Blue Book Flashcards
1
Q
Primary dietary prescription for calcium nephrolithiasis (kidney stones) ? PG. 85
A
Low calcium diet
2
Q
For client with nephrolithiasis the diet should be ___ ash
A
Acid
3
Q
If kidney stone is calcium phosphate the diet must be low in ___ too
A
Phosphorus
4
Q
Primary diet tx for uric acid nephrolithiasis is __ ____
A
Low purine
5
Q
Client with uric acid nephrolithiasis should have a diet low in ____
A
Methionine
6
Q
What is methionine?
A
Precursor of the amino acid cystine
7
Q
2 foods high in methionine?
A
Milk and eggs
8
Q
Clients with cystine nephrolithiasis should have an ____ ash diet
A
Alkaline
9
Q
Inc. fluids over 3000 cc /day is more effective in treating renal calculi than ANY dietary modification, T/F?
A
True. Want to flush tract than worry about diet
10
Q
Acid-Ash diet
A
Meat, fish, eggs, and cereals are emphasized, with little fruit and vegetables and no milk or cheese.
11
Q
What is the common name for Laryngotracheobronchitis - LTB
A
Croup
12
Q
What is the typical temp elevation in croup?
A
Low grade, usually below 102, but can go up to 104.
13
Q
Are ATBs helpful for croup? For epiglottits?
A
For croup, no. Epiglottitis, yes
14
Q
Is croup viral or bacterial?
A
Viral
15
Q
With which condition is croup most often confused?
A
Epiglottitis
16
Q
Can croup be managed at home? Can epiglottitis be managed at home?
A
Yes. No, epiglottitis is a 911 emergency
17
Q
Are sedatives used for kids with croup?
A
No, bc this would mask the signs of respiratory distress
18
Q
What causes epiglottitis? A virus or bacteria?
A
H. influenza BACTERIA
19
Q
What is the best tx for croup?
A
Cool moist air
20
Q
What should never be done to a child with epiglottitis?
A
Never put anything in the child’s mouth, ie, a tongue blade can lead to obstruction
21
Q
What are the typical signs and symptoms of croup?
A
Barking cough, inspiratory stridor, labored resp. pattern
22
Q
What 3 signs tell you that the child has epiglottitis instead of croup?
A
Muffled voice, drooling, increased fever
23
Q
When is croup bad enough to be evaluated by a doc?
A
When retractions, and high pitched stridor are present
24
Q
What lead level needs intervention?
A
50-60 micrograms/ dl
25
With which class of drugs will a child with lead poisoning be treated?
Chelating agents
26
What do chelating drugs do?
They increase the excretion of heavy metals
27
The most freq. cause of lead poisoning is...
Ingestion of lead-based paint chips
28
Name 3 common chelating agents for lead poisoning
Eat Big Donuts
EDTA,
BAL in oil
desferal,
29
6 S&S of lead poisoning
Dumb Chicks Act Stupid Crazy
Drowsiness,
clumsiness,
ataxia-the loss of full control of bodily movements
seizures,
coma,
resp. arrest
30
Sx of lead poisoning show up in the ____ system
Neuro
31
Leukemia is cancer of the ___ forming tissues
Blood
32
The type of cell that is most common and problematic in leukemia is ____
Immature WBC
33
In leukemia, the platelet count is ...
Low, bc the bone marrow is going "wild" producing all those immature WBC - no energy or nutrients to make platelets
34
Bc the RBCs are low, the pt will exhibit ___ and ___
Pallor and fatigue
35
Bc of the immature WBCs, the pt is at risk for ___
Infection
36
Bc of low platelets, the pt is at risk for ___, ___, ____and ___
Bruising, ecchymosis, bleeding, petechiae
37
What causes lymph gland enlargement in leukemia?
All those small immature WBC clog the lymph system
38
Should you take an oral temp on a child with leukemia?
Yes, as long as they are over 4 years old, in remission, and have no sores in their mouth
39
Should the child with active leukemia use straws, forks, cups?
NO straws, NO forks, YES cups
40
RN's priority in tx a child with newly diagnosed leukemia is...
Dec. risk of infection
41
When the leukemia child's platelets and WBC's are low, his activities should be ...
Limited
42
When the platelet and WBCs are low the nurse should not insert a..
Suppository
43
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 or measure blood counts)
44
Why are kids on chemo also on allopurinol
To prevent uric acid kidney stones (remember when chemo kills cancer cells, purines and uric acid build up and could cause kidney stones
45
Why do some kids with leukemia have joint pain?
The immature WBCs infiltrate the joint and cause inflammation
46
Why is a child with leukemia at risk for neuro sx due to ICP?
The immature WBCs infiltrate the brain and cause inflammation
47
What is alopecia?
Hair loss
48
If the platelet count is low In leukemia what drug should the child not take?
Aspirin
49
Is the alopecia from chemo permanent?
No. It will grow back. (Alopecia of radiation therapy is permanent bc the follicle is destroyed)
50
What does ANC mean?
Absolute Neutrophil Count
51
What is the ANC used for in leukemia?
If ANC <500, then pt will be on protective isolation
52
Which is used more commonly to decide if the pt should be on isolation: WBC or ANC
ANC is more reliable and valid
53
By the end of the 1st 6 months of life an infants birthweight should ____
Double
54
Ideal food for infants is ___
Breast milk
55
Breast milk contains substances that increase immunities T/F?
T
56
Bottle-fed infants dont bond well with their moms T/F?
F
57
The 1 nutrient that commercial formulas are typically low in is ___
Fe
58
Breast milk does not contain iron T/F?
False. However, it does not contain enough iron- so they should be fed iron fortified cereal starting at 6 months
59
At what age should the infant be fed cows/goats milk?
Not before 12 months
60
What is the major problem with feeding an infant skim milk?
They dont get enough calories and dont grow. Dehydration from excessive solute load and inability to concentrate urine
61
When should the infant be introduced to textured solid foods?
4-6 months
62
What is the first food that an infant should be introduced to?
Iron fortified rice cereal
63
When forced to eat, the preschool child will...
Rebel
64
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 an issue
One
65
Refusal to eat is common in preschoolers T/F?
True, but still offer a variety
66
Youngsters develop food preferences by..
Observing significant ppl in their environ
67
School-age kids grow at a slower rate than infants, toddlers, or adolescents T/F?
True
68
What dietary strategy is most appropriate for the industrious school-age child?
Wholesome snacks, bc they are often too busy too eat
69
Girls in adolescence need more calories than adolescent boys T/F?
False, boys need more cals
70
Adolescents should take vitamin supplements T/F? PG. 90
T
71
Mastitis and breast engorgement are more likely to occur in...
Primipara
72
Where does the organism that causes mastitis come from?
The INFANTS nose or mouth
73
Which organism most commonly causes mastitis
Staph
74
Prolonged intervals between breast- feeding (dec/inc) the incidence of mastitis
Increase
75
Can too-tight bras lead to mastitis?
Yes, by preventing emptying of ducts
76
Mastitis usually occurs at least ___ days after delivery
10
77
When mastitis is present the breasts are ___, ____, and ____
Hard, swollen, warm
78
Mastitis is accompanied with a fever over
102
79
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
80
If mastitis occurs 1+ weeks after delivery, when does breast engorgement occur?
2-5 days after delivery
81
Does breast engorgement interfere with nursing?
Yes, the infant has a difficult time latching on
82
What class of drugs is used to treat mastitis?
ATBs
83
ATBs are used to treat breast engorgement (T/F)?
F
84
Which Application of (warm H2O compresses/ice packs) is the preferred tx for breast engorgement?
Ice packs to dec swelling
85
The mother with mastitis should stop breast feeding (T/F)?
False. The mother must keep breast feeding. (Offer unaffected breast first).
86
If the mother has an open abscess on her breast, she must not breastfeed (T/F)?
T
87
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
88
What is the best tx for breast engorgement?
Breast feeding - it will balance supply and demand
89
What is mastoiditis?
Inflammation / infection of the mastoid process
90
What is the most common cause of mastoiditis?
Chronic otitis media
91
What are the 5 S&;S of mastoiditis?
Drainage from ear,
high fever,
HA, and
ear pain,
tenderness over mastoid process
92
What unusual post-op complication can result from mastoidectomy?
Facial nerve paralysis d/t accidental damage during surgerym
93
What should you do to assess for facial nerve paralysis post-mastoidectomy?
Have the patient smile and wrinkle forehead
94
What is the medical tx of mastoiditis?
Systemic ATBs
95
What is the surgery for mastoiditis called?
Simple or radical mastoidectomy
96
Will a simple mastoidectomy worsen hearing?
No, a radical mastoidectomy may
97
Should the nurse change the post- mastoidectomy dressing?
No, reinforce it. Physician changes first post-op dressing
98
What is a common side effect of mastoidectomy
Dizziness (vertigo)
99
What is a major nursing diagnosis post- mastoidectomy ? PG 92
Safety
100
Define Menieres diease
An increase in endolymph in the inner ear causing severe vertigo
101
What's the famous triad of S&S in Meniere's?
Paroxysmal whirling vertigo - sensorineural
hearing loss -
tinnitus (ringing in the ears)
102
Does Meniere's occur more in men or women?
Women
103
What should the client do if they have an attack?
Bedrest
104
What safety measures should be followed with Meniere's?
Side rails up x4, ambulate only with assistance
105
What age group in Meniere's highest in?
40-60
106
What can prevent the attacks of Meniere's?
Avoid sudden movements
107
What electrolyte is given to ppl with Meniere's?
Ammonium chloride
108
What surgery is done for Meniere's?
Labyrinthectomy
109
What disease often follows labyrinthectomy?
Bell's palsy - facial paralysis, will go away in a few month
110
What is the activity order after labyrinthectomy?
Bedrest
111
When surgery is preformed for Meniere's, what are the consequences?
Hearing is totally lost in surgical ear
112
What should the client avoid after labyrinthectomy?
Sudden movements and increase Na foods
113
What type of diet is the client with Meniere's on?
Low sodium
114
What two classes of drugs are given in Meniere's?
Antihistamines and diuretics (Diamox)
115
Meningitis is an inflammation of the ___ of the ___ and spinal ___
Linings, brain, cord
116
Meningitis can be caused by ___, ___, and ____.
Viruses, bacteria, and chemicals
117
The 4 most common organisms that cause meningitis are...
Pneumococcus, meningococcus, streptococcus, H. Influenza
118
Child with meningitis is most likely to be (lethargic or irritable) at first.
Irritable
119
What visual S&S will the pt with meningitis have?
Photophobia (over-sensitivity to light)
120
What is the most common musculo- skeletal S&S of meningitis?
Stiff neck - nuchal rigidity
121
Will the pt with meningitis have a HA?
Yes
122
Kernig's sign is positive when there is pain in the ___ when attempting to straighten the leg with the ___ flexed
Knee; hip
123
What type of vomiting is present in meningitis?
Projectile
124
What is the definitive diagnostic test for meningitis?
Lumbar puncture with culture of CSF
125
If the pt has meningitis, the CSF shows ___ pressure, ___ WBC, and ____ protein, ___ glucose
Inc., inc., inc., dec
126
On what type of isolation will the patient with meningitis be?
Contact and respiratory precaution
127
How long will the patient with meningitis be on these precautions?
Until they have been on an ATB for 48h
128
The room of a pt with meningitis should be ___ and ___?
Dark and quiet
129
The client with meningitis can develop ?
Seizures
130
What is opisthotonos?
Arching of back (entire body) from hyperextension of the neck and ankles, d/t severe meningeal irritation
131
If a patient has opisthotonos, in what position would you place them?
Side lying
132
Average duration of menstrual flow is ___. The normal range is ___ to ___ days.
5 days, 3-6
133
Average blood loss during menstruation is ____ cc
50-60 cc.
134
Name the two phases of the ovarian cycle
```
Follicular phase (first 14 days),
luteal phase (second 14 days)
```
135
the menstrual cycle, day 1 is the day on which...
Menstrual discharge begins
136
How long does an ovarian cycle last?
28d
137
How many days after ovulation does menstruation begin?
14 days
138
What hormones are active during the follicular phase?
FSH and Estrogen
139
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.
140
If an ovum is fertilized during the luteal phase what hormone will be secreted?
HCG (human chorionic gonadotropin)
141
During menstruation, the average daily loss of iron is ___ mg.
0.5 to 1.0 mg
142
What occurs during the follicular phase of the ovarian cycle?
It accomplishes maturation of the graafian follicle which results in ovulation
143
What type of environmental modification is best for a migraine?
Dark, quiet, environment
144
The long term tx of migraine focuses upon...
Assessing things that bring on stress and then planning to avoid them
145
What type of pain is typical of migraines?
Throbbing
146
Are migraines more or less common in men?
Less
147
Besides pain, ppl with migraines complain of what other S&S?
N&V, and visual disturbances
148
What are the processes occurring in migraines?
Reflex constriction then dilation of cerebral arteries
149
Where is the pain of migraines most likely located?
Temporal, supraorbital
150
Name a drug given to tx migraine?
Sansert (methsergide) (met-i- sir-jide), Cafergot (prophylaxis: Imipramine) (I-mip-a-rine)
151
Are migraine HAs usually unilateral or bilateral?
Unilateral
152
When Inderal is given in migraine headache, is it used to prevent or treat an attack?
To prevent. It does not treat
153
MS is a progressive ____ disease of the CNS.
Demyelinating---cause the loss or destruction of myelin in (nerve tissue).
154
Myelin promotes ___, ___ ___ of nerve impulses.
Fast, smooth conduction
155
With demyelination the nerve impulses become ___ and ____.
Slow, uncoordinated
156
MS affects men more than women (T/F)
False, affects women more than men
157
What age group usually gets MS?
20-40
158
MS usually occurs in (hot/cool) climates
Cool
159
What is the 1st sign of MS?
Blurred or double vision
160
MS can lead to urinary incontinence (T/F)
True
161
MS can lead to impotence in males (T/F)
T
162
Patients with MS should be taught to walk with a ___ -___ gait
Wide-based
163
Why are Adrenocorticotropic Hormone (ACTH) and prednisone given during acute MS?
To dec. edema in the demyelination process
164
For acute exacerbations of MS ___ per IV is often used
ACTH (Corticotropin)
165
What drug can be given to treat urinary retention in MS?
Urecholine, Bethanocol
166
Will the muscles of MS clients be spastic or flaccid
Spastic
167
What 3 drugs can be given for muscle spasms?
Valium, Baclofen (Lioresal), Dantrium
168
Which does Baclofen causes (constipation/ diarrhea)
Constipation
169
Which does Dantrium causes (constipation/ diarrhea)
Diarrhea (Hint: the D's go together, Dantrium and Diarrhea)
170
Patients with MS should have (inc/restricted) fluids
Increased to dilute urine and reduce incidence of UTI
171
The diet of a patient with MS should be ___ -ash
Acid
172
What major sense is affected most in MS (besides vision)?
Tactile (touch) - they burn themselves easily
173
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)
174
In Myasthenia Gravis (MG) there is a disturbance in transmission of impulses at the ___ ____.
Neuromuscular junction
175
The #1 sign of MG is ____ ____ ___
Severe muscle weakness
176
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.
177
MG affects men more than women (T/F)
False, affects women more than men
178
When women get MG they are usually old or young?
Old
179
What neurotransmitter is problematic in MG?
Acetylcholine
A seat a col line
180
What class of drug is used to tx MG?
Anticholinesterases
181
What ending do anticholinesterases have?
-stigmine
182
Are anticholinesterases sympathetic or parasympathetic?
parasympathetic
183
Anticholinesterases will have (sympathetic or cholinergic) side effects
Cholinergic (they will mimic the parasympathetic nervous system
184
What surgery CAN be done for MG?
Thymectomy (removal of thymus)
185
The severe muscle weakness of MG gets better with exercises (T/F)
False, it is worse with activity
186
What will the facial appearance of a patient with MG look like?
Mask-like with a snarling smile (called a myasthenic smile
187
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
188
Besides the Tensilon Test, what other diagnostic tests confirm a diagnosis of MG?
Electromylogram (EMG)
189
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
190
Do you give anticholinesterases with or without food?
With food, about 1/2 hour ac; giving ac helps strengthen muscles of swallowing
191
What type of diet should the pt with MG be on?
Soft
192
What equipment should be at the bedside of an MG patient?
Suction apparatus (for meals), Tracheostomy/ endotube (for ventilation)
193
Name the two types of crises that a MG pt can have
Cholinergic (too much Mestinon); Myasthenic (not enough Mestinon)
194
The #1 danger in Myasthenic and Cholinergic crisis is ___ ___.
Respiratory arrest
195
What words will the client use to describe the pain of an MI?
Crushing, heavy, squeezing, radiating to left arm, neck, jaw, shoulder
196
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
197
What is the #1 S&;S of an MI?
Severe chest pain unrelieved by rest and nitroglycerine
198
Males are more likely to get an MI than females (T/F)
T
199
Due to MI occurs within _____ of symptom onset in 50% of all patients.
One hour
200
What pain medication is given for the pain of a MI (Give three).
Morphine, Demerol, Nitroglycerine
201
What is the reason for giving post MI patients ASA?
To prevent platelets from forming clots in the coronary arteries
202
Name a new drug with anti-platelet activity.
Plavix
203
The three most common complications after MI are ____ _____,_____, and _______
Cardiogenic shock, arrhythmia, CHF
204
In Abruptio Placenta, the placenta ____________ from the uterine wall ____________.
Separates, prematurely
205
Give another name for an MI.
Heart attack
206
What will the activity order
| be for the post-MI client?
Bed rest with bedside commode
207
What is the most common arrhythmia after a MI?
Premature ventricular contractions (PVCs)
208
What cardiac enzymes indicate an MI?
Elevated CPK, LDH, SGOT
209
What serum protein rises soonest after myocardial cell injury?
Troponin
210
Do people without cell damage have troponin in their blood?
No it is only present when myocardial cells are damaged.
211
How soon after cell damage does troponin increase?
As soon as 3 hours (can remain elevated for 7 days)
212
When will the client with an MI be allowed to engage in sexual intercourse after an MI?
6 weeks after discharge.
213
Will fluid resuscitation (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)
214
Will the client with a MI be nauseated?...diaphoretic?
Yes and yes
215
What will the extremities of the client with a MI feel like?
Cold and clammy
216
What is the permanent EKG change seen post MI?
ST wave changes
217
Of CPK and LDH which rises earliest?
CPK
218
What drug will be used to treat PVCs of MI?
Lidocaine
219
Will the client with a MI need 100% O2 for their entire stay in the hospital?
No, just moderate flow (42% or 3 to 6 liters for first 48hours)
220
Clear liquid diet (UC or Crohn's)
Ulcerative colitis diet
221
Bed rest (UC or Crohn's)
UC
222
```
Women mostly (UC or
Crohn's)
```
UC
223
One-layer ulceration's with edema of bowel (UC or Crohn's)
UC
224
Steroids (UC or Crohn's)
Either
225
Steroids (UC or Crohn's)
Either
226
I&O (UC or Crohn's)
Either
227
Rectum & Sigmoid colon (UC or Crohn's)
UC
228
Bloody diarrhea (UC or Crohn's
UC
229
Young adults (UC or Crohn's)
UC
230
Surgery with ileostomy (UC or Crohn's)
Either
231
Ileostomy (UC or Crohn's)
Either
232
Jewish clients (UC or Crohn's)
Either
233
Lesion through all layers of the bowel (UC or Crohn's)
Crohn’s
234
Terminal-distal-small intestine (UC or Crohn's)
Crohn’s
235
Regional enteritis (UC or Crohn's)
Crohn’s
236
Adults, up to 40 (UC or Crohn's)
Crohn’s
237
Lesions form patches (UC or Crohn's)
Crohn’s
238
Sulfa drugs (UC or Crohn's)
Crohn’s
239
Granulomas (UC or Crohn's)
Crohn's---hint: "gran"ny Crohn
240
String sign" on barium enema (UC or Crohn's)
Crohn’s
241
Diarrhea (UC or Crohn's)
Crohn’s
242
Pain & cramping (UC or Crohn's)
Crohn’s
243
Steroids (Prednisone) (UC or Crohn's)
Either
244
The purpose of an upper GI is to detect ___________.
Ulcerations
245
What 3 structures does an upper GI series visualize?
Esophagus, stomach, duodenum
246
Does barium come in different flavors?
Yes
247
What is the most uncomfortable aspect of an upper GI series?
Lying & turning on a hard, flat X-ray table
248
1622. Is fasting required before an upper GI series?
Yes, usually NPO after midnight.
249
How much barium is swallowed?
8oz
250
Barium is ___________ in
| consistency.
Chalky-bitter taste
251
If an ulceration does not reduce by 50% on upper GI in 3
| weeks of medication treatment then _________ is suspected.
Malignancy
252
What are the 3 classic vital signs?
Temperature, pulse, respiration
253
Measurement of vitals requires a doctors orders.
False
254
The temperature of the extremities and skin is (higher/lower) than the core.
Lower
255
List the 5 most common sites in which to measure the temperature.
Oral, axillary, rectal, tympanic, temporal
256
The normal adult temperature via the oral route is..
96.8
257
The normal rectal temperature is..
99.6
258
The normal axillary temperature is
97.6
259
Body temperature is (increased/decreased) with activity.
Increased
260
With any oral temperature device, the meter must be
| ______ the ________, and the ______ must
under, tongue, mouth , closed
261
If your client is 4 years old or younger, should you take an oral temperature?
No
262
Can you measure an oral temperature on an unconscious patient?
No
263
Can you measure an oral temperature on someone with an
| NG tube in place?
No
264
If the client is found smoking, eating or drinking when you
| are about to take a temperature you should wait ______ (at least).
15 minuets
265
Should you use the oral route for measuring temperature when a client has oxygen per nasal cannulae?
Yes
266
People on seizure precaution should have their temperature measured by which route?
Any route except oral
267
People with facial trauma should have their temperature measured by which route?
Any route except oral or tympanic
268
Clients with rectal surgery, should have their temperatures measured by which route?
Any route except rectal
269
People with heart blocks or conduction problems should not have their temperatures taken per _____. Why?
Rectum-vagal stimu lation causes more heart block.
270
When using a glass thermometer it should remain in the
| mouth for _______ minutes.
3-10
271
When using a glass thermometer it should remain in the rectum for _______ minutes.
2-3
272
When using a glass thermometer it should remain in the axilla for _______ minutes.
8-11
273
In the normal adult, which is longer, inspiration or expiration?
Expiration
274
What is the normal respiratory for an adult?
12-20
275
What is the normal respiratory for an adult?
Any respiratory rate below 10 per minute.
276
What is tachynpea?
Any respiratory rate about 24 per minute.
277
Is it acceptable practice to count the number or respiration in 15 seconds and multiply by 4 to get the rate. (T/F)
Yes, if the respirations are regular.
278
What is the pulse?
The surge of blood ejected from the left ventricle.
279
What is the average pulse rate
| for an adult?
72 per minute (60 to 100)
280
What rate classifies as tachy in an adult?
A rate above 100 per minute
281
What rate classifies as brady in an adult?
A rate below 60 per minute
282
Will pain alone increase the pulse rate?
Yes, pain alone can increase the pulse rate?
283
Which finger should never be used to determine a pulse?
The thumb
284
What does it mean to measure an apical pulse?
To auscultate with a stethoscope over the chest to hear the heart rate.
285
If a pulse is irregular how would you determine the rate?
Count one full minute
286
If an apical/radial pulse is regular how would you determine
| the rate?
Count for 30 seconds and multiply by 2.
287
What is an apical-radial pulse?
When 2 nurses measure the apical rate simultaneously with the radial rate for
comp ar ison .
288
How long must an apical-radial pulse be measured?
Always for 1 full minute
289
How many nurses are needed to measure an apical-radial pulse?
Always two (it is never acceptable for one nurse to measure the apical pulse for a minute then measure the radial or a minute.)
290
What is a voiding cystogram?
It is a series of X-rays taken as the person with a full bladder is asked to void.
The X-rays show any reflux of urine back up the ureters (a dye if injected prior to this)
291
Does the client need to have a catheter
| inserted for a voiding cystogram?
Yes
292
Is the client sedated for the voiding
| cystogram?
No
293
Is the client NPO for the voiding
| cystogram?
No, just clear liquid breakfast
294
What problems does a voiding cystogram diagnose best?
Bladder filling problems, vesicoureteral reflux
295
What precautions are necessary for
| males during a voiding cystogram?
Shielding the testicles from the X- rays
296
Is there a bowel evacuation prep for a voiding cystogram
No
297
For what reason are Montgomery straps used?
Permit you to remove & replace dressings without using tape (protects the skin)
298
Sutures in general are removed by the ___ day.
7th
299
Leaving a wound open to air decease infection by eliminating what 3 environmental conditions?
Dark, warm, moist
300
To remove tape always pull
| (toward/away) from the wound.
Toward (this way you don't put pressure/pull on the suture line.
301
Define contusion.
Bruise (internal)
302
Define debridement.
Removal of necrotic tissue from a wound.
303
What is the purpose of a wound drain?
Remove secretions from the area so healing occurs.
304
To prevent germs from getting into or out of a wound you should use what type of dressing?
An occlusive dressing
305
What solution is put onto the skin to protect it from the irritating effects of the tape?
Tincture of benzoin
306
Withwhatisa round closed in first intention?
Sutures or steri-strips, staples
307
What is another name of second
| intention?
Granulation
308
When swabbing an incision you would start at the incision or 1 Inch away from the incision?
Start at the incision and move outward.
309
After you remove soiled dressings and before you put on the sterile dressing you must....
Wash your hands and put on sterile gloves
310
What is meant be the phrase "advance the drain 1 inch"?
You pull the drain out 1 inch.
311
After advancing a Penrose drain you
| (should/should not) cut off the excess drain?
Should
312
When a dressing is saturated, germs
| can enter the wound from the outside. (T/F)
True, by a process called capillary action .
313
When is a bad time to change
| dressings?
Mealtime
314
Define laceration.
Cut
315
Whatisthe#1 difference between sealed & unsealed radiation?
Both are internal forms of radiotherapy however, in sealed, a solid object is placed in a body cavity;
in unsealed a radioactive substance is injected in liquid form into a vein
316
What are the 3 principles the
nurse uses to protect
self when caring for a client with a sealed radioactive implant?
Time, distance, shielding
317
What is another name for external
| radiation therapy?
Beam or X-rays
318
Whatisthe difference
| between external radiation treatment and internal radiation treatment?
In external the tumor is bombarded with x-rays & nothing is placed in the body; in internal there is some radioactive substance introduced into the body
319
Of sealed internal, unsealed internal,
| and external radiation treatment, which is MOST dangerous for the nurse?
Sealed internal, unsealed internal and external radiation treatment is of no danger to the nurse unless the nurse is in the radiation treatment room during the treatment.
320
Should pregnant nurses care for
| patient receiving sealed internal radiotherapy?
No
321
Should pregnant nurses care for a
| patient receiving unsealed internal radiotherapy?
Maybe, as long as they don't contact body secretions.
322
What skin products should
| the patient receiving external radiotherapy AVOID?
No ointments with metals like zinc oxide, no talcum powder
323
Describe the hygiene measures
| the you teach the patient receiving external radiotherapy?
Use plain water only, no soaps, pat dry, can use cornstarch for itch
324
What are the 8 major side effects
| of radiotherapy?
Pruritis, erythema, burning, sloughing of skin, anorexia, nausea & vomiting, diarrhea, bone marrow depression
325
When the patient is receiving radioactive iodine what precautions is/are most important?
Wear gloves while in possible contact with urine, special precautions taken to dispose of the urine.
326
Rape is a crime of passion. (T/F)
False, it is a violent act
327
Most rapes occur involving two
| people of different races. (T/F)
False, usually the same race
328
When must psychological care of the rape victim begin?
In the emergency room
329
Immediately after
| rape,awomanwho iscalmand composed is adjusting well. (T/F)
False, calmness & a composed attitude are SIGNS of Rape Trauma syndrome, (calm person is just as disorganized as the crying and upset lady)
330
Scoliosis is a ______
| curvature of the ______.
Lateral, spine
331
Scoliosis is MOST common in the
_______ and
______ sections of the spinal column.
Thoracic and lumbar
332
Scoliosis in the thoracic spine is
usually convex to the
(left/right).
Right
333
Scoliosis in the lumbar spine is
| usually convex to the (left/right).
Left (*Hint: curve Left in Lumbar)
334
With which other two spine
| deformities is scoliosis associated?
Kyphosis (humpback), Lordosis (swayback)
335
What is Kyphosis?
Humpback in the thoracic area
336
What is Lordosis?
Swayback in the lumbar region (Lumbar, Lordosis)
337
What is the difference between structural and functional scoliosis?
Structural-you are born with; Functional-you get from bad posture
338
What age group should be routinely screened for scoliosis?
Young teens
339
What are the 3 subjective complaints of clients with scoliosis?
Back pain, dyspnea, fatigue
340
What test/exam CONFIRMS the diagnosis of scoliosis?
X-rays of the spine
341
What type of brace is most commonly used for scoliosis?
Milwaukee Brace
342
Name 4 exercises used to treat mild scoliosis.
Heel lifts; sit-ups; hyperextension of the spine; breathing exercises
343
What kind of treatment is done for severe
| scoliosis?
Surgical fusion with rod insertion
344
What type of cast is used post-operatively for scoliosis?
Risser cast
345
What kind of rod is used to "fix" curvature?
Harrington Rod
346
Scoliosis MOST commonly affects _____ _____
| type of clients
Teenage female
347
How many hours a day should the client wear a Milkwaukee brace?
23
348
What solution should be used on the skin where the
| brace rubs?
Tincture of benzoin or alcohol,no lotions of ointments- you want to toughen the skin not soften it
349
Clients with a Milwaukee brace should avoid vigorous
| exercise. (T/F)
True
350
After corrective SURGERY for Scoliosis how is the client turned?
Log rolled (in a body cast)
351
How often should the neurovascular status of the
| extremities of a client in a Risser cast be measured? Fresh post- operatively?
Every 2 hours
352
What is a common complication of a
| client in a body cast (like a Risser cast)?
Cast syndrome
353
What is cast syndrome?
Nausea, vomiting and abdominal distention that can result in intestinal obstruction
354
What group of people get cast syndrome?
Anyone in a body cast
355
Whatisthe treatment of for cast syndrome?
Removal of the cast, NG tube to decompress, NPO
356
How would you, the nurse, assess for
| developing cast syndrome?
Ask the client if they are experiencing any abdominal symptoms-keep track of bowel movements & passing flatus (if not having BMs or passing flatus, cast syndrome is suspected)
357
What causes cast syndrome,
| specifically in a Risser cast?
Hyperextension of the spine by a body cast: the hyperextension interrupts the nerve & blood supply to the gut
358
The inheritance pattern of sickle-cell anemia is _____
| _____.
Autosomal recessive
359
What does heterozygous mean?
It means you only have 1 defective gene from 1 parent.
360
People who are (hetero/homo) have sickle cell
| trait.
Heterozygous
361
What does homozygous mean?
It means you have the defective gene from both parents.
362
People who are (hetero/homo)zygous have sickle cell disease.
Homozygous
363
People with sickle cell TRAIT only carry the disease, they DO NOT have symptoms. (T/F)
True-usually it has occurred that in times of SEVERE stress, the TRAIT does cause some symptoms but not usually.
364
What are the #1 and #2 causes of sickle
| cell crisis?
Hypoxia, dehydration
365
The most common type of crisis that
| occurs is a ______-______ crisis.
Vaso-occlusive criss
366
In vaso-occlusive crisis the vessels become
| occluded with ______ ______.
Abnormal RBC's
367
The abnormal hemoglobin produced by people with sickle cell anemia is called Hgb ______.
Hgb S -- it "sickles"
368
What shape does Hgb S make the RBC's?
Crescent-shaped
369
What are the top 3 priorities in care of the client with sickle-cell crisis?
Oxygenation
Hydration
PAIN control
370
What activity order will the client with sickle cell CRISIS have?
Bedrest
371
Tylenol, Morphine, Demoral, Aspirin which is
| NEVER given to a sickle-cell patient?
Aspirin-it can cause acidosis which makes the crisis and sickling worse
372
At what age is death most likely in sickle cell anemia?
Young adult
373
Sickle-cell anemia symptoms do not appear before
| the age of ____ months due to the presence of _____ ______.
6 months , fetal hemoglobin
374
Sickle cell anemia is most commonly seen in
| blacks/whites
Blacks
375
Should a child in sickle-cell crisis wear tight clothes?
No, it can occlude vessels even more.
376
Spinal cord injuries are more common in males. (T/F)
True
377
In what age range is spinal cord injury most common?
15-25
378
The #1 goal in emergency treatment of spinal cord injury is...
Immobilization of the spine
379
When halo traction is being used to immobilize the spinal cord the client is allowed to _______.
Ambulate
380
When the patient with spinal cord injury is in tongs or
| on a stryker frame or on a circoelectric bed they are on
Absolute bed rest
381
The 2 most common surgeries used to treat a spinal cord injury are ____ and _____ _____.
Laminectomy and spinal fusion
382
What is spinal shock?
It is a common occurrence in spinal cord injury in which the spinal cord swells above and below the level in injury
383
When does spinal shock
| occur?
Immediately or within 2 hours of injury
384
How long does spinal shock
| last?
5 days to 3 months
385
When the spinal cordinjuryisat
| level of _____ to _____ the patient will be a quadriplegic.
C1 to C8
386
When the spinal cord injury is between _____
and
_____, there is permanent respiratory paralysis.
C1 and C4
387
Can the patient with spinal cord injury at C7 level
| have respiratory arrest?
Yes, because even thought his injury was below C4, spinal shock can lead to loss function above the level, however the will not be permanently ventilator dependent-he will breath on when once spinal shock goes away.
388
Spinal cord injury in the
thoracic/lumbar regions result
in ___plegia.
Paraplegia
389
Ifairway obstruction
occursatthe accident site and
you suspect spinal cord injury, what maneuver is used to open the airway?
Modified jaw thrust
390
In spinal cord injury never
| ______ the neck.
I Move, hyperextend
391
How should you change the position of the spinal cord
| injury patient after he has an order to be up? Why?
Slowly, because of severe orthostatic hypotension (they use a tilt table)
392
1769. For the patient with neurogenic bladder you should
| straight catheterize every ____ hours.
6 hours
393
The patient with spinal cord injury will have (flaccid/spastic) muscles.
Spastic
394
Name 3 drugs used to treat spasms.
Valium
Baclofen
Dantrium
395
What is automatic dysflexia or hyperreflexia?
A common complication of quadriplegics in response to a full bladder or bowel.
396
What are the vital sign changes seen in autonomic dysreflexia?
```
Sweating
Headache
Nausea & vomiting
Gooseflesh
Severe HYPERtension
```
397
What do you do first for the client experiencing autonomic dysreflexia?
Raise HOB
398
What do you do second for the client experiencing autonomic dysreflexia?
Check the bladder, check the bowel
399
Do you need to call the doctor for autonomic dysreflexia?
No, only call the doctor if draining the bladder & removing impaction does not work
400
What is the #1 treatment for autonomic dysreflexia?
Drain the bladder, empty the bowel
401
What is the purpose of restricting activity after spinal
| tap?
To prevent headache due to CSF loss
402
Should the client drink after a spinal tap?
Yes, encourage fluids to replace CSF
403
Do you need an informed consent for a spinal tap?
Yes
404
Should CSF contain blood?
No
405
Does the client have to be
| NPO before a spinal tap?
No
406
What is the normal color of cerebrospinal fluid?
Clear, colorless
407
Into what space is the needle
inserted during a spinal
tap?
Subarachnoid space
408
Can the client turn side-to-side after a
| spinal tap?
Yes
409
In what position should the client
| be during a spinal tap?
Lateral decubitus (on their side) position and knees to chest
410
Identify the activity restriction
| necessary after lumbar puncture?
Lie flat for 6 to 12 hours
411
What are the 2 purposes of a
| spinal tap?
To measure or relieve pressure and obtain a CSF sample
412
Does the client have to be sedated
| before a spinal tap?
No
413
Antibiotic (Define)
A drug that destroys or inhibits growth of micro-organisms
414
Asepsis (Define)
Absence of organisms causing disease
415
Antiseptic (Define)
A substance used to destroy or inhibit the growth of pathogens but not necessarily their spores (in general SAFE TO USE ON PEOPLE)
416
Disinfectant (Define)
A substance used to destroy pathogens but not necessarily their spores (in general not intended for use on persons)
417
Bactericide (Define)
Substance capable of destroying micro-organisms but not necessarily their spores
418
Bacteriostatic (Define)
Substance that prevents or inhibits the growth of micro-organisms
419
Anaerobe (Define)
Micro-organisms that do not require free oxygen to live
420
Aerobe (Define)
Micro-organisms requiring free oxygen to live
421
Pathogen (Define)
Micro-organism that causes disease
422
Clean technique
| Define
Practices that help reduce the number & spread of micro-organisms (synonym for medical asepsis)
423
Sterile (Define)
An item on which all micro-organism have been destroyed
424
Coagulate (Define)
Process that thickens or congeals a substance
425
Host (Define)
An animal or a person upon which or in which micro- organisms live.
426
Portal of entry (Define)
Part of the body where organisms enter
427
Contaminate (Define
To make something unclean or unsterile
428
Surgical asepsis (Define)
Practices that render & keep objects & areas free from all micro-organisms (synonym for sterile techniques)
429
Medical asepsis (Define)
Practices that help reduce the number & spread of micro- organisms (synonym for clean techniques).
430
Spore (Define)
A cell produced by a micro- organism which develops into active micro-organisms under proper conditions.
431
Which hand should hold the suction catheter?
Which
should hold the connecting tube?
The dominant, the non- dominant
432
The nurse should use (medical/surgical)
| asepsis during airway suction?
Surgical asepsis (sterile technique)
433
What kind of lubricant should be used on the suction catheter?
Sterile water-soluble
434
Should the suction be continuous or
| intermittent?
Intermittent to prevent mucosal damage
435
For how long should suction be applied
| during any one entry of the catheter?
10 seconds
436
How often should the nurse clear the tubing during suctioning?
After each pass/entry/removal
437
Which way would you turn the client's head to suction
the right mainstem bronchus?
The left mainstem bronchus?
To the left, to the right
438
The best client position during airway suctioning is _______.
Semi-fowlers
439
The suction should be delivered while
| (inserting/removing) the catheter.
While removing the catheter
440
What outcomes would indicate that suctioning was effective?
Clear even lung sounds, normal vital signs
441
How often should the client's airway be suctioned?
When it needs to be, for example moist lung sounds, tachycardia, restlessness (hypoxia), ineffective cough
442
The unconscious client should assume what position
| during suctioning?
Side-lying, facing nurse
443
If not contraindicated, what action by the nurse, before suctioning, would most likely reduce hypoxia during suctioning?
Administer a few breaths at 100% oxygen before beginning.
444
What solution should be used to clear the tubing
| during suctioning?
Sterile saline
445
With what size catheter should an adult's airway be suctioned?
12 to 16 French
446
How much suction should be used for an infant?
Less than 80 mm Hg
447
How much suction should be used for a child?
80to100mmHg
448
How much suction should be used for an adult?
120to150mmHg
449
Doyouassessfor suicide potential
whenever a
patient makes any statement about wanting to die or kill self?
Yes, in fact whenever a patient makes a statement about wishing or wanting to die or kill self you must ALWAYS AND FIRST assess for suicide potential*-stop everything and assess for suicide patient (except CPR, of course
450
Children are at _____ risk for suicide.
Low risk for suicide
451
```
Adolescents are (low/high) risk for
suicide.
```
High
452
The use of pills makes the patient
| (low/moderate/high) risk for suicide.
Moderate
453
The patient who has NO definite plan is
| (low/high) risk for suicide.
Low risk
454
The use of _____, _______, and ______ to kill self,
| make high risk suicide.
Guns, ropes, knives
455
Who is at higher risk for suicide, a man or awoman?
Man
456
Of: married, divorced, and
| separated, which marital status is highest risk for suicide? Lowest risk of suicide?
Highest-separated then divorced Lowest-married
457
The goal of action while the suicidal
| patient is still off the phone is to get _______ person _______ the ______
Another person on the scene (it then immediately decreases risk) Remember: people who are alone are always high risk
458
Once the patient is admitted for
| attempted suicide should you ever discuss the attempt with them?
pt, focus on the present and future.
459
-pathy
Disease, suffering
460
-penia
Lack, deficiency of
461
-sect
To cut
462
-plast
Plastic surgery on a specified part
463
-sclerosis
Hardening of a tissue by: inflammation, deposition of mineral salt; an infiltration of connective tissue fibers
464
-centesis
A perforation or puncture
465
-genic
Produce, originate, become
466
-emia
Blood
467
-otomy
Butting
468
-pexy
Fixation of something
469
-atresia
Condition of occlusion
470
-desis
Binding, fusing
471
-cele
Combining form meaning a tumor or swelling or a cavity
472
-cis
Cut, kill
473
-rhapy; -rrhapy
Joining in a seam, suturatio
474
-scope; -scopy
Instrument for observation
475
-osis
Indicates condition, process
476
-oma
Tu mor
477
-ostomy
Surgical opening
478
-stasis
Stoppage
479
-itis
I n flammation
480
-ology
Study of; knowledge, science
481
-lysis
Breaking down
482
-ectomy
Surgical removal of
483
-tripsy
Crushing of something by a surgical instrument
484
-ase
Used in naming enzymes
485
-gram; -graphy
Write; record
486
Syphilis first infects the
Mucous membranes
487
What are the stages of syphilis?
Primary, secondary, latent, late
488
Syphilis is a fatal disease if untreated. (T/F)
True
489
What organism causes syphilis?
Treponema palladium
490
What is the lesion like in primary syphilis?
The chancre (pronounced shanker)
491
The chancres of syphilis are
| painful/painless
Painless
492
Chancres disappear without treatment. (T/F)
True
493
Late syphilis attacks which 3 body organs?
Liver, heart, brain
494
What test CONFIRMS the presence of
| syphilis?
Dark-field illumination of the treponema palladium
495
What is the treatment of choice for syphilis?
Pencillin
496
Why is penicillin administered with
Procaine?
With Probenecid?
Procaine makes the shot less painful; Probenecid blocks the excretion of penicillin
497
Whatisthemost common sign of
| neurosyphillis?
Ataxia (gait problems)
498
What does TENS stand for? Hey
Transcutaneous electrical nerve stimu lator
499
. Is it an invasive procedure?
No, the skin in never broken.
500
Can TENS be used for acute or chronic pain?
Both
501
TENS use is based upon the _______ _______ of pain relief.
Gate control
502
TENS electrodes stimulate (Large/small) diameter fibers.
Large-this is the basis of gate control theory.
503
TENS electrodes are placed into the ..
Skin
504
Can TENS units be placed over an incision to
| decrease incisional pain?
Never
505
Patient with what other mechanic device in use cannot use
| TENS?
Cardiac pacemaker
506
How often should the patient be taught to change the TENS electrodes?
Every day
507
How is a dorsal-column stimulator different than a TENS
| unit?
Dorsal column stimulation electrodes are surgically implanted by the spinal cord; the patient has to undergo a laminectomy to place the DCS electr od es.
508
In what group of clients is thoracentesis
| contraindicated?
Uncooperative, bleeding disorders
509
. What instruction is most important to give the client undergoing thoracentesis?
Don't move or cough
510
What is thoracentesis?
The pleural space is entered by puncture & fluid is drained by gravity into bottles-allows the lungs rto re-expand
511
If a client has a cough, what should be done before
| thoracentesis?
Give him a cough suppressant.
512
Does thoracentesis require a signed
| informed consent?
Yes, it invades a body cavity.
513
Describe the position the client should assume during a thoracentesis?
Upright with arms & shoulders elevated, slighting leaning forward
514
What is exopthalmos?
Bulging outward eyes
515
To care for a patient with
| exopthalmos the patient should wear _____ _____ and use _________ ________.
Dark sunglasses, artificial tears
516
Radioactive iodine is given to hyperthyroid patients because it _______ ______ plus decreases production of ________ _______.
Destroys tissue, thyroid hormone
517
The #1 problem with using Propylthiouracil is ____.
Agranulocytosis
518
What do you teach to all patients on drugs which have granulocytosis as a side effect?
Report any sore throat immediately
519
Lugols solution decreases the _________ of the thyroid gland.
Vascu lar ity
520
Lugols solution should be given _____a ______ to prevent staining of the teeth.
Through a straw
521
SSKI should be given with _____ ______ to decrease the
| ________
Fruit juices; bitter taste (SSKI-super saturated sollution of potassium iodide)
522
Patients with either hypo or hyper thyroid can go into thyroid storm. (T/F)
True
523
Give another name for thyroid storm
Thyrotoxicosis, thyroid crisis
524
In thyrotoxicosis, the temperature ______; the heart rate ______ and the patient becomes __________.
Increases (106);
increases;
deliriou s/comatose
525
What is the first thing a nurse does when thyroid storm occurs?
Give oxygen
526
What is the 2nd thing a nurse does when thyroid crisis occurs?
Call MD, can pack in ice or use hypothermia blanket
527
What are the side effects of thyroid replacement drugs?
Tachycardia, palpitations and other signs seen in hyperthyroidism
528
Why is Lugols solution given pre- operatively thyroidectomy?
To decrease the vascularity of the gland & minimize blood loss
529
After thyroidectomy you check for wound hemorrhage by...
Slipping your hand under the neck and shoulders.
530
The #1 complication of thyroidectomy in the first 8 to 12 hours is __________.
Hemorrhage-or maybe airway
531
When moving the fresh post- operative thyroidectomy patient you must take care to never _____
Move the neck
532
Post-operatively thyroidectomy patients will have sand bags on either side of the ______.
Neck
533
Why do you assess the post-operative
| thyroidectomy patient's voice for hoarseness periodically?
Because during surgery the surgeon may have nicked the recurrent laryngeal nerve. (This nerve is tested on the state boards!)
534
Will the post-operative thyroidectomy patient be allowed to talk?
He is on the voice rest unless you are assessing his voice
535
What positions should the post-operative
| thyroidectomy patient be?
Semi-fowlers with neck supported in midline
536
What3piecesof equipment must be in the room with thyroid storm?
Suction, tracheotomy set, oxygen
537
What calcium imbalance is common in the post-op thyroidectomy patient?
Hypocalcemia-due to accidental removal of the parathyroids.
538
When is hypocalcemia most likely to occur after thyroidectomy? Why?
The 2nd and 3rd post operative day-because it takes awhile for the level to drop.
539
Hypocalcemia will cause (tetany/severe muscle weakness).
Tetany
540
What drug is used to treat decreased
| calcium?
Calcium gluconate
541
What is Chvostek's sign?
A sign of hypocalcemia, it is when you tap the cheek, the patient puffs out the cheeks. (CHvostek and CHeeks)
542
What is Trousseau's sign?
It is a sign or hypocalcemia-it is when you get a carpopedal spasm of the hand when you apply a blood pressure cuff to the lower arm.
543
What is the earliest sign of hypocalcemia?
Tremors/tingling
544
Should you palpate the thyroid of the
| hyperthyroid patient after ectomy?
No, it the could send them into thyroid storm
545
Can dental work send a hyperthyroid client into thyroid storm?
Yes, any stress can.
546
1929. Give another name for TPN.
Hyperalimentation
547
Hyperalimentation contains
| hypertonic ___, ____ acids, ______, ______, and _____.
Glucose, amino acids, water, minerals, vitamins
548
TPN can be safely given via a central
| line. (T/F)
Yes, this is the preferred route.
549
TPN can be safely infusedviaa
| peripheral IV line. (T/F)
It can, but only for a very short period (48 to 72 hours maximum).
550
If a TPN solution is running too slow
and is 2 hours behind
can you increase the rate 20%. (T/F)
No, never ever speed up the rate.
551
If a TPN infusion runsintoofastit
| creates a ____ osmolar imbalance.
Hyperosmolar-because of all the solu tes
552
It is okay however toslowtherate
| down if the client leaves the unit. (T/F)
False, never slow the rate down-it could cause hypoglycemia.
553
What tests must the nurse perform
| every 6 hours when apatientison TPN?
#1 accu check, #2 urine glu cose/aceton e
554
IV lipid emulsions can be given
| central or peripheral. (T/F)
True
555
Be certain to shake a lipid emulsion
| before admininstration. (T/F)
False, never shake it, shaking damages the molecules.
556
Into which port of a peripheral IV line can a lipid infusion be piggybacked?
The port closest to the insertion catheter site. More recently, lipids are included in the hyperalimentation bag & there is no separate administration of the lipids
557
What is meant by tracheo-
| esophageal malformation?
These are a group of congenital birth defects in which the esophagus and trachea are malformed.
558
What are the 3 most common tracheo-esophageal malformations?
1) Esophageal atresia-EA,
2) tracheo-esophageal fistula-TEF
3) tracheo- esophageal fistula with esophageal astresia- TEF w/EA
559
What is the defect called esophageal fistula?
An opening between the esophagus & trachea but the esophagus is connected to the stomach & trachea is connected to the lungs.
560
Of: tracheo-esophageal fistula, esophageal atresia, and tracheo-esopheal astresia with fistula, which is the most common?
Tracheo-esophageal fistula with esophageal astresia
561
Name-a blind end esophagus: the trachea is connected to the lungs.
Simple esophageal atresia
562
Name-the trachea is connected to the lungs, the esophagus is connected to the stomach, but there is a hole connecting the trachea and the esophagus.
Tracheo-esophageal fistu la
563
Name-a blind end esophagus, the trachea is connected to the lungs, and the trachea and esophagus are joined.
Tracheo-esophageal fistula with esophageal astresia
564
. If an infant has tracheo- esophageal fistula with esophageal
atresia, what 3 signs will show up at first feeding?
Three C's-coughing, choking, cyanosis
565
In an infant chokes, coughs, or gets cyanotic during the first feeding what should the nurse do to ASSESS for tracheo-esophageal fistula with espophageal atresia?
Attempt to gently pass a catheter into the esophagus if you meet resistance STOP, there most probably is esophageal atresia.
566
How is the diagnosis of tracheo-esophageal fistula with esophageal atresia confirmed?
X-ray with barium
567
Prior to surgery for repair of tracheo-esophageal fistula with esophageal atresia, how is the infant fed?
They are NPO but fed by G-tube (gastronomy)
568
Does a tracheo-esophageal fistula with esophageal atresia have to be repaired immediately?
No-can be maintained with G-tube feedings and suctioning until are old enough & stable enough to tolerate surgery.
569
The #1 problem for infants with un-repaired tracheo- esophageal fistula with esophageal atresia is..
Aspiration, secondary problem in malnutrition.
570
How do you meet the oral sucking needs of an infant with with un-repaired tracheo-esophageal fistula with esophageal atresia?
Use pacifiers, even though they don't take anything orally, they should still be encouraged to suck.
571
How should an infant with tracheo-esophageal fistula with esophageal atresia be positioned?
HOB up 30 degrees.
572
Should you suction the blind esophageal pouch of esophageal atresia?
Yes, PRN, otherwise they may aspirate mucous
573
What is the common cleaning solution used during tracheostomy care?
Hydrogen peroxide
574
Cut the old trach ties (before/after) you have secured the new ties in place.
After
575
Is it acceptable to scrub the inside of the tracheostomy cannula with a brush during tracheostomy care?
Yes, it is desirable
576
What are the 2 major reasons for performing tracheostomy care?
To keep the airway patent, to keep the stoma site clean (decrease infection)
577
Tie the ends of the trach ties in a (bow knot/double knot).
Only a double knot
578
Trach care is performed by (clean/sterile) technique.
Sterile
579
What must you do before performing trach care (besides wash your hands)?
Suction the airway
580
A properly snug set of trach ties allows _______ finger(s) to be placed between the neck and ties.
One
581
Both hands must be kept sterile throughout the entire trach care procedure. (T/F)
False, only the dominant hand remains sterile
582
When trach suctioning and care is performed by the client at home, sterile technique must be followed. (T/F)
False, clean technique is adequate
583
What is another name for trigeminial neuralgia?
Tic douloureux
584
Which cranial nerve is affected by trigeminial neuralgia?
Cranial nerve 5
585
What is the #1 symptom of trigeminial neuralgia?
Episodic, severe one- sided facial pain
586
What drug treats trigeminial neuralgia?
Tegretol
587
What triggers attacks of trigeminal neuralgia?
Breezes, cold or hot food s/flu id s, tooth brushing, chewing, touching the face, talking
588
Is surgery done for trigeminal neuralgia?
Yes, nerve avulsion (destroying the nerve)
589
What environmental modifications are necessary in care of the patient with trigeminial neuralgia?
Prevent drafts or temperature extreme.
590
What dietary modifications are necessary in the care of a patient with trigeminal neuralgia?
Lukewarm, small frequent semi-solid food s
591
After surgery for trigeminial neuralgia, the patient's affected eye will be ______ and the patient should chew food on the _________ side.
Protected; unaffected
592
What organism causes pulmonary TB?
Mycobacterium tuberculosis
593
The mode of transmission of the mycobacterium
| tubercuolsis organism is by _____ _____.
Droplet nuclei
594
What living conditions predispose you to TB?
Crowded, poorly ventilated
595
The incubation period of tuberculosis is...
4to8weeks
596
What is the typical lung lesion in TB called?
A tubercle
597
In TB, the appetite is ____; the client _______ weight and the temperature ________ in the _______
Decreased, loses, elevates, afternoon
598
In TB, the appetite is ____; the client _______ weight and the temperature ________ in the _________.
Decreased, loses, elevates, afternoon
599
What is a Mantoux test?
An intradermal skin test to screen for TB-called PPD
600
When should a Mantoux test be read?
48 to 72 hours after test injection
601
What qualifies as a positive Mantoux?
More than 10 mm induration (hardness), remember redness has nothing to do with the test being positive
602
Name three drugs given to treat TB.
Isoniazid, Rifampin, Ethambutol
603
How often and when during the day should Isoniazid,
| Rifampin, and Ethambutol be given?
Every day, all together
604
What is the #1 side effect of Isoniazid?
Peripheral neuritis-take B6 to prevent
605
After how many weeks of drug therapy is the client considered NO LONGER contagious?
2to4weeks
606
What isolation techniques are required for TB?
N-95 masks
607
What test is most diagnostic for TB?
Sputum for acid-fact bacilla
608
What does the sputum look like in TB?
Purulent (pus) or hemoptysis (blood)
609
When should you obtain a sputum specimen for acid fast bacilli TB?
Early AM
