(1) ANDREA'S ULTIMATE NURSING 2 FINAL SET

What type of tubing is used when administering Lipids?

"Y" Tubing as the lipids are thick/viscous

Who is most at risk of getting a spinal cord injury?

#1 is Men aged 15-25 #2 is the elderly due to osteoporosis and falls.

What are the symptoms of polycythemia vera?

** Hypervolemia & Hyperviscosity: HTN Splenomegaly Thrombophlebitis Hemmorrhagic phenomena Ruddy Face: Face red due to increased RBC's Epigastric pain Hyperuricemia - gout, pruritus

What biological response modifiers do we give for MS?

*ABC's* Interferons: - beta-1a (Avonex): Given IM once/week. - beta-1b (Betaseron): Given SUBQ *Patients may experience flu like symptoms with this treatment* Synthetic Immunomodulator - glatiramer acetate (Copaxone) *These medications do not cure MS. They attempt to suppress the immune system to prevent it from attacking the myelin on neurons.*

Risk factors for Primary HTN:

*Age - after age 50 *Alcohol *Tobacco use *Diabetes Mellitus *Elevated serum lipids - increased cholesterol and triglycerides *Excess dietary sodium *Gender - More prevalent in men, however after age 64/menopause, women have the same risk as men. *Family History - close blood relative has hypertension *Obesity *Ethnicity - #1 African Americans, #2 Hispanics, #3 Native Americans. *Sedentary lifestyle *Socioeconomic status - poor people more likely to have HTN. No $ for treatment, eat fast food because its cheap. *Stress

What are the normal lab values for the *Basic Metabolic Panel*? *BUN*: *Na⁺*: *Ca²⁺*: *Cr*: *K⁺*: *Cl*:

*BUN*: 10-20 mg/100mL *Na⁺*: 135-145 mEq/L *Ca²⁺*: 8.6-10.2 mg/dL *Cr*: 0.7-1.4 mg/100mL *K⁺*: 3.5-5.0 mEq/L *Cl*: 97-107 mEq/L

Nursing Priorities POST PCTA

*Bed rest* *HOB less than 30 degrees* *Immobilization of limb* Counter pressure Circulatory assess (pedal pulses, popliteal femoral, feel for cold extremities) Vital signs & EKG monitoring Pain management Hydration I&O

What 3 things should we educate the patient about in regards to taking Coumadin at home?

*DO NOT CHANGE BRANDS!!* - Use same brand of coumadin always and do not switch. *AVOID CRANBERRY JUICE WHILE TAKING COUMADIN!!* Eat green leafy vegetables *CONSISTENTLY* (the same amount everyday)

BPH treatment

*Depends on severity Indwelling catheter (Coude for those with BPH) Pharmacotherapy Balloon dilation of urethra Minimally and invasive procedures (Table 34-4) to reduce prostate size Urethral stents if surgery is not an option

What nutritional supplements should be given to someone with Irritable Bowel Disease?

*IRON SUPPLEMENTATION* is very important. Vitamin Supplements include: B12, zinc, folate, calcium, vit. D, vit. C.

How long do TIA's last?

*Less than 1 hour.* (Used to be less than 24 hours)

Why should someone with HTN quit smoking?

*Nicotine contained in tobacco causes *vasoconstriction* and *increases BP*, especially in people with hypertension. *Smoking tobacco is also a major risk factor for CVD. *The cardiovascular benefits of stopping tobacco use are seen within 1 year in all age groups. *Strongly encourage everyone, especially patients with hypertension, to avoid tobacco use. Advise those who continue to use tobacco products to monitor their BP during use

Treatment for both Flaccid & Spastic Bowel:

*Patients with spinal injuries will be placed on a strict bowel regimen/routine. (Every night at the same time *CONSISTENTLY*, patient should have a BM) *Suppositories *High fiber/residue diet *High fluid intake *Stool softeners (Colace)

What are the normal lab values for the *Complete Blood Count*? *RBC*: *Hct* (males): *Hct* (females): *Hgb* (males): *Hgb* (females): *WBC*:

*RBC*: 4.2-5.9 million/mm³ *Hct* (males): 42-50% *Hct* (females): 40-48% *Hgb* (males): 13-18g/dL *Hgb* (females): 12-16g/dL *WBC*: 5.0-10.0³ cells/mm³

What are the normal ranges for the following? *Temperature*: (C and F) *Pulse*: *Respirations*: *BP*: *Pain*: *SpO₂*: *Blood Glucose*:

*Temperature*: 35.8-37.5C; 96.4-99.5F *Pulse*: 60-100bpm *Respirations*: 12-20 *BP*: 120/80 *Pain*: 0 *SpO₂*: 94-100% *Blood Glucose*: 70-100

What are some side effects of histamine (H2R) receptor blockers? (4 things)

*Xerostomia - dry mouth Dry skin Tinnitus: ear ringing Constipation/diarrhea

Risk factors of COPD:

- #1 is Smoking - Second hand smoke - Occupational chemicals and dust - Air pollution - indoor and outdoor - Infection - Genetics - Alpha1-antitrypsin (AAT) deficiency: genetic disorder - test done in younger patients if someone between ages of 20-30 develops COPD. - Ageing

Treatments/Nursing Interventions for Back Pain:

- *Pain relief/Pharmacotherapy* - Improved physical mobility - Weight reduction - Stress reduction - *Therapeutic exercise program (2-3 times/week): No high impact aerobic exercises for those with back pain. Want patient to walk. No running, no swimming - swimming is good for joints, not for bones.* - Improvement of posture - Referrals: PT, dietician - Patient education - Surgery - last resort

Arterial Bypass Postprocedure Care:

- 24-48 hour ICU or Step-down Unit stay - Arterial line for continuous BP measurement (bp must be within a certain range) - Titration of medication to maintain the BP within a tight range - Foley with urometer for hourly urine outputs - Neurovascular assessments - check pulses, color, and sensations - Monitor for complications such as compartment syndrome, kidney failure, hemorrhage - Monitoring of anticoagulation if ordered - Pain assessment - Discharge teaching

Prevention of Influenza

- 3 C's: clean hands, cover mouth, contain. - Vaccination

Type 2 diabetes risk factors you CAN'T fix:

- 45 years or older - close relative with diabetes - other medical conditions - high risk ethnic background (#1 blacks, #2 hispanics, #3 native americans) - history of gestational diabetes

HIV Treatment

- ARV: active anti-retroviral - HAART: highly active antiretroviral treatment GOAL: zero viral load **Strict adherence to the regimen is vital (must take medication as prescribed and on a schedule)

Pneumonia (what is it? What are the 2 different types? Can you die from it?)

- Acute inflammation of the lung parenchyma (alveolar ducts and respiratory ducts) - Community-acquired (CAP) & Hospital-acquired (HAP) - Yes, this infection is associated with high morbidity & mortality

What 4 hormones are secreted from the Adrenal Cortex?

- Aldosterone (mineralocorticoid) - Cortisol (glucocorticoid) - Androgens (for males - also produced in testes) - Estrogens (for females)

Additional Supportive Treatment/Medications for Respiratory disorders

- Analgesics: for someone who has an infection - Antipyretics: for someone who has fever & infection - Hydration: Thins out thick secretions and makes them easier to come up - Antibiotics: If bacterial infection is present - Oxygen: Usually ordered but can be used without an order in urgent situations where the patient needs oxygen.

What medications do we use to treat GERD?

- Antacids - H2 receptor antagonists - PPIs (Proton Pump Inhibitors) - Prokinetics

What are some things we can teach our patient's as nurses about surgery?

- Anti-embolism stockings/sequential compression device (SCDs) - Leg exercises - Coughing & deep breathing and Incentive spirometer (especially if its an abdominal surgery or a longer surgery - this can prevent atelectasis in lungs) - Pain management: patients need to take their pain meds. - NGT (educate the patient on what to expect to help decrease patient anxiety), drains, colostomy, IV's, ventilator, catheters

What medications would we give to someone with IBS who is suffering from diarrhea?

- Antidiarrheal such as *Loperamide (Imodium)* - can also decrease amount of fluid that comes out of ostomy. - Anticholinergics such as *propantheline (Pro-Banthine)*

How can we prevent Lyme disease?

- Applying insect repellent - Performing frequent tick checks if outside/after being outside - Tuck in clothing to cover exposed areas of skin - Spraying insecticides in the yard to kill off ticks/prevent them from coming - If bitten, proper removal of the tick is necessary - use tweezers

What should we do Post colonoscopy?

- Assess for abdominal cramping in patient - Assessment for rectal bleeding and signs of perforation

Nursing Interventions for Voiding cystouretherography (VCUG) or IV Urogram diagnostic procedures:

- Assess for allergies to shellfish or iodine as contrast will be used. - Assess renal function - look at BUN & creatinine - Pregnancy test for all women of child bearing age

Multiple Sclerosis is very hard to diagnose. What are some ways we can diagnose MS?

- Assessing signs & symptoms - Good health history & physical - MRI (may show white lesions on brain which indicates MS) - Lumbar puncture

Postop Nursing Care for those that have had a back surgery:

- Assessment (#1) - assess for bleeding, assess neuro, assess incision site, assess for CSF leak. *ABC's - airway, breathing, circulation. - Patient should be laid FLAT postoperatively. - Log roll every 2 hours (everything must move all together) - Pillow supporting neck and knees - OOB in 1 smooth motion - Delegation to UAP - position changing, toileting, vital signs. - Physical therapy referral - PT will be 1st to get patient OOB - Patient education - how to move, *no coughing*, tell them not to pull on side rails/try moving themselves because it can affect the incision, no heavy lifting, educate that back pain is not 100% curable and that they may still have pain. - Monitor Vital signs - Encourage Incentive Spirometer use - Monitor for infection/inflammation/hernia reoccurrence (Significant pain increase out of no where)

Nursing Interventions for patients with Osteoporosis:

- Assessment is *#1* - Medications and vitamin supplementation like calcium & vitamin D. - Physical activity/weight-bearing activity - walking - Lifestyle modifications (stop drinking & smoking, stop drinking soda as it contributes to osteoporosis) - Referrals: PT, dietary, social services - Delegation to UAP: assisting patient with ADL's - Educate patient on how to use assistive devices & the importance of consuming calcium rich foods. - Home safety

What is the nurses role in helping to manage polycythemia vera?

- Assist w/ phlebotomy - Strict I's and O's: avoid overload or underhydration which can cause increased viscosity - Meds: SE - Assess nutritional status, may take in less b/c feel full/dyspepsia - Will need phlebotomy q 2-3 months *BIGGEST concern: thrombus*

S/S of CEREBELLAR MS

- Ataxia - Nystagmus - eye moves rapidly and uncontrollably - Dysarthria - slurred speech - Dysphagia

What is the cause of inflammatory anemia?

- Autoimmune and infectious disorders (HIV, hepatitis, Malaria) that lead to chronic inflammation which leads to anemia - Heart failure - Malignant diseases - Bleeding episodes

What are some things that can cause GERD that we should tell our patients to avoid?

- Avoid eating/drinking 2 hours before bed-time - Maintain normal weight (obesity causes GERD) - Avoid triggers/causes (ex: avoid spicy foods) - Head elevation during sleep - Avoid constrictive clothing/belts that wrap around the waist** - this can cause reflux. - Smoking cessation - smoking causes GERD.

Our goal is to PREVENT peripheral arterial disease. What are some things we can control in regards to *Nutrition* that can help prevent PAD?

- BMI <25 kg/m2 - Waist circumference: <40 inches for men and <35 inches for women - Diet high in fruits, vegetables, and whole grains - Diet low in cholesterol, saturated fat, and salt

Tuberculosis What type of infection is it? (bacterial/viral) What bacteria causes TB? What is TB treated with? What are the defining characteristics of TB? How do we diagnose TB? What precautions are used when caring for someone with TB?

- Bacterial - Mycobacterium Tuberculosis - Antibiotics (INH, Rifampin) - Defining Characteristics: coughing up blood, fever, chills, weight loss, no appetite, fatigue, night sweats, chest pain due to infection - Diagnosed through Tuberculin Skin Test/Mantoux Test/PPD placement/TB Gold - Airborne precautions (N95 mask, negative pressure room, door to room must remain closed)

Syphilis What type of infection is it? (bacterial/viral) What is the name of the bacteria? Name and define the three stages of Syphilis Can it be cured? What is a common complication of Syphilis? How do we diagnose syphilis? How do we treat Syphilis? What precautions do we use when taking care of someone who has Syphilis?

- Bacterial - a spirochete bacteria known as "Treponoma Pallidium" - Primary Stage: painless chancre appears Secondary Stage: Latency follows, disease can still be spread. Tertiary Stage: Late stage symptoms, no sores present at this point - can't be spread sexually at this point but person is very sick. - Yes, with antibiotic treatment. - Aortitis - inflammation of the aorta - Blood test or culture of the lesion - With antibiotics (Penicillin G, or if patient is allergic to Penicillin: Tetracycline/Doxycycline) - Contact Precautions

Interventions for Osteoarthritis

- Balance Rest & Activity - overuse and underuse are a problem. - Regular Exercise - want a therapeutic plan for exercise - found that exercise is even better than medication - swimming is excellent for OA patients. - Maintain a healthy weight - eat healthy foods - may need nutritional consult. - Hot/Cold Patches are fine for OA - whatever the patient prefers. - Swimming is an excellent exercise for OA, but not for osteoporosis. - Pilates, tai chi, & yoga are highly effective for patients with OA - they help OA patients get in motion.

A patient who just had gastric surgery should:

- Be monitored for signs and symptoms of dehydration (concentrated urine + excessive thirst) - Adequate fluid intake (30 mL at a time, and not during or right after meals) - Eat liquid/pureed food for first 6 weeks then advance to nutrient-dense foods and protein (<1 cup) - Avoid simple sugars and empty caloric foods - Chew food slowly and thoroughly and avoid overeating - Take Vitamin and mineral supplements - Walk daily for 30 min. - ATTEND Follow-up doctor's appointments

Post procedure complications for PCTA:

- Bleeding at the insertion site: look out for expanding hematoma at insertion site. Small amount of bruising is expected. - Cardiac symptoms - patient can have heart attack/arrhythmias that occur during or after procedure. - Perfusion - loss of blood flow below the site where the catheter was inserted. - Acute Kidney Injury (AKI) due to dye if dye is used.

What are some TESTS that might have to be done BEFORE Surgery?

- Blood work (electrolyte panel to assess electrolytes and CBC to assess RBC's, WBC's, and platelets. - Urinalysis (assesses for UTI) - Chest X-Ray (assesses for pulmonary/cardiac disorders/enlargement) - Pulmonary Function Test - Electrocardiogram - Pregnancy test

Clinical Manifestations of Ulcerative Colitis

- Bloody, mucus diarrhea - LLQ pain - Frequent bowel movements - Extraintestinal manifestations (skin/eye lesions, liver disease, arthritis) - Tachycardia, hypotension, fever, pallor, hypovolemic shock from dehydration and/or rectal bleeding

Newer Combination Inhalers Include:

- Breo Ellipta (Fluticasone/vilanterol): Used for COPD & asthma management - its an inhaled coritcosteroid combined with Long-acting Beta2 Adrenergic Agonists - administered via dry powdered inhaler - once a day dose. - Anoro Ellipta (Umeclidinium/vilanterol): used for COPD management - not approved for asthma - it's a Long Acting Muscarinic Anticholinergic combined with Long-acting Beta2 Adrenergic Agonists - administered via dry powdered inhaler - once a day dose.

What medications would we give to someone with IBS who is suffering from constipation?

- Bulk forming laxatives - Hydrophilic colloids such as (Miralax, Metamucil) - Stool softeners (Colace)

What are some diagnostic lab studies that diagnose aplastic anemia?

- CBC will show Low Hgb, WBC, and platelet values - Low reticulocyte count - Prolonged bleeding time - Elevated serum iron and TIBC - Hypocellular bone marrow with increased fat content (yellow marrow) *Low Hgb, Low WBC, Low Platelets, Low reticulocytes, High Serum Iron, High TIBC = aplastic anemia*

Resulting Effects of PEM:

- Cachexia (skin & bones - the look of wasting away) - Muscle/fat wasting - Loss of plasma proteins =oedema (swelling & pitting edema) - Decreased liver and kidney function = inability to excrete toxins - Loss of immune function = gastrointestinal infections - Loss of digestive tract = amino acids cant be utilized for proteins - Loss of muscle/heart tissue = atrophy, weakness, heart failure

HSV-2

- Can live anywhere in genital area (penis, vagina, anus) - Lesions are present on genitals.

*Temperature*: 35.8-37.5C; 96.4-99.5F *Pulse*: 60-100bpm *Respirations*: 12-20 *BP*: 120/80 *Pain*: 0 *SpO₂*: 94-100% *Blood Glucose*: 70-100 *IF ANY OF THE ABOVE RESULTS ARE NOT IN THE EXPECTED RANGE, LIST THREE STEPS YOU COULD/SHOULD TAKE AS A NURSING STUDENT.*

- Check equipment - Verify placement - Reassess - Check patient's baseline - Notify instructor

Asthma

- Chronic Inflammatory disorder of the airways - Exacerbations - Reversible

S/S of OTHER types of MS

- Chronic Pain - often caused from spasticity - give muscle relaxant - Bladder dysfunction - Memory loss - Decreased concentration - Emotional instability (anger,depression,euphoria)

Fluoroquinolones

- Ciprofloxacin - Levofloxacin Broad spectrum antibiotics used to treat UTI's.

What are ways we can treat chronic venous insufficiency?

- Compression: #1 treatment - Elevation - Prevent or treat infection - Treat wounds (dressings, skin grafting)

Define Scleroderma

- Connective tissue disease causing hardening of skin, of esophagus, and of GI tract. - Causes problems with eating, GERD. - Face becomes mask like and doesn't move - skin elasticity is lost. - Remissions and exacerbations - Progressive, chronic, debilitating - Inflammation and edema r/t collagen accumulation in the skin - Fibrotic changes lead to loss of skin elasticity and movement - Same occurs in blood vessels, synovium, skeletal muscles, heart lungs, GI, kidneys *Scleroderma goes hand in hand with Lupus*

Side effects of opioids:

- Constipation - Sedation and confusion - nausea & vomiting - Pruritis and urinary retention - Respiratory depression (especially with IV or epidural doses)

Non pharmacological pain relief measures

- Cutaneous Stimulation and Massage - Thermal Therapies - Transcutaneous Electrical Nerve Stimulation (TENS) - Distraction - Relaxation - Guided Imagery - Hypnosis - Music Therapy

4 Nursing Interventions for Scleroderma:

- Decrease pain - Maintain moderate exercise - Smoking cessation critical - Monitor for impaired swallowing & constipation

Complications that can develop from Influenza

- Dehydration - Highly Communicable (Easily spread)

Postoperative Complications

- Depressed respirations (Stirrup method - first try to wake up patient as when they are awake respirations are deeper - Narcan as a last resort (naloxone) - Laryngospasm (spasm of vocal cords) - Aspiration (nausea and vomiting - turn patient on their side; have suction available) - Cardiac arrest - Hypo/Hypertension > hypotension: loss of blood during procedure - Dysrhythmias - Syncope: dizziness - DVT/PE - Infection (Pneumonia which usually occurs after the 3rd day, wound/skin, UTI, Systemic infection like sepsis) - Wound Dehiscence (5th-10th day wound opens up) - Evisceration (common in obese patients - organ pops out of incision - cover with sterile saline gauze and call the surgeon)

Risk Factors for Chronic Glomerulonephritis

- Diabetes - SLE (Lupus) - Hypertensive nephrosclerosis: hardening of the vessels that lead to the renal arteries.

Defining Characteristics of Irritable Bowel Syndrome

- Diarrhea, constipation, or *BOTH* - Abdominal pain - Abdominal distention - Excessive flatulence - Defecation urgency - Sensation of incomplete evacuation - Increased pain when eating, decreased pain when going to the restroom.

What are some contributing factors that can cause Irritable Bowel Syndrome?

- Diet: fatty greasy foods/foods that trigger your stomach - Alcohol - Smoking - Medications: can aggravate IBS - Psychologic - Hormones - Heredity

common causes of folic acid deficiency:

- Dietary deficiency - lack of intake - Malabsorption syndromes - ex: Chrones disease - Drugs - Increased requirement - Alcohol abuse and anorexia - Loss during hemodialysis

Indicators that the patient should seek attention for help with GERD:

- Difficulty Swallowing - Symptoms persisting for over a week - Heartburn more than 1 time a week - Occurring at night and waking patient *NOTE: Older adults with a recent onset of heartburn - can be a symptom of MI*

What are some complications caused by IBS?

- Diverticulosis - Dehydration: can cause electrolyte imbalance - Impacted bowel: caused by constipation - Hemorrhoids: caused by diarrhea/constipation/constant wiping - educate patient on how to treat Hemorrhoids (creams) - Depression/anxiety

Who's at risk of getting osteomyelitis?

- Elderly - Obese people - Those who are malnutritioned - Substance abusers - Diabetics - Immunosuppressed patients (Cancer patients) - Long term steroid use - Sickle Cell anemia patients - Vascular insufficiency.

What are ways we can prevent DVT?

- Elevate legs when sitting - Avoid crossing legs when sitting - Active/passive ROM - Post-op ambulation - Compression stockings - Sequential compression devices (SCDs) - Prophylactic Anticoagulants: Heparin / Lovenox (Enoxaparin): Given IV/SUBQ. More side effects, more to monitor. Xarelto (Rivaroxaban): Given PO. Less side effects, less monitoring.

How can we diagnose PUD:

- Endoscopy with biopsy - Esophagogastroduodenoscopy (EGD) - Check for Helicobacter pylori (H. pylori) - Upper GI Series - Barium contrast studies - Complete blood count: Checks for WBC, Hgb, Hematocrit and Hematocrit to assess for bleeding

Upper motor neurons

- Entirely within the CNS - Initiates voluntary movement - UMN are affected with injuries above the sacral spinal cord segments (higher level injuries)

Complications caused by GERD:

- Esophagitis - inflammation of esophagus - Ulceration - Esophageal stricture: Narrowing/tightening of the esophagus - Barrett's esophagus: normal tissue lining the esophagus changes to tissue that resembles the lining of the intestines - Aspiration - Spasm within the Respiratory system - Dental erosion

In what cases would we potentially see Metabolic Alkalosis?

- Excessive ingestion of antacids - NG tube drainage - Excessive vomiting

Our goal is to PREVENT peripheral arterial disease. State how *Exercise* can prevent PAD. What is the most effective exercise for individuals with intermittent claudication? How often should we exercise?

- Exercise improves oxygen extraction in the legs and skeletal metabolism - Walking is the most effective exercise for individuals with intermittent claudication - 30 to 60 minutes daily, 3 times/week

Symptoms of Rheumatoid Arthritis:

- Extreme fatigue, fever, pain - Dry mucous membranes in eyes & mouth - Swollen, red, warm & painful joints - Soft Raynauds nodules may be present - Nodules are nontender, movable, and evident over bony prominences. - Raynauds disease may be present. - Fingers deviate outward (swan-neck deformity) - Stiffness in the morning that takes an hour or longer to subside. - Cold feet & hands - Ibuprofen does not relieve pain because RA is an autoimmune disorder and this is what is causing the inflammation. - Elevated ESR & ANA - inflammatory markers. - Affects entire body (systemically) because RA is an autoimmune disorder. - Affects joints bilaterally (on both sides)

Complications of Cataract Surgery:

- Eye pain (minimum) - Hemorrhage, infection - Toxic Anterior Segment Syndrome (intraocular inflammation)

Symptoms of SLE

- Fatigue & malaise, weakness - Weight loss, fever, anorexia - Myalgia, arthralgia, anemia Skin: - Photosensitivity with rash: Intermittent butterfly shaped rash on nose/cheeks - Dry scaly raised rash to face or upper body (sun exposed areas) - Erythema of palms Neuro: Subtle changes in behavior, mood disorders, depression (can also have seizures) Cardiovascular: - Pericarditis → chest pain - Pleuritis → SOB - Atherosclerosis Renal - Lupus Nephritis: destruction of kidneys. Fatal complication of SLE.

8 Clinical Manifestations of Guillain-Barré Syndrome

- Fatigue while talking - Facial weakness - symmetrical/both sides of face. - Cranial nerve involvement - Paresthesias - numbness/tingling - Pain resembling a "charlie horse" - Difficulty walking - Motor weakness (flaccid paralysis) - Respiratory compromise/failure

What are the side effects of Proton Pump Inhibitors?

- Fracture risk (osteoporosis-related w/long term use) - Clostridium difficile (C-diff)* - Community acquired pneumonia (CAP) - Increase intragastric bacterial growth and the risk for infection - Decreased absorption of Vit. B12 - Decreased Magnesium levels - Decreased kidney/liver function*

Name 1 example of a Loop diuretic. What is their common ending? What are the side effects? Nursing Interventions?

- Furosemide. - Commonly end in -ide - SE's: Constipation, HYPOkalemia, electrolyte abnormalities, increases uric acid - NI's: Increase intake of foods rich in potassium (raisins, apricots, strawberries, avocados, potatoes), monitor basic metabolic panel

Complications of PUD:

- GI hemorrhage - most common due to ulcerations and vascularity of gut *EMERGENCY - Bowel perforation*EMERGENCY - Obstruction from scarring or acute inflammation*EMERGENCY - Abdominal or intestinal infarction*EMERGENCY - Ulcer penetration into attached structures - Increased risk of gastric adenocarcinoma (in patients with H. pylori) - Peritonitis*EMERGENCY - Anemia - from bleeding

Cobalamin (Vitamin B12) Deficiency can also occur in the following:

- GI surgery - Chronic diseases of the GI tract - Chronic alcoholics - Long-term users of H2-histamine receptor blockers and proton pump inhibitors - Strict vegetarians (vitamin b12 is provided from animal meat)

How do we treat pneumonia?

- Give antibiotics (after sputum culture collected) - Oxygen therapy - Pain management, splinting - Fever reduction - Hydration - Nutrition - Rest

Symptoms of Graves Disease Include:

- Goiter: *Classic sign. Symmetrically enlarged thyroid. - Weight loss: due to increased BMR - Heat intolerance: over heated - Can cause hyperhidrosis (increased sweat) - Thin, brittle hair - Easily fatigued - Tachycardia/palpitations - Anxious/nervous/irritable - Insomnia/difficulty concentrating - Can affect fertility

How can we prevent Hospital Acquired Infections?

- HAND HYGIENE - Appropriate use of PPE by HCP's and visitors (the proper way to put PPE on and off) - Following proper precautions for each patient - Sterilization of room & equipment

Causes of SIADH:

- Head Injury - Pituitary tumor - Lung cancer - Certain chemotherapies - TB

Contributing/Risk factors for GERD

- Hiatal hernia: top of stomach protrudes upwards interfering with digestion. - Incompetent lower esophageal sphincter (LES): LES allows food to go into the stomach - if it doesn't close all the way, food can go either up/down. - Decreased gastric acid (HCL) clearance: common in elderly - Nutrition - Medications may cause symptoms of GERD (meds that cause GERD are NSAIDS, steroids, certain antibiotics, antihypertensive meds) - Abdominal surgery - Pregnancy - Obesity - Pyloric stenosis: pyloric sphincter issues - Alcohol - SMOKING - Certain foods: spicy foods, high acidic foods, citrus (grapefruits, tomatos), Garlic, Onions, Carbonated Drinks (beer, soda, champagne) - Patients with reflux lose their intrinsic factor (enzyme that metabolizes b12) without IF you can't absorb b12 and you will need injections.

How can we diagnose IBS?

- History & Physical: - Rome III criteria - Bristol Stool Form Scale - Stool sample: occult blood (OB), Ova & parasites (O&P), culture & sensitivity - Blood work - CBC (assesses WBC, hemoglobin, hematocrit), ESR (checks for inflammation, this will help us rule out IBD), albumin (normal: 3.5-5.0. We'd want to know albumin - lets us know if there is a malabsorption issue) - Colonoscopy or sigmoidoscopy: look inside intestines without being invasive

What are the symptoms of Cushings?

- Hyperglycemia - due to too much cortisol - Tissue wasting - Electrolyte imbalance (Decreased K+ & Increased Na+) - HTN - Weight gain - Abnormal fat distribution - become very heavy and round in face (moon face) & trunk area - not legs or arms. Long term and severe Cushings causes Buffalo Hump (a bump of fat on their back) - Increase Susceptibility to infection - Due to taking hydrosteroids (they are anti-inflammatories that suppress the immune system.) Since body is producing too many steroids, this suppresses the immune system, making you more susceptible to infections - fever does not spike very high. - Androgen production - increase acne, changes in facial hair - Mental changes - poor concentration, memory loss, steroid psychosis (patients can become psychotic - patients feel antsy. Steroid inhalers and creams won't do this, but steroids given IV or PO can have this effect because they are systemic) - Ecchymosis (bruising) - Poor wound healing

What are some causes of PUD?

- Hypersecretion of acids & bile salts - Overuse of aspirin & NSAIDs - Ischemia - H. pylori - Glucocorticoids - Stress

4 Clinical Manifestations of Hypertensive Crisis

- Hypertensive encephalopathy - a sudden rise in BP is associated with Headache, n/v, seizures, confusion, coma - Renal insufficiency to renal failure - Cardiac decompensation - MI, HF, pulmonary edema, chest pain, dyspnea - Aortic dissection - excruciating chest and back pain and possibly reduced or absent pulses in the extremities.

In PAD, Amputation may need to occur if:

- If adequate blood flow is not restored - If severe infection occurs - Nonhealing arterial ulcers and gangrene

Benefits of Cataracts Surgery:

- Improved Vision - Be better able to take care of self - Have minimal to no pain

Why would someone with anemia experience Pruritus (itching)?

- Increase in serum and skin bile salt concentrations - excess bilirubin deposits underneath the skin causing itching

Complications of Diverticulitis

- Infection - Perforation - Abscesses - Peritonitis: surgical emergency - inflammation of the peritoneum, the tissue that lines the inner wall of the abdomen and covers and supports most of your abdominal organs. - Intestinal obstruction - Rectal hemorrhage - Portal pyaemia - Fistula

Complications of Herpes Zoster:

- Infection: due to open lesions - Scarring: from itching lesions - post herpetic neuralgia: 10% of population get it - happens afterwards - feeling that the virus has returned - feeling comes and goes (lesions are not active) - eye complications - Ophthalmic herpes zoster - disseminated.

Causes of Chronic Pyelonephritis

- Inflammation - Infection - UTI's - Vesicoureteral reflux - urine travels backwards (up instead of down)

Acute Bronchitis

- Inflammation of the bronchi - Follows an upper respiratory infection (URI): starts with a cold and then leads to acute bronchitis - COUGH is persistent: Lasts 10 - 20 days with a lot of sputum production Associated symptoms: Low-grade fever, headache, malaise, SOB with exertion, wheezes or rhonchi, achey, flu-like symptoms *Negative chest X-ray

Different methods of general anesthesia administration:

- Inhaled - IV - Both IV & Inhaled (balanced anesthesia)

What is the function of Cilostazol (Pletal)? What is it prescribed with? How should it be given (with food/without food)?

- Inhibits platelet aggregation (aka thrombus formation) - ↑ vasodilation - Prescribed with exercise routine - Give on empty stomach (30 minutes before or 2 hours after a meal) w/ full glass of water *1st line treatment for intermittent claudication*

When documenting a patient's Oxygen Saturation, what other information must be documented with it?

- Is the patient on room air, or oxygen? - If on O₂, what is the method of delivery? Flow rate/ percentage?

Teaching Points used to educate patients on Polycythemia Vera:

- Keep well hydrated - Elevate feet when sitting: Prevent DVT, enhances blood flow. - PROM/AROM, exercise - Electric Shaver - do not use a regular razor due to bleeding - Soft toothbrush - avoid bleeding - Report chest pain - coronary arteries may be clogged.

People with right-hemisphere damage experience:

- Left sided paralysis/weakness - Spatial/perceptual deficits - Quick, impulsive behavior - Short attention span - Not aware of disabilities

How can COPD negatively affect us?

- Loss of elastic recoil - air trapping - hyperinflation - excess mucous production - impaired gas exchange - pulmonary vascular changes: pulmonary hypertension, Cor Pulmonale (abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels), Respiratory failure.

Why take ACE inhibitors for PAD? What is an example of an ACE inhibitors? What are the benefits? What are the side effects?

- Lowers blood pressure and blocks vasoconstriction by blocking Angiotensin. - Benefits: ↓ Cardiovascular morbidity ↓ Mortality ↑ Peripheral blood flow ↑ ABI ↑ Walking distance - Example: Ramipril (Altace) - Side effects: Angioedema (swelling of mouth and lips), high potassium, jaundice, hypotension, neutropenia

How can we diagnose Cobalamin Deficiency?

- Macrocytic (normochromic: color is fine) RBCs have abnormal shapes and fragile cell membranes. - Serum cobalamin levels are decreased. - Normal serum folate levels and low cobalamin levels suggest megaloblastic anemia is due to cobalamin deficiency. - Upper GI endoscopy with biopsy of gastric mucosa

Normal Transferrin Levels?

- Male: 215-265 mg/dL - Female: 250-380 mg/dL - Diagnostic for iron deficiency anemia

Who is at risk for PEM (Protein energy malnutrition)?

- Malnourished children (Marasmus and Kwashiorkor) - Poverty-stricken - Elderly living alone - Eating disorders - Those with long-term illnesses

Signs that patient has DVT:

- May have unilateral pain or swelling of extremity - May have an increase of calf circumference - Warmth and erythema on the skin overlying the site of the thrombus - Positive Homan's sign: calf pain upon dorsiflexion of the foot when leg is raised.

What happens if Aplastic Anemia goes untreated?

- Median survival rate is 3 to 6 months - only 20% survive longer than 1 year

What antibiotics help treat Trachomonis Vaginosis?

- Metronidazole (Flagyl) *avoid alcohol with this med* - Clindamycin (Cleocin) suppository/vaginal cream *can decrease condom effectiveness*

What are some things that lead to Diabetic Ketoacidosis?

- Missed or insufficient doses of insulin - Physical and emotional stress with release of glucagon, epinephrine, norepinephrine and cortisol - Illness and Infection

Carotid Endarterectomy (CEA) Post-Op Care

- Monitor BP frequently because we want the BP to be on the higher side. Systolic of 160 or 170 is preferred. This indicates increased blood flow to the brain. - Maintain head alignment - avoid pressure on neck. - Neuro assessments - Assess neck for swelling and bleeding. - Prevent Increased ICP (avoid sneezing, coughing, straining)

Nursing Interventions for Adrenalectomy:

- Monitor for hemorrhage (Internal hemorrhage can be indicated through increased HR and decreased BP - monitor vital signs) - Encourage Deep breathing (helps clear anesthesia), coughing, Incentive spirometer (pre-medicate them as this will be painful) - Monitor for hormone imbalances - if both adrenal glands are removed, patient will have Addison's and will need hormone replacement. Body may adjust if only one is removed. The first 24-48 hours after surgery there may be an increase in hormones due to the surgical manipulation of the adrenal glands. - Monitor for signs of infection. - Administer IV steroids

Causes of DI:

- Most common cause: Brain tumor directly on pituitary gland. - Head injury/brain injury - Surgery (removal of pituitary gland)

Appendix Rupture causes:`

- Muscle rigidity: Board-like stomach - Increased temp & pulse rate - decreased BP - patient lies very still due to severe pain on movement

Pre-op orders:

- NPO/IV Fluids - Medications (diabetics will still need their insulin, cardiac meds will still be needed for those with cardiac problems) - Antibiotics are not given until in holding area.

When diagnosing tuberculosis, we perform a mantoux test - what are the measurements of the reaction on the skin that indicate "Negative for TB", "Positive TB for the Immunocompromised", and "Positive TB for the general public."

- Negative for TB: 0-4 mm - Positive TB for Immunocompromised: 5 mm or greater - Positive TB for the general public: 10 mm or greater

What is the main function of antacids? When should it be taken?

- Neutralizes hydrochloric acid - Take 1-3 hours after meals and at bedtime

Define COMPLICATED UTI

- Nosocomial/CAUTI's (catheter associated UTI) - Complicated UTI's are recurrent - Urologic abnormalities may be a cause for recurrent UTI's - Diabetics & immunocompromised often get recurrent UTI's

S/S of SENSORY MS

- Numbness & tingling - Patchy blindness - Vertigo - Tinnitus

Warning signals of a stroke/cva:

- Numbness, weakness, paralysis - typically one sided - Loss of balance/coordination/dizziness - Sudden vision changes - "black curtain" being pulled over eyes. - Difficulty speaking or understanding - Slurring words/can't get words out. - TIA's (warning strokes)

Complications of Crohn's Disease

- Nutritional deficits (Weight loss, malnutrition/malabsorption, secondary anemia) - Patient may or may not be thin. - Strictures, abscesses, fissures, fistulas - Small bowel obstructions - Osteoporosis - caused by malabsorption - Arthritis - Stomatitis - painful ulcers in mouth - Colon cancer

Uric Acid Stones

- Occurs in Gout / IBS - Happens due to ↑ uric acid production - Happens due to ↑ protein diet. - Happens due to ↑ alcohol intake. - Happens due to low urine output & dehydration.

6 Ways to treat Pulmonary Embolism:

- Oxygen - Thrombolytic therapy (ICU) - tPA (most severe side effect: intracranial hemorrhage - we will first see change in level of consciousness), streptokinase, urokinase - Unfractionated heparin / low molecular weight heparin / Coumadin / Xarelto - Monitor therapeutic levels - Inferior vena cava (IVC) filter - Opioids for pain management

How can we treat Diverticulitis?

- PO antibiotics 7-10 days - analgesics - antispasmodics - IV fluids/antibiotics if hospitalized - high fiber diet for outpatient - clear liquid diet or NPO if hospitalized - NGT if vomiting or distended - Bowel resection

Symptoms of Osteoarthritis

- Pain - Morning Stiffness - no longer than 30 minutes - Loss of ROM - Crepitus upon movement - Local swelling, not systemically inflammatory - No redness - Asymmetrical (one sided) - ESR & ANA (inflammatory markers) are within normal limits. - Heberden's Nodes & Bouchard's Nodes

Postoperative Nursing Care FOR GERD PROCEDURE:

- Pain management - Prevention of nausea and vomiting* - Listen for Bowel sounds - peristalsis - Liquid diet initially - will progress to regular - No lifting or straining Educate patient to... - report persistent heartburn & regurgitation - chew foods thoroughly to avoid scraping of the surgical area - may report mild dysphagia (difficulty swallowing)

Common CLINICAL MANIFESTATIONS of Iron Deficiency Anemia:

- Pallor is the most common finding. - Glossitis (inflammation of the tongue) is the second most common. - Cheilitis (inflamamtion of the lips)

Lower motor neurons

- Part of the PNS - Directly innervate skeletal muscle - Essential for muscle contraction

HSV-1

- People with HSV-1 commonly experience cold like symptoms. - Commonly represented by cold sores around the mouth or on skin of facial area. - Highly contagious through contact

Symptoms of Acute Glomerulonephritis:

- Periorbital edema in AM - Hematuria/brown urine - Decreased urine output - Lethargic - Fluid overload - hypertension

Why take Anti-Platelets for PAD & Side Effects

- Prevents formation of thromboemboli SEs: Bleeding, anti-platelet coagulation, Angioedema, tinnitus (with aspirin), bronchospasm, Steven Johnson's aka sloughing of the skin (in severe cases)

How can recurrent episodes of Raynaud's be prevented?

- Protect from cold - Avoid temperature extremes - Stop all tobacco use - Avoid caffeine - Avoid drugs that have vasoconstrictive effect: Amphetamines, Cocaine, Pseudoephedrine

Defining Characteristics/Symptoms of GERD

- Pyrosis (burning sensation) - Non-cardiac chest pain - Regurgitation - Respiratory symptoms (GERD can cause asthma) - Dental erosion from all acidity that travels upward into mouth - Hypersalivation - Dyspepsia (indigestion) - Dysphagia or odynophagia - Esophagitis

How we diagnose Influenza:

- Rapid Flu Test (swab of mouth that gives instant results) - 3 day culture

Time = Brain

- Rapid intervention is crucial in the treatment of acute ischemic strokes. - Permanent neurological damage is more likely to occur the longer a stroke goes without medical attention.

Defining characteristics of herpes zoster virus (shingles)

- Rash follows dermatome - Pain and burning sensation - Disseminated Zoster: Happens to people who are very immunocompromised - only form that can be spread via airborne. The rest is contact.

What are the goals of treatment for COPD?

- Relieve symptoms - Improve exercise tolerance - Prevent and treat exacerbations - Improve quality of life - Improve nutrition - many need protein supplements

Nursing Interventions for Homonymous Hemianopsia:

- Remind patient of deficit, to move the affected side - Move head to scan - Place objects where patient can see them - Approach/talk to patient from side he sees on

What are some nursing interventions we can perform for a patient with Addison's disease?

- Replace glucocorticoids (with hydrocortisone) - Replace mineralocorticoids (with fludrocortisone (Florinef)) *GIVE STEROIDS IN THE EARLY MORNING AS THIS IS WHEN THE BODY NORMALLY PRODUCES THEM - WE WANT TO MIMIC THE BODY.* - Monitor I/O, weigh daily, Vital Signs (Especially bp). Ensure patient doesn't get postural hypotension. - Teaching is important. Make sure to educate patient on disease as it is life long.

People with left-hemisphere damage experience:

- Right sided paralysis/weakness - Language deficits - Slow, cautious behavior - Distress/depression related to awareness of disability

What are the diagnostic findings for folic acid deficiency?

- Serum folate level is low. (Normal is 3 to 25 mg/mL) - Serum cobalamin level is normal - the gastric analysis is positive for hydrochloric acid.

What are some things that can lead to HEMOLYSIS or DESTRUCTION OF RBCs?

- Sickle cell disease - Medications (methyldopa) - Incompatible blood - Trauma (ex: cardiopulmonary bipass)

4 Ways to diagnose Scleroderma:

- Skin biopsy: identify cellular changes specific to scleroderma - *the best way to diagnose.* - Pulmonary studies - ventilation/perfusion - Echocardiogram - ANA +

HIV prevention:

- Standard Precautions - Barriers: condoms, dental dams - Safe sex practices - Safe Needle exchange programs (clinics give out clean and unused needles + syringes to reduce infection in drug users)

How do we diagnose Crohn's disease?

- Stool for Occult Blood - Serum levels - CBC, WBC, ESR, albumin - Sigmoid/colonoscopy - Small bowel series - shows thinning of the ileum - CT scan: bowel thickening/obstructions can be viewed here.

How to treat Malignant Hyperthermia

- Stop anesthetic - Hyperventilate 100% O2 - Cool down - Give "Dantrolene (Dantrium)" via IV

List some causes of back pain:

- Strains - Heavy lifting - Bad posture - Osteoarthritis of spine for elderly - Spinal stenosis - Degenerative disc disease - Herniated discs - Bulging discs - Cancer of bones - Obesity - Stress, depression

Risk Factors for Acute Glomerulonephritis

- Streptococcal infection of upper respiratory tract - Systemic lupus erythematosus (SLE) - Vascular injury - Disseminated intravascular coagulation (DIC) - Diabetes - Genetics

Nursing Interventions for DI & SIADH:

- Strict Intake/Output's - Monitor urine specific gravity (hourly) - Monitor urine and serum osmolality (initially q 4 hours - may progress to once per shift) - Weigh daily - Monitor vital signs - lung sounds especially - check for crackles (sign of fluid overload)

STD's that can be transmitted perinatally:

- Syphilis *crosses placental barrier - HIV *crosses placental barrier - Hepatitis B *crosses placental barrier - Herpes Simplex Virus *infects baby as they pass through birth canal - Gonorrhea *infects baby as they pass through birth canal - Chlamydia *infects baby as they pass through birth canal - Trichomoniasis *infects baby as they pass through birth canal

When treating Tuberculosis with Antibiotics: What is the best advice to give to the patient in regards to achieving the most optimal recovery and preventing the spread of infection? How long should a person receive treatment for before they can go back to being out in public/living a normal life? How long should a person remain on treatment for to ensure the infection is gone for good?

- Take medications on time everyday and as prescribed - 2-4 weeks - 1 year

Homonymous Hemianopsia

- The loss of the right or left half of the field of vision in both eyes. - More commonly seen with right hemisphere damage, but can also occur with left hemisphere damage.

Calcium Oxylate Stones

- The most common form of kidney stones - Occur in hypercalcemia - Occur in hyperparathyroidism - Occur from ↑ vitamin D production - Occur from intestinal bypass surgeries - Occur from dehydration

Perception of pain

- The point at which a person is aware of pain. - The somatosensory cortex identifies the location and intensity of pain, whereas the association cortex, primarily the limbic system, determines how a person feels about it. There is no single pain center.

Our goal is to PREVENT peripheral arterial disease. State ways we can *Modify our Life Style* to prevent PAD.

- Tobacco cessation - Aggressive treatment of hyperlipidemia (Statin & dietary changes) - BP maintained <140/90 - Glycosylated hemoglobin (Hgb A1C) <7.0% for diabetics

What is the treatment of choice for folic acid deficiency?

- Treated by replacement therapy (Usual dose is 1 mg per day by mouth) *duration of treatment depends on the reason for the deficiency* - Encourage patient to eat foods with large amounts of folic acid.

Diagnostics of Acute Pyelonephritis:

- Ultrasound of Kidney area - to rule out stones - CT scan of Kidney area - to rule out stones - Urine culture and sensitivity

Adjuvant Analgesic Therapy

- Used alone or in conjunction with opioids and nonopioids - Generally developed for other purposes, but also effective for pain

Who is at risk of getting appendicitis?

- Usually ages between 11-20. - Happens more in the winter maybe because people are less active. - More prevalent in males. - Could be genetic. - Usually uncommon in elderly but symptoms are more vague.

What are the clinical manifestations of appendicitis?

- Vague periumbilical pain progressing to right lower quadrant pain - Low grade fever, nausea/vomiting - McBurney point: rebound tenderness upon release after pressing down on RLQ - Rovsing sign: Palpating lower left quadrant, then let go and patient feels pain in lower right quadrant.

Human Papilloma Virus (HPV) AKA Genital Warts What type of infection is it? (bacterial/viral) How is it transmitted? What population is at high risk of contracting HPV? What are some defining characteristics of HPV? What are some complications of HPV? How do we diagnose HPV? What precautions do we use with someone who has HPV? How can we prevent HPV?

- Viral - Sexually - Young sexually active individuals - Genital warts (cauliflower-like), lesions - Cervical cancer, may need total hysterectomy - Pap Smear - if positive, biopsy may be taken. - Contact Precautions - Annual pap smears, condom use, and vaccination usually given between 11 and 26 years of age. Optimal results if given before person is sexually active.

Pre-op checklist for nurses:

- Vital signs/height and weight - Consent signed? - H&P (on chart/dated?) - Diagnostics - NPO, ID band, allergies (allergy band should be put on) - Hospital gown, jewelry (given to a significant other to hold onto), nails (no nail polish), piercings - Disposition of valuables (for inpatient - items need to be put in a bag and labeled and given to patient's family) - Scrub (skin prep), preop meds, voided, side rails up when sedative is administered

Symptoms of BPH

- Weak urine stream - Frequent urination - Dribbling after urination - Urge to urinate - Leakage of urine (overflow incontinence) - Nocturia - frequently urinating at night

S/S of MOTOR MS

- Weakness - area of weakness depends where myelin is affected - Paralysis - Diplopia - double vision - Spasticity of muscles - Scanning speech - someone who pauses a lot while speaking - Fatigue

Proper Body Mechanics for Lifting Objects to avoid straining the back:

- When lifting, keep the back straight and hold the load as close to the body as possible. - Lift with the large leg muscles, not the back muscles. - Use trunk muscles to stabilize the spine. - Squat while keeping the back straight when it is necessary to pick up something off the floor. - Avoid twisting the trunk of the body, lifting above waist level, and reaching up for any length of time.

How to Diagnose Back Issues:

- X-ray (#1) - Bone scan (looks at bone density) - CT scan - MRI (for disc issues - this can check for bulging/herniation of discs) - EMG (checks for disorders in spinal nerve roots) - Blood work - looks for elevated WBC count. - ESR: Erythrocyte Sedimentation Rate - Identifies inflammation in body.

Trichomonas Vaginosis What type of infection is this? (bacterial/viral) What is the name of the bacteria that causes this? How is this disease transmitted? What are some complications in men/women caused by this? What are some defining characteristics? How do we diagnose it? How do we treat it? What precautions are used when caring for someone who has this?

- bacterial - Protozoa - Sexually - Men: Urethritis Women: Vaginitis - Yellow-green frothy discharge with strong foul smelling odor, burning and itching. - Swab, examination of genitals (vaginal and cervical redness + strawberry spots), & a chance in discharge pH. - Antibiotics: Metronidazole (Flagyl) *avoid alcohol with this med* Clindamycin (Cleocin) suppository/vaginal cream *can decrease condom effectiveness* - Contact

Opioids

- bind to mu receptor sites located throughout the nervous system - are the mainstay in the management of all types of pain. - Formerly called narcotics. * Mu receptors are found in throughout the central nervous system, especially in the brain stem and spinal cord.

How much blood is lost during menstruation? How much Iron?

- blood loss: 45 mL - Iron: 22 mg

What are some things the anesthesiologist will check for BEFORE surgery?

- cardiac and respiratory history (Did patient smoke?) - previous experience with anesthesia (nausea, vomiting, allergies, and family member reactions) - current medications (anticoagulants need to be stopped a week before surgery)

Cholinergic Crisis - cause: tensilon test result: signs + symptoms:

- cause: Over stimulation of the muscles caused by too much acetylcholine - this is due to excessive medication (patient misunderstood med instructions and has doubled their dose) - tensilon test result: Negative - symptoms don't get better after injection. - signs + symptoms: abdominal cramps, diarrhea, increased pulmonary secretions which can lead to respiratory distress and bronchial spasms.

Myasthenic Crisis - cause: tensilon test result: signs + symptoms:

- cause: Under stimulation of the muscles (muscle weakness) due to too little acetylcholine - this can be caused by under medication (person forgets to take meds) or commonly, infection - tensilon test result: Positive - symptoms get better after injection. - signs + symptoms: ↑ BP, ↑HR, ↑RR, severe respiratory distress, bowel + bladder incontinence.

What are the reportable STD's?

- chlamydia - gonorrhea - HIV/AIDS - Syphilis - Chancroid

Define UNCOMPLICATED UTI

- communically acquired - not usually recurrent - usually affects young women

What are some ways we can prevent Chlamydia/Gonorrhea?

- condom use - chlamydia testing for women who are sexually active under the age of 25 - limit # of sexual partners

Why would someone with anemia experience pallor?

- decreased hemoglobin - decreased blood flow to the skin

To assess for Homonymous Hemianopsia we look for:

- denial of left/right side of body - visual spatial neglect

Who are some patients that have a higher risk of getting influenza?

- elderly - newborns/infants - immunocompromised people

Myasthenia Gravis Signs & Symptoms:

- fatigue of skeletal muscles, typically from the diaphragm up. - ptosis (eye drooping), difficulty moving eyes/eye lids - Difficulty Chewing - Difficulty Swallowing - Difficulty Speaking (dysphonia) - Difficulty Breathing

How to prevent HSV:

- hand washing - consistent and correct use of condoms and barrier protection - educating sexual partners: virus can be spread without symptoms

What are some things that need to be done BEFORE surgery?

- health history - must know all medications the patient is on - must know drug & alcohol history - physical exam (head to toe) - consultations (ex: cardiac clearance)

How do we diagnose Asthma?

- health history/physical assessment - Chest x-ray to rule out pneumonia - arterial blood gases (ABG's) - pulmonary function tests - peak expiratory flow rate (PEFR)

Prolonged cardiopulmonary symptoms of anemia can lead to:

- heart failure - peripheral edema - ascites - pulmonary/systemic congestion

Name some chemicals that increase the transmission of pain:

- histamine - bradykinin - acetylcholine - serotonin - substance P

How do we diagnose Lyme disease?

- look for signs and symptoms - blood test

Increased levels of glucose predisposes patients to:

- neuropathic disease - microvascular complications - macrovascular complications - hypertension

What questions would a nurse ask to obtain information on their patient's pain?

- onset: when did it start? - location: where is the pain? - quality: describe the type of pain you're feeling - Intensity: ask patient to rate pain intensity on a scale of 1-10 or show them another scale to rate their pain. - timing: How long have you had this pain? Does it come and go? Is it worse at any specific point during the day? - personal meaning: how has the pain affected your life? has it affected your ability to perform ADL's? - Aggravating/Alleviating factors: what makes the pain better? what makes it worse?

Type 2 diabetes risk factors you CAN fix:

- overweight - low activity level - high blood pressure - high cholesterol

5 defining characteristics of Carpal Tunnel Syndrome:

- pain - weakness along media - numbness - paresthesia - night pain

Factors that influence pain response:

- past experiences - anxiety and depression - culture - gender

Systemic Allergic Reactions

- rare - starts at site then spreads to generalized uticaria (hives)

Gonorrhea (N. Gonnorrhoeae) & Chlamydia Trachomatis Who is at high risk for contracting Chlamydia? Who is at high risk for contracting Gonorrhea? What symptoms may appear in women? What complications may appear in women? What symptoms appear in men? What complications may appear in men? How do we diagnose Gonorrhea/Chlamydia? How do we treat Gonorrhea/Chlamydia?

- sexually active women under age 24 - men who have sexual relations with other men and young women. - Women usually are asymptomatic (if symptoms are experienced, it would be UTI, vaginitis (itching), and mucous discharge) - Pelvic Inflammatory Disease - Burning during urination, penile discharge (usually what makes them seek medical attention), and painful swollen testes. - Epididymitis - Urine test, Swab of vagina/penis - Antibiotics: Chlamydia is treated with: Doxycycline or Azithromycin. Gonorrhea is treated with: Ceftriaxone.

What do you do as a health care provider if you believe you have been exposed to HIV? (ex: you have pricked yourself with the needle of someone who has HIV)

- standard precautions - wash area - notify supervisor - notify employee health services - consent for HIV testing (patient and person affected must sign) - Prophylactic antiretroviral treatment within 72 hours X 4 weeks - Follow up for people who are exposed: 1 month, 3 months, and 6 months - Document

How can we treat Diverticulosis?

- stool softeners - bulk forming agents - antispasmodics - high fiber diet - clear liquids if need to rest bowel

Oxygen therapy Improves:

- survival rate - cognitive performance - sleep - exercise tolerance - nutritional status *also treats exacerbations

The Symptomatic non-AIDS defining stage of HIV

- the 2nd stage of HIV - symptoms develop - CD4 T-cell count is 200-499 (it begins to drop as the virus progresses)

The AIDS Stage of HIV

- the 3rd and final stage ; HIV has fully progressed into AIDS at this point. - We know the patient has AIDS due to CD4 T cell counts being 200 or less.

The asymptomatic/primary stage of HIV

- the first stage of HIV - this is when the virus is replicating and there are no other symptoms at this time. - CD4 T-cell count is greater than or equal to 500 (it's in normal range)

Define Aplastic Anemia

- there is a decrease in all blood cell types (wbc, rbc, platelets) - hypocellular bone marrow - ranges from chronic to critical - bone marrow transplant may be needed

Treatments for Acute Pyelonephritis:

- treatment is based on urine culture & sensitivity results - 2 week course of antibiotics PO (for at home) or IV (for in hospital) - Hydration - drink plenty of fluids

Anemia of Chronic Disease/Inflammation is associated with:

- underproduction of RBCs - mild shortening of RBC survival *usually a mild type of anemia but can become severe if underlying causes are not treated

Acute asthma attacks consist of these symptoms:

- wheeze - tachycardia/tachypnea - chest tightness - use of accessory muscles - anxiety - cough *Can be life threatening

Aldrete Scoring System

-Determines readiness for discharge from recovery room (PACU) to the surgical floor * need aldrete score of 8 or better to be discharged from PACU

tPA medications commonly end in:

-ase

What is the common suffix for PPIs?

-prazole

Door to needle time for fibrinolytics

0 min: stroke patient arrives to unit < 10 min: Initial MD evaluation (patient lab work, history, NIHSS) < 15 min: Stroke team notified. < 25 min: CT scan initiated. < 45 min: CT & labs interpreted. < 60 min: tPA administered if patient is a candidate. GOAL DOOR TO NEEDLE TIME IS COMPLETED IN 60 MIN OR LESS.

List the scores for Normal Bone density, osteopenia, and osteoporosis.

0 to -1.0 = normal bone density -1.0 to -2.5 = osteopenia Anything less than -2.5 = osteoporosis. (Ex: -3 is less than -2.5)

Normal range for creatinine:

0.6-1.2

Give the normal level for: *Creatinine*

0.7-1.4 mg/dL

Scores of NIH Stroke Scale: 0: 1-4: 5-15: 15-20: 21-42:

0: no stroke 1-4: minor stroke 5-15: moderate stroke 15-20: moderate/severe stroke 21-42: severe stroke

Specific gravity of water:

1

2 mL of whole blood contains (? mg) of iron.

1 mg

Proper elevation of leg includes:

1 pillow under thigh, no pillow under knee, 2 pillows under calf. We want the leg to be higher than the thigh like a slope, so that the blood will flow back towards the heart. *elevate leg higher than the level of the heart*

After treatment of Chlamydia/Gonorrhea begins, how long should the person receiving the treatment refrain from sexual activity?

1 week

What are the 4 different types of parenteral nutrition?

1) Total Parenteral Nutrition (TPN) via CVAD 2) Partial Parenteral Nutrition (PPN) via peripheral line 3) Total Nutrient Admixture (TNA) = PN + Lipids - 3-in-1 - 2-in-1 where lipids infuse separately 4) Lipids

Bronchodilators relieve bronchospasms in 3 ways:

1) increase oxygen distribution 2) reduce airway obstruction 3) alter smooth muscle tone

Anemia of Chronic Disease/Inflammation usually develops after (how many months?) of disease activity.

1-2 months

DUODENAL ULCERS - 1. Describe the type of pain that occurs with Duodenal Ulcers 2. Where does pain occur with Duodenal Ulcers? 3. How soon after eating does pain occur? 4. What time during the early morning hours might pain be felt? 5. What decreases the pain & why? 6. What is very unlikely to occur? If this occurs, what will patient present with? 7. What do people who have Duodenal Ulcers have an increased risk for as compared to people with gastric ulcers? 8. Are Duodenal Ulcers curable?

1. "Burning" or "cramp-like" pain. 2. Pain felt in the mid-epigastric region and/or back. 3. Pain occurs 1 1/2 to 3 hours after meals 4. Pain may occur between 1-2 am 5. Ingestion of food decreases pain because chyme coats the stomach 6. Hemmorrhage less likely to occur in patients with duodenal ulcers, but if a hemmorrhage does occur, patient will present with *Melena* (black tarry stools - common with duodenal ulcers) 7. Increased risk of perforation of bowel than people with gastric ulcers 8. Yes, duodenal ulcers are curable

GASTRIC ULCERS - 1. Describe the type of pain that occurs with gastric ulcers. 2. In what area does the pain occur? 3. How soon after a meal does pain occur? 4. What aggravates the pain? 5. What relieves the pain? 6. What do patients with gastric ulcers have an increased risk of? 7. Because of this increased risk, this is commonly seen in patients with gastric ulcers:

1. "Burning" or "gaseous" stomach pain 2. Pain high in epigastrium 3. Pain occurs 30 min to 1 hour after meals 4. Food aggravates pain 5. Vomiting relieves pain 6. Increased risk of hemorrhage/GI Bleed 7. Hematemesis - vomiting of blood

List each deficiency that occurs in Addison's Disease, what it causes, and the symptoms associated with each.

1. *Decrease in Aldosterone* leads to an *INCREASE in sodium excretion* - this causes dehydration, hypotension, and hyperkalemia. 2. *Decrease in Glucocorticoids* (like cortisol) leads to a *decrease in Gluconeogenesis* - this causes symptoms similar to those in hypoglycemia - weakness, tiredness, weight loss. 3. *Decrease in Androgens* do not produce many symptoms for men as they also produce androgens in the testes, but for *WOMEN*, we can have *loss of pubic/axillary hair*

Name 4 Postoperative complications that can occur after a Thyroidectomy.

1. *Hemorrhage* due to vascularity of thyroid - assess dressing in front and in back for blood. Heart rate will go up and BP will go down during hemorrhage. 2. *Airway obstruction* - monitor for stridor which is indicative of airway occlusion. You cannot intubate someone with an airway occlusion because the tube won't fit down their airway due to swelling. 3. *Laryngeal nerve damage* - thyroid is very close to vocal cords - patient may temporarily lose their voice or sound hoarse. 4. *Hypocalcemia* due to Parathyroids being affected. Some common signs of hypocalcemia include Trousseau's Sign (BP cuff on and hand begins to spasm) & Chvostek's sign (tapping on cheek causes twitching)

List what types of Anemia are common among the older adult population.

1. 1/3 have a nutritional type of anemia (iron, folate, cobalamin) 2. Another 1/3 have renal insufficiency and/or chronic inflammation 3. Another 1/3 have unexplained anemia

Name 3 types of Immunomodulators/Immunosuppressants:

1. 6-mercaptopu*rine* (*6-MP*) 2. azathiop*rine* (*AZA*, Imuran) 3. *methotrexate* (Rheumatrex, Trexall)

What are 3 ways to diagnose Addison's Disease:

1. ACTH stimulation test: ACTH will be given via IM injection. Plasma will be drawn afterwards (30-60 min later). By giving exterior ACTH (mimics pituitary gland), the adrenal glands should begin producing more hormones. Since Adrenal Glands are not functioning, *blood will show decreased cortisol levels despite injection of ACTH*. 2. Serum Electrolytes: decreased sodium, decreased glucose, increased potassium. 3. 24 hour urine free cortisol levels - If cortisols are barely being produced, we will see little to no cortisol in the urine. This indicates Addison's disease.

What 3 hormones are secreted by the pituitary gland?

1. ADH - which affects the kidneys 2. TSH - which affects the thyroid gland 3. ACTH - which affects the adrenal glands

What are 7 things we see in someone with venous insufficiency?

1. Aching/cramping in the extremity relieved with *elevation*. 2. Pulses present. 3. Extremity is red & warm. 4. Thick/tough/leathery skin with brawny pigment aka *Venous Dermatitis*. 5. Edema 6. Poor healing. 7. Ulcers (Superficial, pink w/ uneven edges, usually present above medial malleolus)

In Addisonian Crisis, show the 2 pathologies of what happens when *Aldosterone* stops being produced.

1. Adrenal Glands Not Functioning → Aldosterone very low/absent → Kidney is affected - water & sodium is lost → Low fluid volume → Shock → Brain is affected - coma or death. 2. Adrenal Glands Not Functioning → Aldosterone very low/absent → Heart irregular & output decreases → Low blood pressure → Shock → Brain is affected - coma or death.

In Addisonian Crisis, show the 2 pathologies of what happens when *Cortisol* stops being produced.

1. Adrenal Glands Not functioning → Cortisol is very low or absent → liver function decreases → low sugar → extremely low sugar → Brain is affected - coma or death. 2. Adrenal Glands Not Functioning → Cortisol is very low or absent → Stomach digestive enzymes decrease → vomiting/diarrhea/cramps → Brain is affected - coma or death.

Name 3 treatments for Cushings:

1. Adrenalectomy (if adrenal glands are the problem) 2. Transsphenoidal hypophysectomy (if pituitary is problem) 3. Radiation for a large tumor - it will help shrink it.

List the risk factors for Peripheral Artery Disease:

1. Age 60-80 2. Poor diet/sedentary lifestyle 3. Obesity 4. Smoking 5. Pre-existing health conditions (hyperlipidemia aka high cholesterol, hypertension, diabetes, coronary artery disease, clotting disorders) 6. Hyperhomocysteinemia: Having elevated homocysteine levels in the blood due to lack of folic acid, vitamin b12, and vitamin b6. This disorder is associated with atherosclerosis and blood clots.

What are 2 things to be aware of about Antacids:

1. Antacids have high sodium content - not to be used in elderly patients/people with high blood pressure, liver cirrhosis, or renal disease. 2. Magnesium preparations are not to be used in patients with renal failure.

What 3 medications can we give to treat Graves disease?

1. Anti-thyroid drugs 2. Iodines 3. Beta adrenergic blockers

What medications do we give for Spastic Bladder?

1. Anticholinergics - to relax spastic bladders. - propantheline (Pro-Banthine) - oxybutynin (Ditropan) 2. Skeletal Muscle Relaxants - baclofen (Lioresal): Helps with general muscle spasms but will also relax bladder muscle.

Name 5 ways to manage Myasthenia Gravis:

1. Anticholinesterase inhibitors/Cholinergics such as pyridostigmine bromide (Mestinon): this med must be given on time or symptoms of MG can worsen quickly. 2. Corticosteroids (prednisone): Given if patient reacts poorly to Mestinon or during an exacerbation. It's an anti-inflammatory. 3. Immunosuppressants: Given as a last resort if patient is not responding to any other medications. 4. Plasmapheresis: Temporary improvement seen with this medication. 5. Thymus gland removal: Done for the 75% of people that have Hyperplasia of the thymus gland and the doctor believes this is causing MG - it may or may not cure MG, but a cure is never gaurenteed. Thymus gland removal can lead to an increased risk for infection.

What are 3 things we can do to treat DVT's?

1. Anticoagulant therapy - use of anticoagulants like Heparin/Lovenox/Xarelto to keep blood thin and prevent clot from becoming larger. 2. Thrombolytic Therapy - administration of drugs known as Lytics that are used to dissolve a clot. 3. Greenfield filter - a filter placed inside the inferior vena cava that catches blood clots as they travel upward; this filter prevents the blood clots from reaching the lungs, while still allowing blood to flow around the captured clot.

What are the 2 Clinical Variations of Guillain-Barré Syndrome? Which one is more common?

1. Ascending - symptoms begin at feet and work their way up - *this is the most common* 2. Descending - symptoms begin at the head and work their way down.

Name 2 Anti Platelet Medications:

1. Aspirin 2. Clopidogrel (Plavix)

Patients with Gout should avoid what 2 medications and why?

1. Aspirin 2. Thiazide Diuretics Because these block renal excretion of Uric Acid.

What are 3 things someone with gout should avoid?

1. Aspirin & thiazide diuretics 2. Dehydration (allows uric acid levels to stay in the body and not be passed through the urine.) 3. Purine Containing Foods (organ meats, hard cheeses, shell fish, high salt containing foods, deli meats)

List 4 Defining Characteristics of Osteoporosis:

1. Asymptomatic: x-ray shows osteoporosis when 25-40% of the bone has already been changed. 2. Decreased calcium absorption (common in postmenopausal women) 3. Kyphosis/Dowager's contracture: hunched back 4. Fractures

6 Complications of PAD:

1. Atrophy of the skin and underlying muscles (legs are skinny) 2. Delayed healing due to decreased o2 3. Wound infection due to decreased o2 4. Tissue necrosis 5. Arterial ulcers 6. Amputation if Ulcers turn gangrenous and don't heal.

How to diagnose Chronic Pyelonephritis:

1. BUN & Creatinine assesses kidney function. 2. WBC asseses for active infection. 3. Voiding cystouretherography (VCUG)-uses contrast - shows reflux 4. IV urogram-uses contrast - shows anatomical issues like obstructions, masses, lesions, or stenosis. *Urinary analysis for those with Chronic Pyelonephritis may show as normal, so this test may not be done*

How can we treat Paget's Disease?

1. Bisphosphonates, NSAIDS (for pain) 2. Joint replacement (last resort)

What are some side effects of heparin?

1. Bleeding 2. HIT - Heparin induced thrombocytopenia

2 Complications of Osteoporosis:

1. Bone Fractures 2. Loss of height (kyphosis)

What 2 ways can we diagnose Paget's Disease?

1. Bone Scan - help us determine the extent of the disease 2. X-ray - confirm paget's disease

5 Minimally Invasive Procedures that treat BPH:

1. Catheterization 2. Transurethral microwave thermotherapy (TUMT) 3. Transurethral needle ablation (TUNA) 4. Laser prostatectomy 5. Intra-prostate urethral stents

We use these 2 methods to assess for painful stimuli:

1. Central Stimulation 2. Peripheral Stimulation

6 POSTOP Nursing Actions for a patient going in for Percutaneous Transluminal Angioplasty:

1. Check bleeding at insertion site (brachial/femoral) 2. Check for swelling at the insertion site which can indicate hematoma 3. Vital sign assessment 4. Neurovascular assessment - check pulses. 5. Bedrest 6-8 hours 6. Antiplatelet agents

List two different diagnostic evaluations for Graves Disease:

1. Check serum levels: there will be *increased levels of T3 & T4* and *decreased levels of TSH.* 2. Thyroid Scan/Radioactive Iodine Uptake: Iodine is swallowed - 24 hours later there is a scan. They look to see how much iodine is absorbed by the Thyroid. In graves disease, there will be an *increased RAIU.*

What medications do we give for Flaccid Bladder?

1. Cholinergics - stimulates muscles of bladder. - bethanechol (Urecholine)

What are some things that could lead to BLOOD LOSS and therefor a REDUCTIONS OF RBCs?

1. Chronic Hemorrhage - bleeding duodenal ulcer - colorectal cancer - liver disease - acute trauma - ruptured aortic aneurysm - GI bleed

Name 2 drugs prescribed for Intermittent Claudication: What decreases the efficacy of these medications by 20%?

1. Cilostazol (Pletal) 2. Pentoxifylline (Trental) *SMOKING* decreased efficacy by 20%

What are the 3 ways we can diagnose Anemia?

1. Complete Blood Count (CBC) - will show low hemoglobin and low hematocrit 2. Reticulocyte Count - Reticulocytes are what RBC's are called before they completely mature - they are newly produced by the bone marrow. Someone with Anemia will have a high reticulocyte count. 3. Peripheral Blood Smear - Viewed under microscope - anemia is diagnosed by the shape, size, and color of the RBC's. SO LOW HEMOGLOBIN, LOW HEMATOCRIT, HIGH RETICULOCYTES = ANEMIA

What are the 2 major types of Aplastic Anemia?

1. Congenital (aka present from birth): Chromosomal alterations 2. Acquired: Results from exposure to ionizing radiation, chemical agents, viral and bacterial infections

What are some adverse effects of Iron Supplements?

1. Constipation - patient should increase fluid and fiber intake. 2. Dark green stool - inform patient that this is to be expected. 3. GI Upset - not normally given with food but if this occurs it is OK to give with a small amount of food. 4. Staining of teeth - this occurs with liquid iron - instruct patient to brush teeth after.

4 C's of Addiction:

1. Craving the substance 2. Compulsive use 3. Lack of Control 4. Continued use despite harm

What factors affect obesity?

1. Culture: culture driven diets (ex: americans eat lots of fast foods) 2. Gender: CDC states 35% of all men are obese and 40% of all women. 3. Age: occurs mostly in middle age/elderly age 4. Socioeconomic Status: people who are poor eat processed foods/fast foods because they are cheap.

What are 8 common symptoms of Hypothyroidism?

1. Decreased BMR which causes *weight gain* 2. Decreased GI Motility which causes *constipation* 3. *Decreased heart rate* which causes *decreased cardiac output* 4. *Fatigue* 5. *Impairment of neurologic function* 6. *Abnormalities in lipid metabolism* 7. Feeling full all the time 8. Feeling cold all the time

What are the 3 causes of anemia?

1. Decreased RBC Production 2. Blood loss 3. Increased RBC destruction

Common lab findings that Indicate hypothyroidism:

1. Decreased T3 & T4 levels. 2. Decreased RAIU. 3. Increased TSH levels.

A Smaller than average RBC indicates 3 things:

1. Deficiency in Iron Anemia 2. Microcytic Anemia (RBC is small, often caused by a deficiency in Iron) 3. Hypochromic Anemia (RBC is paler than normal)

A bigger than average RBC indicates:

1. Deficiency in vitamin B12 & folic acid Anemia 2. Macrocytic Anemia (RBCs are large) 3. Megaloblastic Anemia (bone marrow produces unusually large, structurally abnormal, immature red blood cells - they are destroyed quickly as they are too big to fit through the arteries)

Name 3 things that could cause decreased RBC production:

1. Deficient nutrients - lack of iron: iron is needed to make RBC's - lack of cobalamin (vitamin b12) & folic acid: without these, the RBC does not mature correctly. 2. Decreased Erythropoietin - a hormone produced by kidneys that targets bone marrow to produce RBCs - without erythropoietin, bone marrow is not able to produce RBCs. 3. Decreased Iron Availability

What are the 2 disorders associated with ADH?

1. Diabetes Insipidus (DI) 2. Syndrome of Inappropriate ADH (SIADH)

Pain is caused by what 3 things:

1. Disruption of nerve endings 2. Spasms/fatigue 3. Inflammation

1. If upper motor neurons are injured, weakness will occur where? 2. With injured upper motor neurons, what type of muscle tone will we have?

1. Distal to the injury (below) 2. Spastic

Preoperative Considerations for a patient who will have Carpal Tunnel Surgery:

1. Don't have to worry about patient being NPO for this procedure because only a local sedative is used.

What are 5 ways to diagnose PAD/Atherosclerosis?

1. Doppler Ultrasounds - assesses for clots and blood flow. 2. Ankle-Brachial Index - noninvasive way to check for peripheral artery disease (PAD). (ankle systolic BP / the higher of Right or Left brachial systolic BP) 3. Duplex imaging: Checks to see how well blood is flowing back and forth. (See red & blue on a screen) 4. Segmental systolic pressure measurements: used to measure actual limb blood pressures. The purpose of these measurements is to look at arterial occlusion. - Plethysmography: Measures wavelengths of bp's - greater than 30 mm Hg = arterial narrowing 5. Invasive Digital Angiography

What are 4 common side effects among all antihypertensive drugs?

1. Dry mouth 2. Orthostatic hypotension 3. Sexual dysfunction (impotence) 4. Frequent urination

Symptoms of a UTI

1. Dysuria - painful/difficult urination 2. Hematuria 3. Nocturia 4. Urgency/frequency - feeling the need to go all the time 5. "Dribbling" 6. Incontinence 7. Suprapubic or pelvic pain 8. Back pain 9. Dullness on percussion

Postoperative Interventions for Total Hip Arthroplasty (THA):

1. Early ambulation 2. Wound assessments 3. DVT prophylaxis 4. Pain management 5. Cell saver infusion 6. Maintenance of alignment 7. Abductor pillow, raised seats: don't want patient having knee at 90 degrees because they can dislocate the replacement that was just put in. 8. HOB 60 degrees or less - never sit them up 90 degrees because replacement can dislocate 9. Use fractured bed pan. 10. Do not cross legs. 11. Educate on S/S of dislocation: all of a sudden, they will have severe shooting pain - one leg is shorter than the other - they can't walk - leg may be flexed out or flexed in - maybe they heard a popping sound.

Postoperative Interventions for Total Knee Arthroplasty (TKA):

1. Early ambulation 2. Wound assessments 3. DVT prophylaxis 4. Pain management 5. Knee immobilization (sized to patient), Ice & compression (underneath ACE wrap) 6. Weight bearing limitations - do not bear weight on knee. 7. Encourage foot flexion every hour while awake. 8. Assist patient with use of assistive devices.

Signs & Symptoms of Kidney Failure

1. Elevated BUN/creatinine - seen in blood test 2. Retinal hemorrhages/vascular changes 3. Sudden/severe nose bleed 4. Stroke - far into disease 5. Seizure - far into disease 6. Cardiomegaly: Heart is enlarged - from fluid overload 7. Left ventricular hypertrophy: from fluid overload 8. Swollen feet 9. Nocturia 10. Signs and symptoms of kidney failure - Bubbly/foamy urine, proteinuria - JVD from fluid overload, CHF from fluid overload, anemia

What are 3 causes of Parkinsonianism?

1. Encephalitis (brain inflammation) 2. Carbon Monoxide Poisoning 3. Antipsychotic medications (*HALDOL*)

Plasmapharesis is a common treatment used for Guillain-Barré Syndrome - nursing interventions include:

1. Ensure patient has plenty of fluids and is adequately hydrated. 2. Monitor BP because patient can become hypotensive.

What are 2 things that can help improve venous circulation?

1. Exercise 2. Intermittent Compression Therapy (compression stockings)

Nonpharmacologic Nursing Interventions for Rheumatoid Arthritis:

1. Eye drops - for dry eyes 2. Hard candy + good mouth care - for dry mouth 3. Educate patient to alternate rest + activity. 4. Help patient get involved in a therapeutic exercise program - swimming 5. Educate patient to quit smoking 6. Educate patient to wear splints, but only wear them when you need to (not all the time) 7. Hot/cold packs to reduce pain

Glasgow Coma Scale assesses what 3 areas?

1. Eye opening 2. Motor response 3. Verbal response

7 Clinical Manifestations of ALS:

1. Fatigue & Weakness 2. Dysarthria - difficulty speaking 3. Dysphagia 4. Muscle wasting 5. Spastic muscles 6. Eventually flaccid paralysis 7. Cognitive ability - stays intact. *Patient is "Trapped in body" as mind is completely intact even though body is completely paralyzed.*

1. Name 2 Long Acting (Basal) Insulins. 2. What is their onset, peak, & duration. 3. When would we give this insulin? 4. Can it be mixed?

1. Glargine (Lantus, Toujeo), Detemir (Levemir) 2. Onset: 2 hours. Peak: Continuous, no defined peak. Duration: 24 hours. 3. Is given to regulate glucose between meals and overnight - doesn't need to be given with meals - May be given at any time of day but needs to be consistent time to avoid overlapping of dosage 4. Can't be mixed with other insulins.

How to Prevent Back Injuries (3 Ways):

1. Good body mechanics when lifting. 2. Abdominal muscles/core strengthening exercises 3. Stretching

5 Ways to Diagnose Osteoarthritis:

1. Good history + physical. 2. Blood work - look for inflammatory markers (rules out other causes) 3. MRI can show osteophytes + loss of joint space. 4. Arthroscopy (GOLD STANDARD): Microscopic camera goes in and views the joint spaces - not performed commonly when Doctor is sure patient has OA. 5. Synovial Fluid Analysis (to rule out RA): Clear in color with OA.

6 Ways To Diagnose Myasthenia Gravis:

1. Health history + signs and symptoms. 2. "Look at the Ceiling Test" - patient will look up to the ceiling and need to close their eyes soon after because their eyes are so fatigued. 3. Tensilon Test - Edrophonium aka Tensilon is given IV. When patient looks up at the ceiling, they can keep their eyes up without being fatigued. - this test does not last long (only 5 min) and is not a treatment - it is for diagnostic purposes only. 4. Blood Test - will look for Acetylcholine Receptor Antibodies (AChR) - 85% of patients have this. 5. EMG Studies - supports a diagnosis, not an actual diagnostic itself. Measures muscle response or electrical activity in response to a nerve's stimulation of the muscle 6. CT Scan - checks for overgrown Thymus gland

For Autonomic Dysreflexia, we always want to assess for:

1. High Blood Pressure (ex: 220/110) 2. Headache 3. Blurred vision 4. Diaphoresis/Vasodilation (above level of injury) 5. Bradycardia

How is Cushing's Diagnosed?

1. High glucose levels (hyperglycemia) 2. Electrolyte imbalance - sodium high & potassium low. 3. 24-hour urine free cortisol levels will be increased. 4. *Dexamethasone suppression test*: Screening test for Cushings.

1. Name 2 Intermediate Acting (NPH) Insulins. 2. What is their onset, peak, & duration? 3. When would we give this insulin? 4. Can it be mixed? 5. What is the ONLY way to administer this insulin?

1. Humulin-N, Novolin-N. 2. Onset: 2-4 hours. Peak: 6-8 hours. Duration: 12-16 hours. 3. Given after meals. 4. Can be mixed with short acting insulin. 5. SubQ Injection

1. Name 2 Short Acting (also known as "Regular") Insulin 2. What is their onset, peak, & duration? 3. When would we give this insulin? 4. Can it be mixed? 5. How can we administer this insulin?

1. Humulin-R, Novolin-R 2. Onset: 30-60 min. Peak: 2-3 hours. Duration: 4-6 hours. 3. Give 20-30 min before meals. Also used as treatment for DKA. 4. Yes, with a longer acting insulin. 5. ONLY INSULIN THAT CAN BE GIVEN VIA IV! Can also be given subcutaneously.

6 Ways to Prevent UTI's

1. Hygiene 2. Voiding habits: try not to hold urine in for a long time. 3. Fluid intake: The more dehydrated and concentrated the urine is, the more likely you are to getting a UTI. 4. Postcoital prophylaxis: women should void before and after intercourse. 5. Sterile technique for catheterization 6. Avoid UTI irritants (coffee, tea, citrus, colas, and alcohol)

What are three types of patients that should not receive high doses of methylprednisolone?

1. Immunocompromised 2. Diabetics 3. Those with penetrating injuries

Risk Factors for UTI

1. Inability/failure to empty bladder completely* 2. Obstructed urinary flow* 3. Catheterization of urinary tract 4. Inflammation/abrasion of urethral mucosa 5. Diabetes Mellitus* 6. Pregnancy* 7. Neurologic disorders 8. Elderly 9. Postmenopausal women 10. Sexually active women

Common Causes of Iron-Deficiency Anemia:

1. Inadequate dietary intake 2. Malabsorption (due to removal of duodenum) 3. Blood loss 4. Pregnancy (because of the diversion of iron to the fetus for erythropoiesis, blood loss at delivery, and lactation.)

List 5 Complications of Any Joint Replacement:

1. Infection 2. Prosthesis dislocation 3. Neurovascular complications 4. Bleeding/clotting 5. DVT and PE

Risk factors for Carpal Tunnel Syndrome:

1. Jobs that require excessive wrist movement - secretaries who constantly type. 2. People who play the guitar/piano 3. Cashiers

3 Ways to Diagnose Osteoporosis:

1. Lab tests: allows us to check calcium and vitamin D levels. 2. X-Ray: rules in/out fractures/pathological bone changes. 3. *Bone mineral density testing* (#1 way to diagnose)

3 Ways to Diagnose Rheumatoid Arthritis:

1. Labs (ESR & ANA Will be positive) 2. Imaging (x-ray will show bone erosion) 3. Arthrocentesis (Synovial fluid analysis: Synovial fluid will be cloudy & milky present with auto antibodies)

1. Name 3 Rapid Acting Insulins 2. What is their onset, peak, & duration? 3. When would we give this insulin? 4. What is it used in conjunction with? 5. How can we administer this insulin? 6. How soon after injection should the patient eat a meal?

1. Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra) 2. Onset: 15 minutes. Peak: 1 hour. Duration: 3-5 hours 3. Administered for rapid reduction of glucose levels. Can be given at meal time. 4. It is used in conjunction with long acting insulin. 5. Can be given via SUBQ injection or through insulin pump. 6. 5-15 minutes after injection

Postoperative Considerations for a patient who has had Carpal Tunnel Surgery:

1. Make sure splint is in place. 2. Make sure they are medicated for pain. 3. Educate patient on how to use splint and on pain medication. 4. Assist with daily activities and make sure patients will have assistance at home.

What are 4 things we can teach a patient with Addison's Disease?

1. May need to increase doses of cortisol with increased stressors/surgery (Adrenal Glands usually help with fight vs flight response, but in Addison's they aren't working) 2. Should increase sodium in diet. 3. Should always wear a medical alert bracelet. 4. Should carry emergency cortisol pen with them.

Here are some examples of physical activity that can reduce blood pressure. State how often each exercise should be performed. 1. Moderate-intensity aerobic exercise 2. Moderate-vigorous intensity aerobic exercise 3. Muscle strengthening activities 4. Flexibility & balance exercises

1. Moderate-intensity aerobic activity: at least 30 minutes 5 days a week (most days) 2. Moderate to Vigorous-intensity aerobic activity: at least 40 minutes, 3 days a week 3. Muscle-strengthening activities: at least 2 times a week 4. Flexibility & balance exercises: 2 times a week

6 Defining Characteristics of Paget's Disease:

1. Mosaic pattern of bone 2. Bowing of the legs 3. Enlarged skull 4. Thickened long bones 5. Waddling gait 6. Pain and warmth over overgrowth of bones

What are the side effects of Immunosuppressant therapy?

1. Myelosuppression (decrease in bone marrow activity) 2. Aplastic anemia (body can't produce new RBCs) 3. GI and bladder toxicity 4. Teratogenic (causes birth defects)

3 PREOP Nursing Actions for a patient going in for Percutaneous Transluminal Angioplasty:

1. NPO 2. Groin site shave and prep both sides - electric razor isn't used - use tape to remove hair. 3. Intravenous access (IVF)

3 Medications taken for acute gout management:

1. NSAIDS: Indomethacin or Ibuprofen 2. Colchicine (Colcrys) 3. Corticosteroids

Which 2 medications increases the risk of perforation in an inflamed appendix?

1. NSAIDs 2. Laxatives

ADH regulates what 2 things:

1. Osmolality 2. Blood volume

What are the 6 P's of Peripheral Artery Disease:

1. Pain (severe, shooting, stabbing, burning) 2. Pallor (lighter color than the rest of skin in extremity) 3. Pulselessness (no palpable pulses) 4. Poikilothermia (cool temperature on palpation) 5. Paresthesia (numbness, tingling) 6. Paralysis of extremity (immobility - late sign*)

Nursing Interventions for SLE

1. Patient education: alternate rest with activity, wear sunscreen, don't smoke, wear splints when needed. 2. Monitor vital signs, urine output, daily weights. 3. Perform good mouth care.

What should we make sure is done prior to a Digital Angiography?

1. Patient's kidney function (BUN & creatinine) 2. Check for allergies to shellfish and iodine. 3. If patient is on metformin (stop it 48 hours before, with lots of fluids to get it out of system) 4. Check if patient is pregnant 5. Check pulses & mark them with a marker. 6. NPO after midnight day before 7. Signed consent.

How do we clear the bowel before a procedure?

1. Patients should be placed on a clear liquid diet and then NPO - this helps to clear out the bowel. 2. Give laxatives and enemas until bowel movements are clear. - 1-gal polyethylene (GoLYTELY, Colyte): prescription medicine used by adults to clean the colon before a colonoscopy or barium enema X-ray examination - cleans colon by giving patient diarrhea.

How can we manage pain (3 ways)?

1. Physical Therapy 2. Pharmacologic support (muscle relaxants for spasms) 3. Surgical intervention: Nerves are clipped.

What are 2 treatments for Guillain-Barré Syndrome?

1. Plasmapheresis: Whole blood is removed from body. RBC's and WBC's are separated from the plasma and returned to the body without plasma. Body will then begin to reproduce plasma. This treatment must be started early (within 1st week after symptoms begin) to be most effective. 2. High dose immunoglobulin therapy: IV INJECTION OF PROTEINS/IMMUNOGLOBULINS THAT CAUSE IMMUNE SYSTEM TO STOP ATTACKING ITSELF.

1. Identify 3 different types of CORTICOSTEROIDS we could prescribe to patients with IBD. 2. What should we avoid when taking corticosteroids? 3. What do these corticosteroids do for someone with IBD? 4. Is it for long term/short term use? 5. List the side effects.

1. Prednisone (Deltasone): given oral, for outpatient use. Hydrocortisone (Solu-Cortef): given via IV, for hospitalized patients. Budesonide (Entocort/Uceris): oral or rectal enema, given more specifically for distal colon disease. 2. Avoid grapefruit juice - not good to take with a lot of medications because it can counteract the meds. 3. Assist in reduction of inflammation. 4. Short term use only. 5. Side effects: Ulcers in the stomach and duodenum, adrenal suppression, hypokalemia, flu-like symptoms, osteoporosis

2 Classifications of Gout & Their Differences:

1. Primary: Genetic factor is the cause. 2. Secondary: Medications/other disease processes are the cause. *Both are treated the same way.*

What are the 2 types of descending tracts?

1. Pyramidal tract 2. Extrapyramidal tract

Name 2 types of Bone Mineral Density Studies and what area of the body each is performed on:

1. QUS Scan (Quantitative Ultrasound) - usually done on heel bone. 2. DEXA Scan (Dual Energy X-Ray Absorptiometry) - usually done on forearm, hip, or spine.

Renal Calculi Symptoms

1. Renal colic: pain caused by urinary tract stone - Sharp, sudden flank region pain. - Pain may radiate to groin, intestines, and abdominal area. - Patient may have abdominal pain along with diarrhea. - Dysuria: painful urination 2. Hematuria 3. Nausea/vomiting 4. Pallor 5. Cold clammy skin 6. Chills/fever

3 ways to help manage pain for a patient with gout:

1. Rest the joint 2. Give medications 3. Ice joint to decrease inflammation (*NO HEAT*)

What are 5 ways to diagnose Guillain-Barré Syndrome?

1. S&S - Areflexia: Absent reflexes is a key diagnosis 2. Lumbar puncture - assesses CSF for Guillain-Barré Syndrome - *PROTEINS WILL BE FOUND IN THE CSF OF SOMEONE WITH GUILLAIN BARRE SYNDROME!!!* CSF is noramlly clear, not cloudy/sticky. Band-aid goes on after and patient should lie flat for 3-4 hours. 3. EMG: Views muscle activity and tests peripheral nerves. 4. Forced Vital Capacity (FVC): Max amount of air person can force out of the lungs after a deep breath in - used to detect pulmonary problems before respiratory dysfunction progresses. 5. Negative Inspiratory Force (NIF): the greatest force that the chest muscles can exert to take in a breath - used to detect pulmonary problems before respiratory dysfunction progresses. *Changes in FVC & NIF are key to early intervention for neuromuscular respiratory failure*

List 8 problems that can occur from lack of mobility:

1. SKIN INTEGRITY - AT RISK FOR ULCERS 2. THROMBOPHLEBITIS - INCREASED RISK FOR CLOTS 3. Osteoporosis - prevent through weight bearing exercises 4. Muscle atrophy - caused by not using muscles. Do PROM and AROM. 5. Contractures 6. Fatigue 7. Alteration in coordination, gait, posture (mostly for Parkinson's) 8. Pain

What are 5 things that can trigger Raynaud's Phenomenon?

1. Smoking 2. Stress 3. Caffeine 4. Cold medicines containing Pseudoephedrin 5. Beta Blockers

What are 3 ways we can get osteomyelitis?

1. Soft tissue infection - ex: infected venous ulcers 2. Direct bone contamination from bone surgeries, traumatic injury, or open fractures. 3. Hematogenous (blood borne bacteria) spread from other sites of infection (ex: infected tonsils, boils, infected teeth, upper respiratory infections)

1. If lower motor neurons are injured, weakness will occur where? 2. With injured lower motor neurons, what type of muscle tone will we have?

1. Specific to peripheral nerve root 2. Flaccid

6 Treatments for Carpal Tunnel Syndrome BEFORE LAST RESORT OF SURGERY:

1. Splints/wrist support - keeps wrist in alignment to prevent flexion/extension of wrist 2. Ergonomic changes (pad on keyboard for secretaries) 3. NSAIDs - treats inflammation (Pregabalin/Lyrica - treats nerve pain) 4. Cortisone injections - short lived + painful. 5. Yoga 6. Acupuncture If all other treatments fail, then surgery will be done. Surgery is a last resort patients take a long time to heal. Recovery can take weeks to months.

3 Risk factors for developing DVT/Thrombus

1. Stasis of blood - could be caused from standing a lot / surgery 2. Endothelial Injury (aka Injury to blood vessels) - could be caused from smoking / trauma 3. Hypercoagulation

Defining Characteristics of Osteomyelitis

1. Sudden - will show signs of sepsis suddenly (chills, high fever, rapid pulse, and general malaise) 2. Localized pain (pulsating by site of infection) 3. Swelling/redness around infected bone 4. Purulent drainage - white pus 5. Elevated WBC (normal is 5-10) 6. Fatigue

What are the 3 types of Nociceptive pain?

1. Superficial Somatic Pain (skin, mucous membranes) 2. Deep Somatic Pain (bone, blood vessels, muscles, connective tissue) 3. Visceral Pain (pain in body organs - pain may be felt in different areas other than at the actual site of the organ due to scattered nociceptors)

Name 3 types of Central Stimulation:

1. Supraorbital pressure: thumb pressing below eye socket. 2. Trapezius squeeze 3. Sternal rub: knuckle pressing hard into sternum.

A patient has hypothyroidism and is taking Levothyroxine Sodium for treatment. What are 5 things we should teach this patient regarding this medication?

1. Take on empty stomach (take in morning 30-60 min before consuming anything so it mimics the body and because it speeds everything up. It is also absorbed faster on empty stomach!) 2. Check pulse daily (this medication will speed up HR. If tachycardia occurs it indicates you may be taking too much of the medication and may need the dose adjusted) 3. Signs and symptoms of hypo/hyperthyroidism. 4. Patient must take this medication for life. 5. Teach patient to report any chest pain.

If patients with osteoarthritis are feeling pain, what are 2 things they can do?

1. Take tylenol 2. Rest (Alternate rest with activity)

1. What should we take calcium replacement with? 2. What can we do so that side effects aren't as severe? 3. List the side effects of calcium replacement therapy:

1. Take with meals or orange juice 2. Split the dose (600 mg in morning, 600 at night) 3. Side effects: abdominal distension, bloating, renal calculi.

Management for Spastic Bladder

1. Teach patient the "Trigger reflex" - putting patient on a bladder schedule by teaching them to cause the spasm on purpose. Ex: Stroking the inner thigh. 2. Catheterization - to empty out any residual urine that may be left over. Checks for Post Void Residual urine. 3. Medications - augment the bladder training program.

6 More Symptoms of PAD other than the 6 P's:

1. Thin, shiny, scaly, and taut skin 2.Loss of hair on the lower legs 3. Brittle nails 4. Diminished or absent pedal, popliteal, or femoral pulses (work way up while palpating pulses - start at pedal and go up from there) 5. Pallor of foot with leg elevation 6. Rubor (redness) of foot with dependent position

What are the 2 different types of Ischemic strokes?

1. Thrombotic 2. Embolic

What are 2 Joint Replacement Surgeries that can be done to treat Paget's Disease?

1. Total hip arthroplasty (THA) 2. Total knee arthroplasty (TKA)

3 INVASIVE Procedures that treat BPH:

1. Transurethral resection of the prostate (TURP) 2. Transurethral incision of the prostate (TUIP) 3. Prostatectomy

What may be a cause of excess cortisol production in cushings?

1. Tumor on adrenal glands. 2. High doses of external steroids can increase cortisol.

What are the 2 types of Inflammatory Bowel Disease?

1. Ulcerative Colitis 2. Crohn's Disease

What are the 2 most common causes of Hemorrhagic stroke?

1. Uncontrolled high blood pressure 2. Aneurysm (weakening of the arterial wall)

How to Diagnose UTI

1. Urinalysis - look for increased WBC's and bacterial colonies greater than 10^5 2. Urine Culture & Sensitivity - Need "clean catch" urine specimen - Culture determines the infectious agent, aka what is causing the infection. - Sensitivity determines which antibiotic is best to treat this specific infection. 3. STD testing - since STD's like vaginitis and urethritis mimic symptoms of UTI's, we can perform this test to determine if symptoms are actually caused from an STD and not a UTI. Helps to rule out.

List 3 Bladder Problems that may be caused by neurogenic bladder:

1. Urinary Calculi - can be caused by decreased mobility. (Prevention is fluids - want urine acidic - give cranberry juice) 2. Urinary Retention - Biggest issue with urinary retention: Can lead to an infection/UTI. Check PVR & do bladder scans. 3. Autonomic Dysreflexia: associated with spinal cord injury only. Exaggerated response of the sympathetic NS. Typically occurs in T6 or above. The higher the injury, the higher the chance of this happening. This is not as common in lower injuries.

Flaccid Bladder Management

1. Valsalva maneuver 2. Credé: patient makes a fist and then massages bladder with fist. 3. Catheterization - to empty out any residual urine that may be left over. Checks for Post Void Residual. 4. Medications

Best 3 tests used to diagnose Pulmonary Embolism:

1. Venous duplex/ultrasound 2. Spiral CT/VQ Scan 3. Pulmonary angiography - very invasive procedure but most accurate - not commonly performed due to invasive nature.

3 main fractures caused by Osteoporosis:

1. Vertebral/compression fractures. 2. Wrist fracture from trying to break fall with wrist 3. Hip fracture from falling.

List 5 lifestyle modifications one can make to reduce blood pressure:

1. Weight loss (22lbs = systolic lowered by 5-20 mm Hg) *through diet & exercise* 2. Diet - calorie restriction & DASH diet. 3. Physical Activity 4. Avoid tobacco products/quit smoking 5. Manage psychosocial risk factors (stress)

Symptoms of Acute Pyelonephritis

1. painful urination (dysuria) 2. urinary frequency 3. fever, chills 4. elevated WBCs 5. lower back pain, flank pain, 6. nausea, vomiting 7. headache 8. malaise

Process of going under general anesthesia:

1. ringing in ears 2. pupil dilation 3. unconsciousness 4. shallow respirations

Name 2 examples of AMINOSALICYLATES What is their function? What is their side effects?

1. sulfasalazine (Azulfidine) 2. mesalamine (Asacol, Pentasa) - *SULFA FREE* Function: *Treats Ulcerative Colitis* - Decreases mild to moderate inflammation. Maintains remission and suppresses the immune system response. Side Effects: S

Normal range of specific gravity:

1.010-1.025

Normal Specific Gravity of Urine

1.010-1.030

Specific Gravity of urine normal range?

1.015 to 1.025 (powerpoint) 1.003 to 1.035 (book table 40-4)

Give the normal level for: *Magnesium*

1.3-2.3 mEq/L

Height Loss with Osteoporosis:

1/3 of height lost every decade after 50 with osteoporosis.

What % of Type 1 Diabetes is genetic?

10% (not commonly genetic but there is still a slight chance)

If nothing else is available, Parenteral Nutrition should be replaced with:

10% Dextrose & H2O via IV

What is the recommended weight loss for someone who is obese?

10% of their initial body weight

Normal range for BUN:

10-20

Give the normal level for: *BUN*

10-20 mg/dL

How much residual urine should be present in the bladder before we straight catheterize the patient?

100 mL

Give the normal level for: *Platelets*

100,000-400,000 /mm³

Pre-diabetic fasting blood glucose:

100-125 mg/dL

How many mg of calcium should adults (age 19-50) receive a day?

1000 mg/day

Normal Hemoglobin for Females

12-16

Give the normal level for: *HGB*

12-18 g/dL

Do not administer opioids if respirations are less than

12/min

Prehypertension

120-139/80-89

How many mg of calcium should those over age 51 receive a day?

1200 mg/day

Diagnostic Testing For Diabetes Fasting (8 hours) Blood Glucose equal to or greater than:

126 mg/dL

How many mg of calcium should those in puberty (age 9-19) receive a day?

1300 mg/day

Give the normal level for: *Sodium*

135-145 mEq/L

Normal Hemoglobin for Males

14-18

Hypertension STAGE 1

140-159/90-99

Goal blood pressure for diabetics:

140/80 mm Hg

Gastric Ulcers account for (?%) of Peptic Ulcer Disease cases.

15%

Ice should only be applied for:

15-20 min

For postop care of a patient who received a Transsphenoidal Hypophysectomy, we want to elevate the head of the bed to (? degrees) because:

15-30 degrees to prevent headaches caused from CSF leaks.

To avoid the possibility of long term complications, a diabetic should properly manage their insulin. They should try to keep their blood sugar consistently below:

150 mg/dL

Normal Inspiratory Expiratory Ratio:

1:2 - meaning that expiration takes twice as long as inspiration

What are 2 Interventions for Autonomic Dysreflexia?

1st: HOB up as high as possible - this will decrease the BP - High BP causes concern for stroke & heart attack. 2nd: Remove stimulus - might need to unkink foley catheter, straight catheterize patient to empty bladder, check bowel, turn & position patient.

For the Glasgow Coma Scale, what is the sequence of stimulation?

1st: voice 2nd: shout 3rd: shake 4th: pain

Coronary Artery Perfusion Tests - Name 2 examples, what to do before the procedure, what to do after the procedure, what are some side effects of the procedure.

2 Examples: SPECT, PET (PET picks up increased glucose metabolism which indicates decreased blood flow - if patient is diabetic, we want to make sure that persons BG levels are within normal range before having this test.) Radioactive isotopes are injected into veins. What to do before: Patient should be NPO after midnight the night before. Ask about allergies. What to do after: Patient should increase fluid intake after test because urine will be radioactive for 24 hours post testing. We want to expel all radiation. Side effects: Allergic reaction, arrhythmias, flushing sensation, chest pain, MI

Percocet is (#?) drugs. List what they are.

2 drugs - 5 mg oxycodone (opioid) 325 mg acetaminophen

How long does someone with ALS typically live after diagnosis?

2-7 Years

After a TUNA & TUMT, a foley catheter will be in place for how long?

2-7 days

The therapeutic range of INR for those on Coumadin:

2.0-3.0

Diagnostic Testing For Diabetes Random (blood sugar taken at any time) Blood Glucose equal to or greater than (?) on more than one occasion.

200 mg/dL

What is the normal range of HCO3?

22-26 (below 22 is acidic, above 26 is basic)

How is Pheochromocytoma diagnosed?

24-Hour Urinary Catecholamines and Metanephrines Test - this is the most reliable way to diagnose - measures catecholamine metabolites and catecholamines - Catecholamines will be high in those with Pheochromocytoma. VMA (vanillylmandelic acid) 24 hr urine MRI - allows us to view tumors

Patients with osteoporosis are asymptomatic - it is often undetected on x-rays until there is a (?%) change in bone already.

25-40%

A diabetic should avoid exercise if BG levels are greater than (? mg/dL)

250 mg/dL

Osmolality of an Isotonic Solution?

280-300 mOsm/L

What's the normal serum Osmolality?

280-300 mOsm/L

If the 1st line of treatment for H. Pylori doesn't work, what do we do next?

2nd line of treatment which is - Metronidazole or Tetracycline + a peptobismol and PPI.

What are the 3 MAIN indicators of Diabetes?

3 P's: Polydipsia: Increased thirst Polyuria: Increased urination Polyphagia: Increased hunger

Surgical Techniques: Laparoscopic Surgery

3 Puncture wounds - abdomen is filled with CO2. Gas pain afterwards is usually an issue.

How many sublingual nitroglycerin tablets should a person take before calling 911?

3 doses 5 minutes apart - if after 15 minutes the pain has not subsided, 911 should be called as rapid intervention is required.

How soon after treatment of Chlamydia/Gonorrhea should a female be retested for the infection?

3 months after treatment

What % of patients with UC will develop colon cancer?

3%

A patient with a UTI will receive what cycle of antibiotics?

3-4 day cycle OR 7-10 day cycle - depending on severity.

What are some fast acting carbohydrates we can give to a conscious patient experiencing hypoglycemia?

3-4 glucose tablets 4-6 oz fruit juice/regular soda 6-10 hard candies 2-3 tsp sugar

How much sodium should someone with renal calculi consume per day?

3-4 grams/day

Give the normal level for: *Phosphorus*

3-4.5 mg/dL

Normal Albumin Levels?

3.5-5 g/dL

Give the normal level for: *Potassium*

3.8-5 mEq/L

1 unit of insulin lowers blood sugar levels (how much?)

30 to 100 mg

What is the BMI for CLASS 1 OBESITY:

30 to 35

The posterior portion of the pituitary gland makes up (?%) of the entire pituitary gland.

30%

Waist circumference women:

35 inches or less

What is the BMI for CLASS 2 OBESITY:

35 to 40

What is the normal range of CO2?

35-45 (below 35 is basic, above 45 is acidic)

On a scale from 1-10, what is moderate pain?

4-6

Normal prostate specific antigen:

4. More than 4: patient is fine Less than 4: patient has issues

Normal pH of Urine?

4.5-8.0

Waist circumference Men:

40 inches or less

Give the normal level for: *HCT*

40%-50%

Initial symptoms of HIV:

40-70% of patients enter the acute stage develop flu-like or mononucleosis-like symptoms, fever, headache, sore throat, erythematous rash (looks like sunburn), diarrhea, and generalized lymphadenopathy (severely swollen glands)

Maximum mg of tylenol to administer in 1 day:

4000 mg

After PPD is administered, how long after should the skin be checked?

48-72 hours later

In someone with Anemia, their RBC count will be less than:

5 million

Of all Diabetes cases, Type 1 diabetes is what % of them?

5%

Only (?%-?%) of ingested Iron is absorbed.

5%-10%

Give the normal level for: *WBCs*

5,000 - 10,000 cells/mm³

Normal Amount of RBCs In Blood

5-10 million

A weight loss of 22 lbs (10 kg) may decrease systolic BP by:

5-20 mm Hg

fin*asteride* (Proscar), dut*asteride* (Avodart)

5-alpha reductase inhibitors TREATS BPH by reducing the size of the prostate gland by interfering with the conversion of testosterone to dihyroxytestosterone (DHT - stimulates growth of prostate) SE's: decreased libido, decreased volume of ejaculation, and erectile dysfunction Takes 3-6 months to be effective

Parkinson's typically occurs after what age?

50

Histamine Receptor (H2R) Blockers promote esophageal healing in (?%) of patients.

50%

(?-? mL) of blood loss from the upper GI tract is required for stools to appear black (melena; the black color is from the iron in the RBCs)

50-75 mL

Normal range for WBCs:

5000-10000/mm3

Diastolic BP rises until approximately age (?) and then declines.

55

Normal pH of urine:

6.5-7.5

What is the level of Uric Acid in the blood that indicates a positive result for Gout?

6.8 or more

On a scale from 1-10, what is severe pain?

7 or greater

Normal pH of blood?

7.35-7.45

What is the normal range of pH?

7.35-7.45 (below 7.35 is acidic, above 7.45 is basic)

THE PERFECT NORMAL LEVEL OF pH IS:

7.40

FEV1/FVC ratio less than (?%) indicates obstructive lung disease.

70%

The anterior portion of the pituitary gland makes up (?%) of the entire pituitary gland.

70%

What is the preprandial (fasting/before eating) glucose level for a diabetic?

70-130 mg/dL

Give the normal level for: *Calcium*

8.5-10.5 mg/dL

Biliopancreatic diversion with duodenal switch

80 percent of the stomach is removed, leaving a smaller tube-shaped stomach, similar to a banana. However, the valve that releases food to the small intestine (the pyloric valve) remains, along with a limited portion of the small intestine that normally connects to the stomach (duodenum). The second step bypasses the majority of the intestine by connecting the end portion of the intestine to the duodenum near the stomach. A BPD/DS both limits how much you can eat and reduces the absorption of nutrients, including proteins and fats.

Duodenal Ulcers account for (?%) of Peptic Ulcer Disease cases.

80%

Spirometry less than (?%) indicates chronic obstructive diseases.

80%

What is the normal range of PaO2 (arterial oxygen)?

80-100 mm Hg

Normal fasting glucose for a non diabetic:

80-90 mg/dL

Proton Pump Inhibitors promote esophageal healing in (?%) of patients.

80-90%

Goal is to maintain SpO2 above (?%) in patients with chronic respiratory conditions.

90%

We want to maintain O2Sat of (?%) or above for this with COPD.

90%

What % of Type 2 diabetes is genetic?

90% (much more genetic than Type 1)

We want to maintain O2Sat of (?%) or above for those with asthma.

93%

What is the normal value for SaO2 (pulse ox)?

94% or greater

Of all Diabetes cases, Type 2 diabetes is what % of them?

95%

Give the normal level for: *Chloride*

95-105 mEq/L

Although we can administer tPA up to 4.5 hours after the onset of symptoms, what is our GOAL time to administer it?

< 60 minutes after symptoms start.

LDLs should be:

<100

According to the joint commission, what is normal BP?

<120/<80

Triglycerides should be:

<150

Total cholesterol should be:

<200

Hypertension STAGE 2

>160/>100

HDLs should be:

>60

What causes Pheochromocytoma?

A Tumor on the adrenal medulla - not common - usually benign (90% benign, 10% malignant)

Define Pyelonephritis

A bacterial infection of the renal pelvis, tubules, and interstitial tissue of one or both kidneys.

Uric acid levels screen for:

A baseline of normal uric acid levels because these levels usually increase with diuretic therapy.

State the rationale for first giving a bolus dose of heparin and then giving a continuous drip?

A bolus dose is administered first to get the patient to the therapeutic range of the medication. A continuous drip is then given to maintain this therapeutic range.

Define Hemorrhagic Stroke

A breakage or "blowout" of a cerebral artery due to extreme high blood pressure or an aneurysm (weakening of the arterial wall). These strokes commonly affect younger people.

Critical Limb Ischemia

A chronic condition characterized by ischemic rest pain, arterial leg ulcers, and/or gangrene of the leg caused by advanced peripheral arterial disease.

Define Systemic Lupus Erythematosus (SLE)

A chronic, progressive, inflammatory auto-immune disease that occurs due to anti-DNA antibodies that attack the body's blood vessels, lymph nodes, & GI tract. The blood vessels become inflamed and necrotic. It is very difficult to diagnose.

Define Emphysema and state the most common symptom of it.

A condition in which the air sacs of the lungs (Alveoli) are damaged and enlarged, causing breathlessness. Most common symptom: dyspnea

Pseudoaddiction

A condition resembling drug addiction (it is not) but caused by under prescription of drugs to treat pain in the patient, causing them to seek more. Behaviors resolve when pain is effectively treated which is how it can be distinguished from true addiction.

Toxic Megacolon

A deadly complication of ulcerative colitis - its when food becomes trapped in part of the intestines, causing a hard mass in the colon. It becomes infected and may cause the bowel to perforate. *DEADLY*.

Kwashiorkor

A disease of chronic malnutrition during childhood that develops in children whose diets are deficient of protein; occurs in children between 6 months and 3 years of age; Subcutaneous fat is preserved; Oedema present; enlarged fatty liver; ribs are not prominent; lethargic; muscle wasting mild or absent; poor appetite; person suffering needs adequate amounts of protein.

Define Graves Disease

A form of hyperthyroidism and also an autoimmune malfunction - a malfunction in the body's immune system releases abnormal antibodies that mimics or binds to TSH, causing an overproduction of T3 and T4

Stress-related mucosal disease (SRMD)

A form of peptic ulcer disease that often occurs in ICU patients that are stressed from trauma or burns; 74-100% of critically ill patients gets SRMD. Untreated will lead to gastric ischemia or death of gastric area.

Zollinger Ellison Syndrome (ZES)

A genetic form of peptic ulcer disease - people are born with gastrinomas and duodenal ulcers from hypersecretion of hydrochloric acid. 1/3 of these gastrinomas are malignant - patient runs risk of getting cancer - Resistant to standard treatment for H. Pylori.

Define intermittent claudication

A hallmark symptom of PAD in lower extremities. Cramping/Ischemic muscle pain that is caused by a constant level of exercise due to lactic acid build up. Resolves within 10 minutes or less with rest as lactic acid dissolves. There is an increased demand for oxygen but a decreased supply.

Fecalith

A hard, impacted mass of feces in the colon

Malignant Hyperthermia

A hereditary condition of uncontrolled heat production that occurs when susceptible people receive certain anesthetic drugs. Signs: - tachycardia (earliest sign) - tachypnea - hypercarbia/hypoxemia (retain CO2, oxygen levels go down) - Muscle rigidity - Ventricular dysrhythmias - extreme hyperthermia (increase in temp) and it is a late sign; temps can go as high as 107 to 109 degrees and can be life threatening.

Gastric Band

A laparoscopic adjustable gastric band, commonly referred to as a lap band, is an inflatable silicone device surgically implanted around the top portion of the stomach to help a person lose weight.

If someone is physically incapable of performing the physical activity needed for the stress test, what are they given instead?

A med (adenosin) that causes the heart to work harder & pump faster like during exercise. Inform patient they may feel nauseous, flushed, diaphoretic.

Autonomic Dysreflexia Patho

A medical emergency that occurs in people with spinal cord injuries above the level of T6. Caused by an irritating stimulus below the level of injury (for example, a full bladder) → massive sympathetic response is triggered → which causes widespread vasoconstriction BELOW level of injury and vasodilation ABOVE the level of the injury → which leads to hypertension → baroreceptors in blood vessels detect hypertensive crisis and send signals to the brain to vasodilate → this leads to vasodilation above the injury, but descending inhibitory signals are blocked by the spinal cord injury so area below injury remains vasoconstricted.

How do we treat Hypothyroidism?

A medication known as Levothyroxine sodium (Brand name: Synthroid)

Embolus

A moving blood clot that travels through the blood stream.

Define Polycythemia Vera

A neoplastic disease arising from a chromosomal mutation - Increased number of erythrocytes, granulocytes (WBC's), and platelets due to uncontrolled production by the bone marrow. The blood thickens and the blood volume increases.

Roflumilast (Daliresp)

A newer medication - phosphodiesterase 4 (PDE4) inhibitor - phosphodiesterase 4 (PDE4) inhibitor - indicated for maintenance treatment of severe COPD - suppresses the inflammatory response - directly inhibits mucus production - one tablet daily.

Guillain-Barré Syndrome

A paralysis affecting the myelinated neurons of the PNS - affects motor neurons more than sensory neurons - thought to be a cell mediated immunologic reaction - exact cause is unknown.

Define Hypertension

A persistent systolic BP (SBP) ≥140 mm Hg, diastolic BP (DBP) ≥90 mm Hg, or current use of antihypertensive drug.

Positive Tensilon Test

A person tests positive for Myasthenia Gravis when their muscles get stronger after being injected with Tensilon.

Nondippers

A person who's BP level remains constant even during sleep when BP is supposed to drop by 10%. Patients with HTN often do not show this normal nocturnal dip.

Define MERCI - Mechanical embolus removal in cerebral ischemia

A procedure usually performed on patients who are not a candidate for tPA - a long thin wire is threaded through a catheter into the femoral artery and up into the carotid artery. The clot is then pulled out.

How do we treat obesity?

A program of lifestyle modification, composed of diet, exercise, and behavioral changes

Dilutional Hyponatremia

A serum sodium that is low not because of an absolute lack of sodium but because of excess amounts of water in the body. This commonly occurs in SIADH, a disorder involving over production of ADH (anti-diuretic hormone).

Define Thyroid Storm + List the symptoms of a Thyroid Storm

A severe life threatening exacerbation of hyperthyroidism/graves disease. Common symptoms that the patient should be monitored for are *fever, tachycardia, HTN, chest pain.*

What are some side effects of Radioactive Iodine Therapy?

A side effect of this therapy is shrinking of the thyroid so much that the patient then develops HYPOthyroidism. However, hypothyroidism is "easier" to treat.

Secondary Progressive MS

A stage of MS which comes after relapsing remitting MS for many people. With this type of MS your disability gets steadily worse. You're no longer likely to have relapses.

Metabolic Syndrome

A syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL (good cholesterol) levels, and high fasting levels of blood sugar) that are linked to increased risk of cardiovascular disease and Type 2 diabetes.

Hepatitis

A systemic, viral infection involving necrosis and inflammation of liver cells - This virus attacks liver cells and can result in either acute or chronic liver dysfunction and disease

Hemoglobin A1C test

A test that measures the average blood glucose over 2 to 3 months

People with Parkinson's disease have problems with which tract of the spinal cord?

A type of descending tract known as the *EXTRAPYRAMIDAL TRACT.*

Define Embolic Stroke - what is it caused by? what is the onset? it occurs without prior history of? who is mainly affected?

A type of ischemic stroke that: - is caused by a clot, usually from the heart (people with Afib are at high risk) - has a sudden onset - occurs without prior history of TIA's - commonly occurs among older people

Define Thrombotic stroke - what is it caused by? where does this stroke commonly occur? what is the onset? who is mainly affected?

A type of ischemic stroke that: - is commonly caused by atherosclerosis - commonly occurs in the carotid arteries - does not develop abruptly, it develops gradually over time. - mainly affects older people as older people have more plaque build up within the arteries. - occurs in people with a history of TIA's (warning strokes)

Marasmus

A wasting away of body tissues in the infant's first year, caused by severe protein-calorie deficiency; subcutaneous fat is not preserved; Oedema is absent; No fatty liver; Ribs become very prominent; Alert and irritable; severe muscle wasting; voracious feeder; person suffering from Marasmus needs adequate amount of protein, fats, and carbohydrates.

What is the equation used to figure out Ankle Brachial Index (ABI)?

ABI = ankle systolic BP / the higher of Right or Left brachial systolic BP

List the RISK FACTORS for Osteoporosis

ACCESS - Alcohol use Corticosteroid use Calcium Low Estrogen Low Smoking Sedentary Life Style Other Risk Factors: Genetics Age Caucasian/Asian Females Those with small statures - 125 lbs or less. High caffeine intake 2 or more alcoholic beverages a night High doses of corticosteroids High doses of antiseizure medications High levels of Heparin High levels of thyroid hormone Anorexia Malabsorption Issues Chemotherapy

If we have a *decreased osmolality* (very little substance with lots of fluid) and an *increased blood volume*, what will ADH do?

ADH will be inhibited because we want to get rid of the excess fluid within the body.

If someone is experiencing dehydration, what will ADH do?

ADH will be released because we want to hold on to the little amount of fluid we have left.

If we have an *increased osmolality* (presence of a lot of substance and less fluid) and a *decreased blood volume* (due to highly concentrated blood), what will ADH do?

ADH will be released because we want to retain the little amount of fluid that is available.

Blood test useful in diagnosing SLE:

ANA

List the lab results if a patient is positive for SLE: ANA CRP Anti-dsDNA Anti-Sm ESR C3, C4

ANA - elevated - *If this is Elevated, doctors will look further for SLE and may order Anti-dsDNA test. If not elevated, no further testing will be done.* CRP - elevated Anti-dsDNA - elevated Anti-Sm - elevated ESR - elevated C3, C4 - decreased

What type of dressing would we apply over a skin graft site?

gel based dressing or vaseline gauze

When diagnosing respiratory disorders, AAT looks for:

genetic issues with COPD

Foods containing vitamin A:

green leafy vegetables

Define Pannus:

highly vascular granular tissue that forms within a joint causing patient to lose total motion - commonly seen in Rheumatoid Arthritis

Type 2 diabetics are more prone to: (hypo/hyperglycemia?)

hyperglycemia

Frontal lobe is responsible for:

impulsive behavior, judgement, personality, abstract thoughts, primary & voluntary motor skills, and speech production (broca's area)

Akinesia

inability to initiate movement

BPH can cause:

incomplete bladder emptying/urinary retention

Although the cause of primary hypertension is unknown, there are many risk factors that play a role. What are these risk factors?

increased SNS activity overproduction of sodium-retaining hormones and vasoconstricting substances increased sodium intake greater than ideal body weight diabetes mellitus tobacco use excessive alcohol consumption

Superficial Thrombophlebitis

inflammation of a vein near the surface due to the presence of a blood clot - can occur due to IV therapy - palpable, firm, subcutaneous cordlike vein.

Appendicitis

inflammation of the appendix

Cystitis

inflammation of the bladder

Define Gastritis:

inflammation of the lining of the stomach

Peritonitis

inflammation of the peritoneal cavity; may be caused by chemical irritation or bacterial invasion

Osteomalacia is caused by:

insufficient amount of vitamin D and calcium

What lab value is assessed for patients on Heparin?

aPTT (normal range is 25-35 seconds)

Ankylosis

abnormal stiffening and immobility of a joint due to fusion of the bones

The serum lipid profile screens for:

additional risk factors that lead to atherosclerosis and CVD.

ACTH affects the:

adrenal glands

ACTH

adrenocorticotropic hormone

Thyroiditis: Hashimoto's

an autoimmune disorder that can cause hypothyroidism/underactive thyroid. (The immune system mistakenly attacks the thyroid gland.)

Define Creatinine Kinase (CK)

an enzyme released into the blood when there is injury to 3 specific tissues - *brain, heart, and skeletal tissue*.

Herpes Simplex Virus (HSV)

an infection that manifests with painful, watery blisters on the skin and mucous membranes

Define Hyperthyroidism

an overactive thyroid gland

What does a PaO2 of 20 mm Hg indicate?

anoxic brain injury probable *Anoxic brain Injury occurs when there is lack of oxygen to the brain*

Ondansetron (Zofran)

anti-nausea medication initially used to help prevent nausea during chemotherapy

Metoclopramide (Reglan)

anti-nausea medication that increases peristalsis in the intestines.

How long does it take for someone with Guillain Barre Syndrome to recover?

anywhere from 4-6 months to 2 years

Main cause of CAD:

atherosclerosis

What is an antispasmodic usually given to patients with MS?

baclofen (Lioresal)

Name the side effects of Biologics (Tumor Necrosis Factor (TNF) Blocking Agents)

bacterial sepsis, invasive fungal infections and TB

Roux-en-Y gastric bypass

bariatric surgery that involves stapling the stomach to decrease its size and then shortening the jejunum and connecting it to the small stomach pouch, causing the base of the duodenum leading from the nonfunctioning portion of the stomach to form a Y configuration, which decreases the pathway of food through the intestine, thus reducing absorption of calories and fats

Roux-en-Y gastric bypass (RGB)

bariatric surgery that involves stapling the stomach to decrease its size and then shortening the jejunum and connecting it to the small stomach pouch, causing the base of the duodenum leading from the nonfunctioning portion of the stomach to form a Y configuration, which decreases the pathway of food through the intestine, thus reducing absorption of calories and fats

What Aldrete score does the patient need to have in order to be transferred out of the PACU?

between 8 and 10

Examples of Non Opioids are:

ASA, Tylenol, NSAIDs

The best site to inject insulin:

Abdomen

Surgical Techniques: Natural Orifice Surgery

Abdominal surgery where the entrance wound is through either the stomach or through the vagina. (endoscopy)

Decerebrate Posturing

Abnormal extension of the extremities - hands and feet extend outward and away from the body - this indicates that there is little to no brain function left - only brain stem may be functioning at this point.

Decorticate Posturing

Abnormal flexion or "curling inward" of the extremities - this indicates that there is little to no brain function left and that the upper mid brain is damaged.

Where does an amputation occur?

Above the area where the damage is

In Autonomic Dysreflexia, vasodilation occurs:

Above the level of the injury.

In pneumothorax, auscultating breath sounds will reveal:

Absent/diminished breath sounds on the affected side.

Nitrates - oral, transdermal, sublingual

Action: venous and arterial dilation, increased oxygen supply. Relieves symptoms of angina Side effects: headache, dizziness, syncope, hypotension, flushing, palpitations Nursing Interventions: Assessment of blood pressure before administering (monitor for Orthostatic hypotension), assess for relief of symptoms, wear gloves when preparing and administering patch, give acetaminophen or aspirin to decrease headache. Tell patient to notify HCP if: - dry mouth - blurred vision occurs

Upper UTI's can be:

Acute or chronic

What can we give via IV for severe Herpes Zoster?

Acyclovir

What "Biologic" Medication is used for both Crohn's & UC?

Adalimumab (Humira)

Hyperpigmentation occurs in:

Addison's Disease.

Patients requiring oxygen therapy need to be taught the importance of:

Adhering to the oxygen prescription - patients often think they can tell when they need oxygen based off of their symptoms which is unreliable in detecting the need for supplemental O2.

What is the target population to educate on Chlamydia/Gonorrhea?

Adolescent/Young adult

What are the risk factors for Diverticular Disease?

Advancing age (more common over age 40) Smoking Low-fiber diet Sedentary lifestyle Constipation* Most common Obesity Previous diverticula

BPH Risk Factors:

African-American - get bph at a younger age than most - around age 40 Current/former smokers Heavy alcohol consumption HTN CAD diabetes

What should we do within the 1st hour for a suspected stroke victim?

After immediate recognition of stroke symptoms, call EMS. Upon arrival at hospital, CT scan should be done within 25-45 minutes. If CT scan comes back negative for hemorrhagic stroke, our goal is the administer tPA within 60 minutes. If patient is not a candidate for tPA, he/she can get a thromboectomy (MERCI) which can be done up to 24 hours after stroke symptoms appear.

Glucagon & Insulin Explained

After you eat, there is a spike in glucagon (glucose) created by the liver. Glucose rushes into the blood, triggering insulin to kick in to lower the blood sugar.

Non modifiable risk factors of CAD

Age - (contractibility lessens, muscle atrophy aka heart) Sex - (Females lose estrogen as they age and they are more at risk after menopause then men. Men are high risk before age 55. Females have smaller arteries than men which also makes it easier for them to be occluded) Heredity - close relative has CAD or high cholesterol levels. Race - African American females are very susceptible. Disparity - socioeconomic status

Non-controllable risk factors for CVA:

Age > 55 - each decade over 55 doubles our risk. Male - higher risk than female. More stroke survivors are females. Family History African-American & hispanics are higher risk

What age is SLE commonly diagnosed? What gender is SLE more likely to occur? What race is SLE more likely to occur? What are some causes of SLE?

Age: 15-40 Gender: Women Race: Black/Hispanic Causes: Medications, pregnancy (exacerbation factor), UV exposure

Systolic BP increases with:

Aging

What are some non-pharmalogical ways we can manage COPD?

Airway clearance (pursed lip breathing, huff cough), pulmonary rehabilitation, nutritional therapy, physical therapy, psychosocial support

4 Medications for long term gout management:

Allopurinol (Zyloprim) (XOI) Febuxostat (Uloric) (XOI) Probenecid (Benemid) (Uricosuric agent) Colbenemid (Probenecid + Colchicine)

Duplex Imaging

Allows the doctor to view blood flow through arteries/veins. (Blue & red is seen on screen)

Glucagon, a hormone that raises blood sugar levels, is produced by:

Alpha cells in the islets of langerhans within the pancreas

doxaz*osin* (Cardura), teraz*osin*, tamsul*osin* (Flomax)

Alpha-adrenergic Receptor Blockers Promotes smooth muscle relaxation of the bladder and prostate (also used to treat HTN). Offers relief of BPH symptoms, but does not treat hyperplasia. SE: orthostatic hypotension, dizziness, retrograde ejaculation, and nasal congestion Takes 2-3 weeks to see an improvement.

Define Dumping Syndrome & SYMPTOMS

Also called rapid gastric emptying, occurs when food (especially sugar), moves too fast from the stomach to the small intestines. Gastric surgery is the main cause. Usually occurs 15-30 min after eating. Symptoms: nausea, vomiting, abdominal cramping, pain, diarrhea, bloating, dizziness/light headed, flushing (red face), sweating, increased heart rate, the need to lay down after a meal.

Dead Space Ventilation

Also known as *reduced perfusion* to a lung unit, occurs when *alveoli do not have adequate blood supply* for gas exchange to occur, such as with pulmonary emboli (PE) and pulmonary infarction.

Symptoms of UTI IN THE ELDERLY

Altered Mental State, lethargy, loss of appetite

s/s of sepsis:

Altered mental status, high fever, tachycardic, low bp/high bp, diabetics will have out of control sugars.

What do Methylxanthines do? Long term/short term use? What is an example? What can it cause?

Alternative therapy for mild persistent asthma and COPD; treatment for long term problems or disorders; not for treatment of acute exacerabations Example: Theophylline (Uniphyl, Theodur) Can cause Toxic affects (monitor serum levels), and can cause CV problems.

List the side effects for antacids with Aluminum - Magnesium -

Aluminum - causes constipation Magnesium - causes diarrhea

85% of patients with Guillain-Barré Syndrome will be able to (?) after 6 months. 22% of patients with Guillain-Barré Syndrome will have type of (?) due to permanent damage of nerves. 3-6% of patients with Guillain-Barré Syndrome will (?) - however, this is not common.

Ambulate Permanent disability Relapse

If we want someone on TPN to get proteins, we would administer:

Amino Acids

What are 3 drugs that have vasoconstrictive effects and should be avoided to prevent Raynaud's?

Amphetamines, Cocaine, Pseudoephedrine

Define Heparin Induced Thrombocytopenia

An Immune reaction to heparin - Platelets become dysfunctional, stick together, and form "white clots" that can cause thrombosis - low platelet count - usually occurs 6-14 days after the start of heparin.

Define Anti-Thyroid drugs and list 2 examples and their side effects.

An anti-thyroid drug is prescribed to treat Graves disease. It works by bringing the thyroid gland back down to a normal size, which usually takes about 4-8 weeks. Medications: 1. propylthiouracil (PTU) 2. methimazole (Tapazole) Side effects: Agranulocytosis aka decreased granulocytes/lowered WBC count. This makes you more susceptible to infections.

Anthropometric Assessment

An assessment of the body that measures size, shape, and the composition of what is underneath your skin.

It is believed that Type 1 Diabetes is:

An autoimmune response to a virus that triggers an enzyme to destroy beta cells inside the pancreas, causing no insulin to be secreted.

A nurse caring for a patient with Paget's disease is analyzing the patient's laboratory values. What values are most often seen in a patient with Paget's disease?

An elevated serum alkaline phosphatase level and a normal serum calcium level

Define Peptic Ulcer Disease

An erosion of the mucosal wall of the stomach, pylorus, & duodenum - Characterized by Blood vessel destruction, bleeding, and ulcerations

Define Myxedema Coma & list symptoms.

An extreme and severe exacerbation of hypothyroidism. Symptoms include: - Significant drop in core body temp (94/95 degrees) - Hypoxemia (low o2) & hypercapnia (increased co2) which can lead to respiratory failure. - Hypoglycemia: due to sluggish liver - Hypotension *30-60% mortality rate - treatment needed or patient can die*

Removal of the Thymus gland for treatment of Myasthenia Gravis can lead to:

An increased risk for infection.

Transurethral incision of the prostate (TUIP)

An instrument is passed through the urethra. Incisions are made in the prostate and prostate capsule to reduce the prostate's pressure on the urethra and to reduce urethral constriction

Insulin lipohypertrophy

An insulin complication where fibrous fatty masses form at the injection site due to not rotating injection sites.

On an EKG, ST depression indicates:

Angina

Define Myoglobin

Another blood protein that is responsible for transporting oxygen.

What do Anti-IgE medications do? How are they given and how often? What is the downside to IgE medications? Long term/short term use?

Anti-IgE is a form of treatment for allergic conditions that treats moderate to severe persistent allergic asthma and chronic idiopathic urticaria (hives with an unknown cause). Given via SubQ injection every 2-4 weeks. The downside is there is a risk for anaphylaxis and they are expensive. Long term use.

ASA (aspirin)

Anti-inflammatory effect; can cause bleeding (affects platelets); great for arthritis

What is the function of Aspirin?

Anti-platelet agent that decreases the risk of MI, stroke, and death due to its blood thinning properties.

What is the function of Clopidogrel (Plavix)? What can't be taken with Clopidogrel & why?

Anti-platelet that prevents cardiovascular ischemic events in patients with PAD, but does not treat Intermittent claudication. Keeps blood thin. Cannot take Plavix with *Omeprazole* because Omeprazole cuts potency of Plavix in half.

What are some things we can educate our patient about in regards to Osteomyelitis?

Antibiotic therapy & pain management - Educate patient that they will have to go home on antibiotics through their PICC line. PICC care - going home with PICC Wound care - family members may have to be educated on how to properly change dressings Joint protection Activity limitations Ice - NO HEAT Follow Up Appointments - let them know all the information about who they are following up with, where, and when.

Antacids can interfere with:

Antibiotics

What medications are used to treat appendicitis?

Antibiotics Stool softeners Bulk forming laxatives Fiber supplementation

How do we treat chronic gastritis?

Antibiotics & PPI for H. Pylori Hydration Make lifestyle changes (stop eating spicy foods, quit smoking/cut back) Increase Probiotics

How do we treat Lyme Disease?

Antibiotics (Doxycycline, Cefuroxime, Amoxicillin)

When would we give an Anticholinesterase inhibitors/Cholinergics for Myasthenia Gravis? Name an example.

Anticholinesterase Inhibitor: drug that inhibits the acetylcholinesterase enzyme from breaking down acetylcholine, thereby increasing the action of acetylcholine, *which helps the muscles to contract.* Example: pyridostigmine bromide (Mestinon)

Neuropathic pain can be treated with:

Antidepressants

If a patient with Autonomic Dysreflexia's BP does not reduce after interventions, you will have to give:

Antihypertensives - Hydralazine via IV. OR Vasodilator - Nitro paste: this should be applied to the areas where vasodilation are occurring (which is usually above the level of injury) for best absorption.

How do we treat Hepatitis B?

Antiviral - Tenofovir

How do we treat HSV?

Antiviral meds SUCH AS ACYCLOVIR - these suppress viral load and decrease recurrence and shedding, does NOT cure.

What type of medications can we give to someone with Influenza?

Antivirals - these medications won't cure the virus but it will diminish the symptoms of the virus - must be taken within 2 days of first developing symptoms.

What some common causes of mixed acidosis?

Apnea, cardiac arrest

What should never be done if appendicitis is suspected?

Applying heat to the lower right quadrant of the abdomen - this can cause the appendix to rupture.

A key diagnosing factor of Guillain-Barré Syndrome is:

Areflexia - absent reflexes

Surgical Treatment for Osteoarthritis:

Arthroplasty - a surgical reconstruction/replacement of a joint

Most UTI's are considered ascending/descending?

Ascending - the infection will travel upward if not treated

If there is anything about clinical you are unsure about, what should you do?

Ask instructor

Priority nursing intervention for Myasthenia Gravis is to:

Assess breathing and respiratory status

Nursing Interventions for Glomerulonephritis

Assess for previous infections: sore throat, skin lesions Physiologic Assessments: - fluid and electrolyte status - cardiac status - neurologic status Strict I & O with daily weights* can be delegated to UAP Monitoring V/S *UAP's can't monitor but can get vital signs Diet/fluid restrictions: Decrease protein, decrease sodium & decrease fluids (renal diet) Medications as indicated: antihypertensive, diuretics, corticosteroids, immunosuppressants Teach importance of follow-up care

(?) has a clinical outcome of airflow obstruction.

Asthma

Symptoms of Chronic Pyelonephritis

Asymptomatic, but if symptoms occur: 1. headache 2. fatigue 3. poor appetite 4. polyuria 5. excessive thirst 6. weight loss

The nurse should ensure that the patient wears their compression stockings for (how long)?

At all times possible.

If a patient has a stroke within their cerebellum, they may appear:

Ataxic (unbalanced)

Collapsing of alveoli from retained secretions and obstruction is known as:

Atelectasis

If a client with COPD is weak and cannot produce an effective cough, meaning secretions cannot be removed, what is the #1 thing the nurse should monitor the patient closely for?

Atelectasis

The leading cause of Peripheral Artery Disease is:

Atherosclerosis

What is the antidote of Nitroglycerine?

Atropine

What happens when auscultating/palpating a Goiter?

Auscultating: Bruit is heard. Palpating: Thrill is felt.

Define Addison's Disease

Autoimmune disease of the adrenal glands; the adrenal glands are not functioning and therefor cannot produce hormones like Aldosterone, Cortisol, & Androgens. *Fluid loss increases.*

This DESCENDING TRACT - *Extrapyramidal tract* - is responsible for:

Automatic movement, posture

The higher the level of Injury, the more likely a person is to have:

Autonomic Dysreflexia

What diabetic related complication do these clinical manifestations describe? Cardiovascular: resting tachycardia, orthostatic hypotension, MI GI: N/V, diarrhea, constipation related to delayed gastric emptying. Urinary: decreased sensation of bladder fullness. Neurogenic bladder. Sexual dysfunction Management: Treatment depends on symptoms. Delayed gastric emptying: small frequent meals medications: metoclopromide (Reglan): increases peristalsis

Autonomic Neuropathy

What etiologic factor is related to the onset of RHEUMATOID ARTHRITIS? A. Increasing age B. Genetic Predisposition C. Environmental Exposures to carcinogens D. History of osteoarthritis

B, Genetic Predisposition

Informed consent paperwork should be signed by the patient (before/after?) the patient has received their medication for surgery.

BEFORE

In order to qualify as a candidate for bariatric surgery you must have the following:

BMI >40 OR BMI >35 with comorbidities

Trousseau's Sign

BP cuff on and hand begins to spasm - a common sign of hypocalcemia.

During a hemorrhage, what commonly happens to BP and HR?

BP drops, HR goes up.

Continuing infection after a course of treatment

Bacterial Persistence

Lyme Disease

Bacterial infection transmitted by deer ticks (Borrelia burgdorferi)

LDL

Bad cholesterol (want lower number)

Cerebellum is responsible for:

Balance and coordination

ECG/EKG screens for:

Baseline information of cardiac status - it can reveal the presence of Left Ventricular Hypertrophy, cardiac ischemia, or previous MI.

Blood sugar is monitored when?

Before meals and at bedtime

When BP is low, baroreceptors will:

Begin firing - this sends a message to the sympathetic vasomotor center inside the medulla to vasoconstrict, helping bring the BP back to normal.

In Autonomic Dysreflexia, vasoconstriction occurs:

Below the level of the injury.

Causes of Chronic Gastritis:

Benign/malignant stomach ulcers Helicobacter pylori (H. pylori)* Autoimmune diseases Diet Medications Alcohol Smoking Chronic reflux Intense stress

Insulin is a hormone secreted by:

Beta Cells in the Islets of Langerhans within the pancreas

Why would we give Beta Adrenergic Blockers for Graves Disease? Give an example of a Beta Adrenergic Blocker.

Beta adrenergic blockers bring down the heart rate; this slows down the sympathetic nervous system which may help with other symptoms of Graves disease. Example: propranolol (Inderal)

For a patient that underwent a Transsphenoidal Hypophysectomy, any drainage found on the mustache dressing is tested for:

Beta transferrin, a protein only found in CSF. If it tests positive, this indicates a definite CSF leak.

When heparin is given, we want the therapeutic range for aPTT levels to be:

Between 50 and 90 seconds. *Less than 50 seconds, blood is still too viscous. More than 90 seconds, blood is thinned too much and there is an increased risk for bleeding.*

What is the peak age of onset for Myasthenia Gravis? What is the most common gender to get Myasthenia Gravis?

Between ages 20-30 More common in women

cholestyramine (Questran) List Action, Side Effects, Nursing Interventions

Bile Acid Sequestrant Action: decreases total cholesterol and LDLs Side effects: *GI discomfort, constipation, diarrhea*, fat seen in stools, increased prothrombin time (clotting), Vitamin A, D and K deficiency, Nursing: give 1 h before or 2 h after meals, increase fiber in the diet, assess for bleeding *Follow-up cholesterol levels to evaluate effectiveness - For all lipid lowering meds*

Biggest risk of tPA:

Bleeding + hemorrhage

What is the function of histamine (H2) receptor blockers?

Blocks action of histamine on the gastric wall - prevents stomach cells from producing HCL- they decrease secretion of HCL acid by 70% in 24 hrs - they promote esophageal healing in 50% of patients.

Anticholinergics - Short (SAMA) and Long Acting Muscarinic (LAMA) What do they do? What is a common side effect? Give Examples of Each (and how is each example used)

Blocks bronchoconstriction by the parasympathetic nervous system Common side effect is dry mouth. Examples: - Short acting muscarinic anticholinergic (SAMA): Ipratropium (Atrovent) - can be inhaled through nebulizer or metered dose inhaler - it is short acting and treats acute exacerbations - can be combined with SABAs (like Albuterol) - Long acting muscarinic anticholinergic (LAMA): Tiatropium (Spiriva) - can be inhaled through dry powder inhaler - used for long acting/maintenance treatment.

Narcan (naloxone)

Blocks subjective and objective opioid affects

Diagnostic Findings of Diabetic Ketoacidosis

Blood Glucose levels greater than 250 mg/dL Low serum pH 6.8-7.3 (acidosis) Positive urine and serum Ketones Glucose in urine Abnormal sodium, potassium and chloride levels

What is important to monitor if our patients are on PN?

Blood Glucose levels incase of rebound hypoglycemia

Major cause of Iron Deficiency in Adults is:

Blood Loss

What is a NEW way that we are beginning to test for PPD?

Blood Test (QuantiFERON, TB Gold)

What is the problem caused when too much glucose is built up in the blood?

Blood becomes very viscous and thick and could potentially cause hyperlipidemia, atherosclerosis, vision problems, etc.

Presence of sugar in the urine requires immediate:

Blood glucose level testing

More fluid volume leads to an increased:

Blood pressure

Define Troponin

Blood protein that regulates heart contractions. When it's elevated it indicates an injury has occured. *This is the best for diagnosing Myocardial Infarctions

Diagnosis of Herpes Zoster:

Blood test

How do we diagnose HIV?

Blood test

How do we diagnose HSV?

Blood test

4 Ways to Diagnose Gout

Blood test for Uric Acid levels - most common diagnostic used - Uric acid level of 6.8 in the blood is positive for Gout & patient will have symptoms. 24 hour urine will let us know how much uric acid is in the urine. X-Ray on patient will show haziness over the specific joint/punched out areas that indicate gout. Gold Standard: Aspirating the site with a needle to assess for crystals - very rarely occurs

What is the most commonly used method for diagnosing Gout?

Blood test to assess Uric acid levels - UA level of 6.8 or more in the blood is positive for gout.

How are D-Dimers used in diagnosing DVT's?

Blood test used to rule out DVT. If you have a clot, body will produce D-Dimer, indicating a clot is present and the body is trying to break it down (Fibrinolytic: Breaking down a clot). Results are not specific and accurate. If negative, you don't have a clot. Not used to diagnose, just used to rule out.

Someone with Afib is at high risk for an embolic stroke. What medications do they take to reduce this risk?

Blood thinners (anti-coagulants)

What is BUN? What is the proper levels?

Blood urea nitrogen found in the blood - indicates how well liver/kidneys are working; 10-20

In ulcerative colitis, what does stool look like?

Bloody mucousy diarrhea.

Spinal cord injury patients have an inability to regulate:

Body temperature - they will not shiver when it is too cold, and they will not sweat if it is too hot - they take on the temperature of their environment.

Osteoblasts

Bone Forming cells

Osteoclasts

Bone-destroying cells

Define Osteophyte

Bony outgrowths around joint margins

People with duodenal ulcers have an increased risk of (?) than people with gastric ulcers.

Bowel Perforation

Descending tracts begin in the (?) and end in the (?)

Brain, spinal cord

(?) Includes the presence of cough and sputum production for atleast 2-3 months in each of 2 consecutive years.

Bronchitis

Avoid beta blockers that block both beta 1 and beta 2 receptors for a patient with asthma and COPD, because it may cause:

Bronchoconstriction

Exophthalmos

Bulging eyes due to impaired venous drainage & long term graves disease. 40% of patients will have this.

Diverticular Disease

Bulging pouches (diverticula) occur when the mucosa and submucosa layers of the colon herniate through the muscle wall - Most commonly occurs in the distal sigmoid colon.

Most common symptom of PUD:

Burning stomach pain

The most common way to get a UTI is:

By ascending infection (transurethral) - in which bacteria colonize the periurethral area and enter the bladder by means of the urethra.

In the older adult population, signs and symptoms may go unrecognized or may be mistaken for normal aging changes. We can determine for sure that they have Anemia by checking their:

CBC

Toomey Syringe

CLOTS that are draining into the drainage bag can sometimes get stuck & cause a blockage within the tube, preventing drainage from entering the bag. This syringe allows us to flush the tubing of the drainage bag. Sometimes doctors will do this, sometimes nurses will.

What levels indicate Mixed Acidosis? (List: pH, CO2, HCO3, O2)

CO2: greater than 45 HCO3: less than 22 pH: less than 7.35 O2: less than 40

What levels indicate Mixed Alkalosis? (List: pH, CO2, HCO3, O2)

CO2: less than 35 HCO3: greater than 26 pH: greater than 7.45

What precautions do we use for LOCALIZED Herpes Zoster virus?

CONTACT Precautions

What type of precautions would we use for someone who has HSV?

CONTACT; HSV-1 doesn't require gown up, but does require gloves.

What is the 3rd leading cause of death in the US?

COPD

What disease do these characteristics describe? - Preventable & treatable, NOT Reversible - Combination of Emphysema and/or chronic bronchitis, or just one of these. - Progressive/gets worse over time - Chronic inflammatory response - Main cause: cigarette smoking - Alveoli are destroyed and become non functioning - lower respiratory related. - 3rd leading cause of death in U.S. - Causes chronic airflow limitations.

COPD (Chronic Obstructive Pulmonary Disease)

In what cases would we potentially see Respiratory Acidosis?

COPD, overdose, cardiopulmonary arrest

Symptoms of Scleroderma

CREST - Calcinosis - calcium deposits in the skin Raynaud's Phenomenon - spasm of blood vessels in response to cold/stress Esophageal Dysfunction - acid reflux and decrease in motility of esophagus. Sclerodactyly - thickening and tightening of skin on fingers + hands. Telangiectasias - dilation of capillaries causing red marks on surface of skin.

For postop care of a patient who received a Transsphenoidal Hypophysectomy, we want to monitor them for:

CSF leakage - Dura is broken through to get to the pituitary gland during the surgery. CSF usually stops leaking on it's own within 72 hours, however, the Dura may continue to leak CSF, and the patient will need to return to the OR to have the dura patched up. If there is a leak present, that means there is space for an infection to come in & invade. A type of infection could be meningitis which is very severe. *Dark yellow halo (leakage) present on mustache dressing may indicate a CSF leak.* Drainage is tested for beta transferrin, a protein only found in CSF. If test is positive for beta transferrin, this indicates a definite CSF leak.

A sudden loss of brain function from a disruption of blood supply to a part of the brain.

CVA (Cerebral Vascular Accident)

TPN is administered via

CVAD (PICC, Implanted, Tunneled & non-tunneled catheters)

PTH regulates:

Calcium and phosphorous metabolism by acting on bone, kidney, & intestinal tract PTH increases calcium absorption within the bones. PTH also helps release the calcium from the bones into the blood stream.

Treatment of Raynaud's Phenomenon

Calcium channel blockers as it relaxes smooth muscle and assists with dilation

Complications of HSV:

Can be spread through nerves, potentially causing: - Meningitis - Encephalitis - Neonatal transmission

Rheumatoid Arthritis age of onset:

Can happen at any age

Treatment of Parkinson's: What is the function of Carbidopa: What is the function of Levadopa:

Carbidopa: Helps get more Levadopa across the blood brain barrier. Levadopa: Replaces dopamine

What is the function of Cortisol?

Carbohydrate, fat, and protein metabolism.

Provides energy

Carbohydrates

Median nerve is compressed at wrist, resulting in numbness or pain.

Carpal Tunnel Syndrome

What 2 hormones are secreted from the Adrenal Medulla & what is their function?

Catecholamines: - Epinephrine: Increases HR & vasodilation - Norepinephrine: Increases BP & vasoconstriction

In regards to classifying Anemias, it is easier to discuss patient care by focusing on the:

Cause of the Anemia (Etiology)

Dawn Phenomenon

Caused by release of growth hormone and is common among teenagers - blood glucose begins to rise at approx 3 am and continues to rise to extremely high levels. Treatment: Increase dose of insulin at bedtime.

What antibiotics help treat Gonorrhea?

Ceftriaxone.

Narcotics/Opioids have no (?) effect

Ceiling effect - which means you can continue to increase the dose and still get an analgesic effect. Ibuprofen is an example of a medication that DOES have a ceiling effect.

We administer Glucose Content of 10% or greater through a:

Central Venous Access Device

If someone is slurring their words, what is something important we might want to check and why?

Check blood glucose levels in case the slurred speech is an indicator of hypoglycemia - this can help rule out a stroke.

How do we diagnose Chronic Gastritis? (4 things)

Check for H. Pylori. Check for anemia. Check stool for microscopic blood. Perform an endoscopy

How are CBC's used in diagnosing DVT's?

Check hemoglobin, hematocrit, and platelets for any signs of Polycythemia Vera - an overproduction of WBC, RBC's, and platelets that makes the blood very viscous and thick. Thick blood puts patient at a higher risk for developing DVT.

Nursing Considerations for tube feedings:

Check that placement has been verified by radiography Assess for tolerance of feedings/medications (is patient vomiting?) Assess placement for every time you access the tube. Prevent dislodgement (tube from coming out) Maintain patency of tubes Monitor for constipation/diarrhea, abdominal distention, abdominal pain Ensure that patient is in semi to high fowler's position with the HOB elevated to atleast 30 degrees.

How can we diagnose Pneumonia?

Chest X Ray, auscultation, systemic symptoms, elevated WBC & fever, pain when coughing, altered mental status, hypoxemia, ABGs.

COPD PHENOTYPE: Blue bloater

Chronic Bronchitis - person has a higher body weight - person may appear blue/cyanotic

What are the risk factors for malnutrition?

Chronic disease Restrictive diet Trauma Burns Major surgery - ex: Gastric Bypass Hypermetabolic Malabsorption Elderly Financial limitations Dysphagia Poor functional status Depression Dementia

Main cause of COPD:

Cigarette Smoking

What drug is the 1st line of treatment for Intermittent Claudication?

Cilostazol (Pletal)

Antibiotic to eliminate H. Pylori

Clarithromycin (Biaxin)

List the medications and their side effects that are used to treat H. Pylori

Clarithromycin (Biaxin): - SIDE EFFECTS: headache, colitis, nausea, abdominal pain, coagulation abnormalities Amoxicillin (Amoxil) - SIDE EFFECTS: colitis, N&V, seizures, insomnia, dizziness, anxiety, thrombocytopenia, anaphylaxis, rash, unsusceptible organism overgrowth. Metronidazole (Flagyl) - SIDE EFFECTS: edema, headache, neutropenia, puritis, candida overgrowth, urinary, sinusitis Tetracycline - SIDE EFFECTS: GI, joint pain, allergic reaction, throat irritation, vaginal itching, C-diff associated diarrhea, very bad headache, blindness Pepto-Bismol PPIs

List the Tuberculosis Classifications (0 to 5)

Class 0: no active disease of TB - if tested, person would be negative. Class 1: exposure to TB, but no evidence of infection. Class 2: Latent infection (TB is laying dormant within the person), but no sign of disease symptoms yet. Class 3: TB is now clinically active Class 4: TB is present but is no longer active Class 5: Diagnosis Pending

Etiologic classification of Anemia is based on:

Clinical Conditions that caused the Anemia

Myelin

Coating on neurotransmitters which is broken down during a disease known as Multiple Sclerosis

UTI irritants that should be avoided include:

Coffee Tea Colas Citrus Alcohol

What do calcium channel blockers commonly end in? Name an example. What are the side effects? Nursing Interventions?

Commonly end in -ipine. Ex: Amlodipine SE's: constipation, impotence, bradycardia, dizziness, decreased bp, peripheral edema NI's: be careful when using this med on someone with HF/heart blocks.

E-Coli causes about (?%) of community acquired UTI's and (?%) of hospital acquired UTI's. This indicates lapses in hygiene.

Community acquired: 85% Hospital acquired: 50%

(?) exists in the presence of stones or obstruction.

Complicated UTI

Define Dumping Syndrome

Complication of gastric surgery that involves: - Rapid gastric emptying - Abdominal cramping - Nausea/vomiting/severe diarrhea 20-40 min after eating - Sweating/flushing "red face" - Tachycardia To avoid dumping syndrome: Put patient in Fowler's position & limit fluids.

Wernicke's area, located within the temporal lobe, is responsible for:

Comprehension of speech.

What is the #1 treatment for chronic venous insufficiency?

Compression (stockings, boots, ace wraps)

Define Osmolality

Concentration of particles in a solution

Atherosclerosis

Condition in which fatty deposits called plaque build up on the inner walls of the arteries causing the arteries to become narrowed

Genital warts are referred to as:

Condylomata

Rheumatic disorders affect the joints, bones, muscles, and (?) tissue.

Connective Tissue

Uric acid deposits inside areas of:

Connective tissue/joints

What is the most common risk factor of Diverticular Disease?

Constipation

Diencephalon

Contains thalamus, hypothalamus, and pituitary gland.

The kidneys contribute to BP regulation by:

Controlling sodium excretion and extracellular fluid (ECF) volume. (Sodium retention results in water retention, which causes an increased ECF volume. This increases the venous return to the heart and the stroke volume. Together, these increase CO and BP)

Brain Stem Function:

Controls breathing and blood pressure.

Transduction of pain

Converts energy produced by a stimuli into electrical energy - process that begins in the periphery when pain producing stimuli sends an impulse across a peripheral nerve fiber - neurotransmitters are released

Give examples of Macrovascular Complications:

Coronary Artery Disease (effects vessels of the heart) Cerebral Vascular Disease (effects blood vessels in brain) Peripheral Vascular Disease (effects vessels of the lower extremities)

The best treatment of chronic disease anemia is:

Correction of the underlying disorders

What medication should be given for Scleroderma?

Corticosteroids to reduce inflammation

Ileostomy

Created with the end of the small intestines - liquid and small particles of undigested food waste will exit through this type of ostomy.

Creatinine clearance is used to screen for:

Creatinine clearance reflects Glomerular filtration rate - a decreased creatinine clearance indicates renal insufficiency

- Inflammation of all layers of the bowel. - 50% have granulomas; not connective but rather cobblestone in appearance - lesions develop inside the mouth - increased prevalence in females - young onset - 15 to 30 years old - peaks between ages of 60 and 80. - believed to be an autoimmune disease - not yet proven

Crohn's Disease

In what form of IBD do ulcerations line the mouth and intestines?

Crohn's Disease

Which disease can cause an early cessation of menses? Why?

Cushing's syndrome - this happens due to increased Androgen hormone.

A CBC is performed on a patient who is diagnosed with SLE. Which finding would the nurse expect? A. Increased neutrophils B. Ubcreased red blood cell count C. Increased WBC count D. Decreased numbers of all cell types

D

The pulse oximeter is an assessment tool used to evaluate the:

capillary oxygen saturation

Most common medication given for Parkinson's: What are some side effects that can occur when the patient has been taking this medication for a long time? How can we treat these side effects?

carbidopa/levadopa (Sinemet) *Most beneficial first few years of taking this medication* SE's: - Unpredictability: patients do not know if they will respond to their medications or not. - "Wearing Off" Effect: the longer the patient takes this medication, the more likely it will wear off. May need to increase frequency. - Parodoxical Intoxication: Symptoms become worse. These side effects can be treated by doing a "Drug Holiday" aka Carbidopa/Levadopa is stopped for a week or two, allowing the body to "cleanse itself" of the medication. After a few weeks, the medication is restarted.

What is the gold standard for diagnosing CAD?

cardiac catheterization

Define CK-MB

cardiac marker specific to heart tissue - these levels will be elevated if there is damage to the heart tissue.

Nociceptive pain caused by?

caused by tissue damage

Local Anesthesia

causes the loss of sensation in a limited area by injecting an anesthetic solution near that area without loss of consciousness

3 primary symptoms of COPD

chronic cough, sputum production, dyspnea on exertion *weight loss is also common

Ulcerative colitis

chronic inflammation of the colon with presence of ulcers

Foods containing vitamin C:

citrus fruits, tomatoes, cantalope

Cataract

clouding of the lens of the eye, which causes poor vision

When measuring various findings during assessment, should *inches* or *cm* be utilized?

cm

thyrotoxicosis

condition caused by excessive secretion of thyroid hormones

What are the 6 symptoms of Addisonian Crisis?

DEHYDRATION LOW BLOOD SUGAR VOMITING DIARRHEA CRAMPS LOW BP

The biggest concern with removal of the pituitary gland is:

DI (because without the pituitary gland, there is no ADH being produced, leading to DI)

DKA VS HHNS

DKA: - Commonly occurs in Type 1 Diabetes - Can be caused from insulin omission/physiologic stress - Rapid onset, less than 24 hours - Glucose levels: Greater than 250 mg/dL - Arterial pH: less than 7.3 - Ketones are present - Serum: 300-350 mOsm/L - Bicarb level: Less than 15 mEq/L - Bun/Creatinine is elevated - Mortality: Less than 5% HHNS: - Commonly occurs in Type 2 Diabetes - Can be caused by physiologic stress - Slow onset, takes several days - Glucose levels: Greater than 600 mg/dL - Arterial pH: normal - No ketones are present - Serum: Greater than 350 mOsm/L - Bicarb level: Normal - Bun/Creatinine is elevated - Mortality: 10-40%

What 3 classes of drugs are used to treat Rheumatoid Arthritis?

DMARDS, Biologics, Antimalarial Therapy

Folic acid is required for (?)

DNA synthesis, which is responsible for RBC production and maturation

Nursing Interventions for malnutrition:

Daily calorie count High-protein, high-calorie foods Multiple, small feedings Supplements (protein drinks) Appetite stimulants (Megace, Marisol) Diet diary Dietitian consult Parental nutrition

Does Vasodilation increase or decrease BP?

Decrease

Diabetes Insipidus is caused by a (increase/decrease?) production of ADH.

Decreased (Deficiency) - this means the body will begin losing fluid excessively.

4 Complications Caused by Back Pain:

Decreased mobility Gait abnormalities (foot drop) Diminished reflexes Autonomic dysfunction - back pain so severe that it affects bowel & bladder control

Uncontrolled pain leads to:

Decreased quality of life Anxiety and stress Functional Impairment GI, renal, and musculoskeleton problems

What serum electrolyte levels indicate Addison's disease?

Decreased sodium, decreased glucose, Increased potassium

What are 3 functions of Proton Pump Inhibitors?

Decreases gastric HCL acid secretion - also treats ulcers & gerd

For postop care of a patient who received a Transsphenoidal Hypophysectomy, we want to encourage:

Deep breathing and use of incentive spirometer - THESE DO NOT INCREASE ICP. Oral care without brushing teeth for 10 days.

In Diverticulosis, how is pain relieved?

Defecation/passing gas

Define Amyotrophic Lateral Sclerosis (ALS)

Degeneration of motor neurons in brain & spinal cord for unknown reasons - Twice as common in men than women - A rare but fatal disease (Patients live anywhere from 2-7 years after diagnosis.) - Electrical & chemical messages originate in brain but the dead motor neurons cannot produce or transport vital signals to muscles.

Alpha-glucosidase inhibitors

Delay digestion of carbohydrates Must be taken immediately before a meal Lowers post-prandial blood glucose level Examples: - acarbose (Precose) - miglitol (Glyset) Side effects: Hypoglycemia GI Symptoms: Diarrhea, Flatulence

In someone with PAD, what position do we place them in for pain relief?

Dependent Position (dangle the legs)

If we want someone on TPN to get Carbohydrates, we would administer:

Dextrose

BLOOD TEST LEVELS FOR DIAGNOSIS OF DIABETES AND PREDIABETES: List the fasting plasma glucose levels for diagnosing Diabetes, Prediabetes, and Normal.

Diabetes: 126 or above Prediabetes: 100 to 125 Normal: 99 or below

BLOOD TEST LEVELS FOR DIAGNOSIS OF DIABETES AND PREDIABETES: List the oral glucose tolerance test levels for diagnosing diabetes, prediabetes, and normal.

Diabetes: 200 or above Prediabetes: 140 to 199 Normal: 139 or below

BLOOD TEST LEVELS FOR DIAGNOSIS OF DIABETES AND PREDIABETES: List the A1C percentages for diagnosing Diabetes, Prediabetes, and Normal.

Diabetes: 6.5% or above Prediabetes: 5.7-6.4% Normal: 5%

What diabetes complication do the following symptoms represent? (diabetic ketoacidosis/hyperglycemia/hypoglycemia) Hyperglycemia Abdominal Cramps Acidosis Polyuria Polydipsia Orthostatic Hypotension (volume depletion) Nausea/Vomiting Kussmaul Respirations Fruity Breath Mental Status Changes

Diabetic Ketoacidosis

In what cases would we potentially see Metabolic Acidosis?

Diabetic Ketoacidosis, Renal Failure

What diabetic related complication do these clinical manifestations describe? - Characterized by albuminuria, hypertension and renal insufficiency. - Breakdown of insulin decreases (could lead to hypoglycemia) - Frequent hypoglycemic episodes. - Hypertension Management: Control hypertension. Monitor for albumin in the urine. Avoid nephrotoxic medications. (IV dye) Low sodium, low protein diet. ACE inhibitors lower BP and reduce microalbuminuria. ARB's. Dialysis or kidney transplantation.

Diabetic Nephropathy

What diabetic related complication do these clinical manifestations describe? Group of diseases that affect all types of nerves: peripheral and autonomic. Related to elevated BG over a period of years. Attributed to vascular or metabolic mechanisms or both. Disruption in blood supply to nerves.

Diabetic Neuropathy Examples: - Motor neuropathy: muscle weakness - Sensory neuropathy: loss of feeling - Autonomic neuropathy: loss of sweat/moisture that leads to dry, cracking skin

What diabetic related complication do these clinical manifestations describe? - affects type 1 & type 2 diabetics - Caused by changes in the small blood vessels of the retina. - Increased risk with chronic hyperglycemia and hypertension. - Signs/symptoms: Floaters, sudden visual changes or loss of vision. Management: Prevention through glucose control. BP control. Smoking cessation. Patient education. Encourage routine ophthalmic exams. Address patients adjustment to vision impairment and use of assistive devices.

Diabetic Retinopathy

Give examples of Microvascular Complications:

Diabetic Retinopathy & Diabetic Nephropathy (Retina and Kidneys)

EMG for diagnosing Carpal Tunnel Syndrome

Diagnoses Carpal tunnel syndrome - Checks median nerve motor conduction - a delay over 5 milliseconds indicates Carpal Tunnel Syndrome.

Phalen's Test

Diagnoses carpal tunnel syndrome - patient brings back of wrists together forming a 90 degree angle and if symptoms are recreated from this, carpal tunnel is ruled IN.

Tinel's Sign

Diagnoses carpal tunnel syndrome - percussion of nerve that creates symptoms of carpal tunnel is a positive diagnosis for carpal tunnel syndrome.

Symptoms of Myasthenia Gravis usually occur above the:

Diaphragm

COPD patients are encouraged to use what type of breathing and why?

Diaphragmatic breathing because it increases lung expansion

Causes of Acute Gastritis:

Diet Excessive alcohol Acute illnesses/trauma Radiation therapy Ingestion of strong acid/alkali *Overuse of ASA/NSAIDs/corticosteroids

What 4 ways besides using medications can we treat gerd?

Diet Weight loss Laparoscopic management Endoscopic management

DASH Eating Plan

Dietary Approaches to Stop Hypertension - lowers BP and LDL cholesterol. This plan emphasizes fruits, vegetables, fat-free or low-fat milk and milk products, whole grains, fish, poultry, beans, seeds, and nuts. AVOID red meat, salt, sweets, added sugars, and sugar-containing beverages.

How can we prevent CAD?

Dietary changes Therapeutic exercise program Stop smoking Control blood pressure Control blood sugar Reduce stress Take medications as prescribed When to call HCP

Treatment just for Spastic Bowel (Caused by UMN lesions)

Digital stimulation - finger stimulates the bowel and patient can have a BM - this triggers a BM to help get the patient on a normal bowel emptying regimen.

Pre-procedure of cataract surgery:

Dilating the eyes

Sulfonylureas

Directly stimulate pancreas to secrete insulin - functioning pancreas is necessary. glyburide (Micronase) glimepiride (Amaryl) glipizide (Glucotrol) Side Effects: weight gain, hypoglycemia, can increase or decrease glucose levels

Primary Progressive MS

Disease progression from onset, without plateaus remissions.

Total Knee Arthroplasty (TKA)

Diseased joint is cut out, shaped, and then the implants are put into place. Implants can be metal, ceramic, or plastic depending on each individual patient's needs.

tPA function:

Dissolves blood clots

If there is an arterial blockage, where will pain be felt?

Distal (below) to where the blockage is due to lack of blood flow to that area.

Where does Diverticular Disease most commonly occur?

Distal Sigmoid Colon (Lower part of large intestines)

What is often the 1st line of treatment for HTN?

Diuretics (although patients usually require a combination of antihypertensives, not just one)

- Sudden onset of mild to severe pain in LLQ - Nausea, vomiting, fever, chills, leukocytosis (elevated WBC count) - *Rebound tenderness for perforation - May lead to septicemia if untreated - Diagnosed with CT scan - CBC & ESR - *Symptoms are less pronounced in the elderly and delayed reporting symptoms out of fear

Diverticulitis

NSAIDS should not be taken in those that have (?) because they can Increase bowel perforation.

Diverticulitis

- Typically symptom-free - Mild symptoms include intervals of diarrhea, nausea, anorexia, abdominal distention - Discomfort relieved by defecation or the passage of flatus - Repeated episodes may lead to large bowel narrowing - Diagnosed with colonoscopy if no peritoneal irritation

Diverticulosis

What are the 2 clinical forms of Diverticular Disease?

Diverticulosis & Diverticulitis

If a patient on opiate therapy goes into respiratory arrest (unresponsive and low breaths/min), what should you do after they recover?

consult with the health care provider to reduce the dose of the opiate

Symptoms experienced in severe hypertension: *think DADPF

Dizziness Angina Dyspnea Palpitations Fatigue

To Treat Cholinergic Crisis, we:

Do not give meds - give antidote such as atropine (because its an anticholinergic and can dry up secretions)

Why is Lovenox "better" than Heparin?

Do not need to monitor PTT and is less likely to cause HIT (Heparin Induced Thrombocytopenia).

Superficial clots are not as dangerous as deep clots because superficial clots:

Do not reach systemic circulation

Continuous Bladder Irrigation (CBI)

Done after TURP - CBI is done through a 3 way catheter - one port is for outflow, one is for the balloon, and one is for the irrigation fluid to flow in. CBI bag is usually 3000 mL. Remember, what goes in MUST COME OUT into the drainage bag. GOAL: WE WANT TO MAKE SURE URINE IS TURNING FROM DARK CHERRY CLOTTY RED TO PINK. Patients DO NOT GO HOME ON CBI. Once urine has maintained its normal appearance, CBI will be disconnected. Patient WILL go home with Foley catheter in place.

Allen Test (what does it assess and how do we perform the allen test?)

Done before we do ABG's - it assesses circulation - depress ulnar and radial artery at the same time until hand becomes white - one side is released and watched to see if color returns to the hand. If color returns to normal, patient is fine, if not, there are circulation problems and it lets us know that ABG is probably not the best test for our patient to take.

Define Intra-articular Injections

Done to help treat Osteoarthritis - Hyaluronic acid is injected into the joint and acts as a synthetic synovial fluid. This allows for better movement.

What antibiotics help treat Chlamydia?

Doxycycline or Azithromycin.

What type of precautions are used for patients with Influenza?

Droplet - wear surgical mask, gown, and gloves

The 3 most common symptoms of asthma:

cough, dyspnea, wheezing

Define Sjogren's Syndrome - during what disease does this syndrome usually occur?

Dry eyes (eye drops to relieve), dry mouth (hard candies to relieve), and even vaginal dryness in young females - this occurs during Rheumatoid Arthritis.

Complications of Gastric Surgery

Dumping syndrome Postprandial hypoglycemia - sugar drops a couple hours after eating Bile reflux gastritis

Type O blood are more prone to getting:

Duodenal Ulcers

Iron Absorption occurs in the:

Duodenum

Nephrostomy

creation of an artificial opening into the kidney

In a patient with Myasthenia Gravis, their muscles will be strongest during what time of day?

During the morning - as the day progresses, muscles will get weaker.

List the pathophysiology of venous insufficiency:

Dysfunctional valves → Decreased venous return → Increased venous pressure → Edema, Venous Ulcers, Discoloration & Thick Skin

Upper abdominal discomfort associated with eating - also known as indigestion.

Dyspepsia

What is the most common symptom in people with GI dysfunction?

Dyspepsia

DYSPHASIA VS DYSPHAGIA

Dyspha*s*ia = inability to speak (*S*PEECH) Dyspha*g*ia = inability to swallow (*G*ULP)

Stress Testing

EKG electrodes are attached to the person's chest to monitor the heart while the person performs activity (runs on the treadmill.)

Blood test useful in evaluating treatment of SLE:

ESR

In IBS, there is increased pain when (?) and decreased pain when (?)

Eating, defecating

What medication is used to TEST for Myasthenia Gravis?

Edrophonium (Tensilon)

When a patient is taking antibiotics for a UTI, what is important to mention?

Educate the patient that they must finish the antibiotics even if symptoms go away because they can become resistant to the antibiotic or the infection can ascend upward without the patient even realizing.

What is the key to preventing Myxedema Coma in patients with hypothyroidism?

Educating patients about Levothyroxine Sodium - they really need to understand everything about this medication because they will be on it for life.

How do we treat Iron Deficiency Anemia?

Efforts are aimed at replacing iron - 1st: Nutritional therapy aka increasing oral consumption of iron containing foods (give red meats, organ meats, dark green leafy veggies, nuts, apricots) 2nd: If nutrition is already accurate, oral or occasional parenteral iron supplements 3rd: If iron deficiency is from acute blood loss, transfusion of packed RBCs may be necessary: Given if HgB is 8 or less.

Patient cannot receive lipids if they are allergic to:

Eggs & soy proteins

What's a Vagotomy? Why are they done?

cutting of certain branches of the vagus nerve, performed with gastric surgery to *reduce the amount of gastric acid* produced and thus *reduce the recurrence of ulcers* - this also *reduces gastric and intestinal motility*

If we want someone on TPN to get minerals, we would administer:

Electrolytes and trace elements

Pulmonary Embolism Pathophysiology

Embolus lodges in the pulmonary artery which decreases or obstructs pulmonary blood flow. This leads to VQ mismatch, an imbalance between pulmonary ventilation and perfusion - The alveoli are being ventilated but are not being perfused. This in turn leads to tissue hypoxia. Vasoactive substances are then released causing vasoconstriction and bronchial constriction. Pulmonary HTN may also occur which can in turn lead to right-sided heart failure. *CAN BE FATAL!*

A category of COPD - a disease of the airways characterized by destruction of the walls of over-distended alveoli.

Emphysema

COPD PHENOTYPE: Pink Puffer

Emphysema - person has low body weight

Chemicals that reduce/inhibit the transmission of pain:

Endorphins, Enkephalins, Dynorphins

Thiazolidinediones

Enhances insulin action at receptor sites Does not increase insulin secretion from beta cells of pancreas Can impair liver function Can be used in conjunction with sulfonylureas, metformin or insulin Examples: pioglitazone (Actos) rosiglitazone (Avandia) Side Effects: Hypoglycemia Cardiac toxicity (including stroke) Congestive heart failure (CHF) Liver

Define benign prostatic hyperplasia (BPH).

Enlargement of the prostate gland

Difference between enteral nutrition and parenteral nutrition:

Enteral Nutrition: aka tube feeding - given directly into the GI tract - uses the gut - more convenient - less risky - less costly Parenteral Nutrition: Aka TPN - given through a central vein/IV - gives the gut a rest - less convenient - more risk for infection - more costly

What is the name of the rash associated with Lyme disease? (Also known as the "bullseye rash")

Erythema Migrans

3 types of PUD:

Esophageal, Gastric (stomach) and Duodenal (small intestine)*

computed tomography (CT) scan

Evaluates anatomy, coronary circulation and the great vessels **Can Screen for calcium & give us a calcium score - this is important because it correlates directly to atherosclerotic disease and CAD. *High calcium score = high risk for CAD.* Can be done with or without contrast Noninvasive without contrast Contrast considerations Kidney complications - drink plenty of water after CT scan to avoid. Check for allergy to dye/shellfish

Define Cushings

Excess cortisol secretion potentially caused by a tumor on the adrenal gland or high dosages of exogenous steroids.

How should sublingual nitroglycerin tablets be stored? When do they expire?

Expires 6 months after opening bottle/container Keep in a neutral temperature (room temp) and out of direct sunlight/heat

True or false: Placebo is an appropriate way to test a client's truthfulness about pain.

FALSE

True or false: Surgical interventions are usually necessary for those with IBS.

FALSE - surgical interventions are not necessary for those with IBS, but usually ARE necessary for those with IBD.

T/F: A CT Scan will immediately show the effects of an ischemic stroke.

FALSE, a CT Scan will immediately show the effects of a hemorrhagic stroke. A CT scan can pick up an ischemic stroke days after it has happened.

T/F: We should assess for pupils during our Glasgow Coma assessment.

FALSE, pupils are assessed during the neurological assessment.

True or false: Chlamydia/Gonorrhea are Non-Reportable communicable diseases.

FALSE, they are reportable

True or false: Type 2 diabetes can become type 1 diabetes.

FALSE.

True or false: Someone with PVD should take aspirin everyday with dinner.

FALSE. Aspirin is an antiplatelet used for PAD.

True or false: For postop care of a patient who received a Transsphenoidal Hypophysectomy, you should remove the nasal packing to assess for CSF drainage.

FALSE. Do not remove the nasal packing. It should remain in the nose for 3-4 days after the procedure.

T/F: Guillain-Barré Syndrome will affect the patient's level of consciousness.

FALSE. It does not.

T/F: Removal of an enlarged Thymus gland guarantees that Myasthenia Gravis will be cured.

FALSE. It may be cured, but there is no guarantee. (about 50% of patients are cured)

True or false: A patient's family member can press the button to administer the patient's PCA for them.

FALSE. Nobody but the patient should be pressing the button to administer their medication.

When would Fresh Frozen Plasma be given as opposed to Vitamin K as an antidote for Coumadin?

FFP is usually given to trauma patients

What pain scale would we use for a patient aged 0-6 months?

FLACC pain scale

Chvostek's Sign

Facial spasm occurs when cheek is tapped - a common sign of hypocalcemia.

Long term complications if Diabetes is not managed:

Failure of different organs, especially the eyes, kidneys, nerves, heart, and blood vessels.

True or false: As a nursing student, it is okay to pass meds with the patient's primary nurse.

False

True or false: Only physicians can insert a PICC into the right basilic vein

False

True or false: Type 2 diabetics never need insulin.

False

True or false: an advantage of the PICC is that an x-ray is not needed to confirm placement.

False

T/F: Carpal Tunnel is an emergency surgery.

False - it is an elective surgery.

T/F: In Crohn's disease, RLQ pain is relieved with defecation.

False - it is not.

T/F: A patient with back pain should be on strict bed rest.

False - we want the patient up and ambulating as soon as possible. For those with *severe* back pain, maximum bed rest is for 2 days.

True or false: Hemorrhagic strokes are more common than Ischemic strokes.

False, ischemic strokes are more common.

True or false: COPD is preventable, treatable, and curable.

False, it is preventable and treatable but NOT curable.

T/F: Patients with Osteoarthritis should avoid exercises like swimming.

False, swimming is very beneficial for those with OA, But NOT for those with osteoporosis.

T/F: There is a developed cure for Parkinson's disease.

False, there is no cure for Parkinson's disease. However, there is treatments.

T/F: Patient will go home with CBI.

False, they won't.

T/F: A complete blood count is necessary to confirm if a patient with pyelonephritis is free of infection.

False, wanna check urine not blood.

T/F: You should use only ice packs on patients with Osteoarthritis.

False, you can use hot or cold packs.

T/F: Absence of blood in the urine means the patient does not have a UTI.

False.

T/F: Acute Pyelonephritis is an immunologic disease that causes progressive destruction of nephrons, resulting in chronic renal insufficiency.

False.

T/F: Osteoarthritis is a normal process that occurs with aging.

False.

T/F: Scleroderma is curable.

False.

T/F: ALS is curable with treatments.

False. ALS is not curable and there is no treatment for this disease.

T/F: Hypertension is the leading cause of renal failure.

False. It is the 2nd highest cause of renal failure, #1 being Diabetes.

T/F: Guillain-Barré Syndrome is deadly.

False. Patients with GBS don't necessarily die from the disease itself, but rather from respiratory failure or infection.

Reduces acid secretion by blocking histamine-2 receptors

Famotidine (Pepcid)

Name some examples of histamine (H2R) receptor blockers?

Famotidine (Pepcid) Ranitidine (Zantac) Cimetidine (Tagamet)

Give the normal levels for: *Glucose*

Fasting: 60-100 mg/dL Nonfasting: 100-140 mg/dL

Common Symptoms of Anemia:

Fatigue, lethargy, tachycardia, pallor, jaundice, low hemoglobin and low RBC count.

Provides long term energy, insulation and protection

Fats

Opiophobia

Fear of opioids because of addiction/overdoses

Parenteral Nutrition

Feeding a person intravenously

Enteral Nutrition

Feeding that goes directly into the stomach/digestive tract (PEG TUBE, J TUBE, NG TUBE)

Hypothyroidism is 5x more common among what gender?

Females

Who is most at risk of getting Osteoarthritis? (age + gender)

Females over age 40

At what age should males/females receive bone mineral density test?

Females: after menopause. Males: After 50 or sooner if they have risk factors. *How often they go back depends on what is found!

Classic sign of a flare up in a patient with SLE is:

Fever

Systemic allergic reactions include:

Fever and chills

fenofibrate (Tricor)

Fibric acid derivative Action: lowers triglycerides and increases HDLs Side effects: Pulmonary embolism, DVT, *rhabdomyolysis*, arrhythmias Nursing: Can increase anticoagulation effects of warfarin, need for follow-up cholesterol levels to evaluate effectiveness.

Initially, all spinal cord injuries present with:

Flaccid-ness

Difference between Cold & Flu:

Flu is accompanied by diarrhea, vomiting, and fever, while colds usually are not.

Defining Characteristics of Lyme Disease

Flu like symptoms: - Fever - headache - fatigue - characteristic skin rash called erythema migrans, AKA: "bullseye rash" - Can become severe - Severe cases affect joints, cardiac and nervous system

Post Op Care for BPH Procedures

Fluid balance/I&O's Pain relief: Tamsulosin (Flomax) Monitor for: - Hemorrhage - Infection - DVT - Catheter obstruction (indicator is distention in suprapubic area) Educate patient on: - Foley catheter care at home - Activity restrictions - S&S of urinary retention, UTI, sexual dysfunction - Resuming certain medications (Coumadin, Aspirin) - Tamsulosin (Flomax) may cause orthostatic hypotension

What nursing interventions would we perform specifically for DI?

Fluid replacement and administration of synthetic ADH (Vasopressin/DDAVP)

What nursing interventions would we perform specifically for SIADH?

Fluid restrictions & frequent neurological assessments for low sodium symptoms. Give 3% NS (hypertonic solution) for low sodium levels (less than 120)

What is the difference between the clinical manifestations of Folic Acid Deficiency and Cobalamin Deficiency?

Folic Acid Deficiency doesn't have neurological manifestations - only cobalamin deficiency presents with neurological manifestations due to vitamin b12 supporting the myelin sheath on nerves

Immunosuppressant Therapy Drugs should be given with (?) to decrease toxicity.

Folic Acid Supplements

When should follow up urine cultures be done for patients with Acute Pyelonephritis?

Follow-up urine culture should be 2 weeks after antibiotic is completed

A patient with osteomyelitis will be on antibiotics for:

For acute osteomyelitis, IV antibiotic therapy continues for 6 weeks - chronic osteomyelitis may require longer treatment. After the infection appears to be controlled, the antibiotics may be administered orally for up to 3 months.

Fat Embolism

Freely floating fat globule in the blood stream, which can obstruct blood circulation to vital organs (e.g., heart, lungs, brain). Usually caused by injury to subcutaneous tissue or a bone fracture that allows fat release.

80% of people with Autonomic Dysreflexia have it due to:

Full Bladder (Another cause could be a full bowel but it is less common)

DMARD - sulfasalazine (Azulfadine) - function, considerations, side effects.

Function: Anti-inflammatory, decreases lymphocyte responses Considerations: Anything sulfa based requires an allergy assessment - Sulfas are used concurrently with NSAIDs - Penicillin's can cause sensitivity when used with Sulfa drugs Side Effects: GI upset, skin rash, headache, liver abnormalities, anemia, *Any sulfa drug causes photosensitivity.

COX2 inhibitor - Celecoxib (celebrex) - Function & side effects

Function: Decreases pain + inflammation in those with Osteoarthritis. Patients who can't take NSAIDS (they cause GI bleeding) due to GI complications can take this medication. Side effects: High blood pressure - use cautiously in patients who have existing cardiovascular disease as it can lead to an increased risk for MI or stroke.

DMARD - Methotrexate (Rheumatrex) - function, considerations, side effects.

Function: Drug of choice to treat Rheumatoid Arthritis. Rapid anti-inflammatory. Considerations: Give with folic acid supplement to decrease toxicity. Side effects: myelosuppression, aplastic anemia and GI and bladder toxicity, teratogenic

*Bisphosphonates* - list it's function, how it should be taken, side effects, and 3 examples of this type of drug.

Function: Inhibits osteoclast activity (slows/stops breakdown of bone) How it should be taken: - Take on an empty stomach with full glass of water - Sit up, 90 degrees for at least 30-60 minutes after taking this medication. Side effects: GI ulcers, jaw necrosis Examples: alen*dronate* (Fosamax), rise*dronate* (Actonel), iban*dronate* (Boniva)

DMARD - cyclosporine (Neoral) - Function?

Function: Newer medication that treats RA by Inhibiting T-lymphocytes directly and stops the immune response.

*SERMS (Selective Estrogen Receptor Modulator)* - list its function, side effects, and 1 example of this type of drug.

Function: Preserves bone mass density (whatever you have left) Side effects: Increased risk for stroke, thromboembolism, allergic reaction, chest tightness Example: raloxifene (Evista)

Biologics - Tumor Necrosis Factor (TNF) Blocking Agents: *etanercept (Enbrel)* *adalimumab (Humira)* *infliximab (Remicade)* - function? considerations? side effects?

Function: TNF blockers suppress the immune system by blocking the activity of TNF, a substance in the body that can cause inflammation and lead to immune-system diseases - in this case, TNF blockers are used to treat Rheumatoid Arthritis. Considerations: - Manteaux testing before starting treatment is recommended because patients are at high risk of getting TB. - Serious infection risk, no live vaccines Side effects: bacterial sepsis, invasive fungal infections and TB.

Antimalarial Therapy - *hydroxychloroquine (Plaquenil)* - function? side effects?

Function: Treats Rheumatoid Arthritis - anti-inflammatory that works well with Methotrexate Side effects: BM suppression, GI ulcers, infection risk, skin rashes, bladder toxicity, visual changes, headaches, photosensitivity

Interleukin (IL)-1 Receptor Antagonist *anakinra (Kineret)* - function? how can it be given? side effects?

Function: Treats Rheumatoid Arthritis by blocking IL-1 receptors which decreases inflammation and immune response. How it can be given: Injectable/IV Side effects: High risk for infection

colchicine (Colcrys) - function, side effects, & considerations for taking this medication.

Function: Treats acute stages of Gout (does not prevent gout) Interferes with the functions of the WBCs in initiating and perpetuating inflammatory response aka prevents inflammatory response. Side effects: GI upset, severe diarrhea, n/v, abdominal pain, aplastic anemia. Considerations: - Take with meals - Avoid grapefruit juice - Should be taken within 24 hours of onset of acute gout symptoms. *Patient is usually told to take this medication only until their pain stops or when they get severe diarrhea.

Uricosuric - *Probenecid* - Function & Side effects. What decreases the action of this medication?

Function: Treats gout by inhibiting renal reabsorption of urates & increasing renal excretion - decreases serum uric acid. Side Effects: *Kidney stones, GI upset, aplastic anemia, flushing. *Action is decreased by salicylates.*

Side effects of antiviral meds:

GI Discomfort Seizures Dizziness Headache Renal failure Stevens-Johnson Syndrome Thrombocytopenia

What medicine is used to treat diabetic neuropathy?

Gabapentin (Teurotin), Lyrica

Type A blood are more prone to getting:

Gastric Ulcers

What is pernicious anemia?

Gastric mucosa does not secrete Intrinsic Factor due to either gastric mucosal atrophy or autoimmune destruction of parietal cells. Intrinsic Factor is needed in order for cobalamin (vitamin b12) to be absorbed. Since vitamin b12 cannot be absorbed, a deficiency is formed, resulting in pernicious anemia.

What are the Gastrointestinal and Neuromuscular Manifestations caused by Cobalamin Deficiency? *These manifestations also occur in Pernicious Anemia as that is the cause of cobalamin deficiency*

Gastro: Sore tongue, anorexia, nausea, vomiting, & abdominal pain Neuromuscular: Weakness, paresthesias of feet & hands, ↓ vibratory and position senses, ataxia (loss of control of body movements), muscle weakness, and impaired thought processes

Backward flow of gastric contents from the stomach into the esophagus is known as:

Gastroesophageal Reflux Disease (GERD) *Also might be known as ACID REFLUX or REGURGITATION.*

Parietal lobe is responsible for:

General sensation

To Treat Myasthenic Crisis, we:

Give Anticholinesterase/Cholinergic meds (Mestinon) - drug that inhibits the acetylcholinesterase enzyme from breaking down acetylcholine, thereby increasing the action of acetylcholine, *which helps the muscles to contract.*

1ST LINE OF H. PYLORI TREATMENT:

Give antibiotics and PPI's for 10 days.

Treatment for neurogenic + spinal shock:

Give high doses of methylprednisolone (a steroid) - immunocompromised, diabetics, and those with penetrating injury will not receive this medication - this medication must be given within 8 hours of injury for it to be effective. They give the steroid to reduce swelling.

The main objective in treating patients with hypoxemia and hypercapnia is to:

Give them sufficient oxygen to improve oxygenation

When would we give a Immunosuppressant for Myasthenia Gravis?

Given as a last resort if patient is not responding to any other medications.

When would we give a Corticosteroid for Myasthenia Gravis? Name an example.

Given if patient reacts poorly to Mestinon or during an exacerbation. It's an anti-inflammatory Example: Prednisone

Cortisol is a:

Glucocorticoid

For treatment of Addison's disease, we want to replace Glucocorticoids with (?) and Mineralocorticoids with (?) What time during the day would we administer these replacement steroids?

Glucocorticoids → Hydrocortisone Mineralocorticoids → Fludrocortisone (Florinef) Replacement steroids should be administered in the early morning as this is when the body normally produces them - we want to mimic the body as much as possible.

What is the peak postprandial (after eating) glucose level for a diabetic?

Goal is to be less than 180 mg/dL

Types of Spinal Cord Injuries: Flexion-Rotation

Going forward and twisting to the side (falling off a bike, falling off a horse)

HDL

Good cholesterol (want higher number)

Diet that fights inflammation (good for rheumatoid arthritis) should consist of what foods? What foods should be avoided?

Good for reducing inflammation: whole grains, fresh fruit, vegetables, legumes, seeds, nuts, fish Foods that should be avoided/minimized: Red meats, dairy products, simple sugar foods.

Metabolic disorder which causes urate crystal deposits in the joints and other tissues causing inflammation

Gout

Most common cause of hyperthyroidism:

Graves Disease

Hyperthyroidism VS Graves Disease

Graves' disease is a type of autoimmune problem that causes the thyroid gland to produce too much thyroid hormone, which is called hyperthyroidism. Antibodies cause the immune system to mistakenly attack the thyroid gland. Graves' disease is often the underlying cause of hyperthyroidism

What is the BMI for CLASS 3 OBESITY:

Greater than 40

HDL (good) cholesterol levels in Men:

Greater than 40 mg/dL

HDL (good) cholesterol levels in Women:

Greater than 60 mg/dL

Normal CD4 T cell count

Greater than or equal to 500

If a patient with DVT is not a candidate for anticoagulation therapy, what surgical intervention could be done to minimize the risk of Pulmonary Embolism?

Greenfield Filter/IVC Filter

Highest risk of developing Chronic Gastritis is from:

H. Pylori

Name 1 example of a Thiazide diuretic. What are the side effects? Nursing Interventions?

HCTZ or Hydrochlorothiazide SE's: Constipation, hypokalemia, electrolyte abnormalities, increases uric acid levels. NI's: Not for patients with renal insufficiency - increase potassium intake - protect skin due to photosensitivity - monitor bmp.

What diabetic related complication do these clinical manifestations describe? Hyperosmolality (greater than or equal to 340mOsm/L) Hyperglycemia (greater than or equal to 600mg/dL) Ketosis is minimal or absent Onset slower over several days Physiological Stressor (surgery, infection) Profound dehydration Mental Status Changes Elevated BUN/ Creatinine

HHNS

The most common STI in sexually active young people is:

HPV

Controllable risk factors for CVA:

HTN Atrial fibrillation High Cholesterol Smoking - doubles risk of stroke. Women on birth control pills. Obesity Heavy alcohol consumption Diabetes - 2 to 4x the risk with diabetes.

The best way to prevent the flu/infection:

Handwashing

Disseminated Zoster

Happens to people who are very immunocompromised - only form that can be spread via airborne. The rest is contact.

What would the nurse do to assess for a herniated disc?

Have the client lie on the back and lift the leg, keeping it straight - this action stretches the sciatic nerve - if the patient experiences pain that radiates into the leg, he/she is positive for a herniated disc.

Define Hyperhomocysteinemia

Having elevated homocysteine levels in the blood due to lack of folic acid, vitamin b12, and vitamin b6. This disorder is associated with atherosclerosis and blood clots.

Types of Spinal Cord Injuries: Hyperextension

Head goes back - a higher cervical injury

Types of Spinal Cord Injuries: Hyperflexion

Head goes forward (ex: head on collision)

Symptoms experienced in Hypertensive Crisis: *think HAND

Headaches* Dyspnea Anxiety* Nosebleeds*

Beta 1 receptors are located in: Do they increase/decrease BP?

Heart, Increase BP (vasoconstriction)

For postop care of a patient who received a Transsphenoidal Hypophysectomy, we should NEVER administer:

Heavy dosed narcotics for pain relief as we have to monitor the patient's level of consciousness.

Minerals

Help Build bones and teeth; aid in muscle function & nervous system activity

The cerebrum is composed of 2 (?)

Hemispheres - a right hemisphere and a left hemisphere. Within each hemisphere are lobes.

4 Risks of Angiography:

Hemorrhage Thrombosis Renal impairment Allergic reaction

tPA should not be given to someone who has had what type of stroke:

Hemorrhagic stroke

If someone is hemorrhaging, what will ADH do?

Hemorrhaging indicates MORE substances and LESS fluids - ADH will be released to help us try to retain fluid that is being lost.

What is the purpose of giving Heparin/Lovenox to someone that has DVT?

Heparin and Lovenox *DO NOT DISSOLVE THE CLOT*. It thins the blood and prevents the clot from becoming larger.

There is no vaccine to prevent and no Immunoglobulin to protect people who were exposed to:

Hepatitis C

Tylenol

Hepatotoxicity (monitor LFT's and bilirubin); analgesic and antipyretic effects (no anti-platelet) MAX DOSE: 3000 mg

Saw Palmetto

Herbal therapy that provides symptom relief of BPH - it increases urinary flow and decreases post void residual - it decreases the conversion of testosterone to DHT (dht stimulates growth of the prostate) - Better tolerated, less expensive and may be as effective as medication - SEs: GI, increase risk of bleeding, stop taking prior to dental or surgical procedures.

Mild Anemia Levels & Symptoms

HgB Levels: 10-12 Symptoms: may exist without symptoms - if patient experiences symptoms, it is because they have an underlying disease or their body is compensating - these symptoms would include: palpitations, dyspnea, and mild fatigue

Moderate Anemia Levels & Symptoms

HgB Levels: 6-10 Symptoms: Cardiopulmonary symptoms are increased - may be experienced during rest or activity

Severe Anemia Levels & Symptoms

HgB Levels: Less than 6 Symptoms: the patient will have many different symptoms involving multiple body systems.

If someone has a serum sodium level of 150+, what will ADH do?

High Sodium indicates MORE substances and LESS fluid - ADH will be released because we want to hold onto the fluid we have.

What diet should someone with IBD be on?

High calorie, high protein, low residue (aka low fiber) diet

Are CVAD's used to administer high volumes or small volumes?

High volumes

The higher the cardiac output, BP will be:

Higher

What is the *highest* score on the Glasgow Coma Scale and what does it indicate? What is the *lowest* score on the Glasgow Coma Scale and what does it indicate?

Highest score: 15 - this indicates normal eye opening, motor, and verbal responses. Lowest score: 3 - this indicates the worst level of neurological functioning. *A score of 8 or below indicates neurological disturbances*

A mediator that supports the inflammatory process in asthma and is secreted by mast cells.

Histamine

How do we diagnose appendicitis?

History and Physical Abdominal ultrasound CT with Oral Contrast Abdominal MRI Blood work (look for elevated WBC count)

How to diagnose BPH:

History and physical exam (Digital Rectal Exam) Lab work - *Prostate Specific Antigen* (not that reliable anymore - high levels found in blood indicate prostate cancer) and *creatinine* to check kidney function. Transrectal Ultrasound (TRUS) Uroflowmetry - patient urinates into device and device measures pressure of the urine stream Post Void Residual (PVR) VCUG

List the 8 Risk factors for pulmonary embolism:

History of thromboembolism (VTE) Recent surgery Central Venous Catheters Long bone fractures (fat embolus) Immobility Estrogen therapy Malignancy (prostate and lung) Obesity

What determines the severity of Anemia?

How fast you become Anemic

MODIFIABLE risk factors for CAD:

Hyperlipidemia - high cholesterol Hypertension - elevated bp Cigarette smoking - causes direct inflammation of the arteries Physical inactivity - activity strengthens heart and keeps weight down. Obesity Diabetes Elevated homocysteine and CRP level

70% of people diagnosed with Myasthenia Gravis have:

Hyperplasia (enlargement) of the Thymus Gland which causes increased production of the antibodies that block Acetylcholine receptor sites.

Persistently Increased Systemic Vascular Resistance is the hallmark sign of:

Hypertension

Secondary hypertension is a contributing factor of:

Hypertensive Crisis

In what cases would we potentially see Respiratory Alkalosis?

Hyperventilation

What can occur without parathyroid glands?

Hypocalcemia

What diabetes complication do the following symptoms represent? (diabetic ketoacidosis/hyperglycemia/hypoglycemia) Lightheadedness Inability to concentrate Headache Confusion Slurred speech Impaired coordination Combative behavior Double vision Drowsiness Tachycardia

Hypoglycemia

This gland controls the pituitary gland:

Hypothalamus

Rome III Criteria is a medical aid to help diagnose:

IBS

What antibiotics are used to treat TB?

INH, Rifampin

What lab value is assessed for patients on Coumadin?

INR (Normal range is between 0.75-1.25 but we want patients on Coumadin to have a therapeutic range between 2-3)

How do we administer Vitamin K?

IV, IM, PO, SUBQ

How can Vitamin K be given? (Antidote for Coumadin)

IV/SUBQ injection - IV is only given for emergencies. Use Z-track technique as it can stain the skin orange.

Common Sites of Atherosclerotic Lesions

Iliac artery Femoral artery Popliteal artery Tibial artery Peroneal artery

Ventilation Perfusion Mismatch

Imbalance between pulmonary ventilation and perfusion; The alveoli are being ventilated but are not being perfused (no blood flow) or vice versa - this in turn leads to tissue hypoxia

What are some things we can do to manage Hypoglycemia? (For a conscious patient, an unconscious patient, & a hospitalized patient)

Immediate for Conscious Patient: - Snack of 15 g fast acting carbohydrate - Reassess in 15 minutes; repeat snack if needed Patient unable to swallow or Unconscious: - Glucagon 1mg IM or subq: short acting follow with snack Hospitalized Patient: - D50W 25 to 50 mL Intravenous Push (IVP) at a rate of 10 mL/min. **Must have functioning IV

We should instruct our patients to immediately report what signs and symptoms after PCTA surgery?

Immediately report signs and symptoms of angina (including chest pain), infection, fluid overload (tachycardia, dyspnea, edema), and abrupt arterial reclosure (chest pain, ECG changes).

Name the 13 risk factors for DVT:

Immobility Orthopedic surgery: Knee/hip replacement Obesity Hypercoagulability History of prior clots Smoking Pregnancy Estrogen therapy: oral contraceptives and steroids Neoplasms/Cancers Heart disease: Afib, Congestive HF. Trauma Advanced Age Atrial fibrillation

Define Rheumatoid Arthritis

Immune mediated, chronic, inflammatory disease - a systemic autoimmune problem where Rheumatoid factor (RF) antibodies form against IgG and attack body's own synovial fluid & joints. The synovial membrane becomes inflamed. *What makes this different from Osteoarthritis is that this is a chronic autoimmune disease and inflammatory disorder - Osteoarthritis is non-inflammatory and not autoimmune.*

How do we treat aplastic anemia?

Immune therapies and bone marrow transplantation can be curative.

What happens if we don't properly manage pain?

Immunity goes down, wounds don't heal properly, DVT can happen (no exercise), and atelectasis (no exercise)

Acute Glomerulonephritis

Immunologic response triggers inflammation The acute phase usually lasts 2 weeks - symptoms will begin to appear.

A characteristic of ALS that is not seen in MS is:

Impairment of respiratory system

What is the primary focus of the nurse for a patient with bronchitis?

Implementing measures to clear pulmonary secretions.

Reflex/Spastic Neurogenic Bladder

Impulses cannot travel from lower spinal cord to cortex because of UMN lesion - common in injuries that occur above the sacrum - ex: spinal cord injury patients, MS patients, and even stroke patients. Reflex arc is intact, meaning any kind of stimulus will cause the bladder to become spastic. The result is uncontrolled expulsion of urine without complete emptying (urinary incontinence + retention)

In what disease will we see Heberden's Nodes & Bouchard's Nodes?

In Osteoarthritis

After amputation, what are the steps to obtaining a proper Prosthetic?

In order to get a prosthetic, the stump must be healed - after amputation, stump should be elevated on one thin pillow. Ace wrap is wrapped around stump to help form the shape that will fit inside the prosthetic. Patient will fit in final life long prosthetic 6 months after amputation.

When is the best time of day to take antihypertensive medications?

In the morning

What time of day should we apply compression stockings?

In the morning before getting out of bed.

Which type of voiding dysfunction is seen in clients diagnosed with Parkinson disease?

Incontinence

Does Vasoconstriction increase or decrease BP?

Increase

Syndrome of Inappropriate ADH (SIADH) is caused by a (increase/decrease?) production of ADH.

Increase (Excessive Release) - this means the body will retain large amounts of fluid.

What should we do Post barium enema?

Increase Fluids & take laxatives to expel barium (barium can cause constipation and impactions - it needs to come out!)

To prevent refeeding syndrome:

Increase feedings at a very slow rate

Why would someone with anemia experience Jaundice?

Increase in concentration of serum bilirubin

Thyroid Gland Functions:

Increase metabolism (increase oxygen consumption, increase heat production, increase sympathetic nervous system) & increase energy requirements

What do Alpha 1 antagonists do? What is their common ending? Name an Example. What are the side effects? Nursing Interventions?

Increase vasodilation commonly end in -sin Example: Prazosin SE's: first dose syncope, hypernatremia, hypervolemia, priapism (persistent + painful erection) NI's: start dose slowly and then titrate; monitor BP for 2 hours after initiation of treatment because it can cause orthostatic hypotension.

People who develop Gestational Diabetes during pregnancy have a (lessened/increased?) risk of developing Type 2 Diabetes in the future.

Increased

Increase in Cardiac Output and Systemic Vascular Resistance =

Increased BP

All DMARDS have what side effect on patients?

Increased risk for infection because it is suppressing the body's immune system.

What are some general indicators of Diabetes?

Increased thirst Increased urination Increased hunger Unexplained weight loss Fatigue Irritability Blurred Vision Slow Healing Cuts & Bruises

What is Norepinephrine's function?

Increases BP & vasoconstriction

What is Epinephrine's function?

Increases HR & vasodilation

Glitinides (Meglitinides)

Increases pancreatic insulin release Medication should not be taken if meal skipped Example: repaglinide (Prandin) Side effects: Hypoglycemia GI symptoms Upper Resp. Infection Back pain Headache

When would we give parenteral iron? How is parenteral iron given? What is something to be aware of for parenteral administration? How long should this therapy continue?

Indicated for malabsorption, oral iron intolerance, need for iron beyond normal limits, poor patient compliance. Given via IV or IM injection. Something to be aware of is that IM injections may stain the skin. Z-Track technique prevents this. 2-3 months after hemoglobin levels return to normal.

A sign that the PPD is positive for Tuberculosis is that the site becomes (?) after 48-72 hours.

Indurated (Hard)

The most common cause of death in patients with chronic neuromuscular disorders is:

Infection

Define LOWER Urinary Tract Infection

Infection that affects the bladder, urethra, or the prostate (for males) - may see cystitis, urethritis, prostatitis.

Define UPPER Urinary Tract Infection

Infection that affects the kidneys or ureters - may see Pyelonephritis, renal abscesses, Ureteritis.

Define Hospital Acquired Infections (HAI's)

Infection that the patient did NOT come in with, but was obtained during their stay in the hospital - a common and unfortunate cause of HAIs is from poor practices among health care providers. (Ex: UTI's caused from insertion of urinary catheters)

Osteomyelitis

Infection within the bone.

Glomerulonephritis

Inflammation of the glomeruli within the kidney - can be acute or chronic - *Glomeruli are the functional unit of the kidneys - they remove waste from kidneys*

How to treat Irritable Bowel Disease:

Inflammatory Medications

What "Biologic" Medication is used for Ulcerative Colitis?

Infliximab (Remicade)

What are some examples of Combination Inhalers?

Inhaled Corticosteroid & Long-acting Beta2 Adrenergic Agonists: - Fluticasone/salmeterol (Advair): Inhaled via MDI/DPI - Budesonide/formoterol (Symbicort): Inhaled via MDI Short Acting Muscarinic Anticholinergic (SAMA) & Short-acting Beta2-Adrenergic Agonists (SABA) - Ipratropium/albuterol (Combined it is known as DuoNeb): Inhaled via MDI or nebulizer - can be used for acute exacerbations - commonly used in hospital

What do Alpha 2 Agonists do? Name an example. What are the side effects? Nursing Interventions?

Inhibit reuptake of norepinephrine. Decreases SVR (Systemic vascular resistance) and BP. Not first line treatment. Example: Clonidine SE's: hypernatremia, hypervolemia, sedation, orthostatic hypotension, constipation, drowsiness, impotence. NI's: Monitor BP, Monitor for orthostatic hypotension

If t4/t3 are high, TSH will be:

Inhibited

NSAIDs

Inhibits the synthesis of prostaglandins - the release of prostaglandins in tissues causes pain, edema, and inflammation. By inhibiting the synthesis of prostaglandins, anti-inflammatory drugs decrease inflammation and pain. GI disturbances - not recommended in those with advanced renal disease - GI bleed may occur especially in older adults.

Lovenox (low molecular weight heparin) - define and state who is a candidate for this medication.

Inhibits thrombin formation due to reduced factor IIa activity and enhanced inhibition of factor Xa and thrombin. Candidates: stable, low risk for bleeding, adequate renal function

In a patient with asthma, when will you hear wheezes (inspiration or expiration)?

Initially on EXPIRATION and as it progresses then on INSPIRATION as well.

Why is Raynaud's Phenomenon also called Red, White, and Blue disease?

Initially, fingers turn white due to lack of blood flow. Then they turn blue due to lack of oxygen. Then they turn red when blood flow returns. *WHITE, BLUE, RED*

Cystolitholapaxy

Instrument is inserted into the urethra that breaks up kidney stones

Type 1 diabetics are dependent on:

Insulin

How Insulin Works Explained

Insulin is like the "key" that opens the door for glucose to enter into the cell and be utilized by the cell for energy. Without insulin, glucose stays in the blood and does not enter the cell. The cell will use other things for energy - proteins and fats. This explains why people with diabetes lose weight.

A patient on tPA (thrombolytic therapy) shows changes in their level of consciousness. What does this indicate?

Intracranial Hemorrhage (the most severe side effect of thrombolytic therapy)

The most serious complication of thrombolytic therapy is:

Intracranial bleed

For postop care of a patient who received a Transsphenoidal Hypophysectomy, we want to make sure that the patient DOES NOT INCREASE (?) :

Intracranial pressure - ICP can be increased through coughing, sneezing, valsalva maneuver, and sucking through a straw.

People with GERD can lose their (?) making them incapable of metabolizing vitamin B12 and they will then need injection treatments.

Intrinsic Factor

In Guillain-Barré Syndrome, if patient's diaphragm becomes paralyzed, we must:

Intubate them and put them on a ventilator.

The "gold standard" for diagnosing PAD is:

Invasive Digital Angiography

Define Iodine drugs - what do they do, is the treatment short term or long term, and when are they most commonly given? Name 1 example. What is something we can inform the patient about in regards to this type of medication?

Iodine drugs, prescribed to treat Graves disease, decrease the size and vascularity of the thyroid gland. Not a long term treatment. Often given before surgery to have thyroid be as normal as possible. Example: saturated solution potassium iodine (SSKI) Medication is liquid and can stain teeth - should be drank through a straw.

What type of Anemia is common among pregnant/breastfeeding women and why?

Iron Deficiency Anemia because the baby is consuming most if not all of the mother's iron through the breast milk.

In stasis dermatitis, what is responsible for the brownish discoloration of the extremity?

Iron Deposits

Diseases or surgery that alter, destroy, or remove the absorption surface of the Duodenum causes (?) due to the fact that this area is where iron absorption occurs.

Iron-Deficiency Anemia

A condition characterized by inflammation of the intestinal system

Irritable Bowel Disease

Not a true disease, but a functional disorder presenting with vague GI symptoms.

Irritable Bowel Syndrome

What are the 2 different types of strokes?

Ischemic & Hemorrhagic

Neutropenic precautions

Isolation procedures to protect an immunocompromised patient from infections

How is Computed tomography venography (CTV) used in diagnosing DVT's?

It is a more invasive procedure that is used to detect blood clots within the veins - Veins are injected with dye and then an x-ray is taken. Always ask about allergies to shellfish and inquire about kidney function before this procedure.

Define Hypothyroidism

It is a natural deficiency in thyroid hormone; underactive thyroid gland

The pituitary gland is known as the "master gland" because:

It is in charge of secreting certain hormones, and is also in charge of telling other glands to secrete hormones. The hormones secreted stimulate an organ.

When would we use sublingual nitroglycerine tablets/sublingual nitroglycerine spray?

It is only used during episodes of angina and as needed. Not used for prevention.

Why would we perform a CBC on someone if we wanted to diagnose respiratory disorders?

It looks for infection/rules out other possibilities.

Although it is not the most common method for diagnosing Gout, what is the *GOLD STANDARD* for diagnosing Gout?

Joint Aspiration - Aspirating the site with a needle to assess for crystals

What electrolytes are imbalanced in Crohn's disease?

K, Mg, Ca, Albumin

The most common site for calculi formation is the:

Kidney

Types of Spinal Cord Injuries: Penetrating

Knife wound, gun shot wound

Most popular area of backpain/most common area for herniations:

L4, L5, S1

Triglycerides have a direct correlation to:

LDLs If one is high, the other will be high.' If one is low the other will be low.

In Ulcerative Colitis, where is pain felt?

LLQ

In diverticulitis, where is the pain felt?

LLQ.

6 Ways to Diagnose Osteomyelitis:

Labs - CBC to check WBC. ESR to check inflammation. Blood/wound culture* NECESSITY - want to know what is causing infection to treat it appropriately. Hang broad spectrum antibiotic and then when culture comes back we can switch antibiotic to exact one that is needed. X-ray findings *Radioisotope bone scans* - definitive diagnosis *MRI* - definitive diagnosis *Gold standard Diagnostic: Needle Biopsy of Bone - allows us to see what infection is inside the bone.

Define Anemia

Lack of RBC's or lack of hemoglobin or BOTH

Define Ischemic Stroke

Lack of blood flow to a certain area of the brain caused by a blockage (clot.)

The left hemisphere of the brain is responsible for:

Language (2 speech areas - Broca's & Wernicke's - are located in the left hemisphere)

Deficiency of ADH causes:

Large amounts of fluid loss

Increased production of ADH causes:

Large amounts of fluid retained

Acute Back Pain

Lasting less than 3 months

Chronic Back Pain

Lasting more than 3 months

Osmolality of a Hypotonic Solution?

Less than 280 mOsm/L

On a scale from 1-10, what is mild pain?

Less than 3

For a diabetic, their A1C test results should be:

Less than 7%

Refeeding Syndrome

Lethal condition when patients have not eaten for 7-10 days. The body has been deprived of food for a long time and is in a starvation state (body is feeding on itself to survive). When food is introduced to these patients, their insulin spikes and electrolytes begin to decrease. They can die.

When reading the dipstick diagnostic chart, what will be present if there is an infection?

Leukocytes & Nitrites

Antihypertensive medications are prescribed when:

Life style modifications were unsuccessful for first 3 months (when BP reaches 150/90)

A patient with Glomerulonephritis is placed on the renal diet. What does this consist of?

Limiting proteins, sodium, and fluids.

If we want someone on TPN to get fats, we would administer:

Lipid Emulsion

This treats/prevents essential fatty acid deficiency

Lipid Emulsion

What are some diagnostics that indicate malnutrition?

Lipid profile Serum electrolytes Complete blood count (CBC) Vitamin & mineral levels: - B12 (190-900 ng/mL) - Vitamin D (20-50 ng/mL) - Calcium (8.5-10.5 mg/dL) - Thiamine (B1) (70-200nmol/L)

omega-3 acid ethyl esters (Lovaza)

Lipid-regulator agent: Action: Decreases triglycerides Side effects: altered taste, increased liver enzymes, rash Nursing: assess liver enzymes, may increase bleeding when used with aspirin and warfarin

Name 1 example of an ACE Inhibitor. What is their common ending? What are the side effects? Nursing Interventions?

Lisinopril. Commonly end in -pril. SE's: Hyperkalemia, dry cough, angioedema, renal insufficiency (renal failure), HF NI's: Avoid increased potassium intake, take 1 hour before meals, measure bp before giving, do not abruptly stop taking

List the following for HBV (Hepatitis B) Mode of transmission: Incubation: Immunity: Signs & Symptoms: Outcome: Precaution:

List the following for HBV (Hepatitis B) Mode of transmission: Body fluid, parenteral, sexual contact, highly transmitted through blood (needles + sexual contact) Incubation: 60-150 days Immunity: Vaccine available Signs & Symptoms: A person is either asymptomatic or experiences insidious symptoms such as: Joint pain, rash, anorexia, sleep disturbances, fever, dyspepsia, URQ pain, flu-like symptoms Outcome: Can be severe, increased risk of chronic liver disease and cancer Precaution: Standard

List the following for HCV (Hepatitis C) Mode of transmission: Incubation: Immunity: Signs & Symptoms: Outcome: Precaution:

List the following for HCV (Hepatitis C) Mode of transmission: Blood and blood products, sharing needles, sexually Incubation: 14-160 Days Immunity: No vaccine to protect against it Signs & Symptoms: Similar to HBV. Outcome: Chronic disease, carrier, and increased risk of liver cancer. Precaution: Standard

Because of the serious infection risk that comes with Biologic Therapy, patients must avoid getting:

Live vaccines

What organ release glucose into the blood?

Liver

Uric acid creates (?) in areas where uric acid has been deposited.

Local inflammation

Are CVAD's used for long term or short term use?

Long term

What do Leukotriene Modifiers do? Long term/short term use? What is an example of a Leukotriene Receptor Blocker? What is an example of a Leukotriene Synthesis Inhibitor?

Long term asthma control medication - stops action of leukotrienes - decreases inflammatory response - not used to treat acute exacerbations. Leukotriene Receptor Blocker: Montelukast (Singulair) Leukotriene Synthesis Inhibitor: Zileuton (ZyfloCR) *Liver toxicity can occur - monitor liver enzymes

What do Long-acting Beta2 Adrenergic Agonists (LABAs) do? Can be used for co-therapy with: Long term/short term use? Not used for the treatment of: Side effects include: What is an example?

Long term control in moderate to severe persistent asthma Co-therapy with Inhaled corticosteroids for asthma Not used for the treatment of acute exacerbations Side effects include headache, dry throat, tremor, dizziness, pharyngitis Example: Salmeterol (Serevent)

XOI's like allopurinol (Zyloprim) & febustat (Uloric) - function, side effects, nursing considerations.

Long term treatment of chronic gout - *Prevents* uric acid in the blood by blocking uric acid formation Side effects: - Increases action of antidiabetic agents (could cause hypoglycemia, diabetics should monitor blood sugar) - hypotension - hepatitis - bone marrow depression - N/V - flushing - rash - increases theophylline toxicity Nursing Considerations: With allopurinol, increase fluid intake - patient should drink 3000 mL of fluid per day.

Treatment for Chronic Pyelonephritis:

Long-term prophylactic antibiotic - urinary analgesic: phenazopyridine - monitor renal function - if patient is hospitalized, measure strict I&O's, ensure patient is drinking 3-4 liters of fluids per day, and assess their temperature every 4 hours. Educate patient on medications they will go home with.

Ultrasound for diagnosing Carpal Tunnel Syndrome

Looks for impairment in movement of median nerve

What does a PaO2 of 30 mm Hg indicate?

Loss of Consciousness

Complete spinal cord injury

Loss of all sensory, proprioception (ability to know where your body is), & voluntary motor activity

Define Spinal Shock

Loss of spinal reflexes - result of disruption of communication between lower and upper motor neurons - flaccid paralysis occurs.

Receptive Aphasia (Wernicke's)

Loss of the individual's ability to comprehend what has been said to him/her by someone else - the words the patient is hearing do not make sense - this is due to damage of Wernicke's Area, located in the left hemisphere of the brain.

Define Neurogenic Shock and list the signs + symptoms.

Loss of vasomotor tone & impairment of autonomic function - sympathetic tone lost below level of injury - Commonly seen in high cervical/high thoracic injuries (above T6/T7) - the higher the injury the more chance of neurogenic shock. S/S: hypotension, bradycardia, warm & dry skin Monitor patients with neurogenic shock closely for fevers.

There is a lower incidence of HIT when taking:

Lovenox

What is more dangerous to a client presently: a *low* glucose level or a *high* glucose level? Why?

Low glucose level; lowers more quickly and can lead to *L*oss *O*f *C*onsciousness/ Seizures.

What electrolyte and nutrient alterations occur in refeeding syndrome?

Low magnesium, low phosphate, low potassium, low thiamine Hyperglycemia Salt and water retention (oedema) Fatty liver

If someone has a serum sodium level of 129, what will ADH do?

Low sodium indicates that there is MORE fluid and LESS substance - ADH will be inhibited so that the excess fluid can be expelled.

The lower the cardiac output, BP will be:

Lower

Flaccid Bowel

Lower motor neuron disease/injury - Defecation occurs infrequently and in small amounts - stool may become hard from just sitting in intestines and fecal impaction can occur.

Insulin (raises/lowers?) glucose levels.

Lowers

Define Discoid Lupus Erythematosus (DLE)

Lupus that affects the skin only - will have skin rash/discoid lesions.

interferon beta-1A (Avonex) treats:

MS

This Corticosteroid, Prednisone, treats:

MS exacerbations

Give the chemical makeup for these Antacids: Maalox - Mylanta - Tums - Pepto Bismol - Rolaids -

Maalox (aluminum & magnesium based) Mylanta (aluminum & magnesium based) Tums (Calcium) Pepto Bismol (Calcium) Rolaids (Calcium)

List possible side effects of: Maalox - Mylanta - (why would they have these side effects?)

Maalox and Mylanta can both cause constipation and diarrhea. This is because the chemical makeup for both is *aluminum* and *magnesium*. Aluminum causes constipation Magnesium causes diarrhea

Immunosuppresant Therapy

Maintains remission - USUALLY USED FOR IBD. PREVENTS RELAPSE - These medications provide better quality of life - THIS IS ONLY GIVEN IF DOCTOR FEELS BENEFITS OUTWEIGH THE RISKS.

What is the function of Aldosterone?

Maintenance of Extra cellular fluid volume by promoting sodium absorption and potassium excretion. (Helps you hold onto sodium and get rid of potassium)

Who is at risk of getting PUD?

Major illness/trauma/surgical patients - Stress Related Mucosal Disease (SRMD) Those born with it - Genetic - Type A blood: more prone to gastric ulcers - Type O blood: more prone to duodenal ulcer - Family history Gastric or duodenal mucosal defects Cigarette smoking or use of smokeless tobacco Exposure to irritants High stress Medications Normal aging Those who eat Spicy foods, drink milk + caffeine Those with Chronic respiratory or kidney disease Elderly over age 60

Risk factors for Renal Calculi:

Male (more common in men) May have reoccurrence after having an incident Hyperparathyroidism Hypercalcemia - the most common types of stones are made of calcium. Hyperuricemia - high uric acid Genetic Spring/Summer season - more risk of becoming dehydrated & dehydration leads to calculi.

ALS is more common in what gender?

Males

Cellular imbalance between supply of nutrients/energy and the body's demand for them

Malnutrition

What are the 4 main arteries used for bypass grafts?

Mammary in chest wall, saphenous vein, thoracic & radial artery.

Treatment just for Flaccid Bowel (Caused by LMN lesions)

Manual Removal - finger is inserted into the rectum and stool is removed.

Define C-Reactive Protein (CRP)

Marker of inflammation - not a diagnostic tool

If we suspect someone has DVT, we should never:

Massage their legs as it can dislodge any clots that may have formed

What is Prealbumin? What is the proper levels?

Measure nutritional status at that exact moment in time; females: 17-31 males: 19-37

What do serum electrolytes & blood glucose levels screen for?

Measurement of serum electrolytes, especially *potassium*, is important to detect *hyperaldosteronism*, a cause of secondary hypertension. Blood glucose levels assist in the diagnosis of Diabetes Mellitus.

What is creatinine? What is the proper levels?

Measures kidney function; 0.6-1.4

What is Albumin? What is the proper levels?

Measures nutritional status from the past couple of months; 3.5-5

NIH Stroke Scale

Measures several aspects of brain function - consciousness, vision, sensation, movement, speech, and language - takes about 10 to 15 minutes to complete - is not used for emergencies.

Foods containing zinc:

Meat, seafood

Who is the person to change the first surgical dressing after the skin graft operation?

Medical Doctor

Bristol Stool Chart

Medical aid to classify stool.

Preoperative Nursing Interventions for both Total hip arthroplasty (THA) & Total knee arthroplasty (TKA)

Medical/surgical history Assessment Patient Education - tell them they will be ambulating as soon as they return to unit, pain meds. Antibiotics prior and/or prophylactic Chlorhexidine/antiseptic soap skin prep

This group of disorders is caused by impaired DNA synthesis (which if DNA synthesis is impaired, defective RBC maturation results) and characterized by megaloblasts (large/macrocytic abnormal RBCs). Majority of these disorders result from deficiency in Cobalamin (Vitamin B12) and folic acid.

Megaloblastic Anemias

In healthy older men, a modest decline in hemoglobin of about (? g/dL) occurs between ages 70 and 88 years, in part because of the decreased production of testosterone. Only a minimal decrease in hemoglobin occurs between these ages in healthy women (about ? g/dL).

Men: 1 g/dL Women: 0.2 g/dL

Waist circumference that indicates obesity in men/women:

Men: >40 Women: >36

Flaccid Neurogenic Bladder

Message that bladder is full gets to brain but bladder cannot interpret the message due to LMN lesions, so it remains flaccid - Damage to reflex arc - loss of sensation of bladder fullness results in overfill & distention of bladder - Can occur in those with spinal cord injuries (paraplegics that have an S2-S4 Injury will see a flaccid bladder, & in some diabetic patients with BPH)

What is important to remember when administering Mestinon for Myasthenia Gravis?

Mestinon must be given ON TIME or symptoms of MG can rapidly worsen.

Osteoporosis

Metabolic Bone disorder - loss of bone is greater than new bone being formed.

(?) is the first choice in treatment for Rheumatoid Arthritis.

Methotrexate

Name 1 example of a Beta Blocker What is their common ending? What are the side effects? Nursing Interventions?

Metoprolol Commonly end in -olol SE's: masks hypoglycemia, masks bradycardia, bradycardia, fatigue, bronchospasm, heart block, cold extremities. NI's: Never abruptly stop taking this medication, even before surgeries. Abruptly stopping this medication can cause rebound HTN and tachycardia. Do not use in patients with asthma/COPD. Diabetics need to monitor glucose levels as this medication masks signs of hypoglycemia. *HOLD MEDICATION IF HR IS LESS THAN 60.*

What is the equation used to calculate BMI?

Metric: BMI = weight (kg)/height(m^2) Other: BMI = weight (lbs) x 703 / height (inches^2)

What age group is commonly affected by Graves disease?

Middle age - 20's, 30's, 40's.

When is the onset of pernicious anemia?

Middle age or later (After 40) - 60 is the most common age of diagnosis

Type 2 diabetes is commonly seen in what population?

Middle aged adults and older (40+) (It is now being seen in younger people, even children, due to the increasing obesity epidemic)

Jejunum

Middle portion of the small intestine between the duodenum and the ileum

Levels of Hemoglobin for Mild, Moderate & Severe Iron-Deficiency Anemia What happens if HgB drops below 8?

Mild: HgB 10-12 Moderate: HgB 6-10 Severe: HgB < 6 If HgB drops below 8, blood transfusion is required.

Early stages of MS result in:

Minimal nerve damage

Transurethral needle ablation (TUNA)

Minimally invasive procedure that treats BPH - A needle is inserted into the urethra and increases the temperature of the area as well - the needle itself is heated.

Transurethral microwave thermotherapy (TUMT)

Minimally invasive procedure that treats BPH - a catheter is ascended into the urethra - this catheter emits microwaves/heat around the area which heats up to 113 degrees Fahrenheit which burns & distinegrates the tissue surrounding the catheter.

A synthetic prostaglandin with antisecretory and protective effects

Misoprostol (Cytotec)

List the following for HAV (Hepatitis A) Mode of transmission: Incubation: Immunity: Signs & Symptoms: Outcome: Precaution:

Mode of transmission: Fecal-Oral Route Incubation: 14-35 days Immunity: Vaccine available Signs & Symptoms: - Asymptomatic flu-like, GI upset - Preicteric phase: It has not affected the liver yet - May see: Dark urine, jaundice, tender liver (not seen in Preicteric phase) Outcome: Mild, high recovery rate - not chronic Precaution: Contact Enteric Precautions *HEV is similar to HAV*

What type of activity is usually prescribed for someone with Osteoarthritis?

Moderate activity - aerobic exercises like swimming are a good choice

If a diabetic is going to exercise, what should they do before and after?

Monitor glucose levels and eat a snack both before and after

A BMI greater than 40 or 100 lbs overweight indicates:

Morbid Obesity

How much residual urine is strongly associated with the risk of infection?

More than 100 mL

Osmolality of a Hypertonic Solution?

More than 300 mOsm/L

What is the most accurate way to classify Anemias?

Morphologic System (Focusing on the cellular characteristics)

Extracorporeal shock wave lithotripsy (ESWL)

Most common way to treat + get rid of renal calculi Shock waves break up stones so they are more easily passed

The descending tracts of the spinal cord are for:

Motor pathway

Prostaglandin Analog & Mucosal Barrier - name an example of each, their side effects, and nursing considerations. *administered together for treatment of peptic ulcer disease*

Mucosal Barrier: Sulcrafate (Carafate) Prostaglandin Analog: Misoprostol (Cytotec) - Particularly useful in treating ulcers caused by NSAIDs. *CAN CAUSE MISCARRIAGES* *Avoid medications 2 hours before or after taking this medication* SIDE EFFECTS OF THIS COMBINATION: constipation, nausea

A chronic disease of the CNS characterized by degeneration & loss of myelin in the brain, spinal cord, & cerebrum.

Multiple Sclerosis

If we want someone on TPN to get Vitamins, we would administer:

Multivitamin infusion

Acetylcholine Stimulates:

Muscle contraction

Name 5 different kinds of pharmacologic therapy for pain relief:

Muscle relaxants Anti-inflammatory drugs Non-narcotic analgesics Nerve blocks Epidurals

Droplet Precautions

Must be followed for a patient known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing, sneezing, talking, or laughing.

A disease of the neuromuscular junction characterized by fluctuating weakness of certain skeletal muscles - It is an autoimmune process caused by antibodies that block acetylcholine receptor sites at the neuromuscular juction, therefor preventing acetylcholine molecules from attaching to the receptors & allowing for muscle contraction to occur.

Myasthenia Gravis

This cholinergic medication, pyridostigmine bromide (Mestinon), treats:

Myasthenia Gravis

Define Stable Angina Pectoris

Myocardial Ischemia - oxygen demand is greater than oxygen supply, usually as a result of obstruction.

As BP increases, so does the risk for:

Myocardial infarction (MI), heart failure, stroke, and renal disease.

Homonymous Hemianopsia is also known as:

NEGLECT or "Amorphosynthesis" (anosognosia)

Should we use inflammatory medications to treat Irritable Bowel Syndrome?

NO - there is technically no inflammation present with IBS.

IBS is characterized by:

NOT INFLAMMATION, but spastic twisting of certain areas in the intestines.

What medications are taken for SLE?

NSAIDS and Aspirin Corticosteroids - Topical for skin rash - Oral (prednisone) and IV (methyprednisone) *Not used to prevent* Immunosuppressive agents - Azathioprine (Imuran) - Cyclophosphamide (Cytoxan) - Methotrexate (DMARD) Anti-malarial - Hydroxychloroquine (Plaquenil) - Chloroquine (Aralen)

What are some common medications that may cause GERD?

NSAIDS, steroids, certain antibiotics, antihypertensive meds

What "Biologic" Medication is used for Crohn's disease?

Natizumab (Tysabri)

Symptoms that identify Gastritis:

Nausea Vomiting Anorexia A feeling of fullness/Loss of appetite Weight loss from loss of appetite/not eating Pain in the stomach area

For postop care of a patient who received a Transsphenoidal Hypophysectomy, we need to replace:

Necessary Hormones (ex: *ADH & thyroid hormones* will need to be replaced because the pituitary gland is no longer there to produce them. *All adrenal gland hormones* will need to be replaced as well, because pituitary is no longer present to tell the adrenal gland to send out hormones. Entire pituitary removed = will need replacements hormones for life. Partial removal of pituitary may not indicate the need for replacement hormones for life.)

Gold Standard for diagnosing Osteomyelitis:

Needle Biopsy of Bone

A fatal complication of SLE is:

Nephritis

Late stages of MS result in:

Nerve impulses are completely blocked.

WE SHOULD NEVER GIVE A TAP WATER ENEMA TO WHO AND WHY?

Never give tap water enemas to someone with a spinal cord injury because it can perforate their bowel - spinal cord injury patients cannot tell you when they feel like they have to go.

Intestinal Transplant

New procedure - the colon/large intestines of a cadaver are surgically implanted into the patient.

niacin (Niaspan)

Nicotinic acid derivative - B Vitamin Action: decreases lipoprotein and triglyceride levels. Can cause peripheral vasodilation Side effects: flushing of face and neck, blurred or loss of vision, orthostatic hypotension, hepatotoxicity, GI upset, hyperglycemia, increased uric acid Nursing: take with aspirin or an NSAID to decrease side effects, can increase blood sugar and uric acid levels. Monitor of liver enzymes.

Carpal Tunnel Syndrome pain occurs mainly at:

Night

In PAD, pain is worse during what time of day?

Night time

What 2 things do the following? - help maintain low arterial tone - inhibit growth of smooth muscle layer - inhibit platelet aggregation

Nitric Oxide and Prostacyclin

Can lantis or "long acting" insulins be mixed with other insulins?

No

If the time frame of when stroke symptoms started are unknown, is the patient a candidate for tPA?

No - tPA works most effectively with minimal side effects when it is administered within 4.5 hours after the onset of symptoms.

Biguanides

No effect on pancreatic beta cells Decreases liver glucose output Some decrease in insulin resistance Not for clients with renal impairment Avoid alcohol and contrast dye metformin (Glucophage) Side Effects: Hypoglycemia GI symptoms- Nausea/Diarrhea/Abdominal pain Possible acute pancreatitis

Stroke in the cerebrum (and death of cerebrum tissue) causes:

No higher level of thinking (the person cannot speak and may or may not be breathing on their own) leaving us with only brain stem functioning.

Ketosis explained:

No insulin being produced results in cells not being able to use glucose; cells deprived of glucose begin using fat for metabolism; a byproduct of fat metabolism is ketones - when ketones build up in the blood, it causes DKA.

How do we treat Hepatitis A?

No medications known to help - just manage symptoms

Is Primary hypertension curable?

No, but is treatable.

Is Hyperthyroidism/Graves Disease curable?

No, but it is treatable.

Are vital signs affected by chronic pain?

No, the body adjusts to the pain.

For mild to moderate pain, we want to use:

Non opioids

An equal amount of osteoblasts and osteoclasts indicates:

Normal Bone

A BMI from 18.5-24.9 indicates:

Normal Weight

Normal Range for INR: Therapeutic Range for INR:

Normal range: 0.75-1.25 Therapeutic range: 2.0-3.0

aPTT normal range: aPTT therapeutic range:

Normal range: 25-35 seconds is normal. Therapeutic range: 50-90 seconds

Physical Dependence

Not addiction, but body gets used to chemicals of the drug and begins to depend on it. If medication is abruptly stopped, this decreases the blood level of the drug - it can cause withdrawal symptoms. Withdrawal Symptoms: anxiety, irritability, diaphoresis, shaking chills, constricted pupils, tremors, abdominal cramps, N&V, diarrhea, rhinorrhea

Demerol

Not used much anymore due to CNS toxicity (ex: hallucinations, seizures) - no longer a good drug of choice as it is outdated - should not be used for more than 48 hours for acute pain or anyone with decreased renal or CNS diseases - use cautiously in elderly as they have a hard time metabolizing which can lead to confusion/sedation.

Circulating Nurse

Nurse who assists the surgeon and scrub nurse by providing needed materials during the procedure and by handling the surgical specimen. This person does not wear sterile clothing and may enter and leave the operating room during the procedure. (Monitors aseptic practices to avoid breaks in technique, checks equipment for safety and function, accounts for all equipment/supplies, implements fire safety precautions) *AN EXTRA PAIR OF EYES*

Bedside swallow screening can be done by:

Nurses or Speech Therapists

Energy obtained from consuming proper amounts of nourishment/nutrients and energy

Nutrition

Interventions for Obesity

Nutritional therapy Exercise Behavioral modification & Support Groups Appetite-Suppressing Drugs/hormonal therapies

Rheumatoid Arthritis Joints VS Osteoarthritis Joints

OA: hard, bony joints, no redness, no warmth RA: soft, swollen, inflamed, red, warm

4 Oral Medications that are effective for Osteoarthritis: 1 Topical Cream effective for Osteoarthritis:

ORAL MEDS: 1. NSAIDS: Ibuprofen, Naproxen, Diclofenac - decreases pain + inflammation. 2. Acetaminophen: Tylenol - helps with pain 3. COX2 inhibitors: Celecoxib (celebrex) - decreases pain + inflammation. 4. Opioids - last resort TOPICAL: 1. Capsaicin (Zostrix)

A BMI of 30 and above indicates:

Obesity

Largest risk factor for Type 2 Diabetes:

Obesity

How to prevent malignant hyperthermia

Obtain family history (if MH runs in family, a different anesthetic will be used)

Buerger's Disease (thromboangiitis obliterans) - what is it? what's the cause? what gender and age is it most commonly seen in? describe pain. how is it diagnosed? how is it treated? is it curable?

Occlusion of blood vessel resulting in thrombus formation and dead tissue beyond the obstruction. This diminished blood supply leads to damage and death of tissue. Cause is unknown but is assumed that Autoimmune disease is responsible. Strong association with smokers and men less than 40 years of age. Pain is bilateral and symmetrical. Diagnosis: High hematocrit due to viscosity, angiogram, allen test. Treatment: - Stop smoking - Same as for atherosclerotic PAD Not curable.

Local Allergic Reaction

Occurs 1 to 2 hours after injection - rare - red, swelling, tenderness at site

Osteoarthritis age of onset:

Occurs later in life, usually after 60

Herpes Simplex Encephalitis

Occurs occasionally Spread from herpes simplex I Treated with antiviral meds

Hypertensive Urgency

Occurs over days to weeks BP >180/110 with no clinical evidence of target organ disease

Hypertensive Emergency

Occurs over hours to days BP >220/140 with target organ disease

Insulin Resistance

Often related to obesity & can be overcome by weight loss. Individuals requiring 200 units or more of insulin.

Blocks ATPase enzyme and secretion of HCl acid.

Omeprazole (prilosec)

What are Short Acting Beta2 Adrenergic Agonists? (SABAs) State what they do + give examples. Long term/short term use?

One of the only meds used in acute respiratory distress - directly bronchodilates - its inhaled - can raise heart rate - it's a "rescue" inhaler meaning patient should only use it when they are in distress. Short term use only - not for long term management. Examples: - Albuterol (Proventil, Ventolin, AccuNeb) - Levalbuterol (Xopenex)

What age is the onset for Crohn's disease? What is the peak age for Crohn's disease?

Onset: 15-30 years of age Peak: 60-80 years of age

A patient taking sublingual nitroglycerin should NOT:

Operate machinery/drive

Dilaudid (hydromorphone)

Opioid Analgesic - more potent than morphine. Can be given PO, liquid, rectal, subq, IM, or IV

On dark skinned patients, where can we assess for pallor/jaundice?

Oral Mucosa, Hard Palate, Nail Beds, Sclera

What forms of Nitroglycerine are used to *prevent* angina?

Oral, sustained release, and patch

Appetite Suppressing drugs

Orlistat (Xenical) Phentermine (Suprenza) Sibutramine HCL (Meridia) Lorcaserin (Belviq) Naltrexone HCL/bupropion HCL (Contrave)

(?) is a chronic, noninflammatory progressive disorder that causes cartilage deterioration in synovial joints and vertebrae.

Osteoarthritis

Osteomalacia Info

Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. As a result, the skeleton softens and weakens, causing pain, tenderness to touch, bowing of the bones, and pathologic fractures. On physical examination, skeletal deformities (spinal kyphosis and bowed legs) give patients an unusual appearance and a waddling gait.

In osteoarthritis, synovial fluid degenerates until eventually there is bone on bone contact - bone pieces then break off from this contact - these bone pieces are called:

Osteophytes

More Osteoclasts than osteoblasts indicates:

Osteoporosis

A BMI from 25-29.9 indicates:

Overweight

When would we apply oxygen to a patient experiencing angina and why?

Oxygen should be initiated at the onset of chest pain - it increases myocardial oxygen supply and decreases oxygen demand. Decreases chest pain *Monitor SaO2*

What is the first line of treatment for someone experiencing exacerbation of COPD?

Oxygen therapy (2 L via nasal cannula)

What pain scale would we use for a patient that has dementia?

PAINAD (Pain assessment in advanced dementia)

A type of IV line that can be used for parenteral nutrition with a higher osmolality

PICC

What are the different types of CVAD's?

PICC - used for weeks to months Implanted - for long term use Tunneled - for long term use Non-tunneled catheters - short term (less than 6 weeks)

A 5% dextrose solution + amino acids, electrolytes, vitamins, and fat emulsion is:

PPN

How can we assess pain?

PQRST - pain, quality, radiation, severity of symptoms, timing

If there is not enough calcium present in the body, (?) is released.

PTH

What levels of PaO2 and SaO2 indicate MODERATE HYPOXEMIA?

PaO2: 40-59 mm Hg SaO2: 75-89%

What levels of PaO2 and SaO2 indicate MILD HYPOXEMIA?

PaO2: 60-79 mm Hg SaO2: 90-94%

What levels of PaO2 and SaO2 indicate SEVERE HYPOXEMIA

PaO2: Less than 40 mm Hg SaO2: Less than 75%

Symptoms of dyspepsia include:

Pain & burning sensation Bloating/fullness Belching Heartburn Acidic taste in mouth - laying flat & acidic taste comes up in mouth (ACID REFLUX)

4 Nursing Interventions for Gout

Pain Management: rest the joint, give medications. Ice joint to decrease inflammation, no heat should be applied. Hydration: patient should be drinking at least 2 L of fluid a day. Diet: Patients should avoid purine containing foods (organ meats, hard cheeses, shell fish, high salt containing foods, deli meats) Healthy weight: being over weight increases risk for gout.

McBurney's Point

Pain in RLQ with appendicitis - rebound tenderness in RLQ (pressing down and then upon release patient feels pain)

In Crohn's Disease, where is pain felt and when?

Pain is felt in the RLQ and is felt after eating.

Margo McCaffery's definition of pain

Pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does

Renal Calculi Treatment

Pain medication & IV FLUIDS - Ketorolac (Toradol): treats renal stone pain. Reduces swelling and facilitates passage of the stone. It is an NSAID. Adequate hydration - Greater than 2L of urine output recommended - *Limit sodium to 3 - 4 g/day* Dietary changes depending on type of stone Strain all urine/I&O Avoid meds that increase stone formation Surgical intervention

Sciatica

Pain radiating along the sciatic nerve, which runs down one side only (unilateral). Pain will start at the nerve and travel all the way down to the toes.

Common symptom of bladder cancer:

Painless hematuria

In Rheumatoid Arthritis, Synovial Membrane destruction leads to the formation of a:

Pannus - highly vascular granular tissue that forms within a joint causing patient to lose total motion.

What is the treatment of choice for Cobalamin Deficiency?

Parenteral or intranasal administration of cobalamin is the treatment of choice. IM injections are done daily for 2 weeks and then monthly for the rest of life. Patients will die within 1-3 years without treatment.

This Dopaminergic medication, carbidopa/levadopa (Sinemet), treats:

Parkinson's Disease

Define Parkinson's Disease & DOPAMINE

Parkinson's Disease: Injury or impairment of dopamine-producing cells of the substantia nigra in the mid-brain. Dopamine: a neurotransmitter that is essential for normal functioning of extrapyramidal system (control of posture, support, & automatic movement)

Incomplete spinal cord injury

Part of the spinal cord is still intact

Antrectomy - Billroth I

Partial gastrectomy with removal of distal 2/3 stomach and anastomosis of gastric stump to duodenum

Antrectomy - Billroth II

Partial gastrectomy with removal of distal 2/3 stomach and anastomosis of gastric stump to jejunum

How do we know patient is ready for discharge from PACU?

Patient can move all extremities voluntarily and on command, patient breathes deeply and coughs freely, BP +20 mm of pre-anesthetic level, patient is fully awake, patient has o2 sat of 92% or greater on room air.

Complication of Acute Pyelonephritis

Patient could relapse and become asymptomatic & progress to chronic pyelonephritis

Oral Glucose Tolerance Test

Patient fasts for 10-12 hours, then a fasting blood sample is taken. A glucose load (75g/300mL beverage) is given. Blood sample is drawn again after the beverage has been ingested at 1, 2, and 3 hour intervals. *If after 2 hours blood glucose is still at 140, patient is most likely diabetic.

Somogyi Effect

Patient has normal blood glucose at night before sleep, they take their insulin and don't eat - at approx 2-3 am there is a sharp decrease in blood glucose. Counter regulatory hormones kick in. Hormones begin to elevate blood sugar levels to save the body from dying; when patient wakes up, blood sugar is extremely high. Treatment: Give snack before bed, if this doesn't help decrease evening dose of insulin.

Surgical Techniques: Conventional Surgery

Patient is opened up with scalpel.

Progressive Relapsing MS

Patient will have distinct attacks of symptoms, called relapses. You may or may not fully recover after these relapses. Between relapses, the disease continues to get worse slowly. PRMS is the least common type of multiple sclerosis.

What are 2 things we teach patients who are going to have radioactive Iodine therapy?

Patients should increase fluids 2-3 days after the procedure. Avoid being close to pregnant women and children JUST INCASE radioactivity can be spread. Flush toilet 2-3 times after use to ensure radioactivity can't be spread to someone else.

An example of peripheral stimulation:

Pen pressed against nailbed

What antibiotics help treat Syphilis?

Penicillin G, or if patient is allergic to Penicillin, Tetracycline/Doxycycline

Hypertension is also known as "The Silent Killer" because:

People are asymptomatic until it becomes very severe.

The right hemisphere of the brain is responsible for:

Perceptual/Spatial Relationships

What is commonly used along with the Peripheral Artery Bypass?

Percutaneous transluminal balloon angioplasty (PTA) with stenting

We administer Glucose Content of 5% through a:

Peripheral Access Device

Any disease process that affects the arteries is known as:

Peripheral Artery Disease (PAD)

Involves progressive narrowing and degeneration of arteries of the brain, heart, kidneys, mesentery, and extremities. This is called:

Peripheral Artery Disease (PAD)

Type of IV line used for parenteral nutrition with a lower osmolality of 5% dextrose or less

Peripheral IV

What diabetic related complication do these clinical manifestations describe? Paresthesia Burning sensation Decrease proprioception. Joint deformities Management: Blood glucose control. Nonopioid analgesics. Antidepressants: Tricyclic antidepressant medications:amitriptyline, desipramine (Norpramin) and imipramine (Tofranil) serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta) Antiseizure medications: gabapentin (Neurontin), pregabalin (Lyrica) and carbamazepine (Carbatrol, Tegretol)

Peripheral Neuropathy

What is the most common surgical approach to treating PAD?

Peripheral artery bypass surgery with graft (autogenous vein/synthetic graft is used for grafting)- This procedure allows us to bypass the blockage, allowing blood to flow through the graft into the lower extremity.

We want to prevent upper UTIs from becoming chronic because this can eventually lead to:

Permanent kidney damage

Parkinsonianism & it's causes:

Person has symptoms of Parkinson's Disease but doesn't actually have the disease. Causes: Encephalitis (brain inflammation), carbon monoxide poisioning, antipsychotic medications (such as Haldol)

Tetraplegic/Quadriplegic

Person unable to use their extremities - they always have a low blood pressure and a low heart rate due to their injury.

If stroke occurs in the frontal lobe, what is usually affected?

Personality is usually changed

When assessing a patient who is on Heparin for bleeding, look for:

Petechiae, hematuria, ecchymosis, and IV site bleeding.

4 Ways to diagnose Carpal Tunnel Syndrome:

Phalen's test Tinel's sign Electromyography (EMG) Ultrasound (US)

Excess catecholamines (epinephrine/norepinephrine) secreted by the Adrenal Medulla results in:

Pheochromocytoma

Radiculopathy

Pinched nerve root in spinal column

The Endocrine System consists of the following glands:

Pineal Hypothalamus Pituitary Thyroid Parathyroid Thymus Adrenals Pancreas Ovaries Testes

For Continuous Bladder Irrigation (CBI), we want to make sure the urine turns from dark cherry clotty red to:

Pink

Carotid Endarterectomy (CEA)

Plaque built up at bifurcation of arteries is removed - this treatment is for someone experiencing symptomatic TIA's - 70% Blockage of carotid artery is a candidate for carotid endarterectomy.

Segmental systolic BP measurements

Plethysmography: Measures wavelengths of bp's - bp's greater than 30 mm Hg = arterial narrowing - cuffs are placed on the extremities.

Common HIV related infections

Pneumonia Kaposi Sarcoma Shingles Fungal Infections (Ex: thrush)

Uric Acid Deposits in the big toe are known as:

Podagra

What are some things that lead to over nutrition/Obesity?

Poor diet Daily intake of soda and high sugar Metabolic syndrome (high bp, insulin resistance, high waist circumference) Pro-inflammatory and pro-thrombotic cascades triggered by the extra adipose tissue appear to increase cardiovascular risk independently. Sedentary lifestyle

People who have had the BCG Vaccine usually turn up (?) when being tested for TB, even though they don't actually have the disease.

Positive

Define Honan's Sign - is it an accurate test? - who performs it? - is it still commonly used?

Positive Homan's sign is indicated by calf pain upon dorsiflexion of the foot when the leg raised - it is not commonly used anymore as it has been known to dislodge blood clots - it is not very accurate, as it only shows positive results in 10% of clients and false-positives are common - it is usually performed by a medical doctor.

What is a medication that we can give for Carpal Tunnel Syndrome that treats nerve pain?

Pregabalin (Lyrica)

Radioactive Iodine Therapy won't be given to:

Pregnant women/women of child bearing age.

Goal for Upper UTI

Prevent kidney damage

Treating Osteomyelitis

Prevention is the goal, however if it is too late- Stop infectious process as soon as possible Prevent complications - keep patient clean. Follow policies and orders. Manage pain Manage contributing factors: diabetic management (blood sugars) - educate patient that they will be on insulin in the hospital and may or may not be put on it at home depending on how controlled they are. Surgical management - sequestrectomy (removal of dead bone), debridement, and if needed amputation.

Abductor Pillow

Prevents patient who has had a total hip replacement from crossing their legs.

Addisons occurs during:

Primary Adrenal Insufficiency

Define Neurogenic Bladder

Problems with nerves of the bladder that can potentially lead to urinary incontinence or overdistention of the bladder due to retention of urine.

Percutaneous Transluminal Angioplasty

Procedure in which the artery is dilated with a balloon to restore blood flow in the artery blocked by plaque.

Vascular Endothelium

Produces vasoactive substances (Nitric Oxide & Prostacycline) to maintain low arterial tone

Define Osteoarthritis (OA)

Progressive, non-inflammatory disease of diathroidial joints (joints that contain synovial fluid) where cartilage is lost causing the bones to eventually rub together.

(?) are chemical substances believed to increase the sensitivity of pain receptors

Prostaglandins

NSAIDs block (?), causing (?)

Prostaglandins, vasoconstriction and increased BP

Prostatectomy

Prostate gland is removed - usually done laparoscopically

The older a man gets the higher his risk is for getting:

Prostatitis

Antidote for Heparin:

Protamine Sulfate

How do we treat Hepatitis C?

Protease Inhibitors - saquinavir (Fortovase, Invirase)

Builds new tissues, antibodies, enzymes, hormones, and other compounds

Protein

Lack of protein and/or energy (calories) resulting in emaciation (thinness/weakness)

Protein Energy Malnutrition (PEM)

Chronic Glomerulonephritis

Proteinuria caused by repeated glomerular injury/renal destruction - patients may be asymptomatic. Symptoms worsen over time: - Kidneys reduced in size with fibrous tissue - Glomeruli/tubules are scarred - Renal artery thickening/stenosis which can lead to high blood pressure.

What medication helps treat H. Pylori when prescribed with antibiotics?

Proton Pump Inhibitors

Why should someone with HTN manage their psychosocial risk factors? What are some psychosocial risk factors?

Psychosocial risk factors have direct effects on the cardiovascular system by activating the Sympathetic Nervous System and stress hormones. This can cause a wide variety of pathophysiologic responses, including hypertension. Risk factors include low socioeconomic status, social isolation and lack of support, stress at work and in family life, and negative emotions such as depression and hostility

Steroid Psychosis

Psychotic disorder caused by systemic (PO/IV) use of corticosteroids. Steroid psychosis cannot occur from steroid creams or inhalers - Seen in CUSHINGS.

Number one symptom of Myasthenia Gravis:

Ptosis (eye drooping)

Major risk of DVT:

Pulmonary Embolism

A clot that has lodged in a pulmonary artery is known as:

Pulmonary Embolus

Calf muscles help to:

Pump the blood through the veins back to the heart.

Gout is a heterogeneous group of conditions related to genetic defect of (?) metabolism.

Purine

What do Malabsorption procedures do? Give 2 examples of Malabsorption procedures.

Purpose: Decreases nutrient absorption by shortening the length of the small intestine 1. Jejunoileal bypass (JIB) 2. Biliopancreatic diversion (BPD)*More common

Infection of the kidney and ureter

Pyelonephritis

How often should PN tubing be changed?

Q 24 hours

What is the best way to prevent getting COPD?

QUIT SMOKING (SMOKING CESSATION)

Lung transplant and bullectomy improve the overall:

Quality of life for a client w/ COPD

Clinical Manifestations of Crohn's disease:

RLQ pain unrelieved with defection Intestinal cramping/spasm after eating Ulcerations in mouth and lining of intestines Chronic diarrhea Fluid/electrolyte imbalances (K, Mg, Ca, Alb) Anal abscess Fever, leukocytosis (high white blood cell count) Steatorrhea (fat globules in feces)

3 Defining Characteristics of Back Pain:

Radiculopathy: Pinched nerve root in spinal column. Sciatica: Pain radiating along the sciatic nerve, which runs down one side only (unilateral). Pain will start at the nerve and travel all the way down to the toes. Paravertebral Spasm: Back muscle spasms

What is radioactive iodine therapy?

Radio active iodine therapy done for hyperthyroidism - it is given to produce a euthyroid (normal sized thyroid). It shrinks the thyroid within 6-8 weeks. Usually a one time dose. 5% of patients may need a second dose.

Glucagon (raises/lowers?) glucose levels.

Raises.

Cysteine Stones

Rare inherited defect that causes kidneys to excrete too much cystines in urine - genetic.

This results from abrupt discontinuation of TPN

Rebound hypoglycemia

Before starting Biologic Therapy, the patient must first:

Receive manteaux testing (aka TB testing) because this therapy can cause TB.

Reinfection following a successful course of treatment.

Recurrent UTI

What's another name for Crohn's Disease?

Regional Enteritis

What is the function of ADH (anti-diuretic hormone) ?

Regulation of fluid volume in the body - makes us stop urinating & helps us retain fluid.

Small Bowel Resection

Removal of a portion of the small intestines that is problematic (up to 50% can be removed)

Define Transsphenoidal Hypophysectomy:

Removal of the pituitary gland due to tumor causing DI/SIADH

FEV1/FVC Ratio

Represents entire pulmonary capacity

Emergent Surgery

Requires immediate intervention because of life-threatening consequences (Ex: someone hemorrhaging)

What does increased carbon dioxide tension in arterial blood lead to?

Respiratory acidosis and chronic respiratory failure.

Sedation comes before (?)

Respiratory depression

How can we relieve pain caused by Angina?

Rest / nitrates

Goal for arterial ulcers:

Restore blood flow so that wound can heal.

What is the underlying pathology of asthma?

Reversible and diffuse airway inflammation - the airways become hyper responsive (they respond to stimuli in an exaggerated manner)

When should you notify your instructor or primary nurse about abnormal blood glucose readings?

Right away

If a patient's right pupil is abnormal, it indicates a problem on the (?) side of the brain:

Right side - pupils are ipsilateral.

This medication is used to treat ALS:

Riluzole

What temperature should PN be?

Room Temp

Characteristics of Arterial Ulcers:

Round regular shape Smooth edges Necrosis Minimal drainage Pale wound bed High pain

Pernicious anemia is more common in what 2 races?

Scandinavians & African Americans

If Chronic Pyelonephritis goes undetected, what can potentially occur?

Scarring of kidney or End Stage Renal Disease (ESRD)

Describe the Dexamethasone suppression test. What does it test for?

Screening test for *Cushings*. Dexamethasone is a glucocorticoid. It is given at night. This should cause Pituitary to slow down the production of ACTH. Blood is drawn the next morning. If levels of ACTH are high, this indicates a problem (maybe with the adrenal glands) and further testing will be carried out. If levels are normal/decreased, the result is normal.

For someone who has had a hemorrhagic stroke, how should we elevate the head of the bed?

Semi-Fowlers, 15-30 degrees to decrease intracranial pressure and promote venous drainage.

The ascending tracts of the spinal cord are for:

Sensory Pathways

Define Addisonian Crisis

Serious life threatening condition characterized by insufficient cortisol production. Symptoms included: dehydration, low blood sugar, vomiting, diarrhea, cramps, low bp.

Define Each Lab Test: Serum RF Anti-CCP CRP ESR ANA C3, C4

Serum RF (Rheumatoid Factor): generalized inflammatory marker - positive in all inflammatory disorders Anti-CCP: shows erosion - expensive so this test will be done after doing basic inflammatory markers. CRP: Inflammatory marker - elevates in presence of inflammation ESR: Inflammatory marker - elevates in presence of inflammation ANA: Inflammatory marker - elevates in presence of inflammation C3, C4: Inflammatory markers that respond to the immune response and are often decreased.

What will labs look like in Rheumatoid Arthritis? Serum RF: Anti-CCP: CRP: ESR: ANA: RBC count: C3, C4:

Serum RF - elevated Anti-CCP - elevated CRP - elevated ESR - elevated ANA - elevated RBC count - decreased C3, C4 - decreased

Pain relief measures should be done before pain becomes (?)

Severe

What are some contraindications to bariatric surgery?

Severe Bulimia Untreated major depression/psychosis Current drug/alcohol abuse Severe cardiac disease with anesthesia risk Severe coagulopathy Inability to comply with nutritional requirements

Are peripheral access devices used for long term or short term use?

Short term

Virchow's triad:

Shows the 3 risk factors for developing DVT/thrombus

Shunting

Shunting, also known as *reduced ventilation* to a lung unit, causes unoxygenated blood to move from the right side of the heart to the left side and into systemic circulation; it may result from obstruction of the distal airways, such as with pneumonia, atelectasis, tumor, or a mucus plug.

If a patient is having an episode of angina, what is the first thing we want to have the patient do?

Sit down, take sublingual nitroglycerine

Scleroderma usually begins with (?) involvement.

Skin

Steps of Neurovascular Assessment

Skin color Skin temperature Pulses Capillary refill Sensation Mobility (ROM)

Severe venous ulcers may need:

Skin grafting Here is a picture of an ulcer that may need a graft →

How do we administer Protamine Sulfate?

Slow infusion via IV (used as an antidote for Heparin)

Dysarthria

Slurred speech

Are peripheral venous access devices used to administer high volumes or small volumes?

Smaller Volumes

Substances such as (?) and (?) are also controlled by the Hypothalamus.

Sodium & Potassium

This Anticholinergic medication, oxybutynin (Ditropan), treats:

Spastic Bladder

Spinal shock is resolving when (?) begins to occur.

Spasticity

Baroreceptors

Specialized nerve endings located in the carotid arteries and arch of the aorta. Baroreceptors have an important role in the maintenance of BP stability during normal activities. They are sensitive to stretching and, when stimulated by an increase in BP, send inhibitory impulses to the sympathetic vasomotor center. Inhibition of the SNS results in decreased HR, decreased force of contraction, and vasodilation in peripheral arterioles. When a fall in BP is sensed by the baroreceptors, the SNS is activated. The result is constriction of the peripheral arterioles, increased HR, and increased contractility of the heart. In the presence of long-standing hypertension, the baroreceptors become adjusted to elevated levels of BP and recognize this level as "normal."

Specific Gravity VS Osmolality

Specific Gravity Measures "concentration" of a solution while Osmolality measures "Substances" within a solution.

Broca's area, located in the frontal lobe, is responsible for:

Speech production.

Types of Spinal Cord Injuries: Compression

Spinal cord becomes compressed

Name 1 example of a Potassium Sparing Diuretic. What are the side effects. Nursing Interventions?

Spironolacotone SE's: hyperkalemia, constipation NI's: Avoid foods rich in potassium

What is the main symptom of CAD?

Stable Angina Pectoris

Define Each Stage of COPD

Stage 1: Mild COPD Stage 2: Moderate COPD Stage 3: Severe COPD Stage 4: Very severe COPD

What precautions do we use for Disseminated Herpes Zoster virus?

Standard, AIRBORN, and contact until lesions are dry.

70-80% of Osteomyelitis (bone infections) are caused by:

Staphylococcus Aureus

Atorvastatin (Lipitor), Simvastatin (Zocor)

Statin (HMG-CoA reductase inhibitor) Action: restricts lipoprotein production Side effects: Leg pain, *elevation of liver enzymes* (ALT & AST), *muscle aches*, *rhabdomyolysis (muscle breakdown)* Nursing: monitor liver enzymes, educate patient about symptoms of muscle aches. Can elevate digoxin, warfarin and oral contraceptive levels.

Thrombus

Stationary blood clot that obstructs circulation

WHO analgesic ladder

Step 1: mild to moderate pain -Nonopioid analgesic -NSAIDs and acetaminophen Step 2: more severe pain -Add opioid analgesic - oxycodone, hydrocodone Step 3: severe pain -Substitute powerful opioid—morphine, fentanyl

Churns and mixes food with gastric secretions (hydrochloric acid) into a semiliquid mass called chyme

Stomach

Define Combined procedure of BIPASS and GASTRIC SLEEVE. Name 2 examples

Stomach is cut and reduced in size and is then attached to the last section of the intestines. Roux-en-Y gastric bypass (RYGB) Biliopancreatic diversion with duodenal switch (BPD/DS)

When BP is high, baroreceptors will:

Stop firing - this sends a message to the sympathetic vasomotor center inside the medulla to vasodilate, helping bring the BP back to normal.

Time Out Protocol

Stopping before performing the operation to make sure it is the correct patient, the correct procedure, and the correct site

An example of a thrombolytic drug:

Streptokinase

Metabolic Cascade is unleashed by:

Stroke/Injury

NPH insulin is only given via (?) injection

Subq

What is a nursing intervention we can perform for someone with Exopthalmos?

Supportive eye care. Example: Ointment for the eyes if they are open for a long time and have trouble closing. Also eye drops for dryness.

Who's in the OR? (5)

Surgeon, assistant surgeon, scrub nurse (sterile), circulating nurse (responsible for charting), Anesthesia care provider

When would we perform surgery for IBD?

Surgery is a last resort - we would perform surgery if there is: Intractable disease (pain that is not curable by any known means), poor quality of life, & severe complications from the disease/treatment.

Optional Surgery

Surgery that is not critical to survival or function (ex: cosmetic surgery)

Define Bariatric Surgery

Surgical management of obesity when other weight control methods have failed

Laparoscopic Nissen fundoplication

Surgical procedure that treats gerd & hiatal hernia by restoring the function of the LES - the top of the stomach is wrapped around the lower esophagus and it is sutured in place - this becomes the new functioning sphincter.

Discectomy

Surgical removal of an intervertebral disc, usually due to disc herniation

Atherectomy

Surgical removal of plaque buildup from the interior of an artery - device goes in and collects plaque build up.

Echocardiogram screens for:

Suspected Left Ventricular Hypertrophy

How is Parkinson's diagnosed?

Symptoms are assessed - if patient has 2 out of 4 of the TRAP symptoms, patient is diagnosed with Parkinson's. Often, if patient has symptoms of parkinson's, doctor will prescribe anti-parkinson's medications and if they help treat the symptoms, the patient is diagnosed as positive for the disease.

What are some symptoms of aplastic anemia?

Symptoms caused by suppression of any or all bone marrow elements - Fatigue, dyspnea, Cardiovascular and cerebral responses Neutropenia - patient put on neutropenic precautions

Cushings Syndrome VS Cushings Disease

Syndrome: Adrenal Gland produces too much ACTH (may be due to tumors on adrenal glands) Disease: Pituitary Gland produces too much ACTH (may be due to tumor on pituitary gland) *The symptoms are the same for both, only the treatment differs.

Arthrocentesis

Synovial fluid aspiration that is done to diagnose Rheumatoid Arthritis

Hormones have a (?) effect.

Systemic

Isolated Systolic Hypertension

Systolic is high but diastolic is normal Systolic >140, diastolic is <90

Thyroid gland secretes:

T4 & T3 hormones

T4 VS T3

T4 - Thyroxine - little weaker T3 - Tri-iodothyronine - 5x more potent

Autonomic Dysreflexia typically occurs in what level of injury?

T6 or Above - the higher the injury, the higher the chance of this happening

A 10-50% dextrose solution + amino acids, fat emulsion, electrolytes, vitamins, and water is:

TPN

What can be delegated to UAP?

Taking vital signs Recording input/output Weighing the patient Checking fingerstick glucose levels *UAP's are NOT allowed to teach*

Regional Anesthesia

Temporary interruption of nerve conduction, is produced by injecting an anesthetic solution near the nerves to be blocked. - Spinal: Injected into the subarachnoid space - Epidural: Injected into the epidural space - used for labor and delivery; side effect is urinary retention. - Peripheral nerve block

5 Symptoms of Pheochromocytoma:

The 5 H's: Hypertension *NUMBER ONE SIGN!!* (ex: 220/110) Headache Hypermetabolism Hyperglycemia Hyperhydrosis Palpitations Nervousness

Ankle Brachial Index

The ankle-brachial pressure index (ABPI) or ankle-brachial index (ABI) is the ratio of the blood pressure at the ankle to the blood pressure in the upper arm (brachium). Compared to the arm, lower blood pressure in the leg suggests blocked arteries due to peripheral artery disease (PAD).

Renal Calculi can occur anywhere from:

The bladder to the kidney (anywhere in the urinary tract)

Osmolality measures:

The dissolved particles in the blood

When it comes to Tuberculosis, what is something we should consider within the Elderly population?

The elderly may not show signs or symptoms of TB right away as their immune system has a delayed response - they may, however, show signs of altered mental status. They can have false negatives during checks for TB.

Expressive Aphasia (Broca's)

The inability to produce language (despite being able to understand language) - this is due to damage to Broca's Area, located in the left hemisphere of the brain.

Contracture

The lack of joint mobility caused by abnormal shortening of a muscle

Beta 2 receptors are located in: What do they cause?

The lungs - cause bronchodilation and vasodilation

What is transferrin? What is the proper levels?

The main protein in the blood that binds to iron and transports it throughout the body; 212-360

Define ACTH Stimulation Test

The most common & definitive way to diagnose Addison's. ACTH will be given via IM injection. Plasma will be drawn afterwards (30-60 min later). By giving exterior ACTH (mimics pituitary gland), the adrenal glands should begin producing more hormones. Since Adrenal Glands are not functioning, blood will show decreased cortisol levels despite injection of ACTH.

A maximum score of 42 on the NIH Stroke Scale represents:

The most severe and devastating stroke.

Spinal Stenosis

The narrowing of the spinal canal caused by excessive bone growth, thickening of tissue in the canal (such as ligaments or cartilage), herniated disc, or all three.

C4 or higher injury indicates:

The patient will be ventilator dependent.

Ischemic Penumbra

The perimeter around ischemic area (where the stroke is) known as the penumbra that will also die without immediate intervention.

Air Embolism

The presence of air in the veins, which can lead to cardiac arrest if it enters the heart. Can be caused by surgery or misuse of IV.

If you have a blockage in the left femoral artery, which side would the doctor go in on to remove the blockage?

The right side (they try to always go in on the opposite side)

Hemoglobin Levels are used to determine:

The severity of anemia

Morphologic classification of Anemia is based on:

The size and color of the RBC

Informed Consent - The Nurse VS The Surgeon

The surgeon discloses details on diagnosis and treatment options. The nurse acknowledges that the correct patient is signing the consent form (in an emergency, family members are able to sign on behalf of the patient)

Transurethral resection of the prostate (TURP)

The surgical instrument is introduced via the urethra to the prostate, which can then be viewed directly. The prostate gland is removed in small chips with an electrical cutting loop.

Laminectomy

The surgical removal of a lamina, or posterior portion, of a vertebra to relieve pressure on the nerve roots of the spine caused by stenosis.

When it comes to Tuberculosis, HIV patients have a hard time fighting it off due to:

Their repressed immune system

Struvite Stones - what are they & what causes them to occur?

These stones grow rapidly and become very large - they are very painful. - Occur from recurrent UTI's. - Occur from neurogenic bladder - Occur from ↑ alkalinity of urine

If a patient's pupils are dilated, this indicates:

They are in pain. The patient is fine if pupils are constricted.

What is the function of veins?

They bring blood back to the heart.

What is the function of arteries?

They carry oxygenated blood away from the heart to the body tissues.

What is a rule for administering Iron supplements?

They should be given on an empty stomach as this is when the iron is best absorbed.

If someone has excess amounts of IV fluid running in, what will ADH do?

This indicates that there is MORE fluid and LESS substance - ADH will be inhibited so that the excess fluid can be expelled.

Total Colectomy/Ileostomy

This is done for very severe cases - entire colon/large intestines is removed. Small intestines are either attached to the rectum or an ileostomy is created.

Cincinatti Stroke Scale

This scale is used to diagnose the presence of a stroke in a patient, and is usually done before admitting the patient to the hospital. It assesses for facial drooping, arm drift, and abnormal speech - all of which are indicators of a stroke.

Define Primary Form/Idiopathic Form Osteoarthritis

This type of Osteoarthritis is caused by genetics

Define Secondary Osteoarthritis

This type of Osteoarthritis is commonly caused by Trauma/abuse/overuse of joint - using the same joints over and over again (those who play sports) - commonly seen in knees, hips, wrists, & hands. Could also be caused by Congenital Disorders/Disease processes like Rheumatoid Arthritis/Osteoporosis - these diseases allow for OA to occur more easily.

Who is at risk of getting venous insufficiency? Name 3.

Those who stand for prolonged periods of time (Nurses, teachers), Pregnant Women, and Obese people

What is the biggest concern with polycythemia vera?

Thrombus formation

Numbness caused by carpal tunnel occurs mainly in these 3 fingers:

Thumb, index, and middle finger

What assessment findings indicate ASPIRIN TOXICITY?

Tinnitus, confusion, heartburn, bloating, nausea

Why would we give antibiotics to someone with Crohn's disease/Ulcerative Colitis?

To treat secondary infections such as abscesses, perforation, & peritonitis - antibiotics should never be used as treatment for Crohns/Ulcerative Colitis - *ANTIBIOTICS DO NOT MAINTAIN REMISSION* example of an antibiotic: metronidazole (Flagyl)

How can we diagnose obesity?

Total cholesterol, blood pressure, BMI, weighing patient

Complications of Ulcerative Colitis

Toxic megacolon Perforation/Peritonitis Severe diarrhea Hemorrhage/Anemia Thrombotic risk Arthritis/Osteoporotic fractures Anal abscess, fistula, fissures 3% of patients with UC will develop colon cancer

4 steps of the pain pathway

Transduction Transmission Perception Modulation

Most common cause of spinal cord injury:

Trauma (ex: motor vehicle accidents)

How to treat Gastric Ulcers:

Treat with H2 receptors and probiotics - DO NOT TAKE NSAIDS BECAUSE THEY MAY BE CAUSING THE ULCERS.

Laser Prostatectomy

Treats BPH - Delivers a laser beam transurethrally to cut or destroy parts of the prostate

Intra-prostate urethral stent

Treats BPH - Stents are inserted when surgery is not an option.

Tamsulosin (Flomax)

Treats BPH - may cause orthostatic hypotension

What is the function of Pentoxifylline (Trental)? How should it be given (with food/without food)? What are 3 side effects associated with this medication?

Treats Intermittent Claudication and also PVD. ↑ Erythrocyte flexibility ↓ Blood viscosity (thins blood) Take with food or milk. SE's: Angioedema, tachycardia, hypotension.

Ureteroscopy

Treats Renal Calculi - An examination of the upper urinary tract, usually performed with a ureteroscope that is passed through the urethra and the bladder, and then directly into the ureter - allows the doctor to actually look at the stone and remove it.

percutaneous transluminal coronary angioplasty (PTCA)

Treats severe plaque in arteries - widening the arteries allows for better blood flow.

Key Features of Parkinson's Disease - "TRAP"

Tremor - "pill rolling" - increases at rest Rigidity - patient is very stiff - known as "cogwheeling" Akinesia/Bradykinesia - Bradykinesia occurs first and its a slowing of automatic movement (ex: blinking, smiling). Akinesia is complete loss of automatic movement. Patient loses natural ability to react (they have a "mask like" face). Patient may also lose natural ability to swallow (patient will drool a lot) Postural Disturbances: Patient is stooped/hunched over and has a shuffled gait. *Those with Parkinson's also have orthostatic hypotension and depression.

T/F: 1/3 (33%) of Adults in the US have hypertension.

True

T/F: 30% of Adults in the US are prehypertensive.

True

T/F: 8% of Adults in the US have undiagnosed hypertension.

True

T/F: Dipsticks can be delegated to UAP.

True

T/F: Following initial treatment of acute pyelonephritis, the patient should have a follow up urine culture.

True

T/F: Gout is not curable.

True

T/F: In Gout, there are periods of exacerbations and remissions.

True

T/F: In a patient with acute pylonephritis, an Intravenous Pyelogram (IVP) may be performed after the infection is resolved to evaluate the urinary system for abnormalities.

True

T/F: Parkinson's may be genetic.

True

T/F: Patients with osteoporosis are often asymptomatic.

True

T/F: Production of hydrochloric acid and digestive enzymes decreases with age.

True

T/F: Rheumatoid Arthritis is composed of periods of unpredictable exacerbations and remissions.

True

T/F: There is a direct relationship between hypertension and cardiovascular disease (CVD)

True

T/F: Walls of esophagus and stomach thin with aging, and secretions lessen

True

True or False: Anemia in the older adult population is commonly caused by co-morbid conditions such as cancer or renal disease.

True

True or false: As a nursing student, it is not okay to pass meds with the patient's primary nurse.

True

True or false: CVAD insertion is more difficult for the HCP to insert in a dehydrated patient.

True

True or false: Cobalamin deficiency anemia is reversible with ongoing treatment but the neuromuscular complications are not reversible.

True

True or false: Finger sticks can be delegated to UAP.

True

True or false: Hyperglycemia occurs as a result of the highly concentrated dextrose content in TPN.

True

True or false: Lipids can be infused with PN.

True

True or false: Stress (cortisol) increases blood sugar

True

True or false: Type 2 diabetics are not ketosis prone.

True

True or false: UAP can reattach telemetry monitors to patients.

True

True or false: You can administer medications through Parenteral Nutrition.

True

True or false: You can be overweight and malnourished.

True

True or false: You should never mix combination insulins with regular due to chemical binding concerns.

True

True or false: You should not smoke or use a flame near oxygen.

True

t/f: 50% of people with DVT have no symptoms.

True

True or false: An order is needed for oxygen.

True (BUT IN EMERGENCIES, WE CAN APPLY OXYGEN WITHOUT AN ORDER IF PATIENT IS IN NEED)

True or false: You should take your iron pills with vitamin C.

True - VITAMIN C helps the body absorb iron.

True or false: Anemia is not a specific disease.

True - it is a manifestation of a pathological process.

True or false: Type 2 diabetics still produce insulin.

True - type 2 diabetics still produce insulin; either it is not enough or their cells are unresponsive to it

True or false: Lipids should be infused slowly over 12-24 hours.

True because of the thickness of the lipids

True or false: IM injections should be avoided during anticoagulation therapy.

True, patient could bleed significantly.

T/F: Guillain Barre Syndrome is curable.

True.

T/F: MS is more common than Guillain Barre Syndrome.

True.

T/F: Medications given for Graves can put patients into remission.

True.

T/F: You can get UTI's through a fistula.

True.

T/F: You can get UTI's through the blood stream.

True.

True or False: Type 1 diabetics are more prone to Ketosis than Type 2 diabetics.

True.

True or false: Diabetes will lead to high blood pressure and vice versa.

True.

What is a common treatment for malnutrition?

Tube feedings

Risk factor of Addison's Disease:

Tuberculosis

Microvascular Complications are more common in Type 1 or Type 2 diabetes?

Type 1 Diabetes

Macrovascular Complications are more common in Type 1 or Type 2 diabetes?

Type 2

TIBC (Total Iron Binding Capacity) Goes (up/down?) when their is low iron in the blood.

UP

What is the most definitive way to diagnose GERD?

UPPER GI ENDOSCOPY - this will assess for competence (if its working) of the Lower Esophageal Sphincter, inflammation, scaring & strictures, cellular changes

Incretin Mimetics

USED IN TYPE 2 ONLY Used in combination with biguanides or sulfonylureas Delays gastric emptying, enhances insulin secretion, helps patient feel satisfied Administer 1 hour before meals Exanatide (Byetta)- injection

Synthetic Human Amylin

USEFUL IN BOTH TYPE 1 AND 2 Suppresses glucagon secretion Used with insulin EX: Pramlintide (Symlin)- injection

- Inflammation of mucosal and submucosal layers of the rectum and spreading proximally (UP) to entire colon - Multiple contiguous ulcerations - Abscesses can form - Shedding of the colonic epithelium, causing bleeding - Bowel narrows, shortens, and thickens from muscular hypertrophy and fat deposits

Ulcerative Colitis

Echocardiogram

Ultrasound image of the heart that evaluates the size, shape, and motion of the heart and its valves. Warmed gel is applied to the chest.

(?) occurs in an otherwise normal urinary tract.

Uncomplicated UTI

A BMI below 18.5 indicates:

Underweight

What is the cause of Rheumatoid Arthritis?

Unknown

2/3 of patients with Guillain-Barre Syndrome have this type of infection 2-3 weeks before experiencing GBS symptoms

Upper Respiratory Infection or GI infection

Reflex/Spastic Bowel

Upper motor neuron disease/injury - Defecation occurs suddenly without warning

The 2nd most common reason to seek health care is:

Urinary Tract Infections

Complications for all minimally invasive BPH procedures include:

Urinary retention UTI Pain

Phenazopyridine (Pyridium)

Urinary tract analgesic that also helps with bladder spasms. Side effects: Can cause urine to turn bright orange and may stain undergarments.

For SIADH, list the following: Urine Output Urine Specific Gravity Urine Osmolality Serum Osmolality Patient's Weight Blood Pressure Medical Treatment Nursing Diagnosis *REMEMBER*: SIADH is caused by overproduction and release of ADH.

Urine Output: Decreased urine output; 50, 30, and eventually 10 mL/hr. Urine Specific Gravity: High specific gravity due to very concentrated urine Urine Osmolality: High/increased Serum Osmolality: Low, dilutional hyponatremia presents. Patient's Weight: Gain weight, but do not get edematous. Blood Pressure: BP stays more on normal side Medical Treatment: Fluid restrictions - not allowed to drink plain water due to *dilutional hyponatremia* because it will further dilute the sodium levels. For severe, restrict to 800 mL of fluid in 24 hrs. *Do not leave water pitcher at bedside.* If sodium drops less than 120, seizures, neurological changes, confusion, & lethargy can occur. Hypertonic solution will be administered (3% NS) to help correct low sodium. Low sodium leads to muscle cramps, weakness, lethargy, confusion, and eventually seizures. Nursing Diagnosis: Fluid volume excess

For DI, list the following: Urine Output Urine Specific Gravity Urine Osmolality Serum Osmolality Patient's Weight Blood Pressure Medical Treatment Nursing Diagnosis *REMEMBER*: DI is caused by insufficient/lack of production of ADH.

Urine Output: Urine output greatly increases; more than 250 mL per hour. Urine Specific Gravity: Low specific gravity (urine is very diluted) Urine Osmolality: Low Serum Osmolality: Increased; due to hypernatremia Patient's Weight: Patient will lose weight and have poor skin turgor Blood Pressure: BP drops very low, HR goes up to compensate (tachycardia). Medical Treatment: Give synthetic ADH (DDAVP) - can be given SUBQ/intranasal - After DDAVP is given, the urine output will decrease. Nursing Diagnosis: Fluid volume deficit

Multimodal drug therapy

Use of both drug therapy and non drug therapy together

What should you do if you cannot find a pulse at an expected site?

Use the Doppler

Continuous Passive Motion Machine (CPM)

Used After joint replacement surgery Restores joint function Exercises extremity/joint Extends extremity to prescribed angle for specific period of time, then releases joint Operates continuously while on As degree of tension is tolerated, settings altered to increase joint mobility

semi-Fowler's

Used for examinations of the chest and comfort

Low Fowler's

Used for examinations of the chest and comfort/sleep

Supine

Used for exams of the anterior

Prone

Used for exams of the posterior

High Fowler's

Used for facilitating breathing, eating and examinations of the chest

Oral Antibiotic Agents

Used for patients with type 2 diabetes who cannot be treated with diet and exercise alone; combination of oral drugs may be used; side effect is hypoglycemia. ex: metformin

Surgical Trendelenburg

Used for pelvic surgery

Knee-chest

Used for rectal examinations

Sim's

Used for rectal exams and enemas

Jackknife

Used for rectal surgery

Trendelenburg

Used for the treatment of hypotension and shock

Lithotomy

Used for vaginal exams

Dorsal recumbent

Used for vaginal exams (more comfortable for older women)

What are direct arterial vasodilators used for? Name 4 examples. Name Side effects. Name Nursing Interventions.

Used in emergency situations to lower BP quickly and administered via IV push. Short acting and *used for hypertensive crisis*. Patient is only kept on the med for 24 hours because prolonged exposure to this med can lead to cyanide accumulation in blood (aka toxicity). Examples: Nitropurside Nitroglycerine Hydralazine Minixodil SE's: facial flushing, dizziness, palpitations, headache NI's: Monitor BP frequently

FAST

Used to assess patients for stroke during emergencies.

Define Greenfield Filter:

Used to treat DVT - a filter placed inside the inferior vena cava that catches blood clots as they travel upward; this filter prevents the blood clots from reaching the lungs, while still allowing blood to flow around the captured clot.

Contact Enteric Precautions

Used when caring for someone who is infected with enteric bacteria - ex: a patient with Clostridium Difficile

When is it appropriate to use Ambulatory Blood Pressure Monitoring?

Useful for patients who have elevated BP readings in a clinical setting and normal readings when BP is measured elsewhere. This phenomenon is referred to as *"white coat" hypertension*. Other potential applications for ABPM include *suspected antihypertensive drug resistance*, *hypotensive symptoms with antihypertensive drugs*, *episodic hypertension*, or *SNS dysfunction*.

Doppler Ultrasound

Uses soundwaves

What do Inhaled corticosteroids do? How often are they taken? Long term/short term use? What are they used for? What are some examples of Inhaled corticosteroids? What can these sometimes cause?

Usually they are inhaled - they are used to prevent/decrease inflammation in the respiratory system. They are taken daily on a fixed schedule. Long term use. Not for treatment of acute exacerbation - used to control. Examples: - Fluticasone (Flovent) - DPI or MDI - Budesonide (Pulmicort) - DPI Can cause oral candidiasis (thrush, a white fungal infection), dry mouth, hoarseness. To prevent this from happening, rinse mouth, inhaler, and spacer after use.

A blood clot that forms within venous system usually in the lower extremities & associated with prolonged bed rest is known as:

VTE (Venous Thromboembolism)/DVT (deep vein thrombosis)

Prevention of Herpes Zoster

Vaccine

Women can sometimes get (?) while taking antibiotics.

Vaginal yeast infections - antifungals may be prescribed.

Name 1 example of an ARB. What is their common ending? What are the side effects? What are the nursing interventions?

Valsartan Commonly end in -sartan. SE's: hyperkalemia, angioedema, renal insufficiency (renal failure), heart failure NI's: Avoid foods high in potassium & salt + salt substitutes.

Alpha 1 Receptors cause:

Vasoconstriction

Alpha 2 Receptors cause:

Vasodilation

Prostaglandins (PGE2 and PGI2) secreted by the renal medulla have a (?) effect on the systemic circulation. This results in decreased SVR and lowering of BP

Vasodilator

Raynaud's Phenomenon - what is it? what is it in response to? what is the cause? what might it be associated with but isn't proven yet? what gender + age does it mainly affect? what is it also known as? is it curable?

Vasospasm of small arteries/arterioles of extremities (usually in hands/feet). Usually occurs in response to cold or emotional stress. Etiology is unknown - associated with connective tissue diseases - might be associated with rheumatoid arthritis. Usually occurs among young females between ages of 15 and 40 Known as the Red, White, & Blue disease. Not curable.

Lyme disease is a (?) borne disease.

Vector Borne

How is Venous-Duplex Ultrasound used in diagnosing DVT's?

Venous duplex ultrasound is a non invasive procedure that uses harmless sound waves to observe blood flow and detect blood clots through the extremities.

Name some volume restrictive procedures aka procedures that reduce the stomach reservoir

Vertical banded gastroplasty (VBG) Laparoscopic adjustable gastric banding (LAGB) Sleeve gastrectomy*most popular Intragastric balloon placement

How do we treat pernicious anemia?

Vitamin B12 Injections for the rest of life

Antidote for Coumadin:

Vitamin K & FFP (Fresh frozen plasma)

Facilitates use of other nutrients; involved in regulating growth and manufacturing hormones

Vitamins

This DESCENDING TRACT - *Pyramidal tract* - is responsible for:

Voluntary movements

If the patient is a candidate for tPA, tPA should be administered how soon after the onset of symptoms?

WITHIN 4.5 hours after symptoms present, but GOAL is to administer tPA within *60 MINUTES*

Dissolves and carries nutrients, removes wastes and regulates body temperatures

Water

*Hormone Replacement Therapy* - list different ways of administration, considerations for administration, list side effects, and 1 example of this type of drug regarding Osteoporosis.

Ways to administer: Nasal spray, SQ, IM (no PO form) Considerations for administration: Alternate nares because its very irritating and can cause epistaxis (bleeding from the nose) Side effects: Nasal irritation, flushing (redness), GI, urinary frequency Example: Calcitonin (Calcimar)

When do we begin experiencing symptoms of CAD?

We begin experiencing angina pectoris when arteries are 75% occluded.

Can we give immunosuppresents to someone with MS?

We can, but they are given as a last resort because they severely suppress the immune system, putting the patient at an increased risk for infection.

When do we discontinue Heparin therapy?

We discontinue Heparin when Coumadin begins working - we know Coumadin has taken affect when it reaches an INR between 2 and 3. This usually takes about 3-5 days.

When it comes time to treat a stroke, it is crucial that we rule out the possibility of hemorrhagic strokes with a CT scan because:

We need to administer tPA immediately to dissolve any harmful clots - if the person has had a hemorrhagic stroke, *WE WOULD NOT ADMINISTER tPA!* However, if the CT scan shows they are negative for a hemorrhagic stroke, we can proceed with administration of tPA as long as it is within the desired time frame of 4.5 hours.

For Gout, we want to apply (?) over the site, not (?)

We want to apply ice over the site, not heat as the site is already warm

If a patient who has Addison's is scheduled for a surgery, what is something we should ensure happens as the nurse?

We want to make sure our patient has taken their medications before their surgery. If these medications are withheld, it could send the patient into Addisonian Crisis.

How do we treat PUD?

We want to treat the cause: - Reduce degree of gastric acidity - Enhance mucosal defense mechanisms Medications - usually not just 1, we treat with a combination of different meds. - Antacids - Pepto-Bismol - H2R blockers - PPIs - Antibiotics & PPI for H. pylori - Prostaglandin analog & mucosal barrier

How do we treat Myxedema Coma?

We want to treat the symptoms - Our #1 priority is to make sure our patients are breathing. Give supplemental O2 or apply ventilation as necessary. If patient is unconscious, give Levothyroxine sodium via IV. If patient is conscious, it can be given PO. Giving Levothyroxine sodium will give them the missing hormone they need to correct this exacerbation. For hypoglycemia, we want to administer IV fluids with Dextrose (ex: 50% Dextrose). For low blood pressure we want to give IV fluids - these will help bring up the blood pressure.

Where should we administer heparin in someone with a spinal injury?

We want to try to give heparin *above the level of the injury*

Symptoms of ALS will begin with:

Weakness starting in the muscles supplied by the cranial nerves - difficulty talking, swallowing, and then breathing will occur.

Venous ulcers are very (dry/wet?)

Wet

Post-op

What's done after surgery

Pre-op

What's done before surgery

Intra-op

What's done during surgery

When someone's bronchial tubes are constricted, what sound do you hear?

Wheezes

Global Aphasia

When both production and understanding of language is damaged. (Broca's & Wernicke's area are both damaged)

*Renin-angiotensin-aldosterone system (RAAS)* contributes to BP regulation by:

When low blood pressure occurs in the body, the RAAS system kicks in to bring the blood pressure back to normal. After low BP is first detected, the *LIVER releases a hormone called ANGIOTENSINOGEN* into the blood. Next, the kidney detects angiotensinogen has been released into the bloodstream, so the *KIDNEY releases an enzyme called RENIN.* Together, *RENIN AND ANGIOTENSINOGEN PRODUCE ANGIOTENSIN-1.* When Angiotensin-1 reaches the lungs, the *LUNGS will then release ACE.* Together, *ACE AND ANGIOTENSIN 1 PRODUCE ANGIOTENSIN 2.* Angiotensin 2 works on both the *adrenal glands* & the *kidneys*. When Angiotensin 2 reaches the adrenal glands, *ALDOSTERONE IS RELEASED!* We know that Aldosterone helps to increase blood pressure by: 1 - Increasing sodium absorption → which increases fluid volume → which then finally *INCREASES BLOOD PRESSURE!* Also remember as a side note that potassium is being excreted through the urine, so it is decreased. When Angiotensin 2 reaches the kidneys, it causes *VASOCONSTRICTION OF THE ARTERIOLES* which then *INCREASES BLOOD PRESSURE!*

Temporal Lobe is responsible for:

Where sound is received/processed

diabetic retinopathy

damage to the retina as a complication of uncontrolled diabetes

Define pancytopenia

deficiency of all three cellular components of the blood (red cells, white cells, and platelets).

IV Urogram

diagnoses chronic pyelonephritis

Voiding cystouretherography (VCUG)

diagnoses chronic pyelonephritis

How to treat Type 2 Diabetes:

diet, exercise, and oral hypoglycemics

Osteomalacia

disease marked by softening of the bone caused by calcium and vitamin D deficiency

Most common areas affected with Crohn's Disease:

distal ileum & ascending colon - but it can occur anywhere

Diverticulitis

diverticula (herniation of mucosa of intestine) become inflamed and infected - symptoms present.

Treatment for acute bronchitis:

drink plenty of fluids, rest, anti-inflammatory agents. for cough relief - cough suppressants and bronchodilators (like albuterol) to open airways. USUALLY NO ANTIBIOTICS - it is a viral infection.

Diabetic Ketoacidosis depletes:

electrolytes

Secondary Hypertension

elevated BP with a specific cause that often can be identified and corrected; accounts for 5-10% of hypertension in adults.

Primary (essential or idiopathic) hypertension:

elevated BP without an identified cause; accounts for 90% to 95% of all cases of hypertension.

Goiter

enlargement of the thyroid gland, commonly seen in hyperthyroidism/graves disease

Acetylcholinesterase

enzyme that breaks down acetylcholine, making muscles weak. To prevent this break down, we can give anticholinesterase meds/Cholinergics.

What is a type of therapy done for chronic disease anemia?

erythropoietin therapy - "EPOTIN ALPHA OR PROCRIT" GIVEN SUBQ - stimulates RBC production through the bone marrow - once hemoglobin is raised by 2-3 points, treatment is stopped.

Long muscular tube lined with mucosa where food and fluid travel to the stomach

esophagus

Define Digital Angiography:

examination by X-ray of blood or lymph vessels, carried out after dye is injected into veins.

Strictureplasty

Widening of strictures obstructing the bowel - this fixes the narrowing of the colon

Any cortisol replacement therapy should be taken (with/without?) food:

With food

Relapsing-remitting MS

With this type, you have flare-ups of the disease, or relapses. Between these flare-ups, you have periods of recovery, or remissions. This is the most common type of MS to have and usually occurs in the early stages of MS.

Complications of appendicitis:

Wound infection Dehiscence Intestinal obstruction Incisional hernia Peritonitis*EMERGENCY Paralytic ileus*EMERGENCY

Sequestrectomy

excision of a sequestrum (segment of necrosed bone) usually performed to treat osteomyelitis

Antrectomy

excision of the antrum (of the stomach)

Renal Calculi Diagnostics

X-rays (KUB) - Kidney, ureter, bladder x-ray Ultrasonography*: Assesses kidney for stones. IV urography: Contrast is used - procedure used to visualize abnormalities of the urinary system, including the kidneys, ureters, and bladder. Retrograde pyelography: Contrast is used - an imaging test that uses X-rays to look at your bladder, ureters, and kidneys Labs: Calcium and Uric acid levels will be assessed. Stone analysis: Patient goes home and pees through a strainer - strainer catches stones. Lab will run diagnostics on these stones.

Dry mouth is also known as:

Xerostomia

Are vital signs affected by acute pain?

Yes

Is a BP of 120/90 hypertensive?

Yes, because the diastolic number is at 90.

Is a BP of 150/80 hypertensive?

Yes, because the systolic number is 150.

Is secondary hypertension curable?

Yes.

MS commonly occurs in which age group? MS commonly affects which gender more? MS commonly affects which race more? What causes MS?

Young adults aged 20-40 Females Caucasians No cause has been identified.

Type 1 diabetes is common in what part of the population?

Younger, thin patients.

cardiac catheterization

a catheter is inserted into the femoral or radial artery and is advanced up the aorta, into the left ventricle and then into the coronary arteries - allows us to evaluate patency of arteries/veins letting us see if there are any blockages - patient may experience flushing/palpitations during or after - patient must be NPO before procedure. This is the *GOLD STANDARD* of diagnosing CAD.

Prediabetes

a condition in which the blood sugar level is higher than normal, but not high enough to be classified as Diabetes - they can prevent Diabetes by changing lifestyle (dieting and exercising)

herpes zoster (shingles)

a disease that involves a painful, blistering rash accompanied by headache, fever, and a general feeling of unwellness

Type 1 Diabetes

a disorder in which the pancreas produces little to no insulin

Type 2 Diabetes

a disorder where the body cells no longer respond to the insulin produced by the pancreas

Patient Controlled Analgesia (PCA)

a drug delivery system that uses a computerized pump with a button the patient can press to deliver a dose of an analgesic through an intravenous catheter

Gestational Diabetes

a form of diabetes mellitus that occurs during some pregnancies

Myasthenia gravis is caused by:

a lower motor neuron lesion

Hyperglysemic Hyperosmolar Nonketotic Syndrome

a metabolic complication of diabetes mellitus (DM) characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness. It most often occurs in type 2 DM, often in the setting of physiologic stress. Hyperosmolar hyperglycemic state is diagnosed by severe hyperglycemia and plasma hyperosmolality and absence of significant ketosis. Treatment is IV saline solution and insulin. Complications include coma, seizures, and death.

Arterial Stenosis

a narrowing of the inner channel of arteries and smaller arterioles due to the buildup of plaque

Ambulatory Blood Pressure monitoring:

a noninvasive, fully automated system that measures BP at preset intervals over a 24-hour period - Tell patients to hold their arm still by their side when the device is taking a reading. Also ask them to maintain a diary of activities that may affect BP - Useful for patients who have elevated BP readings in a clinical setting and normal readings when BP is measured elsewhere -

Scrub Nurse

a nurse who assists surgeons during surgery, wearing sterile attire and handling sterile equipment and supplies (prepares sutures, ligatures, special equipment; accounts for sponges, needles, and instruments)

Adrenal Glands

a pair of endocrine glands that sit just above the kidneys and secrete hormones that help arouse the body in times of stress.

Biliopancreatic diversion (BPD)

a portion of the stomach is removed. The intestine is cut and the last section of the intestine is reattached to the remaining stomach.

Deep Brain Stimulation

a procedure done to treat Parkinson's disease - A permanent stimulating lead placed in brain & connected to an impulse generator that's implanted in the chest - controlled by radio frequency transmissions from a computer - DBS helps interrupt "short-circuits" in brain

Define Homocysteine

a promoter of early atherosclerosis - blood protein found in people who eat alot of red meat - if elevated, it can indicate an increased risk for heart disease/cad.

Colostomy

a surgical operation that creates an opening from the colon/large intestine to the surface of the body to function as an anus - solid waste exits this type of ostomy.

Gastric Sleeve Procedure

a surgical procedure to treat obesity that involves removing a large part of the stomach so the remainder resembles a tube or sleeve in order to limit the volume that the stomach can hold

Secondary Diabetes

a type of diabetes caused by another disease or certain drugs or chemicals (ex: long term use of steroids, long term use of oral contraceptives)

The most debilitating clinical manifestation of multiple sclerosis is:

fatigue

Defining Characteristics of Influenza aka "The Flu"

fever, chills, weakness, muscle aches, joint pain, nausea, vomiting and headache.

6 Minute Walk Test (COPD)

for insurance purposes - diagnoses if patient needs medication at home. Patient may need oxygen at home. Done by physical therapy or respiratory specialist.

FEV

forced expiratory volume - Maximum amount of air a person can exhale from their lungs

FEV1

forced expiratory volume in 1 second

FVC

forced vital capacity - amount of gas that can be forcibly and rapidly exhaled after a full inspiration

Nephrolithiasis

kidney stones

ADH affects the:

kidneys

A right hemisphere stroke will cause:

left sided hemiparesis/hemiplegia - weakness and paralysis will occur contralateral to the brain injury.

VQ Scan

lung ventilation (airflow)/perfusion (blood flow) scan - the scan looks for any evidence of pulmonary embolism in the lungs.

EKG/ECG (electrocardiogram)

measurement of the electrical activity of the heart (monitors rate and rhythm)

High protein foods:

meat, beans, cheese, tofu

GU Blood loss occurs primarly from:

menstrual bleeding

What steroid would we give to help decrease inflammation in someone having an MS exacerbation?

methylprednisolone (Solu-medrol)

Foods high in calcium:

milk, broccoli, green leafy vegetables, almonds, celery, butternut squash, pumpkin seeds, sesame seeds, orange juice, tofu* for vegetarians, kidney beans

Aldosterone is a:

mineralocorticoid

It is out of a UAP's scope of practice to do what 5 things:

monitor, assess, evaluate results, educate, or teach the patient

Urostomy (ileal conduit)

most needed for bladder cancer, but also needed for kidney disease/trauma - no true restrictions to clothing or activity - ureters are attached to a small piece of ileum (small intestine) & bladder is removed - ileum produces mucus.

Where teeth, tongue, and salivary glands begin food digestion

mouth

Transmission of pain

movement of pain impulses from the periphery to the spinal cord & then to the brain

Name 3 examples of Biologics (Tumor Necrosis Factor (TNF) Blocking Agents) and what each is specifically used for:

natizumab (Tysabri): (Crohn's disease) infliximab (Remicade): (UC) adalimumab (Humira): (Crohn's/UC)

COX2 inhibitors

newer class of NSAIDS, block the COX-2 enzyme responsible for inflammation and the production of substances associated with pain (prostaglandins)

Aplastic Anemia is classified as a (?) anemia because although Hgb, WBC, and platelet values are decreased, other RBC indices are generally normal.

normocytic, normochromic anemia

Outpatient Surgery

operative procedures performed on clients who return home the same day, performed on patients of optimal health and who's recovery is expected to occur quickly

define Inpatient Surgery

operative procedures performed on persons admitted to a hospital and expected to remain in the hospital for a period of time

MSO4 (Morphine Sulfate)

opioid analgesic - can be given PO (liquid), SubQ, IM, IV

Methadone

opioid analgesic used to treat intractable pain (ex: cancer pain & heroin withdrawal)

Insulin Injection sites

outer arm, abdomen, hip area, thigh

Treatment for BOTH Myasthenic & Cholinergic Crisis

oxygen, possible ventilation depending on severity.

What levels indicate Metabolic Alkalosis? (List: pH, CO2, HCO3, O2)

pH: Greater than 7.45 CO2: 35-45 HCO3: Greater than 26 O2: 80 - 100

What levels indicate Respiratory Alkalosis? (List: pH, CO2, HCO3, O2)

pH: Greater than 7.45 CO2: Less than 35 HCO3: Less than 22 O2: 80-100

What levels indicate Respiratory Acidosis? (List: pH, CO2, HCO3, O2)

pH: Less than 7.35 CO2: Greater than 45 HCO3: 22-26 O2: Normal or Hypoxemic

What levels indicate Metabolic Acidosis? (List: pH, CO2, HCO3, O2)

pH: less than 7.35 CO2: 35-45 HCO3: less than 22 O2 normal or hypoxemic

Neuropathic Pain

pain from damage to neurons of either the peripheral or central nervous system (healing has completed but pain is still present)

Phantom Limb Pain

pain in a limb (or extremity) that has been amputated

Rovsing Sign

pain in the RLQ when the LLQ is palpated (indicative of appendicitis)

Referred Pain

pain that is felt in a location other than where the pain originates

Define plegia

paralysis

Paraplegic

paralyzed from the waist down

Quadriplegic

paralyzed in both arms and both legs

Parathyroid glands secrete:

parathyroid hormone (PTH)

Required Surgery

patient needs to have surgery, planned within a few weeks or months (cataract surgery)

What are some common causes of GI blood loss?

peptic ulcer, gastritis, esophagitis, diverticuli, hemorrhoids, and neoplasia

PPN is administered via

peripheral line

Cobalamin deficiency (Vitamin B12) is most commonly caused by:

pernicious anemia, which results in poor cobalamin (vitamin B12) absorption through the GI tract

Define Localizes

person brings extremity towards area of pain

Sputum Culture

person can cough up sputum/we can suction out sputum into a cup to have it sent out to the lab. Cultures should always be done before antibiotics are given.

Define Withdraws

person pulls away from pain

- Muscular structure shared by the digestive and respiratory tracts - It joins the mouth and nasal passages to the esophagus

pharynx

Predictive behavior that may indicate opioid addiction:

prescription forgery, selling prescription drugs, stealing or borrowing another patients drugs, injecting oral forms, recurrent loss prescriptions

Laboratory values that support a diagnosis of pyelonephritis:

presence of pyuria, leukocytosis, hematuria, and bacteriuria

Moderate sedation

previously referred to as conscious sedation, involves the use of sedation to depress the level of consciousness without altering the patient's ability to maintain a patent airway and to respond to physical stimuli and verbal commands

Modulation of pain

process by which the sensation of pain is inhibited or modified Inhibitory neurotransmitters such as endorphins (endogenous opioids), serotonin, norepinephrine, and gamma-aminobutyric acid (GABA) hinder the transmission of pain and help produce an analgesic effect. (the pain is still there but it is lessened)

Insulin regulates:

production, use, and storage of glucose

The diet of someone with venous insufficiency should consist of:

protein, adequate calories, Vitamin A, Vitamin C, Zinc.

Bowel Perforation

puncture in the wall of the GI tract, contents within the stomach or intestine may then spill into abdominal cavity with potential to cause infection known as peritonitis

Negative Feedback Mechanism

reaching a target level and then shutting off; this is how hormones are affected.

With Lower Motor Neuron injury, you lose the:

reflex arch

If t4/t3 are low, TSH will be:

released

proctocolectomy and ileostomy

removal of the colon, rectum and anus; surgical closure of the anus. End of ileum comes through the abdominal wall (ostomy).

Treatment of secondary hypertension is aimed at:

removing/treating the underlying cause

Long term methods of regulating BP include:

renal and hormonal processes that regulate arteriolar resistance and blood volume

Routine Urinalysis, BUN & Creatinine Serum levels are used to screen for:

renal involvement and to provide baseline information about kidney function.

Systemic Vascular Resistance

resistance to blood flow out of the left ventricle created by the systemic circulatory system

A left hemisphere stroke will cause:

right sided hemiparesis/hemiplegia - weakness and paralysis will occur contralateral to the brain injury.

The Five Rights of Delegation

right task right circumstance right person right direction/communication right supervision/evaluation

The ascending tracts carry:

sensory input to higher levels of CNS.

Codeine

short acting - weak opioid - given via PO by tablet or liquid *cough syrup*

Disadvantage of IV administrated analgesics:

short duration, possible respiratory depression, and careful dosage calculations are needed.

Pulmonary Function Test (PFTs)/peak flow

show how well the lungs are working. The tests measure lung volume, capacity, rates of flow, and gas exchange.

Bradykinesia

slowness of movement

Tophi

small, whitish nodules of uric acid crystals that have collected within a joint, caused by Gout

What are some foods that may cause GERD?

spicy foods, high acidic foods, citrus (grapefruits, tomatos), Garlic, Onions, Carbonated Drinks (beer, soda, champagne)

Ascending tracts begin in the (?) and end in the (?)

spinal cord, brain

Urolithiasis

stones in the urinary tract

Urgent Surgery

surgery that is not an emergency, but must be done within a reasonably short time frame to preserve health (ex: gallbladder removal)

Elective Surgery

surgery that is recommended but can be omitted or delayed without catastrophe (someone needs a knee replacement)

Arthrocentesis

surgical puncture to remove a sample of synovial fluid from the joint space

Percutaneous Nephrolithotomy

surgical removal of a kidney stone through a small incision in the back

Thyroidectomy

surgical removal of the thyroid gland (can have partial thyroidectomy or subtotal thyroidectomy)

Pyloroplasty

surgical repair of the pyloric sphincter - improves gastric emptying

Ostomy

surgically created opening from an area inside the body to the outside

Oedema

swelling caused by excess fluid

Too many Catecholamines in the body causes overstimulation of the (?) which leads to a hyper metabolic state.

sympathetic nervous system

Short term methods of regulating BP include:

sympathetic nervous system (SNS) and vascular endothelium - they become active within a few seconds.

NIH Stroke Scale scores greater than 4 are treated with:

tPA

True or false: Additives to TPN solutions may include regular insulin and famotidine (PEPCID)

tRUE

Arthrography

taking x-ray images after injection of contrast material into a joint

General Anesthesia

the blockage of all body sensations, causing loss of consciousness and loss of reflexes.

Hormones travel through:

the bloodstream

The endocrine system consists of:

the body's glands and hormones.

Duodenum

the first part of the small intestine immediately beyond the stomach, leading to the jejunum.

The most common complications of hypertension are *target organ diseases* occurring in (List the diseases):

the heart (hypertensive heart disease) brain (cerebrovascular disease) peripheral vessels (peripheral vascular disease) kidneys (nephrosclerosis) eyes (retinal damage & vision loss)

Cerebrum

the most anterior part of the brain that provides the highest level of function

Tolerance

the need for increasing doses of opioids to achieve the same therapeutic effect) develops in almost all patients taking opioids for extended periods. Patients requiring opioids over a long term, especially cancer patients, need increasing dosages to relieve pain/feel an analgesic effect.

High osmolality indicates:

the presence of a lot of substance and less fluid.

Diverticulosis

the presence of a number of diverticula (herniation of mucosa of intestine) in the colon - they are present without inflammation or symptoms.

Patients with active signs and symptoms of ulcerative colitis shouldn't undergo barium enemas because of:

the risk of precipitating toxic megacolon

Arthroscopy

the visual examination of the internal structure of a joint

For a patient receiving a Transsphenoidal Hypophysectomy, we want to inform them that:

they will wake up with nasal packing & a mustache dressing, so they will be breathing through their mouth.

osteopenia

thinner than average bone density, but not as thin as that of osteoporosis - the midpoint between having normal bones and having osteoporosis.

TSH affects the:

thyroid gland

TSH

thyroid stimulating hormone

Hydrochloric acid, histamine, and pepsin cause:

tissue edema, increased capillary permeability, possible hemorrhage from ulcerations and erosion of the stomach lining.

Why are diagnostic studies performed for HTN?

to (1) identify or rule out causes of secondary hypertension, (2) evaluate target organ disease, (3) determine overall cardiovascular risk, or (4) establish baseline levels before initiating therapy.

Goal for asthma:

to achieve and maintain control of asthma

diabetic neuropathy

too much blood sugar can make neurons less/more sensitive to pain (characterized by pins and needle sensation and loss of sensation in lower extremities)

Paget's Disease

too much bone growth/build up of osteoblasts in certain areas is Paget's Disease.

What are 5 Nursing Interventions to perform for someone experiencing Addisonian Crisis?

treat the Symptoms: 1. Treat dehydration with D5 NS 2. Replace steroids - Glucocorticoids (cortisol) are replaced with *hydrocortisone* - Mineralocorticoids (aldosterone) are replaced with *fludrocortisone* 3. Replace glucose with Dextrose 50% 4. For hyperkalemia - give insulin with dextrose (to shift K+ into cells) 5. BP should be restored with IV fluids.

Ileal Conduit

urinary diversion in which the ureters are connected to the ileum with a stoma created on the abdominal wall

Surgical Techniques: Robotic Surgery

use of small surgical instruments attached to a computer and operated by the surgeon from a console several feet from the operating table

Endothelin

vasoconstrictor

Low osmolality indicates:

very little substance with lots of fluid

Occipital lobe is responsible for:

visual processing

Define paresis

weakness

Steattorhea - define this term and state what it is a clinical manifestation of.

when fat globules are present in feces - this is a clinical manifestation of Crohn's disease

What are some diagnostic findings that signify Chronic Disease/Inflammatory Anemia?

↑ Serum ferritin ↑ Iron stores Normal folate (folic acid) Normal cobalamin (vitamin b12)