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1533 Final Flashcards

1
Q

Delirium Assessment

A

Confusion Assessment Model tool
CAM
Can be done without an order

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2
Q

Delirium can lead to

A

Changes in level of consciousness
Irreversible brain damage
Death

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3
Q

Delirium symptoms

A 
Stupor - hypoactive
Excessive activity - hyperactive
Disorganized thinking
Short attention
Hallucinations, delusion, fear, anxiety, paranoia
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4
Q

Dementia symptoms are -

Where as delirium symptoms are -

A

Long term onset

Acute onset

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5
Q

Because of unknown underlying causes, delirium is considered a

A

Medical emergency

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6
Q

Delirium prevention

A 
Reorienting
Early mobilization
Pain control
Good sleep
Enhance communication methods (hearing aids, glasses)
O2 levels 
Hydration
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7
Q

Delirium treatment

A

Fall prevention
Discontinue none essential meds
Monitor nutrition and fluids
Familiar environment ques like fam interaction

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8
Q

Haldol does NOT work for

A

Elderly with dementia

Has opposite effect

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9
Q

Dementia is -

Most common dementia is -

A

General decline in higher brain function

AD

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10
Q

3 Stages of AD

A

Preclinical - Minor forgetfulness, small difficulties
Mild Cognitive - Noticeable mild changes that can be measured, limitations in independent living start
Severe - Significant impairment of thinking, behavior and functioning independently

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11
Q

Medications for Alzheimer’s

A

Donepezil
Rivastigmine
Galantamine
(Anticholinesterase inhibitors)

Memantine
(Preserves memory)

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12
Q

Risk factors for Dementia/delirium

A 
Aging
Low education
Down syndrome
Family history
Smoking x2 to x4 fold increase
Obesity
Insulin resistance
Dyslipidemia - high level of lipids
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13
Q

Dyslipidemia

A

High level of lipids

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14
Q

Med good for hyperactive delirium

A

Haldol

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15
Q

Assessment for Alzheimers

A

Mini COG

Can be done without orders

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16
Q

Assessment for cognitive performance of the elderly

A

Mini Mental State Examination

MMSE

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17
Q

In elderly, cognition may be effected by

A 
Sensory impairment
Physiologic health
Environment
Sleep 
Psychosocial influence
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18
Q

Delirium

A

Acute confused state

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19
Q

Alzheimer Disease

AD

A

6th leading cause of death

Progressive degenerative neurologic disease

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20
Q

AD is most common in people over

A

65y/o

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21
Q

AD Patho

A

Neurofibrillary tangles - nonfunctional neurons

Neurotic plaque - deposits of amyloid protein in the brain

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22
Q

Reality orientation with AD

A

Who and where a person is in a time continuum, this will only WORSER mental/emotional state of AD patient due to increased anxiety

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23
Q

Nursing roles in AD

Supporting cognitive function

A 
Calm predictable routine
Simple explanations
Memory aids
Physical and verbal stimulation
Clock/calendar display
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24
Q

Therapies for Phobias

A

Cognitive Behavioral Therapy CBT
Group Therapy
Guided Mastery Therapy

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25
Meds for phobias
Antidepressants SSRI Paroxetine, fluoxetine Tricyclic antidepressants imipramine Monoamine oxidase inhibitors MOAIs Benzodiazepines Alprazolam Clonazepam
26
SSRIs can increased suicidal thinking in patients age-
18-24
27
Benzos can lead to
Dependence
28
Anorexia Nursing interventions
``` Establish trust and expression Periodic weight Encourage small frequent meals PN/TPN Assess bowels Supervise patient during meal and 1 hour after ```
29
When anorexic patients eat they can develop refeeding syndrome S/S are
Hypophosphatemia, hypokalemia, hypomagnesemia, fluid overload, edema.
30
Assess anorexic patients
electrolytes for refeeding syndrome for suicidal ideations for good sleep and energy Weight I&O
31
Selye's General Adaptation Syndrome GAS ARE
Alarm stage Resistance stage Exhaustion stage
32
Fetal alcohol spectrum disorder characteristics
``` Small head Short eye openings Flat midface (cheeks) Smooth philtrum (space under nose) Underdeveloped jaw Low nasal bridge Epicanthal folds Short nose Thin upper lip ```
33
Fetal alcohol spectrum disorder characteristics
``` Small head Short eye openings Flat midface (cheeks) Smooth philtrum (space under nose) Underdeveloped jaw Low nasal bridge Epicanthal folds Short nose Thin upper lip ```
34
Neonatal abstinence syndrome NAS occurs when mother takes
``` Amphetamines Barbituates Benzos Cocaine Marijuana Opiates ```
35
NAS treatment is for drug dependence
Methadone
36
Antabuse
Disulfiram | Creates negative reaction to alcohol
37
NAS baby clinical manifestations
``` Fussy/hard to calm Excessive sucking BUT poor feeding High pitched cry D/V Trembling or jittery ``` Full withdrawal symptoms - muscle tone increase, seizures, breathing problems
38
Peripheral neuropathy Alcohol myopathy GI-itis
Complications of alcoholism
39
Wernicke's encephalopathy Korsakoff's psychosis Alcohol cardiomyopathy
Complications of alcoholism
40
Cirrhosis Blood dyscrasia Fetal alcohol syndrome
Complications of alcoholism
41
Legal intoxication level
Alcohol level over 0.08
42
Alcohol dependence is 4 times more likely in patients with
Mental illness
43
SIADH
Syndrome of inappropriate ADH (antidiuretic hormone) TOO MUCH ADH RETAIN WATER
44
SIADH lab values
Hypoosmolality Urine concentration greater than 100 Natriuresis - NA in urine greater than 30
45
SIADH Symptoms
Fluid in lungs Early - Cramps, N/V Late - Confusion, seizers, coma
46
Hallmark of SIADH
Hyponatremia blood serum | Hypernatremia in urine
47
Hypernatremia symptoms | FRIED
``` Fever Restlessness Increased fluids Edema Decreased urine, dry mouth ```
48
Hypernatremia can be treated with diuretics but diuretics an lead to
Hypokalemia
49
Potassium wasting diuretics
Furosemide | Hydrochlorothiazide
50
Potassium sparing diuretics
Spironolactone
51
is dehydration FVD
NO, dehydration is loss of water alone | INCREASE in electrolytes
52
in FVD unlike dehydration
Fluids AND electrolytes are lost and need replacement
53
Dehydration symptoms
``` Dry mouth Poor skin turgor Low BP High Na High HR Weight loss ```
54
Urine specific gravity
1.005-1.030
55
Creatinine and BUN normal | AND with dehydration
Creatinine 0.6-1.2 will be over 1.2 | BUN 10-20 will be over 20
56
DI causes
Head injury Pituitary tumor Craniotomy
57
DI MOA
Pituitary gland shuts off ADH supply to kidneys
58
In DI, patients bodies cant stop peeing, as a result the symptoms will be
``` BP decrease Thirst Increase Hypovolemia Hypernatremia Tachycardia Urine Specific gravity low ```
59
Nursing care for DI
Monitor and replace fluids Check neuro status, vitals, mucous membrane
60
DI water movement
Polydipsia Polyuria Nocturia
61
Meds for DI
Desmopressin ddAVP | Vasopressin
62
Because of incontinence, the elderly are reluctant to best way to tell if a pt is dehydrated is
Drink enough water Filling of veins in hands
63
COPD MOA
Chronic inflammation damages lung tissue causing scarring that narrows the airway
64
COPD associated complications
Chronic Bronchitis | Emphysema
65
COPD symptoms
Chronic cough Sputum production Dyspnea Weight loss Barrel Chest
66
COPD management
``` Smoking cessation Exacerbation management O2 therapy Pneumococcal/influenza vaccines Pulmonary rehab ```
67
Meds for COPD
Bronchodilators and Corticosteroids Antibiotics Mucolytics Antitussives
68
Nursing management for COPD
Airway clearance Breathing patterns Activity tolerance
69
Asthma MOA
Chronic inflammation or mucous membrane and edema due to hyperresponsiveness
70
Asthma symptoms
Cough Chest tightness Wheezing Dyspnea
71
Manifestations of asthma
Diaphoresis Tachycardia Hypoxemia Cyanosis
72
Fast acting and long acting meds for asthma
Fast - fast beta 2 agonists Anticholinergics Long - long beta 2 agonists Corticosteroids
73
Teach asthma patients to
Avoid triggers Use inhaler Monitor peak flow When to seek aid
74
Gas exchange corticosteroid
Triamcinolone
75
Use bronchodilator _ | Use Corticosteroid _
First | Second
76
Use mouth wash after
Corticosteroids WILL cause thrush
77
Anticholinergics
Will decrease acetylcholine relaxing breathing Ipratropium bromide
78
RSV children should be placed on what precaution
Droplet Can be cohorted
79
To prevent RSV
Wash hands at day care and after exposure to individuals with cold symptoms
80
Hospitalize RSV child with what symptoms
Tachypnea Retraction Poor oral intake Lethargy
81
Severe, continuous asthma that is unresponsive to meds
Status Asthmaticus
82
Diagnosing Asthma
Episodic symptoms of airflow obstruction Airflow it at least partially reversible, Other causes are excluded
83
Blood pH PaCO2 HCO3
7.35-7.45 45-35 22-26
84
Metabolic acidosis
Bicarbonate less than 22 DKA Kidney failure Diarrhea HYPERkalemia
85
Kusmaul breathing
Metabolic acidosis
86
Diamox
Decreases bicarb reabsorption Treats metabolic alkalosis Can cause metabolic acidosis
87
A/B of vomiting
Metabolic alkalosis | loss of H
88
Treat metabolic alkalosis with
Antiemetic Stop suction Stop diuretics "loop and thiazide especially" Monitor ABGs Give diamox
89
Flu symptoms Hyperactive reflex Confusion A/B
Metabolic Alkalosis
90
Metabolic alkalosis S/S
Bradypnea Hypoventilation under 12 HYPOkalemia EKG changes Tetany Tremors Muscle weakness Fatigue
91
Metabolic acidosis s/s
Kusmaul breathing Confusion Weakness Lob BP N/V HYPERkalemia
92
Respiratory acidosis S/S
``` Neuro drop Drowsiness, confusion, fatigue Headaches RR less than 12 Hypotension ```
93
Resp Acidosis interventions
Admin O2 Encourage cough Deep breathing Watch K
94
Respirator alkalosis s/s
Resp rate over 20 Confusion Fatigue Tachycardia Tetany EKG changes Muscle cramps Positive Chauvstics
95
Resp alkalosis interventions
Monitor lytes Paper bag Hold breath Calcium gluconate for tetany
96
3Ps of Diabetes
Polyuria Polydipsia Polyphagia
97
Type 2 diab
Patient becomes insulin resistant due to high blood glucose over time
98
T2 diab risk factors
Diet Lifestyle Medication
99
A1C
Checks blood sugar for past 3-4 months
100
Brown thick skin on neck and armpits
Acanthosis nigricans | T2 Diab sign
101
Normal unfasted glucose value Pre diabetic value Diabetics value
70-115 NA 200+
102
Fasting glucose value Fasted pre diabetic value Fasted diabetic value
Less than 100 100-125 126+
103
A1C normal value Pre diabetic value Diabetic value
less than 5.7 5.7-6.4 Over 6.5
104
Sugar under 70 hypogly
Brain will die
105
Diabetic complications of kidneys
Nephropathy Kidneys will DIE creatinine over 1.2
106
Diabetic complications of nerves
``` Loss of sensation Sugar foot Slow healing Retinopathy Blindness ```
107
Diabetic complications of heart and brain
HTN Atherosclerosis CVA Stroke
108
Oral agents only work for _ diab
T2
109
PO drugs for t2 diab Toxic to
Metformin Glipizide Glyburide Pioglitazone Acarbose Toxic to liver
110
for diabetics, avoid FOOT
Flipflops, high heels, nylon OTC corn removal Overly hot baths, use thermometer Toe injuries, daily inspection, use mirror
111
NOs of diabetic foot care
NO callous removal NO heavy powder NO rubbing with hands NO hot baths
112
Diabetic diet good
High fiber Complex carbs BROWN beans, rice, bread, peanut butter Whole wheat/grain/milk
113
Diabetic diet bad
``` Simple sugars Soda Candy White bread/rice Juice #1 offender ```
114
Antithyroid meds
Methimazole Propylthiouracil Can cause hypothyroidism
115
Hypothyroidism symptoms Low and Slow
``` Weight gain, shot metabolism Unable to tolerate cold Goiter Tiredness Fatigue Slow HR Depression Memory loss ```
116
Hypothyroidism Skin GI Hair
Dry, rough, cold Constipation Thin brittle
117
Myxedema
Swelling of face and eyes | Hypothyroidism
118
Hypothyroidism risk factors
Women middle to older age Hashimotos Iodine deficiency Pituitary tumor
119
Hypothyroidism monitor
HR BP RR Blood glucose Weight
120
Meds for hypothyroidism
Levothyroxine Liothyroinine Lotrix
121
Hypothyroidism how it is diagnosed
Under secretion of T3 and T4 Blood test for t3 t4 and TSH
122
INsulin
protein hormone made in pancreas Puts sugar and potassium INto cells
123
In t2 diab pt becomes insulin _
resistant
124
Best t2 diab treatment
Diet Lifestyle Exercise
125
Insulin peaks =
plates | Give food
126
IV only insulin
REGULAR | Right in the vein
127
Clear days before cloudy days
Regular Clear insulin first | NPH Cloudy insulin second
128
RN of insulin
Regular first | NPH iNtermediate second
129
Best location for insulin injection
Abdomen rotate daily NEVER aspirate fat tissue NEVER massage or hot compress
130
Insulin on sick days
Still give | Monitor closely
131
LONG Acting insulin | 'Old guys"
``` NO peak NO mix SEPARATE syringes Duration 24+h NO risk of hypoglycemia ```
132
Detemir | gLARGine
Last all year LARGe lasting Long lasting insulins
133
NPH insulin Cloudy dudes Always mixed up
iNtermediate NEVER IV Mix Clear to Cloudy Duration 14+h
134
NPH Insulin peak
4-12h | 5-6 most dangerous
135
Regular insulin
Goes right in Ready to go IV ONLY iv insulin Duration 5-8h
136
Regular insulin peaks
2-4h
137
Rapid insulin
MOST DEADLY PRIORITY | 15min onset
138
Rapid insulin peak
30-90 min
139
ASSpart Lispro Glulisine
Move you ASS Lis time Go Limosine RAPID acting insulins
140
Rapid acting insulin is given
DURING a meal PT is eating DONT give until food is delivered
141
CSII
Continuous subcutaneous insulin infusion Fewer swings Nice even basal rate
142
NPH insulin names have an _
N Humulin N Novolin N
143
Regular insulin names have an _
R Humulin R Novolin R
144
T1 diabetes
Body kills own pancreas cells Body has no insulin Autoimmune Can be passed down genetically PTs are insulin dependent FOR LIFE
145
3Ms of metformin side efects
Minicam chance of hypoglycemia Massive weight gain Major liver and kidney toxicity NOT for liver serosis or hypatitis patients
146
Hold metformin for _ before_ because
48h Cath lab Contrast due and metformin will KILL kidneys
147
GlipizIDE GlyburIDE
G heart may DIE bad for heart Hypoglycemia Weight gain Sun burn Toxic for elderly
148
Pioglitazone side effects
HF Liver failure edema crackles weight gain
149
Acarbose side effects
Carb blocker Flatus and diarrhea Don't give to IBS patients
150
TPN complications
Hyperglycemia, may need insulin GI atrophy Dumping syndrome
151
Sites to run TPN
Peripheral or Central line
152
For TPN patients check blood glucose _ because is at risk of hyperglycemia. May need to be put on _
q6h insulin
153
For home health TPN monitor
Lytes Daily
154
TPN is a _ procedue
Sterile
155
Parenteral nutrition indications
``` Come Preop GI problems Pancreatitis Paralytic ileus ```
156
Peripheral TPN site guidelines
Less preferred No dextrose above 10 Less than 2 weeks
157
Central TPN site guidelines
Preferred method PICC Percutaneous Triple lumen
158
TPN feeding rate
50ml/hr to start 100-125ml/hr as tolerated
159
TPN too rapid symptoms
Hyperosmolarity ``` Headache Nausea Fever Chills Malaise ```
160
TPN too slow symptoms
Rebound hypoglycemia ``` Confusion Tremors Hypotension Tachycardia Cool clammy skin ```
161
TPN nutrition IVs always use _ to infuse at a _ change tubing _
Pumps Constant 24h
162
Nutrition maintenance
Keep refrigerated | Warm to room temp when giving
163
With TPN monitor daily
Weight Glucose Temp I&O
164
With TPN monitor every other day
BUN Ca Mg
165
With TPN monitor weekly
``` CBC Platelets Prothrombin AST ALT liver Serum albumin ```
166
Before starting TPN perform
Chest x-ray to verify placement
167
What irritates peptic ulcers
NSAIDs Acidic foods Sodas
168
Where can peptic ulcers happen what is it
Anywhere in the digestive tract Erosion of mucous membrane creating an excavation
169
Peptic ulcer bacteria
H Pylori
170
Peptic ulcer is caused by
NSAIDs H Pylori Alcohol, smoking, fam hist, Zolinger-ellison too much stomach acid
171
Peptic ulcer pain management
Tylenol Antacids NO NSAIDs
172
With peptic ulcers monitor for
Anemia | Bleeding
173
Keep a _ with peptic ulcers
Food diary At least 72 hr
174
Care for peptic ulcer pts in order
PAIN ANXIETY Nutritional imbalance Knowledge deficit
175
Best indicator of malabsorption
Low albumin
176
Older adult nutrition requires
Fewer calories and more nutrient rich foods
177
Excessive fluid intake tan lead to patient
Not eating enough
178
Steotorrhea
Fat in stool malnutrition
179
Transferrin level
Less than 100 Severe protein depletion Malnutrition
180
Low prealbumin and nutrition
Malnutrition
181
Low BUN and nutrition
Malnutrition
182
Normal albumin level
3.5-5.0 Less means malnutrition
183
Most common complication of pregnancy
Gestational hypertension
184
First question to ask hypertension PT
Fam history
185
Gestational hypertension characteristics
No proteinuria | Systolic bp over 140 or diastolic over 90 after 20 weeks gestation
186
In preeclampsia patient will have
Proteinuria AND hypertension symptoms
187
Preeclampsia symtpoms
``` Headache Oliguria Blurred vision Edema Thrombocytopenia Rena failure Cerebral disturbances ```
188
How to cure preeclampsia
Give birth
189
S3 heart sound indicates
Mitral regurgitation | Left side HF
190
Murmur
Skip in pulse do pulse for the full 60 sec for these patients INDICATES MVP
191
Mitral valve prolapse symptoms
``` Atypical chest pain Palpitations SOB Dizziness Syncope ```
192
Mitral valve prolaps meds
Antiarrhythmics CCB BB for pain
193
Antiarrhythmics
Amiodarone Flecainide Help with MVP
194
MVP consumables to avoid
Caffeine Alcohol Tobacco
195
Meds containing these products can worsen MVP
Alcohol Caffeine Ephedrine Epinephrine
196
Mid systolic click
Indicates Mitral Valve Prolapse
197
Calcium channel blocker med endings
ZemAmilDipine
198
Calcium channel blockers calm the heart by
Dropping both HR and BP Zem and Amil Dropping only BP Dipine
199
CCB or calcium channel blocers
Count HR and BP, hold if HR below 60 or BP below 100 sys Change positions slowly Bad headaches
200
Beta Blockers LOL endings
Atenolol Block Beats for LOw HR and Low BP
201
Beta Blockers are contraindicated in patients with
Resp distress
202
BBBB of beta blockers
HR less than 60, BP less than 100, DO NOT GIVE Breathing problems Bad for HF- new edema, worsening crackles, rapid weight gain, new JVD Blood sugar masking
203
Digoxin
DIGs for deeper contractions Does not affect BP ONLY decreases HR
204
ACE and ARBs
Act to lower BP only NOT HR
205
ACE and ARB ending
ACE pril | ARB sartan
206
ACE and ARBs side effects
Avoid Pregos Angioedema Airaway risk ACE only Cough Ace only Elevated K
207
Angioedema
Risk with ACEs only Airway closure Face and mucosa swelling
208
AAA of ARBs and ACEs
Antihypertensive (lowers BP, NOT HR) AVOID pregos and breastfeeding ADDS Potassium, hyperkalemia
209
Digoxin is a
TOXIN Toxicity over 2.0 serum K bellow 3.5 increases Dig toxicity
210
#1 Drug for acute or worsening HF
Diuretics Lower BP Furosemide Spironolactone
211
Post op Abdominal surgery non pharmacological pain management
Pillow splinting
212
Wong-baker FACES scale
Pain scale Adults and children as young as 3
213
FLACC
Pain scale for young children Face Leg Activity Crying Consolability
214
CPOT
Modeled after FLACC Used for PTs who can not self report in critical care
215
When is pain worst after surgery
24-48h
216
Post op pain is accompanied by
N/V give Phenargan Reglan or Compazine
217
Sickle cell pain symptoms
``` Fussy Crying Pain Fever Swelling ```
218
Sickle cell anemia symptoms occur at
6m, this is when fetal hemoglobin diminishes
219
Tests for Sickle Cell Anemia
Dithionite - not precise | Hemoglobin Electrophoresis - PRECISE
220
Sickle cell anemia pain management
Elevate hands and feet to promote blood flow Warm compress Remove restrictive clothing Opioids Around The Clock
221
Dactylitis
Inflammation of hands and feet with SCA
222
Hydroxyurea
Used to treat SCA and cancer | Creates fetal hemoglobin
223
Kidneys and SCA
Unable to concentrate urine | Hydration is a HIGH PRIORITY
224
Renal Calculi Treatment
PAIN 1st intervention Relieve pain 2 flush stones 3 strain all urine for stones 4 use ambulation to facilitate passage NO BEDREST, WALK NO MASSAGE, more damage
225
Shockwave lithotripsy
Breaks up calculi Blood and stones will be present Bruising and pain normal
226
PVD pain type
Neuropathic
227
PVD meds
Gabapentin Venlafaxine Vicodin Percocet
228
PVD affects
ANYWHERE outside the heart
229
PVD patient legs should be
eleVated
230
PAD patient legs should be
hAnged
231
Claudication
Calf pain Sign of low O2 PAD
232
PVD VEINY
``` Voluptuous pulses Edema Irregular shaped sores No sharp pain DULL pain only Yellow and brown ankles ```
233
PVD Risk factors
Smoking Diabetes Cholesterol HTN
234
Diagnosing PVD and PAD
Doppler ultrasound | Arterial Brachial Index
235
For PAD you can apply a
Warm pad under the legs
236
Antibiotics for diverticulitis
Broad spectrum Flagyl Cipro
237
Diagnosing diverticulosis
Colonoscopy Barium enema CT scan W/contrast
238
Diverticulitis
Inflammation of the diverticula
239
If ruptured, diverticulitis can become
Peritonitis and sepsis
240
Diverticulitis S/S | POUCH
``` Pain LLQ Observe bloating and blood Unrelenting cramps Constipation High temp ```
241
Diverticulitis nursing care focus
GI assessment | Diet regiment
242
Initial phase of diverticulitis nursing care
NPO Assess for peritonitis Hydrate Pain meds
243
Diet for diverticulitis
HIGH FIBER Fresh fruit and veg, oats, grains and beans drink 2-3L a day
244
Psyllium Probiotics
Fiber supplement for diverticulitis gut flora for diverticulitis
245
Palpable mass Lack of motility NV Backing up
Diverticulitis | EMERGENCY
246
Peritonitis s/s
``` Rebound tenderness Muscle rigidity Fast shallow breaths at rest Distended abdomen Ascites Fever ```
247
Neurogenic bladder
Nerve disfunction leading to incontinence
248
Neuro bladder can lead to
Infection MOST COMMON Renal calculi Impaired skin Urinary incontinence
249
Neuro bladder edu
bladder retraining program
250
Neuro bladder med
Bethanechol to help pee Anticholinergics Oxybutinine
251
Neuro bladder eval
I&O Residual volume Urinalysis
252
Neuro bladder intervnetions
``` Emptying regularly Intermittent cath Low calcium diet Ambulation Increase fluid intake ```
253
ID bowel obstruction with
Sigmoidoscopy | Colonoscopy
254
Nursing treatment for bowel obstruction
Ambulate Monitor I&O Ensure tube placement Auscultate
255
IV fluids for bowel obstruction
Water Sodium Chloride Potassium
256
Large bowel obstruction assessment methods
X ray CT MRI
257
Hyperresonance on percussion
mechanical obstruction finding
258
Due to frequent vomiting with small bowel obstruction, the pt is at risk of metabolic
Alkalosis | Loss of H
259
IV fluids for bowel obstruction
NS or LR with K
260
With bowel obstruction check NG tube for
Coffee grounds or bright red color indicating blood
261
Non surgical bowel obstruction treatment
``` Fluid and lytes NG suction Antibiotics TPN Analgesics NO OPIOIDS ```
262
To encourage return of peristalsis have the pt
Ambulate
263
Most bowel obstruction occurs in the
small intestine
264
Hyperactive bowel sounds | borborigmi indicates
Small bowel obstruction
265
Since liquids can not go through digestive tract, small bowel obstruction will lead to
dehydration | lyte imbalance
266
Nursing treatment for large bowel obstruction
Admin fluids/lytes Auscultate Maintain interventions like NG decomp
267
BUN with bowel obstruction
HIGH dehydration
268
Bowel obstruction pts are at risk of
Shock Peritonitis Venous thromboembolism
269
WBC in bowel obstruction
Will be high
270
DVT s/s
``` Edema/swelling warmth cyanosis pain tenderness increase in circumference ```
271
DVT Diagnostics
Duplex venous ultrasonography Plethysmography MRI Ascending contrast venography
272
Prophylaxis for DVT
Heparin Oral anticoagulants Early mobilization
273
DVT pulses Skin
Weak, bounding Warm, red, swollen, pain, parasthesia, cyanosis
274
Prevention of blood clots and DVT
Walk Compression stockings Hydrate
275
If DVT is suspected to become PE do this test
VQ scan | Lung perfusion ventilation scan
276
DVT extremity should be
Elevated 10-20 degrees ABOVE heart | Have a warm, moist compress
277
Measure DVT limb to check for
Compartment syndrome
278
With DVT, clothing should be
Lose
279
Injectables for DVT
Heparin lmw heparin Enoxaparin
280
Oral meds for DVT
Warfarin
281
What is used to disolve existing VTEs
Thrombolytics | t-PA
282
Anticoagulants
``` Aspirin Clopidgorel Warfarin Heparin Lovenox ```
283
Antithrombotics
Activase
284
for DVT heparin should be given in _ form
DRIP
285
PT INR normal | PT INR with warfarin therapeutic
0.75-1.25 seconds Therapeutic 2-3 seconds
286
aPPT time normal aPPT time on heparin
30-40 sec 1.5-2 TIMES the normal
287
D-dimer test
Checks activity of thrombin and plasmin Normal plasma does NOT have D dimers
288
Heparin precaution
Give Calcium and D
289
Normal clotting time Clotting time on anticoagulant therapy
70-120 sec 150-600 sec
290
Platelet count Adult Child
150,000-400,000 200,000-475,000
291
Fibrinogen values
200-400
292
To reverse warfarin give
Vit K
293
To reverse heparin give
Protamine sulfate
294
Warfarin onset
3-5 days
295
Otitis media risk factors
Young age Day care History Recurring upper resp infections
296
tympanosclerosis
hardening of eardrum result of Otitis media
297
Diagnosing otitis media
Sign of fluid Tympanic bulging Ear pain Inflammation Otoscopy Tympanometry
298
Otitis media fam education
Waiting for symptoms to resolve on own FINISH antibiotics Follow up Explain OME impact on hearing and speech
299
Preventing Otitis Media
Breastfeeding for 6 to 12 m No second hand smoke Prevnar influenza vaccine
300
Itching Pain Drainage Fullness in ear canal
Otitis
301
Pain management with otitis media
Acetaminophen Ibuprofen Sever - narcotics Lie on affected side and place warm or cold compress
302
Nursing goals for UTI
Eradicate infection Promote comfort Prevent recurrence
303
Risk factors for UTI
``` Female Diabetic Pregnant Neuro disorder Gout Calculi ```
304
UTI in elderly 1st sign
Delirium
305
Most common UTI bacteria
E.coli
306
UTI can lead to
Pyelonephritis
307
UTI prevention for women
Cranberry juice Cotton underwear Void after sex Avoid tight pants
308
Comp vs Uncomp UTIs
Comp - hospital acquired Uncomp - community acquired
309
Cellulitis
Bacteria enter SUBCUTANEOUS tissue
310
Most common cellulitis bacteria
Streptococcus | Staphylococcus
311
Cellutlitis s/s
Swelling Localized redness Warmth Pain Fever Chills Sweating Tender lymph nodes
312
Redness with cellulitis is
NOT uniform Skips areas Eventually becomes pitting range peal
313
Nursing management of cellulitis
Elevate affected are 6 in above heart Apply cool moist packs Once inflammation is resolved use warm moist packs
314
Osteomyelitis
Infection of bone
315
Osteomyelitis types
Hematogenous - blood infection Contiguous - contamination due to surgery Vascular insufficiency - PVD, diab feet, most common
316
Risks for osteomyelitis
Old age Poor nourishment Obesity
317
Most common osteomyelitis bacteria
Staphylococcus aureus
318
Osteomyelitis progression
Inflamation puss vascularity edema as blood vessels lead infection to marrow in 2-3 days thrombosis ischemia and necrosis will occur
319
Sequestrum
Dead bone tissue | Osteomyelitis
320
Involucrum
Forms around sequestrum Chronic osteomyelitis
321
Osteomyelitis Blood borne- Adjacent - Chronic - Diabetic -
Will have sepsis that may mask symptoms site will be painful swollen tender Cross contamination, no sepsis site will be painful swollen tender involucrum/sequestrum Non healing ulcer that drains pus poor glycemic control and vascular problems lead to infection
322
Diagnosing osteomyelitis
Xray MRI WBC ESR
323
Antibiotics for osteomyelitis are given Supportive measures include infected area should be
for a longer period of time 3 to 6 weeks hydration, diet high in vit protein immobilized
324
Sprain
Injury to ligament and tendon that surrounds a joint Twisting or hyperextension
325
1st, 2nd, 3rd degree sprains
1st - mild local hematoma mild pain edema tenderness 2nd - moderate edema tenderness pain with motion, joint instability 3rd - severe avulsion of bone severe pain, increased edema, abnormal joint motion
326
Sprain treatment
PRICE (protection, rest, ice, compression, elevation) Elastic compression bandages If 3rd splint brace or cast
327
For sprains cold packs are good for first | apply for no longer than
24-72 h 20 min
328
with sprains monitor for increase in pain and decrease in motion/sensation may indicate
compartment syndrome
329
With sprains monitor every for first then every
15m 1-2h 30min

S2 1533 (3 decks)

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