366 Exam 2 Flashcards
What is phlebitis?
Irritation and infection
Sx: erythema, streak formation, pain, edema,
Tx: warm compress to vasodilator
What is infiltration?
Fluid getting into surrounding tissue
Sx: skin blanched, cool to touch, edema, pain, bruised, area can feel hard
Tx: dc iv, warm compress to vasodilator
What is extravasation?
Reaction to drug that is only compatiblewith bv, comes into contact with tissue
Sx: burning, decaying/necrotic tissue, pain,
TX: dc infusion, attempt to aspirate drug, cold compress, see if antidote call pharm for antidote, notify provider
Hypotonic iv solution?
Lower osmolality, cells swell, water movement into cells. Und in patients with hypernatremia
Isotonic iv fluid?
Same osmotality. Increases ECF doesn’t move into cells
Hypertonic iv fluid?
Higher osmolality, cells shrink, water moves out of cells. Used to treat hyponatremis and trauma patients
Cardiac A&p
5L / min,
Pericardial sac → 2 layers + 10-20 ml fluid
3 cardiac layers → epi-, myo-, endo-
4 chambers divided by septum
2 av values, 2 semilunar values, unidirectional blood flow
Coronary arteries → RCA, LCA/ left main
What causes a MI?
Thrombus blocking blood flow causes irreversible myocardial cell death
What is stemi mi?
ST elevation, occlusive thrombus
TX: Mona, PCI - balloon, thrombolytic therapy, cabg, anti platelet, anticoag
What is nstemi mi?
Nonocclusive, t wave depression or inversion
TX: Mona, stress testing, anticoag, PCI stent, cabg
Parts of EKG, what is p wave?
Impulses move through atria
Parts of EKG, what is Pr interval?
Amount of time it takes for impulse to travel from atria to ventricles
Part of EKG, what is QRS complex?
Impulse moves through ventricles
Parts of EKG, what is t wave?
Ventricles depolarize
Parts of EKG, what is time between end of T wave and start of P wave?
Heart at rest
What are diagnostic test for heart failure?
CXR: cardiomegaly
ECG: rhythm, wide Qrs?
Echo: value function, ef, wall Motion
Cath: pulmonary pressures, filling pressures, coronary arteries, ef%
Labs: Na / cl ↓, bun / cr/ LFT ↑, rbc ↓, 02/ CO2 ↓, BNP > 100
Define hypertension
Normal: SBP < 120, DBP < 80
Elevated: SBP 120 - 129 , DBP <80
Stage 1 hypertension: SBP 130-139, DBP 80-89
Stage 2 hypertension: SBP > 140, DBP > 90
Hypertensive crisis: SBP > 180, DBP > 120
What are the 3 phases of peri- operative care?
Pre-op, intra-op, post-op
What are nursing responsibilities during pre-op?
Intake an information, history, meds, labs I psychosocial, consent
What is nursing considerations for intra-op?
Safety maintenance, monitoring, communication with family, anticipating and critical thinking, scds, positioning , site prep
What is nursing considerations for post -op?
Frequent assessments, airways, cardio stability, pain and anxiety relief, surgical site, gi function, urine output, ambulate ASAP
Complications! Shock, hemorrhage,DVT, PE,cerebral vascular accident, urinary retention, pneumonia & acteractasis, intestinal obstruction
What are national patient safety goals?
Identify patients correctly, prevent surgical mistakes, improve communication, safe med administration, alarm safety, reduce risk of health care associated infections, identify patient safety risks, improve health care equity
How to calculate iv infusion rate?
Volume to be given / hours to infuse = ml/hr
Or
Volume to be given X 60min / # of mins to be infused = ml/hr
How to calculate drops per minute?
Amount of fluid to be given x drop factor/ time in min= gtt/ min,
Or
1: amount of fluid to be given / hours to be administered = ml/hr
2: ml per hour X drop factor / 60 min = gtt/min
What are AlC levels for diabetes?
> 6.5% = diabetes
5.7 - 6.4 %= prediabetes
Below 5.7% = normal
What are blood glucose levels In relation to diabetes?
Fasting = 126 (diabetes), 100 - 125 (prediabetes), 99 or below (normal)
Glucose tolerance test= 200 or above (diabetes), 140 - 199 ( prediabetes ), 140 or below (normal)
What would be a sign of diabetes in a urine test?
Ketones or glucose
What is type 1 diabetes?
Autoimmune disorder against insulin
Beta cells in pancreas stop producing insulin or do not produce enough to survive
Sx: polydipsia, polyuria, polyphagia
Requires exogenous insulin
What is type 2 diabetes?
Non-insulin dependent
Risk factors: overweight/obese, advanced age, family history,
Pancreas continues to produce insulin, but not enough or body does not use it properly
Insulin resistance, inappropriate hepatic glucose production, altered production of hormones and cytokines by adipose tissue
Sx: none, recurrent infection,fatigue, polydipsis, polyuris, polyphasis
What is insulin lispro?
Class: short duration, rapid acting
Onset: 5-10 min
Peak: 30 - 90 min
What is regular insulin?
Class: short duration, shout acting
Onset: 30 min - 1 hour
Peak: 2-5 hours
What is NPH insulin?
Class: intermediate acting
Onset: 1 - 2 hours
Peak: 4-12 hours
What is insulins glargine?
Class: long acting
Onset: 1-2 hours
Peck: none
What are signs of hypoglycemia?
!COOL AND CLAMMY GIVE THEM CANDY!
Pallor, dizziness, headache, shaky, nervous, irritable, hungry, sweaty, blurred vision, confusion, slurred speech, tachycardia, numbness in fingers/ toes/ mouth, severe! Seizure & coma → death
What are signs of hyperglycemia?
!HOT AND DRY SUGAR IS HIGH!
↑ thirst, dry mouth, ↑ urination, weakness, fired, blurred vision, glycosuria, nausea, vomiting, abdominal pain, sob, loss of consciousness. Severe! DKA/HHS
What are signs of DKA?
Blood glucose > 240
Arterial ph < 7.3
Serum bicarbonate < 15
Presence of ketones in urine or blood
Management: iv access for fluids and electrolytes, short acting insulin, O2, K and bicarb for severe acidosis,monitor consciousness, 02, urine, vs
S/s: fast breathing, flushed face, frequent urination, dry skin/ mouth, fruity breath, headache, muscle stillness, lethargy/confusion, n/v, abdominal pain
What is HHS?
More common in type 2 diabetes
UTIs, pneumonia, sepsis, acute illness, newly diagnosed,
Common cormorbidity of infection & dehydration
Cx: stroke, heart attack, meds, fluid loss,
Labs: ph > 7.3
Plasma glucose > 600
Ketones in urine= none or trace
TX: treat ↑ glucose with insulin, aggressive iv fluid for correction of fluid loss, administer electrolytes
What are chronic complications of diabetes?
Retinopathy→ yearly eye exam
Nephropathy→ annual urinalysis
Neuropathy → daily checks and annual comprehensive exam
Cvd» annual visits
What is Cho and connection factors, give an example.
Correction factor - 1:40 >150. The patients blood glucose is 200, now much insulin will you administer?
200 - 150 = 50
50 / 40 = 1.25 → 1.5
What are pediatric cardiac disorders that ↓ pulmonary blood flow?
ASD/VSD → blood mixes and dumps into pulmonary circuit
PDA → aortic and pulmonic flow together
Av - canal →
S/s:
Color → pink
Respiration → perfort, tachypnea
Feel → edema on right side, putty, ↑ liver size
