic activity is sensed. Can overpace a **tachydysrhythmia and/or deliver an electrical shock.
Permanent pacemaker teaching: Inform other providers and dentists about the pacemaker. Some tests, such as magnetic resonance imaging and therapeutic diathermy (heat therapy), may be contraindicated.
Pacemakers will set off airport security detectors, and officials should be notified. The airport security device should not affect pacemaker functioning. Airport security personnel should not place wand detection devices directly over the pacemaker.
The treatment of choice for a symptomatic ventricular escape rhythm is:
Pacing
Compartment Syndrome Signs and Symptoms: 5 P's
Pain Pallor Pulse declined or absent Pressure increased Paresthesia
Arterial occlusion: 4 P's
Pain Pulselessness or absent pulse Pallor Paresthesia
Describe the process of withdrawal form an opiate agonist?
Pain medications (opioid direct), takes about 2 days for symptoms to peak and about 5-7 days to disappear
Retinal Detachment :
Painless change in vision (floaters caused by blood cells in the vitreous and flashes of light as the vitreous humor pulls on the retina). Photopsia ( recurrent flashes of light).
Risk Factors: Obesity, physical inactivity, high triglycerides (greater than 250 mg/dL), and hypertension may lead to the development of insulin resistance and type 2 diabetes.
Pancreatitis and Cushing's syndrome are secondary causes of diabetes.
Atropine works by inhibiting:
Parasympathetic response
Stage II pressure ulcer
Partial-thickness skin loss involving the epidermis and the dermis. The ulcer is visible and superficial and may appear as an abrasion, blister, or shallow crater. Edema persists, and the ulcer may become infected, possibly with pain and scant drainage.
While assessing a patient, you note a pulsatile mass in the abdomen. Suddenly this mass is no longer palpable, and the patient's blood pressure begins to drop. You suspect that the:
Patient's aneurysm has ruptured
who has the authority to sign the informed consent for surgery?
Patient, advanced directive (designated person), if no one is available and is emergent to do surgery the physicians can sign
Risk for the patient with peptic ulcer disease?
Perforation (peritonitis, death)
IUD: potential problems with use—"PAINS"
Period (menstrual: late, spotting, bleeding) Abdominal pain, dyspareunia Infection (abnormal vaginal discharge) Not feeling well, fever or chills String missing
Which of the following is most indicative of right ventricular infarct?
Peripheral edema
What is the importance of bowel sound assessment for a patient who has had an abdominal surgery?
Peristalsis has returned in ALL four quadrants
Death usually occurs due to respiratory failure within 3 to 5 years of the initial manifestations. The cause of ALS is unknown, and there is no cure.
Physical Assessment Findings: Muscle weakness - usually begins in one part of the body Muscle atrophy; Dysphagia ; Dysarthria; Hyperreflexia of deep tendon reflexes;
Pilocarpine (Isopto Carpine - ophthalmic solution)
Pilocarpine is a miotic, which constricts the pupil and allows for better circulation of the aqueous humor. Miotics can cause blurred vision.
MS is an autoimmune disorder characterized by the development of plaque in the white matter of the central nervous system.
Plaque damages the myelin sheath and interferes with impulse transmission between the CNS and the body.
Pneumothorax Signs: P-THORAX
Pleuretic pain Trachea deviation Hyperresonance Onset sudden Reduced breath sounds (& dyspnea) Absent fremitus X-ray shows collapsed lung
Below-the-knee amputation
Position: The client should be placed in the prone position several times a day to prevent hip flexion contractions.
The sodium-potassium pump functions to move:
Potassium ions into the cell and sodium ions out of the cell
A bone marrow - Post Monitor for evidence of infection and bleeding. Apply ice to the biopsy site. Administer mild analgesics; avoid aspirin or medications that affect clotting
Potential Complications: Bleeding and infection
Dystocia: general aspects (maternal)—"4P's"
Powers Passageway Passenger Psych
Pramlintide delays oral medication absorption, so oral medications should be taken 1 to 2 hr after pramlintide injection
Pramlintide should not be mixed in a syringe with any type of insulin
Pre-End Stage Renal Disease (pre-ESRD):
Pre-ESRD, or diminished renal reserve/renal insufficiency, is a predialysis condition characterized by an increase in serum creatinine. Goals of nutritional therapy for pre-ESRD are to: Help preserve remaining renal function by limiting the intake of protein and phosphorus. Control blood glucose levels and hypertension, which are both risk factors. Protein restriction is key for clients with pre-ESRD. Slows the progression of renal disease. Too little protein results in breakdown of body protein, so protein intake must be carefully determined. Restricting phosphorus intake slows the progression of renal disease. High levels of phosphorus contribute to calcium and phosphorus deposits in the kidneys. Dietary recommendations for pre-ESRD: Limit meat intake. Limit dairy products to ½ cup per day. Limit high-phosphorus foods (peanut butter, dried peas and beans, bran, cola, chocolate, beer, some whole grains). Restrict sodium intake to maintain blood pressure. Caution clients to use vitamin and mineral supplements ONLY when recommended by their provider.
Wolff-Parkinson-White syndrome is a:
Preexcitation syndrome
The most important factor in determining stroke volume in a healthy heart is:
Preload
Medications The priority intervention for treating glaucoma is drug therapy. Client teaching should include the following:
Prescribed eye medication is beneficial if used every 12 hr. Instill one drop in each eye twice daily. Wait 10 to 15 min in between eye drops if more than one is prescribed by the provider.
Vaginal Flush Complications
Preterm Labor: Ruptured membranes, signs of infection
A critical nursing goal for a post-operative liver transplant patient who is receiving Imuran?
Prevent infection
Primary nursing goal for a patient with an immunodeficiency disease?
Prevent infection
Priority nursing a concern for the patient with immuno suppression related to chemotherapy?
Prevent infection, hand-washing.
Best time to teach the patient about the use of a PCA (Patient Controlled Analgesia.)
Prior to surgery (this is when you informs hat there will be additional medication if needed)
Patient teaching about the use of the incentive spirometer?
Prior to surgery, inhale slowly and keep it between the parameters to inflate your lungs fully to prevent complications especially pneumonia
Prioritization
Prioritization includes clinical care coordination such as clinical decision making, priority setting, organizational skills, use of resources, time management, and evaluation of care. Clinical decisions are made by completing a thorough assessment which will help you make good judgments later when you see a changing clinical condition. A poor initial assessment can lead to missed findings later on. Priority setting refers to addressing problems and prioritizing care. It is critical for efficient care. The RN uses his/her knowledge of pathophysiology when prioritizing interventions with multiple clients. Orders of prioritization: 1. Treat first any immediate threats to a patient's survival or safety. Ex. obstructed airway, loss of consciousness, psychological episode or anxiety attack. ABC's. 2. Next, treat actual problems. Ex. nausea, full bowel or bladder, comfort measures. 3. Then, treat relatively urgent actual or potential problems that the patient or family does not recognize. Ex. Monitoring for post-op complications, anticipating teaching needs of a patient that may be unaware of side effects of meds. 4. Lastly, treat actual or potential problems where help may be needed in the future. Ex Teaching for self-care in the home. Here are some great principles to help you as you prioritize: Systemic before local Acute before chronic Actual before potential Listen don't assume Recognize first then apply clinical knowledge Maslow's Hierarchy of Needs: Prioritize according to Maslow with physiological and safety issues before psychological esteem issues.
Working Phase
Problem Solve
Placenta Previa (PP) versus Abruptio Placenta (AP)
Problem: PP--> Low implantation of the placenta AP--> Premature separation of the placenta Incidence: PP--> It occurs in approximately 5 in every 1000 pregnancies AP--> It occurs in about 10% of pregnancies and is the most common cause of perinatal death Risk factors: PP--> increased parity, advanced maternal age, past cesarean births, past uterine curettage, multiple gestation, AP--> high parity, advanced maternal age, a short umbilical cord, chronic hypertensive disease, pregnancy-induced hypertension, direct trauma, vasoconstriction from cigarette use, thrombic conditions that lead to thrombosis such as autoimmune antibodies Bleeding: PP--> Always present AP--> May or may not be present Color of blood in bleeding episodes: PP--> Bright red AP--> Dark red Pain during bleeding: PP--> Painless AP--> Sharp, stabbing pain Management: PP--> Place the woman immediately on bed rest in a side-lyon position. Weight perineal pads. NEVER attempt a pelvic or rectal examination because it may initiate massive blood loss. AP--> Fluid replacement. Oxygen by mask. Monitor FHR. Keep the woman in a lateral position. DO NOT perform any vaginal or pelvic examinations or give enema. Pregnancy must be terminated because the fetus cannot obtain adequate oxygen and nutrients. If birth does not seem imminent, cesarean birth is method of choice for delivery.
Cataract
Progressive and painless loss of vision
Atherosclerosis is a disease characterized by:
Progressive narrowing of the lumen of medium and large arteries
Short-acting beta2 agonists, such as albuterol (Proventil, Ventolin)
Provide rapid relief of acute symptoms and prevent exercise-induced asthma.
Secure the pacemaker battery pack. Take care when moving the client, and ensure that there is enough wire slack. ☐ For a permanent pacemaker
Provide the client with a pacemaker identification card including the manufacturer's name, model number, mode of function, rate parameters, and expected battery life.
Angle-closure glaucoma ■ Rapid onset of elevated IOP; ■ Decreased or blurred vision; ■ Seeing halos around lights; ■
Pupils are nonreactive to light ■ Severe pain and nausea; ■ Photophobia;
Signs of a Kaposi's sarcoma lesion?
Purple, irregular borders, not ulcerated lesions, all over the body
Chadwick's Sign
Purplish vulva during pregnancy
Characteristics of empyema?
Pus in the pleural space of the thoracic cavity
The part of the ECG tracing that is most important for detecting life-threatening arrhythmias is the:
QRS complex
Anemia lab
RBC 4.20-4.87
Delegation
RNs DO NOT delegate what they can EAT--evaluate, assess, teach
Angle-closure glaucoma
Rapid onset of elevated IOP
Atrial flutter is almost always caused by:
Rapid reentry
The first evidence in a patient's history of a possible immunodeficiency disease?
Recent history of repeated infections
Nursing Interventions: Discuss the impact of alopecia on self-image. Encourage the client to express feelings.
Recommend use of information from the American Cancer Society on managing alopecia. Provide referral to a cancer support group.
Treatment for a patient with left ventricular failure includes medications to:
Reduce afterload
DKA Lack of sufficient insulin related to undiagnosed or untreated type 1 diabetes mellitus or nonadherence to a diabetic regimen
Reduced or missed dose of insulin (insufficient dosing of insulin or error in dosage)
The activation of myocardial tissue more than one time by the same impulse is called:
Reentry
What is the best recommendation for a newly diagnosed diabetic 2 patients that lives independently?
Refer to support group
Third-degree heart block tends to have:
Regular but independent atrial and ventricular rhythms
Regular insulin
Regular insulin has a peak effect around 1 to 5 hr following administration
Atrial Fibrillation (controlled)
Regularity: Irregular; no pattern to it's irregularity Rate: <100 bpm P-Wave: Not present PRI: Since no P wave is present, PRI is not determined QRS: <.12 seconds
Atrial Fibrillation (Uncontrolled)
Regularity: Irregular; no pattern to it's irregularity Rate: Majority of time is >350 bpm P Waves: No P Waves Present PRI: Since no P Waves, no PRI can be determined QRS: Should be <.12 seconds
Second Degree Heart Block (Wenckebach)
Regularity: R-R Wave is irregular; R-R interval gets progressively shorter as PRI gets progressively longer Rate: Ventricular rate is slightly slower than normal; atrial rate is normal P-Waves: upright and uniform; some p waves are not followed by the QRS complex PRI: gets progressively longer until one p wave is not followed by a QRS complex; after the blocked beat, cycle starts over QRS: < .12 seconds
Atrial Tachycardia (SVT)
Regularity: R-R intervals are constant; Regular Rate: artial/ventricular rates are equal; heart rate is between 150-250 bpm. P-Wave: One P Wave in front of every QRS; may be flattened or notched; because of the rapid rate, the P waves can be hidden within the T waves PRI: .12-.20 seconds and constant QRS: <.12 seconds
3rd Degree Heart Block
Regularity: Regular Rate: 40-60 bpm if junctional; 20-40 bpm if focus is ventricular. P Wave: upright and uniform; more p waves than QRS complexes PRI: no relationship between p waves and QRS complexes QRS: < .12 seconds if junctional; > .12 seconds if ventricular
Premature Ventricular Contraction (PVC)
Regularity: Regular or Irregular Rate: Determined by underlying rhythm; but frequently do not produce a pulse P-Waves: Ectopic is not preceded by a P-Wave PRI: None QRS: Wide and Bizarre; measuring at least .12 seconds; T wave is often in opposite direction from QRS.
Ventricular Tachycardia
Regularity: Usually regular Rate: Ventricular Rate: 150-250 bpm; if rate is <150 bpm, it's a slow VT; if exceeds 250 bpm, Ventricular Flutter P Waves: None of QRS will be preceded by P Waves PRI: no PRI QRS: wide and bizarre measuring at least .12 seconds; hard to tell between QRS and T wave
Ventricular Fibrillation
Regularity: chaotic Rate: cannot be determined P Waves: no P waves present PRI: no PRI QRS: no discernible QRS complexes
First Degree Heart Block
Regularity: depend on the rhythm Rate: Depend on underlying rhythm P Waves: Upright and Uniform; each P Wave will be followed by a QRS complex PRI: constant across entire strip, but always > .20 seconds. QRS: < .12 seconds
Second Degree Heart Block (Morbitz)
Regularity: if conduction ratio is consistent, R-R interval will be constant and rhythm, regular. If conduction ratio varies, the R-R will be irregular Rate: atrial rate is usually normal; ventricular rate will be in bradycardia P Waves: upright and uniform; always be more P waves than QRS PRI: constant; might be longer than normal QRS: <.12 seconds
Identify three complications of TPN
Related Content 1 - Infection and sepsis Monitor for manifestations of fever, chills, increased WBCs, and redness around catheter insertion site.
You are treating a 70-year-old male patient with atrial fibrillation. The patient's ventricular heart rate is 180 beats per minute, the blood pressure is 90/60, and the patient complains of chest pain. If this patient's atrial fibrillation has been present for more than 48 hours, conversion of this patient's rhythm may lead to:
Release of emboli
Disease modifying anti-rheumatic drugs (DMARDs) ■ DMARDs work in a variety of ways to slow the progression of RA and suppress the immune system's reaction to RA that causes pain and inflammation
Relief of symptoms may not occur for several weeks. ■ Antimalarial agent - hydroxychloroquine (Plaquenil) ■ Antibiotic - minocycline (Minocin) ■ Sulfonamide - sulfasalazine (Azulfidine)
Crutch walking
Remember the phase "step up" when picturing a person going up stairs with crutches. The good leg goes up first followed by the crutches and the bad leg. The opposite happens going down the stairs....OR "up to heaven...down to hell"
Metformin most common side effect
Renal (kidney) failure
Repaglinide should not be taken just before bedtime; Repaglinide is not taken upon awakening in the morning
Repaglinide causes a rapid, short-lived release of insulin. The client should take this medication within 30 min before each meal so that insulin is available when food is digested
Client Education: A bone marrow: Explain the procedure to be performed: use of local anesthesia, sensation of pressure or brief pain.
Report excessive bleeding and evidence of infection to the provider. Check the biopsy site daily. It should be clean, dry and intact. If there are sutures, return in 7 to 10 days for removal.
Corticosteroids such as prednisone
Report increased weakness and jaundice to provider. Avoid stopping baclofen abruptly.
Limit activities. Avoid tilting head back to wash hair. Limit cooking and housekeeping. Avoid rapid, jerky movements, such as vacuuming. Avoid driving and operating machinery. Avoid sports.
Report pain with nausea/vomiting - indications of increased IOP or hemorrhage. ☐ Final best vision is not expected until 4 to 6 weeks after surgery
Signs of an anaphylactic reaction?
Respiratory distress, hives, swelling around eyes, swelling of lips, swelling of tongue
Abnormal early post-operative signs?
Respiratory distress, urinary retention, bright red bleeding or emesis, signs of shock
Ischemia caused by unstable angina:
Responds well to treatment with antiplatelet agents
Teaching a patient about her newly diagnosed rheumatoid arthritis?
Rest and exercise, autoimmune disease for the rest of your life
Hypoxia: RAT (signs of early) BED (signs of late)
Restlessness Anxiety Tachycardia and tachypnea Bradycardia Extreme restlessness Dyspnea
Atrial Flutter
Rhythm: Regular atrial rhythm; irregular ventricular rate Rate: 250-350 bpm P-Wave: well defined P waves; "sawtooth" appearance PRI: Usually impossible to determine the PR in this arrhythmia. QRS: <.12 seconds
JVD. What side of heart?
Right
The right coronary artery and the left anterior descending artery supply most of the blood to the:
Right atrium and ventricle
An inferior-wall MI is usually caused by occlusion of the _____ artery.
Right coronary
Patients usually describe the pain of an aortic dissection as:
Ripping or tearing
Macular degeneration, often called age-related macular degeneration (AMD), is the central loss of vision that affects the macula of the eye. There is no cure
Risk Factors: Dry macular degeneration: Female Short body stature Diet lacking carotene and vitamin A
The sound heard when the AV valves close during ventricular systole is:
S1
The dominant pacemaker of the heart under normal conditions is the:
SA node
SSRI's
SSRIs: Selective Serotonin Reuptake Inhibitors. These medications include Citalopram (Celexa), Fluoxetine (Prozac), or Sertraline (Zoloft). The client should avoid using St. John's Wort with these medications, and should eat a healthy diet while on these medications.
You are called to evaluate a 64-year-old woman who complains of palpitations, weakness, and dizziness. Her heart rate is 160 beats per minute, her blood pressure is 118/ 80 and her respiratory rate is 28. The ECG tracing shows narrow QRS complexes and no identifiable P waves. This rhythm is most likely:
SVT
Salmeterol - Asthma
Salmeterol - Advise client to use to prevent an asthma attack and not at the onset of an attack
Ventricular Arrythmias Etiology
Same as PVC but also cardiomyopathy, myocardial irritability
Post Cardioversion Care
Same as when a pt is in A-Fib If elective, digoxin is usually withheld for 48hrs prior to cardioversion to prevent dysrhythmias after procedure airway patency should be maintained and the patient state of consciousness should be evaluated
You are treating a 65-year-old man who is complaining of chest pain and difficulty breathing. On ECG examination, you note that his ventricular heart rate is 56, and there are more P waves than QRS complexes. The PR interval is constant when a QRS follows a P wave. The QRS complexes are normal and narrow.You suspect this patient has what type of heart block?
Second-degree type II
Signs of a pulmonary embolus?
Sense of impending dume, extremely restless, sudden sharp pain in chest, respiratory distress, petechiae in upper part of chest
You are treating a 65-year-old man who is complaining of chest pain and difficulty breathing. On ECG examination, you note that his ventricular heart rate is 56, and there are more P waves than QRS complexes. The PR interval is constant when a QRS follows a P wave. The QRS complexes are normal and narrow. This type of block is usually associated with:
Septal MI
In a 12-lead ECG, leads V1 and V2 are:
Septal leads
The left anterior descending coronary artery mainly supplies blood to the:
Septum
You are treating a 65-year-old man who is complaining of chest pain and difficulty breathing. On ECG examination, you note that his ventricular heart rate is 56, and there are more P waves than QRS complexes. The PR interval is constant when a QRS follows a P wave. The QRS complexes are normal and narrow. This type of heart block is typically considered to be a:
Serious arrhythmia regardless of signs and symptoms
SNRI's
Serotonin Norepinephrine Reuptake Inhibitors. Common SNRIs include Venlafaxine (Effexor) and Duloxetine (Cymbalta). Adverse effects may include nausea, weight gain, and sexual dysfunction.
Reinforcing Teaching About Oppositional Defiant Disorder
Set clear limits on unacceptable behaviors and be consistent. Reward system for acceptable behavior.
Hyperemesis Gravidarum
Severe morning sickness with unrelenting, excessive nausea or vomiting that prevents adequate intake of food and fluids
Eclampsia
Severe preeclampsia symptoms with seizure activity or coma
You are treating a patient who is complaining that his heart is "skipping beats." On ECG evaluation, you see frequent PVCs that are occurring in groups. The patient's blood pressure is 100 systolic. Treatment for this patient:
Should include oxygen and lidocaine
Delirium (occurs quickly)
Simple orientation and low stimuli environment
What are the four Supra-Ventricular Tachycardias (SVT)?
Sinus Tachycardia (100-160 bpm) Atrial Tachycardia (150-250 bpm) Atrial Flutter (150-250 bpm) Junctional Tachycardia (100-180 bpm)
While evaluating a 22-year-old female runner who called 911 because she fell and twisted her ankle, you apply an ECG monitor. Her heart rate is 46, P waves are normal and upright, the PR interval is 0.16 second, and the QRS complex looks normal. There is a QRS complex following each P wave. The patient's ECG tracing reflects:
Sinus bradycardia
You see an irregular rhythm on the monitor with a rate of 66 to 80, a normal PR interval, and a P wave for every QRS. The rate speeds up and slows down with the patient's respiratory rate. You suspect that this rhythm is:
Sinus dysrhythmia
An ECG strip shows a regular rhythm with a QRS complex of 0.08, a rate of 145, a PR interval of 0.12, and one upright P wave before each QRS complex. You suspect that this rhythm is:
Sinus tachycardia
Characteristics of orthopnea?
Sit or stand to breath deeply (place on chair facing back or lean over table)
The position of comfort for a patient with left ventricular failure is usually:
Sitting with legs dependent
A nursing measure to prevent or minimized dumping syndrome?
Six small meals
When analyzing an ECG tracing, you notice that the rhythm is highly irregular. The best method to calculate the rate is the
Six-second count method
Newborn Car Seat Safety
Snug harness across axillary. Not across abdomen or neck.
You are treating a patient who is in PEA following home dialysis. Which of the following drugs may be indicated?
Sodium bicarbonate
Depolarization takes place when:
Sodium ions rush into the cell
Sodium polystyrene - Instruct the client to take a mild laxative if constipated, and teach how to take blood pressure
Sodium polystyrene - Monitor for hypokalemia, and restrict sodium intake.
A blood pressure reading in an adult of 180/110 is considered:
Stage 3 hypertension
Heart Murmur Causes: SPASM
Stenosis of a valve Partial obstruction Aneurysms Septal defect Mitral regurgitation
The most serious complication of a hernia?
Strangulation it occluded blood supply and obstructs intestinal flow
Characteristics of pain?
Subjective (whatever and wherever the patient says it is), pain often occurs when there is tissue damage. Chronic: long last pain over six months acute: less than six months
Assessment: Myasthenia gravis Risk factors associated with rheumatoid arthritis, scleroderma, and systemic lupus erythematosus
Subjective Data: Progressive muscle weakness; Diplopia; Difficulty chewing and swallowing; Respiratory dysfunction; Bowel and bladder dysfunction; Poor posture; Fatigue after exertion
Retinal detachment
Sudden loss of vision without pain
Electromyography Shows the neuromuscular transmission characteristics of MG. Decrease in amplitude of the muscle is demonstrated over a series of consecutive muscle contractions
Surgical Interventions Thymectomy - removal of the thymus gland is done to attain better control or complete remission. May take months to years to see results due to the life of the circulating T cells.
The ventricles of the heart are innervated mainly by:
Sympathetic nerve fibers
Compartment syndrome
Symptoms: Pulselessness (late sign), Increased pain unrelieved with elevation or by pain medication
Heart Failure
Symptoms: Shortness of breath, fatigue, jugular vein distention, and an S3 are signs/symptoms of heart failure resulting from the decreased pumping ability of the heart and increased fluid volume.
You are treating a 70-year-old male patient with atrial fibrillation. The patient's ventricular heart rate is 180 beats per minute, the blood pressure is 90/60, and the patient complains of chest pain. You have determined that your atrial fibrillation patient is unstable and requires electrical therapy. You will perform _____ countershock with _____ joules
Synchronized; 100
You are called to evaluate a 64-year-old woman who complains of palpitations, weakness, and dizziness. Her heart rate is 160 beats per minute, her blood pressure is 118/ 80 and her respiratory rate is 28. The ECG tracing shows narrow QRS complexes and no identifiable P waves. The patient begins to develop chest pain, and her blood pressure drops to 100/60. The treatment of choice for this patient is now:
Synchronous cardioversion
TCAs
TCAs: Tricyclic Antidepressants. Amitriptyline (Elavil) is an example. Anticholinergic effects and orthostatic hypotension may occur.
Ventricular Asystole
TEA: trans-cutaneous pacemaker, epinephrine, atropine
Hypoglycemia Signs: TIRED
Tachycardia Irritability Restlessness Excessive hunger Depression and diaphoresis
Permanent pacemaker teaching: Prevent wire dislodgement (wear sling when out of bed, do not raise arm above shoulder for 1 to 2 weeks).
Take pulse daily at the same time. Notify the provider if heart rate is less than five beats below the pacemaker rate.
Counseling the patient who is afraid of pain associated with an upcoming surgery?
Talk to them preoperatively and explain that we're going to observe you and do our utmost to keep you safe and make sure that any pain is treated quickly, do not be afraid to ask
Exenatide
Teach the client that exenatide should not be given within 1 hr of oral antibiotics, acetaminophen, or an oral contraceptive due to its ability to slow gastric emptying
Teach the client to take levothyroxine on an empty stomach, usually 1 hr before breakfast.
Teach the client that thyroid replacement therapy is usually lifelong. Monitor for adverse effects that indicate that the dosage needs to be reduced.
Traction Patient Care: TRACTION
Temperature of extremity is assessed for signs of infection Ropes hang freely Alignment of body and injured area Circulation check (5 P's) Type and location of fracture Increase fluid intake Overhead trapeze No weights on bed or floor
Preterm infant: Anticipated problems—"TRIES"
Temperature regulation (poor) Resistance to infections (poor) Immature liver Elimination problems (necrotizing enterocolitis [NEC]) Sensory-perceptual functions (retinopathy of prematurity [ROP])
Which of the following is a correctable cause of PEA?
Tension pneumothorax
While analyzing an ECG you cannot identify a Q wave. This means:
The Q wave may not be visible in the lead you are viewing
Regularity
The amount of consistency in the frequency and intensity of contractions.
Duration
The amount of time elapsed from the beginning of one contraction to the end of the same contraction.
Frequency
The amount of time from the beginning of one contraction to the beginning of the next contraction
Anticonvulsants
The anticonvulsants are medications used for the treatment of epileptic seizures. These meds suppress the rapid and firing of neurons in the brain that start a seizure. Drugs for all types of seizures, except petit mal: CaPhe like cafe in French CA rbamazepine PHE nytoin/Phenobarbital Drugs for petit mal seizures: ValEt Val proic Acid Et hosuximide Phenytoin: adverse effects P - interactions H irsutism E nlarged gums N ystagmus Y ellow-browning of skin T eratogenicity O steomalacia I nterference with B metabolism (hence anemia) N europathies: vertigo, ataxia, headache All anti-epileptic drugs can be remembered by this mnemonic: Dr.BHAISAB's New PC. D ...Deoxy barbiturates B ...Barbiturates H ....Hydantoin A ....Aliphatic carb acids I ....Iminostilbenes S ....Succinimides B ....Benzodiazepines (BZD's) N ....Newer drugs P ....Phenyltriazines C ...Cyclic gaba analogues
Open-angle glaucoma - most common form of glaucoma. Open-angle refers to the angle between the iris and sclera.
The aqueous humor outflow is decreased due to blockages in the eye's drainage system (Canal of Schlemm and trabecular meshwork), causing a rise in IOP.
Which of the following is true of the coronary arteries?
The coronary arteries begin just above the aortic valve
Laboratory Tests -
The expected reference range for T3 is 70 to 205 ng/dL, and the expected reference range for T 4 is 4 to 12 mcg/dL.)
Longitudinal lie
The fetal long axis is parallel to the mother's long axis. The fetus is either in a breech or vertex presentation
If the left ventricle loses 25% of its muscle mass due to myocardial infarction:
The heart can still pump effectively
Absolute bradycardia means that:
The heart rate is less than 60 beats per minute
Rheumatoid arthritis - RA is an autoimmune disease that is precipitated by WBCs attacking synovial tissue. The WBCs cause the synovial tissue to become inflamed and thickened.
The inflammation can extend to the cartilage, bone, tendons, and ligaments that surround the joint. Joint deformity and bone erosion may result from these changes, decreasing the joint's range of motion and function.
Transverse lie
The long axis of the fetus is at a right angle to the mother's long axis. This is incompatible with a vaginal delivery if the fetus remains in this position
Complications:
The manifestations of both can be very similar (muscle weakness, respiratory failure). The client's highest risk for injury is due to respiratory compromise and failure.
ECT
The most common type of brain stimulation therapy is electronconvulsive therapy or ECT. ECT is generally performed for major depressive disorders, schizophrenia or acute manic disorders. Most clients receive therapy three times a week for two to three weeks. Prior to ECT, carefully screen the client for any home medication use. Lithium, MAOIs and all seizure threshold medications should be discontinued two weeks prior to ECT. After therapy, reorient the client as short term memory loss is common.
Exenatide
The nurse should monitor daily blood glucose testing by the client, periodic HbA1c tests, and periodic kidney function testing. Exenatide should be used cautiously in clients who have any renal impairment.
Nursing Care: Adverse effects include cardiac effects, chest pain, hypertension, and palpitations, especially in older adults
The nurse should monitor thyroid function tests: T3, T4, and TSH
The older adult is at risk for altered metabolism of medication due to decreased kidney and liver function because of the aging process.
The older adult may have visional alterations; yellowing of lens, decreased depth perception, cataracts, which can affect ability to read information and attend to medication administration.
Permanent pacemaker: Incision using a local anesthetic and IV sedation. The pacemaker may be reprogrammed externally after procedure.
The pacemaker battery will last about 10 years. The pacemaker pulse generator must be replaced when this occurs.
Characteristics of informed consent?
The physician informs the patient about the procedure being done
Surgical Interventions: Surgical removal of the lens; A small incision is made, and the lens is either removed in one piece, or in several pieces, after being broken up using sound waves.
The posterior capsule is retained. A replacement; or intraocular lens is inserted. Replacement lenses can correct refractive errors, resulting in improved vision.
Station
The relationship of the presenting part to the maternal ischial spines that measures the degree of descent of the fetus.
Intensity
The strength of the uterine contraction.
Radioactive iodine (131 I) is administered orally 24 hr prior to a thyroid scan.
The thyroid absorbs the radiation, which results in destruction of cells that produce thyroid hormone
abuse
There are several different types of abuse, including physical, sexual, or emotional. Abuse tends to be cyclic, following a pattern on tension building, battering and honeymoon phase. When test questions appear related to abuse, look for the phase to determine the correct response.
Admittance of a postpartum client to a medical-surgical unit
There are times when a woman may be hospitalized during the postpartum period for a medical condition. When this occurs, she'll most likely be placed on a general medical-surgical unit. Her admission will cause you to ask: "What's normal during the weeks following the birth of a baby?" * Breasts. Within the first 24 hours postpartum, colostrum appears and is followed by breast milk within the first 72 hours. Breast engorgement is most likely to occur around day 4 postpartum. The engorged breast will appear full, taut, and even shiny. Although this is normal, it may be very uncomfortable for your client. In contrast, a woman with mastitis will usually run a fever higher than 100° F, report feeling "ill," and have one breast that's affected (firm, inflamed, swollen, and exquisitely tender to touch). If your client is breastfeeding her newborn, she'll require a breast pump. Depending on the medications ordered, the milk may need to be disposed of and not used for the baby. * Lochia. Sometimes women will experience lochia (vaginal discharge) until the time of their 6-week postpartum visit. Immediately after delivery, the lochia is red and heavy enough to require a pad change every 1 to 2 hours. By 7 days postpartum, the lochia should be lighter in color (pink to red) and amount, requiring a pad change every 4 hours. Lochia that becomes heavier, has a foul odor, and is accompanied by pelvic pain isn't a normal finding and requires immediate intervention. * Perineal care. For the first 2 weeks following delivery, clients will need to perform perineal hygiene as taught during the immediate postpartum period. This may include perineal water rinses following elimination using warm water or medicinal rinses, use of sitz baths, and comfort medications to the perineal and anal area. * Cesarean section. If your client delivered her baby via cesarean section, continued assessment of the surgical incision is warranted for the first 2 to 3 weeks postpartum. Redness and warmth around the incision, excessive bruising around the incision, or incisional drainage requires immediate intervention. If the surgeon used staples to close the incision, they're usually removed approximately 5 days post-delivery. Remember, the hospitalized postpartum client is likely to be very emotional. Not only will she be experiencing the normal hormonal fluctuations of the postpartum period, she'll may also be distraught leaving her newborn at home and feeling that she's missing bonding time with her child. Visitation between the mother and her infant may be very limited to minimize the infant's risk of infection, but visits should be arranged if at all possible.
The relationship between cancer and heredity?
There can be a predisposition in family for specific types of cancer (ex: other family members have history of cancer, go get checked out. Do not wait until it hits you)
During the period between action potentials:
There is excessive sodium in the cell
Permanent pacemaker teaching: Never place items that generate a magnetic field directly over the pacemaker generator.
These items can affect function and settings. This includes garage door openers, burglar alarms, strong magnets, generators and other power transmitters, and large stereo speakers.
Oral Hypoglycemic Agents
These medications promote insulin release from the pancreas. Clients who are prescribed oral hypoglycemic agents do not produce enough insulin to lower their blood glucose (blood sugar) levels. Prescribed for clients with type 2 Diabetes Mellitus. Common Oral Hypoglycemic Agents: glipizide( Gluco trol, Gluco trolXL). See the form of glucose in the drug name? chlorpropamide ( Diab ines).See the form of Diabetes in the drug name? glyburide ( Diab inese,Micronase). See the form of Diabetes in the drug name? metforminHC1 ( Gluco phage). See the form of glucose in the drug name?
Anterior Pituitary Hormons/Growth Hormones
These medications stimulate growth. Are used to treat growth hormone deficiencies. Use cautiously in clients who have Diabetes Mellitus since these medications cause hyperglycemia because of the decreased use of glucose. Common Anterior Pituitary Hormones/Growth Hormone Agents: somatropin somatrem(Protropin)
Corticosteroids (prednisone) are strong anti-inflammatory medications that may be given for acute exacerbations or advanced forms of the disease.
They are not given for long-term therapy due to significant adverse effects (osteoporosis, hyperglycemia, immunosuppression, cataracts).
Chemotherapy : Pathophysiology of the Problem; Alopecia occurs as an adverse effect of chemotherapy medications.
They interfere with the life cycle of rapidly proliferating cells, such as those found in hair follicles, resulting in hair loss
Anticholinergic medications, such as ipratropium (Atrovent), block the parasympathetic nervous system.
This allows for the sympathetic nervous system effects of increased bronchodilation and decreased pulmonary secretions. These medications are long-acting and used to prevent bronchospasms
Therapeutic Procedures Plasmapheresis removes circulating antibodies from the plasma.
This is usually done several times over a period of days and may continue on a regular basis for some clients.
You are treating a 75-year-old woman who has a history of diabetes and atherosclerosis. Her chief complaint is persistent heartburn. You suspect:
This may be a cardiovascular problem
Thyroid-NonRadioactive Iodine (hyperthyroidism)
This medication creates a high level of iodine that will reduce iodine uptake by the thyroid gland. It inhibits the thyroid hormone production and blocks the release of thyroid hormones into the bloodstream. This medication tastes nasty; has a metallic taste! Clients are to drink this medication through a straw to prevent tooth discoloration. Radioactivity precautions are not necessary due to this drug is nonradioactive.
Cycloplegic mydriatic (Atropine 1% ophthalmic solution)
This medication prevents pupil constriction for prolonged periods of time and relaxes muscles in the eye. Dilates the eye preoperatively and for visualization of the eye's internal structures.
Posterior Pituitary Hormones/Antidiuretic Hormone
This medication promotes the reabsorption of water within the kidneys; causes vaso constriction due to the contraction of vascular smooth muscle. Common Posterior Pituitary Hormones/Antidiruetic Hormones: desmopressin (DDAVP, stimate) vaso pressin (Pitressin synthetic) (See the form of vaso in the drug name, for vaso constriction)
Amyotrophic lateral sclerosis (ALS) is a degenerative neurological disorder of the upper and lower motor neurons that results in deterioration and death of the motor neurons.
This results in progressive paralysis and muscle wasting that eventually causes respiratory paralysis and death. Cognitive function is not usually affected
Vision and hearing deficits may interfere with the understanding of teaching, reading of materials, and preparation of medications.
Tissue deterioration secondary to aging may impact the client's ability to prepare food, care for self, perform ADLs, perform foot/wound care, and perform glucose monitoring.
Why does the nurse take a complete medication history, including the use of supplements, when admitting a patient for surgery?
To know what can cause adverse reactions and what may interfere with postoperative medications
The purpose of giving cyclosporine to a patient after a kidney transplant?
To prevent tissue rejection
Diagnostic Procedures ■ Visual assessments ☐ Decrease in visual acuity and peripheral vision
Tonometry Toetry is used to measure IOP. IOP, expected reference range is 10 to 21 mm Hg) is elevated with glaucoma w/ angle-closure.
Plasmapheresis: ■ Removes circulating antibodies from plasma, decreasing attacks on the client's tissues ◯ May be done for a severe, life-threatening exacerbation
Total joint arthroplasty - RA ■ Surgical repair and replacement of a joint may be done for a severely deformed joint that has not responded to medication therapy.
Infections during pregnancy—"TORCH"
Toxoplasmosis Other (hepatitis B, syphilis, group B beta strep) Rubella Cytomegalovirus Herpes simplex virus
Which of the following is a class I intervention for all symptomatic bradycardias?
Transcutaneous pacing
You are treating a 65-year-old man who is complaining of chest pain and difficulty breathing. On ECG examination, you note that his ventricular heart rate is 56, and there are more P waves than QRS complexes. The PR interval is constant when a QRS follows a P wave. The QRS complexes are normal and narrow. Prehospital care for this patient consists of:
Transcutaneous pacing
Characteristics of ultrasound as a diagnostic tool. What does it do and how does it work?
Transducer emits hundreds of thousand sound waves at high frequency wherever there is a density, it converts the sound waves back and creates an image.
You are treating a 65-year-old man who is complaining of chest pain and difficulty breathing. On ECG examination, you note that his ventricular heart rate is 56, and there are more P waves than QRS complexes. The PR interval is constant when a QRS follows a P wave. The QRS complexes are normal and narrow. The definitive treatment for this patient is:
Transvenous pacemaker insertion
The valve between the right atrium and the right ventricle is the:
Tricuspid valve
continuous passive motion (CPM) machine
Turn of the CPM machine during meals to promote comfort and dietary intake. -The affected extremity should maintain neutral alignment.
Priority nursing action before administering a blood transfusion to a patient?
Two lisenced nurses check the blood and the chart, then check once entered the room
Electrical Cardioversion
Tx of choice if pt has a hemodynamically unstable tachydysrhythmia; unstable ventricular tachycardia w/ a pulse; prevention of life-threatening dysrhythmias; cardioversion can be planned or emergent; proper cardioversion will correct pt dysrhythmia w/ minimal discomfort and maximum safety
Medications that are contraindicated for the patient with Cirrhosis?
Tylenol
Type 1 diabetes mellitus is an autoimmune dysfunction involving the destruction of beta cells, which produce insulin in the islets of Langerhans of the pancreas. Immune system cells and antibodies are present in circulation and may also be triggered by certain genetic tissue types or viral infections.
Type 1 diabetes mellitus usually occurs at a young age, and there are no successful interventions to prevent the disease.
Short-acting insulin Regular insulin (Humulin R, Novolin R). Administer 30 to 60 min before meals to control postprandial hyperglycemia. Available in two concentrations.
U-500 is reserved for the client who has insulin resistance and is never administered IV. U-100 is prescribed for most clients and may be administered IV
For a temporary pacemaker
Unattached pacemaker wires can cause cardiac arrhythmias or ventricular fibrillation, even when not attached to pacemaker generator.
Pramlintide can cause hypoglycemia, especially when the client also takes insulin, so it is important to eat a meal after injecting this medication.
Unused medication in the open pramlintide vial should be discarded after 28 day' Unused medication in the open pramlintide vial should be discarded after 28 day
Client Education: Wear hats, turbans, and wigs. Avoid the use of damaging hair-care measures, such as electric rollers and curling irons, hair dye, and permanent waves.
Use a soft hair brush or wide-tooth comb for grooming. Avoid sun exposure. Use a diaper rash ointment or cream for itching. Alopecia is temporary, and hair will return when chemotherapy is discontinued
MS - Nursing Care : Assess and intervene as needed to maintain a patent airway (muscle weakness of diaphragm, respiratory, and intercostal muscles).
Use energy conservation measures. Allow for periods of rest. Assess swallowing to prevent aspiration. Keep oxygen, endotracheal intubation, suctioning equipment, and a bag valve mask available at the client's bedside.
Methylxanthines, such as theophylline (Theo-24), require close monitoring of serum medication levels due to a narrow therapeutic range.
Use only when other treatments are ineffective. Theophylline - Monitor the client's serum levels for toxicity. Side effects will include tachycardia, nausea, and diarrhea
Most new AEDs:
Use waveforms that are more effective at lower energy settings
When preparing for a 12-lead ECG, locate the 4th intercostal space, just to the right of the sternum and place lead:
V1
Parasympathetic control of the heart is provided by the:
Vagus nerve
You are called to evaluate a 64-year-old woman who complains of palpitations, weakness, and dizziness. Her heart rate is 160 beats per minute, her blood pressure is 118/ 80 and her respiratory rate is 28. The ECG tracing shows narrow QRS complexes and no identifiable P waves. The first recommended treatment for this patient is:
Valsalva maneuver
VEAL CHOP-which relates to fetal heart rate.
Variable decels => Cord compression (usually a change in mother's position helps) Early decels => Head compression (decels mirror the contractions; this is not a sign of fetal problems) Accelerations => O2 (baby is well oxygenated-this is good) Late decels => Placental utero insufficiency (this is bad and means there is decreased perfusion of blood/oxygen/nutrients to the baby).
Norepinephrine's major effect is:
Vasoconstriction
Cardiac Arrest
Ventricular Asystole due to VFib Etiology: trauma, overdose, MI Clinical Signs: asystole or VFib, no definable waves, absence of VS
Preload is defined as:
Ventricular end-diastolic volume
Your patient has a regular bradycardic rhythm with a rate of 40, no P waves, and a QRS greater than 0.12. This is:
Ventricular escape rhythm
Patients with pulseless ventricular tachycardia should be treated as though they have:
Ventricular fibrillation
The most common arrhythmia in sudden cardiac arrest is:
Ventricular fibrillation
Which of the following is an absolute indication for unsynchronized cardioversion?
Ventricular fibrillation
Which of the following is true of ventricular tachycardia?
Ventricular tachycardia is triggered by a PVC
17 year old having an emergency surgery. What type of consent is best to intervene?
Verbal
Nursing procedure after giving a clinic patient an injection of penicillin?
Wait 20-30 minutes to see if there is an allergic reaction
ECG analysis reveals that each P wave in the tracing has a different shape. The heart rate is 80 beats per minute. This is called:
Wandering pacemaker
Newborn Water and Room Temp
Water: 120F or lower Room: 97.9-99 F
Hypoglycemia - S/S
Weight gain greater than 1 kg/day Inform the provider and anticipate a decrease in the concentration, rate of administration or volume of lipid emulsion. Monitor the client's intake of oral nutrients
Anti-reabsorptives
What is anati-reabsorptive? Bone is a living organ which is continually being removed (resorbed) and rebuilt. Osteoporosis develops when there is more resorption than rebuilding. Antiresorptive medications are designed to slow bone removal and or improve bone mass. Treating and preventing osteoporosis can involve lifestyle changes and sometimes medication. Lifestyle change includes diet and exercise, and fall prevention. Prevention and treatment of osteoporosis involve medications that work by preventing bone breakdown or promote new bone formation. Medications Bisphosphonates prevent the loss of bone mass Alendronate (Fosamax) Monthly used to treat and prevent osteoporosis in menopausal women. Facts: The benefits of Fosamax can even be seen in elderly women over 75 years of age. Hint: Fosamax has been associated with severe esophagitis and ulcers of the esophagus. Should be avoided in clients with history of gastric ulcers. Risedronate (Actonel): This is a newer drug and less likely to cause esophageal irritation Hint: Teach clients taking either drug to take on an empty stomach with at least 8 ounces (240 ml) of water, while sitting or standing. This minimizes the chances of the pill being lodged in the esophagus. Clients should also remain upright for at least 30 minutes after taking these pills to avoid reflux in to the esophagus. For those clients who cannot tolerate the esophagus side effects of Fosamax, estrogen, etidronate (Didronel), and calcitonin are possible alternatives. Teriparatide (Forteo): It acts like parathyroid hormone and stimulates osteoblasts, thus increasing their activity. Promotes bone formation. Facts: This drug is associated with a risk of bone tumors so is only used when the benefits outweigh the risks.
Oral hypoglycemics
What is diabetes? Diabetes is a disorder that affects glucose metabolism. Type 1 diabetes: The client either makes no insulin or not enough insulin. Type 2 diabetes: The client makes enough insulin at least early in the disease but is unable to transport glucose from the blood into the cells. In both cases, the individual is unable to metabolize glucose. The purpose of oral hypoglycemics is to assist with glucose metabolism. Medications There are four classes of hypoglycemic drugs: · Sulfonylureas Tolbutamide (Orin ase); glyburide; Micron ase Stimulates insulin production Associated with weight gain · Biguanide: Metformin o First line drug in type 2 diabetes o Reduces the production of glucose within the liver o Associated with modest weight loss o Less likely to cause hypoglycemia. o Significant lipid-lowering activity. · Thiazolidinediones o Reverses insulin resistance o Increases glucose uptake and decreased glucose production o Associated with severe liver damage · Alpha-glucosidaseinhibitors. o Acarbose (Precose) o Reduces the absorption of dietary glucose o Associated with flatulence and diarrhea Hints: No matter which class the client will be taking there is always the risk of hypoglycemia Be sure to teach client how to recognize early signs and symptoms of hypoglycemia as well as appropriate interventions.
Antirheumatics
What is rheumatoid arthritis? Rheumatoid arthritis (RA) is a chronic disease that results in inflammation of the joints and surrounding tissues. RA affects the lining of the joints and the painful swelling can result in bone erosion and joint deformities. It is the small joints in hands and feet are most often affected. Treatment is designed to provide symptom relief and some delay in progression of the disorder but not a cure. Medications Disease-modifying Antirheumatic drugs (DMARDs), glucocorticoids, and non-steroidal anti-inflammatory drugs (NSAIDs) may be used individually or in combination to manage this chronic disorder. The major categories of antirhematics are: DMARDs I - Major Nonbiologic DMARDs · Cytotoxic medications: Methotrexate (Rheumatrex), leflunomide (Arava) · Antimalarial agents: Hydroxychloroquine (Plaquenil) · Anti-inflammatory medication: Sulfasalazine (Azulfidine) · Tetracycline antibiotic: Minocycline (Minocin) DMARDs II - Major Biologic DMARDs · Etanercept (Enbrel) · Infliximab (Remicade) · Adalimumab (Humira) · Rituximab (Rituxan) · Abatacept (Orencia) DMARDs III - Minor nonbiologic and biologic DMARDs · Gold salts: Aurothioglucose (Solganal) · Penicillamine (Cuprimine, Depen) · Cytotoxic medications: Azathioprine (Imuran), cyclosporine (Sandimmune, Gengraf, Neoral) · Glucocorticoids: · Prednisone (Deltasone), prednisolone (Prelone) ● NSAIDs Hints: DMARDs slow joint degeneration and progression of rheumatoid arthritis. Glucocorticoids and NSAIDs provide symptom relief from inflammation and pain. Rheumatrex ( methotrexate ) is the most commonly used DMARD. This is because it has been shown to work as well or better than any other single medicine. It is also relatively inexpensive and generally safe. Methotrexate has many food and drug interactions especially affect digoxin and phenytoin. Very difficult to absorb and should be taken on an empty stomach. Taking folic acid helps reduce some of the side effects. Methotrexate's biggest advantage could be that it has been shown to be safe to take for long periods of time and can even be used in children.
Cephalopelvic disproportion
When the fetus has a head size, shape or position that does not allow for passage through the pelvis.
Demand pacemakers fire:
When the patient's rate drops below a preset number
An ECG can help to determine:
Whether there is ischemic cardiac muscle
Bundle Branch Block (Left)
Wide QRS (>.12 seconds) Left Bundle Branch ("M") Can deteriorate to a 3rd Degree HB
Bundle Branch Block (Right)
Wide QRS (>.12 seconds) Right Bundle Branch Block ("V") Can deteriorate to a 3rd Degree HB
Blurred vision worsening as detachment increases.
With progression of detachment, painless vision loss that may be described as veil, curtain or cobweb that eliminates part of the visual field.
Jugular vein distention in cardiac patients should be evaluated with the patient positioned:
With the head elevated 45 degrees
What disorder is caused by an accessory atrioventricular connection leading to re-entrant supraventricular tachycardia?
Wolff-Parkinson-White syndrome
pain scale to be used with children?
Wong baker faces scale
Nursing intervention after a wound evisceration?
Wound opens and intestines come out, cover with warm normal saline
Characteristics of Jaundice?
Yellow, discoloration of the skin, mucous membranes, and sclerae of the eyes, caused by bilirubin. Look at liver and bilirubin test
Is the HIV positive patient contagious before acquiring full-blown AIDS?
Yes
osmotic diuretics: mannitol
acute phase kidney injury, cerebral edema, prevent kidney failure in shock, monitor for heart failure, kidney failure, lithium excretion is increased
TPN to end before new one comes what do you do
administer dextrose 10% in water
antigout med decreases uric acid level
allopurinol
Constant bubbling in a water seal chamber (of a chest tube) is an indication of
an air leak
Direct renin inhibitors: aliskiren, HTN
angiodema, hyperkalemia, diarrhea- dose related, decreases levels of furosemide, atorvastatin can increase levels, monitor for hypotension, avoid high fat meals
digoxin interactions
antacids and metoclopramide decrease digoxin, amiodarone, quinidine, verapamil, diltiazem, propafenone, flecainide increase digoxin levers, cortico, diuretics, thiazides, amphotericin B may decrease K levels- monitor HR- report is less than 60, eat high K diet
after circumcision
apply petroleum jelly w/every diaper change
case mgr
arranges for transportation to health care appts w/mental health
thiazide diuretics: hydrochlorothiazide, chlorothiazide, methyclothiazide, thiazide-type diuretics, indapamide, chlorthalidone, metolazone- moderate diuretic
assess for dehydration, report less that 30ml/hr, decrease in K, increase in glucose, avoid in pregnancy and lactation, no risk of hearing loss- alternate day can increase electrolyte imbalance
pt reports abuse
assess pt, check for injuries
A 44-year-old male complains of occasional palpitations, shortness of breath, dizziness and chest discomfort. Physical examination: Pulse: Irregularly irregular JVP: absent "a" waves Heart sounds: variable intensity S1 with occasional S3 Lab: EKG: Variable ventricular rate (90-190); Irregular RR intervals. Blood: CK-MB normal Chest X ray: Normal
atrial fibrillation
List 4 types of supraventricular tachycardias.
atrial tachycardia atrial flutter atrial fibrillation AV node reentrant tachycardia atrioventricular reentrant tachycardia
Procainamide: interactions
avoid antidysrhythmics, anticholinergic meds, antihypertneives, advise to take as prescribed, advise not to crush or chew sustained release preparations
propranolol
avoid w/ asthma, diabetes- monitor blood glucose b/c it masks signs of hypoglycemia
atropine
blocks the cardiac muscarinic receptors and inhibits the parasympathetic nervous system. The blockage of parasympathetic activity results in an increased heart rate. When the heart rate increases, cardiac output will also increase.
metoprolol and propranolol
bradycardia, cautiously in diabetes, decreased cardiac output- monitor and notify, AV clock- baseline ECG, OH, rebound myocardium excitation: taper off meds: monitor clients taking beta blocker concurrently
Propafenone: complications
bradycardia, heart failure, dizziness, weakness, monitor HR, chest pain edema. contraindicated in clients w/ AV block, severe heart failure, severe hypotension, and cardiogenic shock, use cautiously w/ heart, liver, kidney, failure. respiratory orders, older clients
Digoxin: complications
bradycardia, hypotension (therapeutic level: .5-.8) nausea, vomiting, dyrhythmias, hypokalemia, contraindicated: tachycardia, fibrillation, not use AV block, bradycardia, renal disease, hypothyroidism, cardiomyopathy
verapamil: complications
bradycardia, hypotension, HF, constipation, pregnancy risk, contraindicated in patients w/ IV form not used w/ tachycardia,
20 weeks gestation, having urinary frequency
c/s
16 weeks gestation
can get AFP test done
Pernicious anemia
check b12
early decelerations
check cervix
lidocaine interactions
cimetidine, beta blockers, phenytoin, monitor client for CNS depression, IV admin is usually started w/ loading dose, used for no more than 24hr
dialysis fistula
client teaching: avoid lifting heavy objects with access-site arm, avoid carrying objects that compress the extremity, avoid sleeping on top of the extremity with the access device, perform hand exercises that promote fistula maturation, check the access site at intervals following dialysis, apply light pressure if bleeding, notify the provider if the site continues to bleed after 30 min following dialysis.
Intenstinal gas is a common side effect of
clients following a cesarean birth
Bulimia Plan of Care when meal planning
closely monitor the client during and after meals to prevent purging
Sucralfate for PUD
coats stomach to prevent formation of ulcer and aids with healing existing ulcers
iron side effect
constipation
pediatric creatinine level
cord --> 0.6-1.2 newborn --> 0.3-1.0 infant 0.2-0.4 child --> 0.3-0.7 adolescent --> 0.5-1.0
pediatric carbon dioxide
cord--> 14-22 premature 1 week --> 14-27 newborn --> 13-22 infant, child --> 20-28
Sucking stab wound
cover wound
HMG COA Reductase inhibitors: the statins
decrease LDL, increase HDL, hepatotoxic, myopathy, monitor CK, no grapefruit juice, erythromycin, ketoconazole, ezetimibe, gemfibrozil, fenofibrate
Class 1B-- LIdocaine: mexiletine, tocainide
decrease electrical conduction, automaticity, repolarization rate: short term use only for ventricular dysrhythmias
Class 1A-- Procainamide, quinidine gluconate, quinidien sulfast, disopyramide
decrease electrical conduction, automaticity, repolarization rate: used w/ supraventricular tachycardia, ventricular tachycardia, atrial flutter, atrial fibrilation:
Class 1C: propafenone, flecainide
decrease electrical conduction, decrease excitability, increase rate or repolarlization: SVT
mag sulfate
decreased urine output decreased respirations decreased pulmonary edema
class II medications: propanolol hydrochloride, esmolol hydrochloride, acebutolol hydrochloride
decreases HR, slow rate of conduction, decrease atrial ectopic stimulation: used w/ Atrial fibrillation, atrial flutter, paroxysmal SVT, hypertension, angina
What is the name of the wide QRS wave with a slurred upstroke seen in Wolff-Parkinson-White syndrome?
delta wave - widened QRS signifies pre-excitation
Occupational therapy for
difficulty brushing teeth
Where to start IV first after mastectomy
distal opposite arm
breastfeeding w/hep c
don't breast feed if you have cracked nipples
centrally acting alpha agonists: clonidine, guanfacine HCL, methyldopa: migrain, ADHD, HTN, withdrawal, severe cancer pain
drowsiness, dry mouth, rebound hypertension so taper. dont use patch w/ scleroderma and lupus, use cautiously w/ stroke, MI, DM, depression, renal failure. careful w/ prazosin and TCAs,
cardiac glycosides: digoxin: treatment of heart failure and dysrhythmias
dysrhythmias, consume high K foods, .5-2 serum levels of digoxin, avoid use of quinidine, verapamil, thiazide, ACE can increase digoxin levels, antacids decrease
dopamine adverse
dysrhythmias, necrosis
Cranial nerve VIII
ears
Gastric surgery
eat 3 meals
adrenergic agonists:
epinephrine, dopamine, dobutamine, isoproterenol, terbutaline
Loop diuretics: furosemide, ethacrynic acid, bumetande, torsemide
excessive diuresis, monitor for dehydration, output less than 30ml/hr, hypotension, ototoxcity (irreversible w/ ethacrynic acid), hypokalemia, avoid in pregnancy, digoxin can increase toxicity, monitor BP, lithium, NSAIDs decrease effect
hypertensive crisis: nitroprusside, nitroglycerin, nicardipine, clevidipine, enalaprilat, esmolol HCl
excessive hypotension, cyanide poisoning- increased for liver issues, reduce by giving less than 5mcg/kg/min or thiosulfate, avoid prolonged use, protect from light, discard after 24 hr
s/s of hemolytic blood transfusion
flank pain
non-pharm relation technique for pain management in labor
focal point
Taking hold phase
focuses on maternal role and care of the newborn; eager to learn; may develop blues
lorazepam
for seizures
Rheumatoid arthritis pain
freq rest during the day
Insulins not to mix
garglarine and determis
Postural drainage
give albuterol, trendelenberg; 1 hour before meals or 2 hours after
Respite care
give caretaker break
respite care
gives family a break
Positive TB
hard raised bump
Left homonymous hemianopsia
has lost the left visual field of both eyes. They are unable to visualize anything to the left of midline of the body.
Newborn reflex shown on day 1
hear voice
Valproic acid can cause
hepatic toxicity
cholesterol absorption inhibitor: ezetimibe- decreases LDL
hepatitis, myopathy, don't take w/ bile acid, , fibrates if taken w/ statin monitor for more liver issues
Glasgow Coma Scale (head injuries) (eyes, verbal, motor)
highest number 15, good. lowest number 3, severe.
K-sparing diuretics: spironolactone, triamterene, amiloride, may take 12-48hr to work- less strong
hyperkalemia, endocrine effects (impotence and irregular menstrual), no w/ kidney failure
aldosterone antagonists: eplerenone, spironolactone: used w/ HTN, Heart failure
hyperkalemia, hyponatremia, flulike manifestations-report, dizziness, can cause lithium toxicity
angina
hyperlipidemia
epinephrine complications:
hypertension, dysrhythmias,
electrolyte imbalance manifestations:
hypocakelmia--> flat T waves on ECG hypercalcemia--> decreased deep tendon reflexes (DTRs) hypocalcemia--> tetany hyperkalemia--> tall peaked T waves on ECG
Propranolol: complications
hypotension, bradycardia, heart failure, fatigue, contraindicated in AV clock, heart failure, bradycardia, diabetes, liver, thyroid, respiratory, Wolff-parkinson white
Cardinal sign of ARDS
hypoxemia
retinal reattachment surgery home care
i put can't read right away after might have been can lift up to 15 lbs
borderline personality disorder
impulsive, fear of being alone
dispose of insulin needles @ home
in coffee container
bile-acid sequestrants: colesevelam HCL, colestipol- decrease LDL
increase fiber intake, oral fluids, take other meds 4hr before admin
amiodarone interactions
increase plasma levels, cholestyramine decreases levels of amiodarone, use cautiously w/ diuretics, beta blockers, verapamil, no grapefruit juice. may increase digoxinn toxicity- highly toxic
dobutamine adverse
increased HR
dobutamine: beta 1
increased HR, myocardial contraction, rate of conduction: used w/ heart failure
Nifedipein
increased HR- can give beta blocker to fix, observe for swelling (can give diuretic), acute toxicity- monitor VS, admin. norepi, calcium, isoproterenol, lidocaine, iv fluids, gastric lavarge- slowling HR w/ beta blockers, no grapefruit juice
order of abdominal assessment
inspect, auscultate, palpate, percuss
Heparin
is an anticoagulant that inhibits the conversation of prothrombin to thrombin. Patients on an anticoagulant drug such as heparin are at an increased risk of bleeding. -Signs of bleeding: ecchymoses, tarry stools, mucosal bleeding, and pink/ red-tinged urine.
Glasgow Coma Score
is calculated by using appropriate stimuli (a painful stimulus may be necessary) and then assessing the clients response in three areas. Eye opening (E) - The best eye response, with responses ranging from 4 to 1 4 = Eye opening occurs spontaneously. 3 = Eye opening occurs secondary to voice. 2 = Eye opening occurs secondary to pain. 1 = Eye opening does not occur. Verbal (V) - The best verbal response, with responses ranging from 5 to 1 5 = Conversation is coherent and oriented. 4 = Conversation is incoherent and disoriented. 3 = Words are spoken, but inappropriately. 2 = Sounds are made, but no words. 1 = Vocalization does not occur. Motor (M) - The best motor response, with responses ranging from 6 to 1 6 = Commands are followed. 5 = Local reaction to pain occurs. 4 = There is a general withdrawal to pain. 3 = Decorticate posture (adduction of arms, flexion of elbows and wrists) is present. 2 = Decerebrate posture (abduction of arms, extension of elbows and wrists) is present. 1 = Motor response does not occur. Responses within each subscale are added, with the total score quantitatively describing the client's level of consciousness. E + V + M = Total GCS
Myoglobin
is the earliest marker of injury to cardiac or skeletal muscle and levels no longer evident after 24 hr.
Synchronized cardioversion
is the electrical management of choice for atrial fibrillation, supra ventricular tachycardia (SVT) and ventricular tachycardia with a pulse.
Nursing Interventions during late or variable deceleration
left lateral position, oxygen, c-section
Have pt lie on this side during gastric levage for NG tube
left-prevents aspiration
chart says pt has HIV but didn't
libel
Patient can't sleep
light snack before bed
haldol
lip smacking
Ethambutol (Myambutol)-for tb
loss of color discrimination-discontinue
dopamine: shock and heart failure
low dose: renal blood dilation moderate: beta 1: renal dilation, increase HR, myocardial contractility, increased rate of conduction high: all above and vasoconstriction
diverticulitis diet
low fiber
diet for chronic renal failure
low protein & potassium
procainamide: complications
lupus- resolves w/ disconinuation, control systems w/ NSAIDs, neutropenia and thrombocytopenia, cardiotoxicity, hypotension, pregnancy risk, contraindicated w/ hypersensitivity to procaine and quinidine, myasthenia gravis,
Malfunctioning IV machine
mark as defected and get new one
propafenone interactions
may slow metabolism and cause an increase in the levels of digoxin, anticoagulants, and propranolol; quinidine and amiodarone increase toxicity, monitor ECG, bradycardia hypotension
Adenosine interactions
methyxanthines block receptors, dipridamole uptake in inhibited, short half life- so adverse are mild and last for less than one minute.
Beta Blockers:
metoprolol, atenolol, metoprolol succinate, esmolo, propranolol, nadolol, carvedilol, labetalol: HTN, agnina, migrain, glaucoma
Extreme focus
mild anxiety
antianginal agent: ranolazine; lower cardiac O2 demand
monitor ECG for QT prolonging, elevated BP, avoid use grapefruit juice, HIV protease, macrolide antibiotics, verapamil, quinidine, digoxin, simvastatin
clozaril interventions
monitor WBC
Cardiac tamponade
muffled heart sounds, pulsus paradoxus,
meds used for angina
nefedipine, amlodipine, nicardipine, verapamil, diltiazem
meds used for HTN
nifedipine,verapamil, diltiazem, amlodipine, felodipine, nicardipine
Neutropenic pts
no fresh flowers
Chest tube tidaling
normal
Thoracentesis causes pneumothorax expected finding
not friction rub; tracheal deviation
charge nurse scheduling resolution between nurses
nurse listens to both sides
Bulimia Therapeutic Nursing Care
offer small and frequent meals
pt refuses last minute for a procedure he already consented for
okay to stop procedure
Dehydration
oliguria
Hyperglycemia - blood glucose level usually greater than 250 mg/dL. Polyuria (excess urine production and frequency) from osmotic diuresis
olydipsia (excessive thirst) due to dehydration Loss of skin turgor, skin warm and dry Dry mucous membranes Weakness and malaise Rapid weak pulse and hypotension
Prednisolone acetate (Pred Forte
ophthalmic solution) ■ Prednisolone acetate is an ocular steroid used to decrease inflammation.
2nd Degree Heart Block Causes
organic heart disease, MI, Dig Toxicity, Beta and Calcium Blockers
Opioid agonist naloxone then what happens
pain
Treating xerostomia following radiation
pat dry.
iv site red and warm
phlebitis
DM
polyuria, polydipsia,polyphagia
Hypovolemic shock
position: Supine with legs elevated (shock position)
Glasgow coma score 14
pt alertx3
amiodarone: complications
pulmonary toxicity, sinus bradycardia and AV block, monitor BP, HF, visual disturbances, liver and thyroid dysfunction, phlebitis with IV admin, hypotension, bradycardia, contraindicated in patients w/ AV block, pregnancy risk: av block, bradycardia, newborns and infants, HF, fluid and electrolyte imbalance
Expected finding in cardiac tamponade
pulsus paradoxus-drop in bp during inspiration
thoracentesis, & painful w/breathing
put pt on UNAFFECTED side for 1 hour or longer
location for peripheral line
radial
dementia patient
raise 1 side rail
sublingual tablet and translingual spray
rapid onset, short duration treat acute attack, and prophylaxis of acute use at first sign, prior to activity known to cause pain, stored in cool, dark place
how good nurse plans her day
rechecks her priorities half way through her shift
intermittent enteral tube feeding diarrhea after each feeding
reduce rate of feeding
daughter feeling guilty about admitting parent into long-term facility: THERAPEUTIC RESPONSE
rephrase what daughter is feeling
Lyme disease
report to health department
Battery
rn gave med against consent
Assault
rn threatened to restrain pt
Varicella
scabs okay
List 3 ECG findings in Wolff-Parkinson-White syndrome.
short PR interval wide QRS delta wave
Informed consent
signed willingly
List 3 possible diagnoses if QRS < 120 ms.
sinus arrhythmia supraventricular rhythm junctional tachycardia
adenosine: complications
sinus bradycardia, hypotension, dyspnea, flushing of face, monitor ECG- effects last 1min or less. contraindicated in second and third degree heart block, AV block, atrial flutter, atrial fibrillation
Thoracentesis position
sitting position, arms raised and resting overbed table.
topical ointment
slow onset, long duration long term phrophylaxis remove prior dose before applying new dose, clean hairless area, cover w/ saran, avoid touching ointment,
sustained release
slow onset, long duration long term prophylaxis against anginal attacks swallow w/o crushing or chewing- empty stomach w/ water
transdermal
slow onset, long duration long-term prophylaxis against attacks patches shouldn't be cut, rotate, no hair, remove w/ soap and water, remove at night
swallowing difficulty referral
speech therapy
alpha adrenergic blockers: prazosin, doxazosin mesylate, terazosin: HTN, BPH
start with low dose, first dose given at night, change positions slowly, use carefully w/ antihypertensives. take med w/ food.
Diazepam (benzo) should be given for?
status epileptcus
Delegate to LPN
sterile dressing
confirmation of ng placement
stomach ph
A 46-year-old woman arrived in the ER complaining of sudden onset of palpitations, lightheadedness, and shortness of breath. These symptoms began approximately 2 hours previously. PE: BP 95/70 mm Hg Heart Rate - averages 170 beats/min, regular Rest of her physical examination is unremarkable EKG: abnormal P waves; P-R intervals are within normal limits; normal QRS complexes
supraventricular tachycardia
rash on hands and feet
syphilis
prednisone
take at night
Stroke pt with agnosia at dinner
tell pt its a fork use it to eat
When a client is experiencing a wound evisceration...
the nurse should initially stay with the client and call for help. Next, the nurse should place saline-soaked gauze on the exposed bowels to keep the internal organs moist. The nurse should then place the client in a supine position with his hips and knees bent to relieve pressure from the open wound. Last, the nurse should take the client's vital signs to assess for changes in hemodynamics.
lupus s/s
there was a rash but wasn't butterfly photosensitivity
How to measure Fundal Height
top of symphysis pubis to top of fundus
True Labor vs False Labor Abdominal Discomfort
true: low back and abdominal false: abd and groin
stage 4 pressure ulcer
tunneling
Pt with femur fracture highest prioroty
upper chest petechiae-risk for fat embolism syndrome
notify dr while on iron for?
urine color changes
organic nitrates: nitroglycerin, nitro-time (capsules), nitrostat (subling tablet), nitorlingual (spray), nitro-bid (topical), nitro-dur (transderm), nitro-bid Iv, isosorbide dinitrate, isosorbide mononitrate- treat angina
use aspirin or acetaminophen to relive pain, OH, reflex tachy, tolerance, can increase cranial pressure, avoid alcohol, careful w/ beta blocker, calcium channel, diuretic, NO with viagra etc.
IV
used for angina that doesn't respond to other meds, contorl BP or induce hypotension suring surgery, heart failure from acute MI use glass IV bottle, start slow and titrate up,
ACE inhibitors: captopril (1hr before meal), enalapril, enalaprilat (only one for IV), fosinopril, lisinopril, ramipril, moexipril (1hr before meal): vasodilate, excrete water and sodium
used in: heart failure, HTN, MI, nephropathy. stop diuretic 2-3days before ACE, dry cough, hyperkalmeia, rash and alter taste-report, angiodema, neutropenia, can increase lithium levels, avoid use of NSAIDs
ARBs: losartan, valsartan, irbesartan, candesartan, olmesartan: dilate and excrete
uses: HTN, prevent mortality following MI, stroke, angiodema, fetal injury, given PO
Epinephrine: alpha 1, beta 1 and 2
vacoconstrict, increase HR, heart contraction, rate of conduction, bronchodilation helps w/ slows absorption of local anesthetics, manages superficial bleeding, decreased congestion of nasal mucosa, increased BP, treatment of AV block and cardiac arrest, asthma
Cervical lacerations are common complications from
vacuum-assisted birth are rare but can include perineal, vaginal, or cervical lacerations
List 3 possible diagnoses if QRS > 120 ms.
ventricular tachycardia supraventricular rhythm with additional bundle branch block additional accessory AV pathway
propranolol interactions
verapamil, dilitiazem have additive cardiosuprression effects, careful w/ diabetic patients; instruct clients to take apical pulse and notify provider of changes
meds used for cardiac dysrhythmias
verapamil, diltiazem
Warfarin
vitamin k for toxicity; INR 2-3; PT 11-12.5
Peritoneal dialysis
warm solution before
Difficulty voiding
warm water
HF monitoring
weights
when can kid return to school for chicken pox
when lesions are crusted over
Cleft Lip
while feeding hold in upright position.
Endometiral infection usually occurs
with a prolonged rupture of membranes, not vacuum-assisted births.
calcium channel blockers: nifedipine,verapamil, diltiazem, amlodipine, felodipine, nicardipine
works on arteries, veins not affected
Clozapine side affect
wt gain
Hypotension › Tensilon has no positive effect on manifestations, and can actually worsen findings (more anticholinesterase - more cholinergic manifestations).
› Manifestations decrease with the administration of an anticholinergic medication, such as atropine.
MIXED CRISIS: › Clients may experience mixed crisis when myasthenic crisis is overtreated with anticholinesterase drugs.
› Manifestations include dyspnea, dysphagia, dysarthria, restlessness, apprehension, salivation, and lacrimation.
Monitor for the possible complications of hypovolemia, hypokalemia, and hypocalcemia.
■ Client Education - Instruct the client that the procedure will typically last 2 to 5 hr.
Avoid touching the tip of the application bottle to the eye. ■ Always wash hands before and after use.
■ Once eyedrop is instilled, apply pressure using the punctal occlusion technique (placing pressure on the inner corner of the eye).
Objective Data - SLE ■ Fever (also a major symptom of exacerbation) ■ Anemia ■ Lymphadenopathy ■ Pericarditis (presence of a cardiac friction rub or pleural friction rub)
■ Raynaud's phenomenon (arteriolar vasospasm in response to cold/stress) ■ Findings consistent with organ involvement (kidney, heart, lungs, and vasculature) ■ Butterfly rash on face
S/S Pain at rest and with movement ◯ Morning stiffness ◯ Pleuritic pain (pain upon inspiration) ◯ Xerostomia (dry mouth) ◯ Anorexia/weight loss ◯ Fatigue ◯ Paresthesias ◯ Recent illness/stressor ◯ Joint pain ◯ Lack of function
● Objective Data ◯ Joint swelling and deformity ■ Joint swelling, warmth, and erythema. ■ Finger, hands, wrists, knees, and foot joints are generally affected. interphalangeal and metacarpophalangeal joints. ■ Joints may become deformed merely by completing ADLs. ■ Ulnar deviation, swan neck, and boutonnière deformities are common in the fingers.
AIDS - Nursing Care: Assess risk factors (sexual practices, IV drug use). ◯ Monitor fluid intake/urinary output. ◯ Obtain daily weights to monitor weight loss. ◯ Monitor nutritional intake. ◯ Monitor electrolytes.
◯ Assess skin integrity (rashes, open areas, bruising). ◯ Assess the client's pain status. ◯ Monitor vital signs (especially temperature). ◯ Assess lung sounds/respiratory status (diminished lung sounds). ◯ Assess neurological status (confusion, dementia, visual changes).
Any condition that increases carbohydrate metabolism, such as physical or emotional stress, illness, infection (No. 1 cause of DKA), surgery, or trauma that requires an increased need for insulin
☐ Increased hormone production (e.g., cortisol, glucagon, epinephrine) stimulates the liver to produce glucose and decreases the effect of insulin.
Systemic manifestations ☐ Hypertension and edema (renal compromise) ☐ Urine output (renal compromise) ☐ Diminished breath sounds (pleural effusion) ☐ Tachycardia and sharp inspiratory chest pain (pericarditis)
☐ Rubor, pallor, and cyanosis of hands/feet (vasculitis/vasospasm, Raynaud's phenomenon) ☐ Arthralgias, myalgias, and polyarthritis (joint and connective tissue involvement) ☐ Changes in mental status that indicate neurologic involvement (psychoses, paresis, seizures) ☐ BUN, serum creatinine, and urinary output for renal involvement
