Pn2 final exam

Furosemide

Potassium depleting

Spirnorolactone

Potassium sparing

t-PA

Powerful thrombolytic IV dangerous, high risk

INR range

0.8-1.1

Mixing insulin

1-roll insulin 2- wipe vial w alcohol and inject air in NPH 3-wipe vile with alcohol and inject air into regular 4-withdraw regular insulin 5- withdraw NPH insulin 6- verify insulin withdrawn with order

Ulcerative Colitis Symptoms

-Bloody diarrhea (hallmark) -Tenesmus (fecal urgency) -LLQ cramps relieved with defecation

Hypertensive Medications

-Diuretics -Beta-Blockers -Calcium Channel Blockers -ACE Inhibitors -General vasodilators

cycstic fibrosis

-build of thick mucus -recessive disorder-both parents -thick secretions -affects resp. System and GI -can see mucus in stool -interventions: Increase fluid IV -cough/deep breathing -incentive spirometer 10x an hr.

Atherosclerosis

A platelet and fat accumulation causing a narrowing of the arterial lumen and reducing blood flow. -pain to areas deprived of blood -bruit (swishing, turbulent flow) -weak pulses -pallor -cyanosis -decreased cap refill LABS: cholesterol CPK OR troponin if cardiac

Abdominal Aortic Aneurysm (AAA)

A rapidly fatal condition in which the walls of the aorta in the abdomen weaken and blood leaks into the layers of the vessel, causing it to bulge. -can be asymptomatic sometimes palpable Mass in abd. With a pulse Smoking and family history and hypertension biggest risk factors RUPTURE=sudden onset, severe abdominal, flank or back pain— immediate surgery and blood transfusions Monitor BP closely overtime Give anti hypertensives

After load

Amount of force the ventricles need to overcome to eject the blood out of the heart

Hypoglycemia

An irregular or fast heart beat Fatigue Pale skin Shakiness Anxiety Sweating Hunger Irritability

ARBS

Angiotensin II Receptor Blockers -Valsartan, Losartan -avoid food high in potassium -ARBs causes hyperkalemia

Hypercalcemia

Bone pain Kidney stones Polyuria

HHNS HYPERGLYCEMIC HYPEROSMOLAR NONKETOTIC SYNDROME

Can take days or weeks to develop. Possible signs and symptoms include: BLOOD SUGAR LEVEL ABOVE 600 Excessive thirst Dry mouth Increased urination Warm, dry skin Fever Drowsiness/confusion Hallucinations Vision loss Convulsions Coma No ketones present in serum or urine

BETA BLOCKERS

Causes the heart to bear more slowly and with less force, which lowers BP. They work by blocking the effects of epinephrine. -client teaching: may cause dizziness, fatigue, light headedness -do not stop taking abruptly -check Bp before giving Atenolol, metropolol

Ménière's disease

Causes vertigo tinnitus and hearing loss Vertigo, nausea/vomiting, nystagmus, severe headaches fullness of ear hearing loss Teach to move head slowly Reduce sodium Stop smoking Comply with drug therapy Drugs- diuretics, antiemetics

Chrones disease

Chronic inflammation of the small intestine (most often) the colon or both. Inflammation causes thickened bowel wall Malabsorption/fluid/electrolyte loss Key symptoms- diarrhea, abdominal pain, low grade fever

SLE

Chronic, progressive, inflammatory connective tissues autoimmune disorder or that can lead to multiple organ failure-frequently damages the kidneys Poly arthritis pain, fatigue, weakness Butterfly rash, lesions, alopecia, joint deformities, decreased mobility, fever X-ray, MRI, CT monitor: TEMPERATURE give-hydrochloroquine, NSAIDs, glucocorticoids and immunosuppressive agents Teach skin protection

Peripheral artery disease

Claudication -Intermittent cramping of skeletal muscles with exercise -standard=able to walk one city block without pain -positive= pain with ambulation, pain with elevation, relief with dependent position or rest -pain progresses to necrosis/gangrene -decrease or loss of pulses -dependent redness,cool skin, pallor or blue dusky -muscle atrophy -hair loss -dry or scaly skin -ulcers LABS:cholesterol INTERVENTIONS: monitor peripheral pulses, keep warm, give antiplatelets, anticoagulants TEACH: avoid nicotine, exercise, avoid cold, foot care

Cataracts

Cloudy and blurring if Lens Opacity makes it difficult to see retina Visual acuity restricted No pain or eye redness No cute need surgical removal and replacement of the lens especially if ADLs are affected After cataract surgery removal of lens with an implant the patient is encouraged to avoid bending head below the waist. No pain

Ph- 7.44 Co2- 28 Co3- 24

Compensated Respiratory alkalosis

Asthma

Condition that occurs intermittently Occurs in two ways -inflammation -airway hyperresponsiveness leading to bronchoconstriction Symptoms- wheezing, dyspnea, coughing, waking from sleep with symptoms Rescue enhaler needed more than twice weekly Activity limited it stopped by symptoms Avoid environmental triggers Use bronchodilator 30 min before exercise Always carry relief enhaler Long acting beta agonist should never be prescribed alone for asthma therapy and is not to be used during an acute asthma attack (example: salmeterol)

Hearing loss

Conductive- inflammation or obstruction of external or middle ear, eardrum tumor, overgrowth Caused by cerumen, foreign body, perforation of the tympanic membrane, edema, infection of the external or middle ear, tumor, ostosclerosis Sensorineural- inner ear sensory nerve damage, hair cells, loud noises, drugs Caused by prolonged exposure to noise, predbycusis, ototoxic substance Maenieres disease, DM,infection Mixed- conductive-sensorineural

Simvastatin

Contraindicated in clients with liver disease

Glaucoma

Damage the optic nerve Damage caused by an abnormally high pressure in eyes Glaucoma is one of the leading causes of Blindness for people for people over the age of 60 -eye pain, nausea, and vomiting -headaches, red eyes -haloes around lights Low vision blurred vision narrows vision or blind spots

DKA

Develops quickly, sometimes within 24hrs Excessive thirst Frequent urination Nausea vomitin BLOOD SUGAR LEVEL ABOVE 300 Life threatening emergency caused by deficiency of insulin Fruity breath Kussmual respirations Abdominal discomfort Dry skin and mouth Flushed face Headache muscle stiffness or aches Being very tired nausea and vomiting ABGs-metabolic acidosis

Improving outcomes of HF

Diet and exercise Lifestyle changes Weight loss Activity plan

Fluid overload symptoms

Dyspnea Fatigue Hypertension Tachycardia Tachypnea Bounding pulses Wt. gain Edema Crackles Distended neck veins LABS: Serum and urine osmolarity, urine specific gravity Diagnostic- chest X-ray, echocardiogram if heart failure Monitor: I&Os, vital signs, Weight High fowlers position, limit fluid intake Give- diuretics, oxygen, no IVF, Restrict sodium

COPD

Emphysema Chronic bronchitis Characterized by bronchospams and dyspnea -tissue damage not reversible -increases in severity leads to resp. Failure Breathing: diaphragmatic breathing, pursed lip breathing Management- effective couching, o2 therapy, suctioning, hydration, positioning

Dehydration (fluid volume deficit)

Fatigue Dizziness Weakness Thirst Hypotension Tachycardia Weak pulses Dry mucus membranes Labs: serum osmolarity l, urine specific gravity, BUN/cr. Monitor: vital signs, I&Os, weight Urine output needs to be at least 30ml/hr Fall precautions Encourage Po intake Give IVG, colloids, crystalloids, and electrolytes

Pulmonary edema

Fluid in the lungs S/s: cracking in bases Dyspnea at rest Disorientation Confusion Late stages: PINK FROTHY SPUTUM -high fowlers -oxygen -nitroglycerin -rapid-acting diuretics IV Morphine sulfate Assessment

Pneumonia

Excessive fluid in the lungs resulting from inflammatory process -inflammation triggered by infectious organisms, inhalation of irritants -community acquired -ventilator associated -aspiration Findings: dyspnea, chills, fever, cough, dark sputum, crackles, wheezing, elevated RR and Pulse

Contractility

Force of the contraction of the heart muscle

Parkinson's disease

Four cardinal symptoms: Tremors Muscle rigidity Postural instability Bradykinesia Safety concerns: Falls, mobility,

Hyperglycemia

Fruity smelling breath Nessus and vomiting Dry mouth Weakness Confusion Coma Abdominal pain

Sickle cell anemia

Genetic hemoglobin disorder Pain most common symptom Cardiovascular changes Respiratory changes Pain related to poor tissue oxygenation and joint destruction Potential for infection, sepsis, multiple organ failure and death Interventions: manage pain, drug therapy- analgesic, hydration, oxygen, prevent sepsis

Retinitis pigmentosa

Genetic,hereditary retinal nerve cells degenerate causing night blindness, decreased vision leading to complete blindness No treatment; I Use sunglasses; may benefit from retinal transplant

Emergency treatment for impending anaphylaxis first

Give patient oxygen Then IV Vitals

BNP

Good indicator of heart failure if over 1000 Normal is under 100 Acts as a vasodilator and a diuretic

Primary open angle glaucoma

Gradual loss of peripheral vision, central intact Foggy vision (damage to optic nerve due to prolonged pressure) Usually painless or mild eye aching or headaches Halos around lights

Complications from diabetes

Heart disease Foot problems Kidney disease Eye problems

Diuretics

Help rid the body of salt (sodium) and water Watch serum potassium levels- withhold of pulse is less than 60

ACE inhibitors

Helps relax the veins and arteries to lower Bp "PRIL" Captopril, Enalapril, Afosiopril Antihypertensive. Blocks ACE in lungs from converting angiotensin I to angiotensin II (powerful vasoconstrictor). Decreases BP, Decreased Aldosterone secretions, Sodium and fluid loss. Check BP before giving (hypotension) *Orthostatic Hypotension

Hyperkalemia

High sodium S/s: irritable Confusion Sleepy

Hypomagnesemia

Hyperactive deep tendon reflexes Elevated BP Numbness/ tingling

Positive Chvostek sign

Hypocalcemia

Heparin

IV or SQ, works immediately PTT labs for effectiveness Low molecular weight Heparin (Lovenox) PROTAMINE SULFATE FOR REVERSAL

When do healthcare workers get tested for HIV after exposure

Immediately after , 3 months and again at 6 months

Calcium channel blockers

Lowers BP Prevents calcium from entering the cells of the heart and arteries. Calcium causes the heart and arteries to contract more strongly. Avoid grapefruit Assess HR and BP

Macular degeneration

Macular degeneration-deterioration of macula (central vision) Age related (dry) - gradual blood flow issues Wet- blood vessel or exudative Blurred vision is a key symptom

Hypokalemia

Increased ICP Seizures Behavioral changes

HIV related complications

Infections especially pneumonia opportunistic protozol, fungal, bacterial, viral Malignancies-kaposis sarcoma KS malignant lymphomas invasive cancers HPV Labs- CD4 and T-cell count Stages of HIV 0-4 Monitor/reassess- signs and symptoms of infection lab results Do-actions- reduce infection risk maintain quality of life maintain dignity Give HIV antivirals

Glaucoma medications

Lataniorost (xalatan) Travoprost (travatan z) Tagfluprost (zioptan) These help decrease eye pressure by improving how fluid drains from your eye or by decreasing the amount of fluid Your eye makes

Most common cause of right side heart failure

Left side heart failure

Hypermagnesemia

Loss of deep tendon reflexes Bradycardia Hypotension

Reducing long term diabetes complications

Maintain healthy weight No smoking Exercise Healthy diet

Ph-7.33 Co2-25 Co3-12

Metabolic acidosis

Insulin resistance

Metformin is usually the first choice

Diabetic retinopathy

Micro vascular glucose causes retinal capillaries to become hypoxic Better glucose control reduces chances

Osteoarthritis

Most common arthritis type Progressive loss of cartilage Joint pain/stiffness Usually older than 60, crepitus in joints, Heberdens nodes, joint effusions, atrophy of skeletal muscle -loss of function characterized by progressive deterioration Osteoporosis (bone spurs) Cartilage disintegrates, bone and cartilage "float" into joint, causing crepitus -Heberbins nodes , X-ray, MRI, CT Labs - ESR,CRP

Hypocalcemia

Muscle stiffness Muscle spasms Trousseaus Chevosteks teteny

Right side HF

Nocturia Enlarged liver Weight gain JVD Edema (peripheral) Anorexia Nausea Swelling hands Right side HF causes: Left ventricular failure Right ventricular MI Pulmonary hypertension

PT range

Normal: 11 to 15.5 sec.

Anaphylactic reaction

Nursing interventions Maintain airway Prevent shock (positioning) Administer IV fluids -helps with volume

Intermediate insulin-NPH or Lente

Onset 2-4 hours Peak 4-12 hours Duration 10-16 hours

Peak was/basal (long acting ) insulins-determir and glargine

Onset 2-8 hours Duration 20-24 hours Do not mix with others insulins

Short acting-regular

Onset 30-60 min Peak in 2-5 hours Duration 5-8 hours Regular-insulin is the only kind for IV use

Warfarin (Coumadin)

Oral takes days to be effective PT/INR labs-goal= 2.0-3.0 Dietary education: avoid foods high in vitamin K- green leafy vegetables VITAMIN K FOR REVERSAL

chronic venous insufficiency

Pain -Edema, reddish/brownish thickened skin, ulcers -monitor skin integrity -Elevate legs -wound care -compression stockings -SCDs -give diuretics

Status epilepticus

Prolongs seizures that's lasts more than 5 min or repeated seizures over 30 minutes Medical emergency Establish airway ABGs IV push lorazepam, diazepam Loading dose IV phenytoin

Symptoms of retinal detachment

Purulent drainage Severe pain Decreased visual acuity This is an emergency when part of the eye retina pulls always from supportive tissues The appearance of many bits of debris floaters sudden flashes of light or a shadow in the vision field are symptoms Prompt medical treatment can often save vision In the eye.

Insulin therapy

Rapid acting -lispro (humalog) or insulin aspart (novalog) Onset 5-25 min Peak 30-120 min Duration 2-5 hours

Digoxin

Reduce strain and keep heart beating normally

Ph-7.48 Co2-28 Co3-28

Respiratory alkalosis

Left sided Hf

SOB when lying down. Wheezing/crackles Edema of the lungs Acute confusion Tachycardia Oliguria Not steady/dizzy/weak Left side HF causes: Hypertension Coronary heart disease Valvular disease MI

Status asthmaticus

Sever, life threatening, acute episode of airway obstruction Intensifies once it begins, often does not respond to common therapy Patient can develop pneumothorax and cardiac/respiratory arrest Treatment: IV fluids, bronchodilator, steroids, epinephrine, oxygen

Rheumatoid arthritis

Symmetrical joint involvement Usually symmetrical, at least 3 joints affected, nodules over bony prominences, swelling, weakness, weight loss, fever, parasthesia, joint deformities Labs - RF, ANA, ESR Common connective tissues disease chronic, progressive, systemic inflammatory autoimmune disease; affects primarily synovial joints transformed autoantibodies rheumatoid factors form and attack health tissue causing inflammation Xray, CT, MRI, arthrocentesis, bone scan Glucocorticoids, NSAIDS, immunosuppressive agents

Acute arterial insufficiency

The 5ps when present MEDICAL EMERGENCY! Pain Pulselessness Pallor Paresthesia Paralysis

Systemic hypertension

The cause of heart failure in most cases

Retinal tears/detachments/holes

Trauma,traction, separation-sudden and painful, bright flashes and floaters

Preload

Volume of blood in the ventricle before systole Diuretics, diet, low sodium, no salt substitute

Diabetes

Type 1- characterized by destruction of the pancreatic beta cells- insulin dependent Pancreas produces little or no insulin -s&s APPEAR SUDDENLY -increased thirst -frequent ruination -bed wetting in children who previously ddnt wet the bed during the night Extreme hunger AUTOIMMUNE DISEASE Type 2- involves insulin resistance and impaired insulin secretion pancreas does not produce enough insulin -occurs more GRADUALLY OVER TIME -blurred vision -slow healing sores -frequent infections -numbness or tingling in the hands or feet -areas of darkened skin, usually in the armpits and neck Gestational- glucose intolerance with onset during pregnancy Diabetes insipidus is an disorder in which there is an abnormal increase in urine output fluid intake and often thirst.

Hypersensitivity

Type 1- rapid hypersensitivity reactions angioedema, anaphylaxis AIRWAY, trendelenburg, IV,fluids,O2. Epinephrine IM, steroids, antihistamines Type 2- cytotoxic reactions hemolytic anemia, transfusion reaction Type 3- immune complex reactions, prednisone rheumatoid arthritis's, lupus, autoimmune disorders, serum sickness Tyoe 4- delayed hypersensitivity reactions, corticosteroids poison ivy, mosquito bite, ppd skin test for tb

urinary incontinence

Types: Stress- weak sphincter when increase in mobility, relaxed pelvic floor and increased abdominal pressure, i.e. coughing, sneezing, exercising Urge- loss if urine preceded by a strong need to void Overflow- urethral blockage so bladder is unable to empty properly Urge? no urge? pain? With abdominal flexion or Not Labs: U/A Diagnostic- bladder scan, cystoscopy, CT Causes : UTI, Spinal cord injury l, brain disorder, uterine prolapse, prostrate infection, severe constipation, loss of sphincter closure ability.

HIV

Usually transmitted via sexual contact, parenterally, perinatally It is not transmitted casually or by sharing household utensils, towels linens or toilets, mosquitoes or insects Progression of disease can be months to years Personal life factors can affect the timing Frequency of exposure to HIV Presence of other STDs Nutrition Stress Labs-CD4 and T-cell count , antibody test, ELISA, Western blot, viral load testing, CBC,stool biopsy

Tests for hearing

Weber test- screening test for hearing performed with a tuning fork. It can detect unilateral one sided conductive hearing loss middle ear hearing loss and unilateral sensorineural hearing loss inner ear hearing loss Rinne test - used to evaluate hearing loss in one ear The rinne teat differentiates sound transmitted through air conduction from those transmitted through bone conduction via the mastoid bone. By comparing air and bone conduction it helps detect conductive hearing loss in one ear

Ulcerative colitis

chronic inflammation of the colon with presence of ulcers Affects only the large intestine Hemorrhage is more common

Most common cause of digoxin toxicity

hypokalemia S/s: vision changes, diarrhea, nausea, vomiting, and confusion

Angle-closure glaucoma

sudden onset, medial emergency Headache or brow pain Nausea and vomiting Halos around lights Loss of peripheral vision Sudden blurred vision with decreased light perception

Spinal cord injury

the type of paralysis is determined by the level of the vertebra closest to the injury Management: airway, breathing pattern, circulation