2900 Exam One Flashcards
what are some different classifications of genetic disorders?
single gene (dominant, recessive, x linked), multifactorial, chromosomal disorders
what do genetic tests help with?
diagnosis of disease or risk assessment for developing a disease
what does GINA stand for and do?
Genetic Information Non-discrimination Act
it prevents discrimination in healthcare coverage and employment based on genetic information
what is a genetic counselor?
a specialist trained in both genetics and counseling to help people at all stages of the genetic testing process
what is gene therapy?
experimental therapy that uses targeted genes to treat or prevent diseases
what are some risk factors for genetic disease that might come up in a genetic health history?
disease in more than one close relative
disease that does not usually affect a certain gender
disease occurring at earlier age than expected
combination of certain diseases in a family
what are some manifestations of COPD?
shortness of breath cough recurrent infections poor nutrition respiratory acidosis chest pain mucus production
what are some questions we could ask a COPD patient to assess severity of symptoms?
activity tolerance/SOB at rest
appetite
sputum production and appearance
what are some common treatments for COPD exacerbation?
oxygen humidifiers and nebulizers SABAs corticosteroids antibiotics CPAP
what is the best oxygen administration method for COPD patients and why?
venturi mask, because it can deliver a fixed amount of oxygen at lower levels independent of the patient’s respiratory rate
what are two methods of breathing retraining used for COPD patients?
pursed lip breathing
diaphragmatic breathing
what is PEEP?
positive end expiratory pressure. a method of mechanical ventilation to prevent alveolar collapse
what are some nutrition recommendations for COPD?
rest and do respiratory treatments before eating
small frequent meals with snacks
high calorie, high protein meals
ensure adequate fluid intake between meals
what is included in pulmonary rehabilitation?
smoking cessation or avoidance
exercise training
nutrition counseling
education
what kind of exercise training is usually done for COPD patients?
focus on ambulation and some work on upper body muscles
what is ARDS?
acute respiratory distress syndrome, which is a sudden progressive acute respiratory failure. the alveolar-capillary membrane becomes damaged and more permeable to intravascular fluid
what are some direct lung injury methods from which ARDS can develop?
aspiration pneumonia sepsis embolism oxygen toxicity inhalation of toxic substances
what are some indirect lung injury methods from which ARDS can develop?
also sepsis trauma pancreatitis DIV extensive time on cardiopulmonary bypass opioid overdose head injury shock transfusion reaction
what are early signs of ARDS?
dyspnea tachypnea cough crackles mild hypoxemia respiratory alkalosis
what are later signs of ARDS?
increasing dyspnea retractions decreased lung compliance decreased functional residual capacity hypoxemia white lung on x-ray pleural effusion organ dysfunction pulmonary edema
what is the goal for care of ARDS?
maintaining airway and monitoring respiratory status
what breathing assistance do most ARDS patients have?
mechanical ventilation (PEEP)
what positioning strategies might help with ARDS?
prone and lateral rotation
what are important things to monitor for ARDS patients?
ABGs lung sounds hemodynamics fluid balance nutrition status
what are some complications that can develop because of ARDS?
infection oxygen toxicity paralytic ileus AKI decreased cardiac output respiratory failure pulmonary emboli or fibrosis ventilator associated pneumonia
what are some vasopressor drugs used for treatment of ARDS?
dopamine
dobutamine
norepinephrine
normal calcium lab values
8.6-10.2 mg/dL
normal carbon dioxide lab values
23-29 mEq/L
normal chloride lab values
96-106 mEq/L
normal creatinine lab values
0.6-1.3 mg/dL
normal glucose lab values
70-99 mg/dL
normal BUN lab values
6-20 mg/dL
normal magnesium lab values
1.5-2.5 mEq/L
normal GFR
greater than 60 mL/min
normal bilirubin lab values
0.2-1.2 mg/dL
normal hemoglobin lab values men and women
men 13-16 g/dL
women 11-15 g/dL
normal hematocrit lab values men and women
men 38-48%
women 35-45%
normal WBC level
4000-11,000 cells/microliter of blood
what is the difference between preterm labor and preterm contractions?
preterm labor: cervical change and uterine contractions
preterm contractions: only contractions without cervical change
what are some risk factors for preterm labor?
history of past preterm birth pregnant with multiples being overweight or underweight before getting pregnant uterine or cervical anomalies having an eating disorder family history of preterm birth smoking
what are some clinical manifestations of preterm labor?
cramping pelvic pressure vaginal discomfort increased vaginal discharge loss of fluid vaginal bleeding
what are pharmacological interventions for preterm labor?
betamethasone to promote fetal lung maturity
tocolytics to to suppress uterine contractions
fluids to calm uterine contractions
what are nursing actions when a client is in suspected preterm labor?
continuous external fetal monitoring and TOCO monitor/measure blood loss urinalysis looking for a UTI large bore IV and fluids notify MD hydration
what should clients be taught in regards to preterm labor?
symptoms of PTL
what do to if suspected: stop activity, lie down, drink water, wait one hour, call doctor if symptoms worsen
definition of gestational hypertension
hypertension without proteinuria or other systemic preeclampsia findings after 20 weeks gestation
definition of preeclampsia?
hypertension with proteinuria after 20 weeks gestation in a woman who didn’t have either previously
what is HELLP syndrome?
a severe variant of preeclampsia
characterized by hemolysis, elevated liver enzymes, and low platelets
how will hemoglobin levels look different in preeclampsia and HELLP?
they may be increased in preeclampsia
they will be decreased in HELLP
what are some risks in teen pregnancy?
hypertension
anemia
preeclampsia
preterm labor
what are some risk factors for preeclampsia?
first pregnancy age over 40 more than 7 years between pregnancies family history obesity GDM/any other diabetes multifetal pregnancy previous preeclampsia or hypertension renal disease
what are lab/clinical findings with preeclampsia?
increased hct hypertension increased creatinine increased liver enzymes proteinuria decreased platelets
what are assessment findings for preeclampsia?
headache edema RUQ or epigastric pain hyperreflexia seizures visual disturbances water retention increased BP proteinuria
why is magnesium sulfate used in preeclampsia?
its a CNS depressant that can prevent and treat seizure activity
what are signs of magnesium toxicity?
decreased BP
decreased urine output
respirations less than 12/minute
absent deep tendon reflexes
what other meds might be used in preeclampsia?
meds to control blood pressure, like labetalol, nifedipine, and hydralazine
what is the antidote to magnesium sulfate?
calcium gluconate
what are some risk factors for bleeding during the third trimester?
previous c-section advanced maternal age multiparity smoking hypertension cocaine use abdominal trauma PROM
what is placenta previa?
when the placenta is low lying and partially or fully covers the cervix. may or may not separate from the uterine wall
what is placental abruption?
early separation of the placenta from the uterus
what are assessment findings with placenta previa?
painless bright red bleeding
low lying placenta
soft/relaxed/non-tender uterus
what are assessment findings for placental abruption?
bleeding
cramping and pain
uterine tenderness and rigidity
contractions
what are interventions for placenta previa?
observation and bed rest if bleeding stops
type and screen blood
initiate large bore IV access
emergency c-section if necessary
what are interventions for placental abruption?
if 30-34 weeks, monitor closely
if at term or bleeding is severe, proceed to immediate birth and monitor closely
what are risk factors for gestational diabetes?
obesity age over 25 previous macrosomic infant hypertension family history of diabetes fasting glucose over 140
what are normal screening parameters for a one hour GTT?
less than 130-140 mg/dL
what is needed for a positive diagnosis of GDM?
exceeding two or more parameters in the 3 hour glucose tolerance test
where should fasting blood sugar levels be in GDM?
between 65 and 95 mg/dL
where should blood sugar be one hour after a meal in GDM?
less than 130-140 mg/dL
what is the normal treatment regimen for GDM?
diet restrictions and exercise
oral antidiabetics and insulin if lifestyle modifications dont work
what are later risks to the mother with GDM?
likelihood of GDM in later pregnancies
higher chance of developing T2DM later in life
what is the first intervention to be tried when late decelerations are noted on the fetal strip?
reposition the mother and administer oxygen
What are common indications for c-section?
complete placenta previa or placental abruption
malpresentation of fetus
non-reassuring fetal status
history of c-section
what are risk factors associated with c-section?
hemorrhage UTI infection fetal injury wound dehiscence
what is betametasone for and when is it given?
it promotes fetal lung maturity and should be given 24-48 hours before delivery
what is a trial of labor?
observing woman and baby for a reasonable period of time in active labor to assess safety of vaginal birth
when is a trial of labor often done?
when a vaginal birth after caesarian is being attempted
what drug is most commonly given to treat postpartum hemorrhage?
carboprost tromethamine
what are some common complications of a labor epidural?
maternal hypotension
fetal bradycardia
nausea/vomiting
what equipment/supplies should be ready in preparation for a preterm birth?
resuscitation equipment
betamethasone
what is the difference between a benign and malignant tumor?
benign: well-differentiated lump
malignant: out of control growth, can easily invade and metastasize
what nursing action should the nurse always take before administering chemotherapy?
make sure that catheter/PICC line/port are in the right place so there isnt an extravasation of chemo into the tissues
what are some nursing cares to remember for patients receiving radiation therapy?
radiation can cause effects on the skin like a sunburn (redness and dryness) and its important to take care of the skin and keep it hydrated and intact
what things will the nurse need to help the patient receiving chemo/radiation manage?
nausea vomiting anorexia diarrhea constipation
what tests and body systems will the nurse need to monitor in the patient receiving chemo/radiation?
liver function immunity/WBCs platelets skin status kidney function neuro status cardiac and respiratory systems
what are priority nursing/interprofessional cares for patients with superior vena cava syndrome?
radiation therapy to the site of obstruction, chemo to shrink the tumor, or a stent to treat the obstruction
what are manifestations of superior vena cava syndrome?
facial/periorbital edema
distended head/neck/chest veins
headaches
seizures
what are priority cares for patients with SIADH?
correct sodium water imbalance through fluid restriction, salt tablets, and possible Lasix therapy
what needs to be remembered about sodium levels with SIADH?
it will be low initially because of water retention. monitor it closely and don’t correct it rapidly, because that can cause seizures or death
what are some key manifestations of SIADH?
water retention
low sodium
nausea/vomiting
seizures
what are some key manifestations of cardiac tamponade?
heavy feeling in chest SOB tachycardia dysphagia distant heart sounds diaphoresis anxiety decreased LOC
what is the main treatment to correct cardiac tamponade?
draining fluid from around the heart (pericardiocentesis)
what are nursing cares to be performed with cardiac tamponade?
oxygen
IV fluids
vasopressor therapy to relieve pressure on heart
how much should healthy adults void in one day?
usually 1-2 liters
prerenal causes of AKI
cardiac issues like MI internal or external bleeding dehydration burns anything that hinders perfusion to kidneys
intrarenal causes of AKI
nephrotoxic drugs
postrenal causes of AKI
blocked urinary tract
renal caliculi
enlarged prostate
a 24 hour urine collection looks at..
creatinine clearance level
what is a normal GFR
90 ml/min or greater
what are some other ways to assess the kidneys and their function?
urinalysis BUN serum electrolytes renal ultrasounds renal scan CT scan renal biopsy
what will urine output look like in the oliguric stage of AKI?
less than 400 ml/day
what are some nursing interventions to consider for patients with AKI?
low protein diet
monitoring safety due to possible confusion
skin care and pressure ulcer prevention
mouth care
daily weights and monitoring fluid status
what are interventions for hyperkalemia?
regular insulin + IV glucose sodium bicarb calcium gluconate hemodialysis kayexalate ventassa potassium restricted diet
what does kayaxalate do?
produces osmotic diarrhea to remove potassium from the body
what does veltassa do?
bind potassium in the GI tract
what are nutrition interventions for AKI?
limit protein: get energy from carb and fat sources
regulate potassium and sodium, limit phosphates
30-40% of calories from fat
monitor strict intake and output
how much might patients void in the oliguric stage of AKI?
3-6 liters/day
AKI patients are at risk for which acid/base imbalance?
metabolic acidosis
what are some manifestations of metabolic acidosis in AKI patients?
decreased pH
confusion
Kussmaul breathing
what are some reasons to do PD?
immediate initiation lower infection risk easier on heart less dietary restrictions better for diabetics
what are some reasons for HD?
rapid fluid removal
better urea/creatinine clearance
better potassium removal
less protein loss
what are some complications of PD?
peritonitis exit site infection hernias bleeding protein loss pulmonary complications hyperglycemia
what are some complications of HD?
hypotension cramps infection vascular access problems blood loss hepatitis disequilibrium syndrome
what is disequilibrium syndrome?
cerebral edema and increased intracranial pressure as a result of hemodialysis
what causes most cases of hypercalcemia?
hyperparathyroidism
what effect does hypercalcemia have on the body?
sedative effects (reduced excitability of muscles and nerves)
what are other general manifestations of hypercalcemia?
reduced muscle/nerve excitability fatigue confusion lethargy weakness hallucinations coma dysrhythmias
What dysrhythmias are most common in hypercalcemia?
heart block
v-tach
what are some interventions for mild hypercalcemia?
stop eating so much calcium and stop taking meds with calcium
increase weight bearing activity
drink 3-4 liters of fluid daily to promote calcium excretion
what are some some interventions for severe hypercalcemia?
IV saline to maintain urine output watch for fluid overload bisphosphonates calcitonin to increase calcium excretion dialysis in very severe cases
what are some nursing interventions for respiratory acidosis?
give oxygen
encourage coughing/deep breathing/spirometry
no respiratory depressing drugs
watch potassium levels closely
give antibiotics if acidosis is caused by pneumonia
what are some nursing interventions for respiratory alkalosis?
paper bag breathing
monitor calcium and potassium levels (can be severely decreased)
teach breathing techniques to slow respirations
what are some nursing interventions for metabolic acidosis?
watch electrolyte levels monitor neuro status monitor intake and output monitor respiratory status treat underlying cause
what are some nursing interventions for metabolic alkalosis?
anti-emetics
treat cause of alkalosis
stop suctioning or diuretics if underlying cause
monitor ABGs
what part of the brain controls thermoregulation?
hypothalamus
what are some things that can lower core body temp?
drug use
alcohol use
hypothyroidism
