Labs and stuff

secondary OA aka osteoarthritis how common? results from?

-less common -results from musculoskeletal conditions like rheumatoid arthritis or congenital anomalies, trauma, joint sepsis or metabolic conditions like DM, paget's or blood disorders like hemophilia, sickle cell anemia

Post op nursing care for ovarian cancer

- Assess vital signs, pain, I & O (esp. urine &/or drains) - Antiembolism stockings, early ambulation; SCDs - Incentive Spirometer (IS), TCDB

Fat embolism 1st sign? s/s? prevention? treatment?

-Altered mental status - 1st sign, increased RR+ pulse+temp., crackles, decreased SaO2 dyspnea, chest pain, petechiae, increased ESR+lipase and decreased Ca+RNC+platelets, respiratory failure from pulmonary edema -Prevention- Immobilization of fracture site -Treatment:NOTIFY MD!, Bedrest, Gentle handling, Promote oxygenation, Promote hydration, Fracture immobilization,Steroids

Muskuloskeletal safety assessments? collabs?

-Assessment-Posture, Gait, ROM, Size and symmetry , Strength and tone, Occupation, Living arrangements -Collaboration:Home health care, Rehabilitation

Spiral of gout process

Attack starts, crystals form, white blood cells attack, crystals pop cell, cell releases proteins, proteins call in more white blood cells and cause inflammation and pain, proteins lower ph making it possible for more crystals to form, attack starts over

Skin care of gastroenteritis

Avoid toilet paper and harsh soaps, clean with warm water followed by thorough gentle drying. Cream oil or gel can be applied to damp warm washcloth to remove stool or skin wipes. Protective barrier cream van be applied to skin between stools. Sitz bath can reduce discomfort. If leakage of stool cotton or panty liners

Corticosteroids common examples? SE? Education? Responsibility?

Azmacort or fluticasone/Flovent inhalant, prednisone PO, solumedrol IV. SE: Irritability, headache, increased blood glucose, Cushingoid effects, weight gain, GI issues. Don't abruptly stop taking meds, take with food, monitor weight, avoid excess salt intake+people with infection+injury. Monitor BG levels and VS, oral care. Used as last resort for asthma

Sulfasalazine examples? Report?

Azulfidine and EN tabs. Metabolized into 5-ASA. Report nausea,vomitting, anorexia, rash, headache, anemia,hepatitis, infertility.

Oral glucose tolerance test

Balanced diet with carb intake >150g for minimum of 3 days before while maintaining normal activity, test performed in morning after 10-12 hour fast, fasting blood sample obtained, drink 300 mL of flavored beverage containing 75 g glucose within 5 min. Of fasting sample, blood drawn at 30 minutes for 2 hours, remain at rest the whole test

Liver vs. spleen for blood

Balances blood cell production with blood cell destruction and assists with immunity, stores platelets, filters antigens. vs. clotting factors bile for vitamin K and stores blood/iron

Performing IV assessment

Begin with insertion site and work upward following the tubing. Make sure no phlebitis and dressing clean, dry, adherent on all sides. Check everything secure, no tape on connections, check rate by counting drops or checking pump. Check all labels for patient's name and fluid or medication

At risk factors for depression? What to checK?

Being old, sadness, hopelessness, losses. Do you have a plan

Eructation aka

Belching

Antihistamines common examples? Function? Can be administered? SE? Education? Responsibility?

Benadryl, Zyrtec, Claritin, Allegra. PO but Benadryl can be IV. Decreased symptoms of histamine excess (sneezing, rhinorrhea, pruritus, urticaria). Suppression of cough.SE: dizziness, confusion, sedation, dry mouth. Don't drive or operate machines. Provide good oral hygiene to include use of oral moisturizers

Seborrheic keratosis define? S/s? Common in? Increase in? Removed by?

Benign epidermal neoplasm •Have a "pasted on" plaque like appearance •Common in middle age •Increase in numbers with time •Removed by cryosurgery or curettage for cosmetic reasons or if a lesion becomes irritated

Nevus/mole define? Normal nevi have? 1/2? If changes? Treatment?

Benign growth of the pigment forming cells •Normal nevi have regular, well defined borders, & uniform color •½ of malignant melanomas arise from multicolored nevi with irregular or spreading borders •If changes size, itches, tender or bleeding = suspicious •Treat by surgical removal •Biopsy if suspicious

Liver function

Bile, storage of vitamins/minerals, protection, metabolism of amino acids to remove ammonia to urea+fatty acids+triglycerides, kupffer cells rid bacteria/anemic RBCs/harmful compounds like drugs, synthesizes plasma proteins, stores/releases glycogen

Etiology of acute pancreatitis

Biliary tract disease, gallstones, trauma of biliary tract, pancrease, gastric, duodenal procedures like cholecystectomy and gastrectomy or endoscopic retrograde cholangiopancreatography, pancreatic obstruction, metabolic disturbances like hyperlipidemia, hyperparathyroidism, hypercacemia, renal failure or transplant, genetics, gastric or duodenal ulcers, viral infections, alcoholism, drugs

Management of hyperkalemia

Bind and excrete Sodium polystyrene (Kaexylate) Po or retention enema Drive it back into the cell Regular insulin and D50W IV Sodium bicarbonate IV Calcium gluconate IV Filter it out of the blood Hemodialysis

Treatment of polyps

Biopsy, polypectomy, with familial adenomatous polyposis possibly total colectomy. Postop care: monitor for pain, distention, rectal bleeding, drainage, fever

DM is leading cause of?

Blindness, ESRD, lower limb amputations

Symptoms of IBS

Bloating, gas, abdominal distention, cramps, diarrhea, constipation, pain in left lower quadrant , generally looks well with stable weight and nutritional and fluid status WNLs, with constipation bowel sounds may be hypoactive, with diarrhea may be hyperactive

Increased ICP can result from

Blockage of blood flow of CSF, change in cerebral blood flow, thrombus formation

Ductal ectasia define

Blocked breast ducts causing discharge from nipples

Treatment for aplastic anemia

Blood transfusions, allogeneic hematopoietic stem cell or bone marrow transplant, immunosuppressive therapy like prednisone, antihymocyte globulin, cyclosporine A, daclizumab/Zenapax

Symptoms and signs of ulcerative colitis

Bloody stool, tenesmus aka urgent sensation to defecate, lower ab colicky pain, malaise, anorexia, anemia, dehydration, fever and weight loss, polyarthritis, ankylosis spondylitis, erythema nodosum, abscesses, malabsorption, cancer, oral and skin lesions

Blue nails findings?

Blue that blanches means respiratory failure, methemoglobinuria, venous stasis

Hyperphosphatemia caused from?

Bone fractures in healing, bone tumors, acromegaly

Diagnosing osteoporosis

Bone mass density t score less than -2.5

Key features of Paget's

Bone/joint pain, low back and sciatic nerve pain, bowing of long bones, loss of spinal curvature, enlarged thick skull, pathological fractures, bone cancer aka osteopenia sarcoma, flushed warm skin, apathy, lethargy, fatigue, hyperparathyroidism, gout, urinary/renal stones, heart failure

Poor diet=?

Anemia which causes low libido

Complications related to increasing growth of colorectal cancer tumor locally or through metastatic spread include

Bowel obstruction, perforation with resulting peritonitis, abscess formation, fistula formation to urinary bladder or vagina. Frank bleeding

Culture define?

Broad term referring to patterns of behavior acquired over time including beliefs, values, customs, habits, language, thoughts, ways.

Define contusion

Brusing of brain tissue and found at site of impact aka coup or in line opposite site of intact contrecoup

Carb counting for DM carbs have? Serving size is? Regardless of ? Typically? Insulin dose based on? Total grams of carbs used to? Prescribed? Use?

Carbs have greatest impact on glucose levels Serving size is 15 g of CHO Regardless of food source Typically 45 to 60 g per meal Insulin dose based on number of CHOs consumed Total grams of carbs are used to calculate the bolus dose of insulin Prescribed insulin-to-carbohydrate ratio (1:15) Use total carbs on food labels

Movement of K from ECF to ICF

Can help reduce K temporarily. K movement into cells is enhanced by insulin since it increases Na-K pumps which move K from ECF into the cell, so IVs containing glucose and insulin are prescribed to help decrease K. Usually 100ml of 10-20% glucose with 10-20 units of regular insulin and are hypertonic infusing in central line or in vein with high blood flow.

Combination insulin therapy can? Provides? Commercially?

Can mix short- or rapid-acting insulin with intermediate-acting insulin in same syringe Provides mealtime and basal coverage in one injection Commercially premixed or self-mix

CA125 define

Cancer antigen that's elevated in ovarian cancer, endometriosis, fibroids, and measures presence of damaged endometrial and uterine tissue in blood

Hypercalcemia caused from? Can cause?

Cancer, Paget's, bone fractures in healing. Can cause heart block, digitalis issue, cardiac arrest.

Elevated ALP caused from?

Cancer, Paget's, osteomalacia, bone/liver damage

Depressed levels of gastric secretion suggest? Increased levels?

Cancer, zollinger Ellison syndrome and duodenal ulcers

Other things to assess for reproductive system

Childhood illnesses i.e. Mumps => Orchitis Chronic Illness i.e. DM => impotence; vag. dryness Surgeries; Medications; Radiation; Chemotherapy STDs => obstruction and/or infertility Infections i.e. pelvic inflammatory disease (PID)

Gallstones composed of? Classifications?

Cholesterol, bilirubin, bile salts, calcium, proteins. Cholesterol or pigment which are associated with cirrhosis

Small intestines regions

Duodenum, jejunum, ileum

Risk factors for endometrial/uterine cancer

During reproductive years, family history/HNPCC, DM, hypertension, obesity, uterine polyps, late menopause, nulliparity/no childbirths, smoking, tamoxifen/Nolvadex for breast cancer

The dryness, smoothing, and thinning of vag can cause? Treatment?

Dyspareunia Aka genital pain before, during, or after sex. Water lube

Key features of increased ICP

Decreased LOC, behavior changes, headache, n/v, change in speech, aphasia, change in sensorimotor status, pupillary changes, cranial nerve issues, ataxia, seizures, cushing's triad, hypertension, widened pulse pressure, bradycardia, decerebrate/extensor, decorticatiate/flexion

Meningitis key features

Decreased LOC, disoriented, photophobia, nystagmus, abnormal eye movements, hemiparesis, Hemiplegia, decreased tone, cranial nerve dysfunction, short attention span, behavior changes, headaches, muscle aches/pain, n/v, fever/chills, tachycardia, red macular rash if meningococcal, increased ICP due to exudate, seizures

hypophosphatemia signs/symptoms

Decreased SV+CO, slow weak pulses, cardiac depression/damage, weak muscles with possible breakdown causing rhabdomyolysis, respiratory failure, bone density decreases leading to fractures, lumps/depressions in bone, if severe irritability/seizures/coma

Elderly changes for GI

Decreased absorption, peristalsis, sensation to defecate causing constipation, distention, gastritis, accumulation of drugs

Biliary obstruction causes?

Decreased bile causing prevention of absorption get fat soluble vitamins like vitamin K so clotting factors not made, jaundice due to hepatocellular disease or intrahepatic obstruction which caused decreased excretion of bilirubin, edema fibrosis, scarring, priorities aka itching

Osteopenia

Decreased bone density

Aging changes to urinary system

Decreased glomerular filtration rate causing dehydration and not of as good ability to rid body of drugs, nocturia, decreased bladder capacity, weakened sphincter and shortened urethra, tendency to retain urine

White/pallor skin cause? Significance?

Decreased hemoglobin/blood flow, genetics. Anemia, shock/blood loss, vascular compromise, emotions, edema, albinism, vitiligo

Vagal nerve stimulation define

Device surgically implanted in left chest and controls continuous simple or complex partial seizures

Acute complications of DM

Diabetic ketoacidosis (DKA) due to lack of insulin+ketosis Hyperosmolar hyperglycemic syndrome (HHS) due to insulin deficiency and dehydration Hypoglycemia aka insulin reaction

Prostate cancer symptoms

Difficulty in starting to urinate, frequent bladder infections, urinary retention, hematuria, nocturia, pain when ejaculating, extremely high PSA aka prostate specific antigen, elevated serum acid phosphatase

Receptive/wernicke's/sensory aphasia

Diffulting understanding spoken+written words, their speech is meaningless, may use made up words

Common drugs for anticonvulsants

Dilantin /phenytoin phenobarbital/Luminal Tegretol/carbamazapine Klonopin/clonazepam

About AV access

Do not use it for anything but dialysis Asses graft and fistulas for bruit and thrill q shift before an after dialysis Do not use arm/leg with AV access for BP, venipuncture or IVs Assess circulation distal to the access Do not remove the caps or open the clamp on the AV access catheters

Diabetic foot care

Don't go barefoot, clip toenails straight across, wash/inspect daily, don't soak, keep in between toes clean/dry, lotion after cleaning except in between toes, don't wear same shoes 2 days in row, cotton socks daily, no sandals/open toed/straps between toes, don't cross legs, no garters/tight stockings, no extreme temps, no smoking, see podiatrist if corns/calluses, diligent wound care

When dressing stroke patient

Dress weak side 1st step toward strong side 1st, transfer toward strong side 1st, sling for shoulder joint protection

Minimizing pain for UC: abdominal pain? For skin excoriation and or irritation from frequent bowel movements?

Drugs, positioning, nutrition, observe for peritonitis, music therapy and guided imagery. Mild soap and water after each BM, nutrition, sitz bath, thin coat of AD ointment or aloe, medicated wipes instead of tissue, ostomy supplies that fit, antidiarrheals, symptoms of megacolon aka fever, leukocyte sits, tachycardia, distended ab,

After bathing for DM

Dry feet and seal with thin coat of petroleum jelly/un scented hand cream, no oils/creams between toes, don't soak feet

Extra hepatic obstructive jaundice

Due to chronic cholecystitis from obstructed bile flow to duodenum causing accumulation of bile salts on skin causing pruritus, bilirubin can't reach large intestines so no urobilinogen causing clay colored stool and then dark irine

Ethnicity define?

Common social customs, values, beliefs that isn't based on race

Nursing care for enteral

Confirm placement via measuring tube length, visual assessment, pH of aspirate, initial X-ray best, auscultation. Securing tube, hygiene, maintaining patency, administering meds, preventing aspiration

Simple partial seizure

Conscious throughout and reports aurora/unusual sensation before seizure takes place

With arms out to the side, the patient touches the nose 2-3 times test component

Coordination

Hypocalcemia interventions

Drugs lik Ca, aluminum hydroxide, vitamin D, magnesium sulfate/muscle relaxants. Nutrition. Environmental management for safety like keeping room quiet, limiting visitors, adjusting light, using soft voice. Seizure precautions like bed low w/ side rails, bed on floor, keeping O2+suction+drugs+endo tracheal tray near. Injury prevention with lift sheet for moving

Interventions for fluid overload

Drugs, nutrition, monitoring to ensure safety, restore balance, give supportive care until imbalance resolved, prevent future overload

Positive pressure ventilator types

Pressure cycled that push air until pressure met. Time cycled where air pushed until time met. Volume cycled push air until preset volume delivered. Microprocessor that are computer managed

During seizures?

Prevent injury Protect head Avoid restraint or forcing any object in mouth Turn head to side if possible Loosen clothing DOCUMENT! Grand Mal/Tonic Clonic Seizure lasts 2-5 min

Main interventions for dehydration

Prevent injury/patient safety, fluid replacement, drug therapy to prevent more fluid loss and increase fluid compartment volumes to normal

Alkalosis interventions

Prevent loss of H, K, Ca, and Cl, restore fluids, monitor changes, patient safety. Antiemetic drugs if due to vomiting, fluid/electrolyte therapy if due to diuretics,

Acid suppression for PUD used to? Drugs used?

Prevent rebleeding. Drugs used: h2 receptor antagonists, proton pump inhibitors, antacids

Priority focus of care after conventional surgery for hiatal hernia

Prevent respiratory complications, elevate HOB at least 30 degrees, support incision during coughing

Patient avoids fractures by

Preventing falls, managing risk factors, and adhering to preventative or treatment measures for bone loss

Preventing hemorrhoids

Prevention of constipation most important, fiber in diet like whole grains/raw vegetables/fruits, drinking plenty of water, avoid straining at stool, exercise with gradual buildup, maintain healthy weight

Primary, secondary, tertiary health promotion for hypertension

Primary: exercise, <Na diet. Secondary: BP screenings. Tertiary: meds

Chronic pancreatitis

Progressive, destructive disease of pancreas with remissions and exacerbations. Categories: chronic calcifying pancreatitis from alcoholism, chronic obstructive pancreatitis from gallstones, autoimmune , idiopathic/hereditary chronic pancreatitis

Clients at risk for PE

Prolonged Immobility Central venous catheters S/P Surgery and/or Trauma Obesity/Smoking Hx Hx of thromboembolism Pregnancy

Status epilepticus is

Prolonged seizure longer than 5 minutes or repeated seizures over 30 minutes

Decrease of acid components cause

Prolonged vomiting, NG suctioning, hypercortisolism, hyperaldosteronism, thiazide diuretics

Insulin functions? Not necessary for?

Promotes glucose uptake in skeletal/cardiac muscle, storage of glucose as glycogen aka glycogenesis, increases protein+fat/lipid deposition/synthesis, inhibits ketogenesis+gluconeogenesis aka glucose from noncarbs+lipolysis+proteolysis+glycogenolysis. Not necessary for glucose transport in brain, liver, blood cells

Primary health promotion? Examples?

Promoting health and preventing disease/injury, anticipatory planning and actions, examples: immunizations, family planning services, nutrition, exercise, weight control, physical activity, advising to quit smoking, teaching health risk assessments, safety

Men >50 years assess?

Prostate Specific Antigen (PSA) Antigen PSA (2.5 - 4 ng/ml) before DRE

PT define? Decrease can mean?

Prothrombin time for coagulation test to evaluate liver. Increase in K

Double contrast barium enema intervals?

Q 5 years

Promoting communication with advanced AD

Questions that require only yes/no, instructions with pictures, one step instructions, gestures to help them understand, validate feelings, limit choices, never assume they're totally confused, anticipate needs, interpret nonverbal communication

What helps minimize confusion and disorientation and gives dementia patients a sense of security

Quiet speaking, clear/simple explanations, memory aids, prominent clocks/calendars for time, color coding doors for finding room

Madeline Leininger

RN and theorist and defined transcultural nursing as an area of study that focuses on care, health, illness patterns of people in beliefs, values, practices

Preventing PE

ROM exercises, ambulate asap, no tight clothing, no pressure under knees, elevate affected limbs above heart, change position q 2 hours, no massaging, no crossing legs, prophylactic low dose anticoagulants, no valsalva maneuvers, stool softeners, smoking cessation

Stretta procedure define

Radio frequency energy through endoscope using needles placed near gastroesophageal junction which decreases vagus nerve activity reducing discomfort of patient

Early sex =?

Raised risk for cervical cancer

Mealtime insulin/bolus preps

Rapid acting or short acting

Speed shock cause? S/s? Treatment? Prevention?

Rapid infusion which causes toxic levels. S/S: lightheadedness, dizziness, chest tightness, flushed face, irregular pulse, LOC, shock, cardiac arrest. Treatment: immediately discontinue, hang isotonic solution to KVO, monitor VS, notify. Prevention: adhere to infusion rate

Testing for TB

Rapid nuclei can acid amplification test, acid fast smear but not specific to TB, blood analysis via ELISA, sputum culture CONFIRMS diagnosis but takes 1-4 weeks, Mantoux/PPD test + indicates exposure and possible infection or dormant. Chest X-ray detects active or old healed TB

General appearance for kidney disease

Rashes, brushing, yellowish, edema around feet, shins, sacrum, eyes

Blumberg so sign aka

Rebound tenderness aka pain felt on release

Clinical manifestations of colorectal cancer

Rectal bleeding, anemia, change in stool consistency or shape, dark colored or Brit red stool,

Adrenal glucocorticoids

Regulate protein metabolism by increasing or decreasing catabolism to reduce or intensify bone matrix and aid in regulating calcium and phosphorus absorption

Most common cause of GERD

Relaxation of lower esophageal sphincter

Leptin

Released by fat cells to control appetite

Purpose of GERD treatment

Relieve symptoms, treat esophagitis, prevent complications like strictures and Barrett's esophagus

Communication for people with AD: do what? Focus conversations to? Divert? Sensory? Avoid? Use? Therapeutic? Friendly?

Reminisce about familiar topics Focus conversations to areas of remaining competence Divert patient's attention when upset Sensory stimulation Avoid approaching as a child Use humor tactfully Therapeutic Touch Friendly smile

Types of memory

Remote/long term, recall/recent, immediate/new memory

Surgical management of endometrial/uterine cancer

Removal of uterus, fallopian tubes, & ovaries {total hysterectomy w bilateral salpingectomy/oophorectomy (BSO)}

Papillotomy define

Remove gallstones

Diagnosis of DM should be

Repeated to rule out error unless classic manifestations of hyperglycemia present

Teaching for self management of UC?

Report fever over 101, tachycardia, palpitations, increase in diarrhea, abdominal pain, nausea/vomiting. Avoid foods that make stool thicker or cause gas including high fiber goods like nuts, raw vegetables, corn, celery, apples with peels, popcorn.

Skin interventions for fluid overload

Reposition every 2 hours, assess for skin breakdown, pressure reducing mattress

Management of pressure ulcers

Reposition q 2 hours, use air mattress, clean with mild soap, keep free of moisture/feces, do not rest on hip bone, place pillow under legs from mid-calf to ankle to keep heels off bed, maintain HOB at 30 degrees, increase calories and protein

Major meds for AD

Resperidol for antidepressant, Aricept for memory, Namenda for deterioration, Exelon for memory

Decreased PaCO2 from?

Respiratory alkalosis, excess ventilation, diarrhea

Under elimination of H conditions in respiratory acidosis

Respiratory depression, inadequate chest expansion, airway obstruction, alveolar-capillary block

Preventing fecal impaction

Eat high fiber foods including raw fruits and vegetables and whole grains, adequate fluids, don't routinely take laxatives, exercise, warm beverages and prune juice for peristalsis, take bulk forming products like Metamucil, check stool for amount and frequency since oozing of soft or diarrheal stool indicate fecal impaction, have patient sit on toilet or bedside commode instead of bed pan

Cullen's sign define and can indicate

Ecchymosis around umbilicus and can indicate intra abdominal bleeding

Pyloric obstruction caused by? Symptoms? Treatment?

Edema, spasm, scar tissue. Feeling full, distention, nausea after eating, vomiting un digested food, metabolic alkalosis+dehydration. Restoring fluids+electrolytes+decompressing stomach via nasogastric suction.

Tensilon test aka? Define? Positive if? Determines?

Edrophonium/tensilon and neostigmine/prostigmin injected. Positive if better muscle tone for 4-5 min. Determines if MG due to cholinergic crisis aka too much cholinesterase inhibitor or myasthenic crisis aka too little cholinesterase inhibitor

Rn interventions for testicular cancer

Education, support, surveillance for 5-10 years, history/physical/psychosocial assessment, sperm storage after diagnosis and before radiation/chemo, support group referrals

Dis functional uterine bleeding DUB define? Occurs most often? Occurs when there is?

Excessive & frequent bleeding > Q 21 days Occurs most often @ beginning or end of her reproductive years Occurs when there is a hormonal imbalance and when the ovaries fail to ovulate;

Earliest change signaling diabetic kidney disease

Excretion of 30+mg of albumin per day

Pancreas function

Exocrine: carb, fat, protein digestion via trypsin, chymotrypsin, amylase, lipase Endocrine: alpha cells for glucagon and beta cells for insulin

Hyperkalemia expected In? If greater than 6?

Expected in ESRD with missed dialysis, if greater than 6 represents high risk of cardia dysrhythmias and is a clinical red flag

Patient prep for bronchoscope, laryngoscopy, and mediastinoscopy

Explain, consent, labs, NPO 4-8 hours before, benzo's or opioids for sedation, benzocaine spray or lidocaine best for anesthetic to numb

Surgical management for ovarian cancer

Exploratory laparotomy to diagnose, treat, & stage ovarian tumors Total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH w BSO) with lymph node dissection Cytoreduction: debulking of very large tumors

Causes of aplastic anemia

Exposure to drugs, radiation, benzene, chloramphenicol, alkylating agents, anti metabolites, sulfonamides, insecticides, viral infections like Epstein-Barr, hep. B, cytomegalovirus

If decannulation occurs after 72 hours

Extend neck and open tissue of stoma with curved Kelly clamp to secure airway and quickly replace tube and check for airflow through tube and bilateral breath sounds , ventilate with bag valve mask

Acceleration injury vs. deceleration

External force contacting head, placing it in motion vs. moving head suddenly stops/hits stationary object

Klinefelter syndrome

Extra sex chromosome XXY in men where they can have no s/s or s/s of enlarged breast gynecomastia, sparse facial and body hair, small testes, and inability to produce sperm

Glasgow coma scale 3 areas?

Eye opening/4 choices: randomly, sound, pain, never. verbal response/5 for oriented, confused, inappropriate, none. motor response/6 for commands, pain, abnormal/normal flexion, extension, none.

Ketones made from? Due to? Via? Due to? Carb needs for protein sparing and prevention of ketosis?

Fat fragments due to inadequate carbs via fat metabolism due to starvation. 50-100 g/day.

Avoid treatment with carbs that contain

Fat like candy, cookies, whole milk, ice cream since fat will slow down absorption of sugar

Hypokalemia s/s

Fatigue, malaise, confusion, muscle weakness, shallow respirations, abdominal distention, paralytic ileus, hypotension, weak pulse. Can result due to treatment of DKA

Lactic acidosis s/s

Fatigue, usually muscle pain, difficulty breathing, unusual stomach discomfort, dizziness, lightheadedness, irregular heart beats

Dehydration define? Can be due to? Which types are there?

Fluid intake/retention less than needed resulting in volume/plasma deficit. Can be due to too little intake, too much output, loss of body water via shifts from plasma to interstitial space aka relative. Can be just water loss or water+electrolyte loss calls isotonic dehydration

Complications of myomectomy/transcervical endometrial resection and what to report

Fluid overload, emoblism, hemorrhage, perforation of uterus/bowel/bladder/ureter, increased menstrual bleeding, incomplete suppression of menstruation, pain, bleeding.

Interventions for gastroenteritis

Fluid replacement and drugs and skin care

SIAD syndrome of inappropriate antidiuretic hormone treatment

Fluid restriction, IV 3% hypertonic Na

Prescription for infusion should include

Fluid type, rate in mL/hr or total amount of fluid and total number of hours for infusion, drugs and the specific dose to be added

Osteoarthritis anatomy

Fusiform swelling of joints, heberdens nodes

Other conditions resulting in hyperglycemia

Genetic defects of beta cells and insulin action and Down syndrome, pancreas disease/ inflammation/trauma/neoplasia / cystic fibrosis/hemochromatosis, endocrinpathies like acromegaly, cushing's, glucagon a, photochromocytoma, hyperthyroidism, aldosteronism. Drug/chemicals like glucocorticoids, TH, thiazides. Infection like rubella, cytomegalovirus, HIV.

Cervical cancer risk factors

Girls/young, HPV, multiple births, smoking, <18 years for sec, multiple sex partners, African Americans, contraceptives, STDs, obesity, family history, HIV/AIDS, low socioeconomic status, sex partner had previous partner who developed cervical cancer, intrauterine exposure to DES

Long acting insulin examples? Onset? Peak? Duration? Which can be given twice a day? Both reduce? Don't do what?

Glargine/Lantus, detemir/ Levemir. .8/1-4 hours. No peak for lantus, 6-8 hrs Levemir. Duration 24+ hours Lantus, 5.7-24 Levemir. Detemir/Levemir can be given twice a day. Both reduce risk for hypoglycemia. Don't mix with any other insulin in same syringe

Metaglip is combo of?

Glipizide & metFORMIN.

DM Counter regulatory hormones examples? Do what?

Glucagon, epinephrine, growth hormone, cortisol. Oppose insulin, stimulate glucose production in liver, decrease movement of glucose into cells, maintain normal BG levels

Osteoarthritis drugs

Glucosamine, chondroitin, lidocaine/Lidoderm 3 patches q 12 hours, salicylates/aspecreme patch/gel/cream, capsaicin, cortisone injections, hyaluronate/Hyalgan/Hylan/Synvisc, analgesics like NSAIDs Celecoxib/Celebrex, acetaminophen/Tylenol, muscle relaxant for spasms cyclobenzaprine hydrochloride/Flexeril

Fructosamine

Glucose bound to amino groups on serum protein proteins/albumin die in 14 days so good for testing a short time frame.Tests: glycosylated serum albumin/protein GSA/GSP

Carb metabolism- glucose is? Stored as? What locations?

Glucose is key and stored as glycogen in liver which is provided via hydrolysis or stored in muscles for use during exercise

What causes ketoacidosis ? How to fix?

Glucose not available so body breaks down fat and ketones formed due to breakdown. To fix correct fluid volume deficit and lower blood glucose with insulin to drive K back into cell

Glucovance is combo of?

Glyburide and metFORMIN.

Complications of DM can be reduced with

Glycemic, hypertension, and hyperlipidemia/cholesterol management

Energy sources for critical illness

Glycogen, protein used more, depleting lean body mass causing negative N balance causing concentrated urine

Hemoglobin A1C test Aka? Used to? Goal? Reflects? Diseases affecting?

Glycosylated hemoglobin: reflects glucose levels over past 2 to 3 months(120 days) Used to diagnose, monitor response to therapy, and screen patients with prediabetes Goal: less than 6.5% (American College of Endocrinology) to 7% (ADA) Reflects the amount of glycosylated hemoglobin as a percentage of total hemoglobin Diseases affecting RBCs can influence the hemoglobin A1C level

Agents for female infertility types

GnRH analogs, synthetic androgens

Early s/s of stroke

Golden 1st hour: Sudden numbness/weakness of face/arm/leg, sudden confusion, trouble speaking or understanding, sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, loss of balance/coordination, sudden/severe headache

ADA proposed treatment outcomes for glycosylated hemoglobin HbA1c and BG levels

HbA1c <7%, premeal/preprandial BG 70-130mg/dL, peak after meal postprandial BG levels <180mg/dL

Glomerunephritis symptoms

Headache, raised BP, facial edema, lethargy, low grade fever, weight gain, proteinuria, hematuria, oliguria, dysuria, crackles, neck vein distention, decreased GFR, BUN increased, ASO titers positive for strept. If due to strept.

Subdural +epidural hematomas and intracranial hemorrhage are manifested by? Treatment of hematomas? Hemorrhage?

Headache, rapid decline in LOC, neuro deficits, herniation syndromes, CV+cardiac arrest. Surgical removal. Osmotic diuretics, ICP monitoring

CKD symtooms

Headaches, low ability to concentrate urine, polyuria, oliguria, high BUN And creatinine, edema, GFR decreases under 90 to 30, anemia, high K and BP, weakness, fatigue

Presbycusis aka

Hearing loss that increases with age

Most severe complications of hyperkalemia

Heart block and ventricular fibrillation

2011 leading cause of mortality for 45+

Heart disease 1, cancer 2, respiratory disease 3

Major contributing factors of DM

Heart disease, stroke, hypertension

Hyponatremia can be caused by?

Heart failure

Symptoms of severe reflux reaching pharynx or mouth or pulmonary aspiration

Heartburn, chest pain, asthma, morning hoarseness, pneumonia

Dyspepsia define

Heartburn, or regurgitation and main symptom of GERD

Key features of sliding hiatal hernias

Heartburn, regurgitation, chest pain, dysphagia, belching, reflux like asthma from aspiration. Symptoms worsen after meal or supine

Factors that increase blood flow from injection site that increase insulin absorption

Heat, massage, exercise

Acute gastritis cause

Helicobacter pylori infection, other bacterial infection, long term NSAID, alcohol, caffeine, corticosteroids, radiation, infections of acids/alkalis, stress, anxiety

Common causes of dehydration

Hemorrhage, vomiting, diarrhea, salivation, fistulas, ileostomy, diaphoresis, burns, wounds, NPO, diuretics, GI suction, hyperventilation, renal failure, diabetes insipidus, difficulty swallowing, impaired thirst, unconsciousness, fever impaired motor function

Most common causes of cirrhosis

Hep. c, alcoholism, biliary obstruction

Chronic hepatitis usually due to? Can lead to?

Hep.b or c. Which can lead to cirrhosis and liver cancer

All causes of cirrhosis

Hepatitis, alcohol, drugs , gallbladder disease or an autoimmune form called primary biliary cirrhosis which are genetic, fatty Over aka steatohepatitis, cardiovascular disease

Polycystic disease of kidney. Etiology? Cysts? Care?

Hereditary disorder, usually appears after age of 40 Cysts replace normal tissue. Most patients develop ESKD (End Stage Kidney Disease) commonly known as ESRD (End Stage Renal Disease). Care: control HTN, prevent infection, genetic counseling, good candidates for transplant

MI labs

High Troponin for first few hours, creatine kinase-MB up to 24 hours, myoglobin 2 hours

COPD non med interventions

High calorie/protein diet, pulmonary rehab, lung transplant/reduction for end stage COPD, airway patency most important, frequent focused assessments, cough enhancement, o2 therapy

Duodenal ulcer patho? Key features?

High gastric acid secretion lowering pH, protein/calcium/vagus nerve excitation stimulate acid, also rapid emptying of food from stomach reducing buffering effect. Normal diffusion of acid back into stomach w/ increased secretion of gastric acid+increased stomach emptying

Fractures of hip

High mortality rate r/t complications Review chart 20-2 Pre-op/Post-op Review chart 20-3 Activity OOB next post-op day Stand on unaffected leg Hip flexion less than 90 degrees Physical therapy / Occupational therapy Transfer to rehab facility, if ordered Review chart 20-3

Histamine receptor antagonists aka? Examples and dosage? Function? Which example is long acting and are safer for long term use? Symptoms of use?

Histamine blockers. Famotidine aka Pepcid 20-40mg, ranitidine aka Zantac 150mg, nizatidine aka Axid 150mg. Decrease acid. Ranitidine aka Zantac. Dysrhythmias

Treatment for prostate cancer

Hormone treatment, orchiectomy aka removal of testicles, radiation, radical prostatectomy

Neuromuscular alkalosis key features

Hyper reflexia, muscle cramping, twitching, muscle weakness

Relative cause of hypercalcemia

Hyperparathyroidism, malignancy/cancer, hyperthyroidism, immobility, glucocorticoids , dehydration

Hyperplasia define? BPH?

Hyperplasia: increase in # of cells. BPH grows inward causing narrowing of urethra

Causes of relative hypocalcemia

Hyperproteinemia, alkalosis, Ca chealators/binders, citrate, mithramycin, penicillamine, Na cellulose phosphate aka Calcibind, aredia, acute pancreatitis, Hyperphosphatemia, immobility, removal or destruction of parathyroid glands

CV changes in ESRD

Hypertension CHF CAD Pericarditis Hyperkalemia

Dextrose 5% in 0.45% NS tonicity? Same as? Provides? Used to? Used as? Monitor?

Hypertonic. Same as 0.45% NS except provides 170cal/L. Provides free water and sodium & chloride Used to replace hypotonic fluid losses Used as maintenance solution although it does not replace daily losses of other electrolytes Monitor VS, lung sounds, Na, I/O

Dextrose 5% in 0.9% NS tonicity? Same as? Used to? Only solution that? Contains? Doesn't provide? May cause ?

Hypertonic. Same as 0.9 NS except provides 179cal/L. Used to expand IV volume & replace ECF losses Only solution that may be administered with blood products Contains sodium & chloride in excess of plasma levels Does not provide free water, or other electrolytes May cause IV overload or hyperchloremic acidosis

3% saline tonicity? Used to treat? Must be administered?

Hypertonic. Used to treat symptomatic hyponatremia Must be administered slowly & with extreme caution because it may cause dangerous IV volume overload & pulmonary edema

Alkalosis usually occurs with

Hypocalcemia and hypokalemia

POP Nonsurgical management

Improve pelvic muscle strength & tone through pelvic exercises (i.e. Kegel exercises) Pessaries/spheres worn in the vagina to elevate the uterine prolapse Postmenopausal: Intravaginal estrogen therapy to prevent atrophy & weakening of vaginal walls Bladder training Promoting bowel elimination

Phosphate buffering system location? Function?

In kidneys when bicarbonate is made it's reabsorbed into blood with Na and uiriine has excess of anions like phosphate HPO4 2- which draws H into urine which forms acid and then excreted in urine

Respiratory changes due to fluid overload

Increased rate, shallow respirations, increased dyspnea, crackles

Hep. C mode of transmission and prevention

Infected blood and needles, no vaccine

Hep b mode of transmission and prevention

Infected blood, sex, needles, from mother to newborn. There is a vaccine

Key features of chronic pancreatitis

Intense ab pain but less than acute, abdominal tenderness, ascites, left upper quadrant mass , respiratory compromise, steatorrhea causing clay colored stools, weight loss, jaundice, dark urine, polyuria/polydipsia/polyphagia due to DM

Paroxysmal nocturnal dyspnea PND

Intermittent dyspnea during sleep that can awake patient and can be associated with chronic lung disease or left HF

Lactated ringers tonicity? Similar in? Used to? May be used to? Doesn't provide?

Isotonic. Similar in composition to normal plasma except does not contain magnesium Used to treat losses from burns & lower GI tract and fluid resuscitation May be used to treat mild metabolic acidosis but should not be used to treat lactic acidosis Does not provide free water or calories

How to increase K excretion to lower K? Only for if?

K excreting diuretics like furosemide/Lasix . Only for if kidney function is normal.

Intracellular fluid electrolytes

K, Mg, phosphate, sulfate

If obstruction suspected

Keep patient NPO

Surgical management of acute pancreatitis

Laparoscopic cholecystectomy to remove gallstones, pseudo cysts, abscesses

What drugs are avoided for diverticular disease

Laxatives and enemas because they increase intestinal motility

Diaphragmatic/abdominal breathing

Lie on back with knees bent or sit in chair, place hands or book on abdomen, begin breathing from abdomen while keeping chest still

Status asthmaticus define? Treatment?

Life threatening acute episode of airway obstruction that doens't respond to short acting drugs causing labored breathing, wheezing, distention of neck veins, possible pneumothorax or cardiac/respiratory arrest. Treatment: IV fluids, systemic bronchodilators, steroids, epinephrine, O2

Bleeding esophageal varices is? Bleeding can be? Bleeding can cause?

Life threatening since severe blood loss can cause shock due to hypovolemia. Bleeding can be hematemesis aka blood in vomit or melena aka black tarry stools. Which bleeding can cause loss of consciousness.

Nutrition therapy for GERD

Limit chocolate, alcohol, fatty foods, caffeine, carbonated beverages, spicy foods, acidic foods , peppermint. Eat 4-6 small meals. Don't eat 3 hours before bed. Eat slowly

ADA recommendations for DM

Limit saturated fat <7% of total colors, lower intake of trains fat, cholesterol <200mg/day, 2+ servings of fish/week

Rapid acting insulin examples? Onset? Peak ? Duration? Take when?

Lispro/Humalog, aspart/Novolog, glulisine/Apidra. 10/15-30/20 min. 30 min-3 hours. 3-5 hours. Take 10/15-1 minute before eating

Bilirubin in urine can indicate

Liver or biliary disease or obstruction

Osteomalacia define? releated to? adult equivalent of?

Loss of bone related to vitamin d deficiency adult equivalent of rickets in children

Obstruction below duodenum but above large bowed results in

Loss of both acids and bases so acid balance not compromised

Coarse crackles, low pitched crackles character? Associated with?

Low pitched coarse, discontinuous rattling caused by fluid/secretions in large airways and can change with coughing or suctioning. Bronchitis, pneumonia, tumors, pulmonary edema.

GnRH analog examples

Lupron, Antagoni, cetrotide, synarel

Interventions for glomerulonephritis

Managing infection, diuretics, antihypertensive, 500-600 ml of fluids, potassium and protein restrictions, dialysis as worst case, plasmapheresis aka filtering of plasma, Reduced sodium diet

Diagnostic testing for TB

Mantoux test: Intradermal injection of 0.1mL of PPD into the forearm. +: swelling/redness 10+mm 2-3 days after, - if immunosupressed/old can still be + Sputum smear: Acid-fast smear provides an indication of tubercle bacillus Sputum culture: Confirms presents of M. Tuberculosis Chest x-ray: Reveals lesions

BUN creatinine ratio norm

Mass 12:1 to 20:1

Testicular cancer s/s

Mass, oligospermia/low sperm count, azoospermia/absence of living sperM

Benign breast disorders

Mastalgia, fibroadenoma, fibrocystic breast condition, ductal ectasia, intraductal papilloma

Education on leiomyomas

May have heavy bleeding, pain from fibroid twists, surgery

Dis functional uterine bleeding DUB assessment

Menstrual History & Focused Assessment RN assess for symptoms of anemia; CBC TSH & reproductive hormones; CA 125 NP: Pelvic Exam, Pap test, rectal exam Test for STDs; Endometrial biopsy Transvaginal US r/o fibroids & to measure the endometrium Sonohysterography: to visualize the uterine cavity via vag US

COPD meds

Methylxanthines (Theophylline) Corticosteriods (Fluticasone, Prednisone, IV solumedrol) NSAIDS Mucolytic agents (Mucomyst, Guaifenesin) Beta adrenergic agents (Albuterol) Cholinergic antagonist (Ipatropium)

Pro kinetic drug example? Dosage? Function?

Metoclopramide aka Reglan 10mg 3-4 times daily. Increases gastric emptying

RN safety priority for Uc?

Monitor stools for frank bright bleeding or black tarry melena, hematocrit, hemoglobin, electrolytes, VS, anemia if slow prolonged bleeding, fever tachycardia, fluid depletion, LOC changes if dehydration or anemia.

Patient safety for dehydration

Monitoring VS esp. HR/BP, muscle strength, gain, stability, LOC. Instruct to get up slowly, fall precautions

Dawn phenomenon define? Due to? Most severe in?

Morning 2-8 or 5-6 AM hyperglycemia present on awakening Due to release of counter-regulatory hormones in predawn hours. Most severe in young when GH is at its peak

Basal bolus regimen most closely mimics? Rapid or? Intermediate or?

Most closely mimics endogenous insulin production Rapid- or short-acting (bolus) insulin before meals Intermediate- or long-acting (basal) background insulin once or twice a day

Endometrial/uterine cancer in USA? Association with conditions?

Most common GYN malignancy in USA Association w conditions causing prolonged exposure to estrogen without the protective effects of progesterone; i.e. failure to ovulate

Fibroadenoma description? Incidence?

Most common benign breast lesion, solid mass unattached. During teen-30s

Pruritus is the most? Define?

Most common complaint in dermatology. =itching. May be sign of internal disease, caused by irritants, side effect to radiation/meds/dry skin/allergies/stress. Can lead to excoriation, infections. Treatment: prevent dry skin, bathe ever other day, antihistamines, topical drugs, emollients, fluid intake to 3000ml/day, cut/file nails, scratch mittens at night, cool sleeping environment, cool shower, oatmeal/tar

Surgical management of CD: compared to UC? Indications for surgery? Procedures?

Not as successful. Fistula resection of diseased area, perforation, massive hemorrhage, intestinal obstruction, strictures, abscesses, cancer. Resection of small bowel aka ileum or ileocecal via MIS laparoscopy, open surgery, stricturoplasty which increases bowel diameter

Purpuric leasions are? Examples?

Not normal bleeding into tissue. Petechiae, eccymosis

Dumping syndrome managed how

Nutrition via smaller meals, eliminating liquids ingested with meals, high protein, high fat, low to moderate carb diet, acarbose decreases carb absorption, somatostatin octreotide Sandostatin subQ before meals, low sugar and spices and dairy

Interventions for fluid excess with cirrhosis

Nutritional therapy, drugs, paracentisis,respiratory support

Antifungal topical/oral

Nystatin/Mycostatin, Terbinafine/Lamisil, Tolnaftate/Tinactin

Hydrocephalus caused by? S/S? Treatment?

Obstruction of normal CSF pathway from edema, lesion, hematoma, blood in subarachnoid space. S/S: same is increased ICP. Intravascular catheter/ventriculostomy or shunt to drain CSF

How to test for NG tube placement

Obtain sample of gastric contents by aspirating with 50ml catheter tipped syringe, test pH of gastric counts should be 1-3.5, obtain X-ray

Antacids for? Do what? Examples? Symptoms of use?

Occasional episodes of heartburn. Elevated pH deactivating pepsin and elevate LES pressure. Examples: maalox, malanga, gaviscon, calcium carbonate/Tums. Constipation, diarrhea

Unclassified/idiopathic seizures

Occur for no known reason and don't fit into generalized or partial classifications

Assessment for cervical cancer

Often asymptomatic; classic symptom is painless vaginal bleeding/spotting As cancer grows bleeding ^ in frequency, duration, & amount Chest, leg, flank, pelvic pain Dysuria, hematuria

Never use what to treat sunburns?

Oil based products

Risk factors for stroke that cannot be changed

Old age, men, post menopausal women, family history, race/black, MI, migraine headaches, prior stroke, sickle cell disease, berry aneurysm

Define menopause

One full year with no period

Treatment for iron deficiency

Oral ferrous sulfate for mild anemia and take between meals to increase absorption. IV or IM iron aka dexferrum or Feraheme for severe anemia

Increase of base components cause

Oral ingestion of antacids, milk-alkali syndrome. Parenteral admin of blood, sodium bicarbonate, TPN

Pelvic inflammatory disease PID define? Caused by?

Organisms from lower genital tract migrate to uterus and Fallopian tubes which can cause endometritis, salpingitis, oophoritis, parametritis, peritonitis, tubal abscess, infertility, sepsis, ectopic pregnancy. Chalmydia trachomatis, neisseria gonorrhoeae etc.

Mannitol function? Aka?

Osmotic diuretic for cerebral edema aka osmotrol

Common cause for actual hyperkalemia

Over ingestion of salt substitutes/K/IV/bolus, transfusion of blood, addisons/adrenalectomy or adrenal insufficiency, kidney failure, K sparing diuretics, angiotensin-converting enzyme inhibitors ACEIs

Blood osmolarity is a measure of? Normal when decreased?

Overall concentration of particles in blood so good indicator of hydration status. Norm is 285-295. When decreased ADH inhibited so no water absorbed to increase it

When CO2 level increases? When CO2 decreases?

PH drops indicating more H and when CO2 decreases pH rises with fewer free H

Combined alkalosis labs ph? HCO3? PaO2? PaCO2? K? Ca? Cl?

PH high, HCO3 high, PaO2 normal, PaCO2 low, K low, Ca low, Cl low

Nonmechanical obstruction clinical manifestations

Pain constant, abdominal distention, decreased bowel sounds early and absent bowel sounds later, vomiting gastric contents and bile frequent but not foul odor, possible obstipation

Dysuria

Pain during urination

Define homan's sign +

Pain in calf on dorsiflexion of foot and occurs in small % with DVT but fake + is common

Primary purposes of drug therapy in treatment of PUD

Pain relief, eliminate h.pylori infection, heal ulcerations, prevent recurrence

Priority patient problems for patients with PUD

Pain, GI bleeding

Manifestations of pneumothorax

Pain, ^ HR, ^ shallow respirations, feeling of air hunger, prominence on affected side that doesn't move with respiratory effort, trachea slanted, nagging cough, cyanosis, reduced breath sounds, inequal chest, subq emphysema

Integumentary changes in ESRD

Pallor Grey-bronze pigmentation Dry, scaly skin Hair and nails dry, brittle, and thin

Key features of anemia

Pallor, coolness, cold intolerance, brittle club nails that are not convex but concave, tachycardia that increases after meals, murmurs, gallops, orthostatic hypotension, dyspnea, decrease o2 sat., increased somnolence and fatigue, headache, infection risk

Before puncturing implanted port

Palpate to locate septum to find it for puncture. Flush after each use and at least once a month with 5mL or 100u/L heparin to prevent clots in port and is aka locking or de-accessing. Also always check for blood return. If no blood return hold drug until patency and needle placement established.

Elevated amylase and lipase due to

Pancreatitis

Lab and diagnostics for cervical cancer

Pap smear; CA 125 (IF abnormal then below occurs) HPV typing DNA test to assess high risk types Colposcopy w cervical tissue biopsy (assess for dysplasia or CA) Endocervical curettage

Rolling hernias aka? Define? Features

Paraesophageal hernias. Gastroesophageal junction rains in normal location but fundus rolls through esophageal hiatus and into the chest beside the esophagus. Usually no reflux but volvulus aka twisting, obstruction, and strangulation aka stricture, iron deficiency anemia

Right brain damage s/s

Paralyzed/Hemiplegia/hemiparesis left side, impaired humor, spatial-perceptual deficits, quick/impulsive behaviors, performance memory deficits, indifference to the disability, issues with proprioception, unaware of deficits, disoriented to time/place/person/faces, poor judgement, unilateral body neglect syndrome on left side where patient is unaware if left side, neglect of left visual field aka homonymous hemianopsia, no depth perception, confabulation/euphoria/smiling/over estmation of ability, loss of ability to hear tones

No surgical interventions for obstructed intestines usually for?

Partial obstruction, no strangulation, paralytic ileus, terminal disease.

PTT aka? For?

Partial thromboplastin time for anticoagulant status for heparin

Pathophysiology of peritonitis

Peritoneal cavity contaminated by bacteria or chemicals via perforation from appendicitis, diverticulitis, PUD or wound, gallbladder, bowelobstruction, or UTI, leakage of bile, pancreatic enzymes, gastric enzymes so inflammation and if not completely walled off inflammation spreads

Vascular skin lesion

Petechiae, spider angioma, Ecchymosis, telangiectasia, cherry angioma

Metabolic acidosis labs ph? HCO3? PaO2? PaCO2? K? Ca? Cl?

Ph high, HCO3 high, PaO2 normal, PaCo2 normal or high, K low, Ca low, Cl low

Respiratory alkalosis labs ph? HCO3? PaO2? PaCO2? K? Ca? Cl?

Ph high, HCO3 normal, PaO2 normal, PaCO2 low, K low, Ca low, Cl high

Actoplusmet is combo of?

Pioglitazone HCL & metFORMIN

Duetact is combo of

Pioglitazone HCL and glimepiride

Skin changes for fluid overload

Pitting edema and skin pale/cool, risk for skin breakdown

TB interventions for newly diagnosed of suspected TB

Placed in respiratory isolation Negative pressure rooms, N95 mask

Techniques to increase intra thoracic pressure and prevent air emboli during IV set change include

Placing patient in flat position so catheter exit site is at or below heart, valsalva maneuver by holding breath and bearing down, timing change to cycle when patient is expiring air during breathing, timing change to inspiratory cycle when patient receiving positive pressure mechanical ventilation

Pleural friction rub association

Pleurisy, tuberculosis, pulmonary infarction, pneumonia, lung cancer

Pleurisy aka? Define?

Pleuritis. Inflammation of pleural cavity

Preventing pneumonia

Pneumococcal polysaccaride vaccine PPV23, season flu vaccine, hand washing, avoiding large crowds during cold/flu season, know if at risk (>65, chronic issue, no movement), positioning/cough/turn/deep breath if mobility issue, clean equipment, avoid pollutants, rest/sleep, healthy diet, 3 L of nonalcoholic fluids

Unilateral vs. bilateral crackles

Pneumonia vs. HF

Pulmonary changes in ESRD

Pneumonitis, kussmaul respirations

Which issue associated with central IV's that don't occur with PICCs

Pneumothorax

Ace inhibitors and angiotensin receptor blockers/ARB's

Suppress renin-angiotensin system, block aldosterone which prevents Na+H2O retention

Rh antigen- Rh negative? Antibody development can be prevented by? People who have Rh positive can receive?

Rh negative doens't have antigen and doesn't form antibodies unless sensitized through infusion with Rh positive or from pregnancy/birth which following will then make antibodies. Antibody development can be prevented by giving anti-Rh-immunoglobulin. People who have Rh positive can receive RBC transfusion from Rh- but Rh- shouldn't receive Rh + blood

Duodenal ulcer pain location? Occurs when?

Right of epigastrium. Occurs 90min to 3 hours after eating and at night

Elevated homocysteine means

Risk factor for CVD

high fat diet=?

Risk for breast, ovary, prostate cancer

Stroke prevention

Smoking, substance abuse, obsity, sedentary life, oral contraceptives, use of PPAs found in antihistamine

Platelets transfusion tools? Prevention of reaction? S/S? Does it require compatibility?

Special platelet set with special filter for platelets. diphenhydramine/Benadryl and acetaminophen/Tylenol before transfusion. S/S: febrile and rigors/chills but not true reaction, it's normal . No compatibility required

Aldactone aka? Class? Use? Causes?

Spirnolactone. K-sparing diuretic. Management of hyperaldosteronism , edema, HR, cirrhosis, hypertension, hypokalemia. Loss of NaHCO3+Ca while saving K+H

Wheeze character? Associated with?

Squeaky musical continuous sounds associated with air rushing through narrowed airways and don't clear with coughing. Inflammation, bronchospasm, edema, secretions, pulmonary vessel engorgment

Alpha Glucosidase inhibitors aka? Function? Take when? Effectiveness measured by? Examples?

Starch blockers. Slows down absorption of carbs in s. Intestines lowering postprandial BG. Take with 1st bite of each meal. Effectiveness measured by checking 2 hour postprandial glucose levels. Acarbose/Precose, miglitol/Glyset. SE:diarrhea, ab pain, gas. Breast feeding, pregnant, children, intestinal disorders, liver/kidney disease

Status epilepticus is? It is? Treatment?

Status Epilepticus is a complication of Tonic Clonic/Grand Mal seizures It is life threatening because it uses up all oxygen and heart may stop. Treatment: IV Ativan or Valium to stop motor movement followed by Dilantin or Cerebyx to prevent recurrence.

Patient education for postop laparoscopic nissen fundoplication after discharge

Stay on soft diet for a week, avoid carbonated drinks, remain on antireflux meds for a month. Don't drive for a week, walk every day, no heavy lifting, remove small dressings 2 days after, shower, don't remove steri strips until 10 days, wash incisions with soap and water, report any redness or drainage, report fever over 101/nausea/vomiting/bloating/pain, follow up 3-4 weeks after

Sulfonamides examples? Purpose? Side effects?

Trimethoprim sulfamethoxazole aka Bactrim/Septra//Sulfatrim/Sultrex. Antimicrobial. SE: exposure to sun, form crystals in kidney so drink 3L fluids

Ketone testing indications?

Type 1 diabetes Consistently elevated BG > or = 300 mg/dl Hyperketonuria + hyperglycemia = medical emergency Symptoms of ketoacidosis Illness Weight loss program Pregnancy or gestational diabetes

Physical assessment for kidneys

UO, skin color. Color of urine, amount of void, pain or burning, difficulty, LOC, bulging in upper quads, bladder distention, Bruins, BP, edema, pan at costovertebral angle, radiating, renal colic

Diagnostics of endometriosis

US, laparoscopy for visualization of implants

Patient with fever, or older adult who becomes increasingly confused should always be evaluated for?

UTI

Osteomyelitis can be caused by what clinical manifestations?

UTI's, IV catheters Hickman, hemodialysis, IV drug use, Periodontal disease, Penetrating trauma

Holding urine in can lead to

UTI, bladder stones R/t urinary stasis and retention

Two most common chronic inflammatory bowel diseases

Ulcerative colitis and Crohn's disease

Benign prostatic hypertrophy presents as? Cancer presents as?

Uniform, elastic, no tender enlargement. Cancer: stony, hard nodule

Hemorrhoids define? Types?

Unnaturally swollen or distended veins in anorectal region. Types: internal or external

+ antinuclear antibody ANA test means? Aka? Usually?

Unusual antibodies present that cause tissue death aka autoimmune CTDs like RA. AKA Fluorescent method aka FANA. Usually - and only small few +

Hemorrhoidectomy postop?

Urinary retention , pain. Eat high fiber and fluid, avoid laxatives, monitor for bleeding, moist heat like sitz bath, first bowel movement can be painful

Aminosalicylates are? Aka? How they function? Examples?

Used to treat/prevent UC. Aka 5-ASAs. Inhibits prostaglandins. Examples: sulfasalazine aka Azulfidine, Azulfidine and EN tabs, mesalamine aka Asacol, Pentasa, Rowasa, Apriso, Canasa, glucocorticoids aka prednisone and prednisolone, immunomodulators like infliximab aka Remicade and adalimumab aka Humira

High flow delivery systems

Venturi mask, aerosol mask, face tent, tracheostomy, t-piece. 24-100% concentration of O2 and 8-15L/min

fluid compartments

extracellular fluid that includes interstitial fluid, blood, lymph, bone, connective tissue water, and transcellular fluid like CSF, synovial fluid, peritoneal fluid, and pleural fluid. intracellular fluid

Although micro angiopathy can be found throughout body the area most affected are

eyes (retinopathy), the kidneys (nephropathy), and the skin (dermopathy).

Nonsurgical management of acute pancreatitis

fasting, rest, drugs like opioids/histamine receptor antagonists/proton pump inhibitors, comfort measures, endoscopic retrograde cholangiopancreatography with sphincterotomy, NGT with suction for vomiting or biliary obstruction or paralytic ileus, fetal position

Continuous glucose monitors still require

finger-stick measurements and the use of a blood glucose monitor to calibrate the sensor and to make treatment decisions.

Oxygen induced hypoventilation

When main issue is hypoxic or ventilated mechanically who has hypercarbia aka CO2 retention leading to loss of sensitivity to high PaCo2 aka CO2 narcosis which means when patient with low PaO2 and high PaCO2 gets 50% o2 therapy PaO2 increases removing trigger for breathing causing respiratory depression

To prevent falls/injuries at home for AD?

all obvious hazards are removed, hand rails are installed, adequate lighting, night lights, driving prohibited, smoking under supervision, doors leading from house secured, outside activities supervised, ID bracelet since hazard free environment allows independence and autonomy

Oral candidiasis define? Normal? There is an association with?

an acute or chronic yeast like fungal infection of the mouth or GI tract •Normal inhabitant of the GI tract; thrives in moist warm, places •There is an association with repeated fungal infections & Diabetes Mellitus; obesity; suppressed immune system; or antibiotic therapy

complications with THA

hip dislocation, venous thromboembolism aka VTE, infection, anemia, neuroovascular compromise

A 37 year old female reports to the nurse, " I have been having my period for 3.5 weeks now". What laboratory tests would be priority for the nurse to assess?

human chorionic gonadotropin HCG to rule out pregnancy before diagnostic tests, complete blood count since bleeding can be anemic, PTT for clotting factors to check if Von willebrand's disease

late RA manifestations

joint deformities, moderate/severe pain, morning stiffness aka gel phenomenon, osteoporosis, fatigue, anemia, weight loss, subcutaneous nodules, peripheral neuropathy, vasculitis, pericarditis, fibrotic lung disease, sjogren's syndrome, renal disease, felty's syndrome, effusions aka swelling joints, fever, periungual lesions, foot drop, respiratory complications, cardiac complications

early RA manifestations

joint stiffness, swelling, pain, fatigue, generalized weakness and morning stiffness, anorexia, low grade fever, joint inflammation, paresthesias, migratory arthritis

to prevent pressure ulcers for THA

keep heels off bed

teaching for MG

no infection, stress, surgery, hard exercise, sedatives, enemas, OTC drugs without doc, no heat, crowds,

alpha globulin normal number? increased possibly with?

normal 0.1-0.3 g/dL. increased possibly with RA

albumin normal number? decreasing occurs with?

normal 3.4-5g/dL. decreased occurs with chronic inflammation or infection

If patient with RA reports cervical pain which may radiate down one arm or loss of ROM in cervical spine

notify doctor asap because patient can become quadriparetic or quadriplegic or branches of phrenic nerve that can compromise respiratory function

if hip dislocated after THA

surgeon relocates hip then hip immobilized by abduction splint

Exploratory laparotomy define? If adhesions found? If tumor or diverticulitis found? If infarction? In severe cases?

Surgical opening of abdominal cavity to investigate cause of obstruction.mif adhesions found they're cut off, if tumor/diverticulitis colon resection with primary anastomosis or temp./permanent colostomy, if caused by infarction embolectomy/thromboectomy/resection of gangrenous, possible colectomy in severe cases

Troponin normals?

T <0.2ng/mL, I <0.3ng/mL

Education for endometriosis?

Teach patients that temporary post-op pain from carbon dioxide can occur in shoulders & chest

Decreased bone density rn interventions

Teach safety to prevent falls, reinforce need to exercise

Reason to hospitalize for diverticulitis

Temp. Higher than 101, severe and persistent ab pain over 3 days, and/or lower GI bleeding

Complications related to fundoplication procedures and assessment findings for each

Temporary dysphagia via difficulty swallowing, gas bloat syndrome via difficulty belching, atelectasis/pneumonia via dyspnea/chest pain/fever, obstructed nasogastric tube via nausea/vomiting/abdominal distention/no draining of NG tube

Reocurrence for gastric vs. duodenal ulcers

Tends to heal and recurs often at same location vs. 60-% cur within 1 year and 90% cur in 2 years

Myasthenia gravis diagnostics

Tensilon test IV

Orchitis define? Treatment?

Testicular inflammation. CBR; scrotal support & elevation; ice; antibiotics after urine & prostate cultures obtained; NSAIDs; scrotal support; 0 lifting or sex X 4 weeks. If abscess, orchiectomy (removal of 1 or both testes

Surgical management of colorectal cancer is? Examples?

The best method. Colon resection with reanastomosis aka removal of tumor and regional lymph nodes, colectomy with colostomy or ileostomy/ileoanal pull through aka colon removal, abdominoperineal resection, colostomy to create surgical opening of colon onto surface of abdomen

Hydrothorax cause? S/s? Treatment? Prevention?

Transaction of subclavian vein and placement of catheter in thoracic cavity causing IV infusion into cavity. S/S: chest pain, dyspnea, cyanosis, absence of vesicular breath sounds, murmur and flat sound. Treatment: remove, aspirate fluid, monitor, notify. Prevention: use jugular or upper extremity instead of subclavian, use ultrasound for location

Chylothorax cause? S/S? Treament? Prevention?

Transaction of thoracic duct on left side allowing lymph in pleural cavity. S/S: dyspnea, tachycardia, chest pain, cyanosis, withdraw of milk like substance. Treatment: remove, monitor, notify, O2 Prevention: use right side for subclavian vein insertion, use jugular or upper extremity sites, use ultrasound for location

Acute hemolytic transfusion reactions define? When it develops.? Signs?

Transfusion of incompatible blood, usually develops in 15 minutes. Signs: chills, fever, back pain, headache, dyspnea, chest pain, tachycardia, tachypnea

Crohn's disease presents as

Transmittal inflammation that causes thickened bowel wall with strictures and deep ulcerations aka cobblestone appearance which put patient at risk for fistula resulting in severe diarrhea and malabsorption which can cause anemia

Surgical management of COPD

Transplant off single lung or lung reduction surgery

Mini nutritional assessment define? 1st part? 2nd part?

2 part rapid assessment. 1st: about intake, mobility, BMI. If patient scores 11 points or less 2nd part completed 12 additional questions

INR normal? What drug associated?

2-3 Coumadin/Warfarin

crutches fit

2-3 fingers between axilla and top of crutch when crutch tip at least 6 inches diagonally in front of foot and adjusted so elbow flexed no more than 30 degrees when palm on handle

Alpha globulin normal? Increased means?

.1-.3g/dL and increased with RA

Usual starting dose of insulin

.5-1 unit/kg of body weight/day

BSE for premenopausal women> for postmenapausal?

1 week after period because hormonal influence on breasts is decreased. Any day of month

Paget's disease aka? define?

Aka osteitis deformans. Metabolic disorder where bone excessively broken down and reformed causing structurally disorganized causing weak bones, bowing, fractures.

Short acting beta agonists for short term immediate relief of asthma

Albuterol/Proventil/Ventolin, bitolterol/Tornalate, levalbuterol/Xopenex, pirbuterol/Maxair, terbutaline/Brethaire

Hypoglycemia defined as

BG <40mg/dL

Cystitis

Bladder infection usually in women

Genu varum

Bow legged deformity

Ammonia used for? Or is converted to? Elevations due to? Normal?

Bulding amino acids or converted to urea. Cirrhosis or hepatitis. 15-110mg/dL

Large intestines anatomy

Cecum, appendix, colon consisting of ascending/transverse/descending/sigmoid colon, rectum, anal canal

Cephalosporin example? SE?

Cefadroxil aka duricef, ceflixime aka Suprax. SE: watery diarrhea

Cephalosporins

Ceftriaxone/Cefixime, Rocephin/Suprax

Lacto vegetarian diet you can eat

Dairy but no eggs+fish

GU findings for cirrhosis

Dark urine

Gonorrhea transmission? S/s?

Direct contact. PID, endometritis, salpingitis aka Fallopian tube infection, peritonitis, arthritis, meningitis, hepatitis, dysuria, penile discharge, change in vag discharge, anal itching/irritation, reddened throat, ulcerated lips, tender gums, fever, skin lesions

Clinical presentation of Crohn's? If disease occurs in ileum only?

Dirrahea, abdominal pain usually in right lower quadrant that's constant, pain around umbilicus before and after BMs, weight loss, but, Lowe grade fever which is common with fistulas, abscesses, inflammation. If only in ileum diarrhea 5-6 times a day often with soft loose stool

Define diabetes insipidus?

Disease causing frequent urination and excessive thirst that can be caused from surgery

Ovarian cancer define

Disordered rapid growth in response to excessive exposure to estrogen and is the leading cause of death from female reproductive cancers. Low survival rate if late stage detection.

Hypomagnesium can cause?

Dissrhythmia, tachycardia

Most common form of sensory neuropathy? Affects? Aka? Characteristics?

Distal symmetric polyneuropathy which affects hands and/or feet bilaterally aka stocking glove neuropathy. Loss of sensation, abnormal sensation, burning/cramping/crushing/tearing pain that is worse at night, paresthesias aka tingling/burning/itching, atrophy, deformity, fine movement limits

Drugs for hypertension

Diuretic, beta blocker, or both

Liraglutide/Victoza glucagon like peptide receptor agonists SE

Do not use in patients with a personal or family history of medullary thyroid cancer. Acute pancreatitis has been associated with its use.

Tetracyclines

Doxycycline, oxytetracycline

Pulmonary findings for cirrhosis

Dyspnea, hyperventilation, hypoxemia

CV findings for cirrhosis

Dysrhythmias, collateral circulation, fatigue. Peripheral edema, portal hypertension, spider angiomas

clinical significance of diffusion

ECF has 10 times more sodium than ICF due to cell membrane impermeability and sodium pumps that pump sodium outside cell. Also glucose higher in ECF needs insulin to move inside cell

Diagnostics for seizures

EEG, CT/computed tomography, MRI, PET/positron emission tomography

Lab tests for peptic ulcer disease

ELISA, serologic testing for anti h. Pylori antibodies, breath test for urease, decreased hemoglobin and hematocrit from venous bleeding , occult blood in stool

Multiple sclerosis diagnostics

EMG

Intermittent enteral nutrition administration

Every 3-6 hours over 30-60 minutes

Raloxifene aka? Drug type? Does what?

Evista. Estrogen agonist/antagonist. Prevents/treats osteoporosis

Conditions for overproduction of H in metabolic acidosis

Excess breakdown of fatty acids from diabetic ketoacidosis or starvation, anaerobic glucose breakdown forming lactic acid like in heavy exercise/seizures/fever/reduced O2 intake, excess intake of acids like alcohol/aspirin/ethanol/methanol/salicylate

Hypervolemia define? Aka?

Excess fluid in ECF aka fluid overload

Screening recommendations for men and women for colorectal cancer? What age?

FOBT, sigmoidoscopy, double contrast barium enema, colonoscopy. After50 years

H2 receptor antagonists examples? Function?

Famotidine aka Pepcid, nizatidine aka Axid. Blocks gastric secretions

Key features of paraesophageal hernias

Feeling of fullness after eating, breathlessness after eating, feeling of suffocation, chest pain that mimics angina, worsening of manifestations in a recumbent position

Decreased WBC from

Felty's syndrome from RA

Four f's of women cholecystitis

Female, forty, fat, fertile

Antifungals

Flu console, amphotericin B, diflucan abelcet, amphotec

Hep a symptoms

Flu like very mild some GI illness

Intra-arterial therapy used for? Location? Inserted through?

For blood samples, monitoring pressures, infusing chemo. Location: radial, brachial, femoral for samples and arterial pressure, pulmonary for measuring left heart function, hepatic/celiac/carotid for chemo. Inserted through veins in upper extremities, jugular, subclavian.

UTI key features

Frequency, urgency, dys urina, difficulty initiating, low back pain, nocturia, incontinence, hematuria, pyuria, bacteriuria, retention. Possible fever, chills, nausea, vomiting, malaise, flank pain. For elders: mental confusion, unexplained falls, tachycardia, tachyons a, hypotension, loss of appetite

Early symptoms of DKA

Frequent urination High blood glucose (blood sugar) levels (>250 mg/dL) High levels of ketones in the urine Blood pH lower than 7.30 Serum bicarbonate level < 16 mEq/L Lethargy and weakness Dehydration causing decreased HCO3+Na+Ca+mg+PO4+pH, if mild ^ K if severe low K Poor skin turgor Dry mucous membranes Tachycardia Orthostatic hypotension

Define hemorrhagic stroke

From aneurysm that cause headaches or hypertension leading to arteriovenous malformation usually occurs during activit worsen after initial onset

Methemoglobinemia define

From benzocaine spray where conversion of normal hemoglobin to methemoglobin which is altered iron state that doesn't carry o2 resulting in hypoxia. Normal <1% as it increases causing cyanosis, anxiety, tachycardia, lethargy, death. Should be suspected if no response to supplemental O2, cyanotic, and blood chocolate brown color. Reversed with O2 and IV of methylene blue

Ecchymosis and hematoma define? Cause? S/S? Treatment? Prevention

From infiltration of blood into tissue and hematoma from uncontrolled bleeding. Cause: unskilled or multiple attempts, caogulopathy or fragile veins, laceration of vein/artery. S/S: swelling, bruising, pain/tenderness. Treatment: when removing apply light pressure, for hematoma direct pressure until bleeding stops, elevate, ice for 24 hours, then warm compress. Prevention: avoid veins that cannot be easily seen/palpate do, good technique

Viral aseptic meningitis from? CSF characteristics? S/s?

From measles, mumps, herpes simplex, herpes zoster. No organisms in CSF, no exudate in CSF. Fever, photophobia, upper respiratory infections s/s, headache, myalgia, nausea/vomitintg

Autologous vs. syngeneic vs. allogeneic transplants

From own stem cells vs. taken from identical sibling vs. HLA matched sibling or unrelated matched donor

Laparoscopy pre? During? Post?

Consent, anesthetic. Lithotomy position, catheter, needle to infuse CO2. Oral analgesics, shoulder pain, avoid strenuous activity for 1 week.

Late symptoms of DKA

Constantly feeling tired Dry or flushed skin Nausea, vomiting, or abdominal pain, anorexia Rapid deep Difficulty breathing Kussmaul respirations Sweet, fruity acetone breath odor Skin dry and loose, eyes soft and sunken A hard time paying attention, or confusion

Hep. A mode of transmission and prevention

Contaminated food and water, there is a vaccine

Hep e mode of transmission and prevention

Contaminated water and no vaccine

Warfarin aka? Does what? Labs? Antidote? Avoid?

Coumadin. Inhibits clotting. PT/INR, INR between 1.5-2 to prevent DVT/stroke/hemorrhage. Antidote Vitamin K. Avoid broccoli N, cauliflower, spinach, kale, trees, liver, NSAIDS, vitamin E, birth control, garlic

Lung manifestations of GERD

Crackles, coughing, hoarseness, wheezing, bronchitis due to aspiration and regurgitation

Conventional surgical procedures for seizure/epilepsy

Cutting off portion of brain causing it, partial corpus callostomy where brain sectioned to prevent impulses from one side to other

Blood sugar symptoms? 600-1000? Normal?

Hot and dry sugar high aka hyperglycemia. Cold and clammy need some candy aka hypoglycemia. 600-1000 in DKA not unusual hypertonic hypovolemia . Normal is 70-110mg/dL.

Ghrelin

Hunger hormone

Etiology of CKD

Hypertension Diabetes Mellitus Infection Inflammatory diseases Connective tissue diseases Congenital and heredity disorders Toxic nephropathy Obstructive nephropathy

Key features of chronic pyelonephritis

Hypertension Inability to conserve sodium Decreased concentrating ability Development of hyperkalemia and acidosis

Circulatory overload s/s:

Hypertension, bounding pulse, distended jugulars, dyspnea, restlessness, confusion. Prevention: monitoring I/O, infusing slowly, diuretics

Risk factors for stroke that can be changed

Hypertension, high cholesterol, transient ischemic attacks, CVD/atherosclerosis/a. Fib, diabetes, blood clot disorders, sleep ape=bea

Dextrose 10% in water tonicity? Provides? Electrolytes? How many kcal/L provided?

Hypertonic. Provides free water only, no electrolytes, spares proteins to treat hyperkalemia, can worsen hypotension, increase edema, cause hyponatremia, irritates veins 340 kcal/L

Flu s/s

Headache, fever/chills, muscle aches, weakness, coughing/sneezing

Pursed lip breathing: helps? Steps?

Helps manage dyspnea. Close mouth and breath in through nose for 2 seconds, purse lips and breath out slowly through mouth without puffing out cheeks and use abdominal muscles to squeeze air out for 4 seconds

Morphine sulfate function? SE? Admin?

Helps pain with MI/pulmonary edema via vasodilation, depressed CNS. SE: confusion, respiratory failure, hypotension, constipation. PO, IM, IV

Hemorrhage for gastric vs. duodenal ulcers

Hematemesis more common than melena vs. melena more common than hematemesis

Lab assessment of UC

Hematocrit and hemoglobin low, increased WBC, C-reactive protein, and ESR due to inflammation. low sodium, potassium, chloride, albumin due to diarrhea and malabsorption,

Self monitored BG is affected by

Hematocrit values, anemia gives false high and polycythemia false low, icodextrin extraneal dialysis causes false elevation due to maltose, galactose/xylophone in foods/herbs also give false elevation

Dehydration from DM leads to

Hemoconcentration Aka increased concentration, hypovolemia, aka decreased blood volume, hyperviscosity aka thick blood, poor perfusion, hypoxia, acidoss

Chronic renal replacement therapies

Hemodialysis, peritoneal dialysis, renal transplant

Labs for colorectal cancer

Hemoglobin and hematocrit are lower. Liver function tests elevated, positive result for occult blood in stool, carcinoembryonic antigen CEA elevated which is normally 5mcg/L

If patient experiences respiratory distress during mechanical ventilation

Immediately remove ventilator and provide ventilation via bag valve KSAs to see whether problem is ventilator or patient

Azathioprine/Imuran and cyclophosphamid/Cytoxan drug use? Can cause?

Immunosuppression for RA. Can cause cancer, sterility, hair loss, WBC decrease

Define prediabetes IGT diagnosed via? IFG diagnosed when?

Impaired glucose intolerance IGT, impaired fasting glucose IFG, or both leading to body damage like in heart and b.vessels. Diagnosed via 2 hour oral glucose tolerance test OGTT values =140mg/dL-199mg/dL. Fasting BG are 100mg/dL-125mg/dL

Midline catheters used for

Impaired skin integrity, limited peripheral veins, anticoagulants and/or steroid currently in use, fluids for hydration, antibiotics, heparin infusion for DVT, bronchodilators like aminophylline, steroids

Prolonged PT secondary to

Impaired synthesis of clotting proteins from liver damage

If temporary or permanent surgical diversion for UC teach what

Importance of adequate salt and water since ileostomy decreases these. Urge to be cautious in situations that lead to heavy sweeting or fluid loss . They can use regular wear or extended wear solid barriers to bag that last 3-7 days,

Diagnosis of cholecystitisa?What's best?

Increased WBC, AST, LDH, and alkaline phosphatase, bilirubin, if pancreas involved amylase and lipase elevated. X-ray if calcified gallstones, endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography with gadolinium that has no iodine, ultrasonography is best.

Cause of hemorrhoids

Increased abdominal pressure, pregnancy, constipation with straining, obesity, heart failure, prolonged sitting or standing, strenuous exercise and weight lifting, decreased fluid intake

Azotemia

Increased blood urea nitrogen and creatinine suggestive of kidney impairment

Increased and decreased specific gravity can indicate

Increased can indicate decreased kidney perfusion, ADH issues, congestive heart failure. Decreased can mean chronic kidney disease, diabetes insipidus, hypertension, diuretics, lithium

Define sun downing

Increased confusion at night most likely from AD that is helped via nightlight

Nephrotic syndrome

Increased glomerular permeability to allow larger molecule to pass

Reddish blue cause? Significance?

Increased hemoglobin, decreased peripheral circulation. Polycythemia Vera, inadequate tissue perfusion

Aspiration pneumonia s/s?

Increased temp, pulse, dry mucous membranes, decreased urinary output, diminished breath sounds especially in lower, SOB, chest discomfort

Adaptive action to prevent complications during fluid overload in ECF

Increased venous return and contractility, fluid shifts to interstitial space causing edema, decreased ADH and aldosterone, increased natriuretic peptide, increased renal excretion

In patient taking digoxin/lanoxin hypokalemia

Increases sensitivity of heart to drug resulting in toxicity

Propranolol +Lopressor+Tenormin aka? Alert? Class? Used for? SE? Check?

Inderal, metoprolol, atenolol. High. Beta blocker. Antianginal, antiarrhythmic, antihypertensive, preventing MI. SE: slows HR, hypotension, bradycardia, fatigue, sex dysfunction, bronchospasm/wheezing. Check BP, pulse

Define dyspepsia

Indigestion, heartburn

Hypoxia from trach caused by

Ineffective oxygenation before/during/after suctioning, using catheter that's too large for artificial airway, prolonged suctioning, excess suction pressure, too frequent suctioning

Don't give D5w to

Infants or head injury patients since can cause cerebral edema

Dermatitis define? Aka? Occurs in? Symptoms? Exacerbated by? Diagnosis? Treatment?

Inflammation of skin. Atopic or contact aka eczema. Occurs in family history of hay fever, asthma or unknown cause. S/S: dry skin, itch, rash, redness, lesions. Exacerbated by foods, stress, clothing, contact. Diagnosis: family history, serum IgE, scratch test. Treatment: cool compress, antihistamines, gloves, creams, oatmeal baths, no rubbing, steroid creams, avoid irritants

Acalculous cholecystitis

Inflammation without gallstones and usually from biliary stasis like decrease in blood flow usually from sepsis, severe trauma or burns, long term total parenteral nutrition, organ failure, major surgery. Hypovolemia

Localized vs. dependent/pitting, vs. no pitting edema and conditions that cause each

Inflammatory response due to trauma vs. fluid/electrolyte imbalance and/ or venous/cardiac insuffiency due to CHF/kidney disease/liver cirrhosis/venous thrombosis vs. endocrine imbalance due to hypothyroidism/myxedema

ED implants

Inflatable implant uses 2 cylinders surgically placed inside penis and when erection desired man uses pump to fill cylinders. Another type in malleable which bolsters erections with surgically implanted rods

Nursing responsibility of transfusion

Informed consent, double check orders,confirm transfusion is appropriate

Primary continuous admin set used to? What can be attached? Depending on drug compatibility? Change every?

Infuse primary IV by either gravity infusion or infusion pump. A secondary admin set aka piggyback attached to primary set at Y injection site for intermittent meds. Depending on drug compatibility can have multiple secondary sets. Change every 72-96 hours

Vascular access device define? Can be?

Infusion catheter, plastic tube placed in vessel to deliver fluids/meds. Can be peripheral veins or large central veins of chest, midline catheters, peripherally inserted central catheters, no tunneled percutaneous central venous catheters, tunneled catheters, implanted ports, hemodialysis catheters

Ringers solution tonicity? Similar to? Doesn't? Used to?

Isotonic. Similar in composition to plasma except that it has excess chloride, no magnesium, and no bicarbonate Does not provide free water or calories Used to expand the IV volume & replace ECF losses

0.9% saline tonicity? Used to? Only solution that? Contains? Does not? May cause?

Isotonic. Used to expand IV volume & replace ECF losses and KVO Only solution that may be administered with blood products Contains sodium & chloride in excess of plasma levels Does not provide free water, calories, or other electrolytes May cause IV overload or hyperchloremic acidosis

Postcholecystectomy syndrome causes?

Pseudo dust, common bile duct leak. Stricture or obstruction, sphincter of Oddi dysfunction, gallstones, sclerosing cholangitis. Diverticular compression

Nurse best response for psoriasis

Psoriasis has exacerbations and remissions, cannot be curred, topic corticosteroids and tar and warm climates and UV light preps to suppress cell division

Maslows hierarchy of needs stages?

Psychological breathing+food+water+sex+sleep+etc. Safety security of body+employment+resources+morality+family+health+property. Love/belonging. Esteem aka confidence+achievement+respect. Self actualization aka morality+creativity+problem solving+acceptance of facts

Preop nursing care for breast cancer

Psychological preparation Teaching re: postop Jackson Pratt; Drainage should be < 25 ml/day before drain removed Dressing over incision Address body image issues Provide written information Refer to support groups i.e. Reach to Recovery (American Cancer Society); Susan G. Komen3 Day Run for a Cure

Hemothorax cause? S/s? Treatment? Prevention?

Puncture of subclavian vein/artery causing blood in pleural cavity S/S: dyspnea, tachycardia, decreased hemoglobin. treatment: remove catheter, assess, notify, O2, apply pressure on site after removed. Prevention: use jugular or upper extremity sit, use ultrasound for location

Key features of acute gastritis? Symptoms last how long?

Rapid onset of epigastric pain/discomfort, nausea and vomiting, hematemesis aka vomiting blood, gastric hemorrhage, dyspepsia aka heartburn, anorexia, melena aka traces of blood in stool. Few hours or days

COPD respiratory changes

Rapid, shallow respirations, abnormal breathing pattern where abs sucked in during inspiration, accessory muscles in abs or neck used, high RR, asymmetric chest expansion, limited diaphragm movement aka excursion, fremitus, wheezes, reduced breath sounds

Somogyi effect define? Release of?

Rebound effect in which an overdose of insulin at night causes hypoglycemia Release of counterregulatory hormones causes rebound hyperglycemia in morning causing headaches, night sweats, nightmares, 2-4AM hypoglycemia

Fluid and electrolyte management for DKA

Restore volume and maintain perfusion via 15-20mL/kg/hr during first hour, replace totally body fluid loss via hypotonics 4-14mL/kg/hr, when BG reaches 250 give 5% dextrose in 0.45 NS to prevent hypoglycemia and edema,

Nutrition therapy for fluid overload

Restrictions on fluid and sodium if chronic. For salt can be no salt added or strict 2-4g/day

Respiratory s/s of allergic reaction

Rhinitis, chest tightness, weakness, dyspnea, urticaria, severe wheezing, loss of consciousness

Drug for bacterial meningitis

Rifampin, Rifadin, Rofact, Cipro, Recephin

Bacterial transfusion reaction s/s?

S/S: tachycardia, hypotension, fever, chills, shock

Orchitis s/s

Scrotal pain, edema, heavy feelings in testicle, dysuria, pain on ejaculation, blood in semen, discharge from penis, n/v, pain to inguinal canal

Cerebyx/fosphenytoin and Dilantin/phenytoin care? Therapeutic range? Takes how long? Give with? Need? Used for?

Scrupulous oral hygiene needed for gingival hyperplasia (IV incompatability to most drugs) -Therapeutic range is 10-20mg/L -Takes 7-14 days to establish -Give with meals for common GI effects -Need regular follow up monitoring RBC and Calcium to detect low values -Used for a variety of seizure types

Main interventions for secondary epilepsy and non epileptic seizures and primary epilepsy

Secondary epilepsy and non epileptic seizures: removing/treating underlying condition or cause. Primary epilepsy: drugs

Parietal cells and chief cells define

Secrete HCL, secrete pepsinogen/intrinsic factor to aid absorption of vitamin B12

Aldosterone secreted by? When? Prevents and promotes?

Secreted by adrenal cortex when sodium in ECF is decreased to prevent water and sodium loss and promote potassium excretion/lossfrom kidneys to increase blood osmolarity and blood volume

Natriuretic peptides NPs are secreted by? In response to? Function?

Secreted by cells that line heart atria and ventricles in response to increased blood volume/pressure which stretch heart and creates opposite effect of aldosterone in kidneys to inhibit sodium reabsorption and increase filtration/urine resulting in decreased blood volume and osmolarity

When on mechanical ventilator do you suction

Secretion, increased peak airway pressure PIP, rhonchi/wheezes, decreased breath sounds

Suctioning needed when

Secretions audible, crackles, wheezes, restlessness, increased pulse/RR, mucus in artificial airway present, increase in peak airway pressure

Self determination akas? Define?

Self management or patient autonomy, patients are capable of making decisions about their care

Pre albumin measures? Normal?

Sensitive indicator of nutritition normal range 15-36mh/dL

Allergic transfusion reactions define? Symptoms. Can be?

Sensitive to foreign plasma proteins, symptoms: flushing, itching, hives, fever. Can be anaphylactic reaction

Braden scale questions

Sensory perception/mental status, moisture, activity, mobility, nutrition, friction and shear, incontinence

PID s/s

Sepsis, ectopic pregnancy, infertility, tenderness aka adnexa, menstrual irregularity, no signs possible, irregular vag bleeeding, dysuria, vag discharge change, dyspareunia aka painful sex, malaise, fever, chills, friable cervix

Assessing stoma

Should be reddish pink, moist protrude about 3/4 inch aka 2 cm, right after surgery may be slightly edematous, slight bleeding is common, check for leakage, skin should be intact, without redness or excoriation

Patients requiring clear/full liquid diets with DM

Should have 200g of carbs daily

Tegretol/Carbamazine side effects? Rare but? Used for?

Side effects decrease in severity over time Bruising, sore throat, bleeding can occur Rare but severe bone marrow toxicities make reg. follow up more important. Used for a variety of seizure types.

Uremia

Signs and symptoms of end stage renal disease aka chronic renal disease

Folic acid deficiency similar? Caused by?

Similar s/s as b12 anemia. Anticonvulsants and oral contraceptives can prevent absorption, methotrexate, nutrition, malabsorption from Crohn's, alcohol. supplements may be required

If you cannot remove vascular access device

Simple distractions, deep breathing and if that doesn't work apply heat and keep dry while having patient drink warm liquids, or meds to relax as worst care, and if none of those wok imaging to determine if thrombosis

Promoting adequate nutrition for AD

Simple, calm, familiar foods that looks appetizing/taste good, one dish at a time, food cut to small pieces, liquids may be easier if gelatin added, temperature checked

PICC lumen configurations

Single, dual, or triple lumen configuration with groshong valve and pressure activated safety valve or available as power PICCs for contrast injection and can be connected to transducers to monitor central venous pressure

Janumet is combo of?

Sitagliptin & metformin

Sterile dressings over insertion site for short peripheral catheter? After removing dressing from midline or central venous catheter

Site rotation every 72-96 hours. Note the external catheter length and compare length with original length of insertion because if has changed placement has too.

SBAR define

Situation, backing info, assessment info, recommendation of what's needed/desired outcome

associated syndromes of late RA

Sjogrens syndrome: dry eyes/ keratoconjunctivitis, mouth/xerostomia, and vagina. associated with anti-ss-a antibodies Felty's syndrome: hypatosplenomegaly aka enlarged liver+spleen and leukopenia Caplan's syndrome: rheumatoid nodules in lungs and pneumoconiosis

Which tissues have receptors for insulin and considered insulin dependent

Skeletal muscle and adipose tissue and liver for glycogen

Elevated LDH can indicate?

Skeletal muscle necrosis, cancer, muscular dystrophy

Elevated AST can indicate?

Skeletal muscle trauma, muscular dystrophy, necrosis of liver like hepatitis/cirrhosis

Simple facemask, partial rebreather, nonrebreather mask interventiosn

Skin care, monitor risk for aspiration, no twisting/kinking reservoir bag

Best place to assess skin turgor for elders

Skin over sternum or forehead

Strenuous activity can be perceived by body as? In type 1 who is ketosis? Strenuous activity should be avoided if?

Stress causing release of counterregulatory hormones resulting in temp. Elevation of BG. In type 1 who is ketosis excercise can worsen hyperglycemia and ketosis. Should be avoided if BG >300mg/dL and if ketones present. If no ketosis don't postpone exercise

Chronic complications of DM

Stroke, hypertension, dermopathy, altherosclerosis, nephropathy, neurogenic bladder, retinopathy, cataracts, glaucoma, blindness, coronary artery disease, gastro paresis, islet cell loss, peripheral vascular altherosclerosis, gangrene, erectile dysfunction, infections

Alternative sites for infusion

Sub q, intraosseous, intra-arterial, intra peritoneal, intra spinal

Acids are? The strength measures by?

Substances that release/donates H when dissolved in water. THe strength measures by how easily it releases H

Engraftment define? Assess for?

Successful take of transplanted cells in the patient's bone marrow from peripheral blood. Assess for chimerism aka presence of donor cells, if regressive chimerism aka cells stay mostly patient's it indicates graft failure

Mucosal barrier fortifier example? Dose? Purpos

Sucralfate aka Carafate. 1g four times of 2g twice daily usually before and after meals. Binds with bile acids and pepsin to protect stomach mucosa.

Psuedoephedrine aka? FunctiON?

Sudafed. Decongestant

DKA onset? Precipitating factors? Manifestations? Serum glucose? Osmolarity? Ketones? Ph? HCO3? Na? BUN? Creatinine? Urine ketones?

Sudden. Stress/infection/inadequate insulin. Ketosis, kussmaul, fruit breath, n/v, cramps, dehydration/electrolyte loss: polyuria, polydipsia, weight loss, dry skin, sunken eyes, soft eyeballs, lethargy/coma. >300mg/dL. Variable. Positive at 1:2, <7.35, <15mEq, low/normal/high, >30mg/dL, >1,5 due to dehydration, positive

Antibacterial med categories

Sulfonamides, penicillin, antibiotic/antiprotozoal, tetracycline, macrolide, cephalosporins

Most common treatment of hiatal hernias

Surgery

Chlamydia diagnosis? Treatment?

Swab tissue culture or urine test. Azithromycin/Zithromax or doxycycline/Monodox and if allergic erythromycin, ofloxacin, levofloxacin

Define penile tumescence

Swelling

Cardiac changes with COPD

Swelling of feet/ankles aka dependent edema, right sided heart failure, Pallor/frank cyanosis

Interventions for IBS

Symptom diary , avoid caffeine, alcohol, egg, wheat, sorbitol,M fructose, milk if lactose intolerant, take fiber, drink 8-10 cups water, chew food slowly, possibly bulk forming of antidiarrheal drugs, stress reduction

Surgical procedure for prostate

TURP, supra public abdominal incision bladder entered. Perineal perineal incision, retro public abdominal incision where bladder not enetered

Teaching for pancreatic enzyme replacement

Take with meal or snack and water, if difficulty swallowing cover with applesauce or break over it, admin after antacid/2 blockers, don't chew when taking, don't take with protein, wipe lips with wet towel to remove residual enzymes

Hormone antagosists

Tamoxifen, Lupron, cytadren, arimidex, casodex, femara, eulexin, faslodex, zoladex, amomasin, eligard, nilandron, nolvadex, fareston

Mini mental state example is? Developed when? How many questions? How many total points? Greater the score? Used to?

Tests orientation, registration, attention, calculation, recall, speech Developed in 1965 11 questions 30 points total score Greater the score the less dysfunction Used to estimate relative mental competence and decline of cognitive functioning as seen in Dementia

Patients at risk for hypoglycemic unawareness? Treatment?

Those with repeated episodes of hypoglemics, older patients, patients who use beta adrenergic blockers. Treatment: BG goals that are somewhat higher than patients who can detect and manage onset

Nerve damage s/s? Treatment? Prevention

Tingling, feeling of pins and needles, numbness. Treatment: stop immediately, remove if discomfort doesn't improve when secured. Prevention: avoid using cephalic vein near wrist, avoid using veins on Palm side of wrist, secure catheter, support areas of joint flexion with arm board

Best most reliable method for assessing return of peristalsis is

To ask if patient has passed flatus within past 8 hours or a stool within the past 12-24 hours

Lactate dehydrogenase LDH normal range?

Total 100-190 units/L

Breast conserving surgery vs. modified radical mastectomy

Lumpectomy so tumor and small tissue removed vs. affected breast removed+lymph nodes due to inability to have radiation or present of large tumor

Nutritional management of hyperkalemia avoid

Meats, organs, preserved meats, dairy, dried fruit, fruits like bananas, cantaloupe, kiwi, oranges, vegetables like avocados, broccoli, dried beans/peas, mushrooms, potatoes, seaweed, soybeans, spinach

Rapid acting insulin can be

Mixed with NPH

Middle phase of Alzheimer's aka? Define

Moderate to Severe- Memory loss increases, personality changes, wandering, aphasia, frustrated, angry, sensitive

Recovery stage of ARF treatment

Treatment Monitor BUN & Creatinine routinely Monitor GFR Adjust medication according to renal function Patient and family education essential!

Sulfonamides meds

Trimethroprim/Sulfanethoxazole, Bactrim/Septra

Polyuria

More than 2000ml per 24 hours

Esophageal manometry aka? Procedure?

Motility test. Water filled catheters inserted in nose or mouth and slowly withdrawn while measurements of LES pressure and peristalsis recorded

Define testicular torsion? Treatment?

Twisting of spermatic cord. Surgical emergency to untangle within 6 hours of s/s onset or loss of testicle

Causes for false low pulse ox reading

Movement, hypothermia, decreased peripheral blood flow, ambient light, decreased hemoglobin, edema, nail polish

Type 1 vs. type 2 eye exam

Type 1 eye exam with dilation within 5 years after onset then repeated annually. Type 2 at time of diagnosis and annually after

Postop care for UC surgery? Ileostomy begins to drain when? How much fluids? Hospital stay how long? For RPC-IPAA?

NPO with NG tube for suction. Within 24 hours. After NPO 500 ml more fluids each day. Hospital stay 2-5 days. Internal pouch can become inflamed and treated with metonidazole aka Flagyl and after second stage may have burning during elimination

Nonsurgical interventions for obstructed intestines

NPO, NG tube with suction to decompress,disimpaction and enema, IV fluid replacement, monitor VS and intake and output and weight, total parenteral nutrition possibly, pain medsight be withheld, frequent position changes, semi fowlers, if strangulation IV antibiotics , drugs that enhance motility like octreotide acetate aka Sandostatin

Rheumatoid arthritis drugs

NSAIDs, methotrexate, leflunomide/Arava, corticosteroids, immunosuppressants

Common complications of obesity

Type 2 DM, hypertension, hyperlipidemia, CAD, stroke, peripheral artery disease, metabolic syndrome, sleep apnea, hypoventilation syndrome, depression, urinary incontinence, cholelithiasis aka gallstones, gout, back pain, osteoarthritis, decreased wound healing

Key features of intra renal intrinsic AKI and postrenal azotemia aka acute kidney disease

Oliguria, a urina, increased specific gravity, hypertension,tachycardia, vein distention, increased venous pressure, SOB. Orthopnea, crackles, edema, friction rub, anorexia, nausea, vomiting, flank pain, lethargy, headache, tremors, confusion, weight gain

Mannitol alcohol sugar 5% or 25% action and use? Nursing considerations?

Oliguric diuresis, reduces cerebral edema, eliminates toxins. May cause fluid overload, cause electrolyte imbalances, cellular dehydration, extravasation can cause tissue necrosis.

Drugs to never give for cirrhosis

Opioids, sedatives, barbiturates

Hypocalcemia caused from? Can cause?

Osteoporosis or osteomalacia. Can cause dysrhythmias, cardiac arrest, malabsorption, renal failure, pancreatitis

Difference between osteoporosis and osteomalacia

Osteoporosis: decreased mass from lack of Ca all other minerals and hormones normal Osteomalacia: de mineralized bone from lack of vitamin D, phosphatase high, PTH high or normal, phosphate low or normak

Causes of meningitis

Otitis media, pneumonia, acute/chronic sinusitis, sickle cell anemia, brain/spinal injury, immunosuppression, infection, older people, piercings

Intraductal papilloma define

Outgrowth of tissue in breast ducts causing nipple discharge

AFP aka alpha feta protein is elevated when?

Ovarian cancer present

Abdominal distention and nausea/vomiting caused by?

Over feeding. To prevent chest residuals q 4-6 hours, hold if >200mL on 2 assessments

Post op pain meds for THA

Oxycodone+acetaminophen aka Percocet/tylox and NSAIDs like ketorolac/toradol/acular, ibuprofen/motrin

Respiratory acidosis labs ph? HCO3? PaO2? PaCO2? K? Ca? Cl?

PH low, HCO3 normal, PaO2 low, PaCO2 high, K high, Ca normal, Cl high or low

Metabolic acidosis labs ph? Bicarbonate? PaO2? PaCO2? K? Ca? Cl?

PH low, bicarbonate low <21, PaO2 normal, PaCO2 normal or decreased, serum K high, Ca normal, Cl normal or high

Care of patient with kidney stones

Pain control Increase fluid intake Possibly special diet, particularly low oxalate Lithotripsy: expect urine to be cherry red pain when pass fragments Strain urine

Key features of cholecystitis

Upper ab pain that can radiate to right shoulder, pain triggered by high fat or high volume meal, anorexia, nausea and or vomiting, dyspepsia, eructation aka belching, gas, ab fullness, rebound tenderness aka blumberg, fever, jaundice, clay colored stool, dark urine, steatorrhea, biliary colic due to stones which can cause tissue spasm

Gastric ulcer pain location? Aggravated by?

Upper epigastrium on left of midline and aggravated by food

Clinical manifestations of ESRD

Uremia: syndrome incorporates all signs and symptoms seen in every organ system throughout the body Result of retained substances Water Electrolytes Hormones Urea, creatinine, uric acid

Stage 5 uremic syndrome

Uremic Syndrome Excessive uremic waste products All other organ systems fail Fetor uremicus Uremic frost Death is imminent without treatment

Names of infectious disorders of urinary

Urethritis, cystitis aka bladder, postatitis, pyelonephritis is kidney

Lab data for infectious cystitis

Urinalysis Hematuria Pyuria Bacteria count >100,000 colonies of organisms/ml Urine culture and sensitivity Identify causative organism Avoid contamination

primary vs revision arthroplasty? usually for?

first time vs. if implant loosens and needs fixing. usually for total hip arthroplasty THA aka total hip replacement

palpitations define? cause?

fluttering or unpleasant feeling in cheat due to irregular heart beat. Cause: changes in HR, rhythm. Increase in force of heart contractions. tachycardia, strenuous activity, anxiety, stress, fatigue, insomnia, hyperthyroidism, caffeine, nicotine, alcohol

amputation common complications

hemorrhage, infection, phantom limb pain, neuroma, flexion contractures

erythrocyte sedimentation rate aka ESR if elevated confirms? normal?

if elevated confirms inflammation/inflammatory disease like RA or infection, anemia, soft tissue damage. Normal: male: up to 15mm/hr, female:up to 20mm/hr

osmolarity

number of milliequivalents/milliosmoles in a liter of solution

Home care education for trach

Use shower shield cover airway with cloth to protect it during day, increase humidity in home, wear medical alert bracelet that identifies inability to speak

Central IV therapy define? Location? Requires?

Vascular access device placed in central circulation within superior vena cava near junction with right atrium. Require verification of placement via chest radiograph before solutions infused.

Elevated hematocrit?

Vascular volume depletion

Agents for erectile dysfunction categories? Meds?

Vasodilator, inhibitor, phosphodiesterase-5 inhibitor. Viagra/sidenafil, Cialis, Levitra

Micturition

Voiding

Health belief model define? Based on? Demographic?

What people believe to be true about themselves in regards to their health •Based on 1) perceived susceptibility to disease; 2) perceived seriousness of disease; 3) perceived benefits of action •Demographic variables, personality, peer group pressure, knowledge, & prior contact with disease are influencing factors

Gastric ulcer patho? Key characteristics?

When break in mucosa occurs hydrochloric acid injures epithelium causing back diffusion of acid or dysfunction of the pyloric sphincter and w/ out normal functioning bile refluxes into stomach causing deceased blood flow to lining. Normal gastric secretion+delayed stomach emptying w/ increased diffusion of gastric acid back into stomach

When fluids permitted post colonoscopy

When peristalsis has returned

Dryness aka? Define? Common problem in? Prevention?

Xerosis. Fine flaking of outer layer of skin. Common in elderly if itched can lead to lichenification and/or infection. Prevention: moisturizing soaps, oils, un scented creams/lotions, humidifier, bathe every other day, tepid water, superfatted soap, pat dry, no tight clothes, fluid intake of 3000mL, avoid caffeine and alcohol

Hysterisalpingogram

Xray of cervix, uterus, Fallopian tubes 2-5 days after end of period. Laxative, enema, suppository before. Will have pain. Give pad, contact if bloody discharge for >4 days, lower pain, fever, tachycardia

Define icterus

Yellow discoloration of sclerae due to jaundice

Sputum if infection

Yellow/green

Mr. Jones, a 70 year old client, reports to the nurse, "At night, I wake up at least twice to go to the bathroom to urinate". What is the nurse's best response to Mr. Jones

You will need to have a digital rectal examination to check benign prostatic hyperplasia BPH since related to aging/hormonal issues

Labs/diagnostics for ovarian cancer

^ cancer antigen test (CA-125) Transvaginal ultrasound CT scan, CXR CBC w Liver profile Pap smear is of LIMITED VALUE for detection

angina define? location? relieved with?a

sudden in response to exertion, emotion, temps. Squeezing viselike pain. Location: substernal and can spread to chest and back and/or down arms. Usually left side of chest and relieved with rest, nitrates, O2

interventions for RA

synovectomy:remove inflamed synovium for knee/elbow for RA TJA aka total joint arthroplasty

cane used on what side? positioning?

on unaffected side and no more than 30 degrees of elbow flexion

Oral meds for ED examples? Function? Take? Contraindicated with?

phosphodiesterase/PDE inhibitors like viagra, cialis, levitra which improve blood flow during arousal. Take Only 1x a day 1 hour before sex, not PRN. Contraindicated with nitrate b/c hypotension and <blood blood flow to vital organs

external fixation define? advantages? disadvantages?

pins or wires inserted through skin and affected bone and then connected to external frame. advantages: minimal blood loss, early ambulation, maintains alignment in closed fractures that won't maintain position in a cast, easy access to wound. Disadvantage: increased risk for pin site infection leading to osteomyelitis. in first 48-72 hours clear fluid drainage or weeping is expected

exercises to prevent VTE aka venous thromboembolism

plantar flexion, dorsiflexion, circumduction, gluteal by pushing heels into bed and quadriceps muscle setting by straightening legs and pushing the back of knees into bed, straight leg raises(SLRs),

preop care for THA or knee arthroplasty

preop care for THA or knee arthroplasty

Progesterone define

prepares body for conception & pregnancy; "pro-gestation"; maintains & regulates menstrual cycle

Testosterone define

responsible for prostate function; maintains muscle bulk, adequate levels of RBCs, bone growth, a sense of well-being, & sexual function; may improve Erectile Dysfunction (ED)

DVT treatment nonsurgical

rest or amb, studies did not show that amb => PE and DVT did not worsen ; SCDs; DO NOT MASSAGE AFFECTED EXTREMITY, monitor for PE; anticoagulants IV Heparin, then PO Coumadin; or low molecular weight heparin i.e. enoxaparin (Lovenox) or dalteparin (Fragmin); tPA

nonpharmacologic interventions of RA

rest, positioning, ice/heat, hypnosis, acupuncture, imagery, music, stress management, treating obesity, calcium, fish/fish oil, GLA, tai chi, spiritual practices

Endometriosis results from? Monthly cyclic bleeding? Scarring leads to?

results from overproduction of prostaglandin & estrogen, which leads to chronic inflammation because endometrial tissue is implanted outside of the uterus usually ovaries aka chocolate cyst@ ectopic sites. -monthly cyclic bleeding occurs @ the ectopic site of implantation, which irritates & scars the surrounding tissue -scarring leads to adhesions & infertility

Abnormal breast findings

retraction, mass, lump, cyst, venous prominence, edema, peau d'orange, nipple inversion, inflammation

Connective tissue disease (CTD) is the major focus of? ctd's are mostly? aka?

rheumatology, the study of rheumatic disease. CTD's are mostly autoimmune disorders. CTD AKA arthritis

postop care of TKA

same as THA except no need for hip abduction and CPM aka continuous passive motion machine may be used, if no CPM knee rests flat on bed or with one pillow under lower calf and food to encourage slight extension, no hyperextension, patients able to slightly weight bear unless not cemented

Inflammation from recurrent diverticulitis can cause

scarring which narrows bowel lumen which can cause obstruction and possible fistulas

neuroma

sensitive tumor of damaged nerves from amputation

Androgen define

sex hormones made in the ovaries & converted to estrogen

empty and measure fluid in surgical drain every? amount of drainage should be?

shift, total amount of drainage less than 50 mL/8hours

canes

should be used on strongest side of body

cast issues? if patient immobilized?

skin breakdown, infection, circulation impairment, peripheral nerve damage. If patient immobilized pneumonia, atelectasis, thromboembolism, constipation

Synthetic androgen meds

Testosterone, danazol, cyclomen, danocrine

Packed RBC volume? Infusion time? Indications

200-250mL, 2-4 hours. For anemia hemoglobin <6g/dL, 6-10g/dL depending on symptoms,

Beau's grooves define? Can indicate?

1mm wide horizontal depressions in nail/ Acute/severe illness, prolonged febrile state, isolated periods of malnutrition

% of water in each of the 2 compartments

1/3rd in ECF and 2/3rd in ICF

What is max length of time to apply painful stimuli in comatose patient

20-30 seconds

Serum calcium normal?

9-10.5mg/dL and decreased in elders

Progesterone decreased? Elevations?

Amenorrhea, neoplasms, ovary dysfunction. Ovarian cyst

Drug therapy for GERD

Antacids, histamine blockers, protein pump inhibitors

High platelets

Chronic disease, anemia

Over elimination of bicarbonate ion metabolic acidosis conditions

Diarrhea

Reproductive health: role of RN? Emphasis on?

Education. health promotion & education **

COPD types

Emphysema or bronchitis

Intra operative care for DM

IV infusion of insulin, glucose, K for BG 140-180, 5g glucose/hour

Erectile dysfunction ED define

Impotence, functional/psychological/sudden onset like stress and organic causes

Arthralgias

Joint aches

Anuria

Less than 100ml per 24 hours

RBC normal men? Women?

Men 4.7-6.1 million cells/mcL, female 4.2-5.4 million cells/mcL

PaO2 vs. SpO2/SaO2

Partial pressure of o2 in blood vs. pulse ox O2/ABG o2

Estrogen/progestin combo

Prempro aka conjugated estrogens with medroxyprogesterone, ortho-prefest Fem HRT

signs of hip dislocation

pain, shortening of leg, rotation of leg

Serum bicarbonate normal? If =11?

20-30mmol/L. If serum bicarbonate CO2 is 11 bicarbonate is being consumed due to severe metabolic acidosis seen in DKA and is very low

Base excesses caused by

Excess intake of bicarbonates, carbonates, acetates, and citrates like antacids, blood transfusions

CK-MB normal?

0

Serum lipase normal? Increased due to?

0-110 units/L due to pancreatitis

Aspartate aminotransferase AST normal range?

0-35units/L or 5-40 units/L from liver, increased in elders

Gamma globulin normal? Increased means?

0.8-1.6 g/dL. Inflammatory CTDs

Single donor platelets volume? Infusion time? Indications

200ml, 30 min. History of febrile/allergic reactions, or stem cell transplant. Single donor has one donor

Physical assessment for colorectal cancer

Assessment for distention and masses, visible peristaltic waves, high pitched tinkling bowel sound due to partial bowel obstruction, total absence of bowel signs due to complete obstruction

RN process

Assessment/data collection, analysis/diagnosis, planning, implementation, evaluation

Neurologic finding for cirrhosis

Asterixis, paresthesias of feet, peripheral nerve degeneration. Encephalopathy, reversal of sleep wake pattern, sensory disturbances

What to check for with skin cancer? Notify if? Check when?

Asymmetry, border irregularity, color variation, diameter >6mm, evolving or changing feature. Notify if >1 of the above features. Check monthly

It;s recommended for those who use meds that cause hypoglycemia to schedule exercise when?

1 hour after meal or have 10-15g carb snack and check BG before exercise. And small carb snack taken every 30 minutes during exercise, carry glucose tabs or hard candies

1kg of weight gain/loss = ?

1 liter of retained/lost fluid

Ankle-brachial index normal? If lower indicates?

1 or more=ankle systolic pressure/dorsalis pedis/tibial divided by brachial systolic pressure to measure vascular status. Vascular disease.

Leading cause of mortality 35-44

1 unintentional injuries, 2 malignant neoplasms, 3 heart disease

Leading cause of mortality 20-34

1 unintentional injuries, 2 suicide, 3 homicide

Leading cause of mortality 20-34

1 unintentional injury, 2 suicide, 3 homicide

A 20 year old sexually active female asks the RN, "When should I have a Pap smear?" The nurse's best response is

At 21 between period no douching, vag meds, or deodorant before or sex 24 hours before

Rn interventions during/after IV rtPA

10% of dose Bolus over 1 minute, and .9mg/kg infusion, stroke unit, neuro assessment/VS q 10-15 minutes during and q 30 min. After, if >180/105 BP antihypertensives, no invasive tubes, follow up CT after

Oliguria

100-400 ml per 24 hours

Surrounding mucosa for gastric vs. duodenal ulcers

Atrophic gastritis vs. no gastritis

a sudden weight increase of 2.2 lbs can result from

excess fluid 1 L in interstitial spaces aka edema

Amputation pain drugs

Calcitonin, beta blockers aka propranolol for dull burning, antiepileptic drugs aka carbamazepine/tegretol or gabapentin/Neuronten for sharp pain, antispasmodic aka baclofen/Lioresal for spasms/cramping, antidepressants

A. Fib drugs

Calcium channel blockers like cardizem/diltiazem, beta blockers like metoprolol/esmolol, dixoxin, anticoagulants/antiplatelets

Osteoporosis drugs

Calcium+Vit. D. Biphosphonates -Fosamax/aldendronate, ibandronate/Boniva, risedronate/Actonel prevents bone loss/resorption and increases density. Estrogen agonists/antagonists prevent loss and increases density

What helps people with Alzheimer's interpret their surroundings and activities

Calm predictable environment where stimuli are limited and regular routine is established

Colostomy should start functioning when? Sh of be emptied when

2-4 days. Should be emptied one third to one half full, entire pouch system changed q 3-7 days

1 L of water weighs how man pounds? Meaning? A weight change of 1 pound indicates fluid volume change of?

2.2 pounds meaning weight changes are best indicator of fluid loss or gains. A weight change of 1 pound indicates fluid volume change of 500ml

Urine albumin

20-200g/min or 30-300mg/hr indicate microalbuminuria/proteinuria indicating microvascular changes

Bicarbonate arterial normal? Venous normal? Increase cause? Decrease cause?

21-28mEq/L, 24-29mEq/L. Increased: metabolic alkalosis, bicarbonate therapy. Decreased: metabolic acidosis, diarrhea, pancreatitis

Normal bicarbonate CO2 range? Function? Regulated by? decreased indicates? Increased indicates? Interventions?

22-30. Is a buffer that prevents accumulation of acids and regulated by kidneys. Decreased indicates metabolic acidosis and increased indicated metabolic alkalosis. Assess LOC, renal function, expect need for IV fluids.

Diagnosing GERD

24 hour ambulatory esophageal pH monitoring, esophagogastroduodenoscopy , esophageal manometry

the body functions best when the osmolartiy of fluids in all spaces is close to? when all fluids have this concentration body fluids are? aka? or?

270-300mEq. when all fluids have this concentration body fluids are isosmotic to each other aka isotonic or normotonic

Assessment for pneumonia

Chest, pleuritic, or abdominal pain Headache, fever, chills Difficulty breathing Tachypnea Productive cough with mucus Purulent sputum production Crackles, wheezing, or bronchial breath sounds Increased tactile fremitus Dullness to percussion Hypotension, rapid pulse (secondary to dehydration, or advanced stage

Define abdominal circumference? High is associated with? High risk for men? WomeN?

Abdominal girth is the measurement of the distance around the abdomen at the umbilicus; indicator of abdominal fat •A high abdominal circumference is associated with an increased risk for type 2 diabetes, dyslipidemia, hypertension, & CVD •High Risk Men: >102 cm ( >40 in) •High Risk Women: >88 cm ( >35 in)

Postcholecystectomy syndrome signs

Abdominal or epigastric pain with vomitting

Symptoms of polycystic kidney disease

Abdominal or flank pain Hypertension Nocturia Increased abdominal girth Constipation Bloody or cloudy urine Kidney stones

Exenatide/Byetta glucagon like peptide receptor agonists SE

Acute pancreatitis and kidney problems have been associated with its use.

Antivirals

Acyclovir, valcyclovir, fanciclovir, docosonal, Zovirax, Valtrex, cytovene, abreva

Skin antiviral? Antibacterial? Antifungal? Antibiotics? Anesthetic? Antiparasitic? Steroid? Antipsoriatic?

Acyclovir. Bacitracin. Nystatin. Penicillin/Erythromycin. Benzocaine. Lindane. Hydrocortisone. Methotrexate

gait for crutches

3 point so little weight bearing on affected leg

Glasgow coma scale scoring for coma? Moderately severe? Mild? Normal?

3 through 8 critical and in a coma 9 through 12 moderately severe but not in a coma 13-14 mild 15 is normal

ALT normal

3-35 units/L

Serum phosphorus norm?

3-4.5mg/dL and decreased in elders.

phosphorus normal range? Most where? Major? Function? Lowered phosphorus=? Which hormone regulates?

3-4.5mg/dL. Most in bones. Major anion in ICF. For activating vitamins/enzymes, forming ATP for energy, cell growth, metabolism, acid-base balance, Ca homeostasis. Lower phosphorus=Increase in Ca. Increase in PTH=loss of phosphorus, decrease in PTH=increase in phosphorus

DM exercise minimum? Exercise examples? Muscle and joint strengthening examples?

3-4x/week for 20-40minutes. Brisk walking, jogging, bicycling, treadmill, swimming. Weight lifting, calisthenics/floor excercises. In type 1 Lowers BG so 70kg needs 15g additional CHO/hour. Raise BG >100mg/dL before starting, don't exercise 1 hour before insulin injection or peak action, carry simple sugar

Midline catheters are how long? Lumen? Inserted where? Used for how long? Considered in?

3-8 inches long, double or single lumen. Inserted in veins of upper arm usually the median ante cubical vein with ultrasound guidance, basilic vein preferred over cephalon vein since larger diameter, axillary vein. Used for therapies for 1-4 weeks. Considered in peripheral circulation

Aldolase ALD normal? Elevations can indicate?

3-8.2 units/dL. Polymuositis and dermatomyositis, muscular dystrophy.

Albumin normal? Decreased means?

3.4-5g/dL. Chronic inflammation/infection, hepatic issues

Potassium normal? Function? Critical value? Major? Intake? Controlled how?

3.5-5mEq/L. Helps keep blood pressure levels stable regulating heart contractions and helping muscle function. Critical value greater than or equal to 6. Major cation of ICF. Intake=2-20g/day. Controlled via Na-K pump and kidney excretion due to aldosterone

Uric acid norm

3.5-7.8

Short peripheral catheters length and gauge sizes? Can stay in vein for how long?

3/4- 1 1/4 inch with gauge sizes from 26-14. Can stay in vein for 72-96 hours but then require removal and insertion in another vein. Best location is dorsal veins, basilic, cephalon, and median veins and branches

Alkaline phosphatase ALP normal range?

30-120 units/L, increases in elders

Ileostomy nutrition

Chew thoroughly, no high fiber or cellulose foods like corn, nuts, coconut, Chinese vegetables, beans, tough fiber meats, shrimp and lobster, rice, bran, vegetables with skin

Diagnostic testing of Uc

Colonoscopy is best but also CT scan, barium enema

Mixed aphasia

Combination of expressive and receptive where they cannot read/write and understand/speak

Intra peritoneal therapy used for? What kinds are there? Stages? Positioning?

Admin of chemo for ovarian and GI tumors that moved into peritoneum. Implanted port or external catheter for short term for large quantities of fluid. Stages: instillation, dwell for 1-4 hours, drain. Semi-fowler's position and possibly move side to side to distribute fluid.

During infusion

Admin using filtered tubing, dilute with only NS, remain with patient for first 15-30 minutes, infuse at rate, monitor VS

Interventions for UTI

Administer meds Pt. Education Hygiene practices:Fluid intake, Alcohol, caffeine, Medications, Diet, cranberry or prune juice, vitamin C 500-1000

Mycolytic administer via? Function? Education

Administered via nebulizer (Mucosil, Mycomyst) or PO (Guaifenesin) Thin secretions, thus making them easier to cough up. Education: Teach patient how to use nebulizers correctly

Neurogenic s/s of hypoglycemia

Adrenergic: shaky/tremulous, heart pounding, nervous/anxious. Cholinergic: sweaty, hungry, tingling

Abdominal assessment of cirrhosis

Advanced practice can palpate and percuss right upper quadrant, measure abdominal girth around widest diameter at end of exhalation, take daily weight

Improving mobility after stroke

Affected leg regains function more quickly than arm. Support flaccid arm with pillow/sling, prevent DVT

CO normal

4-7 L/min

Insulin pump users must check their BG level how many times a day

4-8 times or more per day

Normal triglycerides for males? Females?

40-160mg/dL, females 35-135mg/dL

Hematocrit normal males? Females?

40.7/42-50.3/52%, females 36.1/37-44.3/47%

Normal total lipids

400-1000mg/dL

minimum amount of urine per day needed to excrete toxic waste? aka?

400-600mL aka obligatory urine output

WBC volume? Time? Indications

400mL 1 hour. For sepsis, neutropenic infection not responding to antibiotics

10 g of oral glucose raises plasma glucose by? 20g of oral glucose?

40mg/dL over 30 minutes. 60mg/dL over 45 minutes

Carb recommendation for DM

45-65% o calories, minimum of 130g/day. Fruit, vegetables, whole drains, legumes, low fat milk

WBC normal

4500-10000 cells/mcL

Glucose lowering effects of excercise can last up to

48 hours after so it's possible for hypoglycemia for that long after

Drug therapy for benign prostatic hypertrophy

5 alpha reductase inhibitors like Proscar aka finasteride and dutasteride aka Avodart to reduce prostate size. Alpha andregenic blockers like Hytrin, Cardura, Flomax

Normal bowel sounds in a minute

5-30

Calcium normal in mEq and mg/dl?function? Ion w/

5-6mEq/L or 9-10.5 mg/dL. helping with muscle contractions, nerve signaling, blood clotting, cell division, activating enzymes, and forming/maintaining bones and teeth. Ion w/ 2 positive charges aka divalent cation that exists in bound form in bone which has the most and and ionized/unbound aka free form in ECF the least amount though

Drugs for CD

5-Asa drugs for mild to moderate, azathrioprine aka Imuran and mercaptopurine aka Purinethol and methotrexate MTX for moderate to severe that suppress immune system, monoclonal antibody drugs that decrease inflammation like infliximab aka Remicade, adalimumab aka Humira, natalizumab aka Tysabri, and certolizumab pegol aka Cimzia, and glucocorticoids, and metronidazole aka Flagyl

Age+gender for gastric and duodenal ulcers

50+ males+females

Nonsurgical management of PUD upper GI bleeding

ABC. With hypovolemia monitor fluid status, intravascular isotonic fluid replacement,serum electrolytes assessed, blood transfusion, fresh plasma, monitor hematocrit/hemoglobin/coagulation. If mild bleeding weakness and perspiration, with blood loss greater than 1L/day shock symptoms like hypotension, chills, palpitations, diaphoresis, weak thready pulse. NG tube, endoscopic therapies, acid suppression, drugs

Serum complement normal? Decreased when?

75-160units/mL. Autoimmune diseases, anemia, infection

USDA recommendations for older adults

8 glasses of water, fiber, and calcium/vitamin D and b12 supplements with reduction in sodium and cholesterol foods

Normal arterial PaO2

80-100 mm Hg

Normal urine creatinine clearance

85-135ml/min

Normal GFR

90-120ml/min

hypotension define? if present assess via?

90/60 or less. Korotkoff sounds can be less audible/absent. Palpate BP, use doppler, or use arterial catheter

chloride normal range

98-106mEq/l. Major anion of ECF. Works with Na to maintain osmotic pressure, forms HCl, HCO3 exchanged for Cl.

Pap <21? 21-29? 30-65? >65? Historectomy?

< 21 y/o: Should not be tested Annual Pap test @ 21 y/o 21 - 29 y/o: Q 3 years, q 2 for liquid based test 30 - 65 y/o: Q 5 years + HPV test; if no HPV test then Q 3 years > 65 y/o w regular WNL cervical CA screen = 0 None

Normal fasting glucose? 2 hour OGTT glucose normal? A1c %?

<100, <140, 4-6%

Preop care for DM

<200mg/dL BG, sulfonylureas discontinued 1 day before, metFORMIN/glucophage discontinued 48 hours before, all other orals are stopped day of, long acting changed to short acting 1-2 days before

PID risk factors

<26 years, multiple sex partners, IUDs, smoking, chlamydia, gonorrhea, history of STDs

Prostate specific antigen normal? Increased? Prep for test?

<4 NG/mL. Prostatitis, benign prostatic hyperplasia, prostate cancer. No ejaculation for 24 hours before test , blood for PSA should be drawn before DRE

Glomerular filtration rate which can indicate kidney disease

<60

Myoglobin norm

<90mcg/L

Diabetes fasting plasma glucose normal? 2 hour OGTT glucose normal? Random plasma glucose and A1C% normals?

> or equal to 126 on 2 times or >126mg/dL, >200 for 2 hours with glucose load of 75g, >200+symptoms, >6.5, >8 poor diabetic control

Care of patient with meningitis

ABCs, VS/neuro check 2-4 hours, drugs, I/O, cranial nerve assess, vascular assess, weight, ROM every 4 hours, quiet environment, low light, bed rest with HOB 30 degrees, monitor/prevent increased ICP, vascular disinclined, fluid/electrolyte imbalance, seizures, shock

O2 therapy for COPD: need for O2 determined by? May need? Primary drive for breathing is?

ABG results and SpO2. May need O2 at 2-4 L/min or 40% via venturi mask COPD patients primary drive for breathing is a LOW O2, therefore administration of O2 > 2-3 L/min may cause respiratory arrest.

Diagnostics for PE

ABG, CXR/CT angiogram, transesophageal ECHO

Bronchitis diagnostics

ABGs Sputum CBC Liver enzymes CXR Pulmonary function test (lung volumes, flow volumes, and diffusion capacity) Peak expiratory flow rates

Plasma transfusions requires?

ABO compatibility

Drugs for microalbuminuria and advanced nephropathy

ACE inhibitors or angiotensin receptor blockers

Angiotensin converting enzyme inhibitors aka? Do what? Includes? SE?

ACE. Prevents vasoconstriction decreases Na+H2O retention and lowers vascular resistance. Captopril/capoten. SE:Dry cough

Seizures and meningitis can cause increase in what hormone

ADH causing water retention, dilution of NaCl, sodium loss by kidneys,, increased ICP

What UAPs can do

ADLs, bathing, grooming, dressing, toileting, ambulating, feeding without swallowing precautions, positioning, bed making, specimen collecting, intake and output, vital signs on stable clients

Testing for testicular cancer

AFP and HCG, liver function test (lactate dehydogenase), x-rays, to determine metastasis

ALT vs. AST

ALT more specific to liver where AST can be found in muscle, kidney, brain and heart

Cerebral salt wasting define? Treatment

ANF causing hyponatremia, decreased osmolarity, decreased blood volume. Sodium and isotonic fluid volume replacement

Vascular access for dialysis

AV catheters that are temp. Or implanted, AV fistula, AV graft

Key features of small bowel obstruction

Ab pain/discomfort possibly accompanied with visible peristaltic waves in upper/mid abdomen, upper or epigastric abdominal distention, nausea and early profuse vomitting with possible fecal material, obstipation, severe fluid and electrolyte imbalances, metabolic alkalosis

Physical assessment of gastroenteritis

Abdominal distention, hyperactive bowel sound, if dehydrated poor skin turgid, fever, orthostatic BP, hypotension, oliguria

Donor A recipients?

A, AB

Donor O recipients

A, B, AB, O

Chronic gastritis cause based on type

A:autoimmune/genetic. B: h.pylori, drugs, surger, chrohn's, uremia, graft vs. host disease. Atrophic: old age, toxic substances, h.pylori, autoimmune

Donor AB recipients

AB

Physical assessment of acute pancreatitis

Abdominal pain in mid epigastric or left upper quadrant, radiation of pain to back left flank or shoulder and worsens by supine position and gets better in fetal position or sitting upright bending forward, weight loss from nausea and vomiting, jaundice, gray blur discoloration of abdomen, gray blue discoloration of flanks, absent or decreased bowel sounds if paralytic ileus, abdominal tenderness rigidity or guarding resulting from peritonitis, palpable mass if pseudocyst, elevated temp, tachycardia, decreased BP, left lung pleural effusions, atelectasis, pneumonia

Amylase and lipase test given if

Abdominal pain or V

Crepitus define

Air trapped in/under skin and felt as crackling

Teriparatide aka? does what?

Aka Forteo acts as PTH and treats osteoporosis

Falls precaution

Assess for orthostatic hypotension, leg muscle strength, orient to environment, call for help to get out bed, use walker/cane for ambulating, help to toilet every 1-2 hours, clean up spills ASAP, adequate lighting at all times of day, call light, bed in lowest position and locked, objects patient needs within reach, handrails, encourage family to stay

Postop nursing care for testicular cancer

Assess for paralytic ileus Assess for pain from surgical incision Assess for immobility after surgery Assess for injury Educate re: home care: scrotal support, dry dressing, sutures d/c in 10 days, no heavy lifting > 15 #, no stair climbing, no driving, TSE Q month, Support groups F/U w MD re: further tx or silicone prosthesis

A 28 year old female with endometriosis asks the nurse "Why do I have to have a transvaginal ultrasound?" The nurse's best response is

Assess for pelvic masses that can be mistaken for endometriosis

Self management of asthma

Assess symptom severity 2x daily with peak flow meter that is based off personal best so they know when drugs or assistance needed then use flow meter after drugs. You want to be 80% or above personal best.

Patient management of chest tube drainage

Assess, check alignment of trachea, check if tube eyelets are visible, deep breath, cough, incentive spirometry, reposition if burning pain in chest

Older adults receiving transfusion

Assess circulatory/kidney/fluid status before, use 19 gauge, try to use blood <1 week old, take VS every 15 minutes, assess for overload via rapid/bounding pulse, hypertension, pallor/cyanosis, assess for transfusion reaction via rapid thready pulse, hypotension, pallor/cyanosis, admin slowly taking 2-4 hours for each unit, avoid concurrent fluid admin, allow 2 full hours after admin of 1 unit before admin of next

Codeine sulfate class? Function?

Anti-tussive. Suppresses cough reflex

Lab findings of DKA: BG? Blood pH? Serum bicarbonate? Urine+serum?

BG >250mg/dL, arterial blood pH <7.3, serum bicarbonate <16mEq, and moderate-high ketone levels in urine+serum

overweight vs. obesity

BMI 25-30 vs. BMI > 30

Trousseau's sign

BP cuff inflated greater than systolic pressure for 1-4 minutes , if positive hand and fingers go into spasm in palmar flexion

Risk factors for breast cancer

BRCA1 &/or BRCA2 genetic factors; + family history Exposure to high-dose radiation to thorax Early menarche & late menopause Nulliparity aka no child or 1st birth after 30 y/o 1+ alcoholic drinks/day Obesity b/c fat tissue becomes a major source of estrogen Postmenopausal women receiving > 5 years of Hormone Replacement Therapy w estrogen & progestin

BUN and creatinine normals? Both elevated due to? If BUN high and creatinine normal? If BUN and creatinine low?

BUN 10-20, creatinine 0.8-1.2. Elevated due to ESRD reflecting need for or missed dialysis. If BUN hi and create normal patient dry. BUN and creatinine low is liver disease

Tuberculosis patho

Bacilli make it past the upper airway defense systems and enter the lungs. The organism implants in alveoli or respiratory bronchiole An inflammatory response is initiated as the bacteria multiply. The organism continues to slowly grow and enters into the lymphatic system A tubercle lesion is formed

Antibacterial Topical

Bacitracin/Baciguent, Chloramphenicol(Chloromycetin), Gentamicin(Garamycin)

Cellulitis define? Caused by? S/S? Treatment?

Bacterial infection of the deep connective tissue •Caused by Staph or Strep •Skin is red, hot, shiny painful, edematous •Treatment-rest, heat elevation, Penicillins or Cephalosporins except MRSA => treat with Vancomycin

Donor B recipient to?

B, AB

Blindness vision #? Defined as? Legal blindness?

BCVA of 20/70 to 20/200 Blindness is defined as BCVA that can range from 20/400 to no light perception (NLP). Legal Blindness- ranges from the inability to perceive light to having some vision remaining

Post op care for DM

BG 140-180mg/dL for critically ill

Criteria for resolution of DKA

BG <200, HCO3 >18mEq, pH higher than 7.3, ion gap <12

When sick with DM notify if

BG >250, ketonuria >24 hours, cannot take food/fluids, illness lasts >1-2 days, persistent n/v, moderate/large ketones, BG elevation after 2 doses of insulin, high >101.5 temperature, increasing fever, fever >24 hours

Gait

Balance, steadiness, ease and length of stride

Patient scheduled for cerebral blood flow with use of radioactive substance, which meds does rn anticipate the physican will likely withhold from patient for 24 hours before

CNS depressants/stimulants

Carbonic anhydrase equation

CO2+H2O < > H2CO3 < > HCO3- + H+

COPD complications

COPD affects the oxygenation & perfusion to all tissues. Cor pulmonale (right sided heart failure) Hypoxemia and acidosis Increase in respiratory infections secondary to increased mucous and poor oxygenation (Ensure patients are aware of early s/s of respiratory infection) Cardiac dysrhythmias secondary to hypoxemia Malnutrition (secondary to dyspnea & early satiety)

Noninvasive positive pressure ventilation. Examples

CPAP for positive pressure throughout inhalation and exhalation, volume/flow limited during inspiration, pressure limited which include pressure support/control and BiPAP during inspiration and expiration

Diagnostic tests for dementia

CT scan - shows brain atrophy-rule out brain tumor or stroke CBC - rule out vitamin deficiencies, lead poisoning Blood chemistry - rule out kidney failure and thyroid problems Test for syphilis and HIV infection Lumbar puncture - rule out meningitis and encephalitis Electroencephalogram - rule out Creutzfeldt-Jakob

Verapamil, nifedipine, diltiazem aka? Class? Use? SE? Monitor?

Calan/Verelan, Adalat/Procardia, Cardizem. Calcium channel blockers. Antianginal, antihypertensive, antiarrhythmic via vasodilation+reduction of rate. SE:arrhythmia, HF, hypotension, bradycardia. BP, pulse, I/O

Labs to check and diagnostics of endometrial/uterine cancer

CBC CA 125 HCG to r/o pregnancy Transvaginal ultrasound (Gold standard) Endometrial biopsy (Gold standard) CXR, CT scan of pelvis, MRI abd & pelvis IVP, Abdominal ultrasound Liver & bone scan

Diagnostics for pneumonia

CBC Sputum Sample Blood and urine culture (As soon as possible usually before 1st dose of antibotics) ABGs and pulse oximetry Serum electrolytes r/o dehydration CXR Thoracentesis- Diagnostic and therapeutic Chest tube placement

Labs of IBS

CBC, albumin, erythrocytes sedimentation rate, stools for occult blood normal. Hydrogen breath test since when bacterial overgrowth or malabsorption of nutrients present hydrogen made

When lack of coordination interferes with self-feeding

Have them eat with spoon/fingers, apron/smock used, feeding patient yourself

Signs of sickle cell disease

Chronic anemia, Hbg 5-11, fatigue, jaundice, bone and joint deformities, leg ulcers, enlarged organs like spleen and liver, reoccurring infections, sepsis, vessel occlusion causing acute chest syndrome, priapism, pain, heart failure , SOB, murmurs, s3, vein distention, vessel occlusion indicated by coolness after/slow refill/reduced/absent pulse, HR ^, BP low, priapism aka prolonged erection, pallor, cyanosis, poor tissue perfusion causing decreased wound healing causing ulcers/sores,kidney failure, fever seizures, stroke, pronation drift

cause of compartment syndrome

external pressure like tight dressings/casts, internal pressure like blood/fluid from fractures, burns, bites, IVs

Catheter migration causes? S/s? Treatment? Prevention?

Coughing, vomiting, sneezing, heavy lighting, congestive heart failure. S/s: if jugular vein running stream/gurgling on side of insertion, for zygos vein back pain between shoulders, neuro complications. Treatment: stop infusion, flush, notify, chest X-ray. Prevention: place properly, avoid excess activity

Venous spasm s/s? Treatment? Prevention

Cramping, pain, numbness, slowing rate, inability to withdraw midline or PICC. Treatment: slow infusion rate, warm compress, don't immediately remove short peripheral, if during midline or PICC removal no forceful removal, reapply dressing, drink warm fluids, 12-24 hr may be needed before removal. Prevention: allow time to return to normal, infuse at room temp., for midline or PICC withdraw in short segments

Patient scheduled for CT with contrast media which lab result could impact procedure prompting rn to notify radiology department and provider

Creatinine level

A 25 year old male reports having lower abdominal pain; scrotal pain & swelling; & fever. The nurse anticipates that the client will need

Culture of urine/prostate secretions, broad spectrum antibiotics, antipyretics/analgesics, ultrasound since client can have epididymitis or orchitis

Paps tests for? =? 0 cervix=?

Cultures for trichomoniasis, HPV, STD's, HIV, PSA, bacterial, viral, fungal, parasites estrogen. =TAH/TVH+cervix. 0 cervix=0 pap

Primary endocrine disorder of pancreas? Exocrine function?

DM. Breakdown of starches, proteins, fats

What should RN teach patient in regards to prevention of dry skin

Daily fluid intake of 2000-3000mL, bathing with moisturizing soaps/oils/lotions, tepid warm bath, shower every other day

Nursing responsibility for hemodialysis

Daily weight (before and after dialysis) Hold BP meds before dialysis Prevent hypotension Orthostatic BP Hold folic acid and antibiotics as they will be removed by dialysis Assess for orthostatic BP Observe for bleeding LOC HA, nausea

Heart disease angiopathy define? Leading cause of? More common in? What can prevent/minimize complications?

Damage to vessels secondary to chronic hyperglycemia. Leading cause of DM related death. More common in those with DM. Tight glucose control can prevent/minimize complications

Head injury meds

Decadron, prednisone/solumedrol, mannitol

Nutrition for Muskuloskeletal decrease? Promote?

Decrease caffeine, carbonated beverages, alcohol and tobacco use Promote appropriate protein intake, dairy products, dark green, leafy vegetables, and bony fish products, appropriate Vitamin C, D, and iron intake

Health promotion to decrease colorectal cancer risk

Decrease fat, refined carbs, low fiber foods, increase fiber

Hypertonic colloid examples?

D5 1/2 NS. D5NS, hypertonic saline aka 3% or 5% NS. Shifts fluid back in circulation, replaces electrolytes. Irritating to veins, can cause fluid overload, hyperatremia, hyperchloremia. Hypertonic saline slow inflammation and increases cap. Permeability

Composition of parenteral nutrients

D50 up to 70% if runs out hang D10, amino acids 10-15%, electrolytes like K, phosphorus, Mg, Na, Cl. Trace elements like zinc, copper, phosphorus. Vitamins like ascorbic acid, A, D, E, K. Lipids 10-20% , meds like Pepcid or insulin

Hyperosmolar hyperglycemic syndrome HHS less common than? Often occurs in? Often related to? Usually there's a history of?

DKA. Patients >60 years with type 2. Related to impaired thirst sensation and/or functional inability to replace fluids. Usually a history of inadequate fluid intake, increasing mental depression, and polyuria.

Medical identification suggested for? Aka?

DM aka medicalert bracelet/necklace

Meds that can cause kidney issues

DM, hypertension, cardiac issues, hormonals, cancer, arthritis, psychiatric disorders, antibiotics like gentamicin aka Garamycin, laxatives, analgesics, NSAIDs, acetaminophen, creatinine supplements

Steatorrhea aka? Due to?

Fatty stools from malabsorption of fat in small intestines

Oliguric stage treatment

Fluids treat hypovolemia Diuretics: furosemide Correct hyperkalemia Diet restrictions K+, Phosphorous Protein Correct acidosis

Caring for PICC lines for med admin? not actively used? After drawing blood? Always use what to flush anytime

Flushing with 10mL NS before and after med admin. 5mL heparin in 10mL syringe daily if not used. 20mL NS flushed after drawing blood. ALways use 10mL syringes to flush to prevent catheter rupture

Iron deficiency anemia most? Decreased? S/S? Caused by? Treatment?

Most common, decreased iron supply for RBCs., RBC's small/microcytic, weakness, pallor, mouth fissures, brittle concave nails. Caused by blood loss, poor GI absorption, inadequate diet, alcoholism, partial gastrectomy, pregnancy, adolescence, infection. Treatment: oral ferrous sulfate between meals, if severe IV/IM using Z iron dextran/Dexferrum, iron deficiency associated with kidney disease rug derumoxytol/ Ferraheme

Diffuse neuropathies are? Types?

Most common, involve widespread nerve function loss, slow onset, bilateral, permanent. Types: Distal symmetric polyneuropathy, autonomic neuropathy

Kidney acid-base characteristics

Most powerful regulator, responds to large/chronic fluctuations, slowest response(hours-days), longest duration

Vitamin b12 purpose? When folic acid not in cells? Also involved in ?

Necessary to move folic acid into cells, when folic acid not in cells improper DNA synthesis and cell increases aka megaloblastic or macrocytic anemia. B12 also involved in spinal cord myelination

A patient who's hypoxemia and has chronic hypercarbia

Needs lower levels of o2 usually 1-2 L/min <3L/min via nasal cannula to prevent decreased respiratory effor

Infant mortality is? This rate is often? Per CDC in 2010? Deaths attributed to?

The infant mortality rate is an estimate of the number of infant deaths for every 1,000 live births •This rate is often used as an indicator to measure the health and well-being of a nation, because factors affecting the health of entire populations can also impact the mortality rate of infants. •Per CDC in 2010, the infant mortality rate was 6 infant deaths per 1,000 live births •Deaths attributed to: Birth Defects; Preterm; SIDS; pregnancy complications; Injuries (i.e. suffocation)

Diagnosis of Creutzfeldt-Jakob disease

There is currently no single diagnostic test for CJD. The first concern is to rule out treatable forms of dementia such as encephalitis or chronic meningitis. The only way to confirm a diagnosis of CJD is by brain biopsy or autopsy. In a brain biopsy, a neurosurgeon removes a small piece of tissue from the patient's brain so that it can be examined by a neurologist. Because a correct diagnosis of CJD does not help the patient, a brain biopsy is discouraged unless it is need to rule out a treatable disorder. While CJD can be transmitted to other people, the risk of this happening is extremely small.

Relative hyperkalemia cause

Tissue damage, acidosis, hyperuricemia, uncontrolled diabetes mellitus

When a patient is NPO do what with insulin

Withhold rapid/short acting and amyloid/incretin mimetics, still admin basal insulin

Incorporate skin assessment into the routine part of daily care while _________________________ or ___________________________ .

bathing your patient or assisting with hygiene.

vasculitis define? increased lesions=?

blood vessel involvement in RA and can cause organ supplied by that vessel to be affected and ischemic. increased lesions=increased vasculitis

syncope define? due to?

brief loss of consciousness due to decreased perfusion to brain from decreased CO like cardiac rhythm issues, valvular disorders

paresthesias

burning and tingling sensations from peripheral neuropathy associated with decreased circulation from RA

diet requirements for new bones

calcium, phosphorus, vitamin D, protein, iron

emergency care for traumatic amputation

call 911, then ABC, then dress it tightly, then hold part above heart, then put severed part zip lock that is then placed in ice water

edema develops with?

changes in normal hydrostatic pressure differences like in R. sided heart failure that causes venous hydrostatic pressure to increase until higher than pressure in interstitial space causing excess fluid from capillaries into interstitial space

assessing neurovascular for THA

check color, temp., distal pulses, capillary refill, movement, sensation

If patient experiencing morning hyperglycemia

checking blood glucose levels at bedtime, between 2:00 AM and 4:00 AM for hypoglycemia will help determine if the cause is the Somogyi effect or Dawn phenomenon

major CVD symptoms

chest pain/discomfort, dyspnea, fatigue, palpitations, weight gain, syncope, extremity pain, indigestion, fatigue after small activities

Most autoimmune diseases are characterized by

chronic pain and joint deterioration, which results in decreased function and impaired mobility. Some are localized and some are systemic.

priority problems for patients with osteoarthritis

chronic pain related to cartilage deterioration and decreased mobility related to joint pain and muscle atrophy

enhancing body image for RA

communicate acceptance of patient, encourage to express feelings, use personal items, emphasize strengths

FSH and LH define

control the menstrual cycle & ovulation (egg production). Both levels rise & fall together during menses

decreased perfusion skin

cool, pale, moist

intermittent claudication define? related to? cause? relieved by?

cramping in legs, butt while walking related to decreased arterial tissue perfusion aka blood supply. Cause: ischemia from artherosclerosis, venous insuffiency of peripheral blood vessels. Relieved by resting, lowering extemity to decrease tissue demands or enhancing arterial blood flow

Define hydrocele ? Treatment?

cystic mass filled w fluid that form around testis. Needle and syringe drainage or surgical removal

thrombocytopenia define? can occur with?

decreased platelets, can occur with heparin aka anticoagulants

ANA and NCSBN both defined delegation as? Ncsbn? Ana?

the process for a nurse to direct another person to perform nursing tasks and activities. NCSBN nurse transferring authority ANA transfer of responsibility

Demita patients with sleep issues, wandering, inappropriate behaviors are most likely to occur when

there are unmet underlying physical or psychological needs. Caregivers must identify the needs of patients who are exhibiting these behaviors because further health decline may occur if the source of the problem is not corrected

Surgical management for DVT

thrombectomy; inferior vena cava filtration: surgeon inserts a filter device into femoral vein; device is meant to trap emboli in inferior vena cava before they progress to the lungs

resorption

destruction of bone equal to build up until 35 yrs olds

Risks for acute renal failure

Pre existing diseas, chronic hypertension, DM, heart failure, shock

Respiratory: increased H or CO2 does what?

Stimulates increased RR and depth causing more CO2 to be lost decreasing H raising pH

Priorities for hyperkalemia

Through drug therapy: monitoring and preventing cardiac complications, safety for falls, monitoring response, teaching

Calcium channel blockers name? Do what?

verapamil hydrochloride/Calan. Lower BP via vasodilation and blocks heart conduction decreasing HR

Endometrial biopsy/aspiration assess for? Post?

Asses for cancer, menstrual issues, infertility. Post: pad, spotting present 1-2 days, no sex/douching until all discharge ceased

Symptoms of antidiarrheals? Examples of antidiarrheals?

Colon dilation, toxic megacolon.diphenoxylate hydrochloride and atropine sulfate aka Lomotil and loperamide aka Imodium

Management of delirium

Elimination or correction of the underlying cause Symptomatic and supportive measures Treat agitation without diminishing consciousness Treat hallucinations and Paranoid ideations Haldol, Ativan, lorazepam.

PE surgical interventions

Embolectomy: Surgical removal of embolus from pulmonary blood vessels Inferior Vena Cava Interruption: with placement of a vena cava filter

Acute symptoms of pyelonephritis

Fever, chills, tachycardia, tachypnea Flank, back, or loin pain Abdominal discomfort Nausea and vomiting Urgency, frequency, nocturia General malaise or fatigue Cognitive changes (older adults)

LH-RH agonists function? Agents?

For premenopausal Block LH + FSH preventing estrogen production for breast cancer. Goserelin/Zoladex, Leuprolide/Lupron. S/E: menopausal symptoms

Carotid artery angioplasty with stunting

For preventing/managing ischemic stroke and uses distal/embolized protective device inserted in femoral artery to get clot debris

Fractures of knee

Pre-op/Post-op care Same as total hip arthroplasty EXCEPT Maintaining hip abduction NOT necessary Continuous passive motion Applied in PACU Prevention of scar tissue Review chart 20-4

If hemorrhoids symptoms after no surgical treatment longer than 3-5 days?

Surgery like ultrasound coagulation, rubber band ligation. Circular stapling, laser assisted, or simple resection

Surgical management of pyelonephritis

Surgery to correct problems causing urine reflex or obstruction via pyelolithotomy aka stone removal or nephrectomy aka removal of kidney, ureteroplasty aka ureter repair or revision

Malnutrition risk factor? Malnutrition causes?

Surgery, trauma, sepsis, chronic illness, GI issues, eating disorders, dysphagia, pancreatitis, substance abuse. Causes negative N balance

Tracheotomy vs. tracheostomy

Surgical incision into trachea to create airway vs. tracheal stoma

Stages of pressure ulcers

1: red or blue/purple, intact skin nonblanchable. 2: nonintact partial thickness abrasion or blister. 3: full thickness subcutaneous tissue damage or necrosis. 4: full thickness exposed muscle, tendon or bone. Unstageable if full thickness loss, Eschar aka blackening/gray/brown or slough obscures depth of wound

NIH stroke scale assessment

1st 3 hours, must diagnose cause of CVA, clot means OK for tPA, hemorrhagic strokes delay rehab. 11 areas of assessment and serve as baseline

1st vs. 2nd. Vs. 3rd fluid shifts

1st normal distribution. 2nd excess interstitial fluid aka edema. 3rd fluid with usually no fluid

For skin irritation and pruritus associated with jaundice teach

To use cool rather than warm water no excess soap and use lotion for skin

Incretin mimetics SE?

Weight loss, decreased appetite, nausea, vomiting, dizziness, headache, constipation, indigestion, itching at site

Assessment of ED

1st step is to determine if cause = organic Medical, social, sexual history & PE Hormone testing US: to assess blood flow to penis Nocturnal penile tumescence test: if night-time erections, ED is NOT organic; refer to sex therapist

Basal cell carcinoma limited? Usually seen? S/s? Diagnosis? Treatment?

Ability to metastasize. Usually seen in adults >40yrs. Pearly, smooth, hard, firm papule lesion with crater and waxy borders and telangiectasis and pigment flecks. Diagnosis via history or biopsy. Treatment: surgery with 95% cure rate

Lymph edema define

Abnormal accumulation of protein fluid in sub Q tissue on the affected limb after mastectomy

Autoimmune hemolytic anemia caused by?

Abnormal immune function where body doesn't recognize RBC as self

5g CHO/carbs raises BG

About 20mg/dL

Platelets pooled volume? Infusion time? Indications

About 300mL, 15-30min. FOr thrombocytopenia where platelets <20,000. Patients actively bleeding with platelets <50,000. Platelets <10,000. From multiple donors.

Perineal wound care

Absorbing dressing like feminine napkin, jockey type shorts, Sitz bath, pain meds, side lying, foam pads or soft pillow to sit on. Avoid air rings or rubber donuts

SpO2 normal?

95-100% older adults can be lower

How to prevent gas bloat syndrome? Define

Avoid carbonated drinks, no gas producing or high fat foods,no gum or straws. When patient can't belch

Ileostomy drug therapy

Avoid enteric coated and capsule meds, no laxatives or enemas, you should have loose stool and notify if no stool in 6-12 hours

Flushing catheter for short peripheral catheters? For all others? Limited to no more than ? Should be from?

For short peripheral catheter 3mL, for all others 5-1mL. But limited to no more than 30mL in 24 hours. Should be from single dose container or pre filled syringe

Assessment for aplastic anemia

History of bone marrow disorders, family history of Fanconi anemia, weakness, pallor, petechiae, CBC, fatigue, Ecchymosis

Lung cancer s/s

Hoarseness Persistent cough/wheezing Blood/rust sputum Hemoptysis Weight loss Chest/shoulder/arm pain Recurring episodes of pleural effusion, pneumonia, bronchitis Dyspnea Fremitus Dull/flat percussions

Incretin mimetics differences

Byetta admin twice daily at mealtime, bydureon injected once weekly, Victoza once a day regardless of meals

Complications of acute pancreatitis

Hypovolemia, hemorrhage, acute renal failure, paralytic ileus, hypovolemic or septic shock, pleural effusion, respiratory distress syndrome, pneumonia, multi organ failure, DIC

Key features of large bowel obstruction

Intermittent lower abdominal cramping. Lower abdominal distention, minimal or no vomiting, obstipation or ribbon like stools, no major fluid and electrolyte imbalances, metabolic acidosis which not always present

Reducing anxiety and agitation with AD

Emotional support that reinforces positive self image, environment kept familiar, noise-free, when patient has catastrophic reaction remain calm and don't force activity and instead postpone, listening to music, stroking/rocking, distraction , education for caregivers

Admin of insulin absorption fastest from? What is preferred site? Don't inject in? Rotate?

Absorption is fastest from abdomen, followed by arm, thigh, and buttock/back Abdomen is preferred site Do not inject in site to be exercised Rotate injections within one particular site at least 1/2 - 1 inch away from previous site

Rheumatoid arthritis characteristics? define?

-Characteristics-Chronic, progressive, systemic inflammatory connective tissue disease affecting mostly synovial joints, bilateral, Exacerbations and remissions -Autoantibodies attack health tissue and synovium and pannus aka vascular granulation tissue forms that erodes cartilage and destroys bone but can happen anywhere there is connective tissue Review Chart 20-8 and Table 20

Amputation post op care assess? drugs? interventions?

-Assess tissue perfusion, Pain, Phantom Limb Pain is real and managed differently from residual limb pain -IV Calcitonin, Beta-blockers, Anti-epileptics, Anti-spasmodics, Alternative therapies -Prevent infection, Promote mobility, Physical therapy, ROM exercises to prevent contractures, Positioning, Supine every 3-4 hours for 20-30 minutes to prevent contractures, Bring shoe for prosthesis fitting, Encourage communication of feelings

Osteoporosis drug therapy 3 types?

-Calcium and Vit D -Bisphosphonates- Fosamax/alendronate, ibandronate/Boniva, risedronate/Actonel prevents bone loss/resorption and increases bone density -Estrogen Agonists/Antagonists prevents bone loss and increases bone density

Blood clot embolism s/s? prevention? treatment?

-Same as fat embolism but NO petechiae -Prevention measures:Leg exercises, TED hose, Sequential compression devices (SCDs) -Treatment:, Bedrest, Promote oxygenation, Anticoagulants, Thrombolytics, Possible surgery

Pelvic organ prolapse POP locations? Which is most common?

-Cystocele (bladder) -Rectocele (rectum) -Uterine (uterus) Uterine: most common

Clinical manifestations of osteoporosis? Movement restriction & spinal deformity may result in ?

-Dowager's hump, kyphosis of the dorsal spine is present, Loss of 2-3 inches in height, Fractures -Constipation, abdominal distention, reflux esophagitis, and respiratory compromise in severe cases

Amputation types? assessment? emergency interventions?

-Elective or traumatic, Upper or lower extremities -Assessment Neurovascular Psychosocial -Emergency interventions: Call 911, Assess ABCs , Apply direct pressure, Elevate extremity, Amputated part care

Sprain define? management?

-Excessive stretching of ligaments -Management: Rest, Ice - 24-48 hours, Compression bandage, Elevation, Immobilization

Strain define? management?

-Excessive stretching of muscles or tendons -Management: Cold/Heat, Activity limitation, Medications

Osteoporosis interventions increase? avoid? do what other 2 things?

-Increased Calcium and Vit D, protein, Vit c, and iron is important to promote bone healing for those sustaining fractures, Soy rice products fortified with Vit D for lactose intolerance -Avoid excessive alcohol & caffeine and tobacco -Exercise -Create hazard free environment

Osteomyelitis management nonsurgical? surgical?

-No surgical management: IV antibiotic therapy started ASAP, Contact precautions, PICC line for home IV therapy, Wound may be irrigated continuously or intermittently with antibiotics, hyperbaric O2 therapy -Surgical management: Reserved for those with chronic cases, Sequestrectomy that debrides necrotic bone, Grafts, Microvascular bone transfer, amputation

7 Immobility complications

-Pressure ulcers, Atelectasis, Venous thromboembolism, Constipation, Urinary retention, Joint contractures, Pneumonia

Fracture equipment

-Traction-Types: Skin or Buck's Skeletal Plaster Brace Circumferential -Purpose:Reduction/Alignment, Rest, Decrease muscle spasm,Decrease pain Examples: walkers, crutches, canes, casts

Imaging of osteoporosis: xrays show? dual xray absorptiometry? baseline DXA scan recommended for?

-X-rays-show fractures and decreased bone density -Dual X-ray absorptiometry (DXA)-most common diagnostic tool for measuring bone mineral density -Baseline DXA scan recommended for women in 40's

Testicular cancer affects? Highly? Risk factors?

Affects men age 20 to 54 Highly treatable and curable Risk factors: cryptorchidism (undescended testicle), HIV +, family history, cancer of one testicle, Caucasian American race

An increase in bicarbonate causes

Amount of H to decrease and pH increase

Ferritin test measures? Normal?

Amount of free iron in plasma and reprqesents 1% of total iron. Normal is 12-300

Isotonic define? Isontonic parenteral solutions define? Risk for?

Amount of water inside cell equal to amount outside. 270-300mOsm/L. Risk for fluid overload.

Penicillins examples? SE?

Amoxicillin aka Amoxil, amoxicillin clavulanate aka Augmentin. SE: watery diarrhea, use additional BC

Vein and catheter selection for older adults

Avoid fragile skin and small veins on back of hand and select IV site higher on arm. Use flat tourniquet. BP cuff, tapping, opening and closing fist, placing extremity lower than heart, applying heat for 10-20 minutes, trendelenburg, hydration can be used for vein distention before venipuncture.10-15 degree angles. Midline or PICC maybe best.

COPD is characterized by? Vs. asthma?

Emphysema and chronic bronchitis aka COPD characterized by broncho spasm and dyspnea and tissue damage not reversible and increases over time? Asthma is chronic but has intermittent reversible airflow obstruction and wheezing

+ homan's sign means

Dorsiflexion of foot with calf pain can mean DVT so report

Positive babinski's

Dorsiflexion of great toe and fanning of others over 2. It's supposed to be plantar flexion

Imaging assessment of colorectal cancer? What is best

Double contrast barium enema, colonoscopy, CT scan, MRI, sigmoidoscopy. Colonoscopy best

Normal symptoms post colonoscopy? If polypectomy or tissue biopsy performed?

Feeling full, cramping, passage of flatus. Small amount of blood in first stool

Preventing aspiration during swallowing for trach

Avoid meals when fatigued, smaller meals, don't hurry, emergency suctioning equipment at hand, avoid thin liquids, thicken all liquids, avoid foods that generate liquids during chewing like fruit, upright position, suction after cuff deflation, eat slowly, dry swallow after each bite, tuck chin down while swallowing, if coughing stop until airway clear, monitor VS

Central herniation from increased ICP

Downward shift of brainstem and diecephalon from supratentorial lesion causing cheyen stokes, pinpoint/no reactive pupils, hemodynamic instability

GI changes in ESRD

Fetor uremicus Nausea, vomiting, anorexia Gastritis, ulceration Constipation

When pouch not possible for fistula due to location

Drainage managed with wall suction or a vacuum assisted closure using catheter

Bubbling in chamber chest tube connects to means? No bubbles? Excess bubbles? Fluctuation in water seal chamber? No fluctuation?

Drainage present, normal during forced expiration/coughing. Kinked tube. Air leak. Normal. Lung hasn't fully expanded or obstruction in tube

INR define? Associated with which drug? Normal is?

International normalized ratio for coagulation to monitor anticoagulant status in warfarin/Coumadin. Normal is 1

Asthma management for self education

Avoid triggers, avoid meds like aspirin/NSAIDs/beta blockers, avoid MSG, bronchodilators 30 min. Before exercise, adequate sleep/rest, reduce stress/anxiety, wash all bedding with hot water for dust mites, monitor peak expirations flow rates 2x daily, seek care if gray/blue fingers/lips+dyspnea+issues walking/talking+retraction of neck/chest/ribs+nasal flaring

What you should avoid and eat for hypophosphatemia

Avoid: milk, cheese, yogurt, collards, rhubarb Eat: fish, beef, chicken, pork, organ meats, nuts, whole grain breads/cereal

Macrolide meds

Azithromycin, Zithromax

Sulfasalazine aka? Does what? SE?

Azulfidine. Decreases inflammation slowing RA. SE: lowers sperm, renal/liver toxicity, urine crystals if not enough water

Folliculitis define? Caused by? Usually? S/S? Treatment?

An infection that arises in the hair follicles, or inflammation of the oil gland from which hair grows •Caused by physical injury-shaving, or occlusion in hair bearing areas •Bacterial etiology, usually staph •Signs & symptoms - pustule occasional papule at hair follicle, ingrown hairs , loss of hair, pustular raised red rash •Treatment - no shaving, use soap, topical or systemic antibiotics

Define hepatopulmonary syndrome

Ascites fluid causes dyspnea due to increased pressure, possible crackles,

Osteoarthritis define? most? aka? characteristics? who has it most?

-noninflammatory degenerative joint disease due to less synovial fluid and enzymes that break down articular matrix and osteophytes aka bone spurs form then fissures, calcifications and ulcerations develop causing thinning cartilage and body repair process can't overcome rapid degeneration so cartilage disintegrates and pieces of bone/cartilage float in joint causing crepitus resulting in pain and stiffness -most common arthritis and major cause of disability in adults. -aka osteoarthrosis or degenerative joint disease(DJD) -Progressive deterioration, Loss of hyaline/articular cartilage, Unilateral. -Older patients+women have it most.

Beta-adrenergic blockers end in? Are? Includes?

-olol. Cardio selective that lowers HR+BP or noncardioselective. Metoprolol/Lopressor, Toprol, propranolol/inderal, atenolol/tenormin

Fluid and electrolyte findings of cirrhosis

Ascites, decreased blood volume. Hypoatremia or hypernatremia, hypocalcemia, hypokalemia, peripheral edema, water retention

Protein intake for DM

15-20% of total daily calories with normal kidney function, microalbuminuria 10% of calories, ESRD <0.8g/kg/day

Diabetes exercise type and amount? Benefits?

150 minutes/week or 30 minutes 5x/day aerobic, Resistance training three times/week if type 2. If ketones are present don't exercise Lowered insulin resistance+BG+triglycerides+LDL, weight loss, raised HDL, better BP and circulation for up to 24-72 hours

Platelet normal?

150,000-450,000 cells/dL

Normal urine output for adults

1500-2000 ml a day or within 500ml of volume ingested

Impetigo define? Predisposing factors? S/S? Treatment?

..is a superficial bacterial infection of the skin, contagious •predisposing factors-break in the skin, dermatitis, warm climates, poor hygiene, children •signs/symptoms/diagnosis:red patches that fill with yellow fluid; then crusts or erosions - culture or gram-stain •Treatment:antibiotics (PCN or derivative), Allergic to PCN treat with Erythromycin; Mupirocin (Bactroban) ointment, contact isolation, avoid scratching

Crystalloids examples

.25% NS, .45% NS, D5W, 0.9% NS, LR, D51/2NS, D5NS, 3% or 5% hypertonic saline

Normal CSF specific gravity? PH? Appearance? RBCs? WBCs? Lumbar protein? Cisternal protein? Ventricular protein? Glucose? Microbes? Opening pressure with lumbar puncture?

1.007, 7.35, clear/colorless, none, 0-8/microliters, 15-45 mg/dL, 15-25mg/dL, 5-15 mg/dL, none, 60-150 mmH2O

Therapeutic PTT? Normal PTT? What drug associated With PTT and platelets?

1.5-2.5 times normal value. 20-30 seconds or 30-40 Heparin and you take PTT before therapy, q 4 hours when therapy begins, and daily after

Magnesium normal? Function? Stored where? Daily oral intake?

1.5-2.5mEq ppt or 1.3-2.1 needed for muscle contractions, proper heart rhythms, nerve functioning, bone building strength, reducing anxiety, carb digestion, ATP formation, vitamin activation, cell growth, keeping stable protein fluid balance, blood coagulation. Stored in bones/cartilage/ICF. Daily oral intake 300mg.

Normal ICP? Increased ICP? Panic level?

10-15 mmHg, 16-20 mmHg, >25

For mild hypoglycemia where hungry, irritable, shaky, weak, headache BG<60mg

10-15g of carbs via glucose tabs/gel, 1/2 cup fruit juice or regular soft drink, 1 cup skim milk, 6-10 hard candies, 4 cubes sugar, 6 saltines, 3 graham crackers, 1 tbsp honey/syrup

BUN serum norm for all and elders

10-20 mg/dL , elders 8-23 mg/dL

Blood urea nitrogen normal? Increased due to? Decreased due to? If dehydrated?

10-20mg/dL. Increased= dehydration, excess protein intake, impaired renal function. Decreased= over hydration, liver damage, malnutrition. if dehydrated false results possible because BUN increases when blood concentrated.

Impaired fasting glucose aka IFG: fasting plasma glucose normal? Random plasma glucose and A1C % normal?

100-125, prediabetes 5.7%

PT normal? Therapeutic range?

11-12.5 seconds. 1.5-2 times normal

Normal cholesterol? Increased due to? Decreased due to?

122-200mg/dL. Pancreatitis or biliary obstruction. Liver damage.

Hemoglobin normal males? Females?

13.8/14-17.2/18gm/dL, females 12.1/12-15.1/16gm/dL

Sodium normal? function? Major? Normal intake in a day?

136-145mEq in ECF. Helps maintain fluid balance needed for muscle contractions, and helps with nerve signaling. Major cation in ECF and maintains it's osmolarity. Normal intake a day is 6-13g

Impaired glucose tolerance IGT 2 hour OGTT glucose normal? Random plasma glucose and A1C% normals?

140-200, prediabetes 5.7%

Fiber intake for DM

14g per 1000 calories, 25 g per day from legumes, cereal, fruits, vegetables, whole grains

Iron facts? Normal for females?males? Intake?

2/3 is contained in hemoglobin, 1/3 stored in bone marrow, spleen, liver, muscle. Normal is females: 60-160mcg/dL, males 80-180mcg/dL, intake 2-6g

Fresh frozen plasma volume? Infusion time? Indications?

200mL 15-30min. Deficiency in plasma coagulation factors, PT/PTT 1.5 times normal

Pain for gastric vs. duodenal ulcers

30-60 min after meal and at night that's worsened with food ingestion vs. 1.5-3 hours after meal, at night usually 1-2 am and relieved with ingesting food

Temp range for insulin vials and pens

32 F- 86 F

Normal arterial PaCO2? Venous?

35-45 mmHg. 40-50mm Hg

ACS Guidelines for Prostate Cancer Screening and Early Detection

50 year old recommend to have PSA Higher risk 45 year old African Americans First degree relative with prostate cancer before 65 Higher risk 40 Multiple first-degree relatives with prostate cancer at early age Prostate Specific Antigen (PSA) >10 ng/mL increase risk of prostate cancer

In acute care settings for hypoglycemia treatment

50% dextrose 20-30mL via IV push, if patient cannot swallow NS no IV access glucagon 1mg IM in deltoid or sub q but can cause nausea/vomiting so to prevent aspiration put patient on their side

To encourage weight loss of 1 pound a week dietician subtracts

500 calories each day

1 pint is how many ml? And 1 pint can also be how many grams

500ml+500grams

water body weight percentages for healthy younger adults, healthy older adults, and kids

55-60%, 50-55%, 80%

Normal ejection fraction

55-65%

Serum amylase normal in international units and regular units?

56-90 international units/L, 25-125 units/L

Teaching for hypoglycemia

5g of CHO raises BG 20mg/dL, I'd BG <50mg/dL 20-30g of CHO, if BG 51-70mg/dL 10-15g CHO

HR normal?

60-100 beats/min

Normal LDLs

60-180mg/dL in high risk, <100mg/dL for moderate risk

DM nutritional therapy carbs minimum/day? Cholesterol? Protein? Fiber? Monitor?

>130 g/day, Cholesterol < 200 mg/day, Limit trans fatty acids (commercially fried foods and bakery items), Protein 15% - 20% of total calories(Decrease with microalbumuria to slow progression of kidney disease), Fiber: improves carbohydrate metabolism and lower cholesterol 25-30 grams /day Add gradually Fruits, vegetables, whole grains, legumes, low-fat milk. Monitor with CHO counting, exchanges, or experienced-based estimation

Reversible ischemic neuro deficit RIND lasts how long

>24 hours but <1 week, s/s come and go

DKA labs: plasma glucose? Arterial pH? Serum bicarbonate? Urine ketones? Serum ketones? Effective serum osmolality? Anion gap? Alteration in sensoria or mental obtundation?

>250 BG, 7.25-<7 pH, 15-<10 mEq/L, positive urine ketones, positive serum ketones, variable, <10-<12, alert/drowsy/stupor/coma

Risk factors for ovarian cancer

>40 years, family history/HNPCC, DM, nulliparity, >30 years 1st pregnancy, breast cancer, colorectal cancer, infertility, BRCA1/BRCA2, early period late menopause, endometriosis, obesity/high fat diet

When to test for DM

>45years, overweight younger BMI >25 and have a 1st degree relative with DM, inactive, high risk ethnic group, had baby >9lbs, hypertensive >140/90, HDL<35 and/or triglycerides>250, polycystic ovary syndrome, IFG/IGT on previous testing, history of vascular disease

Who is at most risk for enlarged prostate?

>50 years. Causes bladder outlet obstruction, urinary stasis, retention, overflow incontinence, and nocturia

Normal HDLs for females? Males?

>55mg/dL, males >45mg/dL

HHS labs: plasma glucose? PH? Serum bicarbonate? Urine ketones? Serum ketones? Effective serum osmolality? Anion gap? Alteration in sensoria or mental obtundation?

>600 BG, >7.3 pH, >15 mEq/L, small urine ketones, small serum ketones, >320 mOsm/kg, <12, stupor/coma

HHS BG level? Most? Serum osmolarity? Ketones? Difference between HHS and DKA?

>600mg/dL. Most severe neuro manifestations because of raised serum osmolality aka hyperosmolar >320mOsm/L. Ketones are absent/minimal. Fewer early s/s so not recognized as quickly, profound dehydration, >600 BG, >320mOsm/L osmolarity, ketosis absent.

Fibrinolytic therapy can be given up to 4.5 hours for patients unless

>80 years, INR < or equal to 1.7, baseline stroke scale >25, history of stroke and diabetes

Signs and symptoms of hypokalemia? Cause?

A SIC Walt. Alkalosis, shallow respirations, irritability, confusion and drowsiness, weakness/weak reflexes and fatigue, arrhythmias, lethargy, thready weak pulse. Hypotension, decreased peristalsis possible paralytic ileus, nausea, vomiting, constipation, abdominal distention. Fluid overload, diuretic therapy, insulin admin, hyperaldosteronism

Patho of pulmonary embolism

A collection of particulate matter (solids, liquids, air) that enters venous circulation & lodges in pulmonary vessels. Large emboli obstruct pulmonary blood flow, reduce oxygenation of all tissues, including pulmonary tissue. Deoxygenated blood moves to arterial circulation causing hypoxemia

Fluids and meds infused through midline catheter should have

A pH between 5-9 and final osmolarity of less than 600 to prevent phlebitis and/or thrombosis. Not for infusion of vesicant meds that cause severe tissue damage is they escape into sub q tissue aka extravasation, nor for parenteral nutrition formulas, dextrose, blood samples

Ketone bodies are? Hyperketonuria? Hypketonuria?

A product of fat metabolism. indicates a severe lack of insulin Hyperketonuria without hyperglycemia suggest wt loss is occurring without disrupting blood glucose control

Guidelines for communicating with non English speaking patients

Interpreters who are same gender/ age if possible, void relatives, speak slowly, use common words, maintain eye contact unless culturally unacceptable, be careful about no verbals

Interventions for hypomagnesemia

Drugs like high-ceiling/loop diuretics, osmotic diuretics, aminoglycosides antibiotics, drugs with phosphorus are all discontinued. IV MgSO4 given but monitor deep tendon reflexes hourly. Oral Mg causes diarrhea increasing Mg loss. If hypocalcemia also present drugs to increase Ca too

GI findings for cirrhosis

Abdominal pain, anorexia, ascites, clay colored stool, diarrhea, esophageal varices, gallstones, gastritis, GI bleeding, hemorrhoids, hepatomegaly, hiatal hernia, hypersplenism, malnutrition, nausea, nodular liver, bloody vomiting

Clinical manifestations of hepatitis

Abdominal pain, changes in skin or sclera, arthralgia aka joint pain, myalgia muscle pain, diarrhea/constipation, changes in color of urine or stool, fever, lethargy, malaise, nausea and vomiting, pruritus aka itching, right upper quadrant pain, jaundice, dark urine and clay stool

Assessment for ovarian cancer

Abdominal pain, swelling or mass Vague GI disturbances, indigestion, gas Urinary frequency or incontinence Enlarged ovary, weight loss, vag bleeding, pleural effusion, ascites, lymphedema, intestinal obstruction

Surgical management of peritonitis

Abdominal surgery to control contamination, remove foreign material, drain collected fluid. Exploratory laparotomy or laparoscopy to remove or repair the inflamed or perforated organ like appendectomy, colon resection with or without a colostomy, for a perforated diverticulum

History assessment for obstruction of intestines

Abdominal surgery, radiation, inflammatory bowel disease, gallstones, hernias, trauma, peritonitis, tumors, recent nausea/vomiting/emesis color, pain, flatus, singultus aka hiccups, colorectal cancer history, blood in stool, bowel pattern, body temp less than 100 for uncomplicated obstruction, temp higher than 100 and elevated pulse could be stangulated obstruction or peritonitis, hypotension

Most important interventions for meningitis

Accurately monitoring and documenting neuro status every 4 hours

Aspirin aka? Does what? SE? Don't use with? Monitor?

Acetylsalicylic acid. Antiplatelets to prevent MI, antipyretic, analgesic, inflammation like arthritis. SE: GI bleeding, n/v, anemia. Don't use w/ anticoagulants+NSAIDs+diuretics+ACE inhibitors. Monitor liver

Who needs dialysis

Acid base, electrolytes, intoxicants, overload of fluids, uremic symptoms AEIOU

AIDET

Acknowledge, introduce, duration, explanation, thanks

Base is ?

Act as either an acid releasing H or base binding with H depending on blood pH

Fecal occult blood test FOBT requires? Compared to FIT

Active component of guaiac. More likely to yield false positives and unlike FIT patient must avoid certain drugs like anticoagulants/NSAIDS and foods like raw fruits/vegetables / red meat

Open surgical repair of hiatal hernia

Activity restrictions for 3-6weeks, use stool softener, laxatives, avoid straining, inspect incision daily, avoid contact with people with respiratory infection, eat smaller more request meals, report swelling/redness/drainage/fever/tenderness/symptoms of cold or flu

Indications for tracheostomy

Acute airway obstruction, need for airway protection, laryngeal trauma, airway involvement during head/neck surgery, requires CXR after to r/o pneumothorax

Interstitial edema

Acute brain swelling and associated with hypertension, increased CSF pressure. Controlled via measures to reduce BP, decrease CSF pressure, or increase cerebral perfusion pressure CPP to above 70

Treatment of SCD crisis focus on? Treatment?

Acute pain from poor perfusion, chronic pain, sepsis potential, organ dysfunction/death potential. Oxygen therapy, hydration, via water/D5W/1/2 NS D5W/hypotonics, pain control, blood transfusions, no constricted clothing, promote venous return, no raised knees, HOB >30 degrees, temp of room >72, check circulation every hour via pulse ox, capillary refill, peripheral pulses, toe temperature, hydroxyurea/Droxia to reduce sickle cells but can cause leukemia and birth defects

Agents for Herpes Viruses

Acyclovir/Zovirax, Famciclovir/Famvir, Valacyclovir/Valtrex, Ganciclovir/Cytovene

Air embolism cause? S/s? Treatment? Prevention?

Air in central venous system during insertion, accidental disconnecting of tubing, tubing changes, catheter rupture/removal. S/S: chest pain, dyspnea, hypoxia, anxiety, tachycardia, hypotension, nausea, light headed, dizzy, loud churning over pericardium. Treatment: prevent inadvertent disconnection, use lcaps, close slide clamp when changing caps, when inserting/removing catheter place patient flat and have them do valsalva maneuver or hold breath, apply occlusive dressing with ointment when removing central catheter and remain in place for 24 hours

Aerophagia define? Prevention?

Air swallowing from attempt to reverse or clear acid reflux. Teach to relax before and after meals, eat and drink slowly , chew food thoroughly, frequent position changed, ambulation, worst case simethicone 80mg four times a day

Home tuberculosis care

Airborne precautions not necessary but all members of household need TB testing. Have patient wear mask in crowds. Sputum specimens needed q 2-4 weeks after drug therapy started . When results of 3 specimens negative they can go back to work

Biological response modifiers aka? Class of ? Do what? Examples? SE?

Aka BMRs/biological. DMARDs. Most neutralize TNF/interleukin for RA via IV/injection. Ex: Etanercept/Enbrel, infliximab/Remicade, adalimumab/Humira, anakinra/kineret, abatacept/orencia, tocilizumab/actemra. SE: infection

Disease modifying anti rheumatic drugs aka? Does what? What type? Examples?

Aka DMARDs. Slows RA. Immunosuppressive. Ex: Methotrexate, leflunomide/Arava, hydroxychloroquine/Plaquenil, biological response modifiers/BMRs

Dual X-ray absorptiometry aka? define?

Aka DXA Most commonly used screening for measuring bone mineral density

raloxifene aka? drug type? does what?

Aka Evista estrogen agonist/antagonist. Prevents And treats osteoporosis

Hydroxychloroquine aka? Does what? SE? Drug type?

Aka Plaquenil. Slows RA. Anti malarial. SE: stomach discomfort, light headedness, headache, retinal damage. DMARD

Thiazolidinediones aka? most effective in those with? Function? Examples? Rarely used because? Doesn't cause?

Aka insulin sensitizers. Most effective in those with insulin resistance Improve insulin sensitivity, transport, and utilization at target tissues and decreases liver made glucose, reduce lipids Pioglitazone/Actose, Rosiglitazone/Avandia. Rarely used because of adverse effects like MI or HF or bladder cancer. Doesn't cause hypoglycemia

Times cruris, corporsis, capitis aka? Spread how? S/s? Treatment?

Aka jockitch, ringworm type fungal infection or groin/scrotum. Spread via direct contact. S/S: itching, gray patches, moist skin. Treatment: Lotrimin topical, Griseofulvin PO, no tight fitting clothes, personal hygiene, shower shoes, avoid sharing personal care items, get rid of pets since can be transmitted from them

Metabolic syndrome aka? Define?

Aka syndrome X, simultaneous of metabolic factors that increase type 2 DM and CVD risk. Include: abdominal obesity waist >40inch for men, >35women, hyperglycemia fasting glucose >100mg/dL, hypertension >130/85, hyperlipidemia triglycerides >150mg/dL HDL <40mg/dL men and <50mg/dL women

Microalbuminuria define? Men and women normal?

Albumin in urine and means endothelial dysfunction in CVD seen in hypertension, metabolic syndromes, DM, kidney disease. 2-20mg, 2.8-28

Colloid examples

Albumin/plasma protein, dextran/polysaccharide, hetastarch

Labs for Muskuloskeletal

Alkaline phosphatase/ALP, muscle enzymes, creatine kinase/CK-MM, aspartate aminotransferase/AST, aldolase/ALD, lactic dehydrogenase/LDH, calcium, phosphorus, H&H, platelets

Cause of relative hypokalemia

Alkalosis, hyperinsulinism, hyperalimentation, total parenteral nutrition, water intoxication, IV with low K

PICCs Can be used for? Can be inserted how long?

All infusions there are no limits and can be used for blood sampling/infusion with pump. Can be inserted for unlimited time

Injected vasodilation drugs for errection

Alprodastril/Caverject, Paverine, phentolamine/Regitine. Complications include priapism aka persistent abnormal erection, scarring, fibrosis, bleedingg, brushing, pain, infectionz

Immunomodulators are drugs that?

Alter immune response in conjunction with steroids decreasing amount of steroids needed. Examples include infliximab aka Remicade, adalimumab aka Humira

Neuromuscular changes for fluid overload

Altered LOC, headache, visual disturbances, muscle weakness, paresthesia

Maalox and mylanta made of? Drug type? When to take? Dose?

Aluminum hydroxide and magnesium hydroxide. Antacids. 1 hour before and 2-3 hours after each meal. 30ml

Emphysema patho

Alveolar sacs lose elasticity, small airways narrow, hyperinflation of lungs causing dyspnea and increased RR Alveoli become enlarged and flabby with a decreased area for effective gas exchange Air trapping because lungs do not recoil which causes increase work of breathing. Diaphragm becomes flat and weak which causes use of accessory muscles & air hunger. CO2 is produced faster than it can be removed which results in respiratory acidosis. pH < 7.35 & CO2 >45. Low arterial oxygen (PaO2) secondary to decreased ability for gas diffusion.

Types of dementias

Alzheimer's Disease Dementia with Lewy Bodies Vascular Dementia AIDS related Dementia Parkinson's Disease Creutzfelot-Jacob Disease

Prophylaxis against contrast induced nephropathy

Aminophylline NS NaHCO3 N-acetylcyteine (Mucomyst) Hold NSAIDS, ACEIs and diuretics

Abcdef interventions for copd

Aminophylline, bronchodilators, chest physiotherapy, deliver o2 at 2-4 liters, expectorants, force fluids

Common drugs of UC

Aminosalicylates, glucocorticoids, antidiarrheals, immunomodulators

Key features of TBI

Amnesia, headache, dizziness, seizure, loss of consciousness or sleepiness, restlessness/irritability, disorientation/confusion, scalp bruising/tenderness, personality changes, Diplopoda, gait changes

Bronchitis patho

An inflammation of the bronchioles and bronchi caused by chronic exposure to irritants Irritant triggers inflammation, vasodilation, congestion, mucosal edema, and bronchospasms Chronic inflammation causes increase in number and size of mucous glands which produce increased amounts of thick mucous. Thick bronchial walls plus increased mucous block smaller airways and narrow large airways resulting in hypoxemia & respiratory acidosis.

OTC drugs for AD

Ancillary treatment with NSAID of vitamin E, antidepressants for behavior haloperidol/Haldol, olanzapine/Zyprexa, quetiapine/Seroquel, risperidone/Risperdal

Significant male hormones? WNL For males/females?

Androgens - Testosterone: primary male hormone; produced by testes; wnl = 280 - 1,080 ng/dL; females wnl = 15 - 70 ng/dL

Hematologic findings of cirrhosis

Anemia, disseminated coagulation. Impaired coagulation, splenomegaly, thrombocytopenia

Causes of respiratory depression

Anesthetics/drugs/electrolyte imbalance/head or neck trauma/pesticides/botulism/brain edema or tumors/cerebral aneurysm/stroke/over hydration

Bruit over abdominal aorta, renal arteries, and iliac arteries can indicate

Aneurysm so don't percuss and notify

Angiotensin 2 receptor antagonists 3 aka? Do what? Includes? SE?

Angiotensin 2 receptor blockers, ARB's, sartans. Selectively block angiotensin. Includes cancersartan/Atacand, losartan/Cozaar

HF drugs

Angiotensin-converting enzyme/ACE inhibitor, angiotensin-receptor blockers/ARB's, diuretics, nitrates, inotropics like beta-adrenergic agonists, phosphodiesterase inhibitors, calcium sensitizers, digoxin/lanoxin

Late clubbing define? Can indicate?

Angle exceeds 180, edematous and spondy when palpated, drumstick appearance. Can mean prolonged hypoxia, emphysema, COPD, lung cancer, cystic fibrosis, chronic heart disease

When to get mammography?

Annually after 40 since can detect that which isn't palpable

Ketones in urine can indicate

Anorexia, fasting, diabetic ketoacidosis, incomplete metabolism of fatty aci

Hep B symptoms

Anorexia, nausea, vomiting, fever, fatigue, ruq pain, dark urine with light stool, joint pain, jaundice

Gaviscon drug type? Made of? Does what? When to take? Dose?

Antacids.alginic acid and sodium bicarbonate. Forms thick foam that floats on top of gastric contents so if reflux occurs foam enters first and buffers acid. after meals and bedtime. 10-20mL

Interventions for hypophosphatemia

Antacids/osmotic diuretics/calcium supplements discontinued. Vit.D and phosphorus supplements given. Nutrition includes increasing phosphorus foods and decreasing Ca food.

Treatment for pneumonia

Anti-infectives: Ceftiazone (Rocephin) IV or Amoxicillin Clavulanate (Augmentin) PO. (used except if viral) Bronchodilators: Albuterol Antitussives: Codeine Sulfate Hydration IV and/or PO High calorie diet Hygiene (oral) and rest Prevention: Pneumococcal vaccine Q5yrs & Influenza vaccine Q1 yr. NSAIDs

Steroid creams action? Do not? Applied? May increase? Should not be? Have local?

Anti-inflammatory action: suppress cell division •Do not cure the dermatitis •Applied only to the lesion •May increase blood glucose •Should not be covered with occlusive dressings to limit the systemic absorption •Have local side effects i.e. atrophy, stinging

Nitroglycerine class? Use?

Antianginal. Acute(translingual+ointment)+long term prophylactic(oral+transdermal) for angina, HF, MI via increasing blood flow, vasodilation. SE: hypotension, tachycardia, syncope. Looses potency fast, wear gloves, glass bottle.

Tube misplacement/dislodgement can cause? If suspected? Check when/how?

Aspiration, aspiration pneumonia, and possible death. If suspected remove. Check before each feeding/meds or q 4-8 hours. X-ray most reliable, but ascultation via 20-30mL air in tube while listening over stomach to hear whooshing, testing aspirate pH/bilirubin/trypsin/pepsin, assessing CO2 because if so in lungs

What drug is recommended 24-48 hours after stroke onset

Aspirin/Ecotrin but shouldn't be given within 24 hours of rtPA

Nonsurgical management of pyelonephritis

Antibiotics and urinary antiseptics, 2L of fluid a day

PID treatment

Antibiotics, analgesics, heat to abdomen/back, semi-fowler's position, avoid sex until antibiotics complete, check temperature, surgery to remove abscesses, extra fluids, no antacids, take antibiotics on empty stomach

Diarrhea predominant IBS-D

Antidiarrheals like loperamide aka Imodium, psyllium bulker. For women alosetron aka Lotronex a serotonin receptor but should report constipation, fever, ab pain, fatigue, darkened urine, bloody diarrhea, rectal bleeding

Minimizing bleeding in PE

Antidotes, monitor q 2 hours, examine stools, measure abdominal girth, assess labs, electric razor, soft toothbrush, no floss, no aspirin, no contact sports, if bumped apply ice, avoid hard foods, check mouth/skin daily, stool softener, no enemas/suppositories, no tight clothes, don't blow nose

Flu treatment

Antiviral Medications- Shorten duration of infections and prevents the virus from spreading through the respiratory tract. Increased fluids Anti-pyretics Bed rest- to decrease O2 demand Pt education- annual vaccines, staying home, hand washing

Thrombosis cause? S/s? Treatment? Prevention

Anything that damages lining, traumatic venipuncture, multiple attempts at venipuncture, too large catheter, hyper coagulable state and venous stasis. S/S: slowed or stopped rate, swelling, tenderness, redness, engorged peripheral veins. Treatment: stop infusion and remove, cold compress, elevate extremity, for central venous catheters notify. Prevention: correct technique, make only two attempts for venipuncture, smallest gauge, secure, arm boards used if inserted at point of flexion, adequate hydration, warfarin for central venous

Most common acute inflammatory bowel problems

Appendicitis, gastroenteritis, peritonitis

Statement included in assessment of mental status

Appropriateness of clothes to weather conditions

Leflunomide aka? Does what? SE? Drug type?

Arava. Diminishes inflammatory arthritis. Given 20mg q day. SE: hair loss, diarrhea, decreased WBCs/platelets, increased liver enzymes. DMARD

Decorticate (Flexion) and Decerebrate (Extension) Postures

Arms adducted and flexed, flexed wrists, internally rotated knees and plantar flexion vs. arms adducted/extended elbows extended, wrists/arms pronated and flexed, plantar flexion, opisthotonos aka spasm bower forward. Both are ate mental deterioration signs

Step 3 of system for med use in asthma control

As needed rapid beta-agonist aka inhaler, daily treatment using one: low dose ICS+ long acting beta-agonist, medium/high dose ICS, low dose ICS and leukotriene modifier, low dose ICS and sustained released theophylline

Stool according to where colostomy is

Ascending colon liquid, transverse colon pasty, descending colon solid

Cardiovascular acidosis key features

At first raised HR as it progresses Delayed conduction ranging from bradycardia to heart block, tall t waves, wife died QRS, prolonged PR, hypotension, thready peripheral pulses

Cyclic enteral nutrition administration

At night over 8-12 hours, same as continuous except stopped for a set time to allow patient to do stuff during day including eating small amounts

Define tinea pedis, corporis, capitis

Athletes foot, body, head from direct contact

Lipodystrophy aka? Caused by? What reduces risk? Hypertrophy regresses if? Using hypertrophied sites can cause?

Atrophy of subcutaneous tissue. Caused by using same injection sites frequently. Human insulin reduces risk. Hypertrophy regresses if patient doesn't use site for at least 6 months. Using hypertrophied sites can cause erratic absorption

What is kept bedside during colonoscopy and what's it for

Atropine sulfate in case of bradycardia

Patient with COPD who has chronic hypercarbia and hypoxemia and received O2 therapy and RR drops below 10 breaths a minute

Attempt to arrouse and if no arrousal reduce O2 flow and re assess, if RR does not increased of SpO2 drops call rapid response

Physical assessment for asthma

Audible wheeze and increased RR, coughing, accessory muscles to breath, barrel chest, anteroposterior diameter increase so hypoxemia, cyanosis, tachycardia

After patient hospitalized for diverticulitis what discharge teaching should you give

Avoid all fiber and as inflammation resolves switch gradually to high fiber diet

PUD nutrition

Avoid caffeine, avoid decaf coffee, bland diet, no bedtime snacks, 6 smaller meals, no tobacco

Preventing or managing hemorrhage with cirrhosis intervention types

Drugs, endoscopic therapies, rescue therapies, transjugular intrahepatic portal systemic shunt

When diagnosis and treatment of peritonitis is delayed

Blood vessel dilation continues and body responds by shunting blood to area aka hyperemia and fluid shifts from extracellular fluid compartment into peritoneal cavity and GI tract aka third spacing resulting in hypovolemic shock resulting in insufficient perfusion of kidneys leading to kidney failure with electrolyte imbalance

Dark red or brown urine can indicate

Blood, increased bilirubin, myoglobin present

Drugs for TBI

Bolus Mannitol/osmitrol to lower ICP, lasix/furosemide, opioids, sedatives like lorazepam/Ativan+midazolam/Versed for anxiety, antieleptics like phenytoin/Dilantin to prevent early onset seizures that occur within 7 days after injury

Ocogenic aka

Bone Tumor induced osteomalacia

Bands 3 means? Aka?

Bands are immature neutrophils and indicate segs have died off due to bacteria and leaves baby cells to do fighting which are less effective aka left shift

Diagnostic for hiatal hernia

Barium swallow study with fluoroscopy. Sometimes esophagogastroduodenoscopy for sliding hernias

During process of healing with GERD

Barrett's epithelium aka columnar epithelium replaced with squamous epithelium which is pre malignant, fibrosis and scarring can cause esophageal stricture aka narrowing leading to difficulty swallowing

Function of skin

Barrier, fluid/electrolyte balance, temp. Regulation, sensory organ, vit. D synthesis

The most common base and acid in body? Ratio? To balance?

Base- bicarbonate HCO3- and acid- carbonic acid H2CO3. Ration is 1 carbonic acid to 20 bicarbonate ions to balance CO2 and H

Postatectomy post op care

Bedrest 24 hours, bladder spasms Ditropan/Urispas, avoid rectal treatments, keep stools soft, avoid sitting for long periods, prevent deep vein thrombosis, increase fluids, hemorrhage, voiding issues, sexual dysfunction

How to prevent somogyi effect

Bedtime snack, reduction of insulin or both

Foods and drinks with oxalate

Beets and strawberries, chocolate, coffee, tea, cola, nuts, wheat bran, rhubarb, spinach

People with type 1 often test BG when

Before meals because many patients use insulin pumps or multiple daily injections and base the insulin dose on the carbohydrates in a meal or make adjustments if the premeal value is above or below target. Testing 2 hours after the start of a meal helps a person see how effectively he or she judged what was eaten or to determine if the bolus insulin dose was adequate for that meal.

Nursing care for parenteral - begin? Monitor? Patient on? Regular insulin? Taper off? If DC? Follow protocol for? Must use?

Begin slowly and advanced to desired rate according to fluid/glucose tolerance and nutrition support team follows, monitor lab values since TPN can change daily and weight IO and signs of infection, patient on BG checks every 6 hours, regular insulting can be added as well as sliding scale, taper off 4-6 hours to avoid rebound hypoglycemia unless patient is taking PO carbs, if DC abruptly hang dextrose D10, follow protocol for changing tubing usually q 24 hours and changing central line dressing usually q 48-72, must use pump

Tertiary health promotion define? Examples?

Begins after an illness is diagnosed & treated to reduce disability & to help rehabilitate patients to a maximum level of functioning •Examples: PT for post stroke patients, support groups for post mastectomy patients, meds, therapy, surgery, rehab, job training

Best labs to check renal function

Best is GFR, and BUN, creatinine

Hypoglycemia can be difficult to recognize due to

Beta blockers

Topical glucocorticoids

Betamethasone/Diprosone, Desoximetasone/Topicort, Hydrocortisone/Hytone, Dexamethasone/Decaderm

Main buffer of ECF

Bicarbonate which comes from intestinal absorption, pancreatic production, kidney reabsorption and breakdown of carbonic acid to form bicarbonate

Fibrocystic breast condition description ? Incidence?

Bilateral fullness/tenderness, bilateral nodules, cysts. Late teens-20s. Treatment: oral contraceptives, Danazol/Danocrine(can cause stroke, liver disease, increased ICP), vitamins, diuretics,

Alkaline reflux gastropathy aka? Due to? Define? Symptoms?

Bile reflux gastropathy. Pylorus bypassed or removed. Regurgitated bile in stomach and mucosa hyperemia. Symptoms: early satiety aka satisfies quickly with little food, abdominal discomfort, vomiting

Systemic therapy for psoriasis

Biologic agents, i.e. adalimumab (Humira) SQ, alter the immune system to help stop skin cells from growing too quickly; causes immunosuppression & patients are @ risk for infection •Cytotoxic agents, i.e. methotrexate, clears skin lesions •Cyclosporine (Sandimmune) induces immunosuppression & is used when other agents fail

Interventions for elderly stomach changes

Bland foods high in vitamins/iron

Activitities that increase intra ocular pressure

Blinding from waist, lifting more than 10 lbs, sneezing/coughing, blowing nose, straining for BM, vomiting, sex, head in dependent positions, tight shift collars

Hemianopsia aka? Results from? Homonymous hemianopsia define?

Blindness in half of visual field results from damage to optic tract or occipital lobe where patient must turn head to scan complete range of vision. Homonymous=both eyes

Selective estrogen receptor modulators SERMs function? Agents?

Block action of estrogen in breast for breast cancer. Tamoxifen/Nolvadex, Raloxifene/Evista. SE:hot flashes and weight gain

Closed loop obstruction aka? Strangulated obstruction aka

Blockage in two different areas. Obstruction with compromised blood flow and major blood loss can result. With both peritonitis increased and bacteria without blood supply can form and release endotoxins into peritoneal or systemic circulation and cause septic shock.

Dipeptidyl Peptidase 4 DDP-4 inhibitor function? Examples? Aka?

Blocks inactivation of incretin hormones aka GLP and GLP-1 ↑ Insulin release after meals ↓ Glucagon secretion ↓ Hepatic glucose production Sitagliptin/Januvia, saxagliptin/Onglyza, linagliptin/Tradjenta. Aka gliptins.

Hemoptysis define

Blood in sputum usually in those with chronic bronchitis or lung cancer

Other assessments for cirrhosis

Blood in vomit and stool which can be due to gastritis, ulceration or oozing esophageal varices. Fetor hepaticus aka fruity or musty breath odor. Amenorrhea aka no period or testicular atrophy. Gynecomastia aka enlarged breasts. Bruising and petechiae. Mental status and personality changes. Asterixis aka course tremor in wrists and fingers

Syphilis diagnose via

Blood test aka venereal disease research lab serum test and rapid plasma reagin. Treatment: bezathine penicilin

Diagnosising gastritis

Blood test to detect IgG or IgM anti h. Pylori antibodies, esophagogastroduodenoscopy via endoscope with biopsy

Aplastic anemia define? Usually accompanied with?

Bone marrow doesn't make enough RBCs. Usually accompanied with reduced WBCs and platelets aka pancytopenia if all three reduced

GeneraliZed seizures occur and involve? Types?

Both cerebral hemispheres. Tonic-clonic with stiffening/rigidity of muscles and loss of consciousness, and clonic/rhythmic jerking after. Absence type with buried loss of consciousness and blank staring with automatisms/involuntary behaviors. Myoclonic that causes brief jerkining/stiffening. Atonic/akinetic where there's loss of muscle tone

Rheumatoid arthritis anatomy

Boutonnière deformity of thumb, ulnar deviation of metacarpophalangeal joints, swan neck deformity of fingers

Preop care for colorectal cancer surgery - if bowel not obstructed or perforated?

Bowel prep with laxatives, enemas, whole gut lavage with sodium sulfate and polyethylene glycol aka GoLYTELY. For all: antibiotics, fluid and electrolyte replacement is setup,

Vagal stimulation and bronchospasm from trach suctioning s/s?

Bradycardia, hypotension, heart block, ventricular tachycardia, a systole, dysrhythmias. If occurs stop suctioning and oxygenate. If bronchospasms bronchodilator given

Most important tool for confirming stroke

Brain imaging via CT is best or MRI if you need it faster

Secondary seizures result from

Brain lesion, disorders, alcohol withdrawal, electrolyte issues, high fever, stroke, injury, drugs, heart disease. Not considered epilepsy

Define mastalgia

Breast pain

Providing for socialization and intimacy needs for AD

Brief no stressful visits from friends, letters, phone calls, limit visitors to 1-2 at a time, , hobbies/activities appropriate, walking, exercising, pets, plants

Upper GI bleeding key features

Bright red or coffee ground vomitus aka hematemesis, tarry stools or frank bright red blood in stools, melena aka occult blood, decreased blood pressure, increased weak and thready pulse, decreased hemoglobin and hematocrit, vertigo, acute confusion, dizziness, syncope

Drugs for diverticular disease

Broad spectrum antimicrobial said like metronidazole aka Flagyl, trimethoprim sulfamethoxazole aka TMZ/Bactrim/Septra, ciprofloxacin aka Cipro, pain meds

Dopamine receptor agonist example? Mechanism of action? Thought that? Increases?

Bromocriptine (Cycloset) Mechanism of action unknown Thought that patients with type 2 diabetes have low levels of dopamine in morning which can interfere with body's ability to control BG Increases dopamine receptor activity

Normal breath sounds

Bronchial/tubular harsh high pitch sounds heard over trachea/mainstem bronchi and inspiration<expiration, bronchovesicular over branching bronchi where inspiration=expiration, and vesicular soft rustling sound over small bronchioles inspiration > expiration

cholinergic antagonist aka? Common examples? Administered how? Not as? Education?

Bronchodilator. Ipratropium/Atrovent. Inhalant. Not as effect as albuterol but for those who cannot tolerate Albuterol. Carry at all times, shake well before use, increase fluid intake to 4L, report blurred vision, eye pain, headache, palpation said, or insomnia, 2-4 inhales a day.

Xanthine aka? Common examples? Used when? SE? Responsibilities?

Bronchodilator. Theophylline PO and aminophylline IV. For when other dilators are ineffective. SE: ^HR, arrhythmias, N/V, irritability, headache, insomnia. Monitor cardiac status, serum blood levels normal levels are 10-20 mcg/ml, levels above 20 are toxic and patient may have seizures+hypotension

Beta adrenergic agonists aka? Common examples? Administered how? SE? Education?

Bronchodilators. Fast acting Albuterol/Proventil/Ventolin, slow acting Salmeterol. Inhalant. SE: ^ HR, ^ BP, arrhythmias. Albuterol carry at all times, teach to monitor HR, take 5 minutes before any other inhalants, 1-2 inhales q 4-6 hours. Salmeterol instruct to shake before use, 2 inhales q 12 hours

Constipation recombinant IBS-C drug example? Function? Drug for women?

Bulk forming laxatives: psyllium hydrophilic mucilloid aka Metamucil that helps prevent dry, hard, liquid stool. For women lubiprostone Amitiza that's a chloride channel activator

Lung cancer treatment

Chemotherapy Radiation Therapy Photodynamic Therapy (Removal of small bronchial tumors) Lobectomy (Removal of the affected lobe) Pneumonectomy (Removal of an entire lung) Chest tube placement (After thoracotomy) Thoracentesis (To remove excess fluid)

Post thoracentesis

Chest X-ray to rule out pneumothorax, and mediastinal shift, monitor VS+breath sounds, deep breathing,

Marasmic-kwashiorkor

Calorie and protein malnutrition

Glomerulonephritis cause?

Can start in kidney due to genetics or immune issues. Secondary to other disease like diabetes, systemic lupus, HIV, hepatitis. Cirrhosis, bacteria , drugs, toxins

Complications of CD

Cancer of small bowel and colon, fistulas, intestinal obstruction

Captopril aka? Class? Use? SE? Monitor for?

Capoten. ACE inhibitor. Causes vasodilation via lowering aldosterone for hypertension, HF. SE: hypotension, dizziness, cough, proteinuria. BP, pulse, weight

Metabolic effects of ESRD

Carb intolerance, hyperlipidemia and insulinemia

Body buffers

Carbonic acid Na bicarbonate, phosphates, proteins

WHEN EXCESS H ARE MADE OR BROUGHT INTO BODY

Carbonic anhydrase equation shift to left causing more CO2

Peripherally inserted central catheter PICC is? Placement requires? Length? Should be inserted when? Which vein is preferred site? Placement must be?

Catheter inserted through vein of anticubital fossa or middle of upper arm. Placement requires special training and certification. Length:18-29 inches with tip in superior vena cava. Should be inserted early before venipunctures/infusions. Basilic vein is preferred site for insertion but cephalic vein can be used. Placement must be confirmed via X-ray if no fluoroscopy used

Hypocalcemia signs and symptoms

Cats. Convulsions, arrhythmias, tetany, stridor and spasms/Charley horses in calf/foot. Paresthesia, muscle twitching/cramps/spasms, positive trousseau's and chvostek, HR and ECG changes with prolonged ST+QT, weak thready pulse, hypotension, hyperactive bowel sounds, osteoporossis with bone breaks and loss of height

Vitiligo caused by? An ? Onset attributed to? Have increased? Appears in? Treatment?

Caused be hypofunction of the adrenal glands •..an acquired disorder characterized by destruction of melanocytes causing skin & hair to lighten in patches •Onset attributed to stress, or trauma •Have increased risk of certain diseases (i.e. thyroid) •Appears in all races; mostly blacks, tropics •Treatment - UV light, mild topical steroid, cosmetics, •No cure....research continues

Hemolytic transfusion relations caused by? S/S?

Caused by ABO/Rh incompatibility. S/S: fever, chills, disseminated intravascular coagulation, circulatory collapse, apprehension, head ache, chest pain, tachycardia, tachypnea, hypotension, hemoglobinuria, sense of doom.

Urticaria caused by? Aka? Management?

Caused by exposure to allergens. Aka hives that are red/white papules/plaques Management: remove triggering substance and relieve symptoms with antihistamines like benadryl, no alcohol or warm environment

Febrile transfusion reactions caused by? Signs?

Caused by leukocyte incompatibility, produces sudden chills and fever

Define ischemic stroke

Caused by occlusion of cerebral artery by slow s/s thrombus or immediate s/s embolus usually occur during sleep get better after initial onset

Ascites

Collection of fluid in peritoneal cavity caused by increased hydrostatic pressure from portal hypertension causing collection of plasma protein in peritoneal fluid and with this decrease combined with inability to produce albumin serum colloid osmotic pressure decreased resulting in third spacing causing hypovolemia and edema which can cause renal vasoconstriction triggering renin angiotensin system resulting in sodium and water retention increasing hydrostatic pressure and vascular volume leading to more ascites

Ancef aka? Function?

Cefazolin. Anti-infective for pneumonia.

Hypotonic fluid cells? Solute concentration? Hypotonic parenteral solutions define? Risk for?

Cells inflate and eventually burst. Solute concentration inside cell is higher. Less than 270mOsm/L. Risk for phlebitis and infiltration

Hypertonic cells? Solute concentration? Hypertonic parenteral solutions define? Function? Risk for? Ex.?

Cells shrink. Solute concentration inside cell lower. Fluids greater than 300mOsm/L. Corrects fluid, electrolyte, acid base imbalances. Risk for phlebitis and infiltration Ex. Parenteral nutrition

hyperphosphatemia signs/symptoms

Centered on hypocalcemia when phosphorus increases. If Ca okay few direct problems

Gonorrhea treatment?

Cephalosporins: ceftriaxone/Rocephin, cefixime/Suprax, azithromycin/Zithromax, doxycycline/Monodox. Diagnosis: molecular testing via nucleic acid amplification test from swab or urine

As ICP increases

Cerebral perfusion decreases, causing hypoxia, decrease in pH, and increased in CO2, which causes vasodilation, edema, more increase in ICP and it cycles until brain herniates toward brainstem or laterally from unilateral lesion

Macro vascular complications are?

Cerebrovascular disease CVA, stroke, cardiovascular disease, acceleterated atherosclerosis, CAD, MI, peripheral vascular disease, blood viscosity and platelet disorders, heart failure, kidney disease indicated by albuminuria

Colposcopy define? Pre? During? Post?

Cervical, vaginal, vulvar epithelium to locate exact site of precancerous and malignant lesions for biopsy. No douching or vag preps for 24-48 hours before, full bladder. No lubes, NS, then acetic acid, inspection. Clean perineum, pad.

Secondary skin lesions

Changes in appearance of primary lesion: Erosion, scar, ulcer, keloid, fissure, scales, atrophy

Diuretic stage of ARF

Characteristics Onset: UOP > 400 ml/day Duration: 1-3 weeks Azotemia persists

Oliguria stage of ARF

Characteristics UOP < 400 ml/day Azotemia Onset 24 hours after injury Duration 10-14 days

Neuropathic arthroplathy aka?

Charcot's foot. Results in gradual ankle and foot changes leading to joint dysfunction and foot drop, hallucinations vagus aka turning inward of great toe, and abnormal distribution of weight over foot further increasing chances of foot ulcer

Recovery from breast cancer surgery

Check dry gauze dressing and change it when soiled, if soiled more than 1x a day notify, empty drainage 2x a day and measure, drains removed when drainage <25 in 24 hours aka 7-10 days, sponge baths/tub baths keeping incision dry, use arm for normal activities but not exercise, numbness normal, if lymph node removal elevate arm for 30 minutes/day for 6 months, loose fitting clothes, active ROM 1 week after

Oxygen therapy best practive

Check prescription, need prescription for humidification if o2 4 L/min+, check skin around ears/neck/face q 4-8 hours, mouth care q 8 hours, pad elastic band +change position of it, pad areas on skin, cleanse cannula/mask q 4-8 hours, lube nostrils/face/lips with no petroleum cream, no smoking/candles,

Monitoring for complications of enteral feedings

Check residuals every 4-6 hours, residuals greater than 150-200ml can increase chance of aspiration so follow hospital protocol whether to hold feedings temporarily, monitor daily labs weight hydration sugar and signs of fluid overload

Gallbladder function

Collects, concentrates, stores bile from liver and releases it in duodenum when fat present

How cholinesterase inhibitors treat Alzheimer's

Cholinesterase inhibitors are drugs that block the activity of an enzyme in the brain called cholinesterase. Cholinesterase breaks apart the neurotransmitter acetylcholine, which is vital for the transmission of nerve impulses. Cholinesterase inhibitors are used to reduce the action of cholinesterase, thereby making more acetylcholine available to nerve cells in the brain to maintain memory.

Asthma aka? Define?

Chronic airflow limitation. Chronic but with reversible airflow obstruction (Unlike COPD which is non-reversible) Triggered by inflammation in the air or airway hyperresponsiveness that causes bronchoconstriction.

Increased WBC from

Chronic disease, anemia, MI, inflammation

Low hematocrit ?

Chronic disease, anemia, angina, heart failure, hemorrhage, hemolysis

Low hemoglobin? High?

Chronic disease, anemia, angina, heart failure, hemorrhage, hemolysis. Hypoxia or polycythemia vera

decreased RBC? Increased?

Chronic disease, anemia, rheumatic fever, endocarditis, hemorrhage. Hypoxia or polycythemia vera

Osteoporosis define? Types? What causes each type?

Chronic metabolic disease in which bone loss causes decreased density and possible fracture Primary Postmenopausal women and men in 7th or 8th decade of life Secondary May result from medical conditions, long drug therapy, or prolonged immobiity Regional Immobility for longer than 8-12 weeks

Lab assessment with COPD

Chronic respiratory acidosis aka increased PaCO2, and metabolic alkalosis aka increased HCO3 as compensation

Psoriasis define? From? S/s? Treamtent?

Chronic, autoimmune disorder of skin resulting in overstimulation of the immune system => ^ cell division & plaque formation => cells being shed Q 4 days vs Q 28 days •Genetic predisposition/component •Signs: thick, reddened papules or plaques covered by silvery, white scaly patches, nail pitting, Psoriatic arthritis may occur •Treatment:Topical corticosteroids w occlusive dressings, Topical tar: suppresses cell division & inflammation, Arthralin, a hydrocarbon similar to tar, Ultraviolet A and psoralen light therapy &/or Natural sunlight, Education regarding chronic skin condition, Provide psychological care re: disturbed body image, adalimumab/Humira, alefacept/Amevive, entanercept/Enbrel, infliximab/Remicade, topical Folex, Mexate both aka methotrexate, cyclosporine/Sandiummine, azathiprine/Imuran

Fluoroquinolones examples? SE? Function?

Ciprofloxacin aka Cipro/Proquin, Levifloxacin aka Levaquin, Lomefloxacin aka Maxaquin, norfloxacin aka Noroxin, ofloxacin aka Floxin, sparfloxacin aka Zagam. SE: keep out of sun, arrhythmias. Function: bactericidal

Rapid acting, short acting, glargine insulins should be

Clear and all others cloudy

Postop instructions for endoscopic therapies for GERD

Clear liquids 24 hours after, after 24 hours soft diet, no NSAIDS or aspirin for 10 days, use liquid meds, don't use NG tubs for 1 month, contact provider if chest/abdominal pain, bleeding, dysphagia, SOB, nausea/vomiting

Viral meningitis CSF appearance? WBCs? Protein? Glucose? CSF pressure?

Clear, increased, increased, normal/decreased, varies

PID diagnosis

Clinical history, physical exam, labs like HCG test, WBCs, ESR, c-reactive protein

Skin prep for colostomy bag

Clipping bag, clean with soap and water, no moisturizing soaps, skin sealant without alcohol, if raw skin stoma powder or paste, paste or filler cream to fill in creases for flat surface

Monofilaments for testing?

Close eyes during, apply at right angle, apply enough to bend, if they can' treeless 10-g force at risk. Tests Protective sensation on soles of feet on big toe and top of soles should be 5.07

Fibrinolytic therapy define? Given when?

Clot busting recombinant tissue plasminogen activit rtPA Retavase drug/thrombolytic therapy for acute ischemic stroke to dissolve cerebral artery occlusion to prevent infarction. Given within 3 hours last seen normal LSN

Bacterial meningitis CSF appearance? WBCs? Protein? Glucose? CSF Pressure?

Cloudy/turbid, increased, increased, decreased, elevated

Interventions for hemorrhoids

Cold packs, sitz bath, topical anesthetic like lidocaine, steroid cream like hydrocortisone, no toilet paper instead use moistened tissue, Dab to wipe don't wipe regularly, diets high in fiber and fluid, stool softener so like docusate sodium/Colace, no spicy foods/nuts/coffee/alcohol , pain meds, no sitting long periods

Herpes simplex 1 aka?define? Transmitted by? Virus remains? Reactivated in? Treatment?

Cold sore. Non genital viral infection of skin or mucous membrane characterized by painful vesicles that erupt & recur •Can be transmitted by respiratory droplets or direct contact •Virus remains dormant in a cluster of nerve cells •Reactivated in illness, stress, fatigue •Treatment - Zovirax (Acyclovir), ointments, avoid skin to skin contact, analgesics to relieve pain; OTC Abreva

Warts define? Caused by? Develops? Will persist for? Have a role in? Spread by? Treatment?

Common benign skin tumor caused by infection with the human papilloma virus •Develops 1 - 8 months after virus lodged in skin •Will persist for years if not treated •Have a role in pathology of certain cancers •Spread by scratching, rubbing •Treatment - cryosurgery , acids

Classifications of pneumonia

Community Acquired (CAP) Onset in the community or within the first two days of hospitalization Hospital Acquired (HAP) Onset 2 days after hospitalization Ventilator Acquired (VAP)

Cystectomy procedures

Complete removal, ileal conduit, continent pouch, bladder reconstruction aka neon bladder, ureterosigmoidostomy

Clients at risk for TB

Compromised immune system (ex. HIV, elderly) People in overpopulated areas (ex. Homeless shelters, Prisons) IV drug abusers

The carbonic anhydrase equation shows that

Concentration of CO2 directly related to concentration of H

Genital warts aka? Cause? Treatment

Condylomata acuminata. HPV. Increases risk for cervical cancer. Diagnosis: Pap test and probe. Treatment: remove warts and treat symptoms: podofilox/Condylox cream, imiquimod/Aldara cream.

Implanted ports consists of? How many lumens? How is it placed?

Consist of portal body, a septum made of self healing silicone over reservoir, and a catheter. Single or double lumen. Sub q pocket surgically created to house port, catheter inserted in vain and attached to port and incision closed and no part of catheter is visible externally.

DM patients who are sick should

Contact doctor, continue meds, Check BG every 4 hours, check urine for ketones, and drink a glass of sugar free liquid every hour, continue meal plan, if cannot eat solids replace with liquids equal to CHO of usual meal

Scabies define? Transmitted how? Signs?

Contagious skin infection caused by mites, close prolonged contact with persons/fomite/pets. S/S: curved linear ridges in skin with itching, found between fingers, wrists, rashes on pressure points or points of flexion

Insulin pump is? How is it operated? Connected to? Program? Potential for?

Continuous ab catheter subcutaneous rapid acting infusion Battery-operated device Program basal and bolus doses that can vary throughout the day based on carbs, activity, illness Potential for tight glucose control

6 Clinical manifestations for fracture?

Continuous pain, Unnatural movement or deformity, Shortening of extremity related to muscle spasms, Crepitus-bone on bone, Discoloration, Inflammation at fracture site

Basal background insulin used to? Examples?

Control glucose levels in between meals and overnight usually for type 1. Long-acting basal and intermediate acting insulin.

Hypoglycemia skin? Dehydration? Mental status? S/s? Glucose? Ketones?

Cool, clammy. Absent. No change. Anxious, nervous, irritable, confused, seizures, coma. Weakened, double vision, blurred vision, hunger, tachycardia, palpitations. <70. Negative

Diagnostics for skin

Cultures, biopsy, wood's black light, diascopy aka blanching skin to look for lesion, KOH test for fungal infections

Nonsurgical management of diverticular disease

Drugs, nutrition therapy, and rest via no coughing, bending, straining to decrease inflammation and prevent perforation of diverticulum

Osteomyelitis/osteoarthritis labs

Elevated to normal WBCs, ESR normal increases as it progresses, high C reactive protein. bone scan using technetium/gallium dx for osteomyelitis, physical exam for OA

Diuretic stage treatment of arf

Daily weights Frequent BP monitoring Accurate I&O Monitor electrolytes and administer supplement Fluid replacement

ARF it's critical to

Decrease or discontinue meds, furosemide watch for hypokalemia, vasodilators, alkalinizer sodium bicarbonate to reverse acidosis

DKA s/s

Decreased glucose in cells causing polyphagia, breakdown of protein/fats, hyperglycemia over 300mg, glucose in urine, polyuria, polydipsia, nausea, vomiting, weight loss, kussmaul, dehydration with loss of Na and K, low blood volume, increased pulse, decreased BP, ketones in blood and urine, fruity breath, acidosis, decreased LOC, coma, death

Vitamin b12 deficiency caused by? Causes?

Decreased intake of food, or malabsorption of b12 aka pernicious anemia from deficiency of intrinsic factor for vit. B12 absorption which can be from small bowel resection, gastrectomy, chronic diarrhea, diverticula, tapeworm, overgrowth of intestinal bacteria. Causes pernicious anemia via shillings test

Actions to preserve perfusion during dehydration starting with decreased effective circulating volume

Decreased venous return, decreased CO, decreased pressure, increased baroreceptor stimulation, increased sympathetic discharge leading to: 1. Renin angiotensin aldosterone mechanism 2. Compensatory: increased constriction, contractility, venous return, HR, SV, peripheral resistance, CO

Edema shifts of plasma

Elevation of venous hydrostatic pressure Decrease in plasma oncotic pressure Elevation of interstitial oncotic pressure

Goals of treatment for CKD

Delay progression, treat manifestations, chronic renal replacment therapy, I and O, daily weights, possible order fluid restrictions, protein restrictions, K restriction, Na restriction if hypertension, limit dairy and phosphate, monitor electrolytes, manage anemia with iron, folic acid, growth hormones, prevent renal osteodystrophy with phosphate binders Sevelmer, Renagel, calcium supplement, vitamin D calcitriol aka Rocaltrol, BP management, correct acidosis with calciminetics and cenacalet aka Sensipar

Venturi mask

Deliver most accurate o2 concentration without intubation by pulling in RA for each L of O2. 25-50% o2 and 4-10L/min flow. Keep adapter open, change to nasal cannula for meal, no kinks

Alzheimers is a type of

Dementia that cannot be cured with s/s slowly progressing until dysphagia, incontenence, requires total self care

Glycemic index describes? High glycemic index foods?

Describes rise in BG after carb ingestion, high glycemic index foods increase glucose faster

Splenomegaly causes? First sign of?

Destroyed platelets causing thrombocytopenia and increased risk for bleeding. First clinical sign of liver dysfunction

Hemoglobin electrophoresis

Detects abnormal forms of hemoglobin, A is normal, S seen in sickle cell

Nasogastric tube used to

Determine presence of blood in stomach, access bleeding rate, prevent gastric dilation, administer lavage

Counterimmunoelectrophoresis CIE

Determines presence of viruses or Protozoa in CSF, or given if patient has received antibiotics before CSF obtained

Whipple's triad

Determines whether hypoglycemia, manifestations consistent with low BG, low plasma glucose, and resolution of s/s after plasma glucose raised

Common causes of Hyponatremia with actual sodium deficits

Diaphoresis, lasix/furosemide, wound drainage, decreased aldosterone, hyperlipidemia, kidney disease, NPO, low salt diet, cerebral salt wasting syndrome, hyperglycemia

Upper airway obstruction s/s

Diaphoresis, tachycardia, hypertension, hypoxia, hypercarbia, restlessness, anxiety, stern all retractions, see sawing chest, abdominal movements, feeling of impending doom, air hunger

Hiatal hernias aka? Define? Types

Diaphragmatic hernias. Protrusion of the stomach through the esophageal hiatus of the diaphragm into the chest. Sliding and paraesophageal rolling hernias,

Assessment for iron deficiency

Diet in relation to foods high in iron like red meat, organ meat, egg yolks, kidney beans, leafy greens, raisins. Income and local resources, unusual bleeding, family history, fatigue, activity intolerance, weakness, pillow, brittle nails, smooth beefy tongue

Assessment for b12 deficiency

Diet, family and surgical specifically abdominal history. Jaundice, glossitis aka smooth beefy tongue, fatigue, weight loss, paresthesias, boor balance. If pernicious via shilling test to measure b12 in urine after radioactive B12 ingested and if not in urine pernicious anemia

Expressive/Broca's/motor aphasia

Difficulties speaking and writing, patient understands what is being said and that they have deficit

Yellow brown nails clinical findings and significance?

Diffuse yellow to brown can mean jaundice, lymph edema, infection, psoriasis, diabetes, cardiac failure, staining, tetracycline, normal aging. Vertical brown banding is normal in dark skinned patients or negus/melanoma in light skinned

Seizure meds

Dilantin/Phenytoin, Ativan/Valium/diazepam, Valium, phenobarbitol/lumenal sodium sulfoton, tegretol/carbamazepine, neurontin/gabapentin, Cerebyx/fosphenytoin, depakote/divalproex

Varicocele define? Treatment?

Dilated veins behind and testis. Varicocelectomy to prevent sterility

After abdominal surgery or in patient with peritonitis or paralytic ileus bowel sounds will be

Diminished or absent

Massive ascites assessment

Distended abdomen with bulging flanks, dilated abdominal veins aka caput medusae, orthopnea, dyspnea, problems with balance, inguinal or umbilical hernias

Drug therapy for cirrhosis fluid excess? Side effects of loops? Example of diuretic that is K sparing

Diuretics. Furosemide aka Lasix Can cause hypokalemia, Hyponatremia. Spironolactone aka Aldactone conserves K

Storage of insulin: don't? In-use vials? Extra unused insulin? Avoid? Store prefilled syringes?

Don't heat/freeze. In-use vials left at room temp. For up to 4 weeks. Extra unused insulin refridgerated. Avoid direct sunlight. Store pre filled syringes upright for 1 week if 2 insulin types, 30 days for one

Management of system in chest tube drainage systems

Don't strip chest tube, keep lower than chest, keep tube straight, securely taped, assess bubbling/tidaling, check water level in water seal chamber and suction control chamber, document characeteristics of collection chamber, empty collection chamber before drainage makes contact with bottom of tube, when sample drainage needed for culture after cleaning use small needle to sample

Obtaining blood samples don't use? Shouldn't be done within? Central venous and midline?

Don't use short peripheral catheter. Shouldn't be done within an hour of completion. Central venous and mid lines samples can be altered due to drugs but if patient has no venipuncture sites or fearful of needles do it.

Peripheral neuropathy safety

Don't wear new shoes longer than 2 hours, no pointed toe or heels >2 inches, inspect daily, test water temp <110 F, high fiber foods, 2-3L water/day, no rugs, use hand rails

HPV test

Done at same time as Pap for women >30years and for those with abnormal pap. Tests for viruses that can lead to cancer

Examples of cholinesterase inhibitors that maintain memory

Donepezil hydrochloride/Aricept, rivastigmine tartrate/exelon, galantamine hydrobromide/ reminyl

Ileostomy symptoms to watch for? If stomas swelling, ab cramping, distention, or ileostomy contents stop draining?

Drastic increase or decrease in drainage. If stomas swelling, ab cramping, distention, or ileostomy contents stop draining: remove pouch with faceplate, lie down, knee chest position, abdominal massage, moist towns on ab, hot tea, and if none of those work notify

Define lethargic? Stuporous? Comatose?

Drowsy/sleepy but easily awakened. One arousable with vigorous/painful stimulation. Unconscious and no arousal

ADA recommends metFORMIN as initial therapy for type 2 because

Drug doesn't induce weight gain or hypoglycemia and low cost but shouldn't be given to those with kidney disease, with increased creatinine > 1.5-1.4 and side effects of abdominal discomfort and diarrhea, liver disease, HF, >80years, conditions that decrease drug clearance, can cause lactic acidosis

Stevens-Johnson syndrome define

Drug induced skin reaction with local skin involvement, severe, or systemic with mix of vesicles, erosions, crusts, if severe respiratory issues, fluid loss, kidney injury, blindness treatment is to remove the drHansen's disease. mycobacterial infection of the peripheral nervous system with skin involvement causing plaques, red macules, papules, nodules, reduced skin sensation; uncommon in USA. Treatment: stop drugDapsone/DDS/Avlosulfon, rifampin/Rifadin/Rimactame, clofazimine/Lamprene, ofloxacin/Floxin, minocycline/Dynacin/Minocinug

Lumen occlusion cause? s/S? Treatment? Prevention?

Drug precipitate, lip if sludge from fat emulsion, blood clots/fibrin from blood reflux, allowing admin set to stay connected for extended periods after med infused. S/S: infusion stops, inability/difficulty drawing blood/admin fluids, increased resistance of flushing. Treatment: extended period, not suggest, for drug precip determine pH and use hydrochloric acid for acidic and sodium bicarbonate for alkaline drugs, for blood clot use thrombolytic enzymes such as alteplase. Prevention: flush with NS between/before/after meds, use positive pressure flushing when negative fluids connector being used, use positive fluid displacement needless connector

Nonsurgical management of hiatal hernias

Drug therapy like antacids and histamine receptor antagonists, nutrition therapy, lifestyle changes like GERD

For patient with kidney problems with hyperkalemia? Name generic/trade name of drug. How long can it take to reduce? If K dangerously high?

Drug therapy to increase K excretion includes cation exchange resins that promote intestinal sodium absorption and K excretion like sodium polystyrene sulfonate aka Kayexalate but can take many hours to reduce. If K dangerously high additional measures like dialysis are needed

Memantine/Namenda function

Drug which is reported to reduce the clinical deterioration in moderate to severe AD

TB interventions for long term

Drugs 6 months - 2 years isoniazid/INH, rifampin, pyrazinamide, ethambutol, MDR-TB. Encouragement to assure fatigue will decrease and after 2-3 weeks treatment no longer will be contagious. Educate importance of med compliance they need to always have med on hand and possible personal MAR, possible liver damage so no alcohol

Nonsurgical management of chronic pancreatitis

Drugs for pain and nutritional therapy via pancreatic enzyme replacement therapy, h2 blockers, proton pump inhibitors, sodium bicarbonate, TPN, TEN, 4000-6000 calories a day, no alcohol or fat

Interventions for hypercalcemia drugs discontinued? What drugs used?

Drugs like Ringer's, thiazide diuretics, Ca based antacids are discontinued. IV NS used, furosemide/Lasix used, calcium chealators/binders like plicamycin/Mithracin and penicillamine/Cuprimine, phosphorus, calcitonin aka Calcimar, biphosphonates aka etidronate, prostaglandin synthesis inhibitors like aspirin and NSAIDs.

Respiratory acidosis interventions

Drugs like bronchodilators, anti inflammatory so, mucolytics. O2 therapy. Ventilation support with mechanical ventilation. Preventing complications via monitoring

Nursing care for hemodialysis

Drugs like dialyzable, antibiotics, don't give right before dialysis, vasoactive drugs cause hypotension, Don't take BP or blood on access arm, watch fluid intake since there are restrictions and encourage rest

Cause of actual hypokalemia

Drugs like diuretics aka loop Lasix/furosemide, bumetanide/Bumex and thiazide/digitalis/corticosteroids/adrenergic agonists, increased aldosterone, cushing's, diarrhea, vomiting, wound drainage, NG suction, diaphoresis, kidney disease, NPO

Chronic gastritis interventions

Elimination of causative agents, treatment of underlying disease like uremia/Crohn's, avoidance or alcohol/tobacco, health teaching, vitamin b12 supplement

Hypomagnesemia signs and symptoms

Dumb blonde heiress running. Dysphagia, BP high, HR high aka tachycardia, reflexes high like cramps, tremors/numbness/tingling, positive trousseau and Chvostek signs. Muscle weakness, tetany, seizures, psychological depression, psychosis, confusion, hypoactive bowel sounds, anorexia, nausea, constipation, ab distention, possible paralytic ileus

Complications of gastrectomy

Dumping syndrome, alkaline reflux gastropathy, afferent loop syndrome

Afferent loop syndrome occurs when? Cause?

Duodenal loop partially obstructed. Pancreatic and biliary secretions fill intestinal loop which becomes distended causing painful contractions and nausea/vomiting 20-30 minutes after eating

GERD key features

Dyspepsia aka heart burn, regurgitation leading to aspiration/bronchitis, coughing, hoarseness, wheezing, water brash aka hypersalivation, dysphagia, odynophagia aka painful swallowing, epigastric pain, belching, flatulence, nausea, pyrosis and retrosternal burning, globes aka feeling of something in back of throat, pharyngitis , dental caries, chest pain, asthma

Preventing weight loss with COPD

Dyspnea management via resting premeals, small meals, use bronchodilators 30 minutes before meals. Urge to eat high calorie high protein foods

After patient hospitalized for diverticulosis what discharge teaching should you give for eating? What should they not eat?

Eat diet high in cellulose types of fiber like wheat bran, whole grain breads, and cereals 25-35g per day. Fresh fruits and vegetables are added to bulk stools. If they cannot tolerate recommended fiber retirement psyllium hydrophilic mucilloid aka Metamucil can be taken to increase size and consistency, drink fluids to prevent bloating. No nuts, corn, popcorn, cucumbers, tomatoes,nails, strawberries. Fat shouldn't exceed 30% daily caloric intake

Secondary health promotion define? Attempts to? Examples?

Efforts to detect & treat existing preclinical problems at earliest possible stage; screenings when at least 1 risk factor present •Attempts to discover a health problem at a point when intervention may lead to control or eradication ◦Early Detection via screenings and counseling ◦Prompt Diagnosis ◦Prompt Treatment •Examples: medical, dental, vision screening medication administration, wound care

Nutritional management of hyperkalemia you can eat

Eggs, bread, butter, cereal, sugar, fruits like apples, apricots, berries, cherries, cranberries, grapefruit, peaches, pineapple. Vegetables like alfalfa, cabbage, carrots, cauliflower, celery, eggplant, green beans, lettuce, onions, peas, peppers, squash

Diuretic stage of ARF complications

Electrolyte depletion Hypokalemia Hyponatremia Hypovolemia Hypotension

Acidosis can cause

Electrolyte shifts like K can shift into extracellular space causing hyperkalemia

Labs for over hydration? Aka?

Electrolytes normal, decreased hemoglobin, hematocrit, and serum protein due to excess water aka hemodilution. Specific gravity under 1.005

EMG

Electromyography uses electrodes to evaluate diffuse or localized muscle weakness usually accompanied with nerve conduction study

Labs for acute pancreatitis for amylase, lipase, trypsin, elastase, glucose. Calcium, magnesium, bilirubin, alanine aminotransferase, leukocytes, BUN, triglycerides, c reactive protein, platelets, albumin

Elevate amylase, lipase, trypsin, elastase, glucose. Decreased calcium and magnesium. Elevated bilirubin, alanine aminotransferase , leukocytes, BUN, triglycerides, c reactive protein. Decreased platelets, albumin

Lab assessment of hep a, b, c for alt? AST? Alkaline phosphatase? Bilirubin? Other lab tests to confirm

Elevated ALT and AST, alkaline phosphatase and bilirubin elevated. Antigen antibody test, ELISA, liver biopsy

Labs for liver disease for AST, ALT, LDH, alkaline phosphatase, bilirubin, urine urobilinogen, fecal urobilinogen, total protein, albumin, globulin, ammonia, PT, INR. Platelets, RBC, hematocrit, hemoglobin, WBC, creatinine, sodium

Elevated AST ALT LDH alkaline phosphatase bilirubin and urine urobilinogen. Decreased fecal urobilogen. For acute disease increased total protein, for chronic decreased total protein. Decreased albumin. Elevated globulin, ammonia. Prolonged PT and INR, platelet count low, low RBC count, hematocrit, hemoglobin and WBC. Elevated creatinine and low sodium

Hypovolemia lab indications

Elevated BUN, decreased proteins, increased hematocrit

Labs for dehydration? Aka? Not present when?

Elevated hemoglobin, hematocrit, serum osmolarity, glucose, protein, BUN, electrolytes aka hemoconcentration but it's not present when dehydration cause by hemorrhage because loss of all blood and plasma occurs together

Thiazolidinedione SE? Take when?

Elevated liver enzymes, fluid retention, must have periodic blood tests, increased fat, edema. Take before or 30 min. Before meal

Rheumatoid arthritis labs

Elevated rheumatoid factor, antinuclear antibody, ESR

Treatment for neurogenic bladder

Emptying every 3 hours in sitting position to prevent stasis+infection, tightening ab muscles during voiding, using Crede's maneuver aka mild massage downward over lower abs and bladder, cholinergic agonist drugs like bethanechol/Urecholine, catheters

Late stage AD interventions

Encourage ADLs as much as possible for feeling of independence. Validation therapy: recognize and acknowledge feelings/concerns of patient. Example: pt. looking for deceased mother ask to talk about what Mom looks like to not argue and not reinforce the belief

Exercise for Muskuloskeletal encourage? Walking? Promote?

Encourage weight-bearing exercises Walking - 30mins, 3-5 times/week Promote sunlight intake

Gynecological cancers types? Early disease? S/s?

Endometrial (uterine), Cervical, Ovarian cancers Early disease may not have symptoms. S/S:depend upon location & may include vaginal discharge, pain, bleeding, & systemic symptoms (weight loss & anemia).

Which female reproductive cancer is most common type

Endometrial cancer, most deadly: ovarian

Colonoscopy define? Suggested after what age? How often? Procedure? Prep? Positioning of patient?

Endoscope exam of entire large bowel. 50. Every 10 years. Endoscope through rectum and also allows tissue biopsy, sclerotherapy drug can be admined for bleeding. Prep: clear liquid diet the day before without red, orange, purple drinks, NPO except water 4-6 hours, patient drinks liquid sodium phosphate prep for cleaning bowel the night before or gallon of goLYTELY. Left side with knees up. Post: check Vs every 15 minutes

Endoscopic therapies for hemorrhage related to cirrhosis

Endoscopic variceal ligation aka banding to manage esophageal varices where bands around base of varices decrease blood flow. Endoscopic sclerotherapy aka sclerotherapy where varices injected via catheter to stop bleeding

Hysterscopy define

Endoscopy of uterus and cervix

Low molecular weight heparin LMWH examples? SE? Antidote? Labs?

Enoxaparin/Levenox, dalteparin/Fragmin, tinzaparin/innohep, fondaparinux/Arixtra. SE: thrombocytopenia, thrombosis, anemia, hyperkalemia, bleeding. Antidote: protamine sulfate. PT+PTT 1.5-2.5 X the control .

Postop for tracheotomy

Ensure patent airway, confirm bilateral berate sounds, respiratory assessment q 2 hours

Priorities for hypokalemia

Ensuring oxygenation, patient safety for falls, prevention of injury from potassium admin, monitoring response to therapy

Fluid/electrolyte imbalances due to enteral

Enteral feeling osmolarity isotonic 300mOsm to hypertonic 600 mOsm. Even when feed isotonic ECF can become hypertonic unless hypotonic fluids ingested/admined, increased osmolarity causes intracellular and interstitial water to move in plasma increasing water excretion causing osmotic dehydration and if patient has no normal renal/cardiac function can cause circulatory overload and pulmonary edema. Most common is hyperkalemia and hyponatremia due to hyperglycemia induced hyperosmolartiy causing the osmotic diuresis

Etiology of IBS

Environmental, immunologic, genetic, hormonal, stress factors, in US more likely in women, diet, intolerance to dairy, raw fruits, grains

Physical assessment for peptic ulcer disease

Epigastric tenderness at midline between umbilicus and diploid process, if perforation rigid boardlike abdomen and rebound pain, hyperactive bowel sound, dyspepsia, nausea/vomiting, orthostatic BP for fluid volume deficit, increase in pulses when going from sitting to standing, dizziness

Cardiac arrest 1st drug

Epinephrine aka adrenaline for perfusion

Hepatitis can also occur secondary to what infections

Epstein Barr, herpes simplex, varicella zoster, cytomegalovirus

Increased CO2 levels force

Equation to right and increase concentration of H proportionately

Endoscopic therapy for PUD what device used? Procedure? Preop?

Esophagogastroduodenoscopy used. Can isolate bleeding artery to embolism it using octreotide aka Sandostatin of terlipressin aka Novapressin. Preop: insert catheters, NPO 4-6 hours before, consent form. Postop: monitor VS, heart rhythm, o2, ability to swallow, gag reflex

Diagnostic for PUD

Esophagogastroduodenoscopy, nuclear medicine GI bleeding study

After seizures?

Establish airway (post ictal) Turn head to side Suction and/or oxygen as needed Check VS Check blood glucose Orient and reassure patient Document

Clinical manifestations if osteomyelitis

Fever above 101 Swelling around the affected area Erythema of the affected area Tenderness of the affected area Bone pain that is constant, localized, and pulsating; intensifies with movement Ulceration of the skin Sinus tract formation Localized pain Drainage from the affected area Possible bacteremia

Which statement about Glasgow coma scale is correct

Establishes a baseline for eye opening and motor and verbal response and LOC

Significant female reproductive hormones

Estrogens (prod. by ovaries; placenta, adrenal glands) - Progesterone (prod. by ovaries; placenta; adrenals) - Androgens & Relaxin - Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)

C-peptide evaluate? Evaluate? Exogenous does not? Distinguish between?

Evaluate hypoglycemia Evaluate production of insulin made by the body (endogenous) and help differentiate it from insulin that is not produced by the body -medication (exogenous Exogenous does not generated C-Peptide Distinguish between type 1 and type diabetes

FOBT and sigmoidoscopy interval after screening? Comments?

Every 5 years.FOBT two or three samples from three consecutive bowel movements obtained at home

Lacto ovo vegetarian diet you can eat

Everything but meat

Laparoscopy define?

Exam of pelvic cavity to rule out ectopic pregnancy, evaluate ovaries, pelvic masses, aid in diagnosis of infertility, pelvic pain, sterilization, cyst aspiration, removal of tissue, lysis of adhesions, retrieval of intrauterine devices

A woman in her 30s ask the nurse about breast self exam (BSE). The nurse teaches her to

Examine breasts 1 week after LNP, stand in front of mirror, palpate when lying down, palpate when bathing/showering, lie down with arm overhead

PTH decreases Ca by

Excess Ca in plasma. Then thyrocalcitonin TCT from thyroid is increased and Ca decrease by inhibiting bone resorption of Ca, inhibiting vit. D associated intestinal uptake of Ca , and increasing kidney excretion of Ca in urine.

Hypercalcemia signs and symptoms for cardiovascular-including if mild or if severe/prolonged, neuromuscular, GU and GI

Excess clotting causing slow/impaired blood flow/asymmetrical calf/cool feet, dysrhythmias/arrhythmias, heart block, shortened QT interval, mild causes high HR + hypertension, severe/prolong=slow HR, cyanosis/pallor, altered LOC, no paresthesia, Muscle weakness, decreased deep tendon reflexes, polyuria, anorexia. Nausea, vomiting, absent or hypoactive bowel sounds, constipation, abdominal pain, and increased abdominal size

Common causes of fluid overload

Excess fluid replacement, late kidney failure, heart failure, corticosteroid therapy, syndrome of inappropriate ADH, psychiatric disorders with polydipsia, water intoxication

Priority problems for cirrhosis

Excess fluid volume, potential for hemorrhage due to portal hypertension, potential for hepatic encephalopathy due to shunting of portal venous blood and or increased serum ammonia levels

Common causes of Hyponatremia with dilution

Excess ingestion of hypotonic fluids, psychogenic polydipsia, freshwater submersion, kidney failure, irrigation with hypotonic fluids, inappropriate ADH secretion, heart failure

Actual cause of hypercalcemia

Excess intake of Ca and vit.D, kidney failure, thiazide diuretics

Physical assessment for cirrhosis early stages? Late stages?

Fatigue, weight changes, anorexia, vomiting, abdominal pain and liver tenderness, thrombocytopenia. Late stages: GI bleeding, jaundice, ascites, spontaneous bruising, dry skin, rashes, purpuric lesions aka petechiae or ecchymosis, red palms of hand, vascular lesions with red center and radiating branches aka spider angiomas on nose cheeks thorax and shoulders, edema of extremities and sacrum, sicca syndrome, osteoporosis, vitamin A D E K deficiencies

TB s/s?

Fatigue/ Lethargy Weight loss/ Anorexia/nausea Low grade fever/chills Night sweats SOB Persistent Cough/blood sputum Chest tightness with pain Wheezing/dullness/crackles Hemoptysis

Factors contributing to decreased lower esophageal sphincter pressure

Fatty foods, caffeine, chocolate, citrus, tomatoes, smoking, calcium channel blockers, nitrates, peppermint, alcohol, anticholinergic drugs, high levels of estrogen and progesterone, NG tubes

Peripheral parenteral nutrition PPN define? Does This? Less? For?

Feeding via peripheral vein. Doesn't meet all nutritional needs. Less concentrated than TPN. For shorter term therapy

Parenteral nutrition define? Examples.

Feeding when GI cannot be used via IV. Ex. Hyperalimentation aka hyperal, TPN though central veins like PICC or subclavian/jugular, PPN through cannula/catheter in large vein of arm or PICC when some patients can eat a little using IV fat/lipid emulsions and amino acid dextrose, TNA

Side effects of bone marrow/stem cell transplant/replacement

Fever, hypertension, possible red urine, nausea, Pancytopenia aka too few blood cells, graft vs. host disease, veno-occlusive disease aka liver blood block causing jaundice, pain, ascites, weight gain Treatment: Tylenol/acetaminophen, hydrocortisone, DIPHENHYDRAMINE/Bendryl before infusion, antihypertensives or diuretics, TPN, fluid/electrolyte management, blood products, antibiotics, GVHD prophylaxis

Transient ischemic attack TIA lasts how long

Few minutes to a fewer than 24 hours, s/s come and go

Without inflammation diverticula cause?

Few problems unless undisguised food or bactia become trapped and blood supply reduce resulting in diverticulitis which can perforate causing peritonitis and develop an abscess.

TPA

Fibrinolytic drug for PE if large+hemodynamic instability where BP cannot be maintained

Nonsurgical management of acute ischemic stroke

Fibrinolytic therapy and endovascular interventions, possible endarterectomy if thrombus

Fibroids need? During embolization ? This causes?

Fibroids need a blood supply to stay alive and grow. During the uterine artery embolization procedure, the blood supply is purposely blocked. This causes the fibroids to die off.

Leiomyomas aka? Are?

Fibroids/myomas. Are benign, slow-growing solid tumors of uterine myometrium (muscle layer)

Promoting continence with stroke

Figure out why they are incontinent, place patient on bedpan/commode or offer urinal q 2 hours, encourage intake of 2000ml/day, bedside bladder ultrasound for residual urine check to ensure full bladder emptying, have them drink apple/prune juice and consume high fiber foods, stool softener/Colace, no in dwelling catheter

Sunburn define? S/s? Treatment?

First degree/superficial burn. Erythema aka redness and pain. Treatment: comfort, antibiotics if blisters, topical corticosteroids for pain, NSAIDs for inflammation

HHS TREATMENT

First priority: increase blood volume, if shock/severe hypotension NS, otherwise 1/2 NS at 1L/hour to get slow steady improvement in LOC, then after fluid replacement IV insulin then when urine adequate IV K

Hypotonia aka

Flaccid paralysis where patient cannot overcome force of gravity and extremities fall to side and feel heavy and don't have good muscle tone

Symptoms of kidney tumors

Flank pain, blood in urine, palpable kidney mass, pain, bruit, pallor, darkening of nipples. Breast enlargement aka gynecomastia

If patient on mechanical ventilation, agitated, restless, widely fluctuating inspiratory pressure reading, or other signs of air hunger

Flow rate may be too low so increase

High flow systems vs. low flow system

Flow rate that meets entire oxygen needs regardless of breathing pattern vs. doesn't provide enough o2 to meet total o2 need and air volume so tidal volume supplied by RA

Perforation interventions

Fluid and blood and electrolyte replacement. Antibiotics, NPO, maintain nasogastric suction monitor intake and output and VS , look for septic shock like fever, pain, tachycardia, lethargy, anxiety

Weight is most reliable indicator of?

Fluid gain/loss

Maintaining patent tube flush with? If flushing after drugs? If clogged? If water not effective? Dissolve?

Flush with 20-30mL of water q 4 hours during continuous feeding/before and after intermittent feeding or drugs/after checking residual. If flushing after drugs use warm water. If clogged use 30mL water for flushing with 50mL syringe. If water not effective use carbonated beverage. Use liquid meds that are compatible with solution. Dissolve crushed meds in warm water

Physical assessment of pneumonia

Flushed cheeks, bright eyes, anxious, chest pain/discomfort, myalgia, headache, chills,, fever, cough, tachycardia, dyspnea, tachypnea, Hemoptysis, sputum production, chest weakness, crackles or possible wheezing, bronchial breath sounds, fremitus, dull percussion, diminished/unequal chest expansion, hypotension, rapid/weak pulse if hypoxemia, dysrhythmias, increased RR, blood/rust sputum, fever, pleuritic chest pain

Hypernatremia clinical manifestations fried salt? Neuro changes? Muscle and reflex changes?

Flushed skin and low fever, restless/irritable/anxious/confused, increased blood pressure and fluid retention, Edema, decreased urine output and dry mouth, skin flushed, agitation, low grade fever, thirst. Seizures, lethargic, stuporous/comatose, muscle twitching, irregular contractions, weaker muscles, reduced reflexes, irregular CV changes. With hypovolemia pulses difficult to palpate and hypotension, with hypervolemia distended veins, BP high, bounding pulse

Partial seizures aka? Begin where?

Focal/local seizures. Begin in 1 cerebral hemisphere. Some are partial and can become generalized tonic-clonic, tonic or clonic and others are complex

Mini mental state exam follow a? Repeat? Write? Copy? Assess?

Follow a 3 stage command(3) "Take paper in right hand, fold in half, and place on floor" Repeat and Obey "Close your eyes"(1) Write a sentence(1) Copy a design(1) Assess Level of Consciousness

Restorative proctocolectomy with ileo pouch anal anastomosis for? Performed via? What occurs?

For UC. Performed via laparoscopy. Removal of colon and most of rectum and creation of internal pouch then connected to anus and temp. Ileostomy to allow healing afterwards loop ileostomy closed

Total parenteral nutrition

For patients whose GI tract not functioning, anticipated under nutrition greater than 7 days, those who need complete bowel rest for healing like Crohn's, UC, pancreatitis. Goal to establish positive nitrogen balance, maintain weight, decrease muscle wasting. May reduce morbidity and mortality after major surgery, burns, head trauma.

Total proctocolectomy with parmanent ileostomy for? Procedure?

For those who are not candidates or don't want ileo anal ouch. Removal of colon, rectum, and anus with surgical closure of anus, end of ileum out through abdominal wall to form stoma aka ostomy and small intestines eventually performs same functions as colon including absorption of sodium and water

Intraosseous therapy for? Volume? Gauge? Use no longer than? Don't use in? Can cause? Sites?

For trauma, burns, cardiac arrest, DKA or life threatening conditions when veins cannot be found. Large volume parenteral infusions with 15-16 gauge for IO. Use no longer than 24 hours, don't use in osteoporosis, osteogenesis. Can cause fractures, compartment syndrome causing hypoxia,pain, coolness, swelling, discoloration. Sites: proximal tibia most common, distal fetus, medial malleolus in ankle, proximal humerus, iliac crest.

Direct injury vs. indirect head injury

Force produced by blow to head vs. force applied to another body part with rebound effect or brain

Diets low in fiber that cause less bulky stool and constipation have been implicated in

Formation of diverticula and retained un digested food in diverticula can cause diverticulitis, the retained food reduces blood flow to area making bacterial invasion easier

Teriparatide aka? Does what?

Forteo acting as PTH to treat osteoporosis

Tissue trauma from suctioning can result from

Frequency, prolonged suctioning, excess pressure, no rotation of catheter. Prevention: lube with sterile water/saline before, suction only when needed, apply suction during withdrawal using twirling motion

Chronic cholecystitis define? What's usually presents.

From repeated cystic duct obstruction causing chronic inflammation which causes gallbladder to become fibrotic and contracted resulting in decreased motility and deficient absorption and possible pancreatitis and cholangitis aka bile duct inflammation due to backup of bile and can then lead to jaundice. Calculi.

Food containing carbs

Fruits, vegetables, whole grains, low fat milk

Ultrasound for kidney requires

Full bladder

Uremia Define? Manifestations?

Full blown kidney failure causing buildup of nitrogen in urine and manifestations include anorexia, nausea, vomiting, cramps, pruritus, fatigue, lethargy

What's assessed after finding proteinuria?

GFR via creatinine clearance tests and patients with nephropathy have rise in serum creatinine due to BG/hypertension

Managing neuropathic pain

Gabapentin/Neurontin, pregabalin/Lyrica, duloxetine/Cymbalta, capsaicin cream/Zostrix, bed cradle to keep blankets off skin

Preventing genital warts

Gardasil vaccine for females/males, cervarix for females

Dumping syndrome can be caused due to

Gastrectomy for gastric ulcer

GERD aka? Occurs due to?

Gastroesophageal reflux disease. Reflux of GI contents into esophagus causing inflammation

Etiology of cholecystitis

Genetic, obesity, aging, DM, rapid weight loss, prolonged fasting, long term TPN use, gastric bypass, Crohn's, women, increased cholesterol, birth control

Wandering behavior can often be reduced by? Restraints should be?

Gentle persuasion/distraction, restraints should be avoided since increases agitation

Preventing cervical cancer

Girls/young women 9- 26 years should receive HPV vaccine, Gardasil or Cervarix(gives longer protection) before first sexual contact. Pap smears/pelvic exam. 3 injections over 6 months Gardasil for boys & men 9 - 26 years

For patient with sever hypoglycemia BG <20mg/dL who cannot swallow, unconscious, convulsing

Glucagon 1mg sub q or IM, repeat dose in 10 minutes if patient remains unconscious, notify

Type 2 DM define? Aka? Most? Age at onset? S/S? Risk factors? S/s?

Gradual Ranges from insulin resistance with relative deficiency to partial secretory deficit with insulin resistance. Aka adult onset diabetes AODM/non-insulin-dependent diabetes IDDM/ketosis-resistant. The most common type. >50year. Usually none, thirst, fatigue, blurred vision, vascular/neuro issues. Risk factors: Metabolic syndrome(3-5 s/s): overweight, age, genetics, hypertension, high level of triglycerides, decreased HDLs, ethnicity like Blacks, Asians, Hispanics, Hawaiians, Native American. Few symptoms

HHS onset? Precipitating factors? Manifestations? Serum glucose? Osmolarity? Ketones? Ph? HCO3? Na? BUN? Creatinine? Urine ketones?

Gradual. Infection/stress/poor fluid intake. Altered neuro, dehydration/electrolyte loss causing polyuria, polydipsia, weight loss, dry skin, sunken eyes, lethargy/coma. >600. >320. Negative. >7.4, >20mEq. Normal/low. Elevated. Elevated. Negative

Foods with folic acid

Green leafy, liver, yeast, dried beans, nuts

Tuberculosis, pulmonary infarction, bronchial adenoma, lung abscess sputum

Grossly bloody sputum

Robitussin aka? FunctioN?

Guaifenesin. Thins secretions to act as expectorant of mucus. Can cause dizziness

Etiology of peptic ulcers

H. Pylori, NSAIDs, COX-2 inhibitors like Celebrex, corticosteroids, theophylline, caffeine, radiation, genetics

Most gastric and duodenal ulcers caused by

H.pylori

Drugs for gastritis

H2 receptor antagonists, mucosal barrier fortifier, antacids, proton pump inhibitors

Recommended dietary allowance for water? Carbs? Proteins? Fiber? SOdium? K? Dairy? Mg? Sugar? Fat? Alcohol?

H20: 2 - 3 L/day •Carbohydrates: @ least 100g/d; 45-65% of calories •Protein: 56-63 g/day; 10-20% of calories •Fiber: 14 g/1000 calories (Whole grains,fruits/veg) •Sodium: <2,300 mg (~ 1 tsp salt)/day •Potassium: 4,700 mg/day •Calcium/Dairy: 1000 mg/day (3 cups) •Magnesium: 310 - 420 mg/day •Sugar: Women: 6 tsp Men: 9 tsp •Fat: 30% of total calorie intake Alcohol: women 1 drink/day, men 2

HBA1c in relation to mean plasma glucose

HBA1c 6% when glucose 126mg/dL, for each 1% of HBA1c raised how much higher does plasma glucose raises 28 more

Interventions for increased ICP

HOB 25-30 degrees, oxygen therapy, head in midline/neutral position, if severe hemiparesis position on side, no flexion, no clustered procedures, hyper oxygenating before suction, quiet room, low lights, VS q 1-2 hours

Post breast conserving/mastectomy surgery

HOB 30 degrees, affected are elevated on pillow, hand wall climbing, pulley exercise, rope turning

Interventions for ICP

HOB 30 degrees, neck neutral, Avoid valsalva maneuver and increases in intrathoracic and intra-abdominal pressure and aggitated states, Suction only when needed with hyperventilation, Avoid fluid overload, O2 >92% and paCO2 30-35, prevent hypoxia since high O2=vasoconstriction, prevent hypercapnia since paCO2 is vasodilator, maintain MAP at 60-80 minimum, control ICP below 25

Risk factors for cervical cancer

HPV infection, Smoking, Younger than 18 years old with first intercourse; Multiple sex partners, History of STDs, Obesity, Family history of cervical cancer, Sexual partner had a previous partner who developed cervical cancer

cardiovascular changes due to dehydration

HR increases, peripheral pulses weak, BP and pulse pressure decreases, orthostatic/postural hypotension, neck and hand veins are always flat even when no raised above heart(they're supposed to be distende above heart or supine)

After giving fluids for dehydration what should you look for

HR should go down

Genital herpes aka? S/S? Drug Treatment?

HSV-2. S/S: itching/tingling, vesicles/blisters, headaches, fever, malaise, swelling of lymph nodes, painful urination. Acyclovir/Zovirax, famciclovir/Famvir, valacyclovir/Valtrex

Dermatological findings of cirrhosis

Hair changes, caput medusae, ecchymosis, increased pigmentation, jaundice, palmar erythema, pruritus, spider angiomas

My plate

Half meal should be fruits/vegetables, 1/4 grains with at least half whole grains,1/4 protein, small glass of dairy

Nonsurgical interventions for appendicitis

Keep patient with suspected or known appendicitis on NPO, IV fluids, semi fowlers, only after diagnosis of appendicitis can you give opioids and antibiotics and don't give laxatives or enemas, no heat

Preventing CR-BSI

Hand hygiene , maximal barrier precautions using draped head to toe with sterile barrier when inserting central line and use sterile gloves/gown/mask, chlorhexidine for skin disinfection, PICC preferred over subclavian vascular access devices, subclavian sites better than jugular and upper arm, remove line as soon as it isn't needed

CDC recommendation for preventing catheter related bloodstream infections

Hand hygiene before palpation, clip hair, don't shave, ensure skin clean, wear clean gloves, don't touch access site after application of antiseptics, prepare clean skin with 70% alcohol or chlorhexidine before insertion, apply providing iodine to skin and allow it to dry for at least 2 minutes

Preventing HAV

Hand washing, avoiding contaminated food and water, immunoglobulin within 14 days of exposure, vaccine,

Treating amputation pain

Handle residual limb carefully, calcitonin, beta blockers like propranolol for constant dull burning, antiepileptic drugs like carbamazepine/tegretol or gabapentin/Neuronten for sharp pain, antispasmodic like baclofen/Lioresal for spasms/cramping, antidepressants, ultrasounds therapy, massage, heat, biofeedback, relaxation therapy, hypnosis, psychotherapy TENs

Most common cause of paralytic ileus aka nonmechanical obstruction? What predisposes patient to this? Can also be caused by?

Handling of intestines during abdominal surgery and usually function lost for a few hours to several days. Electrolytes disturbances like hypokalemia predispose patient. Can also be caused due to peritonitis, vascular insufficiency aka intestinal ischemia due to arterial or venous thrombosis/embolization

Leprosy aka? Define

Hansen's disease. mycobacterial infection of the peripheral nervous system with skin involvement causing plaques, red macules, papules, nodules, reduced skin sensation; uncommon in USA. Treatment: Dapsone/DDS/Avlosulfon, rifampin/Rifadin/Rimactame, clofazimine/Lamprene, ofloxacin/Floxin, minocycline/Dynacin/Minocin

How is cerebral motor/brain stem integrity assessed

Have them close eyes and hold arms perpendicular with palms up if they can't keep it up and palms pronate aka pronation drift there is issue

If patient has s/s of epididymitis/orchitis

He will need to have cultures done first; antibiotics; analgesics & antipyretics. Ultrasound study is done to R/O an abscess or tumor, esp. if the condition does not resolve within 1 to 2 weeks. CXR is not indicated for a client without respiratory symptoms or reports

Ulcer complications

Hemorrhage causing hematemesis, melena, perforation causing peritoneal cavity leakage resulting in sudden sharp pain and rigid board like abdomen aka peritonitis and septicemia and hypovolemic shock and possible paralytic ileus, pyloric obstruction

Most common complications of PUD

Hemorrhage, perforation, pyloric obstruction, intractable disease

Normal nutrition for cirrhosis

High carbs+proteins, moderate fat

Interventions for elderly large intestines changes

High fiber diet, 1500ml fluids, activity

Meningococcal meningitis high? Occurs most in? Usually caused from?

High mortality within 24 hours. Occurs most in outbreaks with high populations during fall/winter from upper respiratory tract infections. Usually caused from s. Pneumoniae and neisseria meningitidis

TF formula

High osmolality that draws fluid into stomach and intestine, hyperosmolar diuresis and brain dehydration, diarrhea, nausea

Factors that can lead to hepatic encephalopathy in patients with cirrhosis

High protein diet, infections, hypovolemia, hypokalemia, constipation, GI bleeding, drugs

Patient scheduled for EEG how does rn prepare patient

Keeping patient awake from 2am until test time

Hits nails clinical findings? Significance?

Horizontal white banding or areas of opacity from liver or kidney disease or hypoalbuminemia. Generalized pallor due to shock, anemia, arteriosclerotic changes, MI

Nutrition therapy for CD during severe exacerbations? For less severe? Avoid?

Hospitalized for bowel rest with total parenteral nutrition. For less severe exacerbations elemental or semi elemental Vivonex which absorb in jejunum to permit distal small intestine and colon rest. Avoid GI stimulants like caffeine and alcohol

Assess respiratory status and drainage of chest tube?

Hourly, not emptied unless container so full, notify if drainage >100ml/hr. After first 24 hours assess q 8 hours

Morbidity vs. mortality

How frequently a disease occurs vs. number of deaths

BRCA1 & BRCA2

Human genes if mutated altered=cancer

Metabolic acidosis interventions

Hydration, if due to DKA insulin, antidiarrheals if due to diarrhea, bicarbonate if low, monitoring s/s and ABG

ICP can lead to

Hydrocephalus and cerebral edema, hernia tion of brain

Thiazide trade name? Aka? Use?

Hydrodiuril. Diuretic. Hypertension, edema via increasing Na+H2O+Cl+K excretion

Antispasmodic example

Hyoscyamine aka anaspaz, cystospaz. SE: blurred vision, confusion, dizziness, fainting, fast heartbeat, fever, difficulty passing urine, dilated pupils

Common causes of actual hypernatremia

Hyperaldosteronism, kidney failure, corticosteroids, Cushing's syndrome, excess oral sodium, excess sodium IV fluids

DKA labs

Hyperglycemia >300, low bicarbonate <15, and acidosis pH <7.3, with ketonemia, and ketonuria,

Excess loss of CO2 cause

Hyperventilation from fear/anxiety/mechanical ventilation/salicylate toxicity. Hypoxemia-stimulated from hyperventilation, high altitudes, shock, early stage acute pulmonary problems, fever, CNS lesions

Causes of delirium

Hypoglycemia Hypoperfusion of CNS Hypoxia Intracranial bleed Meningitis/encephalitis Poisons/Medications High fever Electrolyte imbalance HIV/AIDS Elderly in unfamiliar environment Thiamine deficiency

Hypoinsulemia can cause

Hypokalemia when treatment with insulin begins

Neuromuscular acidosis key features

Hyporeflexia, skeletal muscle weakness, flaccid paralysis

Priority patient problems for acidosis

Hypotension, decreased perfusion, impaired memory, increased risk for falls

Complications from mechanical ventilation

Hypotension, fluid retention, barotrauma, volutrauma, stress GI ulcer, paralytic ileus, malnutrition, infection, muscle weakness, ventilator dependence

S/s of increased ICP

Hypotension, hypoxemia, hypercapnia, Cushing's triad aka hypertension with widened pulse pressure and bradycardia, thready/irregular/rapid pulse, headache, n/v, seizures, papilladema aka choked disc and is edema+hyperemia of optic disc

Key features of prerenal azotemia aka acute renal disease

Hypotension, tachycardia, decreased CO, venous pressure, urine output, and lethargy

0.45% saline tonicity? Provides? Used to replace? Used as. How many kcal/L provided?

Hypotonic.Provides free water and sodium & chloride Used to replace hypotonic fluid losses Used as maintenance solution although it does not replace daily losses of other electrolytes Provides no calories

Sickle cell disease pathophysiology

Hypoxia, dehydration, infection, venous stasis, pregnancy, alcohol, high altitudes, low/high temp., acidosis, exercise, stress, anesthesia causes sickling of RBC and hemolytic blood destroying anemia, clogs capillaries leading to more hypoxia and sickling leading to ischemia and necrosis mostly in spleen, liver, heart, kidney, brain, joints, bones, retina

Suctioning can cause

Hypoxia, tissue trauma, infection, vagal stimulation, bronchospasm, cardiac dysrhythmias

Cor pulmonale from COPD key features

Hypoxia/hypoxemia, dyspnea, fatigue, enlarged liver, warm/cyanotic hands/feet, bounding pulses, cyanotic lips, distended neck veins, right ventricular enlargement, visible pulsations below sternum, GI issues like nausea/anorexia, dependent edema, metabolic/respiratory acidosis, hypertension

PET supposed to be given but patient suspected of having early Alzheimer's, which statement indicates he didn't understand info

I will be asleep and get mild med to relax. Correct: add or subtract to remember, blindfolded, no insulin in morning

Nonsurgical management of peritonitis

IV fluids, broad spectrum antibiotics, monitor daily weight, intake and output, NG tube to decompress, NPO, O2, pulse oximetry, pain meds

IV urography aka? Pre? Procedure?

IV pyelography. Prep: light meal, clear liquids, or NPO midnight/8 hrs before, bowel prep, check allergies, asthma, kidney failure, metFORMIN, check creatinine, consent. Procedure: dye injected via IV and can cause warm sensation, nausea. Metallic taste, incontinence

ISBAR or ISBARR define

Identify yourself, situation, background, assessment, recommendation, response that receiver provides

The Rule of 15 to treat hypoglycemia

If <70mg/dL 15g of simple fast acting carb like 4-6 oz of fruit juice or soft drink, gels/tabs with specific amount of glucose to carry around, recheck BG 15 min. Later if value still <70mg/dL 15g more cards and recheck BG in 15 minutes, if no significant improvement after 2-3 doses contact provider, because of potential for rebound hypoglycemia after have them ingest complex carb after recovery to prevent hypoglycemia

Treatment for hypoglycemia

If BG <70mg/dL, if more than 70 mg/dL investigate further for cause, if no monitoring equipment initiate treatment.

Tube feeding care/maintenance

If NG or nasoduodenal small tube verified via xray and secured with tape after skin protectant, assess site for infection/excoriation via redness/drainage, rotate tube 360 degrees each day , cover site with sterile dressing every day, check residual q 4-6 hours by aspirating into syringe, if residual feeding obtained slow/stop feeding, check pump, change feeding bag q 24-48 hours, label bag with date/time/initials, change irrigation set q 24 hours,for continuous/cyclic feeding add 4 hours of product to bag at time, closed system preferred, wear gloves, wipe lid of formula can with clean gauze, sterile gloves for critically ill/immunosuppressed, label cans with date/time, refridgerate cans, discard cans q 24 hours, no dye, keep HOB elevated 30 degrees during feeding and for at least 1 hour after if bolus, semi-fowler's for cyclic/continuous, monitor labs and I/O

Acute gastritis interventions

If bleeding or ulceration sever blood transfusion or surgery like gastrectomy/pylori lastly/vagotomy, fluid replacement

ED surgery if caused by? Candidates are? Not recommended for?

If caused by artery blockage leading to penis, this used to restore blood flow. Candidates are younger where blockage stems from injury. Not recommended for older men with widespread narrow arteries

Labs for hyperkalemia if caused by dehydration? If caused by kidney failure?

If dehydration: other electrolytes H&H are elevated. If kidney failure elevated creatinine and BUN, decreased pH, and normal/low H&H

Interventions for hypernatremia if life threatening? If due to fluid loss? If due to fluid and Na loss? If caused by poor kidney excretion? If mild?

If life threatening hemodialysis or blood ultrafiltration. If due to fluid loss hypotonic IV like 0.225% NaCl. If due to fluid and Na loss IV of 0.45% NS. If caused by poor kidney excretion diuretics like furosemide/Lasix or bumetanide/Bumex. If mild nutrition therapy like increasing water intake or NaCl restriction

Romberg sign

If patient stands with eyes close and sways and tests propioreceptive and means cerebellar issue

Surgical management of diverticular disease done when? Procedure done?

If peritonitis, bowel obstruction, or abscess. Colon resection with or without colostomy, possible anastomosis if no severe inflammation or infection.

Minor head injury education for home

If person is sleeping wake q 3-4 hours 1st 2 days asking name/location/name of caregiver, headache/nausea/dizziness normal for 24 hours, acetaminophen for headaches q4 hours, no sedatives/sleeping pills/alcohol for 24 hours, no strenuous activity for 48 hours, no nose blowing/ear cleaning for 48 hours, notify if blurred vision/ear+nose drainage/weakness/slurred speech/vomiting/worsening headache/unequal pupil size

Braden scale when to initiate skin breakdown protocol

If score <16, High risk for skin breakdown, initiation of skin breakdown protocol, high protein diet with 1.25-2g protein/kg/day

Treatment of HHS and DKA

In order:Ensure patent airway, admin of O2, IV NS or 0.45% NS to restore U/O to 30-60mL/hr and raise BP, hemodynamic monitoring for fluid overload, continuous regular insulin drip at 0.1 U/kg/hr, avoid hypoglycemia, be sure U/O at least 30ml/hr before IV K+, monitor EKG, check BG, correct precipitating cause, when BG >250mg/dL IV glucose admin via 5D5 1/2 NS, monitoring of cardiac/renal/mental status

Prosopagnosia

Inability to recognize oneself and other familiar faces

Catheter dislodgement causes? S/s? Treatment? Prevention?

Inadequate securement, excess activity with PICC. S/s: external length changed. Treatment: stop all, flush, determine external catheter length and compare with documentation, notify. Prevention: proper securement, no excess activity

Care postop for inpatient fundoplication

Incentive spirometry , deep breathing/coughing, NG drainage should be dark initially but then turn yellowish green, check for proper NG tube placement every 4-8 hours, frequent oral hygiene, assess hydration status

Older adults and GERD

Incidence of heart burn decreases and instead chest pain. Ear, nose, throat infections. Pulmonary issues like aspiration pneumonia, sleep apnea, asthma.

Yellow-orange skin cause? Significance?

Increase bilirubin/jaundice, increased cartotene/carotemia, increased urochrome. Increased hemolysis, liver disorders, increase in carrots, pregnancy, thyroid deficiency, diabetes, kidney disease

Treatment for b12 deficiency

Increase foods with b12 like animal protein, eggs, diary. Vitamin supplements or injections or cyanocobalamin/Calomist

Gastroenteritis define

Increase in frequency and water content of stools and or vomiting as result of inflammation of the mucous membranes of stomach and intestinal tract Due to virus/bacteria/parasite

Treatment for dawn phenomenon

Increase in insulin or adjustment in admin time

Portal hypertension define? Results from? Causes?

Increase in pressure within the portal vein greater than 5 mm Hg and major complication of cirrhosis and results from increased resistance or blockage causing blood to flow back into spleen causing splenomegaly aka spleen enlargement and veins in esophagus stomach intestines abdomen and rectum become dilated. Can cause ascites aka abdominal fluid, esophageal varices aka distended veins, prominent abdominal veins aka caput medusas and hemorrhoids

As amount of Co2 rises above normal in brain blood and tissues this triggers

Increase in rate and depth of breathing aka hyperventilation decreasing CO2 in ECF

Vasogenic edema

Increase in volume of brain tissue due to abnormal permeability of the walls of cerebral vessels which allow protein rich plasm to infiltrate into extra space of brain

cardio alkalosis key features

Increased HR, normal/low BP, increased digitalis toxicity, thready pulse

Hypoxia s/s

Increased HR/BP, oxygen desaturation, cyanosis, restlessness, anxiety, dysrhythmias and pulse oz <90

Cause of hypermagesemia

Increased Mg intake like antacids/laxatives, kidney disease, hypothyroidism, adrenal insufficiency

CNS alkalosis key features

Increased activity, anxiety, irritability, tetany, seizures, positive Chvostek's, positive Trousseau's, paresthesia, dizziness, confusion

Endocrine findings for cirrhosis

Increased aldosterone, ADH, estrogens, glucocorticoids

Blue skin cause? Significance?

Increased in deoxygenated blood/cyanosis, bleeding from vessels aka petechiae 1-3mm, Ecchymosis >3mm. Cardiopulmonary disease, methemoglobinemia, thrombocytopenia, blood vessels fragile

Pulse 114 and RR 24 can mean

Increased metabolic needs from infection or DKA, fluid volume deficit, metabolic acidosis

Increased bowel sounds from

Increased motility aka borborygmus from diarrhea gastroenteritis or intestinal obstruction or Crohn's disease

GI and renal changes for fluid overload

Increased motility and enlarged liver, possible urine reduction

Cardiovascular changes due to fluid overload

Increased pulse rate, bounding pulse, full peripheral pulses, elevated BP, distented veins, engorged varicose veins, weight gain

Respiratory alkalosis key features

Increased rate and depth of ventilation in respiratory alkalosis, decreased respiratory effort associated with muscle weakness in metabolic alkalosis

Respiratory changes due to dehydration

Increased rate because decreased volume reduces perfusion and oxygenation

Potential complications of acute pancreatitis

Infection that can cause septic shock, hemorrhage aka necrotizing hemorrhagic pancreatitis, kidney failure, paralytic ileus, hypovolemic shock, pleural effusion, respiratory distress syndrome, atelectasis, pneumonia, multi organ system faili m disseminated intravascular coagulation, type 2 DM, jaundice, hyperglycemia,

Foul smelling urine can indicate

Infection, dehydration, foods, drugs

Cloudy urine can indicate

Infection, sediment, high levels of protein

Infectious cystitis is most common? Indwelling catheters? Commonly from what bacteria? Can lead to? Most common cause of

Infectious cystitis most common type of UTI ~50% of patients with indwelling catheters become infected within 1 week Commonly E. Coli Can lead to Pyelonephritis Can lead to life-threatening complications Urosepsis-spread from urinary tract to bloodstream The most common cause of sepsis in hospitalized patient

FSH decreased means? Elevations mean?

Infertility, anorexia, neoplasms. Turner's syndrom

Pathophysiology of cirrhosis? In early disease? As it progresses?

Inflammation caused by toxins or disease causes destruction and tissue becomes nodular that can block bile ducts and blood flow. In early disease causes liver enlargement, firmness, and hardness. As continues liver shrinks

Epididymitis define? Treatment?

Inflammation of epididymis. CBR; scrotal support & elevation; ice; antibiotics after urine & prostate cultures obtained; NSAIDs; scrotal support; 0 lifting or sex X 4 weeks. If abscess, orchiectomy (removal of 1 or both testes

Cholecystitis define? Types?

Inflammation of gallbladder. Acute: calculous or acalculous or chronic

Acute gastritis caused by? Pathological manifestations? Healing occurs when?

Inflammation of gastric mucosa after exposure to local irritants. Pathological manifestations are thick reddened mucous membrane with rugae aka folds, necrosis and inflammation possible . Heals after a few days.

Benign prostatic hypertrophy

Inflammation of prostate resulting in urinary stasis and retention aka overflow urinary incontinence causing dribbling of urine, UTIs, calculi, dilation of ureters aka hydroureter and kidneys aka hydronephrosis and chronic kidney disease, hematuria

High sensitivity C reactive protein aka hsCRP elevation confirms? Normal?

Inflammation/inflammatory disease like RA or infection, tissue damage, hypertension, increased risk for CAD. <1mg/dL

Circulatory overload cause? S/s? Treatment? Prevention

Infusion of fluids greater than system needs. S/s: SOB, cough, BP raised, edema, neck veins engorged, moist breath sounds. Treatment: slow rate, notify, upright position, monitor VS, O2, diuretics. Prevention: monitor I/O, notify as soon as noticed

Respiratory: decreased H or CO2 does what?

Inhibits RR and depth retaining CO2 increasing H and decreasing pH

Alcohol in relation to DM? Is more likely to cause hypoglycemia when?

Inhibits liver glucose causing hypoglycemia, interferes with counterregulatory response, impairs glycogen breakdown. Patient doesn't eat for long time, when basic nutrition poor, glycogen stores depleted so only drink with or shortly after meal

Primary skin lesions

Initial reaction:Macule, patch, bulla, vesicles, papule, plaque, wheat, tumor, pustule, cyst

Chronic complications a diabetic retinopathy

Initially no changes in vision, painless, visible retinal changes, complains of glare annual eye exam with dilation to monitor, see ophthalmologist if blurred/double vision/narrowed field of vision/seeing dark spots/ feeling pressure+pain in eyes

Nontunneled percutaneous central venous catheter CVCs

Inserted by physician through subclavian vein in upper chest or internal jugular vein and in worst case femoral vein and inserted into SVC and confirmed via X-ray. 7-10 inches long. And 1-5 lumens. Use: for trauma, or emergency, critical care, surgery. usually short term but No specific dwell time.

Colposcopy define

Inspection of cervix, vagina, vulva with biopsy

Ab assessment technique

Inspection via standing at side looking down or at eye level, auscultation with diaphragm, percussion, palpation

If 2-4 AM BG high

Insulin dose should be increased and patient should be counseled on bedtime snacks

Exogenous insulin is from? Required for? Prescribed for?

Insulin from an outside source Required for type 1 diabetes Prescribed for patients with type 2 diabetes who cannot control blood glucose by other means during stress like illness

Basal insulin vs. prandial

Insulin secreted at low levels during fasting vs increased levels after eating

If predawn levels less than 60 mg/dL or 3.3 mmol/L and s/s of hypoglycemia present

Insulin should be reduced

In both intestinal obstructions

Intestinal contents accumulate at and above area of obstruction causing distention, peristalsis increases stimulating more secretions adding to distention, bowel then becomes edematous and increased cap permeability causes leaking into peritoneal cavity and intestinal lumen decreasing absorption further and reduced circulatory blood volume causes hypovolemia and electrolyte imbalances, possible bacterial peritonitis with or without perforation

Incretin hormones are released by? Increases when? When glucose normal/elevated? Inactivated by?

Intestines throughout day, increasing in response to meal. When glucose normal/elevated incretins increase insulin synthesis, inhibit glucagon, slow gastric emptying, as well as decreasing hepatic glucose production. Inactivated by DPP-4.

Endovascular intervention for stroke

Intra-arteria thrombolysis using drugs and embolectomy within 6 hours of onset

Continuous enteral nutrition administration ? What's best?

Introduce gradually, full strength formula, progress as tolerated. Small bowel best to prevent aspiration aka j. Tube

What's needed to form RBCs and HGB

Iron, vitamin b12, folic acid, copper, pyridoxine, cobalt, nickel

Cirrhosis define

Irreversible scaring of liver usually caused by chronic reaction to hepatic inflammation and necrosis that usually envelops slow resulting in liver disease.

Postop for nephrostomy

Irrigate carefully if ordered, assess stoma for bleeding or insufficient blood supply, increase fluid intake

S/s of delirium

Irritability, tremulous, insomnia, poor appetite, memory loss, disorientation, inappropriate remarks, transient illusions/hallucinations, difficulty concentrating, restlessness, mood changes, crying, depression, sleep/wake cycle issues

Report what signs in relation to stoma

Ischemia and necrosis via dark red, purple, black color, dry, firm, flaccid, unusual bleeding, mucocutaneous separation aka breakdown of suture line securing stoma to ab wall.

Both terlipressin and somatostatin can cause

Ischemic issues and dysrhythmias so observe cardiac rhythm, apical pulse rate, blood pressure

Dextrose 5% in water- tonicity? Provides what. Used to? How manu kcal/L provided? Electrolytes?

Isotonic outside body until inside and hypotonic due to metabolizing glucose. Provides free water necessary for renal excretion of solutes, used to replace water losses/hypernatremia, provides 179kcal/L. Does not give any electrolytes

Dextrose 5% in 0.225% NS tonicity? Provides? Used to? Provides how much Kcal/L?

Isotonic. Provides sodium, chloride & free water Used to replace hypotonic losses & treat hypernatremia Provides 170 kcal/L

Streptokinase aka? Alert? Class? For? SE? Don't take with? Antidote?

Kabbikinase/Streptase. high. Thrombolytic. For MI, PE, DVT, dissolves fibrin in clots. SE: hemorrhage, ischemia, thromboembolism, bleeding. Aspirin, NSAIDs, garlic. Aminocaproic acid/Amicar.

Noninvasive positive pressure ventilation define? Can cause?

Keeps alveoli open and improve gas exchange for dyspnea, hypercarbia, acute exacerbations of COPD, pulmonary edema, acute asthma. Can cause skin breakdown, pressure around eyes, gastric insufflation causing n/v+aspiration

Albumin plasma protein 5% or 25%

Keeps fluid in vessels, maintains volume, used to replace protein and treat shock and erythroblastosis fetalis. May cause anaphylaxis, fluid overload, pulmonary edema.

Urine ketone bodies are not reliable for evaluating treatment effectiveness because

Ketones variably reabsorbed and may be present long after BG returns to normal

Cause of Hyperphosphatemia

Kidney disease, tumor lysis syndrome, increased intake of phosphorus, hypoparathyroidism, acidosis, hypocalcemia

Underproduction of bicarbonate ions metabolic acidosis conditions

Kidney failure, impaired liver or pancreatic function, dehydration

Under elimination of H metabolic acidosis conditions

Kidney failure, lung issues

24 hour creatinine clearance is best indicator of

Kidney function and deterioration, GFR

What controls bicarbonate? What controls CO2? So pH is?

Kidneys control bicarbonate and lungs control CO2 so pH is function of kidneys divided by lung function

Rifampin purpose ? Interventions

Kills TB. Can stain skin/urine/secretions reddish orange, no alcohol, report dark urine/yellow skin/increased bruising/bleeding since can cause liver damage

Pyrazinamide purpose ? Interventions

Kills TB. Don't take with gout, drink water/increase intake, protective clothing from sun, no alcohol, report dark urine/yellow skin/increased bruising/bleeding since can cause liver damage

Ethambutol purpose? Interventions

Kills TB. No alcohol report vision changes, no gout, increase fluids

Isoniazid/INH purpose? Interventions?

Kills mycobacteria for TB. Take on empty stomach, take vitamin B, no alcohol, report dark urine/yellow appearance of body/increased bruising+bleeding since can cause liver damage

Mcmurray test

Knee flexed/rotated and then pressed while extending leg. + if clicking palpated/heard

Providing care for reduced vision

Knock/announce entrance in room, make sure everyone knows, determine degree of deficit, orient to environment, count steps to bathroom, place personal items at bedside, don't move items without permission, remove clutter, ask type of assistance needed, describe plated food, open packages, use normal voice, offer arm when walking

ADA recommends for preventing macrovascular issues LDL? Triglycerides? HDL in men? In women? Target BP?

LDL <100mg/dL, triglycerides <150mg/dL, HDL in men >40mg/dL, in women >50mg/dL, a BP <130/80

Clinical manifestations of Hyponatremia- neuro changes? GI changes? Respiratory issues? Other organs? CV ? If occurs with hypervolemia? What happens to cells? ECF compared to ICF?

LOC and behavior, headache, lethargy, muscle weakness, diminished deep tendon reflexes, seizures, coma, Nausea, vomiting, ab cramping, increased intestinal motility, diarrhea, respiratory arrest, liver disease, adrenal insufficiency, hypovolemia, rapid weak pulse that's difficult to palpate, decreased BP, if occurs with hypervolemia full bounding pulse with high BP. Cellular swelling and reduced depolarization since osmolarity of ECF lower than ICF

Preop teaching for leiomyomas/fibroids/myomas

Lab tests; CBC, Chemistry Prophylactic antibiotics TCDB; Incentive Spirometer *Early ambulation; leg exercises Pain relief Psychological Assessment

Lactulose aka? Function?

Lactitol. Promotes excretion of ammonia in stool. Side effects: intestinal bloating, cramping, hypokalemia, dehydration

Multiple sclerosis objective data

Mobility, Hyperactive DTRs, Clonus , Positive Babinski, Absent abdominal reflexes, Intention tremor, Cranial nerves, Hearing or vision changes

Causes of actual hypocalcemia

Lactose intolerance, malabsorption syndromes like Celiac/Crohn's , inadequate vit. D, ESRD, kidney failure, diarrhea, steatorrhea, wound drainage, othorpedic surgery or bone healing, thyroid surgery, radiation of check/neck, neck injury

Digoxin aka? Alert? Class? Used for? Does what? Admin? Can cause? Normal blood level? Check? Use caution in?

Lanoxin. High. Cardiac glycoside. Antiarrhythmic. For HF, a.fib. Increases CO and lowers HR. PO/IV. Cardiac, GI, CNS toxicity. 0.5-2 and EKG can identify toxicity. Check K, Ca, Mg, HR, hold if <60

Surgical management of cholecystitis

Laparoscopic cholecystectomy, tradition cholecystectomy

Surgical management of GERD

Laparoscopic nissen fundoplication and is minimally invasive

Hemodyalisis catheters lumen? Used for? How long can be used? Risk for? Lock with? Remember to?

Large lumen. Use:hemodyalisis, pheresis. Tunneled for long term or nontunneled for short. Risk for CR-BSI, DVT. Lock with 1000-10000 units/mL heparin or sodium citrate. Remember to aspirate before any use.

Transjugular intrahepatic portal systemic shunt for hemorrhage related to cirrhosis

Large sheath placed through jugular vein and pushed through liver into portal vein and balloon enlarges tract and stent keeps it open

Peptic ulcer define? Types?

Lesion of stomach or duodenum. Gastric, duodenal, stress

Daily cholesterol intake and same for sodium

Less than 300mg/days. Sodium less than 2300mg/day and <1500mg for 51 years or older and those of any age of blacks and/or have hypertension, diabetes, chronic kidney disease. Low sodium= malabsorption, liver disease, pernicious anemia, cancer, sepsis

Lidocaine aka? Alert? Used for? Does what? SE?

Lidopen. High alert. IV/topical anesthetic or antiarrhythmic. Suppresses spontaneous depolarization. SE: seizures, confusion, muscle twitching

Hyperosmolar hyperglycemic syndrome HHS is? Occurs? Precipitating factors?

Life-threatening syndrome Occurs most often with type 2 diabetes who are able to make insulin to prevent DKA but not enough to prevent hyperglycemia, osmotic diuresis, and ECF depletion UTIs, pneumonia, sepsis, Acute illness, Newly diagnosed type 2 diabetes, Impaired thirst sensation and/or inability to replace fluids

POP post op management

Limit activities, no lifting > 5 pounds, no strenuous exercise, no sex for 6 weeks Moist heating pad/warm compress to abdomen Absorbable sutures Notify MD of signs of infection No straining w BM; may need pain meds w BM Sitz baths Health education

Community based care for post op leiomyomas/fibroids/myomas

Limit stair climbing No driving for 2 - 6 weeks Educate re: expected physical changes Educate re: resuming sexual activity Psychosocial support Provide written material

Major pathophysiology processes during acute pancreatitis

Lipolysis causing hypocalcemia, proteolysis leading to thrombosis and gangrene, necrosis of blood vessels causing hemorrhage and inflammation

Crohn's disease location? Etiology? Peak incidence age? Number of stools? Complications? Need for surgery?

Location is often in ileum and patchy through all layers of bowel. Etiology unknown. 15-40 years. Stool is 5-6 soft loose nonbloody. Complications: fistulas and nutritional deficiencies. Need for surgery is frequent

Ulcerative colitis location? Etiology? Peak incidence. Number of stools? Complications? Need for surgery?

Location starts in recumbent and proceeds in continuous manner toward cecum. Etiology unknown. Peak is 15-25 years and 55-65 years. Number of stools is 10-20 liquid bloody stools a day. Complications:hemorrhage and nutritional deficiencies. Need for surgery is infrequent

Assessment for CD

Look for unintentional weight loss, stool info and presence of blood. Fever, ab pain, nutrition and hydration status, distention, masses, visible peristalsis, perineal area ulcerations fissures or fistulas, decreased or absent bowel sounds, increase in high pitched rushing sounds over narrowed bowel loops, guarding, rigidity

Surgical management of cervical cancer

Loop electrosurgical excision procedure (LEEP) to cut away affected tissue Laser therapy to vaporize abnormal tissue Cryotherapy to freeze the cancer => necrosis Conization to remove affected tissue Hysterectomy

Drug therapy for fluid overload

Loop/high ceiling diuretics i.e. Furosemide/Lasix. Conivaptan aka Vaprisol or tolvaptan aka Samsca if too much ADH or electrolyte loss

Aphasia define? Anomia define?

Loss of ability to comprehend words and speak. Anemia: inability to find words

Apraxia define

Loss of ability to perform complex tasks involving muscle coordination aka inability to use words/objects correctly Examples include bathing, dressing, feeding self

Agnosia define

Loss of ability to recognize and use familiar objects and/or sensory conprehension impaired Not recognizing a familiar room in their home such as the kitchen Not recognizing familiar sounds Eventually not recognizing loved ones

Obstruction at end of small intestine and lower in intestinal tract causes

Loss of alkaline fluids which can lead to metabolic acidosis

An obstruction high in small intestines causes

Loss of gastric hydrochloride which can lead to metabolic alkalosis

Sensory neuropathy define? Affects?

Loss of protective sensation in lower extremitities, monofilament screening. Affects PNS

Nonsurgical management of cholecystitis

Low fat and cholesterol diet, opioids, extracorporeal shock wave lithotripsy if normal weight and good gallbladder function, percutaneous transhepatic biliary catheter to open ducts , anticholinergic drugs, antemetics

Nutritional therapy for diverticular disease

Low fiber or clear liquids, if severe NPO and or NGT

Anemia labs which can be associated with CD? What other labs for CD? If severe diarrhea or fistulas present?

Low folic acid, vitamin b12, albumin. Elevated C-reactive protein and ESR. Also pyuria aka WBC in urinedue to infection from ureteral obstruction, or enterovescial aka bowel to bladder fistula. If severe diarrhea or fistula present patient may have electrolyte losses particularly potassium and magnesium

Labs for malnutrition

Low hemoglobin if anemia/hemorrhage/hemodilution/iinfection/catabolism or high if dehydration/liver disease. If dehydrated low serum albumin

HF labs

Low hemoglobin+hematocrit, high BNP, proteinuria, high specific gravity, microalbuminuria, ABG hypoxemia

Hypoxemia vs. hypoxia

Low o2 in blood vs. decreased tissue oxygenation

Respiratory acidosis pH? PCO2? HCO3-? Differential?

Low pH, PCO2 high, HCO3 normal or increasing. Obstruction, pneumonia, mediastinal disease

Nutrition therapy for cirrhosis fluid excess

Low sodium diet usually 1-2 grams. In late stages vitamin deficiency so supplements of thiamine, float, multivitamins

Rhonchus/rhonchi character? Association

Lower pitched coarse continuous snoring sounds from large airways. Thick secretions, sputum, obstruction by foreign body, tumors

Malnutrition outcome

Lowered CO, malabsorption, respiratory, muscle wasting aka leanness/cachexia, decreased activity tolerance, lethargy, dermatitis, poor wound healing, death, impaired immune system/GI//cardiac/renal/bone formation/brain dysfunction, dry/flaking

Hypermagnesemia signs and symptoms

Lucy viewed dogs sleeping. Low everything aka energy, BP, HR, RR, reflexes, LOC all low with possible cardiac arrest. Vasodilation, diaphoresis, skeletal muscle weakness. ECG has long PR and QRS.

Diagnosing meningitis

Lumbar puncture needed for CSF specimen Viral meningitis is self limiting Bacterial meningitis is transmitted through respiratory droplet and contact with resp. secretions. Serious adverse outcomes with bacterial meningitis Vaccine available for bacterial outbreaks.

Oxygen toxicity define? S/s?

Lung injury from too much o2. Dyspnea, nonproductive cough, chest pain, GI upset, crackles, hypoxemia, atelectasis, pulmonary edema

Hep. D mode of transmission and prevention

Must already have hep.b, infected blood, sex, needles, from infected mom to newborn. Get hep b. Vaccine

Methotrexate aka? Given when? Monitor for?

MTX/Rheumatrex/DMARD. Given once a week dose <25mg for RA. Monitor for low WBCs, platelets, n/v, bone marrow suppression, infection

Assessment for endometrial/uterine cancer

Main symptom is postmenopausal bleeding Watery, bloody vaginal discharge, low back pain, abd pain, pelvic pain Uterine mass, uterine polyp Enlarged uterus (advanced cancer)

Primary treatment goals of ARF

Maintain volume homeostasis, correction of biochemical abnormalities, minimize damage to renal mass

Reduce local airway damage from trach by

Maintaining proper cuff pressures, stabilizing tube, suctioning only when needed, preventing/treating malnutrition, dehydration, hypoxia

Suctioning function

Maintains patent airway and promotes gas exchange by removing secretions when patient cannot cough adequately

Post bronchoscopy, laryngoscopy, and mediastinoscopy

Make sure gag reflex returns, monitor VS including O2 sat and breath sounds q 15 minutes for first 2 hours

Preventing odors for colostomy bag

Make sure no leakage and fully closed, no broccoli, beans, spicy foods, onions, Brussels sprouts, cabbage, cauliflower, cucumbers, mushrooms, peas, gum, smoking, beer, skipping meals, asparagus, turnips, eggs, fish, garlic. Crackers, toast, yogurt, buttermilk, cranberries, parsley prevent gas and odors. Charcoal filters, deodorizers, breath mint in pouch. No aspirin in pouch

Erythrocytes sedimentation rate ESR normal male? Female? Elevated when?

Male <15mm/HR, female <20mm/HR . Inflammation, inflammatory disease like RA, infection, anemia, tissue damage?

Nourishment for gastric vs. duodenal ulcers

Malnourished vs. well nourished

Cause of hypomagnesemia

Malnutrition, alcoholism, ketoacidosis, diarrhea, steatorrhea, celiac disease, Crohn's disease, drugs like diuretics/antibiotics/cisplatin/citrate, ethanol ingestion

Cause of Hypophosphatemia

Malnutrition, starvation, chronic antacid use, hyperparathyroidism, hypercalcemia, kidney failure, malignancy, hyperglycemia, hyperalimentation, respiratory alkalosis, DM, vitamin d deficiency, alcoholism

Diagnostics for breast disorders

Mammography: yearly beginning @ 40 y/o Breast Self Exam (BSE) monthly beginning in 20s; Clinical Breast Exam (CBE): APRN/MD Q 1 - 3 yr Ultrasound: differentiates fluid filled cysts vs mass CXR; CT; Bone, liver, brain scans R/O Metastasis Magnetic resonance imaging (MRI) Biopsies: Only definitive way to diagnose breast CA

Overall goal for treatment with Alzheimer's

Maximize the abilities that the individual with Alzheimer's Disease has left at each phase of the illness.

Grand mal seizure may have? Tonic? What happens for one minute? Clonic? Pupils?

May have aura if a partial seizure becomes a generalized seizure. No aura if generalized seizure from the start. Tonic phase-loses consciousness, falls Apnea and cyanosis for one minute Clonic phase-may bite tongue Pupils dilate Salivates/sweats/incontinence/confusion/soreness/exhaustion

People with type 1 DM require

Mealtime insulin+long acting basal or intermediate acting aka exogenous insulin to survive and may need multiple daily injections of insulin (often four or more) or continuous insulin infusion via an insulin pump to adequately control blood glucose levels.

Nonabsorbable antibiotics examples? Function?

Neomycin sulfate aka mycifradin. Destroys normal flora in bowel diminishing protein breakdown decreasing ammonia production

Gastric analysis purpose? Types? Prep? For gastric acid stimulation test?

Measures hydrochloric acid and pepsin for evaluation of gastric and duodenal disorders via NG tube suction. Basal gastric secretion for hydrochloric acid between meals and gastric acid stimulation. Prep: NPO for 12 hours. NG left while drug stimulates secretions.

Blood urea nitrogen measures? Increase indicates? Decrease indicates?

Measures kidney excretion of nitrogen which is a by product of protein breakdown. Increased due to hepatic or renal disease, dehydration, high protein diet, infection, stress, steroid, GI bleeding , bleeding internally. Decrease can mean malnutrition, fluid volume excess, severe hepatic damage

Phlebitis cause? S/S? Treatment? Prevention?

Mechanical cause due to insertion technique, size, lack of securement, chemical cause due to pH and/or osmolarity, bacterial from break in aseptic technique, poor securement, extended dwell time. S/S: pain, red, inflamed along length, hard/cordlike vein. Treatment: remove at first sign, use warm compress, monitor, document using scale, insert new one in opposite extremity, if due to PICC insertion apply hear, rest, elevate if not better within 72 hours remove. Prevention: smallest gauge, avoid flexion sites, avoid infusing with pH below 5 or above 9 or osmolarity above 500 in peripheral vein, rotate sites every 72-96 hours, secure catheter, aseptic technique, with PICC avoid excess activity

Complications of enteral

Mechanical tube irritation, obstruction most common, aspiration, displacement, cramping, diarrhea, vomitting, distention, gas, dumping syndrome, constipation, metabolic refeeding syndrome, hyperglycemia so initiate at low rate and monitor BS, fluid and electrolyte imbalance

Avoid veins on palmar side of wrist because

Median/cephalon nerve is located close to the vein making venipunctures more painful and difficult to stabilize and lead to permanent loss of function or complex regional pain syndrome causing tingling, pins and needles, or numbness

Treating edometriosis

Medications: NSAIDS, analgesics, oral contraceptives OCPs, Injectable forms of progestins, i.e. medroxyprogesterone (Depo-Provera), heat packs Surgery: laparoscopic removal of endometrial implants & adhesions; laser to vaporize adhesions & endometrial implants

Types of sensory perceptions with left brain damage? Interventions?

Memory deficits, issues carrying out simple tasks. Reorient to month, year, day of week, and circumstances surrounding hospital admission, establish scheduled routine,info given in concise manner, step by step approach

Serum muscle enzyme creatine kinase CK normal range for men? Women?

Men 55-170 units/L, women 30-135units/L

Contributing factors for enlarged prostate

Men age 50 and older African American Family History Elevated testosterone levels High fat diet Hematuria, pea size nodule, elevated PSA >10

Bladder neoplasms more common in? First sign?

Men, whites, smokers. Painless hematuria first sign. Nonsurgical treatment: chemo, radiation, surgical treatment: resection, cystectomy, ileal conduit, urterostomy, ureterosigmoidostomy, nephrostomy with Koch pouch

Assessment for endometriosis

Menstrual & sexual history Pain; dyspareunia; painful defecation; backache Infertility Pelvic exam => pelvic tenderness R/O PID Serum cancer antigen CA-125 Transvaginal ultrasound r/o pelvic masses Nausea/diarrhea

Neuro changes with dehydration

Mental status, low grade fever, confusion

Jentadueto is combo of

MetFORMIN and Tradjenta

Refeeding syndrome define? Causes? Prevention?

Metabolic issue when nutrition restarted for patient in starvation state with protein/fat broken down for energy and insulin decreased, when refeeding begins insulin resumes and cells take up glucose and electrolytes from blood depleting serum levels causing CV, respiratory, neuro issues, hypophosphatemia, shallow RR, weakness, confusion, seizures, increased bleeding. Prevention via careful assessment to supplement nutrition before starvation state

Decreased pH from

Metabolic or respiratory acidosis, ketones, renal failure, starvation, diarrhea, hyperthyroidism

Increased pH from

Metabolic or respiratory alkalosis, loss of gastric fluids, decreased K intake, diuretics, fever, salicylate toxicity, hyperventilation

Drugs for psoriasis topical/systemic

Methotrexate/Folex, Tazarotene/Tazorac, Cyclosporine/Sandimmune

Antibiotic/antiprozoals

Metronidazole/Tinidazole, Flagyl, Tindamax

Lovastatin aka? PO dose? Does what? SE? Taken when?

Mevacor. 20mg. Inhibits enzyme that makes cholesterol. SE: headache, constipation, rhabdomyolosis. Taken at night when enzymes are active since dietary intake love

Interventions for hypermagesemia

Mg free IV's, high-ceiling/loop diuretics like furosemide/Lasix

Diabetic neuropathy define

Micro and macro vascular combo causing pain, nerve damage lessening ability to feel pain/sensation, heat, cold and causing tingling, numbness, weaknesses, if ANS affected whole body.

Diabetic nephropathy aka? Define? Leading cause of? Risk factors? What usually follows?

Micro vascular Kidney disease. Damage to small vessels that supply glomeruli. Leading cause of ESRD. Hypertension, genetics, smoking, chronic hyperglycemia. Late diagnosis of microalbuminuria ESRD and waste product buildup in blood usually follow

Patho of pyelonephritis

Microbial invasion of renal pelvis, inflammation, fibrosis aka scar tissue, decreased tubular reabsorption and secretion, impaired kidney function

Clinical manifestations of mechanical obstruction in small intestine? If strangulation present pain?

Mid abdominal pain or cramping. If strangulation present pain more localized and steady.

Urine specimen collection procedure

Midstream, use first void, obtain before antibiotics, self clean before voiding if clean catch

Mini mental state exam score: mild? Moderate? Severe/final?

Mild (21 - 30) Trouble finding right word, forget familiar names or how to do everyday tasks Moderate (11 - 20) Disoriented, Paranoid and Delusional thoughts, forget major life events and close relatives Severe/Final (0 - 10) Incoherent, difficulty swallowing, incontinence

Nutrition therapy interventions for Hyponatremia used usually for?

Mild hyponatremia. Increase oral sodium and restrict oral fluid intake.

Early phase of Alzheimer's aka? Define

Mild to Moderate- forgetfulness, lack of concentration, disorientation, anxious, frightened, confused, embarrassed, deniaL

Mechanical colonic obstruction causes which symptoms

Milder more intermittent colicky abdominal pain seen with small bowel obstruction, lower abdominal distention, obstipation, ribbon like stools, alterations in bowel patterns, blood in stools if colorectal cancer or diverticulitis is cause, abdominal distention, peristaltic waves visible, high pitched bowel sounds aka borborygmi, cramping, in later stages bowel sounds absent, abdominal tenderness and rigidity minimal

Surgical management of PUD?

Minimally invasive surgery via laparoscopy to remove ulcer or treat hemorrhage, partial stomach removal aka subtotal gastrectomy, pyloroplasty, and/or vagotomy to control acid secretion. Or open surgery

Prostaglandin analogs example? Dose? Function?

Misoprostol aka Cytotec. 200mcg orally four times. Decreases gastric secretions and enhances resistance to mucosal injury when patient taking NSAIDs.

Novolog 70/30 is? Taken when?

Mix of 70% aspart protamine and 30% aspart taken just before eating

70/30 and 50/50 is? Taken when?

Mix of NPH and regular insulin. Taken 30 min before eating

Enteral nutrition define? Used for? Not for? Examples?

Mode of feeding using GI tract for those with malabsorption, cannot swallow due to stroke/head trauma/multiple sclerosis, are critically ill and cannot eat. Not for hemodynamic compromising like peritonitis, pancreatitis, intestinal obstruction, vomiting/diarrhea, paralytic ileus ex. Nasoenteric short term with key feed, entriflex, or Dobbhoff tube like nasogastric or nasoduodenal or nasojejunal placed under pyloric sphincter. Enterostomal long term like gastrostomies with percutaneous endoscopic gastrostomies tube, low profile gastrostomy device and jejunostomies to bypass stomach if gastric disease, upper obstruction, abnormal gastric/duodenal emptying via surgery

Wound care for diabetic ulcers

Moist wound, debridement, eliminating pressure, growth factors for healing

After surgery for peritonitis

Monitor LOC, VS, respiratory status via RR breath sounds, I and O, semi fowlers position to promote drainage of peritoneal contents into lower region of abdominal cavity to also increase lung expandion

Nursing responsibilities for chest tube management

Monitor VS throughout, monitor for tracheal deviation, monitor patency and not dislodged with kinks and at prescribed rate, ensure chest tube never higher than chest, monitor drainage for amount/color/consistency, palpate area around chest tube for crepitus and if felt mark area to assess for spreading, encourage deep breathing/cough, keep petrolatum gauze dressing and sterile dry dressing

What LPNs can do

Monitor client findings as input to RNs ongoing assessment, reinforcement of client teaching from standard care plan, tracheostomy care, suctioning, check nasogastric tube patency, admin of enteral feelings, insertion of urinary catheter, med admin excluding IV meds in several states

Endoscopic retrograde cholangiopancreatography ERCP education

Monitor for cholangitis, bleeding, perforation, sepsis, pancreatitis via severe pain and fever for sepsis. Report abdominal pain, fever, nausea, vomiting

Critical care for acute pancreatitis

Monitor for shock due to hemorrhage via hypotension, tachycardia, change in behavior, LOC

Nonsurgical management of COPD

Monitoring q 2 hours, airway maintenance, breathing techniques, positioning, effective coughing, oxygen therapy, drugs, exercise conditioning, suctioning, hydration, use of vibratory positive pressure device

Total parenteral nutrition solutions contain

More dextrose and proteins and are hyper osmotic which can cause hyperglycemia which if remains without insulin or in presence of hyponatremia.hypokalemia causes water shift to plasma causing dehydration and possible hypovolemic shock and if cardiac/renal issues may develop fluid overload, CHF, or edema

Calculous cholecystitis

Most common where chemical irritation and inflammation result from gallstones aka cholelithiasis that obstruct cystic duct, gallbladder neck, or common bile duct aka choledocholithiasis and trapped bile is reabsorbed plus impaired circulation, edema, distention causes ischemia and infection resulting in necrosis and gangrene and can eventually perforate/rupture which can cause an abscess or peritonitis

Sliding hernias are? Define? Major concerns

Most common. Esophagogastric junction and portion of fundus of stomach slide upward through esophageal hiatus into chest usually from weakening of diaphragm. Volvulas aka twisting and obstruction and esophageal reflux

Isotonic dehydration

Most common. Fluid lost from ECF , no shift of fluids between spaces so ICF remains normal and circulating blood volume decreased aka hypovolemia leading to inadequate perfusion

Midclavicular PICC associated with? Used only when?

Much higher rates of thrombosis than when tip in superior vena cava, used only when an atomic or pathophysiologic changes prohibit placement in SVC

Smokers with chronic bronchitis sputum

Mucoid

Peptic ulcer disease results when

Mucosal defenses become impaired and no longer protect epithelium from acid and pepsin

Signs and symptoms of hyperkalemia? Cause?

Murder. Muscle cramps/twitching,/weakness/tingling/numbness aka paresthesia, urine abnormalities, respiratory distress/weakness, decreased cardiac contractility, EKG changes with tall t waves absent P waves and wide QRS, reflexes. Diarrhea, hyperactive bowel sounds, palpitations/irregularities, bradycardia, hypotension, ectopic beats, heart block, a systole, ventricular fibrillation

Elevated creatine kinase can indicate?

Muscle trauma, Paget's, electromyography effects, brain, myocardial, skeletal muscle necrosis/injury

Muskuloskeletal changes in ESRD

Musculoskeletal Skeletal changes Result of alterations in calcium and phosphorous metabolism Hyperphosphatemia and hypocalcemia Weakens bones, increased risk of fractures Kidneys lose ability to convert Vit. D to active form Prone to fractures, joint pain

IV potassium must be? Double? Dilution no greater than? Max infusion rate? Never to exceed? High risk for? IV access in?

Must be diluted and added to IV only in pharmacy. Double check IV. Dilution no greater than 1mEq of K to 10mL solution, max infusion rate 5-10mEq/hr never to exceed 20mEq/hr. High risk for phlebitis q 1 hour. IV access in large vein avoiding hand

Leiomyomas/fibroids/myomas surgery

Myomectomy Via laser to remove rumors, Hysterectomy, Uterine embolization, transcervical endometrial resection using heat to destroy endometrium, total vaginal hysterectomy though vag, total abdominal hysterectomy via horizontal bikini incision

Other interventions for hemorrhage related to cirrhosis

NG tube to detect new bleeding , packed rbc, fresh plasma, dextran, albumin, platelets

Post op for exploratory laparotomy

NG tube until peristalsis/paralytic ileus resumes, clear liquid diet until peristalsis returns

Formation of ammonium in kidney function

NH3/ammonia formed during protein breakdown and secreted in urine that can combine with excess H to form ammonium NH4 to excrete in urine to increase pH

To prevent lymphedema after breast cancer surgery

NO BP, injections, or blood draws on affected arm* SIGN PLACED ABOVE BED & ON CHART/DOOR

Intermediate acting insulin examples? Onset? Peak? Duration? Also used as? Only? Is?

NPH/Humulin N or Novolin N. 1.5 hours-4. 4-12 hours. 12/16-18/24+ hours. Also used as basal insulin. Only basal insulin that can be mixed with short and rapid insulin. Is cloudy that must be agitated.

Managing impaired swallowing after stroke

NPO until assessed for impaired voluntary cough and gag reflexes, if patient doesn't pass they need speech language pathologist to evaluate further to then give suggestions on feeding like thickened liquids

Common causes of relative hypernatremia

NPO, increased metabolism, fever, hyperventilation, infection, diaphoresis, diarrhea, dehydration

Isotonic crystalloid examples? Action/use? Considerations?

NS, LR. No fluid shift, vascular expansion and electrolyte replacement. May cause fluid overload, edema, dilute hemoglobin, cause acidosis, electrolyte imbalance

Nonsteroidal anti inflammatory drugs aka? Can be used for? Examples? SE? Monitor?

NSAIDs, used for inflammation/pain/fever. Ex: Celecoxid/Celebrex, ibuprofen/Advil, aspirin. SE: bleeding, CV issues, Na retention, edema, hypertension, renal issues. Monitor fluid, BP, renal function, electrolytes, CBC, CNS

Extracellular fluid electrolytes

Na, Cl, bicarbonate, albumin

Low flow o2 deliver systems examples

Nasal cannula, face masks: simple, partial rebreather, nonrebreather

End stage renal disease symptoms

Neuro issues, high BP, pitting edema, periorbital edema, pericarditis, SOB, thick sputum, ammonia breath, metallic taste, ulcerations in mouth, anorexia, nausea, vomiting, behavior changes, bleeding, high K, dry flaky skin, pruritus, eccymosis, purpura, yellow gray skin, cramps. Bone pain

Patho changes with Alzheimer's

Neurofibrillary tangles Plaques Granulovascular degeneration of brain cells Loss of brain mass

For Muskuloskeletal issues remember

Neuromuscular checks and infection preventions

Urinary antiseptic example? Admin suggestion?

Nitrofurantoin aka Furadantin, macrobid, macrodantin, urotoin. Drink with full glass of water and drink 3L

Absorption atelectasis

No N in air since on O2 and causes alveoli to collapse detected via auscultation so monitor for crackles and decreased breath sounds q 1-2 hours

PDA-5 inhibitors for ED S/E?

No alcohol, dyspepsia, headaches, facial flushing, stuffy nose , cramps, n/a

Diet at home for chronic pancreatitis

No caffeine, alcohol, keep it bland, low fat, high protein and calories frequent meals

Define fasting

No calories for at least 8 hours

Elderly s/s of infection

No fever but altered LOC

Blood glucose testing requires? For?

No food/drink except water for at least 8 hours before, for non pregnant and least expensive

Diagnosing AD

No lab test except at autopsy for neurofibrillary tangles and neurotic plaques. Genetic testing for apolipoprotein E4, decreased amyloid beta protein precursor SBPP

Patient recovery for cervical biopsy

No lifting for 2 weeks, rest 24 hours after, report excess bleeding more than that of period/infection signs, no douching/tampons/sex for 2 weeks, keep perineum clean/dry using antiseptic rinses and changing pads frequently

Obstipation aka

No passage of stool and failure to pass flatus accompany complete obstruction

Bloop group gastric vs. duodenal ulcers

No pattern vs. type O

Care after total vag/abdominal hysterectomy

No period, more rest, limit stairs to 5x a day, no lifting anything>5-10 lbs, gradually increased walking, avoid sitting for long, no leg crossing, no exercise 2-6 weeks, no driving until approved, no sex 4-6 weeks, take temp for 3 days, check incision, report increased drainage or change in it, temp >100, pain, redness, swelling, burning on urination

Amenorrhea define

No periods

Care after local cervical ablation therapies

No sex/tampons/douching, take showers only, no lifting , report bleeding foul smell or fever. All for 3 weeks

Community based care for ovarian cancer: no? Follow up? Refer to? Advanced disease?

No tampons, douches, sexual intercourse for ~ 6 weeks Follow up with Surgeon Refer to support services Advanced disease: Refer to Hospice/Grief Counseling

BUN creatinine ratio helps determine? Increased? Decreased? No change?

Non kidney related factors. Increased indicates fluid felicity, obstructive uropathy, catabolic state, high protein diet. Decreased indicates fluid excess or acute renal tubular acidosis. No change indicates renal impairment

Implanted ports are accessed by

Noncoring needle aka Huber that has special tip that slices through septum that can tolerate 2000-750 punctures

Anthropometric measurements

Noninvasive methods of evaluating nutrition via height, weight, assement of body fat

Infiltration define? Cause? S/s? Treatment? Prevention

Nonvesicant Into extra vascular tissue. Pictured vein wall, blood flow obstruction, inflammation, fibrin sheath, damaged septum of implant, dislodged port access needle. S/S: rate slows, edema, skin tightness, blanching, coolness, burning, tenderness, fluid leaking, absence of blood return. Treatment: stop infusion and remove, sterile dressing, elevate, warm for speeded healing or cold compress for pain/swelling, insert new one in opposite extremity, implanted port remove and insert new needle, rate using INS scale. Prevention: catheter stabilization, using smallest catheter, avoid area of flexion, no restraints at site, make successive venipunctures proximal to previous site, monitor, central venous catheters obtain blood return, protect from clothing

Preventing diabetic kidney disease

Normal BP, correcting hyperlipidemia, restricting dietary protein, annual microalbuminuria test, BG control, promptly treating UTI's, preventing dehydration, no smoking, reduce nephrotoxins drugs like antifungals, NSAIDS, certain antibiotics

Stomach acid production for gastric vs. duodenal ulcers

Normal/hyposecretion vs. hypersecretion

Define epistaxis

Nose bleed

PSA is? PSA should be done when?

Not specific to prostate cancer because other prostate issues can raise PSA like prostatic is and BPH. PSA should be done before DRE since DRE increases PSA

If patient has distended neck veins, syncope, cyanosis, hypotensioN? If patient has sudden onset of dyspnea and chest pain

Notify rapid response for both could be PE, elevate HOB

Legal responsibility for the RN to delegate a task to a LPN or UAP is determined by

Nurse practitioner act, employer policy, national standards of care, ana and other national organizations

Priority when caring for patient with fistula

Nutrition and fluid and electrolyte balance since patient at risk for malnutrition, dehydration, and hypokalemia and preserving and protecting skin

Nondrug interventions for UC

Nutrition therapy and rest. NPO, parenteral nutrition, formulas to drink like Vivonec, no alcohol and caffeine and raw vegetables/high fiber foods/carbonated beverages/dairy/pepper/nuts/corn/dried fruits/smoking

PE interventions

O2 therapy (including mechanical ventilation if needed) Frequent ABGs & continuous pulse ox IV fluids Frequent VS+lung sounds+cardiac+respiratory status q 1-2 hours Anticoagulant therapy Fibrinolytics (Clot buster's) Antianxiety medications

Care during PE

O2 therapy, high fowler's, telemetry, venous access, pulse ox, ass respiratory status q 30 minutes, assess cardiac status, chest imaging/labs done, exam for petechiae on thorax, anticoagulants, bleeding assessment, handle gentle, bleeding precautions

Interventions for pneumonia

O2 therapy: Collaborative or Independent? Cough, deep breathe, and incentive spirometry: Collaborative or Independent? Adequate hydration- 3L/day unless otherwise contraindicated Bronchodilators

Leiomyomas/fibroids/myomas Nonsurgical management

OCPs Induce artificial menopause with goserelin (Zoladex) & leuprolide (Lupron Depot) Magnetic resonance-guided focused ultrasound: a pulse of ultrasound used to heat tumor & destroy it Uterine artery embolization to starve tumors of circulation, allowing them to shrink

Nonsurgical management of DUB

OCPs or patch - Hormone manipulation w estrogen &/or progestin (artificial progesterone) - Injectable leuprolide (Lupron) to decrease FSH & LH causing amenorrhea

Major risk factors for colorectal cancer

Older than 50 years, genetics, diseases that predispose the patient to cancer like familial adenomatous polyposis, Crohn's disease, ulcerative colitis, infectious agents like h.pylori, streptococcus bovis, hpv, smoking. Increased body fat, inactivity, alcohol

Those at greater risk for fluid overload

Older, cardiac/kidney/pulmonary/liver problems

Health care acquired risk factors for pneumonia

Older, chronic lung disease, gram-neg. colonization of mouth/throat/stomach, altered LOC, recent aspiration, endo tracheal/tracheostomy/NG tube, poor nutrition, immunocompromised, uses drugs that increase gastric pH like histamine blockers or antacids, alkaline tube feedings, mechanical venilation

Proton pump inhibitors examples and dosage? Are main? Function? Frequency of ingestion? Symptoms from use?

Omeprazole aka Prilosec 20-30mg, lansoprazole aka Prevacid 15-60mg, Omeprazole/ sodium bicarbonate aka Zegerid, rabeprazole aka Aciphex 60-120mg, dexansoprazole aka Kapidex, pantoprazole aka Protonix 40mg, esomeprazole aka Nexium 20-40mg. Treatment for severe GERD. Inhibit gastric gastric secretion. Once or twice a day, Zegerid short term. Community acquired pneumonia, GI infections, hip fracture, impaired calcium absorption and protein digestion

DM my plate

One half plate filled with no starchy vegetables, one fourth filled with starch, one fourth protein, glass of nonfat milk, small piece of fresh fruit

Kombiglyze X-R is combo of?

Onglyza and metFORMIN or saxigliptin and metFORMIN extended release

Delirium with ETOH/drug withdrawal occurs when? Additional s/s?

Onset in about 3 days. Tachycardia, diaphoresis, pallor, dilated pupils, mild hypertension, tremulous mess, deteriorating mental status, increased temp., increased restlessness,increased irritability

Biguanides example? Functions? SE? Used for? Take with? Report?

Oral Metformin/Glucophage Reduce glucose production by liver, Enhance insulin sensitivity/uptake, Improve glucose transport May cause weight loss, lactic acidosis, GI issues Used in prevention of type 2 diabetes in those <60 years, prediabetes, gestational DM, hypertension, or those already with type 2. Take with meal and 8 cups water daily, report flu s/s, withhold 48 hours before contrast

Genital herpes interventions

Oral analgesics, local anesthetic so, ice/warm compress, sitz bath, increase fluid, pour water over genitals while voiding, catheterize, genital hygiene, wash hands, wear gloves, avoid sex

Meds for Paget's

Oral biphosphonates

Why are enteral tube feedings preferred?

Oral intake is inadequate or not possible and GI functioning normally, preserves GI integrity, prevents bacterial translocation, preserves normal sequence of intestinal and hepatic metabolism before releasing nutrients into system circulation, lower cost, can be tolerated well and can be used long term and at home

Promoting independence in self-care for AD

Organize activities into short steps, occupational therapists to suggest ways tom simplify tasks or suggest adaptive equipment, supervision, encouraging choices when appropriate

Polyuria, polydipsia, and polyphagia from DM

Osmotic diuresis due to excess glucose and as result sodium, chloride, K are excreted and water loss severe causing polydipsia, and because cells receive no glucose cell starvation triggers polyphagia

Hypophosphatemia caused from?

Osteomalacia

Types of central IV's

PICC, no tunneled percutaneous central venous catheters, tunneled central venous catheters, implanted ports, hemodialysis catheters

Cervical cultures via Pap smear should be diagnostic for

PID caused by chlamydia and gonorrhea

Drug regimen for h. Pylori

PPI triple therapy aka proton pump inhibitor like lansoprazole aka Prevacid, plus two antibiotics like metronidazole aka Flagyl and tetracycline aka Ala-tet/Panmycin or clarithromycin aka Biaxin and amoxicillin aka Amoxil for 7-14 days

Long term aspirin or NSAIDs can cause

PUD, GI bleeding

Which factors are protential contraindications for having MRI

Pacemaker, implanted infusion pump, ferromagnetic aneurysm clip, confusion/agitation, continuous life support

Before seizures?

Pad siderails but not with pillows Remove objects that may harm patient Do not leave patient alone IV access O2 and suction at bedside

Treatment of pressure ulcers

Pad surfaces, HOB <30 degrees, lift sheets, reposition q 2 hours, no rubber rings on sacrum, slide boards for movement to another bed, pillows/wedges between bed and bony surfaces, heels off bed, 2000-3000mL/day water, protein and calorie intake, inspect skin daily, use moisturizers when skin damp, dry areas, absorbent pads, moisture barriers, no massage, humidify room, clean skin with mild fatted soap, tepid bath, disposable cleaning cloth for perineal area, pat dry, no powders/talc on perineum, skin barrier

Oral biphosphonates for?

Paget's

EPIDIDYMITIS s/s

Pain along inguinal cancel, along vas deferens, followed with pain/swelling in scrotum/groin, fever, pyuria, bacteriuria, possible abscess

Assessing diverticular disease for diverticulitis? For overall?

Pain in left lower quadrant or generalized if peritonitis, history of constipation, low grade fever, nausea, abdominal pain, bleeding from rectum, chills, tachycardia usually due to diverticulitis. Overall distention, tenderness, localized muscle spasm

Nursing care for endometriosis

Pain relief with NSAIDs, restoring sex function, decreasing fear/anxiety, enhancing self esteem and education about fertility, oral contraceptives, progestins like medroxyprogesterone acetate/Provera/Medroxyhexal and norethindrone acetate/aygestin, heat, laparoscopic removal via lazer

Assessment for meningitis

Pain when hyper extending head, pain when flexing leg at knee, when patient lying and head is raised/flexed the knees/hips flex with head raise aka brudzinski, fever, severe headache, unchallenged rigidity, rash, kernig's sign aka inability to extend leg when thigh is flexed upon abdomen

Signs of sickle cell disease crisis? Treatment?

Pain, organ damage, increased risk of infection, early death. 3-4L water/day, no alcohol/smoking, have them contact at first sign of illness/infection, flu shots, pneumonia vaccine, avoid extreme hot/cold, avoid travel to high altitudes, genetic counseling, no excess activity, mild exercise >3x/week

Norms for urine color, odor, turbidity, specific grav, pH, glucose, ketones, protein, bilirubin, RBC, WBC, casts, crystals, bacteria, parasites, leukoesterase, nitrites

Pale yellow, ammonia, clear, 1.005-1.030, ph 6, less than 0.5g/day, none. 0.8mg/day, none, 0-2, 0-5, none, none, less than 1000, none, none, none

Left brain damage s/s

Paralyzed/Hemiplegia/hemiparesis on right side, speech-language deficits, slow/cautious behavior, language/reading memory deficit, distress and depression in relation to disability, math/analytic deficits, aphasia(speech), alexia/dyslexia(reading), agraphia(writing), acalculia(math) , deficit in right visual field aka homonymous hemianopsia, slowness/cautiousness/anxiety/depression

Intestinal obstruction classifications

Partial or complete and mechanical aka blockage by problems outside intestines like in Crohn's or adhesions or in intestinal lumen like tumors. Or non mechanical aka paralytic/adynamic ileus where no physical obstruction in or outside intestine and instead peristalsis is decreased or absent due neuromuscular disturbance

Chronic gastritis pathological manifestations? Caused by? Associated with? Categories?

Patchy diffuse/spread out inflammation of lining, walls/lining thin and atrophy. Function of parietal acid secreting cells decreases and source of intrinsic factor lost causing vitamin b12 deficiency causing pernicious anemia and gradual section decreased until just mucous and water. Associated with gastric cancer+PUD. Type A, B, or atrophic

Define nephropathy

Pathological change in kidney reducing function leading to failure, decreased GFR, microalbuminuria. DM is leading cause. Risk factors:10-15 years DM, retinopathy, poor glucose control, uncontrolled hypertension, genetics

UAP examples

Patient care techs/assistants

Subtherapeutic vs. therapeutic vs. prolonged PTT in patients on anticoagulants

Patient not receiving enough heparin vs. clotting time increased vs. at risk for bleeding heparin is held/decreased

PACE define

Patient problem, assessment/actions, continuing/changes, evaluation

Instructions for pramlintide

Patients should be instructed to eat a meal with at least 250 calories and keep a form of fast-acting glucose on hand in the event that hypoglycemia develops. When pramlintide is used, the bolus dose of insulin should be reduced

Penicillin meds

Penicillin benzathine, bicillin

Barbiturate coma

Pentobarbital sodium/Nembutal used for intracranial hypertension/^ ICP that cannot be controlled. Complications: decreased GI motility, cardiac dysrhythmias, hypokalemia, hypotension, fluctuating temp.

Types of breast biopsies

Percutaneous: fine-needle aspiration, stereotactic and core biopsies Surgical biopsies: excision, incision, and wire needle localization

Complications to look for post colonoscopy

Perforation via severe pain, hemorrhage via rapid BP drop, hypovolemic shock via dizziness/decreased BP/tachycardia/pallor/ altered mental status

CSF leaks s/s

Periorbital edema and Ecchymosis, rhinorrhea aka leaking nose, postouriculor Ecchymosis aka bruising behind ears, otorrhea aka leaking from ears, halo sign where blood pools and ring around it indicating CSF

Amylin analog example? Function? Used concurrently with? Injected how and where? Watch for?

Pramlintide/Symlin Analog of insulin slows gastric emptying, reduces postprandial glucagon secretion, increases satiety Used concurrently with insulin for type 1 Symlin60+2 symlin 120 Subcutaneously not mixed with insulin in thigh or abdomen before meals Watch for hypoglycemia, nausea if eating less than 30 gms/carbs <200 cal, weight loss

Early warning signs of hypglycemia

Peripheral autonomic symptoms: sweating, irritability, tremulous mess, anxiety, tachycardia, hunger

Radiologic procedures for PUD for patients with? Tool used? Procedure?

Persistent massive upper GI bleeding. Catheter directed embolization through femoral artery and arteriogram performed and liquid clots artery bleeding

Combined acidosis labs ph? HCO3? PaO2? PaCO2? K? Ca? Cl?

Ph low, HCO3 high or low, PaO2 low, PaCO2 high, K high, Ca normal, Cl high

ED medical management

Pharmacological via oral meds, injected vasodilators, intra urethral applications via pellet. Penile implants/prosthesis. Vacuum constriction device to maintain erection

Bladder analgesic example? SE?

Phenazopyridine aka azodine, prodium, pyridiate, pyridium, uristat. SE: red or orange urine

Human dimensions

Physical, emotional, intellectual, environmental, sociocultural, spiritual

Endoluminal gastroplication define

Physician tightens LES through endoscope using sutures

Early phase AD interventions

Picture of patient placed on their door, pictures of family member's name, reminisce, low noise, low environmental distractions, no abstract /excessive decorations, no pictures on wall, daily routine, put things in same place, communications boards with day, week, month, year, clocks

Pulmonary edema sputum

Pink frothy

Complications of parenteral

Pneumothorax, air embolism, sepsis, hyperglycemia, rebound hypoglycemia, fluid imbalance due to high glucose formulas/osmotic diuresis/shifts of electrolytes/k/phosphorus into cells, fluid overload, phlebitis, occlusion, catheter displacement and contamination

Insertion related complications for central venous catheters

Pneumothorax, hemothorax, chylothorax, hydro thorax, air embolism, arterial puncture, malpositioned catheter

Hepatorenal syndrome indicates? Manifestations?

Poor prognosis for liver failure since usually causes death. Sudden decrease of urine oliguria, elevated BUN and creatinine, low urine sodium secreted, increased urine osmolarity

Fine crackles/rales/high pitches rails character? Associated with?

Popping, discontinuous, Velcro sounds caused by air moving into deflated airways. Asbestos, atelectasis, interstitial fibrosis, bronchitis, pneumonia, chronic pulmonary disease

Hepatic cell damage can lead to these common complications

Portal hypertension, ascites and esophageal varies, coagulation defects, jaundice, portal systemic encephalopathy with hepatic coma, hepatorenal syndrome, spontaneous bacterial peritonitis

Portal hypertensive gastropathy can occur due to? Causes?

Portal hypertension. Slow gastric bleeding, occult positive stool, anemia

Hepatic encephalopathy aka? Results from? Due to?

Portal systemic encephalopathy. Liver failure. Symptoms: sleep and mood disturbances, mental status changes, speech issues, altered LOC, impaired thinking and neuromuscular issues, elevated ammonia and gamma acid. Stages: prodromal, impending, stuporous, comatose. Due to shunting of blood to central circulation so substances absorbed by intestines are not broken down or detoxified

Complex partial seizures cause? Aka?

Possible wandering before then Loss of consciousness aka syncope for 1-3 minutes with automatisms and then after amnesia. Aka psychomotor/temporal lobe seizures

What is priority

Post op patient, status declines from baseline, shock, chest pain, post diagnostic procedure, equipment/tubing malfunction, cardiac ventilation

Post op nursing care

Postop vital signs and PCA pain medication Assess dressing for bleeding; HOB & arm ^ Assess & measure Jackson Pratt drainage Amb, Reg diet, light arm exercises, education Referral to Support Groups prior to D/C home Breast Reconstruction => Plastic Surgeon

While assessing gait and equilibrium rn observes that the patient has romberg's sign, what is priority patient problem associated with this objective data

Potential for falls related to dysfunctions in awareness of body position

Alpha-adrenergic antagonists drug names? Do what?

Prazosin/Minipress, doxazosin/Cardura, terazosin/Hytrin, Aldomet. Vasodilators that lower BP

Kidney biopsy pre? Procedure? Post?

Pre:consent, NPO 4-6 hours, platelets/PTT/PT/INR must be assessed for risk of bleeding, supine with pillow under ab and shoulders. Procedure: needle used. Post: pressure to site for 20 min, Bedrest 24 hours, encourage fluids, check hematocrit and hemoglobin, make sure no bleeding

Pain assessment

Precipitation/palliative, quality/quantity, region/radiation, severity scale, timing

Estrogens meds

Premarin estrogen conjugated, Estraderm, Estrace, Depgynogen,depogen, delestrogen, duragen, Valerie's, ogen, esinyl, feminone

Acute pancreatitis caused by? Leads to

Premature activation of excessive pancreatic enzymes that destroy distal tissue and cells resulting in autodigestion and fibrosis. Leads to wide variety of symptoms like edema to necrotizing hemorrhagic pancreatitis aka bleeding pancreatic tissue leading to tissue death

Hydrogen breath test prep? Procedure?

Prep: NPO for 12 hours. Patient blows in analyzer then eats test sugar and if lactose tolerance evaluated lactose.

Cystoscopy and cystourethroscopy prep? Procedure? Post?

Prep: light evening meal, NPO after midnight, bowel prep. Procedure: remove tumors, enlarged prostate, cystoscope put in urethra. Post: urine may be light pink but no clots

If drainage not mixed with blood then test for? If drainage mixed with blood?

Presence of glucose in CSF which should be 45-75. Test drop on linen or gauze for halo sign aka light/yellow outer ring around dark inner circl

Define diverticulosis

Presence of many abdominal pouch like herniations aka diverticula in wall of intestine

+ Rheumatoid factor means?

Presence of unusual antibodies of immunoglobulins G/M that develop in CTDs like RA, cancer, others

To help communicate with patient with aphasia

Present 1 idea/thought in a sentence, use simple one step commands, speak slowly, use que/gesture, avoid ye/no questions with expressive aphasia, alternate forms of communication like computer, board, flash cards with pics

Priority care after esophagogastroduodenoscopy

Preventing aspiration by having them be NPO until gag reflex back. And monitoring for perforation such as pain bleeding or fever

Define beneficence

Preventing harm and ensuring well being

Drug therapy for cirrhosis hemorrhage

Prevention:Beta blockers like propranolol aka Inderal to prevent bleeding, antibiotics since infection can increase risk like norfloxacin aka Noroxin or ciprofloxacin aka Cipro Treatment: vasoactive drugs that reduce portal prewar like terlipressin or somatostatin or octreotide

Bilirubin is? Made by? Total Elevations can indicate? Total Normal?

Primary pigment in bile. Made by liver. Impaired secretion, hemolysis,biliary obstruction, hepatic damage. 0.1-1mg/dL.

Primary, secondary, tertiary health promotion for obesity

Primary: weight loss, diet, exercise. Secondary:BMI screening, tertiary: meds, bariatric surgery

Hemostasis

Process of blood clotting

Sigmoidoscopy aka? Define? Prep? Positioning?

Proctosigmoidoscopy.endoscopic exam of rectum and sigmoid colon to screen for cancer and bleeding and inflammatory bowel disease and do tissue biopsy. Prep: clear liquid diet for 24 hours, cleansing enema, laxative. Left side knee chest.

Seizure phases

Prodromal=Pre seizure May have aura if seizure begins as a partial seizure Ictal=seizure Post-ictal=after seizure May need airway cleared, suctioning, oxygen

Blue bloater chronic bronchitis s/s

Productive cough, hypoxia, expirations wheezing, cyanotic nail beds, restless, SOB, tachypnea, acidosis, hypercapnia

Global aphasia

Profound speech/language issues, no speech/sound cannot be understood

People with type 2 DM

Progresses and may not have adequately controlled BG causing them to need exogenous insulin aka mealtime or oral insulin and also basal insulin

Chronic kidney disease is? Most common cause? Is it reversible? Kidneys no longer? National kidney foundations. Return of function?

Progressive Diabetes and hypertension most common causes Irreversible loss of renal function Kidneys no longer capable of maintaining an internal environment consistent with life National Kidney Foundation (NKF) Kidney damage or a decreased kidney glomerular filtration rate (GFR) < 60 ml/min for 3 or 4 months Return of function is not anticipated

Communication strategies with Alzheimer's: promote? Use? Face? Be? Focus on? Speak? Refrain from?

Promote Orientation- Identify yourself Use short, simple words/phrases Face to face contact Be near the client when talking Focus on one topic at a time Speak softly and calmly Refrain from challenge/confrontation

Myasthenia gravis rn considerations

Promote respiratory support, mobility, self-care and communication, nutritional support, safety Main priority during myasthenic crisis: airway Education

The RN uses critical thinking and professional judgment when following the Five Rights of Delegation, to be sure that the delegation or assignment is:

Right task, right circumstances, to the right person, right directions/communication, right supervision/evaluation

Pathophysiology of gastritis? Pathological changes include?

Prostaglandins provide protective barrier preventing stomach from digesting itself aka autodigestion, if break in barrier injury occurs and is worsened by histamine release, vagus nerve stimulation, hydrochloric acid which causes edema, hemorrhage, erosion. Pathological changes include vascular congestion, edema, acute inflammatory cell infiltration, degenerative changes in epithelium

Antidote for heparin? Warfarin? Fibrinolytic therapy?

Protamine sulfate. Phytonadione, vitamin K. Clotting factors, fresh frozen plasma, aminocaproic acid/Amicar

Interventions for delirium

Protect from injury - monitor environment Provide for adequate rest - promote sleep wake cycle Promote comfort Pain management Give reassurance Maintenance of fluids and electrolytes Orient frequently to time, place, situation, and person Use clocks, calendar, and familiar items in patient's room Placement of eye glasses and hearing aids Night lights to decrease illusions Allow family at bedside Hide catheters, mattress on floor if needed, treat underlying source

Care of patient during tonic-clonic or complete partial seizure

Protect from injury, nothing in mouth, turn to side for airway, loosen clothing, suction as needed, no restraints, record time began/ended, after VS/neuro checks/keep on side, rest

Chemical acid-base regulators? Characteristics?

Protein buffers that are most common(albumin+ globulins in ECF, hemoglobin), chemical buffers like bicarbonate in ECF+ICF and phosphate in ICF. Characteristics: rapid, immediate response, handles small fluctuations in H

Serum creatinine is made when? Norms for males females and elders?

Protein or muscle breaks down and usually filtered and excreted in urine so if elevated means kidney disease. Norms- males 0.6-1.2 mg/dL, women 0.5-1.1 mg/dL, both 0.8-1.2 decreased in elders

Drug therapy for PUD

Proton pump inhibitors like Omeprazole aka Prilosec, lansoprazole aka Prevacid, rabeprazole aka Acipjex, pantoprazole aka Protonix, and esomeprazole aka Nexium that suppress acid production. And h2 receptor antagonists like Famotidine aka Pepcid and nizatidine aka Axid that block histamine stimulated gastric secretions

Rectocele aka? S/s?

Protrusion of rectum through vaginal wall. Constipation, hemorrhoids, fecal impaction, feeling of rectal/vag fullness, bulge when bearing down

Progestins meds

Provera medroxyprogesterone cycrin,norluate, micronor, nor-QD, prometrium

RN interventions for endometrial/uterine cancer

Provide education & written materials Refer to support services/emotional support Encourage self-management w ADLS Home care after surgery is the same as that after a hysterectomy. Home health nursing. Hospice care/Grief Counseling

Pelvic organ prolapse assessment

Pt feels as if "something is falling out", dyspareunia, backache, pelvic pressure Protrusion/bulge noted on pelvic exam Stress urinary incontinence, UTI Bladder herniation Symptoms of rectal or vaginal fullness Constipation, hemorrhoids, fecal impaction

Leiomyomas/fibroids/myomas assessment

Pt seeks medical attention r/t heavy bleeding Pain, pelvic pressure, constipation Urinary retention or frequency Abdomen increasing in size Dyspareunia; infertility Iron deficiency anemia Urine or serum HCG; CA 125 Endometrial biopsy to r/o cancer Transvaginal ultrasound, laparoscopy, hysteroscopy, MRI

Vacuum devices for ED aka?

Pumps. Penis placed in cylinder, pump draws air out creating vacuum around penis causing it to fill with blood for erection. Elastic band worn around base maintaining erection

Pneumothorax cause? S/s? Treatment? Prevention?

Puncture of pleural over lungs letting in air S/S: chest pain, dyspnea, apprehension, cyanosis, decreased breath sounds, abnormal X-ray. Treatment: remove catheter, monitor, notify, admin O2. Prevention: use jugular or upper extremity insertion sites instead of subclavian, use ultrasound to locate veins

Key features of severe TBI

Pupil changes, bradycardia, papilladema, hypertension, widened pulse pressure, hypotension and tachycardia if hypovolemic shock, nuchal rigidity if CSF leak

Colonoscopy intervals

Q 10 years

Female reproductive system RN? ANP/NP?

RN performs a focused assessment for concerns APN/NP will perform the Breast, GYN/pelvic exam & Pap test, usu. @ end of PE; RN will assist

postop amputation RN interventions

ROM exercises, trapeze, turn patient every 2 hours, firm mattress, prone position every 3-4 hours for 20-30 minutes, shrinking stump

Key features of peritonitis

Rigid boardlike abdomen, abdominal/shoulder/chest pain, distended abdomen, nausea/anorexia/vomiting, diminishing bowel sounds, inability to pass flatus or feces, rebound tenderness, high fever, tachycardia, dehydration, decreased urine output, hiccups, possible compromise in respirator status, knees flexed, pain with coughing/movement, bowel sounds decrease eventually stopping due to inflammation

No surgical management of colorectal cancer

Radiation, adjuvant chemotherapy for stage 2-3 using 5-fluorouracil with leucovorin aka folinic acid, capecitabine aka Xeloda or FOLFOX

Nonsurgical management of endometrial/uterine cancer

Radiation, chemo, complementary therapies like herbs/vitamins

Breast cancer management

Radiation; Chemotherapy Hormone Therapy to reduce estrogen available to breast tumor to stop growth Complementary/Alternative TX:i.e. Prayer Surgical Management: Lumpectomy or Mastectomy w lymph node dissection Stem Cell Transplantation: rescue therapy after high dose chemo

CVA assessment

Raise arms, smile, speak a sentence. Altered alert/oriented, memory, judgement, Visual field loss/Homonymous hemianopsia, One sided neglect, Hemiplegia or hemiparesis, Dysphagia, Incontinence, impaired communication either being global/receptive/expressive/mixed

Tests for microalbuminuria

Random spot urine collection is best, 24 hour urine collection, timed urine collection

Breast cancer in men is? Most occur with? Characteristics? Poor? Same treatment as?

Rare Most occur with a genetic mutation in BRCA1 or BRCA2 gene Hard, painless, subareolar mass; gynecomastia, nipple discharge, ulceration Poor survival rate due to delayed diagnosis & advanced disease. Men may not suspect breast CA when mass felt. Same treatment as in women

Food with iron

Red meat, organ meat, egg yolks, kidney beans, leafy greens, raisins

Site infection s/s? Treatment? Prevention?

Red, swollen, warm, tenderness, purulent or malodorous exudate. Treatment: clean site with alcohol, for short peripheral/midline/PICC remove using sterile technique, send catheter tip for culture, cover with dry sterile dressing, notify. Prevention: aseptic technique when inserting/maintaining/removing catheters, good hand hygiene, clean/dry/adherent at all times

What LPN's can't do

Redelegate, complete discharge teaching

The base of all insulin preps is?

Regular insulin. Onset, peak, duration times are manipulated by zinc, acetate, buffers, and protamine

Short acting insulin examples? Onset? Peak? Duration? Take when?

Regular/Humulin R or Novolin R. 30min-1/1.5 hour. 2-5 hour. 5-8 hours. Take 20-30/45 min before eating. More likely to cause hypoglycemia due to longer duration

Parathyroid hormone increases Ca levels by:

Releasing free Ca from bone storage sites aka resorption. Stimulating vit. D activation to help increase intestinal absorption of dietary calcium. Inhibiting kidney Ca excretion. Stimulating kidney Ca reabsorpiton

Improving communication for AD

Remain unhurried, reduce noises/distractions, use clear easy sentences. In early stages: lists/written instruction, later states: tactile stimul like hugs or hand pats interpreted as signs of affection/concern/security

Juxtaglomerular complex creates what

Renin when BP low which then converts to angiotensin 1 causing secretion of aldosterone that increases reabsorption of sodium and water and excretion of K

In patient w/ classic s/s of hyperglycemia(polyuria, polydipsia, weight loss) or crisis with plasma glucose >200 what test? Otherwise?

Repeat testing not needed. Criteria 1-3 should be confirmed by repeat testing to rule out error using same test used initially

Tunneled central venous catheters aka VADs admin requires? How many lumens? Used for?

Requires surgical placement and removal. Have single, dual, or triple lumens. Use: frequent, long term infusion like parenteral nutrition for months-years or hard antibiotics when PICC cannot be used so they can use upper body, or for when oncology patient doesn't want implanted port so they don't have to get needle stick

Elevated HCO3=? Low HCO3?

Respiratory acidosis as compensation for primary metabolic alkalosis. Respiratory alkalosis as compensation for primary metabolic acidosis

Increased PaCO2 from?

Respiratory acidosis, emphysema, pneumonia, cardiac failure, respiratory depression

Family/caregiver for AD

Respite care Attentive listening Teaching Reminiscing stimulates memory Structured routine Divert patient's attention when upset Social conversation

Interventions for hepatitis

Rest, diet high in carbs and calories, small frequent meals, prevention of complications, since viral no drug cure, no meds or alcohol, avoid intercourse and blood donations, educate to hand wash,

Surgical management of UC

Restorative proctocolectomy with ileopouch-anal anastomosis, total proctocolectomy with permanent ileostomy

Cytotoxic/cellular edema

Result of hypoxia insult which causes disturbance in cellular metabolism, Na pump, active ion transport and brain depleted of O2, glucose, glycogen and converts to aneorobic metabolism, and Na levels decrease <120mEq/L causing accumulation of fluid in brain cells and can lead to vasogenic edema increasing ICP

Von willebrand's disease define

Results from low clotting factor 8 and common sign is heavy menstrual bleeding

Acute renal failure is? Usually associated with?

Reversible Abrupt and sudden and inability to excrete metabolic waste, maintain fluid and electrolyte balance. Usually associated with oliguria <30ml/hr or <400ml/day , raised BUN and creatinine, azotemia aka nitrogen in blood

Anti-infectives common examples? Can be administered ? SE? Education? Responsibility?

Rocephin, Augmentin, Zoysn, Zynvox. PO, IV, IM. SE: N/V, diarrhea, rash. Advise to finish ALL, don't charge. Ensure ordered cultures are collected before first dose

Seizure precautions

Room suction and oxygen set up Bite plate taped on wall above bed Padded siderails up/bed low IV access established via saline lock

Diverticulitis can result in

Rupture of diverticulum with peritonitis, pelvis abscess, bowel obstruction, fistula, persistent fever or pain, uncontrolled bleeding

Allergic/anaphylactic transfusion reaction s/s? Prevention?

S/S: urticaria, itching, bronchospasms, anaphylaxis. Prevention: WBC-reduced or washed RBCs where WBC, plasma, IgA has been removed.

Orthopnea

SOB when lying down but relieved by sitting up and can be associated with chronic lung disease or left HF

Admin of insulin is typically? Regular insulin can be given? Cannot be taken?

SQ, IV, orally

Diverticula define? Symptoms? Diagnosis? Treatment?

Sacs resulting from hernias ion of esophageal mucosa and su mucosa into surrounding tissue. Dysohagia, regurgitation/reflux, nocturnal cough, halitosis aka bad breath. Diagnosed via esophagogastroduodenoscopy. Nutrition therapy, positioning, no restrictive clothing, surgery to remove the diverticula

Step 5 of system for med use in asthma control

Same as 4 +: oral glucocorticosteroids or anti IgE

COPD drugs

Same as asthma: beta-adrenergic agents, cholinergic antagonists, xanthines, corticosteroids, and cromones. Focuses on long therapy/drugs like arformoterol/Brovana or tiotropium/Spiriva. More likely to have systemic drugs and inhalants. Also mucolytics, like guaifenesin/Organidin/Nadecon or mucinex, nebulizer treatments with mucolytics like acetylcysteine/Mucosil/Mucomyst or dornase Alfa/Pulmozyme.

Placement of midline catheters do not insert when?

Same as short peripheral venous catheters no placement of arm with mastectomy, lymph edema, paralysis, dialysis grafts, fistulas

Most important roll of nurse with patient with hiatal hernia

Same education as GERD HOB elevated, no restrictive clothing, upright after eating, no straining, diet restrictions, reduce weight

Tube obstruction from tracheostomy occurs as result of? S/S? Assess? If tube obstruction occurs?

Secretions or cuff displacement. S/S; dyspnea, noisy respirations, difficulty suctioning, thick/dry secretions, unexplained peak pressure. Assess q 1 hours for patency, help cough/deep breath, inner cannula care, humidifying, suctioning. If tube obstruction occurs notify

BG steady in? Blood glucose homeostasis driven by?

Steady in blood stream. Insulin which moves glucose from blood into cells and glucagon/epinephrine which brings glucose out of storage

Early prostate cancer antigen EPCA-2 define?

Serum marker for prostate CA & detects changes early, very sensitive

Using peak flow meter

Set to 0, standing position, take deep breath, blow breath out as hard/fast as able to, reset and perform 2 additional times and use highest reading of the 3

History assessment of acute pancreatitis

Severe ab pain, ask if during drinking or eating high fat meal, family history, drinking history, history of abdominal surgery, history of PUD, renal failure, vascular disorders, hyperparathyroidism, hyperlipidemia, viral infections

Clinical manifestations of acute pancreatitis

Severe abdominal pain, Cullen's sign, turners sign, bowel sounds, abdominal tenderness, rigidity, guarding, ascites, pleural effusions, vs changes

Infliximab aka Remicade and adalimumab aka Humira for? Is? Adverse effects? Humira more for.

Severe complications of UC like megacolon that can lead to gangrene and peritonitis and extra intestinal manifestations. Is an IgG that reduces TNF. Adverse effect:immunosuppressant so can become sick. Adalimumab aka Humira more for Crohn's

After uterine artery embolization for leiomyomas ?

Severe cramping 2-4 days, give pain meds, raise HOB, ambulate 2-4 hours after

Complications of CD vs. UC starting with CD first?

Severe malabsorption, fistulas more common in CD, hemorrhage more common in UC

Final phase of Alzheimer's aka? Define

Severe to Late- Mute, babbling, agnosia, totally incapacitated, unaware of what is going on

Autonomic neuropathy

Sex dysfunction, neurogenic bladder aka retention/incontinence, diarrhea, gastroparesis due to vagus nerve aka delayed emptying which can cause anorexia/nausea/vomiting/gastroesophageal reflux, persistent fullness, hypoglycemic unawareness, postural hypotension, resting tachycardia,painless MI, infection. Affects almost whole body

How to instill eye meds

Shake suspensions or "milky" solutions to obtain the desired medication level. Wash hands thoroughly before and after the procedure. Ensure adequate lighting. Read the label of the eye medication to make sure it is the correct medication. Assume a comfortable position. Do not touch the tip of the medication container to any part of eye or face. Hold the lower lid down; do not press on the eye-ball. Apply gentle pressure to the cheek bone to anchor the finger holding the lid Instill eye drops before applying ointments. Apply a ½-inch ribbon of ointment to the lower conjunctival sac. Keep the eyelids closed, and apply gentle pressure on the inner canthus (punctal occlusion) near the bridge of the nose for 1 or 2 minutes immediately after instilling eyedrops. Using a clean tissue, gently pat skin to absorb excess eyedrops that run onto the cheeks. Wait 5 to 10 minutes before instilling another eye medication.

Define concussion

Shaky movement of brain

Dextran polysaccharide 40 kda or 70 kda

Shifts fluid into vessels for vascular expansion, prolongs hemodynamic response when given with Hypertonic saline. May cause fluid overload and hypersensitivity, increases risk of bleeding, contraindicated in bleeding disorders/CHF/renal failure

Hetastarch HES 6% or 10% action and use? Nursing considerations?

Shifts fluid into vessels for vascular expansion. May cause hypersensitivity and fluid overload, increased risk of bleeding, not good for CHF and renal failure

Herpes zoster aka? Spread how? Is a? Caused by? S/S? Post herpetic neuralgia?

Shingles or varicella zoster. Spread by contact with the fluid from the blisters •..is a highly contagious acute viral infection that produces painful eruptions along the nerves •Caused by reactivation of dormant varicella zoster (chicken pox) virus •Signs & symptoms-painful, burning, vesicles on trunk, depression common, crusts •Post herpetic neuralgia - older patients

Glucocorticoids aka? Used for? Examples? SE? Monitor for?

Steroids. 10-150mg PO, IV, enema. For RA, anti inflammatory, immunosuppression. Ex: prednisone/Deltasone. SE: DM, infection, fluid/electrolyte issues, hypertension, osteoporosis, glaucoma, K depletion, raised glucose. Monitor for moon face, buffalo hump, striae, acne, thin skin, bruising, cataracts

Removing vascular access device for short peripheral catheters? For midline and PICCs? Nontunneled percutaneous central catheters? For all do what? Tunneled and implanted needs?

Short peripheral catheters pull laterally to remove dressing and cover with dry gauze. Midline and PICCs remove Cather in short segment from insertion site and if resistance felt stop and never apply force. Nontunneled percutaneous central catheters clip sutures and withdraw. For all apply pressure with dry gauze and apply sterile gauze dressing with antiseptic ointment Tunneled and implanted needs surgery to remove.

Peripheral IV types

Short peripheral catheters, midline catheters

Contraindications to enteral feedings

Short term need least invasive done\NG, severe acute pancreatitis, high output proximal fistulas, inability to gain access, intractable vomiting and diarrhea, GI issues

Types of tubes for enteral nutrition

Short term use due to tissue irritation: nasogastric, nasoduodenal, nasojejunal Longer than 4 weeks: gastrostomy, PEG, jejunostomy

Glucagon-like peptide receptor agonists function? Must take when? Aka?

Simulate glucagon-like peptide-1 (GLP-1) aka incretin which triggers pancreas to secrete insulin with food, which is decreased in type 2, increases insulin sensitivity, Inhibit glucagon secretion, Decrease gastric emptying, Increases satiety, decreases liver production of glucose Must take oral meds 1 hour before injecting exenatide/Byetta and liraglutide/Victoza, bydureon/long acting. Aka incretin mimetics

Effective coughing procedure

Sit in chair or side of bed, shoulders inward, hugging pillow against stomach, few breaths, after 3-5 breaths in through nose out through pursed lips take deeper breath, bend forward while coughing 2-3 times from same breath

First sign of testicular cancer

Slight enlargement of testicle accompanied with discomfort

Type 1 DM define? Aka? Onset in those?

Slow Beta cell destruction leading to absolute insulin deficiency, autoimmune due to virus, idiopathic which then leads to DKA, weight loss, polydipsia, polyuria, polyphagia. AKA juvenile-onset/insulin-dependent/ketose-prone diabetes. Abrupt onset in those <30-40 years

Crohn's disease define? Affects what? Usually affects?

Slowly progressive and unpredictable Inflammatory disease of small intestine, colon, or both with involvement of multiple regions with normal sections in between called skip lesions with remission and exacerbations. It can affect GI tract from mouth to anus but usually affects terminal ileus.

Enteroscopy aka? Function? Procedure? Post?

Small bowel capsule endoscopy. View small intestine. Video shows entire small bowel via eight lead sensors and abdominal belt and capsule that is ingested. Prep: fast for 8-10 hours and NPO for first 2 hours. Post swallowing normal diet 4 hours after

Interventions for elderly pancreas changes

Small frequent feedings, assess for diarrhea

HHS s/s? Because these manifestations?

Somnolence, coma, seizures, hemiparesis, aphasia, dry mouth, extreme thirst, initially polyuria/later decreased dark urine, warm/dry skin, high fever over 101, sleepiness, confusion, vision loss, hallucinations, weakness on one side of body. B/c these manifestations resemble stroke immediate glucose level is critical for correct diagnosis.

Hypertonia aka

Spastic paralysis causing fixed positions or contractures of extremities and ROM restricted

Glasgow begin each phas of assessment by

Speaking normal, if no response louder, if no response shaking, if unsuccessful pain via supra orbital pressure, trapezius muscle squeeze, mandibular jaw pressure, sternal/breastbone rub

Stages of CKD

Stage 1 - Kidney damage with normal or increased GFR (> 90ml/min) Stage 2 - Mild reduction in GFR (60-90 ml/min) Stage 3 - Moderate reduction GFR (30-90 ml/min) Stage 4 - Severe reduction in GFR (15-29 ml/min) Stage 5 - Kidney Failure (GFR < 15)

Stage 4of CKD

Stage 4: Renal Insufficiency Mild azotemia > 75% nephron mass destroyed GFR 15 - 29 Impaired ability to concentrate urine Symptoms of polyuria and nocturia Avoid or reduce dosage of medications with renal excretion

Stage 5 of CKD

Stage 5: End Stage Renal Disease (ESRD) Azotemia Urine is isosmotic to plasma 90% nephron mass destroyed 10% GFR; < 15 ml/min or dialysis Creatinine clearance < 15 ml/min Chronic abnormalities Oliguria Uremia Electrolyte & fluid imbalances Dialysis/transplant to sustain life

Stages 1-3 of CKD

Stages 1-3: Decreased renal reserve BUN & Creatinine normal Asymptomatic Renal impairment detected by stressing the kidney and testing the GFR Acute or Chronic Renal failure Primary Goals: Prevention of kidney injury and delay the progression of the disease

Bolus enteral nutrition administration

Start with 120-240ml of formula at meal times or q 3-4 hours over 10-20 minutes. Gradually increase amount per feeding using gravity bag

Meds recommended for patients who don't reach lipid ADA goals with lifestyle modifications and for those >40 years with other CVD risk factors

Statins

BG homeostasis when person eats and BG rises? As body cells use glucose?

Stimulates pancreas to release insulin which stimulates uptake of glucose into cells and storage as glycogen in liver+muscles and stimulates excess glucose into fat. As body cells use glucose blood levels decline and low BG stimulates pancreas to release glucagon which stimulates liver cells to break down glycogen and release glucose in blood causing it to rise

Elder vs. younger GI issues

Stomach cancer vs. inflammatory bowel disease

Colorectal cancer screening test

Stool tests: fecal occult blood test etc

Transfusion reaction interventions

Stop transfusion, KVO with NS, take VS and stay with patient, treat symptoms, inform physician and blood bank, will likely have to send blood back to bank with tubing attached, document, reassure patient and family, do not restart transfusion

SGLT-2 inhibitors aka? Examples? Function? SE? Not recommended for? Recommended starting dose?

Sugar transporter inhibitor. Invokana/Farxiga. Inhibits SGLT-2 reducing reabsorption of glucose. SE: weight loss, increase urinary glucose, genital yeast, UTI, increased thirst, urination, constipation, nausea, hypotension. Not recommended for people with kidney disease. Recommended starting dose lower and can be increased

What UAP's can't do

Supervise other UAPs, re delegate, complete pain assessment

Preventing/managing wandering AD

Supervision, area with max observation, sitters/family for monitoring, away from stairs/elevators, no room changes, avoid restraints, treat pain, reorientation and validation therapy, frequent toileting, prevent overstimulation

For peritonitis before incision is closed

Surgeons irrigates peritoneum with antibiotic solutions and several catheters may be inserted to drain the cavity and provide route for irrigation after surgery

Chvostek's sign test

Tap face just below and in front of ear over facial nerve to trigger facial twitching of one side of mouth, nose, cheek

Pediculosis symptoms? Define? raised prevalence where? Diagnosis? Treatment?

Symptoms-pinpoint erythema, itching esp. around nape of the neck, reporting "crawling" or "biting" feelings •parasite: feeds on scalp and leaves eggs "nits that transmit disease •^ prevalence: schools •diagnosis-hand held lens - clothing & bedding dry cleaned; do not share combs, topical shampoos i.e. lindane (Kwell), or PO ivermectin/stromectol

Traditional cholecystectomy

T tube drain to ensure patency and JP drainage tube used to prevent fluid accumulation. Post op: opioids, antiemetics, wound care, keep drainage under site of insertion, diet low in fag

Teaching for post op leiomyomas/fibroids/myomas

TCDB, IS, amb., pain, antibiotics, support

Meds for UTI

TMP-SMZ (Trimethoprim-Sulfamethoxazole, Bactrim, Septra) Furadantin (Macrodantin) Cipro Levaquin Norfloxacin (Noroxin) Gantrisin Cefixime Pyridium (bladder analgesic)

CVA med after hemorrhage ruled out

TPA aka tissue plasminogen activator example: Activase

COPD General appearance

Thin, loss of muscle, thick neck, slow moving, stooped, foreword bending posture Aka orthopneic/tripod position, activity intolerance

Tinel's sign

Tapping median nerve of wrist for CTS

Admin of oral potassium

Tastes bad and since can cause nausea/vomiting give during or after meal

Herpes zoster goal of treatment? Treatment? Prevention?

The goal of treatment is to relieve the pain •Acyclovir - start within 3 days •Cold compresses •Sedation at bedtime •Triamcinolone topical/cortisone decrease inflammation •Contact Precautions •Prevention: 1 Herpes Zoster Vaccine SQ for adults > 50 who do not have shingles

Noninvasive options for enlarged prostate

Thermotherapy: transurethral needle ablation TUNA, transurethral microwave therapy TUMT, interstitial laser coagulation ILC aka contact laser prostatectomy CLP, electro vaporization of the prostate EVAP, stents, laser balloon dilation

Because DPP-4 inhibitors are glucose dependent? SE? Can be taken?

They lower potential for hypoglycemia and don't cause weight gain like other meds for DM. SE: upper respiratory infection, stuffy/runny nose, sore throat, headache, UTI, nasophayngitis. Can be taken with or w/o food

Post op after lobectomy/thoracotomy without pneumonectomy

They will have chest tube, keep tube below chest, for water seal chest tube keep 2cm of water in seal to prevent air from flowing back into patient/check water level/use sterile water

Diuretics types? Function of each?

Thiazidine inhibits Na, Cl, water reabsorption&promotes K+HCO3+Mg excretion. Loop high ceiling aka furosemide/Lasix+torsemide/Demadex inhibits Na+C;+H2O reabsorption&K excretion. K-sparing like spirnolactone/Aldactone inhibits Na reabsorption in exchange for retaining K

Micro vascular DM complications? Specific to diabetes? Usually appears when?

Thickening of vessel membranes in capillaries and arterioles, glucose toxicity, ischemia causing hypoxia Specific to diabetes:Retinopathy Nephropathy Dermopathy Neuropathy Usually appear 10 to 20 years after diagnosis

Red nail findings and significance?

Thin dark red verticals lines aka splinter hemorrhages from endocarditis, trichinosis, trauma, normal in some. Red discoloration of lunula from cardiac insufficiency. Dark red nail beds due to polycythemia Vera.

Promoting nutritional intake

Toilets and mouth are before mealtime, glasses/hearing aids in place, bedpans/urinals/basins removed from site, analgesics/antiemetics 1 hour before, sit in chair if possible, observe patient's intake, ask about food likes/dislikes, encourage self feeding, feed slow,decrease distractions, adequate light, no offensive odors, document, visual appealing and cold/warm meals, no interruptions

Circulatory overload transfusion reaction define?symptoms?

Too much blood delivered too fast. Symptoms: cough, dyspnea, headache, tachycardia

Relative Ca loss causes

Total body calcium amounts to remain normal while Ca levels are low when unbound Ca is reduced or when parathyroid gland function is decreased

Interventions for unilateral body neglect syndrome in right stroke/damage

Touch and use both sides of body, encourage them to wash both sides of body, when dressing remind them to dress affected side first, if hemianopsia present teach patient to turn head from side to side to expand visual field

Notify for what issues in chest tube drainage systems

Tracheal deviation, sudden/increased dyspnea, o2 sat <90, drainage >70ml/HR, visible eyelets on chest tube, chest tube falls out but first cover with sterile gauze, chest tube disconnects from system but first put end of tube in container of sterile water keeping below chest, drainage in tube stops in first 24 hours

Complications of tracheostomy

Tracheomalacia, tracheal stenosis, tracheoesophageal fistula, trachea I nominate artery fistula, tube obstruction, tube dislodgement, accidental decannulation, pneumothorax, subcutaneous emphysema, bleeding, infection

TURP management of enlarged prostate? POST OP?

Transurethral resection of prostate TURP using endoscope through urethra to remove tissue. Post op: normal for pink urine, some blood clots, increase fluid intake, ambulate asap, check drainage tube for kinks and clots, sever bladder spasms which can indicate obstruction and obstruction irrigate, assess VS q 2 hours, NS for irrigation, notify if ketchup like urine

Surgical management of POP

Transvaginal repair using surgical vaginal mesh or tape (minimally invasive) Anterior colporrhaphy: Open surgical repair to tighten the pelvic muscles for ^ bladder support Posterior colporrhaphy: Posterior repair reduces rectal bulging Vaginal hysterectomy

Patient that has scabies tells RN that itching becomes unbearable at night, best response is?

Treatment involves using scabicidal shampoos like lindane/Kwell or permethrin/Actin, wash clothes in hot water, scratching can lead to exoriation and infection, confirmed via scraping lesions and microscope exam for mites and eggs

Positioning for inserting nontunneled percutaneous central venous catheter ? What prohibits uses and increases risk?

Trendelenburg, rolled towel between shoulder blades. TRauma, surgery, radiation in chest/neck prohibits use and tracheotomy increases risk for cross contamination of insertion site and the upper chest/neck has more microbes so more risk for infection

Syphilis caused by?s/s?

Treponema. Transmitted via sex and blood and body contact. S/S: ulcer/chancre, malaise, fever, headache, aches/pains, sore throat, rash, warts, lesions, aortic valvular disease, aneurysms, meningitis, hearing loss, paresis.

Cystocele aka? S/s?

Urinary bladder prolapse. Difficulty emptying bladder, urinary frequency/urgency, UTI, stress urinary continence

Function of kidneys

Urinary elimination to maintain body fluid volume and composition, filter waste, regulate BP and acid base balance, make erythropoietin for RBC synthesis and convert vitamin D to active form

Kidney changes in dehydration

Urine concentrated, specific gravity greater than 1.030 color dark and strong odor

Tests for kidney function: urine protein? Urine excretion? Creatinine? Urine glucose for?

Urine protein without kidney symptoms may indicate microvascular changes in the kidney Urine excretion rates of 20 - 200g/min indicate microalbuminuria Creatinine clearance test Poor glucose control Hypertension Urine glucose test for "quick screening" but less precise

Giving transfusion

Use Y tubing for blood on one port and NS on other, y tubing has filter to filter out fibrin clots etc., assess whether blood should be warmed, don't squeeze or rigorously shake blood or other blood products, start slowly according to policy, stay with pt. during first 15-30 minutes, document VS per policy every 5 min for first 15 then every hour, monitor input

Treatment of pressure ulcer

Use ruler to measure size and q-tip to measure depth, observe odors or drainage color, monitor VS/labs, note necrotic/granulation, stage 2-4 are contaminated or contain bacteria, duoderm, wet to dry dressings, enzymes, debridement, antibiotics

24 hour urine creatinine clearance collection procedure

Use signs, use second void, collect all urine after, ice or refrigerate

Coomb's test define? Types? Norm?

Used for blood typing. Direct detects antibodies against RBCs. Indirect detects circulating anti globulins to determine whether antibodies for RBC about to get is present. Normal: negative, you don't want antibodies against RBC

Agent host environment model useful for? Agent? Host? Environment?

Useful for examining the cause of disease •Agent: An environmental factor or stressor that must be present or absent for an illness to occur i.e. bacteria or virus •Host: A living organism capablea of being infected or affected by an agent i.e. client •Environment: All factors external to the host that makes illness more or less likely like physical, social, biological, cultural factors

Teaching for PICC

Usually ADLs but avoid excess physical activity like muscle contractions in arm from heavy lifting that can lead to dislodgement and possible occlusion

Visual issues with right brain damage? Interventions?

Usually depth and distance perception affected with discrimination of right from left or up from down. Use frequent verbal and tactile clues and break down tasks in steps, always approach patient from unaffected side which should face door of room.

Patient with hip pain usually experiences it in?

Usually experiences it in groin or radiates to knee

Interventions for kidney tumors

Usually nephrectomy, dialysis before transplant

Preventing/detecting ICP

VS q 1-2 hours, cardiac monitor, monitor blood gases, avoid flexion/extension of neck, head midline, log roll during turning to prevent hip flexion, HOB >30 degrees

Care during mechanical ventilation

VS q 4 hours, bilateral chest expansion,HOB >30 to prevent pneumonia/aspiration, set alarms, empty when moisture collects, ensure humidity, assess if suction needed q 2 hours, mouth care q 2 hours, assess for GI issues, turn q 2 hours, provide method of communication

Assessment prior to infusion

VS, CBC, IO, IV access, skin color

Postop care leiomyomas/fibroids/myomas

Vag bleeding (< 1 saturated pad/4 hours) - Abd bleeding & intactness @ incision site - Vital Signs and Pain - Urine output per urinary catheter for < 24 hours

Chlamydia s/s:

Vag/penile discharge that is more watery than gonorrheal, dysuria, pelvic pain, irregular bleeding, urethritis, epididymitis, prostasis, infertility, cervicitis, cervical bleeding, salpingitis, PID, ectopic pregnancy, infertility

Key features of chronic gastritis ? Usually?

Vague report of epigastric pain relieved by food, anorexia, nausea/vomiting, intolerance of fatty/spicy foods, pernicious anemia, upheld abdominal discomfort. Usually few symptoms unless ulcerations.

Agents for erectile dysfunction categories? Meds?

Vasodilator. Alprostadil, Caverjecti, Paverine, Phentolamine/Regitine

Dumping syndrome define? Occurs as result of? Symptoms occur when? Early symptoms? Late symptoms occur when? Late symptoms define?

Vasomotor symptoms that occur after eating. Occurs as result of rapid emptying of food into small intestine which shifts fluid into gut causing abdominal distention. Occurs within 30 minutes of eating. Early Symptoms: vertigo , tachycardia , syncope, sweating, pallor, palpitations, desire to lie down. Late symptoms 90 minutes to 3 hours after eating: insulin causes rapid entry of food into jejunum. Late symptoms: dizziness, light headedness, palpitations, diaphoresis, confusion

Antidiabetic hormone aka? Made where ? Stored in? Controlled by? Stimulation of release?

Vasopressin. Made in brain and stored in posterior pituitary that is controlled by hypothalamus in response to increased blood osmolarity and increase in plasma sodium to act on kidneys for water reabsorption decreasing osmolarity and ECF volume to increase

Preventing ventilator associated pneumonia

Ventilator bundle: hand hygiene, oral care q 12 hours, HOB elevation >30 degrees. Oral care with rise before intubation, no jewelry when providing care, remove secretions q 2 hours or continuously if trach, xray for placement, don't go supine within 1 hour after bolus tube feeding, wean off asap

Placement of short peripheral venous catheters

Verify prescription complete and appropriate, for adults choose site in upper extremity and never use wrist, choose no dominant arm when possible, choose distal site and make all subsequent venipunctures proximal to previous sites, don't use on arm with mastectomy/lymph node dissection/arteriovenous shunt/fistula/paralysis/joint flexion/hard or cordlike vein/cellulitis/dermatitis/complications from previous catheter/lymph edema/paralysis of upper extremity/dialysis grafts ,vein must be appropriate length and width to fit size

Extravasation define? Cause? S/S? Treatment? Prevention?

Vesicant into extra vascular tissue with peripheral and central catheters. Pictured vein wall, blood flow obstruction, inflammation, fibrin sheath, damaged septum of implant, dislodged port access needle. S/S: rate slows, edema, skin tightness, blanching, coolness, burning, tenderness, fluid leaking, absence of blood return, blistering, tissue sloughing. Stop infusion and disconnect, aspirate drug, leave short peripheral catheter or port access needle in for antidote, apply cold compress for all drugs except alkaloids and epipodophyllotoxins, photograph site, monitor. Prevention: catheter stabilization, using smallest catheter, avoid area of flexion, no restraints at site, make successive venipunctures proximal to previous site, monitor, central venous catheters obtain blood return, protect from clothing

Cerebral perfusion pressure measured

Via subtracting mean ICP from mean arterial pressure

Tactile vocal fremitus

Vibration of chest when speaking that can occur when pleural space filled with air/pneumothorax or fluid/plueral effusion or bronchus obstructed

Types of meningitis and differences

Viral/aseptic that's most common, self-limiting+patient has complete recovery. Bacterial that is life threatening. Fungal and protozoalOtitis media, pneumonia, acute/chronic sinusitis, sickle cell anemia, brain/spinal injury, immunosuppression, infection, older people, piercings

Multiple sclerosis subjective

Vision, mobility, or sensory changes, Aggravating factors, Personality or behavior changes, Euphoria, poor judgment, attention loss, Sleep patterns, bowel and bladder dysfunction, Numbness or tingling, ADLs

Endoscopic retrograde cholangiopancreatography ERCP define? Procedure? Prep? Post?

Visual and radiographic exam of liver, gallbladder, bile ducts, pancreas to identify cause and location of obstruction. Cannula inserted in common bile duct and radiopaque dye instilled for X-rays, papillotomy can be performed, stents can be inserted in ducts, endoscopy of duodenum and biliary tract. Prep: NPO 6-8 hours , sedation. Post: VS every 15 minutes , assess for gag reflex before fluids or foods

Esophagogastroduodenoscopy EGD define? Prep? Post?

Visual exam of esophagus, stomach, and duodenum and also can be used to give injections and dilate strictures. Prep:NPO 6-8 hours before, sedatives and spray to remove gag reflex administered. Sims left side lying position. Post:Spray suppresses gag reflex for 1-2 hours so NPO until reflex back vitals every 30 minutes

Upper GI radio graphic series define? Prep? Afterward?

Visualization from mouth to duodenojejunal junction using ingested barium. Prep: NPO for 8 hours before. Afterwards drink plenty of fluids and laxative/stool softener and stool will be white for 24-72 hours as barium excreted

pyridoxine aka? Foods?

Vitamin B6. Fortified cereal, chicken, turkey, tuna, salmon, liver, milk, cheese, beans, spinach, carrots, brown rice, bran, whole grains, bananas. Can help high cholesterol, can help heart disease, aids metabolism

Low PTT and prolonged clotting time due to

Vitamin K and manganese deficiency

Symptoms of gastrectomy

Vitamin b12, folic acid, iron deficiencies causing pernicious anemia, atrophic glossitis causing beefy tongue

Causes of osteomalacia

Vitamin d disturbance, kidney disease, liver disease, inflammatory bowel disease, Metabolic error like hypophosphatemia

ARF indications for dialysis

Volume overload that cannot be managed with diuretics Hyperkalemia refractory to medical therapy Correction of acid-base disturbances that are refractory to medical therapy Severe azotemia Uremia

Pyloric obstruction manifested by? Caused by?

Vomiting caused by stasis and gastric dilation. Caused by scarring, edema, inflammation. Symptoms: abdominal bloating, nausea, vomiting, hypochloremic/metabolic alkalosis, hypokalemia

Hypokalemia can indicate

Vomiting, gastric suctioning, diarrhea, drainage from intestinal fistulas

BMI=? Least for risks? Older adults should be?

W in kg/ h in meters. 18.5-25, older adults should be 23-27

How h. Pylori cause ulcers

WBC cause epithelial necrosis, h. Pylori makes urease lowering pH causing more damage

Lab assessment of intestine obstruction

WBC normal unless stangulated obstruction which are high, hemoglobin/hematocrit/creatinine/BUN high due to dehydration. Sodium chloride and potassium reduced due to loss of fluid and electrolytes. Elevated amylase In stangulating obstructions, ABG

Washed RBCs aka? volume? Infusion time? Indications?

WBC poor PRBCs. 200mL, 2-4hours.history of transfusion reaction, hematopoietic stem cell transplant

Aspirating tube wait? Ph of stomach? Intestines? Lungs? Certain drugs?

Wait 1 hour after drugs then flush with 20ml air, collect, test with pH paper, pH should be 0-4 if in stomach if in intestines 7-8 if in longs greater than 6. Certain drugs can raise pH like h2 blockers aka ranitidine/Zantac, famotidine/Pepcid

Dilantin should not be taken with? What else can interfere with antieleptics ?

Warfarin/Coumadin. Citrus like grapefruit can interfere with antiepileptic drugs raising toxicity

Integumentary acidosis key features

Warm, flushed, dry skin in metabolic acidosis, pale to cyanotic and dry skin in respiratory acidosis

Hyperglycemia skin? Dehydration? Mental status? S/s? Glucose? Ketones?

Warm, moist. Present. Rapid/deep kussmaul with acetone/fruity odor. Varies from alert to comatose. Acidosis, hypercapnia, cramps, n/v, if dehydration decreased neck vein filling, orthostatic hypotension, tachycardia, poor turgor. >250. Positive

Suctioning an artificial airway

Wash hands, eye wear occlude suction and adjust pressure to 80-120 to prevent hypoxemia+trauma, setup sterile field, pre oxygenate with 100% O2 for 30 seconds, don't suction during insertion, never suction longer than 10-15 seconds, then hyperoxygenate again for 1-5 minutes, mouth care

Steps to draw NPH and regular insulin

Wash hands, rotate NPH, wipe with alcohol, draw air that equals dose, inject air in NPH then regular insulin, invert regular insulin and withdraw dose, withdraw NPH

Neuro symptoms of hypoglycemia

Weakness, fatigue, difficulties thinking, confusion, behavior changes, emotional changes, seizures, loss of consciousness, brain damage

Nursing assessment for peritoneal dialysis

Weigh daily I &O S/S of volume overload Peritoneal catheter patency Condition of exit site Color and character of effluent Normal- clear, pale yellow Cloudy fluid indicates peritonitis - add antibiotics Fibrin strands indicates clotting - add heparin

Gastritis prevention

Well balanced diet, avoid excess alcohol, use caution in large doses of aspirin/NSAIDs/corticosteroids/erythromycin, avoid caffeine, manage stress, no smoking, avoid toxic substances in work place, seek medical treatment if signs on esophageal reflux

Renin-angiotensin 2 pathway

When kidneys sense BP, volume, o2, osmolarity related to sodium low they secrete renin that activates angiotensin that is acted on by angiotensin converting enzyme aka ACE which turns it into angiotensin 2 that cause vasoconstriction, lowers GFR, aldosterone secretion

Intermittent admin sets define? Med bag from previous dose? Should be changed every? Change blood tubing? Change tubing for propofol/Diprivan?

When no primary continuous fluid infused this used to infuse multiple doses of meds through catheter that's capped with needless connection device. Med bag from previous dose removed for new one. Should be changed every 24 hours, change blood tubing every 4 hours, change tubing for proposal/Diprivan every 6-12 hours.

Subcutaneous infusion used when? Define? Sites? Not for? What can increase absorption? Which tools can be used? Rates? Rotate site how many times?

When oral, IM, vascular access cannot be used. Hypodermoclysis via slow infusion of isotonic fluids. Sites: front/sides of thighs+hips, upper abdomen, under clavicle. Not for >2000mL/day, emergencies, bleeding/coagulation issues. Hyaluronidase can increase absorption. Small gauge, winged/butterfly needle, short peripheral catheter, sub q infusion set used. 30mL/hr started max is 75-80mL/hr, for pain meds 2-3mL/hr. Rotate site once per week

Define subcutaneous emphysema

When there is opening/tear in trachea air escapes into tissue of neck and can progress through chest and face. If skin around trach is puffy and you can feel crackling notify

Tube dislodgement and accidental decannulation define? If tube dislodged on immature tracheostomy ?

When tube not secure prevented via securing tube in place. Ventilate using manual resuscitation bag/facemask while other RN calls rapid response. For safety ensure tube of same type and size + insertion tray at bed side at all times.

Hepatitis define? Most common type? Types of the most common?

Widespread inflammation of liver cells resulting in right upper quadrant pain , disformity, edema of bile channels causing jaundice. Viral. HAV, HBV, HCV, HDV, HEV.

Define ulcerative colitis

Widespread inflammation or rectum and colon associated with remissions and exacerbations. Intestinal mucosa becomes hyperemic, edematous, and reddened and can bleed and cause small erosions/ulcers/abscesses which can result in tissue necrosis, narrow colon, and partial bowel obstruction

Febrile transfusion reactions occur when? S/S? Prevention?

With patient with anti-WBC antibodies from multiple transfusions, WBC transfusions, and Platelet transfusion. S/S: chills, tachycardia, fever, hypotension, tachypnea. Prevention: WBC reduced blood, single donor HLA-matched platelets, WBC filters

Acute normovolemic hemodilution

Withdraw of patient's RBC and volume replacement just before surgery to prevent RBC loss during surgery, then reinfused after surgery

How much alcohol should DM patient drink? You should drink with? One drink equals?

Women 1 drink, men 2. And consumed with snack/meal One drink equals 12 oz beer, 5oz wine, 1.5 oz distilled spirits

Risk factors for endometrial/uterine cancer

Women in reproductive years; Family history, Diabetes Mellitus, Hypertension, Obesity, Uterine polyps, Late menopause, no childbirths, Smoking, Tamoxifen given for breast cancer

Breast cancer more common in?

Women who haven't had kids and moderate alcohol intake

Phalen's maneuver

Wrist test for CTS is paresthesia <60seconds +

Hysterosalpingography HSG define

X-ray of cervix, uterus & tubes Mammography: annually after age 40

hydroxychloroquine aka? does what? side effects? drug type?

aka Plaquenil. slows progression of RA. antimalarial. Side effects:stomach discomfort, light headedness, headache, retinal damage. DMARD.

If patient's peripheral catheter infusion is except the to last longer than 6 days

a midline catheter or PICC should be chosen

Manifestations of endometriosis

abdominal and back pain usually before period, dysmenorrhea, dyspareunia, and infertility

primary drug for osteoarthritis

acetaminophen aka Tylenol or topical drugs like lidocaine aka Lidoderm patches that can be used for 12 hours with up to 3 patches or salicylates aka aspercreme patch/gel/cream, or capsaicin. If those don't work then analgesic NSAIDs like Celecoxib aka Celebrex, or injections of cortisone, hyaluronate aka Hyalgan or hylan aka Synvisc or possibly muscle relaxants like cyclobenzaprine hydrochloride aka Flexeril for spasms.

signs of CS

acute compartment syndrome, hypovolemia, hyperkalemia, rhabdomyolysis aka myoglobulin release from muscle, acute tubular necrosis, dark brown urine, muscle weakness and pain

primary OA aka osteoarthritis cause? what parts of body most affected?

aging, genetics, obesity, trauma, career, smoking. Weight bearing joints like hips and knees, vertebral column, and hands are most commonly affected

Rn inverventions for dementia

aimed at promoting patient function and independence for as long as possible, safety, reducing anxiety/agitation, improving communication, providing for socialization/intimacy, nutrition, activity/rest, educating caregivers

Gout

aka "Gouty arthritis" -Drug therapy, Different medications for acute and chronic -NO aspirin or diuretics -Nutritional therapy, Decrease alcohol, Avoid "starvation" diets, Teach patients to avoid foods that prompt gout attack, Promote hydration

Sulfasalazine aka? does what? side effects?

aka Azulfidine. decreaseds inflammation and slows RA. Side effects: lowers sperm count, renal/liver toxicity, formation or urine crystals if not enough water

biological response modifiers aka? class of? do what? examples? side effects?

aka BMRs or biologics. class of DMARDs, most neutralize tumor necrosis factor or interleukin for RA via IV or injection. Ex: Etanercept/Enbrel, Infliximab/Remicade, Adalimumab/Humira, Anakinra/Kineret, Abatacept/Orencia, tocilizumab/Actemra. Side effects: injection reaction,infection

disease modifying antirheumatic drugs aka? does what? what type? example?

aka DMARDs. slows progression of RA. immunosuppressive. Ex: Methotrexate, Leflunomide/Arava, hydroxychloroquine/Plaquenil, biological response modifiers/BMRs

methotrexate aka? given when? monitor for? aka?

aka MTX/Rheumatrex given in once a week dose less than 25mg for RA. Monitor for low WBCs and platelets, nausea, vomiting, bone marrow suppression and infection. DMARD.

open reduction with internal fixation aka? is most?

aka ORIF is most common methods of reducing and immobilizing fracture

glucocorticoids aka? used for? examples? side effects? monitor for?

aka steroids. 10-150mg PO. used for RA for anti-inflammatory and immunosuppressive effects Ex: prednisone/Deltasone. Side effects: DM, infection, fluid/electrolyte imbalance, hypertension, osteoporosis, glaucoma, K depletion, glucose to increase. Monitor for: moon face, buffalo hump,, striae, acne, thin skin, bruising, cataracts,

open reduction allows surgeon to?

allows surgeon to view fracture

plasmapheresis

antibodies removed from plasma to decrease MG symptoms

A rheumatic disease is

any disease or condition involving the musculoskeletal system

traction define? types?

application of pulling force to part of body to provide reduction, alignment, rest. Types: running traction where pulling is in one direction, balanced suspension which countertracts so that pulling isn't altered when patient/bed moved, skin traction with velcro boot/buck's traction or belt or halter which usually is secured around leg that is 5-10 pounds, skeletal traction with pins, wires, tongs or screws that are surgically inserted in bone

leflunomide aka? does what? side effects? drug type?

arava. diminishes inflammatory arthritis symptoms. given 20mg every day. Side effects: hair loss, diarrhea, decreased WBCs+platelets, increased liver enzymes. DMARD.

Cervical cancer most are caused by?

are caused by certain types of human papilloma virus (HPV) specifically the high risk strains

periungual lesions

around nail bed, brown spots in RA patients

Low testosterone define? Alcohol?

associated with metabolic syndrome, type 2 diabetes, cardiovascular disease; **alcohol inhibits testosterone production

myasthenia gravis what type of disease? characterized by? improves with? s/s? cause? onset? diagnosis?

autoimmune disease characterized by fatigue and weakness that usually improves with rest. S/S ocular palsies, eye+face issues, paresthesia, loss of bowel/bladder control, muscle ache, paresthesias, decreased smell/taste in muscle innervated by cranial nerves and skeletal/respiratory muscles, ptosis, diplopia, dysphagia. not from genetics, possibly thymus, thyroid, RA, lupus. usually slow onset. diagnosis: repetitive nerve stimulation, EMG, tensilon test

Wound control for foot ulcers with DM

debridement, dressings, advanced wound healing products (becaplermin [Regranex]), vacuum-assisted closure, ultrasonography, hyperbaric oxygen, and skin grafting

paradoxical BP define? cause?

decrease in systolic pressure by more than 10 mm Hg during inspiratory phase of respiratory cycle. Anything that alters filling pressure of ventricles causes this like pericardial tamponade, pericarditis, pulmonary hypertension

Assessment of raised ICP? Late changes?

decreased LOC, pupils sluggish, 1-2 pupil dilated, 2 pupils dilated or pinpoint-no reaction. Late changes: widening pulse pressure, bradycardia, decreased/irregular respirations, temperature increased aka cushing's triad

as calcium rises phosphorus

decreases

managing fatigue for RA? if muscle atrophy?

decreasing pain and sleep disturbances. anemia should be treated with iron, folic aci, or vitamins. if muscle atrophy physical therapy, energy conservation like pacing, rest periods, setting priorities, obtaining assistance, plan ahead, don't exceed activity tolerance

Causes of inadequate chest expansion

deformities/weakness from electrolyte imbalances, fatigue, muscular dystrophy/obesity/casts/Escher/ascites,

Irritable bowel syndrome causes? Aka? Define.

diarrhea, constipation, and/or abdominal pain and bloating. Aka spastic colon, mucous colon, nervous colon. Bowel motility changes and increased or decreased bowel transit times result in changes in normal elimination pattern.

hip precautions after THA after discharge

don't sit/stand for prolonged periods, don't cross legs beyond midline, don't bend hips more than 90 degrees, don't twist body when standing, use ambulatory aid like walker, use assistive/adaptive devices for dressing, don't put more weight on affected leg than allowed, resume sex on the advice of surgeon, use raised toilet seat

interventions for osteoarthritis

drug therapy, local or systemic or psychological rest, positioning in functional position, applying heat, applying cold, diathermy, ultrasonagraphy, acupuncture, weight control, therapy, dietary supplements glucosamine and chondroitin, and if nonsurgical methods don't work surgeries like total joint arthroplasty TJA aka total joint replacement or osteotomy that removes damaged cartilage

orthopnea

dyspnea when lying flat and can be due to heart disease

PE assessment

dyspnea, Pleuritic chest pain & increased heart rate, Crackles, cough, hemoptysis, Distended neck veins, syncope, cyanosis, and hypotension, Abnormal EKG and heart sounds, pleural friction rub, diaphoresis, low grade fever, petechiae over chest, decreased SaO2, n/v, malaise Sense of impending doom, anxiety, and fearfulness

tensilon test aka? define? positive if? determines?

edrophonium chloride aka tensilon and neostigmine bromide aka prostigmin is injected and positive if better muscle tone for 4-5 min. Determines if MG due to cholinergic crisis aka too much cholinesterase inhibitor or myasthenic crisis aka too little cholinesterase inhibitor

abduction devices

either pillows or with straps that must be loosened every 2 hours and checked for skin irritation and/or breakdown

Lifestyle therapy for GERD

elevate HOB by 6-12 inches for sleep, sleep in right side lying position, no smoking or alcohol, weight reduction, no constrictive clothing, no lifting heavy objects or straining, no working in bent over or stooped position, no oral contraceptives/anticholinergic agents/sedatives/NSAIDs/nitrates/calcium channel blockers

Chronic complications of DM are primarily those of

end-organ disease from damage to blood vessels/angiopathy secondary to chronic hyperglycemia

Surgical management of DUB

endometrial ablation (removal of built up uterine lining); uterine artery embolization (stopping the blood supply); Dilation & Curettage (D & C); & hysterectomy

baker's cysts

enlarged popliteal bursae behind the knee from RA

Cause of hypochloremia

fluid overload, excessive vomiting, diarrhea, adrenal insufficiency, diuretic therapy, gastric suctioning

calcitonin from? does what?

from thyroid decreases Ca and inhibits bone resorption

anasarca define ? can be due to?

generalized edema can be due to right heart failure

Define d-dimer

global marker of coagulation activation and measures fibrin degradation products produced from clot breakdown

Estrogen define? Alcohol?

growth & development of female sexual characteristics & reproduction; tells cells to grow & (prompts breast tissue growth); helps prevent bone loss; **alcohol ^

nonmed interventions for Paget's

heat, massage, exercise with physical therapist, diets with calcium and vitamin d

acute compartment syndrome high risk of? if suspected? s/s? treatment?

high risk of cast, splints, wraps, ORIF, external fixation. If suspected notify first, if tight dressing loosen it, if cast follow policy on who can remove. Signs/symptoms: pain, numbness/tingling, pale and cool extremity, loss of movement/function+ decreased pulses/pulselessness latest sign. Treatment: fasciotomy via opening fascia to relieve pressure

total joint arthroplasty usually for? helps with? should never be performed on those with?

hip and knee joints but also finger, wrist, elbow, shoulder, toe, and ankles. Helps with osteoarthritis, RA, congenital issues, trauma, and osteonecrosis. They should never be performed on those with any infection, or osteoporosis, diabetes, hypertension patients

Biquanides withhold when and for how long and what to monitor? Contraindications? Can cause?

if patient is undergoing surgery or radiologic procedure with contrast medium for Day or two before and at least 48 hours after. Monitor serum creatinine Renal, liver, cardiac disease, HF, excess alcohol. Can cause lactic acidosis, gas, nausea, cramping if it accumulates

Acidosis from DM causes

increased RR and depth aka kussmaul, fruit breath from acetone, low pH and decreased HCO3, compensatory respiratory alkalosis with decreased PaCO2

compartment syndrome define? causes?

increased pressure in compartment reduces circulation to the area after trauma that causes inflammation which causes, redness, pain, swelling, tingling/numbness, cyanosis, unequal pulses and then necrosis/ischemia, infection, weakness, contracture, myoglobinuric renal failure, possible amputation

PTH does what?

increases and stimultes bone to release Ca in blood and reduces renal excretion of Ca and facilitates Ca absorption

arthritis define? categories?

inflammation of one or more joints. Categories: noninflammatory localized like osteoarthritis that is not autoimmune, or inflammatory systemic autoimmune diseases like rheumatoid arthritis and lupus erythematosus

osteomyelitis pathophysiology

inflammatory response causing edema that causes decreased blood flow to bone causing ishemia+bone necrosis with sequestrum formation that causes abcess

if hyperosmotic IV solution like 2% saline infused into patient with normal ECF osmolarity

infusing fluid would make person's blood hyperosmotic and interstitial fluid would be pulled into circulation and as result plasma volume would expand

facilitated diffusion/transport examples

insulin, sodium pumps

arthrocentesis define?

invasive for joint swelling where needle into joint aspirates synovial fluid to relieve pressure and test fluid for RF and increased WBC's

prevention of joint degeneration

keep body weight normal, don't smoke, avoid activities that stress joints, wear supportive shoes, don't do repetitive stress activities like typing/knitting, avoid risk taking activities

scoliosis define? appears when? types?

lateral curve usually in thoracic area, most likely appears as a kid. Types: congenital, neuromuscular from neuromuscular conditions like cerebral palsy, and idiopathic which cause is unknown

physical therapy for fractures

laterality that helps brain identify injured foot from uninjured foot. aka mirror box therapy where patient covers affected foot while looking at and moving uninjured foot. the brain perceives foot as injured food. Also can use iontophoresis that is method for absorbing steroids to decrease inflammation

most important part of patient/family education for OA

learning how to protect joints. Use large joints instead of small ones, don't turn doorknob clockwise, use two hands to hold objects, sit in chair with high/straight back, when entire palm of both hands to get out of bed not finders, don't bend at waist, bend at knees, use long handled devices, use assistive/adaptive devices like velcro, don't use pillows in bed, avoid twisting/wringing hands

Meglitinides function? Rapid onset? Taken when? Should not be? Examples?

↑ Insulin production from pancreas Rapid onset: ↓ risk for hypoglycemia Taken 1-30 minutes to just before each meal Should not be taken if meal skipped Ex: Repaglinide/Prandin, Nateglinide/Starlix

Leiomyomas/fibroids/myomas meds?

leuprolide acetate (Lupron) - decreases the size of tumors; Gonadotropin releasing hormone analogue that desensitizes the pituitary gonadotropin releasing hormone receptors

Lordosis define? aka? vs. scoliosis define? vs. kyphosis aka? define?

loss of lumbar and cervical curve aka flat back, all spine vertebrae have lateral/side curve usually in thoracic area, aka hunch back usually thoracic but also cervical spine

Barrel chest results from

lung overinflation and diaphragm flattening = weakened effect of diaphragm from emphysema

define measurable and not measurable fluid intake

measurable: oral, parenteral, enemas, irrigation fluids. not measurable: solid foods, metabolism

measurable and not measurable fluid output

measurable: urine, emesis, feces, drainage from body cavities. Not measurable: perspiration, lung vaporization

rheumatoid factor measures? usually?

measures presence of unusual antibodies of immunoglobulins G and M that develop in CTDs like RA, cancer, and other diseases and other but not all + indicate disease esp. in older people. usually -

antinuclear antibody ANA test measures? aka? often?

measures unusual antibodies that cause tissue death in patients with autoimmune disease, CTD's like RA. fluorescent method aka FANA. often negative unless later and only + in a small few with RA

Cause of hyperchloremia

metabolic acidosis, respiratory alkalosis, hypercortisolism

how to monitor for signs/symptoms that could indicate local anesthetic is getting into patients system

metallic tast, tinnitus, nervousness, slurred speech, bradycardia, hypotension, decreased respirations, seizures

presence of most chronic diseases usually causes? and the reason to?

mild to moderate anemia causing fatigue and the reason to monitor CBS for low hemoglobin, hematocrit, and RBC count, and high WBC and platelets

osmosis define? to occur?

movement of water through selectively/semipermeable membrane to have equal concentrations of particles to water even though total amounts of particles and water are different. To occur one fluid space must have particles that cannot move through membrane with concentration gradient

inspection assessment of osteoarthritis

musculoskeletal: look for enlarged joints, hardness, heberden's nodes, bouchard's nodes, joint effusion aka excess joint fluid via moving fluid from infrapatellar notch/area below knee into suprapatellar area above knee, atrophy of skeletal muscle due to no use, contractures, limping, loss of function, check lumbar and cervical spine, radiating pain, stiffness, spasms

clubbing define? indicates?

nail angle of 180 degrees and base of nail spongy to indicate chronic pulmonary disease, congenital heart defects, or cor pulmonale aka right heart failure

cholinergic crisis characteristics? treatment?

nausea, vomiting, diarrhea, ab cramps, blurred vision, pallor, face muscle twitching, pupillary miosis, hypotension. Treatment: atropine

Osmolality define? aka?

number of milliosmoles/mEq in kilogram of solution aka greater amount of particles the higher.

assessment of scoliosis

observe while standing with forward flexion of hips, observe for asymmetry of hip+shoulder, prominence of thoracic ribs and scapula on one side, visible curve of spineQ

crush syndrome occurs from? causes? as muscle becomes ischemic?

occurs from twisting, earthquake, crushing injury that causes hemorrhage and edema thus compressing compartments in leg, arm, pelvis. As muscle becomes ischemic myoglobin and vitamin k released in circulation causing kidney failure and cardiac dysrhythmias

impact of age related changes on fluid balance

skin elasticity, turgor, oils decrease. kidney decreased glomerular filtration and concentrating capacity causing poor excretion of waste and increased water loss. decreased muscle mass causing greater risk for dehydration. diminished thirst reflex causing decreased fluid intake. adrenal atrophy causing poor regulation of sodium and potassium causing hyponatremia and hyperkalemia

Dementia with Lewy bodies is?

one of the most common types of progressive dementia. The central feature of DLB is progressive cognitive decline, combined with three additional defining features: (1) pronounced "fluctuations" in alertness and attention, such as frequent drowsiness, lethargy, lengthy periods of time spent staring into space, or disorganized speech; (2) recurrent visual hallucinations, and (3) Parkinsonian motor symptoms, such as rigidity and the loss of spontaneous movement. People may also suffer from depression.

rheumatoid arthritis onset age? gender most affected? risk factors/cause? disease process? pattern? drugs?

onset age: 35-45, females risk factors/cause: autoimmune, genetic, stress triggers exacerbation, environment disease process: inflammatory disease pattern: bilateral, symmetric, multiple joints, upper extremities first, systemic lab findings: elevated rheumatoid factor, antinuclear antibody, ESR drugs: NSAIDs short term, methotrexate, leflunomide aka Arava, corticosteroids, immunosuppressants

osteoarthritis onset? gender usually? risk factors/cause? disease process? pattern? drugs?

onset: older than 60, female risk factors/cause: aging, genetics, obesity, trauma, occupations disease process: degenerative disease pattern: unilateral, single joint, affects weight bearing joints and hands+spine, nonsystemic drugs: NSAIDs short term, acetaminophen, analgesics

Low body fat and weight may be related to?

ovarian dysfunction; onset of menses; regular menstrual cycles; & low estrogen level

Respiratory alkalosis pH? PCO2? HCO3-? Differential?

pH high, PCO2 low, HCO3- normal or decreasing. Anemia, CHF, exuberant mechanical ventilation

Metabolic alkalosis pH? PCO2? HCO3-? Differential?

pH high. PCO2 normal or increasing. HCO3- high. Vomiting from upper GI obstruction, admin of alkaline solutions

Metabolic acidosis pH? PCO2? HCO3-? Differential?

pH low, PCO2 normal or decreasing. HCO3- low. Diabetes, addisons, renal failure, increased acid production

subluxation aka

partial dislocation

fractures described by cause

pathologic spontaneous fracture: occurs after minimal trauma to bone that's weakened by disease fatigue stress fracture: excessive strain and stress via athletics compression fractures: loading force applied to long axis usually in vertebrae

when caring for patient with CFNB perform? patient shouldn't feel?

perform neurovascular assessment ever 2-4 hours, patient shouldn't feel pain but be able to plantar flex and dorsiflex and feel, be warm, have proper color and capillary refill

cardiac complications of late RA

pericarditis, myocarditis

respiratory complications of late RA

pleurisy, pneumonitis, diffuse interstitial fibrosis, pulmonary hypertension

hip dislocation prevention/intervention

position correctly, keep leg abducted, prevent hip flexion beyond 90 degrees, assess for pain rotation and extremity shortening, report immediately to physician

peripheral nerve blockade aka PNB define? aka?

postop pain management for lower extremity, anesthesiologist injects femoral or sciatic nerve with local anesthetic. aka continuous femoral nerve blockade CFNB

In DUB when ovaries fail to ovulate?

progesterone decreases; without progesterone, prolonged estrogen stimulation causes endometrium to grow causing disordered shedding of uterine lining

Dementia/AD characterized by?

progressive decline and ultimately loss of multiple cognitive functioning including both Memory And at least one of the following:Aphasia, Apraxia, Agnosia, anomia Disturbance in executive functioning

Treatment of testicular cancer

radical orchiectomy, retroperitoneal lymph node dissection (open or laparoscopic), radiation therapy, and chemotherapy

myasthenic crisis characteristics

raised pulse+RR+BP, anoxia, cyanosis, bowel and bladder incontinence, decreaseda urine output, absence of cough/swallow reflex

reduction define? either?

realignment of bone ends for proper healing. either closed or open aka surgical

exercises recommended for patient with OA and RA

recreational: hobbies sports therapeutic exercise: planned activities to improve muscles and ROM. do these on all days unless pain increases. must be active instead of active assist, reduce repetitions when there's inflammation

hemiarthroplasty

replacement of part of joint in shoulder

in hypothermia tissues require?

require fewer nutrients and BP and pulse falls

in hyperthermia tissues require?

require more nutrients and BP and pulse rate rises

muscular dystrophy MD progression? causes? primary problem is? diagnosed via? cure?

slowly or rapid progression. Causes: poor blood flow to muscle, disturbance in nerve-muscle interaction, loss of cell membrane integrity. Primary problem is progressive muscle weakness which can cause respiratory weakness and cardiac failure. Diagnosed via muscle biopsy, aldolase+CK elevated, EMG findings abnormal. No cure only physical and occupational therapy

minimally invasive surgery NIS? cannot be used on?

smaller incision to reduce muscle cutting, but cannot be used on obese or for osteoporosis only for primary THAs

Because brain requires constant supply of glucose to function hypoglycemia can cause

speaking difficulties, visual disturbances, stupor, confusion, seizures and coma, mimics alcohol intoxication

getting patient out of bed after THA

stand on same side of bed as affected leg, after patient sits on bed side remind them to stand on unaffected leg and pivot into the chair

pericarditis define? can be? location? relieved with?

sudden sharp, stabbing, moderate to severe. can be infectious, noninfectious, autoimmune, acute, chronic Location: substernal left side, back. Relieved with sitting upright, analgesia, anti-inflammatory agents

MI onset? usually in? s/s> location? relieved with?

sudden without precipitating factors, usually in morning. Intense stabbing viselike pain/pressure. Location: substernal and can spread to chest and arms, jaw, back, neck. Relieved with morphine, drugs, O2

proper positioning for THA

supine, head slightly elevated

TSA aka? major potential complications? what's used to immobilize joint?

total shoulder arthorplasty. subluxation/partial dislocation and total dislocation is major potential complication. Sling used to immobilize joint

RN interventions for myasthenia gravis

treatment that affects symptoms without influencing actual course of disease like anticholinesterases or cholinergic drugs, or inducing remission like immunosuppressive drugs or corticosteroids, plasmapheresis, thymectomy

cast syndrome define? causes what?

upper intestinal obstruction that causes abdominal distention, pain, nausea, vomiting

postop care of older adult with THA

use abduction pillow or splint, keep heels off bed to prevent pressure ulcers, don't rely on fever as sign of infection, use decreasing mental status to detect infection, move patient slowly out of bed, encourage deep breathing and cough and incentive spirometer every 2 hours to prevent atelectasis and pneumonia, get patient out of bed ASAP, anticipate giving pain meds, expect a temp. change in mental state immediately after surgery, reorient patient frequently

Teaching for continuous glucose monitors

use and interpret calibration and control solutions. Control solution should be used when a glucometer is first used, when a new bottle of strips are used, or if there is a reason to believe that the readings are not correct.

ankle-brachial index used to? equation? normal is? less than 0.8 indicates?

used to measure vascular status of limb blood pressures for amputation. Ankle systolic pressure/dorsalis pedis or tibial divided by brachial systolic pressure. Normal is 1 or higher. less than 0.8 indicate vascular disease

internal fixation uses?

uses pins, screws, rods, plates, or prostheses to immobilize fracture

serum complement usually decreased in? usually total is?

usually decreased in autoimmune diseases, anemia, infection. Usually total 75-160units/mL

lab assessment of osteoarthritis

usually physical exam and history used to diagnose since labs usually normal but labs can be used to screen for associated issues like erythrocyte sedimentation rate aka ESR and high sensitivity C reactive protein aka hsCRP which can be elevated when secondary synovitis occurs

CPM: usually set to? best practice for using it?

usually set to 20-30 degrees flexion and full extension/0 degrees at 2 cycles a min. Ensure it's well padded, check cycle and ROM settings once every 8hrs, ensure joint is properly positioned, if patient confused place controls out of reach, assess patient response, turn off machine during meals, when machine not in use DO NOT store on floor

Health illness continuum views health as? Illustrates?

views health as a constantly changing state, with high level wellness & death being on opposite ends of the scale •This continuum illustrates the ever changing state of health as a person adapts to changes in the internal & external environments to maintain a state of well-being

other care after THA after discharge

walk and perform leg exercises like straight leg raises/gluteal sets/ankle pumps/ham sets, don't cross legs to prevent blood clots, report pain/redness/swelling/chest pain/shortness of breath, if taking anticoagulant follow precautions

if 24 hour output less than 400-600mL

water loss from skin, lungs, and stool. usually 500-100mL/day. Increases during thyroid issues, trauma, burns, stress, fever, hot/dry environment, mechanical ventilation, tachypnea

Pelvic organ prolapse cause by?

weakening of muscles, pregnancy, damage during childbirth, obesity, physical exertion, decreased estrogen weakens pelvic support

kidney control of blood

when renal blood flow/pressure decreases kidneys retain Na and H2O and activate renin angiotensin aldosterone mechanism causing vasconstriction causing BP to rise

WNL BP? Cholesterol? Triglycerides? HDL? LDL? GLOOD GLUCOSE? BMO? ABD. GIRTH? PSA?

•Cholesterol: <200 mg/dl •Triglyceride: <150 mg/dl •HDL: >40 mg/dl •LDL: <70 mg/dl (^ risk pts); <100 mg/dl •Blood Glucose: 60 - 100mg/dl •BMI: 18.5-24.9 •Abd. girth: <40" for men; < 35" for women •PSA: <4 nanograms/ml

Oral candidiasis signs? Treatment? For widespread or resistant infection?

•Signs - white plaques esp. in mouth, that bleed & leave erosions when removed, poor appetite, difficulty swallowing due to pain; infected skin has a moist red, irritated appearance •Treatment - Nystatin/Mycostatin , Fluconazole or Clotrimazole (Mycelex), keep area dry •For widespread or resistant fungal infections, systemic medications i.e. ketoconazole (Nizoral) is used

Health promotion model define? This model? If a behavior becomes a habit? Health related behavior is?