1533 Final Flashcards
Delirium Assessment
Confusion Assessment Model tool
CAM
Can be done without an order
Delirium can lead to
Changes in level of consciousness
Irreversible brain damage
Death
Delirium symptoms
Stupor - hypoactive Excessive activity - hyperactive Disorganized thinking Short attention Hallucinations, delusion, fear, anxiety, paranoia
Dementia symptoms are -
Where as delirium symptoms are -
Long term onset
Acute onset
Because of unknown underlying causes, delirium is considered a
Medical emergency
Delirium prevention
Reorienting Early mobilization Pain control Good sleep Enhance communication methods (hearing aids, glasses) O2 levels Hydration
Delirium treatment
Fall prevention
Discontinue none essential meds
Monitor nutrition and fluids
Familiar environment ques like fam interaction
Haldol does NOT work for
Elderly with dementia
Has opposite effect
Dementia is -
Most common dementia is -
General decline in higher brain function
AD
3 Stages of AD
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
Medications for Alzheimer’s
Donepezil
Rivastigmine
Galantamine
(Anticholinesterase inhibitors)
Memantine
(Preserves memory)
Risk factors for Dementia/delirium
Aging Low education Down syndrome Family history Smoking x2 to x4 fold increase Obesity Insulin resistance Dyslipidemia - high level of lipids
Dyslipidemia
High level of lipids
Med good for hyperactive delirium
Haldol
Assessment for Alzheimers
Mini COG
Can be done without orders
Assessment for cognitive performance of the elderly
Mini Mental State Examination
MMSE
In elderly, cognition may be effected by
Sensory impairment Physiologic health Environment Sleep Psychosocial influence
Delirium
Acute confused state
Alzheimer Disease
AD
6th leading cause of death
Progressive degenerative neurologic disease
AD is most common in people over
65y/o
AD Patho
Neurofibrillary tangles - nonfunctional neurons
Neurotic plaque - deposits of amyloid protein in the brain
Reality orientation with AD
Who and where a person is in a time continuum, this will only WORSER mental/emotional state of AD patient due to increased anxiety
Nursing roles in AD
Supporting cognitive function
Calm predictable routine Simple explanations Memory aids Physical and verbal stimulation Clock/calendar display
Therapies for Phobias
Cognitive Behavioral Therapy CBT
Group Therapy
Guided Mastery Therapy
Meds for phobias
Antidepressants SSRI
Paroxetine, fluoxetine
Tricyclic antidepressants imipramine
Monoamine oxidase inhibitors MOAIs
Benzodiazepines
Alprazolam
Clonazepam
SSRIs can increased suicidal thinking in patients age-
18-24
Benzos can lead to
Dependence
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
When anorexic patients eat they can develop refeeding syndrome
S/S are
Hypophosphatemia, hypokalemia, hypomagnesemia, fluid overload, edema.
Assess anorexic patients
electrolytes for refeeding syndrome
for suicidal ideations
for good sleep and energy
Weight
I&O
Selye’s General Adaptation Syndrome
GAS ARE
Alarm stage
Resistance stage
Exhaustion stage
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
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
Neonatal abstinence syndrome
NAS
occurs when mother takes
Amphetamines Barbituates Benzos Cocaine Marijuana Opiates
NAS treatment is for drug dependence
Methadone
Antabuse
Disulfiram
Creates negative reaction to alcohol
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
Peripheral neuropathy
Alcohol myopathy
GI-itis
Complications of alcoholism
Wernicke’s encephalopathy
Korsakoff’s psychosis
Alcohol cardiomyopathy
Complications of alcoholism
Cirrhosis
Blood dyscrasia
Fetal alcohol syndrome
Complications of alcoholism
Legal intoxication level
Alcohol level over 0.08
Alcohol dependence is 4 times more likely in patients with
Mental illness
SIADH
Syndrome of inappropriate ADH (antidiuretic hormone)
TOO MUCH ADH
RETAIN WATER
SIADH lab values
Hypoosmolality
Urine concentration greater than 100
Natriuresis - NA in urine greater than 30
SIADH Symptoms
Fluid in lungs
Early - Cramps, N/V
Late - Confusion, seizers, coma
Hallmark of SIADH
Hyponatremia blood serum
Hypernatremia in urine
Hypernatremia symptoms
FRIED
Fever Restlessness Increased fluids Edema Decreased urine, dry mouth
Hypernatremia can be treated with diuretics but diuretics an lead to
Hypokalemia
Potassium wasting diuretics
Furosemide
Hydrochlorothiazide
Potassium sparing diuretics
Spironolactone
is dehydration FVD
NO, dehydration is loss of water alone
INCREASE in electrolytes
in FVD unlike dehydration
Fluids AND electrolytes are lost and need replacement
Dehydration symptoms
Dry mouth Poor skin turgor Low BP High Na High HR Weight loss
Urine specific gravity
1.005-1.030
Creatinine and BUN normal
AND with dehydration
Creatinine 0.6-1.2 will be over 1.2
BUN 10-20 will be over 20
DI causes
Head injury
Pituitary tumor
Craniotomy
DI MOA
Pituitary gland shuts off ADH supply to kidneys
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
Nursing care for DI
Monitor and replace fluids
Check neuro status, vitals, mucous membrane
DI water movement
Polydipsia
Polyuria
Nocturia
Meds for DI
Desmopressin ddAVP
Vasopressin
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
COPD MOA
Chronic inflammation damages lung tissue causing scarring that narrows the airway
COPD associated complications
Chronic Bronchitis
Emphysema
COPD symptoms
Chronic cough
Sputum production
Dyspnea
Weight loss
Barrel Chest
COPD management
Smoking cessation Exacerbation management O2 therapy Pneumococcal/influenza vaccines Pulmonary rehab
Meds for COPD
Bronchodilators and Corticosteroids
Antibiotics
Mucolytics
Antitussives
Nursing management for COPD
Airway clearance
Breathing patterns
Activity tolerance
Asthma MOA
Chronic inflammation or mucous membrane and edema due to hyperresponsiveness
Asthma symptoms
Cough
Chest tightness
Wheezing
Dyspnea
Manifestations of asthma
Diaphoresis
Tachycardia
Hypoxemia
Cyanosis
Fast acting and long acting meds for asthma
Fast - fast beta 2 agonists
Anticholinergics
Long - long beta 2 agonists
Corticosteroids
Teach asthma patients to
Avoid triggers
Use inhaler
Monitor peak flow
When to seek aid
Gas exchange corticosteroid
Triamcinolone
Use bronchodilator _
Use Corticosteroid _
First
Second
Use mouth wash after
Corticosteroids
WILL cause thrush
Anticholinergics
Will decrease acetylcholine relaxing breathing
Ipratropium bromide
RSV children should be placed on what precaution
Droplet
Can be cohorted
To prevent RSV
Wash hands at day care and after exposure to individuals with cold symptoms
Hospitalize RSV child with what symptoms
Tachypnea
Retraction
Poor oral intake
Lethargy
Severe, continuous asthma that is unresponsive to meds
Status Asthmaticus
Diagnosing Asthma
Episodic symptoms of airflow obstruction
Airflow it at least partially reversible,
Other causes are excluded
Blood pH
PaCO2
HCO3
7.35-7.45
45-35
22-26
Metabolic acidosis
Bicarbonate less than 22
DKA
Kidney failure
Diarrhea
HYPERkalemia
Kusmaul breathing
Metabolic acidosis
Diamox
Decreases bicarb reabsorption
Treats metabolic alkalosis
Can cause metabolic acidosis
A/B of vomiting
Metabolic alkalosis
loss of H
Treat metabolic alkalosis with
Antiemetic
Stop suction
Stop diuretics “loop and thiazide especially”
Monitor ABGs
Give diamox
Flu symptoms
Hyperactive reflex
Confusion
A/B
Metabolic Alkalosis
Metabolic alkalosis S/S
Bradypnea Hypoventilation
under 12
HYPOkalemia
EKG changes
Tetany
Tremors
Muscle weakness
Fatigue
Metabolic acidosis s/s
Kusmaul breathing
Confusion
Weakness
Lob BP
N/V
HYPERkalemia
Respiratory acidosis S/S
Neuro drop Drowsiness, confusion, fatigue Headaches RR less than 12 Hypotension
Resp Acidosis interventions
Admin O2
Encourage cough
Deep breathing
Watch K
Respirator alkalosis s/s
Resp rate over 20
Confusion
Fatigue
Tachycardia
Tetany
EKG changes
Muscle cramps
Positive Chauvstics
Resp alkalosis interventions
Monitor lytes
Paper bag
Hold breath
Calcium gluconate for tetany
3Ps of Diabetes
Polyuria
Polydipsia
Polyphagia
Type 2 diab
Patient becomes insulin resistant due to high blood glucose over time
T2 diab risk factors
Diet
Lifestyle
Medication
A1C
Checks blood sugar for past 3-4 months
Brown thick skin on neck and armpits
Acanthosis nigricans
T2 Diab sign
Normal unfasted glucose value
Pre diabetic value
Diabetics value
70-115
NA
200+
Fasting glucose value
Fasted pre diabetic value
Fasted diabetic value
Less than 100
100-125
126+
A1C normal value
Pre diabetic value
Diabetic value
less than 5.7
5.7-6.4
Over 6.5
Sugar under 70 hypogly
Brain will die
Diabetic complications of kidneys
Nephropathy
Kidneys will DIE
creatinine over 1.2
Diabetic complications of nerves
Loss of sensation Sugar foot Slow healing Retinopathy Blindness
Diabetic complications of heart and brain
HTN
Atherosclerosis
CVA
Stroke
Oral agents only work for _ diab
T2
PO drugs for t2 diab
Toxic to
Metformin
Glipizide Glyburide
Pioglitazone
Acarbose
Toxic to liver
for diabetics, avoid FOOT
Flipflops, high heels, nylon
OTC corn removal
Overly hot baths, use thermometer
Toe injuries, daily inspection, use mirror
NOs of diabetic foot care
NO callous removal
NO heavy powder
NO rubbing with hands
NO hot baths
Diabetic diet good
High fiber
Complex carbs
BROWN beans, rice, bread, peanut butter
Whole wheat/grain/milk
Diabetic diet bad
Simple sugars Soda Candy White bread/rice Juice #1 offender
Antithyroid meds
Methimazole
Propylthiouracil
Can cause hypothyroidism
Hypothyroidism symptoms
Low and Slow
Weight gain, shot metabolism Unable to tolerate cold Goiter Tiredness Fatigue Slow HR Depression Memory loss
Hypothyroidism
Skin
GI
Hair
Dry, rough, cold
Constipation
Thin brittle
Myxedema
Swelling of face and eyes
Hypothyroidism
Hypothyroidism risk factors
Women
middle to older age
Hashimotos
Iodine deficiency
Pituitary tumor
Hypothyroidism monitor
HR BP RR
Blood glucose
Weight
Meds for hypothyroidism
Levothyroxine
Liothyroinine
Lotrix
Hypothyroidism
how it is diagnosed
Under secretion of T3 and T4
Blood test for t3 t4 and TSH
INsulin
protein hormone made in pancreas
Puts sugar and potassium INto cells
In t2 diab pt becomes insulin _
resistant
Best t2 diab treatment
Diet Lifestyle Exercise
Insulin peaks =
plates
Give food
IV only insulin
REGULAR
Right in the vein
Clear days before cloudy days
Regular Clear insulin first
NPH Cloudy insulin second
RN of insulin
Regular first
NPH iNtermediate second
Best location for insulin injection
Abdomen
rotate daily
NEVER aspirate fat tissue
NEVER massage or hot compress
Insulin on sick days
Still give
Monitor closely
LONG Acting insulin
‘Old guys”
NO peak NO mix SEPARATE syringes Duration 24+h NO risk of hypoglycemia
Detemir
gLARGine
Last all year
LARGe lasting
Long lasting insulins
NPH insulin
Cloudy dudes
Always mixed up
iNtermediate
NEVER IV
Mix Clear to Cloudy
Duration 14+h
NPH Insulin peak
4-12h
5-6 most dangerous
Regular insulin
Goes right in
Ready to go IV
ONLY iv insulin
Duration 5-8h
Regular insulin peaks
2-4h
Rapid insulin
MOST DEADLY PRIORITY
15min onset
Rapid insulin peak
30-90 min
ASSpart
Lispro
Glulisine
Move you ASS
Lis time
Go Limosine
RAPID acting insulins
Rapid acting insulin is given
DURING a meal
PT is eating
DONT give until food is delivered
CSII
Continuous subcutaneous insulin infusion
Fewer swings
Nice even basal rate
NPH insulin names have an _
N
Humulin N
Novolin N
Regular insulin names have an _
R
Humulin R
Novolin R
T1 diabetes
Body kills own pancreas cells
Body has no insulin
Autoimmune
Can be passed down genetically
PTs are insulin dependent FOR LIFE
3Ms of metformin side efects
Minicam chance of hypoglycemia
Massive weight gain
Major liver and kidney toxicity
NOT for liver serosis or hypatitis patients
Hold metformin for _ before_
because
48h
Cath lab
Contrast due and metformin will KILL kidneys
GlipizIDE GlyburIDE
G heart may DIE
bad for heart
Hypoglycemia
Weight gain
Sun burn
Toxic for elderly
Pioglitazone side effects
HF
Liver failure
edema
crackles
weight gain
Acarbose side effects
Carb blocker
Flatus and diarrhea
Don’t give to IBS patients
TPN complications
Hyperglycemia, may need insulin
GI atrophy
Dumping syndrome
Sites to run TPN
Peripheral or Central line
For TPN patients check blood glucose _ because is at risk of hyperglycemia.
May need to be put on _
q6h
insulin
For home health TPN monitor
Lytes Daily
TPN is a _ procedue
Sterile
Parenteral nutrition indications
Come Preop GI problems Pancreatitis Paralytic ileus
Peripheral TPN site guidelines
Less preferred
No dextrose above 10
Less than 2 weeks
Central TPN site guidelines
Preferred method
PICC
Percutaneous
Triple lumen
TPN feeding rate
50ml/hr to start
100-125ml/hr as tolerated
TPN too rapid symptoms
Hyperosmolarity
Headache Nausea Fever Chills Malaise
TPN too slow symptoms
Rebound hypoglycemia
Confusion Tremors Hypotension Tachycardia Cool clammy skin
TPN nutrition IVs always use _ to infuse at a _
change tubing _
Pumps
Constant
24h
Nutrition maintenance
Keep refrigerated
Warm to room temp when giving
With TPN monitor daily
Weight
Glucose
Temp
I&O
With TPN monitor every other day
BUN
Ca
Mg
With TPN monitor weekly
CBC Platelets Prothrombin AST ALT liver Serum albumin
Before starting TPN perform
Chest x-ray to verify placement
What irritates peptic ulcers
NSAIDs
Acidic foods
Sodas
Where can peptic ulcers happen
what is it
Anywhere in the digestive tract
Erosion of mucous membrane creating an excavation
Peptic ulcer bacteria
H Pylori
Peptic ulcer is caused by
NSAIDs
H Pylori
Alcohol, smoking, fam hist,
Zolinger-ellison too much stomach acid
Peptic ulcer pain management
Tylenol
Antacids
NO NSAIDs
With peptic ulcers monitor for
Anemia
Bleeding
Keep a _ with peptic ulcers
Food diary
At least 72 hr
Care for peptic ulcer pts in order
PAIN
ANXIETY
Nutritional imbalance
Knowledge deficit
Best indicator of malabsorption
Low albumin
Older adult nutrition requires
Fewer calories and more nutrient rich foods
Excessive fluid intake tan lead to patient
Not eating enough
Steotorrhea
Fat in stool malnutrition
Transferrin level
Less than 100
Severe protein depletion
Malnutrition
Low prealbumin and nutrition
Malnutrition
Low BUN and nutrition
Malnutrition
Normal albumin level
3.5-5.0
Less means malnutrition
Most common complication of pregnancy
Gestational hypertension
First question to ask hypertension PT
Fam history
Gestational hypertension characteristics
No proteinuria
Systolic bp over 140 or diastolic over 90 after 20 weeks gestation
In preeclampsia patient will have
Proteinuria AND hypertension symptoms
Preeclampsia symtpoms
Headache Oliguria Blurred vision Edema Thrombocytopenia Rena failure Cerebral disturbances
How to cure preeclampsia
Give birth
S3 heart sound indicates
Mitral regurgitation
Left side HF
Murmur
Skip in pulse
do pulse for the full 60 sec for these patients
INDICATES MVP
Mitral valve prolapse symptoms
Atypical chest pain Palpitations SOB Dizziness Syncope
Mitral valve prolaps meds
Antiarrhythmics
CCB BB for pain
Antiarrhythmics
Amiodarone
Flecainide
Help with MVP
MVP consumables to avoid
Caffeine
Alcohol
Tobacco
Meds containing these products can worsen MVP
Alcohol
Caffeine
Ephedrine
Epinephrine
Mid systolic click
Indicates Mitral Valve Prolapse
Calcium channel blocker med endings
ZemAmilDipine
Calcium channel blockers calm the heart by
Dropping both HR and BP
Zem and Amil
Dropping only BP
Dipine
CCB or calcium channel blocers
Count HR and BP, hold if HR below 60 or BP below 100 sys
Change positions slowly
Bad headaches
Beta Blockers LOL endings
Atenolol
Block Beats
for LOw HR
and Low BP
Beta Blockers are contraindicated in patients with
Resp distress
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
Digoxin
DIGs for deeper contractions
Does not affect BP
ONLY decreases HR
ACE and ARBs
Act to lower BP only NOT HR
ACE and ARB ending
ACE pril
ARB sartan
ACE and ARBs side effects
Avoid Pregos
Angioedema Airaway risk ACE only
Cough Ace only
Elevated K
Angioedema
Risk with ACEs only
Airway closure
Face and mucosa swelling
AAA of ARBs and ACEs
Antihypertensive (lowers BP, NOT HR)
AVOID pregos and breastfeeding
ADDS Potassium, hyperkalemia
Digoxin is a
TOXIN
Toxicity over 2.0 serum
K bellow 3.5 increases Dig toxicity
1 Drug for acute or worsening HF
Diuretics
Lower BP
Furosemide
Spironolactone
Post op Abdominal surgery non pharmacological pain management
Pillow splinting
Wong-baker FACES scale
Pain scale
Adults and children as young as 3
FLACC
Pain scale for young children
Face Leg Activity Crying Consolability
CPOT
Modeled after FLACC
Used for PTs who can not self report in critical care
When is pain worst after surgery
24-48h
Post op pain is accompanied by
N/V
give Phenargan Reglan or Compazine
Sickle cell pain symptoms
Fussy Crying Pain Fever Swelling
Sickle cell anemia symptoms occur at
6m, this is when fetal hemoglobin diminishes
Tests for Sickle Cell Anemia
Dithionite - not precise
Hemoglobin Electrophoresis - PRECISE
Sickle cell anemia pain management
Elevate hands and feet to promote blood flow
Warm compress
Remove restrictive clothing
Opioids Around The Clock
Dactylitis
Inflammation of hands and feet with SCA
Hydroxyurea
Used to treat SCA and cancer
Creates fetal hemoglobin
Kidneys and SCA
Unable to concentrate urine
Hydration is a HIGH PRIORITY
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
Shockwave lithotripsy
Breaks up calculi
Blood and stones will be present
Bruising and pain normal
PVD pain type
Neuropathic
PVD meds
Gabapentin
Venlafaxine
Vicodin
Percocet
PVD affects
ANYWHERE outside the heart
PVD patient legs should be
eleVated
PAD patient legs should be
hAnged
Claudication
Calf pain
Sign of low O2
PAD
PVD VEINY
Voluptuous pulses Edema Irregular shaped sores No sharp pain DULL pain only Yellow and brown ankles
PVD Risk factors
Smoking
Diabetes
Cholesterol
HTN
Diagnosing PVD and PAD
Doppler ultrasound
Arterial Brachial Index
For PAD you can apply a
Warm pad under the legs
Antibiotics for diverticulitis
Broad spectrum
Flagyl
Cipro
Diagnosing diverticulosis
Colonoscopy
Barium enema
CT scan W/contrast
Diverticulitis
Inflammation of the diverticula
If ruptured, diverticulitis can become
Peritonitis and sepsis
Diverticulitis S/S
POUCH
Pain LLQ Observe bloating and blood Unrelenting cramps Constipation High temp
Diverticulitis nursing care focus
GI assessment
Diet regiment
Initial phase of diverticulitis nursing care
NPO
Assess for peritonitis
Hydrate
Pain meds
Diet for diverticulitis
HIGH FIBER
Fresh fruit and veg, oats, grains and beans
drink 2-3L a day
Psyllium
Probiotics
Fiber supplement for diverticulitis
gut flora for diverticulitis
Palpable mass
Lack of motility
NV
Backing up
Diverticulitis
EMERGENCY
Peritonitis s/s
Rebound tenderness Muscle rigidity Fast shallow breaths at rest Distended abdomen Ascites Fever
Neurogenic bladder
Nerve disfunction leading to incontinence
Neuro bladder can lead to
Infection MOST COMMON
Renal calculi
Impaired skin
Urinary incontinence
Neuro bladder edu
bladder retraining program
Neuro bladder med
Bethanechol to help pee
Anticholinergics
Oxybutinine
Neuro bladder eval
I&O
Residual volume
Urinalysis
Neuro bladder intervnetions
Emptying regularly Intermittent cath Low calcium diet Ambulation Increase fluid intake
ID bowel obstruction with
Sigmoidoscopy
Colonoscopy
Nursing treatment for bowel obstruction
Ambulate
Monitor I&O
Ensure tube placement
Auscultate
IV fluids for bowel obstruction
Water
Sodium
Chloride
Potassium
Large bowel obstruction assessment methods
X ray
CT
MRI
Hyperresonance on percussion
mechanical obstruction finding
Due to frequent vomiting with small bowel obstruction, the pt is at risk of metabolic
Alkalosis
Loss of H
IV fluids for bowel obstruction
NS or LR with K
With bowel obstruction check NG tube for
Coffee grounds or bright red color indicating blood
Non surgical bowel obstruction treatment
Fluid and lytes NG suction Antibiotics TPN Analgesics NO OPIOIDS
To encourage return of peristalsis have the pt
Ambulate
Most bowel obstruction occurs in the
small intestine
Hyperactive bowel sounds
borborigmi indicates
Small bowel obstruction
Since liquids can not go through digestive tract, small bowel obstruction will lead to
dehydration
lyte imbalance
Nursing treatment for large bowel obstruction
Admin fluids/lytes
Auscultate
Maintain interventions like NG decomp
BUN with bowel obstruction
HIGH dehydration
Bowel obstruction pts are at risk of
Shock
Peritonitis
Venous thromboembolism
WBC in bowel obstruction
Will be high
DVT s/s
Edema/swelling warmth cyanosis pain tenderness increase in circumference
DVT Diagnostics
Duplex venous ultrasonography
Plethysmography
MRI
Ascending contrast venography
Prophylaxis for DVT
Heparin
Oral anticoagulants
Early mobilization
DVT pulses
Skin
Weak, bounding
Warm, red, swollen, pain, parasthesia, cyanosis
Prevention of blood clots and DVT
Walk
Compression stockings
Hydrate
If DVT is suspected to become PE do this test
VQ scan
Lung perfusion ventilation scan
DVT extremity should be
Elevated 10-20 degrees ABOVE heart
Have a warm, moist compress
Measure DVT limb to check for
Compartment syndrome
With DVT, clothing should be
Lose
Injectables for DVT
Heparin
lmw heparin
Enoxaparin
Oral meds for DVT
Warfarin
What is used to disolve existing VTEs
Thrombolytics
t-PA
Anticoagulants
Aspirin Clopidgorel Warfarin Heparin Lovenox
Antithrombotics
Activase
for DVT heparin should be given in _ form
DRIP
PT INR normal
PT INR with warfarin therapeutic
0.75-1.25 seconds
Therapeutic 2-3 seconds
aPPT time normal
aPPT time on heparin
30-40 sec
1.5-2 TIMES the normal
D-dimer test
Checks activity of thrombin and plasmin
Normal plasma does NOT have D dimers
Heparin precaution
Give Calcium and D
Normal clotting time
Clotting time on anticoagulant therapy
70-120 sec
150-600 sec
Platelet count
Adult
Child
150,000-400,000
200,000-475,000
Fibrinogen values
200-400
To reverse warfarin give
Vit K
To reverse heparin give
Protamine sulfate
Warfarin onset
3-5 days
Otitis media risk factors
Young age
Day care
History
Recurring upper resp infections
tympanosclerosis
hardening of eardrum
result of Otitis media
Diagnosing otitis media
Sign of fluid
Tympanic bulging
Ear pain
Inflammation
Otoscopy
Tympanometry
Otitis media fam education
Waiting for symptoms to resolve on own
FINISH antibiotics
Follow up
Explain OME impact on hearing and speech
Preventing Otitis Media
Breastfeeding for 6 to 12 m
No second hand smoke
Prevnar influenza vaccine
Itching
Pain
Drainage
Fullness in ear canal
Otitis
Pain management with otitis media
Acetaminophen
Ibuprofen
Sever - narcotics
Lie on affected side and place warm or cold compress
Nursing goals for UTI
Eradicate infection
Promote comfort
Prevent recurrence
Risk factors for UTI
Female Diabetic Pregnant Neuro disorder Gout Calculi
UTI in elderly 1st sign
Delirium
Most common UTI bacteria
E.coli
UTI can lead to
Pyelonephritis
UTI prevention for women
Cranberry juice
Cotton underwear
Void after sex
Avoid tight pants
Comp vs Uncomp UTIs
Comp - hospital acquired
Uncomp - community acquired
Cellulitis
Bacteria enter SUBCUTANEOUS tissue
Most common cellulitis bacteria
Streptococcus
Staphylococcus
Cellutlitis s/s
Swelling
Localized redness
Warmth
Pain
Fever
Chills
Sweating
Tender lymph nodes
Redness with cellulitis is
NOT uniform
Skips areas
Eventually becomes pitting range peal
Nursing management of cellulitis
Elevate affected are 6 in above heart
Apply cool moist packs
Once inflammation is resolved use warm moist packs
Osteomyelitis
Infection of bone
Osteomyelitis types
Hematogenous - blood infection
Contiguous - contamination due to surgery
Vascular insufficiency - PVD, diab feet, most common
Risks for osteomyelitis
Old age
Poor nourishment
Obesity
Most common osteomyelitis bacteria
Staphylococcus aureus
Osteomyelitis progression
Inflamation puss vascularity edema
as blood vessels lead infection to marrow
in 2-3 days
thrombosis ischemia and necrosis will occur
Sequestrum
Dead bone tissue
Osteomyelitis
Involucrum
Forms around sequestrum
Chronic osteomyelitis
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
Diagnosing osteomyelitis
Xray
MRI
WBC
ESR
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
Sprain
Injury to ligament and tendon that surrounds a joint
Twisting or hyperextension
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
Sprain treatment
PRICE (protection, rest, ice, compression, elevation)
Elastic compression bandages
If 3rd splint brace or cast
For sprains cold packs are good for first
apply for no longer than
24-72 h
20 min
with sprains monitor for increase in pain and decrease in motion/sensation may indicate
compartment syndrome
With sprains monitor every
for first
then every
15m
1-2h
30min