Blue Book Flashcards
primary dietary prescription for calcium nephrolithiasis (kidney stones)?
low calcium diet
for a client with nephrolithiasis (kidney stones) the diet should be _______ ash
acid
if kidney stone is calcium phosphate the diet must me low in ______ too
phosphorus
primary diet tx for uric acid nepholithiasis (kidney stone) is ___ ____
low purine
client with uric acid nepholithiasis (kidney stone) should have a diet low in ___
methionine
what is methionine?
precursor of the amino acid cystine
2 foods high in methionine
eggs & milk
clients with cystine nephrolithiasis (kidney stone) should have an _____ ash diet
alkaline
increased fluids over 3000cc/day is more effective in treating renal calculi than ANY dietary modification. T/F?
true —> want to flush tract then worry about diet
what is the common name for laryngotracheobronchitis (LTB)
croup
what is the typical temp elevation in croup?
low grade
usually below 38.8 but can be up to 40
are abx helpful for croup?
no
are abx helpful for epiglottitis?
yes
is croup viral or bacterial?
viral
which condition is croup most often confused with?
epiglottitis
can croup be managed at home?
yes
can epiglottitis be managed at home?
no, a 911 emergency
are sedatives used for kids with croup
no, this would mask signs of respiratory distress
what causes epiglottitis? Virus or bacteria?
H. Influenza. Bacteria
what is the best tx for croup
cool moist air
what should never be done to a child with epiglottitis?
never put anything in their mouth (tongue blade) as can lead to obstruction.
what are the typical signs and symptoms of croup?
barking cough, inspiratory stridor, laboured respiratory pattern
3 signs a child has epoglottitis instead of croup?
muffled voice, drooling, increased fever
when is croup bad enough to be evaluated by a doc?
when retractions and high pitched stridor are present
what lead level needs intervention
50-60mcg/dl
which which class of drug will a child with lead poisoning be treated?
chelating agents
what do chelating drugs do?
they increase the excretion of heavy metals
the most frequent cause of lead poisoning is…
ingestion of lead based paint chips
name 3 common chelating agents for lead poisoning
EDTA, desferal, BAL in oil
S&S of lead poisoning
drowsiness, clumsiness, ataxia, seizures, coma, respiratory arrest
symptoms of lead poisoning show up in the _____ system
neuro
leukaemia is cancer of the _____ forming tissues
blood
the type of cell that is most common and problematic in leukaemia is _____
immature WBC (B cells)
in leukaemia the RBC count is ….
low —> the bone marrow is going “wild” producing all the immature WBC - no energy or nutrients to make RBC
in leukaemia the platelet count is….
low —> the bone marrow is going “wild” producing all the immature WBC - no energy or nutrients to make platelets
in leukaemia, because RBC is low the pt will exhibit ____ and ____
pallor, fatigue
in leukaemia, because of the immature WBCs, the pt is at risk for ____
infection
in leukaemia, because of low platelets, the pt is at risk for ____, ____, ____, & _____
bruising, ecchymosis, bleeding, petechia
what causes lymph gland enlargement in leukaemia?
all the small immature WBC clog the lymph system
should you take a rectal temp on a child with leukaemia?
no
should you take and oral temp on a child with leukemia
yes, as long as they are over 4yrs, in remission, and have no sores in mouth
should the child with active leukaemia use straws, forks, cups?
no straws, no forks, yes cups
RNs priority in tx a child with newly diagnosed leukaemia is….
decrease risk of infection
when the leukaemia child’s platelets and WBCs are low, their activities should be ____
limited
when the platelets and WBCs are low the nurse should not insert a _____
suppository
are IM injections and IV sticks permitted on a child with leukemia
when labs are low IMs avoided and IVs limited
only done when absolutely necessary (to give chemo of measure blood counts)
why are kids on chemo also on allopurinol
to prevent uric acid kidney stones
when chemo kills cancer cells, purines and uric acid build up and could cause kidney stones
why do some kids with leukaemia have joint pains
immature WBCs infiltrate the joint and cause inflammation
why is a child with leukaemia at risk for neurological symptoms due to ICP
the immature WBCs infiltrate the brain and cause inflammation
what is alopecia?
hair loss
if the platelet count is low, what drug should the child not take?
aspirin
is the alopecia from chemo permanent?
no, it will grow back
is the alopecia from radiation permanent
yes, the follicles are destroyed
what does ANC mean?
absolute neutrophil count
what is the ANC used for in leukaemia?
if ANC is <500 (0.5) then pt will be on protective isolation
which is used more commonly to decide if the pt should be on protective isolation? WBC or ANC?
ANC is more reliable and valid
by the end of the first 6 months of life an infants birthweight should be ___
double
by the end of the first year of life and infants birthweight should be ____
triple
ideal food fo infants is ____
breast milk
breast milk contains substances that increase immunity. T/F?
true
bottle-fed infants don’t bond well with their moms. T/F?
false
the one nutrient that commercial formulas are typically low in is ____
Fe (iron)
breast milk does not contain iron. T/F?
false - but it does not contain enough iron so they should be fed iron fortified cereal starting at 6 months
at what age should the infant be fed cows milks?
not before 12 months
what is the major problem with feeding an infant skim milk?
they don’t get enough calories and don’t grow
dehydration from excessive solute load and inability to concentrate urine
when should the infant be introduced to textured solid foods?
4-6 months
what is the first food that an infant should be introduced to?
iron fortified cereal
when forced to eat, the preschool child will ___
rebel
parents of preschool children should be taught that as long as the child eats ___ good nutritious meal per day, they should not make eating food and issue
one
refusal to eat is common in preschoolers. T/F?
true, but still offer a variety
youngsters develop food preferences by …
observing significant ppl in their environment
school aged kids grow at a slower rate than infants, toddlers, and adolescents. T/F?
true
what dietary strategy is most appropriate for the industrious school aged child?
wholesome snack because they are often too busy to eat
Girls in adolescence need more calories than adolescent boys T/F?
False, boys need more cals
Adolescents should take vitamin supplements T/F?
True
Mastitis and breast engorgement are more likely to occur in…
Primipara
Where does the organism that causes mastitis come from?
The INFANTS nose or mouth
Which organism most commonly causes mastitis
staph
Prolonged intervals between breast- feeding (dec/inc) the incidence of mastitis
increase
Cant too-tight bras lead to mastitis?
Yes, by preventing emptying of ducts
Mastitis usually occurs at least ___ days after delivery
10
Mastitis is accompanied with a fever over ___
38.8
When mastitis is present the breasts are ___, ____, and ____
hard, swollen, warm
If mastitis is caused by an organism , what causes breast engorgement
Temporary increase in vascular & lymph supply to the breast in preparation for milk production
If mastitis occurs 1+ weeks after delivery, when does breast engorgement occur?
2-5 days after delivery
Does breast engorgement interfere with nursing?
Yes, the infant has a difficult time latching on
What class of drugs is used to treat mastitis?
ATBs
ATBs are used to treat breast engorgement (T/F)?
false
application of (warm H2O compresses/ice packs) is the preferred tx for breast engorgement
Ice packs to dec swelling
The mother with mastitis should stop breast feeding (T/F)?
False. The mother must keep breast feeding. (Offer unaffected breast first).
If the mother has an open abscess on her breast, she must not breastfeed (T/F)?
true
For breast engorgement, the non- breastfeeding mother should be told to express milk (T/F)
No, that would increase milk production and would make the problem worse (warm compresses or a warm shower to let milk “leak” is okay - Ice is best
What is the best tx for breast engorgement?
Breast feeding - it will balance supply and demand
What is mastoiditis?
Inflammation / infection of the mastoid process
What is the most common cause of mastoiditis?
Chronic otitis media
What are the 4 S&S of mastoiditis?
Drainage from ear, high fever, HA, and ear pain, tenderness over mastoid process
What unusual post-op complication can result from mastoidectomy?
Facial nerve paralysis d/t accidental damage during surgery
What should you do to assess for facial nerve paralysis post-mastoidectomy?
Have the patient smile and wrinkle forehead
What is the medical tx of mastoiditis?
Systemic ATBs
What is the surgery for mastoiditis called?
Simple or radical mastoidectomy
Will a simple mastoidectomy worsen hearing?
No, a radical mastoidectomy may
Should the nurse change the post- mastoidectomy dressing?
No, reinforce it. Physician changes first post-op dressing
What is a common side effect of mastoidectomy?
Dizziness (vertigo)
What is a major nursing diagnosis post- mastoidectomy ?
safety
Define Menieres disease
An increase in endolymph in the inner ear causing severe vertigo
What’s the famous triad of S&S in Meniere’s?
Paroxysmal whirling vertigo - sensorineural hearing loss - tinnitus (ringing in the ears)
Does Meniere’s occur more in men or women?
WOMEN
What should the client with Meniere’s do if they have an attack?
bed rest
What safety measures should be followed with Meniere’s?
Side rails up x4, ambulate only with assistance
What age group in Meniere’s highest in?
40-60
What can prevent the attacks of Meniere’s?
Avoid sudden movements
What electrolyte is given to ppl with Meniere’s?
Ammonium chloride
What surgery is done for Meniere’s?
Labyrinthectomy
What disease often follows labyrinthectomy?
Bell’s palsy - facial paralysis, will go away in a few month
What is the activity order after labyrinthectomy?
Bed rest
When surgery is preformed for Meniere’s, what are the consequences?
Hearing is totally lost in surgical ear
What should the client avoid after labyrinthectomy?
Sudden movements and increase Na foods
What type of diet is the client with Meniere’s on?
low salt
What two classes of drugs are given in Meniere’s?
Antihistamines and diuretics (Diamox)
Meningitis is an inflammation of the ___ of the ___ and spinal ___
Linings, brain, cord
Meningitis can be caused by ___, ___, and ____.
Viruses, bacteria, and chemicals
The 4 most common organisms that cause meningitis are…
Pneumococcus, meningococcus, streptococcus, H. Influenza
Child with meningitis is most likely to be lethargic or irritable at first.
irritable
What visual S&S will the pt with meningitis have?
Photophobia (over-sensitivity to light)
What is the most common musculo- skeletal S&S of meningitis?
Stiff neck - nuchal rigidity
Will the pt with meningitis have a HA?
yes
Kernig’s sign is positive when there is pain in the ___ when attempting to straighten the leg with the ___ flexed
Knee; hip
What type of vomiting is present in meningitis?
projectile
What is the definitive diagnostic test for meningitis?
Lumbar puncture with culture of CSF
If the pt has meningitis, the CSF shows ___ pressure, ___ WBC, and ____ protein, ___ glucose
increased, increased, increased, decreased
On what type of isolation will the patient with meningitis be?
Contact and respiratory precaution
How long will the patient with meningitis be on these precautions?
Until they have been on an abx for 48h
The room of a pt with meningitis should be ___ and ___
dark and quiet
The client with meningitis can develop ___
Seizures
What is opisthotonos?
Arching of back (entire body) from hyperextension of the neck and ankles, d/t severe meningeal irritation
If a patient has opisthotonos, in what position would you place them?
Side-lying
Average duration of menstrual flow is ___. The normal range is ___ to ___ days.
5 days, 3-6
Average blood loss during menstruation is ____ cc
50-60cc
Name the two phases of the ovarian cycle
Follicular phase (first 14 days), luteal phase (second 14 days)
In the menstrual cycle, day 1 is the day on which…
Menstrual discharge begins
How long does an ovarian cycle last?
28 days
How many days after ovulation does menstruation begin?
14 days
What hormones are active during the follicular phase?
FSH and Estrogen
What is the major function of the luteal phase of the ovarian cycle?
To develop and maintain the corpus luteum which produces progesterone to maintain pregnancy until placenta is est.
If an ovum is fertilized during the luteal phase what hormone will be secreted?
HCG (human chorionic gonadotropin)
During menstruation, the average daily loss of iron is ___ mg.
0.5 to 1.0 mg
What occurs during the follicular phase of the ovarian cycle?
It accomplishes maturation of the graafian follicle which results in ovulation
What type of environmental modification is best for a migraine?
Dark, quiet, environment
The long term tx of migraine focuses upon…
Assessing things that bring on stress and then planning to avoid them
What type of pain is typical of migraines?
throbbing
Are migraines more or less common in men?
less
Besides pain, ppl with migraines complain of what other S&S?
N&V, and visual disturbances
What are the processes occurring in migraines?
Reflex constriction then dilation of cerebral arteries
Where is the pain of migraines most likely located?
Temporal, supraorbital
Name a drug given to tx migraine?
Sansert (methsergide), Cafergot (prophylaxis: Imipramine)
Are migraine HAs usually unilateral or bilateral?
Unilateral
When Inderal is given in migraine headache, is it used to prevent or treat an attack?
To prevent. It does not treat
MS is a progressive ____ disease of the CNS.
Demyelinating
Myelin promotes ___, ___ ___ of nerve impulses.
Fast, smooth conduction
With demyelination the nerve impulses become ___ and ____.
Slow, uncoordinated
MS affects men more than women (T/F)
False, affects women more than men
What age group usually gets MS?
20-40
MS usually occurs in (hot/cool) climates
cool
What is the 1st sign of MS?
Blurred or double vision
MS can lead to urinary incontinence (T/F)
true
MS can lead to impotence in males (T/F)
true
Patients with MS should be taught to walk with a ___ -___ gait
wide based
Why are Adrenocorticotropic Hormone (ACTH) and prednisone given during acute MS?
To dec. edema in the demyelination process
For acute exacerbations of MS ___ per IV is often used
ACTH (Corticotropin)
What drug can be given to treat urinary retention in MS?
Urecholine, Bethanocol
Will the muscles of MS clients be spastic or flaccid
spastic
What 3 drugs can be given for muscle spasms?
Valium, Baclofen (Lioresal), Dantrium
Baclofen causes (constipation/ diarrhea)
Constipation
Dantrium causes (constipation/ diarrhea)
Diarrhea (Hint: the D’s go together, Dantrium and Diarrhea)
Patients with MS should have (inc/restricted) fluids
Increased to dilute urine and reduce incidence of UTI
The diet of a patient with MS should be ___ -ash
acid
What major sense is affected most in MS (besides vision)?
Tactile (touch) - they burn themselves easily
Which will bring on a MS exacerbation: over-heating or chilling?
Both will; but they tend to do better in cool weather (summer will always be a bad time for MS patients)
In Myasthenia Gravis (MG) there is a disturbance in transmission of impulses at the ___ ____.
Neuromuscular junction
The #1 sign of MG is ____ ____ ___
Severe muscle weakness
What is the unique adj. given to describe the early signs of MG?
The early signs (difficulty swallowing, visual problems) are referred to as BULBAR signs.
MG affects men more than women (T/F)
False, affects women more than men
When women get MG they are usually old or young?
OLD
What neurotransmitter is problematic in MG?
Acetycholine
What class of drug is used to tx MG?
Anticholinesterases
What ending do anticholinesterases have?
-stigmine
Are anticholinesterases sympathetic or parasympathetic?
parasympathetic
Anticholinesterases will have (sympathetic/cholinergic) side effects
Cholinergic (they will mimic the parasympathetic nervous system)
What surgery CAN be done for MG?
Thymectomy (removal of thymus)
The severe muscle weakness of MG gets better with exercises (T/F)
False, it is worse with activity
What will the facial appearance of a patient with MG look like?
Mask-like with a snarling smile (called a myasthenic smile)
If a patient has MG, what will be the results of the Tensilon Test?
The patient will show a dramatic sudden increase in muscle strength
Besides the Tensilon Test, what other diagnostic tests confirm a diagnosis of MG?
Electromylogram (EMG)
What is the most important thing to remember about giving Mestinon and other anticholinesterases?
They must be given EXACTLY ON TIME; at home, they might need to set an alarm
Do you give anticholinesterases with or without food?
With food, about 1/2 hour ac; giving ac helps strengthen muscles of swallowing
What type of diet should the pt with MG be on?
soft
What equipment should be at the bedside of an MG patient?
Suction apparatus (for meals), Tracheostomy/ endotube (for ventilation)
Name the two types of crises that a MG pt can have
Cholinergic (too much Mestinon); Myasthenic (not enough Mestinon)
The #1 danger in Myasthenic and Cholinergic crisis is ___ ___.
Respiratory arrest
What words will the client use to describe the pain of an MI?
Crushing, heavy, squeezing, radiating to left arm, neck, jaw, shoulder
What is an MI?
Either a clot, spasm, or plaque, that blocks the coronary arteries causing loss of blood supply to the heart and myocardial cell death
What is the #1 S&S of an MI?
Severe chest pain unrelieved by rest and nitroglycerine
Males are more likely to get an MI than females (T/F)
true
Death d/t MI occurs within ___ hour of symptom onset in 50% of all patients
1
What pain medication is given for the pain of a MI (give three)?
Morphine, Demerol, Nitroglycerine
What is the reason for giving post MI patients ASA?
To prevent platelets from forming clots in the coronary arteries
Name a new drug with anti-platelet activity
plavix
The 3 most common complications after MI are ___, ___, and ____.
Cardiogenic shock, arrhythmia, CHF
What will the activity order be for the post- MI client?
Bed rest with bedside commode
What is the most common arrhythmia after an MI?
PVCs
What cardiac enzymes indicate an MI?
Elevated CPK, LDH, SGOT
What serum protein rises soonest after myocardial cell injury?
troponin
Do people without cell damage have troponin in their blood?
No, troponin is only present when myocardial cells are damaged
How soon after cell damage does troponin increase?
As soon as 3 hours (can remain elevated for 7 days)
When will the client with an MI be allowed to engage in sexual activities after an MI?
6 weeks after discharge
Will fluid resuscitaion (administering large amounts of IV fluid) treat cardiogenic shock?
No, you must use cardiac drugs (giving IVs and blood will not help this kind of shock)
Will the client with an MI be nauseated?… diaphoretic?
yes, yes
What will the extremities of the client with an MI feel like?
cold, clammy
What is the permanent EKG change seen post MI?
ST wave changes
Of CPK and LDH which rises earliest?
CPK
What drug will be used to treat PVCs of MI?
Lidocaine
Will the client with an MI need 100% O2 for their entire stay in the hospital?
No, just moderate flow (42% or 3-6L for first 48h)
Vegetables highest in Na are ___
canned veggies
fruit highest in Na is___
tomato sauce
fresh meats are ___ in Na
low
canned meats are ___ in Na
very hight
smoked foods are ___ in Na
very high
fruits are ___ in Na
low
fruits are ___ in Na
low
veggies are ___ in Na
low
which are higher in Na? veggies or fruits
fruits
breads/cereal are ___ in Na
moderately high
processed meats and cheese are ___ in Na
very high
margarine is much lower in Na than butter. T/F?
true
an NG tube is inserted into the ___ via the ___
stomach, nares
When an NG tube is being used for decompression what is happening?
The stomach is being emptied of its contents by suction
NG tubes are used to pump the stomach of drug overdose clients (T/F)
true
What does gavage mean?
Feed a client with a tube
What does lavage mean?
To continuously irrigate the stomach via NG tube
When an NG tube is used to stop gastric hemorrhage, it is irrigated with ____
iced tap water
How long do you irrigate an NG with iced tap water when the stomach is bleeding?
Until the irrigating solution comes back out clear
What is the maximum suction level used to decompress the GI tract via a NG?
25 mmHg
Why are salem sump tubes best suited for safe gastric suctioning?
Because they have vents that prevent damage to the gastric mucosa
When a NG tube is in for a long time it must be replaced every ___ to ___ weeks
2-3 weeks
People with a NG tube will breathe through their ___
Mouth (mouth care is important)
The best way that the nurse can check if the NG is in the stomach is…
To aspirate gastric contents; auscultating the gastric air bubble is the second best way
Before you put anything down the NG you must do what?
You must check the see if the NG placement is in the stomach
In what position should the client be when a NG is being inserted?
Sitting up with head slightly extended until the tube reaches the back of the throat then have them mildly flex the neck to push the tube in all the way
How do you determine how far to put an NG tube in?
Measure from the tip of the nose to the back of the ear then to the xiphoid process
In what position should the client be during a continuous NG tube feeding?
HOB must be elevated 30 degrees (semi- fowler’s would be acceptable)
Is nephrotic syndrome a disease?
No, it is not a specific disease, it is a group of S&S that can result from many diseases
Is there any hematuria in nephrosis?
No, there is no hematuria in the -oses, but there is hematuria in the -itis’s
What are the dietary modifications for nephrosis ?
High carbs, moderate proteins, low sodium
What is #1 nursing dx in nephrosis?
Alteration in fluid volume, excess
What are the 2 pathophysiologic processes in nephrotic syndrome?
Glomerular inflammation, loss of protein
What S&S are MOST common in nephrosis?
Generalized severe edema
What 2 classes of drugs are given for nephrosis?
steroids, diuretics
Is bed rest common in treating nephrosis?
it is occasionally done, but not nearly as common as in acute glomerulo-nephritis, it is usually is most appropriate when edema is severe
In nephrotic syndrome, the BP will be most likely (hypotensive / hypertensive)
Hypertensive: remember in acute glomerulonephritis, the BP is hypertensive as well
In nephrotic syndrome, the urine is (frothy/very dark or tea-colored)?
Frothy. Remember in AGN, it is tea-colored
Is scrotal edema common in nephrosis?
yes
What is done for scrotal edema?
Elevate the scrotum on a scrotal sling and apply ice
Name the 3 sub-scales in the Glasgow coma scale (GCS)
Best eye opening (E), Best verbal response (V), and best motor response (M)
Whats max score on GCS?
15
What is the minimum score on the GCS?
3
A score equal to or below ____ on the GCS is considered coma
7
Pupillary reaction test cranial nerve ___
3
A respiratory pattern in which there is alternation between apnea and hyperventilation is known as..
Cheyenne-Stokes
A value of 20/80 on visual acuity means that the patient can see at ___ feet what normal people see at ___ feet
20, 80
Babiniski’s reflex is tested by stroking the ___
Bottom lateral surface of the foot
It is always pathologic if a Babinski is negative (T/F)
False, non-walking infants normally have a positive Babinski, walking infants, toddlers, and all other people should normally have a negative Babinski
When a Babinski is positive the ___ ___ ___ flexes and the other ___ fan out
Great toe dorsiflexes, toes
In decorticate posturing, the legs are ____ and the neck and arms are ___ and ___ rotated
extended, flexed, internally
In decerebrate posturing, the legs are ___ and the arms, neck and back are ____
Extended, extended (pronated)
A score of 4 for a reflex means that it is ____
hyperactive
Cerebellar function is evaluated by testing for ____, ____, ____, ____
Posture, gait, balance, coordination (ie Romberg’s sign)
assault
A threat or an attempt to make bodily contact with another person without that person’s consent
battery
An assault that is carried out
Common law
Law resulting from court division that is then followed when other cases involving similar circumstances arise
malpractice
An act of negligence- commonly used when speaking of negligent acts committed by a person working in a certain profession, such as medicine or nursing
ethics
A system that defines actions with respect to their being judged right or wrong
false imprinsonment
Unjustifiable restraint or prevention of the movement of a person without proper consent
misdemeanour
A wrong of less seriousness than a felony
good samaritan law
Law that gives certain persons legal protection when giving aid to someone in an emergency
felony
A wrong of serious nature
negligence
Performing an act that a reasonable and comparable person under similar circumstances would not do, or failing to perform an act that a reasonable and comparable person under similar circumstances would do
invasion of privacy
A wrongful act that violates the right of a person to be let alone
liable
Being accountable, responsible, or answerable for an act
libel
A written untruthful statement about a person that subjects him/her to ridicule or contempt
slander
A spoken untruthful statement about a person that subjects him/him to ridicule or contempt
How could a nurse be convicted of assault?
If the client perceives that the nurse intends to do a procedure without consent or justification
How could a nurse be convicted of battery?
If the nurse willfully touched a client in any manner that is wrong in some way
If a nurse uses restraints to keep a client, who is a danger to himself, in bed, the nurse is likely to be convicted of false imprisonment (T/F)
False, you can detain/restrain a person against their will if they are: 1) a threat to self; 2) a threat to others
In order to legally sign as a witness to informed consent, the nurse must have been present when the physician and client discussed the procedure (T/F)
False. You are only witnessing that the patient was the one who signed the consent
It is NOT necessary for the nurse to determine if the client understands what the physician is said in order to witness an informed consent
True. You are only witnessing a signature
Can a patient legally sign an informed consent after they have received the premedication analgesic for a procedure?
No. The patient would be considered to be under the influence of a mind-altering drug. The consent would be invalid
Name 3 groups of ppl who cannot give legal consent
Minor, unconscious client (even under influence of CNS drugs), mentally ill
In an emergency situation, when client and family cannot give consent, consent is assumed and tx proceeds (T/F)
true
The legality of no code or slow code orders is well-est. in the courts
False- no definitive policy in the courts exists at this time- dealt with on a case-by- case basis
Anxiety-producing thoughts are called ____
obsessions
Repetitive actions designed to reduce anxiety are called _____
Compulsions - such as washing hands over and over, dusting furniture 3 hour per day, refusing to turn your back to anyone
Which defense mechanism is most closely associated with OCD
displacement
Should you allow an OCD person to perform their compulsive behavior?
Yes, give them time to do their ritual and try to set a limit and redirect
Should you ever make an OCD person stop their compulsive behavior?
No, they will become very anxious
Is the patient with OCD neurotic or psychotic?
Neurotic- they know reality
Should you confront the OCD patient with the absurdity of their behavior?
No, just say things like “You washed your hands for so long you must have been very anxious.”
What should you do if an obsessive- complusive person is always late due to their rituals?
Get them started earlier - for ex. if they wash their hands for 1/2 hour before meals and are always late for breakfast, just get them started 1/2 hour earlier
What are the two typer of oral contraceptives?
Progestin only & combination progesterone and estrogen
How many days of the menstrual cycle do you take the progestin only pill?
all 28 days
How many days of the menstrual cycle do you take the combo pill?
You take it on days 5-24, but not on days 24-28 and 1-4 (8 days off)
How log before surgery must you d/c PO contraceptives
one week before surgery
If a woman forgets to take the pill one day, what should she do?
Take it as soon as she remembers it, and take next pill at regular time.
What if a woman forgets to take the pill for two days in a row? What should she do?
Take 2 pills a day for 2 days in a row and then resume normal schedule
What should a woman do if she forgets to take her pill for 3 days or more?
Throw away pack & start new pack same day. Use back-up contraceptive method for 7 days
If a woman doesn’t stop oral contraceptives one week before surgery she is at risk for developing ___
thrombophlebitis
People who smoke more than ___ cigs per day should not be on an oral contraceptive
15, bc if you smoke you have constriction of vessels and this potentates the chances that a woman on oral contraceptives will get thrombophlebitis
If a woman on oral contraceptives misses a period, should she still take pills?
Yes, however, if 2 missed periods occur, stop and have a pregnancy test.
Will breakthrough bleeding, N&V, and breast tenderness go away when a woman is on oral contraceptives?
yes after about 3-6 months of tx
Osteoarthritis is a ____ disease of the ___
degenerative, joint
Osteoarthritis is most commonly caused by the wear and tear of life (T/F)
true
The most common symptom of osteoarthritis is ____ _____
joint pain
What 2 joints are most commonly affected in osteoarthritis?
knee and hip
To control the pain of osteoarthritis one should use heat or cold?
heat
What 3 meds are used in osteoarthritis?
Aspirin, NSAIDs, steroids
What do you observe on the fingers of the client with osteoarthritis?
Heberden’s nodes
Are Heberden’s nodes painful?
Not in the beginning, can be later as swelling occurs
Are rest periods and ROM exercises appropriate in the care of osteoarthritis?
Yes, rest is probably the most effective thing they can do.
The pain of osteoarthritis is usually better or worse with rest? With activity?
Better with rest, worse with activity
What age group gets osteoarthritis?
60-80 years old
Osteoarthritis is more common in females (T/F)
False, it occurs in equal frequency
For cervical osteoarthritis the client should wear..
A cervical collar
What is arthroplasty?
joint replacement
What is arthrodesis?
jont fusion
What is otosclerosis?
Overgrowth of the spongy bone in the middle ear that doesn’t allow the bones of the middle ear to vibrate
What will the client with otosclerosis complain of besides hearing loss?
Buzzing or ringing in the ears (tinnitus)
Do ppl have a loss of hearing with otosclerosis?
yes
What is a corrective surgery for otosclerosis called?
Stapedectomy - removing the stapes bone and replacing it with a micro prosthesis
Should side rails be up after stapedectomy?
Yes, client may feel dizzy
What should the client avoid post- stapedectomy?
Coughing, sneezing, blowing nose, swimming, showers, flying
What warning should you give the client about getting up after stapedectomy?
get up slowly
What should the client expect regarding hearing post-stapedectomy?
An initial decrease with the benefits of surgery noticeable in 6 weeks
What should the client do if he must sneeze after a stapedectomy?
Open his mouth, this de-pressurizes the middle ear
What type of hearing loss is associated with otosclerosis?
conductive
Which sex has a higher incidence of otosclerosis?
women
Do hearing aids help hearing in otosclerosis?
yes
What will be the results of the Rinne test in otosclerosis?
Bone conduction will be better than air conduction
Is stapedectomy done under general or local anesthesia?
local
If the client complains of dec. hearing after stapedectomy what would you say?
It is normal d/t edema. The hearing will start to improve within 6 weeks
Which side will the client be allowed to lie upon post-stapedectomy
Depends on MD: operative side promotes drainage, un- operative side prevents graft dislodgment. Dont make a big deal of position post-op
What 2 drugs are commonly given post- stapedectomy
Codeine/Demerol for pain, Dramamine for dizziness
Cysts on the ovaries are usually malignant (T/F)?
false, usually benign
What is the #1 reasons why MD’s remove ovarian cysts?
Remove before they transform into malignant
Do small ovarian cysts cause S&S?
no, only large ones
Common signs of large ovarian cysts are..
Low back pain, pelvic pain, abnormal bleeding
What does torsion of an ovarian cyst mean?
Twisting of cyst with interruption of its blood supply
What is the big danger from torsion?
Necrosis and rupture of ovary
What other disorders resemble rupture of ovarian cysts?
Appendicitis, rupture of a fallopian tube pregnancy
What affect do oral contraceptives have on ovarian cysts?
They cause it to stop growing and decrease in size
What are the 3 most common signs of ovarian cyst rupture?
Pain, abd distention, abd rigidity
Compare signs of non-ruptured ovarian cysts with the signs of a ruptured ovarian cyst
Non-ruptured= low back pain, dull pelvic pain, abnormal uterine bleeding esp. with mensturation
Ruptured: acute pain, abd distention, and abd rigidity
After surgery to remove an ovarian cyst the woman can return to normal activities between ___ to ___ weeks
4-6 wks
How soon after removal of an ovarian cyst can a woman resume sexual intercourse?
4-6 wks
Should a woman douche after surgery to remove an ovarian cyst?
No, it is not good to douche on a regular basis, it destroys the natural protective vaginal flora
What does lightening mean?
When the fetal head descends into the pelvis
When does fetal head descent occur in pregnancy?
2-3 weeks before birth for primipara
What is the most common positive effect of lightening?
After it occurs the woman can breathe much easier
Name the 2 earliest signs that a woman is likely in labor
Low back pain and show (blood-tinged mucous plug has passed)
What is the most RELIABLE or VALID indication that a woman is in labor?
The onset of regular contractions that result in progressive dilatation/effacement of the cervix
What are the 2 processes that occur to the cervix during labor?
effacement and dilation
What is the meaning of cervical effacement?
the cervix thins
Into how many stages is labor and delivery divided?
4
What is accomplished during the first stage of L&D?
full effacement and dilation
How long is the first stage of labor and delivery for a primagravida? For a multigravida?
12 hours, 6 hours
The 2nd stage of L&B accomplishes..
delivery of an infant
The 2nd stage of L&D begins with ___ and ends with ___ of the ___
Full dilation, delivery, infant
The 2nd stage of labor and delivery lasts ___ hours for a primagravida and ___ hours for a multigravida
1.5, 5
The 3rd stage of L&D accomplishes…
expulsion of placenta
The 3rd stage of the L&D lasts…
<1hr
What occurs during the 4th stage of L&D?
recovery
When does 4th stage of L&D end?
2 hrs after expulsion of placenta
What is the average blood loss during labor?
500 cc
