NU 126- final

as a nurse you are performing an assessment on an asthmatic patient and notice no breath sounds is this normal?

na boo. immediate intervention required

Bernoulli Principle of Air Entertainment

trapping the air like a vacuum which provides a high airflow and controlled O2 enrichment

S/S of Gonorrhea in Women

May be asymptomatic until it gets really complicated vaginal dishcarge abnormal uterine bleeding dysuria

Leuprolide or Lupron can be thought of as?

Medical Menopause

The nurse is caring for a client with severe diarrhea. The nurse recognizes that the client is at risk for developing which acid-base imbalance?

Metabolic Acidosis

A patient over 50 comes into the office, he has a sudden elevated BP recorded. What would you suspect?

Possible Polycystic Kidney Disease

Angina Pectoris

episodes of paroxysms of pain / pressure in the anterior chest. caused by insufficient coronary blood flow

NOCICEPTIVE

PHYSICAL ex. Sunburn

What can develop if Gonorrhea is left untreated?

PID

What position should a patient be in post Tonsillectomy?

PRONE - we do not want secretions to come out *gentle suctioning can be done in the mouth not down the throat

Open Reduction

pins and screws used to put bones back together **SURGERYYYYY***

During which condition will a patient have tetany and increased serum phosphate levels?

hypoparathyroidism (LOW Ca)

D5NS or DSLR

total osmolarity exceeds that of the ECF, once the dextrose metabolizes, hypotonic solution remains

What is a disadvantage of using the transdermal route of opioid administration?

A delay in effect until the dermal layer is saturated

A client is undergoing a lumbar puncture. The nurse educates the client about surgical positioning. Which statement by the nurse is appropriate? "You will be placed flat on the table, face down." "You will be on your back with the head of the bed at 30 degrees." "You will be lying on your side with your knees to your chest." "You will be flat on your back with the table slanted so your head is below your feet."

"You will be lying on your side with your knees to your chest."

What is the onset, peak, and total duration of rapid acting insulins?

*** Onset - 10 to 30 min *** Peak 1-3 hrs Total 3-6 hrs

What is the onset for short acting insulins?

*** Onset 30-60 min *** These should be given 20-30 min before a meal Peak is 2-4 hrs

How long does Intermediate Acting Insulin last? Whats it peak? When should it be administered?

*needs half a day/night its often combined w/ a short acting insulin

What are some functions of Insulin?

*promotes glycogen storage *facilitates glucose utilization in muscles *storage of fat

Retropubic Prostatectomy

*used when there are no bladder abnormalities seen - incision is made on abdomen and between the pubic arch and bladder

Hypoparathyroidism Etiology

- Autoimmune response on parathyroid gland - happens most often with age - Vit D deficiency

What preoperative interventions should the patient take before a Hysterectomy?

- Stop all anticoagulants (NSAIDs ASA and Vit E) - Pregnancy Test day of surgery - Take Prophylactic Antibiotics (administer prior to surgery and d/c day after) - clipped lower abdominal/perineal area - Enema clear out dem bowels

Post OP Hysterectomy Care

- breathing, vitals, pain, bleeding - risk for infection - risk for hemorrhage - assess for vaginal bleeding - count peri pads and saturation - assess for any voiding problems especially if performed vaginally - assess abdominal incision/ stab sites/ vaginal region

what interventions will you take for a patient post hysterectomy to promote peripheral circulation?

- frequent feet and leg exercises - frequent position changes - no pressure under knees - Compression Stockings - Assess for leg pain, redness, warmth - Assess for chest pain, tachycardia, dyspnea - No crossing legs - No extended chair sitting

Which individuals is metformin contraindicated?

-anyone HTN to metformin - acute or chronic METABOLIC ACIDOSIS

What are some teaching points to enforce with a PAD patient?

-no crossing legs -bath water should not exceed normal body temp - avoid constrictive clothing - avoid exposure to cold - no heating pads on extremities; applying to abdomen can cause reflex vasodilation which will drop their BP

When should a long acting insulin like lantus be administered?

1 day in advance **** theres no peak- it stays at a steady level ****

how long do most NSAIDS take to take effect?

1 hour

virchows Triad

1) SLOW blood flow ( STASIS ) 2) Hypercoagulation (birth control, surgery, genetics ) 3)DAMAGE to blood vessels

3 ways cigarettes contribute to CAD.

1) increases carbon monoxide level, less hemoglobin can carry o2 2) nicotinic acid triggers release of catecholamines which raise HR and BP- also causes CA constriction 3)increases platelet adhesion and increases risk for thrombus formation

Okay so we have a patient that has BPH. Doctor orders a catheter, What are some considerations the nurse should be thinking about?

1) patient will prlly need a coude catheter 2) a normal catheters opening may not stay open because its prlly soft ect. the nurse may need a wire or stylet to keep the catheter from closing

Nasal Cannula

1-6 L/ min 22-33%

Normal Urine Specific Gravity

1.005 - 1.030

How long should a patient post tonsillectomy avoid coughing, smoking, and heavy lifting?

10 days

Non Rebreathing Mask

10-15 L/ min 80-100%

How much calcium and Vit D should your patient have/ day

1000-1300 mg/ day Calcium 800-1000 U of VIT D ages 50+

normal PT =

11-13.5 sec

Normal Sodium Levels

135-145 mEq/L

HOw much physical exercise is recommended for menopausal women?

150 minutes / week 1 hour/ day if they need to loose weight

Examples of some Bisphosphonates

Alendronate (Fosamax) Risedronate (Actonel) Ibandronate (Boniva) Zoledronic Acid (Reclast) *IV*

What score on the COMFORT scale indicates adequate sedation and pain control?

17-26

What is the Urine out put goal for all patients ?

1ml/kg/hr

It is recommended that patients anticipating surgery discontinue the use of herbal medicines at least _______________ before surgery, because many herbal agents can adversly affect surgical outcomes

2 weeks

Anything over _________L/min needs humidification.

2-3

How much sodium is recommended for HF patients?

2-3 Grams/day

Gonorrhea Intubation Period

2-7 days SX will appear within 10 days

Secondary Syphilis

2-8 wks later FLU LIKE SYMPTOMS malaise fever lymphadenopathy generalized rash arthralgia

the arm with arthersclorosis will have a difference in BP of more than ______?

20 mmHG

Kidneys receive ________ of the total cardiac output, renal blood flow _____________________ ml/min.

20-25% of total cardiac output renal blood flow 600-1300 ml/min

Normal Vit D levels

20-50 ng/ml

At sea level, the concentration of oxygen in room air is _____%

21%

When do withdrawal symptoms occur when opiods are discontinued?

24 hrs later and reach a peak within 72 hours

What is the time frame for Urgent surgeries?

24-30 hrs

Normal aPTT while on heparin =

25-35 (you want it to be around twice this if administering Heparin)

How much bone demineralization has to occur to be visible on an XRAY?

25-40%

How much water should to a patient drink post TURP to prevent dysuria and to keep urine clear?

2500 mL

A patient's serum sodium concentration is within the normal range. What should the nurse estimate the serum osmolality to be?

275-300 mOsm/kg

dequate hourly urine output for a client with an indwelling urinary catheter is

2ml/kg/hr

Whats required for the diagnosis of HTN in children?

3 High BP's recorded by a health care provider

What is Chronic Pain in pediatrics?

3 months or more

When should patients f/u after completion of ABI treatment for Chlamydia?

3 weeks after * super important for pregnant women

Children as young as _______ years old can use the Wong-Baker FACES pain rating scale.

3 years old

The ability to understand varying degrees of pain in facial expressions appears to be reasonably established by _________ years old.

3 years old

A patient with chronic pyelonephritis asks the nurse how much water he should be drinking/day. What do you advise?

3-4 Liters (unless C/I) (normal water recommendation is 2 L or 8, 8oz glasses/ day )

Symptomatic Gonorrhea patients should be treated within ____ days of onset of symptoms

30 days

Chlorpropamide (diabinese)

36 HR LONGEST ACTING - causes the release of bodys own natural insulin

Computed Tomography (CT)

3D abscess tumors cysts masses contrast dye can be used

A client has been prescribed a fentanyl patch for pain control. The nurse understands that this patch should be replaced every

48-72 hours

Flow rates in excess of ____ to ___ L/min may lead to swallowing of air or may cause irritation and drying of the nasal mucosa

4 to 6 L/min

Trichomonias Intubation Period

4-20 days AVG 1 week

Normal Urine pH ranges

4.5 to 8

Numeric Pain Scales can be used for children as young as ______ years old.

5 years old

Normal A1C is __________________

5.6% or less

Prediabetic A1C is

5.7% - 6.4%

If blood loss exceeds _________ mL (especially if the loss is rapid), replacement is usually indicated

500 mL

Simple Mask

6-8 L / min 40-60% O2

Asymptomatic Gonorrhea patients should have all sexual contacts treated from the last _______ days since onset of symptoms

60

Who is the PPSV-23 pneumococcal vaccine recommended for?

65 and over or 19-65 who smoke or have asthma or HIV positive

What is a standard OR rooms temperature usually range from? What about humidity?

68- 73 F and 30-60% humidity

For the client who is taking aspirin, it is important to stop taking this medication at least how many day(s) before surgery?

7

If a patient scores less than _____ they must remain in the PACU.

7

How soon before surgery should Aspirin be discontinued?

7-10 days before

What is the Aldrete Score usually between before discharge from the PACU ?

8 to 10

Partial Rebreather

8-11 L/Min 50-75*

What should the patients blood sugar range be before during and after surgery?

80-100 mg/dL

How much urine should a patient void/day/hr

800-2000 ml/ day at least 30 ml / hr

What ABI value indicates severe disease?

<0.7

Normal LDL

<100

What BNP lab value is considered normal ?

<100

Normal Triglycerides

<150

Normal Cholesterol

<200

What BP is indicative of a Hypertensive Emergency?

> 220/140 BP - WITH evidence of target tissue damage. which can progress over hours or days

Hypertension

>140/90 based on avg of 2 or more BP's taken 1-4 weeks apart BY A HEALTH CARE PROVIDERRRRRR

What is the criteria for dx of Amenorrhea?

>16 YO or NO secondary sex characteristics >14

What is the criteria for abnormal weight gain in HF patients?

>2-3 lbs in one day or >5 lbs in one week

Normal HDL

>40 M/> 50 F

The nurse expects informed consent to be obtained for insertion of: A) An indwelling urinary catheter B) An intravenous catheter C) A gastrostomy tube D) A nasogastric tube

A gastrostomy tube

During the diagnosis of Endometriosis - the provider will perform what exam in order to accurately diagnose and stage the severity?

A Laparoscopic Exam (STAGE I - IV)

A client weighing 160 pounds diagnosed with hypovolemia, is weighed every day. The health care provider asked to be notified if the patient loses 1,000 mL of fluid in 24 hours. Choose the weight that would be consistent with this amount of fluid loss.

A loss of 0.5 kg or 1 lb represents a fluid loss of about 500 mL. Therefore, a loss of 1,000 mL would be equivalent to the loss of 2 lbs (160 - 2 = 158 lbs).

_________________ is a behavioral pattern of substance use characterized by a compulsion to take the substance primarily to experience its psychic effects

Addiction

Which fractures are most common in Osteoporosis?

Crush Fractures T8 and below Hip and Colle's fractures are most common intertrochanteric and neck fractures of the femur

What diagnostic test do you think the doctor will prescribe a patient who has Hematuria?

Cystoscopy

A client with appendicitis has had an appendectomy. After surgery, what type of pain does the nurse anticipate the client will have?

Acute Pain

At what point of a BPH condition does surgery become imperative?

Acute Urinary Retention Chronic Urinary Tract Infections S/T residual urine in bladder Hematuria Hydronephrosis Bladder neck obstruction symptoms

How is Asthma diagnosed ?

ABGs and pulse ox PFTs PEFR's Skin testing (for allergies) Eosinophil count and IgE (if allergy is present these will be elevated)

How is HPV treated?

ABI's - Penicillin

If there is more CO2 in the blood the patient has

ACIDOSIS

Which members of the OR surgical team verifies the patients name, procedure, and surgical site using objective documentation and data before beginning surgery?

ALL MEMBERS

Pulmonary Edema Clinical Manifestations

ANXIETY SENSE OF BREATHLESSNESS cyanotic nail beds- clammy hands ashen grey skin color weak rapid pulse distended neck veins incessant coughing rapid, noisy, moist sounding breathing pink, frothy sputum acute confusion

Primary Hypothyroidism Cause

AUTOIMMUNE - Hashimoto - thyroiditis - atrophy of gland

Paralytic Ileus S/S

Abdominal Pain Cramping Firmness Tenderness Nausea Vomiting Bowel distention absent bowel sounds

A client is postoperative and has not taken her pain medication. The nurse is performing an assessment at the beginning of her shift and determines that sensitization has occurred. The first nursing intervention is to

Administer the intravenous opiod

Which populations age related decreases in GFR are more rapid?

African Americans

Osteoporosis Risk Factors

Alcohol use Corticosteroid Use Calcium Low Estrogen Low Smoking Sedentary Lifestyle

Many hospitals use a scoring system to determine the patients general condition and readiness for transfer from the PACU. Whats the name of this scoring system?

Aldrete Score

Will cell breakdown occur more rapidly in an acidic environment or alkaline?

Alkaline

What medications are used to help relax the prostate gland therefore releasing urethral pressure increasing urine flow and decreasing residual mass?

Alpha 1 Blockers or Alpha-Adrenergic Blockers

The nurse has been assigned to care for various clients. Which client is at the highest risk for a fluid and electrolyte imbalance? An 82-year-old client who receives all nutrition via tube feedings and whose medications include carvedilol and torsemide. A 45-year-old client who had a laparoscopic appendectomy 24 hours ago and is being advanced to a regular diet. A 79-year-old client admitted with a diagnosis of pneumonia. A 66-year-old client who had an open cholecystectomy with a T-tube placed that is draining 125 mL of bile per shift.

An 82-year-old client who receives all nutrition via tube feedings and whose medications include carvedilol and torsemide.

What positioning is best for PAD patients?

Dangle no leg crossing raise HOB or sleep in a chair keep feet warm (vasodilation) and in dependent position

Sequestrum

Dead NECROTIC BONE

Dietary Recommendations for patients with Menopause

Decrease calories and Fat intake Increase intake of grains, fiber, fruit, and vegetables Encourage Calcium rich foods

Dowagers Hump

Decrease in Height Protruding abdomen Increased Risk for falls

What age related hormonal changes occur after the fourth decade which increase the risk for osteoporosis?

Decreased Calcitonin Decreased Estrogen PTH increases

Which of the following is an inappropriate nursing action by the surgical nurse? Covering the hair with a surgical cap Wearing a surgical jacket with knitted cuffs on the sleeves Wearing sterile gloves over artificial nails Changing shoe covers that become torn

Artificial nails are prohibited in the clinical setting, because they can cause nosocomial infections.

FLACC Pain Assessment Tool

Facial Expression Leg Movement Activity Cry Consolability * measured 1-10 (0 is no pain 10 most possible pain)

prep u: A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem? Consult a skin specialist. Scrub the area vigorously to remove the crust. Apply lotions and take warm baths or soaks. Avoid exposure to direct sunlight.

Apply lotions and take warm baths or soaks

Factor Xa Inhibitors

Arixtra (SQ daily) **** CAUTION W/ RENAL PTs **** PT does not need to be tested

What is the correct timing for administering pain medications for pediatric patients experiencing post op or cancer pain?

Around The Clock (ATC) Schedule

prep u question: A client reports chest pain and heavy breathing when exercising or when stressed. Which is a priority nursing intervention for the client diagnosed with coronary artery disease? Assess chest pain and administer prescribed drugs and oxygen Assess blood pressure and administer aspirin It is not important to assess the client or to notify the physician Assess the client's physical history

Assess chest pain and administer prescribed drugs and O2 * nurses cant just give aspirin to the patient unless there is an order

Before referring to psych, while doing your assessment on a patient with suspected PMDD. Which evaluation is essential?

Assess for Mental Health Are they suicidal? or violent?

Renography / Kidney Scan

Assess renal blood flow

When administering a fentanyl patch, the last dose of sustained-release morphine should be administered at what point? Immediately after the morning shower Before respiratory assessment At the same time the first patch is applied There are no administration requirements

At the same time the first patch is applied because fentanyl patches dont start working until 12-8 hours

Primary Hyperthyroidism (GRAVES DISEASE) etiology

AutoImmune - immunoglobulins copycat TSH

UTI Teachings

Avoid Full bladder Increase Fluid intake at the first sign of a UTI - stop drinking ur vodka and pick up some cranberry juice lady Birth Control - Change Stop bathing in your filth pee after the deed

Tertiary Hypothyroidism

Failure of hypothalamus to secrete TRH

Cystocele

BLADDER

Where does BLOOD BACK UP IN RIGHT SIDED HF?

BODY - VEINS

Hyperparathyroidism

BONE BREAKDOWN KIDNEY STONES

Inhaled Short Acting Beta2 adrenergic agonists (SABAs)

BRONCHIODILATORS

Which drugs classes are used to treat UTI's ?

Bacteriacidals Cephalosporin (UTI) Fluroquinolone (UTI, Pyelonephritis) Penicillin Trimethoprim (sulfamethoxazole combination) Urinary Analgesic - Pyridium

A patient who has bone cancer has a new order for a Fentanyl patch. She has previously been receiving morphine for pain. When administering a Fentanyl patch, the last dose of sustained-release morphine should be administered:

Because it takes 12 to 24 hours for the Fentanyl levels to gradually increase from the first patch, the last dose of sustained-release morphine should be administered at the same time the first patch is applied.

Patient has dysmennorhea, she takes pain meds, when should you advise she take her meds?

Before and for the first few days of the menstrual cycle

Endometriosis

Benign tumor or lesion, growth outside of uterus that contains endometrial tissue

What are some alternative treatments patients may use that contain or facilitate the production natural estrogen and progestins?

Black Cohosh Ginseng Dongqual Soy Products

Hematogenous OsteoMyelitis

Blood Borne spread of infection

______________ is produced due to the presence of angiotensin II, prostaglandin, and ADH

Bradykinin

The nurse is assisting the anesthesiologist with the insertion of an epidural catheter and the administration of an epidural opioid for pain control. What adverse effect of epidural opioids should the nurse monitor for?

Bradypnea

According to the Joint Commission, which of the following is a focus of assessment related to quality of pain?

Description in the clients own words

Venturi Mask

COPD patients because it accurately provides appropriate levels of O2 *** SPECIFICALLY DESIGNED TO DELIVER PRECISE BUT LOWER DOSES OF O2

What are the three most common signs of asthma?

COUGH DYSPNEA WHEEZING chest tightness diaphoresis tachycardia

How can osteoporosis be prevented or managed?

Calcium and VIt D Weight bearing exercises

Corticosteroids (Prednisone) and their potential affect on the surgical experience

Cardiovascular collapse can occur if discontinued suddenly .. Therefore, a bolus of this may be administered via IV before or after surgery

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the physician will order diuretic therapy and restrict fluid and sodium intake to treat the disorder. If the client doesn't comply with the recommended treatment, which complication may arise? a. Cerebral edema b. Hypovolemic shock c. Severe hyperkalemia d. Tetany

Cerebral Edema

The most common cancer caused by HPV is ?

Cervical Cancer

What is a typical sign of Hyperglycemic hyperoslmolar nonketotic syndrome?

Changes in LOC !! because cells are dehydrated since serum is so high glucose

Endometriosis is rare in women who have had _________________.

Children

Pyelonephritis CM

Chills Fever Flank Pain Painful Urination - along with these common symp. : acutely ill leukocytosis Bacteriuria Pyuria Low back pain N/V Headache Malaise

Which electrolyte is a major anion in body fluid?

Chloride

Examples of Methylaxanthine.

Chocolate Cola Coffee

A client with emphysema is at a greater risk for developing which acid-base imbalance?

Chronic respiratory acidosis

Do children fall under complicated or an uncomplicated UTI?

Complicated

During treatment, the main difference between a Complicated and Uncomplicated UTI is :

Complicated UTI's are treated more aggressively so patients may be hospitalized, they are also on ABI's for longer (7-21 days vs. 3-7 days)

If someone got osteomyelitis from a gun shot wound- what type of osteomyelitis would that be? Hematogenous or Contiguous

Contiguous

Retrograde Exam

Contrast dye instilled into catheter and films are taken. the dye is pushed up against the flow of the kidneys and films are taken

Which medications other than Heparin will change the way the body absorbs Calcium?

Corticosteroids Thyroid Supplements Anti Seizure Meds Tetracycline Antacids containing Aluminum

Whats an example of an optional surgery

Cosmetic surgeries

A client is being treated in a substance abuse unit of a local hospital. The nurse understands that when this client has compulsive behavior to use a drug for its psychic effect, the client needs to be monitored for which effect? A) Placebo B) Dependence C) Tolerance D) Addiction

D. Addiction

Which nerve is implicated in the Chvostek's sign?

Facial

Step 3 or 4 Moderate Persistent Asthma

DAILY SX - episodes affect sleep and activity. some limitation on ADL's use of B agonist daily

In the gerontologic population, often the presenting symptom of Angina will be?

DYSPNEA

Bisphosphonates

Daily or weekly to increase bone mass and inhibit osteoclast activity

The nurse is assessing a patient complaining of severe pain. What physiologic indicator does the nurse recognize as significant of acute pain?

Diaphoresis

_____________ Heart Failure has little to no effect on the ejection fraction %.

Diastolic Heart Failure (ventricles dont properly relax so it never fills completely)

What are some contributing factors that could increase the patients risk for Premenstrual Syndrome?

Diet Stress Lack of Exercise CARBS

The potential effects of prior medication therapy must be evaluated before surgery. Which of the following drug classifications may cause respiratory depression from an associated electrolyte imbalance during anesthesia?

Diuretics

What treatments besides O2 is provided for patients with pulmonary edema?

Diuretics and Vasodilators

You are an ICU nurse who has just admitted a new client with an acid/base imbalance. What would you do to provide accurate baseline data for this client? Record intake and output Monitor lab values Document presenting signs and symptoms Implement medication ordered

Document presenting signs and symptoms

In regards to teaching fluid intake, What should you advise a patient with BPH?

Dont drink a large amount of fluid in a short period of time. Avoid Alcohol , Caffeine, Diuretics

During patient teaching, for a patient with Vesicoureteral Reflux and a UTI, you educate the patient to take all the prescribed ABI's , even at Bedtime. Your patient asks why. How do you respond?

Dose at bedtime is necessary because it allows the drug to enter your system and remain in your bladder ect over night.

Diuretics (HCTZ) and their potential affect on the surgical experience

During anesthesia, may cause excessive resp depression r/s from an associated electrolyte imbalance

CM of Endometriosis

Dysmenorrhea Dyspareunia Pelvic Pain Dyschezia Radiation of pain to back an dlegs Depression Loss of work Difficulties with relationships Infertility d/t adhesions and fibrosis Infertility d/t Prostaglandins, cytokines produced by transplanted tissue

Due to decreased vaginal secretions, patients with menopause will experience....

Dyspareunia Increased pH Atrophic Vaginitis

During an angiography, the nurse should be constantly monitoring the patient for any s/s of an allergic reaction to the contrast agent. What are those signs?

Dyspnea N/V Tachycardia Sweating and report immediately

What is added to a patients classification if they require an emergency surgery?

E Ex. P2E

Pulmonary Embolism Prevention Measures

EARLY AMBULATION SCDs- Sequential Compression Device Prophylactic Anti-Coagulants

Secondary Prevention

EARLY DETECTION SCREENINGS

Venous Insufficiency S/S

EDEMA altered pigmentation Lethery -dark brown red Stasis Ulcers Stasis dermatitis Dilated superficial veins Pain Symptoms increase as the day goes on

Which substance reduces the transmission of pain? Endorphins Acetylcholine Serotonin Substance P

ENDORPHINS

Wound Classifications *CLEAN CONTAMINATED*

ENTRY INTO RESP, ALIMENTARY, GU, OR OROPHARYNGEAL TRACTS W/O UNUSUAL CONTAMINATION APPENDECTOMY MINOR BREAK IN ASEPTIC TECHNIQUE MECHANICAL DRAINAGE

Latent Hidden Syphilis

Early latent <1 year = infectious Late latent >1 year = not infectioius

Which diagnostic test is preformed to determine which type of HF a patient has?

Echocardiogram - because it can determine the amount of ejection fraction

DVT S/S

Edema Swelling Tenderness HOMANS SIGN PAIN _ (unreliable if pt just cries out in pain and may not have DVT)

Inotrope

Effects Contractility

Chronotrope

Effects the Rate

Cast Care

Elevate above heart level should not be covered while drying No objects should be inserted because that can cut the skin Foul smell is not normal

Hypertensive Emergency Interventions

Elevate the bed Administer O2 IV antihypertensives+ Vasodilators Monitor BP every 2-3 min with arterial line

Acute Pyelonephritis Renal Characteristics

Enlarged Kidneys (^^^ Pressure) Abscesses may be noted Atrophy/ destruction of tubules

A client being treated for rheumatoid arthritis has been prescribed a glucocorticosteroid. How should the nurse best ensure this client's safety during treatment?

Ensure the client knows to taper down the dose if it is discontinued by the care provider

Septic Arthritis S/S

Erythema monoarthritis pain in joints decreased ROM FEVER IRRITABILITY

How often should you check the patients skin around their pressure points while they are on Oxygen?

Every 4 hours

Long and Intermediate Acting Insulins can be mixed with short acting insulins. T or F

F- only intermediate can not long

Prep U: The client with a fractured left humerus reports dyspnea and chest pain. Pulse oximetry is 88%. Temperature is 100.2 degrees Fahrenheit (38.5 degrees Centigrade); heart rate is 110 beats per minute; respiratory rate is 32 breaths per minute. The nurse suspects the client is experiencing:

FAT EMBOLISM SYNDROME (high temp, tachypnea, tachycardia and hypoxia)

Perimenopause occurs after the ______________ to ________________.

FIrst sign of menopause to cessation of menses for one year after cessation

Which hormones levels will rise to try to increase estrogen secretion?

FSH

With which condition should the nurse expect that a decrease in serum osmolality will occur? Diabetes insipidus Hyperglycemia Kidney failure Uremia

Failure of the kidneys results in multiple fluid and electrolyte abnormalities including fluid volume overload.

What is the time frame and give some examples of Elective Surgeries?

Failure to have surgery not catastrophic can be done at any time ex. repair of scars simple hernia vaginal repair

Most Common Site for Avascular Necrosis of Bone?

Femoral head

Which medication is administered to SHRINK the prostate and improve URINE FLOW by Lowering Dihydrotestosterone levels.

Finasteride (Proscar)

What are the two types of incentive spirometers available?

Flow or Volume

What is the glomerular funciton?

Fluid, electrolyte and acid base balance ** 1st stage of urine production

For an uncomplicated UTI the doctor is most likely to prescribe?

Fluroquinolones- Levofloxacin or Levaquin

The Emergency Department (ED) nurse is caring for a client who is known to make excessive use of laxatives who is showing signs of bradycardia. The client is admitted for hemodialysis. The ED nurse knows that a major goal of managing this client is what? Flush out excess magnesium Prevent magnesium sulfate reactions Provide mechanical ventilation Stop all laxatives

Flush out all magnesium is first then laxatives *** laxatives contain magnesium***

The Emergency Department (ED) nurse is caring for a client who is known to make excessive use of laxatives who is showing signs of bradycardia. The client is admitted for hemodialysis. The ED nurse knows that a major goal of managing this client is what?

Flush out the excess magnesium

An older adult is being treated with opioids for pain relief. Which of the following should the nurse strongly recommend to this client?

Follow a bowel regimen

Prep U : A patient had an above-the-knee amputation of the left leg related to complications from PVD. The nurse enters the patient's room and observes the dressing and bed covers saturated with blood. What is the first action by the nurse? Notify the physician. Apply a tourniquet. Use skin clips to close the wound. Reinforce the dressing.

Following an amputation, immediate postoperative bleeding may develop slowly or may take the form of massive hemorrhage resulting from a loosened suture. A large tourniquet should be in plain sight at the patient's bedside so that if severe bleeding occurs, it can be applied to the residual limb to control the hemorrhage.

When is peak bone mass achieved?

Fourth Decade

What test is the best indicator for kidney function ?

GFR -Creatinine Clearance Test - GFR

Leuprolide

GnRH agonist ends up blocking other hormones treatment of prostate and endometriosis and anemia related to fibroids

The most common bacterias that causes UTI's are ?

Gram Neg Bacilli 80-95% - E-Coli, Klebsiella Gram Pos Bacilli - 10-15% - Staph

What MOS causes Rheumatic Fever

Group A B-hemolytic Strep pharyngitis * most common in children

What is usually the cause of Tonsillitis ?

Group A Beta Hemolytic Streptococci

Normal Saline Solution

H20 + Na + Cl Extracellular Fluid *** used to correct ECF deficits, to replace large Na loss (burn loss) ***

What are some causes of Pulmonary Edema ?

HF (usually Left side unless Right side has progressed) overhydration from IV's altered capillary permeability of lungs inflammation drowning respiratory distress syndrome malignancies of the lymph

What lab findings will indicate hyperthyroidism ?

HIGH t3 T4 LOW TSH

How should a patient with Pulmonary Edema be positioned?

HIIIIIGHHH FOWLERSSSS Sit with legs dangling

The nurse is assigned to care for a client with a serum phosphorus concentration of 5.0 mg/dL (1.61 mmol/L). The nurse anticipates that the client will also experience which electrolyte imbalance?

HYPOCALCEMIA - Calcium and Phosphorus have an inverse relationship and the patient is experiencing hyperphosphoremia right now (anything more than 4.5 mg/dL)

During which condition will a patient have a positive trousseaus sign or chovsteks sign?

HYPOparathyroidism

Oxygen Induced Carbon Dioxide Necrosis

Happens to COPD patients they are stimulated to breathe by low O2 levels so when theyre on O2 masks they dnt receive that stimulus and dont breathe

A patient comes into the office, as a nurse you run the U/A test and notice his urine is particularly acidic. What questions would you ask to narrow down the etiology?

Have you changed your diet recently ? High protien diets promote an acidic urine output. (The presence of ecoli also changes urine to become more acidic)

What are the clinical manifestations of Premenstrual Syndrome?

Headache Low back Pain Irritability/Mood Issues Binge Eating Fear - loss of control Crying spells Depression Breast Tenderness Bloating

Most Common Side Effects of Nitroglycerin

Headaches and Hypotension

For a patient with menopause, its especially important to know the family hx in relation to which diseases? Why?

Heart Disease Breast Cancer Osteoporosis ( lack of estrogen )

Upon auscultation, ventricular gallop is heard; what cardiac disease is this an indication of?

Heart Failure

Transurethral Microwave Invasive Therapy

Heat is applied to prostatic tissue Microwaves from probe water cooling system in place to minimize urethral damage Tissue becomes necrotic and sloughs off

Vesicoureteral Reflux S/S

High Fevers Vomiting Chills

How are oxygen delivery systems classified?

High and Low flow systems

CM of Menopause

Hormonal changes Decreased Estrogen Irregular Menses Breast Tenderness Mood Changes Vasomotor Instability Bone density decreased vaginal tone/secretions depression fatigue forgetfullness weight gain dizzines

How is Acute Pyelonephritis treated in Pregnant Women?

Hospitalization for 2-3 days w/ Parenteral ABI's

Characteristics of Vasomotor Instability :

Hot Flashes Night Sweats Atrophic Changes

Perimenopause S/S

Hot Flashes/ Flushes Vaginal Dryness Irregular menses

What are the names of rapid - acting insulin ?

Humalog (insulin lispro) Novalog (insulin aspart) Glusine (synthetic insulin apidra)

_______ must be provided while oxygen is used -except w/ portable devices

Humidifiers

What is the name of Short Acting Insulins?

Humilin R - regular insulin Novolin R

A client presents with anorexia, nausea and vomiting, deep bone pain, and constipation. The following are the client's laboratory values. Na + 130 mEq/L K + 4.6 mEq/L Cl - 94 mEq/L Mg ++ 2.8 mg/dL Ca ++ 13 mg/dL Which of the following alterations is consistent with the client's findings?

Hypercalcemia greater than 10.2 mg/dL can be dangerous

Why is mobility encouraged in ______________ (hypo or hyper parathyroid) patients?

Hyperparathyroid patients are encouraged to move because this push pressure on the bones and promotes Ca bone reabsorption

Which is worse - Hypertensive Emergency or Hypertensive Urgency?

Hypertensive Emergency

Which could be a potential cause of respiratory acidosis? hyper or hypoventilation

Hypoventilation

Hypoxemia = __________ BP

Hypoxemia increases BP

Primary Prevention

IMMUNIZATION HEALTHY DIETS

A healthy kidney will have _______ creatinine in urine and ______ in blood.

INCREASED creatinine in Urine DECREASED creatinine in blood

How are Hypertensive Emergencies treated?

IV ANTI - HYPERTENSIVES

Antiseizure meds and surgery

IV admin of med may be needed to keep patient seizure free in the IO and PO periods

how is a thyroid storm treated?

IV fluid w/ Dextrose Tylenol (not aspirin) ice packs PTU or Methimazole Hydrocortisone (anti inflammatory) Propranolol and digoxin ( bring HR down)

The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease (COPD) and experiencing respiratory acidosis. The client asks what is making the acidotic state. The nurse is most correct to identify which result of the disease process that causes the rise in pH?

In clients with chronic respiratory acidosis, the client is unable to blow off carbon dioxide leaving in increased amount of hydrogen in the system. The increase in hydrogen ions leads to acidosis. In COPD, the client is able to breathe in oxygen and gas exchange can occur, it is the lungs ability to remove the carbon dioxide from the system.

Atelectasis Treatment

Incentive spirometer PEEP (positive end expiratory pressure mask ) oxygen mechanical/endotrach ventilation cough/deep breathing cupping clapping -chest percussion early ambulation increased fluids opiods/sedatives to prevent pain from coughing semi fowlers position

A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level?

Increases arterial pH because hes breathing off more CO2 then hes taking in

The nursing instructor is talking with her class about spinal anesthesia. What would be the nursing care intervention required when caring for a client recovering from spinal anesthesia?

Instruct the client to remain flat for 6 to 12 hours

Meglitinides

Insulin ^ right after meals * can be combined with metformin * stays in blood for 3-4 hrs * taken before meals

Septic Arthritis is a __________________.

MEDICAL EMERGENCY >24 hrs untreated = irreversible damage * most common in knee

Colpexin Sphere

Intravaginal device that supports the pelvic floor muscles and facilitates exercise of the muscles

Which route of administration of medication is preferred in most acute care situations?

Intravenous - because it is more comfortable. Peak serum concentrations and pain relief occur more rapidly and reliably

When caring for a client who has risk factors for fluid and electrolyte imbalances, which assessment finding is the highest priority for the nurse to follow up? Irregular heart rate Weight loss of 4 lb Mild confusion Blood pressure 96/53 mm Hg

Irregular HR - may indicate a potentially life-threatening cardiac dysrhythmia

Metrorrhagia

Irregular bleeding

Which type of exercise should be avoided by patients with angina?

Isometric

What are the names of some intermediate acting insulins?

Isophane NPH (Humilin N) think neil patrick harris

What is a disadvantage to using the IV route of administration for analgesics?

It has a short duration

Why is bradykinin especially significant?

It maintains blood flow and tubular function **** EVEN IF the BODY IS VASOCONSTRICTED

Lactated Ringers Solution

K + Ca + NaCl ***used to correct dehydration and Na loss and GI loss ***

How are Cystoceles Treated?

Kegel Exercises Pessaries Colpexin Sphere

What are Vesicoureteral Reflux's associated with?

Kidney infections - Pyelonephritis

What are some typical s/s of DKA?

Kussamaul Breathing Acetone breath

Which type of respirations are bound to occur in patients suffering from Diabetic Ketoacidosis ?

Kussmaul respirations

prep u question: As part of health education for a patient with an abnormal fasting lipid profile, the nurse explains that an excess of this lipid leads to the formation of plaque in the arteries. Identify the lipid. Low-density lipoproteins (LDL) High-density lipoproteins (HDL) Triglycerides Total cholesterol

LDL

PAD S/S

LEG PAIN (intermittent claudication - cramping - ischemia in the muscles of the peripherals) usually precipitated by exercise and relieved with rest parathesia pallor of extremity with elevation cool to touch LOW/absent peripheral pulses Skin = SHINY HAIRLESS ulcers on toes feet or lower leg ED

Epiglottis Cause

LIFE THREATENING BACTERIAL INFECTION -SWELLING THAT CAN LEAD TO COMPLETE AIRWAY OBSTRUCTION

Hypoxemia

LOW O2 in BLOOD

Hypoxia

LOW O2 to TISSUES

How do Statin effect the body?

LOWER triglycerides and LDL INCREASE HDL

Thiazolidinediones (TZDs)

LOWERS INSULIN RESISTANCE INCREASES INSULIN ACTION Decreases glucose production IN LIVERRRR especially in the liver, Skeletal muscle, and Adipose tissue

Where does BLOOD BACK UP IN LEFT SIDED HF ?

LUNGS

Spasmodic Croup

MIDNIGHT/TWIGHLIGHT CROUP this has no inflammation just spasms ** short lived

What are the names of some long acting Insulins?

Lantus (Detemir) Levemir (glargine)

How will a decreased GFR effect an elderly patient?

Less efficient excretion and regulation of Na+, acids, bicarb, d/t slower hemostasis

What can patients take as an alternative to corticosteroids?

Leukotriene Modifiers - decrease spasms and inflammation

what position are patients placed when getting a Pelvic Organ Prolapse repaired?

Lithotomy

Which position is used for perineal surgical procedures? Lithotomy Trendelenburg Sims Dorsal recumbent

Lithotomy - used for nearly all perineal, rectal, and vaginal surgeries

SIDE EFFECTS OF Thiazolidinediones

Liver disease elevated ALT (activated Liver Test) Weight Gain Edema Anemia Unexpected pregnany

Opioids ( Morphine sulfate ) affects on surgery

Long term use may alter the patients response to analgesic agents

What is the stimulus to breathe for COPD patients?

Low O2 (not high CO2)

Which type of diet would you recommend for a patient who has Angina?

Low saturated/cholesterol High fiber

__________ doses of anesthetic agents are required in older adults due to decreased tissue elasticity and reduced lean tissue mass.

Lower

Digoxin action

Lower HR Strengthens the Contractility

A client has been diagnosed with an intestinal obstruction and has a nasogastric tube set to low continuous suction. Which acid-base disturbance is this client at risk for developing?

Metabolic Alkalosis -The most common cuase of metabolic alkalosis is vomiting or gastric suction with loss of hydrogen and choloride ions. Gastric fluid has an acid pH, and loss of this acidic fluid increases the alkalinity of body fluids.

Visual Laser ablations have been replaced by...

PVP - Photosensitive Vaporization of the Prostate ** i have to double check this

What type of pain is phantom pain?

Mixed

What areas are assessed on the Aldrete Scoring Sheet?

Mobility Respirations BP Consciousness O2 Sat

Renal Biopsy - Nursing Considerations

Monitor for bleeding for 24 hours then bedrest

Wet Dressings

More wet in use

Acute Arterial Ischemia S/S

Polar Pallor Pain Pulselessness Paralysis Paresthesias

Signs of Hyperkalemia

Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face

Involucrum

NEW abnormal bone formation after necrosis - this is the bodies attempt at like blocking off the sequestrum

Pramlintides can be used with insulin, is it okay for the patient to mix it in the same vial as their insulin?

NO

How should O2 be administered in patients with Pulmonary Edema?

NON-Rebreathing Mask @100% O2 PEEP

____________________________ are similar in design to partial rebreathing masks except that they have additional valves.

NONBREATHING MASKS

Wound Classifications *CLEAN*

NONTRAUMATIC UNINFECTED NO INFLAMMATION NO BREAK IN ASEPTIC TECHNIQUE NO ENTRY INTO RESP, ALIMENTARY, GU, OR OROPHARYNGEAL TRACTS

A patient with a paralytic illeus will have a _____________ due to distention from edema caused from visceral handling

Nasal gastric Tube inserted

Transurethral Needle Ablation

Needle damages using radio frequencies

Bypass Graft Surgery Nursing Care- Considerations

Neuro Checks q1 hr * 8 hrs then q 2 hrs every 24 hrs pulse, cap refill, temp, sensory+motor function doppler evaluation ABI q 8 hrs * 24 hrs monitor I/O VS pain - is it post op or ischemic ??? no crossing legs or prolonged extremity dependence

A client is on a second round of radiation therapy for an inoperable tumor, and asks the nurse for medication to help with pain. The nurse suspects that the client's pain is the result of nerve damage from the radiation. Which type of pain is the client likely experiencing?

Neuropathic Pain

A client has a long hx of DM and developed Diabetic Neuropathy over 25 years ago. The client is w/o breakthrough pain at this point in time. how would this client's pain be classified?

Neuropathic and Chronic

What is a major difference between opiods and non opiods?

Nonopiods have a ceiling effect

What should the nurse be mindfull of while an angiography is taking place and afterwords?

Nurse should monitor for signs or any adverse reactions to the dye or bleeding

Patient teaching is taking place for a patient dx'ed with PMS, What suggestions about diet can you give as a nurse?

Nutritious Diet Whole Grains Low Glycemic Index foods Avoid Caffeine High fat foods avoid Methylaxanthines

Wound Classifications * CONTAMINATED *

OPEN, NEW, TRAUMATIC GROSS SPILLAGE FROM GI TRACT MAJOR BREAK IN ASEPTIC TECHNIQUE ENTRY INTO GU OR BILIARY TRACT WHEN URINE OR BILE IS INFECTED

Ventilator Associated pneumonia

Occurs more than 48 hrs after endotrach intubation

What is the criteria for dx of Secondary Amenorrhea?

Older Women - Absence of menses for 3 cycles or 6 months after normal menarche

The nurse is assessing an older adult patient just admitted to the hospital. Why is it important that the nurse carefully assess pain in the older adult patient?

Older people experience reduced sensory perception

A client is receiving morphine through a patient-controlled analgesia (PCA) system following surgery. The nurse states to the client:

Only you are to push the button for medication. pushing the button frequently does not result in pain relief because there are time limits. dont wait until the pain is severe to push the button

A patient is scheduled for a reduction mammoplasty. What classification of surgery does the nurse understand that this is? Urgent Optional Required Reconstructive

Optional

What are some examples of hormonal treatments that may be provided to a patient with endometriosis?

Oral Contraceptives Injectable Contraceptives Synthetic Androgens GnRH agonists Leuprolide

How is Acute Uncomplicated Pyelonephritis Treated?

Outpatient (if not dehydrated or N/V ) 2 week ABI

Among whom is premenstrual syndrome most common?

Ovulating Women

A patient is to receive general anesthesia with sevoflurane. The nurse anticipates the need for which of the following? Oxygen Alfentanil Rocuronium Lidocaine

Oxygen -inhalation anesthetic

Postoperative phase begins with:

PACU to HOFU

What are the 5 P's indicative of Neurovascular Compromise?

PAIN PALLOR PULSELESSNESS PARESTHESIA PARALYSIS

What is the hallmark sign of Compartment Syndrome

PAIN that occurs or intensifies with PASSIVE ROM

what causes croup

PARAINFLUENZA VIRUS - swelling/obstruction/spasms in the larynx and/or subglottic airways

Neuropathic Pain =

PATHOLOGICAL EX. DM NEUROPATHY OF LEGS

What breathing treatment is commonly used for patients with pulmonary edema?

PEEP - Positive End Expiratory Pressure non rebreathing mask NIPPV

asthmatic patient is sitting at the edge of his bed doing his peak flow readings for today . what should you advise the patient?

PFM should be done standing up . Its done three times and the highest number is documented

Clinical Manifestations Otitis Media

Pain rolls head side to side loss of appetite - hurts upon swallowing ottorhea diarrhea/ vomitting diminished hearing dizziness or vertigo fever irritability

What effect on the body do prostaglandins have?

Painful contractions of the uterus and arteriolar vasospasms

Dyspareunia

Painful intercourse

Which tonsils are usually affected by tonsilitis?

Palatine Tonsils

Which drug is a nondepolarizing muscle relaxant? Pancuronium Fentanyl Succinylcholine Morphine sulfate

Pancuronium / Pavulon

What are some S/S of Oxygen Toxicity?

Paresthesias substernal discomfort restlessness fatigue malaise alveolar infiltrates on cxr atelectasis

When would you consider ordering a Urine for Culture and sensitivity?

Patient presents with Clinical manifestations or if there is bacteria found in urine

What nursing consideration should be recognized when a patient has had a Computed Tomography?

Patient should be NPO the nurse needs to closely monitor renal output and hydration

Syphilis

Penetrates intact skin because its a spirochete - caused by Treponema Pallidum (bacterium) multiplies rapidly and spreads to lymph nodes enters blood stream within hours

How is hypoparathyroidism treated?

Pentobarbital (decrease neuromusclar irritability) Calcium Gluconate IV High Ca diet Vit D supplements Parathormone may be administered

How is intermittent claudication treated?

Pentoxifyline or Ciostazol Antiplatelet agents (plavix or aspirin) Statin Therapy (helps with pain and free walking time)

How is urine moved through the ureters?

Peristaltic contractions

Menopause

Permanent cessation of menses.

In which phase of PACU is the patient ready for discharge?

Phase III

Maslows Hierarchy of Needs

Physiological Safety Love and Belonging Self Esteem Self Actualization

A nurse documents the presence of granulation tissue in a healing wound. Which of the following is the best description for the tissue? Necrotic and hard Pale yet able to blanch with digital pressure Pink to red and soft, noting that it bleeds easily White with long, thin areas of scar tissue

Pink to red and soft, noting that it bleeds easily

Digoxin Toxicity would occur if a patient was administered digoxin despite having LOW ___________ levels.

Potassium ... Digoxin should not be administered if low K+ -- also should not be given if patient has a HR <60

Osteopenia

Pre- Osteoporosis

Unstable Angina is also known as ?

Preinfarction or Crescendo

Is osteoporosis that started after menopause, considered Primary or Secondary Osteoporosis

Primary

Which is more common- primary or secondary HTN?

Primary

Primary vs. Secondary Infertility

Primary - parents have had no kids Secondary - parents had kids now cant

Methimazole (Tapazole)

Primary treatment of choice for hyperthyroidism.

____________ is not produced if ovulation does not occur

Progesterone

Menopause will lead to decreased perineal muscle tone and bladder muscle tone, what are they at risk for? What can you recommend to prevent further decreases in muscle tone?

Prolapse - Kegel Exercises

Hip Fracture Interventions

Promote exercise skin traction before surgery to reduce muscle spasm arthroplasty surgery (repair of hip) Total Hip replacement ***Abduction of legs*** (away from midline) HOB @ 45 degrees *** HIP SHOULD NOT BE BENT >90 degrees *** INSTRUCT PATIENT TO AVOID CROSSING LEGS PREVENT ADDUCTION AVOID LOW TOILET SEATS

Before any invasive procedure, patients who have had Rheumatic fever will need ?

Prophylactic antibiotics to prevent the chances of Strep

Aspirin acts as a _______________ .

Prostaglandin Inhibitor

NSAIDs act as a

Prostaglandin antagonist

A patient over 50 comes into the office, he reports having altered urine patterns. What would you suspect?

Prostate disease

Passive Wound Dressings

Protects- just covers the wound

How are ABI's calculated?

Right brachial SBP (160mmHg) /Right Posterior Tibial (80 mmHg) ABI = 0.5

When a glucose molecule exits the glomerulus it then gets reabsorbed where?

Proximal Tubule

Patient has PMDD. Who should they get referred to ?

Psych because their at high risk for mental health issues

How often should vital signs be taken after surgery?

Pulse, BP, and RR should be recorded at least every 15 minutes for the first hour Then ever 30 min for the next 2 hours then the temp is monitored every 4 hrs for the first 24 hrs

Is jugular vein distention indicative of Left sided HF or Right sided HF?

R sided HF

You are reviewing the blood work for a patient who has had fibroids in the past. What lab value should you keep an eye on?

RBC , Albumin, and Hemoglobin patients who have fibroids are at an increased risk for anemia. lab values which indicate anemia should alert you that the patient may have new fibroids

Anticholinergics

RELAX the smooth muscle

What is released by the kidneys when there is decreased renal perfusion?

RENIN

Epiglottitis Treatment options

Racemic Epinephrine Heliox Corticosteroids Antibiotics IV Fluids Antipyretics

Clean Catch Urine Test

Recommended for Vesicoureteral Reflux *urine collected midstream

Superficial Vein Thrombosis S/S

Redness Pain or tenderness Warmth Cord-like Venous Segment NOT HARMFUL do not dislodge

Which type of insulin is the only type that can be used IV? Why?

Regular Insulin (Humilin R)

What are the kidneys functions?

Regulatory and hormonal through filtration, diffusion, active transport and osmosis

The nurse observes that a postsurgical client has hemorrhaged and is in hypovolemic shock. Which nursing intervention will manage and minimize hemorrhage and shock? Elevating the head of the bed Reinforcing the dressing or applying pressure if bleeding is frank Monitoring vital signs every 15 minutes Encouraging the client to breathe deeply

Reinforcing the dressing or applying pressure if bleeding is frank

prep u: Which nursing assessment finding indicates the client with traction has not met expected outcomes? Capillary refill < 3 seconds Repositions self with trapeze Peripheral pulses +2 bilaterally Right calf warm and swollen

Right calf warm and swollen

Why is Vesicoureteral Reflux's commonly seen in children?

because its usually due to some kind of congenital abnormality

A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level?

Respiratory alkalosis is always caused by hyperventilation- pH will INCREASE because of LOW paCO2

Pulmonary Edema S/S

Restlessness and Anxiety Blue- Grey skin color Clammy WEAK PULSE COUGH NOISY RESPIRATIONS distended neck veins cyanosis PINK FROTHY SPUTUM confusion

Describe the anatomical location of the kidneys.

Retroperitoneal on either side of the vertebral column

semirestricted zone

SCRUBS ARE REQUIRED areas where surgical instruments are processed

What medication is now given instead of estrogen and progestin ?

SERMs - Selective Estrogen Receptor Modulators

Which of the following is a factor affecting an increase in urine osmolality? Syndrome of inappropriate antidiuretic hormone release (SIADH) Alkalosis Fluid volume excess Myocardial infarction

SIADH - because there is too much SIADH there is too much ADH which means more fluid retention and higher concentrated urine

Pulmonary Embolism S/S

SUDDEN severe Chest Pain Dyspnea Fatigue tachypnea , tachycardia (compensation) cough, hemoptysis (blood in sputum) syncope

Pramlintide (Symlin)

SYNTHETIC analog of human amylin. (hormone secreted by Beta cells )

Chronic Pyelonephritis Kidney Characteristics

Scarred Contracted Nonfunctioning

A client is placed on the operating room table for the surgical procedure. Which surgical team member is responsible for handing sterile instruments to the surgeon and assistants?

Scrub Nurse

Responsibilities of performing a surgical hand scrub; setting up the sterile tables; preparing sutures, ligatures, and special equipment belong to?

Scrub Nurse

Which stage of Syphilis is most contagious ?

Secondary

List the medications used to treat PMS

Selective Serotonin Reuptake Inhibitors Prostoglanding Inhibitors Anti- Anxiety Diuretic Oral Contraceptives - low dose estrogen

Which nerve fibers are intermediate in size?

Sensory Fibers

Why is Penicillin not used alone to treat UTI's ?

because of its E. Coli Resistance

Hematuria is a ______________ symptom of a UTI

Severe ( may be bladder cancer )

Step 5 or 6

Severe Persistant Asthma daily sx limited activities use of B-agonist several times daily

What menstrual patterns puts a person at a high risk for endometriosis ?

Short Menses < every 27 days Longer Flow > 7 days

Which diuretic does not cause potassium loss?

Spironolactone

What are the four stages associated with general anesthesia?

Stage 1: Beginning Anesthesia Stage 2: Excitement Stage 3: Surgical Anesthesia Stage 4: Medullary Depression

Main Causative Agent of Septic Arthritis

Staph Aures Group A strep Gohnnorea

You notify the physician that your client is third-spacing fluid. What orders would you expect the physician to give you?

Start IV fluids and blood products

Patient in the ICU has been ordered a 24 hour urine Collection. As the nurse you realize someone emptied the catheter bag. What action will you take next?

Start a new 24 hour collection- previous becomes invalid

When does bleeding occur for a patient who has Premenstrual Syndrome?

Starts 5 DAYS PRIOR and ends @ ONSET of Menses

Patient has syphilis, the doctor is about to Inject Benzathine Penicillin G. You notice the patient has a ABI allergy. What is your next action.

Stop the provider and suggest administering doxycycline or tetracycline.

Why is there a lower incidence of osteoporosis among men?

because they dont have that sudden drop in estrogen like women do, it happens at a much slower rate

A menopausal women with a history of DVT's and other arthersclerosis related diagnoses is being prescribed estrogen and progestin. What other questions related to menopause will you ask the patient?

Stop. she should not be taking estrogen. menopausal women who have a history of DVTs should not be prescribed estrogen

In an effort to reduce surgical complications, the "_______________" was instituted as a national partnership of the Joint Commission and the center for medicaid/medicare services

Surgical Care Improvement Project (SCIP)

Factors increasing urine osmolality include:

Syndrome of inappropriate antidiuretic hormone release (SIADH) fluid volume deficit acidosis congestive heart failure

Normal T3, T4, and TSH levels

T3 80-230 T4 5-12 TSH 0.2-5.4

Wound Classifications *DIRTY*

TRAUMATIC DELAYED REPAIR DEVITALIZED TISSUE FOREIGN BODIES FECAL CONTAMINATION ACUTE INFLAMMATION PURULENT DRAINAGE

What is the earliest sign of malignant hypothermia during surgery?

Tachycardia

External or Internal Bleeding Major S/S

Tachycardia Hypotension decreased serum hematocrit and hemoglobin

Fat Embolism S/S

Tachycardia tachypnea Anxiety SOB Fever

The nurse is caring for a client during an intra operative procedure. When assessing vital signs, which result indicates a need to alert the anesthesiologist immediately? Pulse rate of 110 beats/min Respiratory rate of 18 breaths/min Blood pressure of 104/62 mm Hg Temperature of 102.5 F

Temp of 102.5

When is administration of Flagyl contraindicated?

Teratogenic - do not administer during pregnancy (esp. 1st trimester) Breast feeding Hepatic Problems Blood Dyscarasias (changes in salt ) CNS diseases

So you have a patient that is getting Catheter Traction following TURP. You see there is urine outside of the catheter that has been placed. What should you be thinking ?

That this is probably not a catheter balloon inflation problem (they inflate 30-40 ml) its most likely a bladder spasm issue so you're going to want to give them an antispasmodic

After the filtrate passes through the glomerulus it goes through the tubules. What do the tubules ensure?

That urine output is limited to 1-3 L per day. more than that can cause dehydration

Why is it especially critical if a geriatric patient is experiencing increased Na+ retention.

Their thirst mechanism decreases so they cant just drink water to promote filtration their blood because they dont realize it

Chronic Pyelonephritis S/S - How do they differ from Acute?

There are usually no sx w/o exacerbation excessive thirst

What is a normal Ketone level in urine?

There should be no ketones in a non-diseased patient

Which vitamin is affected by the kidneys in order to absorb calcium in the GI tract?

Vitamin D

The nurse informs the patient that a preventative approach for pain relief will be used, involving NSAIDs. What will this mean for the patient?

The pain med will be administered before the pain is experienced

A patient complains of phantom pain after surgery, what should you do as the nurse?

The sensation of pain and discomfort in an amputated extremity is known as phantom pain. Phantom pain is a normal occurrence after an amputation. It should be treated with medication. The nurse doesn't need to contact the physician at this time.

Whats an important factor to keep in mind while assessing a patient with suspected Premenstrual Syndrome ?

The severity of symptoms has a wide range and its very individualistic

Should a PAD patient ambulate?

YESSS u want them to walk until they feel pain and increase their endurance

Why do older patients experience an increase in the duration of clinical effects of some medications?

They have decreased plasma proteins, more of the anesthetic agent remains free or unbound, and the result is more potent action

What are some examples of secondary amenorrhea causes?

Thyroid Disorders PCOS Medications Pregnancy Breast feeding Adolescents because of moving away from home - going to college anxiety ect Eating Disorders Too little fat

Flow Incentive Spirometer

Tidal volume is not set. Movable balls

What can be given to a pregnant patient with Trichomonas instead of Flagyl ?

Tinidazole (Tindamax)

A client who has undergone extensive fracture repair continues to request opioid pain medication with increasing frequency. The initial surgeries occurred more than 2 months ago, and the nurse is concerned about the repeated requests. What does the nurse suspect to be the cause of the client's frequent appeals for pain medication?

Tolerance

Occlusive Dressing

Topical med that is applied to the skin

Flagyl - Metronidazole

Transient Metallic Taste One time Loading Dose N/V Hot flashes antibuse with ETOH

Syphillis is caused by the bacteria called ___________.

Tripanoma Pallidum

T/F - Purulent drainage post hysterectomy may be a sign of an infection.

True - erythema post hysterectomy may also be a sign of an infection

Which type of personality is more at risk for CAD?

Type A

How is PAD diagnosed?

Ultrasound Angiogram

What is the cause for BPH?

Unknown - some studies suggest estradiol levels and above normal testosterone levels - maybe athersclerosis - presence of testicular androgen - chronic inflammation of the prostate

How long should the patient wait before lifting, straining, driving, and sexual intercourse - post hysterectomy?

Until she gets the Dr.s Approval

When a client with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the client may show signs of alcohol withdrawal delirium during which time period? Immediately upon admission Upon awakening in the postanesthesia care unit Up to 72 hours after alcohol withdrawal Up to 24 hours after alcohol withdrawal

Up to 72 hours after alcohol withdrawal

Predisposing factors - Otitis Media

Upper respiratory infection allergic rhinitis sinusitis cleft palate immune deficiency passive smoking poor feeding techniques exposure to other children

How should the patient be positioned if they have Pulmonary Edema?

Upright with legs dangling over the side of the bed

Which valve is mostly likely incompetent and leading to the pyelonephritis?

Ureterovesical Valve

What are some common sites of Gonorrhea infection?

Urethra Epididymis Prostate Rectum Pharynx

Tests to Diagnose BPH - list in order of increasing invasiveness :

Urinalysis Urine Culture CBC BUN and Serum Creatinine for renal fx PSA KUB Xray IVP Cystourethroscope Exam Bladder Scan Urodynamic Flow studies

BPH CM

Urinary Hesitancy when starting to urinate and decreased volume weak urine stream Interruption of urinary stream nocturia pain with urination bloody urine urinary urgency reoccuring UTI's from incomplete bladder emptying Dribbling after urination

Patient presents with symptoms indicating some kind of bacterial/viral etiology for their Renal Dysfunction. What should be considered by the nurse in this situation?

Urine should be collected BEFORE ADMINISTERING AN ANTIBIOTIC

Perineal Prostatectomy

Used to remove an enlarged prostate filled with *** calculi *** ** treat abscesses ** - good for patients who are poor surgical risks

Why do most men get a UTI ?

Usually because of some kind of obstruction, usually men will present with Prostatitis

Cilostazol (Pletal)

VASODILATOR inhibits platelet aggregation *** c/i in CHF ***

Virchows Triad

Venous Stasis Endothelial Wall Damage Altered Blood Coagulation

The SCIP identifies performance measures aimed at preventing surgical complications, including?

Venous Thromboembolisms and Surgical Site Infections

Which face mask is recommended for COPD patients?

Venturi

Which oxygen mask uses the Bernoulli principle of air entertainment?

Venturi

Premenstrual Dysphoric Disorder (PMDD)

Very severe form of PMS

Which type of pain arises from internal organs such as the kidneys?

Visceral

The nurse is caring for a client with kidney stones who is complaining of severe pain. What type of pain does the nurse understand this client is experiencing?

Visceral Pain

How is Tonsillitis Diagnosed?

Visual exam RSAT (RAPID STREP ANTIGEN TEST) Throat Swab/Culture

What are some non pharmacological methods, or at home herbal meds that patients can take to help relieve the symptoms associated with PMS?

Vit B and E Calcium and Magnesium Oil of Primrose Capsules Ginger Black Cohosh

Other Than Venlafaxine- what vitamins may be prescribed to help with hot flashes related to menopause?

Vit B6 and E

Ergocalciferol

Vit D Supplements

Your patient has osteoporosis and she reports only taking her Vit D Supplement. What teaching can you provide?

Vit D on its own will have no effect at preventing fractures needs to be taken with calcium

Which vitamin can reverse the effects of anticoagulants?

Vit K - advise pt to never just stop taking drug

What type of lubricants do you want to recommend to patients ?

Water based

What should the nurse monitor when a patient is administering corticosteroids?

Weight Vital Signs Serum Glucose Concentration

What consideration should you be thinking about for patients who are diabetic and at an increased risk for a UTI?

Well if they get a UTI its going to be harder to get rid of it for them than for a normal person. ** because they may have a bladder emptying disorder

Why does Otitis Media occur more frequently in children?

because they have a shorter straighter eustachian tube

Phase 1 PACU

area designated for care of surgical patients immediately after surgery and for patients whose condition warrants close monitoring

During the Second stage of Syphilis, what are the known CM?

Widespread rash *** PALMS and SOLES ***

Patient was just given Nitroglycerin, the patients Blood pressure decreases as a result. The nurse goes in one hour later to check BP and notices it is 20 mmHg lower than baseline. What should the nurse do next?

Wipe the cream off because the therapeutic range is a 10 mmHg decrease from baseline-- then notify the provider

How do cardiovascular events differ in men and women?

Women are usually more serious because they ignore and prolong seeking help - pain in the arm, shoulder, neck, jaw, throat, back, under breast bone, or in the stomach Nausea, dizziness, unexplained anxiety, SOB, weakness, ***FATIGUE***, palpitations, cold sweats, paleness

Antibiotics for a UTI are contraindicated for which patients

Women on Birth Control

How is the diagnosis of a paralytic ileus confirmed?

X-ray or CT scan

How will a provider test to confirm the diagnosis of Vesicoureteral Reflux?

Xray first then, Voiding Cytourethogram *using the dye

Is Gonorrhea reportable to the Health department?

YAS

why is it recommended for pneumonia patients to increase their fluid intake?

^ fluids will help thin out mucus secretions

Patients who are on Hormone Therapy need to be taught the s/s of ?

a DVT or Pulmonary Embolism

While palpating the bladder of patient with BPH what should the nurse expect?

a distended bladder from urinary retention

When does menopause occur in Women?

as early as 30s usually between 48 and 55 years

Why are men generally treated longer when they get a UTI?

because its rare for them too so it must have been serious to have caused it in the first place

What should be monitored while administering Heparin to make sure its working?

aPTT

Syphilis Intubation Period

about 3 weeks can be 10-90 days after exposure

What do you want a patient on Warfarins PT to be?

about two times normal

Azotemia

accumulation of nitrogenous wastes

Prostatitis is considered an infection of the ________________.

acute infection of the lower tract

breakthrough pain

acute pain

Exenatide (BYETTA)

adjunct therapy for DM2 to LOWER BS

Pediatric patients as early as what age can use a PCA (patient controlled Analgesia)

age 6

Which particles are too big to pass through the glomerular filtrate?

albumin globulin RBCs

How does Heparin affect the bodys metabolism of calcium?

alters calcium absorption and metabolism

Regarding tolerance and addiction, the nurse understands that

although clients may need increasing levels of opioids, they are not addicted

regional anesthesia

anesthetic agent is injected around nerves so that the area supplied by these nerves is anesthetized

s/s of CAD

angina from ischemia ischemia MI Sudden cardiac death heart failure dysrhythmias cardiac enzymes

What are the screening guidelines for Chlamydia?

annually for sexually active 20-25 year olds , older women who are sexually active

Where does damage occur for a cystocele to occur?

anterior vaginal supportive structures

Whats the difference between Anti-coagulant Therapy and Thrombolytics?

anti coagulants do not dissolve clots that are already formed

Anti-Inflammatory Corticosteroids

anti inflammatory - prevent symptoms of asthma- used as long term treatment

THIONAMIDES

anti-thyroid meds inhibit T3/T4 synthesis

Treatments of Rheumatic Fever

antibiotics NSAIDS Salicylates Corticosteroids

How is Syphillis treated?

antibiotics like penicillin

Tranquilizers (Diazepam or Valium) and their potential affects on the surgical experience

anxiety tension even seizures if withdrawn suddenly

During administration of Alpha 1 Blockers or Alpha-Adrenergic Blockers, what should the nurse closely monitor for?

any signs of hypotension- check vitals before/after administering - these meds will lower BP

Among whom are Thiazolidinediones Contraindicated?

anyone w/ liver disease or ALT more than 2.5

Who is at risk for Aspiration Pneumonia?

anyone who cannot cough or gag -decreased LOC -intubation -positioning -stroke -difficulty swallowing -High residual volumes with feeds (if a pt is on feeding tube you want to make sure theres not a lot of food in the stomach when they lay down because they can choke on it)

appendectomy

appendix removal

prep u: A client with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which is the priority action by the nurse? Assess for complications. Assess for previous opioid drug use. Reposition the client for comfort. Teach relaxation techniques.

assess complications is priority! repositioning and relaxation techniques are both right but not priority

Renal Biopsy

assess unexplained renal dysfunction

Renal Arteriography/ Angiography Purpose

assessment of the arterial blood supply to kidneys

How should the arm be placed before and 24 hrs before surgery ?

at heart level protect from cold venipunctures tape and constrictive dressings

Which of the following medications would the nurse expect to be used to facilitate intubation of the client? diazepam (Valium) pancuronium (Pavulon) fentanyl (Sublimaze) attacurium (Tracrium)

attacurium (Tracrium)

For clients that are prescribed psychostimulants What should the nurse instruct to the client?

avoid caffeine or other stimulants, such as decongestants

Vesicoureteral Reflux (VUR)

back flow of urine from bladder to ureters (up to kidneys)

Urethrovesical Reflux

backward flow of urine from the urethra into the bladder

Pyelonephritis

bacterial infection of the tubules

Why do Condoms not provide 100% protection from HPV?

because HPV can be spread through the areas that are not protected by the condom.

Why is the previous question significant?

because a provider may not know until its too late

why do tympanic membranes rupture in otitis media?

because accumulating fluid - increases pressure and it eventually bursts

Why is bloody urine a possible CM Of BPH?

because enlarged prostates have increased vascularity

TURP procedures usually last 60-90 Min max. Why do they not want the surgery going for longer than that?

because it increases their risk for Hypervolemia and Hyponatremia

COMFORT scale

behavioral scale - each indicator scored 1-5. Total scores range from 8-40. eight indicators = alertness, calmness/agitation, respiratory response, physical movement, BP, HR, muscle tone, and facial tension ***** most recommended ****

Fibroids are almost always __________ .

benign

What medication is contraindicated for women to take if they are hypertensive?

birth control because it increases the risk of emboli

cystitis is an infection of the __________

bladder

Urodynamic Studies

bladder and ureter capacity

Voiding Cytourethogram

bladder gets filled with contrast, patient urinates with fluoroscopy

When administering anticonvulsants what should the nurse monitor?

blood counts and liver function tests

Prostate Specific Antigen Test

blood test that can give you an idea if its prostate cancer because it tests for the presence of an antigen that the cancerous tissue secretes

Coronary Artery Disease

blood vessel disorder leading to narrowing or obstruction of arterial lumen

Osteoporosis bone characteristics

bone becomes more POROUS BRITTLE FRAGILE

Hyperparathyroidism S/S

bone decalcification apathy fatigue muscle weakness hypertension constipation cardiac dysrhythmias change in STATE OF MIND

What are some teaching points for patient leaving the hospital after a pulmonary emobolism?

bruising and bleeding may occur avoid razors use soft bristle tooth brushes report dark, tarry stools no ASA (aspirin) or Antihistamines while on coumadin * avoid long periods of immobility

STING

bulking agent injected into mucous membrane of ureter to decrease the back flow of urine

How does the glomerular filtration rate change as we age?

by 65 its at 1/2 the rate of a young adult

Why is it important not to inject past the dura into the subarachnoid space of the spine for epidurals?

epidurals contain a larger amount of anesthesia, and if it reaches the subarachnoid space it will go to the head and cause severe hypotension, respiratory depression, and cardiac arrest

Acrobose (Precose)

can be used with sulfonylureas, metformin or insulin. *** good for pt with after meal spikes in Glucose *** ** Gas pain and stomach pain/diarrhea especially at onset of treatment - c/i ibs pt

Anticoagulants (warfarin coumadin) and its potential affects on surgery

can increase risk of bleeding

Before Menopause, estrogen is _______________

cardioprotective

Cystography and Cystourethrography

catheterization contrast dye instilled into urethra and bladder ** Intent is to look at the structural integrity of the bladder **

If the patient has Neurosyphilis what will the provider most likely order?

ceftriaxone

What are some examples of sediment found in urine?

cells, casts, crystals, bacteria

Primary Syphilis

chancre - 2-3 weeks after exposure the chancres remain for 3-12 wks and spontaneously heal

Captopril Renal Scan

change blood flow in the kidneys

Whats essential prior to administering digoxin?

check the patients pulse rate

Fluorescent Treponemal Specific Test ( FTA -ABS )

checks for antibodies using blood or spinal fluid. used to confirm dx of SYPHILIS

Treponema Pallidum Particle Agglutination Assay ( TPPA )

checks for antibodies, used after another method tests positive for syphilis ** ONLY DONE ON BLOOD not spinal fluid **

The client takes naproxen (Aleve) for arthritic pain and is now prescribed warfarin (Coumadin) for persistent atrial fibrillation. Due to the interactions of the medications, the nurse

checks the patients stool for color

The nurse is caring for a client undergoing alcohol withdrawal. Which serum laboratory value should the nurse monitor most closely?

chronic alcohol abuse is a major cause of symptomatic hypomagnesemia in the United States. The serum magnesium concentration should be measured at least every 2 or 3 days in clients undergoing alcohol withdrawal.

Asthma

chronic inflammatory disease of the airways that cause hyper-responsiveness, edema, and mucus production

A client with emphysema is at a greater risk for developing which acid-bace imbalance?

chronic respiratory acidosis

A patient is in the operating room for surgery. Which individual would be responsible for ensuring that procedure and site verification occurs and is documented?

circulating Nurse

Who coordinates the surgical teams and ensures, cleanliness, proper temp, humidity, appropriate lighting, safe function of equipment, and the availability of supplies and materials? ** foremost responsibility is making sure consent was given

circulating nurse

a patient with pneumonia will have ________________ whispered pectroliloquy.

clear

Will hot or cold temperatures cause an episode of angina?

cold because it causes vasoconstriction

Rheumatic Fever

collagen disease that injures heart, blood vessels, joints, and subcut tissue

Atelectasis

collapse of the lung - alveoli deflate * common after surgery

Trichomonas

common curable urogenital tract transmission * may increase risk of HIV, cervical neoplasia, adverse pregnancy outcomes, PID, and Infertility

Functional Disability Inventory

comprehensive evaluation of the influence of pain on physical functioning

What can untreated Chlamydia cause in Newborns ?

conjunctival and pulmonic infections

Complex Regional Pain Syndrome

consistant chronic burning sensation in an area of the body *middle age younger women

Low flow oxygen delivery systems

contribute partially to the inspired gas the patient breathes, which means that the patient breathes some room air along with the oxygen ** do not provide precise or constant supply of oxygen ** amount of inspired O2 changes as the persons breathing changes

Circulating Nurse duties

coordinates the care of the patient patient positioning preparing the patients skin for surgery managing surgical specimens anticipating the needs of the surgical team documenting intraoperative events

Trichomonas Symptoms

copious , thin, frothy, yellow/green malodorous, irritating vaginal discharge vulvovaginal burning and pruritis Urethral irritation Dyspareunia Pelvic discomfort occasionally

Intermittent Claudication

cramping pain in the leg is induced by exercise, typically caused by obstruction of the arteries.

how is an epiglottis dx confirmed?

cxr

What teaching should be given to a patient with a catheter traction following TURP?

encourage patient to drink more ( more comfortable because it will lower solute concentration ) patient will feel burning on urination after the catheter is removed- this is normal and will go away Patient will constantly feel the need to void, make sure there is urine flow in the catheter UTI S/S Avoid Caffeine, decongestants, alcohol, and anticholinergics

Examples of High calcium foods.

dairy broccoli salmon cereal orange juice

DAVE

dangle arterial venous elevate

histamine2-receptor antagonists

decrease gastric acidity and volume

What is the stimulus for respirations in COPD patients?

decrease in blood O2

antioholingercs

decrease respiratory tract secretions, dry mucous membranes, and interrupt vagal stimulation

What are some assessment findings of atelectasis

decreased breath sounds decreased pulse ox hypoxemia cough low grade fever respiratory distress anxiety increased HR, RR Difficult breathing while supine Pleural Pain Central Cyanosis

What would the creatinine levels be like for a patient with an unhealthy kidney?

decreased creatinine in urine increased creatinine in blood

STING is considered the _____________ option

endoscopic

Benign Prostatic Hyperplasia

enlarged prostate gland

What positive effects does Hormone Therapy have?

decreases / eliminates persistent and severe hot flashes decreases risk for colorectal cancer Reduces bone loss

What effects on cholesterol do cholestrol absorption inhibitors have?

decreases LDL only by inhibiting the intestinal absorption of cholesterol ex. zetia

Signs of Hypercalcemia

deep bone pain constipation anorexia nausea vomiting polyuria thirst pathologic fractures mental changes

An INCREASE in Urine Specific Gravity indicates?

dehydration decreased perfusion ADH hormone produced with stress Surgery ANESTHESIA morphine oral anti-diabetic meds

Venlafaxine (Effexor) is prescribed to treat?

depression + anxiety It helps with hot flashes primarily

Hypertensive Urgency BP

develops over days or weeks >180/110 no evidence of target organ damage

Symptoms of Hyperkalemia

diarrhea nausea muscle weakness paresthesias cardiac dysrhythmias

What causes metabolic acidosis?

diarrhea, lower intestinal fistulas, ureterostomies, use of diuretics; early renal insufficiency; excessive administration of chloride; and the administration of parenteral nutrition without bicarbonate or bicarbonate-producing solutes (e.g., lactate)

Late Hidden Syphilis CM

difficulty coordinating muscle movements paralysis numbness dementia gradual blindness

Registered Nurse First Assistant

direct supervision of the surgeon handling tissue, providing exposure at the OR field, suturing, and maintaining hemostatsis

Primary hyperparathyroidism etiology

directly due to parathyroid glands

Clinical manifestations of FVE include

distended neck veins crackles in the lung field shortness of breath increased blood pressure tachycardia.

Palmetto Extract (saw palmetto)

doesn't shrink the overall size of the prostate but it seems to shrink the inner lining that puts pressure on the tubes that carry urine also might prevent testosterone from being converted to dihydrotestosterone (DHT). * studies show it may not have any real significant effect

Upper Extremity Arterial Occlusive Disease - S/S

drop a lot of objects arms go numb while driving coolness pallor decreased capillary refill diminished radial pulse

How is the dye inserted during an Angiography

dye is inserted into renal arteries through the femoral artery

If there was a patient with a suspected fissure or opening in their bladder what will be seen in the cystography?

dye will leak out of the openings

What side effects on the GI system do Bisphosphonates have?

dyspepsia nausea flatulence diarrhea constipation

Gonorrhea Symptoms

dysuria white/ yellow/ green discharge

If a patient begins feeling symptoms following exercise that indicate he is hypoglycemic. What should the patient do?

eat 15 of ^ index carb

how should the patient be positioned with Venous Deficiency?

elevate extremity (q2h 15-30 min) *elevate foot of bed during sleep warm moist packs avoid sitting more than an hour at a time no leg crossing compression stocking

What are some examples of community health nurses?

epidemiologist case manager coordinator of services provided to a group of patients hospice or parish nurse

if Gonorrhea is left untreated in men what painful condition can it lead to?

epididymis/ orchitis may cause sterility

The kidneys also produce ____________ in response to low o2

erythropoietin

Electromyography (EMG)

evaluates muscle/ nerve problems

How often should an adult be screened with a lipid profile for CAD?

every five years or less depending on their risk factors

How often should a patient post bypass surgery have neurovascular checks?

every hour for 8 hours then every 2 hours for 24 hrs ABI is every 8 hrs for the first 24 hrs

Silent Ischemia

evidence of ischemia on tests but no symptoms of pain ect.

Menorrhagia

excessive bleeding

Intravenous Urography

excretory urography intravenous pyelography dye is added so the structures can be seen clearer

If blood glucose levels are >/= 250 and there are ketones in urine the patient should not

exercise until blood glucose is more at a normal level and free of ketones

myxedema

extreme hypothyroidism low BP, BS, Temp, Pulse EDEMA

Which type of surgeries are full IV anesthesia?

eye surgeries because vomiting would increase intraocular pressure and endanger vision in the operated eye

Secondary Hypothyroidism Cause

failure of Pituitary to secrete TSH

Symptoms of hypokalemia

fatigue weakness anorexia nausea vomiting cardiac dysrhythmias muscle weakness paresthesias leg cramps

Hemorrhage during/after surgery Signs and Symptoms

feelings of apprehension decreased cardiac output vascular resistance breathing becomes labored and "air hunger" will be exhibited patient will feel cold may experience tinnitus

How should a patient at risk for PE be positioned?

feet should be resting on the floor or chair. Not dangling! no crossing legs semi fowlers position

Important Difference between regular Heparin and the Low Molecular Weight Heparin ?

fewer complications with Low Molecular Weight Heparin

laparoscopic myomectomy

fibroid removal is less invasive than abdominal myomectomy, and uses four incisions located in the pelvis and abdomen for removal of superficial and some deep fibroids

Parenteral dosages of opioids are not the same. Why ?

first pass effect, an oral opioid is partially metabolized in the liver before reaching the central circulation. therefore oral dosages must be larger to compensate

What is the SHOCK POSITION?

flat on back; legs elevated at a 20 degree angle; knees kept straight

Fat Embolism Syndrome

fractures of long bones have high yellow marrow (fat) content . crushing injuries or multiple fractures can lead to this

Contiguous Osteomyelitis

from contamination next to something- surgery, open fracture or traumatic injury

Which intervention is appropriate for a nurse caring for a client in severe pain receiving a continuous IV of morphine?

get a baseline of vitals before giving IV

Patients who have SIADH will have hypo or hypernatremia?

hyponatremia. because of excess fluid retention theres more water then there is sodium

A client experiencing a severe anxiety attack and hyperventilating presents to the emergency department. The nurse would expect the client's pH value to be?

greater than 7.45 because the patient is experiencing respiratory alkalosis

What should be done if a patient has hair on their body that is coming in contact with the surgical site?

hair should be removed with clippers not shaved

registered nurse first assistant

handles tissue, provides exposure at the operative field, suturing, and maintaining homeostasis

Suprapubic Prostectomy are good for patients who

have a very large prostate, and/or if they have some issues with their bladder that can also be treated with this procedure

what different clinical manifestations of HTN will be seen in children?

head rubbing head banging waking up and crying in the middle of the night dizziness

What is a common aftereffect of spinal anesthesia?

headache

Transurethral Thermotherapy

heat is applied to tissue - it decreases in size as a result - this is considered a minimal procedure

Sulfonylureas

help beta cells in pancreas produce more insulin * may inhibit release of glucagon commonly combined with metformin

Moisture Retentive Dressings

help remove exudate resurfacing less infection/scarring

Which meds may be given to prevent clotting or thrombus formation preoperatively?

heparin or Lovanox

D50 Solution

high dextrose concentration VERY HYPOTONIC - must be given through a central line so it can be diluted by rapid blood flow

How should a patient be positioned if they have asthma?

high fowlers

Dihydrotestosterone levels and its relationship to the prostate

higher dihydrotestosterone levels = larger the prostate

Pathophysiology of Malignant Hyperthermia

hypermetabolic condition that involves altered mechanisms of calcium function in skeletal muscle cells. This disruption of calcium causes clinical symptoms of hypermetabolism, which in turn increases metabolic contraction (rigidity) and causes hyperthermia and change to CNS

Which patients will have heat intolerance?

hyperthyroidic

A client reports muscle cramps in the calves and feeling "tired a lot." The client is taking ethacrynic acid (Edecrin) for hypotension. Based on these symptoms, the client will be evaluated for which electrolyte imbalance?

hypokalemia

Hypoxemia leads to ___________

hypoxia

PreMenstrual Syndrome

idiopathic MAYBE serotonin issue

What is the etiology of Dysmenorrhea?

idiopathic- suspected to be because of excessive prostaglandins

When is IV Nitroglycerine C/I ?

if patient is hypotensive

Where will you find Neisseria Gonorrhorae MOS in a patient who has Gonorrhea?

in exudate and secretions of infected mucous surfaces

Intramural Fibroid

in muscle wall

How are all the oxygen masks documented?

in percent concentration EXCEPT THE NASAL CANNULA- THATS MEASURED IN L/MIN

What areas are considered sterile on the body?

in the front from the chest to the level of the sterile field and sleeves from 2 inches above the elbow to the stockinette cuff

The pain in PAD is _______ where the clotting is.

in the muscle below

Ketone Bodies are a byproduct of ?

incomplete metabolism of fatty acids

what is the stimulus for respirations in disease free patients?

increase in CO2 levels

What is hyperglycemias affect on wound healing?

increase the risk of surgical wound infection

Increased Parathormone =

increased Blood Ca+ decreased blood Phosphorus

Increased Calcitonin secretion =

increased Ca deposit in Bone

What are some early signs of hypervolemia ?

increased breathing effort, weight gain, elevated BP,

When Urine's Specific gravity decreases, this may suggest?

increased fluid intake diabetes insipidus

What are some disadvantages of getting a perineal prostectomy?

increased risk for Infection and heavy bleeding Possible damage to the rectal and anal sphincter Possible urinary incontinence Temporary or Permanent Impotence

The order of phases in the PACU increases as the condition of the patient ___________

increases (phase III = discharge)

Pentoxifyline (Trental)

increases erythrocyte flexibility *ANTIPLATELET EFFECTS* decreases blood viscosity

What are some indications of anesthesia awareness?

increases in BP, HR, and patient movement

How does exercise lower blood glucose levels?

increasing uptake of glucose by body muscles and improves in insulin utilization- ** changes blood lipid concentration

For whom are high flow Oxygen delivery systems intended for ?

indicated for patients who require a constant and precise amount of oxygen

what causes Status Asthmaticus?

infection, anxiety, *Nebulizer Abuse*, dehydration and hypersensitivity to aspirin

Erythrocyte Sedimentation Rate will help detect any signs of ?

inflammation

Tonsilitis

inflammation infection *SORE THROAT*

Pneumonia

inflammation of lung parenchyma (alveoli + resp bronchioles ) that is caused by a microbial agen

Otitis Media

inflammation of the middle ear

Ochitis

inflammation of the tubes attached to the testicles

Malignant Hyperthermia

inherited disorder that occurs when body temperature, muscle metabolism, and heat production increase rapidly, progressively, and uncontrollably in response to stress and some anesthetic agents

Estrogen ___________ bone breakdown.

inhibits

Clinical Manifestations of Malignant Hyperthermia

initial S/s r/t Cardio and Musculoskeletal Activity **Tachycardia > 150 BPM SNS stimulation leads to ventricular dysrhythmias, hypotension, decreased cardiac output, oliguria, and cardiac arrest tetanus like movements occur often in the jaw

Where is epidural anesthesia administered?

injected in the area that surrounds the dura mater of the spinal cord

kyphoplasty / vertebroplasty

injection of poly cement into fractured vertebrae - results in, rapid pain relief, and improved quality of life

where is spinal anesthesia administered?

injection through the dura mater into the subarachnoid space surrounding the spinal cord.

patients with croup will present with what type of stridor?

inspiratory stridor

If a patient complains of chest pain, shortness of breath, dizziness, or nausea upon exercise what should the nurse do?

instruct the patient to stop the exercise immediately

Which circumstances place a patient at risk for cardiovascular disease?

insulin resistance abdominal obesity dyslipidemia HTN Prothrombic state - high fibrinogen levels Pro-inflammatory state- C reactive protein

DEMAND OXYGEN DELIVERY SYSTEM

interrupts the flow of O2 during exhalating when it is otherwise mostly wasted

ECG's done on a patient with a pulmonary embolism will show?

inverted T wave *CXR will just exclude other causes not show the embolus

Angiogram Considerations

iodine allergy - observe pt for dyspnea, N/v, tachycardia, sweating

Side Effects of Bronchiodilators

irritability tremors nervousness insomnia

D5W IV Solution

isotonic/hypotonic 1/3 is intracellular 2/3 extracellular ***given to supply water and correct serum osmolarity*** caution for patients with increased intracranial pressure due to hyperglycemic effects

What determines the type of treatment provided for a UTI?

it depends on where the infection is and what type of bacteria it is

Whats an advantage of using a Endotracheal tube ?

it seals off the lungs from the esophagus

Estrogens relation to the cardiovascular system

its cardioprotective

arthrocentesis

joint aspiration

How is Septic Arthritis treated?

joint aspiration to get a culture is done - blood tests too IV antibiotics then SURGERY - Joint Drainage antibiotics may be prescribed based on culture results

arthralgia

joint pain

Jackson Pratt Drain

keeps constant negative pressure so fluid does not build up in surgical site

Laparoscopic Cryomyolysis

lap procedure that freezes and thaws using ultrasound to guide (-197 C)

laparoscopic Myolysis

laparoscopic procedure that coagulates blood vessels that supply the fibroid with shrinkage of the fibroid

suprapubic prostatectomy procedure

large horizontal abdominal incision bladder is exposed generally 2-3 hours prostate removed through the bladder bladder diseases can now be treated

If a patient states that they are allergic to kiwi, avocado, or banana, or they cannot blow up balloons, they may have a ?

latex allergy

Upper Extremity aarterial occlusive disease

less common less severe

Normal Fasting Blood sugar should be

less than 100

The nurse should not administer the prescribed opiate therapy if respirations are <______ breaths per minute.

less than 12 breaths per minute

myxedema coma

life threatening pleural effusion pericardial effusion extreme weakness LOC

TURP Syndrome

life-threatening complication of a transurethral resection of the prostate procedure. It occurs as a consequence of the absorption into the prostatic venous sinuses of the fluids used to irrigate the bladder during the operation. *** characterized by; HYPERVOLEMIA , HYPONATREMIA, HYPO-OSMOLARITY ***

How is cretinism treated?

lifelong thyroxine (t4)

PTH is secreted in the presence of ___________ blood calcium levels

low

If disruption of a wound occurs (dehiscence or evisceration) what interventions should be taken ?

low Fowlers position instruct to lie quietly the protruding coils of intestine are covered with sterile dressings moistened with sterile saline solution and the surgeon is notified at once

A patient having myxedema will present with which lab findings?

low T3, Low T3 Elevated TSH (body feels no T3, T4 so high TSH)

Transurethral Needle Ablation (TUNA)

low level radio frequencies via micro needles through a catheter to destroy prostate tissue body reabsorbs the dead tissue

SIMPLE MASKS are used to administer ____________ to _____________ concentrations of oxygen

low to moderate

Closed Reduction

manipulated back and cast

CM of Fibroids

may be asymptomatic menorrhagia metrorrhagia pain, pressure, backache, constipation, urinary problems from pressure on surrounding organs

Repaglinide (Prandin)

may be taken two, three, or four times a day - depending on how many meals

Phenothiazines (Chlorpromazine) and their potential affects on the surgical experience

may increase the hypotensive action of anesthetics

Insulins and their potential affects on the surgical experience

may need to be administered to keep Blood glucose within normal range

What makes Unstable Angina so much more dangerous than stable?

may not be relieved with rest or NTG

ceiling effect

means that doses higher than the recommended dose will not produce greater pain relief

Urodynamic Flow Studies

measures Bladder pressure, sensation and urine flow rate -- how does the musculature innervate?

Blood Urea Nitrogen (BUN)

measures renal excretion of urea nitrogen

Airway pressure Release Ventilation (APRV)

mechanical ventilation - on inspiration the pt receives a preset level of continuous positive airway pressure, and pressure is periodically released to aid expiration

Continuous Mandatory Ventilation (CMV)

mechanical ventilation - ventilator completely controls the patients ventilation - RARELY USED because of synchrony, used in paralyzed or anesthetized pts

intermittent mandatory ventilation (IMV)

mechanical ventilation that provides a combo of mechanically assisted breaths and spontaneous

Assist-Control (A/C) Ventilation

mechanical ventilation- in the absence of spontaneous breathing, the machine delivers a controlled breath at a preset minimum rate and tidal volume

Do men, or women have longer urethras?

men- 6-8 in long

What precaution should be taken for patients on metformin going in for a radiographic study?

metformin should be withheld 48 hrs before and after study due to risk of lactic acidosis

first intention healing

method of healing in which wound edges are surgically approximated and integumentary continuity is restored without granulation

Non Opiods are suitable for _________ to _________ pain.

mild to moderate pain.

Tertiary Prevention

minimizing deterioration and improving quality of life

You are looking at a patients lab report and see a BNP level of 145 what are you going to do?

mix water and fiber in a glass and shove it up your butt :) jk, this is a sign of HF- notify provider

Condylomata Lata

moist wart like, weeping papules. Characteristic of secondary Syphilis

Interactive Wound

moist wound environment + works with wound bed compartments *** hydrogels, foam, neosporin ***

T3 is _______________________ than T4

more potent and rapid acting

In contrast to adults children metabolize opiods ______________.

more quickly so they need higher doses for the same results

Nucleic Acid Application Test )NAAT)

most commonly used to diagnose chlamidya its specific

Which nerve fibers are the largest and have the thickest myelin sheaths?

motor fibers

Pediatric Pain Questionnaire (PPQ)

multidimensional pain instrument to assess patient and parental perceptions of the pain experience. Pain history, pain language, the colors children associate with pain, emotions experienced, the worst pain experiences, coping methods, positive aspects of pain, and the location of current pain are all examined.

What is Creatinine a product of? What does it indicate?

muscle catabolism

Where will patients with PAD feel pain if they are having ischemic muscle pain?

muscle groups one joint below the blockage* early indicator of disease

What can trigger malignant hyperthermia?

myopathies emotional stress heatstroke neuroleptic malignant syndrome strenuous exercise exertion trauma

Photosensitive Vaporization of the Prostate (PVP)

new - similar results to TURP Uses low energy instead of electrical current (TURP) Good for smaller prostates Better recovery

If a patient cannot sign their preoperative consent forms because they are under legal age or mentally incapable, permission is otherwise obtained from?

next of kin or legal guardian

A patient is breathing through the high flow venturi mask breathing system, you notice the patient is not taking deep breaths in. Will this effect the percentage of O2 getting delivered ?

no - high flow systems are unaffected by breathing rate or quality

What are some advantages of IV anesthesia administration?

no buzzing or roaring or dizziness known to follow vapor anesthesia duration of action is brief patient awakens with little nausea or vomiting

What is a normal response while exercise testing someone who may have PAD?

no drop in BP with exercise - tredmil helps determine how long the pt can walk before developing pain and to measure ankle BP in response to walking

Patient has BPH, should he wait every time he needs to go to the bathroom?

no, patient should be advised to urinate as soon as the urge arises

Hydrocolloids

nonpermeable to H20 and 02

Hypertensive Urgency

nosebleeds, severe headaches managed with oral meds with a goal of normalization of BP within 24to 48 hrs

Patients under general anesthesia are _____________, ____________________.

not arousable, not even to painful stimuli

Visual Laser Ablation

not done often

The routine use of hyperoxia (high levels of o2) is _____________________ to reduce surgical site infections

not recommended

If dark brown blood is seen in a patient post tonsillectomy what interventions should take place immediately?

nothing thats normal, its bright red blood thats the problem.

HCAP (Health Care associated Pneumonia)

occurs in non hospitalized pt with extensive health care contact; nursing home, LTC facility, hemodialysis, home infusion therapy or wound care

Oxygen Toxicity

occurs when too high a concentration of O2 (greater than 50%) is administered for an extended period

Who is at the greatest risk of getting Septic Arthritis?

old hx of joint replacement

How should Bisphosphonates be taken?

on an empty stomach- no food or liquid 30-60 minutes after

When are contraceptives recommended for Menopausal Women ?

one year post cessation of menses

Which part of the sterile drapes is considered sterile?

only the top surface

Hospital Associated Pneumonia (HAP)

onset of pneumonia symp more than 48 hrs after admission

Endarterectomy

opening the artery and removing the obstructing plaque

Equianalgesic

opiod

Why are NPO patients at risk for pneumonia?

oral care is important. since they arent eating or drinking higher rate of bacteria growth will occur in the patients mouth and travel down trachea

In Osteoporosis , ________ activity is greater than ___________.

osteoclast activity is greater than osteoblast

Side effects of Corticosteroids

osteoporosis HTN decreased immunity increased hunger may slow growth in children *

Foam Dressings

over bony primeness

Hydronephrosis

overtime damage that occurs to the kidney and ureters

Mixed Pain =

physiological + pathological ex. Phantom Pain

Variant Angina

pain at rest with reversible ST seg elevation --- thought to be caused by vasospasms

recurrent pain

pain that is episodic and recurs

dyschezia

painful Bowel movements

Signs of Hypovolemic Shock

pallor cool; moist skin rapid breathing cyanosis of the lips, gums, and tongue rapid, weak, thready pulse; narrowing pulse pressure; low blood pressure; and concentrated urine

What are physiologic responses to pain?

pallor tachycardia diaphoresis hypertension

Physiologic responses to pain include:

pallor, tachycardia, diaphoresis, and hypertension.

Hip Fractures S/S

paralysis pain deformity crepitus edema External rotation of leg shortening of extremity AVASCULAR NECROSIS HIGH CHANCE OF OCCURRING BECAUSE BLOCKED BLOOD FLOW TO FEMORAL HEAD

subluxation

partial dislocation

pneumothorax

partial or complete lung collapse

What type of fracture occurs without trauma or falls?

pathologic fractures

Nursing Consideration for Ibandronate or Boniva?

patient must be able to sit up for at least an hour after administration

General Anesthesia Stage 3: Surgical Anesthesia

patient unconscious and lies quietly on the table. pupils are small but CONTRACT when exposed to light. RR, PR, CO are normal, skin is pink or flushed.

Acute Pyloneophritis symptoms differ from Cystitis in that ...

patient with pyelonephritis will have flank pain, fever, Both may have increased urinary frequency, urgency , dysuria or pain above the pubic region

Secondary Hyperparathyroidism etiology

patients who have kidney failure as a result of phosphorus retention

Phase II PACU

patients whose condition no longer required the close monitoring provided in a phase I PACU

What diagnostic indicators will lead you to believe the patient has trichomonas

pear shaped mobile flagellates Vaginal secretions Male urine sample (early morning) ELEVATED pH Cervical Erythema

What does the HbA1C test test for?

percentage of hemoglobin molecules with a glucose molecule attached to it

Community Based Nursing

philosophy of care in which the care is provided as patients and their families move among various service providers outside of hospitals

What assessment findings will you gather for a patient with pneumonia?

pleritic chest pain shaking chills use of accessory muscles dyspnea tachypnea myalgia orthopnea **** rusty blood tinged sputum with strep, staph, or klebsiella pneumonia **** crackles and rhochi dullness to percussion increased tactile fremitus egophony whispered pectroliloquy orthopnea- shortness of breath while reclining

Continuous Positive Airway Pressure (CPAP)

positive pressure applied throughout the Respiratory Cycle to a spontaneously breathing pt to promote alveolar and airway stability

Positive End-Expiratory Pressure

positive pressure maintained by ventilator at the end of exhalation (instead of normal 0). this helps increase functional residual capacity and open collapsed alveoli; improves oxygenation with lower fraction of inspired o2

Autolytic Debridement

process that uses bodies own digestive enzymes to break down necrotic tissue

How do the kidneys aid in the regulation of BP?

produce Renin - RAAS system

PAD - Peripheral Artery Disease

progressive narrowing of the arteries of the upper and lower extremities

Dipeptidyl Peptidase-4 Inhibitor / Satigliptin (Januvia )

prolongs effects of ^ insulin, decreased Glucagon secretion, and decreased GI emptying -rapidly absorbed, peak effect 1-4 hrs few adverse effects

Calcitonin ________________ bone formation and ______________ bone reabsorption

promotes bone formation and inhibits bone reabsorption

Active wound care

promotes healing through moist wound environment. SKIN GRAFT ***THINK BIOACTIVE***

How is Chronic Pyelonephritis treated?

prophylactic antimicrobial therapy

What is urea nitrogen a byproduct of ?

protein metabolism in the liver

Cretinism S/S

protruding tongue growth retardation short limbs lack of hair/teeth pot belly umbilical hernia large anterior fontanelles poor feeding weight gain horace cry jaundice

evisceration

protrusion of organs through the surgical incision

LAMINAR airflow units

provide 400-500 air exchanges per hour

how should children's ears be examined?

pull down (adults is up and back

What can rapid or excessive administration of IV solutions cause in the geriatric population?

pulmonary edema

Pessaries (Rubber/Plastic)

push bladder up and keep it in place

ottorhea

puss drainage out of ear

HCAHPS Score

quality metric that measures the patients quality of care from a random sampling of patients that were hospitalized

What medications may be prescribed for children experiencing CROUP?

racemic epinephrine for bronchodilation and corticosteroid (anti-inflammatory)

What is injected during a renography?

radionuclide (radioactive)

What can BUN be affected by?

rapid cell destruction because of steroid use, it can also be affected by infection and the presence of blood in tissues

Malignant Hyperthermia

rare often inherited muscle disorder that is chemically induced by anesthetic agents

What may occur if a patient suddenly stops taking their anti-hypertensive medications ?

rebound hypertension

Rectocele

rectum pouches upward, pushing posterior vaginal wall forward

What does decreased pulse pressure reflect?

reduced stroke volume

Unintended intraoperative awareness

refers to a patient becoming cognizant of surgical interventions while under general anesthesia and then recalling the incident.

Kidneys also produce prostaglandin. What action do prostaglandins have on kidney function?

regulates kidney filtration kidney vascular resistance renin production

Explain how hypo-pharyngeal obstruction takes place PostOP

relaxation of muscles extends to the pharynx. When the patient lies on his/her back the jaw and the tongue fall backward and the air passages become obstructed

GnRH action

released from hypothalamus targets the pituitary to release FSH - stimulates ovulation

Total Hysterectomy

removal of cervix and uterus

salpingio-oophorectomy

removal of fallopian tube and ovary

Myomectomy

removal of fibroids and reconstruction of the uterus

Hysteroscopic Resection

removal of fibroids using hysteroscope using an electrical loop and cautery

PARTIAL REBREATHING MASKS have a _________________________ that must remain inflated during both inspiration and expiration. The nurse adjusts the oxygen flow to ensure the bag does not collapse on inhalations.

reservoir bag

How can the cannula or mask be cleaned?

rinse using warm clear water

A client receiving moderate sedation for a minor surgical procedure begins to vomit. What should the nurse do first? Roll the client onto his or her side. Suction the mouth. Provide a basin. Administer an antiemetic medication.

roll the pt to their side

How should open bottles of insulin be kept?

room temperature for 30 days

S/S of Status Asthmaticus

same as asthma but as it worsens, wheezing may disappear

PTU (propylthiouracil)

second drug of choice when methimazole use fails

Why are obese patients at a high risk for getting osteoporosis?

sedentary lifestyle. estrogen is stored in fat

What position do you want to place a patient who is suffering from angina?

semi fowlers

A patient that has OM should be in which position?

semi fowlers - head should be elevated

Which condition is a heightened response that occurs after exposure to a noxious stimulus?

sensitization

Phase III PACU

setting in which the patient is cared for in the immediate postoperative period and then prepared for discharge from the facility

Among whom are Thrombolytic Therapies contraindicated in?

severe HTN surgery within 10 days CVA in past 2 months

ABI <0.7 =

severe arterial disease

Jarisch-Herxheimer Rash

severe rxn after administration of ABI's because the spirochetes release all their antigens when it dies and the immune system goes into hyperdrive. similar to septic shock - the patient will have fever, chills, hypotension, tachycardia, and hyperventilation ` * rxn to antimicrobial trtmt of syphilis *

Calcium Alginates

sheets or mats - good for irritated or emaciated meat

What is skin like in PAD patients?

shiny taut hairless ulcers pale *THICK nails

Whats the benefit of using a laparoscopic assist with vaginal hysterectomy as opposed to a straight up total abdominal hysterectomy?

shorter hosp stay decreased risk for infection

PAP smear Teaching

should get done every 6 months no douching, vaginal meds, tampons, lubricants 24 hrs before PAP smear

What affect on fibroids do GnRH analogues like Leuprolide have ?

shrink the fibroids

Avascular Necrosis of Bone is most likely to occur in what patients?

sickle cell patients on steroids

Why does hyperkalemia occur in Diabetic ketoacidosis patient ?

since the blood is acidic that means theres a lot of H+ ions - H+ likes to exchange with K+ ions which means theres more K+ in the blood

Why do uncontrolled Type 1 DM patients end up loosing weight?

since their bodies cant recognize the glucose because of no insulin; lipolysis and protein catabolism

When do fibroids usually develop and what is their rate of growth like?

slow usually 25- 40 years

Alpha-Glucosidase Inhibitors

slows the absorption of glucose in the small intestine - breaks down starchy foods in the gut

What type of diet should a patient be on Post Tonsillectomy?

soft diet - liquids no red or brown foods, no citrus, no dairy

Paralytic Ileus - what is it ?

sometimes caused by abdominal surgery. may also be caused by the use of narcotics. Air fills the bowel and is unable to pass. Bowel sounds will be absent.

Tonsillitis S/S

sore throat dysphagia odynophagia fever cervical adenopathy

Ultrasonography is able to detect :

sound waves are used to produce images. These images will show kidney size, cortical thickness, urinary tract tumors, cysts, masses

Glucose greater than 200 will __________

spill into the urine because its beyond the renal threshold for glucose

Captopril Renal Scan Nursing Considerations

standard precautions hypotension may occur

Why do oral anti-diabetic meds cause an increase in Urines specific gravity?

the kidney reabsorbs water and urine becomes more concentrated as a result

Okay a patient comes into the ER with an open fracture. What is the very first thing u should do as a nurse- do u wanna check vitals first or put a sterile dressing on the wound?

sterile dressing first then vitals

The scrub nurse is responsible for preparing the :

sterile instruments for the surgical procedure

Erythropoietin function

stimulates bone marrow to produce RBC's

General Anesthesia Stage 2: Excitement

struggling, shouting, talking, singing, laughing, or crying, is often avoided if IV anesthetic agents are administered smoothly and quickly. Pupils dilate, but they contract if exposed to light; the pulse rate is rapid, and respirations may be irregular. ** important during this phase for anesthetist to be assisted incase of uncontrollable movements ect.

Intracavity Fibroid

submucosal right in the lining of the uterus

Signs and Symptoms of Oxygen Toxicity

substernal discomfort paresthesias dyspnea restlessness fatigue malaise progressive respiratory difficulty refractory hypoxemia alveolar atelectasis alveolar infiltrates AED CXR

Chorea (St Vitus Dance)

sudden aimless, irregular movements of extremities, involuntary facial grimaces, speech disturbances, muscle weakness

Epiglottis S/S

sudden onset HIGH FEVER sore throat dysphagia DROOLING AGITATION lethargy TRIPOD POSITION no spontaneous cough voice is thick, muffled, croaking sound on inspiration

If a patient has Viral Tonsillitis what interventions can be performed?

supportive care warm saline gargles non-aspirin anelgesics anti-pyretics increased fluids

Third-Intention Healing

surgical approximation of wound edges is delayed and skin is restored by opposing areas of granulation

myringotomy

surgical incision of the TM to drain infected middle ear fluid

Stage 1 Intermittent Asthma

sx less than 2 times a week no interference with normal activity

Step 2 Mild Persistent Asthma

sx more than 2 times/week good peak flow minor limitation on normal activity

Which nerve fibers are the smallest and have a minimal covering?

sympathetic fibers

The VDLR and Rapid Plasma Regain or RPR test is used to diagnose ?

syphillis - screening

Is left sided heart failure usually systolic or diastolic HF?

systolic - pumping

Which assessment findings will you see in a patient suffering from a fat embolism?

tachypnea tachycardia confusion hypoxemia petechial rash * diffuse infiltrates on CXR

What changes will occur in HR and RR in a patient with croup?

tachypnea tachycardia

What teachings will you give your patient who is going to start taking Caltrate or Citrocal ?

take with meals or vit C drink to promote absorption Some s/e may include abdominal distention and constipation

The nursing instructor is talking with her class about spinal anesthesia. What would be the nursing care intervention required when caring for a client recovering from spinal anesthesia?

tell the client to lay flat for at least 6-12 hours

Bucks Traction is used for ?

temporary management of femoral hip or low back pain

When monitoring creatinine levels - an increase in blood serum creatinine will indicate that ?

that at least 50% of renal function is lost

If a patient is referred to as P6 that indicates?

that the patient is brain dead

Your patient is asking you about HPV and states that its okay to have unprotected sex as long as there are no breakouts. How do you reply?

thats incorrect, it can still be transmitted even w/o any visible lesions ect

The release of ADH has what effect?

the body retains water

Who is responsible for doing the second verification of the surgical procedure and site and documenting that information?

the circulating nurse

What does the test for urine electrolytes indicate?

the function of the tubules

The greater number of births = _________ risk for a prolapse

the greater the risk

Why may a patient experience hyperglycemia after surgery?

the high stress from having surgery can trigger increased levels of catecholamine

How is hormone therapy used currently to treat menopause and why?

the lowest dose for the shortest time possible. Risk for: Breast Cancer Heart Attach Stroke Blood Clots

Intraoperative phase begins when:

the patient is transferred onto the OR bed and ends with admission to the PACU

How does the prostates anatomical location gradually change in BPH?

the prostate extends UPWARD into the BLADDER and INWARD ----- NARROWING of prostatic urethral canal

How does the ANA define nursing?

the protection promotion and optimization of health and the ability to prevent illness or injury, alleviate suffering through diagnosis and treatment and to advocate in the care of individuals

balneotherapy

the treatment of disease by bathing in mineral springs.

Prior to an angiography, when the patient is getting the dye injected into them- what should the nurse be telling the client?

the warm sensation is the contrast agent going into your body

Radical Hysterectomy

the whole mother load that includes : the cervix, vagina, and uterus

What type of oxygen system are the nonbreathing masks?

they can facilitate 100% o2 which would make it a high flow system but since the mask is not an exact fit its impossible to know that 100% o2 delivery, thats why its called a LOW FLOW system

How do the tubules change as we age?

they have a decreased ability to concentrate urine *nocturia

What effect may corticosteroids have on patients going in for surgery?

they increase the risk for adrenal insufficiency. if the patient has received in the last year they must inform the anesthetist

What signs/ symptoms do the elderly present with when they have UTI?

they may be asymptomatic or confused

General Anesthesia Stage : Medullary Depression

this stage is reached if too much anesthesia has been administered. Respirations become shallow, pulse is weak and thready, and the pupils become widely dilated no longer contracting to light Cyanosis develops and then death

Transurethral Resection of the Prostate (TURP)

this was super common before, its been replaced by less invasive procedures now * moderate to severe BPH *

What are some characteristics of patients who had malignant hyperthermia?

those with strong and bulky muscles, a hx of muscle cramps or muscle weakness and unexplained temp elevation

What should you never do while examing a patient with suspected epiglottitis?

throat examination - because it can completely close the airway

Where is the prostate removed through in a Perineal Prostectomy.?

through ur mom. but really it is removed through an - incision in the perineum -

How is HPV 2 transmitted

through wet surfaces Self transmission sexy time

What effect do Resins or Bile Acid Sequestrants have on the body?

thye lower LDL Minimal effect on triglycerides NO EFFECT ON HDL because all they do is bind to cholesterol and break it down

Volume Incentive Spirometer

tidal volume is set. patient takes a deep breath and exhales into the mouthpieces, pauses at peak inflation and then exhales.

Symptoms of Hypocalcemia

tingling in the extremities and the area around the mouth and muscle abdominal cramps

What is the purpose of a Renal Arteriography/ Angiography ?

to determine the cause of decreased renal function

Why must corticosteroids by tapered down slowly?

to prevent an adrenal crisis

Oxygen Toxicity

too high a concentration of O2 *greater than 50% * is administered for an extended period (longer than 48 hrs)

Leukocytosis

too many wbcs in blood

What treatment is available for HPV 2 ?

treat pain no cure antivirals can be given to supress and shorten the course (Acyclovic, valacyclovir, Famcyclovir)

Endotracheal intubation

tube through the nose or mouth into the trachea

Tympanostomy

tubes for OME lasting longer than 4-6 months and associated with hearing loss. pressure equalizing tubes

Nursing Consideration for Pyridium

turns urine orange - can turn eye contacts orange too

how long must a patient REMAIN IN THE PACU?

until fully recovered from the anesthetic agent (stable BP, respiratory function, O2sat)

The patient is NPO prior to having a colonoscopy. The patient is to take a daily blood pressure pill prior to the procedure. Until when may water be given prior to the procedure?

up to 2 hours before surgery - major purpose of withholding food and fluid before surgery is to prevent aspiration

How should a patient be positioned if they have CROUP

upright

How should a patient with epiglottitis be positioned?

upright

Urethritis is an infection of the ______________

ur dumb :P lol

Hypospadias

urethral opening found on ventral surface

What are some nursing considerations while working with Nitrates?

use gloves while administering. bottle should be stored in a cool dry place , should not be exposed to heat/sunlight

Describe the function of Bradykinin.

used to dilate arterioles * this increases the permeability of solutes!!!

Thrombolytic (Fibrinolytic) Therapy

used to treat massive PE - Tissue Plasminogen Activator dissolves the clot

Visual Analogue Scale (VAS)

uses descriptors along a line that provides a highly subjective evaluation of pain. Recommended over the Numeric Rating Scale (NRS) *Often used for older children and adults

Does your body vasodilate or vasoconstrict under stress?

vasoconstrict - so u want to relax them to lower BP for pt with PAD - instruct patient to avoid cold

What do u need to develop a venous thrombosis?

virchows triad

A client is admitted with generalized abdominal pain, nausea, vomiting, and hypotension. The client has not passed stool in over 1 week and has been in pain for the past 4 days. Which type of pain would you expect the client to be experiencing?

visceral

Procidentia

visible uterine prolapse

General Anesthesia Stage 1: Beginning Anesthesia

warmth, dizziness, and a feeling of detachment, ringing, roaring, or buzzing in the ears, may sense inability to move the extremities easily. Noises are exaggerated- even low voices or minor sounds seem loud and unreal. ***** important for unnecessary noises and motions to be avoided now.

Hydrogels

water helps autolytic debridement

What are the pulses of PAD patients like?

weak or absent

When is an anesthetic agent considered metabolized ?

when all three systems (motor, sensory, and autonomic) are no longer affected

Antibiotics (Erythromycin) and its potential affects on the surgical experience

when combined with curariform muscle relaxant, nerve transmission is interrupted and apnea from resp paralysis may result

When does the preoperative phase begin?

when the decision to proceed with surgical intervention is made and ends with the transfer of the patient onto the OR bed

When are nasal cannula indicated?

when the pt requires a low to medium concentration of O2 *precise accuracy is not essential

What is BNP indicative of?

when there is toooooo much fluid in the ventricles, this peptide is released *** SIGN OF HF ***

What allows for Pelvic Organ Prolapses to occur?

with age, weakening of the vaginal walls childbirth literally rips women apart inside lol atrophy/hormone deficiency

How should a PAD patient be positioned?

with the affected limb LOWER THAN THE HEART *** NO LEG CROSSING ***

prep u: A nurse advises a patient with a casted femur fracture to check for signs of a fat embolism. She tells the patient that the onset of symptoms for FES occur:

within 12-48 hrs

After Menopause, ____________________

women are in the same boat as men in regards to their cardiovascular health

Are women who had children earlier - or later- in life more predisposed to Endometriosis?

women who had children later

Biguinides

work mainly by decreasing glucose production from the liver - makes the muscles more sensitive to insulin ***** GLUCOPHAGE (METFORMIN ****** ### GI side effects does not cause weight gain may be used with sulfonylureas med should be taken with meals

Second-Intention Healing

wound edges where not surgically approximated so skin continuity is restored by the process known as granulation

During teaching for a patient with Vesicoureteral Reflux/ UTI, what teaching is really important in regards to the effects on their kidneys.

you want to tell them all the negative effects of multiple infections (scarring ect)

An Uncomplicated UTI refers to patients who are:

young not prego with an eggo non diabetic w/o structural problems or previous UTI's

Urethovesical Reflux's are most commonly seen in _________

young children