Hurst Q cards
Water heater setting
Below 120F
ECG changes with hyperkalemia
Bradycardia. Tall and peaked T waves. Prolonged PR intervals. Flat or absent P waves, widened QRS, conduction blocks, and ventricular fibrillation
hyperkalemia
CAUSES-kidney trouble, spironolactone-makes u retain potassium. S/S-begins with muscle twitching, then proceeds to muscle weakness then flaccid paralysis. life threatening arrhythmias. TREATMENT-dialysis, calcium gluconate decreases arrhythmias. glucose and insulin. insulin carries glucose and potassium into the cells, worry ab hypokalemia and hypoglycemia. sodium polystyrene sulfonate (kayexalate)-exchange k ions for Na ions.
Chemotherapy Full Precautions
Chemotherapy Gown 2 pairs of chemotherapy gloves-one under gown, one over gown. Goggles and/or mask if splashing or inhalation can occur
hypertonic solutions
"packed with particles". volume expanders that draw fluid into the VS from the cells. D10W, 3%NS, 5%NS, D5LR, D51/2 NS, D5NS, TPN, Albumin. used for hyponatremia, 3rd spacing, severe edema, burns, or ascites. will return fluid volume to VS. watch for FVE, monitor in ICU with monitoring for BP, HR, CVP esp if 3 or 5% NS
general ways to prevent infection
-Private room -Wash hands -Have patients own supplies in room (ex: own cups, BP cuffs, stethscope) -Limit people in the room (visitors and nurses) -Change dressings and IV tubing daily -No fresh flowers or potted plants -Cough and deep breath --> decrease risk for pneumonia -Avoid crowds, wear mask in public -Dont share tolities -Bathe warm moist areas twice daily -Wash hands after touching a pet or other people -avoid undercooked meat, seafood or eggs NO SUSHI -Avoid raw fruits or vegetables, -Drink only fresh water -report to hospital for any temp of 100.4 -no alchol based mouthwash
Isotonic solution=balanced solutions
0.9% Nacl Lactated Ringers D5W d51/4NS. these stay in VS and could cause FVE. used to replace fluids in V,N, burns,sweating and trauma. DO NOT GIVE to hypertensive, cardiac disease or renal disease. be careful ab hypernatremia. give LR for shock, blood=NS
spill chemotherapy on hands and floor ordered response?
1. wash hands with soap and water 2. get spill kit from wall in client's room. 3. put on respirator mask 4. put on chemotherapy gown 5. put on 2 pairs of gloves 6. put on goggles. 7. use absorbent pads to wipe up spill. the floor needs to be cleaned THREE TIMES. use ALL protective equipment for cleanup
American Burn Association
2-4ml of LR x body weight in kg x % of TBSA burned=total fluid needed. 1st 8hrs=1/2 of total volume 2nd 8 hrs=1/4 of total volume 3rd 8hrs=1/4 of total volume. 24hrs of when burn occured
what do the liver enzymes do if the liver is damaged
ALT and AST will increase is liver is damaged
Partially compensated
All values are abnormal
Hypomagesemia causes
Diarrhea, alcoholism- suppresses ADH- not eating, and diuresising more then normal. treatment- give some Mg, check kidney function before and during IV mg. seizure precautions, eat mag, flushing and sweating when starting IV mg? STOP IT
A client with chronic liver disease has ascites and is being treated with an albumin infusion. What should the nurse anticipate and monitor in this client?
Fluid volume excess bc albumin is a hypertonic solution.
red blood cell transfusions
For clients with symptomatic anemia We do not want Hgb/Hct to drop below 8 g/dl and 24%
rule of nines
Head and Neck= 9% Each upper ext= 9% Each lower ext= 18% Front trunk= 18% Back trunk= 18% Genitalia= 1% so anterior arm would be 4.5 but whole arm is 9
fluid retention think
Heart Problems First! bounding and full pulse. more volume more pressure
Hypercalcemia causes
Hyperparathyroidism-too much PTH which makes calcium go up. thiazides-retain calcium immobilation-have to bear weight to keep CA in the bones but nah so it goes in blood and raises serum ca. s/s-brittle bones, kidney stones-most made of calcium treatment-move, fluids-prevent kidney stones, CA inverse relationship with phosphorus so add phos or protein to diet, steriods to decrease CA. give biphosphates(etidronate) and calcitonin-treats osteophorosis
Hyperaldosteronism (conn's syndrome)
Hypersecretion of aldosterone from the adrenal cortex. retain sodium and water- leads to FVE
A client is admitted following a severe burn. What changes related to fluid status would the nurse anticipate?
Hypovolemia, third spacing, low CVP, increased USG
FVD symptoms
Low BP- risk for orthostatic hypotension, High HR, high RR. pulse-weak and thready Dry mouth, thirst Rapid weight loss Low urine output Confusion, lethargy SG>1.030 (High)-urine is very concentrated High HCT High BUN (Blow Urea Nitrogen) Low Na High Osmo cvp-down, vasoconstrict. IV HARD stick
Extravasation of Chemotherapy
Major complication of IV Chemotherapy. vesicant- type of chemo drug that if it infiltrates will cause tissue necrosis. s/s- pain, swelling, no blood return treatment- prevention. stop the infusion and send for the extravasation kit. stay with the client.
A client is admitted with hypocalcemia. Which treatment would the nurse anticipate for this client?
PO calcium, vitamin d, sevelamer hydrochloride (phosphate binder)
The nurse is preparing to administer magnesium sulfate IV to an alcoholic client with hypomagnesemia. Prior to the initiation of IV magnesium, which assessment data would be important for the nurse to document?
RR, DTR, UO
Rome
Respiratory Opposite Metabolic Equal. respiatory bc lung one is 45 acid, 35 is base.
Foods high in potassium
Spinach, fennel, kale, mustard greens, brussel sprouts, broccoli, eggplants, parsley, cucumber, bell pepper, ginger root, tuna, halibut, cauliflower, lima beans, potatoes (white or sweet), cabbage, cantaloupe, tomatoes, apricots, strawberries, avacado, banana, kiwi, oranges.
total laryngectomy
Surgical removal of the entire larynx - vocal cords, epiglottis, thyroid cartilage. will have a permament trach or laryngectomy. upper trachea has to be rerouted out through the upper neck. post op-mid-fowlers 30-45% watch for carotid artery and innominate artery rupture!! FREQUENT MOUTH CARE
risk factors for cancer
Tobacco, alcohol, dietary causes, obesity, physical inactivity, poor nutrition, immunosuppressed, age >60, african americans, heredity, exposure to ultra-violet radiation, exposure to carcinogens, stress, chronic irritation, previous history of cancer
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Too many letters= too much water, retain water, FVE. UOP decrease bc they are retaining water. urine concentrated, blood diluted. serum sodium=low bc hella water. urine specific gravity=high,
ECG changes with hypokalemia
U waves, PVCs, Ventricular tachycardia
how to dispose chemotherapy?
YELLOW rigid chemotherapy waste container for sharps and IV epiquipment. yellow chemotherapy waste bag for gowns, gloves, and disposable items. wash with SOAP AND WATER
Neutropenia
a decreased number of neutrophils. best way to assess is by calculating an absolute neutrophil count. ANC (2500-8000 cells) tells how well your client can handle an infection treat-antibiotics, implement neutropenic precaustions.
signs of rejection in a post stem cell transplant
abdominal pain, jaundice, pruititis, diarrhea
other therapies for cancer pain management
acupressure, acupuncture, cannabis, distraction, hydrotherapy, massage
urinary output for burns
adults 0.5-1ml/kg/hr. electrical burn- 75-200ml/hr is goal kids- 1ml/kg/hr
what medication do you give after the first 24hrs of a burn
albumin. holds onto fluid in the vas. space. work load of the heart will increase. but if you stress heart too much then check CVP hourly to make sure the infusion is not overloading and going into FVE.
IV potassium
always assess UO before/during IV potassium. have to have a pump, mix well, burning?slow infusion
if cancer invades the bone marrow, it can lead to... (3)
anemia(low RBC), leukopenia(low WBC), thrombocytopenia(low platelet)
Neutropenic precautions
antibiotics as prescribed vital signs at least every 4 hrs private room with door closed and posted sign antimicrobial soap for handwashing no invasive procedure (IM injection, rectal exams/meds) avoid indwelling catheters or NG tubes if at all possible limit use of acetaminophen (tylenol)
ADH problems
anything that upsets the pitutary gland. aka craniotomy, head injury, sinus sugery, transsphenoidal, hypophysectomy, pituitaty tumor, any condition that can lead to increased ICP= adh problem
nclex tip-radiation
assume they all emit radiation to be safe
when should women have a colonoscopy
at age 50 then every 10 years.
how to prevent dislodgement of implant
bedrest, decrease fiber in diet, prevent bladder distension, have indwelling catheter. if it becoems dislodges- gloves, forceps, place implant in a lead lined container, leave in room and call radiation department
kidney chemicals
bicarb & hydrogen. normal bicarb(HCO3) 22-26. so think metabolic. when they are compensating they are excreting them through the urine. take hours to days to do their job
what cancer is fever an early sign of
blood(leukemia) cancers and lymphoma
hematologic cancers treatment
bone marrow and stem cell transplants. same transplant but from different areas. stem cells are given into a vein, and settle into the bone marrow and produce healthy blood cells
what to do after a mastecomy?
brush hair, squeeze tennis balls, wall climbing, flex and extend elbow. promotes new collateral collection
Major lung chemical
c02, so think respiratory when co2 is abnormal. normal is 35-45. but backwards bc greater then 45 is acidic and less then 35 is basic. only way to get rid is to exhale. lungs respond fast
what do u do if the innominate artery
call the pcp and go to the OR
Hypokalemia
causes-vomiting, NG suction, diuretics, not eating. s/s- first muscle cramps, then muscle weakness, then arrhythmias. treatment-give potassium, spironolactone- makes u retain potassium, eat more potassium.
diagnosis for cancer
caution change in bowel/bladder habit a sore that does not heal unusual bleeding/discharge thickening or lump in breast or elsewhere indigestion or difficulty swallowing obvious change in wart or mole nagging cough or hoarseness
what to look for if they have a mastectomy
check for bleeding on the front and back, blood can pool in the back
why is surgery the first type of treatment?
could be used for prevention, diagnosis, or to treat it by removing.
Thrombocytopenia- big deal in cancer
decrease in the number of circulating platelets in the blood. they are responsible for clotting and to prevent bleeding risk factors- advanced metastatic disease, hematological malignacies, bleeding disorders-hemophilia, liver disease, ITP(idiopathic thrombocytopenia purpura). bacterial infections, anticoagulant medications-aspirin, clopidogrel, heparin, warfarin, result of cancer treatments
Hyperventilation
decreased CO2 so alkalosis.
Increased CO2 means
decreased LOC. decreased O2
Hypernatremia
dehydration. too much sodium not enough water. causes-hyperventilation-exhale lose water, heat stroke, DI. s/s-dry mouth, thirsty, swollen tongue, neuro changes. treatment-restrict sodium, dilute client with fluids(IV fluids) so sodium goes down. daily weights, I&O, lab work. watch feeding tubes bc they get dehydrated easily
The nurse is preparing a teaching plan for a client newly diagnosed with fluid retention and heart failure. What should the nurse advise the client to avoid?
effervescent soluble medications, chicken noodle soup, deli-ham sammy
what is the rule of nine not used for
electrical burns but only thermal burns
external radiation s/s
erythema, shedding of skin, fatigue, pancytopenia. DO NOT WASH OFF MARKING, no lotion on marking. protect site from sunlight and UV for 1 year
red or brown urine after a burn
expected after a major burn/electrical injury. obv monitor
burns treatment for inhalation injury
give 100% oxygen
before hydrotherapy
give pain meds, worry ab cross contamination for whirl pool
hypotonic solution
goes into VS then shifts out into the cells to replace cellular fluid. they rehydrate but do not cause hypertension ex-D2.5W, 1/2NS, 0.33NS. used for pts who have hypertension, renal, or cardic disease and needs fluid replacement. also used for dilution when a client has hypernatremia and cellular dehydration. WATCH for CELLULAR EDEMA
respiratory acidosis s/s
headache, confused, sleepy. hypoxic. treatment-fix breathing problem. deep breathing, pneumothorax-chest tubes.
A client with deep partial thickness burns to arms and legs is admitted to the burn unit. The nurse knows elevated results are most likely to be noted initially in what laboratory tests?
hematocrit, potassium, creatinine.
Thrombocytopenia assessment
history, VS, pulse ox, oozing from surg site, change in LOC, reports Headache, pupil changes, conjunctival hemorrages(eyes bloodshot), petechiae-arms, legs, mouths (spots), ecchymosis (brusing), purpura (lots of red and purple bruising), bleeding from rectum, ears, nose, throat treatment-give them some platelets
metabolic acidosis- potassium
hyperkalemia
respiratory alkalosis
hyperventilation. could be acute aspirin overdose. s/s- lightheaded or faith feeling, peri-oral numbness, numbness and tingling in fingers or toes. treatment-may have to sedate, treat the cause!!
metabolic alkalosis-potassium
hypokalemia. excessive vomiting
Hypocalcemia causes, s/s, treatment
hypoparathyroidism, radical neck, thyroidectomy=not enough PTH. treatment-PO calcium. IV CA-give sloww and make sure always on heart monitor- widens QRS, decrease HR, too fast-arrthymia.. vitamin d, phosphate binders (decrease phos= increase calcium) sevelamer hydrochloride, calcium acetate.
FVD
hypovolemia aka shock. loss of fluid from anywhere-V,D, thoracentesis, paracentesis, hemorrhage. 3rd spacing- fluid in place that does u no good, worry ab hypotension. polyuria so DM. POLYURIA THINK SHOCK
sodium level
in blood is dependant on how much water you have in blood. think neuro checks
hypoventilation
increased CO2 so acidosis
radiation therapy-internal
internal(brachytherapy)-gets the radiation close to the cancer or target tissue. unsealed-emits radiation through body fluids. given IV or PO. radioactive for 24-48hrs sealed or solid-client emits radiation, body fluids are not radioactive. placed close to or inside the tumor. can be permanent or temp.
sodium and potassium have an
inverse relationship
patient teaching about chemotherapy
is excreted for 3-7 days after administration so may still excrete when discharged
bedrest is good for FVE bc
it induces diuresis by releasing ANP which you lose sodium and water and decrease production of ADH
metabolic acidosis
kidneys are the issue and lungs are compensating. retaining hydrogen or too little bicarb. RR will increase to get rid of acid. causes- DKA, starvation, renal failure, severe diarrhea. s/s- depends on cause, hyperkalemia. treat the cause
if question says assessment/ evaulation
look for presence or absense of pertinent s/s
Before a mammogram what should the client not have on their body?
lotion, powder, deodorant
dietary risk factors for cancer
low fiber, increased red meat, increased animal fat, nitrates(processed sandwhich meats), alcohol, preservatives and additives.
FVE treatment
low sodium diet/restrict fluids. duirectics-loop= furosemide or bumetanide when lasix doesnt work. hydrochloroyhiazide. watch electrolyte problems bc diurectics lose potassium!!! potassium sparing- spironalactone- watch for hyperkalemia
Before giving antibiotics you should first
make sure the cultures have been collected
what medication given to flush out the kidneys
mannitol-never refriderate. usually only diuretic given for a burn, may increase fluids and report when color turns CLEAR
Centra venous pressure
measured in right atrium, up in FVE. normal-2-6mmHg, 5-10 cmH20.
symptoms of hypomagnesemia and hypocalcemia
muscle tone-rigid/tight, seizure risk, stridor/laryngospasm-airway is a smooth muscle, positive chvostek-tap cheek (twitching is bad). positive trousseau-pump uo BP cuff-tremor. arrhythmias, DTRs increase, mind changes, swallowing problems
what lab work do you monitor in cancer
neutrophils
if lymph nodes were removed with mastectomy, what do you avoid
no procedures on the arm of the affected side for a lifetime. no constriction, no BP, no blouse with elastic, no watch, no IV, wear gloves when gardening, no nail biting, watch small cuts, and no sunburn. no purse. bc can turn into a big infection on affected arm
diabetes insipidus
not enough ADH- lose water, FVD, worried ab shock. NO BLOOD SUGARS!! DI=DIURESIS. urine diluted, blood concentrated. going into shock but still putting out hella diluted urine.
DVT-cancer
number 2 cause of death in cancer clients why is cancer a big risk? prolonged bedrest, surgery, use of central line, extrenal compression of vessels by tumor, invasion of vessels by tumor, certain chemo drugs. worried ab development of PE
Addison's disease
occurs when the adrenal glands do not produce enough of the hormones cortisol or aldosterone. lose sodium and water and go into FVD
uncompensated
pH and one other value are abnormal. the other value is normal bc its not trying to fix the problem
Fully compensated
pH is normal, but the other 2 are abnormal.
normal ABGS
pH: 7.35-7.45 PaO2: 80-100 PaCO2: 35-45 HCO3: 22-26
If the kidneys aren't working well, __________ will go up.
potassium
Lab work to ensure proper nutrition and positive nitrogen balance
prealbumin-shortest halflife and changes the quickest
external radiation
process of administering radiation to the patient via a radiation machine located outside the body. is not radioactive!!
what are needed in the diet to promote healing?
protein and vitamin c
fatigue and pain
provide periods of rest, naps, and limit visitation time treat pain without worry ab dependance OPIODS ARE GOLD STANDARD FOR CANCER PAIN- no ceiling on dose of opiod for cancer pain, limit the dose bc of side effects, client dependent! also give stool softener for constipation induced from opidods
Hypermagnesemia causes, s/s, and treatment
renal failure antacids s/s- flushing and warmth, mg causes vasodilutation-decreases BP treatment-ventilator. RR less than 12=vent, dialysis-kidneys aren't working, calcium gluconate-antidote for Magnesium toxicity.
Hypoxia
restlessness and tachycardia
medications given for NV in cancer
routine antiemtic meds are usually given the first week of chemo. ondansetron (zofran)- blocks the effects of serotonin. serotonin receptor antagonist(all end in tron), pill or IV, usually have few side effects, low drowsiness effect. netupitant/palonosetron (akynzeo)- oral combination antiemtic, prevents acute and delayed NV caused from chemo. only 1 dose-1 pill one hour befroe chemo.
daily weights
same time, same scale, same clothes, void first,
common symptoms of hypermagnesemia and hypercalcemia
sedated DTR- decrease muscle tone-weak/flacid arrhythmias-yes LOC-down pulse-down RR-down
Magnesium and Calcium act like
sedatives think muscles first mg-1.3-2.1 ca-9.0-10.5
foods high in mag
spinach, mustard greens, summer squash, broccoli, halibut, turnip greens, pumpkin seeds, peppermint, cucumber, green beans, celery, kale, sunflower seeds, sesame seeds, and flax seeds
what immunizations do you give after a burn
tetanus toxoid- takes 2-4weeks to develop, active immunity. can't remember when they got their last shot? then they get the immune globulin(passive immunity) gives u immediate protection
internal radiation precautions
time-only short visits distance-stand as far as possible shielding- lead shield nursing assignments rotated daily, only care for 1 client with radiation implant on a shift. wear film badge-to track amount of radiation. restrict visitors, visitor visits only 30 min, stay 6 feet away, no younger then 16, no pregnant, wear gloves
burns- why does HR increase
to pump the little fluid to the organs, CO decrease, UO decrease
metabolic alkalosis
too much bicarb, too little hydrogen. causes- loss of upper GI contents-aka losing acid. too many antacids- too much base. s/s- depends on cause, observe LOC. serum potassium will go down in alkalosis think K LO. monitor for muscle cramps and life threatening arrhythmias. fix the problem and replace potassium
Cushing's disease
too much of all steroids, too much aldosterone . retain sodium and water- leads to FVE
Hyponatremia-dilution
too much water, not enough sodium. causes- drinking H20 for fluid replacement (drink gatorade)-bc only replaces water and dilutes the blood. psychogenic polydipsia- loves to drink water. D5w-sugar and water. SIADH-retaining water. s/s-headache, seizure, coma. treatment- needs sodium, not water. neuro problems? need hypertonic saline so 3% or 5%. worry ab FVE
fluid status for burns
urine output!! only time its not daily weights
ADH another name
vasopressin(pitressin). or desmopressin acetate(DDAVP) may be utilized as an ADH replacement in DI
When do chemo drugs work best?
when the cells are actively growing so when the tumor first begins to develop. early detection for cancer is best
breast self-examination
women- monthly do the exam when period is almost over so day 7-12. post menopausal do on the same day of every month. greater then 40 need a yearly clincial breast exam. 20-39 need one every 3 years
what do you worry ab with mycin drugs
worry when BUN or creatinine increase or if they report any hearing loss. can lead to ototoxicity (irreversible hearing loss) and nephrotoxicity. if bun and creatinine increase assume client has nephrotoxicity