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Adult Health II > Adult Heath II -- Test 3 > Flashcards

Adult Heath II -- Test 3 Flashcards

1
Q

Parkinson’s S/S

A

bradykinesia, resting tremor; rigidity; mental status (depression), postural instability

excess ACh – constipation, ortho HOTN, diaphoresis, flusing

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2
Q

Parkinson’s Rx

A

Levodopa (dopamine precursor) and Carbidopa (inhibits peripheral conversion of levodopa = more for brain)

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3
Q

Parkinson’s Rx A/E

A

dyskenisa, dystonia, on/off

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4
Q

Drugs that cause PD-like Sx

A

antipsychotics (ie Haldol, lithium & others), antiemetics (ie Compazine), Reglan, antiHTN (ie reserpine, aldomet), illicit drugs (ie methamphetamines)

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5
Q

Fall Precautions

A

PT for balance, low & locked bed, fall bracelet, don’t get up alone, bed alarm, non-skid footwear, no throw rugs, furniture w/ open pathways to walk

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6
Q

Aspiration Precautions

A

HOB elevated before & after meal, lung sounds before & after eating, ensure not pocketing food in mouth, thickened liquids if needed, soft foods

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7
Q

Paraplegia

A

injury occurring from T1 through L4 w/ paralysis of lower extremities

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8
Q

Quadraplegia

A

– injury occurring from C1 through C8 w/ paralysis of all 4 extremities

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9
Q

Emergency Care for SCI

A

maintain patent airway, immobilize on spinal backboard w/ head in neutral position w/ a C-collar to prevent an incomplete injury from becoming complete, prevent head flexion/rotation/extension, if severe cervical injury skeletal traction should be placed in the ER; always suspect SCI until ruled out, improper handling can cause further neurological damage/loss of function
Edema can extend up cord extending deficits, tx w/ methylprednisolone w/i 8hrs of SCI (not for penetrating injuries); enormous dosages

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10
Q

Cervical traction

A

ALWAYS CONTINOUS, requires pin site care, assess for alignment, amount (lbs) will depend on level of injury, alignment & reduction obtained via x-ray, various types of tongs; in for 5 days then sx

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11
Q

Halo traction

A

– high to mid cervical fractures w/o cord injury; teaching – 10-12 weeks, post op don’t raise HOB until ordered, walker, swivel chair, low heeled shoes, straws for drinking, sponge bath (no showers/baths), don’t use bars to move pt, don’t lift more than 10lbs, button up shirts

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12
Q

C collar

A

post-sx: 2 collars (wear one wash the other), change collar in front of mirror, snug but not tight, should prevent nodding yes/no, complication: pressure ulcers

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13
Q

Neurogenic spinal shock

A

acute SCI complication, ischemic event (lack of circulation) 30 min – 6 weeks; s/s – hypotension (tx w/ dopamine), bradycardia, warm/dry extremities, inability to regulate temp, areflexia below injury, no sensation/movement

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14
Q

Hyperkalemia

A

acute SCI complication assess during first couple of weeks; loss of K from paralyzed muscle; tx w/ Kayexylate, diuretics if tolerated by hypotension, insulin

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15
Q

Autonomic dysreflexia

A

potentially chronic massive sympathetic response to visceral stimulation that occurs after spinal shock resolved & reflex activity has returned, more likely w/ injuries above T5-6, disconnect b/w PNS & SNS, intact lower motor neurons sense painful stimuli below level of injury (ie full bladder); message trying to get to brain is blocked so looks for another route

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16
Q

Autonomic dysreflexia S/S

A

sudden & severe HTN (250/180), pounding h/a, bradycardia, arterial dilation/flushed skin/sweating above T6, nasal congestion, cool skin/goose bumps below injury

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17
Q

Autonomic dysreflexia Etiology

A

bladder/bowel distention, tight dressings, decubitus ulcers, anything that normally causes pain below lesion, PG

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18
Q

Autonomic dysreflexia Tx

A

sit pt up (they are orthostatic), monitor BP, look for cause & alleviate it, vasodilators (apresoline, Procardia, nitroglycerin); teach pt to prevent

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19
Q

Immobility hazards

A

pneumonia, DVT & decubitus ulcers – every system is compromised by bed rest; turn/cough/deep breathe often, meds, early mobility

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20
Q

Back Tx

A

– brief bed rest (2 days – longer bedrest results in greater disability), PT including exercises (after acute pain subsides), ice/heat/massage, body mechanics, traction; meds – NSAIDs, opioids, muscle relaxants, steroids

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21
Q

Myelogram – intro

A

– specialized x-ray; lumbar puncture below L3 & injection of contrast into subarachnoid space (can show bony overgrowth, spinal cord tumors/abscesses, HNP/pinched nerve)

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22
Q

Myelogram – pre

A

allergies to contrast, kidney/thyroid/liver problems (inhibit excretion of contrast – BUN & creatinine), permit signed, pre-op drug, NPO at least 4-8hrs, d/c drugs that lower seizure threshold including: (phenothiazines ie Phenergan, TCA (ie Elavil), CNS stimulants, Glucophage, Demerol shouldn’t be ordered; d/c drugs that cause blood thinning ie ASA, NSAIDs, Plavix, Anticoagulants

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23
Q

Myelogram – post

A

force fluids, low to semi-fowler’s, assess for voiding, assess LE movement, assess for spinal h/a, if outpatient need a driver

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24
Q

Laminectomy – post

A

removal of entire lamina (sm bony plate on the back of the vertebrae) to relieve pressure on the spinal canal; post-op – always log roll, don’t ambulate or raise HOB w/o an order, always have draw sheet on bed, report any neuro deficit (ie motor loss, urinary retention, sensory loss), stool softener as ordered, assess wound, TCDB q2h, antibiotics ordered, avoid drugs that increase bleeding, pain mgmt., NSAIDs may not be ordered b/c want inflammation, don’t drive/check w/ MD, TLSO (thoracic lumbar sacral orthodesis ie brace) q3-6mos; complications – neuro deficit, retroperitoneal hemorrhage, CSF leak

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25
Q

Cauda equina syndrome

A

complete/bilateral compression of lower lumbar & sacral roots (below conus medullaris) causing sensory & motor loss below level of lesion (flaccid LE, decreased DTRs, urinary & fecal incontinence or retention); sx emergency

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26
Q

Five Ps

A

pain, pallor, polar, paresthesia, pulselessness, paralysis, perception, pressure

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27
Q

Trigeminal neuralgia

A

unilateral facial pain d/t disease of sensory branches of trigeminal nerve (CN 5); s/s – burning, knifelike/lightninglike shock in trigeminal branches including lips, upper/ lower gums, cheek, forehead or side of nose, pain is abrupt & intense w/ unpredictable duration & recurrences; cause unknown but may be r/t trauma of jaw or ear/teeth infection; triggers – minimal stimulation by eating, brushing teeth, talking, cold blast of air

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28
Q

Trigeminal neuralgia Tx

A

Meds - antiepileptic meds (ie carbamazepine, oxcarbazepine), antidepressants (ie Amitriptyline), muscle relaxants (ie baclofen)
Sx – glycerol rhizotomy (chemical ablation), percutaneous rhizotomy (radiofrequency ablation), microvascular decompression, gamma knife radiosurgery (targeted radiation to site)

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29
Q

Trigeminal neuralgia – Nx

A

pain mgmt., response to drug tx, nutritional status, oral hygiene, teaching for sx prep, post-op care if residual deficits after sx (loss of sensory on that side), social isolation r/t uncertainty of pain events

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30
Q

Bell’s palsy

A

steroids for inflammation; antivirals if viral & doxycycline if Lyme’s disease

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31
Q

Peripheral neuropathy

A

DM, vascular abnormalities, renal/liver failure, B12 deficiency, AIDS/other immune disorders, drug toxicity, infection, toxic substances (ie heavy metals), trauma

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32
Q

Peripheral neuropathy S/S

A

muscle weakness w/ or w/o atrophy, pain that’s described as stabbing/cutting/ searing, paresthesia (ie tingling, burning, numbness), loss of sensation, impaired reflexes

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33
Q

Peripheral neuropathy Tx

A

removal/tx underlying cause, neuropathic pain use: antiepileptic tx (ie gabapentin), antidepressants (ie nortriptyline), opioids; teaching – smoking worsens, elastic stockings to facilitate venous return, caution re extremity care (ie protect from burns/trauma/temp changes)

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34
Q

Tetanus

A

severe polyradiculitis & polyneuritis affecting spinal & cranial nerves; causes – traumatic wound, dental infection, chronic OM, heroin injection, human & animal bites, open fractures; 100% fatal in severe form

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35
Q

Tetanus S/S

A

stiffness in jaw (trismus) or neck, fever, tonic convulsions (opisthotonos), laryngeal & resp spasm causing apnea, overstimulation of sympathetic nervous system (diaphoresis, labile HTN, tachycardia, arrhythmias, hyperthermia);

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36
Q

Tetanus Tx

A

– tetanus toxoid booster & tetanus immune globulin before onset of symptoms, control spasms w/ deep sedation (ie valium, barbituates, neuromuscular blocking agents ie vecuronium), penicillin or other antibiotics to tx infection; nursing mgmt. – prevention w/ Td booster q10yrs, immediate cleansing of wound w/ soap & H2O, acute – pain mgmt., quiet/dark room to prevent spasms/seizures, trach w/ mechanical vent, rehab; READ BOX IN BOOK ABOUT TETANUS

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37
Q

Botulism

A

most serious type of food poisoning but also can be contracted through open wounds/ nasal inhalation, neurotoxin destroys/inhibits transmission of ACh leading to disturbed muscle movement;

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38
Q

Botulism S/S

A

n/v, abdominal cramping, neurologic manifestations (difficulty in convergence of eyes, photophobia, ptosis, paralysis of extraocular muscles, blurred/double vision, dry mouth, sore throat, difficulty swallowing), other symptoms (paralytic ileus, muscle weakness, seizures, resp problems/resp arrest);

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39
Q

Botulism Tx

A

botulism antitoxin IV, GI tract purges (non-Mg laxatives, enemas, lavage w/ charcoal); nursing mgmt. – prevention w/ proper food prep, vent support if needed, care of pt w/ altered mobility

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40
Q

Functions of kidney

A

Regulatory – maintain body fluid vol & composition, filter waste products for elimination, acid-base regulation
Hormonal – regulate BP (through Renin), Erythropoietin (RBC Synthesis), metabolize Vit D to active form

41
Q

Kidney terms

A

Oliguria – decreased urine output to b/w 100-400mL/24hr; 30mL/hr or 720mL/24hrs is normal
Anuria – no urination (total output less than 100mL/24hr)
Dysuria – painful urination
Nocturia – waking from sleep d/t need to urinate
Polyuria – output greater than 2000mL/24hr
Uremia – full blown renal failure; collection of metabolic wastes in the bloodstream

42
Q

Urinalysis

A

ideal is 1st morning void, color/odor/turbidity, specific gravity; normal = amber yellow, pH 4-8 (average 6), specific gravity 1.003-1.030, RBC 0-4, WBC 0-5, no glucose/ ketones/bilirubin, few casts, bacteria less than 10k/mL; urinalysis doesn’t have to be sterile

43
Q

Urine culture

A

done when urinalysis is abnormal (ie WBC, leukoesterase or nitrites) or symptoms of UTI, needs to be clean catch or catheter derived specimen

44
Q

BUN

A

measures renal excretion of urea nitrogen (by-product of protein metabolism in liver); elevation may or may not indicate renal disease (other factors taken into account ie varies according to hydration, trauma can elevate); normal 6-20

45
Q

Serum creatinine

A

end product of muscle & protein metabolism filtered by kidneys & excreted in urine (muscle mass & metabolism are usually constant so this is a good indicator of kidney function); normal less than 1.3 (any elevation is important)

46
Q

KUB

A

kidneys/ureter/bladder x-ray (shows structures of urinary tract system but it’s a flat plate of whole abdomen)

47
Q

IVP

A

contrast x-ray of kidneys to look at renal system

48
Q

Bladder scan

A

portable u/s to see how much urine is in the bladder to determine if catheterization is necessary; verify empty bladder, post void residual (over 150mL after voiding will probably cath them)

49
Q

24 Hr Urine Collection

A

for Creatinine of other collections ie NaCl, Ca, other electrolytes; 24hr urine collection; throw away 1st void at 10am then collect all specimens until 10am next day & save that last urine, may need to store on ice, start over if contaminated

50
Q

Creatinine clearance

A

better indicator of kidney function (approximates GFR); normal = 70-135mL/min

51
Q

Cystoscopy

A

looks into bladder for infections, tumors, sources of bleeding, structural problems, etc; post-procedure will have pink tinged urine so increase fluids; contraindications – acute UTI, severely enlarged prostate

52
Q

Cystitis

A

inflammation or infection of bladder; s/s – frequency, urgency & dysuria are prime symptoms but can also have cloudy/foul smelling/blood tinged urine, older adults may present w/ confusion

53
Q

Cystitis Dx

A

urinalysis (100k+ organisms, positive for leukoesterase & nitrites, presence of WBC & RBC, urine culture/sensitivity confirms organism & antibiotics needed)

54
Q

Cystitis Tx

A

urinary antiseptics or antibiotics X3days (ie cipro, Bactrim), analgesics (ie pyridium which stains body fluids), antispasmodics (ie anaspaz)

55
Q

Pyelonephritis

A

acute/active infection of kidneys (often can be ascending infection); s/s – low-grade fever, chills, N&V, flank pain or CVA tenderness, cystitis symptoms

56
Q

Pyelonephritis Dx

A

urinalysis & culture, elevated WBC, blood cultures, KUB, u/s for anomalies

57
Q

Pyelonephritis Tx

A

Bactrim or Cipro usually 14-21 days, f/u culture after tx, sx repair of anomalies

58
Q

Glomerulonephritis Intro

A

immune complex deposition (antibody-antigen & complement) w/i glomeruli leads to inflammation & ineffective renal filtration ability ie SLE, post-strep infection; s/s – proteinuria, hematuria, generalized edema & other symptoms of fluid overload, elevated BP, elevated BUN & Creatinine (not infection symptoms!!!!); best way to evaluate pt’s fluid status = BP & daily weights

59
Q

Glomerulonephritis Dx

A

assess for previous often Group A Strep infection, urinalysis, BUN & creatinine, testing for immunological reactions (ie ANA, IgG, C3 complement levels), renal biopsy

60
Q

Glomerulonephritis Tx

A

symptomatic/supportive care, antibiotics if infection, mg fluid overload w/ Na & H2O restriction/diuretics, diet restriction of protein & Na, oliguria can lead to increased K which needs tx, antihypertensives, may need plasmaphoresis to remove immune complexes or short-term dialysis

61
Q

Renal cancer

A

may have no symptoms, early sign = painless hematuria, palpable mass, dull flank pain, general malignancy symptoms (weight loss, anemia, fatigue)

62
Q

Renal cancer Dx

A

urinalysis (r/o other urinary problems), CT/MRI/US, renal biopsy

63
Q

Renal cancer Tx

A

nephrectomy (remove kidneys, adrenal gland, fat & lymph nodes), radiation, chemo (if metastatic), immunotherapy (biologic response modifiers)

64
Q

Bladder cancer S/S

A

may have no symptoms, early sign = painless hematuria, palpable mass, dull flank pain, general malignancy symptoms (weight loss, anemia, fatigue)

65
Q

Bladder cancer Dx

A

urinalysis (r/o other urinary problems), CT/MRI/US, renal biopsy

66
Q

Bladder cancer Tx

A

nephrectomy (remove kidneys, adrenal gland, fat & lymph nodes), radiation, chemo (if metastatic), immunotherapy (biologic response modifiers)

67
Q

Renal / Urinary calculi

A

stones in urinary tract (a lot of stones contain Ca), strong family & personal hx

68
Q

Renal / Urinary calculi Dx

A

severe flank/abdominal pain aka renal colic, N&V, pallor, diaphoresis; dx – urinalysis usually shows hematuria & crystals, KUB/CT/US; nursing mgmt. – pain, hydration, strain urine for stones

69
Q

Renal / Urinary calculi Tx

A

different procedures for stone removal

70
Q

Causes of ARF

A

inadequate kidney perfusion ie shock, PE, anaphylaxis (prerenal failure #1 cause), damage to glomeruli/interstitial tissue or tubules ie infection/drugs/cancer (intrarenal failure), obstruction of urine flow ie ureter stone (postrenal failure)

71
Q

Phases of ARF – Onset

A

Onset – begins w/ precipitating event (ie blood loss = hypotension from trauma) & continues until oliguria, may see elevated BUN & creatinine; can occur over several hrs-days

72
Q

Phases of ARF – Oliguric

A

output less than 400mL/24hr that doesn’t respond to fluid challenges or diuretics; elevated BUN & creatinine, hyperkalemia, hyperphosphatemia, hypermagnesemia

73
Q

Phases of ARF – Diuretic

A

high output phase occurs after correction of precipitating event when renal tubular function is reestablished; BUN begins to normalize; usually occurs 2-6 weeks after onset

74
Q

Phases of ARF - Recovery

A

renal function continues to improve although may never reach pre-illness levels

75
Q

ARF Dx

A

creatinine & BUN elevated & continue to increase at same pace (can get really high ie creatinine 6mg & BUN 100), K & phosphorus increased, Ca decreased, specific gravity usually decreased & fixed at 1.010 (inability of tubules to produce concentrated or dilute urine), creatinine clearance, alteration in ABGs (ie metabolic acidosis is the main thing)

76
Q

ARF Tx

A

correct cause then tx major problems of compromised fluid vol regulation & electrolyte imbalances w/ drugs (diuretics, dopamine gtt, Ca channel blockers to promote renal blood flow), diet, renal replacement tx w/ dialysis, fluid challenge w/ NS

77
Q

ARF dialysis

A

temporary hemodialysis (using temp access port in subclavian or jugular vs fistula used for CRF), peritoneal dialysis, continuous renal replacement therapies (pts are too hemodynamically unstable for HD)

78
Q

ARF and CRF diet

A

restrict protein, Na, K & fluids; admin Fe/Ca/Vit D, may need to tube feed/TPN if to ill for oral

79
Q

ARF risk factors

A

– DM, HTN, glomerulonephritis, PKD, systemic disease (ie Lupus), ARF that doesn’t resolve

80
Q

CRF risk factors

A

– DM, HTN, glomerulonephritis, PKD, systemic disease (ie Lupus), ARF that doesn’t resolve

81
Q

CRF Stages – diminished renal reserve

A

diminished renal reserve – no accumulation of metabolic wastes b/c nephrons in overdrive to compensate but creatinine clearance may show some changes

82
Q

CRF Stages – renal insuffiiciency

A

unaffected nephrons damaged by increased pressure leading to symptoms w/ elevated BUN & creatinine; end stage renal disease (ERSD) – no functioning nephrons = need dialysis

83
Q

ESRD – renal insufficiency

A

BUN & Creatinine increasing, kidneys lose ability to concentrate, polyuria & nocturia, h/a, mild anemia, weakness & fatigue

84
Q

ESRD S/S

A

BUN & creatinine significantly increased, specific gravity fixed at plasma level (1.010), oliguric, dialysis necessary, sallow/yellow discoloration of skin, uremic frost, pruritus, CNS depression, peripheral neuropathy, psychological changes (withdrawal, depression, psychosis), elevated BP, CHF, pericarditis, anorexia, N&V, GI bleeding, PUD, constipation, hyperglycemia, hyperlipidemia, anemia-bleeding, hyperparathyroid, amenorrhea, infertility, impotence, gout, GFR less than 10%, renal osteodystrophy; uremia – collection of metabolic wastes in bloodstream w/ development of clinical symptoms

85
Q

ESRD – uremic syndrome

A

hyperparathyroidism, glucose intolerance, pulmonary edema, Kussmaul’s respirations, proteinuria, hematuria, nocturia, oliguria, fixed specific gravity, anorexia, N&V, gastroenteritis, hiccups, abdominal pain, GI bleeding, PUD, osteodystrophy, bone pain, spontaneous fractures, diminished leukocyte count & increased susceptibility to infection, apathy, lethargy, h/a, impaired cognition, insomnia, restless leg syndrome, gait disturbances, paresthesias, seizures, decreased LOC, coma, HTN, CAD, dysrhythmias, pericarditis, pericardial effusion, cerebrovascular disease, CHF, anemia, impaired clotting, amenorrhea, impotence, spontaneous abortion, pallor, uremic skin color & frost (yellow green), dry skin, poor turgor, pruritus, ecchymosis, azotemia (big time uremia), edema, hyperkalemia, hyperphosphatemia, hypocalcemia, hypermagnesia, acidosis, hyperlipidemia, hyperuricemia, malnutrition

86
Q

CRF ABNORMAL LAB VALUES

A 
creatinine  < 1.3
BUN  6-20
Hgb/Hct (11-17/35-50%)
Na, K,
Mg (1.5-2.5)
Ca (8.6-10.2)
Phosphorus (2.4-4.4)
Bicarb (22-26)
Urine proteins (should be none)
87
Q

CRF Tx

A

control of HTN/anemia/electrolyte imbalances – diuretics for fluid retention & HTN early on in renal insufficiency (not ESRD), dialysis, renal transplant; anemia – colony stimulating factors (Epogen/Procrit)

88
Q

Assess AV fistula

A

(aka shunt) – auscultate bruit & palpate for thrill to ensure adequate circulation; also no BP/blood draw in fistula arm

89
Q

Peritoneal dialysis – Nx

A

daily weight, strict aseptic technique (mask & sterile gloves), hand washing, monitor I&O; after draining: assess color (should be yellow like urine), consistency of flow (if decreasing elevate HOB/turn), if cloudy/fibrinous clots notify MD, check catheter site, assess for pain; complications

90
Q

Peritoneal dialysis – peritonitis

A

fever, persistent abdominal pain & cramping, slow/cloudy dialysis drainage, increased WBC, swelling/tenderness around catheter

91
Q

Dialysis – DRUGS TO AVOID

A

usually don’t give AM meds b/c will get dialyzed out, give after dialysis; avoid drugs that cause hypotension prior to dialysis

92
Q

Exclusions for Renal Transplant

A

older than 70, unresolved malignancies, active infectious process, HIV+, cirrhosis/hepatitis, substance abusers, COPD, LVEF less than 20%, BMI greater than 35, psychosocial/behavioral abnormalities

93
Q

BPH S/S

A

voiding symptoms including: difficulty initiating stream, reduced force of urinary stream, intermittency, dribbling urine, sensation of incomplete bladder emptying, frequency, urgency, nocturia; potential complications: acute urinary retention, UTI: phyleonephritis (inflammatory or infectious), sepsis, backflow leading to hydronephrosis & renal failure

94
Q

BPH Dx vs prostate cancer

A

DRE – BPH presents as uniform, elastic, non-tender enlargement vs cancer presents as stony-hard nodule
PSA – elevated in both BPH & Prostate Ca; normal = 4-10ng/mL, greater the # larger the tumor
Creatinine & BUN – renal complications
If Abnormal DRE & PSA: KUB – to evaluate renal system; IV pyelogram – contrast x-ray of kidneys to look at renal system; Cystourethroscopy – cystoscope to view urethra, bladder neck & bladder; Bladder scan – to assess postvoid residual

95
Q

BPH conservative care Nx

A

watch & wait to see if causing urinary difficulties; dietary changes – avoid ETOH/caffeine/lg amounts of fluids in short time/drinking fluids 2-3hrs before bedtime; avoid meds that can cause urinary retention (decongestants, anticholinergics ie scopolamine, atropine)

96
Q

TURP transurethral resection of prostate

A

post op care w/ continuous bladder irrigation – tissue is removed & coagulated (to reduce pressure on urethra), irrigation solution carries out debris; bleeding is a common complication (assess clotting factors pre-op); post-op – clots normal 24-36hrs, hematuria

97
Q

CBI continuous bladder irrigation

A

NS irrigation 24hrs after TURP adjusted to maintain colorless or light pink drainage return, tape cath to leg to provide gentle traction, balloon at end of catheter is pulled down into prostatic tissue removal area to put pressure on area & maintain hemostasis; complications – potential hemorrhage, bladder spasms (tx w/ antispasmodics ie oxybutynin/Ditropan)

98
Q

Hormonal therapy for Prostrate Cancer

A

estrogens inhibit release of LH from pituitary which stops hormone stimulation to prostate (ie Megace or Depo-Provera)

Adult Health II (3 decks)

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