Hurst Q cards

Water heater setting

Below 120F

ECG changes with hyperkalemia

Bradycardia. Tall and peaked T waves. Prolonged PR intervals. Flat or absent P waves, widened QRS, conduction blocks, and ventricular fibrillation

hyperkalemia

CAUSES-kidney trouble, spironolactone-makes u retain potassium. S/S-begins with muscle twitching, then proceeds to muscle weakness then flaccid paralysis. life threatening arrhythmias. TREATMENT-dialysis, calcium gluconate decreases arrhythmias. glucose and insulin. insulin carries glucose and potassium into the cells, worry ab hypokalemia and hypoglycemia. sodium polystyrene sulfonate (kayexalate)-exchange k ions for Na ions.

Chemotherapy Full Precautions

Chemotherapy Gown 2 pairs of chemotherapy gloves-one under gown, one over gown. Goggles and/or mask if splashing or inhalation can occur

hypertonic solutions

"packed with particles". volume expanders that draw fluid into the VS from the cells. D10W, 3%NS, 5%NS, D5LR, D51/2 NS, D5NS, TPN, Albumin. used for hyponatremia, 3rd spacing, severe edema, burns, or ascites. will return fluid volume to VS. watch for FVE, monitor in ICU with monitoring for BP, HR, CVP esp if 3 or 5% NS

general ways to prevent infection

-Private room -Wash hands -Have patients own supplies in room (ex: own cups, BP cuffs, stethscope) -Limit people in the room (visitors and nurses) -Change dressings and IV tubing daily -No fresh flowers or potted plants -Cough and deep breath --> decrease risk for pneumonia -Avoid crowds, wear mask in public -Dont share tolities -Bathe warm moist areas twice daily -Wash hands after touching a pet or other people -avoid undercooked meat, seafood or eggs NO SUSHI -Avoid raw fruits or vegetables, -Drink only fresh water -report to hospital for any temp of 100.4 -no alchol based mouthwash

Isotonic solution=balanced solutions

0.9% Nacl Lactated Ringers D5W d51/4NS. these stay in VS and could cause FVE. used to replace fluids in V,N, burns,sweating and trauma. DO NOT GIVE to hypertensive, cardiac disease or renal disease. be careful ab hypernatremia. give LR for shock, blood=NS

spill chemotherapy on hands and floor ordered response?

1. wash hands with soap and water 2. get spill kit from wall in client's room. 3. put on respirator mask 4. put on chemotherapy gown 5. put on 2 pairs of gloves 6. put on goggles. 7. use absorbent pads to wipe up spill. the floor needs to be cleaned THREE TIMES. use ALL protective equipment for cleanup

American Burn Association

2-4ml of LR x body weight in kg x % of TBSA burned=total fluid needed. 1st 8hrs=1/2 of total volume 2nd 8 hrs=1/4 of total volume 3rd 8hrs=1/4 of total volume. 24hrs of when burn occured

what do the liver enzymes do if the liver is damaged

ALT and AST will increase is liver is damaged

Partially compensated

All values are abnormal

Hypomagesemia causes

Diarrhea, alcoholism- suppresses ADH- not eating, and diuresising more then normal. treatment- give some Mg, check kidney function before and during IV mg. seizure precautions, eat mag, flushing and sweating when starting IV mg? STOP IT

A client with chronic liver disease has ascites and is being treated with an albumin infusion. What should the nurse anticipate and monitor in this client?

Fluid volume excess bc albumin is a hypertonic solution.

red blood cell transfusions

For clients with symptomatic anemia We do not want Hgb/Hct to drop below 8 g/dl and 24%

rule of nines

Head and Neck= 9% Each upper ext= 9% Each lower ext= 18% Front trunk= 18% Back trunk= 18% Genitalia= 1% so anterior arm would be 4.5 but whole arm is 9

fluid retention think

Heart Problems First! bounding and full pulse. more volume more pressure

Hypercalcemia causes

Hyperparathyroidism-too much PTH which makes calcium go up. thiazides-retain calcium immobilation-have to bear weight to keep CA in the bones but nah so it goes in blood and raises serum ca. s/s-brittle bones, kidney stones-most made of calcium treatment-move, fluids-prevent kidney stones, CA inverse relationship with phosphorus so add phos or protein to diet, steriods to decrease CA. give biphosphates(etidronate) and calcitonin-treats osteophorosis

Hyperaldosteronism (conn's syndrome)

Hypersecretion of aldosterone from the adrenal cortex. retain sodium and water- leads to FVE

A client is admitted following a severe burn. What changes related to fluid status would the nurse anticipate?

Hypovolemia, third spacing, low CVP, increased USG

FVD symptoms

Low BP- risk for orthostatic hypotension, High HR, high RR. pulse-weak and thready Dry mouth, thirst Rapid weight loss Low urine output Confusion, lethargy SG>1.030 (High)-urine is very concentrated High HCT High BUN (Blow Urea Nitrogen) Low Na High Osmo cvp-down, vasoconstrict. IV HARD stick

Extravasation of Chemotherapy

Major complication of IV Chemotherapy. vesicant- type of chemo drug that if it infiltrates will cause tissue necrosis. s/s- pain, swelling, no blood return treatment- prevention. stop the infusion and send for the extravasation kit. stay with the client.

A client is admitted with hypocalcemia. Which treatment would the nurse anticipate for this client?

PO calcium, vitamin d, sevelamer hydrochloride (phosphate binder)

The nurse is preparing to administer magnesium sulfate IV to an alcoholic client with hypomagnesemia. Prior to the initiation of IV magnesium, which assessment data would be important for the nurse to document?

RR, DTR, UO

Rome

Respiratory Opposite Metabolic Equal. respiatory bc lung one is 45 acid, 35 is base.

Foods high in potassium

Spinach, fennel, kale, mustard greens, brussel sprouts, broccoli, eggplants, parsley, cucumber, bell pepper, ginger root, tuna, halibut, cauliflower, lima beans, potatoes (white or sweet), cabbage, cantaloupe, tomatoes, apricots, strawberries, avacado, banana, kiwi, oranges.

total laryngectomy

Surgical removal of the entire larynx - vocal cords, epiglottis, thyroid cartilage. will have a permament trach or laryngectomy. upper trachea has to be rerouted out through the upper neck. post op-mid-fowlers 30-45% watch for carotid artery and innominate artery rupture!! FREQUENT MOUTH CARE

risk factors for cancer

Tobacco, alcohol, dietary causes, obesity, physical inactivity, poor nutrition, immunosuppressed, age >60, african americans, heredity, exposure to ultra-violet radiation, exposure to carcinogens, stress, chronic irritation, previous history of cancer

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Too many letters= too much water, retain water, FVE. UOP decrease bc they are retaining water. urine concentrated, blood diluted. serum sodium=low bc hella water. urine specific gravity=high,

ECG changes with hypokalemia

U waves, PVCs, Ventricular tachycardia

how to dispose chemotherapy?

YELLOW rigid chemotherapy waste container for sharps and IV epiquipment. yellow chemotherapy waste bag for gowns, gloves, and disposable items. wash with SOAP AND WATER

Neutropenia

a decreased number of neutrophils. best way to assess is by calculating an absolute neutrophil count. ANC (2500-8000 cells) tells how well your client can handle an infection treat-antibiotics, implement neutropenic precaustions.

signs of rejection in a post stem cell transplant

abdominal pain, jaundice, pruititis, diarrhea

other therapies for cancer pain management

acupressure, acupuncture, cannabis, distraction, hydrotherapy, massage

urinary output for burns

adults 0.5-1ml/kg/hr. electrical burn- 75-200ml/hr is goal kids- 1ml/kg/hr

what medication do you give after the first 24hrs of a burn

albumin. holds onto fluid in the vas. space. work load of the heart will increase. but if you stress heart too much then check CVP hourly to make sure the infusion is not overloading and going into FVE.

IV potassium

always assess UO before/during IV potassium. have to have a pump, mix well, burning?slow infusion

if cancer invades the bone marrow, it can lead to... (3)

anemia(low RBC), leukopenia(low WBC), thrombocytopenia(low platelet)

Neutropenic precautions

antibiotics as prescribed vital signs at least every 4 hrs private room with door closed and posted sign antimicrobial soap for handwashing no invasive procedure (IM injection, rectal exams/meds) avoid indwelling catheters or NG tubes if at all possible limit use of acetaminophen (tylenol)

ADH problems

anything that upsets the pitutary gland. aka craniotomy, head injury, sinus sugery, transsphenoidal, hypophysectomy, pituitaty tumor, any condition that can lead to increased ICP= adh problem

nclex tip-radiation

assume they all emit radiation to be safe

when should women have a colonoscopy

at age 50 then every 10 years.

how to prevent dislodgement of implant

bedrest, decrease fiber in diet, prevent bladder distension, have indwelling catheter. if it becoems dislodges- gloves, forceps, place implant in a lead lined container, leave in room and call radiation department

kidney chemicals

bicarb & hydrogen. normal bicarb(HCO3) 22-26. so think metabolic. when they are compensating they are excreting them through the urine. take hours to days to do their job

what cancer is fever an early sign of

blood(leukemia) cancers and lymphoma

hematologic cancers treatment

bone marrow and stem cell transplants. same transplant but from different areas. stem cells are given into a vein, and settle into the bone marrow and produce healthy blood cells

what to do after a mastecomy?

brush hair, squeeze tennis balls, wall climbing, flex and extend elbow. promotes new collateral collection

Major lung chemical

c02, so think respiratory when co2 is abnormal. normal is 35-45. but backwards bc greater then 45 is acidic and less then 35 is basic. only way to get rid is to exhale. lungs respond fast

what do u do if the innominate artery

call the pcp and go to the OR

Hypokalemia

causes-vomiting, NG suction, diuretics, not eating. s/s- first muscle cramps, then muscle weakness, then arrhythmias. treatment-give potassium, spironolactone- makes u retain potassium, eat more potassium.

diagnosis for cancer

caution change in bowel/bladder habit a sore that does not heal unusual bleeding/discharge thickening or lump in breast or elsewhere indigestion or difficulty swallowing obvious change in wart or mole nagging cough or hoarseness

what to look for if they have a mastectomy

check for bleeding on the front and back, blood can pool in the back

why is surgery the first type of treatment?

could be used for prevention, diagnosis, or to treat it by removing.

Thrombocytopenia- big deal in cancer

decrease in the number of circulating platelets in the blood. they are responsible for clotting and to prevent bleeding risk factors- advanced metastatic disease, hematological malignacies, bleeding disorders-hemophilia, liver disease, ITP(idiopathic thrombocytopenia purpura). bacterial infections, anticoagulant medications-aspirin, clopidogrel, heparin, warfarin, result of cancer treatments

Hyperventilation

decreased CO2 so alkalosis.

Increased CO2 means

decreased LOC. decreased O2

Hypernatremia

dehydration. too much sodium not enough water. causes-hyperventilation-exhale lose water, heat stroke, DI. s/s-dry mouth, thirsty, swollen tongue, neuro changes. treatment-restrict sodium, dilute client with fluids(IV fluids) so sodium goes down. daily weights, I&O, lab work. watch feeding tubes bc they get dehydrated easily

The nurse is preparing a teaching plan for a client newly diagnosed with fluid retention and heart failure. What should the nurse advise the client to avoid?

effervescent soluble medications, chicken noodle soup, deli-ham sammy

what is the rule of nine not used for

electrical burns but only thermal burns

external radiation s/s

erythema, shedding of skin, fatigue, pancytopenia. DO NOT WASH OFF MARKING, no lotion on marking. protect site from sunlight and UV for 1 year

red or brown urine after a burn

expected after a major burn/electrical injury. obv monitor

burns treatment for inhalation injury

give 100% oxygen

before hydrotherapy

give pain meds, worry ab cross contamination for whirl pool

hypotonic solution

goes into VS then shifts out into the cells to replace cellular fluid. they rehydrate but do not cause hypertension ex-D2.5W, 1/2NS, 0.33NS. used for pts who have hypertension, renal, or cardic disease and needs fluid replacement. also used for dilution when a client has hypernatremia and cellular dehydration. WATCH for CELLULAR EDEMA

respiratory acidosis s/s

headache, confused, sleepy. hypoxic. treatment-fix breathing problem. deep breathing, pneumothorax-chest tubes.

A client with deep partial thickness burns to arms and legs is admitted to the burn unit. The nurse knows elevated results are most likely to be noted initially in what laboratory tests?

hematocrit, potassium, creatinine.

Thrombocytopenia assessment

history, VS, pulse ox, oozing from surg site, change in LOC, reports Headache, pupil changes, conjunctival hemorrages(eyes bloodshot), petechiae-arms, legs, mouths (spots), ecchymosis (brusing), purpura (lots of red and purple bruising), bleeding from rectum, ears, nose, throat treatment-give them some platelets

metabolic acidosis- potassium

hyperkalemia

respiratory alkalosis

hyperventilation. could be acute aspirin overdose. s/s- lightheaded or faith feeling, peri-oral numbness, numbness and tingling in fingers or toes. treatment-may have to sedate, treat the cause!!

metabolic alkalosis-potassium

hypokalemia. excessive vomiting

Hypocalcemia causes, s/s, treatment

hypoparathyroidism, radical neck, thyroidectomy=not enough PTH. treatment-PO calcium. IV CA-give sloww and make sure always on heart monitor- widens QRS, decrease HR, too fast-arrthymia.. vitamin d, phosphate binders (decrease phos= increase calcium) sevelamer hydrochloride, calcium acetate.

FVD

hypovolemia aka shock. loss of fluid from anywhere-V,D, thoracentesis, paracentesis, hemorrhage. 3rd spacing- fluid in place that does u no good, worry ab hypotension. polyuria so DM. POLYURIA THINK SHOCK

sodium level

in blood is dependant on how much water you have in blood. think neuro checks

hypoventilation

increased CO2 so acidosis

radiation therapy-internal

internal(brachytherapy)-gets the radiation close to the cancer or target tissue. unsealed-emits radiation through body fluids. given IV or PO. radioactive for 24-48hrs sealed or solid-client emits radiation, body fluids are not radioactive. placed close to or inside the tumor. can be permanent or temp.

sodium and potassium have an

inverse relationship

patient teaching about chemotherapy

is excreted for 3-7 days after administration so may still excrete when discharged

bedrest is good for FVE bc

it induces diuresis by releasing ANP which you lose sodium and water and decrease production of ADH

metabolic acidosis

kidneys are the issue and lungs are compensating. retaining hydrogen or too little bicarb. RR will increase to get rid of acid. causes- DKA, starvation, renal failure, severe diarrhea. s/s- depends on cause, hyperkalemia. treat the cause

if question says assessment/ evaulation

look for presence or absense of pertinent s/s

Before a mammogram what should the client not have on their body?

lotion, powder, deodorant

dietary risk factors for cancer

low fiber, increased red meat, increased animal fat, nitrates(processed sandwhich meats), alcohol, preservatives and additives.

FVE treatment

low sodium diet/restrict fluids. duirectics-loop= furosemide or bumetanide when lasix doesnt work. hydrochloroyhiazide. watch electrolyte problems bc diurectics lose potassium!!! potassium sparing- spironalactone- watch for hyperkalemia

Before giving antibiotics you should first

make sure the cultures have been collected

what medication given to flush out the kidneys

mannitol-never refriderate. usually only diuretic given for a burn, may increase fluids and report when color turns CLEAR

Centra venous pressure

measured in right atrium, up in FVE. normal-2-6mmHg, 5-10 cmH20.

symptoms of hypomagnesemia and hypocalcemia

muscle tone-rigid/tight, seizure risk, stridor/laryngospasm-airway is a smooth muscle, positive chvostek-tap cheek (twitching is bad). positive trousseau-pump uo BP cuff-tremor. arrhythmias, DTRs increase, mind changes, swallowing problems

what lab work do you monitor in cancer

neutrophils

if lymph nodes were removed with mastectomy, what do you avoid

no procedures on the arm of the affected side for a lifetime. no constriction, no BP, no blouse with elastic, no watch, no IV, wear gloves when gardening, no nail biting, watch small cuts, and no sunburn. no purse. bc can turn into a big infection on affected arm

diabetes insipidus

not enough ADH- lose water, FVD, worried ab shock. NO BLOOD SUGARS!! DI=DIURESIS. urine diluted, blood concentrated. going into shock but still putting out hella diluted urine.

DVT-cancer

number 2 cause of death in cancer clients why is cancer a big risk? prolonged bedrest, surgery, use of central line, extrenal compression of vessels by tumor, invasion of vessels by tumor, certain chemo drugs. worried ab development of PE

Addison's disease

occurs when the adrenal glands do not produce enough of the hormones cortisol or aldosterone. lose sodium and water and go into FVD

uncompensated

pH and one other value are abnormal. the other value is normal bc its not trying to fix the problem

Fully compensated

pH is normal, but the other 2 are abnormal.

normal ABGS

pH: 7.35-7.45 PaO2: 80-100 PaCO2: 35-45 HCO3: 22-26

If the kidneys aren't working well, __________ will go up.

potassium

Lab work to ensure proper nutrition and positive nitrogen balance

prealbumin-shortest halflife and changes the quickest

external radiation

process of administering radiation to the patient via a radiation machine located outside the body. is not radioactive!!

what are needed in the diet to promote healing?

protein and vitamin c

fatigue and pain

provide periods of rest, naps, and limit visitation time treat pain without worry ab dependance OPIODS ARE GOLD STANDARD FOR CANCER PAIN- no ceiling on dose of opiod for cancer pain, limit the dose bc of side effects, client dependent! also give stool softener for constipation induced from opidods

Hypermagnesemia causes, s/s, and treatment

renal failure antacids s/s- flushing and warmth, mg causes vasodilutation-decreases BP treatment-ventilator. RR less than 12=vent, dialysis-kidneys aren't working, calcium gluconate-antidote for Magnesium toxicity.

Hypoxia

restlessness and tachycardia

medications given for NV in cancer

routine antiemtic meds are usually given the first week of chemo. ondansetron (zofran)- blocks the effects of serotonin. serotonin receptor antagonist(all end in tron), pill or IV, usually have few side effects, low drowsiness effect. netupitant/palonosetron (akynzeo)- oral combination antiemtic, prevents acute and delayed NV caused from chemo. only 1 dose-1 pill one hour befroe chemo.

daily weights

same time, same scale, same clothes, void first,

common symptoms of hypermagnesemia and hypercalcemia

sedated DTR- decrease muscle tone-weak/flacid arrhythmias-yes LOC-down pulse-down RR-down

Magnesium and Calcium act like

sedatives think muscles first mg-1.3-2.1 ca-9.0-10.5

foods high in mag

spinach, mustard greens, summer squash, broccoli, halibut, turnip greens, pumpkin seeds, peppermint, cucumber, green beans, celery, kale, sunflower seeds, sesame seeds, and flax seeds

what immunizations do you give after a burn

tetanus toxoid- takes 2-4weeks to develop, active immunity. can't remember when they got their last shot? then they get the immune globulin(passive immunity) gives u immediate protection

internal radiation precautions

time-only short visits distance-stand as far as possible shielding- lead shield nursing assignments rotated daily, only care for 1 client with radiation implant on a shift. wear film badge-to track amount of radiation. restrict visitors, visitor visits only 30 min, stay 6 feet away, no younger then 16, no pregnant, wear gloves

burns- why does HR increase

to pump the little fluid to the organs, CO decrease, UO decrease

metabolic alkalosis

too much bicarb, too little hydrogen. causes- loss of upper GI contents-aka losing acid. too many antacids- too much base. s/s- depends on cause, observe LOC. serum potassium will go down in alkalosis think K LO. monitor for muscle cramps and life threatening arrhythmias. fix the problem and replace potassium

Cushing's disease

too much of all steroids, too much aldosterone . retain sodium and water- leads to FVE

Hyponatremia-dilution

too much water, not enough sodium. causes- drinking H20 for fluid replacement (drink gatorade)-bc only replaces water and dilutes the blood. psychogenic polydipsia- loves to drink water. D5w-sugar and water. SIADH-retaining water. s/s-headache, seizure, coma. treatment- needs sodium, not water. neuro problems? need hypertonic saline so 3% or 5%. worry ab FVE

fluid status for burns

urine output!! only time its not daily weights

ADH another name

vasopressin(pitressin). or desmopressin acetate(DDAVP) may be utilized as an ADH replacement in DI

When do chemo drugs work best?

when the cells are actively growing so when the tumor first begins to develop. early detection for cancer is best

breast self-examination

women- monthly do the exam when period is almost over so day 7-12. post menopausal do on the same day of every month. greater then 40 need a yearly clincial breast exam. 20-39 need one every 3 years

what do you worry ab with mycin drugs

worry when BUN or creatinine increase or if they report any hearing loss. can lead to ototoxicity (irreversible hearing loss) and nephrotoxicity. if bun and creatinine increase assume client has nephrotoxicity