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Semester 2 > Adults Final > Flashcards

Adults Final Flashcards

1
Q

When is a pain assessment performed?

A

On admission or initial assessment
Each new report of pain
Before and after pain med admin
When indicated by changes in condition or treatment

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2
Q

Who is the most reliable source of information for pain?

A

The patient

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3
Q

How do you perform a pain assessment?

A

Begin by asking “do you have any pain?”
Rate pain on scale of 1-10
COLDERA or OLDCART

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4
Q

You suspect a patient is lying about their pain, what do you do?

A

You still have to take pts report as serious and truthful - do not have the right to withhold medications

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5
Q

What are the pain assessment tools used for specific populations (nonverbal, young children, advance dementia, critical care)?

A

Nonverbal = The Hierarchy of Pain Measures
Young children = FLACC
Dementia = PAINAD
CC = CPOT

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6
Q

How do you treat pain in the elderly? What should you monitor?

A

Start low and go slow
Use acetaminophen b/c of high risk for NSAID toxicity
Reduce opioid dose 25-50%

Assess: sedation/CNS, toxicity, signs of a/e, kidney function

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7
Q

How does unrelieved pain affect each body system?

A

Endocrine- high ACTH, cortisol, ADH, low insulin
Metabolic- insulin resistance&raquo_space;> hyperglycemia
CV- high HR/BP, risk for HTN and DVT
Respiratory- atelectasis, hypoxemia, infx
GU- low UO, fluid overload, hypokalemia
GI- low gastric motility
Muscle- spasms, immobility
Cognition- confusion
Immune- low immune response
QOL- sleepness, anxiety, fear, thoughts of suicide

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8
Q

What is the difference b/w acute, chronic, and breathrough pain?

A

Acute- short duration and usually resolves

Chronic- longer than acute, limited or lasts lifetime; can be cancerous or noncancerous

Breathrough- chronic pain with acute exacerbations

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9
Q

Describe the differences between nociceptive pain and neuropathic pain (give examples). Which is most responsive to pharmacologic management?

A

Nociceptive- tissue injury (ex. somatic or visceral); most responsive to meds

Neuropathic- damage to the PNS/CNS (ex. phantom pain, neuropathy)

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10
Q

What is the difference between dependence, tolerance, and addiction?

A

Dependence- manifestation of withdrawal upon stopping (takes 2 or more wks w/ opioids)

Tolerance- increased dosing needed to maintain effects

Addiction- chronic, relapsing, treatable; compulsive use and craving; psychological dependence

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11
Q

Name and describe the 3 basic pharmacological interventions for pain.

A
  1. Opioids- act on CNS to block pain receptors
  2. NSAIDS- decrease pain by inhibiting cyclo-oxygenase
  3. Local anesthetic- block nerve conduction
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12
Q

Name the 2 types of non-opioid analgesics

A
  1. Acetaminophen

2. NSAIDS

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13
Q

What do you need to consider about acetaminophen?

A

Never exceed >4g/day

Monitor liver functions

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14
Q

What do you need to consider about NSAIDs?

A

Monitor kidney function

Potential for GI bleed

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15
Q

What is the biggest adverse effect of opioids?

A

Respiratory depression

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16
Q

What should you know about applying opioid patches?

A

Always rotate the sites

Never use heat or massage the medication into the skin

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17
Q

List how these medications are administered and the onset, peak, and duration for:

  • Acetaminophen
  • Ibuprofen
  • Codeine
  • Fentanyl
  • Morphine
  • Oxycodone
A

Acetaminophen - oral - 30-45m, 0.5-1h, 4-6h

Ibuprofen - oral - (analgesic) 30-60m, n/a, 4-6h; (anti-inflam) <7d, 1-2wk, n/a

Codeine - oral - 15-30m, 0.5-1h, 4-6h

Fentanyl - patch - n/a, 20-72h, 72h

Morphine - oral - 15-60m, 1h, 3-6h

Oxycodone - oral - 15m, 1-2h, 3-4h

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18
Q

What is the antidote for most opioids?

A

Naloxone

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19
Q

Name all pain medications

A 
NSAID (ibuprofen)
Acetaminophen 
Codeine
Fentanyl 
Morphine
Oxycodone
Vicodin
Dilaudid
Toridol
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20
Q

What is the biggest s/e of Toradol?

A

Steven-Johnsons Syndrome

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21
Q

How are epidurals usually administered?

A

Through a PCA pump

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22
Q

What are the benefits of using a PCA pump?

A

Patient can bolus themselves
Set basal rate so they cant overdose
Allows for better control of pain
Can be used at home

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23
Q

Who can press the pump clicker on a PCA?

A

Only the patient

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24
Q

What are nursing considerations for opioids?

A

Potential for withdrawal
Need tapering schedule if on opioids for more than a couple days
Need to monitor for respiratory depression - low dose as soon as there are s/s of sedation

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25
Q

What is the best approach to prevent pain?

A

Around the clock pain management (ATC)

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26
Q

Who is responsible for pain management of a patient?

A

Everyone- multiple disciplinary approach

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27
Q

What are non-pharm interventions for pain relief?

A 
Massage
Positioning 
Hot/col
PT/acupuncture
Breathing/meditation 
Prayer
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28
Q

Is asthma reversible or irreversible?

A

Largely reversible

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29
Q

What is the strongest predisposing factor for asthma?

A

Allergy

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30
Q

What are the manifestations of asthma?

A 
Cough
Wheezing
Dyspnea, chest tightness
Diaphoresis
Tachy
Hypoxemia, central cyanosis
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31
Q

What is the term for an asthma attack?

A

Status Asthaticus

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32
Q

How do you treat an asthma exacerbation?

A 
Rescue med- SABAs first
Give corticosteroid if unresponsive 
O2
Monitor pulse ox, lung sounds, and effectiveness of meds
Measure lung fxn with peak flow
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33
Q

What are the quick relief asthma meds? What are the long relief?

A

Quick- beta adrenergic agonists SABA (albuterol), anticholinergics (Atrovent)
Long- Corticosteroids (Fluticasone), LABAS (salmeterol), leukotrienes (singulair)

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34
Q

What do you need to educate an asthma patient about?

A 
Identify and avoid triggers
Inhalation method 
Peak flow
Asthma action plan 
When to call for help
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35
Q

What are the 2 causes of COPD?

A

Emphysema and bronchitis

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36
Q

What is the #1 risk factor for COPD?

A

Smoking

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37
Q

Is COPD reversible?

A

No but it is treatable and preventable

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38
Q

What are the differences between emphysema and bronchitis (how are they diagnoses and s/s)?

A

Bronchitis “blue bloater”- daily, productive cough for >3 mo in 2 consecutive years
- overweight, cyanotic, high hgb, peripheral edema, rhonchi, wheezing

Emphysema “pink puffer” - permanent enlargement and destruction of air spaces; cxr find flat diaphragm
- older, thin, severe dyspnea, hyperinflation, quiet chest

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39
Q

What are the 3 primary symptoms of COPD?

A

Dyspnea&raquo_space; weight loss
Chronic cough
Sputum

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40
Q

What can hyperinflation and the use of accessory muscles result in?

A

Barrel chest

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41
Q

How might you encourage a pt with COPD to breath to maximize air flow?

A

Through pursed lips

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42
Q

How do you assess COPD?

A 
HH
Pulmonary fxn test 
ABGs
CXR
Spirometry
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43
Q

What are some complications of COPD?

A 
Pneumonia
R-HF (cor pulmonale) 
Chronic atelectasis
Respiratory failure
Pneumothorax 
Clubbing
Weight loss/thinning
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44
Q

How do you prevent atelectasis?

A 
Incentive spirometry 
Cough/deep breath 
Oral care 2x/day
Understand teachings
Get out of bed 3x/day
HOB elevated
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45
Q

How can you prevent COPD exacerbations?

A

Pneumonia/flu vaccines
Stop smoking
O2
Minimize risk factors

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46
Q

How come you have to be careful giving O2 therapy to a pt with COPD?

A

You want to prevent hyperoxygenating them; CO2 can get trapped in the alveoli

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47
Q

How to you manage a COPD exacerbation?

A 
Elevate HOB 90 degrees
Suction 
Bronchodilators
Incentive spirometry 
Manage anxiety
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48
Q

What medications can be given to someone with COPD?

A 
Bronchodilators, MDIs
Corticosteroids
Antibiotics
Mucolytics 
Antitussives
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49
Q

What are the major signs of atelectasis?

A

Labored breathing
Hypoxemia
Decreased breath sounds

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50
Q

List and describe the 4 classificaticatirns of pneumonia.

A
  1. Community acquired (CAP)- dx w/in 48 hrs of hospital admission, picked up prior to admission
  2. Healthcare associated (HCAP)- dx of non-hospitalized pt that had extensive healthcare contact
  3. Hospital acquired (HAP)- dx after 48 hrs of hospital admission
  4. Ventilator acquired (VAP)- dx more than 48 hrs after intubation on ventilator
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51
Q

What are the risk factors for pneumonia?

A 
HF
Diabetes
Alcoholism
COPD
HIV/AIDS
Flu
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52
Q

What are manifestations of pneumonia?

A 
Orthopnea
Crackles
Purulent sputum
Fever
Fremitus
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53
Q

What medication(s) are used to treat pneumonia?

A

Antibiotics (if bacterial)

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54
Q

How is pneumonia dx?

A

Sputum culture done by nurse

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55
Q

What supportive treatment can be provided to a pt with pneumonia?

A 
Fluids
O2
Antipyretics
Antitussives
Decongestants
Antihistamine
Elevate HOB 
Humidification
Positional changes 
Chest PT
Incentive spirometry
Rest 
Coughing techniques 
Nutrition the pt will eat 
Provide hygiene
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56
Q

How can pneumonia be prevented? (who is this most relevant for?

A

Vaccination - those >65 or >19 and immunocompromised

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57
Q

How do you prevent aspiration?

A 
Hob >30 degrees
Assess sedation and respiration 
Thickened fluids
Speech/swallow consult 
Ensure placement of NG tube
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58
Q

How do you use an MDI?

A 
Remove cap
Shake
Sit upright and breath out completely 
Activate the MDI and breath in slowly
Hold for 10 sec 
Allow 1 min between puffs
Finish by rinsing mouth with water
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59
Q

How is TB transmitted and what kind of precautions are these pts on?

A

Airborne transmission/precaution

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60
Q

What is TB?

A

Infection of lung parenchyma

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61
Q

What are risk factors for TB?

A 
Close contact with TB
Substance use
Immunocompromised
Healthcare workers
Travel
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62
Q

How do you treat TB and what should you monitor during tx?

A

Isonazid (INH) and Rifampin (orange urine/tears)- monitor liver fxn tests

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63
Q

Who do you report TB to?

A

The health department

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64
Q

How do you assess/diagnose TB?

A

Mantoux method&raquo_space;> CXR
Sputum testing
Drug susceptibility

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65
Q

What is the biggest concern with TB?

A

Preventing transmission

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66
Q

What is a pulmonary embolism and what causes it?

A

obstruction of pulmonary artery by clot that originated somewhere else in the venous system or right side of the heart

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67
Q

What causes silent aspiration?

A

Nonfunctioning NG tube&raquo_space;> GI contents accumulate in stomach

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68
Q

What are the nursing interventions for TB?

A 
Isolation and droplet precautions
Fluids (loosen secretions) 
Positioning 
Eduction on meds and transmission
Nutrition and sleep
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69
Q

What kind of imbalance does a PE result in? Why is this bad?

A

Ventilation-perfusion problem&raquo_space;> right ventricular HF, shock

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70
Q

How can you prevent a PE?

A

Early ambulation after surgery
Anticoags
Avoid venous stasis

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71
Q

What are risk factors for PE?

A 
Pregnancy
Immobility 
Hypercoaguable state 
HF
Surgery
Trauma
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72
Q

What are the most common s/s of PE?

A

Chest pain #1

Dyspnea

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73
Q

How do you confirm a PE?

A 
VQ scan*
d-dimer
CXR
EKG
ABGs
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74
Q

How do you avoid venous stasis?

A

Activity/exercise

Compression boots/stockings

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75
Q

How do you treat a PE?

A

Anticoag and thrombolytic therapy

Potential surgery to remove clot

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76
Q

What is the priority nursing action for someone who is SOB and anxious?

A

Pulse ox

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77
Q

Why is it important to assess sleep quality in a pt with COPD? How can sleep affect COPD?

A

Those who sleep worse at night have higher rates of exacerbations and lower QOL

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78
Q

A patient on portable O2 therapy says they want to start smoking again, what do you tell them?

A

Smoking next to O2 is extremely dangerous because O2 is highly flammable

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79
Q

What is the goal of O2 therapy in pts with COPD?

A

Achieve acceptable O2 levels without a fall in pH

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80
Q

What is a sign of impending respiratory failure in someone experiencing an asthma attck?

A

PaCO2

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81
Q

What are the differences between peak flow and spirometry?

A

Peak flow measures highest airflow during forced expiration to measure asthma severity/control

Spirometry is a method of deep breathing to encourage maximal inhalation and exhalation

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82
Q

How is HTN defined and measured?

A

BP >140/90

Average of at least 2 BP readings 1-4wks apart

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83
Q 
What is normal BP? 
Elevated BP? 
Stage 1 HTN? 
Stage 2 HTN?
Hypertensive crisis?
A 
Normal = 120/80
Elevated = 120-129/<80
Stage 1 = 130-139/80-89
Stage 2 = >140/>90
Crisis = >180 and/or >120
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84
Q

What is the earliest sign of hypoxia?

A

Restlessness

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85
Q

What are risk factors for HTN?

A

Modifiable- smoking, obesity, inactivity, dyslipidemia, type 2 diabetes, GFR <60

Nonmodifiable- age, FH

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86
Q

What is the goal BP for those with HTN?

A

<140/90 (older adults <150/90)

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87
Q

What lifestyle modifications can be made to reduce HTN?

A

Weight loss
Activity/exercise
DASH diet
Reduce alcohol consumption

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88
Q

What medications can be used to treat HTN?

A 
Beta blockers
ACEs
CCBs
ARBs
Diuretics
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89
Q

How do beta blockers work and what are some considerations?

A

Decrease HR by reducing excitability of the heart and release renin to lower BP

Hold if HR<60
Assess before/after admin
Take with food
Taper off

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90
Q

How do CCBs work and what are some considerations?

A

Vasodilate to lower BP

Avoid GF

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91
Q

How do ACEs work and what are some considerations?

A

Prevent vasoconstriction

S/E: dry hacking cough, hyperkalemia, orthostatic hypotension

Use ARB is coughing
Monitor renal
Take on an empty stomach
Avoid NSAIDs

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92
Q

How do thiazide diuretics work and what are some considerations?

A

Decrease blood volume

S/E: hyponatremia, hypokalemia, hypercalcemia, polyuria

Monitor e- , renal fxn 
Encourage fluid intake 
Daily weights and strict I&O
Take early in day 
Encourage low sodium diet
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93
Q

How do Lasix work and what are some considerations?

A

Decrease blood volume

S/E: hypokalemia, hypocalcemia, hyperglycemia, ototoxicity

Take with food
Take early in day
Monitor e-, kidney fxn
Daily weights and strict I&Os

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94
Q

What is atherosclerosis and what can it lead to?

A

accumulation of lipid deposits and fibrous tissue within arterial walls and lumens reduce blood flow&raquo_space;> CAD

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95
Q

What is CAD?

A

Narrowing/blocking of coronary vessels from atherosclerosis

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96
Q

What are the manifestations of atherosclerosis? What is something to consider about women?

A

Angina pectoris*
Epigastric distress
Pain radiating to jaw/left arm
SOB

Women experience atypical symptoms

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97
Q

What are non-modifiable and modifiable RF for atherosclerosis?

A

Nonmod- FH, age (M>45, W>55), gender, race

Mod- high cholesterol, smoking, HTN, type 2 DM

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98
Q

How can you prevent CAD?

A

cholesterol control/diet
exercise
smoking cessation
medications&raquo_space;> manage HTN/diabetes

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99
Q

What is the most common medication used to treat high cholesterol? How do they work? What are major s/e and considerations?

A

Statins

  • low total cholesterol, LDL. triglycerides
  • raise HDL
  • inhibit lipid synthesis

S/E: rhabdo and myopathy

  • monitor liver
  • statins arent stat
  • no GF
  • admin in evening
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100
Q

What is angina?

A

Chest pain caused by insufficient blood flow to heart

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101
Q

Stable vs. unstable angina (when does it occur, treatment)

A

Stable- provoked by exercise, emotion, or heavy meal&raquo_space;> rest and nitro (can pretreat)

Unstable- new onset occurs at rest&raquo_space;> MONA

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102
Q

How do you administer nitro?

A

1x/5min for 15 min&raquo_space;> call 911 if not relieved

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103
Q

What does MONA stand for?

A

Morphine
Oxygen
Nitroglycerine
Aspirin

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104
Q

How does someone know that nitroglycerine is working?

A

Burns

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105
Q

How do you assess angina?

A

Take VS, EKG, pain assessment

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106
Q

What do you do if someone is having angina that did not respond to nitro?

A

MONA
NPO
Best rest (bed pan only)

May be a heart attack

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107
Q

What are geriatric considerations for CAD?

A

Silent CAD is most common
Presenting symptom is dyspnea*
Diminished pain receptors
Use meds cautiously

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108
Q

What medications are used to treat MI?

A 
Nitro- vasodilate to reduce O2 consumption
Beta blockers- slow HR
CCBs- slow HR
Antiplatelets- prevents platelet coag
Anticoags- prevents thrombi coag
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109
Q

What is an MI?

A

Complete occlusion of artery leads to ischemia and necrosis of the myocardium

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110
Q

How do you assess for an MI?

A

Assess chest pain- continues at rest despite chest pain

EKG- Elevation in ST

Labs- myoglobin, creatinine kinase, troponin

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111
Q

What cardiac enzyme is specific to the heart?

A

Troponin - increases progressively in each of the three tests

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112
Q

What are nursing interventions for someone having an MI?

A 
O2 and med therapy
Frequent VS
Bed rest, HOB elevated
I&Os
Perfusion
Position changes
Report changes in condition
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113
Q

What major s/e should you monitor for if youre pt receives thrombolytic therapy?

A

Bleeding

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114
Q

How can you take nitro?

A

Sublingual or buccal

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115
Q

What is the “bad” cholesterol?

A

LDL

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116
Q

HF is categorized by s/s of these 2 things.

A

Fluid overload* or inadequate tissue perfusion

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117
Q

Is HF reversible?

A

Yes, if caught early enough

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118
Q

Systolic failure indicates what kind of problem in the heart? What about diastolic failure?

A

Systolic failure = heart contracting problem

Diastolic = heart filling problem

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119
Q

Right sided heart failure is also known as what?

A

Cor pulmonale

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120
Q

Compare ride-sided to left-sided HF (what are the s/s of both).

A

Right = peripheral congestion, JVD, hepato/splenomegaly, ascites, weight gain

Left = pulmonary congestion, crackles, dyspnea on exertion, S3 ventricular gallop, low O2 sat, oliguria, tachy, cyanotic, dry cough, restless

121
Q

What are the stages of HF (I-IV)?

A

I. No limitations to activity

II. Comfortable at rest but slight limitations to activity

III. Comfortable at rest but marked limitations to activity

IV. Unable to carry out any activity; cardiac insufficiency even at rest

122
Q

What are the classifications of HF (A-D)?

A

A. High risk for developing (HTN, ASC, DM, Met Syn)

B. Dysfunction w/o symptoms (hz of MI, LV hypertrophy, low ejection)

C. Dysfunction w/ symptoms (SOB, fatique, decreased activity tolerance)

D. End stage (max med therapy, recurrent hospitalization)

123
Q

How do you treat someone in end stage HF? (implement treatment from all stages)

A

A. Control RF
B. ACEs/ARBs, beta blocker, statins, digoxin
C. Diuretics, aldosterone antagonists, sodium restrictions, defibrillator
D. Fluid restrictions, palliative care, possible transplant, mechanical support

124
Q

How can you improve/maintain activity tolerance in someone with HF?

A 
No extreme temps
Wait 2h after eating 
Daily activity 
Modify activity to conserve energy 
Bed rest for acute exacerbations
125
Q

What should educate a HF patient about?

A

Meds
Low sodium and fluid restrictions (K rich foods if on Digoxin)
How to monitor for fluid overload (daily weights)
Exercise/activity
Stress management
Prevention of infx
When to call HCP

126
Q

What are examples of potassium rich foods?

A

Potatoes
Pork
Oranges

127
Q

What are geriatric considerations for HF?

A

Increased risk of Dig toxicity

Renal fxn may make them resistant to diuretics and more susceptible to changes in fluid/e-

128
Q

Define hypervolemia

A

Retention of Na and H20 in same proportions (can be life threatening)

129
Q

Define hypovolemia and explain how it differs from dehydration.

A

Loss of H2O and e-

Dehydration is just the loss of water

130
Q

How does Digoxin work and what should you monitor for?

A

Increased CO (treats HF)

Monitor for toxicity (aura, yellow halo), hypokalemia, hypercalcemia, hold for HR<60

131
Q

How do you treat hypovolemia?

A

Replace fluids

132
Q

What lab value indicated hyponatremia?

A

<135

133
Q

What are s/s of hyponatremia?

A 
Lethargy 
HA
Confusion
Seizures*
Coma*

Think: NEURO

134
Q

What causes hyponatremia?

A

Severe dilution of blood or increased sodium loss

135
Q

What are the 7 things you must monitor for in someone with hyponatremia?

A
  1. I&Os
  2. Specific gravity <1.010
  3. Assess for bounding pulse and/or JVD
  4. Changes in BP or RR
  5. Decrease LOC
  6. Daily weights
  7. Assess for pitting edema
136
Q

What lab values indicate hypernatremia?

A

NA >145

137
Q

What are the causes of hypernatremia?

A

Think: MODEL

Meds or meals
Osmotic diuretics 
DI
Excess H20 loss
Low H20 intake
138
Q

What population is most effected by hypernatremia?

A

Very young/old or impaired

139
Q

What are s/s of hypernatemia?

A 
Decreased LOC
Thirst 
Weakness
Nausea
Increased HR/decreased BP
Dry
140
Q

What lab values indicate hypokalemia?

A

K <3.5

141
Q

What causes hypokalemia?

A

Respiratory alkalosis (hyperventilating), diuretics, NG suction, meds

142
Q

What are s/s of hypokalemia?

A

Think: A SIC WALT

Alkalosis
Shallow respirations
Irritability
Confusion
Weakness >> paralysis
Arrhythmia >>> EKG changes
Lethargic
Thready pulse
143
Q

How do you treat hypokalemia and what are some considerations?

A

IV Potassium

  • only when life threatening
  • admin on pump at lowest rate (limit to 20 mEq/hr)
  • must be on EKG
  • warn them it BURNS! (can use cool pack)
144
Q

What lab value indicates hyperkalemia?

A

K >5

145
Q

What are s/s of hyperkalemia?

A

twitching&raquo_space; cramps&raquo_space; paralysis
changes in EKG/dysrhythmias
low BP
diarrhea

146
Q

How do you treat hyperkalemia?

A 
Calcium
Insulin
Albuterol 
Kayexalate- K specific laxative
Diuretic
Possible dialysis
147
Q

What lab value indicates hypocalcemia?

A

Ca <8.6

148
Q

What are s/s of hypocalcemia?

A

Think: CATS GO NUMB

Convulsions 
Arrhythmias
Tetany
Spams and stridor
GO NUMB

+Chovestek
+Trousseau

149
Q

If parathyroid levels are high, calcium levels are high or low?

A

High

150
Q

How do you treat hypocalcemia?

A

Seizure precautions!
IV calcium gluconate (for emergencies)
Calcium and Vit D supplements
Exercise/weight bearing

151
Q

What lab value indicates hypercalcemia?

A

Ca >10.5

152
Q

What are s/s of hypercalcemia?

A 
Stones 
Bones
Groans
Psychiatric moans 
Deep tendon reflexes
Fractures
Flank pain
153
Q

What are the 3 types of IV solutions? Give examples of each and explain what their purpose are.

A

Isotonic (0.9% NS, LR) - expand volume, dilute meds, keep vein open, resuscitate fluid

Hypotonic (D5W) - metabolize glucose and hydrate cell

Hypertonic (D5 1/2 NS) - Na and volume replacement

154
Q

Who should not receive hypotonic solutions?

A

Infants and heady injury

155
Q

How should you administer hypertonic solutions?

A

Slowly (monitor BP, HR, lung sounds, Na values, and urine)

156
Q

What are normal blood sugar ranges?

A

60-100

157
Q

What is the defining difference between DM I and II?

A

DM I - insulin producing cells in pancreas are destroyed; insulin-dependent

DM II - insulin resistance or impair insulin secretions (preventable)

158
Q

What are risk factors for DM I?

A

Early onset <30y
FH
Possible toxin

159
Q

What are risk factors for DM II?

A 
Obesity 
Age
Impaired FBG or glucose tolerance
HTN
HDL <35, triglyc >250
Hz of gestational diabetes
160
Q

What are s/s of hyperglycemia?

A

Fatique, HA, 3 P’s

161
Q

What are s/s of hypoglycemia?

A

Diaphoresis, confusion, tachy, irritable, hungry

162
Q

What are common s/s for both DM I and II?

A

3 P’s

polyuria, polyphagia, polydipsia

163
Q

What is the nursing priority if someone appears to be hyper or hypoglycemia?

A

Take BS

164
Q

What can cause hypoglycemia?

A

Too much insulin
Not enough food
Excessive activity

165
Q

If you confirm someone is hypoglycemia, what is your next nursing priority?

A

Provide 15g of fast-acting carbs like 4-6oz juice or glucose tabs

166
Q

What is the next nursing priority after someone begins to recover from a hypoglycemic episode?

A

Re-check BS in 15 min, retreat if <70

Provide snack with carbs and PRO

167
Q

Is hypo or hyperglyemia more acutely life threatening?

A

Hypo&raquo_space;> seizures, LOC, death (hyper is in the long term if left untreated)

168
Q

What is your nursing intervention if someone hypoglycemic and unconscious?

A

Admin IV dextrose (know PRNs!) or use glucagon pen

169
Q

What is the goal of diabetes med management?

A

Hgb <7%

170
Q

What are the 5 components of diabetes management?

A
  1. Nutrition
  2. Exercise
  3. Monitoring
  4. Meds
  5. Education
171
Q

What is the goal of diabetes dietary management?

A

Control calorie intake
Eat low and complex carbs
Normalize lipids and BP

172
Q

What is the criteria for diagnosing diabetes?

A

FBG >126
Post-prandial/random >200
HgbA1C >6.5

173
Q

What are the sick day rules?

A

Keep tracking BS
Dont stop taking insulin (may even need more)
Drink plenty of fluids
Call MD if vomiting and cant take PO

174
Q

List the 4 types of exogenous insulin with their onset, peak, and duration.

A

Rapid (Lispro) - 10-15m, 1h, 2-4h
Short (Regular) - 30-60m, 2-3h, 4-6h
Intermediate (NPH) - 2-4h, 4-12h, 16-20h
Long (Glargine) - 1h, no peak, 24h

175
Q

Which insulin can be given IV?

A

Regular

176
Q

When do you take fast-acting insulin?

A

Immediate needs, post-prandial

177
Q

When do you take short-acting insulin?

A

20-30 min before meal

178
Q

When do you take intermediate insulin?

A

After food

179
Q

When do you take long acting insulin?

A

When you need a basal dose

180
Q

How do hang insulin?

A

Flush line completely with insulin and discard first 50 ml

181
Q

What is the most dangerous s/e of insulin therapy?

A

Hypoglycemia

182
Q

What are the 3 main oral antidiabetic agents used to treat DM II and how do they work?

A
  1. 2nd gen sulfonylureas- stimulate beta cells insulin secretion
  2. biguanides- inhibits glucose production and increases tissue sensitivity
  3. alpha-glucosidase- delays glucose absorption
183
Q

What are the acute complications of diabetes?

A

HHS
DKA
Hypoglycemia

184
Q

Compare DKA and HHS (whos effected, causes, onset, pH, ketones, kidneys, mortality)

A

DKA- BG >300, more common in DMI, caused by no insulin or increased stress, onset <24h, acidic pH, ketones (kussmaul respirations), elevated BUN/creat, lower mortality

HHS - more common in DMII , physiologic stress, slow onset (days), normal pH, no ketones, elevated BUN/creat, higher mortality

185
Q

How do you treat DKA?

A

IV fluids and regular insulin
Bicarb
e- replacement (K!)
Monitor BG, renal, urine, EKG, lungs

186
Q

How do you treat HHS?

A

IV fluids and insulin
Monitor fluid volume and e-

Prevention is key!

187
Q

What are the 2 long term complications of diabetes?

A

Macrovascular- changes in large blood vessels (atherosclerosis)

Microvascular - changes in capillaries (neuropathy)

188
Q

What is diabetes insipidus and what are typical s/s?

A

Insufficient ADH causes polydipsia and polyuria

dehydrated, low BP, high Na

189
Q

How do you manage diabetes insipidus?

A 
Vaso/Desmopressin
Thiazide diuretics 
Monitor for hyperglycemia
Strict I&O, monitor e-
Fluid replacement
Determine cause
190
Q

What is SIADH and what are s/s?

A

Excessive ADH retains fluids

Fluid retention and dilutional hyponatremia

191
Q

How do you manage SIADH?

A

Diuretics (lasix)
Fluid restrictions
Strict I&O, daily weight
Monitor for s/s of hyponatremia&raquo_space; neuro/seizures

192
Q

What lab values indicate hyperthyroidism? Hypothyroidism?

A

Hypo = high TSH, low T3/T4

Hyper = low TSH, high T3/4

193
Q

What causes hypothyroidism and what are s/s?

A

Iodine deficiency or Hashimoto

Everything slowwwws- low HR, GI, reflexes; always cold, thinning hair, croaky voice

194
Q

What is severe hypothyroidism called?

A

Myxedema - extremely low HR, RR, temp&raquo_space; coma, death

195
Q

How do you treat hypothyroidism and what do you need to know about tx?

A

Levothyroxine - tx is lifelong, TSH levels will be checked yearly, s/s of hyperthyroidism, take 1st thing in morning with big glass of water, dont ever double up dose, and avoid iron or calcium supplements

196
Q

What is the main cause of hyperthyroidism and who is more at risk? What are s/s?

A

Graves disease (autoimmune)- more common in women

Everything speeds up - fast HR/BP, diarrhea, weight loss, exopthalomus, etc..

197
Q

How do you treat hyperthyroidism? What should you know about this tx?

A

Thionamides- PTU/methamazole or surgery to remove thyroid

PTU can affect liver
Need to monitor WBCs for agranulocytosis
Monitor for hyperthyroidism

198
Q

What is a complication of hyperthyroidism? What are s/s?

A

Thyroid storm:

  • temp >106F
  • HR >140 bpm
  • severe N/V/D, jaundice
  • seizures, coma
199
Q

What e- does the parathyoid control? What does hyper/hypoparathyroid indicate about this e-?

A

Calcium

Hyper- high calcium
Hypo- low calcium

200
Q

How do you treat hyperparathyroidism? Calcemia crisis?

A

Hyper - surgery to remove abnormal parathyroid tissue, hydration

Crisis- hydrate to prevent renal calculi, avoid thiazides, increase mobility, prevent constipation, monitor for tetany

201
Q

How do you manage hypoparathyroidism?

A

Normalize serum ca (give IV/PO ca)
Admin parathormone (Natpara)
Minimize stimulation
Diet high in ca & vit d, low in phosphorous

202
Q

Describe addisons disease (cause, s/s, complications, meds)

A

No cortisol production from cortex of kidneys from autoimmune disorder

S/S: weak, fatiqued, hypotension, hypoglycemic, hyponatremia, hyperkalemia, dark pigmentation of skin

Untreated can lead to adisonian crisis&raquo_space; coma, shock

Tx with steroid supplementation for life

203
Q

What patient teaching is needed for someone being treated for Addison’s dz?

A 
Lifelong therapy
Don't stop abruptly
Med ID bracelet
Avoid stress
Diet high in carbs and PRO
Fluids and salt!
When to call HCP
Tell providers about treatment prior to surgery
204
Q

Describe Cushing’s disease (cause, s/s, meds)

A

Excessive adrenal activity or corticosteroid use

S/S: hyperglycemia, central obesity, buffalo hump, moon face, acne, HTN, hypernatremia, hypokalemia

205
Q

How do you treat/prevent constipation?

A 
Establish bowel patterns/schedule
Increase fiber and fluids
Respond to urges
Increase activity
Laxatives/stool softeners
206
Q

How do you treat/prevent diarrhea?

A

Maintain diet and fluids*
Rest
Avoid irritating foods (caffeine, soda, extreme temp foods)
Avoid high fiber foods (milk, grains)
Consider meds causing it
Consider potential for lactose intolerance
BRAT

207
Q

What are key considerations for constipation or diarrhea?

A

E- and fluids

Determine the causes

208
Q

What is the difference between acute and chronic gastritis?

A

Acute - usually due to dietary discretion

Chronic - usually due to H. Pylori or prolonged inflammation of stomach

209
Q

What are the 4 priority nursing interventions for a pt with gastritis? Which is the most important and why?

A
  1. Reduce anxiety
  2. Optimal nutrition
    - NPO > clear liquids > solid foods
    - AVOID TRIGGERS (caffeine, alcohol, smoking)
  3. Fluid balance
  4. Pain relief
210
Q

What are the 2 major causes of PUD?

A

H. Pylori

NSAIDS

211
Q

Gastric ulcers vs. duodenal ulcers

A

Gastric - pain 30m-1h after eating (HCl), less severe

Duodenal - most often due to H. Pylori; pain 2-3h after meal, more severe

212
Q

What is the main priority for PUD?

A

Relieve pain and anxiety

213
Q

How do you treat PUD?

A

Lifestyle- avoid aspirin, NSAIDS, alcohol

Meds- H2 antagonist (pepcid), antibiotics (flagyl), PPIs (lansoprazole), bismuth salts

214
Q

Diverticulum vs. Diverticulitis vs. Diverticulosis

A
  • um = outpouching of bowel thru defect in muscle layer of sigmoid
  • itis = infx/inflammation of outpouching
  • osis = multiple outpouchings w/o inflammation or infx
215
Q

Where is diverticulitis usually felt? How is it diagnoses?

A

LLQ and colonoscopy

216
Q

What is the main cause of diverticulitis?

A

Poor low fiber diet

217
Q

What diet prevent diverticulitis? What diet treats diverticulitis (give examples)?

A

Prevent - high fiber and fluid

Treat - low fiber and fluids

  • eggs, fish, rice, noodles
  • cooked veg/fruit
  • no nuts/seeds
  • avoid processed sugar/excess carbs
  • avoid red meat
218
Q

Crohns vs. UC (origin, pattern, symptoms, complications, risk of colon cancer, surgery)

A

Crohns = origin in terminal ileum, “skip” lesions, crampy abd pain, can lead to fistula/abcess/obstruction, slight increased risk for CC, surgery only for complications

UC = origin in rectum, contiguous, bloody diarrhea, can lead to hemorrhage or megacolon, marked increased risk for CC, surgery is curative

219
Q

Who may need TPN? How is it given?

A

Someone who needs to give GI a break (IBS, pancreatitis)

Given thru central line for IV infusion

220
Q

Upper GI bleed vs. lower GI bleed

A 
upper = dark, tarry >> melena
lower = bright red, bloody
221
Q

Where is appendicitis felt? What happens if the pain is relieved? What are your nursing interventions?

A

Rebound pain at McBurney’s point (RLQ)

Sudden pain relief = peritonitis (burst)

NPO > surgery, relieve pain, provide post-op care

222
Q

List and describe the 4 signs of appendicitus.

A
  1. Bloombergs - rebound tenderness of RLQ
  2. Psoas - RLQ pain when right hip is extended
  3. Obturator - pain on internal rotation of hip
  4. Rovsing - palpating LLQ causes pain in RLQ
223
Q

What are the liver function tests? (all of them!)

A

ALP
AST
ALT
GGT, GGTP, LDH

224
Q

List the 6 major associated conditions for liver disease and explain how they all relate

A

cirrhosis > jaundice and PHTN > esophageal varices, ascites, encephalopathy

225
Q

Describe jaundice and the difference between hepatocellular and obstructive.

A

Yellow-greenish sclera a skin from increase bilirubin >2

Hepatocellular - liver is so damaged that it cannot transport bilirubin effectively

Obstructive - blockage prevents proper excretion of bile

226
Q

What is lactulose used for?

A

Treats hepatic encephalopathy by binding to ammonia and excreting it thru the stool

227
Q

How do you manage esophageal varices? (focus on nursing)

A

Screen every 2-3 yrs if already have cirrhosis

Med- IV fluids, e-, ocreotide,(simvastatin, vasopressin)

Nursing- NPO and gastric suction, vit K therapy, monitor BP, monitor cognition/response/anxiety

228
Q

What kind of diet is someone with encephalopathy going to be on?

A

Low protein

229
Q

Which hepatitis have vaccines?

A

A and B

230
Q

Describe the transmission modes and prevention methods for hep A, B, C.

A

A: fecal-oral (prevent w/ hand hygiene, washing foods, vaccine)

B: blood, sex, bodily fluids (prevent w/ condoms, vaccine)

C: chronic disease; blood, sex, needles (prevent w/ auto retracting needles, needle sharing education)

231
Q

Which hepatitis is most common?

A

Hep C

232
Q

How will you treat ascites?

A

Low sodium diet
Diuretics (spironalactone)
Best rest
Paracentesis

233
Q

Cholelithiasis (patho, pain, and risk factors)

A

Pigment or cholesterol stones*

RF: CF, diabetes, rapid weight change, estrogen therapy

S/S: RUQ pain to right shoulder

234
Q

How do you manage cholelithiasis?

A 
NG or NPO >> soft, low-fat, high carb and pro diet 
Low fowler*
Care of biliary drainage
Pain management 
Turn, cough and deep breath, splint*
Ambulate
235
Q

Pancreatitis (acute vs chronic, labs, RF, pain)

A

Acute - obstruction of pancreatic duct causes autodigestion

Chronic- progressive, inflammatory disorder

Elevated lipase and amylase
RF: alcohol, GI surgery, trauma, med toxicity
Pain: LUQ/epigastric to back/shoulder

236
Q

What are 2 positive signs of pancreatitis?

A

Turner (flank bruising) and Cullen (umbilical bruising)

237
Q

What is the nursing management for pancreatitis?

A

1 relieve pain

NPO
Tx underlying cause

238
Q

What is a warning sign of an impending stroke?

A

TIA

239
Q

What are risk factors for a stroke?

A 
Age >55
Gender-male
Alcohol abuse
HTN**
CVD
A-fib
High cholesterol 
Obesity
Diabetes
Oral contraceptives
Smoking, drugs
240
Q

Hemorrhagic vs. Ischemic stoke (cause, presentation, tx)

A

Hemorrhagic - hemorrhage, aneurysm; exploding headache; surgery to stop bleeding

Ischemic - clot; hemiparesis; TPA

241
Q

How can you prevent a stroke?

A 
Lifestyle changes
Carotid endarterectomy
Anticoag for a-fib
Antiplatelet
Statins
Antihypertensives
242
Q

How do you diagnose a stroke?

A

CT scan

243
Q

How do you manage an active stroke?

A 
Call code
Best rest, sedate
O2, maintain airway 
Possible tPa
Continually assess VS
244
Q

What is criteria for tPA?

A 
Ischemic
>18
W/in 3h of onset
BP <185/110
No previous stroke
No seizure at onset
PT<15sec, INR <1.7
No heparin w/in 48h
No platelets >100,000
Glucose >50 
No hz of head bleeds
No major surgery w/in 2 wks
No stroke or head injury w/in 3 mo
No GI or urinary bleeding w/on 21d
Not pregnant
245
Q

What is the major s/e of tpa therapy?

A

Bleeding

246
Q

What are two examples of anticoag therapy? What about antiplatelet?

A

Anticoag: hep and coum
Antiplatelet: aspirin

Use aspirin when anticoag is contraindicated

247
Q

How do you manage a patient recovering from stroke?

A 
Promote safety 
Neuro checks 
Enhance self-care
Nutrition > aspiration 
Bowel and bladder control > constipation
248
Q

Focal vs. Generalized Seizures

A

Focal - one hemisphere; motor or nonmotor, aware

Generalzed - bilateral distribution; motor, absent (tonic-clonic)

249
Q

What are the 4 stages of a seizure?

A
  1. Prodromal
  2. Aura
    3 Ictal
  3. Post-ictal
250
Q

What is the nursing priority for someone seizing?

A

Prevent injury

251
Q

What is the plan of care for someone experiencing a seizure? What should you NOT do?

A 
Privacy
Note time of onset
Get to bed, if able 
Ease to floor or raise siderails
Protect head or remove pillows
Loosen constrictive clothing
Remove glasses
Move furniture
Place on side 
Suction if necessary

DO NOT
stick anything in their mouth
restrain them
trying to open their jaw

252
Q

How do you manage the post-ictal stage of a seizure?

A

Allow them to rest (sleepy!)
Don’t immediately make them get up
Reorient them

253
Q

A migraine is what type of headache?

A

Primary- no know organic cause

254
Q

How do you assess a headache?

A

COLDERA

255
Q

How do you treat a headache?

A

Medications (vasoconstrictors, caffeine)
Avoid triggers (vasodilators, alcohol)
100% O2 mask
Elevate HOB 30degrees
Comfort- quiet, dark, massage, local heat

256
Q

What do you manage a fracture in an emergency? What should you NOT do?

A 
Immobilize 
Cover any exposure w gauze
Rest
Ice
Compress
Elevate
Anti-inflammatory

DO NOT try to reduce it

257
Q

List 2 major complications of fractures (cause, s/s)

A

Fat embolism- fat globules from marrow leak from bone and occlude vessel (RD, numbness, weakness)

Compartment Syndrome (pain!)&raquo_space; avascular necrosis

258
Q

What are the 6 P’s and what do they assess? Which is the earliest indicator of a problem?

A

Assess neurovascular fxn

  1. Pallor
  2. Pain (earliest indicator)*
  3. Poikilothermia (takes on ambient temp)
  4. Pulselessness
  5. Paralysis
  6. Polar
259
Q

What patient education is needed for a pt with a fracture?

A 
Assistance with ADLs
Activity
Meds
Pad with moleskin
Blow hairdryer on itch
Do not stick anything into cast
When to call HCP
Follow-up care
260
Q

What is the nursing care for someone in traction?

A 
Ensure proper transitioning of pt and apparatus
Assess 6P's and report pain ASAP
Assess skin 3x/day > pressure ulcers
Active foot exercises q1h 
Compression boots or anticoag therapy
261
Q

What are possible complications of tractions?

A 
Pressure ulcers 
DVTs
Pneumonia/atelectasis
Urine stasis 
Constipation
Infx
262
Q

Hip vs. Knee Replacement Surgery (assess, positioning, mobility, drainage)

A

Hip- keep abduction, limit flexion to 90; ambulation begins 1d post-op; remove drain 24-48h, risk for infx 24mo

Knee- assess neuro; continual passive motion (CPM), ambulate 1d post-op; drain removes 24-48h)

263
Q

Define osteoporosis and list RF

A

Bone resorption > formation

RF: 
Genetics
Female, small frame 
Advanced age, post menopausal 
Low ca, vit d, or calories; high phosphorous
Sedentary, no weight bearing
Caffeine, alcohol, smoking, no sun
Corticosteroids
264
Q

How do you prevent osteoporosis? How do you treat it?

A

Prevent:
Increase activity and wt bearing exercises
Increase intake of Ca and Vit D (or supplements)

Treat:
Calcium and Vit D
Bisphosphonate- inhibits osteoclasts
Calcitonin

265
Q

Define osteomalacia and its causes.

A

Inadequate bone mineralization due to deficiency of activated vitamin D &raquo_space; softening of long bones

Causes:
GI disorder
Severe renal insufficiency
Hyperparathyroid
Dietary deficiency
266
Q

How do you treat osteomalacia?

A

Treat the reason for vit D deficiency

Kidney dz = calcitriol
Malabsorption = calcium and vit D supp
Sunlight

267
Q

Define osteomyelitis (causes, prevention, tx)

A

Infection of bone
Caused by MRSA
Prevention is the goal!
Treat with long term abx therapy

268
Q

When does discharge teaching start?

A

Begins on admission!

269
Q

What does the nurse assess for pre-op?

A 
Current health/baseline exam
HH
Meds and allergies
Dentition
Drug or alcohol use
Nutrition and fluid status
Pre-op fasting status  
Psychosocial and supports
270
Q

Informed consent (nurse vs. surgeon responsibilities, when is it needed, validity, where does it go?)

A

Surgeon explains and gets consent
Nurse can enforce education and witness signature
Needed in an non-emergent surgery
Only valid prior to psychoactive med admin
Accompanies pt to OR

271
Q

What are the aspects of the surgical pre-op checklist?

A 
Informed consent
Teaching completed
NPO
In gown
Allergy and ID band 
No jewelry 
Voided 
Pre-op meds
Side rails up 
Contacts and dentures out 
No nail polish 
VS w/in 4h before or 30 min after 
Lab work on chart 
Skin prep 
Know hz of aspirin, antidepressants, steroids, NSAIDS
272
Q

What are 3 things that much be verified before surgery?

A

Patient ID
Surgical procedure
Surgical site (signed by pt and doc)

273
Q

What are intraop complications?

A 
Malignant hyperthermia
Hypoxia
Anaphylaxis
Hypothermia
Infection 
Anesthesia awareness
274
Q

What is malignant hyperthermia, what is the first sign, and how do you treat it?

A

RAPID RISE in HR (#1 sign), temp muscle contractions

Think: Some Hot Dude Better Give Iced Fluids Fast

Stop gas 
Hyperventilate (100% O2)
Dantrolene
Bicarb
Glucose and insulin
Ice
Fast heart 
Furosemide (monitor fluid output)
275
Q

What is the PACU and the 3 phases?

A

Post-anesthesia care unit

  1. Immediate recovery (intensive care)&raquo_space; II or med-surge
  2. Pt prepared for self acre
  3. Pt prepared for discharge
276
Q

What is the nursing priority for a patient in the PACU post-op?

A

Maintain airway

Then&raquo_space; reorient, stable VS, no s/s of hemorrhage or resume motor and sensory fxn, complications

277
Q

What VS is immediately reportable to a provider in the PACU and why? What needs to be considered?

A

SBP <90 or trending down 5 mmHg q15m

Indicative of bleed
Need to know baseline

278
Q

What do you do if a patient starts to complain of nausea?

A

Put them on their side

279
Q

What is the priority of nursing management for those who are immunocompromised?

A

Reduce risk of infection

280
Q

How is HIV transmitted and what kinds of precautions do healthcare workers need to take with a patient HIV+?

A

Blood, sex, or birth/breast milk

Standard precautions

281
Q

What are the stages of HIV (0-3)- which is considered AIDS?

A
  1. Early infx; labs positive
  2. Primary; development of antibodies (CD4+ t cells 500-1500)
  3. Tcells between 200-499
  4. Tcells <200 (AIDS)
282
Q

What are the respiratory, GI, and oncologic manifestations of HIV?

A

Respiratory- pneumonia, TB

GI - wasting syndrome, anorexia, N/V/D

Oncologic- KAPOSI SARCOMA and AID-related lymphoma

283
Q

What is Karposi sarcoma?

A

Cancer that causes red/purple patched to grow under the skin (from advanced AIDS)

284
Q

What treatment does someone receive if they have been exposed to HIV?

A

Prophylaxis w/in 72h

285
Q

How do you treat HIV/AIDS?

A

Antiretroviral therapy (ART)

  • increased CD4+
  • decreased comorbidities
286
Q

What are the nursing priorities with an HIV patient?

A 
Promote usual bowel patterns 
(diarrhea is common)
Prevent infection 
Improve airway 
Improve nutrition 
Improve knowledge (transmitting) 
Decrease sense of isolation
287
Q

What is rheumatic disease? What is the most common manifestation? What are the 3 most common RF?

A

Automimmune, degenerative, inflammatory disease of joints, muscles, and soft tissue
Marked by periods of remission and exacerbation

Arthritis is most common s/s

RF:
Smoking
FH
Illness

288
Q

What are the nursing priorities for someone with rheumatic disease?

A 
Pain management
Fatigue
Impaired mobility 
Self care deficit
Effective coping 
Disturbed body image 
Complications of meds
289
Q

What is the most common treatment for rheumatic disease?

A

Humira

290
Q

Define metastasis, malignancy, and benign

A

Metastasis - when abnormal cells access lymph and blood and begin to circulate

Malignancy- cells characteristic of cancer

Benign - non cancerous cells

291
Q

Explain the 3 steps of carcinogenesis and list carcinogenic factors/agents.

A

Initiation: apoptosis
Promotion: benign lesions
Progression: angiogenesis

Virus/bacteria
Sunlight, radiation, chronic irritation
Tobacco, asbesos
Genetics
Lifestyle
Hormones
292
Q

What are primary, secondary, and tertiary cancer prevention methods?

A

Primary: health promotion strategies (healthy weight, diet, activity)

Secondary: screenings and identification of precancerous lesions (breast cancer = mammogram)

Tertiary: monitoring and prevention of cancer recurrence

293
Q

What are nursing priorities for cancer pts?

A

Promote nutrition
Relieve pain
Decrease fatigue
Improve body image

294
Q

What are the 4 categories of awareness contexts related to end of life care?

A
  1. Closed- pt unaware of terminal state (inability to cope)
  2. Suspected- pt suspects what others know
  3. Mutual pretense- everyone involved is aware but pretend otherwise
    Open- everyone is aware and acknowledge the terminal sate
295
Q

What is a DNR? DNI? CMO? Advanced directive?

A

DNR- code status, do not resuscitate
DNI- code status, do not intubate
CMO- comfort measures only
Advanced directives- document regarding end f life preferences (living will, proxy/power of attorney)

296
Q

What is the difference between palliative care and hospice?

A

Palliative care is for anyone with an advance illness to improve QOL

Hospice is care for patients who are completely irresponsive to treatment of serious illness (life expectancy in <6mo)

297
Q

What are the principles of hospice care?

A 
Death must be accepted 
Managed by interdisciplinary team 
Pain and other symptoms must be managed
Pt + family = ONE UNIT
Home care
Bereavement care for family after death
298
Q

What is death and was s/s of indicative that death is coming?

A

Permanent cessation of respiratory and circulatory fxn

Withdrawal, somnolent
Long periods of sleeping
Increased time between breaths
Weak, irregular pulse
Diminished BP
Skin becomes blotchy/colored
299
Q

Define grief, mourning, and bereavement.

A

Grief- personal feelings about a loss

Mourning- expression of grief and assoc. behaviors

Bereavment- period of mourning

Semester 2 (2 decks)

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