Labs and stuff
secondary OA aka osteoarthritis how common? results from?
-less common -results from musculoskeletal conditions like rheumatoid arthritis or congenital anomalies, trauma, joint sepsis or metabolic conditions like DM, paget's or blood disorders like hemophilia, sickle cell anemia
Post op nursing care for ovarian cancer
- Assess vital signs, pain, I & O (esp. urine &/or drains) - Antiembolism stockings, early ambulation; SCDs - Incentive Spirometer (IS), TCDB
Fat embolism 1st sign? s/s? prevention? treatment?
-Altered mental status - 1st sign, increased RR+ pulse+temp., crackles, decreased SaO2 dyspnea, chest pain, petechiae, increased ESR+lipase and decreased Ca+RNC+platelets, respiratory failure from pulmonary edema -Prevention- Immobilization of fracture site -Treatment:NOTIFY MD!, Bedrest, Gentle handling, Promote oxygenation, Promote hydration, Fracture immobilization,Steroids
Muskuloskeletal safety assessments? collabs?
-Assessment-Posture, Gait, ROM, Size and symmetry , Strength and tone, Occupation, Living arrangements -Collaboration:Home health care, Rehabilitation
Spiral of gout process
Attack starts, crystals form, white blood cells attack, crystals pop cell, cell releases proteins, proteins call in more white blood cells and cause inflammation and pain, proteins lower ph making it possible for more crystals to form, attack starts over
Skin care of gastroenteritis
Avoid toilet paper and harsh soaps, clean with warm water followed by thorough gentle drying. Cream oil or gel can be applied to damp warm washcloth to remove stool or skin wipes. Protective barrier cream van be applied to skin between stools. Sitz bath can reduce discomfort. If leakage of stool cotton or panty liners
Corticosteroids common examples? SE? Education? Responsibility?
Azmacort or fluticasone/Flovent inhalant, prednisone PO, solumedrol IV. SE: Irritability, headache, increased blood glucose, Cushingoid effects, weight gain, GI issues. Don't abruptly stop taking meds, take with food, monitor weight, avoid excess salt intake+people with infection+injury. Monitor BG levels and VS, oral care. Used as last resort for asthma
Sulfasalazine examples? Report?
Azulfidine and EN tabs. Metabolized into 5-ASA. Report nausea,vomitting, anorexia, rash, headache, anemia,hepatitis, infertility.
Oral glucose tolerance test
Balanced diet with carb intake >150g for minimum of 3 days before while maintaining normal activity, test performed in morning after 10-12 hour fast, fasting blood sample obtained, drink 300 mL of flavored beverage containing 75 g glucose within 5 min. Of fasting sample, blood drawn at 30 minutes for 2 hours, remain at rest the whole test
Liver vs. spleen for blood
Balances blood cell production with blood cell destruction and assists with immunity, stores platelets, filters antigens. vs. clotting factors bile for vitamin K and stores blood/iron
Performing IV assessment
Begin with insertion site and work upward following the tubing. Make sure no phlebitis and dressing clean, dry, adherent on all sides. Check everything secure, no tape on connections, check rate by counting drops or checking pump. Check all labels for patient's name and fluid or medication
At risk factors for depression? What to checK?
Being old, sadness, hopelessness, losses. Do you have a plan
Eructation aka
Belching
Antihistamines common examples? Function? Can be administered? SE? Education? Responsibility?
Benadryl, Zyrtec, Claritin, Allegra. PO but Benadryl can be IV. Decreased symptoms of histamine excess (sneezing, rhinorrhea, pruritus, urticaria). Suppression of cough.SE: dizziness, confusion, sedation, dry mouth. Don't drive or operate machines. Provide good oral hygiene to include use of oral moisturizers
Seborrheic keratosis define? S/s? Common in? Increase in? Removed by?
Benign epidermal neoplasm •Have a "pasted on" plaque like appearance •Common in middle age •Increase in numbers with time •Removed by cryosurgery or curettage for cosmetic reasons or if a lesion becomes irritated
Nevus/mole define? Normal nevi have? 1/2? If changes? Treatment?
Benign growth of the pigment forming cells •Normal nevi have regular, well defined borders, & uniform color •½ of malignant melanomas arise from multicolored nevi with irregular or spreading borders •If changes size, itches, tender or bleeding = suspicious •Treat by surgical removal •Biopsy if suspicious
Liver function
Bile, storage of vitamins/minerals, protection, metabolism of amino acids to remove ammonia to urea+fatty acids+triglycerides, kupffer cells rid bacteria/anemic RBCs/harmful compounds like drugs, synthesizes plasma proteins, stores/releases glycogen
Etiology of acute pancreatitis
Biliary tract disease, gallstones, trauma of biliary tract, pancrease, gastric, duodenal procedures like cholecystectomy and gastrectomy or endoscopic retrograde cholangiopancreatography, pancreatic obstruction, metabolic disturbances like hyperlipidemia, hyperparathyroidism, hypercacemia, renal failure or transplant, genetics, gastric or duodenal ulcers, viral infections, alcoholism, drugs
Management of hyperkalemia
Bind and excrete Sodium polystyrene (Kaexylate) Po or retention enema Drive it back into the cell Regular insulin and D50W IV Sodium bicarbonate IV Calcium gluconate IV Filter it out of the blood Hemodialysis
Treatment of polyps
Biopsy, polypectomy, with familial adenomatous polyposis possibly total colectomy. Postop care: monitor for pain, distention, rectal bleeding, drainage, fever
DM is leading cause of?
Blindness, ESRD, lower limb amputations
Symptoms of IBS
Bloating, gas, abdominal distention, cramps, diarrhea, constipation, pain in left lower quadrant , generally looks well with stable weight and nutritional and fluid status WNLs, with constipation bowel sounds may be hypoactive, with diarrhea may be hyperactive
Increased ICP can result from
Blockage of blood flow of CSF, change in cerebral blood flow, thrombus formation
Ductal ectasia define
Blocked breast ducts causing discharge from nipples
Treatment for aplastic anemia
Blood transfusions, allogeneic hematopoietic stem cell or bone marrow transplant, immunosuppressive therapy like prednisone, antihymocyte globulin, cyclosporine A, daclizumab/Zenapax
Symptoms and signs of ulcerative colitis
Bloody stool, tenesmus aka urgent sensation to defecate, lower ab colicky pain, malaise, anorexia, anemia, dehydration, fever and weight loss, polyarthritis, ankylosis spondylitis, erythema nodosum, abscesses, malabsorption, cancer, oral and skin lesions
Blue nails findings?
Blue that blanches means respiratory failure, methemoglobinuria, venous stasis
Hyperphosphatemia caused from?
Bone fractures in healing, bone tumors, acromegaly
Diagnosing osteoporosis
Bone mass density t score less than -2.5
Key features of Paget's
Bone/joint pain, low back and sciatic nerve pain, bowing of long bones, loss of spinal curvature, enlarged thick skull, pathological fractures, bone cancer aka osteopenia sarcoma, flushed warm skin, apathy, lethargy, fatigue, hyperparathyroidism, gout, urinary/renal stones, heart failure
Poor diet=?
Anemia which causes low libido
Complications related to increasing growth of colorectal cancer tumor locally or through metastatic spread include
Bowel obstruction, perforation with resulting peritonitis, abscess formation, fistula formation to urinary bladder or vagina. Frank bleeding
Culture define?
Broad term referring to patterns of behavior acquired over time including beliefs, values, customs, habits, language, thoughts, ways.
Define contusion
Brusing of brain tissue and found at site of impact aka coup or in line opposite site of intact contrecoup
Carb counting for DM carbs have? Serving size is? Regardless of ? Typically? Insulin dose based on? Total grams of carbs used to? Prescribed? Use?
Carbs have greatest impact on glucose levels Serving size is 15 g of CHO Regardless of food source Typically 45 to 60 g per meal Insulin dose based on number of CHOs consumed Total grams of carbs are used to calculate the bolus dose of insulin Prescribed insulin-to-carbohydrate ratio (1:15) Use total carbs on food labels
Movement of K from ECF to ICF
Can help reduce K temporarily. K movement into cells is enhanced by insulin since it increases Na-K pumps which move K from ECF into the cell, so IVs containing glucose and insulin are prescribed to help decrease K. Usually 100ml of 10-20% glucose with 10-20 units of regular insulin and are hypertonic infusing in central line or in vein with high blood flow.
Combination insulin therapy can? Provides? Commercially?
Can mix short- or rapid-acting insulin with intermediate-acting insulin in same syringe Provides mealtime and basal coverage in one injection Commercially premixed or self-mix
CA125 define
Cancer antigen that's elevated in ovarian cancer, endometriosis, fibroids, and measures presence of damaged endometrial and uterine tissue in blood
Hypercalcemia caused from? Can cause?
Cancer, Paget's, bone fractures in healing. Can cause heart block, digitalis issue, cardiac arrest.
Elevated ALP caused from?
Cancer, Paget's, osteomalacia, bone/liver damage
Depressed levels of gastric secretion suggest? Increased levels?
Cancer, zollinger Ellison syndrome and duodenal ulcers
Other things to assess for reproductive system
Childhood illnesses i.e. Mumps => Orchitis Chronic Illness i.e. DM => impotence; vag. dryness Surgeries; Medications; Radiation; Chemotherapy STDs => obstruction and/or infertility Infections i.e. pelvic inflammatory disease (PID)
Gallstones composed of? Classifications?
Cholesterol, bilirubin, bile salts, calcium, proteins. Cholesterol or pigment which are associated with cirrhosis
Small intestines regions
Duodenum, jejunum, ileum
Risk factors for endometrial/uterine cancer
During reproductive years, family history/HNPCC, DM, hypertension, obesity, uterine polyps, late menopause, nulliparity/no childbirths, smoking, tamoxifen/Nolvadex for breast cancer
The dryness, smoothing, and thinning of vag can cause? Treatment?
Dyspareunia Aka genital pain before, during, or after sex. Water lube
Key features of increased ICP
Decreased LOC, behavior changes, headache, n/v, change in speech, aphasia, change in sensorimotor status, pupillary changes, cranial nerve issues, ataxia, seizures, cushing's triad, hypertension, widened pulse pressure, bradycardia, decerebrate/extensor, decorticatiate/flexion
Meningitis key features
Decreased LOC, disoriented, photophobia, nystagmus, abnormal eye movements, hemiparesis, Hemiplegia, decreased tone, cranial nerve dysfunction, short attention span, behavior changes, headaches, muscle aches/pain, n/v, fever/chills, tachycardia, red macular rash if meningococcal, increased ICP due to exudate, seizures
hypophosphatemia signs/symptoms
Decreased SV+CO, slow weak pulses, cardiac depression/damage, weak muscles with possible breakdown causing rhabdomyolysis, respiratory failure, bone density decreases leading to fractures, lumps/depressions in bone, if severe irritability/seizures/coma
Elderly changes for GI
Decreased absorption, peristalsis, sensation to defecate causing constipation, distention, gastritis, accumulation of drugs
Biliary obstruction causes?
Decreased bile causing prevention of absorption get fat soluble vitamins like vitamin K so clotting factors not made, jaundice due to hepatocellular disease or intrahepatic obstruction which caused decreased excretion of bilirubin, edema fibrosis, scarring, priorities aka itching
Osteopenia
Decreased bone density
Aging changes to urinary system
Decreased glomerular filtration rate causing dehydration and not of as good ability to rid body of drugs, nocturia, decreased bladder capacity, weakened sphincter and shortened urethra, tendency to retain urine
White/pallor skin cause? Significance?
Decreased hemoglobin/blood flow, genetics. Anemia, shock/blood loss, vascular compromise, emotions, edema, albinism, vitiligo
Vagal nerve stimulation define
Device surgically implanted in left chest and controls continuous simple or complex partial seizures
Acute complications of DM
Diabetic ketoacidosis (DKA) due to lack of insulin+ketosis Hyperosmolar hyperglycemic syndrome (HHS) due to insulin deficiency and dehydration Hypoglycemia aka insulin reaction
Prostate cancer symptoms
Difficulty in starting to urinate, frequent bladder infections, urinary retention, hematuria, nocturia, pain when ejaculating, extremely high PSA aka prostate specific antigen, elevated serum acid phosphatase
Receptive/wernicke's/sensory aphasia
Diffulting understanding spoken+written words, their speech is meaningless, may use made up words
Common drugs for anticonvulsants
Dilantin /phenytoin phenobarbital/Luminal Tegretol/carbamazapine Klonopin/clonazepam
About AV access
Do not use it for anything but dialysis Asses graft and fistulas for bruit and thrill q shift before an after dialysis Do not use arm/leg with AV access for BP, venipuncture or IVs Assess circulation distal to the access Do not remove the caps or open the clamp on the AV access catheters
Diabetic foot care
Don't go barefoot, clip toenails straight across, wash/inspect daily, don't soak, keep in between toes clean/dry, lotion after cleaning except in between toes, don't wear same shoes 2 days in row, cotton socks daily, no sandals/open toed/straps between toes, don't cross legs, no garters/tight stockings, no extreme temps, no smoking, see podiatrist if corns/calluses, diligent wound care
When dressing stroke patient
Dress weak side 1st step toward strong side 1st, transfer toward strong side 1st, sling for shoulder joint protection
Minimizing pain for UC: abdominal pain? For skin excoriation and or irritation from frequent bowel movements?
Drugs, positioning, nutrition, observe for peritonitis, music therapy and guided imagery. Mild soap and water after each BM, nutrition, sitz bath, thin coat of AD ointment or aloe, medicated wipes instead of tissue, ostomy supplies that fit, antidiarrheals, symptoms of megacolon aka fever, leukocyte sits, tachycardia, distended ab,
After bathing for DM
Dry feet and seal with thin coat of petroleum jelly/un scented hand cream, no oils/creams between toes, don't soak feet
Extra hepatic obstructive jaundice
Due to chronic cholecystitis from obstructed bile flow to duodenum causing accumulation of bile salts on skin causing pruritus, bilirubin can't reach large intestines so no urobilinogen causing clay colored stool and then dark irine
Ethnicity define?
Common social customs, values, beliefs that isn't based on race
Nursing care for enteral
Confirm placement via measuring tube length, visual assessment, pH of aspirate, initial X-ray best, auscultation. Securing tube, hygiene, maintaining patency, administering meds, preventing aspiration
Simple partial seizure
Conscious throughout and reports aurora/unusual sensation before seizure takes place
With arms out to the side, the patient touches the nose 2-3 times test component
Coordination
Hypocalcemia interventions
Drugs lik Ca, aluminum hydroxide, vitamin D, magnesium sulfate/muscle relaxants. Nutrition. Environmental management for safety like keeping room quiet, limiting visitors, adjusting light, using soft voice. Seizure precautions like bed low w/ side rails, bed on floor, keeping O2+suction+drugs+endo tracheal tray near. Injury prevention with lift sheet for moving
Interventions for fluid overload
Drugs, nutrition, monitoring to ensure safety, restore balance, give supportive care until imbalance resolved, prevent future overload
Positive pressure ventilator types
Pressure cycled that push air until pressure met. Time cycled where air pushed until time met. Volume cycled push air until preset volume delivered. Microprocessor that are computer managed
During seizures?
Prevent injury Protect head Avoid restraint or forcing any object in mouth Turn head to side if possible Loosen clothing DOCUMENT! Grand Mal/Tonic Clonic Seizure lasts 2-5 min
Main interventions for dehydration
Prevent injury/patient safety, fluid replacement, drug therapy to prevent more fluid loss and increase fluid compartment volumes to normal
Alkalosis interventions
Prevent loss of H, K, Ca, and Cl, restore fluids, monitor changes, patient safety. Antiemetic drugs if due to vomiting, fluid/electrolyte therapy if due to diuretics,
Acid suppression for PUD used to? Drugs used?
Prevent rebleeding. Drugs used: h2 receptor antagonists, proton pump inhibitors, antacids
Priority focus of care after conventional surgery for hiatal hernia
Prevent respiratory complications, elevate HOB at least 30 degrees, support incision during coughing
Patient avoids fractures by
Preventing falls, managing risk factors, and adhering to preventative or treatment measures for bone loss
Preventing hemorrhoids
Prevention of constipation most important, fiber in diet like whole grains/raw vegetables/fruits, drinking plenty of water, avoid straining at stool, exercise with gradual buildup, maintain healthy weight
Primary, secondary, tertiary health promotion for hypertension
Primary: exercise, <Na diet. Secondary: BP screenings. Tertiary: meds
Chronic pancreatitis
Progressive, destructive disease of pancreas with remissions and exacerbations. Categories: chronic calcifying pancreatitis from alcoholism, chronic obstructive pancreatitis from gallstones, autoimmune , idiopathic/hereditary chronic pancreatitis
Clients at risk for PE
Prolonged Immobility Central venous catheters S/P Surgery and/or Trauma Obesity/Smoking Hx Hx of thromboembolism Pregnancy
Status epilepticus is
Prolonged seizure longer than 5 minutes or repeated seizures over 30 minutes
Decrease of acid components cause
Prolonged vomiting, NG suctioning, hypercortisolism, hyperaldosteronism, thiazide diuretics
Insulin functions? Not necessary for?
Promotes glucose uptake in skeletal/cardiac muscle, storage of glucose as glycogen aka glycogenesis, increases protein+fat/lipid deposition/synthesis, inhibits ketogenesis+gluconeogenesis aka glucose from noncarbs+lipolysis+proteolysis+glycogenolysis. Not necessary for glucose transport in brain, liver, blood cells
Primary health promotion? Examples?
Promoting health and preventing disease/injury, anticipatory planning and actions, examples: immunizations, family planning services, nutrition, exercise, weight control, physical activity, advising to quit smoking, teaching health risk assessments, safety
Men >50 years assess?
Prostate Specific Antigen (PSA) Antigen PSA (2.5 - 4 ng/ml) before DRE
PT define? Decrease can mean?
Prothrombin time for coagulation test to evaluate liver. Increase in K
Double contrast barium enema intervals?
Q 5 years
Promoting communication with advanced AD
Questions that require only yes/no, instructions with pictures, one step instructions, gestures to help them understand, validate feelings, limit choices, never assume they're totally confused, anticipate needs, interpret nonverbal communication
What helps minimize confusion and disorientation and gives dementia patients a sense of security
Quiet speaking, clear/simple explanations, memory aids, prominent clocks/calendars for time, color coding doors for finding room
Madeline Leininger
RN and theorist and defined transcultural nursing as an area of study that focuses on care, health, illness patterns of people in beliefs, values, practices
Preventing PE
ROM exercises, ambulate asap, no tight clothing, no pressure under knees, elevate affected limbs above heart, change position q 2 hours, no massaging, no crossing legs, prophylactic low dose anticoagulants, no valsalva maneuvers, stool softeners, smoking cessation
Stretta procedure define
Radio frequency energy through endoscope using needles placed near gastroesophageal junction which decreases vagus nerve activity reducing discomfort of patient
Early sex =?
Raised risk for cervical cancer
Mealtime insulin/bolus preps
Rapid acting or short acting
Speed shock cause? S/s? Treatment? Prevention?
Rapid infusion which causes toxic levels. S/S: lightheadedness, dizziness, chest tightness, flushed face, irregular pulse, LOC, shock, cardiac arrest. Treatment: immediately discontinue, hang isotonic solution to KVO, monitor VS, notify. Prevention: adhere to infusion rate
Testing for TB
Rapid nuclei can acid amplification test, acid fast smear but not specific to TB, blood analysis via ELISA, sputum culture CONFIRMS diagnosis but takes 1-4 weeks, Mantoux/PPD test + indicates exposure and possible infection or dormant. Chest X-ray detects active or old healed TB
General appearance for kidney disease
Rashes, brushing, yellowish, edema around feet, shins, sacrum, eyes
Blumberg so sign aka
Rebound tenderness aka pain felt on release
Clinical manifestations of colorectal cancer
Rectal bleeding, anemia, change in stool consistency or shape, dark colored or Brit red stool,
Adrenal glucocorticoids
Regulate protein metabolism by increasing or decreasing catabolism to reduce or intensify bone matrix and aid in regulating calcium and phosphorus absorption
Most common cause of GERD
Relaxation of lower esophageal sphincter
Leptin
Released by fat cells to control appetite
Purpose of GERD treatment
Relieve symptoms, treat esophagitis, prevent complications like strictures and Barrett's esophagus
Communication for people with AD: do what? Focus conversations to? Divert? Sensory? Avoid? Use? Therapeutic? Friendly?
Reminisce about familiar topics Focus conversations to areas of remaining competence Divert patient's attention when upset Sensory stimulation Avoid approaching as a child Use humor tactfully Therapeutic Touch Friendly smile
Types of memory
Remote/long term, recall/recent, immediate/new memory
Surgical management of endometrial/uterine cancer
Removal of uterus, fallopian tubes, & ovaries {total hysterectomy w bilateral salpingectomy/oophorectomy (BSO)}
Papillotomy define
Remove gallstones
Diagnosis of DM should be
Repeated to rule out error unless classic manifestations of hyperglycemia present
Teaching for self management of UC?
Report fever over 101, tachycardia, palpitations, increase in diarrhea, abdominal pain, nausea/vomiting. Avoid foods that make stool thicker or cause gas including high fiber goods like nuts, raw vegetables, corn, celery, apples with peels, popcorn.
Skin interventions for fluid overload
Reposition every 2 hours, assess for skin breakdown, pressure reducing mattress
Management of pressure ulcers
Reposition q 2 hours, use air mattress, clean with mild soap, keep free of moisture/feces, do not rest on hip bone, place pillow under legs from mid-calf to ankle to keep heels off bed, maintain HOB at 30 degrees, increase calories and protein
Major meds for AD
Resperidol for antidepressant, Aricept for memory, Namenda for deterioration, Exelon for memory
Decreased PaCO2 from?
Respiratory alkalosis, excess ventilation, diarrhea
Under elimination of H conditions in respiratory acidosis
Respiratory depression, inadequate chest expansion, airway obstruction, alveolar-capillary block
Preventing fecal impaction
Eat high fiber foods including raw fruits and vegetables and whole grains, adequate fluids, don't routinely take laxatives, exercise, warm beverages and prune juice for peristalsis, take bulk forming products like Metamucil, check stool for amount and frequency since oozing of soft or diarrheal stool indicate fecal impaction, have patient sit on toilet or bedside commode instead of bed pan
Cullen's sign define and can indicate
Ecchymosis around umbilicus and can indicate intra abdominal bleeding
Pyloric obstruction caused by? Symptoms? Treatment?
Edema, spasm, scar tissue. Feeling full, distention, nausea after eating, vomiting un digested food, metabolic alkalosis+dehydration. Restoring fluids+electrolytes+decompressing stomach via nasogastric suction.
Tensilon test aka? Define? Positive if? Determines?
Edrophonium/tensilon and neostigmine/prostigmin injected. Positive if better muscle tone for 4-5 min. Determines if MG due to cholinergic crisis aka too much cholinesterase inhibitor or myasthenic crisis aka too little cholinesterase inhibitor
Rn interventions for testicular cancer
Education, support, surveillance for 5-10 years, history/physical/psychosocial assessment, sperm storage after diagnosis and before radiation/chemo, support group referrals
Dis functional uterine bleeding DUB define? Occurs most often? Occurs when there is?
Excessive & frequent bleeding > Q 21 days Occurs most often @ beginning or end of her reproductive years Occurs when there is a hormonal imbalance and when the ovaries fail to ovulate;
Earliest change signaling diabetic kidney disease
Excretion of 30+mg of albumin per day
Pancreas function
Exocrine: carb, fat, protein digestion via trypsin, chymotrypsin, amylase, lipase Endocrine: alpha cells for glucagon and beta cells for insulin
Hyperkalemia expected In? If greater than 6?
Expected in ESRD with missed dialysis, if greater than 6 represents high risk of cardia dysrhythmias and is a clinical red flag
Patient prep for bronchoscope, laryngoscopy, and mediastinoscopy
Explain, consent, labs, NPO 4-8 hours before, benzo's or opioids for sedation, benzocaine spray or lidocaine best for anesthetic to numb
Surgical management for ovarian cancer
Exploratory laparotomy to diagnose, treat, & stage ovarian tumors Total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH w BSO) with lymph node dissection Cytoreduction: debulking of very large tumors
Causes of aplastic anemia
Exposure to drugs, radiation, benzene, chloramphenicol, alkylating agents, anti metabolites, sulfonamides, insecticides, viral infections like Epstein-Barr, hep. B, cytomegalovirus
If decannulation occurs after 72 hours
Extend neck and open tissue of stoma with curved Kelly clamp to secure airway and quickly replace tube and check for airflow through tube and bilateral breath sounds , ventilate with bag valve mask
Acceleration injury vs. deceleration
External force contacting head, placing it in motion vs. moving head suddenly stops/hits stationary object
Klinefelter syndrome
Extra sex chromosome XXY in men where they can have no s/s or s/s of enlarged breast gynecomastia, sparse facial and body hair, small testes, and inability to produce sperm
Glasgow coma scale 3 areas?
Eye opening/4 choices: randomly, sound, pain, never. verbal response/5 for oriented, confused, inappropriate, none. motor response/6 for commands, pain, abnormal/normal flexion, extension, none.
Ketones made from? Due to? Via? Due to? Carb needs for protein sparing and prevention of ketosis?
Fat fragments due to inadequate carbs via fat metabolism due to starvation. 50-100 g/day.
Avoid treatment with carbs that contain
Fat like candy, cookies, whole milk, ice cream since fat will slow down absorption of sugar
Hypokalemia s/s
Fatigue, malaise, confusion, muscle weakness, shallow respirations, abdominal distention, paralytic ileus, hypotension, weak pulse. Can result due to treatment of DKA
Lactic acidosis s/s
Fatigue, usually muscle pain, difficulty breathing, unusual stomach discomfort, dizziness, lightheadedness, irregular heart beats
Dehydration define? Can be due to? Which types are there?
Fluid intake/retention less than needed resulting in volume/plasma deficit. Can be due to too little intake, too much output, loss of body water via shifts from plasma to interstitial space aka relative. Can be just water loss or water+electrolyte loss calls isotonic dehydration
Complications of myomectomy/transcervical endometrial resection and what to report
Fluid overload, emoblism, hemorrhage, perforation of uterus/bowel/bladder/ureter, increased menstrual bleeding, incomplete suppression of menstruation, pain, bleeding.
Interventions for gastroenteritis
Fluid replacement and drugs and skin care
SIAD syndrome of inappropriate antidiuretic hormone treatment
Fluid restriction, IV 3% hypertonic Na
Prescription for infusion should include
Fluid type, rate in mL/hr or total amount of fluid and total number of hours for infusion, drugs and the specific dose to be added
Osteoarthritis anatomy
Fusiform swelling of joints, heberdens nodes
Other conditions resulting in hyperglycemia
Genetic defects of beta cells and insulin action and Down syndrome, pancreas disease/ inflammation/trauma/neoplasia / cystic fibrosis/hemochromatosis, endocrinpathies like acromegaly, cushing's, glucagon a, photochromocytoma, hyperthyroidism, aldosteronism. Drug/chemicals like glucocorticoids, TH, thiazides. Infection like rubella, cytomegalovirus, HIV.
Cervical cancer risk factors
Girls/young, HPV, multiple births, smoking, <18 years for sec, multiple sex partners, African Americans, contraceptives, STDs, obesity, family history, HIV/AIDS, low socioeconomic status, sex partner had previous partner who developed cervical cancer, intrauterine exposure to DES
Long acting insulin examples? Onset? Peak? Duration? Which can be given twice a day? Both reduce? Don't do what?
Glargine/Lantus, detemir/ Levemir. .8/1-4 hours. No peak for lantus, 6-8 hrs Levemir. Duration 24+ hours Lantus, 5.7-24 Levemir. Detemir/Levemir can be given twice a day. Both reduce risk for hypoglycemia. Don't mix with any other insulin in same syringe
Metaglip is combo of?
Glipizide & metFORMIN.
DM Counter regulatory hormones examples? Do what?
Glucagon, epinephrine, growth hormone, cortisol. Oppose insulin, stimulate glucose production in liver, decrease movement of glucose into cells, maintain normal BG levels
Osteoarthritis drugs
Glucosamine, chondroitin, lidocaine/Lidoderm 3 patches q 12 hours, salicylates/aspecreme patch/gel/cream, capsaicin, cortisone injections, hyaluronate/Hyalgan/Hylan/Synvisc, analgesics like NSAIDs Celecoxib/Celebrex, acetaminophen/Tylenol, muscle relaxant for spasms cyclobenzaprine hydrochloride/Flexeril
Fructosamine
Glucose bound to amino groups on serum protein proteins/albumin die in 14 days so good for testing a short time frame.Tests: glycosylated serum albumin/protein GSA/GSP
Carb metabolism- glucose is? Stored as? What locations?
Glucose is key and stored as glycogen in liver which is provided via hydrolysis or stored in muscles for use during exercise
What causes ketoacidosis ? How to fix?
Glucose not available so body breaks down fat and ketones formed due to breakdown. To fix correct fluid volume deficit and lower blood glucose with insulin to drive K back into cell
Glucovance is combo of?
Glyburide and metFORMIN.
Complications of DM can be reduced with
Glycemic, hypertension, and hyperlipidemia/cholesterol management
Energy sources for critical illness
Glycogen, protein used more, depleting lean body mass causing negative N balance causing concentrated urine
Hemoglobin A1C test Aka? Used to? Goal? Reflects? Diseases affecting?
Glycosylated hemoglobin: reflects glucose levels over past 2 to 3 months(120 days) Used to diagnose, monitor response to therapy, and screen patients with prediabetes Goal: less than 6.5% (American College of Endocrinology) to 7% (ADA) Reflects the amount of glycosylated hemoglobin as a percentage of total hemoglobin Diseases affecting RBCs can influence the hemoglobin A1C level
Agents for female infertility types
GnRH analogs, synthetic androgens
Early s/s of stroke
Golden 1st hour: Sudden numbness/weakness of face/arm/leg, sudden confusion, trouble speaking or understanding, sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, loss of balance/coordination, sudden/severe headache
ADA proposed treatment outcomes for glycosylated hemoglobin HbA1c and BG levels
HbA1c <7%, premeal/preprandial BG 70-130mg/dL, peak after meal postprandial BG levels <180mg/dL
Glomerunephritis symptoms
Headache, raised BP, facial edema, lethargy, low grade fever, weight gain, proteinuria, hematuria, oliguria, dysuria, crackles, neck vein distention, decreased GFR, BUN increased, ASO titers positive for strept. If due to strept.
Subdural +epidural hematomas and intracranial hemorrhage are manifested by? Treatment of hematomas? Hemorrhage?
Headache, rapid decline in LOC, neuro deficits, herniation syndromes, CV+cardiac arrest. Surgical removal. Osmotic diuretics, ICP monitoring
CKD symtooms
Headaches, low ability to concentrate urine, polyuria, oliguria, high BUN And creatinine, edema, GFR decreases under 90 to 30, anemia, high K and BP, weakness, fatigue
Presbycusis aka
Hearing loss that increases with age
Most severe complications of hyperkalemia
Heart block and ventricular fibrillation
2011 leading cause of mortality for 45+
Heart disease 1, cancer 2, respiratory disease 3
Major contributing factors of DM
Heart disease, stroke, hypertension
Hyponatremia can be caused by?
Heart failure
Symptoms of severe reflux reaching pharynx or mouth or pulmonary aspiration
Heartburn, chest pain, asthma, morning hoarseness, pneumonia
Dyspepsia define
Heartburn, or regurgitation and main symptom of GERD
Key features of sliding hiatal hernias
Heartburn, regurgitation, chest pain, dysphagia, belching, reflux like asthma from aspiration. Symptoms worsen after meal or supine
Factors that increase blood flow from injection site that increase insulin absorption
Heat, massage, exercise
Acute gastritis cause
Helicobacter pylori infection, other bacterial infection, long term NSAID, alcohol, caffeine, corticosteroids, radiation, infections of acids/alkalis, stress, anxiety
Common causes of dehydration
Hemorrhage, vomiting, diarrhea, salivation, fistulas, ileostomy, diaphoresis, burns, wounds, NPO, diuretics, GI suction, hyperventilation, renal failure, diabetes insipidus, difficulty swallowing, impaired thirst, unconsciousness, fever impaired motor function
Most common causes of cirrhosis
Hep. c, alcoholism, biliary obstruction
Chronic hepatitis usually due to? Can lead to?
Hep.b or c. Which can lead to cirrhosis and liver cancer
All causes of cirrhosis
Hepatitis, alcohol, drugs , gallbladder disease or an autoimmune form called primary biliary cirrhosis which are genetic, fatty Over aka steatohepatitis, cardiovascular disease
Polycystic disease of kidney. Etiology? Cysts? Care?
Hereditary disorder, usually appears after age of 40 Cysts replace normal tissue. Most patients develop ESKD (End Stage Kidney Disease) commonly known as ESRD (End Stage Renal Disease). Care: control HTN, prevent infection, genetic counseling, good candidates for transplant
MI labs
High Troponin for first few hours, creatine kinase-MB up to 24 hours, myoglobin 2 hours
COPD non med interventions
High calorie/protein diet, pulmonary rehab, lung transplant/reduction for end stage COPD, airway patency most important, frequent focused assessments, cough enhancement, o2 therapy
Duodenal ulcer patho? Key features?
High gastric acid secretion lowering pH, protein/calcium/vagus nerve excitation stimulate acid, also rapid emptying of food from stomach reducing buffering effect. Normal diffusion of acid back into stomach w/ increased secretion of gastric acid+increased stomach emptying
Fractures of hip
High mortality rate r/t complications Review chart 20-2 Pre-op/Post-op Review chart 20-3 Activity OOB next post-op day Stand on unaffected leg Hip flexion less than 90 degrees Physical therapy / Occupational therapy Transfer to rehab facility, if ordered Review chart 20-3
Histamine receptor antagonists aka? Examples and dosage? Function? Which example is long acting and are safer for long term use? Symptoms of use?
Histamine blockers. Famotidine aka Pepcid 20-40mg, ranitidine aka Zantac 150mg, nizatidine aka Axid 150mg. Decrease acid. Ranitidine aka Zantac. Dysrhythmias
Treatment for prostate cancer
Hormone treatment, orchiectomy aka removal of testicles, radiation, radical prostatectomy
Neuromuscular alkalosis key features
Hyper reflexia, muscle cramping, twitching, muscle weakness
Relative cause of hypercalcemia
Hyperparathyroidism, malignancy/cancer, hyperthyroidism, immobility, glucocorticoids , dehydration
Hyperplasia define? BPH?
Hyperplasia: increase in # of cells. BPH grows inward causing narrowing of urethra
Causes of relative hypocalcemia
Hyperproteinemia, alkalosis, Ca chealators/binders, citrate, mithramycin, penicillamine, Na cellulose phosphate aka Calcibind, aredia, acute pancreatitis, Hyperphosphatemia, immobility, removal or destruction of parathyroid glands
CV changes in ESRD
Hypertension CHF CAD Pericarditis Hyperkalemia
Dextrose 5% in 0.45% NS tonicity? Same as? Provides? Used to? Used as? Monitor?
Hypertonic. Same as 0.45% NS except provides 170cal/L. Provides free water and sodium & chloride Used to replace hypotonic fluid losses Used as maintenance solution although it does not replace daily losses of other electrolytes Monitor VS, lung sounds, Na, I/O
Dextrose 5% in 0.9% NS tonicity? Same as? Used to? Only solution that? Contains? Doesn't provide? May cause ?
Hypertonic. Same as 0.9 NS except provides 179cal/L. Used to expand IV volume & replace ECF losses Only solution that may be administered with blood products Contains sodium & chloride in excess of plasma levels Does not provide free water, or other electrolytes May cause IV overload or hyperchloremic acidosis
3% saline tonicity? Used to treat? Must be administered?
Hypertonic. Used to treat symptomatic hyponatremia Must be administered slowly & with extreme caution because it may cause dangerous IV volume overload & pulmonary edema
Alkalosis usually occurs with
Hypocalcemia and hypokalemia
POP Nonsurgical management
Improve pelvic muscle strength & tone through pelvic exercises (i.e. Kegel exercises) Pessaries/spheres worn in the vagina to elevate the uterine prolapse Postmenopausal: Intravaginal estrogen therapy to prevent atrophy & weakening of vaginal walls Bladder training Promoting bowel elimination
Phosphate buffering system location? Function?
In kidneys when bicarbonate is made it's reabsorbed into blood with Na and uiriine has excess of anions like phosphate HPO4 2- which draws H into urine which forms acid and then excreted in urine
Respiratory changes due to fluid overload
Increased rate, shallow respirations, increased dyspnea, crackles
Hep. C mode of transmission and prevention
Infected blood and needles, no vaccine
Hep b mode of transmission and prevention
Infected blood, sex, needles, from mother to newborn. There is a vaccine
Key features of chronic pancreatitis
Intense ab pain but less than acute, abdominal tenderness, ascites, left upper quadrant mass , respiratory compromise, steatorrhea causing clay colored stools, weight loss, jaundice, dark urine, polyuria/polydipsia/polyphagia due to DM
Paroxysmal nocturnal dyspnea PND
Intermittent dyspnea during sleep that can awake patient and can be associated with chronic lung disease or left HF
Lactated ringers tonicity? Similar in? Used to? May be used to? Doesn't provide?
Isotonic. Similar in composition to normal plasma except does not contain magnesium Used to treat losses from burns & lower GI tract and fluid resuscitation May be used to treat mild metabolic acidosis but should not be used to treat lactic acidosis Does not provide free water or calories
How to increase K excretion to lower K? Only for if?
K excreting diuretics like furosemide/Lasix . Only for if kidney function is normal.
Intracellular fluid electrolytes
K, Mg, phosphate, sulfate
If obstruction suspected
Keep patient NPO
Surgical management of acute pancreatitis
Laparoscopic cholecystectomy to remove gallstones, pseudo cysts, abscesses
What drugs are avoided for diverticular disease
Laxatives and enemas because they increase intestinal motility
Diaphragmatic/abdominal breathing
Lie on back with knees bent or sit in chair, place hands or book on abdomen, begin breathing from abdomen while keeping chest still
Status asthmaticus define? Treatment?
Life threatening acute episode of airway obstruction that doens't respond to short acting drugs causing labored breathing, wheezing, distention of neck veins, possible pneumothorax or cardiac/respiratory arrest. Treatment: IV fluids, systemic bronchodilators, steroids, epinephrine, O2
Bleeding esophageal varices is? Bleeding can be? Bleeding can cause?
Life threatening since severe blood loss can cause shock due to hypovolemia. Bleeding can be hematemesis aka blood in vomit or melena aka black tarry stools. Which bleeding can cause loss of consciousness.
Nutrition therapy for GERD
Limit chocolate, alcohol, fatty foods, caffeine, carbonated beverages, spicy foods, acidic foods , peppermint. Eat 4-6 small meals. Don't eat 3 hours before bed. Eat slowly
ADA recommendations for DM
Limit saturated fat <7% of total colors, lower intake of trains fat, cholesterol <200mg/day, 2+ servings of fish/week
Rapid acting insulin examples? Onset? Peak ? Duration? Take when?
Lispro/Humalog, aspart/Novolog, glulisine/Apidra. 10/15-30/20 min. 30 min-3 hours. 3-5 hours. Take 10/15-1 minute before eating
Bilirubin in urine can indicate
Liver or biliary disease or obstruction
Osteomalacia define? releated to? adult equivalent of?
Loss of bone related to vitamin d deficiency adult equivalent of rickets in children
Obstruction below duodenum but above large bowed results in
Loss of both acids and bases so acid balance not compromised
Coarse crackles, low pitched crackles character? Associated with?
Low pitched coarse, discontinuous rattling caused by fluid/secretions in large airways and can change with coughing or suctioning. Bronchitis, pneumonia, tumors, pulmonary edema.
GnRH analog examples
Lupron, Antagoni, cetrotide, synarel
Interventions for glomerulonephritis
Managing infection, diuretics, antihypertensive, 500-600 ml of fluids, potassium and protein restrictions, dialysis as worst case, plasmapheresis aka filtering of plasma, Reduced sodium diet
Diagnostic testing for TB
Mantoux test: Intradermal injection of 0.1mL of PPD into the forearm. +: swelling/redness 10+mm 2-3 days after, - if immunosupressed/old can still be + Sputum smear: Acid-fast smear provides an indication of tubercle bacillus Sputum culture: Confirms presents of M. Tuberculosis Chest x-ray: Reveals lesions
BUN creatinine ratio norm
Mass 12:1 to 20:1
Testicular cancer s/s
Mass, oligospermia/low sperm count, azoospermia/absence of living sperM
Benign breast disorders
Mastalgia, fibroadenoma, fibrocystic breast condition, ductal ectasia, intraductal papilloma
Education on leiomyomas
May have heavy bleeding, pain from fibroid twists, surgery
Dis functional uterine bleeding DUB assessment
Menstrual History & Focused Assessment RN assess for symptoms of anemia; CBC TSH & reproductive hormones; CA 125 NP: Pelvic Exam, Pap test, rectal exam Test for STDs; Endometrial biopsy Transvaginal US r/o fibroids & to measure the endometrium Sonohysterography: to visualize the uterine cavity via vag US
COPD meds
Methylxanthines (Theophylline) Corticosteriods (Fluticasone, Prednisone, IV solumedrol) NSAIDS Mucolytic agents (Mucomyst, Guaifenesin) Beta adrenergic agents (Albuterol) Cholinergic antagonist (Ipatropium)
Pro kinetic drug example? Dosage? Function?
Metoclopramide aka Reglan 10mg 3-4 times daily. Increases gastric emptying
RN safety priority for Uc?
Monitor stools for frank bright bleeding or black tarry melena, hematocrit, hemoglobin, electrolytes, VS, anemia if slow prolonged bleeding, fever tachycardia, fluid depletion, LOC changes if dehydration or anemia.
Patient safety for dehydration
Monitoring VS esp. HR/BP, muscle strength, gain, stability, LOC. Instruct to get up slowly, fall precautions
Dawn phenomenon define? Due to? Most severe in?
Morning 2-8 or 5-6 AM hyperglycemia present on awakening Due to release of counter-regulatory hormones in predawn hours. Most severe in young when GH is at its peak
Basal bolus regimen most closely mimics? Rapid or? Intermediate or?
Most closely mimics endogenous insulin production Rapid- or short-acting (bolus) insulin before meals Intermediate- or long-acting (basal) background insulin once or twice a day
Endometrial/uterine cancer in USA? Association with conditions?
Most common GYN malignancy in USA Association w conditions causing prolonged exposure to estrogen without the protective effects of progesterone; i.e. failure to ovulate
Fibroadenoma description? Incidence?
Most common benign breast lesion, solid mass unattached. During teen-30s
Pruritus is the most? Define?
Most common complaint in dermatology. =itching. May be sign of internal disease, caused by irritants, side effect to radiation/meds/dry skin/allergies/stress. Can lead to excoriation, infections. Treatment: prevent dry skin, bathe ever other day, antihistamines, topical drugs, emollients, fluid intake to 3000ml/day, cut/file nails, scratch mittens at night, cool sleeping environment, cool shower, oatmeal/tar
Surgical management of CD: compared to UC? Indications for surgery? Procedures?
Not as successful. Fistula resection of diseased area, perforation, massive hemorrhage, intestinal obstruction, strictures, abscesses, cancer. Resection of small bowel aka ileum or ileocecal via MIS laparoscopy, open surgery, stricturoplasty which increases bowel diameter
Purpuric leasions are? Examples?
Not normal bleeding into tissue. Petechiae, eccymosis
Dumping syndrome managed how
Nutrition via smaller meals, eliminating liquids ingested with meals, high protein, high fat, low to moderate carb diet, acarbose decreases carb absorption, somatostatin octreotide Sandostatin subQ before meals, low sugar and spices and dairy
Interventions for fluid excess with cirrhosis
Nutritional therapy, drugs, paracentisis,respiratory support
Antifungal topical/oral
Nystatin/Mycostatin, Terbinafine/Lamisil, Tolnaftate/Tinactin
Hydrocephalus caused by? S/S? Treatment?
Obstruction of normal CSF pathway from edema, lesion, hematoma, blood in subarachnoid space. S/S: same is increased ICP. Intravascular catheter/ventriculostomy or shunt to drain CSF
How to test for NG tube placement
Obtain sample of gastric contents by aspirating with 50ml catheter tipped syringe, test pH of gastric counts should be 1-3.5, obtain X-ray
Antacids for? Do what? Examples? Symptoms of use?
Occasional episodes of heartburn. Elevated pH deactivating pepsin and elevate LES pressure. Examples: maalox, malanga, gaviscon, calcium carbonate/Tums. Constipation, diarrhea
Unclassified/idiopathic seizures
Occur for no known reason and don't fit into generalized or partial classifications
Assessment for cervical cancer
Often asymptomatic; classic symptom is painless vaginal bleeding/spotting As cancer grows bleeding ^ in frequency, duration, & amount Chest, leg, flank, pelvic pain Dysuria, hematuria
Never use what to treat sunburns?
Oil based products
Risk factors for stroke that cannot be changed
Old age, men, post menopausal women, family history, race/black, MI, migraine headaches, prior stroke, sickle cell disease, berry aneurysm
Define menopause
One full year with no period
Treatment for iron deficiency
Oral ferrous sulfate for mild anemia and take between meals to increase absorption. IV or IM iron aka dexferrum or Feraheme for severe anemia
Increase of base components cause
Oral ingestion of antacids, milk-alkali syndrome. Parenteral admin of blood, sodium bicarbonate, TPN
Pelvic inflammatory disease PID define? Caused by?
Organisms from lower genital tract migrate to uterus and Fallopian tubes which can cause endometritis, salpingitis, oophoritis, parametritis, peritonitis, tubal abscess, infertility, sepsis, ectopic pregnancy. Chalmydia trachomatis, neisseria gonorrhoeae etc.
Mannitol function? Aka?
Osmotic diuretic for cerebral edema aka osmotrol
Common cause for actual hyperkalemia
Over ingestion of salt substitutes/K/IV/bolus, transfusion of blood, addisons/adrenalectomy or adrenal insufficiency, kidney failure, K sparing diuretics, angiotensin-converting enzyme inhibitors ACEIs
Blood osmolarity is a measure of? Normal when decreased?
Overall concentration of particles in blood so good indicator of hydration status. Norm is 285-295. When decreased ADH inhibited so no water absorbed to increase it
When CO2 level increases? When CO2 decreases?
PH drops indicating more H and when CO2 decreases pH rises with fewer free H
Combined alkalosis labs ph? HCO3? PaO2? PaCO2? K? Ca? Cl?
PH high, HCO3 high, PaO2 normal, PaCO2 low, K low, Ca low, Cl low
Nonmechanical obstruction clinical manifestations
Pain constant, abdominal distention, decreased bowel sounds early and absent bowel sounds later, vomiting gastric contents and bile frequent but not foul odor, possible obstipation
Dysuria
Pain during urination
Define homan's sign +
Pain in calf on dorsiflexion of foot and occurs in small % with DVT but fake + is common
Primary purposes of drug therapy in treatment of PUD
Pain relief, eliminate h.pylori infection, heal ulcerations, prevent recurrence
Priority patient problems for patients with PUD
Pain, GI bleeding
Manifestations of pneumothorax
Pain, ^ HR, ^ shallow respirations, feeling of air hunger, prominence on affected side that doesn't move with respiratory effort, trachea slanted, nagging cough, cyanosis, reduced breath sounds, inequal chest, subq emphysema
Integumentary changes in ESRD
Pallor Grey-bronze pigmentation Dry, scaly skin Hair and nails dry, brittle, and thin
Key features of anemia
Pallor, coolness, cold intolerance, brittle club nails that are not convex but concave, tachycardia that increases after meals, murmurs, gallops, orthostatic hypotension, dyspnea, decrease o2 sat., increased somnolence and fatigue, headache, infection risk
Before puncturing implanted port
Palpate to locate septum to find it for puncture. Flush after each use and at least once a month with 5mL or 100u/L heparin to prevent clots in port and is aka locking or de-accessing. Also always check for blood return. If no blood return hold drug until patency and needle placement established.
Elevated amylase and lipase due to
Pancreatitis
Lab and diagnostics for cervical cancer
Pap smear; CA 125 (IF abnormal then below occurs) HPV typing DNA test to assess high risk types Colposcopy w cervical tissue biopsy (assess for dysplasia or CA) Endocervical curettage
Rolling hernias aka? Define? Features
Paraesophageal hernias. Gastroesophageal junction rains in normal location but fundus rolls through esophageal hiatus and into the chest beside the esophagus. Usually no reflux but volvulus aka twisting, obstruction, and strangulation aka stricture, iron deficiency anemia
Right brain damage s/s
Paralyzed/Hemiplegia/hemiparesis left side, impaired humor, spatial-perceptual deficits, quick/impulsive behaviors, performance memory deficits, indifference to the disability, issues with proprioception, unaware of deficits, disoriented to time/place/person/faces, poor judgement, unilateral body neglect syndrome on left side where patient is unaware if left side, neglect of left visual field aka homonymous hemianopsia, no depth perception, confabulation/euphoria/smiling/over estmation of ability, loss of ability to hear tones
No surgical interventions for obstructed intestines usually for?
Partial obstruction, no strangulation, paralytic ileus, terminal disease.
PTT aka? For?
Partial thromboplastin time for anticoagulant status for heparin
Pathophysiology of peritonitis
Peritoneal cavity contaminated by bacteria or chemicals via perforation from appendicitis, diverticulitis, PUD or wound, gallbladder, bowelobstruction, or UTI, leakage of bile, pancreatic enzymes, gastric enzymes so inflammation and if not completely walled off inflammation spreads
Vascular skin lesion
Petechiae, spider angioma, Ecchymosis, telangiectasia, cherry angioma
Metabolic acidosis labs ph? HCO3? PaO2? PaCO2? K? Ca? Cl?
Ph high, HCO3 high, PaO2 normal, PaCo2 normal or high, K low, Ca low, Cl low
Respiratory alkalosis labs ph? HCO3? PaO2? PaCO2? K? Ca? Cl?
Ph high, HCO3 normal, PaO2 normal, PaCO2 low, K low, Ca low, Cl high
Actoplusmet is combo of?
Pioglitazone HCL & metFORMIN
Duetact is combo of
Pioglitazone HCL and glimepiride
Skin changes for fluid overload
Pitting edema and skin pale/cool, risk for skin breakdown
TB interventions for newly diagnosed of suspected TB
Placed in respiratory isolation Negative pressure rooms, N95 mask
Techniques to increase intra thoracic pressure and prevent air emboli during IV set change include
Placing patient in flat position so catheter exit site is at or below heart, valsalva maneuver by holding breath and bearing down, timing change to cycle when patient is expiring air during breathing, timing change to inspiratory cycle when patient receiving positive pressure mechanical ventilation
Pleural friction rub association
Pleurisy, tuberculosis, pulmonary infarction, pneumonia, lung cancer
Pleurisy aka? Define?
Pleuritis. Inflammation of pleural cavity
Preventing pneumonia
Pneumococcal polysaccaride vaccine PPV23, season flu vaccine, hand washing, avoiding large crowds during cold/flu season, know if at risk (>65, chronic issue, no movement), positioning/cough/turn/deep breath if mobility issue, clean equipment, avoid pollutants, rest/sleep, healthy diet, 3 L of nonalcoholic fluids
Unilateral vs. bilateral crackles
Pneumonia vs. HF
Pulmonary changes in ESRD
Pneumonitis, kussmaul respirations
Which issue associated with central IV's that don't occur with PICCs
Pneumothorax
Ace inhibitors and angiotensin receptor blockers/ARB's
Suppress renin-angiotensin system, block aldosterone which prevents Na+H2O retention
Rh antigen- Rh negative? Antibody development can be prevented by? People who have Rh positive can receive?
Rh negative doens't have antigen and doesn't form antibodies unless sensitized through infusion with Rh positive or from pregnancy/birth which following will then make antibodies. Antibody development can be prevented by giving anti-Rh-immunoglobulin. People who have Rh positive can receive RBC transfusion from Rh- but Rh- shouldn't receive Rh + blood
Duodenal ulcer pain location? Occurs when?
Right of epigastrium. Occurs 90min to 3 hours after eating and at night
Elevated homocysteine means
Risk factor for CVD
high fat diet=?
Risk for breast, ovary, prostate cancer
Stroke prevention
Smoking, substance abuse, obsity, sedentary life, oral contraceptives, use of PPAs found in antihistamine
Platelets transfusion tools? Prevention of reaction? S/S? Does it require compatibility?
Special platelet set with special filter for platelets. diphenhydramine/Benadryl and acetaminophen/Tylenol before transfusion. S/S: febrile and rigors/chills but not true reaction, it's normal . No compatibility required
Aldactone aka? Class? Use? Causes?
Spirnolactone. K-sparing diuretic. Management of hyperaldosteronism , edema, HR, cirrhosis, hypertension, hypokalemia. Loss of NaHCO3+Ca while saving K+H
Wheeze character? Associated with?
Squeaky musical continuous sounds associated with air rushing through narrowed airways and don't clear with coughing. Inflammation, bronchospasm, edema, secretions, pulmonary vessel engorgment
Alpha Glucosidase inhibitors aka? Function? Take when? Effectiveness measured by? Examples?
Starch blockers. Slows down absorption of carbs in s. Intestines lowering postprandial BG. Take with 1st bite of each meal. Effectiveness measured by checking 2 hour postprandial glucose levels. Acarbose/Precose, miglitol/Glyset. SE:diarrhea, ab pain, gas. Breast feeding, pregnant, children, intestinal disorders, liver/kidney disease
Status epilepticus is? It is? Treatment?
Status Epilepticus is a complication of Tonic Clonic/Grand Mal seizures It is life threatening because it uses up all oxygen and heart may stop. Treatment: IV Ativan or Valium to stop motor movement followed by Dilantin or Cerebyx to prevent recurrence.
Patient education for postop laparoscopic nissen fundoplication after discharge
Stay on soft diet for a week, avoid carbonated drinks, remain on antireflux meds for a month. Don't drive for a week, walk every day, no heavy lifting, remove small dressings 2 days after, shower, don't remove steri strips until 10 days, wash incisions with soap and water, report any redness or drainage, report fever over 101/nausea/vomiting/bloating/pain, follow up 3-4 weeks after
Sulfonamides examples? Purpose? Side effects?
Trimethoprim sulfamethoxazole aka Bactrim/Septra//Sulfatrim/Sultrex. Antimicrobial. SE: exposure to sun, form crystals in kidney so drink 3L fluids
Ketone testing indications?
Type 1 diabetes Consistently elevated BG > or = 300 mg/dl Hyperketonuria + hyperglycemia = medical emergency Symptoms of ketoacidosis Illness Weight loss program Pregnancy or gestational diabetes
Physical assessment for kidneys
UO, skin color. Color of urine, amount of void, pain or burning, difficulty, LOC, bulging in upper quads, bladder distention, Bruins, BP, edema, pan at costovertebral angle, radiating, renal colic
Diagnostics of endometriosis
US, laparoscopy for visualization of implants
Patient with fever, or older adult who becomes increasingly confused should always be evaluated for?
UTI
Osteomyelitis can be caused by what clinical manifestations?
UTI's, IV catheters Hickman, hemodialysis, IV drug use, Periodontal disease, Penetrating trauma
Holding urine in can lead to
UTI, bladder stones R/t urinary stasis and retention
Two most common chronic inflammatory bowel diseases
Ulcerative colitis and Crohn's disease
Benign prostatic hypertrophy presents as? Cancer presents as?
Uniform, elastic, no tender enlargement. Cancer: stony, hard nodule
Hemorrhoids define? Types?
Unnaturally swollen or distended veins in anorectal region. Types: internal or external
+ antinuclear antibody ANA test means? Aka? Usually?
Unusual antibodies present that cause tissue death aka autoimmune CTDs like RA. AKA Fluorescent method aka FANA. Usually - and only small few +
Hemorrhoidectomy postop?
Urinary retention , pain. Eat high fiber and fluid, avoid laxatives, monitor for bleeding, moist heat like sitz bath, first bowel movement can be painful
Aminosalicylates are? Aka? How they function? Examples?
Used to treat/prevent UC. Aka 5-ASAs. Inhibits prostaglandins. Examples: sulfasalazine aka Azulfidine, Azulfidine and EN tabs, mesalamine aka Asacol, Pentasa, Rowasa, Apriso, Canasa, glucocorticoids aka prednisone and prednisolone, immunomodulators like infliximab aka Remicade and adalimumab aka Humira
High flow delivery systems
Venturi mask, aerosol mask, face tent, tracheostomy, t-piece. 24-100% concentration of O2 and 8-15L/min
fluid compartments
extracellular fluid that includes interstitial fluid, blood, lymph, bone, connective tissue water, and transcellular fluid like CSF, synovial fluid, peritoneal fluid, and pleural fluid. intracellular fluid
Although micro angiopathy can be found throughout body the area most affected are
eyes (retinopathy), the kidneys (nephropathy), and the skin (dermopathy).
Nonsurgical management of acute pancreatitis
fasting, rest, drugs like opioids/histamine receptor antagonists/proton pump inhibitors, comfort measures, endoscopic retrograde cholangiopancreatography with sphincterotomy, NGT with suction for vomiting or biliary obstruction or paralytic ileus, fetal position
Continuous glucose monitors still require
finger-stick measurements and the use of a blood glucose monitor to calibrate the sensor and to make treatment decisions.
Oxygen induced hypoventilation
When main issue is hypoxic or ventilated mechanically who has hypercarbia aka CO2 retention leading to loss of sensitivity to high PaCo2 aka CO2 narcosis which means when patient with low PaO2 and high PaCO2 gets 50% o2 therapy PaO2 increases removing trigger for breathing causing respiratory depression
To prevent falls/injuries at home for AD?
all obvious hazards are removed, hand rails are installed, adequate lighting, night lights, driving prohibited, smoking under supervision, doors leading from house secured, outside activities supervised, ID bracelet since hazard free environment allows independence and autonomy
Oral candidiasis define? Normal? There is an association with?
an acute or chronic yeast like fungal infection of the mouth or GI tract •Normal inhabitant of the GI tract; thrives in moist warm, places •There is an association with repeated fungal infections & Diabetes Mellitus; obesity; suppressed immune system; or antibiotic therapy
complications with THA
hip dislocation, venous thromboembolism aka VTE, infection, anemia, neuroovascular compromise
A 37 year old female reports to the nurse, " I have been having my period for 3.5 weeks now". What laboratory tests would be priority for the nurse to assess?
human chorionic gonadotropin HCG to rule out pregnancy before diagnostic tests, complete blood count since bleeding can be anemic, PTT for clotting factors to check if Von willebrand's disease
late RA manifestations
joint deformities, moderate/severe pain, morning stiffness aka gel phenomenon, osteoporosis, fatigue, anemia, weight loss, subcutaneous nodules, peripheral neuropathy, vasculitis, pericarditis, fibrotic lung disease, sjogren's syndrome, renal disease, felty's syndrome, effusions aka swelling joints, fever, periungual lesions, foot drop, respiratory complications, cardiac complications
early RA manifestations
joint stiffness, swelling, pain, fatigue, generalized weakness and morning stiffness, anorexia, low grade fever, joint inflammation, paresthesias, migratory arthritis
to prevent pressure ulcers for THA
keep heels off bed
teaching for MG
no infection, stress, surgery, hard exercise, sedatives, enemas, OTC drugs without doc, no heat, crowds,
alpha globulin normal number? increased possibly with?
normal 0.1-0.3 g/dL. increased possibly with RA
albumin normal number? decreasing occurs with?
normal 3.4-5g/dL. decreased occurs with chronic inflammation or infection
If patient with RA reports cervical pain which may radiate down one arm or loss of ROM in cervical spine
notify doctor asap because patient can become quadriparetic or quadriplegic or branches of phrenic nerve that can compromise respiratory function
if hip dislocated after THA
surgeon relocates hip then hip immobilized by abduction splint
Exploratory laparotomy define? If adhesions found? If tumor or diverticulitis found? If infarction? In severe cases?
Surgical opening of abdominal cavity to investigate cause of obstruction.mif adhesions found they're cut off, if tumor/diverticulitis colon resection with primary anastomosis or temp./permanent colostomy, if caused by infarction embolectomy/thromboectomy/resection of gangrenous, possible colectomy in severe cases
Troponin normals?
T <0.2ng/mL, I <0.3ng/mL
Education for endometriosis?
Teach patients that temporary post-op pain from carbon dioxide can occur in shoulders & chest
Decreased bone density rn interventions
Teach safety to prevent falls, reinforce need to exercise
Reason to hospitalize for diverticulitis
Temp. Higher than 101, severe and persistent ab pain over 3 days, and/or lower GI bleeding
Complications related to fundoplication procedures and assessment findings for each
Temporary dysphagia via difficulty swallowing, gas bloat syndrome via difficulty belching, atelectasis/pneumonia via dyspnea/chest pain/fever, obstructed nasogastric tube via nausea/vomiting/abdominal distention/no draining of NG tube
Reocurrence for gastric vs. duodenal ulcers
Tends to heal and recurs often at same location vs. 60-% cur within 1 year and 90% cur in 2 years
Myasthenia gravis diagnostics
Tensilon test IV
Orchitis define? Treatment?
Testicular inflammation. CBR; scrotal support & elevation; ice; antibiotics after urine & prostate cultures obtained; NSAIDs; scrotal support; 0 lifting or sex X 4 weeks. If abscess, orchiectomy (removal of 1 or both testes
Surgical management of colorectal cancer is? Examples?
The best method. Colon resection with reanastomosis aka removal of tumor and regional lymph nodes, colectomy with colostomy or ileostomy/ileoanal pull through aka colon removal, abdominoperineal resection, colostomy to create surgical opening of colon onto surface of abdomen
Hydrothorax cause? S/s? Treatment? Prevention?
Transaction of subclavian vein and placement of catheter in thoracic cavity causing IV infusion into cavity. S/S: chest pain, dyspnea, cyanosis, absence of vesicular breath sounds, murmur and flat sound. Treatment: remove, aspirate fluid, monitor, notify. Prevention: use jugular or upper extremity instead of subclavian, use ultrasound for location
Chylothorax cause? S/S? Treament? Prevention?
Transaction of thoracic duct on left side allowing lymph in pleural cavity. S/S: dyspnea, tachycardia, chest pain, cyanosis, withdraw of milk like substance. Treatment: remove, monitor, notify, O2 Prevention: use right side for subclavian vein insertion, use jugular or upper extremity sites, use ultrasound for location
Acute hemolytic transfusion reactions define? When it develops.? Signs?
Transfusion of incompatible blood, usually develops in 15 minutes. Signs: chills, fever, back pain, headache, dyspnea, chest pain, tachycardia, tachypnea
Crohn's disease presents as
Transmittal inflammation that causes thickened bowel wall with strictures and deep ulcerations aka cobblestone appearance which put patient at risk for fistula resulting in severe diarrhea and malabsorption which can cause anemia
Surgical management of COPD
Transplant off single lung or lung reduction surgery
Mini nutritional assessment define? 1st part? 2nd part?
2 part rapid assessment. 1st: about intake, mobility, BMI. If patient scores 11 points or less 2nd part completed 12 additional questions
INR normal? What drug associated?
2-3 Coumadin/Warfarin
crutches fit
2-3 fingers between axilla and top of crutch when crutch tip at least 6 inches diagonally in front of foot and adjusted so elbow flexed no more than 30 degrees when palm on handle
Alpha globulin normal? Increased means?
.1-.3g/dL and increased with RA
Usual starting dose of insulin
.5-1 unit/kg of body weight/day
BSE for premenopausal women> for postmenapausal?
1 week after period because hormonal influence on breasts is decreased. Any day of month
Paget's disease aka? define?
Aka osteitis deformans. Metabolic disorder where bone excessively broken down and reformed causing structurally disorganized causing weak bones, bowing, fractures.
Short acting beta agonists for short term immediate relief of asthma
Albuterol/Proventil/Ventolin, bitolterol/Tornalate, levalbuterol/Xopenex, pirbuterol/Maxair, terbutaline/Brethaire
Hypoglycemia defined as
BG <40mg/dL
Cystitis
Bladder infection usually in women
Genu varum
Bow legged deformity
Ammonia used for? Or is converted to? Elevations due to? Normal?
Bulding amino acids or converted to urea. Cirrhosis or hepatitis. 15-110mg/dL
Large intestines anatomy
Cecum, appendix, colon consisting of ascending/transverse/descending/sigmoid colon, rectum, anal canal
Cephalosporin example? SE?
Cefadroxil aka duricef, ceflixime aka Suprax. SE: watery diarrhea
Cephalosporins
Ceftriaxone/Cefixime, Rocephin/Suprax
Lacto vegetarian diet you can eat
Dairy but no eggs+fish
GU findings for cirrhosis
Dark urine
Gonorrhea transmission? S/s?
Direct contact. PID, endometritis, salpingitis aka Fallopian tube infection, peritonitis, arthritis, meningitis, hepatitis, dysuria, penile discharge, change in vag discharge, anal itching/irritation, reddened throat, ulcerated lips, tender gums, fever, skin lesions
Clinical presentation of Crohn's? If disease occurs in ileum only?
Dirrahea, abdominal pain usually in right lower quadrant that's constant, pain around umbilicus before and after BMs, weight loss, but, Lowe grade fever which is common with fistulas, abscesses, inflammation. If only in ileum diarrhea 5-6 times a day often with soft loose stool
Define diabetes insipidus?
Disease causing frequent urination and excessive thirst that can be caused from surgery
Ovarian cancer define
Disordered rapid growth in response to excessive exposure to estrogen and is the leading cause of death from female reproductive cancers. Low survival rate if late stage detection.
Hypomagnesium can cause?
Dissrhythmia, tachycardia
Most common form of sensory neuropathy? Affects? Aka? Characteristics?
Distal symmetric polyneuropathy which affects hands and/or feet bilaterally aka stocking glove neuropathy. Loss of sensation, abnormal sensation, burning/cramping/crushing/tearing pain that is worse at night, paresthesias aka tingling/burning/itching, atrophy, deformity, fine movement limits
Drugs for hypertension
Diuretic, beta blocker, or both
Liraglutide/Victoza glucagon like peptide receptor agonists SE
Do not use in patients with a personal or family history of medullary thyroid cancer. Acute pancreatitis has been associated with its use.
Tetracyclines
Doxycycline, oxytetracycline
Pulmonary findings for cirrhosis
Dyspnea, hyperventilation, hypoxemia
CV findings for cirrhosis
Dysrhythmias, collateral circulation, fatigue. Peripheral edema, portal hypertension, spider angiomas
clinical significance of diffusion
ECF has 10 times more sodium than ICF due to cell membrane impermeability and sodium pumps that pump sodium outside cell. Also glucose higher in ECF needs insulin to move inside cell
Diagnostics for seizures
EEG, CT/computed tomography, MRI, PET/positron emission tomography
Lab tests for peptic ulcer disease
ELISA, serologic testing for anti h. Pylori antibodies, breath test for urease, decreased hemoglobin and hematocrit from venous bleeding , occult blood in stool
Multiple sclerosis diagnostics
EMG
Intermittent enteral nutrition administration
Every 3-6 hours over 30-60 minutes
Raloxifene aka? Drug type? Does what?
Evista. Estrogen agonist/antagonist. Prevents/treats osteoporosis
Conditions for overproduction of H in metabolic acidosis
Excess breakdown of fatty acids from diabetic ketoacidosis or starvation, anaerobic glucose breakdown forming lactic acid like in heavy exercise/seizures/fever/reduced O2 intake, excess intake of acids like alcohol/aspirin/ethanol/methanol/salicylate
Hypervolemia define? Aka?
Excess fluid in ECF aka fluid overload
Screening recommendations for men and women for colorectal cancer? What age?
FOBT, sigmoidoscopy, double contrast barium enema, colonoscopy. After50 years
H2 receptor antagonists examples? Function?
Famotidine aka Pepcid, nizatidine aka Axid. Blocks gastric secretions
Key features of paraesophageal hernias
Feeling of fullness after eating, breathlessness after eating, feeling of suffocation, chest pain that mimics angina, worsening of manifestations in a recumbent position
Decreased WBC from
Felty's syndrome from RA
Four f's of women cholecystitis
Female, forty, fat, fertile
Antifungals
Flu console, amphotericin B, diflucan abelcet, amphotec
Hep a symptoms
Flu like very mild some GI illness
Intra-arterial therapy used for? Location? Inserted through?
For blood samples, monitoring pressures, infusing chemo. Location: radial, brachial, femoral for samples and arterial pressure, pulmonary for measuring left heart function, hepatic/celiac/carotid for chemo. Inserted through veins in upper extremities, jugular, subclavian.
UTI key features
Frequency, urgency, dys urina, difficulty initiating, low back pain, nocturia, incontinence, hematuria, pyuria, bacteriuria, retention. Possible fever, chills, nausea, vomiting, malaise, flank pain. For elders: mental confusion, unexplained falls, tachycardia, tachyons a, hypotension, loss of appetite
Early symptoms of DKA
Frequent urination High blood glucose (blood sugar) levels (>250 mg/dL) High levels of ketones in the urine Blood pH lower than 7.30 Serum bicarbonate level < 16 mEq/L Lethargy and weakness Dehydration causing decreased HCO3+Na+Ca+mg+PO4+pH, if mild ^ K if severe low K Poor skin turgor Dry mucous membranes Tachycardia Orthostatic hypotension
Define hemorrhagic stroke
From aneurysm that cause headaches or hypertension leading to arteriovenous malformation usually occurs during activit worsen after initial onset
Methemoglobinemia define
From benzocaine spray where conversion of normal hemoglobin to methemoglobin which is altered iron state that doesn't carry o2 resulting in hypoxia. Normal <1% as it increases causing cyanosis, anxiety, tachycardia, lethargy, death. Should be suspected if no response to supplemental O2, cyanotic, and blood chocolate brown color. Reversed with O2 and IV of methylene blue
Ecchymosis and hematoma define? Cause? S/S? Treatment? Prevention
From infiltration of blood into tissue and hematoma from uncontrolled bleeding. Cause: unskilled or multiple attempts, caogulopathy or fragile veins, laceration of vein/artery. S/S: swelling, bruising, pain/tenderness. Treatment: when removing apply light pressure, for hematoma direct pressure until bleeding stops, elevate, ice for 24 hours, then warm compress. Prevention: avoid veins that cannot be easily seen/palpate do, good technique
Viral aseptic meningitis from? CSF characteristics? S/s?
From measles, mumps, herpes simplex, herpes zoster. No organisms in CSF, no exudate in CSF. Fever, photophobia, upper respiratory infections s/s, headache, myalgia, nausea/vomitintg
Autologous vs. syngeneic vs. allogeneic transplants
From own stem cells vs. taken from identical sibling vs. HLA matched sibling or unrelated matched donor
Laparoscopy pre? During? Post?
Consent, anesthetic. Lithotomy position, catheter, needle to infuse CO2. Oral analgesics, shoulder pain, avoid strenuous activity for 1 week.
Late symptoms of DKA
Constantly feeling tired Dry or flushed skin Nausea, vomiting, or abdominal pain, anorexia Rapid deep Difficulty breathing Kussmaul respirations Sweet, fruity acetone breath odor Skin dry and loose, eyes soft and sunken A hard time paying attention, or confusion
Hep. A mode of transmission and prevention
Contaminated food and water, there is a vaccine
Hep e mode of transmission and prevention
Contaminated water and no vaccine
Warfarin aka? Does what? Labs? Antidote? Avoid?
Coumadin. Inhibits clotting. PT/INR, INR between 1.5-2 to prevent DVT/stroke/hemorrhage. Antidote Vitamin K. Avoid broccoli N, cauliflower, spinach, kale, trees, liver, NSAIDS, vitamin E, birth control, garlic
Lung manifestations of GERD
Crackles, coughing, hoarseness, wheezing, bronchitis due to aspiration and regurgitation
Conventional surgical procedures for seizure/epilepsy
Cutting off portion of brain causing it, partial corpus callostomy where brain sectioned to prevent impulses from one side to other
Blood sugar symptoms? 600-1000? Normal?
Hot and dry sugar high aka hyperglycemia. Cold and clammy need some candy aka hypoglycemia. 600-1000 in DKA not unusual hypertonic hypovolemia . Normal is 70-110mg/dL.
Ghrelin
Hunger hormone
Etiology of CKD
Hypertension Diabetes Mellitus Infection Inflammatory diseases Connective tissue diseases Congenital and heredity disorders Toxic nephropathy Obstructive nephropathy
Key features of chronic pyelonephritis
Hypertension Inability to conserve sodium Decreased concentrating ability Development of hyperkalemia and acidosis
Circulatory overload s/s:
Hypertension, bounding pulse, distended jugulars, dyspnea, restlessness, confusion. Prevention: monitoring I/O, infusing slowly, diuretics
Risk factors for stroke that can be changed
Hypertension, high cholesterol, transient ischemic attacks, CVD/atherosclerosis/a. Fib, diabetes, blood clot disorders, sleep ape=bea
Dextrose 10% in water tonicity? Provides? Electrolytes? How many kcal/L provided?
Hypertonic. Provides free water only, no electrolytes, spares proteins to treat hyperkalemia, can worsen hypotension, increase edema, cause hyponatremia, irritates veins 340 kcal/L
Flu s/s
Headache, fever/chills, muscle aches, weakness, coughing/sneezing
Pursed lip breathing: helps? Steps?
Helps manage dyspnea. Close mouth and breath in through nose for 2 seconds, purse lips and breath out slowly through mouth without puffing out cheeks and use abdominal muscles to squeeze air out for 4 seconds
Morphine sulfate function? SE? Admin?
Helps pain with MI/pulmonary edema via vasodilation, depressed CNS. SE: confusion, respiratory failure, hypotension, constipation. PO, IM, IV
Hemorrhage for gastric vs. duodenal ulcers
Hematemesis more common than melena vs. melena more common than hematemesis
Lab assessment of UC
Hematocrit and hemoglobin low, increased WBC, C-reactive protein, and ESR due to inflammation. low sodium, potassium, chloride, albumin due to diarrhea and malabsorption,
Self monitored BG is affected by
Hematocrit values, anemia gives false high and polycythemia false low, icodextrin extraneal dialysis causes false elevation due to maltose, galactose/xylophone in foods/herbs also give false elevation
Dehydration from DM leads to
Hemoconcentration Aka increased concentration, hypovolemia, aka decreased blood volume, hyperviscosity aka thick blood, poor perfusion, hypoxia, acidoss
Chronic renal replacement therapies
Hemodialysis, peritoneal dialysis, renal transplant
Labs for colorectal cancer
Hemoglobin and hematocrit are lower. Liver function tests elevated, positive result for occult blood in stool, carcinoembryonic antigen CEA elevated which is normally 5mcg/L
If patient experiences respiratory distress during mechanical ventilation
Immediately remove ventilator and provide ventilation via bag valve KSAs to see whether problem is ventilator or patient
Azathioprine/Imuran and cyclophosphamid/Cytoxan drug use? Can cause?
Immunosuppression for RA. Can cause cancer, sterility, hair loss, WBC decrease
Define prediabetes IGT diagnosed via? IFG diagnosed when?
Impaired glucose intolerance IGT, impaired fasting glucose IFG, or both leading to body damage like in heart and b.vessels. Diagnosed via 2 hour oral glucose tolerance test OGTT values =140mg/dL-199mg/dL. Fasting BG are 100mg/dL-125mg/dL
Midline catheters used for
Impaired skin integrity, limited peripheral veins, anticoagulants and/or steroid currently in use, fluids for hydration, antibiotics, heparin infusion for DVT, bronchodilators like aminophylline, steroids
Prolonged PT secondary to
Impaired synthesis of clotting proteins from liver damage
If temporary or permanent surgical diversion for UC teach what
Importance of adequate salt and water since ileostomy decreases these. Urge to be cautious in situations that lead to heavy sweeting or fluid loss . They can use regular wear or extended wear solid barriers to bag that last 3-7 days,
Diagnosis of cholecystitisa?What's best?
Increased WBC, AST, LDH, and alkaline phosphatase, bilirubin, if pancreas involved amylase and lipase elevated. X-ray if calcified gallstones, endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography with gadolinium that has no iodine, ultrasonography is best.
Cause of hemorrhoids
Increased abdominal pressure, pregnancy, constipation with straining, obesity, heart failure, prolonged sitting or standing, strenuous exercise and weight lifting, decreased fluid intake
Azotemia
Increased blood urea nitrogen and creatinine suggestive of kidney impairment
Increased and decreased specific gravity can indicate
Increased can indicate decreased kidney perfusion, ADH issues, congestive heart failure. Decreased can mean chronic kidney disease, diabetes insipidus, hypertension, diuretics, lithium
Define sun downing
Increased confusion at night most likely from AD that is helped via nightlight
Nephrotic syndrome
Increased glomerular permeability to allow larger molecule to pass
Reddish blue cause? Significance?
Increased hemoglobin, decreased peripheral circulation. Polycythemia Vera, inadequate tissue perfusion
Aspiration pneumonia s/s?
Increased temp, pulse, dry mucous membranes, decreased urinary output, diminished breath sounds especially in lower, SOB, chest discomfort
Adaptive action to prevent complications during fluid overload in ECF
Increased venous return and contractility, fluid shifts to interstitial space causing edema, decreased ADH and aldosterone, increased natriuretic peptide, increased renal excretion
In patient taking digoxin/lanoxin hypokalemia
Increases sensitivity of heart to drug resulting in toxicity
Propranolol +Lopressor+Tenormin aka? Alert? Class? Used for? SE? Check?
Inderal, metoprolol, atenolol. High. Beta blocker. Antianginal, antiarrhythmic, antihypertensive, preventing MI. SE: slows HR, hypotension, bradycardia, fatigue, sex dysfunction, bronchospasm/wheezing. Check BP, pulse
Define dyspepsia
Indigestion, heartburn
Hypoxia from trach caused by
Ineffective oxygenation before/during/after suctioning, using catheter that's too large for artificial airway, prolonged suctioning, excess suction pressure, too frequent suctioning
Don't give D5w to
Infants or head injury patients since can cause cerebral edema
Dermatitis define? Aka? Occurs in? Symptoms? Exacerbated by? Diagnosis? Treatment?
Inflammation of skin. Atopic or contact aka eczema. Occurs in family history of hay fever, asthma or unknown cause. S/S: dry skin, itch, rash, redness, lesions. Exacerbated by foods, stress, clothing, contact. Diagnosis: family history, serum IgE, scratch test. Treatment: cool compress, antihistamines, gloves, creams, oatmeal baths, no rubbing, steroid creams, avoid irritants
Acalculous cholecystitis
Inflammation without gallstones and usually from biliary stasis like decrease in blood flow usually from sepsis, severe trauma or burns, long term total parenteral nutrition, organ failure, major surgery. Hypovolemia
Localized vs. dependent/pitting, vs. no pitting edema and conditions that cause each
Inflammatory response due to trauma vs. fluid/electrolyte imbalance and/ or venous/cardiac insuffiency due to CHF/kidney disease/liver cirrhosis/venous thrombosis vs. endocrine imbalance due to hypothyroidism/myxedema
ED implants
Inflatable implant uses 2 cylinders surgically placed inside penis and when erection desired man uses pump to fill cylinders. Another type in malleable which bolsters erections with surgically implanted rods
Nursing responsibility of transfusion
Informed consent, double check orders,confirm transfusion is appropriate
Primary continuous admin set used to? What can be attached? Depending on drug compatibility? Change every?
Infuse primary IV by either gravity infusion or infusion pump. A secondary admin set aka piggyback attached to primary set at Y injection site for intermittent meds. Depending on drug compatibility can have multiple secondary sets. Change every 72-96 hours
Vascular access device define? Can be?
Infusion catheter, plastic tube placed in vessel to deliver fluids/meds. Can be peripheral veins or large central veins of chest, midline catheters, peripherally inserted central catheters, no tunneled percutaneous central venous catheters, tunneled catheters, implanted ports, hemodialysis catheters
Ringers solution tonicity? Similar to? Doesn't? Used to?
Isotonic. Similar in composition to plasma except that it has excess chloride, no magnesium, and no bicarbonate Does not provide free water or calories Used to expand the IV volume & replace ECF losses
0.9% saline tonicity? Used to? Only solution that? Contains? Does not? May cause?
Isotonic. Used to expand IV volume & replace ECF losses and KVO Only solution that may be administered with blood products Contains sodium & chloride in excess of plasma levels Does not provide free water, calories, or other electrolytes May cause IV overload or hyperchloremic acidosis
Postcholecystectomy syndrome causes?
Pseudo dust, common bile duct leak. Stricture or obstruction, sphincter of Oddi dysfunction, gallstones, sclerosing cholangitis. Diverticular compression
Nurse best response for psoriasis
Psoriasis has exacerbations and remissions, cannot be curred, topic corticosteroids and tar and warm climates and UV light preps to suppress cell division
Maslows hierarchy of needs stages?
Psychological breathing+food+water+sex+sleep+etc. Safety security of body+employment+resources+morality+family+health+property. Love/belonging. Esteem aka confidence+achievement+respect. Self actualization aka morality+creativity+problem solving+acceptance of facts
Preop nursing care for breast cancer
Psychological preparation Teaching re: postop Jackson Pratt; Drainage should be < 25 ml/day before drain removed Dressing over incision Address body image issues Provide written information Refer to support groups i.e. Reach to Recovery (American Cancer Society); Susan G. Komen3 Day Run for a Cure
Hemothorax cause? S/s? Treatment? Prevention?
Puncture of subclavian vein/artery causing blood in pleural cavity S/S: dyspnea, tachycardia, decreased hemoglobin. treatment: remove catheter, assess, notify, O2, apply pressure on site after removed. Prevention: use jugular or upper extremity sit, use ultrasound for location
Key features of acute gastritis? Symptoms last how long?
Rapid onset of epigastric pain/discomfort, nausea and vomiting, hematemesis aka vomiting blood, gastric hemorrhage, dyspepsia aka heartburn, anorexia, melena aka traces of blood in stool. Few hours or days
COPD respiratory changes
Rapid, shallow respirations, abnormal breathing pattern where abs sucked in during inspiration, accessory muscles in abs or neck used, high RR, asymmetric chest expansion, limited diaphragm movement aka excursion, fremitus, wheezes, reduced breath sounds
Somogyi effect define? Release of?
Rebound effect in which an overdose of insulin at night causes hypoglycemia Release of counterregulatory hormones causes rebound hyperglycemia in morning causing headaches, night sweats, nightmares, 2-4AM hypoglycemia
Fluid and electrolyte management for DKA
Restore volume and maintain perfusion via 15-20mL/kg/hr during first hour, replace totally body fluid loss via hypotonics 4-14mL/kg/hr, when BG reaches 250 give 5% dextrose in 0.45 NS to prevent hypoglycemia and edema,
Nutrition therapy for fluid overload
Restrictions on fluid and sodium if chronic. For salt can be no salt added or strict 2-4g/day
Respiratory s/s of allergic reaction
Rhinitis, chest tightness, weakness, dyspnea, urticaria, severe wheezing, loss of consciousness
Drug for bacterial meningitis
Rifampin, Rifadin, Rofact, Cipro, Recephin
Bacterial transfusion reaction s/s?
S/S: tachycardia, hypotension, fever, chills, shock
Orchitis s/s
Scrotal pain, edema, heavy feelings in testicle, dysuria, pain on ejaculation, blood in semen, discharge from penis, n/v, pain to inguinal canal
Cerebyx/fosphenytoin and Dilantin/phenytoin care? Therapeutic range? Takes how long? Give with? Need? Used for?
Scrupulous oral hygiene needed for gingival hyperplasia (IV incompatability to most drugs) -Therapeutic range is 10-20mg/L -Takes 7-14 days to establish -Give with meals for common GI effects -Need regular follow up monitoring RBC and Calcium to detect low values -Used for a variety of seizure types
Main interventions for secondary epilepsy and non epileptic seizures and primary epilepsy
Secondary epilepsy and non epileptic seizures: removing/treating underlying condition or cause. Primary epilepsy: drugs
Parietal cells and chief cells define
Secrete HCL, secrete pepsinogen/intrinsic factor to aid absorption of vitamin B12
Aldosterone secreted by? When? Prevents and promotes?
Secreted by adrenal cortex when sodium in ECF is decreased to prevent water and sodium loss and promote potassium excretion/lossfrom kidneys to increase blood osmolarity and blood volume
Natriuretic peptides NPs are secreted by? In response to? Function?
Secreted by cells that line heart atria and ventricles in response to increased blood volume/pressure which stretch heart and creates opposite effect of aldosterone in kidneys to inhibit sodium reabsorption and increase filtration/urine resulting in decreased blood volume and osmolarity
When on mechanical ventilator do you suction
Secretion, increased peak airway pressure PIP, rhonchi/wheezes, decreased breath sounds
Suctioning needed when
Secretions audible, crackles, wheezes, restlessness, increased pulse/RR, mucus in artificial airway present, increase in peak airway pressure
Self determination akas? Define?
Self management or patient autonomy, patients are capable of making decisions about their care
Pre albumin measures? Normal?
Sensitive indicator of nutritition normal range 15-36mh/dL
Allergic transfusion reactions define? Symptoms. Can be?
Sensitive to foreign plasma proteins, symptoms: flushing, itching, hives, fever. Can be anaphylactic reaction
Braden scale questions
Sensory perception/mental status, moisture, activity, mobility, nutrition, friction and shear, incontinence
PID s/s
Sepsis, ectopic pregnancy, infertility, tenderness aka adnexa, menstrual irregularity, no signs possible, irregular vag bleeeding, dysuria, vag discharge change, dyspareunia aka painful sex, malaise, fever, chills, friable cervix
Assessing stoma
Should be reddish pink, moist protrude about 3/4 inch aka 2 cm, right after surgery may be slightly edematous, slight bleeding is common, check for leakage, skin should be intact, without redness or excoriation
Patients requiring clear/full liquid diets with DM
Should have 200g of carbs daily
Tegretol/Carbamazine side effects? Rare but? Used for?
Side effects decrease in severity over time Bruising, sore throat, bleeding can occur Rare but severe bone marrow toxicities make reg. follow up more important. Used for a variety of seizure types.
Uremia
Signs and symptoms of end stage renal disease aka chronic renal disease
Folic acid deficiency similar? Caused by?
Similar s/s as b12 anemia. Anticonvulsants and oral contraceptives can prevent absorption, methotrexate, nutrition, malabsorption from Crohn's, alcohol. supplements may be required
If you cannot remove vascular access device
Simple distractions, deep breathing and if that doesn't work apply heat and keep dry while having patient drink warm liquids, or meds to relax as worst care, and if none of those wok imaging to determine if thrombosis
Promoting adequate nutrition for AD
Simple, calm, familiar foods that looks appetizing/taste good, one dish at a time, food cut to small pieces, liquids may be easier if gelatin added, temperature checked
PICC lumen configurations
Single, dual, or triple lumen configuration with groshong valve and pressure activated safety valve or available as power PICCs for contrast injection and can be connected to transducers to monitor central venous pressure
Janumet is combo of?
Sitagliptin & metformin
Sterile dressings over insertion site for short peripheral catheter? After removing dressing from midline or central venous catheter
Site rotation every 72-96 hours. Note the external catheter length and compare length with original length of insertion because if has changed placement has too.
SBAR define
Situation, backing info, assessment info, recommendation of what's needed/desired outcome
associated syndromes of late RA
Sjogrens syndrome: dry eyes/ keratoconjunctivitis, mouth/xerostomia, and vagina. associated with anti-ss-a antibodies Felty's syndrome: hypatosplenomegaly aka enlarged liver+spleen and leukopenia Caplan's syndrome: rheumatoid nodules in lungs and pneumoconiosis
Which tissues have receptors for insulin and considered insulin dependent
Skeletal muscle and adipose tissue and liver for glycogen
Elevated LDH can indicate?
Skeletal muscle necrosis, cancer, muscular dystrophy
Elevated AST can indicate?
Skeletal muscle trauma, muscular dystrophy, necrosis of liver like hepatitis/cirrhosis
Simple facemask, partial rebreather, nonrebreather mask interventiosn
Skin care, monitor risk for aspiration, no twisting/kinking reservoir bag
Best place to assess skin turgor for elders
Skin over sternum or forehead
Strenuous activity can be perceived by body as? In type 1 who is ketosis? Strenuous activity should be avoided if?
Stress causing release of counterregulatory hormones resulting in temp. Elevation of BG. In type 1 who is ketosis excercise can worsen hyperglycemia and ketosis. Should be avoided if BG >300mg/dL and if ketones present. If no ketosis don't postpone exercise
Chronic complications of DM
Stroke, hypertension, dermopathy, altherosclerosis, nephropathy, neurogenic bladder, retinopathy, cataracts, glaucoma, blindness, coronary artery disease, gastro paresis, islet cell loss, peripheral vascular altherosclerosis, gangrene, erectile dysfunction, infections
Alternative sites for infusion
Sub q, intraosseous, intra-arterial, intra peritoneal, intra spinal
Acids are? The strength measures by?
Substances that release/donates H when dissolved in water. THe strength measures by how easily it releases H
Engraftment define? Assess for?
Successful take of transplanted cells in the patient's bone marrow from peripheral blood. Assess for chimerism aka presence of donor cells, if regressive chimerism aka cells stay mostly patient's it indicates graft failure
Mucosal barrier fortifier example? Dose? Purpos
Sucralfate aka Carafate. 1g four times of 2g twice daily usually before and after meals. Binds with bile acids and pepsin to protect stomach mucosa.
Psuedoephedrine aka? FunctiON?
Sudafed. Decongestant
DKA onset? Precipitating factors? Manifestations? Serum glucose? Osmolarity? Ketones? Ph? HCO3? Na? BUN? Creatinine? Urine ketones?
Sudden. Stress/infection/inadequate insulin. Ketosis, kussmaul, fruit breath, n/v, cramps, dehydration/electrolyte loss: polyuria, polydipsia, weight loss, dry skin, sunken eyes, soft eyeballs, lethargy/coma. >300mg/dL. Variable. Positive at 1:2, <7.35, <15mEq, low/normal/high, >30mg/dL, >1,5 due to dehydration, positive
Antibacterial med categories
Sulfonamides, penicillin, antibiotic/antiprotozoal, tetracycline, macrolide, cephalosporins
Most common treatment of hiatal hernias
Surgery
Chlamydia diagnosis? Treatment?
Swab tissue culture or urine test. Azithromycin/Zithromax or doxycycline/Monodox and if allergic erythromycin, ofloxacin, levofloxacin
Define penile tumescence
Swelling
Cardiac changes with COPD
Swelling of feet/ankles aka dependent edema, right sided heart failure, Pallor/frank cyanosis
Interventions for IBS
Symptom diary , avoid caffeine, alcohol, egg, wheat, sorbitol,M fructose, milk if lactose intolerant, take fiber, drink 8-10 cups water, chew food slowly, possibly bulk forming of antidiarrheal drugs, stress reduction
Surgical procedure for prostate
TURP, supra public abdominal incision bladder entered. Perineal perineal incision, retro public abdominal incision where bladder not enetered
Teaching for pancreatic enzyme replacement
Take with meal or snack and water, if difficulty swallowing cover with applesauce or break over it, admin after antacid/2 blockers, don't chew when taking, don't take with protein, wipe lips with wet towel to remove residual enzymes
Hormone antagosists
Tamoxifen, Lupron, cytadren, arimidex, casodex, femara, eulexin, faslodex, zoladex, amomasin, eligard, nilandron, nolvadex, fareston
Mini mental state example is? Developed when? How many questions? How many total points? Greater the score? Used to?
Tests orientation, registration, attention, calculation, recall, speech Developed in 1965 11 questions 30 points total score Greater the score the less dysfunction Used to estimate relative mental competence and decline of cognitive functioning as seen in Dementia
Patients at risk for hypoglycemic unawareness? Treatment?
Those with repeated episodes of hypoglemics, older patients, patients who use beta adrenergic blockers. Treatment: BG goals that are somewhat higher than patients who can detect and manage onset
Nerve damage s/s? Treatment? Prevention
Tingling, feeling of pins and needles, numbness. Treatment: stop immediately, remove if discomfort doesn't improve when secured. Prevention: avoid using cephalic vein near wrist, avoid using veins on Palm side of wrist, secure catheter, support areas of joint flexion with arm board
Best most reliable method for assessing return of peristalsis is
To ask if patient has passed flatus within past 8 hours or a stool within the past 12-24 hours
Lactate dehydrogenase LDH normal range?
Total 100-190 units/L
Breast conserving surgery vs. modified radical mastectomy
Lumpectomy so tumor and small tissue removed vs. affected breast removed+lymph nodes due to inability to have radiation or present of large tumor
Nutritional management of hyperkalemia avoid
Meats, organs, preserved meats, dairy, dried fruit, fruits like bananas, cantaloupe, kiwi, oranges, vegetables like avocados, broccoli, dried beans/peas, mushrooms, potatoes, seaweed, soybeans, spinach
Rapid acting insulin can be
Mixed with NPH
Middle phase of Alzheimer's aka? Define
Moderate to Severe- Memory loss increases, personality changes, wandering, aphasia, frustrated, angry, sensitive
Recovery stage of ARF treatment
Treatment Monitor BUN & Creatinine routinely Monitor GFR Adjust medication according to renal function Patient and family education essential!
Sulfonamides meds
Trimethroprim/Sulfanethoxazole, Bactrim/Septra
Polyuria
More than 2000ml per 24 hours
Esophageal manometry aka? Procedure?
Motility test. Water filled catheters inserted in nose or mouth and slowly withdrawn while measurements of LES pressure and peristalsis recorded
Define testicular torsion? Treatment?
Twisting of spermatic cord. Surgical emergency to untangle within 6 hours of s/s onset or loss of testicle
Causes for false low pulse ox reading
Movement, hypothermia, decreased peripheral blood flow, ambient light, decreased hemoglobin, edema, nail polish
Type 1 vs. type 2 eye exam
Type 1 eye exam with dilation within 5 years after onset then repeated annually. Type 2 at time of diagnosis and annually after
Postop care for UC surgery? Ileostomy begins to drain when? How much fluids? Hospital stay how long? For RPC-IPAA?
NPO with NG tube for suction. Within 24 hours. After NPO 500 ml more fluids each day. Hospital stay 2-5 days. Internal pouch can become inflamed and treated with metonidazole aka Flagyl and after second stage may have burning during elimination
Nonsurgical interventions for obstructed intestines
NPO, NG tube with suction to decompress,disimpaction and enema, IV fluid replacement, monitor VS and intake and output and weight, total parenteral nutrition possibly, pain medsight be withheld, frequent position changes, semi fowlers, if strangulation IV antibiotics , drugs that enhance motility like octreotide acetate aka Sandostatin
Rheumatoid arthritis drugs
NSAIDs, methotrexate, leflunomide/Arava, corticosteroids, immunosuppressants
Common complications of obesity
Type 2 DM, hypertension, hyperlipidemia, CAD, stroke, peripheral artery disease, metabolic syndrome, sleep apnea, hypoventilation syndrome, depression, urinary incontinence, cholelithiasis aka gallstones, gout, back pain, osteoarthritis, decreased wound healing
Key features of intra renal intrinsic AKI and postrenal azotemia aka acute kidney disease
Oliguria, a urina, increased specific gravity, hypertension,tachycardia, vein distention, increased venous pressure, SOB. Orthopnea, crackles, edema, friction rub, anorexia, nausea, vomiting, flank pain, lethargy, headache, tremors, confusion, weight gain
Mannitol alcohol sugar 5% or 25% action and use? Nursing considerations?
Oliguric diuresis, reduces cerebral edema, eliminates toxins. May cause fluid overload, cause electrolyte imbalances, cellular dehydration, extravasation can cause tissue necrosis.
Drugs to never give for cirrhosis
Opioids, sedatives, barbiturates
Hypocalcemia caused from? Can cause?
Osteoporosis or osteomalacia. Can cause dysrhythmias, cardiac arrest, malabsorption, renal failure, pancreatitis
Difference between osteoporosis and osteomalacia
Osteoporosis: decreased mass from lack of Ca all other minerals and hormones normal Osteomalacia: de mineralized bone from lack of vitamin D, phosphatase high, PTH high or normal, phosphate low or normak
Causes of meningitis
Otitis media, pneumonia, acute/chronic sinusitis, sickle cell anemia, brain/spinal injury, immunosuppression, infection, older people, piercings
Intraductal papilloma define
Outgrowth of tissue in breast ducts causing nipple discharge
AFP aka alpha feta protein is elevated when?
Ovarian cancer present
Abdominal distention and nausea/vomiting caused by?
Over feeding. To prevent chest residuals q 4-6 hours, hold if >200mL on 2 assessments
Post op pain meds for THA
Oxycodone+acetaminophen aka Percocet/tylox and NSAIDs like ketorolac/toradol/acular, ibuprofen/motrin
Respiratory acidosis labs ph? HCO3? PaO2? PaCO2? K? Ca? Cl?
PH low, HCO3 normal, PaO2 low, PaCO2 high, K high, Ca normal, Cl high or low
Metabolic acidosis labs ph? Bicarbonate? PaO2? PaCO2? K? Ca? Cl?
PH low, bicarbonate low <21, PaO2 normal, PaCO2 normal or decreased, serum K high, Ca normal, Cl normal or high
Care of patient with kidney stones
Pain control Increase fluid intake Possibly special diet, particularly low oxalate Lithotripsy: expect urine to be cherry red pain when pass fragments Strain urine
Key features of cholecystitis
Upper ab pain that can radiate to right shoulder, pain triggered by high fat or high volume meal, anorexia, nausea and or vomiting, dyspepsia, eructation aka belching, gas, ab fullness, rebound tenderness aka blumberg, fever, jaundice, clay colored stool, dark urine, steatorrhea, biliary colic due to stones which can cause tissue spasm
Gastric ulcer pain location? Aggravated by?
Upper epigastrium on left of midline and aggravated by food
Clinical manifestations of ESRD
Uremia: syndrome incorporates all signs and symptoms seen in every organ system throughout the body Result of retained substances Water Electrolytes Hormones Urea, creatinine, uric acid
Stage 5 uremic syndrome
Uremic Syndrome Excessive uremic waste products All other organ systems fail Fetor uremicus Uremic frost Death is imminent without treatment
Names of infectious disorders of urinary
Urethritis, cystitis aka bladder, postatitis, pyelonephritis is kidney
Lab data for infectious cystitis
Urinalysis Hematuria Pyuria Bacteria count >100,000 colonies of organisms/ml Urine culture and sensitivity Identify causative organism Avoid contamination
primary vs revision arthroplasty? usually for?
first time vs. if implant loosens and needs fixing. usually for total hip arthroplasty THA aka total hip replacement
palpitations define? cause?
fluttering or unpleasant feeling in cheat due to irregular heart beat. Cause: changes in HR, rhythm. Increase in force of heart contractions. tachycardia, strenuous activity, anxiety, stress, fatigue, insomnia, hyperthyroidism, caffeine, nicotine, alcohol
amputation common complications
hemorrhage, infection, phantom limb pain, neuroma, flexion contractures
erythrocyte sedimentation rate aka ESR if elevated confirms? normal?
if elevated confirms inflammation/inflammatory disease like RA or infection, anemia, soft tissue damage. Normal: male: up to 15mm/hr, female:up to 20mm/hr
osmolarity
number of milliequivalents/milliosmoles in a liter of solution
Home care education for trach
Use shower shield cover airway with cloth to protect it during day, increase humidity in home, wear medical alert bracelet that identifies inability to speak
Central IV therapy define? Location? Requires?
Vascular access device placed in central circulation within superior vena cava near junction with right atrium. Require verification of placement via chest radiograph before solutions infused.
Elevated hematocrit?
Vascular volume depletion
Agents for erectile dysfunction categories? Meds?
Vasodilator, inhibitor, phosphodiesterase-5 inhibitor. Viagra/sidenafil, Cialis, Levitra
Micturition
Voiding
Health belief model define? Based on? Demographic?
What people believe to be true about themselves in regards to their health •Based on 1) perceived susceptibility to disease; 2) perceived seriousness of disease; 3) perceived benefits of action •Demographic variables, personality, peer group pressure, knowledge, & prior contact with disease are influencing factors
Gastric ulcer patho? Key characteristics?
When break in mucosa occurs hydrochloric acid injures epithelium causing back diffusion of acid or dysfunction of the pyloric sphincter and w/ out normal functioning bile refluxes into stomach causing deceased blood flow to lining. Normal gastric secretion+delayed stomach emptying w/ increased diffusion of gastric acid back into stomach
When fluids permitted post colonoscopy
When peristalsis has returned
Dryness aka? Define? Common problem in? Prevention?
Xerosis. Fine flaking of outer layer of skin. Common in elderly if itched can lead to lichenification and/or infection. Prevention: moisturizing soaps, oils, un scented creams/lotions, humidifier, bathe every other day, tepid water, superfatted soap, pat dry, no tight clothes, fluid intake of 3000mL, avoid caffeine and alcohol
Hysterisalpingogram
Xray of cervix, uterus, Fallopian tubes 2-5 days after end of period. Laxative, enema, suppository before. Will have pain. Give pad, contact if bloody discharge for >4 days, lower pain, fever, tachycardia
Define icterus
Yellow discoloration of sclerae due to jaundice
Sputum if infection
Yellow/green
Mr. Jones, a 70 year old client, reports to the nurse, "At night, I wake up at least twice to go to the bathroom to urinate". What is the nurse's best response to Mr. Jones
You will need to have a digital rectal examination to check benign prostatic hyperplasia BPH since related to aging/hormonal issues
Labs/diagnostics for ovarian cancer
^ cancer antigen test (CA-125) Transvaginal ultrasound CT scan, CXR CBC w Liver profile Pap smear is of LIMITED VALUE for detection
angina define? location? relieved with?a
sudden in response to exertion, emotion, temps. Squeezing viselike pain. Location: substernal and can spread to chest and back and/or down arms. Usually left side of chest and relieved with rest, nitrates, O2
interventions for RA
synovectomy:remove inflamed synovium for knee/elbow for RA TJA aka total joint arthroplasty
cane used on what side? positioning?
on unaffected side and no more than 30 degrees of elbow flexion
Oral meds for ED examples? Function? Take? Contraindicated with?
phosphodiesterase/PDE inhibitors like viagra, cialis, levitra which improve blood flow during arousal. Take Only 1x a day 1 hour before sex, not PRN. Contraindicated with nitrate b/c hypotension and <blood blood flow to vital organs
external fixation define? advantages? disadvantages?
pins or wires inserted through skin and affected bone and then connected to external frame. advantages: minimal blood loss, early ambulation, maintains alignment in closed fractures that won't maintain position in a cast, easy access to wound. Disadvantage: increased risk for pin site infection leading to osteomyelitis. in first 48-72 hours clear fluid drainage or weeping is expected
exercises to prevent VTE aka venous thromboembolism
plantar flexion, dorsiflexion, circumduction, gluteal by pushing heels into bed and quadriceps muscle setting by straightening legs and pushing the back of knees into bed, straight leg raises(SLRs),
preop care for THA or knee arthroplasty
preop care for THA or knee arthroplasty
Progesterone define
prepares body for conception & pregnancy; "pro-gestation"; maintains & regulates menstrual cycle
Testosterone define
responsible for prostate function; maintains muscle bulk, adequate levels of RBCs, bone growth, a sense of well-being, & sexual function; may improve Erectile Dysfunction (ED)
DVT treatment nonsurgical
rest or amb, studies did not show that amb => PE and DVT did not worsen ; SCDs; DO NOT MASSAGE AFFECTED EXTREMITY, monitor for PE; anticoagulants IV Heparin, then PO Coumadin; or low molecular weight heparin i.e. enoxaparin (Lovenox) or dalteparin (Fragmin); tPA
nonpharmacologic interventions of RA
rest, positioning, ice/heat, hypnosis, acupuncture, imagery, music, stress management, treating obesity, calcium, fish/fish oil, GLA, tai chi, spiritual practices
Endometriosis results from? Monthly cyclic bleeding? Scarring leads to?
results from overproduction of prostaglandin & estrogen, which leads to chronic inflammation because endometrial tissue is implanted outside of the uterus usually ovaries aka chocolate cyst@ ectopic sites. -monthly cyclic bleeding occurs @ the ectopic site of implantation, which irritates & scars the surrounding tissue -scarring leads to adhesions & infertility
Abnormal breast findings
retraction, mass, lump, cyst, venous prominence, edema, peau d'orange, nipple inversion, inflammation
Connective tissue disease (CTD) is the major focus of? ctd's are mostly? aka?
rheumatology, the study of rheumatic disease. CTD's are mostly autoimmune disorders. CTD AKA arthritis
postop care of TKA
same as THA except no need for hip abduction and CPM aka continuous passive motion machine may be used, if no CPM knee rests flat on bed or with one pillow under lower calf and food to encourage slight extension, no hyperextension, patients able to slightly weight bear unless not cemented
Inflammation from recurrent diverticulitis can cause
scarring which narrows bowel lumen which can cause obstruction and possible fistulas
neuroma
sensitive tumor of damaged nerves from amputation
Androgen define
sex hormones made in the ovaries & converted to estrogen
empty and measure fluid in surgical drain every? amount of drainage should be?
shift, total amount of drainage less than 50 mL/8hours
canes
should be used on strongest side of body
cast issues? if patient immobilized?
skin breakdown, infection, circulation impairment, peripheral nerve damage. If patient immobilized pneumonia, atelectasis, thromboembolism, constipation
Synthetic androgen meds
Testosterone, danazol, cyclomen, danocrine
Packed RBC volume? Infusion time? Indications
200-250mL, 2-4 hours. For anemia hemoglobin <6g/dL, 6-10g/dL depending on symptoms,
Beau's grooves define? Can indicate?
1mm wide horizontal depressions in nail/ Acute/severe illness, prolonged febrile state, isolated periods of malnutrition
% of water in each of the 2 compartments
1/3rd in ECF and 2/3rd in ICF
What is max length of time to apply painful stimuli in comatose patient
20-30 seconds
Serum calcium normal?
9-10.5mg/dL and decreased in elders
Progesterone decreased? Elevations?
Amenorrhea, neoplasms, ovary dysfunction. Ovarian cyst
Drug therapy for GERD
Antacids, histamine blockers, protein pump inhibitors
High platelets
Chronic disease, anemia
Over elimination of bicarbonate ion metabolic acidosis conditions
Diarrhea
Reproductive health: role of RN? Emphasis on?
Education. health promotion & education **
COPD types
Emphysema or bronchitis
Intra operative care for DM
IV infusion of insulin, glucose, K for BG 140-180, 5g glucose/hour
Erectile dysfunction ED define
Impotence, functional/psychological/sudden onset like stress and organic causes
Arthralgias
Joint aches
Anuria
Less than 100ml per 24 hours
RBC normal men? Women?
Men 4.7-6.1 million cells/mcL, female 4.2-5.4 million cells/mcL
PaO2 vs. SpO2/SaO2
Partial pressure of o2 in blood vs. pulse ox O2/ABG o2
Estrogen/progestin combo
Prempro aka conjugated estrogens with medroxyprogesterone, ortho-prefest Fem HRT
signs of hip dislocation
pain, shortening of leg, rotation of leg
Serum bicarbonate normal? If =11?
20-30mmol/L. If serum bicarbonate CO2 is 11 bicarbonate is being consumed due to severe metabolic acidosis seen in DKA and is very low
Base excesses caused by
Excess intake of bicarbonates, carbonates, acetates, and citrates like antacids, blood transfusions
CK-MB normal?
0
Serum lipase normal? Increased due to?
0-110 units/L due to pancreatitis
Aspartate aminotransferase AST normal range?
0-35units/L or 5-40 units/L from liver, increased in elders
Gamma globulin normal? Increased means?
0.8-1.6 g/dL. Inflammatory CTDs
Single donor platelets volume? Infusion time? Indications
200ml, 30 min. History of febrile/allergic reactions, or stem cell transplant. Single donor has one donor
Physical assessment for colorectal cancer
Assessment for distention and masses, visible peristaltic waves, high pitched tinkling bowel sound due to partial bowel obstruction, total absence of bowel signs due to complete obstruction
RN process
Assessment/data collection, analysis/diagnosis, planning, implementation, evaluation
Neurologic finding for cirrhosis
Asterixis, paresthesias of feet, peripheral nerve degeneration. Encephalopathy, reversal of sleep wake pattern, sensory disturbances
What to check for with skin cancer? Notify if? Check when?
Asymmetry, border irregularity, color variation, diameter >6mm, evolving or changing feature. Notify if >1 of the above features. Check monthly
It;s recommended for those who use meds that cause hypoglycemia to schedule exercise when?
1 hour after meal or have 10-15g carb snack and check BG before exercise. And small carb snack taken every 30 minutes during exercise, carry glucose tabs or hard candies
1kg of weight gain/loss = ?
1 liter of retained/lost fluid
Ankle-brachial index normal? If lower indicates?
1 or more=ankle systolic pressure/dorsalis pedis/tibial divided by brachial systolic pressure to measure vascular status. Vascular disease.
Leading cause of mortality 35-44
1 unintentional injuries, 2 malignant neoplasms, 3 heart disease
Leading cause of mortality 20-34
1 unintentional injuries, 2 suicide, 3 homicide
Leading cause of mortality 20-34
1 unintentional injury, 2 suicide, 3 homicide
A 20 year old sexually active female asks the RN, "When should I have a Pap smear?" The nurse's best response is
At 21 between period no douching, vag meds, or deodorant before or sex 24 hours before
Rn interventions during/after IV rtPA
10% of dose Bolus over 1 minute, and .9mg/kg infusion, stroke unit, neuro assessment/VS q 10-15 minutes during and q 30 min. After, if >180/105 BP antihypertensives, no invasive tubes, follow up CT after
Oliguria
100-400 ml per 24 hours
Surrounding mucosa for gastric vs. duodenal ulcers
Atrophic gastritis vs. no gastritis
a sudden weight increase of 2.2 lbs can result from
excess fluid 1 L in interstitial spaces aka edema
Amputation pain drugs
Calcitonin, beta blockers aka propranolol for dull burning, antiepileptic drugs aka carbamazepine/tegretol or gabapentin/Neuronten for sharp pain, antispasmodic aka baclofen/Lioresal for spasms/cramping, antidepressants
A. Fib drugs
Calcium channel blockers like cardizem/diltiazem, beta blockers like metoprolol/esmolol, dixoxin, anticoagulants/antiplatelets
Osteoporosis drugs
Calcium+Vit. D. Biphosphonates -Fosamax/aldendronate, ibandronate/Boniva, risedronate/Actonel prevents bone loss/resorption and increases density. Estrogen agonists/antagonists prevent loss and increases density
What helps people with Alzheimer's interpret their surroundings and activities
Calm predictable environment where stimuli are limited and regular routine is established
Colostomy should start functioning when? Sh of be emptied when
2-4 days. Should be emptied one third to one half full, entire pouch system changed q 3-7 days
1 L of water weighs how man pounds? Meaning? A weight change of 1 pound indicates fluid volume change of?
2.2 pounds meaning weight changes are best indicator of fluid loss or gains. A weight change of 1 pound indicates fluid volume change of 500ml
Urine albumin
20-200g/min or 30-300mg/hr indicate microalbuminuria/proteinuria indicating microvascular changes
Bicarbonate arterial normal? Venous normal? Increase cause? Decrease cause?
21-28mEq/L, 24-29mEq/L. Increased: metabolic alkalosis, bicarbonate therapy. Decreased: metabolic acidosis, diarrhea, pancreatitis
Normal bicarbonate CO2 range? Function? Regulated by? decreased indicates? Increased indicates? Interventions?
22-30. Is a buffer that prevents accumulation of acids and regulated by kidneys. Decreased indicates metabolic acidosis and increased indicated metabolic alkalosis. Assess LOC, renal function, expect need for IV fluids.
Diagnosing GERD
24 hour ambulatory esophageal pH monitoring, esophagogastroduodenoscopy , esophageal manometry
the body functions best when the osmolartiy of fluids in all spaces is close to? when all fluids have this concentration body fluids are? aka? or?
270-300mEq. when all fluids have this concentration body fluids are isosmotic to each other aka isotonic or normotonic
Assessment for pneumonia
Chest, pleuritic, or abdominal pain Headache, fever, chills Difficulty breathing Tachypnea Productive cough with mucus Purulent sputum production Crackles, wheezing, or bronchial breath sounds Increased tactile fremitus Dullness to percussion Hypotension, rapid pulse (secondary to dehydration, or advanced stage
Define abdominal circumference? High is associated with? High risk for men? WomeN?
Abdominal girth is the measurement of the distance around the abdomen at the umbilicus; indicator of abdominal fat •A high abdominal circumference is associated with an increased risk for type 2 diabetes, dyslipidemia, hypertension, & CVD •High Risk Men: >102 cm ( >40 in) •High Risk Women: >88 cm ( >35 in)
Postcholecystectomy syndrome signs
Abdominal or epigastric pain with vomitting
Symptoms of polycystic kidney disease
Abdominal or flank pain Hypertension Nocturia Increased abdominal girth Constipation Bloody or cloudy urine Kidney stones
Exenatide/Byetta glucagon like peptide receptor agonists SE
Acute pancreatitis and kidney problems have been associated with its use.
Antivirals
Acyclovir, valcyclovir, fanciclovir, docosonal, Zovirax, Valtrex, cytovene, abreva
Skin antiviral? Antibacterial? Antifungal? Antibiotics? Anesthetic? Antiparasitic? Steroid? Antipsoriatic?
Acyclovir. Bacitracin. Nystatin. Penicillin/Erythromycin. Benzocaine. Lindane. Hydrocortisone. Methotrexate
gait for crutches
3 point so little weight bearing on affected leg
Glasgow coma scale scoring for coma? Moderately severe? Mild? Normal?
3 through 8 critical and in a coma 9 through 12 moderately severe but not in a coma 13-14 mild 15 is normal
ALT normal
3-35 units/L
Serum phosphorus norm?
3-4.5mg/dL and decreased in elders.
phosphorus normal range? Most where? Major? Function? Lowered phosphorus=? Which hormone regulates?
3-4.5mg/dL. Most in bones. Major anion in ICF. For activating vitamins/enzymes, forming ATP for energy, cell growth, metabolism, acid-base balance, Ca homeostasis. Lower phosphorus=Increase in Ca. Increase in PTH=loss of phosphorus, decrease in PTH=increase in phosphorus
DM exercise minimum? Exercise examples? Muscle and joint strengthening examples?
3-4x/week for 20-40minutes. Brisk walking, jogging, bicycling, treadmill, swimming. Weight lifting, calisthenics/floor excercises. In type 1 Lowers BG so 70kg needs 15g additional CHO/hour. Raise BG >100mg/dL before starting, don't exercise 1 hour before insulin injection or peak action, carry simple sugar
Midline catheters are how long? Lumen? Inserted where? Used for how long? Considered in?
3-8 inches long, double or single lumen. Inserted in veins of upper arm usually the median ante cubical vein with ultrasound guidance, basilic vein preferred over cephalon vein since larger diameter, axillary vein. Used for therapies for 1-4 weeks. Considered in peripheral circulation
Aldolase ALD normal? Elevations can indicate?
3-8.2 units/dL. Polymuositis and dermatomyositis, muscular dystrophy.
Albumin normal? Decreased means?
3.4-5g/dL. Chronic inflammation/infection, hepatic issues
Potassium normal? Function? Critical value? Major? Intake? Controlled how?
3.5-5mEq/L. Helps keep blood pressure levels stable regulating heart contractions and helping muscle function. Critical value greater than or equal to 6. Major cation of ICF. Intake=2-20g/day. Controlled via Na-K pump and kidney excretion due to aldosterone
Uric acid norm
3.5-7.8
Short peripheral catheters length and gauge sizes? Can stay in vein for how long?
3/4- 1 1/4 inch with gauge sizes from 26-14. Can stay in vein for 72-96 hours but then require removal and insertion in another vein. Best location is dorsal veins, basilic, cephalon, and median veins and branches
Alkaline phosphatase ALP normal range?
30-120 units/L, increases in elders
Ileostomy nutrition
Chew thoroughly, no high fiber or cellulose foods like corn, nuts, coconut, Chinese vegetables, beans, tough fiber meats, shrimp and lobster, rice, bran, vegetables with skin
Diagnostic testing of Uc
Colonoscopy is best but also CT scan, barium enema
Mixed aphasia
Combination of expressive and receptive where they cannot read/write and understand/speak
Intra peritoneal therapy used for? What kinds are there? Stages? Positioning?
Admin of chemo for ovarian and GI tumors that moved into peritoneum. Implanted port or external catheter for short term for large quantities of fluid. Stages: instillation, dwell for 1-4 hours, drain. Semi-fowler's position and possibly move side to side to distribute fluid.
During infusion
Admin using filtered tubing, dilute with only NS, remain with patient for first 15-30 minutes, infuse at rate, monitor VS
Interventions for UTI
Administer meds Pt. Education Hygiene practices:Fluid intake, Alcohol, caffeine, Medications, Diet, cranberry or prune juice, vitamin C 500-1000
Mycolytic administer via? Function? Education
Administered via nebulizer (Mucosil, Mycomyst) or PO (Guaifenesin) Thin secretions, thus making them easier to cough up. Education: Teach patient how to use nebulizers correctly
Neurogenic s/s of hypoglycemia
Adrenergic: shaky/tremulous, heart pounding, nervous/anxious. Cholinergic: sweaty, hungry, tingling
Abdominal assessment of cirrhosis
Advanced practice can palpate and percuss right upper quadrant, measure abdominal girth around widest diameter at end of exhalation, take daily weight
Improving mobility after stroke
Affected leg regains function more quickly than arm. Support flaccid arm with pillow/sling, prevent DVT
CO normal
4-7 L/min
Insulin pump users must check their BG level how many times a day
4-8 times or more per day
Normal triglycerides for males? Females?
40-160mg/dL, females 35-135mg/dL
Hematocrit normal males? Females?
40.7/42-50.3/52%, females 36.1/37-44.3/47%
Normal total lipids
400-1000mg/dL
minimum amount of urine per day needed to excrete toxic waste? aka?
400-600mL aka obligatory urine output
WBC volume? Time? Indications
400mL 1 hour. For sepsis, neutropenic infection not responding to antibiotics
10 g of oral glucose raises plasma glucose by? 20g of oral glucose?
40mg/dL over 30 minutes. 60mg/dL over 45 minutes
Carb recommendation for DM
45-65% o calories, minimum of 130g/day. Fruit, vegetables, whole drains, legumes, low fat milk
WBC normal
4500-10000 cells/mcL
Glucose lowering effects of excercise can last up to
48 hours after so it's possible for hypoglycemia for that long after
Drug therapy for benign prostatic hypertrophy
5 alpha reductase inhibitors like Proscar aka finasteride and dutasteride aka Avodart to reduce prostate size. Alpha andregenic blockers like Hytrin, Cardura, Flomax
Normal bowel sounds in a minute
5-30
Calcium normal in mEq and mg/dl?function? Ion w/
5-6mEq/L or 9-10.5 mg/dL. helping with muscle contractions, nerve signaling, blood clotting, cell division, activating enzymes, and forming/maintaining bones and teeth. Ion w/ 2 positive charges aka divalent cation that exists in bound form in bone which has the most and and ionized/unbound aka free form in ECF the least amount though
Drugs for CD
5-Asa drugs for mild to moderate, azathrioprine aka Imuran and mercaptopurine aka Purinethol and methotrexate MTX for moderate to severe that suppress immune system, monoclonal antibody drugs that decrease inflammation like infliximab aka Remicade, adalimumab aka Humira, natalizumab aka Tysabri, and certolizumab pegol aka Cimzia, and glucocorticoids, and metronidazole aka Flagyl
Age+gender for gastric and duodenal ulcers
50+ males+females
Nonsurgical management of PUD upper GI bleeding
ABC. With hypovolemia monitor fluid status, intravascular isotonic fluid replacement,serum electrolytes assessed, blood transfusion, fresh plasma, monitor hematocrit/hemoglobin/coagulation. If mild bleeding weakness and perspiration, with blood loss greater than 1L/day shock symptoms like hypotension, chills, palpitations, diaphoresis, weak thready pulse. NG tube, endoscopic therapies, acid suppression, drugs
Serum complement normal? Decreased when?
75-160units/mL. Autoimmune diseases, anemia, infection
USDA recommendations for older adults
8 glasses of water, fiber, and calcium/vitamin D and b12 supplements with reduction in sodium and cholesterol foods
Normal arterial PaO2
80-100 mm Hg
Normal urine creatinine clearance
85-135ml/min
Normal GFR
90-120ml/min
hypotension define? if present assess via?
90/60 or less. Korotkoff sounds can be less audible/absent. Palpate BP, use doppler, or use arterial catheter
chloride normal range
98-106mEq/l. Major anion of ECF. Works with Na to maintain osmotic pressure, forms HCl, HCO3 exchanged for Cl.
Pap <21? 21-29? 30-65? >65? Historectomy?
< 21 y/o: Should not be tested Annual Pap test @ 21 y/o 21 - 29 y/o: Q 3 years, q 2 for liquid based test 30 - 65 y/o: Q 5 years + HPV test; if no HPV test then Q 3 years > 65 y/o w regular WNL cervical CA screen = 0 None
Normal fasting glucose? 2 hour OGTT glucose normal? A1c %?
<100, <140, 4-6%
Preop care for DM
<200mg/dL BG, sulfonylureas discontinued 1 day before, metFORMIN/glucophage discontinued 48 hours before, all other orals are stopped day of, long acting changed to short acting 1-2 days before
PID risk factors
<26 years, multiple sex partners, IUDs, smoking, chlamydia, gonorrhea, history of STDs
Prostate specific antigen normal? Increased? Prep for test?
<4 NG/mL. Prostatitis, benign prostatic hyperplasia, prostate cancer. No ejaculation for 24 hours before test , blood for PSA should be drawn before DRE
Glomerular filtration rate which can indicate kidney disease
<60
Myoglobin norm
<90mcg/L
Diabetes fasting plasma glucose normal? 2 hour OGTT glucose normal? Random plasma glucose and A1C% normals?
> or equal to 126 on 2 times or >126mg/dL, >200 for 2 hours with glucose load of 75g, >200+symptoms, >6.5, >8 poor diabetic control
Care of patient with meningitis
ABCs, VS/neuro check 2-4 hours, drugs, I/O, cranial nerve assess, vascular assess, weight, ROM every 4 hours, quiet environment, low light, bed rest with HOB 30 degrees, monitor/prevent increased ICP, vascular disinclined, fluid/electrolyte imbalance, seizures, shock
O2 therapy for COPD: need for O2 determined by? May need? Primary drive for breathing is?
ABG results and SpO2. May need O2 at 2-4 L/min or 40% via venturi mask COPD patients primary drive for breathing is a LOW O2, therefore administration of O2 > 2-3 L/min may cause respiratory arrest.
Diagnostics for PE
ABG, CXR/CT angiogram, transesophageal ECHO
Bronchitis diagnostics
ABGs Sputum CBC Liver enzymes CXR Pulmonary function test (lung volumes, flow volumes, and diffusion capacity) Peak expiratory flow rates
Plasma transfusions requires?
ABO compatibility
Drugs for microalbuminuria and advanced nephropathy
ACE inhibitors or angiotensin receptor blockers
Angiotensin converting enzyme inhibitors aka? Do what? Includes? SE?
ACE. Prevents vasoconstriction decreases Na+H2O retention and lowers vascular resistance. Captopril/capoten. SE:Dry cough
Seizures and meningitis can cause increase in what hormone
ADH causing water retention, dilution of NaCl, sodium loss by kidneys,, increased ICP
What UAPs can do
ADLs, bathing, grooming, dressing, toileting, ambulating, feeding without swallowing precautions, positioning, bed making, specimen collecting, intake and output, vital signs on stable clients
Testing for testicular cancer
AFP and HCG, liver function test (lactate dehydogenase), x-rays, to determine metastasis
ALT vs. AST
ALT more specific to liver where AST can be found in muscle, kidney, brain and heart
Cerebral salt wasting define? Treatment
ANF causing hyponatremia, decreased osmolarity, decreased blood volume. Sodium and isotonic fluid volume replacement
Vascular access for dialysis
AV catheters that are temp. Or implanted, AV fistula, AV graft
Key features of small bowel obstruction
Ab pain/discomfort possibly accompanied with visible peristaltic waves in upper/mid abdomen, upper or epigastric abdominal distention, nausea and early profuse vomitting with possible fecal material, obstipation, severe fluid and electrolyte imbalances, metabolic alkalosis
Physical assessment of gastroenteritis
Abdominal distention, hyperactive bowel sound, if dehydrated poor skin turgid, fever, orthostatic BP, hypotension, oliguria
Donor A recipients?
A, AB
Donor O recipients
A, B, AB, O
Chronic gastritis cause based on type
A:autoimmune/genetic. B: h.pylori, drugs, surger, chrohn's, uremia, graft vs. host disease. Atrophic: old age, toxic substances, h.pylori, autoimmune
Donor AB recipients
AB
Physical assessment of acute pancreatitis
Abdominal pain in mid epigastric or left upper quadrant, radiation of pain to back left flank or shoulder and worsens by supine position and gets better in fetal position or sitting upright bending forward, weight loss from nausea and vomiting, jaundice, gray blur discoloration of abdomen, gray blue discoloration of flanks, absent or decreased bowel sounds if paralytic ileus, abdominal tenderness rigidity or guarding resulting from peritonitis, palpable mass if pseudocyst, elevated temp, tachycardia, decreased BP, left lung pleural effusions, atelectasis, pneumonia
Amylase and lipase test given if
Abdominal pain or V
Crepitus define
Air trapped in/under skin and felt as crackling
Teriparatide aka? does what?
Aka Forteo acts as PTH and treats osteoporosis
Falls precaution
Assess for orthostatic hypotension, leg muscle strength, orient to environment, call for help to get out bed, use walker/cane for ambulating, help to toilet every 1-2 hours, clean up spills ASAP, adequate lighting at all times of day, call light, bed in lowest position and locked, objects patient needs within reach, handrails, encourage family to stay
Postop nursing care for testicular cancer
Assess for paralytic ileus Assess for pain from surgical incision Assess for immobility after surgery Assess for injury Educate re: home care: scrotal support, dry dressing, sutures d/c in 10 days, no heavy lifting > 15 #, no stair climbing, no driving, TSE Q month, Support groups F/U w MD re: further tx or silicone prosthesis
A 28 year old female with endometriosis asks the nurse "Why do I have to have a transvaginal ultrasound?" The nurse's best response is
Assess for pelvic masses that can be mistaken for endometriosis
Self management of asthma
Assess symptom severity 2x daily with peak flow meter that is based off personal best so they know when drugs or assistance needed then use flow meter after drugs. You want to be 80% or above personal best.
Patient management of chest tube drainage
Assess, check alignment of trachea, check if tube eyelets are visible, deep breath, cough, incentive spirometry, reposition if burning pain in chest
Older adults receiving transfusion
Assess circulatory/kidney/fluid status before, use 19 gauge, try to use blood <1 week old, take VS every 15 minutes, assess for overload via rapid/bounding pulse, hypertension, pallor/cyanosis, assess for transfusion reaction via rapid thready pulse, hypotension, pallor/cyanosis, admin slowly taking 2-4 hours for each unit, avoid concurrent fluid admin, allow 2 full hours after admin of 1 unit before admin of next
Codeine sulfate class? Function?
Anti-tussive. Suppresses cough reflex
Lab findings of DKA: BG? Blood pH? Serum bicarbonate? Urine+serum?
BG >250mg/dL, arterial blood pH <7.3, serum bicarbonate <16mEq, and moderate-high ketone levels in urine+serum
overweight vs. obesity
BMI 25-30 vs. BMI > 30
Trousseau's sign
BP cuff inflated greater than systolic pressure for 1-4 minutes , if positive hand and fingers go into spasm in palmar flexion
Risk factors for breast cancer
BRCA1 &/or BRCA2 genetic factors; + family history Exposure to high-dose radiation to thorax Early menarche & late menopause Nulliparity aka no child or 1st birth after 30 y/o 1+ alcoholic drinks/day Obesity b/c fat tissue becomes a major source of estrogen Postmenopausal women receiving > 5 years of Hormone Replacement Therapy w estrogen & progestin
BUN and creatinine normals? Both elevated due to? If BUN high and creatinine normal? If BUN and creatinine low?
BUN 10-20, creatinine 0.8-1.2. Elevated due to ESRD reflecting need for or missed dialysis. If BUN hi and create normal patient dry. BUN and creatinine low is liver disease
Tuberculosis patho
Bacilli make it past the upper airway defense systems and enter the lungs. The organism implants in alveoli or respiratory bronchiole An inflammatory response is initiated as the bacteria multiply. The organism continues to slowly grow and enters into the lymphatic system A tubercle lesion is formed
Antibacterial Topical
Bacitracin/Baciguent, Chloramphenicol(Chloromycetin), Gentamicin(Garamycin)
Cellulitis define? Caused by? S/S? Treatment?
Bacterial infection of the deep connective tissue •Caused by Staph or Strep •Skin is red, hot, shiny painful, edematous •Treatment-rest, heat elevation, Penicillins or Cephalosporins except MRSA => treat with Vancomycin
Donor B recipient to?
B, AB
Blindness vision #? Defined as? Legal blindness?
BCVA of 20/70 to 20/200 Blindness is defined as BCVA that can range from 20/400 to no light perception (NLP). Legal Blindness- ranges from the inability to perceive light to having some vision remaining
Post op care for DM
BG 140-180mg/dL for critically ill
Criteria for resolution of DKA
BG <200, HCO3 >18mEq, pH higher than 7.3, ion gap <12
When sick with DM notify if
BG >250, ketonuria >24 hours, cannot take food/fluids, illness lasts >1-2 days, persistent n/v, moderate/large ketones, BG elevation after 2 doses of insulin, high >101.5 temperature, increasing fever, fever >24 hours
Gait
Balance, steadiness, ease and length of stride
Patient scheduled for cerebral blood flow with use of radioactive substance, which meds does rn anticipate the physican will likely withhold from patient for 24 hours before
CNS depressants/stimulants
Carbonic anhydrase equation
CO2+H2O < > H2CO3 < > HCO3- + H+
COPD complications
COPD affects the oxygenation & perfusion to all tissues. Cor pulmonale (right sided heart failure) Hypoxemia and acidosis Increase in respiratory infections secondary to increased mucous and poor oxygenation (Ensure patients are aware of early s/s of respiratory infection) Cardiac dysrhythmias secondary to hypoxemia Malnutrition (secondary to dyspnea & early satiety)
Noninvasive positive pressure ventilation. Examples
CPAP for positive pressure throughout inhalation and exhalation, volume/flow limited during inspiration, pressure limited which include pressure support/control and BiPAP during inspiration and expiration
Diagnostic tests for dementia
CT scan - shows brain atrophy-rule out brain tumor or stroke CBC - rule out vitamin deficiencies, lead poisoning Blood chemistry - rule out kidney failure and thyroid problems Test for syphilis and HIV infection Lumbar puncture - rule out meningitis and encephalitis Electroencephalogram - rule out Creutzfeldt-Jakob
Verapamil, nifedipine, diltiazem aka? Class? Use? SE? Monitor?
Calan/Verelan, Adalat/Procardia, Cardizem. Calcium channel blockers. Antianginal, antihypertensive, antiarrhythmic via vasodilation+reduction of rate. SE:arrhythmia, HF, hypotension, bradycardia. BP, pulse, I/O
Labs to check and diagnostics of endometrial/uterine cancer
CBC CA 125 HCG to r/o pregnancy Transvaginal ultrasound (Gold standard) Endometrial biopsy (Gold standard) CXR, CT scan of pelvis, MRI abd & pelvis IVP, Abdominal ultrasound Liver & bone scan
Diagnostics for pneumonia
CBC Sputum Sample Blood and urine culture (As soon as possible usually before 1st dose of antibotics) ABGs and pulse oximetry Serum electrolytes r/o dehydration CXR Thoracentesis- Diagnostic and therapeutic Chest tube placement
Labs of IBS
CBC, albumin, erythrocytes sedimentation rate, stools for occult blood normal. Hydrogen breath test since when bacterial overgrowth or malabsorption of nutrients present hydrogen made
When lack of coordination interferes with self-feeding
Have them eat with spoon/fingers, apron/smock used, feeding patient yourself
Signs of sickle cell disease
Chronic anemia, Hbg 5-11, fatigue, jaundice, bone and joint deformities, leg ulcers, enlarged organs like spleen and liver, reoccurring infections, sepsis, vessel occlusion causing acute chest syndrome, priapism, pain, heart failure , SOB, murmurs, s3, vein distention, vessel occlusion indicated by coolness after/slow refill/reduced/absent pulse, HR ^, BP low, priapism aka prolonged erection, pallor, cyanosis, poor tissue perfusion causing decreased wound healing causing ulcers/sores,kidney failure, fever seizures, stroke, pronation drift
cause of compartment syndrome
external pressure like tight dressings/casts, internal pressure like blood/fluid from fractures, burns, bites, IVs
Catheter migration causes? S/s? Treatment? Prevention?
Coughing, vomiting, sneezing, heavy lighting, congestive heart failure. S/s: if jugular vein running stream/gurgling on side of insertion, for zygos vein back pain between shoulders, neuro complications. Treatment: stop infusion, flush, notify, chest X-ray. Prevention: place properly, avoid excess activity
Venous spasm s/s? Treatment? Prevention
Cramping, pain, numbness, slowing rate, inability to withdraw midline or PICC. Treatment: slow infusion rate, warm compress, don't immediately remove short peripheral, if during midline or PICC removal no forceful removal, reapply dressing, drink warm fluids, 12-24 hr may be needed before removal. Prevention: allow time to return to normal, infuse at room temp., for midline or PICC withdraw in short segments
Patient scheduled for CT with contrast media which lab result could impact procedure prompting rn to notify radiology department and provider
Creatinine level
A 25 year old male reports having lower abdominal pain; scrotal pain & swelling; & fever. The nurse anticipates that the client will need
Culture of urine/prostate secretions, broad spectrum antibiotics, antipyretics/analgesics, ultrasound since client can have epididymitis or orchitis
Paps tests for? =? 0 cervix=?
Cultures for trichomoniasis, HPV, STD's, HIV, PSA, bacterial, viral, fungal, parasites estrogen. =TAH/TVH+cervix. 0 cervix=0 pap
Primary endocrine disorder of pancreas? Exocrine function?
DM. Breakdown of starches, proteins, fats
What should RN teach patient in regards to prevention of dry skin
Daily fluid intake of 2000-3000mL, bathing with moisturizing soaps/oils/lotions, tepid warm bath, shower every other day
Nursing responsibility for hemodialysis
Daily weight (before and after dialysis) Hold BP meds before dialysis Prevent hypotension Orthostatic BP Hold folic acid and antibiotics as they will be removed by dialysis Assess for orthostatic BP Observe for bleeding LOC HA, nausea
Heart disease angiopathy define? Leading cause of? More common in? What can prevent/minimize complications?
Damage to vessels secondary to chronic hyperglycemia. Leading cause of DM related death. More common in those with DM. Tight glucose control can prevent/minimize complications
Head injury meds
Decadron, prednisone/solumedrol, mannitol
Nutrition for Muskuloskeletal decrease? Promote?
Decrease caffeine, carbonated beverages, alcohol and tobacco use Promote appropriate protein intake, dairy products, dark green, leafy vegetables, and bony fish products, appropriate Vitamin C, D, and iron intake
Health promotion to decrease colorectal cancer risk
Decrease fat, refined carbs, low fiber foods, increase fiber
Hypertonic colloid examples?
D5 1/2 NS. D5NS, hypertonic saline aka 3% or 5% NS. Shifts fluid back in circulation, replaces electrolytes. Irritating to veins, can cause fluid overload, hyperatremia, hyperchloremia. Hypertonic saline slow inflammation and increases cap. Permeability
Composition of parenteral nutrients
D50 up to 70% if runs out hang D10, amino acids 10-15%, electrolytes like K, phosphorus, Mg, Na, Cl. Trace elements like zinc, copper, phosphorus. Vitamins like ascorbic acid, A, D, E, K. Lipids 10-20% , meds like Pepcid or insulin
Hyperosmolar hyperglycemic syndrome HHS less common than? Often occurs in? Often related to? Usually there's a history of?
DKA. Patients >60 years with type 2. Related to impaired thirst sensation and/or functional inability to replace fluids. Usually a history of inadequate fluid intake, increasing mental depression, and polyuria.
Medical identification suggested for? Aka?
DM aka medicalert bracelet/necklace
Meds that can cause kidney issues
DM, hypertension, cardiac issues, hormonals, cancer, arthritis, psychiatric disorders, antibiotics like gentamicin aka Garamycin, laxatives, analgesics, NSAIDs, acetaminophen, creatinine supplements
Steatorrhea aka? Due to?
Fatty stools from malabsorption of fat in small intestines
Oliguric stage treatment
Fluids treat hypovolemia Diuretics: furosemide Correct hyperkalemia Diet restrictions K+, Phosphorous Protein Correct acidosis
Caring for PICC lines for med admin? not actively used? After drawing blood? Always use what to flush anytime
Flushing with 10mL NS before and after med admin. 5mL heparin in 10mL syringe daily if not used. 20mL NS flushed after drawing blood. ALways use 10mL syringes to flush to prevent catheter rupture
Iron deficiency anemia most? Decreased? S/S? Caused by? Treatment?
Most common, decreased iron supply for RBCs., RBC's small/microcytic, weakness, pallor, mouth fissures, brittle concave nails. Caused by blood loss, poor GI absorption, inadequate diet, alcoholism, partial gastrectomy, pregnancy, adolescence, infection. Treatment: oral ferrous sulfate between meals, if severe IV/IM using Z iron dextran/Dexferrum, iron deficiency associated with kidney disease rug derumoxytol/ Ferraheme
Diffuse neuropathies are? Types?
Most common, involve widespread nerve function loss, slow onset, bilateral, permanent. Types: Distal symmetric polyneuropathy, autonomic neuropathy
Kidney acid-base characteristics
Most powerful regulator, responds to large/chronic fluctuations, slowest response(hours-days), longest duration
Vitamin b12 purpose? When folic acid not in cells? Also involved in ?
Necessary to move folic acid into cells, when folic acid not in cells improper DNA synthesis and cell increases aka megaloblastic or macrocytic anemia. B12 also involved in spinal cord myelination
A patient who's hypoxemia and has chronic hypercarbia
Needs lower levels of o2 usually 1-2 L/min <3L/min via nasal cannula to prevent decreased respiratory effor
Infant mortality is? This rate is often? Per CDC in 2010? Deaths attributed to?
The infant mortality rate is an estimate of the number of infant deaths for every 1,000 live births •This rate is often used as an indicator to measure the health and well-being of a nation, because factors affecting the health of entire populations can also impact the mortality rate of infants. •Per CDC in 2010, the infant mortality rate was 6 infant deaths per 1,000 live births •Deaths attributed to: Birth Defects; Preterm; SIDS; pregnancy complications; Injuries (i.e. suffocation)
Diagnosis of Creutzfeldt-Jakob disease
There is currently no single diagnostic test for CJD. The first concern is to rule out treatable forms of dementia such as encephalitis or chronic meningitis. The only way to confirm a diagnosis of CJD is by brain biopsy or autopsy. In a brain biopsy, a neurosurgeon removes a small piece of tissue from the patient's brain so that it can be examined by a neurologist. Because a correct diagnosis of CJD does not help the patient, a brain biopsy is discouraged unless it is need to rule out a treatable disorder. While CJD can be transmitted to other people, the risk of this happening is extremely small.
Relative hyperkalemia cause
Tissue damage, acidosis, hyperuricemia, uncontrolled diabetes mellitus
When a patient is NPO do what with insulin
Withhold rapid/short acting and amyloid/incretin mimetics, still admin basal insulin
Incorporate skin assessment into the routine part of daily care while _________________________ or ___________________________ .
bathing your patient or assisting with hygiene.
vasculitis define? increased lesions=?
blood vessel involvement in RA and can cause organ supplied by that vessel to be affected and ischemic. increased lesions=increased vasculitis
syncope define? due to?
brief loss of consciousness due to decreased perfusion to brain from decreased CO like cardiac rhythm issues, valvular disorders
paresthesias
burning and tingling sensations from peripheral neuropathy associated with decreased circulation from RA
diet requirements for new bones
calcium, phosphorus, vitamin D, protein, iron
emergency care for traumatic amputation
call 911, then ABC, then dress it tightly, then hold part above heart, then put severed part zip lock that is then placed in ice water
edema develops with?
changes in normal hydrostatic pressure differences like in R. sided heart failure that causes venous hydrostatic pressure to increase until higher than pressure in interstitial space causing excess fluid from capillaries into interstitial space
assessing neurovascular for THA
check color, temp., distal pulses, capillary refill, movement, sensation
If patient experiencing morning hyperglycemia
checking blood glucose levels at bedtime, between 2:00 AM and 4:00 AM for hypoglycemia will help determine if the cause is the Somogyi effect or Dawn phenomenon
major CVD symptoms
chest pain/discomfort, dyspnea, fatigue, palpitations, weight gain, syncope, extremity pain, indigestion, fatigue after small activities
Most autoimmune diseases are characterized by
chronic pain and joint deterioration, which results in decreased function and impaired mobility. Some are localized and some are systemic.
priority problems for patients with osteoarthritis
chronic pain related to cartilage deterioration and decreased mobility related to joint pain and muscle atrophy
enhancing body image for RA
communicate acceptance of patient, encourage to express feelings, use personal items, emphasize strengths
FSH and LH define
control the menstrual cycle & ovulation (egg production). Both levels rise & fall together during menses
decreased perfusion skin
cool, pale, moist
intermittent claudication define? related to? cause? relieved by?
cramping in legs, butt while walking related to decreased arterial tissue perfusion aka blood supply. Cause: ischemia from artherosclerosis, venous insuffiency of peripheral blood vessels. Relieved by resting, lowering extemity to decrease tissue demands or enhancing arterial blood flow
Define hydrocele ? Treatment?
cystic mass filled w fluid that form around testis. Needle and syringe drainage or surgical removal
thrombocytopenia define? can occur with?
decreased platelets, can occur with heparin aka anticoagulants
ANA and NCSBN both defined delegation as? Ncsbn? Ana?
the process for a nurse to direct another person to perform nursing tasks and activities. NCSBN nurse transferring authority ANA transfer of responsibility
Demita patients with sleep issues, wandering, inappropriate behaviors are most likely to occur when
there are unmet underlying physical or psychological needs. Caregivers must identify the needs of patients who are exhibiting these behaviors because further health decline may occur if the source of the problem is not corrected
Surgical management for DVT
thrombectomy; inferior vena cava filtration: surgeon inserts a filter device into femoral vein; device is meant to trap emboli in inferior vena cava before they progress to the lungs
resorption
destruction of bone equal to build up until 35 yrs olds
Risks for acute renal failure
Pre existing diseas, chronic hypertension, DM, heart failure, shock
Respiratory: increased H or CO2 does what?
Stimulates increased RR and depth causing more CO2 to be lost decreasing H raising pH
Priorities for hyperkalemia
Through drug therapy: monitoring and preventing cardiac complications, safety for falls, monitoring response, teaching
Calcium channel blockers name? Do what?
verapamil hydrochloride/Calan. Lower BP via vasodilation and blocks heart conduction decreasing HR
Endometrial biopsy/aspiration assess for? Post?
Asses for cancer, menstrual issues, infertility. Post: pad, spotting present 1-2 days, no sex/douching until all discharge ceased
Symptoms of antidiarrheals? Examples of antidiarrheals?
Colon dilation, toxic megacolon.diphenoxylate hydrochloride and atropine sulfate aka Lomotil and loperamide aka Imodium
Management of delirium
Elimination or correction of the underlying cause Symptomatic and supportive measures Treat agitation without diminishing consciousness Treat hallucinations and Paranoid ideations Haldol, Ativan, lorazepam.
PE surgical interventions
Embolectomy: Surgical removal of embolus from pulmonary blood vessels Inferior Vena Cava Interruption: with placement of a vena cava filter
Acute symptoms of pyelonephritis
Fever, chills, tachycardia, tachypnea Flank, back, or loin pain Abdominal discomfort Nausea and vomiting Urgency, frequency, nocturia General malaise or fatigue Cognitive changes (older adults)
LH-RH agonists function? Agents?
For premenopausal Block LH + FSH preventing estrogen production for breast cancer. Goserelin/Zoladex, Leuprolide/Lupron. S/E: menopausal symptoms
Carotid artery angioplasty with stunting
For preventing/managing ischemic stroke and uses distal/embolized protective device inserted in femoral artery to get clot debris
Fractures of knee
Pre-op/Post-op care Same as total hip arthroplasty EXCEPT Maintaining hip abduction NOT necessary Continuous passive motion Applied in PACU Prevention of scar tissue Review chart 20-4
If hemorrhoids symptoms after no surgical treatment longer than 3-5 days?
Surgery like ultrasound coagulation, rubber band ligation. Circular stapling, laser assisted, or simple resection
Surgical management of pyelonephritis
Surgery to correct problems causing urine reflex or obstruction via pyelolithotomy aka stone removal or nephrectomy aka removal of kidney, ureteroplasty aka ureter repair or revision
Malnutrition risk factor? Malnutrition causes?
Surgery, trauma, sepsis, chronic illness, GI issues, eating disorders, dysphagia, pancreatitis, substance abuse. Causes negative N balance
Tracheotomy vs. tracheostomy
Surgical incision into trachea to create airway vs. tracheal stoma
Stages of pressure ulcers
1: red or blue/purple, intact skin nonblanchable. 2: nonintact partial thickness abrasion or blister. 3: full thickness subcutaneous tissue damage or necrosis. 4: full thickness exposed muscle, tendon or bone. Unstageable if full thickness loss, Eschar aka blackening/gray/brown or slough obscures depth of wound
NIH stroke scale assessment
1st 3 hours, must diagnose cause of CVA, clot means OK for tPA, hemorrhagic strokes delay rehab. 11 areas of assessment and serve as baseline
1st vs. 2nd. Vs. 3rd fluid shifts
1st normal distribution. 2nd excess interstitial fluid aka edema. 3rd fluid with usually no fluid
For skin irritation and pruritus associated with jaundice teach
To use cool rather than warm water no excess soap and use lotion for skin
Incretin mimetics SE?
Weight loss, decreased appetite, nausea, vomiting, dizziness, headache, constipation, indigestion, itching at site
Assessment of ED
1st step is to determine if cause = organic Medical, social, sexual history & PE Hormone testing US: to assess blood flow to penis Nocturnal penile tumescence test: if night-time erections, ED is NOT organic; refer to sex therapist
Basal cell carcinoma limited? Usually seen? S/s? Diagnosis? Treatment?
Ability to metastasize. Usually seen in adults >40yrs. Pearly, smooth, hard, firm papule lesion with crater and waxy borders and telangiectasis and pigment flecks. Diagnosis via history or biopsy. Treatment: surgery with 95% cure rate
Lymph edema define
Abnormal accumulation of protein fluid in sub Q tissue on the affected limb after mastectomy
Autoimmune hemolytic anemia caused by?
Abnormal immune function where body doesn't recognize RBC as self
5g CHO/carbs raises BG
About 20mg/dL
Platelets pooled volume? Infusion time? Indications
About 300mL, 15-30min. FOr thrombocytopenia where platelets <20,000. Patients actively bleeding with platelets <50,000. Platelets <10,000. From multiple donors.
Perineal wound care
Absorbing dressing like feminine napkin, jockey type shorts, Sitz bath, pain meds, side lying, foam pads or soft pillow to sit on. Avoid air rings or rubber donuts
SpO2 normal?
95-100% older adults can be lower
How to prevent gas bloat syndrome? Define
Avoid carbonated drinks, no gas producing or high fat foods,no gum or straws. When patient can't belch
Ileostomy drug therapy
Avoid enteric coated and capsule meds, no laxatives or enemas, you should have loose stool and notify if no stool in 6-12 hours
Flushing catheter for short peripheral catheters? For all others? Limited to no more than ? Should be from?
For short peripheral catheter 3mL, for all others 5-1mL. But limited to no more than 30mL in 24 hours. Should be from single dose container or pre filled syringe
Assessment for aplastic anemia
History of bone marrow disorders, family history of Fanconi anemia, weakness, pallor, petechiae, CBC, fatigue, Ecchymosis
Lung cancer s/s
Hoarseness Persistent cough/wheezing Blood/rust sputum Hemoptysis Weight loss Chest/shoulder/arm pain Recurring episodes of pleural effusion, pneumonia, bronchitis Dyspnea Fremitus Dull/flat percussions
Incretin mimetics differences
Byetta admin twice daily at mealtime, bydureon injected once weekly, Victoza once a day regardless of meals
Complications of acute pancreatitis
Hypovolemia, hemorrhage, acute renal failure, paralytic ileus, hypovolemic or septic shock, pleural effusion, respiratory distress syndrome, pneumonia, multi organ failure, DIC
Key features of large bowel obstruction
Intermittent lower abdominal cramping. Lower abdominal distention, minimal or no vomiting, obstipation or ribbon like stools, no major fluid and electrolyte imbalances, metabolic acidosis which not always present
Reducing anxiety and agitation with AD
Emotional support that reinforces positive self image, environment kept familiar, noise-free, when patient has catastrophic reaction remain calm and don't force activity and instead postpone, listening to music, stroking/rocking, distraction , education for caregivers
Admin of insulin absorption fastest from? What is preferred site? Don't inject in? Rotate?
Absorption is fastest from abdomen, followed by arm, thigh, and buttock/back Abdomen is preferred site Do not inject in site to be exercised Rotate injections within one particular site at least 1/2 - 1 inch away from previous site
Rheumatoid arthritis characteristics? define?
-Characteristics-Chronic, progressive, systemic inflammatory connective tissue disease affecting mostly synovial joints, bilateral, Exacerbations and remissions -Autoantibodies attack health tissue and synovium and pannus aka vascular granulation tissue forms that erodes cartilage and destroys bone but can happen anywhere there is connective tissue Review Chart 20-8 and Table 20
Amputation post op care assess? drugs? interventions?
-Assess tissue perfusion, Pain, Phantom Limb Pain is real and managed differently from residual limb pain -IV Calcitonin, Beta-blockers, Anti-epileptics, Anti-spasmodics, Alternative therapies -Prevent infection, Promote mobility, Physical therapy, ROM exercises to prevent contractures, Positioning, Supine every 3-4 hours for 20-30 minutes to prevent contractures, Bring shoe for prosthesis fitting, Encourage communication of feelings
Osteoporosis drug therapy 3 types?
-Calcium and Vit D -Bisphosphonates- Fosamax/alendronate, ibandronate/Boniva, risedronate/Actonel prevents bone loss/resorption and increases bone density -Estrogen Agonists/Antagonists prevents bone loss and increases bone density
Blood clot embolism s/s? prevention? treatment?
-Same as fat embolism but NO petechiae -Prevention measures:Leg exercises, TED hose, Sequential compression devices (SCDs) -Treatment:, Bedrest, Promote oxygenation, Anticoagulants, Thrombolytics, Possible surgery
Pelvic organ prolapse POP locations? Which is most common?
-Cystocele (bladder) -Rectocele (rectum) -Uterine (uterus) Uterine: most common
Clinical manifestations of osteoporosis? Movement restriction & spinal deformity may result in ?
-Dowager's hump, kyphosis of the dorsal spine is present, Loss of 2-3 inches in height, Fractures -Constipation, abdominal distention, reflux esophagitis, and respiratory compromise in severe cases
Amputation types? assessment? emergency interventions?
-Elective or traumatic, Upper or lower extremities -Assessment Neurovascular Psychosocial -Emergency interventions: Call 911, Assess ABCs , Apply direct pressure, Elevate extremity, Amputated part care
Sprain define? management?
-Excessive stretching of ligaments -Management: Rest, Ice - 24-48 hours, Compression bandage, Elevation, Immobilization
Strain define? management?
-Excessive stretching of muscles or tendons -Management: Cold/Heat, Activity limitation, Medications
Osteoporosis interventions increase? avoid? do what other 2 things?
-Increased Calcium and Vit D, protein, Vit c, and iron is important to promote bone healing for those sustaining fractures, Soy rice products fortified with Vit D for lactose intolerance -Avoid excessive alcohol & caffeine and tobacco -Exercise -Create hazard free environment
Osteomyelitis management nonsurgical? surgical?
-No surgical management: IV antibiotic therapy started ASAP, Contact precautions, PICC line for home IV therapy, Wound may be irrigated continuously or intermittently with antibiotics, hyperbaric O2 therapy -Surgical management: Reserved for those with chronic cases, Sequestrectomy that debrides necrotic bone, Grafts, Microvascular bone transfer, amputation
7 Immobility complications
-Pressure ulcers, Atelectasis, Venous thromboembolism, Constipation, Urinary retention, Joint contractures, Pneumonia
Fracture equipment
-Traction-Types: Skin or Buck's Skeletal Plaster Brace Circumferential -Purpose:Reduction/Alignment, Rest, Decrease muscle spasm,Decrease pain Examples: walkers, crutches, canes, casts
Imaging of osteoporosis: xrays show? dual xray absorptiometry? baseline DXA scan recommended for?
-X-rays-show fractures and decreased bone density -Dual X-ray absorptiometry (DXA)-most common diagnostic tool for measuring bone mineral density -Baseline DXA scan recommended for women in 40's
Testicular cancer affects? Highly? Risk factors?
Affects men age 20 to 54 Highly treatable and curable Risk factors: cryptorchidism (undescended testicle), HIV +, family history, cancer of one testicle, Caucasian American race
An increase in bicarbonate causes
Amount of H to decrease and pH increase
Ferritin test measures? Normal?
Amount of free iron in plasma and reprqesents 1% of total iron. Normal is 12-300
Isotonic define? Isontonic parenteral solutions define? Risk for?
Amount of water inside cell equal to amount outside. 270-300mOsm/L. Risk for fluid overload.
Penicillins examples? SE?
Amoxicillin aka Amoxil, amoxicillin clavulanate aka Augmentin. SE: watery diarrhea, use additional BC
Vein and catheter selection for older adults
Avoid fragile skin and small veins on back of hand and select IV site higher on arm. Use flat tourniquet. BP cuff, tapping, opening and closing fist, placing extremity lower than heart, applying heat for 10-20 minutes, trendelenburg, hydration can be used for vein distention before venipuncture.10-15 degree angles. Midline or PICC maybe best.
COPD is characterized by? Vs. asthma?
Emphysema and chronic bronchitis aka COPD characterized by broncho spasm and dyspnea and tissue damage not reversible and increases over time? Asthma is chronic but has intermittent reversible airflow obstruction and wheezing
+ homan's sign means
Dorsiflexion of foot with calf pain can mean DVT so report
Positive babinski's
Dorsiflexion of great toe and fanning of others over 2. It's supposed to be plantar flexion
Imaging assessment of colorectal cancer? What is best
Double contrast barium enema, colonoscopy, CT scan, MRI, sigmoidoscopy. Colonoscopy best
Normal symptoms post colonoscopy? If polypectomy or tissue biopsy performed?
Feeling full, cramping, passage of flatus. Small amount of blood in first stool
Preventing aspiration during swallowing for trach
Avoid meals when fatigued, smaller meals, don't hurry, emergency suctioning equipment at hand, avoid thin liquids, thicken all liquids, avoid foods that generate liquids during chewing like fruit, upright position, suction after cuff deflation, eat slowly, dry swallow after each bite, tuck chin down while swallowing, if coughing stop until airway clear, monitor VS
Central herniation from increased ICP
Downward shift of brainstem and diecephalon from supratentorial lesion causing cheyen stokes, pinpoint/no reactive pupils, hemodynamic instability
GI changes in ESRD
Fetor uremicus Nausea, vomiting, anorexia Gastritis, ulceration Constipation
When pouch not possible for fistula due to location
Drainage managed with wall suction or a vacuum assisted closure using catheter
Bubbling in chamber chest tube connects to means? No bubbles? Excess bubbles? Fluctuation in water seal chamber? No fluctuation?
Drainage present, normal during forced expiration/coughing. Kinked tube. Air leak. Normal. Lung hasn't fully expanded or obstruction in tube
INR define? Associated with which drug? Normal is?
International normalized ratio for coagulation to monitor anticoagulant status in warfarin/Coumadin. Normal is 1
Asthma management for self education
Avoid triggers, avoid meds like aspirin/NSAIDs/beta blockers, avoid MSG, bronchodilators 30 min. Before exercise, adequate sleep/rest, reduce stress/anxiety, wash all bedding with hot water for dust mites, monitor peak expirations flow rates 2x daily, seek care if gray/blue fingers/lips+dyspnea+issues walking/talking+retraction of neck/chest/ribs+nasal flaring
What you should avoid and eat for hypophosphatemia
Avoid: milk, cheese, yogurt, collards, rhubarb Eat: fish, beef, chicken, pork, organ meats, nuts, whole grain breads/cereal
Macrolide meds
Azithromycin, Zithromax
Sulfasalazine aka? Does what? SE?
Azulfidine. Decreases inflammation slowing RA. SE: lowers sperm, renal/liver toxicity, urine crystals if not enough water
Folliculitis define? Caused by? Usually? S/S? Treatment?
An infection that arises in the hair follicles, or inflammation of the oil gland from which hair grows •Caused by physical injury-shaving, or occlusion in hair bearing areas •Bacterial etiology, usually staph •Signs & symptoms - pustule occasional papule at hair follicle, ingrown hairs , loss of hair, pustular raised red rash •Treatment - no shaving, use soap, topical or systemic antibiotics
Define hepatopulmonary syndrome
Ascites fluid causes dyspnea due to increased pressure, possible crackles,
Osteoarthritis define? most? aka? characteristics? who has it most?
-noninflammatory degenerative joint disease due to less synovial fluid and enzymes that break down articular matrix and osteophytes aka bone spurs form then fissures, calcifications and ulcerations develop causing thinning cartilage and body repair process can't overcome rapid degeneration so cartilage disintegrates and pieces of bone/cartilage float in joint causing crepitus resulting in pain and stiffness -most common arthritis and major cause of disability in adults. -aka osteoarthrosis or degenerative joint disease(DJD) -Progressive deterioration, Loss of hyaline/articular cartilage, Unilateral. -Older patients+women have it most.
Beta-adrenergic blockers end in? Are? Includes?
-olol. Cardio selective that lowers HR+BP or noncardioselective. Metoprolol/Lopressor, Toprol, propranolol/inderal, atenolol/tenormin
Fluid and electrolyte findings of cirrhosis
Ascites, decreased blood volume. Hypoatremia or hypernatremia, hypocalcemia, hypokalemia, peripheral edema, water retention
Protein intake for DM
15-20% of total daily calories with normal kidney function, microalbuminuria 10% of calories, ESRD <0.8g/kg/day
Diabetes exercise type and amount? Benefits?
150 minutes/week or 30 minutes 5x/day aerobic, Resistance training three times/week if type 2. If ketones are present don't exercise Lowered insulin resistance+BG+triglycerides+LDL, weight loss, raised HDL, better BP and circulation for up to 24-72 hours
Platelet normal?
150,000-450,000 cells/dL
Normal urine output for adults
1500-2000 ml a day or within 500ml of volume ingested
Impetigo define? Predisposing factors? S/S? Treatment?
..is a superficial bacterial infection of the skin, contagious •predisposing factors-break in the skin, dermatitis, warm climates, poor hygiene, children •signs/symptoms/diagnosis:red patches that fill with yellow fluid; then crusts or erosions - culture or gram-stain •Treatment:antibiotics (PCN or derivative), Allergic to PCN treat with Erythromycin; Mupirocin (Bactroban) ointment, contact isolation, avoid scratching
Crystalloids examples
.25% NS, .45% NS, D5W, 0.9% NS, LR, D51/2NS, D5NS, 3% or 5% hypertonic saline
Normal CSF specific gravity? PH? Appearance? RBCs? WBCs? Lumbar protein? Cisternal protein? Ventricular protein? Glucose? Microbes? Opening pressure with lumbar puncture?
1.007, 7.35, clear/colorless, none, 0-8/microliters, 15-45 mg/dL, 15-25mg/dL, 5-15 mg/dL, none, 60-150 mmH2O
Therapeutic PTT? Normal PTT? What drug associated With PTT and platelets?
1.5-2.5 times normal value. 20-30 seconds or 30-40 Heparin and you take PTT before therapy, q 4 hours when therapy begins, and daily after
Magnesium normal? Function? Stored where? Daily oral intake?
1.5-2.5mEq ppt or 1.3-2.1 needed for muscle contractions, proper heart rhythms, nerve functioning, bone building strength, reducing anxiety, carb digestion, ATP formation, vitamin activation, cell growth, keeping stable protein fluid balance, blood coagulation. Stored in bones/cartilage/ICF. Daily oral intake 300mg.
Normal ICP? Increased ICP? Panic level?
10-15 mmHg, 16-20 mmHg, >25
For mild hypoglycemia where hungry, irritable, shaky, weak, headache BG<60mg
10-15g of carbs via glucose tabs/gel, 1/2 cup fruit juice or regular soft drink, 1 cup skim milk, 6-10 hard candies, 4 cubes sugar, 6 saltines, 3 graham crackers, 1 tbsp honey/syrup
BUN serum norm for all and elders
10-20 mg/dL , elders 8-23 mg/dL
Blood urea nitrogen normal? Increased due to? Decreased due to? If dehydrated?
10-20mg/dL. Increased= dehydration, excess protein intake, impaired renal function. Decreased= over hydration, liver damage, malnutrition. if dehydrated false results possible because BUN increases when blood concentrated.
Impaired fasting glucose aka IFG: fasting plasma glucose normal? Random plasma glucose and A1C % normal?
100-125, prediabetes 5.7%
PT normal? Therapeutic range?
11-12.5 seconds. 1.5-2 times normal
Normal cholesterol? Increased due to? Decreased due to?
122-200mg/dL. Pancreatitis or biliary obstruction. Liver damage.
Hemoglobin normal males? Females?
13.8/14-17.2/18gm/dL, females 12.1/12-15.1/16gm/dL
Sodium normal? function? Major? Normal intake in a day?
136-145mEq in ECF. Helps maintain fluid balance needed for muscle contractions, and helps with nerve signaling. Major cation in ECF and maintains it's osmolarity. Normal intake a day is 6-13g
Impaired glucose tolerance IGT 2 hour OGTT glucose normal? Random plasma glucose and A1C% normals?
140-200, prediabetes 5.7%
Fiber intake for DM
14g per 1000 calories, 25 g per day from legumes, cereal, fruits, vegetables, whole grains
Iron facts? Normal for females?males? Intake?
2/3 is contained in hemoglobin, 1/3 stored in bone marrow, spleen, liver, muscle. Normal is females: 60-160mcg/dL, males 80-180mcg/dL, intake 2-6g
Fresh frozen plasma volume? Infusion time? Indications?
200mL 15-30min. Deficiency in plasma coagulation factors, PT/PTT 1.5 times normal
Pain for gastric vs. duodenal ulcers
30-60 min after meal and at night that's worsened with food ingestion vs. 1.5-3 hours after meal, at night usually 1-2 am and relieved with ingesting food
Temp range for insulin vials and pens
32 F- 86 F
Normal arterial PaCO2? Venous?
35-45 mmHg. 40-50mm Hg
ACS Guidelines for Prostate Cancer Screening and Early Detection
50 year old recommend to have PSA Higher risk 45 year old African Americans First degree relative with prostate cancer before 65 Higher risk 40 Multiple first-degree relatives with prostate cancer at early age Prostate Specific Antigen (PSA) >10 ng/mL increase risk of prostate cancer
In acute care settings for hypoglycemia treatment
50% dextrose 20-30mL via IV push, if patient cannot swallow NS no IV access glucagon 1mg IM in deltoid or sub q but can cause nausea/vomiting so to prevent aspiration put patient on their side
To encourage weight loss of 1 pound a week dietician subtracts
500 calories each day
1 pint is how many ml? And 1 pint can also be how many grams
500ml+500grams
water body weight percentages for healthy younger adults, healthy older adults, and kids
55-60%, 50-55%, 80%
Normal ejection fraction
55-65%
Serum amylase normal in international units and regular units?
56-90 international units/L, 25-125 units/L
Teaching for hypoglycemia
5g of CHO raises BG 20mg/dL, I'd BG <50mg/dL 20-30g of CHO, if BG 51-70mg/dL 10-15g CHO
HR normal?
60-100 beats/min
Normal LDLs
60-180mg/dL in high risk, <100mg/dL for moderate risk
DM nutritional therapy carbs minimum/day? Cholesterol? Protein? Fiber? Monitor?
>130 g/day, Cholesterol < 200 mg/day, Limit trans fatty acids (commercially fried foods and bakery items), Protein 15% - 20% of total calories(Decrease with microalbumuria to slow progression of kidney disease), Fiber: improves carbohydrate metabolism and lower cholesterol 25-30 grams /day Add gradually Fruits, vegetables, whole grains, legumes, low-fat milk. Monitor with CHO counting, exchanges, or experienced-based estimation
Reversible ischemic neuro deficit RIND lasts how long
>24 hours but <1 week, s/s come and go
DKA labs: plasma glucose? Arterial pH? Serum bicarbonate? Urine ketones? Serum ketones? Effective serum osmolality? Anion gap? Alteration in sensoria or mental obtundation?
>250 BG, 7.25-<7 pH, 15-<10 mEq/L, positive urine ketones, positive serum ketones, variable, <10-<12, alert/drowsy/stupor/coma
Risk factors for ovarian cancer
>40 years, family history/HNPCC, DM, nulliparity, >30 years 1st pregnancy, breast cancer, colorectal cancer, infertility, BRCA1/BRCA2, early period late menopause, endometriosis, obesity/high fat diet
When to test for DM
>45years, overweight younger BMI >25 and have a 1st degree relative with DM, inactive, high risk ethnic group, had baby >9lbs, hypertensive >140/90, HDL<35 and/or triglycerides>250, polycystic ovary syndrome, IFG/IGT on previous testing, history of vascular disease
Who is at most risk for enlarged prostate?
>50 years. Causes bladder outlet obstruction, urinary stasis, retention, overflow incontinence, and nocturia
Normal HDLs for females? Males?
>55mg/dL, males >45mg/dL
HHS labs: plasma glucose? PH? Serum bicarbonate? Urine ketones? Serum ketones? Effective serum osmolality? Anion gap? Alteration in sensoria or mental obtundation?
>600 BG, >7.3 pH, >15 mEq/L, small urine ketones, small serum ketones, >320 mOsm/kg, <12, stupor/coma
HHS BG level? Most? Serum osmolarity? Ketones? Difference between HHS and DKA?
>600mg/dL. Most severe neuro manifestations because of raised serum osmolality aka hyperosmolar >320mOsm/L. Ketones are absent/minimal. Fewer early s/s so not recognized as quickly, profound dehydration, >600 BG, >320mOsm/L osmolarity, ketosis absent.
Fibrinolytic therapy can be given up to 4.5 hours for patients unless
>80 years, INR < or equal to 1.7, baseline stroke scale >25, history of stroke and diabetes
Signs and symptoms of hypokalemia? Cause?
A SIC Walt. Alkalosis, shallow respirations, irritability, confusion and drowsiness, weakness/weak reflexes and fatigue, arrhythmias, lethargy, thready weak pulse. Hypotension, decreased peristalsis possible paralytic ileus, nausea, vomiting, constipation, abdominal distention. Fluid overload, diuretic therapy, insulin admin, hyperaldosteronism
Patho of pulmonary embolism
A collection of particulate matter (solids, liquids, air) that enters venous circulation & lodges in pulmonary vessels. Large emboli obstruct pulmonary blood flow, reduce oxygenation of all tissues, including pulmonary tissue. Deoxygenated blood moves to arterial circulation causing hypoxemia
Fluids and meds infused through midline catheter should have
A pH between 5-9 and final osmolarity of less than 600 to prevent phlebitis and/or thrombosis. Not for infusion of vesicant meds that cause severe tissue damage is they escape into sub q tissue aka extravasation, nor for parenteral nutrition formulas, dextrose, blood samples
Ketone bodies are? Hyperketonuria? Hypketonuria?
A product of fat metabolism. indicates a severe lack of insulin Hyperketonuria without hyperglycemia suggest wt loss is occurring without disrupting blood glucose control
Guidelines for communicating with non English speaking patients
Interpreters who are same gender/ age if possible, void relatives, speak slowly, use common words, maintain eye contact unless culturally unacceptable, be careful about no verbals
Interventions for hypomagnesemia
Drugs like high-ceiling/loop diuretics, osmotic diuretics, aminoglycosides antibiotics, drugs with phosphorus are all discontinued. IV MgSO4 given but monitor deep tendon reflexes hourly. Oral Mg causes diarrhea increasing Mg loss. If hypocalcemia also present drugs to increase Ca too
GI findings for cirrhosis
Abdominal pain, anorexia, ascites, clay colored stool, diarrhea, esophageal varices, gallstones, gastritis, GI bleeding, hemorrhoids, hepatomegaly, hiatal hernia, hypersplenism, malnutrition, nausea, nodular liver, bloody vomiting
Clinical manifestations of hepatitis
Abdominal pain, changes in skin or sclera, arthralgia aka joint pain, myalgia muscle pain, diarrhea/constipation, changes in color of urine or stool, fever, lethargy, malaise, nausea and vomiting, pruritus aka itching, right upper quadrant pain, jaundice, dark urine and clay stool
Assessment for ovarian cancer
Abdominal pain, swelling or mass Vague GI disturbances, indigestion, gas Urinary frequency or incontinence Enlarged ovary, weight loss, vag bleeding, pleural effusion, ascites, lymphedema, intestinal obstruction
Surgical management of peritonitis
Abdominal surgery to control contamination, remove foreign material, drain collected fluid. Exploratory laparotomy or laparoscopy to remove or repair the inflamed or perforated organ like appendectomy, colon resection with or without a colostomy, for a perforated diverticulum
History assessment for obstruction of intestines
Abdominal surgery, radiation, inflammatory bowel disease, gallstones, hernias, trauma, peritonitis, tumors, recent nausea/vomiting/emesis color, pain, flatus, singultus aka hiccups, colorectal cancer history, blood in stool, bowel pattern, body temp less than 100 for uncomplicated obstruction, temp higher than 100 and elevated pulse could be stangulated obstruction or peritonitis, hypotension
Most important interventions for meningitis
Accurately monitoring and documenting neuro status every 4 hours
Aspirin aka? Does what? SE? Don't use with? Monitor?
Acetylsalicylic acid. Antiplatelets to prevent MI, antipyretic, analgesic, inflammation like arthritis. SE: GI bleeding, n/v, anemia. Don't use w/ anticoagulants+NSAIDs+diuretics+ACE inhibitors. Monitor liver
Who needs dialysis
Acid base, electrolytes, intoxicants, overload of fluids, uremic symptoms AEIOU
AIDET
Acknowledge, introduce, duration, explanation, thanks
Base is ?
Act as either an acid releasing H or base binding with H depending on blood pH
Fecal occult blood test FOBT requires? Compared to FIT
Active component of guaiac. More likely to yield false positives and unlike FIT patient must avoid certain drugs like anticoagulants/NSAIDS and foods like raw fruits/vegetables / red meat
Open surgical repair of hiatal hernia
Activity restrictions for 3-6weeks, use stool softener, laxatives, avoid straining, inspect incision daily, avoid contact with people with respiratory infection, eat smaller more request meals, report swelling/redness/drainage/fever/tenderness/symptoms of cold or flu
Indications for tracheostomy
Acute airway obstruction, need for airway protection, laryngeal trauma, airway involvement during head/neck surgery, requires CXR after to r/o pneumothorax
Interstitial edema
Acute brain swelling and associated with hypertension, increased CSF pressure. Controlled via measures to reduce BP, decrease CSF pressure, or increase cerebral perfusion pressure CPP to above 70
Treatment of SCD crisis focus on? Treatment?
Acute pain from poor perfusion, chronic pain, sepsis potential, organ dysfunction/death potential. Oxygen therapy, hydration, via water/D5W/1/2 NS D5W/hypotonics, pain control, blood transfusions, no constricted clothing, promote venous return, no raised knees, HOB >30 degrees, temp of room >72, check circulation every hour via pulse ox, capillary refill, peripheral pulses, toe temperature, hydroxyurea/Droxia to reduce sickle cells but can cause leukemia and birth defects
Agents for Herpes Viruses
Acyclovir/Zovirax, Famciclovir/Famvir, Valacyclovir/Valtrex, Ganciclovir/Cytovene
Air embolism cause? S/s? Treatment? Prevention?
Air in central venous system during insertion, accidental disconnecting of tubing, tubing changes, catheter rupture/removal. S/S: chest pain, dyspnea, hypoxia, anxiety, tachycardia, hypotension, nausea, light headed, dizzy, loud churning over pericardium. Treatment: prevent inadvertent disconnection, use lcaps, close slide clamp when changing caps, when inserting/removing catheter place patient flat and have them do valsalva maneuver or hold breath, apply occlusive dressing with ointment when removing central catheter and remain in place for 24 hours
Aerophagia define? Prevention?
Air swallowing from attempt to reverse or clear acid reflux. Teach to relax before and after meals, eat and drink slowly , chew food thoroughly, frequent position changed, ambulation, worst case simethicone 80mg four times a day
Home tuberculosis care
Airborne precautions not necessary but all members of household need TB testing. Have patient wear mask in crowds. Sputum specimens needed q 2-4 weeks after drug therapy started . When results of 3 specimens negative they can go back to work
Biological response modifiers aka? Class of ? Do what? Examples? SE?
Aka BMRs/biological. DMARDs. Most neutralize TNF/interleukin for RA via IV/injection. Ex: Etanercept/Enbrel, infliximab/Remicade, adalimumab/Humira, anakinra/kineret, abatacept/orencia, tocilizumab/actemra. SE: infection
Disease modifying anti rheumatic drugs aka? Does what? What type? Examples?
Aka DMARDs. Slows RA. Immunosuppressive. Ex: Methotrexate, leflunomide/Arava, hydroxychloroquine/Plaquenil, biological response modifiers/BMRs
Dual X-ray absorptiometry aka? define?
Aka DXA Most commonly used screening for measuring bone mineral density
raloxifene aka? drug type? does what?
Aka Evista estrogen agonist/antagonist. Prevents And treats osteoporosis
Hydroxychloroquine aka? Does what? SE? Drug type?
Aka Plaquenil. Slows RA. Anti malarial. SE: stomach discomfort, light headedness, headache, retinal damage. DMARD
Thiazolidinediones aka? most effective in those with? Function? Examples? Rarely used because? Doesn't cause?
Aka insulin sensitizers. Most effective in those with insulin resistance Improve insulin sensitivity, transport, and utilization at target tissues and decreases liver made glucose, reduce lipids Pioglitazone/Actose, Rosiglitazone/Avandia. Rarely used because of adverse effects like MI or HF or bladder cancer. Doesn't cause hypoglycemia
Times cruris, corporsis, capitis aka? Spread how? S/s? Treatment?
Aka jockitch, ringworm type fungal infection or groin/scrotum. Spread via direct contact. S/S: itching, gray patches, moist skin. Treatment: Lotrimin topical, Griseofulvin PO, no tight fitting clothes, personal hygiene, shower shoes, avoid sharing personal care items, get rid of pets since can be transmitted from them
Metabolic syndrome aka? Define?
Aka syndrome X, simultaneous of metabolic factors that increase type 2 DM and CVD risk. Include: abdominal obesity waist >40inch for men, >35women, hyperglycemia fasting glucose >100mg/dL, hypertension >130/85, hyperlipidemia triglycerides >150mg/dL HDL <40mg/dL men and <50mg/dL women
Microalbuminuria define? Men and women normal?
Albumin in urine and means endothelial dysfunction in CVD seen in hypertension, metabolic syndromes, DM, kidney disease. 2-20mg, 2.8-28
Colloid examples
Albumin/plasma protein, dextran/polysaccharide, hetastarch
Labs for Muskuloskeletal
Alkaline phosphatase/ALP, muscle enzymes, creatine kinase/CK-MM, aspartate aminotransferase/AST, aldolase/ALD, lactic dehydrogenase/LDH, calcium, phosphorus, H&H, platelets
Cause of relative hypokalemia
Alkalosis, hyperinsulinism, hyperalimentation, total parenteral nutrition, water intoxication, IV with low K
PICCs Can be used for? Can be inserted how long?
All infusions there are no limits and can be used for blood sampling/infusion with pump. Can be inserted for unlimited time
Injected vasodilation drugs for errection
Alprodastril/Caverject, Paverine, phentolamine/Regitine. Complications include priapism aka persistent abnormal erection, scarring, fibrosis, bleedingg, brushing, pain, infectionz
Immunomodulators are drugs that?
Alter immune response in conjunction with steroids decreasing amount of steroids needed. Examples include infliximab aka Remicade, adalimumab aka Humira
Neuromuscular changes for fluid overload
Altered LOC, headache, visual disturbances, muscle weakness, paresthesia
Maalox and mylanta made of? Drug type? When to take? Dose?
Aluminum hydroxide and magnesium hydroxide. Antacids. 1 hour before and 2-3 hours after each meal. 30ml
Emphysema patho
Alveolar sacs lose elasticity, small airways narrow, hyperinflation of lungs causing dyspnea and increased RR Alveoli become enlarged and flabby with a decreased area for effective gas exchange Air trapping because lungs do not recoil which causes increase work of breathing. Diaphragm becomes flat and weak which causes use of accessory muscles & air hunger. CO2 is produced faster than it can be removed which results in respiratory acidosis. pH < 7.35 & CO2 >45. Low arterial oxygen (PaO2) secondary to decreased ability for gas diffusion.
Types of dementias
Alzheimer's Disease Dementia with Lewy Bodies Vascular Dementia AIDS related Dementia Parkinson's Disease Creutzfelot-Jacob Disease
Prophylaxis against contrast induced nephropathy
Aminophylline NS NaHCO3 N-acetylcyteine (Mucomyst) Hold NSAIDS, ACEIs and diuretics
Abcdef interventions for copd
Aminophylline, bronchodilators, chest physiotherapy, deliver o2 at 2-4 liters, expectorants, force fluids
Common drugs of UC
Aminosalicylates, glucocorticoids, antidiarrheals, immunomodulators
Key features of TBI
Amnesia, headache, dizziness, seizure, loss of consciousness or sleepiness, restlessness/irritability, disorientation/confusion, scalp bruising/tenderness, personality changes, Diplopoda, gait changes
Bronchitis patho
An inflammation of the bronchioles and bronchi caused by chronic exposure to irritants Irritant triggers inflammation, vasodilation, congestion, mucosal edema, and bronchospasms Chronic inflammation causes increase in number and size of mucous glands which produce increased amounts of thick mucous. Thick bronchial walls plus increased mucous block smaller airways and narrow large airways resulting in hypoxemia & respiratory acidosis.
OTC drugs for AD
Ancillary treatment with NSAID of vitamin E, antidepressants for behavior haloperidol/Haldol, olanzapine/Zyprexa, quetiapine/Seroquel, risperidone/Risperdal
Significant male hormones? WNL For males/females?
Androgens - Testosterone: primary male hormone; produced by testes; wnl = 280 - 1,080 ng/dL; females wnl = 15 - 70 ng/dL
Hematologic findings of cirrhosis
Anemia, disseminated coagulation. Impaired coagulation, splenomegaly, thrombocytopenia
Causes of respiratory depression
Anesthetics/drugs/electrolyte imbalance/head or neck trauma/pesticides/botulism/brain edema or tumors/cerebral aneurysm/stroke/over hydration
Bruit over abdominal aorta, renal arteries, and iliac arteries can indicate
Aneurysm so don't percuss and notify
Angiotensin 2 receptor antagonists 3 aka? Do what? Includes? SE?
Angiotensin 2 receptor blockers, ARB's, sartans. Selectively block angiotensin. Includes cancersartan/Atacand, losartan/Cozaar
HF drugs
Angiotensin-converting enzyme/ACE inhibitor, angiotensin-receptor blockers/ARB's, diuretics, nitrates, inotropics like beta-adrenergic agonists, phosphodiesterase inhibitors, calcium sensitizers, digoxin/lanoxin
Late clubbing define? Can indicate?
Angle exceeds 180, edematous and spondy when palpated, drumstick appearance. Can mean prolonged hypoxia, emphysema, COPD, lung cancer, cystic fibrosis, chronic heart disease
When to get mammography?
Annually after 40 since can detect that which isn't palpable
Ketones in urine can indicate
Anorexia, fasting, diabetic ketoacidosis, incomplete metabolism of fatty aci
Hep B symptoms
Anorexia, nausea, vomiting, fever, fatigue, ruq pain, dark urine with light stool, joint pain, jaundice
Gaviscon drug type? Made of? Does what? When to take? Dose?
Antacids.alginic acid and sodium bicarbonate. Forms thick foam that floats on top of gastric contents so if reflux occurs foam enters first and buffers acid. after meals and bedtime. 10-20mL
Interventions for hypophosphatemia
Antacids/osmotic diuretics/calcium supplements discontinued. Vit.D and phosphorus supplements given. Nutrition includes increasing phosphorus foods and decreasing Ca food.
Treatment for pneumonia
Anti-infectives: Ceftiazone (Rocephin) IV or Amoxicillin Clavulanate (Augmentin) PO. (used except if viral) Bronchodilators: Albuterol Antitussives: Codeine Sulfate Hydration IV and/or PO High calorie diet Hygiene (oral) and rest Prevention: Pneumococcal vaccine Q5yrs & Influenza vaccine Q1 yr. NSAIDs
Steroid creams action? Do not? Applied? May increase? Should not be? Have local?
Anti-inflammatory action: suppress cell division •Do not cure the dermatitis •Applied only to the lesion •May increase blood glucose •Should not be covered with occlusive dressings to limit the systemic absorption •Have local side effects i.e. atrophy, stinging
Nitroglycerine class? Use?
Antianginal. Acute(translingual+ointment)+long term prophylactic(oral+transdermal) for angina, HF, MI via increasing blood flow, vasodilation. SE: hypotension, tachycardia, syncope. Looses potency fast, wear gloves, glass bottle.
Tube misplacement/dislodgement can cause? If suspected? Check when/how?
Aspiration, aspiration pneumonia, and possible death. If suspected remove. Check before each feeding/meds or q 4-8 hours. X-ray most reliable, but ascultation via 20-30mL air in tube while listening over stomach to hear whooshing, testing aspirate pH/bilirubin/trypsin/pepsin, assessing CO2 because if so in lungs
What drug is recommended 24-48 hours after stroke onset
Aspirin/Ecotrin but shouldn't be given within 24 hours of rtPA
Nonsurgical management of pyelonephritis
Antibiotics and urinary antiseptics, 2L of fluid a day
PID treatment
Antibiotics, analgesics, heat to abdomen/back, semi-fowler's position, avoid sex until antibiotics complete, check temperature, surgery to remove abscesses, extra fluids, no antacids, take antibiotics on empty stomach
Diarrhea predominant IBS-D
Antidiarrheals like loperamide aka Imodium, psyllium bulker. For women alosetron aka Lotronex a serotonin receptor but should report constipation, fever, ab pain, fatigue, darkened urine, bloody diarrhea, rectal bleeding
Minimizing bleeding in PE
Antidotes, monitor q 2 hours, examine stools, measure abdominal girth, assess labs, electric razor, soft toothbrush, no floss, no aspirin, no contact sports, if bumped apply ice, avoid hard foods, check mouth/skin daily, stool softener, no enemas/suppositories, no tight clothes, don't blow nose
Flu treatment
Antiviral Medications- Shorten duration of infections and prevents the virus from spreading through the respiratory tract. Increased fluids Anti-pyretics Bed rest- to decrease O2 demand Pt education- annual vaccines, staying home, hand washing
Thrombosis cause? S/s? Treatment? Prevention
Anything that damages lining, traumatic venipuncture, multiple attempts at venipuncture, too large catheter, hyper coagulable state and venous stasis. S/S: slowed or stopped rate, swelling, tenderness, redness, engorged peripheral veins. Treatment: stop infusion and remove, cold compress, elevate extremity, for central venous catheters notify. Prevention: correct technique, make only two attempts for venipuncture, smallest gauge, secure, arm boards used if inserted at point of flexion, adequate hydration, warfarin for central venous
Most common acute inflammatory bowel problems
Appendicitis, gastroenteritis, peritonitis
Statement included in assessment of mental status
Appropriateness of clothes to weather conditions
Leflunomide aka? Does what? SE? Drug type?
Arava. Diminishes inflammatory arthritis. Given 20mg q day. SE: hair loss, diarrhea, decreased WBCs/platelets, increased liver enzymes. DMARD
Decorticate (Flexion) and Decerebrate (Extension) Postures
Arms adducted and flexed, flexed wrists, internally rotated knees and plantar flexion vs. arms adducted/extended elbows extended, wrists/arms pronated and flexed, plantar flexion, opisthotonos aka spasm bower forward. Both are ate mental deterioration signs
Step 3 of system for med use in asthma control
As needed rapid beta-agonist aka inhaler, daily treatment using one: low dose ICS+ long acting beta-agonist, medium/high dose ICS, low dose ICS and leukotriene modifier, low dose ICS and sustained released theophylline
Stool according to where colostomy is
Ascending colon liquid, transverse colon pasty, descending colon solid
Cardiovascular acidosis key features
At first raised HR as it progresses Delayed conduction ranging from bradycardia to heart block, tall t waves, wife died QRS, prolonged PR, hypotension, thready peripheral pulses
Cyclic enteral nutrition administration
At night over 8-12 hours, same as continuous except stopped for a set time to allow patient to do stuff during day including eating small amounts
Define tinea pedis, corporis, capitis
Athletes foot, body, head from direct contact
Lipodystrophy aka? Caused by? What reduces risk? Hypertrophy regresses if? Using hypertrophied sites can cause?
Atrophy of subcutaneous tissue. Caused by using same injection sites frequently. Human insulin reduces risk. Hypertrophy regresses if patient doesn't use site for at least 6 months. Using hypertrophied sites can cause erratic absorption
What is kept bedside during colonoscopy and what's it for
Atropine sulfate in case of bradycardia
Patient with COPD who has chronic hypercarbia and hypoxemia and received O2 therapy and RR drops below 10 breaths a minute
Attempt to arrouse and if no arrousal reduce O2 flow and re assess, if RR does not increased of SpO2 drops call rapid response
Physical assessment for asthma
Audible wheeze and increased RR, coughing, accessory muscles to breath, barrel chest, anteroposterior diameter increase so hypoxemia, cyanosis, tachycardia
After patient hospitalized for diverticulitis what discharge teaching should you give
Avoid all fiber and as inflammation resolves switch gradually to high fiber diet
PUD nutrition
Avoid caffeine, avoid decaf coffee, bland diet, no bedtime snacks, 6 smaller meals, no tobacco
Preventing or managing hemorrhage with cirrhosis intervention types
Drugs, endoscopic therapies, rescue therapies, transjugular intrahepatic portal systemic shunt
When diagnosis and treatment of peritonitis is delayed
Blood vessel dilation continues and body responds by shunting blood to area aka hyperemia and fluid shifts from extracellular fluid compartment into peritoneal cavity and GI tract aka third spacing resulting in hypovolemic shock resulting in insufficient perfusion of kidneys leading to kidney failure with electrolyte imbalance
Dark red or brown urine can indicate
Blood, increased bilirubin, myoglobin present
Drugs for TBI
Bolus Mannitol/osmitrol to lower ICP, lasix/furosemide, opioids, sedatives like lorazepam/Ativan+midazolam/Versed for anxiety, antieleptics like phenytoin/Dilantin to prevent early onset seizures that occur within 7 days after injury
Ocogenic aka
Bone Tumor induced osteomalacia
Bands 3 means? Aka?
Bands are immature neutrophils and indicate segs have died off due to bacteria and leaves baby cells to do fighting which are less effective aka left shift
Diagnostic for hiatal hernia
Barium swallow study with fluoroscopy. Sometimes esophagogastroduodenoscopy for sliding hernias
During process of healing with GERD
Barrett's epithelium aka columnar epithelium replaced with squamous epithelium which is pre malignant, fibrosis and scarring can cause esophageal stricture aka narrowing leading to difficulty swallowing
Function of skin
Barrier, fluid/electrolyte balance, temp. Regulation, sensory organ, vit. D synthesis
The most common base and acid in body? Ratio? To balance?
Base- bicarbonate HCO3- and acid- carbonic acid H2CO3. Ration is 1 carbonic acid to 20 bicarbonate ions to balance CO2 and H
Postatectomy post op care
Bedrest 24 hours, bladder spasms Ditropan/Urispas, avoid rectal treatments, keep stools soft, avoid sitting for long periods, prevent deep vein thrombosis, increase fluids, hemorrhage, voiding issues, sexual dysfunction
How to prevent somogyi effect
Bedtime snack, reduction of insulin or both
Foods and drinks with oxalate
Beets and strawberries, chocolate, coffee, tea, cola, nuts, wheat bran, rhubarb, spinach
People with type 1 often test BG when
Before meals because many patients use insulin pumps or multiple daily injections and base the insulin dose on the carbohydrates in a meal or make adjustments if the premeal value is above or below target. Testing 2 hours after the start of a meal helps a person see how effectively he or she judged what was eaten or to determine if the bolus insulin dose was adequate for that meal.
Nursing care for parenteral - begin? Monitor? Patient on? Regular insulin? Taper off? If DC? Follow protocol for? Must use?
Begin slowly and advanced to desired rate according to fluid/glucose tolerance and nutrition support team follows, monitor lab values since TPN can change daily and weight IO and signs of infection, patient on BG checks every 6 hours, regular insulting can be added as well as sliding scale, taper off 4-6 hours to avoid rebound hypoglycemia unless patient is taking PO carbs, if DC abruptly hang dextrose D10, follow protocol for changing tubing usually q 24 hours and changing central line dressing usually q 48-72, must use pump
Tertiary health promotion define? Examples?
Begins after an illness is diagnosed & treated to reduce disability & to help rehabilitate patients to a maximum level of functioning •Examples: PT for post stroke patients, support groups for post mastectomy patients, meds, therapy, surgery, rehab, job training
Best labs to check renal function
Best is GFR, and BUN, creatinine
Hypoglycemia can be difficult to recognize due to
Beta blockers
Topical glucocorticoids
Betamethasone/Diprosone, Desoximetasone/Topicort, Hydrocortisone/Hytone, Dexamethasone/Decaderm
Main buffer of ECF
Bicarbonate which comes from intestinal absorption, pancreatic production, kidney reabsorption and breakdown of carbonic acid to form bicarbonate
Fibrocystic breast condition description ? Incidence?
Bilateral fullness/tenderness, bilateral nodules, cysts. Late teens-20s. Treatment: oral contraceptives, Danazol/Danocrine(can cause stroke, liver disease, increased ICP), vitamins, diuretics,
Alkaline reflux gastropathy aka? Due to? Define? Symptoms?
Bile reflux gastropathy. Pylorus bypassed or removed. Regurgitated bile in stomach and mucosa hyperemia. Symptoms: early satiety aka satisfies quickly with little food, abdominal discomfort, vomiting
Systemic therapy for psoriasis
Biologic agents, i.e. adalimumab (Humira) SQ, alter the immune system to help stop skin cells from growing too quickly; causes immunosuppression & patients are @ risk for infection •Cytotoxic agents, i.e. methotrexate, clears skin lesions •Cyclosporine (Sandimmune) induces immunosuppression & is used when other agents fail
Interventions for elderly stomach changes
Bland foods high in vitamins/iron
Activitities that increase intra ocular pressure
Blinding from waist, lifting more than 10 lbs, sneezing/coughing, blowing nose, straining for BM, vomiting, sex, head in dependent positions, tight shift collars
Hemianopsia aka? Results from? Homonymous hemianopsia define?
Blindness in half of visual field results from damage to optic tract or occipital lobe where patient must turn head to scan complete range of vision. Homonymous=both eyes
Selective estrogen receptor modulators SERMs function? Agents?
Block action of estrogen in breast for breast cancer. Tamoxifen/Nolvadex, Raloxifene/Evista. SE:hot flashes and weight gain
Closed loop obstruction aka? Strangulated obstruction aka
Blockage in two different areas. Obstruction with compromised blood flow and major blood loss can result. With both peritonitis increased and bacteria without blood supply can form and release endotoxins into peritoneal or systemic circulation and cause septic shock.
Dipeptidyl Peptidase 4 DDP-4 inhibitor function? Examples? Aka?
Blocks inactivation of incretin hormones aka GLP and GLP-1 ↑ Insulin release after meals ↓ Glucagon secretion ↓ Hepatic glucose production Sitagliptin/Januvia, saxagliptin/Onglyza, linagliptin/Tradjenta. Aka gliptins.
Hemoptysis define
Blood in sputum usually in those with chronic bronchitis or lung cancer
Other assessments for cirrhosis
Blood in vomit and stool which can be due to gastritis, ulceration or oozing esophageal varices. Fetor hepaticus aka fruity or musty breath odor. Amenorrhea aka no period or testicular atrophy. Gynecomastia aka enlarged breasts. Bruising and petechiae. Mental status and personality changes. Asterixis aka course tremor in wrists and fingers
Syphilis diagnose via
Blood test aka venereal disease research lab serum test and rapid plasma reagin. Treatment: bezathine penicilin
Diagnosising gastritis
Blood test to detect IgG or IgM anti h. Pylori antibodies, esophagogastroduodenoscopy via endoscope with biopsy
Aplastic anemia define? Usually accompanied with?
Bone marrow doesn't make enough RBCs. Usually accompanied with reduced WBCs and platelets aka pancytopenia if all three reduced
GeneraliZed seizures occur and involve? Types?
Both cerebral hemispheres. Tonic-clonic with stiffening/rigidity of muscles and loss of consciousness, and clonic/rhythmic jerking after. Absence type with buried loss of consciousness and blank staring with automatisms/involuntary behaviors. Myoclonic that causes brief jerkining/stiffening. Atonic/akinetic where there's loss of muscle tone
Rheumatoid arthritis anatomy
Boutonnière deformity of thumb, ulnar deviation of metacarpophalangeal joints, swan neck deformity of fingers
Preop care for colorectal cancer surgery - if bowel not obstructed or perforated?
Bowel prep with laxatives, enemas, whole gut lavage with sodium sulfate and polyethylene glycol aka GoLYTELY. For all: antibiotics, fluid and electrolyte replacement is setup,
Vagal stimulation and bronchospasm from trach suctioning s/s?
Bradycardia, hypotension, heart block, ventricular tachycardia, a systole, dysrhythmias. If occurs stop suctioning and oxygenate. If bronchospasms bronchodilator given
Most important tool for confirming stroke
Brain imaging via CT is best or MRI if you need it faster
Secondary seizures result from
Brain lesion, disorders, alcohol withdrawal, electrolyte issues, high fever, stroke, injury, drugs, heart disease. Not considered epilepsy
Define mastalgia
Breast pain
Providing for socialization and intimacy needs for AD
Brief no stressful visits from friends, letters, phone calls, limit visitors to 1-2 at a time, , hobbies/activities appropriate, walking, exercising, pets, plants
Upper GI bleeding key features
Bright red or coffee ground vomitus aka hematemesis, tarry stools or frank bright red blood in stools, melena aka occult blood, decreased blood pressure, increased weak and thready pulse, decreased hemoglobin and hematocrit, vertigo, acute confusion, dizziness, syncope
Drugs for diverticular disease
Broad spectrum antimicrobial said like metronidazole aka Flagyl, trimethoprim sulfamethoxazole aka TMZ/Bactrim/Septra, ciprofloxacin aka Cipro, pain meds
Dopamine receptor agonist example? Mechanism of action? Thought that? Increases?
Bromocriptine (Cycloset) Mechanism of action unknown Thought that patients with type 2 diabetes have low levels of dopamine in morning which can interfere with body's ability to control BG Increases dopamine receptor activity
Normal breath sounds
Bronchial/tubular harsh high pitch sounds heard over trachea/mainstem bronchi and inspiration<expiration, bronchovesicular over branching bronchi where inspiration=expiration, and vesicular soft rustling sound over small bronchioles inspiration > expiration
cholinergic antagonist aka? Common examples? Administered how? Not as? Education?
Bronchodilator. Ipratropium/Atrovent. Inhalant. Not as effect as albuterol but for those who cannot tolerate Albuterol. Carry at all times, shake well before use, increase fluid intake to 4L, report blurred vision, eye pain, headache, palpation said, or insomnia, 2-4 inhales a day.
Xanthine aka? Common examples? Used when? SE? Responsibilities?
Bronchodilator. Theophylline PO and aminophylline IV. For when other dilators are ineffective. SE: ^HR, arrhythmias, N/V, irritability, headache, insomnia. Monitor cardiac status, serum blood levels normal levels are 10-20 mcg/ml, levels above 20 are toxic and patient may have seizures+hypotension
Beta adrenergic agonists aka? Common examples? Administered how? SE? Education?
Bronchodilators. Fast acting Albuterol/Proventil/Ventolin, slow acting Salmeterol. Inhalant. SE: ^ HR, ^ BP, arrhythmias. Albuterol carry at all times, teach to monitor HR, take 5 minutes before any other inhalants, 1-2 inhales q 4-6 hours. Salmeterol instruct to shake before use, 2 inhales q 12 hours
Constipation recombinant IBS-C drug example? Function? Drug for women?
Bulk forming laxatives: psyllium hydrophilic mucilloid aka Metamucil that helps prevent dry, hard, liquid stool. For women lubiprostone Amitiza that's a chloride channel activator
Lung cancer treatment
Chemotherapy Radiation Therapy Photodynamic Therapy (Removal of small bronchial tumors) Lobectomy (Removal of the affected lobe) Pneumonectomy (Removal of an entire lung) Chest tube placement (After thoracotomy) Thoracentesis (To remove excess fluid)
Post thoracentesis
Chest X-ray to rule out pneumothorax, and mediastinal shift, monitor VS+breath sounds, deep breathing,
Marasmic-kwashiorkor
Calorie and protein malnutrition
Glomerulonephritis cause?
Can start in kidney due to genetics or immune issues. Secondary to other disease like diabetes, systemic lupus, HIV, hepatitis. Cirrhosis, bacteria , drugs, toxins
Complications of CD
Cancer of small bowel and colon, fistulas, intestinal obstruction
Captopril aka? Class? Use? SE? Monitor for?
Capoten. ACE inhibitor. Causes vasodilation via lowering aldosterone for hypertension, HF. SE: hypotension, dizziness, cough, proteinuria. BP, pulse, weight
Metabolic effects of ESRD
Carb intolerance, hyperlipidemia and insulinemia
Body buffers
Carbonic acid Na bicarbonate, phosphates, proteins
WHEN EXCESS H ARE MADE OR BROUGHT INTO BODY
Carbonic anhydrase equation shift to left causing more CO2
Peripherally inserted central catheter PICC is? Placement requires? Length? Should be inserted when? Which vein is preferred site? Placement must be?
Catheter inserted through vein of anticubital fossa or middle of upper arm. Placement requires special training and certification. Length:18-29 inches with tip in superior vena cava. Should be inserted early before venipunctures/infusions. Basilic vein is preferred site for insertion but cephalic vein can be used. Placement must be confirmed via X-ray if no fluoroscopy used
Hypocalcemia signs and symptoms
Cats. Convulsions, arrhythmias, tetany, stridor and spasms/Charley horses in calf/foot. Paresthesia, muscle twitching/cramps/spasms, positive trousseau's and chvostek, HR and ECG changes with prolonged ST+QT, weak thready pulse, hypotension, hyperactive bowel sounds, osteoporossis with bone breaks and loss of height
Vitiligo caused by? An ? Onset attributed to? Have increased? Appears in? Treatment?
Caused be hypofunction of the adrenal glands •..an acquired disorder characterized by destruction of melanocytes causing skin & hair to lighten in patches •Onset attributed to stress, or trauma •Have increased risk of certain diseases (i.e. thyroid) •Appears in all races; mostly blacks, tropics •Treatment - UV light, mild topical steroid, cosmetics, •No cure....research continues
Hemolytic transfusion relations caused by? S/S?
Caused by ABO/Rh incompatibility. S/S: fever, chills, disseminated intravascular coagulation, circulatory collapse, apprehension, head ache, chest pain, tachycardia, tachypnea, hypotension, hemoglobinuria, sense of doom.
Urticaria caused by? Aka? Management?
Caused by exposure to allergens. Aka hives that are red/white papules/plaques Management: remove triggering substance and relieve symptoms with antihistamines like benadryl, no alcohol or warm environment
Febrile transfusion reactions caused by? Signs?
Caused by leukocyte incompatibility, produces sudden chills and fever
Define ischemic stroke
Caused by occlusion of cerebral artery by slow s/s thrombus or immediate s/s embolus usually occur during sleep get better after initial onset
Ascites
Collection of fluid in peritoneal cavity caused by increased hydrostatic pressure from portal hypertension causing collection of plasma protein in peritoneal fluid and with this decrease combined with inability to produce albumin serum colloid osmotic pressure decreased resulting in third spacing causing hypovolemia and edema which can cause renal vasoconstriction triggering renin angiotensin system resulting in sodium and water retention increasing hydrostatic pressure and vascular volume leading to more ascites
Ancef aka? Function?
Cefazolin. Anti-infective for pneumonia.
Hypotonic fluid cells? Solute concentration? Hypotonic parenteral solutions define? Risk for?
Cells inflate and eventually burst. Solute concentration inside cell is higher. Less than 270mOsm/L. Risk for phlebitis and infiltration
Hypertonic cells? Solute concentration? Hypertonic parenteral solutions define? Function? Risk for? Ex.?
Cells shrink. Solute concentration inside cell lower. Fluids greater than 300mOsm/L. Corrects fluid, electrolyte, acid base imbalances. Risk for phlebitis and infiltration Ex. Parenteral nutrition
hyperphosphatemia signs/symptoms
Centered on hypocalcemia when phosphorus increases. If Ca okay few direct problems
Gonorrhea treatment?
Cephalosporins: ceftriaxone/Rocephin, cefixime/Suprax, azithromycin/Zithromax, doxycycline/Monodox. Diagnosis: molecular testing via nucleic acid amplification test from swab or urine
As ICP increases
Cerebral perfusion decreases, causing hypoxia, decrease in pH, and increased in CO2, which causes vasodilation, edema, more increase in ICP and it cycles until brain herniates toward brainstem or laterally from unilateral lesion
Macro vascular complications are?
Cerebrovascular disease CVA, stroke, cardiovascular disease, acceleterated atherosclerosis, CAD, MI, peripheral vascular disease, blood viscosity and platelet disorders, heart failure, kidney disease indicated by albuminuria
Colposcopy define? Pre? During? Post?
Cervical, vaginal, vulvar epithelium to locate exact site of precancerous and malignant lesions for biopsy. No douching or vag preps for 24-48 hours before, full bladder. No lubes, NS, then acetic acid, inspection. Clean perineum, pad.
Secondary skin lesions
Changes in appearance of primary lesion: Erosion, scar, ulcer, keloid, fissure, scales, atrophy
Diuretic stage of ARF
Characteristics Onset: UOP > 400 ml/day Duration: 1-3 weeks Azotemia persists
Oliguria stage of ARF
Characteristics UOP < 400 ml/day Azotemia Onset 24 hours after injury Duration 10-14 days
Neuropathic arthroplathy aka?
Charcot's foot. Results in gradual ankle and foot changes leading to joint dysfunction and foot drop, hallucinations vagus aka turning inward of great toe, and abnormal distribution of weight over foot further increasing chances of foot ulcer
Recovery from breast cancer surgery
Check dry gauze dressing and change it when soiled, if soiled more than 1x a day notify, empty drainage 2x a day and measure, drains removed when drainage <25 in 24 hours aka 7-10 days, sponge baths/tub baths keeping incision dry, use arm for normal activities but not exercise, numbness normal, if lymph node removal elevate arm for 30 minutes/day for 6 months, loose fitting clothes, active ROM 1 week after
Oxygen therapy best practive
Check prescription, need prescription for humidification if o2 4 L/min+, check skin around ears/neck/face q 4-8 hours, mouth care q 8 hours, pad elastic band +change position of it, pad areas on skin, cleanse cannula/mask q 4-8 hours, lube nostrils/face/lips with no petroleum cream, no smoking/candles,
Monitoring for complications of enteral feedings
Check residuals every 4-6 hours, residuals greater than 150-200ml can increase chance of aspiration so follow hospital protocol whether to hold feedings temporarily, monitor daily labs weight hydration sugar and signs of fluid overload
Gallbladder function
Collects, concentrates, stores bile from liver and releases it in duodenum when fat present
How cholinesterase inhibitors treat Alzheimer's
Cholinesterase inhibitors are drugs that block the activity of an enzyme in the brain called cholinesterase. Cholinesterase breaks apart the neurotransmitter acetylcholine, which is vital for the transmission of nerve impulses. Cholinesterase inhibitors are used to reduce the action of cholinesterase, thereby making more acetylcholine available to nerve cells in the brain to maintain memory.
Asthma aka? Define?
Chronic airflow limitation. Chronic but with reversible airflow obstruction (Unlike COPD which is non-reversible) Triggered by inflammation in the air or airway hyperresponsiveness that causes bronchoconstriction.
Increased WBC from
Chronic disease, anemia, MI, inflammation
Low hematocrit ?
Chronic disease, anemia, angina, heart failure, hemorrhage, hemolysis
Low hemoglobin? High?
Chronic disease, anemia, angina, heart failure, hemorrhage, hemolysis. Hypoxia or polycythemia vera
decreased RBC? Increased?
Chronic disease, anemia, rheumatic fever, endocarditis, hemorrhage. Hypoxia or polycythemia vera
Osteoporosis define? Types? What causes each type?
Chronic metabolic disease in which bone loss causes decreased density and possible fracture Primary Postmenopausal women and men in 7th or 8th decade of life Secondary May result from medical conditions, long drug therapy, or prolonged immobiity Regional Immobility for longer than 8-12 weeks
Lab assessment with COPD
Chronic respiratory acidosis aka increased PaCO2, and metabolic alkalosis aka increased HCO3 as compensation
Psoriasis define? From? S/s? Treamtent?
Chronic, autoimmune disorder of skin resulting in overstimulation of the immune system => ^ cell division & plaque formation => cells being shed Q 4 days vs Q 28 days •Genetic predisposition/component •Signs: thick, reddened papules or plaques covered by silvery, white scaly patches, nail pitting, Psoriatic arthritis may occur •Treatment:Topical corticosteroids w occlusive dressings, Topical tar: suppresses cell division & inflammation, Arthralin, a hydrocarbon similar to tar, Ultraviolet A and psoralen light therapy &/or Natural sunlight, Education regarding chronic skin condition, Provide psychological care re: disturbed body image, adalimumab/Humira, alefacept/Amevive, entanercept/Enbrel, infliximab/Remicade, topical Folex, Mexate both aka methotrexate, cyclosporine/Sandiummine, azathiprine/Imuran
Fluoroquinolones examples? SE? Function?
Ciprofloxacin aka Cipro/Proquin, Levifloxacin aka Levaquin, Lomefloxacin aka Maxaquin, norfloxacin aka Noroxin, ofloxacin aka Floxin, sparfloxacin aka Zagam. SE: keep out of sun, arrhythmias. Function: bactericidal
Rapid acting, short acting, glargine insulins should be
Clear and all others cloudy
Postop instructions for endoscopic therapies for GERD
Clear liquids 24 hours after, after 24 hours soft diet, no NSAIDS or aspirin for 10 days, use liquid meds, don't use NG tubs for 1 month, contact provider if chest/abdominal pain, bleeding, dysphagia, SOB, nausea/vomiting
Viral meningitis CSF appearance? WBCs? Protein? Glucose? CSF pressure?
Clear, increased, increased, normal/decreased, varies
PID diagnosis
Clinical history, physical exam, labs like HCG test, WBCs, ESR, c-reactive protein
Skin prep for colostomy bag
Clipping bag, clean with soap and water, no moisturizing soaps, skin sealant without alcohol, if raw skin stoma powder or paste, paste or filler cream to fill in creases for flat surface
Monofilaments for testing?
Close eyes during, apply at right angle, apply enough to bend, if they can' treeless 10-g force at risk. Tests Protective sensation on soles of feet on big toe and top of soles should be 5.07
Fibrinolytic therapy define? Given when?
Clot busting recombinant tissue plasminogen activit rtPA Retavase drug/thrombolytic therapy for acute ischemic stroke to dissolve cerebral artery occlusion to prevent infarction. Given within 3 hours last seen normal LSN
Bacterial meningitis CSF appearance? WBCs? Protein? Glucose? CSF Pressure?
Cloudy/turbid, increased, increased, decreased, elevated
Interventions for hemorrhoids
Cold packs, sitz bath, topical anesthetic like lidocaine, steroid cream like hydrocortisone, no toilet paper instead use moistened tissue, Dab to wipe don't wipe regularly, diets high in fiber and fluid, stool softener so like docusate sodium/Colace, no spicy foods/nuts/coffee/alcohol , pain meds, no sitting long periods
Herpes simplex 1 aka?define? Transmitted by? Virus remains? Reactivated in? Treatment?
Cold sore. Non genital viral infection of skin or mucous membrane characterized by painful vesicles that erupt & recur •Can be transmitted by respiratory droplets or direct contact •Virus remains dormant in a cluster of nerve cells •Reactivated in illness, stress, fatigue •Treatment - Zovirax (Acyclovir), ointments, avoid skin to skin contact, analgesics to relieve pain; OTC Abreva
Warts define? Caused by? Develops? Will persist for? Have a role in? Spread by? Treatment?
Common benign skin tumor caused by infection with the human papilloma virus •Develops 1 - 8 months after virus lodged in skin •Will persist for years if not treated •Have a role in pathology of certain cancers •Spread by scratching, rubbing •Treatment - cryosurgery , acids
Classifications of pneumonia
Community Acquired (CAP) Onset in the community or within the first two days of hospitalization Hospital Acquired (HAP) Onset 2 days after hospitalization Ventilator Acquired (VAP)
Cystectomy procedures
Complete removal, ileal conduit, continent pouch, bladder reconstruction aka neon bladder, ureterosigmoidostomy
Clients at risk for TB
Compromised immune system (ex. HIV, elderly) People in overpopulated areas (ex. Homeless shelters, Prisons) IV drug abusers
The carbonic anhydrase equation shows that
Concentration of CO2 directly related to concentration of H
Genital warts aka? Cause? Treatment
Condylomata acuminata. HPV. Increases risk for cervical cancer. Diagnosis: Pap test and probe. Treatment: remove warts and treat symptoms: podofilox/Condylox cream, imiquimod/Aldara cream.
Implanted ports consists of? How many lumens? How is it placed?
Consist of portal body, a septum made of self healing silicone over reservoir, and a catheter. Single or double lumen. Sub q pocket surgically created to house port, catheter inserted in vain and attached to port and incision closed and no part of catheter is visible externally.
DM patients who are sick should
Contact doctor, continue meds, Check BG every 4 hours, check urine for ketones, and drink a glass of sugar free liquid every hour, continue meal plan, if cannot eat solids replace with liquids equal to CHO of usual meal
Scabies define? Transmitted how? Signs?
Contagious skin infection caused by mites, close prolonged contact with persons/fomite/pets. S/S: curved linear ridges in skin with itching, found between fingers, wrists, rashes on pressure points or points of flexion
Insulin pump is? How is it operated? Connected to? Program? Potential for?
Continuous ab catheter subcutaneous rapid acting infusion Battery-operated device Program basal and bolus doses that can vary throughout the day based on carbs, activity, illness Potential for tight glucose control
6 Clinical manifestations for fracture?
Continuous pain, Unnatural movement or deformity, Shortening of extremity related to muscle spasms, Crepitus-bone on bone, Discoloration, Inflammation at fracture site
Basal background insulin used to? Examples?
Control glucose levels in between meals and overnight usually for type 1. Long-acting basal and intermediate acting insulin.
Hypoglycemia skin? Dehydration? Mental status? S/s? Glucose? Ketones?
Cool, clammy. Absent. No change. Anxious, nervous, irritable, confused, seizures, coma. Weakened, double vision, blurred vision, hunger, tachycardia, palpitations. <70. Negative
Diagnostics for skin
Cultures, biopsy, wood's black light, diascopy aka blanching skin to look for lesion, KOH test for fungal infections
Nonsurgical management of diverticular disease
Drugs, nutrition therapy, and rest via no coughing, bending, straining to decrease inflammation and prevent perforation of diverticulum
Osteomyelitis/osteoarthritis labs
Elevated to normal WBCs, ESR normal increases as it progresses, high C reactive protein. bone scan using technetium/gallium dx for osteomyelitis, physical exam for OA
Diuretic stage treatment of arf
Daily weights Frequent BP monitoring Accurate I&O Monitor electrolytes and administer supplement Fluid replacement
ARF it's critical to
Decrease or discontinue meds, furosemide watch for hypokalemia, vasodilators, alkalinizer sodium bicarbonate to reverse acidosis
DKA s/s
Decreased glucose in cells causing polyphagia, breakdown of protein/fats, hyperglycemia over 300mg, glucose in urine, polyuria, polydipsia, nausea, vomiting, weight loss, kussmaul, dehydration with loss of Na and K, low blood volume, increased pulse, decreased BP, ketones in blood and urine, fruity breath, acidosis, decreased LOC, coma, death
Vitamin b12 deficiency caused by? Causes?
Decreased intake of food, or malabsorption of b12 aka pernicious anemia from deficiency of intrinsic factor for vit. B12 absorption which can be from small bowel resection, gastrectomy, chronic diarrhea, diverticula, tapeworm, overgrowth of intestinal bacteria. Causes pernicious anemia via shillings test
Actions to preserve perfusion during dehydration starting with decreased effective circulating volume
Decreased venous return, decreased CO, decreased pressure, increased baroreceptor stimulation, increased sympathetic discharge leading to: 1. Renin angiotensin aldosterone mechanism 2. Compensatory: increased constriction, contractility, venous return, HR, SV, peripheral resistance, CO
Edema shifts of plasma
Elevation of venous hydrostatic pressure Decrease in plasma oncotic pressure Elevation of interstitial oncotic pressure
Goals of treatment for CKD
Delay progression, treat manifestations, chronic renal replacment therapy, I and O, daily weights, possible order fluid restrictions, protein restrictions, K restriction, Na restriction if hypertension, limit dairy and phosphate, monitor electrolytes, manage anemia with iron, folic acid, growth hormones, prevent renal osteodystrophy with phosphate binders Sevelmer, Renagel, calcium supplement, vitamin D calcitriol aka Rocaltrol, BP management, correct acidosis with calciminetics and cenacalet aka Sensipar
Venturi mask
Deliver most accurate o2 concentration without intubation by pulling in RA for each L of O2. 25-50% o2 and 4-10L/min flow. Keep adapter open, change to nasal cannula for meal, no kinks
Alzheimers is a type of
Dementia that cannot be cured with s/s slowly progressing until dysphagia, incontenence, requires total self care
Glycemic index describes? High glycemic index foods?
Describes rise in BG after carb ingestion, high glycemic index foods increase glucose faster
Splenomegaly causes? First sign of?
Destroyed platelets causing thrombocytopenia and increased risk for bleeding. First clinical sign of liver dysfunction
Hemoglobin electrophoresis
Detects abnormal forms of hemoglobin, A is normal, S seen in sickle cell
Nasogastric tube used to
Determine presence of blood in stomach, access bleeding rate, prevent gastric dilation, administer lavage
Counterimmunoelectrophoresis CIE
Determines presence of viruses or Protozoa in CSF, or given if patient has received antibiotics before CSF obtained
Whipple's triad
Determines whether hypoglycemia, manifestations consistent with low BG, low plasma glucose, and resolution of s/s after plasma glucose raised
Common causes of Hyponatremia with actual sodium deficits
Diaphoresis, lasix/furosemide, wound drainage, decreased aldosterone, hyperlipidemia, kidney disease, NPO, low salt diet, cerebral salt wasting syndrome, hyperglycemia
Upper airway obstruction s/s
Diaphoresis, tachycardia, hypertension, hypoxia, hypercarbia, restlessness, anxiety, stern all retractions, see sawing chest, abdominal movements, feeling of impending doom, air hunger
Hiatal hernias aka? Define? Types
Diaphragmatic hernias. Protrusion of the stomach through the esophageal hiatus of the diaphragm into the chest. Sliding and paraesophageal rolling hernias,
Assessment for iron deficiency
Diet in relation to foods high in iron like red meat, organ meat, egg yolks, kidney beans, leafy greens, raisins. Income and local resources, unusual bleeding, family history, fatigue, activity intolerance, weakness, pillow, brittle nails, smooth beefy tongue
Assessment for b12 deficiency
Diet, family and surgical specifically abdominal history. Jaundice, glossitis aka smooth beefy tongue, fatigue, weight loss, paresthesias, boor balance. If pernicious via shilling test to measure b12 in urine after radioactive B12 ingested and if not in urine pernicious anemia
Expressive/Broca's/motor aphasia
Difficulties speaking and writing, patient understands what is being said and that they have deficit
Yellow brown nails clinical findings and significance?
Diffuse yellow to brown can mean jaundice, lymph edema, infection, psoriasis, diabetes, cardiac failure, staining, tetracycline, normal aging. Vertical brown banding is normal in dark skinned patients or negus/melanoma in light skinned
Seizure meds
Dilantin/Phenytoin, Ativan/Valium/diazepam, Valium, phenobarbitol/lumenal sodium sulfoton, tegretol/carbamazepine, neurontin/gabapentin, Cerebyx/fosphenytoin, depakote/divalproex
Varicocele define? Treatment?
Dilated veins behind and testis. Varicocelectomy to prevent sterility
After abdominal surgery or in patient with peritonitis or paralytic ileus bowel sounds will be
Diminished or absent
Massive ascites assessment
Distended abdomen with bulging flanks, dilated abdominal veins aka caput medusae, orthopnea, dyspnea, problems with balance, inguinal or umbilical hernias
Drug therapy for cirrhosis fluid excess? Side effects of loops? Example of diuretic that is K sparing
Diuretics. Furosemide aka Lasix Can cause hypokalemia, Hyponatremia. Spironolactone aka Aldactone conserves K
Storage of insulin: don't? In-use vials? Extra unused insulin? Avoid? Store prefilled syringes?
Don't heat/freeze. In-use vials left at room temp. For up to 4 weeks. Extra unused insulin refridgerated. Avoid direct sunlight. Store pre filled syringes upright for 1 week if 2 insulin types, 30 days for one
Management of system in chest tube drainage systems
Don't strip chest tube, keep lower than chest, keep tube straight, securely taped, assess bubbling/tidaling, check water level in water seal chamber and suction control chamber, document characeteristics of collection chamber, empty collection chamber before drainage makes contact with bottom of tube, when sample drainage needed for culture after cleaning use small needle to sample
Obtaining blood samples don't use? Shouldn't be done within? Central venous and midline?
Don't use short peripheral catheter. Shouldn't be done within an hour of completion. Central venous and mid lines samples can be altered due to drugs but if patient has no venipuncture sites or fearful of needles do it.
Peripheral neuropathy safety
Don't wear new shoes longer than 2 hours, no pointed toe or heels >2 inches, inspect daily, test water temp <110 F, high fiber foods, 2-3L water/day, no rugs, use hand rails
HPV test
Done at same time as Pap for women >30years and for those with abnormal pap. Tests for viruses that can lead to cancer
Examples of cholinesterase inhibitors that maintain memory
Donepezil hydrochloride/Aricept, rivastigmine tartrate/exelon, galantamine hydrobromide/ reminyl
Ileostomy symptoms to watch for? If stomas swelling, ab cramping, distention, or ileostomy contents stop draining?
Drastic increase or decrease in drainage. If stomas swelling, ab cramping, distention, or ileostomy contents stop draining: remove pouch with faceplate, lie down, knee chest position, abdominal massage, moist towns on ab, hot tea, and if none of those work notify
Define lethargic? Stuporous? Comatose?
Drowsy/sleepy but easily awakened. One arousable with vigorous/painful stimulation. Unconscious and no arousal
ADA recommends metFORMIN as initial therapy for type 2 because
Drug doesn't induce weight gain or hypoglycemia and low cost but shouldn't be given to those with kidney disease, with increased creatinine > 1.5-1.4 and side effects of abdominal discomfort and diarrhea, liver disease, HF, >80years, conditions that decrease drug clearance, can cause lactic acidosis
Stevens-Johnson syndrome define
Drug induced skin reaction with local skin involvement, severe, or systemic with mix of vesicles, erosions, crusts, if severe respiratory issues, fluid loss, kidney injury, blindness treatment is to remove the drHansen's disease. mycobacterial infection of the peripheral nervous system with skin involvement causing plaques, red macules, papules, nodules, reduced skin sensation; uncommon in USA. Treatment: stop drugDapsone/DDS/Avlosulfon, rifampin/Rifadin/Rimactame, clofazimine/Lamprene, ofloxacin/Floxin, minocycline/Dynacin/Minocinug
Lumen occlusion cause? s/S? Treatment? Prevention?
Drug precipitate, lip if sludge from fat emulsion, blood clots/fibrin from blood reflux, allowing admin set to stay connected for extended periods after med infused. S/S: infusion stops, inability/difficulty drawing blood/admin fluids, increased resistance of flushing. Treatment: extended period, not suggest, for drug precip determine pH and use hydrochloric acid for acidic and sodium bicarbonate for alkaline drugs, for blood clot use thrombolytic enzymes such as alteplase. Prevention: flush with NS between/before/after meds, use positive pressure flushing when negative fluids connector being used, use positive fluid displacement needless connector
Nonsurgical management of hiatal hernias
Drug therapy like antacids and histamine receptor antagonists, nutrition therapy, lifestyle changes like GERD
For patient with kidney problems with hyperkalemia? Name generic/trade name of drug. How long can it take to reduce? If K dangerously high?
Drug therapy to increase K excretion includes cation exchange resins that promote intestinal sodium absorption and K excretion like sodium polystyrene sulfonate aka Kayexalate but can take many hours to reduce. If K dangerously high additional measures like dialysis are needed
Memantine/Namenda function
Drug which is reported to reduce the clinical deterioration in moderate to severe AD
TB interventions for long term
Drugs 6 months - 2 years isoniazid/INH, rifampin, pyrazinamide, ethambutol, MDR-TB. Encouragement to assure fatigue will decrease and after 2-3 weeks treatment no longer will be contagious. Educate importance of med compliance they need to always have med on hand and possible personal MAR, possible liver damage so no alcohol
Nonsurgical management of chronic pancreatitis
Drugs for pain and nutritional therapy via pancreatic enzyme replacement therapy, h2 blockers, proton pump inhibitors, sodium bicarbonate, TPN, TEN, 4000-6000 calories a day, no alcohol or fat
Interventions for hypercalcemia drugs discontinued? What drugs used?
Drugs like Ringer's, thiazide diuretics, Ca based antacids are discontinued. IV NS used, furosemide/Lasix used, calcium chealators/binders like plicamycin/Mithracin and penicillamine/Cuprimine, phosphorus, calcitonin aka Calcimar, biphosphonates aka etidronate, prostaglandin synthesis inhibitors like aspirin and NSAIDs.
Respiratory acidosis interventions
Drugs like bronchodilators, anti inflammatory so, mucolytics. O2 therapy. Ventilation support with mechanical ventilation. Preventing complications via monitoring
Nursing care for hemodialysis
Drugs like dialyzable, antibiotics, don't give right before dialysis, vasoactive drugs cause hypotension, Don't take BP or blood on access arm, watch fluid intake since there are restrictions and encourage rest
Cause of actual hypokalemia
Drugs like diuretics aka loop Lasix/furosemide, bumetanide/Bumex and thiazide/digitalis/corticosteroids/adrenergic agonists, increased aldosterone, cushing's, diarrhea, vomiting, wound drainage, NG suction, diaphoresis, kidney disease, NPO
Chronic gastritis interventions
Elimination of causative agents, treatment of underlying disease like uremia/Crohn's, avoidance or alcohol/tobacco, health teaching, vitamin b12 supplement
Hypomagnesemia signs and symptoms
Dumb blonde heiress running. Dysphagia, BP high, HR high aka tachycardia, reflexes high like cramps, tremors/numbness/tingling, positive trousseau and Chvostek signs. Muscle weakness, tetany, seizures, psychological depression, psychosis, confusion, hypoactive bowel sounds, anorexia, nausea, constipation, ab distention, possible paralytic ileus
Complications of gastrectomy
Dumping syndrome, alkaline reflux gastropathy, afferent loop syndrome
Afferent loop syndrome occurs when? Cause?
Duodenal loop partially obstructed. Pancreatic and biliary secretions fill intestinal loop which becomes distended causing painful contractions and nausea/vomiting 20-30 minutes after eating
GERD key features
Dyspepsia aka heart burn, regurgitation leading to aspiration/bronchitis, coughing, hoarseness, wheezing, water brash aka hypersalivation, dysphagia, odynophagia aka painful swallowing, epigastric pain, belching, flatulence, nausea, pyrosis and retrosternal burning, globes aka feeling of something in back of throat, pharyngitis , dental caries, chest pain, asthma
Preventing weight loss with COPD
Dyspnea management via resting premeals, small meals, use bronchodilators 30 minutes before meals. Urge to eat high calorie high protein foods
After patient hospitalized for diverticulosis what discharge teaching should you give for eating? What should they not eat?
Eat diet high in cellulose types of fiber like wheat bran, whole grain breads, and cereals 25-35g per day. Fresh fruits and vegetables are added to bulk stools. If they cannot tolerate recommended fiber retirement psyllium hydrophilic mucilloid aka Metamucil can be taken to increase size and consistency, drink fluids to prevent bloating. No nuts, corn, popcorn, cucumbers, tomatoes,nails, strawberries. Fat shouldn't exceed 30% daily caloric intake
Secondary health promotion define? Attempts to? Examples?
Efforts to detect & treat existing preclinical problems at earliest possible stage; screenings when at least 1 risk factor present •Attempts to discover a health problem at a point when intervention may lead to control or eradication ◦Early Detection via screenings and counseling ◦Prompt Diagnosis ◦Prompt Treatment •Examples: medical, dental, vision screening medication administration, wound care
Nutritional management of hyperkalemia you can eat
Eggs, bread, butter, cereal, sugar, fruits like apples, apricots, berries, cherries, cranberries, grapefruit, peaches, pineapple. Vegetables like alfalfa, cabbage, carrots, cauliflower, celery, eggplant, green beans, lettuce, onions, peas, peppers, squash
Diuretic stage of ARF complications
Electrolyte depletion Hypokalemia Hyponatremia Hypovolemia Hypotension
Acidosis can cause
Electrolyte shifts like K can shift into extracellular space causing hyperkalemia
Labs for over hydration? Aka?
Electrolytes normal, decreased hemoglobin, hematocrit, and serum protein due to excess water aka hemodilution. Specific gravity under 1.005
EMG
Electromyography uses electrodes to evaluate diffuse or localized muscle weakness usually accompanied with nerve conduction study
Labs for acute pancreatitis for amylase, lipase, trypsin, elastase, glucose. Calcium, magnesium, bilirubin, alanine aminotransferase, leukocytes, BUN, triglycerides, c reactive protein, platelets, albumin
Elevate amylase, lipase, trypsin, elastase, glucose. Decreased calcium and magnesium. Elevated bilirubin, alanine aminotransferase , leukocytes, BUN, triglycerides, c reactive protein. Decreased platelets, albumin
Lab assessment of hep a, b, c for alt? AST? Alkaline phosphatase? Bilirubin? Other lab tests to confirm
Elevated ALT and AST, alkaline phosphatase and bilirubin elevated. Antigen antibody test, ELISA, liver biopsy
Labs for liver disease for AST, ALT, LDH, alkaline phosphatase, bilirubin, urine urobilinogen, fecal urobilinogen, total protein, albumin, globulin, ammonia, PT, INR. Platelets, RBC, hematocrit, hemoglobin, WBC, creatinine, sodium
Elevated AST ALT LDH alkaline phosphatase bilirubin and urine urobilinogen. Decreased fecal urobilogen. For acute disease increased total protein, for chronic decreased total protein. Decreased albumin. Elevated globulin, ammonia. Prolonged PT and INR, platelet count low, low RBC count, hematocrit, hemoglobin and WBC. Elevated creatinine and low sodium
Hypovolemia lab indications
Elevated BUN, decreased proteins, increased hematocrit
Labs for dehydration? Aka? Not present when?
Elevated hemoglobin, hematocrit, serum osmolarity, glucose, protein, BUN, electrolytes aka hemoconcentration but it's not present when dehydration cause by hemorrhage because loss of all blood and plasma occurs together
Thiazolidinedione SE? Take when?
Elevated liver enzymes, fluid retention, must have periodic blood tests, increased fat, edema. Take before or 30 min. Before meal
Rheumatoid arthritis labs
Elevated rheumatoid factor, antinuclear antibody, ESR
Treatment for neurogenic bladder
Emptying every 3 hours in sitting position to prevent stasis+infection, tightening ab muscles during voiding, using Crede's maneuver aka mild massage downward over lower abs and bladder, cholinergic agonist drugs like bethanechol/Urecholine, catheters
Late stage AD interventions
Encourage ADLs as much as possible for feeling of independence. Validation therapy: recognize and acknowledge feelings/concerns of patient. Example: pt. looking for deceased mother ask to talk about what Mom looks like to not argue and not reinforce the belief
Exercise for Muskuloskeletal encourage? Walking? Promote?
Encourage weight-bearing exercises Walking - 30mins, 3-5 times/week Promote sunlight intake
Gynecological cancers types? Early disease? S/s?
Endometrial (uterine), Cervical, Ovarian cancers Early disease may not have symptoms. S/S:depend upon location & may include vaginal discharge, pain, bleeding, & systemic symptoms (weight loss & anemia).
Which female reproductive cancer is most common type
Endometrial cancer, most deadly: ovarian
Colonoscopy define? Suggested after what age? How often? Procedure? Prep? Positioning of patient?
Endoscope exam of entire large bowel. 50. Every 10 years. Endoscope through rectum and also allows tissue biopsy, sclerotherapy drug can be admined for bleeding. Prep: clear liquid diet the day before without red, orange, purple drinks, NPO except water 4-6 hours, patient drinks liquid sodium phosphate prep for cleaning bowel the night before or gallon of goLYTELY. Left side with knees up. Post: check Vs every 15 minutes
Endoscopic therapies for hemorrhage related to cirrhosis
Endoscopic variceal ligation aka banding to manage esophageal varices where bands around base of varices decrease blood flow. Endoscopic sclerotherapy aka sclerotherapy where varices injected via catheter to stop bleeding
Hysterscopy define
Endoscopy of uterus and cervix
Low molecular weight heparin LMWH examples? SE? Antidote? Labs?
Enoxaparin/Levenox, dalteparin/Fragmin, tinzaparin/innohep, fondaparinux/Arixtra. SE: thrombocytopenia, thrombosis, anemia, hyperkalemia, bleeding. Antidote: protamine sulfate. PT+PTT 1.5-2.5 X the control .
Postop for tracheotomy
Ensure patent airway, confirm bilateral berate sounds, respiratory assessment q 2 hours
Priorities for hypokalemia
Ensuring oxygenation, patient safety for falls, prevention of injury from potassium admin, monitoring response to therapy
Fluid/electrolyte imbalances due to enteral
Enteral feeling osmolarity isotonic 300mOsm to hypertonic 600 mOsm. Even when feed isotonic ECF can become hypertonic unless hypotonic fluids ingested/admined, increased osmolarity causes intracellular and interstitial water to move in plasma increasing water excretion causing osmotic dehydration and if patient has no normal renal/cardiac function can cause circulatory overload and pulmonary edema. Most common is hyperkalemia and hyponatremia due to hyperglycemia induced hyperosmolartiy causing the osmotic diuresis
Etiology of IBS
Environmental, immunologic, genetic, hormonal, stress factors, in US more likely in women, diet, intolerance to dairy, raw fruits, grains
Physical assessment for peptic ulcer disease
Epigastric tenderness at midline between umbilicus and diploid process, if perforation rigid boardlike abdomen and rebound pain, hyperactive bowel sound, dyspepsia, nausea/vomiting, orthostatic BP for fluid volume deficit, increase in pulses when going from sitting to standing, dizziness
Cardiac arrest 1st drug
Epinephrine aka adrenaline for perfusion
Hepatitis can also occur secondary to what infections
Epstein Barr, herpes simplex, varicella zoster, cytomegalovirus
Increased CO2 levels force
Equation to right and increase concentration of H proportionately
Endoscopic therapy for PUD what device used? Procedure? Preop?
Esophagogastroduodenoscopy used. Can isolate bleeding artery to embolism it using octreotide aka Sandostatin of terlipressin aka Novapressin. Preop: insert catheters, NPO 4-6 hours before, consent form. Postop: monitor VS, heart rhythm, o2, ability to swallow, gag reflex
Diagnostic for PUD
Esophagogastroduodenoscopy, nuclear medicine GI bleeding study
After seizures?
Establish airway (post ictal) Turn head to side Suction and/or oxygen as needed Check VS Check blood glucose Orient and reassure patient Document
Clinical manifestations if osteomyelitis
Fever above 101 Swelling around the affected area Erythema of the affected area Tenderness of the affected area Bone pain that is constant, localized, and pulsating; intensifies with movement Ulceration of the skin Sinus tract formation Localized pain Drainage from the affected area Possible bacteremia
Which statement about Glasgow coma scale is correct
Establishes a baseline for eye opening and motor and verbal response and LOC
Significant female reproductive hormones
Estrogens (prod. by ovaries; placenta, adrenal glands) - Progesterone (prod. by ovaries; placenta; adrenals) - Androgens & Relaxin - Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
C-peptide evaluate? Evaluate? Exogenous does not? Distinguish between?
Evaluate hypoglycemia Evaluate production of insulin made by the body (endogenous) and help differentiate it from insulin that is not produced by the body -medication (exogenous Exogenous does not generated C-Peptide Distinguish between type 1 and type diabetes
FOBT and sigmoidoscopy interval after screening? Comments?
Every 5 years.FOBT two or three samples from three consecutive bowel movements obtained at home
Lacto ovo vegetarian diet you can eat
Everything but meat
Laparoscopy define?
Exam of pelvic cavity to rule out ectopic pregnancy, evaluate ovaries, pelvic masses, aid in diagnosis of infertility, pelvic pain, sterilization, cyst aspiration, removal of tissue, lysis of adhesions, retrieval of intrauterine devices
A woman in her 30s ask the nurse about breast self exam (BSE). The nurse teaches her to
Examine breasts 1 week after LNP, stand in front of mirror, palpate when lying down, palpate when bathing/showering, lie down with arm overhead
PTH decreases Ca by
Excess Ca in plasma. Then thyrocalcitonin TCT from thyroid is increased and Ca decrease by inhibiting bone resorption of Ca, inhibiting vit. D associated intestinal uptake of Ca , and increasing kidney excretion of Ca in urine.
Hypercalcemia signs and symptoms for cardiovascular-including if mild or if severe/prolonged, neuromuscular, GU and GI
Excess clotting causing slow/impaired blood flow/asymmetrical calf/cool feet, dysrhythmias/arrhythmias, heart block, shortened QT interval, mild causes high HR + hypertension, severe/prolong=slow HR, cyanosis/pallor, altered LOC, no paresthesia, Muscle weakness, decreased deep tendon reflexes, polyuria, anorexia. Nausea, vomiting, absent or hypoactive bowel sounds, constipation, abdominal pain, and increased abdominal size
Common causes of fluid overload
Excess fluid replacement, late kidney failure, heart failure, corticosteroid therapy, syndrome of inappropriate ADH, psychiatric disorders with polydipsia, water intoxication
Priority problems for cirrhosis
Excess fluid volume, potential for hemorrhage due to portal hypertension, potential for hepatic encephalopathy due to shunting of portal venous blood and or increased serum ammonia levels
Common causes of Hyponatremia with dilution
Excess ingestion of hypotonic fluids, psychogenic polydipsia, freshwater submersion, kidney failure, irrigation with hypotonic fluids, inappropriate ADH secretion, heart failure
Actual cause of hypercalcemia
Excess intake of Ca and vit.D, kidney failure, thiazide diuretics
Physical assessment for cirrhosis early stages? Late stages?
Fatigue, weight changes, anorexia, vomiting, abdominal pain and liver tenderness, thrombocytopenia. Late stages: GI bleeding, jaundice, ascites, spontaneous bruising, dry skin, rashes, purpuric lesions aka petechiae or ecchymosis, red palms of hand, vascular lesions with red center and radiating branches aka spider angiomas on nose cheeks thorax and shoulders, edema of extremities and sacrum, sicca syndrome, osteoporosis, vitamin A D E K deficiencies
TB s/s?
Fatigue/ Lethargy Weight loss/ Anorexia/nausea Low grade fever/chills Night sweats SOB Persistent Cough/blood sputum Chest tightness with pain Wheezing/dullness/crackles Hemoptysis
Factors contributing to decreased lower esophageal sphincter pressure
Fatty foods, caffeine, chocolate, citrus, tomatoes, smoking, calcium channel blockers, nitrates, peppermint, alcohol, anticholinergic drugs, high levels of estrogen and progesterone, NG tubes
Peripheral parenteral nutrition PPN define? Does This? Less? For?
Feeding via peripheral vein. Doesn't meet all nutritional needs. Less concentrated than TPN. For shorter term therapy
Parenteral nutrition define? Examples.
Feeding when GI cannot be used via IV. Ex. Hyperalimentation aka hyperal, TPN though central veins like PICC or subclavian/jugular, PPN through cannula/catheter in large vein of arm or PICC when some patients can eat a little using IV fat/lipid emulsions and amino acid dextrose, TNA
Side effects of bone marrow/stem cell transplant/replacement
Fever, hypertension, possible red urine, nausea, Pancytopenia aka too few blood cells, graft vs. host disease, veno-occlusive disease aka liver blood block causing jaundice, pain, ascites, weight gain Treatment: Tylenol/acetaminophen, hydrocortisone, DIPHENHYDRAMINE/Bendryl before infusion, antihypertensives or diuretics, TPN, fluid/electrolyte management, blood products, antibiotics, GVHD prophylaxis
Transient ischemic attack TIA lasts how long
Few minutes to a fewer than 24 hours, s/s come and go
Without inflammation diverticula cause?
Few problems unless undisguised food or bactia become trapped and blood supply reduce resulting in diverticulitis which can perforate causing peritonitis and develop an abscess.
TPA
Fibrinolytic drug for PE if large+hemodynamic instability where BP cannot be maintained
Nonsurgical management of acute ischemic stroke
Fibrinolytic therapy and endovascular interventions, possible endarterectomy if thrombus
Fibroids need? During embolization ? This causes?
Fibroids need a blood supply to stay alive and grow. During the uterine artery embolization procedure, the blood supply is purposely blocked. This causes the fibroids to die off.
Leiomyomas aka? Are?
Fibroids/myomas. Are benign, slow-growing solid tumors of uterine myometrium (muscle layer)
Promoting continence with stroke
Figure out why they are incontinent, place patient on bedpan/commode or offer urinal q 2 hours, encourage intake of 2000ml/day, bedside bladder ultrasound for residual urine check to ensure full bladder emptying, have them drink apple/prune juice and consume high fiber foods, stool softener/Colace, no in dwelling catheter
Sunburn define? S/s? Treatment?
First degree/superficial burn. Erythema aka redness and pain. Treatment: comfort, antibiotics if blisters, topical corticosteroids for pain, NSAIDs for inflammation
HHS TREATMENT
First priority: increase blood volume, if shock/severe hypotension NS, otherwise 1/2 NS at 1L/hour to get slow steady improvement in LOC, then after fluid replacement IV insulin then when urine adequate IV K
Hypotonia aka
Flaccid paralysis where patient cannot overcome force of gravity and extremities fall to side and feel heavy and don't have good muscle tone
Symptoms of kidney tumors
Flank pain, blood in urine, palpable kidney mass, pain, bruit, pallor, darkening of nipples. Breast enlargement aka gynecomastia
If patient on mechanical ventilation, agitated, restless, widely fluctuating inspiratory pressure reading, or other signs of air hunger
Flow rate may be too low so increase
High flow systems vs. low flow system
Flow rate that meets entire oxygen needs regardless of breathing pattern vs. doesn't provide enough o2 to meet total o2 need and air volume so tidal volume supplied by RA
Perforation interventions
Fluid and blood and electrolyte replacement. Antibiotics, NPO, maintain nasogastric suction monitor intake and output and VS , look for septic shock like fever, pain, tachycardia, lethargy, anxiety
Weight is most reliable indicator of?
Fluid gain/loss
Maintaining patent tube flush with? If flushing after drugs? If clogged? If water not effective? Dissolve?
Flush with 20-30mL of water q 4 hours during continuous feeding/before and after intermittent feeding or drugs/after checking residual. If flushing after drugs use warm water. If clogged use 30mL water for flushing with 50mL syringe. If water not effective use carbonated beverage. Use liquid meds that are compatible with solution. Dissolve crushed meds in warm water
Physical assessment of pneumonia
Flushed cheeks, bright eyes, anxious, chest pain/discomfort, myalgia, headache, chills,, fever, cough, tachycardia, dyspnea, tachypnea, Hemoptysis, sputum production, chest weakness, crackles or possible wheezing, bronchial breath sounds, fremitus, dull percussion, diminished/unequal chest expansion, hypotension, rapid/weak pulse if hypoxemia, dysrhythmias, increased RR, blood/rust sputum, fever, pleuritic chest pain
Hypernatremia clinical manifestations fried salt? Neuro changes? Muscle and reflex changes?
Flushed skin and low fever, restless/irritable/anxious/confused, increased blood pressure and fluid retention, Edema, decreased urine output and dry mouth, skin flushed, agitation, low grade fever, thirst. Seizures, lethargic, stuporous/comatose, muscle twitching, irregular contractions, weaker muscles, reduced reflexes, irregular CV changes. With hypovolemia pulses difficult to palpate and hypotension, with hypervolemia distended veins, BP high, bounding pulse
Partial seizures aka? Begin where?
Focal/local seizures. Begin in 1 cerebral hemisphere. Some are partial and can become generalized tonic-clonic, tonic or clonic and others are complex
Mini mental state exam follow a? Repeat? Write? Copy? Assess?
Follow a 3 stage command(3) "Take paper in right hand, fold in half, and place on floor" Repeat and Obey "Close your eyes"(1) Write a sentence(1) Copy a design(1) Assess Level of Consciousness
Restorative proctocolectomy with ileo pouch anal anastomosis for? Performed via? What occurs?
For UC. Performed via laparoscopy. Removal of colon and most of rectum and creation of internal pouch then connected to anus and temp. Ileostomy to allow healing afterwards loop ileostomy closed
Total parenteral nutrition
For patients whose GI tract not functioning, anticipated under nutrition greater than 7 days, those who need complete bowel rest for healing like Crohn's, UC, pancreatitis. Goal to establish positive nitrogen balance, maintain weight, decrease muscle wasting. May reduce morbidity and mortality after major surgery, burns, head trauma.
Total proctocolectomy with parmanent ileostomy for? Procedure?
For those who are not candidates or don't want ileo anal ouch. Removal of colon, rectum, and anus with surgical closure of anus, end of ileum out through abdominal wall to form stoma aka ostomy and small intestines eventually performs same functions as colon including absorption of sodium and water
Intraosseous therapy for? Volume? Gauge? Use no longer than? Don't use in? Can cause? Sites?
For trauma, burns, cardiac arrest, DKA or life threatening conditions when veins cannot be found. Large volume parenteral infusions with 15-16 gauge for IO. Use no longer than 24 hours, don't use in osteoporosis, osteogenesis. Can cause fractures, compartment syndrome causing hypoxia,pain, coolness, swelling, discoloration. Sites: proximal tibia most common, distal fetus, medial malleolus in ankle, proximal humerus, iliac crest.
Direct injury vs. indirect head injury
Force produced by blow to head vs. force applied to another body part with rebound effect or brain
Diets low in fiber that cause less bulky stool and constipation have been implicated in
Formation of diverticula and retained un digested food in diverticula can cause diverticulitis, the retained food reduces blood flow to area making bacterial invasion easier
Teriparatide aka? Does what?
Forteo acting as PTH to treat osteoporosis
Tissue trauma from suctioning can result from
Frequency, prolonged suctioning, excess pressure, no rotation of catheter. Prevention: lube with sterile water/saline before, suction only when needed, apply suction during withdrawal using twirling motion
Chronic cholecystitis define? What's usually presents.
From repeated cystic duct obstruction causing chronic inflammation which causes gallbladder to become fibrotic and contracted resulting in decreased motility and deficient absorption and possible pancreatitis and cholangitis aka bile duct inflammation due to backup of bile and can then lead to jaundice. Calculi.
Food containing carbs
Fruits, vegetables, whole grains, low fat milk
Ultrasound for kidney requires
Full bladder
Uremia Define? Manifestations?
Full blown kidney failure causing buildup of nitrogen in urine and manifestations include anorexia, nausea, vomiting, cramps, pruritus, fatigue, lethargy
What's assessed after finding proteinuria?
GFR via creatinine clearance tests and patients with nephropathy have rise in serum creatinine due to BG/hypertension
Managing neuropathic pain
Gabapentin/Neurontin, pregabalin/Lyrica, duloxetine/Cymbalta, capsaicin cream/Zostrix, bed cradle to keep blankets off skin
Preventing genital warts
Gardasil vaccine for females/males, cervarix for females
Dumping syndrome can be caused due to
Gastrectomy for gastric ulcer
GERD aka? Occurs due to?
Gastroesophageal reflux disease. Reflux of GI contents into esophagus causing inflammation
Etiology of cholecystitis
Genetic, obesity, aging, DM, rapid weight loss, prolonged fasting, long term TPN use, gastric bypass, Crohn's, women, increased cholesterol, birth control
Wandering behavior can often be reduced by? Restraints should be?
Gentle persuasion/distraction, restraints should be avoided since increases agitation
Preventing cervical cancer
Girls/young women 9- 26 years should receive HPV vaccine, Gardasil or Cervarix(gives longer protection) before first sexual contact. Pap smears/pelvic exam. 3 injections over 6 months Gardasil for boys & men 9 - 26 years
For patient with sever hypoglycemia BG <20mg/dL who cannot swallow, unconscious, convulsing
Glucagon 1mg sub q or IM, repeat dose in 10 minutes if patient remains unconscious, notify
Type 2 DM define? Aka? Most? Age at onset? S/S? Risk factors? S/s?
Gradual Ranges from insulin resistance with relative deficiency to partial secretory deficit with insulin resistance. Aka adult onset diabetes AODM/non-insulin-dependent diabetes IDDM/ketosis-resistant. The most common type. >50year. Usually none, thirst, fatigue, blurred vision, vascular/neuro issues. Risk factors: Metabolic syndrome(3-5 s/s): overweight, age, genetics, hypertension, high level of triglycerides, decreased HDLs, ethnicity like Blacks, Asians, Hispanics, Hawaiians, Native American. Few symptoms
HHS onset? Precipitating factors? Manifestations? Serum glucose? Osmolarity? Ketones? Ph? HCO3? Na? BUN? Creatinine? Urine ketones?
Gradual. Infection/stress/poor fluid intake. Altered neuro, dehydration/electrolyte loss causing polyuria, polydipsia, weight loss, dry skin, sunken eyes, lethargy/coma. >600. >320. Negative. >7.4, >20mEq. Normal/low. Elevated. Elevated. Negative
Foods with folic acid
Green leafy, liver, yeast, dried beans, nuts
Tuberculosis, pulmonary infarction, bronchial adenoma, lung abscess sputum
Grossly bloody sputum
Robitussin aka? FunctioN?
Guaifenesin. Thins secretions to act as expectorant of mucus. Can cause dizziness
Etiology of peptic ulcers
H. Pylori, NSAIDs, COX-2 inhibitors like Celebrex, corticosteroids, theophylline, caffeine, radiation, genetics
Most gastric and duodenal ulcers caused by
H.pylori
Drugs for gastritis
H2 receptor antagonists, mucosal barrier fortifier, antacids, proton pump inhibitors
Recommended dietary allowance for water? Carbs? Proteins? Fiber? SOdium? K? Dairy? Mg? Sugar? Fat? Alcohol?
H20: 2 - 3 L/day •Carbohydrates: @ least 100g/d; 45-65% of calories •Protein: 56-63 g/day; 10-20% of calories •Fiber: 14 g/1000 calories (Whole grains,fruits/veg) •Sodium: <2,300 mg (~ 1 tsp salt)/day •Potassium: 4,700 mg/day •Calcium/Dairy: 1000 mg/day (3 cups) •Magnesium: 310 - 420 mg/day •Sugar: Women: 6 tsp Men: 9 tsp •Fat: 30% of total calorie intake Alcohol: women 1 drink/day, men 2
HBA1c in relation to mean plasma glucose
HBA1c 6% when glucose 126mg/dL, for each 1% of HBA1c raised how much higher does plasma glucose raises 28 more
Interventions for increased ICP
HOB 25-30 degrees, oxygen therapy, head in midline/neutral position, if severe hemiparesis position on side, no flexion, no clustered procedures, hyper oxygenating before suction, quiet room, low lights, VS q 1-2 hours
Post breast conserving/mastectomy surgery
HOB 30 degrees, affected are elevated on pillow, hand wall climbing, pulley exercise, rope turning
Interventions for ICP
HOB 30 degrees, neck neutral, Avoid valsalva maneuver and increases in intrathoracic and intra-abdominal pressure and aggitated states, Suction only when needed with hyperventilation, Avoid fluid overload, O2 >92% and paCO2 30-35, prevent hypoxia since high O2=vasoconstriction, prevent hypercapnia since paCO2 is vasodilator, maintain MAP at 60-80 minimum, control ICP below 25
Risk factors for cervical cancer
HPV infection, Smoking, Younger than 18 years old with first intercourse; Multiple sex partners, History of STDs, Obesity, Family history of cervical cancer, Sexual partner had a previous partner who developed cervical cancer
cardiovascular changes due to dehydration
HR increases, peripheral pulses weak, BP and pulse pressure decreases, orthostatic/postural hypotension, neck and hand veins are always flat even when no raised above heart(they're supposed to be distende above heart or supine)
After giving fluids for dehydration what should you look for
HR should go down
Genital herpes aka? S/S? Drug Treatment?
HSV-2. S/S: itching/tingling, vesicles/blisters, headaches, fever, malaise, swelling of lymph nodes, painful urination. Acyclovir/Zovirax, famciclovir/Famvir, valacyclovir/Valtrex
Dermatological findings of cirrhosis
Hair changes, caput medusae, ecchymosis, increased pigmentation, jaundice, palmar erythema, pruritus, spider angiomas
My plate
Half meal should be fruits/vegetables, 1/4 grains with at least half whole grains,1/4 protein, small glass of dairy
Nonsurgical interventions for appendicitis
Keep patient with suspected or known appendicitis on NPO, IV fluids, semi fowlers, only after diagnosis of appendicitis can you give opioids and antibiotics and don't give laxatives or enemas, no heat
Preventing CR-BSI
Hand hygiene , maximal barrier precautions using draped head to toe with sterile barrier when inserting central line and use sterile gloves/gown/mask, chlorhexidine for skin disinfection, PICC preferred over subclavian vascular access devices, subclavian sites better than jugular and upper arm, remove line as soon as it isn't needed
CDC recommendation for preventing catheter related bloodstream infections
Hand hygiene before palpation, clip hair, don't shave, ensure skin clean, wear clean gloves, don't touch access site after application of antiseptics, prepare clean skin with 70% alcohol or chlorhexidine before insertion, apply providing iodine to skin and allow it to dry for at least 2 minutes
Preventing HAV
Hand washing, avoiding contaminated food and water, immunoglobulin within 14 days of exposure, vaccine,
Treating amputation pain
Handle residual limb carefully, calcitonin, beta blockers like propranolol for constant dull burning, antiepileptic drugs like carbamazepine/tegretol or gabapentin/Neuronten for sharp pain, antispasmodic like baclofen/Lioresal for spasms/cramping, antidepressants, ultrasounds therapy, massage, heat, biofeedback, relaxation therapy, hypnosis, psychotherapy TENs
Most common cause of paralytic ileus aka nonmechanical obstruction? What predisposes patient to this? Can also be caused by?
Handling of intestines during abdominal surgery and usually function lost for a few hours to several days. Electrolytes disturbances like hypokalemia predispose patient. Can also be caused due to peritonitis, vascular insufficiency aka intestinal ischemia due to arterial or venous thrombosis/embolization
Leprosy aka? Define
Hansen's disease. mycobacterial infection of the peripheral nervous system with skin involvement causing plaques, red macules, papules, nodules, reduced skin sensation; uncommon in USA. Treatment: Dapsone/DDS/Avlosulfon, rifampin/Rifadin/Rimactame, clofazimine/Lamprene, ofloxacin/Floxin, minocycline/Dynacin/Minocin
How is cerebral motor/brain stem integrity assessed
Have them close eyes and hold arms perpendicular with palms up if they can't keep it up and palms pronate aka pronation drift there is issue
If patient has s/s of epididymitis/orchitis
He will need to have cultures done first; antibiotics; analgesics & antipyretics. Ultrasound study is done to R/O an abscess or tumor, esp. if the condition does not resolve within 1 to 2 weeks. CXR is not indicated for a client without respiratory symptoms or reports
Ulcer complications
Hemorrhage causing hematemesis, melena, perforation causing peritoneal cavity leakage resulting in sudden sharp pain and rigid board like abdomen aka peritonitis and septicemia and hypovolemic shock and possible paralytic ileus, pyloric obstruction
Most common complications of PUD
Hemorrhage, perforation, pyloric obstruction, intractable disease
Normal nutrition for cirrhosis
High carbs+proteins, moderate fat
Interventions for elderly large intestines changes
High fiber diet, 1500ml fluids, activity
Meningococcal meningitis high? Occurs most in? Usually caused from?
High mortality within 24 hours. Occurs most in outbreaks with high populations during fall/winter from upper respiratory tract infections. Usually caused from s. Pneumoniae and neisseria meningitidis
TF formula
High osmolality that draws fluid into stomach and intestine, hyperosmolar diuresis and brain dehydration, diarrhea, nausea
Factors that can lead to hepatic encephalopathy in patients with cirrhosis
High protein diet, infections, hypovolemia, hypokalemia, constipation, GI bleeding, drugs
Patient scheduled for EEG how does rn prepare patient
Keeping patient awake from 2am until test time
Hits nails clinical findings? Significance?
Horizontal white banding or areas of opacity from liver or kidney disease or hypoalbuminemia. Generalized pallor due to shock, anemia, arteriosclerotic changes, MI
Nutrition therapy for CD during severe exacerbations? For less severe? Avoid?
Hospitalized for bowel rest with total parenteral nutrition. For less severe exacerbations elemental or semi elemental Vivonex which absorb in jejunum to permit distal small intestine and colon rest. Avoid GI stimulants like caffeine and alcohol
Assess respiratory status and drainage of chest tube?
Hourly, not emptied unless container so full, notify if drainage >100ml/hr. After first 24 hours assess q 8 hours
Morbidity vs. mortality
How frequently a disease occurs vs. number of deaths
BRCA1 & BRCA2
Human genes if mutated altered=cancer
Metabolic acidosis interventions
Hydration, if due to DKA insulin, antidiarrheals if due to diarrhea, bicarbonate if low, monitoring s/s and ABG
ICP can lead to
Hydrocephalus and cerebral edema, hernia tion of brain
Thiazide trade name? Aka? Use?
Hydrodiuril. Diuretic. Hypertension, edema via increasing Na+H2O+Cl+K excretion
Antispasmodic example
Hyoscyamine aka anaspaz, cystospaz. SE: blurred vision, confusion, dizziness, fainting, fast heartbeat, fever, difficulty passing urine, dilated pupils
Common causes of actual hypernatremia
Hyperaldosteronism, kidney failure, corticosteroids, Cushing's syndrome, excess oral sodium, excess sodium IV fluids
DKA labs
Hyperglycemia >300, low bicarbonate <15, and acidosis pH <7.3, with ketonemia, and ketonuria,
Excess loss of CO2 cause
Hyperventilation from fear/anxiety/mechanical ventilation/salicylate toxicity. Hypoxemia-stimulated from hyperventilation, high altitudes, shock, early stage acute pulmonary problems, fever, CNS lesions
Causes of delirium
Hypoglycemia Hypoperfusion of CNS Hypoxia Intracranial bleed Meningitis/encephalitis Poisons/Medications High fever Electrolyte imbalance HIV/AIDS Elderly in unfamiliar environment Thiamine deficiency
Hypoinsulemia can cause
Hypokalemia when treatment with insulin begins
Neuromuscular acidosis key features
Hyporeflexia, skeletal muscle weakness, flaccid paralysis
Priority patient problems for acidosis
Hypotension, decreased perfusion, impaired memory, increased risk for falls
Complications from mechanical ventilation
Hypotension, fluid retention, barotrauma, volutrauma, stress GI ulcer, paralytic ileus, malnutrition, infection, muscle weakness, ventilator dependence
S/s of increased ICP
Hypotension, hypoxemia, hypercapnia, Cushing's triad aka hypertension with widened pulse pressure and bradycardia, thready/irregular/rapid pulse, headache, n/v, seizures, papilladema aka choked disc and is edema+hyperemia of optic disc
Key features of prerenal azotemia aka acute renal disease
Hypotension, tachycardia, decreased CO, venous pressure, urine output, and lethargy
0.45% saline tonicity? Provides? Used to replace? Used as. How many kcal/L provided?
Hypotonic.Provides free water and sodium & chloride Used to replace hypotonic fluid losses Used as maintenance solution although it does not replace daily losses of other electrolytes Provides no calories
Sickle cell disease pathophysiology
Hypoxia, dehydration, infection, venous stasis, pregnancy, alcohol, high altitudes, low/high temp., acidosis, exercise, stress, anesthesia causes sickling of RBC and hemolytic blood destroying anemia, clogs capillaries leading to more hypoxia and sickling leading to ischemia and necrosis mostly in spleen, liver, heart, kidney, brain, joints, bones, retina
Suctioning can cause
Hypoxia, tissue trauma, infection, vagal stimulation, bronchospasm, cardiac dysrhythmias
Cor pulmonale from COPD key features
Hypoxia/hypoxemia, dyspnea, fatigue, enlarged liver, warm/cyanotic hands/feet, bounding pulses, cyanotic lips, distended neck veins, right ventricular enlargement, visible pulsations below sternum, GI issues like nausea/anorexia, dependent edema, metabolic/respiratory acidosis, hypertension
PET supposed to be given but patient suspected of having early Alzheimer's, which statement indicates he didn't understand info
I will be asleep and get mild med to relax. Correct: add or subtract to remember, blindfolded, no insulin in morning
Nonsurgical management of peritonitis
IV fluids, broad spectrum antibiotics, monitor daily weight, intake and output, NG tube to decompress, NPO, O2, pulse oximetry, pain meds
IV urography aka? Pre? Procedure?
IV pyelography. Prep: light meal, clear liquids, or NPO midnight/8 hrs before, bowel prep, check allergies, asthma, kidney failure, metFORMIN, check creatinine, consent. Procedure: dye injected via IV and can cause warm sensation, nausea. Metallic taste, incontinence
ISBAR or ISBARR define
Identify yourself, situation, background, assessment, recommendation, response that receiver provides
The Rule of 15 to treat hypoglycemia
If <70mg/dL 15g of simple fast acting carb like 4-6 oz of fruit juice or soft drink, gels/tabs with specific amount of glucose to carry around, recheck BG 15 min. Later if value still <70mg/dL 15g more cards and recheck BG in 15 minutes, if no significant improvement after 2-3 doses contact provider, because of potential for rebound hypoglycemia after have them ingest complex carb after recovery to prevent hypoglycemia
Treatment for hypoglycemia
If BG <70mg/dL, if more than 70 mg/dL investigate further for cause, if no monitoring equipment initiate treatment.
Tube feeding care/maintenance
If NG or nasoduodenal small tube verified via xray and secured with tape after skin protectant, assess site for infection/excoriation via redness/drainage, rotate tube 360 degrees each day , cover site with sterile dressing every day, check residual q 4-6 hours by aspirating into syringe, if residual feeding obtained slow/stop feeding, check pump, change feeding bag q 24-48 hours, label bag with date/time/initials, change irrigation set q 24 hours,for continuous/cyclic feeding add 4 hours of product to bag at time, closed system preferred, wear gloves, wipe lid of formula can with clean gauze, sterile gloves for critically ill/immunosuppressed, label cans with date/time, refridgerate cans, discard cans q 24 hours, no dye, keep HOB elevated 30 degrees during feeding and for at least 1 hour after if bolus, semi-fowler's for cyclic/continuous, monitor labs and I/O
Acute gastritis interventions
If bleeding or ulceration sever blood transfusion or surgery like gastrectomy/pylori lastly/vagotomy, fluid replacement
ED surgery if caused by? Candidates are? Not recommended for?
If caused by artery blockage leading to penis, this used to restore blood flow. Candidates are younger where blockage stems from injury. Not recommended for older men with widespread narrow arteries
Labs for hyperkalemia if caused by dehydration? If caused by kidney failure?
If dehydration: other electrolytes H&H are elevated. If kidney failure elevated creatinine and BUN, decreased pH, and normal/low H&H
Interventions for hypernatremia if life threatening? If due to fluid loss? If due to fluid and Na loss? If caused by poor kidney excretion? If mild?
If life threatening hemodialysis or blood ultrafiltration. If due to fluid loss hypotonic IV like 0.225% NaCl. If due to fluid and Na loss IV of 0.45% NS. If caused by poor kidney excretion diuretics like furosemide/Lasix or bumetanide/Bumex. If mild nutrition therapy like increasing water intake or NaCl restriction
Romberg sign
If patient stands with eyes close and sways and tests propioreceptive and means cerebellar issue
Surgical management of diverticular disease done when? Procedure done?
If peritonitis, bowel obstruction, or abscess. Colon resection with or without colostomy, possible anastomosis if no severe inflammation or infection.
Minor head injury education for home
If person is sleeping wake q 3-4 hours 1st 2 days asking name/location/name of caregiver, headache/nausea/dizziness normal for 24 hours, acetaminophen for headaches q4 hours, no sedatives/sleeping pills/alcohol for 24 hours, no strenuous activity for 48 hours, no nose blowing/ear cleaning for 48 hours, notify if blurred vision/ear+nose drainage/weakness/slurred speech/vomiting/worsening headache/unequal pupil size
Braden scale when to initiate skin breakdown protocol
If score <16, High risk for skin breakdown, initiation of skin breakdown protocol, high protein diet with 1.25-2g protein/kg/day
Treatment of HHS and DKA
In order:Ensure patent airway, admin of O2, IV NS or 0.45% NS to restore U/O to 30-60mL/hr and raise BP, hemodynamic monitoring for fluid overload, continuous regular insulin drip at 0.1 U/kg/hr, avoid hypoglycemia, be sure U/O at least 30ml/hr before IV K+, monitor EKG, check BG, correct precipitating cause, when BG >250mg/dL IV glucose admin via 5D5 1/2 NS, monitoring of cardiac/renal/mental status
Prosopagnosia
Inability to recognize oneself and other familiar faces
Catheter dislodgement causes? S/s? Treatment? Prevention?
Inadequate securement, excess activity with PICC. S/s: external length changed. Treatment: stop all, flush, determine external catheter length and compare with documentation, notify. Prevention: proper securement, no excess activity
Care postop for inpatient fundoplication
Incentive spirometry , deep breathing/coughing, NG drainage should be dark initially but then turn yellowish green, check for proper NG tube placement every 4-8 hours, frequent oral hygiene, assess hydration status
Older adults and GERD
Incidence of heart burn decreases and instead chest pain. Ear, nose, throat infections. Pulmonary issues like aspiration pneumonia, sleep apnea, asthma.
Yellow-orange skin cause? Significance?
Increase bilirubin/jaundice, increased cartotene/carotemia, increased urochrome. Increased hemolysis, liver disorders, increase in carrots, pregnancy, thyroid deficiency, diabetes, kidney disease
Treatment for b12 deficiency
Increase foods with b12 like animal protein, eggs, diary. Vitamin supplements or injections or cyanocobalamin/Calomist
Gastroenteritis define
Increase in frequency and water content of stools and or vomiting as result of inflammation of the mucous membranes of stomach and intestinal tract Due to virus/bacteria/parasite
Treatment for dawn phenomenon
Increase in insulin or adjustment in admin time
Portal hypertension define? Results from? Causes?
Increase in pressure within the portal vein greater than 5 mm Hg and major complication of cirrhosis and results from increased resistance or blockage causing blood to flow back into spleen causing splenomegaly aka spleen enlargement and veins in esophagus stomach intestines abdomen and rectum become dilated. Can cause ascites aka abdominal fluid, esophageal varices aka distended veins, prominent abdominal veins aka caput medusas and hemorrhoids
As amount of Co2 rises above normal in brain blood and tissues this triggers
Increase in rate and depth of breathing aka hyperventilation decreasing CO2 in ECF
Vasogenic edema
Increase in volume of brain tissue due to abnormal permeability of the walls of cerebral vessels which allow protein rich plasm to infiltrate into extra space of brain
cardio alkalosis key features
Increased HR, normal/low BP, increased digitalis toxicity, thready pulse
Hypoxia s/s
Increased HR/BP, oxygen desaturation, cyanosis, restlessness, anxiety, dysrhythmias and pulse oz <90
Cause of hypermagesemia
Increased Mg intake like antacids/laxatives, kidney disease, hypothyroidism, adrenal insufficiency
CNS alkalosis key features
Increased activity, anxiety, irritability, tetany, seizures, positive Chvostek's, positive Trousseau's, paresthesia, dizziness, confusion
Endocrine findings for cirrhosis
Increased aldosterone, ADH, estrogens, glucocorticoids
Blue skin cause? Significance?
Increased in deoxygenated blood/cyanosis, bleeding from vessels aka petechiae 1-3mm, Ecchymosis >3mm. Cardiopulmonary disease, methemoglobinemia, thrombocytopenia, blood vessels fragile
Pulse 114 and RR 24 can mean
Increased metabolic needs from infection or DKA, fluid volume deficit, metabolic acidosis
Increased bowel sounds from
Increased motility aka borborygmus from diarrhea gastroenteritis or intestinal obstruction or Crohn's disease
GI and renal changes for fluid overload
Increased motility and enlarged liver, possible urine reduction
Cardiovascular changes due to fluid overload
Increased pulse rate, bounding pulse, full peripheral pulses, elevated BP, distented veins, engorged varicose veins, weight gain
Respiratory alkalosis key features
Increased rate and depth of ventilation in respiratory alkalosis, decreased respiratory effort associated with muscle weakness in metabolic alkalosis
Respiratory changes due to dehydration
Increased rate because decreased volume reduces perfusion and oxygenation
Potential complications of acute pancreatitis
Infection that can cause septic shock, hemorrhage aka necrotizing hemorrhagic pancreatitis, kidney failure, paralytic ileus, hypovolemic shock, pleural effusion, respiratory distress syndrome, atelectasis, pneumonia, multi organ system faili m disseminated intravascular coagulation, type 2 DM, jaundice, hyperglycemia,
Foul smelling urine can indicate
Infection, dehydration, foods, drugs
Cloudy urine can indicate
Infection, sediment, high levels of protein
Infectious cystitis is most common? Indwelling catheters? Commonly from what bacteria? Can lead to? Most common cause of
Infectious cystitis most common type of UTI ~50% of patients with indwelling catheters become infected within 1 week Commonly E. Coli Can lead to Pyelonephritis Can lead to life-threatening complications Urosepsis-spread from urinary tract to bloodstream The most common cause of sepsis in hospitalized patient
FSH decreased means? Elevations mean?
Infertility, anorexia, neoplasms. Turner's syndrom
Pathophysiology of cirrhosis? In early disease? As it progresses?
Inflammation caused by toxins or disease causes destruction and tissue becomes nodular that can block bile ducts and blood flow. In early disease causes liver enlargement, firmness, and hardness. As continues liver shrinks
Epididymitis define? Treatment?
Inflammation of epididymis. CBR; scrotal support & elevation; ice; antibiotics after urine & prostate cultures obtained; NSAIDs; scrotal support; 0 lifting or sex X 4 weeks. If abscess, orchiectomy (removal of 1 or both testes
Cholecystitis define? Types?
Inflammation of gallbladder. Acute: calculous or acalculous or chronic
Acute gastritis caused by? Pathological manifestations? Healing occurs when?
Inflammation of gastric mucosa after exposure to local irritants. Pathological manifestations are thick reddened mucous membrane with rugae aka folds, necrosis and inflammation possible . Heals after a few days.
Benign prostatic hypertrophy
Inflammation of prostate resulting in urinary stasis and retention aka overflow urinary incontinence causing dribbling of urine, UTIs, calculi, dilation of ureters aka hydroureter and kidneys aka hydronephrosis and chronic kidney disease, hematuria
High sensitivity C reactive protein aka hsCRP elevation confirms? Normal?
Inflammation/inflammatory disease like RA or infection, tissue damage, hypertension, increased risk for CAD. <1mg/dL
Circulatory overload cause? S/s? Treatment? Prevention
Infusion of fluids greater than system needs. S/s: SOB, cough, BP raised, edema, neck veins engorged, moist breath sounds. Treatment: slow rate, notify, upright position, monitor VS, O2, diuretics. Prevention: monitor I/O, notify as soon as noticed
Respiratory: decreased H or CO2 does what?
Inhibits RR and depth retaining CO2 increasing H and decreasing pH
Alcohol in relation to DM? Is more likely to cause hypoglycemia when?
Inhibits liver glucose causing hypoglycemia, interferes with counterregulatory response, impairs glycogen breakdown. Patient doesn't eat for long time, when basic nutrition poor, glycogen stores depleted so only drink with or shortly after meal
Primary skin lesions
Initial reaction:Macule, patch, bulla, vesicles, papule, plaque, wheat, tumor, pustule, cyst
Chronic complications a diabetic retinopathy
Initially no changes in vision, painless, visible retinal changes, complains of glare annual eye exam with dilation to monitor, see ophthalmologist if blurred/double vision/narrowed field of vision/seeing dark spots/ feeling pressure+pain in eyes
Nontunneled percutaneous central venous catheter CVCs
Inserted by physician through subclavian vein in upper chest or internal jugular vein and in worst case femoral vein and inserted into SVC and confirmed via X-ray. 7-10 inches long. And 1-5 lumens. Use: for trauma, or emergency, critical care, surgery. usually short term but No specific dwell time.
Colposcopy define
Inspection of cervix, vagina, vulva with biopsy
Ab assessment technique
Inspection via standing at side looking down or at eye level, auscultation with diaphragm, percussion, palpation
If 2-4 AM BG high
Insulin dose should be increased and patient should be counseled on bedtime snacks
Exogenous insulin is from? Required for? Prescribed for?
Insulin from an outside source Required for type 1 diabetes Prescribed for patients with type 2 diabetes who cannot control blood glucose by other means during stress like illness
Basal insulin vs. prandial
Insulin secreted at low levels during fasting vs increased levels after eating
If predawn levels less than 60 mg/dL or 3.3 mmol/L and s/s of hypoglycemia present
Insulin should be reduced
In both intestinal obstructions
Intestinal contents accumulate at and above area of obstruction causing distention, peristalsis increases stimulating more secretions adding to distention, bowel then becomes edematous and increased cap permeability causes leaking into peritoneal cavity and intestinal lumen decreasing absorption further and reduced circulatory blood volume causes hypovolemia and electrolyte imbalances, possible bacterial peritonitis with or without perforation
Incretin hormones are released by? Increases when? When glucose normal/elevated? Inactivated by?
Intestines throughout day, increasing in response to meal. When glucose normal/elevated incretins increase insulin synthesis, inhibit glucagon, slow gastric emptying, as well as decreasing hepatic glucose production. Inactivated by DPP-4.
Endovascular intervention for stroke
Intra-arteria thrombolysis using drugs and embolectomy within 6 hours of onset
Continuous enteral nutrition administration ? What's best?
Introduce gradually, full strength formula, progress as tolerated. Small bowel best to prevent aspiration aka j. Tube
What's needed to form RBCs and HGB
Iron, vitamin b12, folic acid, copper, pyridoxine, cobalt, nickel
Cirrhosis define
Irreversible scaring of liver usually caused by chronic reaction to hepatic inflammation and necrosis that usually envelops slow resulting in liver disease.
Postop for nephrostomy
Irrigate carefully if ordered, assess stoma for bleeding or insufficient blood supply, increase fluid intake
S/s of delirium
Irritability, tremulous, insomnia, poor appetite, memory loss, disorientation, inappropriate remarks, transient illusions/hallucinations, difficulty concentrating, restlessness, mood changes, crying, depression, sleep/wake cycle issues
Report what signs in relation to stoma
Ischemia and necrosis via dark red, purple, black color, dry, firm, flaccid, unusual bleeding, mucocutaneous separation aka breakdown of suture line securing stoma to ab wall.
Both terlipressin and somatostatin can cause
Ischemic issues and dysrhythmias so observe cardiac rhythm, apical pulse rate, blood pressure
Dextrose 5% in water- tonicity? Provides what. Used to? How manu kcal/L provided? Electrolytes?
Isotonic outside body until inside and hypotonic due to metabolizing glucose. Provides free water necessary for renal excretion of solutes, used to replace water losses/hypernatremia, provides 179kcal/L. Does not give any electrolytes
Dextrose 5% in 0.225% NS tonicity? Provides? Used to? Provides how much Kcal/L?
Isotonic. Provides sodium, chloride & free water Used to replace hypotonic losses & treat hypernatremia Provides 170 kcal/L
Streptokinase aka? Alert? Class? For? SE? Don't take with? Antidote?
Kabbikinase/Streptase. high. Thrombolytic. For MI, PE, DVT, dissolves fibrin in clots. SE: hemorrhage, ischemia, thromboembolism, bleeding. Aspirin, NSAIDs, garlic. Aminocaproic acid/Amicar.
Noninvasive positive pressure ventilation define? Can cause?
Keeps alveoli open and improve gas exchange for dyspnea, hypercarbia, acute exacerbations of COPD, pulmonary edema, acute asthma. Can cause skin breakdown, pressure around eyes, gastric insufflation causing n/v+aspiration
Albumin plasma protein 5% or 25%
Keeps fluid in vessels, maintains volume, used to replace protein and treat shock and erythroblastosis fetalis. May cause anaphylaxis, fluid overload, pulmonary edema.
Urine ketone bodies are not reliable for evaluating treatment effectiveness because
Ketones variably reabsorbed and may be present long after BG returns to normal
Cause of Hyperphosphatemia
Kidney disease, tumor lysis syndrome, increased intake of phosphorus, hypoparathyroidism, acidosis, hypocalcemia
Underproduction of bicarbonate ions metabolic acidosis conditions
Kidney failure, impaired liver or pancreatic function, dehydration
Under elimination of H metabolic acidosis conditions
Kidney failure, lung issues
24 hour creatinine clearance is best indicator of
Kidney function and deterioration, GFR
What controls bicarbonate? What controls CO2? So pH is?
Kidneys control bicarbonate and lungs control CO2 so pH is function of kidneys divided by lung function
Rifampin purpose ? Interventions
Kills TB. Can stain skin/urine/secretions reddish orange, no alcohol, report dark urine/yellow skin/increased bruising/bleeding since can cause liver damage
Pyrazinamide purpose ? Interventions
Kills TB. Don't take with gout, drink water/increase intake, protective clothing from sun, no alcohol, report dark urine/yellow skin/increased bruising/bleeding since can cause liver damage
Ethambutol purpose? Interventions
Kills TB. No alcohol report vision changes, no gout, increase fluids
Isoniazid/INH purpose? Interventions?
Kills mycobacteria for TB. Take on empty stomach, take vitamin B, no alcohol, report dark urine/yellow appearance of body/increased bruising+bleeding since can cause liver damage
Mcmurray test
Knee flexed/rotated and then pressed while extending leg. + if clicking palpated/heard
Providing care for reduced vision
Knock/announce entrance in room, make sure everyone knows, determine degree of deficit, orient to environment, count steps to bathroom, place personal items at bedside, don't move items without permission, remove clutter, ask type of assistance needed, describe plated food, open packages, use normal voice, offer arm when walking
ADA recommends for preventing macrovascular issues LDL? Triglycerides? HDL in men? In women? Target BP?
LDL <100mg/dL, triglycerides <150mg/dL, HDL in men >40mg/dL, in women >50mg/dL, a BP <130/80
Clinical manifestations of Hyponatremia- neuro changes? GI changes? Respiratory issues? Other organs? CV ? If occurs with hypervolemia? What happens to cells? ECF compared to ICF?
LOC and behavior, headache, lethargy, muscle weakness, diminished deep tendon reflexes, seizures, coma, Nausea, vomiting, ab cramping, increased intestinal motility, diarrhea, respiratory arrest, liver disease, adrenal insufficiency, hypovolemia, rapid weak pulse that's difficult to palpate, decreased BP, if occurs with hypervolemia full bounding pulse with high BP. Cellular swelling and reduced depolarization since osmolarity of ECF lower than ICF
Preop teaching for leiomyomas/fibroids/myomas
Lab tests; CBC, Chemistry Prophylactic antibiotics TCDB; Incentive Spirometer *Early ambulation; leg exercises Pain relief Psychological Assessment
Lactulose aka? Function?
Lactitol. Promotes excretion of ammonia in stool. Side effects: intestinal bloating, cramping, hypokalemia, dehydration
Multiple sclerosis objective data
Mobility, Hyperactive DTRs, Clonus , Positive Babinski, Absent abdominal reflexes, Intention tremor, Cranial nerves, Hearing or vision changes
Causes of actual hypocalcemia
Lactose intolerance, malabsorption syndromes like Celiac/Crohn's , inadequate vit. D, ESRD, kidney failure, diarrhea, steatorrhea, wound drainage, othorpedic surgery or bone healing, thyroid surgery, radiation of check/neck, neck injury
Digoxin aka? Alert? Class? Used for? Does what? Admin? Can cause? Normal blood level? Check? Use caution in?
Lanoxin. High. Cardiac glycoside. Antiarrhythmic. For HF, a.fib. Increases CO and lowers HR. PO/IV. Cardiac, GI, CNS toxicity. 0.5-2 and EKG can identify toxicity. Check K, Ca, Mg, HR, hold if <60
Surgical management of cholecystitis
Laparoscopic cholecystectomy, tradition cholecystectomy
Surgical management of GERD
Laparoscopic nissen fundoplication and is minimally invasive
Hemodyalisis catheters lumen? Used for? How long can be used? Risk for? Lock with? Remember to?
Large lumen. Use:hemodyalisis, pheresis. Tunneled for long term or nontunneled for short. Risk for CR-BSI, DVT. Lock with 1000-10000 units/mL heparin or sodium citrate. Remember to aspirate before any use.
Transjugular intrahepatic portal systemic shunt for hemorrhage related to cirrhosis
Large sheath placed through jugular vein and pushed through liver into portal vein and balloon enlarges tract and stent keeps it open
Peptic ulcer define? Types?
Lesion of stomach or duodenum. Gastric, duodenal, stress
Daily cholesterol intake and same for sodium
Less than 300mg/days. Sodium less than 2300mg/day and <1500mg for 51 years or older and those of any age of blacks and/or have hypertension, diabetes, chronic kidney disease. Low sodium= malabsorption, liver disease, pernicious anemia, cancer, sepsis
Lidocaine aka? Alert? Used for? Does what? SE?
Lidopen. High alert. IV/topical anesthetic or antiarrhythmic. Suppresses spontaneous depolarization. SE: seizures, confusion, muscle twitching
Hyperosmolar hyperglycemic syndrome HHS is? Occurs? Precipitating factors?
Life-threatening syndrome Occurs most often with type 2 diabetes who are able to make insulin to prevent DKA but not enough to prevent hyperglycemia, osmotic diuresis, and ECF depletion UTIs, pneumonia, sepsis, Acute illness, Newly diagnosed type 2 diabetes, Impaired thirst sensation and/or inability to replace fluids
POP post op management
Limit activities, no lifting > 5 pounds, no strenuous exercise, no sex for 6 weeks Moist heating pad/warm compress to abdomen Absorbable sutures Notify MD of signs of infection No straining w BM; may need pain meds w BM Sitz baths Health education
Community based care for post op leiomyomas/fibroids/myomas
Limit stair climbing No driving for 2 - 6 weeks Educate re: expected physical changes Educate re: resuming sexual activity Psychosocial support Provide written material
Major pathophysiology processes during acute pancreatitis
Lipolysis causing hypocalcemia, proteolysis leading to thrombosis and gangrene, necrosis of blood vessels causing hemorrhage and inflammation
Crohn's disease location? Etiology? Peak incidence age? Number of stools? Complications? Need for surgery?
Location is often in ileum and patchy through all layers of bowel. Etiology unknown. 15-40 years. Stool is 5-6 soft loose nonbloody. Complications: fistulas and nutritional deficiencies. Need for surgery is frequent
Ulcerative colitis location? Etiology? Peak incidence. Number of stools? Complications? Need for surgery?
Location starts in recumbent and proceeds in continuous manner toward cecum. Etiology unknown. Peak is 15-25 years and 55-65 years. Number of stools is 10-20 liquid bloody stools a day. Complications:hemorrhage and nutritional deficiencies. Need for surgery is infrequent
Assessment for CD
Look for unintentional weight loss, stool info and presence of blood. Fever, ab pain, nutrition and hydration status, distention, masses, visible peristalsis, perineal area ulcerations fissures or fistulas, decreased or absent bowel sounds, increase in high pitched rushing sounds over narrowed bowel loops, guarding, rigidity
Surgical management of cervical cancer
Loop electrosurgical excision procedure (LEEP) to cut away affected tissue Laser therapy to vaporize abnormal tissue Cryotherapy to freeze the cancer => necrosis Conization to remove affected tissue Hysterectomy
Drug therapy for fluid overload
Loop/high ceiling diuretics i.e. Furosemide/Lasix. Conivaptan aka Vaprisol or tolvaptan aka Samsca if too much ADH or electrolyte loss
Aphasia define? Anomia define?
Loss of ability to comprehend words and speak. Anemia: inability to find words
Apraxia define
Loss of ability to perform complex tasks involving muscle coordination aka inability to use words/objects correctly Examples include bathing, dressing, feeding self
Agnosia define
Loss of ability to recognize and use familiar objects and/or sensory conprehension impaired Not recognizing a familiar room in their home such as the kitchen Not recognizing familiar sounds Eventually not recognizing loved ones
Obstruction at end of small intestine and lower in intestinal tract causes
Loss of alkaline fluids which can lead to metabolic acidosis
An obstruction high in small intestines causes
Loss of gastric hydrochloride which can lead to metabolic alkalosis
Sensory neuropathy define? Affects?
Loss of protective sensation in lower extremitities, monofilament screening. Affects PNS
Nonsurgical management of cholecystitis
Low fat and cholesterol diet, opioids, extracorporeal shock wave lithotripsy if normal weight and good gallbladder function, percutaneous transhepatic biliary catheter to open ducts , anticholinergic drugs, antemetics
Nutritional therapy for diverticular disease
Low fiber or clear liquids, if severe NPO and or NGT
Anemia labs which can be associated with CD? What other labs for CD? If severe diarrhea or fistulas present?
Low folic acid, vitamin b12, albumin. Elevated C-reactive protein and ESR. Also pyuria aka WBC in urinedue to infection from ureteral obstruction, or enterovescial aka bowel to bladder fistula. If severe diarrhea or fistula present patient may have electrolyte losses particularly potassium and magnesium
Labs for malnutrition
Low hemoglobin if anemia/hemorrhage/hemodilution/iinfection/catabolism or high if dehydration/liver disease. If dehydrated low serum albumin
HF labs
Low hemoglobin+hematocrit, high BNP, proteinuria, high specific gravity, microalbuminuria, ABG hypoxemia
Hypoxemia vs. hypoxia
Low o2 in blood vs. decreased tissue oxygenation
Respiratory acidosis pH? PCO2? HCO3-? Differential?
Low pH, PCO2 high, HCO3 normal or increasing. Obstruction, pneumonia, mediastinal disease
Nutrition therapy for cirrhosis fluid excess
Low sodium diet usually 1-2 grams. In late stages vitamin deficiency so supplements of thiamine, float, multivitamins
Rhonchus/rhonchi character? Association
Lower pitched coarse continuous snoring sounds from large airways. Thick secretions, sputum, obstruction by foreign body, tumors
Malnutrition outcome
Lowered CO, malabsorption, respiratory, muscle wasting aka leanness/cachexia, decreased activity tolerance, lethargy, dermatitis, poor wound healing, death, impaired immune system/GI//cardiac/renal/bone formation/brain dysfunction, dry/flaking
Hypermagnesemia signs and symptoms
Lucy viewed dogs sleeping. Low everything aka energy, BP, HR, RR, reflexes, LOC all low with possible cardiac arrest. Vasodilation, diaphoresis, skeletal muscle weakness. ECG has long PR and QRS.
Diagnosing meningitis
Lumbar puncture needed for CSF specimen Viral meningitis is self limiting Bacterial meningitis is transmitted through respiratory droplet and contact with resp. secretions. Serious adverse outcomes with bacterial meningitis Vaccine available for bacterial outbreaks.
Oxygen toxicity define? S/s?
Lung injury from too much o2. Dyspnea, nonproductive cough, chest pain, GI upset, crackles, hypoxemia, atelectasis, pulmonary edema
Hep. D mode of transmission and prevention
Must already have hep.b, infected blood, sex, needles, from infected mom to newborn. Get hep b. Vaccine
Methotrexate aka? Given when? Monitor for?
MTX/Rheumatrex/DMARD. Given once a week dose <25mg for RA. Monitor for low WBCs, platelets, n/v, bone marrow suppression, infection
Assessment for endometrial/uterine cancer
Main symptom is postmenopausal bleeding Watery, bloody vaginal discharge, low back pain, abd pain, pelvic pain Uterine mass, uterine polyp Enlarged uterus (advanced cancer)
Primary treatment goals of ARF
Maintain volume homeostasis, correction of biochemical abnormalities, minimize damage to renal mass
Reduce local airway damage from trach by
Maintaining proper cuff pressures, stabilizing tube, suctioning only when needed, preventing/treating malnutrition, dehydration, hypoxia
Suctioning function
Maintains patent airway and promotes gas exchange by removing secretions when patient cannot cough adequately
Post bronchoscopy, laryngoscopy, and mediastinoscopy
Make sure gag reflex returns, monitor VS including O2 sat and breath sounds q 15 minutes for first 2 hours
Preventing odors for colostomy bag
Make sure no leakage and fully closed, no broccoli, beans, spicy foods, onions, Brussels sprouts, cabbage, cauliflower, cucumbers, mushrooms, peas, gum, smoking, beer, skipping meals, asparagus, turnips, eggs, fish, garlic. Crackers, toast, yogurt, buttermilk, cranberries, parsley prevent gas and odors. Charcoal filters, deodorizers, breath mint in pouch. No aspirin in pouch
Erythrocytes sedimentation rate ESR normal male? Female? Elevated when?
Male <15mm/HR, female <20mm/HR . Inflammation, inflammatory disease like RA, infection, anemia, tissue damage?
Nourishment for gastric vs. duodenal ulcers
Malnourished vs. well nourished
Cause of hypomagnesemia
Malnutrition, alcoholism, ketoacidosis, diarrhea, steatorrhea, celiac disease, Crohn's disease, drugs like diuretics/antibiotics/cisplatin/citrate, ethanol ingestion
Cause of Hypophosphatemia
Malnutrition, starvation, chronic antacid use, hyperparathyroidism, hypercalcemia, kidney failure, malignancy, hyperglycemia, hyperalimentation, respiratory alkalosis, DM, vitamin d deficiency, alcoholism
Diagnostics for breast disorders
Mammography: yearly beginning @ 40 y/o Breast Self Exam (BSE) monthly beginning in 20s; Clinical Breast Exam (CBE): APRN/MD Q 1 - 3 yr Ultrasound: differentiates fluid filled cysts vs mass CXR; CT; Bone, liver, brain scans R/O Metastasis Magnetic resonance imaging (MRI) Biopsies: Only definitive way to diagnose breast CA
Overall goal for treatment with Alzheimer's
Maximize the abilities that the individual with Alzheimer's Disease has left at each phase of the illness.
Grand mal seizure may have? Tonic? What happens for one minute? Clonic? Pupils?
May have aura if a partial seizure becomes a generalized seizure. No aura if generalized seizure from the start. Tonic phase-loses consciousness, falls Apnea and cyanosis for one minute Clonic phase-may bite tongue Pupils dilate Salivates/sweats/incontinence/confusion/soreness/exhaustion
People with type 1 DM require
Mealtime insulin+long acting basal or intermediate acting aka exogenous insulin to survive and may need multiple daily injections of insulin (often four or more) or continuous insulin infusion via an insulin pump to adequately control blood glucose levels.
Nonabsorbable antibiotics examples? Function?
Neomycin sulfate aka mycifradin. Destroys normal flora in bowel diminishing protein breakdown decreasing ammonia production
Gastric analysis purpose? Types? Prep? For gastric acid stimulation test?
Measures hydrochloric acid and pepsin for evaluation of gastric and duodenal disorders via NG tube suction. Basal gastric secretion for hydrochloric acid between meals and gastric acid stimulation. Prep: NPO for 12 hours. NG left while drug stimulates secretions.
Blood urea nitrogen measures? Increase indicates? Decrease indicates?
Measures kidney excretion of nitrogen which is a by product of protein breakdown. Increased due to hepatic or renal disease, dehydration, high protein diet, infection, stress, steroid, GI bleeding , bleeding internally. Decrease can mean malnutrition, fluid volume excess, severe hepatic damage
Phlebitis cause? S/S? Treatment? Prevention?
Mechanical cause due to insertion technique, size, lack of securement, chemical cause due to pH and/or osmolarity, bacterial from break in aseptic technique, poor securement, extended dwell time. S/S: pain, red, inflamed along length, hard/cordlike vein. Treatment: remove at first sign, use warm compress, monitor, document using scale, insert new one in opposite extremity, if due to PICC insertion apply hear, rest, elevate if not better within 72 hours remove. Prevention: smallest gauge, avoid flexion sites, avoid infusing with pH below 5 or above 9 or osmolarity above 500 in peripheral vein, rotate sites every 72-96 hours, secure catheter, aseptic technique, with PICC avoid excess activity
Complications of enteral
Mechanical tube irritation, obstruction most common, aspiration, displacement, cramping, diarrhea, vomitting, distention, gas, dumping syndrome, constipation, metabolic refeeding syndrome, hyperglycemia so initiate at low rate and monitor BS, fluid and electrolyte imbalance
Avoid veins on palmar side of wrist because
Median/cephalon nerve is located close to the vein making venipunctures more painful and difficult to stabilize and lead to permanent loss of function or complex regional pain syndrome causing tingling, pins and needles, or numbness
Treating edometriosis
Medications: NSAIDS, analgesics, oral contraceptives OCPs, Injectable forms of progestins, i.e. medroxyprogesterone (Depo-Provera), heat packs Surgery: laparoscopic removal of endometrial implants & adhesions; laser to vaporize adhesions & endometrial implants
Types of sensory perceptions with left brain damage? Interventions?
Memory deficits, issues carrying out simple tasks. Reorient to month, year, day of week, and circumstances surrounding hospital admission, establish scheduled routine,info given in concise manner, step by step approach
Serum muscle enzyme creatine kinase CK normal range for men? Women?
Men 55-170 units/L, women 30-135units/L
Contributing factors for enlarged prostate
Men age 50 and older African American Family History Elevated testosterone levels High fat diet Hematuria, pea size nodule, elevated PSA >10
Bladder neoplasms more common in? First sign?
Men, whites, smokers. Painless hematuria first sign. Nonsurgical treatment: chemo, radiation, surgical treatment: resection, cystectomy, ileal conduit, urterostomy, ureterosigmoidostomy, nephrostomy with Koch pouch
Assessment for endometriosis
Menstrual & sexual history Pain; dyspareunia; painful defecation; backache Infertility Pelvic exam => pelvic tenderness R/O PID Serum cancer antigen CA-125 Transvaginal ultrasound r/o pelvic masses Nausea/diarrhea
Neuro changes with dehydration
Mental status, low grade fever, confusion
Jentadueto is combo of
MetFORMIN and Tradjenta
Refeeding syndrome define? Causes? Prevention?
Metabolic issue when nutrition restarted for patient in starvation state with protein/fat broken down for energy and insulin decreased, when refeeding begins insulin resumes and cells take up glucose and electrolytes from blood depleting serum levels causing CV, respiratory, neuro issues, hypophosphatemia, shallow RR, weakness, confusion, seizures, increased bleeding. Prevention via careful assessment to supplement nutrition before starvation state
Decreased pH from
Metabolic or respiratory acidosis, ketones, renal failure, starvation, diarrhea, hyperthyroidism
Increased pH from
Metabolic or respiratory alkalosis, loss of gastric fluids, decreased K intake, diuretics, fever, salicylate toxicity, hyperventilation
Drugs for psoriasis topical/systemic
Methotrexate/Folex, Tazarotene/Tazorac, Cyclosporine/Sandimmune
Antibiotic/antiprozoals
Metronidazole/Tinidazole, Flagyl, Tindamax
Lovastatin aka? PO dose? Does what? SE? Taken when?
Mevacor. 20mg. Inhibits enzyme that makes cholesterol. SE: headache, constipation, rhabdomyolosis. Taken at night when enzymes are active since dietary intake love
Interventions for hypermagesemia
Mg free IV's, high-ceiling/loop diuretics like furosemide/Lasix
Diabetic neuropathy define
Micro and macro vascular combo causing pain, nerve damage lessening ability to feel pain/sensation, heat, cold and causing tingling, numbness, weaknesses, if ANS affected whole body.
Diabetic nephropathy aka? Define? Leading cause of? Risk factors? What usually follows?
Micro vascular Kidney disease. Damage to small vessels that supply glomeruli. Leading cause of ESRD. Hypertension, genetics, smoking, chronic hyperglycemia. Late diagnosis of microalbuminuria ESRD and waste product buildup in blood usually follow
Patho of pyelonephritis
Microbial invasion of renal pelvis, inflammation, fibrosis aka scar tissue, decreased tubular reabsorption and secretion, impaired kidney function
Clinical manifestations of mechanical obstruction in small intestine? If strangulation present pain?
Mid abdominal pain or cramping. If strangulation present pain more localized and steady.
Urine specimen collection procedure
Midstream, use first void, obtain before antibiotics, self clean before voiding if clean catch
Mini mental state exam score: mild? Moderate? Severe/final?
Mild (21 - 30) Trouble finding right word, forget familiar names or how to do everyday tasks Moderate (11 - 20) Disoriented, Paranoid and Delusional thoughts, forget major life events and close relatives Severe/Final (0 - 10) Incoherent, difficulty swallowing, incontinence
Nutrition therapy interventions for Hyponatremia used usually for?
Mild hyponatremia. Increase oral sodium and restrict oral fluid intake.
Early phase of Alzheimer's aka? Define
Mild to Moderate- forgetfulness, lack of concentration, disorientation, anxious, frightened, confused, embarrassed, deniaL
Mechanical colonic obstruction causes which symptoms
Milder more intermittent colicky abdominal pain seen with small bowel obstruction, lower abdominal distention, obstipation, ribbon like stools, alterations in bowel patterns, blood in stools if colorectal cancer or diverticulitis is cause, abdominal distention, peristaltic waves visible, high pitched bowel sounds aka borborygmi, cramping, in later stages bowel sounds absent, abdominal tenderness and rigidity minimal
Surgical management of PUD?
Minimally invasive surgery via laparoscopy to remove ulcer or treat hemorrhage, partial stomach removal aka subtotal gastrectomy, pyloroplasty, and/or vagotomy to control acid secretion. Or open surgery
Prostaglandin analogs example? Dose? Function?
Misoprostol aka Cytotec. 200mcg orally four times. Decreases gastric secretions and enhances resistance to mucosal injury when patient taking NSAIDs.
Novolog 70/30 is? Taken when?
Mix of 70% aspart protamine and 30% aspart taken just before eating
70/30 and 50/50 is? Taken when?
Mix of NPH and regular insulin. Taken 30 min before eating
Enteral nutrition define? Used for? Not for? Examples?
Mode of feeding using GI tract for those with malabsorption, cannot swallow due to stroke/head trauma/multiple sclerosis, are critically ill and cannot eat. Not for hemodynamic compromising like peritonitis, pancreatitis, intestinal obstruction, vomiting/diarrhea, paralytic ileus ex. Nasoenteric short term with key feed, entriflex, or Dobbhoff tube like nasogastric or nasoduodenal or nasojejunal placed under pyloric sphincter. Enterostomal long term like gastrostomies with percutaneous endoscopic gastrostomies tube, low profile gastrostomy device and jejunostomies to bypass stomach if gastric disease, upper obstruction, abnormal gastric/duodenal emptying via surgery
Wound care for diabetic ulcers
Moist wound, debridement, eliminating pressure, growth factors for healing
After surgery for peritonitis
Monitor LOC, VS, respiratory status via RR breath sounds, I and O, semi fowlers position to promote drainage of peritoneal contents into lower region of abdominal cavity to also increase lung expandion
Nursing responsibilities for chest tube management
Monitor VS throughout, monitor for tracheal deviation, monitor patency and not dislodged with kinks and at prescribed rate, ensure chest tube never higher than chest, monitor drainage for amount/color/consistency, palpate area around chest tube for crepitus and if felt mark area to assess for spreading, encourage deep breathing/cough, keep petrolatum gauze dressing and sterile dry dressing
What LPNs can do
Monitor client findings as input to RNs ongoing assessment, reinforcement of client teaching from standard care plan, tracheostomy care, suctioning, check nasogastric tube patency, admin of enteral feelings, insertion of urinary catheter, med admin excluding IV meds in several states
Endoscopic retrograde cholangiopancreatography ERCP education
Monitor for cholangitis, bleeding, perforation, sepsis, pancreatitis via severe pain and fever for sepsis. Report abdominal pain, fever, nausea, vomiting
Critical care for acute pancreatitis
Monitor for shock due to hemorrhage via hypotension, tachycardia, change in behavior, LOC
Nonsurgical management of COPD
Monitoring q 2 hours, airway maintenance, breathing techniques, positioning, effective coughing, oxygen therapy, drugs, exercise conditioning, suctioning, hydration, use of vibratory positive pressure device
Total parenteral nutrition solutions contain
More dextrose and proteins and are hyper osmotic which can cause hyperglycemia which if remains without insulin or in presence of hyponatremia.hypokalemia causes water shift to plasma causing dehydration and possible hypovolemic shock and if cardiac/renal issues may develop fluid overload, CHF, or edema
Calculous cholecystitis
Most common where chemical irritation and inflammation result from gallstones aka cholelithiasis that obstruct cystic duct, gallbladder neck, or common bile duct aka choledocholithiasis and trapped bile is reabsorbed plus impaired circulation, edema, distention causes ischemia and infection resulting in necrosis and gangrene and can eventually perforate/rupture which can cause an abscess or peritonitis
Sliding hernias are? Define? Major concerns
Most common. Esophagogastric junction and portion of fundus of stomach slide upward through esophageal hiatus into chest usually from weakening of diaphragm. Volvulas aka twisting and obstruction and esophageal reflux
Isotonic dehydration
Most common. Fluid lost from ECF , no shift of fluids between spaces so ICF remains normal and circulating blood volume decreased aka hypovolemia leading to inadequate perfusion
Midclavicular PICC associated with? Used only when?
Much higher rates of thrombosis than when tip in superior vena cava, used only when an atomic or pathophysiologic changes prohibit placement in SVC
Smokers with chronic bronchitis sputum
Mucoid
Peptic ulcer disease results when
Mucosal defenses become impaired and no longer protect epithelium from acid and pepsin
Signs and symptoms of hyperkalemia? Cause?
Murder. Muscle cramps/twitching,/weakness/tingling/numbness aka paresthesia, urine abnormalities, respiratory distress/weakness, decreased cardiac contractility, EKG changes with tall t waves absent P waves and wide QRS, reflexes. Diarrhea, hyperactive bowel sounds, palpitations/irregularities, bradycardia, hypotension, ectopic beats, heart block, a systole, ventricular fibrillation
Elevated creatine kinase can indicate?
Muscle trauma, Paget's, electromyography effects, brain, myocardial, skeletal muscle necrosis/injury
Muskuloskeletal changes in ESRD
Musculoskeletal Skeletal changes Result of alterations in calcium and phosphorous metabolism Hyperphosphatemia and hypocalcemia Weakens bones, increased risk of fractures Kidneys lose ability to convert Vit. D to active form Prone to fractures, joint pain
IV potassium must be? Double? Dilution no greater than? Max infusion rate? Never to exceed? High risk for? IV access in?
Must be diluted and added to IV only in pharmacy. Double check IV. Dilution no greater than 1mEq of K to 10mL solution, max infusion rate 5-10mEq/hr never to exceed 20mEq/hr. High risk for phlebitis q 1 hour. IV access in large vein avoiding hand
Leiomyomas/fibroids/myomas surgery
Myomectomy Via laser to remove rumors, Hysterectomy, Uterine embolization, transcervical endometrial resection using heat to destroy endometrium, total vaginal hysterectomy though vag, total abdominal hysterectomy via horizontal bikini incision
Other interventions for hemorrhage related to cirrhosis
NG tube to detect new bleeding , packed rbc, fresh plasma, dextran, albumin, platelets
Post op for exploratory laparotomy
NG tube until peristalsis/paralytic ileus resumes, clear liquid diet until peristalsis returns
Formation of ammonium in kidney function
NH3/ammonia formed during protein breakdown and secreted in urine that can combine with excess H to form ammonium NH4 to excrete in urine to increase pH
To prevent lymphedema after breast cancer surgery
NO BP, injections, or blood draws on affected arm* SIGN PLACED ABOVE BED & ON CHART/DOOR
Intermediate acting insulin examples? Onset? Peak? Duration? Also used as? Only? Is?
NPH/Humulin N or Novolin N. 1.5 hours-4. 4-12 hours. 12/16-18/24+ hours. Also used as basal insulin. Only basal insulin that can be mixed with short and rapid insulin. Is cloudy that must be agitated.
Managing impaired swallowing after stroke
NPO until assessed for impaired voluntary cough and gag reflexes, if patient doesn't pass they need speech language pathologist to evaluate further to then give suggestions on feeding like thickened liquids
Common causes of relative hypernatremia
NPO, increased metabolism, fever, hyperventilation, infection, diaphoresis, diarrhea, dehydration
Isotonic crystalloid examples? Action/use? Considerations?
NS, LR. No fluid shift, vascular expansion and electrolyte replacement. May cause fluid overload, edema, dilute hemoglobin, cause acidosis, electrolyte imbalance
Nonsteroidal anti inflammatory drugs aka? Can be used for? Examples? SE? Monitor?
NSAIDs, used for inflammation/pain/fever. Ex: Celecoxid/Celebrex, ibuprofen/Advil, aspirin. SE: bleeding, CV issues, Na retention, edema, hypertension, renal issues. Monitor fluid, BP, renal function, electrolytes, CBC, CNS
Extracellular fluid electrolytes
Na, Cl, bicarbonate, albumin
Low flow o2 deliver systems examples
Nasal cannula, face masks: simple, partial rebreather, nonrebreather
End stage renal disease symptoms
Neuro issues, high BP, pitting edema, periorbital edema, pericarditis, SOB, thick sputum, ammonia breath, metallic taste, ulcerations in mouth, anorexia, nausea, vomiting, behavior changes, bleeding, high K, dry flaky skin, pruritus, eccymosis, purpura, yellow gray skin, cramps. Bone pain
Patho changes with Alzheimer's
Neurofibrillary tangles Plaques Granulovascular degeneration of brain cells Loss of brain mass
For Muskuloskeletal issues remember
Neuromuscular checks and infection preventions
Urinary antiseptic example? Admin suggestion?
Nitrofurantoin aka Furadantin, macrobid, macrodantin, urotoin. Drink with full glass of water and drink 3L
Absorption atelectasis
No N in air since on O2 and causes alveoli to collapse detected via auscultation so monitor for crackles and decreased breath sounds q 1-2 hours
PDA-5 inhibitors for ED S/E?
No alcohol, dyspepsia, headaches, facial flushing, stuffy nose , cramps, n/a
Diet at home for chronic pancreatitis
No caffeine, alcohol, keep it bland, low fat, high protein and calories frequent meals
Define fasting
No calories for at least 8 hours
Elderly s/s of infection
No fever but altered LOC
Blood glucose testing requires? For?
No food/drink except water for at least 8 hours before, for non pregnant and least expensive
Diagnosing AD
No lab test except at autopsy for neurofibrillary tangles and neurotic plaques. Genetic testing for apolipoprotein E4, decreased amyloid beta protein precursor SBPP
Patient recovery for cervical biopsy
No lifting for 2 weeks, rest 24 hours after, report excess bleeding more than that of period/infection signs, no douching/tampons/sex for 2 weeks, keep perineum clean/dry using antiseptic rinses and changing pads frequently
Obstipation aka
No passage of stool and failure to pass flatus accompany complete obstruction
Bloop group gastric vs. duodenal ulcers
No pattern vs. type O
Care after total vag/abdominal hysterectomy
No period, more rest, limit stairs to 5x a day, no lifting anything>5-10 lbs, gradually increased walking, avoid sitting for long, no leg crossing, no exercise 2-6 weeks, no driving until approved, no sex 4-6 weeks, take temp for 3 days, check incision, report increased drainage or change in it, temp >100, pain, redness, swelling, burning on urination
Amenorrhea define
No periods
Care after local cervical ablation therapies
No sex/tampons/douching, take showers only, no lifting , report bleeding foul smell or fever. All for 3 weeks
Community based care for ovarian cancer: no? Follow up? Refer to? Advanced disease?
No tampons, douches, sexual intercourse for ~ 6 weeks Follow up with Surgeon Refer to support services Advanced disease: Refer to Hospice/Grief Counseling
BUN creatinine ratio helps determine? Increased? Decreased? No change?
Non kidney related factors. Increased indicates fluid felicity, obstructive uropathy, catabolic state, high protein diet. Decreased indicates fluid excess or acute renal tubular acidosis. No change indicates renal impairment
Implanted ports are accessed by
Noncoring needle aka Huber that has special tip that slices through septum that can tolerate 2000-750 punctures
Anthropometric measurements
Noninvasive methods of evaluating nutrition via height, weight, assement of body fat
Infiltration define? Cause? S/s? Treatment? Prevention
Nonvesicant Into extra vascular tissue. Pictured vein wall, blood flow obstruction, inflammation, fibrin sheath, damaged septum of implant, dislodged port access needle. S/S: rate slows, edema, skin tightness, blanching, coolness, burning, tenderness, fluid leaking, absence of blood return. Treatment: stop infusion and remove, sterile dressing, elevate, warm for speeded healing or cold compress for pain/swelling, insert new one in opposite extremity, implanted port remove and insert new needle, rate using INS scale. Prevention: catheter stabilization, using smallest catheter, avoid area of flexion, no restraints at site, make successive venipunctures proximal to previous site, monitor, central venous catheters obtain blood return, protect from clothing
Preventing diabetic kidney disease
Normal BP, correcting hyperlipidemia, restricting dietary protein, annual microalbuminuria test, BG control, promptly treating UTI's, preventing dehydration, no smoking, reduce nephrotoxins drugs like antifungals, NSAIDS, certain antibiotics
Stomach acid production for gastric vs. duodenal ulcers
Normal/hyposecretion vs. hypersecretion
Define epistaxis
Nose bleed
PSA is? PSA should be done when?
Not specific to prostate cancer because other prostate issues can raise PSA like prostatic is and BPH. PSA should be done before DRE since DRE increases PSA
If patient has distended neck veins, syncope, cyanosis, hypotensioN? If patient has sudden onset of dyspnea and chest pain
Notify rapid response for both could be PE, elevate HOB
Legal responsibility for the RN to delegate a task to a LPN or UAP is determined by
Nurse practitioner act, employer policy, national standards of care, ana and other national organizations
Priority when caring for patient with fistula
Nutrition and fluid and electrolyte balance since patient at risk for malnutrition, dehydration, and hypokalemia and preserving and protecting skin
Nondrug interventions for UC
Nutrition therapy and rest. NPO, parenteral nutrition, formulas to drink like Vivonec, no alcohol and caffeine and raw vegetables/high fiber foods/carbonated beverages/dairy/pepper/nuts/corn/dried fruits/smoking
PE interventions
O2 therapy (including mechanical ventilation if needed) Frequent ABGs & continuous pulse ox IV fluids Frequent VS+lung sounds+cardiac+respiratory status q 1-2 hours Anticoagulant therapy Fibrinolytics (Clot buster's) Antianxiety medications
Care during PE
O2 therapy, high fowler's, telemetry, venous access, pulse ox, ass respiratory status q 30 minutes, assess cardiac status, chest imaging/labs done, exam for petechiae on thorax, anticoagulants, bleeding assessment, handle gentle, bleeding precautions
Interventions for pneumonia
O2 therapy: Collaborative or Independent? Cough, deep breathe, and incentive spirometry: Collaborative or Independent? Adequate hydration- 3L/day unless otherwise contraindicated Bronchodilators
Leiomyomas/fibroids/myomas Nonsurgical management
OCPs Induce artificial menopause with goserelin (Zoladex) & leuprolide (Lupron Depot) Magnetic resonance-guided focused ultrasound: a pulse of ultrasound used to heat tumor & destroy it Uterine artery embolization to starve tumors of circulation, allowing them to shrink
Nonsurgical management of DUB
OCPs or patch - Hormone manipulation w estrogen &/or progestin (artificial progesterone) - Injectable leuprolide (Lupron) to decrease FSH & LH causing amenorrhea
Major risk factors for colorectal cancer
Older than 50 years, genetics, diseases that predispose the patient to cancer like familial adenomatous polyposis, Crohn's disease, ulcerative colitis, infectious agents like h.pylori, streptococcus bovis, hpv, smoking. Increased body fat, inactivity, alcohol
Those at greater risk for fluid overload
Older, cardiac/kidney/pulmonary/liver problems
Health care acquired risk factors for pneumonia
Older, chronic lung disease, gram-neg. colonization of mouth/throat/stomach, altered LOC, recent aspiration, endo tracheal/tracheostomy/NG tube, poor nutrition, immunocompromised, uses drugs that increase gastric pH like histamine blockers or antacids, alkaline tube feedings, mechanical venilation
Proton pump inhibitors examples and dosage? Are main? Function? Frequency of ingestion? Symptoms from use?
Omeprazole aka Prilosec 20-30mg, lansoprazole aka Prevacid 15-60mg, Omeprazole/ sodium bicarbonate aka Zegerid, rabeprazole aka Aciphex 60-120mg, dexansoprazole aka Kapidex, pantoprazole aka Protonix 40mg, esomeprazole aka Nexium 20-40mg. Treatment for severe GERD. Inhibit gastric gastric secretion. Once or twice a day, Zegerid short term. Community acquired pneumonia, GI infections, hip fracture, impaired calcium absorption and protein digestion
DM my plate
One half plate filled with no starchy vegetables, one fourth filled with starch, one fourth protein, glass of nonfat milk, small piece of fresh fruit
Kombiglyze X-R is combo of?
Onglyza and metFORMIN or saxigliptin and metFORMIN extended release
Delirium with ETOH/drug withdrawal occurs when? Additional s/s?
Onset in about 3 days. Tachycardia, diaphoresis, pallor, dilated pupils, mild hypertension, tremulous mess, deteriorating mental status, increased temp., increased restlessness,increased irritability
Biguanides example? Functions? SE? Used for? Take with? Report?
Oral Metformin/Glucophage Reduce glucose production by liver, Enhance insulin sensitivity/uptake, Improve glucose transport May cause weight loss, lactic acidosis, GI issues Used in prevention of type 2 diabetes in those <60 years, prediabetes, gestational DM, hypertension, or those already with type 2. Take with meal and 8 cups water daily, report flu s/s, withhold 48 hours before contrast
Genital herpes interventions
Oral analgesics, local anesthetic so, ice/warm compress, sitz bath, increase fluid, pour water over genitals while voiding, catheterize, genital hygiene, wash hands, wear gloves, avoid sex
Meds for Paget's
Oral biphosphonates
Why are enteral tube feedings preferred?
Oral intake is inadequate or not possible and GI functioning normally, preserves GI integrity, prevents bacterial translocation, preserves normal sequence of intestinal and hepatic metabolism before releasing nutrients into system circulation, lower cost, can be tolerated well and can be used long term and at home
Promoting independence in self-care for AD
Organize activities into short steps, occupational therapists to suggest ways tom simplify tasks or suggest adaptive equipment, supervision, encouraging choices when appropriate
Polyuria, polydipsia, and polyphagia from DM
Osmotic diuresis due to excess glucose and as result sodium, chloride, K are excreted and water loss severe causing polydipsia, and because cells receive no glucose cell starvation triggers polyphagia
Hypophosphatemia caused from?
Osteomalacia
Types of central IV's
PICC, no tunneled percutaneous central venous catheters, tunneled central venous catheters, implanted ports, hemodialysis catheters
Cervical cultures via Pap smear should be diagnostic for
PID caused by chlamydia and gonorrhea
Drug regimen for h. Pylori
PPI triple therapy aka proton pump inhibitor like lansoprazole aka Prevacid, plus two antibiotics like metronidazole aka Flagyl and tetracycline aka Ala-tet/Panmycin or clarithromycin aka Biaxin and amoxicillin aka Amoxil for 7-14 days
Long term aspirin or NSAIDs can cause
PUD, GI bleeding
Which factors are protential contraindications for having MRI
Pacemaker, implanted infusion pump, ferromagnetic aneurysm clip, confusion/agitation, continuous life support
Before seizures?
Pad siderails but not with pillows Remove objects that may harm patient Do not leave patient alone IV access O2 and suction at bedside
Treatment of pressure ulcers
Pad surfaces, HOB <30 degrees, lift sheets, reposition q 2 hours, no rubber rings on sacrum, slide boards for movement to another bed, pillows/wedges between bed and bony surfaces, heels off bed, 2000-3000mL/day water, protein and calorie intake, inspect skin daily, use moisturizers when skin damp, dry areas, absorbent pads, moisture barriers, no massage, humidify room, clean skin with mild fatted soap, tepid bath, disposable cleaning cloth for perineal area, pat dry, no powders/talc on perineum, skin barrier
Oral biphosphonates for?
Paget's
EPIDIDYMITIS s/s
Pain along inguinal cancel, along vas deferens, followed with pain/swelling in scrotum/groin, fever, pyuria, bacteriuria, possible abscess
Assessing diverticular disease for diverticulitis? For overall?
Pain in left lower quadrant or generalized if peritonitis, history of constipation, low grade fever, nausea, abdominal pain, bleeding from rectum, chills, tachycardia usually due to diverticulitis. Overall distention, tenderness, localized muscle spasm
Nursing care for endometriosis
Pain relief with NSAIDs, restoring sex function, decreasing fear/anxiety, enhancing self esteem and education about fertility, oral contraceptives, progestins like medroxyprogesterone acetate/Provera/Medroxyhexal and norethindrone acetate/aygestin, heat, laparoscopic removal via lazer
Assessment for meningitis
Pain when hyper extending head, pain when flexing leg at knee, when patient lying and head is raised/flexed the knees/hips flex with head raise aka brudzinski, fever, severe headache, unchallenged rigidity, rash, kernig's sign aka inability to extend leg when thigh is flexed upon abdomen
Signs of sickle cell disease crisis? Treatment?
Pain, organ damage, increased risk of infection, early death. 3-4L water/day, no alcohol/smoking, have them contact at first sign of illness/infection, flu shots, pneumonia vaccine, avoid extreme hot/cold, avoid travel to high altitudes, genetic counseling, no excess activity, mild exercise >3x/week
Norms for urine color, odor, turbidity, specific grav, pH, glucose, ketones, protein, bilirubin, RBC, WBC, casts, crystals, bacteria, parasites, leukoesterase, nitrites
Pale yellow, ammonia, clear, 1.005-1.030, ph 6, less than 0.5g/day, none. 0.8mg/day, none, 0-2, 0-5, none, none, less than 1000, none, none, none
Left brain damage s/s
Paralyzed/Hemiplegia/hemiparesis on right side, speech-language deficits, slow/cautious behavior, language/reading memory deficit, distress and depression in relation to disability, math/analytic deficits, aphasia(speech), alexia/dyslexia(reading), agraphia(writing), acalculia(math) , deficit in right visual field aka homonymous hemianopsia, slowness/cautiousness/anxiety/depression
Intestinal obstruction classifications
Partial or complete and mechanical aka blockage by problems outside intestines like in Crohn's or adhesions or in intestinal lumen like tumors. Or non mechanical aka paralytic/adynamic ileus where no physical obstruction in or outside intestine and instead peristalsis is decreased or absent due neuromuscular disturbance
Chronic gastritis pathological manifestations? Caused by? Associated with? Categories?
Patchy diffuse/spread out inflammation of lining, walls/lining thin and atrophy. Function of parietal acid secreting cells decreases and source of intrinsic factor lost causing vitamin b12 deficiency causing pernicious anemia and gradual section decreased until just mucous and water. Associated with gastric cancer+PUD. Type A, B, or atrophic
Define nephropathy
Pathological change in kidney reducing function leading to failure, decreased GFR, microalbuminuria. DM is leading cause. Risk factors:10-15 years DM, retinopathy, poor glucose control, uncontrolled hypertension, genetics
UAP examples
Patient care techs/assistants
Subtherapeutic vs. therapeutic vs. prolonged PTT in patients on anticoagulants
Patient not receiving enough heparin vs. clotting time increased vs. at risk for bleeding heparin is held/decreased
PACE define
Patient problem, assessment/actions, continuing/changes, evaluation
Instructions for pramlintide
Patients should be instructed to eat a meal with at least 250 calories and keep a form of fast-acting glucose on hand in the event that hypoglycemia develops. When pramlintide is used, the bolus dose of insulin should be reduced
Penicillin meds
Penicillin benzathine, bicillin
Barbiturate coma
Pentobarbital sodium/Nembutal used for intracranial hypertension/^ ICP that cannot be controlled. Complications: decreased GI motility, cardiac dysrhythmias, hypokalemia, hypotension, fluctuating temp.
Types of breast biopsies
Percutaneous: fine-needle aspiration, stereotactic and core biopsies Surgical biopsies: excision, incision, and wire needle localization
Complications to look for post colonoscopy
Perforation via severe pain, hemorrhage via rapid BP drop, hypovolemic shock via dizziness/decreased BP/tachycardia/pallor/ altered mental status
CSF leaks s/s
Periorbital edema and Ecchymosis, rhinorrhea aka leaking nose, postouriculor Ecchymosis aka bruising behind ears, otorrhea aka leaking from ears, halo sign where blood pools and ring around it indicating CSF
Amylin analog example? Function? Used concurrently with? Injected how and where? Watch for?
Pramlintide/Symlin Analog of insulin slows gastric emptying, reduces postprandial glucagon secretion, increases satiety Used concurrently with insulin for type 1 Symlin60+2 symlin 120 Subcutaneously not mixed with insulin in thigh or abdomen before meals Watch for hypoglycemia, nausea if eating less than 30 gms/carbs <200 cal, weight loss
Early warning signs of hypglycemia
Peripheral autonomic symptoms: sweating, irritability, tremulous mess, anxiety, tachycardia, hunger
Radiologic procedures for PUD for patients with? Tool used? Procedure?
Persistent massive upper GI bleeding. Catheter directed embolization through femoral artery and arteriogram performed and liquid clots artery bleeding
Combined acidosis labs ph? HCO3? PaO2? PaCO2? K? Ca? Cl?
Ph low, HCO3 high or low, PaO2 low, PaCO2 high, K high, Ca normal, Cl high
ED medical management
Pharmacological via oral meds, injected vasodilators, intra urethral applications via pellet. Penile implants/prosthesis. Vacuum constriction device to maintain erection
Bladder analgesic example? SE?
Phenazopyridine aka azodine, prodium, pyridiate, pyridium, uristat. SE: red or orange urine
Human dimensions
Physical, emotional, intellectual, environmental, sociocultural, spiritual
Endoluminal gastroplication define
Physician tightens LES through endoscope using sutures
Early phase AD interventions
Picture of patient placed on their door, pictures of family member's name, reminisce, low noise, low environmental distractions, no abstract /excessive decorations, no pictures on wall, daily routine, put things in same place, communications boards with day, week, month, year, clocks
Pulmonary edema sputum
Pink frothy
Complications of parenteral
Pneumothorax, air embolism, sepsis, hyperglycemia, rebound hypoglycemia, fluid imbalance due to high glucose formulas/osmotic diuresis/shifts of electrolytes/k/phosphorus into cells, fluid overload, phlebitis, occlusion, catheter displacement and contamination
Insertion related complications for central venous catheters
Pneumothorax, hemothorax, chylothorax, hydro thorax, air embolism, arterial puncture, malpositioned catheter
Hepatorenal syndrome indicates? Manifestations?
Poor prognosis for liver failure since usually causes death. Sudden decrease of urine oliguria, elevated BUN and creatinine, low urine sodium secreted, increased urine osmolarity
Fine crackles/rales/high pitches rails character? Associated with?
Popping, discontinuous, Velcro sounds caused by air moving into deflated airways. Asbestos, atelectasis, interstitial fibrosis, bronchitis, pneumonia, chronic pulmonary disease
Hepatic cell damage can lead to these common complications
Portal hypertension, ascites and esophageal varies, coagulation defects, jaundice, portal systemic encephalopathy with hepatic coma, hepatorenal syndrome, spontaneous bacterial peritonitis
Portal hypertensive gastropathy can occur due to? Causes?
Portal hypertension. Slow gastric bleeding, occult positive stool, anemia
Hepatic encephalopathy aka? Results from? Due to?
Portal systemic encephalopathy. Liver failure. Symptoms: sleep and mood disturbances, mental status changes, speech issues, altered LOC, impaired thinking and neuromuscular issues, elevated ammonia and gamma acid. Stages: prodromal, impending, stuporous, comatose. Due to shunting of blood to central circulation so substances absorbed by intestines are not broken down or detoxified
Complex partial seizures cause? Aka?
Possible wandering before then Loss of consciousness aka syncope for 1-3 minutes with automatisms and then after amnesia. Aka psychomotor/temporal lobe seizures
What is priority
Post op patient, status declines from baseline, shock, chest pain, post diagnostic procedure, equipment/tubing malfunction, cardiac ventilation
Post op nursing care
Postop vital signs and PCA pain medication Assess dressing for bleeding; HOB & arm ^ Assess & measure Jackson Pratt drainage Amb, Reg diet, light arm exercises, education Referral to Support Groups prior to D/C home Breast Reconstruction => Plastic Surgeon
While assessing gait and equilibrium rn observes that the patient has romberg's sign, what is priority patient problem associated with this objective data
Potential for falls related to dysfunctions in awareness of body position
Alpha-adrenergic antagonists drug names? Do what?
Prazosin/Minipress, doxazosin/Cardura, terazosin/Hytrin, Aldomet. Vasodilators that lower BP
Kidney biopsy pre? Procedure? Post?
Pre:consent, NPO 4-6 hours, platelets/PTT/PT/INR must be assessed for risk of bleeding, supine with pillow under ab and shoulders. Procedure: needle used. Post: pressure to site for 20 min, Bedrest 24 hours, encourage fluids, check hematocrit and hemoglobin, make sure no bleeding
Pain assessment
Precipitation/palliative, quality/quantity, region/radiation, severity scale, timing
Estrogens meds
Premarin estrogen conjugated, Estraderm, Estrace, Depgynogen,depogen, delestrogen, duragen, Valerie's, ogen, esinyl, feminone
Acute pancreatitis caused by? Leads to
Premature activation of excessive pancreatic enzymes that destroy distal tissue and cells resulting in autodigestion and fibrosis. Leads to wide variety of symptoms like edema to necrotizing hemorrhagic pancreatitis aka bleeding pancreatic tissue leading to tissue death
Hydrogen breath test prep? Procedure?
Prep: NPO for 12 hours. Patient blows in analyzer then eats test sugar and if lactose tolerance evaluated lactose.
Cystoscopy and cystourethroscopy prep? Procedure? Post?
Prep: light evening meal, NPO after midnight, bowel prep. Procedure: remove tumors, enlarged prostate, cystoscope put in urethra. Post: urine may be light pink but no clots
If drainage not mixed with blood then test for? If drainage mixed with blood?
Presence of glucose in CSF which should be 45-75. Test drop on linen or gauze for halo sign aka light/yellow outer ring around dark inner circl
Define diverticulosis
Presence of many abdominal pouch like herniations aka diverticula in wall of intestine
+ Rheumatoid factor means?
Presence of unusual antibodies of immunoglobulins G/M that develop in CTDs like RA, cancer, others
To help communicate with patient with aphasia
Present 1 idea/thought in a sentence, use simple one step commands, speak slowly, use que/gesture, avoid ye/no questions with expressive aphasia, alternate forms of communication like computer, board, flash cards with pics
Priority care after esophagogastroduodenoscopy
Preventing aspiration by having them be NPO until gag reflex back. And monitoring for perforation such as pain bleeding or fever
Define beneficence
Preventing harm and ensuring well being
Drug therapy for cirrhosis hemorrhage
Prevention:Beta blockers like propranolol aka Inderal to prevent bleeding, antibiotics since infection can increase risk like norfloxacin aka Noroxin or ciprofloxacin aka Cipro Treatment: vasoactive drugs that reduce portal prewar like terlipressin or somatostatin or octreotide
Bilirubin is? Made by? Total Elevations can indicate? Total Normal?
Primary pigment in bile. Made by liver. Impaired secretion, hemolysis,biliary obstruction, hepatic damage. 0.1-1mg/dL.
Primary, secondary, tertiary health promotion for obesity
Primary: weight loss, diet, exercise. Secondary:BMI screening, tertiary: meds, bariatric surgery
Hemostasis
Process of blood clotting
Sigmoidoscopy aka? Define? Prep? Positioning?
Proctosigmoidoscopy.endoscopic exam of rectum and sigmoid colon to screen for cancer and bleeding and inflammatory bowel disease and do tissue biopsy. Prep: clear liquid diet for 24 hours, cleansing enema, laxative. Left side knee chest.
Seizure phases
Prodromal=Pre seizure May have aura if seizure begins as a partial seizure Ictal=seizure Post-ictal=after seizure May need airway cleared, suctioning, oxygen
Blue bloater chronic bronchitis s/s
Productive cough, hypoxia, expirations wheezing, cyanotic nail beds, restless, SOB, tachypnea, acidosis, hypercapnia
Global aphasia
Profound speech/language issues, no speech/sound cannot be understood
People with type 2 DM
Progresses and may not have adequately controlled BG causing them to need exogenous insulin aka mealtime or oral insulin and also basal insulin
Chronic kidney disease is? Most common cause? Is it reversible? Kidneys no longer? National kidney foundations. Return of function?
Progressive Diabetes and hypertension most common causes Irreversible loss of renal function Kidneys no longer capable of maintaining an internal environment consistent with life National Kidney Foundation (NKF) Kidney damage or a decreased kidney glomerular filtration rate (GFR) < 60 ml/min for 3 or 4 months Return of function is not anticipated
Communication strategies with Alzheimer's: promote? Use? Face? Be? Focus on? Speak? Refrain from?
Promote Orientation- Identify yourself Use short, simple words/phrases Face to face contact Be near the client when talking Focus on one topic at a time Speak softly and calmly Refrain from challenge/confrontation
Myasthenia gravis rn considerations
Promote respiratory support, mobility, self-care and communication, nutritional support, safety Main priority during myasthenic crisis: airway Education
The RN uses critical thinking and professional judgment when following the Five Rights of Delegation, to be sure that the delegation or assignment is:
Right task, right circumstances, to the right person, right directions/communication, right supervision/evaluation
Pathophysiology of gastritis? Pathological changes include?
Prostaglandins provide protective barrier preventing stomach from digesting itself aka autodigestion, if break in barrier injury occurs and is worsened by histamine release, vagus nerve stimulation, hydrochloric acid which causes edema, hemorrhage, erosion. Pathological changes include vascular congestion, edema, acute inflammatory cell infiltration, degenerative changes in epithelium
Antidote for heparin? Warfarin? Fibrinolytic therapy?
Protamine sulfate. Phytonadione, vitamin K. Clotting factors, fresh frozen plasma, aminocaproic acid/Amicar
Interventions for delirium
Protect from injury - monitor environment Provide for adequate rest - promote sleep wake cycle Promote comfort Pain management Give reassurance Maintenance of fluids and electrolytes Orient frequently to time, place, situation, and person Use clocks, calendar, and familiar items in patient's room Placement of eye glasses and hearing aids Night lights to decrease illusions Allow family at bedside Hide catheters, mattress on floor if needed, treat underlying source
Care of patient during tonic-clonic or complete partial seizure
Protect from injury, nothing in mouth, turn to side for airway, loosen clothing, suction as needed, no restraints, record time began/ended, after VS/neuro checks/keep on side, rest
Chemical acid-base regulators? Characteristics?
Protein buffers that are most common(albumin+ globulins in ECF, hemoglobin), chemical buffers like bicarbonate in ECF+ICF and phosphate in ICF. Characteristics: rapid, immediate response, handles small fluctuations in H
Serum creatinine is made when? Norms for males females and elders?
Protein or muscle breaks down and usually filtered and excreted in urine so if elevated means kidney disease. Norms- males 0.6-1.2 mg/dL, women 0.5-1.1 mg/dL, both 0.8-1.2 decreased in elders
Drug therapy for PUD
Proton pump inhibitors like Omeprazole aka Prilosec, lansoprazole aka Prevacid, rabeprazole aka Acipjex, pantoprazole aka Protonix, and esomeprazole aka Nexium that suppress acid production. And h2 receptor antagonists like Famotidine aka Pepcid and nizatidine aka Axid that block histamine stimulated gastric secretions
Rectocele aka? S/s?
Protrusion of rectum through vaginal wall. Constipation, hemorrhoids, fecal impaction, feeling of rectal/vag fullness, bulge when bearing down
Progestins meds
Provera medroxyprogesterone cycrin,norluate, micronor, nor-QD, prometrium
RN interventions for endometrial/uterine cancer
Provide education & written materials Refer to support services/emotional support Encourage self-management w ADLS Home care after surgery is the same as that after a hysterectomy. Home health nursing. Hospice care/Grief Counseling
Pelvic organ prolapse assessment
Pt feels as if "something is falling out", dyspareunia, backache, pelvic pressure Protrusion/bulge noted on pelvic exam Stress urinary incontinence, UTI Bladder herniation Symptoms of rectal or vaginal fullness Constipation, hemorrhoids, fecal impaction
Leiomyomas/fibroids/myomas assessment
Pt seeks medical attention r/t heavy bleeding Pain, pelvic pressure, constipation Urinary retention or frequency Abdomen increasing in size Dyspareunia; infertility Iron deficiency anemia Urine or serum HCG; CA 125 Endometrial biopsy to r/o cancer Transvaginal ultrasound, laparoscopy, hysteroscopy, MRI
Vacuum devices for ED aka?
Pumps. Penis placed in cylinder, pump draws air out creating vacuum around penis causing it to fill with blood for erection. Elastic band worn around base maintaining erection
Pneumothorax cause? S/s? Treatment? Prevention?
Puncture of pleural over lungs letting in air S/S: chest pain, dyspnea, apprehension, cyanosis, decreased breath sounds, abnormal X-ray. Treatment: remove catheter, monitor, notify, admin O2. Prevention: use jugular or upper extremity insertion sites instead of subclavian, use ultrasound to locate veins
Key features of severe TBI
Pupil changes, bradycardia, papilladema, hypertension, widened pulse pressure, hypotension and tachycardia if hypovolemic shock, nuchal rigidity if CSF leak
Colonoscopy intervals
Q 10 years
Female reproductive system RN? ANP/NP?
RN performs a focused assessment for concerns APN/NP will perform the Breast, GYN/pelvic exam & Pap test, usu. @ end of PE; RN will assist
postop amputation RN interventions
ROM exercises, trapeze, turn patient every 2 hours, firm mattress, prone position every 3-4 hours for 20-30 minutes, shrinking stump
Key features of peritonitis
Rigid boardlike abdomen, abdominal/shoulder/chest pain, distended abdomen, nausea/anorexia/vomiting, diminishing bowel sounds, inability to pass flatus or feces, rebound tenderness, high fever, tachycardia, dehydration, decreased urine output, hiccups, possible compromise in respirator status, knees flexed, pain with coughing/movement, bowel sounds decrease eventually stopping due to inflammation
No surgical management of colorectal cancer
Radiation, adjuvant chemotherapy for stage 2-3 using 5-fluorouracil with leucovorin aka folinic acid, capecitabine aka Xeloda or FOLFOX
Nonsurgical management of endometrial/uterine cancer
Radiation, chemo, complementary therapies like herbs/vitamins
Breast cancer management
Radiation; Chemotherapy Hormone Therapy to reduce estrogen available to breast tumor to stop growth Complementary/Alternative TX:i.e. Prayer Surgical Management: Lumpectomy or Mastectomy w lymph node dissection Stem Cell Transplantation: rescue therapy after high dose chemo
CVA assessment
Raise arms, smile, speak a sentence. Altered alert/oriented, memory, judgement, Visual field loss/Homonymous hemianopsia, One sided neglect, Hemiplegia or hemiparesis, Dysphagia, Incontinence, impaired communication either being global/receptive/expressive/mixed
Tests for microalbuminuria
Random spot urine collection is best, 24 hour urine collection, timed urine collection
Breast cancer in men is? Most occur with? Characteristics? Poor? Same treatment as?
Rare Most occur with a genetic mutation in BRCA1 or BRCA2 gene Hard, painless, subareolar mass; gynecomastia, nipple discharge, ulceration Poor survival rate due to delayed diagnosis & advanced disease. Men may not suspect breast CA when mass felt. Same treatment as in women
Food with iron
Red meat, organ meat, egg yolks, kidney beans, leafy greens, raisins
Site infection s/s? Treatment? Prevention?
Red, swollen, warm, tenderness, purulent or malodorous exudate. Treatment: clean site with alcohol, for short peripheral/midline/PICC remove using sterile technique, send catheter tip for culture, cover with dry sterile dressing, notify. Prevention: aseptic technique when inserting/maintaining/removing catheters, good hand hygiene, clean/dry/adherent at all times
What LPN's can't do
Redelegate, complete discharge teaching
The base of all insulin preps is?
Regular insulin. Onset, peak, duration times are manipulated by zinc, acetate, buffers, and protamine
Short acting insulin examples? Onset? Peak? Duration? Take when?
Regular/Humulin R or Novolin R. 30min-1/1.5 hour. 2-5 hour. 5-8 hours. Take 20-30/45 min before eating. More likely to cause hypoglycemia due to longer duration
Parathyroid hormone increases Ca levels by:
Releasing free Ca from bone storage sites aka resorption. Stimulating vit. D activation to help increase intestinal absorption of dietary calcium. Inhibiting kidney Ca excretion. Stimulating kidney Ca reabsorpiton
Improving communication for AD
Remain unhurried, reduce noises/distractions, use clear easy sentences. In early stages: lists/written instruction, later states: tactile stimul like hugs or hand pats interpreted as signs of affection/concern/security
Juxtaglomerular complex creates what
Renin when BP low which then converts to angiotensin 1 causing secretion of aldosterone that increases reabsorption of sodium and water and excretion of K
In patient w/ classic s/s of hyperglycemia(polyuria, polydipsia, weight loss) or crisis with plasma glucose >200 what test? Otherwise?
Repeat testing not needed. Criteria 1-3 should be confirmed by repeat testing to rule out error using same test used initially
Tunneled central venous catheters aka VADs admin requires? How many lumens? Used for?
Requires surgical placement and removal. Have single, dual, or triple lumens. Use: frequent, long term infusion like parenteral nutrition for months-years or hard antibiotics when PICC cannot be used so they can use upper body, or for when oncology patient doesn't want implanted port so they don't have to get needle stick
Elevated HCO3=? Low HCO3?
Respiratory acidosis as compensation for primary metabolic alkalosis. Respiratory alkalosis as compensation for primary metabolic acidosis
Increased PaCO2 from?
Respiratory acidosis, emphysema, pneumonia, cardiac failure, respiratory depression
Family/caregiver for AD
Respite care Attentive listening Teaching Reminiscing stimulates memory Structured routine Divert patient's attention when upset Social conversation
Interventions for hepatitis
Rest, diet high in carbs and calories, small frequent meals, prevention of complications, since viral no drug cure, no meds or alcohol, avoid intercourse and blood donations, educate to hand wash,
Surgical management of UC
Restorative proctocolectomy with ileopouch-anal anastomosis, total proctocolectomy with permanent ileostomy
Cytotoxic/cellular edema
Result of hypoxia insult which causes disturbance in cellular metabolism, Na pump, active ion transport and brain depleted of O2, glucose, glycogen and converts to aneorobic metabolism, and Na levels decrease <120mEq/L causing accumulation of fluid in brain cells and can lead to vasogenic edema increasing ICP
Von willebrand's disease define
Results from low clotting factor 8 and common sign is heavy menstrual bleeding
Acute renal failure is? Usually associated with?
Reversible Abrupt and sudden and inability to excrete metabolic waste, maintain fluid and electrolyte balance. Usually associated with oliguria <30ml/hr or <400ml/day , raised BUN and creatinine, azotemia aka nitrogen in blood
Anti-infectives common examples? Can be administered ? SE? Education? Responsibility?
Rocephin, Augmentin, Zoysn, Zynvox. PO, IV, IM. SE: N/V, diarrhea, rash. Advise to finish ALL, don't charge. Ensure ordered cultures are collected before first dose
Seizure precautions
Room suction and oxygen set up Bite plate taped on wall above bed Padded siderails up/bed low IV access established via saline lock
Diverticulitis can result in
Rupture of diverticulum with peritonitis, pelvis abscess, bowel obstruction, fistula, persistent fever or pain, uncontrolled bleeding
Allergic/anaphylactic transfusion reaction s/s? Prevention?
S/S: urticaria, itching, bronchospasms, anaphylaxis. Prevention: WBC-reduced or washed RBCs where WBC, plasma, IgA has been removed.
Orthopnea
SOB when lying down but relieved by sitting up and can be associated with chronic lung disease or left HF
Admin of insulin is typically? Regular insulin can be given? Cannot be taken?
SQ, IV, orally
Diverticula define? Symptoms? Diagnosis? Treatment?
Sacs resulting from hernias ion of esophageal mucosa and su mucosa into surrounding tissue. Dysohagia, regurgitation/reflux, nocturnal cough, halitosis aka bad breath. Diagnosed via esophagogastroduodenoscopy. Nutrition therapy, positioning, no restrictive clothing, surgery to remove the diverticula
Step 5 of system for med use in asthma control
Same as 4 +: oral glucocorticosteroids or anti IgE
COPD drugs
Same as asthma: beta-adrenergic agents, cholinergic antagonists, xanthines, corticosteroids, and cromones. Focuses on long therapy/drugs like arformoterol/Brovana or tiotropium/Spiriva. More likely to have systemic drugs and inhalants. Also mucolytics, like guaifenesin/Organidin/Nadecon or mucinex, nebulizer treatments with mucolytics like acetylcysteine/Mucosil/Mucomyst or dornase Alfa/Pulmozyme.
Placement of midline catheters do not insert when?
Same as short peripheral venous catheters no placement of arm with mastectomy, lymph edema, paralysis, dialysis grafts, fistulas
Most important roll of nurse with patient with hiatal hernia
Same education as GERD HOB elevated, no restrictive clothing, upright after eating, no straining, diet restrictions, reduce weight
Tube obstruction from tracheostomy occurs as result of? S/S? Assess? If tube obstruction occurs?
Secretions or cuff displacement. S/S; dyspnea, noisy respirations, difficulty suctioning, thick/dry secretions, unexplained peak pressure. Assess q 1 hours for patency, help cough/deep breath, inner cannula care, humidifying, suctioning. If tube obstruction occurs notify
BG steady in? Blood glucose homeostasis driven by?
Steady in blood stream. Insulin which moves glucose from blood into cells and glucagon/epinephrine which brings glucose out of storage
Early prostate cancer antigen EPCA-2 define?
Serum marker for prostate CA & detects changes early, very sensitive
Using peak flow meter
Set to 0, standing position, take deep breath, blow breath out as hard/fast as able to, reset and perform 2 additional times and use highest reading of the 3
History assessment of acute pancreatitis
Severe ab pain, ask if during drinking or eating high fat meal, family history, drinking history, history of abdominal surgery, history of PUD, renal failure, vascular disorders, hyperparathyroidism, hyperlipidemia, viral infections
Clinical manifestations of acute pancreatitis
Severe abdominal pain, Cullen's sign, turners sign, bowel sounds, abdominal tenderness, rigidity, guarding, ascites, pleural effusions, vs changes
Infliximab aka Remicade and adalimumab aka Humira for? Is? Adverse effects? Humira more for.
Severe complications of UC like megacolon that can lead to gangrene and peritonitis and extra intestinal manifestations. Is an IgG that reduces TNF. Adverse effect:immunosuppressant so can become sick. Adalimumab aka Humira more for Crohn's
After uterine artery embolization for leiomyomas ?
Severe cramping 2-4 days, give pain meds, raise HOB, ambulate 2-4 hours after
Complications of CD vs. UC starting with CD first?
Severe malabsorption, fistulas more common in CD, hemorrhage more common in UC
Final phase of Alzheimer's aka? Define
Severe to Late- Mute, babbling, agnosia, totally incapacitated, unaware of what is going on
Autonomic neuropathy
Sex dysfunction, neurogenic bladder aka retention/incontinence, diarrhea, gastroparesis due to vagus nerve aka delayed emptying which can cause anorexia/nausea/vomiting/gastroesophageal reflux, persistent fullness, hypoglycemic unawareness, postural hypotension, resting tachycardia,painless MI, infection. Affects almost whole body
How to instill eye meds
Shake suspensions or "milky" solutions to obtain the desired medication level. Wash hands thoroughly before and after the procedure. Ensure adequate lighting. Read the label of the eye medication to make sure it is the correct medication. Assume a comfortable position. Do not touch the tip of the medication container to any part of eye or face. Hold the lower lid down; do not press on the eye-ball. Apply gentle pressure to the cheek bone to anchor the finger holding the lid Instill eye drops before applying ointments. Apply a ½-inch ribbon of ointment to the lower conjunctival sac. Keep the eyelids closed, and apply gentle pressure on the inner canthus (punctal occlusion) near the bridge of the nose for 1 or 2 minutes immediately after instilling eyedrops. Using a clean tissue, gently pat skin to absorb excess eyedrops that run onto the cheeks. Wait 5 to 10 minutes before instilling another eye medication.
Define concussion
Shaky movement of brain
Dextran polysaccharide 40 kda or 70 kda
Shifts fluid into vessels for vascular expansion, prolongs hemodynamic response when given with Hypertonic saline. May cause fluid overload and hypersensitivity, increases risk of bleeding, contraindicated in bleeding disorders/CHF/renal failure
Hetastarch HES 6% or 10% action and use? Nursing considerations?
Shifts fluid into vessels for vascular expansion. May cause hypersensitivity and fluid overload, increased risk of bleeding, not good for CHF and renal failure
Herpes zoster aka? Spread how? Is a? Caused by? S/S? Post herpetic neuralgia?
Shingles or varicella zoster. Spread by contact with the fluid from the blisters •..is a highly contagious acute viral infection that produces painful eruptions along the nerves •Caused by reactivation of dormant varicella zoster (chicken pox) virus •Signs & symptoms-painful, burning, vesicles on trunk, depression common, crusts •Post herpetic neuralgia - older patients
Glucocorticoids aka? Used for? Examples? SE? Monitor for?
Steroids. 10-150mg PO, IV, enema. For RA, anti inflammatory, immunosuppression. Ex: prednisone/Deltasone. SE: DM, infection, fluid/electrolyte issues, hypertension, osteoporosis, glaucoma, K depletion, raised glucose. Monitor for moon face, buffalo hump, striae, acne, thin skin, bruising, cataracts
Removing vascular access device for short peripheral catheters? For midline and PICCs? Nontunneled percutaneous central catheters? For all do what? Tunneled and implanted needs?
Short peripheral catheters pull laterally to remove dressing and cover with dry gauze. Midline and PICCs remove Cather in short segment from insertion site and if resistance felt stop and never apply force. Nontunneled percutaneous central catheters clip sutures and withdraw. For all apply pressure with dry gauze and apply sterile gauze dressing with antiseptic ointment Tunneled and implanted needs surgery to remove.
Peripheral IV types
Short peripheral catheters, midline catheters
Contraindications to enteral feedings
Short term need least invasive done\NG, severe acute pancreatitis, high output proximal fistulas, inability to gain access, intractable vomiting and diarrhea, GI issues
Types of tubes for enteral nutrition
Short term use due to tissue irritation: nasogastric, nasoduodenal, nasojejunal Longer than 4 weeks: gastrostomy, PEG, jejunostomy
Glucagon-like peptide receptor agonists function? Must take when? Aka?
Simulate glucagon-like peptide-1 (GLP-1) aka incretin which triggers pancreas to secrete insulin with food, which is decreased in type 2, increases insulin sensitivity, Inhibit glucagon secretion, Decrease gastric emptying, Increases satiety, decreases liver production of glucose Must take oral meds 1 hour before injecting exenatide/Byetta and liraglutide/Victoza, bydureon/long acting. Aka incretin mimetics
Effective coughing procedure
Sit in chair or side of bed, shoulders inward, hugging pillow against stomach, few breaths, after 3-5 breaths in through nose out through pursed lips take deeper breath, bend forward while coughing 2-3 times from same breath
First sign of testicular cancer
Slight enlargement of testicle accompanied with discomfort
Type 1 DM define? Aka? Onset in those?
Slow Beta cell destruction leading to absolute insulin deficiency, autoimmune due to virus, idiopathic which then leads to DKA, weight loss, polydipsia, polyuria, polyphagia. AKA juvenile-onset/insulin-dependent/ketose-prone diabetes. Abrupt onset in those <30-40 years
Crohn's disease define? Affects what? Usually affects?
Slowly progressive and unpredictable Inflammatory disease of small intestine, colon, or both with involvement of multiple regions with normal sections in between called skip lesions with remission and exacerbations. It can affect GI tract from mouth to anus but usually affects terminal ileus.
Enteroscopy aka? Function? Procedure? Post?
Small bowel capsule endoscopy. View small intestine. Video shows entire small bowel via eight lead sensors and abdominal belt and capsule that is ingested. Prep: fast for 8-10 hours and NPO for first 2 hours. Post swallowing normal diet 4 hours after
Interventions for elderly pancreas changes
Small frequent feedings, assess for diarrhea
HHS s/s? Because these manifestations?
Somnolence, coma, seizures, hemiparesis, aphasia, dry mouth, extreme thirst, initially polyuria/later decreased dark urine, warm/dry skin, high fever over 101, sleepiness, confusion, vision loss, hallucinations, weakness on one side of body. B/c these manifestations resemble stroke immediate glucose level is critical for correct diagnosis.
Hypertonia aka
Spastic paralysis causing fixed positions or contractures of extremities and ROM restricted
Glasgow begin each phas of assessment by
Speaking normal, if no response louder, if no response shaking, if unsuccessful pain via supra orbital pressure, trapezius muscle squeeze, mandibular jaw pressure, sternal/breastbone rub
Stages of CKD
Stage 1 - Kidney damage with normal or increased GFR (> 90ml/min) Stage 2 - Mild reduction in GFR (60-90 ml/min) Stage 3 - Moderate reduction GFR (30-90 ml/min) Stage 4 - Severe reduction in GFR (15-29 ml/min) Stage 5 - Kidney Failure (GFR < 15)
Stage 4of CKD
Stage 4: Renal Insufficiency Mild azotemia > 75% nephron mass destroyed GFR 15 - 29 Impaired ability to concentrate urine Symptoms of polyuria and nocturia Avoid or reduce dosage of medications with renal excretion
Stage 5 of CKD
Stage 5: End Stage Renal Disease (ESRD) Azotemia Urine is isosmotic to plasma 90% nephron mass destroyed 10% GFR; < 15 ml/min or dialysis Creatinine clearance < 15 ml/min Chronic abnormalities Oliguria Uremia Electrolyte & fluid imbalances Dialysis/transplant to sustain life
Stages 1-3 of CKD
Stages 1-3: Decreased renal reserve BUN & Creatinine normal Asymptomatic Renal impairment detected by stressing the kidney and testing the GFR Acute or Chronic Renal failure Primary Goals: Prevention of kidney injury and delay the progression of the disease
Bolus enteral nutrition administration
Start with 120-240ml of formula at meal times or q 3-4 hours over 10-20 minutes. Gradually increase amount per feeding using gravity bag
Meds recommended for patients who don't reach lipid ADA goals with lifestyle modifications and for those >40 years with other CVD risk factors
Statins
BG homeostasis when person eats and BG rises? As body cells use glucose?
Stimulates pancreas to release insulin which stimulates uptake of glucose into cells and storage as glycogen in liver+muscles and stimulates excess glucose into fat. As body cells use glucose blood levels decline and low BG stimulates pancreas to release glucagon which stimulates liver cells to break down glycogen and release glucose in blood causing it to rise
Elder vs. younger GI issues
Stomach cancer vs. inflammatory bowel disease
Colorectal cancer screening test
Stool tests: fecal occult blood test etc
Transfusion reaction interventions
Stop transfusion, KVO with NS, take VS and stay with patient, treat symptoms, inform physician and blood bank, will likely have to send blood back to bank with tubing attached, document, reassure patient and family, do not restart transfusion
SGLT-2 inhibitors aka? Examples? Function? SE? Not recommended for? Recommended starting dose?
Sugar transporter inhibitor. Invokana/Farxiga. Inhibits SGLT-2 reducing reabsorption of glucose. SE: weight loss, increase urinary glucose, genital yeast, UTI, increased thirst, urination, constipation, nausea, hypotension. Not recommended for people with kidney disease. Recommended starting dose lower and can be increased
What UAP's can't do
Supervise other UAPs, re delegate, complete pain assessment
Preventing/managing wandering AD
Supervision, area with max observation, sitters/family for monitoring, away from stairs/elevators, no room changes, avoid restraints, treat pain, reorientation and validation therapy, frequent toileting, prevent overstimulation
For peritonitis before incision is closed
Surgeons irrigates peritoneum with antibiotic solutions and several catheters may be inserted to drain the cavity and provide route for irrigation after surgery
Chvostek's sign test
Tap face just below and in front of ear over facial nerve to trigger facial twitching of one side of mouth, nose, cheek
Pediculosis symptoms? Define? raised prevalence where? Diagnosis? Treatment?
Symptoms-pinpoint erythema, itching esp. around nape of the neck, reporting "crawling" or "biting" feelings •parasite: feeds on scalp and leaves eggs "nits that transmit disease •^ prevalence: schools •diagnosis-hand held lens - clothing & bedding dry cleaned; do not share combs, topical shampoos i.e. lindane (Kwell), or PO ivermectin/stromectol
Traditional cholecystectomy
T tube drain to ensure patency and JP drainage tube used to prevent fluid accumulation. Post op: opioids, antiemetics, wound care, keep drainage under site of insertion, diet low in fag
Teaching for post op leiomyomas/fibroids/myomas
TCDB, IS, amb., pain, antibiotics, support
Meds for UTI
TMP-SMZ (Trimethoprim-Sulfamethoxazole, Bactrim, Septra) Furadantin (Macrodantin) Cipro Levaquin Norfloxacin (Noroxin) Gantrisin Cefixime Pyridium (bladder analgesic)
CVA med after hemorrhage ruled out
TPA aka tissue plasminogen activator example: Activase
COPD General appearance
Thin, loss of muscle, thick neck, slow moving, stooped, foreword bending posture Aka orthopneic/tripod position, activity intolerance
Tinel's sign
Tapping median nerve of wrist for CTS
Admin of oral potassium
Tastes bad and since can cause nausea/vomiting give during or after meal
Herpes zoster goal of treatment? Treatment? Prevention?
The goal of treatment is to relieve the pain •Acyclovir - start within 3 days •Cold compresses •Sedation at bedtime •Triamcinolone topical/cortisone decrease inflammation •Contact Precautions •Prevention: 1 Herpes Zoster Vaccine SQ for adults > 50 who do not have shingles
Noninvasive options for enlarged prostate
Thermotherapy: transurethral needle ablation TUNA, transurethral microwave therapy TUMT, interstitial laser coagulation ILC aka contact laser prostatectomy CLP, electro vaporization of the prostate EVAP, stents, laser balloon dilation
Because DPP-4 inhibitors are glucose dependent? SE? Can be taken?
They lower potential for hypoglycemia and don't cause weight gain like other meds for DM. SE: upper respiratory infection, stuffy/runny nose, sore throat, headache, UTI, nasophayngitis. Can be taken with or w/o food
Post op after lobectomy/thoracotomy without pneumonectomy
They will have chest tube, keep tube below chest, for water seal chest tube keep 2cm of water in seal to prevent air from flowing back into patient/check water level/use sterile water
Diuretics types? Function of each?
Thiazidine inhibits Na, Cl, water reabsorption&promotes K+HCO3+Mg excretion. Loop high ceiling aka furosemide/Lasix+torsemide/Demadex inhibits Na+C;+H2O reabsorption&K excretion. K-sparing like spirnolactone/Aldactone inhibits Na reabsorption in exchange for retaining K
Micro vascular DM complications? Specific to diabetes? Usually appears when?
Thickening of vessel membranes in capillaries and arterioles, glucose toxicity, ischemia causing hypoxia Specific to diabetes:Retinopathy Nephropathy Dermopathy Neuropathy Usually appear 10 to 20 years after diagnosis
Red nail findings and significance?
Thin dark red verticals lines aka splinter hemorrhages from endocarditis, trichinosis, trauma, normal in some. Red discoloration of lunula from cardiac insufficiency. Dark red nail beds due to polycythemia Vera.
Promoting nutritional intake
Toilets and mouth are before mealtime, glasses/hearing aids in place, bedpans/urinals/basins removed from site, analgesics/antiemetics 1 hour before, sit in chair if possible, observe patient's intake, ask about food likes/dislikes, encourage self feeding, feed slow,decrease distractions, adequate light, no offensive odors, document, visual appealing and cold/warm meals, no interruptions
Circulatory overload transfusion reaction define?symptoms?
Too much blood delivered too fast. Symptoms: cough, dyspnea, headache, tachycardia
Relative Ca loss causes
Total body calcium amounts to remain normal while Ca levels are low when unbound Ca is reduced or when parathyroid gland function is decreased
Interventions for unilateral body neglect syndrome in right stroke/damage
Touch and use both sides of body, encourage them to wash both sides of body, when dressing remind them to dress affected side first, if hemianopsia present teach patient to turn head from side to side to expand visual field
Notify for what issues in chest tube drainage systems
Tracheal deviation, sudden/increased dyspnea, o2 sat <90, drainage >70ml/HR, visible eyelets on chest tube, chest tube falls out but first cover with sterile gauze, chest tube disconnects from system but first put end of tube in container of sterile water keeping below chest, drainage in tube stops in first 24 hours
Complications of tracheostomy
Tracheomalacia, tracheal stenosis, tracheoesophageal fistula, trachea I nominate artery fistula, tube obstruction, tube dislodgement, accidental decannulation, pneumothorax, subcutaneous emphysema, bleeding, infection
TURP management of enlarged prostate? POST OP?
Transurethral resection of prostate TURP using endoscope through urethra to remove tissue. Post op: normal for pink urine, some blood clots, increase fluid intake, ambulate asap, check drainage tube for kinks and clots, sever bladder spasms which can indicate obstruction and obstruction irrigate, assess VS q 2 hours, NS for irrigation, notify if ketchup like urine
Surgical management of POP
Transvaginal repair using surgical vaginal mesh or tape (minimally invasive) Anterior colporrhaphy: Open surgical repair to tighten the pelvic muscles for ^ bladder support Posterior colporrhaphy: Posterior repair reduces rectal bulging Vaginal hysterectomy
Patient that has scabies tells RN that itching becomes unbearable at night, best response is?
Treatment involves using scabicidal shampoos like lindane/Kwell or permethrin/Actin, wash clothes in hot water, scratching can lead to exoriation and infection, confirmed via scraping lesions and microscope exam for mites and eggs
Positioning for inserting nontunneled percutaneous central venous catheter ? What prohibits uses and increases risk?
Trendelenburg, rolled towel between shoulder blades. TRauma, surgery, radiation in chest/neck prohibits use and tracheotomy increases risk for cross contamination of insertion site and the upper chest/neck has more microbes so more risk for infection
Syphilis caused by?s/s?
Treponema. Transmitted via sex and blood and body contact. S/S: ulcer/chancre, malaise, fever, headache, aches/pains, sore throat, rash, warts, lesions, aortic valvular disease, aneurysms, meningitis, hearing loss, paresis.
Cystocele aka? S/s?
Urinary bladder prolapse. Difficulty emptying bladder, urinary frequency/urgency, UTI, stress urinary continence
Function of kidneys
Urinary elimination to maintain body fluid volume and composition, filter waste, regulate BP and acid base balance, make erythropoietin for RBC synthesis and convert vitamin D to active form
Kidney changes in dehydration
Urine concentrated, specific gravity greater than 1.030 color dark and strong odor
Tests for kidney function: urine protein? Urine excretion? Creatinine? Urine glucose for?
Urine protein without kidney symptoms may indicate microvascular changes in the kidney Urine excretion rates of 20 - 200g/min indicate microalbuminuria Creatinine clearance test Poor glucose control Hypertension Urine glucose test for "quick screening" but less precise
Giving transfusion
Use Y tubing for blood on one port and NS on other, y tubing has filter to filter out fibrin clots etc., assess whether blood should be warmed, don't squeeze or rigorously shake blood or other blood products, start slowly according to policy, stay with pt. during first 15-30 minutes, document VS per policy every 5 min for first 15 then every hour, monitor input
Treatment of pressure ulcer
Use ruler to measure size and q-tip to measure depth, observe odors or drainage color, monitor VS/labs, note necrotic/granulation, stage 2-4 are contaminated or contain bacteria, duoderm, wet to dry dressings, enzymes, debridement, antibiotics
24 hour urine creatinine clearance collection procedure
Use signs, use second void, collect all urine after, ice or refrigerate
Coomb's test define? Types? Norm?
Used for blood typing. Direct detects antibodies against RBCs. Indirect detects circulating anti globulins to determine whether antibodies for RBC about to get is present. Normal: negative, you don't want antibodies against RBC
Agent host environment model useful for? Agent? Host? Environment?
Useful for examining the cause of disease •Agent: An environmental factor or stressor that must be present or absent for an illness to occur i.e. bacteria or virus •Host: A living organism capablea of being infected or affected by an agent i.e. client •Environment: All factors external to the host that makes illness more or less likely like physical, social, biological, cultural factors
Teaching for PICC
Usually ADLs but avoid excess physical activity like muscle contractions in arm from heavy lifting that can lead to dislodgement and possible occlusion
Visual issues with right brain damage? Interventions?
Usually depth and distance perception affected with discrimination of right from left or up from down. Use frequent verbal and tactile clues and break down tasks in steps, always approach patient from unaffected side which should face door of room.
Patient with hip pain usually experiences it in?
Usually experiences it in groin or radiates to knee
Interventions for kidney tumors
Usually nephrectomy, dialysis before transplant
Preventing/detecting ICP
VS q 1-2 hours, cardiac monitor, monitor blood gases, avoid flexion/extension of neck, head midline, log roll during turning to prevent hip flexion, HOB >30 degrees
Care during mechanical ventilation
VS q 4 hours, bilateral chest expansion,HOB >30 to prevent pneumonia/aspiration, set alarms, empty when moisture collects, ensure humidity, assess if suction needed q 2 hours, mouth care q 2 hours, assess for GI issues, turn q 2 hours, provide method of communication
Assessment prior to infusion
VS, CBC, IO, IV access, skin color
Postop care leiomyomas/fibroids/myomas
Vag bleeding (< 1 saturated pad/4 hours) - Abd bleeding & intactness @ incision site - Vital Signs and Pain - Urine output per urinary catheter for < 24 hours
Chlamydia s/s:
Vag/penile discharge that is more watery than gonorrheal, dysuria, pelvic pain, irregular bleeding, urethritis, epididymitis, prostasis, infertility, cervicitis, cervical bleeding, salpingitis, PID, ectopic pregnancy, infertility
Key features of chronic gastritis ? Usually?
Vague report of epigastric pain relieved by food, anorexia, nausea/vomiting, intolerance of fatty/spicy foods, pernicious anemia, upheld abdominal discomfort. Usually few symptoms unless ulcerations.
Agents for erectile dysfunction categories? Meds?
Vasodilator. Alprostadil, Caverjecti, Paverine, Phentolamine/Regitine
Dumping syndrome define? Occurs as result of? Symptoms occur when? Early symptoms? Late symptoms occur when? Late symptoms define?
Vasomotor symptoms that occur after eating. Occurs as result of rapid emptying of food into small intestine which shifts fluid into gut causing abdominal distention. Occurs within 30 minutes of eating. Early Symptoms: vertigo , tachycardia , syncope, sweating, pallor, palpitations, desire to lie down. Late symptoms 90 minutes to 3 hours after eating: insulin causes rapid entry of food into jejunum. Late symptoms: dizziness, light headedness, palpitations, diaphoresis, confusion
Antidiabetic hormone aka? Made where ? Stored in? Controlled by? Stimulation of release?
Vasopressin. Made in brain and stored in posterior pituitary that is controlled by hypothalamus in response to increased blood osmolarity and increase in plasma sodium to act on kidneys for water reabsorption decreasing osmolarity and ECF volume to increase
Preventing ventilator associated pneumonia
Ventilator bundle: hand hygiene, oral care q 12 hours, HOB elevation >30 degrees. Oral care with rise before intubation, no jewelry when providing care, remove secretions q 2 hours or continuously if trach, xray for placement, don't go supine within 1 hour after bolus tube feeding, wean off asap
Placement of short peripheral venous catheters
Verify prescription complete and appropriate, for adults choose site in upper extremity and never use wrist, choose no dominant arm when possible, choose distal site and make all subsequent venipunctures proximal to previous sites, don't use on arm with mastectomy/lymph node dissection/arteriovenous shunt/fistula/paralysis/joint flexion/hard or cordlike vein/cellulitis/dermatitis/complications from previous catheter/lymph edema/paralysis of upper extremity/dialysis grafts ,vein must be appropriate length and width to fit size
Extravasation define? Cause? S/S? Treatment? Prevention?
Vesicant into extra vascular tissue with peripheral and central catheters. Pictured vein wall, blood flow obstruction, inflammation, fibrin sheath, damaged septum of implant, dislodged port access needle. S/S: rate slows, edema, skin tightness, blanching, coolness, burning, tenderness, fluid leaking, absence of blood return, blistering, tissue sloughing. Stop infusion and disconnect, aspirate drug, leave short peripheral catheter or port access needle in for antidote, apply cold compress for all drugs except alkaloids and epipodophyllotoxins, photograph site, monitor. Prevention: catheter stabilization, using smallest catheter, avoid area of flexion, no restraints at site, make successive venipunctures proximal to previous site, monitor, central venous catheters obtain blood return, protect from clothing
Cerebral perfusion pressure measured
Via subtracting mean ICP from mean arterial pressure
Tactile vocal fremitus
Vibration of chest when speaking that can occur when pleural space filled with air/pneumothorax or fluid/plueral effusion or bronchus obstructed
Types of meningitis and differences
Viral/aseptic that's most common, self-limiting+patient has complete recovery. Bacterial that is life threatening. Fungal and protozoalOtitis media, pneumonia, acute/chronic sinusitis, sickle cell anemia, brain/spinal injury, immunosuppression, infection, older people, piercings
Multiple sclerosis subjective
Vision, mobility, or sensory changes, Aggravating factors, Personality or behavior changes, Euphoria, poor judgment, attention loss, Sleep patterns, bowel and bladder dysfunction, Numbness or tingling, ADLs
Endoscopic retrograde cholangiopancreatography ERCP define? Procedure? Prep? Post?
Visual and radiographic exam of liver, gallbladder, bile ducts, pancreas to identify cause and location of obstruction. Cannula inserted in common bile duct and radiopaque dye instilled for X-rays, papillotomy can be performed, stents can be inserted in ducts, endoscopy of duodenum and biliary tract. Prep: NPO 6-8 hours , sedation. Post: VS every 15 minutes , assess for gag reflex before fluids or foods
Esophagogastroduodenoscopy EGD define? Prep? Post?
Visual exam of esophagus, stomach, and duodenum and also can be used to give injections and dilate strictures. Prep:NPO 6-8 hours before, sedatives and spray to remove gag reflex administered. Sims left side lying position. Post:Spray suppresses gag reflex for 1-2 hours so NPO until reflex back vitals every 30 minutes
Upper GI radio graphic series define? Prep? Afterward?
Visualization from mouth to duodenojejunal junction using ingested barium. Prep: NPO for 8 hours before. Afterwards drink plenty of fluids and laxative/stool softener and stool will be white for 24-72 hours as barium excreted
pyridoxine aka? Foods?
Vitamin B6. Fortified cereal, chicken, turkey, tuna, salmon, liver, milk, cheese, beans, spinach, carrots, brown rice, bran, whole grains, bananas. Can help high cholesterol, can help heart disease, aids metabolism
Low PTT and prolonged clotting time due to
Vitamin K and manganese deficiency
Symptoms of gastrectomy
Vitamin b12, folic acid, iron deficiencies causing pernicious anemia, atrophic glossitis causing beefy tongue
Causes of osteomalacia
Vitamin d disturbance, kidney disease, liver disease, inflammatory bowel disease, Metabolic error like hypophosphatemia
ARF indications for dialysis
Volume overload that cannot be managed with diuretics Hyperkalemia refractory to medical therapy Correction of acid-base disturbances that are refractory to medical therapy Severe azotemia Uremia
Pyloric obstruction manifested by? Caused by?
Vomiting caused by stasis and gastric dilation. Caused by scarring, edema, inflammation. Symptoms: abdominal bloating, nausea, vomiting, hypochloremic/metabolic alkalosis, hypokalemia
Hypokalemia can indicate
Vomiting, gastric suctioning, diarrhea, drainage from intestinal fistulas
BMI=? Least for risks? Older adults should be?
W in kg/ h in meters. 18.5-25, older adults should be 23-27
How h. Pylori cause ulcers
WBC cause epithelial necrosis, h. Pylori makes urease lowering pH causing more damage
Lab assessment of intestine obstruction
WBC normal unless stangulated obstruction which are high, hemoglobin/hematocrit/creatinine/BUN high due to dehydration. Sodium chloride and potassium reduced due to loss of fluid and electrolytes. Elevated amylase In stangulating obstructions, ABG
Washed RBCs aka? volume? Infusion time? Indications?
WBC poor PRBCs. 200mL, 2-4hours.history of transfusion reaction, hematopoietic stem cell transplant
Aspirating tube wait? Ph of stomach? Intestines? Lungs? Certain drugs?
Wait 1 hour after drugs then flush with 20ml air, collect, test with pH paper, pH should be 0-4 if in stomach if in intestines 7-8 if in longs greater than 6. Certain drugs can raise pH like h2 blockers aka ranitidine/Zantac, famotidine/Pepcid
Dilantin should not be taken with? What else can interfere with antieleptics ?
Warfarin/Coumadin. Citrus like grapefruit can interfere with antiepileptic drugs raising toxicity
Integumentary acidosis key features
Warm, flushed, dry skin in metabolic acidosis, pale to cyanotic and dry skin in respiratory acidosis
Hyperglycemia skin? Dehydration? Mental status? S/s? Glucose? Ketones?
Warm, moist. Present. Rapid/deep kussmaul with acetone/fruity odor. Varies from alert to comatose. Acidosis, hypercapnia, cramps, n/v, if dehydration decreased neck vein filling, orthostatic hypotension, tachycardia, poor turgor. >250. Positive
Suctioning an artificial airway
Wash hands, eye wear occlude suction and adjust pressure to 80-120 to prevent hypoxemia+trauma, setup sterile field, pre oxygenate with 100% O2 for 30 seconds, don't suction during insertion, never suction longer than 10-15 seconds, then hyperoxygenate again for 1-5 minutes, mouth care
Steps to draw NPH and regular insulin
Wash hands, rotate NPH, wipe with alcohol, draw air that equals dose, inject air in NPH then regular insulin, invert regular insulin and withdraw dose, withdraw NPH
Neuro symptoms of hypoglycemia
Weakness, fatigue, difficulties thinking, confusion, behavior changes, emotional changes, seizures, loss of consciousness, brain damage
Nursing assessment for peritoneal dialysis
Weigh daily I &O S/S of volume overload Peritoneal catheter patency Condition of exit site Color and character of effluent Normal- clear, pale yellow Cloudy fluid indicates peritonitis - add antibiotics Fibrin strands indicates clotting - add heparin
Gastritis prevention
Well balanced diet, avoid excess alcohol, use caution in large doses of aspirin/NSAIDs/corticosteroids/erythromycin, avoid caffeine, manage stress, no smoking, avoid toxic substances in work place, seek medical treatment if signs on esophageal reflux
Renin-angiotensin 2 pathway
When kidneys sense BP, volume, o2, osmolarity related to sodium low they secrete renin that activates angiotensin that is acted on by angiotensin converting enzyme aka ACE which turns it into angiotensin 2 that cause vasoconstriction, lowers GFR, aldosterone secretion
Intermittent admin sets define? Med bag from previous dose? Should be changed every? Change blood tubing? Change tubing for propofol/Diprivan?
When no primary continuous fluid infused this used to infuse multiple doses of meds through catheter that's capped with needless connection device. Med bag from previous dose removed for new one. Should be changed every 24 hours, change blood tubing every 4 hours, change tubing for proposal/Diprivan every 6-12 hours.
Subcutaneous infusion used when? Define? Sites? Not for? What can increase absorption? Which tools can be used? Rates? Rotate site how many times?
When oral, IM, vascular access cannot be used. Hypodermoclysis via slow infusion of isotonic fluids. Sites: front/sides of thighs+hips, upper abdomen, under clavicle. Not for >2000mL/day, emergencies, bleeding/coagulation issues. Hyaluronidase can increase absorption. Small gauge, winged/butterfly needle, short peripheral catheter, sub q infusion set used. 30mL/hr started max is 75-80mL/hr, for pain meds 2-3mL/hr. Rotate site once per week
Define subcutaneous emphysema
When there is opening/tear in trachea air escapes into tissue of neck and can progress through chest and face. If skin around trach is puffy and you can feel crackling notify
Tube dislodgement and accidental decannulation define? If tube dislodged on immature tracheostomy ?
When tube not secure prevented via securing tube in place. Ventilate using manual resuscitation bag/facemask while other RN calls rapid response. For safety ensure tube of same type and size + insertion tray at bed side at all times.
Hepatitis define? Most common type? Types of the most common?
Widespread inflammation of liver cells resulting in right upper quadrant pain , disformity, edema of bile channels causing jaundice. Viral. HAV, HBV, HCV, HDV, HEV.
Define ulcerative colitis
Widespread inflammation or rectum and colon associated with remissions and exacerbations. Intestinal mucosa becomes hyperemic, edematous, and reddened and can bleed and cause small erosions/ulcers/abscesses which can result in tissue necrosis, narrow colon, and partial bowel obstruction
Febrile transfusion reactions occur when? S/S? Prevention?
With patient with anti-WBC antibodies from multiple transfusions, WBC transfusions, and Platelet transfusion. S/S: chills, tachycardia, fever, hypotension, tachypnea. Prevention: WBC reduced blood, single donor HLA-matched platelets, WBC filters
Acute normovolemic hemodilution
Withdraw of patient's RBC and volume replacement just before surgery to prevent RBC loss during surgery, then reinfused after surgery
How much alcohol should DM patient drink? You should drink with? One drink equals?
Women 1 drink, men 2. And consumed with snack/meal One drink equals 12 oz beer, 5oz wine, 1.5 oz distilled spirits
Risk factors for endometrial/uterine cancer
Women in reproductive years; Family history, Diabetes Mellitus, Hypertension, Obesity, Uterine polyps, Late menopause, no childbirths, Smoking, Tamoxifen given for breast cancer
Breast cancer more common in?
Women who haven't had kids and moderate alcohol intake
Phalen's maneuver
Wrist test for CTS is paresthesia <60seconds +
Hysterosalpingography HSG define
X-ray of cervix, uterus & tubes Mammography: annually after age 40
hydroxychloroquine aka? does what? side effects? drug type?
aka Plaquenil. slows progression of RA. antimalarial. Side effects:stomach discomfort, light headedness, headache, retinal damage. DMARD.
If patient's peripheral catheter infusion is except the to last longer than 6 days
a midline catheter or PICC should be chosen
Manifestations of endometriosis
abdominal and back pain usually before period, dysmenorrhea, dyspareunia, and infertility
primary drug for osteoarthritis
acetaminophen aka Tylenol or topical drugs like lidocaine aka Lidoderm patches that can be used for 12 hours with up to 3 patches or salicylates aka aspercreme patch/gel/cream, or capsaicin. If those don't work then analgesic NSAIDs like Celecoxib aka Celebrex, or injections of cortisone, hyaluronate aka Hyalgan or hylan aka Synvisc or possibly muscle relaxants like cyclobenzaprine hydrochloride aka Flexeril for spasms.
signs of CS
acute compartment syndrome, hypovolemia, hyperkalemia, rhabdomyolysis aka myoglobulin release from muscle, acute tubular necrosis, dark brown urine, muscle weakness and pain
primary OA aka osteoarthritis cause? what parts of body most affected?
aging, genetics, obesity, trauma, career, smoking. Weight bearing joints like hips and knees, vertebral column, and hands are most commonly affected
Rn inverventions for dementia
aimed at promoting patient function and independence for as long as possible, safety, reducing anxiety/agitation, improving communication, providing for socialization/intimacy, nutrition, activity/rest, educating caregivers
Gout
aka "Gouty arthritis" -Drug therapy, Different medications for acute and chronic -NO aspirin or diuretics -Nutritional therapy, Decrease alcohol, Avoid "starvation" diets, Teach patients to avoid foods that prompt gout attack, Promote hydration
Sulfasalazine aka? does what? side effects?
aka Azulfidine. decreaseds inflammation and slows RA. Side effects: lowers sperm count, renal/liver toxicity, formation or urine crystals if not enough water
biological response modifiers aka? class of? do what? examples? side effects?
aka BMRs or biologics. class of DMARDs, most neutralize tumor necrosis factor or interleukin for RA via IV or injection. Ex: Etanercept/Enbrel, Infliximab/Remicade, Adalimumab/Humira, Anakinra/Kineret, Abatacept/Orencia, tocilizumab/Actemra. Side effects: injection reaction,infection
disease modifying antirheumatic drugs aka? does what? what type? example?
aka DMARDs. slows progression of RA. immunosuppressive. Ex: Methotrexate, Leflunomide/Arava, hydroxychloroquine/Plaquenil, biological response modifiers/BMRs
methotrexate aka? given when? monitor for? aka?
aka MTX/Rheumatrex given in once a week dose less than 25mg for RA. Monitor for low WBCs and platelets, nausea, vomiting, bone marrow suppression and infection. DMARD.
open reduction with internal fixation aka? is most?
aka ORIF is most common methods of reducing and immobilizing fracture
glucocorticoids aka? used for? examples? side effects? monitor for?
aka steroids. 10-150mg PO. used for RA for anti-inflammatory and immunosuppressive effects Ex: prednisone/Deltasone. Side effects: DM, infection, fluid/electrolyte imbalance, hypertension, osteoporosis, glaucoma, K depletion, glucose to increase. Monitor for: moon face, buffalo hump,, striae, acne, thin skin, bruising, cataracts,
open reduction allows surgeon to?
allows surgeon to view fracture
plasmapheresis
antibodies removed from plasma to decrease MG symptoms
A rheumatic disease is
any disease or condition involving the musculoskeletal system
traction define? types?
application of pulling force to part of body to provide reduction, alignment, rest. Types: running traction where pulling is in one direction, balanced suspension which countertracts so that pulling isn't altered when patient/bed moved, skin traction with velcro boot/buck's traction or belt or halter which usually is secured around leg that is 5-10 pounds, skeletal traction with pins, wires, tongs or screws that are surgically inserted in bone
leflunomide aka? does what? side effects? drug type?
arava. diminishes inflammatory arthritis symptoms. given 20mg every day. Side effects: hair loss, diarrhea, decreased WBCs+platelets, increased liver enzymes. DMARD.
Cervical cancer most are caused by?
are caused by certain types of human papilloma virus (HPV) specifically the high risk strains
periungual lesions
around nail bed, brown spots in RA patients
Low testosterone define? Alcohol?
associated with metabolic syndrome, type 2 diabetes, cardiovascular disease; **alcohol inhibits testosterone production
myasthenia gravis what type of disease? characterized by? improves with? s/s? cause? onset? diagnosis?
autoimmune disease characterized by fatigue and weakness that usually improves with rest. S/S ocular palsies, eye+face issues, paresthesia, loss of bowel/bladder control, muscle ache, paresthesias, decreased smell/taste in muscle innervated by cranial nerves and skeletal/respiratory muscles, ptosis, diplopia, dysphagia. not from genetics, possibly thymus, thyroid, RA, lupus. usually slow onset. diagnosis: repetitive nerve stimulation, EMG, tensilon test
Wound control for foot ulcers with DM
debridement, dressings, advanced wound healing products (becaplermin [Regranex]), vacuum-assisted closure, ultrasonography, hyperbaric oxygen, and skin grafting
paradoxical BP define? cause?
decrease in systolic pressure by more than 10 mm Hg during inspiratory phase of respiratory cycle. Anything that alters filling pressure of ventricles causes this like pericardial tamponade, pericarditis, pulmonary hypertension
Assessment of raised ICP? Late changes?
decreased LOC, pupils sluggish, 1-2 pupil dilated, 2 pupils dilated or pinpoint-no reaction. Late changes: widening pulse pressure, bradycardia, decreased/irregular respirations, temperature increased aka cushing's triad
as calcium rises phosphorus
decreases
managing fatigue for RA? if muscle atrophy?
decreasing pain and sleep disturbances. anemia should be treated with iron, folic aci, or vitamins. if muscle atrophy physical therapy, energy conservation like pacing, rest periods, setting priorities, obtaining assistance, plan ahead, don't exceed activity tolerance
Causes of inadequate chest expansion
deformities/weakness from electrolyte imbalances, fatigue, muscular dystrophy/obesity/casts/Escher/ascites,
Irritable bowel syndrome causes? Aka? Define.
diarrhea, constipation, and/or abdominal pain and bloating. Aka spastic colon, mucous colon, nervous colon. Bowel motility changes and increased or decreased bowel transit times result in changes in normal elimination pattern.
hip precautions after THA after discharge
don't sit/stand for prolonged periods, don't cross legs beyond midline, don't bend hips more than 90 degrees, don't twist body when standing, use ambulatory aid like walker, use assistive/adaptive devices for dressing, don't put more weight on affected leg than allowed, resume sex on the advice of surgeon, use raised toilet seat
interventions for osteoarthritis
drug therapy, local or systemic or psychological rest, positioning in functional position, applying heat, applying cold, diathermy, ultrasonagraphy, acupuncture, weight control, therapy, dietary supplements glucosamine and chondroitin, and if nonsurgical methods don't work surgeries like total joint arthroplasty TJA aka total joint replacement or osteotomy that removes damaged cartilage
orthopnea
dyspnea when lying flat and can be due to heart disease
PE assessment
dyspnea, Pleuritic chest pain & increased heart rate, Crackles, cough, hemoptysis, Distended neck veins, syncope, cyanosis, and hypotension, Abnormal EKG and heart sounds, pleural friction rub, diaphoresis, low grade fever, petechiae over chest, decreased SaO2, n/v, malaise Sense of impending doom, anxiety, and fearfulness
tensilon test aka? define? positive if? determines?
edrophonium chloride aka tensilon and neostigmine bromide aka prostigmin is injected and positive if better muscle tone for 4-5 min. Determines if MG due to cholinergic crisis aka too much cholinesterase inhibitor or myasthenic crisis aka too little cholinesterase inhibitor
abduction devices
either pillows or with straps that must be loosened every 2 hours and checked for skin irritation and/or breakdown
Lifestyle therapy for GERD
elevate HOB by 6-12 inches for sleep, sleep in right side lying position, no smoking or alcohol, weight reduction, no constrictive clothing, no lifting heavy objects or straining, no working in bent over or stooped position, no oral contraceptives/anticholinergic agents/sedatives/NSAIDs/nitrates/calcium channel blockers
Chronic complications of DM are primarily those of
end-organ disease from damage to blood vessels/angiopathy secondary to chronic hyperglycemia
Surgical management of DUB
endometrial ablation (removal of built up uterine lining); uterine artery embolization (stopping the blood supply); Dilation & Curettage (D & C); & hysterectomy
baker's cysts
enlarged popliteal bursae behind the knee from RA
Cause of hypochloremia
fluid overload, excessive vomiting, diarrhea, adrenal insufficiency, diuretic therapy, gastric suctioning
calcitonin from? does what?
from thyroid decreases Ca and inhibits bone resorption
anasarca define ? can be due to?
generalized edema can be due to right heart failure
Define d-dimer
global marker of coagulation activation and measures fibrin degradation products produced from clot breakdown
Estrogen define? Alcohol?
growth & development of female sexual characteristics & reproduction; tells cells to grow & (prompts breast tissue growth); helps prevent bone loss; **alcohol ^
nonmed interventions for Paget's
heat, massage, exercise with physical therapist, diets with calcium and vitamin d
acute compartment syndrome high risk of? if suspected? s/s? treatment?
high risk of cast, splints, wraps, ORIF, external fixation. If suspected notify first, if tight dressing loosen it, if cast follow policy on who can remove. Signs/symptoms: pain, numbness/tingling, pale and cool extremity, loss of movement/function+ decreased pulses/pulselessness latest sign. Treatment: fasciotomy via opening fascia to relieve pressure
total joint arthroplasty usually for? helps with? should never be performed on those with?
hip and knee joints but also finger, wrist, elbow, shoulder, toe, and ankles. Helps with osteoarthritis, RA, congenital issues, trauma, and osteonecrosis. They should never be performed on those with any infection, or osteoporosis, diabetes, hypertension patients
Biquanides withhold when and for how long and what to monitor? Contraindications? Can cause?
if patient is undergoing surgery or radiologic procedure with contrast medium for Day or two before and at least 48 hours after. Monitor serum creatinine Renal, liver, cardiac disease, HF, excess alcohol. Can cause lactic acidosis, gas, nausea, cramping if it accumulates
Acidosis from DM causes
increased RR and depth aka kussmaul, fruit breath from acetone, low pH and decreased HCO3, compensatory respiratory alkalosis with decreased PaCO2
compartment syndrome define? causes?
increased pressure in compartment reduces circulation to the area after trauma that causes inflammation which causes, redness, pain, swelling, tingling/numbness, cyanosis, unequal pulses and then necrosis/ischemia, infection, weakness, contracture, myoglobinuric renal failure, possible amputation
PTH does what?
increases and stimultes bone to release Ca in blood and reduces renal excretion of Ca and facilitates Ca absorption
arthritis define? categories?
inflammation of one or more joints. Categories: noninflammatory localized like osteoarthritis that is not autoimmune, or inflammatory systemic autoimmune diseases like rheumatoid arthritis and lupus erythematosus
osteomyelitis pathophysiology
inflammatory response causing edema that causes decreased blood flow to bone causing ishemia+bone necrosis with sequestrum formation that causes abcess
if hyperosmotic IV solution like 2% saline infused into patient with normal ECF osmolarity
infusing fluid would make person's blood hyperosmotic and interstitial fluid would be pulled into circulation and as result plasma volume would expand
facilitated diffusion/transport examples
insulin, sodium pumps
arthrocentesis define?
invasive for joint swelling where needle into joint aspirates synovial fluid to relieve pressure and test fluid for RF and increased WBC's
prevention of joint degeneration
keep body weight normal, don't smoke, avoid activities that stress joints, wear supportive shoes, don't do repetitive stress activities like typing/knitting, avoid risk taking activities
scoliosis define? appears when? types?
lateral curve usually in thoracic area, most likely appears as a kid. Types: congenital, neuromuscular from neuromuscular conditions like cerebral palsy, and idiopathic which cause is unknown
physical therapy for fractures
laterality that helps brain identify injured foot from uninjured foot. aka mirror box therapy where patient covers affected foot while looking at and moving uninjured foot. the brain perceives foot as injured food. Also can use iontophoresis that is method for absorbing steroids to decrease inflammation
most important part of patient/family education for OA
learning how to protect joints. Use large joints instead of small ones, don't turn doorknob clockwise, use two hands to hold objects, sit in chair with high/straight back, when entire palm of both hands to get out of bed not finders, don't bend at waist, bend at knees, use long handled devices, use assistive/adaptive devices like velcro, don't use pillows in bed, avoid twisting/wringing hands
Meglitinides function? Rapid onset? Taken when? Should not be? Examples?
↑ Insulin production from pancreas Rapid onset: ↓ risk for hypoglycemia Taken 1-30 minutes to just before each meal Should not be taken if meal skipped Ex: Repaglinide/Prandin, Nateglinide/Starlix
Leiomyomas/fibroids/myomas meds?
leuprolide acetate (Lupron) - decreases the size of tumors; Gonadotropin releasing hormone analogue that desensitizes the pituitary gonadotropin releasing hormone receptors
Lordosis define? aka? vs. scoliosis define? vs. kyphosis aka? define?
loss of lumbar and cervical curve aka flat back, all spine vertebrae have lateral/side curve usually in thoracic area, aka hunch back usually thoracic but also cervical spine
Barrel chest results from
lung overinflation and diaphragm flattening = weakened effect of diaphragm from emphysema
define measurable and not measurable fluid intake
measurable: oral, parenteral, enemas, irrigation fluids. not measurable: solid foods, metabolism
measurable and not measurable fluid output
measurable: urine, emesis, feces, drainage from body cavities. Not measurable: perspiration, lung vaporization
rheumatoid factor measures? usually?
measures presence of unusual antibodies of immunoglobulins G and M that develop in CTDs like RA, cancer, and other diseases and other but not all + indicate disease esp. in older people. usually -
antinuclear antibody ANA test measures? aka? often?
measures unusual antibodies that cause tissue death in patients with autoimmune disease, CTD's like RA. fluorescent method aka FANA. often negative unless later and only + in a small few with RA
Cause of hyperchloremia
metabolic acidosis, respiratory alkalosis, hypercortisolism
how to monitor for signs/symptoms that could indicate local anesthetic is getting into patients system
metallic tast, tinnitus, nervousness, slurred speech, bradycardia, hypotension, decreased respirations, seizures
presence of most chronic diseases usually causes? and the reason to?
mild to moderate anemia causing fatigue and the reason to monitor CBS for low hemoglobin, hematocrit, and RBC count, and high WBC and platelets
osmosis define? to occur?
movement of water through selectively/semipermeable membrane to have equal concentrations of particles to water even though total amounts of particles and water are different. To occur one fluid space must have particles that cannot move through membrane with concentration gradient
inspection assessment of osteoarthritis
musculoskeletal: look for enlarged joints, hardness, heberden's nodes, bouchard's nodes, joint effusion aka excess joint fluid via moving fluid from infrapatellar notch/area below knee into suprapatellar area above knee, atrophy of skeletal muscle due to no use, contractures, limping, loss of function, check lumbar and cervical spine, radiating pain, stiffness, spasms
clubbing define? indicates?
nail angle of 180 degrees and base of nail spongy to indicate chronic pulmonary disease, congenital heart defects, or cor pulmonale aka right heart failure
cholinergic crisis characteristics? treatment?
nausea, vomiting, diarrhea, ab cramps, blurred vision, pallor, face muscle twitching, pupillary miosis, hypotension. Treatment: atropine
Osmolality define? aka?
number of milliosmoles/mEq in kilogram of solution aka greater amount of particles the higher.
assessment of scoliosis
observe while standing with forward flexion of hips, observe for asymmetry of hip+shoulder, prominence of thoracic ribs and scapula on one side, visible curve of spineQ
crush syndrome occurs from? causes? as muscle becomes ischemic?
occurs from twisting, earthquake, crushing injury that causes hemorrhage and edema thus compressing compartments in leg, arm, pelvis. As muscle becomes ischemic myoglobin and vitamin k released in circulation causing kidney failure and cardiac dysrhythmias
impact of age related changes on fluid balance
skin elasticity, turgor, oils decrease. kidney decreased glomerular filtration and concentrating capacity causing poor excretion of waste and increased water loss. decreased muscle mass causing greater risk for dehydration. diminished thirst reflex causing decreased fluid intake. adrenal atrophy causing poor regulation of sodium and potassium causing hyponatremia and hyperkalemia
Dementia with Lewy bodies is?
one of the most common types of progressive dementia. The central feature of DLB is progressive cognitive decline, combined with three additional defining features: (1) pronounced "fluctuations" in alertness and attention, such as frequent drowsiness, lethargy, lengthy periods of time spent staring into space, or disorganized speech; (2) recurrent visual hallucinations, and (3) Parkinsonian motor symptoms, such as rigidity and the loss of spontaneous movement. People may also suffer from depression.
rheumatoid arthritis onset age? gender most affected? risk factors/cause? disease process? pattern? drugs?
onset age: 35-45, females risk factors/cause: autoimmune, genetic, stress triggers exacerbation, environment disease process: inflammatory disease pattern: bilateral, symmetric, multiple joints, upper extremities first, systemic lab findings: elevated rheumatoid factor, antinuclear antibody, ESR drugs: NSAIDs short term, methotrexate, leflunomide aka Arava, corticosteroids, immunosuppressants
osteoarthritis onset? gender usually? risk factors/cause? disease process? pattern? drugs?
onset: older than 60, female risk factors/cause: aging, genetics, obesity, trauma, occupations disease process: degenerative disease pattern: unilateral, single joint, affects weight bearing joints and hands+spine, nonsystemic drugs: NSAIDs short term, acetaminophen, analgesics
Low body fat and weight may be related to?
ovarian dysfunction; onset of menses; regular menstrual cycles; & low estrogen level
Respiratory alkalosis pH? PCO2? HCO3-? Differential?
pH high, PCO2 low, HCO3- normal or decreasing. Anemia, CHF, exuberant mechanical ventilation
Metabolic alkalosis pH? PCO2? HCO3-? Differential?
pH high. PCO2 normal or increasing. HCO3- high. Vomiting from upper GI obstruction, admin of alkaline solutions
Metabolic acidosis pH? PCO2? HCO3-? Differential?
pH low, PCO2 normal or decreasing. HCO3- low. Diabetes, addisons, renal failure, increased acid production
subluxation aka
partial dislocation
fractures described by cause
pathologic spontaneous fracture: occurs after minimal trauma to bone that's weakened by disease fatigue stress fracture: excessive strain and stress via athletics compression fractures: loading force applied to long axis usually in vertebrae
when caring for patient with CFNB perform? patient shouldn't feel?
perform neurovascular assessment ever 2-4 hours, patient shouldn't feel pain but be able to plantar flex and dorsiflex and feel, be warm, have proper color and capillary refill
cardiac complications of late RA
pericarditis, myocarditis
respiratory complications of late RA
pleurisy, pneumonitis, diffuse interstitial fibrosis, pulmonary hypertension
hip dislocation prevention/intervention
position correctly, keep leg abducted, prevent hip flexion beyond 90 degrees, assess for pain rotation and extremity shortening, report immediately to physician
peripheral nerve blockade aka PNB define? aka?
postop pain management for lower extremity, anesthesiologist injects femoral or sciatic nerve with local anesthetic. aka continuous femoral nerve blockade CFNB
In DUB when ovaries fail to ovulate?
progesterone decreases; without progesterone, prolonged estrogen stimulation causes endometrium to grow causing disordered shedding of uterine lining
Dementia/AD characterized by?
progressive decline and ultimately loss of multiple cognitive functioning including both Memory And at least one of the following:Aphasia, Apraxia, Agnosia, anomia Disturbance in executive functioning
Treatment of testicular cancer
radical orchiectomy, retroperitoneal lymph node dissection (open or laparoscopic), radiation therapy, and chemotherapy
myasthenic crisis characteristics
raised pulse+RR+BP, anoxia, cyanosis, bowel and bladder incontinence, decreaseda urine output, absence of cough/swallow reflex
reduction define? either?
realignment of bone ends for proper healing. either closed or open aka surgical
exercises recommended for patient with OA and RA
recreational: hobbies sports therapeutic exercise: planned activities to improve muscles and ROM. do these on all days unless pain increases. must be active instead of active assist, reduce repetitions when there's inflammation
hemiarthroplasty
replacement of part of joint in shoulder
in hypothermia tissues require?
require fewer nutrients and BP and pulse falls
in hyperthermia tissues require?
require more nutrients and BP and pulse rate rises
muscular dystrophy MD progression? causes? primary problem is? diagnosed via? cure?
slowly or rapid progression. Causes: poor blood flow to muscle, disturbance in nerve-muscle interaction, loss of cell membrane integrity. Primary problem is progressive muscle weakness which can cause respiratory weakness and cardiac failure. Diagnosed via muscle biopsy, aldolase+CK elevated, EMG findings abnormal. No cure only physical and occupational therapy
minimally invasive surgery NIS? cannot be used on?
smaller incision to reduce muscle cutting, but cannot be used on obese or for osteoporosis only for primary THAs
Because brain requires constant supply of glucose to function hypoglycemia can cause
speaking difficulties, visual disturbances, stupor, confusion, seizures and coma, mimics alcohol intoxication
getting patient out of bed after THA
stand on same side of bed as affected leg, after patient sits on bed side remind them to stand on unaffected leg and pivot into the chair
pericarditis define? can be? location? relieved with?
sudden sharp, stabbing, moderate to severe. can be infectious, noninfectious, autoimmune, acute, chronic Location: substernal left side, back. Relieved with sitting upright, analgesia, anti-inflammatory agents
MI onset? usually in? s/s> location? relieved with?
sudden without precipitating factors, usually in morning. Intense stabbing viselike pain/pressure. Location: substernal and can spread to chest and arms, jaw, back, neck. Relieved with morphine, drugs, O2
proper positioning for THA
supine, head slightly elevated
TSA aka? major potential complications? what's used to immobilize joint?
total shoulder arthorplasty. subluxation/partial dislocation and total dislocation is major potential complication. Sling used to immobilize joint
RN interventions for myasthenia gravis
treatment that affects symptoms without influencing actual course of disease like anticholinesterases or cholinergic drugs, or inducing remission like immunosuppressive drugs or corticosteroids, plasmapheresis, thymectomy
cast syndrome define? causes what?
upper intestinal obstruction that causes abdominal distention, pain, nausea, vomiting
postop care of older adult with THA
use abduction pillow or splint, keep heels off bed to prevent pressure ulcers, don't rely on fever as sign of infection, use decreasing mental status to detect infection, move patient slowly out of bed, encourage deep breathing and cough and incentive spirometer every 2 hours to prevent atelectasis and pneumonia, get patient out of bed ASAP, anticipate giving pain meds, expect a temp. change in mental state immediately after surgery, reorient patient frequently
Teaching for continuous glucose monitors
use and interpret calibration and control solutions. Control solution should be used when a glucometer is first used, when a new bottle of strips are used, or if there is a reason to believe that the readings are not correct.
ankle-brachial index used to? equation? normal is? less than 0.8 indicates?
used to measure vascular status of limb blood pressures for amputation. Ankle systolic pressure/dorsalis pedis or tibial divided by brachial systolic pressure. Normal is 1 or higher. less than 0.8 indicate vascular disease
internal fixation uses?
uses pins, screws, rods, plates, or prostheses to immobilize fracture
serum complement usually decreased in? usually total is?
usually decreased in autoimmune diseases, anemia, infection. Usually total 75-160units/mL
lab assessment of osteoarthritis
usually physical exam and history used to diagnose since labs usually normal but labs can be used to screen for associated issues like erythrocyte sedimentation rate aka ESR and high sensitivity C reactive protein aka hsCRP which can be elevated when secondary synovitis occurs
CPM: usually set to? best practice for using it?
usually set to 20-30 degrees flexion and full extension/0 degrees at 2 cycles a min. Ensure it's well padded, check cycle and ROM settings once every 8hrs, ensure joint is properly positioned, if patient confused place controls out of reach, assess patient response, turn off machine during meals, when machine not in use DO NOT store on floor
Health illness continuum views health as? Illustrates?
views health as a constantly changing state, with high level wellness & death being on opposite ends of the scale •This continuum illustrates the ever changing state of health as a person adapts to changes in the internal & external environments to maintain a state of well-being
other care after THA after discharge
walk and perform leg exercises like straight leg raises/gluteal sets/ankle pumps/ham sets, don't cross legs to prevent blood clots, report pain/redness/swelling/chest pain/shortness of breath, if taking anticoagulant follow precautions
if 24 hour output less than 400-600mL
water loss from skin, lungs, and stool. usually 500-100mL/day. Increases during thyroid issues, trauma, burns, stress, fever, hot/dry environment, mechanical ventilation, tachypnea
Pelvic organ prolapse cause by?
weakening of muscles, pregnancy, damage during childbirth, obesity, physical exertion, decreased estrogen weakens pelvic support
kidney control of blood
when renal blood flow/pressure decreases kidneys retain Na and H2O and activate renin angiotensin aldosterone mechanism causing vasconstriction causing BP to rise
WNL BP? Cholesterol? Triglycerides? HDL? LDL? GLOOD GLUCOSE? BMO? ABD. GIRTH? PSA?
•Cholesterol: <200 mg/dl •Triglyceride: <150 mg/dl •HDL: >40 mg/dl •LDL: <70 mg/dl (^ risk pts); <100 mg/dl •Blood Glucose: 60 - 100mg/dl •BMI: 18.5-24.9 •Abd. girth: <40" for men; < 35" for women •PSA: <4 nanograms/ml
Oral candidiasis signs? Treatment? For widespread or resistant infection?
•Signs - white plaques esp. in mouth, that bleed & leave erosions when removed, poor appetite, difficulty swallowing due to pain; infected skin has a moist red, irritated appearance •Treatment - Nystatin/Mycostatin , Fluconazole or Clotrimazole (Mycelex), keep area dry •For widespread or resistant fungal infections, systemic medications i.e. ketoconazole (Nizoral) is used
Health promotion model define? This model? If a behavior becomes a habit? Health related behavior is?
•States how people interact with their environment as they pursue health •This model incorporates individual characteristics, experiences, & behavior-specific knowledge & beliefs, to motivate health promoting behaviors •If a behavior becomes a habit ^ repeated •Health related behavior is the outcome & is directed toward attaining + health outcomes
Sulfonylureas function? Major side effect? Examples ? Take when?
↑ Insulin production from pancreas and insulin sensitivity Major side effect: hypoglycemia Glipizide/Glucotrol short acting, Glyburide/Micronase/DiaBeta/Glynase long acting, Glimepiride/Amaryl long acting Take with meal or 30 min. Prior to meal