232 midterm Flashcards
List the 4 diagnostics for inflm
WBC count, differential, CRP, rheumatoid factor
List the 7 diagnostics for infection
WBC count, differential, CRP, procalcitonin, C&S, gram stain
How does WBC count tell if there is inflm/inf
WBC are the body’s primary defence so inc. in WBC means inflm response
What is a differential?
breakdown of WBCs
Elevated neutrophils means what type of infection
bacterial or pyogenic
Eosinophil elevation indicates what infection
allergic and parasitic
Elevated basophils are what infections
parasitic and some allergic
Lymphocytes elevated means __ infection
viral
Monocyte elevation is for ___ infections
chronic
What does the rheumatoid factor determine
diagnose rheumatoid arthritis
what population of people can have a false positive for rheumatoid factor?
elderly
CRP and procalcitonin are ___ indicators
nonspecific
What does procalcitonin test for
detect or rule out bacterial sepsis
low levels indicates __ risk of bacterial sepsis
low
What is a culture test?
microorganisms grow in a growth medium
what is a Sensitivity test
determines the sensitivity of bacteria to an antibiotic and evaluates for resistance
Define hyponatremia
low sodium
Mnfts of hyponatremia
weakness, confusion, ataxia, stupor and coma
Causes of hyponatremia
diarrhea, vomiting, diuretics, NG tube
Define hypernatremia
high sodium
Mnfts of hypernatremia
thirst, agitation, mania, convulsions, dry mucous membranes
Causes for hypernatremia
inc. Na intake, excessive free body H2O loss, Cushing syndrome
What is hypokalemia
low potassium
mnfts of hypokalemia
dec. in contractility of smooth, skeletal and cardiac muscles, weakness, paralysis, hyporeflexia, ileus, cardiac dysrhythmias, thirst, flat T waves
causes of hypokalemia
GI losses, diarrhea, vomiting, burns
Define hyperkalemia
high potassium
mnfts of hyperkalemia
irritability, N/V, diarrhea, intestinal colic
causes of hyperkalemia
excessive dietary intake, ARF/CRF, infection
Ex of localized infection
infected wound
mnfts of localized infections
pus, swelling, redness, warmth
Ex of systemic infection
sepsis
mnfts of systemic infection
BP decreases, fever, nausea, HR inc
Name 5 ex of common infections
UTI, pneumonia, hep B&C, ESBL, C-diff, MRSA, VRE, ARO, HIV
What temp is considered a fever
38.5 degrees
Name 3 drugs that treat inflm
anti-inflammatories, NSAIDs- ibuprofen and ASA
3 drugs that are Antipyretics
acetaminophen, ASA, ibuprofen
What are three antipyretics
Acetaminophen, ASA and ibuprophen
Why is acetaminophen the most common antipyretic
can be given across the lifespan and comes in many forms
Ibuprofen decreases ___ and is an ___
inflm, antipyretic
SE of acetaminophen
affects the liver irreversibly
SE of ibuprofen
GI bleeds, ulcers, renal impairment
ASA is not good for fever treatment because…
causes platelet aggregation
SE of ASA
GI. bleeding and Rhys syndrome
3 categories of infections
chronic, acute and colonization
3 examples of chronic inflm
chrones, asthma, arthritis
Define colonization
can’t get rid of bacteria but antibiotics will minimize the amount of bacteria
Name 10 mnfts of infection
inflammation, neutrophils, fever, fatigue, dec BP, burning/inc frequency, delirium, diaphoretic, sputum, crackles, pain with inspiration
Name risk factors of arthritis
age, female, smoking, family history, environment, obesity
Mnfts of arthritis
pain, swollen joints, limits movement, stiffness, fatigue, weakness
Name some non pharmacological Tx for arthritis
heat, water aerobics, braces, mobility, sleep
Pharmacological Tx of arthritis
manage symptoms, reduce inflm, steroids
Risk factors of UTI
catheters, female, poor hygiene, not peeing enough, not completely emptying their bladder when voiding, enlarged prostates, diabetes d/t high glucose in urine
S&S of UTI
pain and burning, frequency, urgency, nocturia, suprapubic or pelvic pain, hematuria
What percent of people don’t show symptoms of UTI why?
50%, colonization
Pharmacological interventions for UTI
antibiotics and drug to decrease spasms in the bladder
Non pharmacological interventions for UTI
inc. fluids, frequent urination, avoid irritants, good hygiene, remove/replace Foley catheter, patient knowledge
Risk factors of C-diff
antibiotics, surgery in abdomen, disease of colon, weakened immune system, chemotherapy drugs
Signs and symptoms of C-diff
watery diarrhea, severe abdominal pain, loss of appetite, fever, blood or pus in stool, weight loss
What tests can be done for C-diff
culture and sensitivity, electrolytes, WBC count and neutrophils
Pharmacological interventions for C diff
vancomycin, fecal transplants, probiotics and antimedics
non pharmacological interventions for c diff
fluids, isolation precautions, maintain nutrition, promote patient knowledge,
What is a primary wound
closed w stitches or staples
What is a secondary wound
pressure wounds and burns left open to heal on their own
What is a tertiary wound
leave open and then close later surgically
What are the 4 stages of wound healing
hemostasis, inflammation, proliferation, remodelling
How long does each stage of wound healing last?
hemo (1-4 days), inflm (up to 4 days), proliferation (4-21 days), remodelling (up to 2 years)
Ex of issues affects hemostasis
anticoagulants, low platelet count
Ex of issues w inflm
immunodeficiency, continuous irritation, infection
Issue w proliferation
not enough nutrition
How fast do acute wounds heal
less than 21 days
Define a chronic wound
reoccurs frequently, disrupted at one or more stages in wound healing
what age is at increased risk of chronic wounds? Why?
Elderly d/t dec mobility, nutrition, diabetes and cardiovascular
Define pressure ulcer
ulcer in a localized area of infarcted soft tissue that occur when pressure is applied to skin over time
10 risk factors for pressure ulcers
friction, prolonged pressure, loss of protective reflex, immobility, malnutrition, incontinence, dry skin, casts, critically ill
Explain care plan for pressure ulcers
assess total skin condition and erythema for blanching, inspect each pressure site and dry skin
Assess mobility, circulatory status, neuromuscular status, nutrition
Stage 1 pressure ulcer
redness, skin still intact, affects top layer
Stage 2 pressure ulcer
going into dermis layer, can have blistering and shearing, inc risk of infection
Stage 3 pressure ulcer
through the dermis layer, damage to SC tissue, drainage, measure length and width
Stage 4 pressure ulcer
all the way down to bone, muscles or tendons, will have drainage
What is an unstageable pressure ulcer covered by
slough or eschar
What causes lower limb ulcers
diabetes, or arterial/venous insufficiency
What diagnostic and treatments for ulcers
doppler ultrasound, compression dressings
Describe a venous ulcer
dull heavy aching, edema, superficial irregular shape, highly exudative, pulse present
Name 4 major goals for venous ulcer prevention
nutrition, restored skin integrity, improved physical mobility, absence of complications
Modifiable risk factors for arterial ulcers
nicotine, diet, HTN, diabetes, obesity, stress, sedentary lifestyle
Non modifiable risk factors for arterial ulcers
age, gender, genetics
Characteristics of arterial ulcers
typically deep and circular, small, minimal drainage, no bleeding and weak pulse
Where are arterial ulcers located
on or between toes, heel, shin
Name 5 arterial ulcer interventions
eliminate restrictive clothing, apply warmth, elevate HOB, exercise as tolerated, proper support surfaces
Why are diabetics likely to have foot ulcers
high blood sugars, hyperglemia, motor and sensory neuropathy, PVD
Assessment of ulcers
Pain, quality of pulses, check edema, limitations in mobility, moisture, nutritional status, Hx of diabetes, vascular disease,
Example of nursing Dx for ulcer
impaired skin integrity r/t vascular insufficiency
Plan for Tx ulcer
improve/restore skin integrity
Name 5 interventions for ulcers
protect skin, remove obstacles from Pt path, frequent repositioning, pain meds, nutrition, change dressings
Name two main things to evaluate if interventions worked for ulcers
restored skin integrity and adequate nutrition
Wound healing past the dermis is known as
scar formation
Name examples of secondary intention wounds
Pressure, venous, arterial, diabetic,
Define nociceptors where are they located and where are they not?
free nerve endings in the skin, cornea, joints, not found in organs and internal structures
What is a mediator for pain
prostaglandin
Explain gate control theory
stimulation from the skin causes nervous impulses from three different systems in the spinal cord. stimulation of the large diameter fibers closes the gate so there is no pain and small fibers opens the gate so pain is felt
name factors influencing pain
past experience, culture, gender, anxiety
How do nurses assess pain
NOPQRSTUV
Non pharmacological Tx of pain
massage, thermal therapies, distraction, relaxation, hypnosis
Describe geriatric considerations for pain sensation
loss of myelination causes decreased perception of pain
What 5 considerations are there for geriatric patients receiving analgesics
need lower dose, metabolizes slower, inc risk of drug toxicity, inc risk of drug interactions, inc risk of depression of nervous and respiratory system
What is the number 1 reason for medical help
pain
Name the 3 types of pain
acute, procedural, chronic
How to assess Pt with disabilities for pain
- non verbal cues including, tense, grimace, sweating, BP, HR inc., interpreters and visual pain scale
non pharmacological Tx for pain
heat, meditation, relaxation, deep breathing,
What is an adjuvant
drug used to dec. amount of other drugs being used
How are nonopioid analgesics used for pain
adjunctive Tx
What therapeutic drug classification is gabapentin, how is it used for pain
anticonvulsants helps with nerve pain (good for diabetics)
Example of antidepressant used for pain. what type of pain
amitriptyline for chronic pain
How do corticosteroids help with pain
stop inflm response
How do NSAIDs help w pain
inflm response
SE of NSAIDs
GI bleed will worsen and anaphylactic shock
What age group can’t have ASA and why
infants b/c of Reyes syndrome
How does ASA help w pain
enhances prostaglandin synthesis
SE of ASA
nausea, tinitus, GI bleeding
Pre/Post checks for giving ASA
allergies, platelets, pain assessment,
if platelets are ___ don’t give ASA
low
therapeutic classification of ibuprofen
NSAIDs, antipyretic
What are available doses of ibuprofen
200-400mg
Indications for ibuprofen
inflm disorders, mild to moderate pain, fever
indications for acetaminophen
inhibits synthesis of prostaglandin
SE of acetaminophen
anaphylactic shock, toxic liver, jaundice
What tests can be done to test liver when giving acetaminophen
liver function tests
Acetaminophen Is used to treat ___ pain
mild
Therapeutic classification of morphine
opioid analgesics
What routes of admin is morphine prescribed
tablets, capsules, suppositories, extended release
Mechanism of action of morphine
binds to opiate receptors in the CNS. Alters perception and response to painful stimuli.
Indication of morphine
moderate to severe chronic pain
SE of morphine
respiratory depression, constipation, hypostatic hypotension
Pre/post assessments for morphine
allergies, pain assess, RR, BP
onset and duration of morphine
rapid onset 60 min lasts up to 7h
therapeutic classification of hydromorphone
opioid analgesis
Routes of admin hydromorphone
tablets, capsules, parenteral, IR and SR
MA of hydromorphone
binds to opiate receptors in CNS alters perception and response to painful stimuli while producing generalized CNS depression
indications of hydromorphone
moderate to severe pain
SE of hydromorphone
toxic epidermal necrosis, hepatotoxicity
Pharmacologic classification of fentanyl
opioid analgesic
routes for fentanyl
parenteral and transdermal
MA of fentanyl
bind to opiate receptors in CNS. Alter perception of and response to painful stimuli while CNS depression
indications for parenteral fentanyl
pre/post anesthesia
indications for transdermal fentanyl
moderate to severe chronic pain requiring 24/7 opioid
Ex of someone needing transdermal fentanyl
cancer Pt
SE of fentanyl
respiratory depression and constipation
Pre/post checks fentanyl
allergies, pain assess, RR, BP, hepatic and renal impairment
Duration of fentanyl patch and can the patches be cut
72H and NO`
pharmacologic classification of naloxone
opioid antagonist
Indications of naloxone
reversal of CNS depression and respiratory depression b/c of suspected overdose
MA of nalaxone
blocks the effects of opioids
SE of naloxone
ventricular arrhythmias, nausea vomiting
pre/post assessments naloxone
RR, BP, level of consciousness,
therapeutic classification of vancomycin
anti-infectives
Indications of vancomycin
Tx of life-threatening infections. Tx pneumonia, meningitis,
MA of vancomycin
binds to bacterial cell wall
Route of admin vancomycin
IV
SE of vancomycin
nephrotoxicity, phlebitis
Pre/post assess for vancomycin
monitor IV site, assess infection, BP, urine output
Pharmacologic classification for cefazolin
first-generation cephalosporins
Indications for cafazolin
Tx of bacterial infections including pneumonia, UTI, genital, billiard tract, bone and joint
Action of cefazolin
bind to bacterial cell wall membrane for cell death
Route of admin cefazolin
IV
SE of cefazolin
diarrhea, nausea, vomiting, rash, pain, phlebitis
Pre/pos assess of cefazolin
Assess for infection, anaphylaxis, monitor bowel Fx, skin rash
WBC signifies activation of ___ response and possible ____
inflammatory, infection
Low elevated levels of PCT means
low risk of bacterial sepsis
Name 10 common infections nurses will encounter
pneumonia, C-diff, sepsis, MRSA, VRE, ARO, HIV, HepB,UTI, ESBL
Antiviral agent ex
acyclovir
Two antibacterial drugs
cefazolin, vancomycin
common side effects of antibiotics
nausea, vomiting, diarrhea, nephrotoxicity, hepatic toxicity
Pediatric considerations for antibiotics
doses are based on weight
Geriatric consideration for antibiotic
lower dosages
Pregnancy consideration for antibiotics
potential harm to fetus or mother
