Final Exam Mega Guide (all guides mixed)

if pH level is 7.52 whats the kidneys response

the kidneys will try to excrete more acid into the urine and absorb bicarb back into the body

What is another name for malignant HTN

the silent killer

What are the two most common drugs given to COPD patients and what route should they be given

theophylline and prednisone; orally

help determine the presence and degree of cervical spine involvement in RA

tomography (CT)

hyperglycemia causes

too little insulin and too much food

A patient has COPD, emphyesma and bronchitis what is the position that raise chest/expand lungs

tripod

electrolyte labs

○ Magnesium → 1.5-2.5 ○ Phosphate → 2.5-4.5 ○ Potassium → 3.5-5 ○ Calcium → 9-10.5 ○ Chloride → 98-106 ○ Sodium → 135-145

HGB A1C

○ Normal < 5.7% ○ Pre 5.7% - 6.4% ○ Diabetic > 6.5%

Fasting glucose

○ Normal: < 99 mg/dL ○ Pre: 100 - 125 mg/dL ○ Diabetic: > 125 mg/dL

what should be a concern if taking digoxin

(blurred vision/ loss of appetite)

what symptoms should you report for victoza (liraglutide)

(intense, sudden abd pain)

S/S for peritonits

-abd pain thats ridges or board like -distention -acute confusion

What are some ways to prevent respiratory infections

-avoid crowds -pneumonia vaccine -annual flu vaccine -monitor closely for early symptoms -risk for increased secretions and/or artificial airway, suctioning

what can status asthmaticus develop and what should you prepare for

-develop pneumothroax and respiratory arrest -prepare epi and oxygen and emergency intubation

what are diet considerations for COPD patient

-high calorie, high protein diet -4-6 small frequent meals -bronchodilator 30 mins before meals -avid caffeine -rest before meals

interventions for dehydration

-oral rehydration FIRST -IV fluids-closely monitored

For clotting concerns what labs would we assess or types of meds would the patient be put on? And also what would we assess in the GI/GU tract

Anticoagulants, look at platelets, PT, PTT, INR, assess if blood in urine or stool

What are CV aging changes

LV might not function well Aorta or large arteries:narrowed Baroreceptor decrease in senstivity

What arteries does atherosclerosis affect

Larger arteries: carotid and femoral

Meds that affect fluid imbalance

Laxatives, deuritcs, pain meds psych meds

Is DKA more common in Type 1 or Type 2 DM?

Type 1

what should we monitor for in heparin drips and what is the antidote?

always monitor PTT which drives the rate of the infusion-want to be HIGH, Protamine sulfate

Substance that binds or accepts hydrogen ions in solution

Base

Decreased compliance of ventricles is called what

Gallops

Sound from pericardial sac due to inflammation or infection

Rub

Where can arterial gallop be heard

S4

what is normal range for urine specfic gravity

1.000-1.030

what is the range for magnesium

1.8-2.6

What is minimum urine amount needed to excrete toxic waste products called and how many ml/day should we urinate?

400-600ml/day and Obligatory urine output

how many sounds should hear in a min for bowel sounds

5-30 sounds every min

normal range for PTT

60-70 seconds

Glucose range

70-140

what is the range for calcium

9.0-10.5 mg/dL

S/S hypoglycemia and range

< 70, cool and clammy, lethargy, fatigue, blurred vision

Random glucose

<140

what is poorly controlled HgA1c considered as

>6.5-7

What other diagnostic test is done for COPD

A classification scale from 1-mild to 4-severe and PFT

Intervention for atherosclerosis

Aerobic physical activity -3-4x a week -moderate to vigors -40 min

What is an increases reabsorption of water in the kidneys and secreted from the posterior pituitary gland causing vasoconstriction

Antidiuretic hormone

Labs for HF

BNP ABG Electrolytes

PA for CAD

BP and HR pulses skin temp Hear sounds, JVD and lung sounds

Difference between control drug vs reliever drug

Control drug: used everyday Relief drugs: stop asthma attack when's started

What are worsening symptoms of HF

Cough with pink frothy sputum Changes in activity tolerance Chest pain Changes to sleep, breathing, fluid status, appetite and urination

If abd bruit is heard what could it indicate and what should the nurse do.

Could indicate a aortic aneurysm DO NOT PALPATE: follow up with provider

How do you diagnose hypertension?

Elevated BP documented in 2 separate occasions on both arms > 130/80

What are s/s of fluid overload

Elevated pulse rate, RR, and BP, Altered LOC, headache, skeletal muscle weakness, paresthesia, visual disturbances, Shallow respirations, crackles, SOB, Pitting edema, cool/pale skin, weight gain, bounding pulses, enlarged liver

T or F should you palpate carotid at the same time

F

What are the triad of symptoms for women as what can these symptoms lead to

Fatigue, SOB and indigestion: MI

What are some interventions for Chron's disease? What is the first intervention you should do first?

First monitor weight, High protein, high calories, low fat and fiber, lots of fluids. Glucocorticoids, immunosuppressors, anti-diarrheal, flagyl.

useful when Tylenol isn't helpful for pain

Ibrouphen

Angiotension II and Aldosterone increase or decrease the BP

Increase

Long acting onset, duration, peak of insulin

Insulin glargine (lantus) onset: 3-4 hours peak: none duration: 24 hr

rapid acting, onset, peak, duration insulin

Insulin largine (humalog) Onset: 15 minutes Peak: 1-2 min Duration: 3-4 hours

What is the first sign of PAD

Intermittent Claudication- have pain when activity not at rest

What are the fluid compartments

Intracellular fluid (ICF) Extracellular fluid (ECF) -interstital: in between -plasma: helps maintain homeostatis

Interventions for PAD

Legs down, NO HEATING PADS, keep home warm and wear socks; avoid cold long period, avoid smoking, stress

What is an example of leukotriene modifier; teaching and how often should be taken

Montelukast: good for allergies; take daily

What does MONA stand for

Morphine, Oxygen, Nitrate, Aspirin

Turbulent blood flow through valves is consider what

Murmur

Do we give IV potassium as IV push

NEVER

non-surgical mgmt of intestinal obstruction

NG tube, NPO and treat cause

What is the most Common surgery for fractures

ORIF

NG tube nursing actions

Provide oral and skin care Verify NG tube placement Encourage patient to not to pull on the tube Document input Don't flush every hr

What are s/s of Emphysema

Pursed lip breathing, barrel chest, no chronic cough, tripoding (bent over/leaning forward to help breathe)

What is snoring sound thick secretions in large airways and normally goes away after doing what?

Rhonchi and after suction of coughing

secondary HTN vs essential HTN

Secondary HTN is a high BP is the result of another condition or disease such as Kidney disease, Pregnancy, maybe surgury for whatever cause Essential HTN is the most common and there is no reason for high BP other than risk factors such as: Family history Smoking, hyperlipidemia no sugury/just meds no symptoms MI/stroke

What is the postprocedural care you have to do for a endoscopic bronchoscopy?

Sedation-monitor VS: O2 stat ; LOC Aspiration precautions until gag reflex returns

TEE vs echocardiogram

TEE: echo of heart but put tube down throat, mild sedation, local anesthesia to throat and aspiration precautions Echocardiogram: picture of the heart no sedation, NPO 3-6 hours before test

What does Angiotensin receptor blockers (ARBs) do and also an example? What are you at a more increase risk for?

They vasodilate which decreases BP, risk for falls, Losartan

What kind of drug is rosiglitazone, what should you teach a patient thats on rosiglitazone

Thiazolidinedione (insulin sensitizers), report vision changes weight gain and peripherial edema teach CV patients to weight daily

What is fluid is removed from the pleural cavity with a needle and up to how much fluid can be removed

Thoracentesis and up to 1000ml

What is the preprocedural you have to for endoscopic bronchoscopy?

Usually NPO 8 hours before Special instructions for diabetics Informed consent

What should you assess for in fluid imbalances

VS specifically HR, RR, temp, I and O, mental status , weight, skin and IV (if one)

interventions with RA

Verbalize and identify patient Wash hands

what is the most accurate indicator of fluid loss or gain?

Weighing the patient.

what should the docter tell an individual about celebrex

avoid or concerned about patients with (angina)

What do dieurtics do?

decrease BP and fluid retention

surgical mgmt of intestinal obstruction

exploratory laparotomy and colectomy

insertion of pins or screws

external fixation

diagnostic for colorectal cancer

fecal occult blood test, colonoscopy

whats the first drug choice for HTN

hydrochlorothiazide

types of acids

hydrogen and CO2

what is a sign of hypomagnesium

hyperreflexia and ventricular dysrrthmias

if a patient is fluid overload would you give them hypotonic, hypertonic or isotonic fluids

hypertonic fluids because they are hypotonic

nursing diagnosis for asthma

ineffective breathing pattern or impaired gas exchange

Who are most at risk for dehydration

infants, elderly and cognitively impaired

elimination is compromised due to a perfusion issue

intestional obstruction

What is the most common dehydration and where is it found

isotonic, ECF

which obstuction is physically obstructing by internal or external sources, bowel is physically blocked inside the lumen

mechanical

history for fluid overload

med history: kidney disease/HF SOB or weight gain

what does MAWDS stand for

medications, activity, weight, diet, symptoms

pH 7.31 CO2 32 HCO3 19

metabolic acidosis partially compensated

What fluids can you give that are isotonic and what is the range

osmolarity: 270-300 0.9% saline and Lactated ringers

What fluids can you give that are hypertonic? and what is the osmolarity

osmolarity: 300-330. D10, D5W with 0.9, 2% NS, D5

movement of water through a semipermeable membrane

osmosis

Contrainfication of hip fracture

osteoporosis

highest risk group for fractures

osteoporosis osteoarthritis elderly patients

what happens if paCO2 levels decrease

pH levels increase

when ABG partially comp

pH: abn CO2: abn HCO3: abn

What does advanced COPD look like

Hyper inflated lungs and flattened diaphragm

S/S for hypokalemia

Hyporreflexia, decrease bowel sounds, dysarthrrmias, paralytic lieu's

what is the short acting and long acting drugs, explain teaching and side effects if any

short acting: albuterol: tachycardia (USE FIRST) long acting: salmeterol: slow onset; doesn't relieve symptoms

what kind of drug is Methotrexate (Rheumatrex, what should the nurse monitor and teach about the drug Methotrexate (Rheumatrex)

slow acting drug taking 4-6 weeks to control joint inflammation Monitor WBC and platelets, Disease-modifying anti-rheumatic drug

What are risk factors for atherosclerosis

smoking, high triglycerides, increase LDL, low HDL, AA, sedentary, diabetes, HTN, stress, genetics predisposition

Which electrolyte is a major cation (positive ion) in the extracellular fluid?

sodium

What is Chronic inflammation of the rectum and rectosigmoid colon. Can extend to the entire colon. Remissions and flare-ups.

UC

What are meds for DVT

Unfractionated heparin, low molecular weight heparin, warfarin (avoid vitamin k), thrombolytics.

What is More severe than normal experience Not reversible Caused by prolonged ischemia, Ischemia/new area of heart

Unstable Angina

Interventions for fluid overload

-prevent skin breakdown -meds: diuretics' -sodium and fluid restirction -monitor I&O - monitor weight daily same time everyday

healing issues for fractures

age nutrition status general health hormonal factors smoking bone affected degree of fracture degree of immobilization of fracture

periop prep

Consent, NPO may take meds with sips of water Marks spot where surgery is going

What diet should a atherosclerosis patient be considered to eat by a dietation/doctor?

Consume fruits, veggies, whole grains, Low fat dairy, Poultry, fish,legumes, nuts, Non-tropical veggie oils, Limit sweets, Sugary beverages, Less than 5% of calories from saturated fats, Similar to DASH diet: sodium and potassium requirements

sick day for DM

Monitor glucose q4 hours or PRN Continue to take insulin or oral antidiabetic agents (Even if not eating) Prevent dehydration (leads to DKA or HHS) Test urine Ketones

intermediate acting onset, duration, peak insulin

NPH (Humulin H) onset: 2-4 hours peak: 4-10 hr duration: 10-16hr

causes of decreased intake

NPO, NG and dysphagia, impaired thrist and unconsciousness

What are interventions for UC

NPO/gut rest, low fiber diet, reduce stress, avoid GI stimulants, watch for skin breakdown, immunosuppressants with steroids, salicylate, anti-diarrheals, minimize pain with opioids.

what are the first line of fluids to give if dehydrated

NS

What married couple deals with fluid balance?

Na+ & Cl-

What is an inhibit or prevent reabsorption of sodium and water in the kidneys and has the diuretic effect

Natriuretic peptides

What fluids can you give that are hypotonic? and whats the osmolarity

0.45% saline, D5 with 0.45 and D5W osmolarity: less than 270

INR normal range

0.8-1.1

How many mls of retained fluid is 1 lb

1 lb = 500mL of retained fluid

Normal range for BUN and CRT

10- 20: BUN 0.59-1.04: CRT

normal range for PT

11-12.5 seconds

range for sodium

135-145

60 yrs or less what should the BP be at?

140/90

60 yrs or older what should the BP be at?

150/90

What is decreases in total body water caused by 2 little intake of fluid or too great loss of fluid

Actual Dehydration

what kind of drug is Acarbose, What are 5 side effect of Acarbose (Precise)?, what does acarbose prevent

alpha-glucosidase inhibitor, Nausea, Vomiting, Diarrhea and Constipation, GI discomfort, after meal hyperglycemia

What should you assess for in beta blockers and when should you not give?

assess BP and HR and dont give if <90bpm

What should you do if a COPD patient is Stating at 80%

assess characteristics because that might be normal

What are some lifestyle modifications for HTN

Diet (Sodium loss, DASH and same as atheroscleorsis) Reduce alcohol, sweets, red meats. Exercise and weight loss (Aerobic Exercises, swimming) Smoking cessation Stress reduction and relax.

Where are arterial ulcers located

End of or between toes, upper aspect of foot, ulcer bed pale with even edges, deep, decreased/absent pulses, pallor with elevation & dependent rubor, gangrene

What is direct visualization of the lung by inserting a camera through trachea, clear secretions, take samples, biopsy of lung tissue

Endoscopic bronchoscopy

Other treatments for asthma

Excerise and activity Oxygen therapy

What are the causes of fluid overload

Excessive fluid replacement, kidney failure, heart failure, SIADH, long term corticosteroid therapy, water intoxication

teaching on asthma

-proper use on inhaler -Teach patient to avoid known allergen and irritants -Teach the patient to use the short-acting bronchodilator first, then an inhaled steroid if they are both prescribed -smoking cessation -reduce stress and anxiety -when to contact provider -use of peak flow meter twice daily

What are the causes of respiratory alkalosis

Excessive loss of CO2 through hyperventilation

What are the factors of BP

*Arterial baroreceptors *Regulation of body fluid volume *The renin-angiotensin-aldosterone system (RAAS)

Your doing pining care for an external fixation prioritize the steps -Prepare supplies and hand hygiene - Verify the patient

-Prepare supplies and hand hygiene - Verify the patient

foot care for diabetics

-Through foot assessment annually -Always wear socks to keep feet warm and to protect the feet -Patient should exam own feet daily -Use lotion but make sure feet are dry -Avoid heating pads

What are the nursing considerations for a thoracentesis

-little or none sedation/sometimes done by bedside -Monitor for pneumothorax -Prep for x ray -Respiratory assessment -Encourage deep breathing

How do you assess for JVD and what are the causes

-make sure patinet at 45 degrees and remove pillow and make sure to turn Causes: HF (right sided), hypervolemia, pulmonary HTN

interventations for intestinal obstruction

-move -no laxatives or enemas -pain meds after dx -Isotonic fluids -TPN -manage NG tube

signs of cast too tight

-pain, numbness, tingling, decreased pulse, cyanosis, and coolness of extremity, paresthesia (pins and needles) -not able to insert finger in between cast and skin -difficulty moving toes

1L of fluid = how many lb = how many kg

2.2 Lb=1 kg= 1L of fluid

1L of fluid equals

2.2lbs

What is normal range for serum osmolarity

270-300

Put in order how insulin affects blood glucose 1)glycogen is stored in the liver 2) Insulin transports glucose to muscle cells 3) Glucose enters the bloodstream 4) Beta cells are stimulated to release insulin 5) GLycogen is converted to glucose by alpha cells (glycogensesis)

3,4,2,1,5

range for potassium

3.5-5.0 mEq/L

The nurse is caring for a patient whose potassium level is 3.0. Which of the following statements would the nurse expect the patient to make? A. I feel so sleepy B. I'm having diaherra C. My leg muscles are cramping D. I can't stop shaking

A

A 54 year old female is admitting to the hospital with an adult exacerbation of heart failure. The client has a history of heart failure and takes furosemide daily. In addition, the clients have a current smoking history, DM type 2, and osteoarthritis. Match the potential heart failure complications with current interventions. 1. Decreased O2 saturation 2. Retention of water and sodium 3. Decrease contractility 4. Arrhythmias 5. Anxiety and increase preload A. Administer oxygen via nasal cannula maintain oxygen saturation greater than 90% B. Administer furosemide as prescribed C. Apply a cardiac monitor D. Administer morphine sulfate as prescribed E administer digoxin as prescribed

A. Administer oxygen via nasal cannula maintain oxygen saturation greater than 90%=1 B. Administer furosemide as prescribed=2 C. Apply a cardiac monitor=4 D. Administer morphine sulfate as prescribed=5 E administer digoxin as prescribed=3

What is the diagnosed test for PAD

ABI (Ankle/ Brachial Index)

A patient with distress has low stats and a RR 30 what should you do next?

APPLY OXYGEN!!

What are breathing tech quiet to improve oxygenation and reduce carbon dioxide for a COPD patient

Abdominal breathing and diaphragmatic Purse lip breathing

What are s/s of chron's disease

Abdominal pain in RLQ, mucus, pus, fat in the stools, weight loss from the malabsorption, fever, fistulas.

Which assessment findings would may indicate to the nurse that an acute peripheral neurovascular dysfunction for the patient recovering from surgery of the foot? Pale skin, atrophy of limb, capillary refill 2 seconds Absent of feeling, cap refill 4 to 5 seconds, cool skin Atrophy of limb, increase motion of limb, thickened toenails Pale skin, weak motion, loss of hair

Absent of feeling, cap refill 4 to 5 seconds, cool skin

Pressure the ventricle must overcome to eject blood

Afterload

The patient asked the nurse what factors affect how long it takes for a hip to heal following hip replacement surgery. What is your best response? (SATA) Age Comorbidities Gender Height Marital Status

Age, Comorbidities

What is a short acting inhaler and side effects

Albuterol and side effect: tachycardia and USE FIRST

What is an increases reabsorption of sodium and water in the kidneys and the kidneys retain more sodium

Aldosterone

What is the less common but most important risk factor

Alpha1-antitrypsin deficiency

What are venous ulcers located

Ankle area, brown pigmentation, ulcer bed pink, shallow with uneven edges, ankle edema and discoloration, pulses present

List cardiac listening sites and who you shouldn't hear and location

Aortic=2nd R ICS sternal border ( no MRS)- S1 correlates with carotid Pulmonic=2nd L ICS sternal border (no MRS) Erbs=3rd L ICS sternal border(no MRS) Tricuspid= 4th or 5th L ICS sterna, border ( no MR) Mitral=5th ICS L mid clavicular ( no MR. G) TURN ON SIDE

is a scope procedure for diagnosing and treating joint problems

Arthroscopy

No steroidal anti inflammatory drug and blood thinner. Also what can this drug reduce the risk of

Aspirin and reduce risk of MI

For MONA what should you assess first then after what would you give

Assess O2- AIRWAY!!, then Nitro

Safety precautions for fluid imbalance

Assess every 2 hrs Monitor respiratory distress Monitor for signs of electrolyte imbalance (EKG, NA and K+) Monitor skin breakdown

The patient has a cast covering their lower leg and half of her foot because of a fracture from two days ago. The patient complains of pain 10/10. The PCA is infusing IV and has controlled the patients until now. What should you do first? Assess temp, pulse and extremities Reposition patient Assess skin breakdown Readminster another dose of PCA IV

Assess temp, pulse and extremities

What is Intermittent, reversible airflow obstruction that affects airways only. Airway hyperresponsiveness leading to bronchoconstriction.

Asthma

What is a type of arteriosclerosis involving formation of plaque within the arterial wall

Atherosclerosis

What should you warrent of Warfarin and what should you eat

Avoid Vitamin K and alcohol and eat leafy green foods

Which perfusion is circulation through thr heart and peripheral tissues

Central perfusion

What is Malignant hypertension and what are s/s

BP Greater than 180/120 mm Hg or greater Morning headaches Blurred vision Dyspnea facial flushing dizziness fainting nose bleeds May have no symptoms Leads to renal failure, LV failure, or stroke

What's the most abundant base

Bicarb

what kind of drug is metformin and what should someone on metformin avoid and Why is Metformin the first drug of choice for Type 2 Diabetics?

Biguanide, alcohol reduce risk of lactic acidosis, Does not cause wight gain or hypoglycemia

what kind of drug is Etanercept, what should the nurse teach a patient on etanercept

Biologic response modifiers, Teach: high risk for developing impaired immunity and subsequent infection, report site reaction Stay away from people with infections and avoid large crowds

What is Blood flow to myocardium is blocked Insufficient oxygen supply to meet the demands of the heart's myocardium Results in ischemia and/or infarction of myocardium d/t severe ischemia or if its for a long time (death of the tissue)

CAD

tell me what fluids you would give a CHF, periop and sepsis patient

CHF: hypertonic periop: isotonic Sepsis: hypotonic

What is Characterized by BRONCHOSPASMS and DYSPNEA (difficult, labored breathing) and NOT reversible

COPD

diagnostic for appendicits and labs

CRP and WBC and U/S and cat scan

what is a good indicator of hydration status

CV changes

What married couple deals with muscle function?

Ca+ & Mg+

A patient with a hip fracture is scheduled to have an ORIF. Which of the following is a patient benefit of the procedure over placement of the cast only? Can ambulate soon Decrease risk for infection Not invasive Does not leave a scar

Can ambulate sooner

what drug can cause can cause acute MI and what should a nurse teach a patient ab this drug

Celecoxib, NOT recommended for a patient with a history of heart disease

interventions for hypoglycemia

Check blood glucose, 15 grams of simple carbs Q15 Mins, administer glucagon, check blood glucose

What should you do if the glucose is 450?

Check electrolytes and dehydration

Prioritize the First line of defense in order Respiratory, Chemical Kidneys

Chemical, Respiratory (seconds), Kidneys (Minutes)

What diagnostic test is used to rule out other lung diseases and to check on progress of patients with respiratory infections or chronic tests

Chest xray

What is Chronic inflammation of the small intestine, colon, or both.

Chron's Disease

Is clubbing an acute or chronic sign of COPD

Chronic

What is inflammation of the bronchi and bronchioles caused by exposure to irritants. Affects only the airways. And more prone to infection.

Chronic Bronchitis

What is Relieved by nitro/rest, last less than 15 mins, caused by exertion/stress, overworked muscle causing decrease O2

Chronic Stable Angina

What is Stable plaque, fixed and very slow growing and unlikely to break off and cause rapid collusion of the artery. ( narrowing of the coronary arteries)

Chronic stable angina

Diagnostic test/lab for DVT

D-dimer, Doppler, venogram and venous duplex ultrasound

drug adherance for HTN

DONT stop meds abruptly because lead to HTN urgency

What is Formation of a venous clot depending on the factors from Virchow's triad (stasis, hypercoagulability, endothelial injury)

DVT

What is the best indicator of fluid balance

Daily weight

What is an important nursing action for a HF patient

Daily weight everyday, same time, same scale

What should you teach a patient about ARBS

Decrease intake of potassium rich foods.

A nurse is assessing a atherosclerosis patient what type of assessment would you? Also what you change first before meds

Do a neurovascular assessment (weak pulses), complete CV exam (bruit) and BP in both arms and CHANGE lifestyle first before meds

Nursing considerations for daily weights

Do daily weights, same time of day, same scale, with same clothing q day

What test shows the rhythm of the heart

EKG

diagnosis for CAD

EKG troponin heart cath stress test

What is diagnostic test for HTN

EKG- show the cardiac abnormalities and complications mutiple BP to see trends determine if secondary: kidney disease; BUN and CT

can confirm inflammation or infection anywhere in the body and what is the range

ESR if greater than 20 than inflammation

Ventricular gallop is early sign of what and where can it be heard

Early sign of HF Heard at S3

A 23 year old open fracture left tibia major soft tissue damage lower leg from a motorcycle accident. Which finding by the nurse would likely indicate the development of osteomyelitis? -Tachycardia - Elevated ESR - Numbness in the left toe - Muscle spasms around the infected bone

Elevated ESR

What is damage to ONLY THE ALVEOLI causing loss of lung elasticity and hyperinflation of lung. It is NOT reversible.

Emphysema

T or F any lab test can diagnose dehydration

F no lab can diagnose dehydration

Requires a carrier, not extra energy

Facilitated diffusion

True or false should we assume giving IV administration is the same as giving orally

False

T or F: You should take Repaglnide (Prandin) after you meals to avoid a spike in glucose?

False, Take immediately before eating

What are nonmodifable risk factors?

Family history/Genetic risks Gender, Age Diabetes, renal disease (partially modifiable when working with PCP) HTN, hyperlipidemia (partially modifiable when working with PCP)

What are three treatments to fix hypercalcemia

Fluid bolus followed by loop diuretics, IV Calcitonin, & Dialysis and phosphorus supplement

What are the two steroids used for impaired gas exchange?

Fluticasone and Prednisone (Last resort and many side effects)

What are the types of steriods; teaching and what one has side effects and what one doesn't

Fluticasone: use daily, no systemic side effects Prednisone: LAST RESORT; many side effects: hyperglycemia and infection

What are some diet recommendations for HTN and what is the sodium restriction

Fruits, veggies and whole grains Low fat dairy products Encourage poultry, fish, legumes, nontropical veggie oil and nuts Limit intake on sweets, sweet beverages and red meats 1500-2400

Patient on metformin is schedule for a CT scan with contrast dye. What should you do?

Hold metformin and 3 days after

Risk factors increase risk for clotting

Genetics, obesity, smoking and immobility

what is first HTN med given and why is it safe for the elderly?

Gets rid of excessive fluid and hydrochlorthiazide

What do you do if a patient has cushing chest pain?

Give nitro and get an EKG

an elvated BNP can indicate? and what would you expect in the patient

HF, edema and swelling, response to fluid overload

If a patient is NPO should you hold or give insulin

HOLD

What does Atherosclerosis leads to CAD then to

HTN

Risks for HF

HTN, CAD, dysrhythmias, smoking, diabetes, obesity and family history

who should be screened annually for microalbuminuria

HTN, CVD and metabolic syndrome

Where can you hear PMI and if it's shifted what's it a sign of

Hear over mitral valve in 5th ICS If shifted: sign of enlarged heart (LV)

What is a heart cath? What diagnostic labs do you get done preop and What do you ask for allergies for this procedure? What is done postop? What is the intervention?

Heart Cath is a invasive procedure that go through the femoral artery to push plaque or see coronary arteries. Pre OP: Fluids may be given 12 to 24 hours before the procedure for renal protection, allergies, Kidney fx, npo, EKG, Consent, labs, Vital signs, Ask about iodine and shellfish Post-op: bleeding, pulses, supine 2-6 hrs Intervention: stent to push the plaque off the walls

components of blood increase due to the decrease portion of fluid and water of blood

Hemoconcencration

Components of blood decrease due to increase of fluid/ water portion of blood

Hemodiluted

A nurse is caring for a patient with a femoral shaft fracture. Which assessment finding warrants immediate intervention by the nurse? -Decrease urine output -Constipation -Hemorrhage -Pain

Hemorrhage

What contributes to CAD then HF

Increase BP causing increase workload of LV, Increase O2 consumption

What are s/s of dehydration

Increased HR/RR, low BP, dry, flaky, flat hand and neck veins, pale mucous membranes, confusion, dizziness, low-grade fever, hemoconcentration, decreased pulses and decrease urine

What are s/s of female MI and what lab helps indicate an MI

Indigestion, SOB, fatigue, Troponin

Inflammation vs Hyperresponsiveness and do they occur at the same time

Inflammation caused by allergens -treated with allergy medications Airway Hyperresponsivenss caused by irritation -Causes:respiratory virus, pollutants, exercise Bronchospasm Yes occur at the same time

Early s/s of RA

Joint stiffness Swelling Pain Fatigue; generalized weakness Weight loss

What electrolyte known as the nosy neighbor follows married couples deals with the heart?

K+

What regulates of sodium affects fluid volume thus affecting BP

Kidneys

What are interventions to prevent DVT

Legs up. SCD and compression stockings, hydration, ambulation, leg excerises, elevate extremity and put heat

Do you change meds or lifestyle changes first?

Lifestyle then meds

What perfusion is circulation to peripheral tissues

Local or peripheral perfusion

Lasix (furosemide)

Loop Diuretic Monitor for thirst, dry mouth, and weight and increase k+ foods

What are s/s of UC

Loose stools 10-20, May be asymptomatic, low-grade fever, abdominal distention, blood, frequent diarrhea, painful urge to defecate

may be used to determine vertebral or knee involvement and look at the organs and structure

MRI

What is the second most-abundant intracellular ion

Magnesium

What are s/s of DVT

May be asymptomatic. Unilateral. Calf/groin tenderness and/or pain, unilateral swelling, redness, edema, warmth, hardening of vein

Etiology of intestinal obstruction

Mechanical: adhesions, appendicitis, hernias, fecal impactions, volvulus (twisting of bowel), intussusception, tumors and people 65 or older nonmechanical: Abd surgury,spinal cord injury paralytic ileus and low potassium, Anesthesia, vascular insufficiency

What treatment would you give a patient with critical/symptomatic hypomagnesemia?

Mg Sulfate IV

How can we test for early signs of Nephropathy?

Microalbuminuria

What are goals for COPD

Minimize anxiety Prevent weight loss Improve activity intolerance Prevent respiratory infection Improve oxygen and CO2 retention

Drufg that prevent angina pain caused by CAD

Nitro SL

What is A progressive deterioration and loss of articular (joint) cartilage and bone in one or more joints. Most common form of arthritis and degenerative disease

OA

A patient had an external fixation of their tibia fracture from four days ago. The nurse said the skin around the patient's skin is swollen, red, purulent drainage. Which of the following is the nurse's priority action? Decrease traction weight Apply a new dressing Prepare for a fasciotomy Obtain a culture of the drainage

Obtain a culture of the drainage

A patient just returned for PACU following internal fixation of the left femoral neck fracture On their back two pillows in between their legs On their right side and left leg bent On their left side and right leg bent Elevate the head at 45 degrees

On their back two pillows in between their legs

What is the primary purpose of the PACU Ongoing critical evaluation and stabilization of the patient Arousal of sedation or anesthesia

Ongoing critical evaluation and stabilization of the patient

What is SOB when lying down

Orthopnea

Ability to pull water across the membrane

Osmotic pressure

Emphysema air trapping causing by

Overstretching of alveoli Enlargement of alveoli Collapse of small airways

What is a result of systemic atherosclerosis → Altered natural flow of blood through arteries and veins of peripheral circulation.

PAD

interventions for OA

PT/OT and aerobic excerises

A 79 year old client has been admitted to the unit the client is diagnosed with a left hip fracture secondary to a fall and is scheduled for a left total hip replacement. Their history includes HTN, Diabetes. The client is a full code and NKA. What is your priority action for this client? Promote rest Therapeutic Communication Pain Management Maintain standard precautions

Pain Management

6 P's

Pain, paralysis, polkthermia, pallor, pulsesness, paraesthia

What is SOB occurs several hours after lying down and related to fluid overload

Paroxysmal nocturnal dyspnea

Blood flow through the vascular system for the delivery of oxygen and nutrients to cells and removal of cellular waster products

Perfusion

What is a common complication of respiratory infections

Pneumonia

The patient came back from PACU had a fractured arm from skiing prepared put the following from highest to lowest priority order Vitals Position for breathing Assess Neuro Compromise Assess Pain

Position for breathing Vitals Assess neurocompromise Assess pain

A patient came in with chronic RA what lab would indicate that

Positive RA

What are risk factors of DVT

Post op patients (ortho), pregnancy, oral contraceptives, immobilization, heart failure or lung disease, obese, smoking, family history over 60; UC

Amount the right ventricles stretch at the END of diastole just before contraction

Preload

Chronic, progressive, systemic, autoimmune, inflammation

RA

What is Chronic, progressive, systemic inflammatory autoimmune disease affects primarily synovial joints, Transformed autoantibodies (rheumatoid factors) form and attack healthy tissue, causing inflammation in the immune system

RA

meds for HF

RAAS (ARB and ace inhibitor) Dieurtics Nitrates (nitroglycerin) Beta blockers (lol) Positive intropic (digoxin)

Assessment for appendicitis

RLQ pain, cramping, pain in between hip bone and belly button

What are some teaching for self management for HTN

Reading and interpreting food labels- reduce sodium and watch a healthy diet Chemical dependence-Helpful in pts with excessive alc intake, caffeine or nicotine Exercise- Develop a plan when or what kind of exercises to help with lifestyle Stress reduction Drug Teaching-Medical compliance or adherence can be a problem d/t the medications side effects are bad and determine if side effects can be treated, what side effects they are having and side effects may decline with taking medication Suddenly stopping meds is ill advised- Advising patient to NOT stop medications abruptly because it can cause lead to HTN urgency

Which symptoms are indicated of a fracture? Tingling, coolness, loss of pulse Loss of sensation, redness, coolness Coolness, redness, pain at the site of injury Redness, warmth, pain at the site of injury

Redness, warmth, pain at the site of injury

What is no actual loss of water but rather water shifts from plasma into the interstitial space.

Relative dehydration

A patient has COPD and is improving activity intolerance what should we assess

Respiratory changes during activity

What are the s/s of respiratory acidosis?

Restlessness, hypoventilation, weakness, think sleepy, confusion, decreased muscle tone and reflexes, increase HR early on, kussmaul respirations, warm, dry, pink skin, hyperkalemia (lab)

What is a long acting bronchodilator? Does this drug relieve symptoms or no?

Salmeterol- slow onset of prevention, No symptoms relieved

What are s/s of asthma?

Shortness of breath, tightness in chest, increase in RR, cyanosis, audible wheezing, increased cough, hypoxemia, use of accessory muscles, barrel chest form air trapping, altered LOC, breathing cycle lengthens with prolonged exhalation

For chronic bronchitis are small or large airways affected first

Small

Risk factors for PAD

Smoking, and stress, sendatry lifestyle, obesity, diet, African-American, hypertension, diabetes, genetic predisposition

Interventions for HF

Sodium (2-3 g per day) and fluid restriction Oxygen, positioning, frequent resp assessment Decreasing fatigue (rest periods) Preventing and managing pulmonary edema

Stable vs unstable plaque

Stable: slow forming thrombosis not prone to break off Unstable: MORE prone to breaking off leading to PE

What are the stages of PAD

Stage 1: asymptomatic (no claudication) Bruit; pedal pulses weak or absent Stage 2: claudication: pain in extremity with exercise Stage 3: rest pain relieved in dependent position help improve blood flow Stage 4: Necrosis/gangrene (most severe) Dead tissue

the more the ventricular muscle cells are stretched, the more forcefully they contract

Starlings law

What are the modifable risk factors?

Stress Smoking Sedentary lifestyle (lack of exercise) Obesity: nutrition Increased saturated fats, sugar, salt Decreased fiber

Amount of blood pumped out of left ventricle from one contraction

Stroke volume

What should you teach older adults about diuretics

Teach older adult to rise slowly, Fluid loss can cause dehydration and low BP

A nurse is monitoring the client's labs and saw one of the labs this morning was a concern to determine a MI is 2.8 what lab test would show that?

Troponin

T or F should you take control drugs that are long term to prevent symptoms

True

cause of hypoglycemia

Too much insulin, too little food, too much exercise

What is the best procedure for PAD? What is the pre-procedure and post procedure care?

Transluminal angioplasty Invasive procedure that puts Catheter threaded through artery to prevent blockage, and may put a stent in to keep artery open Pre-procedure consent, and contrast dye, so check allergies to shellfish Post procedure care kidney assessment and peripheral assessment in supine for 2 to 6 hours

What meds best for PAD

Trental, aspirin, plavix and antihypertensive

labs and diagnostic for peritonitis

WBC (20,000 or greater) diagnostic: abd x-ray or ultrasound

periop care test/labs

WBC (5,000-10,000) - check risk for infection Hgb - anemia Electrolytes: Na+/K+ Blood type/crossmatch - for blood transfusion BUN/creatinine - check kidney function Pregnancy test Pulmonary function test Chest x-ray Electrocardiogram (EKG)

What can activity intolerance indicate for COPD

Worsening of the disease

Theophylline what kind of drug and what type of effect and what disease is this drug used for

Xanthine, narrow therapeutic and used for COPD

useful to determine structural joint changes. Specialized views are obtained when the disease cannot be visualized

Xray

what term is pillow used to keep legs abducted after having hip surgery

abduction pillow

1st drug prescribed for OA and side effect

acetamphion and side effect: liver damage

Substance that releases hydrogen ions in water

acid

energy used to get substance across cell membrane

active transport

if chronic bronchitis patient had sputum what should you assess

amount, color, odor and constistency

what kind of drug is atrovent

anticholergenic bronchodilator

Ipratropium is what kind of drug, side effects, does or doesn't work as good as albuterol

anticholinergic bronchodilator, blurry vision and headache

acute inflammation of appendix

appendicitis

what are characteristics of metabolic syndrome

apple vs pear shaped obesty increase FBS HTN increase cholesterol or increase/decrease HDL

What is a nonsteroidal anti-inflammatory drug and blood thinner that can treat pain, fever, headache and inflammation and reduce the risk of a MI

aspirin

What should you assess before giving a calcium channel blocker and what should you avoid

assess BP and HR AVOID grapefruit

What does your chest look like when you have COPD, emphysema, bronchitis

barrel chest

what drug blocks beta adrenergic receptors in the heart

beta blockers (lol)

when taking coumadin what should you report and what meds should you avoid taking

black stools, NSAID, naproxen

what term is swishing sounds from turbulent blood flow in narrow arteries outside of heart

bruit

what drug slows SA and AV conduction and example

calcium channel blocker, cardizem, verapramil

what should you do before giving glipizide

call PCP prior to OTC

Amount of blood pumped out of left ventricle in one minute

cardiac output

what happens when a person has food stravation

cells cannot make glucose

What are s/s of MI? And when assessing what would do first?

chest pain, SOB, coughing, wheezing, diaphoresis, delay cap refill, APPLY OXYGEN!!

cholesterol, HDL, LDL and triglyceride

cholesterol: <200 HDL:"good cholesterol: >40 LDL:"bad cholesterol" <100 triglyceride: less than 150

What are s/s of chronic bronchitis

chronic cough and sputum, hypoxemia, acidosis, respiratory infection, dyspnea

a patient comes in with a calcium level of 7.5 and has a facial muscle repsonse what is that a sign of

chvosteks

What is the greatest risk factor of COPD

cigarette smoking

What are s/s of PAD

cold and pale extremities, hair loss, pulselessness, dependent rubor, leg pain

Chronic inflammatory disorders cause inflammation on the gut and patients are more likely to get cancer

colorectal cancer

What meds are you give an atherosclerosis patient

combo drugs, statins and fibrates.

force of contraction

contractility

goals for asthma

control and prevent episodes, improve airflow, relieve symptoms

what would a patients lung sounds hear with COPD and emphysema

crackles

drug therapy depends on __

culture, age, cost and severity

excerise for DM

excerise the same time everyday and carry candy if sugar gets low

D-dimer range and looks at

d-dimer: less than 0.50 and risk for DVT

what causes appendicitis

fecalith

movement of fluid across a celluar blood vessel due to hydrostatic pressure

filtration

Do labs increase or decrease in patients with fluid overload

decrease (hemodilution)

Pro of ORIF

decrease risk infection and healing faster

hypernatremia is considered dehydration or fluid overload? and S/S and interventions

dehydration Muscle weakness, Irritability, confusion, seizures, coma, Dysrhythmias Interventions: diuretics and sodium restriction

what can you do to prevent neuropathy

delay onset by controlling glucose

what is the most common response with CV disease

denial

movement of fluids from High to low concentration

diffusion

complications for joint replacement surgery

dislocation, VTE, anemia, neurovascular compromise, infection

drug therapy for HTN

diuretics ACE inhibitors ARB beta blocker calcium channel blocker

What is Post op abdominal surgery and diet advancement

drink plenty of fluids eat enough calories to maintain weight increase protein intake avoid foods high in sugar, fat or sodium

what is a side efffect of lisopril and what should you do if the individual has side effect

dry cough, and change med

what is the best test to diagnose HF

echocardiogram

risk factors for CAD

elevated lipid levels smoking HTN diabetes excessive alc use stress obesity: metabolic syndrome limited physical activity

What happens to glucose during excerise

excerise lowers blood sugar levels. After exercise blood sugar levels might increase. Its important to monitor glucose while excerise possibly bring a candy bar (type 1)

what is hyponatremia considered and S/S and interventions

fluid overload s/s: dysarythrmia, lethargy, coma, seizure, anorexia and diarrhea, swelling, hyperactive bowel sounds Interventions: add sodium to diet, hypertonic fluids, fluid restriction

history for dehydration

food, fluid intake weight loss -meds, wounds, N/V and diaherra

another name for stomach flu

gastroenteritis

increases secretion of insulin

glipizide

what should you avoid with plavix

grapefruit

Glipizide side effect

headache and irriatabile

Whats side effect of long acting and education

headache and shaky, contact provider if patient is having sx and not giving pt is NPO.

PA for HTN

headache, facial flushing, dizzy, fainting, nose bleeds NO SYMPTOMS take BP on both arms complete CV exam

Inability of the heart to work effectively as a "pump" → decline in CO

heart failure

A patient has a potassium of 6.5 what should the patient be wearing

heart moniter

a patient has a potassium of 2.5 what should you moniter

heart rate and rhythm

What is a stress test do? What can you eat anything before the test? What medications should you stop taking before the test? What type of clothing should you wear for the test?

helps determine the functional capacity of the heart, You can eat a light meal two hours before the test, Calcium channel blockers and beta blockers to show a increase workload of the heart, wear comfortable, loose clothing, and rubber soled supportive shoes

carries oxygenation and hydration in the blood and normal ranges

hgb: 12-18 hct: 37-50%

early sign of obstruction is

high pitched bowel sounds

What are the s/s of respiratory alkalosis?

hyperventilation and anxiety,

what are s/s of hypercalcemia

hyporeflexia, muscle weakness and fatigue

If a patient is dehydrated would you give them hypotonic, hypertonic or isotonic fluids

hypotonic fluids because they are hypertonic

What are complications of COPD

hypoxemia (low concentration of O2 in the blood), ACIDOSIS due to CO2 retention, Respiratory infection and failure, cardiac failure causing cor pulmonale (right-sided heart failure), and dysrhythmias.

external device holding bone in place

immobilization

Does serum osmolarity increase or decrease with dehydration

increase

Do all the labs increase or decrease in dehydration

increase (hemoconcentration)

what does hypercarbia mean

increase in CO2

what is a side effect of aldactone

increase in K+

con of external fixation

increase risk of infection

What is an example of a cholinergic antagonist, teaching and side effects

ipratropium: doesn't work as well as albuterol but doesn't cause tachycardia side effect: blurry vision and h/a

When giving IV potassium, should large or small veins be used?

large

CRP

less than 10

what should we watch for in drug zocor

liver disease and to decrease high cholesterol

what diet should crohns patient be on

low residual diet

Almonds, spinach, tofu, avocado and bananas are high in what electrolyte?

magnesium

What type of drug is repaglinide and teach about repaglinide

meglitinide analog (insulin stimulator), s/s of hypoglycemia if dose is skipped if a meal is omitted with or before meals

What does DKA result in?

metabolic acidosis, inability for carbs, fat, proteins to be metabolized, high death rate, BS >300

pH 7.43 CO2 48 HCO3 28

metabolic alkalosis fully compensated

What is the term Risk factor Atherosclerosis and CAD. It is not a disease it's a syndrome so it is a cluster of symptoms without a true known cause.

metabolic syndrome

what should you avoid when in MRI room

metal

What are some ways to improve oxygenation and reduce CO2 retention in COPD, emphysema and chronic bronchitis patients?

monitoring: every 2 hours positioning: upright position, support arms and legs to conserve energy Effective coughing rest periods

What drug is used to prevent angina caused by CAD. This medication is also used to relieve an angina attack that is already occuring

nitroglycerin SL

What is insensible water loss? How much ml/day do each lose

no more than 1100ml, water loss from the skin, lungs, and stool

a patient has COPD, emphysema and brocnhitis should we be working with arms raised

no, keep at chest level and allow rest periods

which obstruction is peristalsis is affected and causing paralytic ileus

non-mechanical

What are risk factors of primary HTN

obesity, insulin resistance (diabetes), high alc intake, high salt intake, age, sedentary lifestyle, stress and family history

what are S/S of OA

obesity, joint stiffness and joint pain

When ABG full comp

pH: norm CO2: abn HCO3: abn

normal range for pH, CO2 and HCO3

pH:7.35-7.45 CO2:35-45 HCO2:22-25

when ABG is uncompensated

pH:abn CO2: norm or abn HCO3: norm or ab

What is the goal for CAD

pain relief improve perfusion increase activity tolerance effective coping decrease complication

What does your skin look like when you have COPD, emphysema, bronchitis?

pallor, cyanosis

solute is what

particles that are dissolved

self assessment for asthma

peak flow meter 2x a day

A redness and swelling (inflammation) of the lining of your belly or abdomen

peritonitis

how porus the membrane is

permeability

ABG

ph- 7.35-7.45 CO2: 35-45 Bicarb: 22-26

3 P's

polyuria, polydipsia, polyphagia

What electrolyte is a major cation of intracellular fluid?

potassium

Spironolactone and what should you monitor

potassium sparing diuretic, monitor weight, decrease k+ foods

what diuretics are postassium wasting vs potassium sparing

potassium wasting: furosemide (lasix), hydrochlorothiazide potassium sparing: Spirolactone

What does Lovenox do? What should you monitor?

prevents clots from forming, daily INR

what does singular prevent and how often you take it

prevents inflammation caused by allergens; daily

a patient has crackles what could that be a sign of

pulmonary edema

What is the most accurate diagnositic test for asthma

pulmonary function tests

A patient has COPD, emphysema, bronchitis what is the technique that allows to control their oxygenation and ventilation that requires a person to inspire the nose and exhale through the mouth at a slow controlled flow?

pursed lip breathing

hyperglycemia s/s and range

range: >140, hot and dry, polyuria, polyphagia, polydipsia, kussmaul respirations, dehydration, drowsiness, abd. Cramps, N/V, increase in ketones

what does RIC stand for

rate of infusion, incompbailties and concentration

transports oxygen in blood and normal range

red blood cells, 4.5-5.5 million

pH 7.33 CO2 49 HCO3 29

respiratory acidosis partially compensated

A CHF patient as a order for activity as tolerated the patient understand what?

rest when SOB

What are causes of Respiratory acidosis

retention of CO2 by respiratory depression, airway obstruction, etc.

what do lungs sound like in chronic bronchitis

rhonchi lung sounds: thick mucus

Is JVD a sign of R-sided or left sided HF

right

A patient has COPD, emphysema, bronchitis what is the best position to have the patient in?

semi fowlers

severe life threatening acute airway obstruction

status asthmaticus

what drug can overstimulate the system and cause sodium retention and increase BP

steriod

how does glucagon maintain glucose levels

stimulates liver storage

risk factors for HTN

stress, smoking, sedentary lifestyle, obesity, diet, diabetes, A.A, above 60 and family hx

preop teaching for joint replacement surgery

teach about PT, OT, crutches. Have them visit the dentist (check for infection), assess risk for clotting/bleeding, autologous blood donation, shower with antiseptic soap

Hydrochlorothiazide (Microzide) and what to teach patient

thiazide diuretic first HTN med and monitor weight and increase K+ foods

Why do COPD patients tend to lose a lot of weight

this is due to burning more calories while using their accessory muscles to breathe and having an increased RR.

A patinet comes in with a calcium level of 8.5 and has left palmer flexion what is that a sign of

trousseau's

the destruction of beta cells type 1 or type 2

type 1

cells are resistant but can take pills type 1 or type 2

type 2

diet for diabetes and is type 1 or type 2 more nutrition based?

type 2, Pleasureable, heart healthy, based on personal preference

What is the general appearance look like for a COPD, emphysema, bronchitis

unbathed

what is the best method of oxygenation for COPD and whats the last resort and for hydration what do you use

venturi mask and suction is last, air humidifier

assessment for type 2

waist to hip ratio

Ways to prevent gastroenteritis

wash hands, cook food well and let it run its course

solvent is what

water

where ever sodium goes _______ follows

water

causes of excessive loss of dehydration

wounds and hypersalvation

How often should DM get their eyes checked because of the increase risk of retinopathy?

yearly exam

what peritonits more common in

young adults and older or had appendcitis

S/S of right sided vs left sided

■Right sided: JVD, edema, increased abdominal girth, weight gain, ascites, increase in BP, edema, polyuria ■ Left sided: frothy sputum, extra heart sounds and lung sounds, pulmonary congestion, oliguria, cool extremities, weak pulses, gallop