CAT Tests Flashcards
what precautions are needed with MRSA pneumonia?
contact precautions- gloves, mask, gown, eyewear as appropriate whenever direct contact with body fluid is expected
limited to sputum in this example
most commonly spread through personnel’s hands
during a blood transfusion, if the temperature increases by less than 1 degree F, then you ______
CTM
not a febrile reaction
pursed-lip breathing allows for longer ______ to excrete CO2
longer
used for COPD patients
client purses lips so that expiration is 3x longer than inspiration
helps slow down breathing
normal serum sodium levels
136-145 mEq/L
insulin is excreted by the _______
KIDNEYS
in CKD, the kidneys function less efficiently and insulin remains in the circulation longer
In the NCLEX world, are you allowed to crush all pills and mix them together in water then administer them through an NG tube?
NO
each drug should be dissolved separately
flush with 15mL between meds reduces risk of obstruction and med incompatibility in NG tube
bluish skin over sacral and gluteal area of newborn is called
mongolian spots
common in infants of african american, native american, and mediterranean descent.
they disappear spontaneously during early years and are of no clinical significance
pink patches on nape of neck of an infant are
stork bites, telangiectases
gradually fade and are of no clinical significance
lateral recumbent position is best for
lumbar punctures
can you administer a pregnancy category A drug to a pregnant client?
yes, type A poses no risk to human fetus and can be safely administered
should arms be straight when using a walker?
should the bilateral leg weakened client push the two-wheeled walker first before taking first step?
no, slightly bent
yes
advance walker with good leg with one sided weakness, not bilateral
is the pneumococcal vaccine a one time dose given at 65?
yes
only given a second shot if the 1st dose was given at 60 (5 years prior)
how often do you need a tetanus booster at 65+
every 10 years
if a transfusion reaction occurs, do you obtain a urine specimen?
do you discard the blood bag and tubing?
do you run NS after?
do you notify blood bank?
yes, you check for presence of hemoglobin as a result of RBC hemolysis
you need to send the blood bag and tubing to the lab after the reaction
yes, run d/c blood tubing and connect NS infusion to maintain open IV line
yes, notify blood bank!
client has NG to suction after bowel obstruction… client is at risk for what acid base imbalance?
metabolic alkalosis d/t loss of acid in gastric fluid (suctioned out)
metabolic acidosis cause by excess acid in blood (renal failure, dehydration)
respiratory alkalosis- caused by CO2 ____ in blood and occurs with ____-ventilation
loss
hyperventilation
respiratory acidosis is caused by _____ CO2 in blood usually caused by ______ air movements in lungs
excess CO2
decreased air movement
ketorolac is an
NSAID
pain, anti-inflammatory
hypromorphone hydrochloride, codeine sulfate and hydrocodone are all
opioids and cause respiratory depression
codeine- weaker opioid, used for mild to moderate pain
hydrocodone- more potent opioid, used for severe pain
which abbreviations do you have to write out?
HS, SC, QD, Qid, PRN
HS, SC, QD can be confused
Qid and PRN are fine
ST depression of 2mm or more indicates
ischemia
QRS duration greater than 0.12 seconds may signify
PVCs
PR interval greater than 0.2 seconds indicates a
heart block
an ST segment elevation of 2mm or more indicates
MI
Is Raynaud phenomenon, HTN, joint pain and BUN=40 common in SLE?
yes, pallor in fingers is common
HTN is expected cardiac side effect, pericarditis is the most common cardiac finding
joint symptoms occur in 90% of SLE population
NO! BUN=40 is well above range of 10-20. also nephritis is the most common renal problem, this needs to be managed to prevent kidney failure
after a needle stick injury, the nurse must initially
wash with soap and water
then
notify manager ASAP
sharp, localized, unilateral chest pain is associated with
pneumothorax
severe substernal chest pain radiating down the left arm is associated with
MI
sharp, burning chest pain moving from one location to another is associated with
extreme anxiety or panic attack
can you give a suppository to an unconscious patient?
yes
bypasses need to swallow medication
is external radiation excreted in the client’s bodily fluids?
NO
severe hypothermia, what is the most important concern?
assess cardiac monitor for dysrhythmias (ventricular)
which vital sign is out of range for a post-op anesthesia client? SpO2 85% BP 90/60 HR 58bpm Temp 100.4F
SpO2 85%
all others are in normal range for post-op client
the tongue extrusion reflex is a
natural reflex for an infant who is not developmentally ready for solid foods
disappears around 4-6 months when solid food can be safely introduced into the diet
what is autologous blood transfusion?
when you donate blood pre-surgery to be transfused post-surgery
which of the following conditions would prevent an autologous transfusion?
acute infection cancer diagnosis AB negative blood type hemoglobin= 8.9 unstable angina
acute infection- risk of bacterial contamination in blood
cancer diagnosis- risk of spreading malignant cells
Hg= 8.9 indicates anemia
unstable angina- C/I as loss of blood via the donation may precipitate an MI
cor pulmonale is another term for
right sided HF
what is a sign of cor pulmonale?
JVD
white frothy sputum is a sign of
left sided HF
finger clubbing is a sign of
chronic hypoxemia
seen in COPD
a client violently vomits in a nurse’s face, what does the nurse do?
- wash face with copious amounts of soap and water
- inform manager
- go to employee health services, start prophylactic treatment
- inform client that they will need to be tested for blood-borne infections
- fill out incident report detailing what happened
false labor
contractions are irregular and do not increase in frequency, duration, and intensity
feels like menstrual cramps
no bloody show
in true labor, walking _____ contractions
intensifies
brings about cervical effacement and dilation
Rights of Delegation
- right supervision
- right person
- right circumstance
- right direction
- right communication
- right supervision: appropriate monitoring and intervention if needed, follow up
- right person: has experience and knows what to do
- right circumstance: using the appropriate client and setting to determine if the delegated task is appropriate. NAP and LPN should not be caring for an unstable client
- right direction: giving clear, concise direction of the delegated task
- right communication: clear directions
promethazine, ondansetron, and scopolamine are all drugs to help with
N/V
promethazine: antihistamine. AE: sedation, dry mouth
ondansetron: serotonin antagonist. none of AE as promethazine
scopolamine: anticholinergic used for motion sickness and N/V
meperidine and hydromorphone are
opioid analgesic for severe pain management
alendronate is a drug to treat
osteoporosis
alendronate should be taken
on an empty stomach with a full glass of water to prevent acid reflux
can take anytime throughout the day
client must remain upright for 30 minutes after taking it to prevent esophagitis
if a patient has heart burn they should eat ____ frequent meals to prevent over distention of the stomach
MORE
should also not eat 2-3 hours before bed, weight loss helps, lifting head of bed helps
insulin glargine is a ____-acting insulin
long
onset 1-1.5 hours
lasts 24 hours
when transitioning a DKA client from a short acting insulin drip to insulin glargine, you should keep the regular insulin running for ______ hours after administering the glargine
1-2 hours
prevents hyperglycemia by allowing the long acting to kick in before stopping the short acting insulin
when a DKA client is making this transition, they are stable
in SLE, we educate clients to wear _____
sunscreen
prevents rashes and photosensitivity
in SLE patients, especially adolescent females, a ____ rich diet is recommended for those taking corticosteroids
Ca+2
the priority nursing diagnosis for a client in a sickle cell crisis is ineffective ________
ineffective peripheral tissue perfusion
cerebral tissue perfusion is a concern but not the highest priority
when does the Babinski reflex disappear?
2 years
dorsiflexion and fanning of toes when bottom of foot is stroked
internal radiation
people should not be in the room without a dosimeter badge to monitor radiation exposure
trash may be too radioactive to service like other trash
family should only come for 30 minutes, minimal risk
pregnant individuals are at most risk- teratogenic-related abnormalities
venous ______ are a serious complication of venous insuffiency
venous ulcerations
when you see apathy and depression in a withdrawal patient, that is likely from a _____ withdrawal
stimulant
legumes, grains and fish should be encouraged for a ____ deficient diet
Vitamin B1 deficient
tomatoes, potatoes and fruit juice is appropriate for a vitamin __ deficient patient
C
leafy vegetables, eggs, and cheese is appropriate for a vitamin ___ deficient patient
K
liver, sweet potatoes, and carrots are appropriate for a vitamin ___ deficient patient
A
exenatide stimulates the pancreas to secrete ______ when blood sugar levels are high
insulin
exenatide should be administered
twice a day within 1 hours before the morning and evening meals
_____ precautions are implemented when caring for a client with measles for up to 4 days after the onset of rash
airborne
_______ precautions are used for clients with diphtheria, rubella, streptococcal pharyngitis, pertussis, mumps
droplet
c-diff requires _____ precautions
contact
hypocalcemia results from blood transfusions containing _____
citrate
citrate from blood transfusions causes _____ cell membrane permeability leading to increased neuromuscular excitability, which may result in
increased
numbness or tingling in ears, nose, fingers and toes d/t citrate causing hypocalcemia
if severe, laryngospasm, seizures, and cardiac arrest may occur
hypercalcemia causes _____ neuromuscular excitability
S&S?
decreased
S&S: fatigue, hypoactive deep tendon reflexes, decreased muscle strength and tone, bone pain, decreased GI motility
hyponatremia results in fluid shifts into cerebral spaces causing ______
cerebral edema
can results in seizure, coma, respiratory arrest
hypernatremia causes fluid to shift ____ of the intracellular fluid resulting in cellular _____
out
dehydration
cerebral vessels shrink and tear, resulting in cerebral hemorrhage
S&S: lethargy, irritability on stimulation, high pitched cry
hypocalcemia is anticipated with ______ processes
alkalotic
serum potassium levels are often _____ in metabolic acidosis
HIGH
as pH drops, excess H ions enter RBCs causing K+ to leave the cells, resulting in hyperkalemia
a client who is fatigue, dry skin, poorly healing wound likely is experiencing
malnutrition
starvation can lead to metabolic _______
acidosis
low bicarb levels
cyanosis of the tongue, jaundiced skin and slow capillary refill are common with what patients?
sickle cell
cyanosis of tongue- poor profusion
jaundices- rapid breakdown of RBCs
slow cap refill- poor capillary profusion
*slurred speech is not common- indicates stroke!
BNP normal value
<100
elevated BNP indicates congestive HF
sedimentation rate: normal values
Men under 50: <15 mm/h
Men over 50: <20 mm/h
Females under 50: <25 mm/h
Females over 50: <30 mm/h
elevated sedimentation rate indicates
inflammatory process going on
elevated CRP indicates
inflammation, tissue injury, infection, atherosclerosis
CRP normal value
1 mg/L
INR warfarin therapeutic range
2.5-3.5 seconds
elevated INR indicates high risk of _____
bleeding
takes longer for blood to clot
the term station in OB means
the relationship between the presenting fetal parts to the ischial spines
placing a client recovering from an above the knee amputation in a ____ position prevents the development of hip contractures
prone
30 minutes, 3-4x/day
elevating the limb on a pillow for 2 hours and sitting in a chair for greater than an hour both encourage the development of hip contractures
can NAPs bladder scan even with nurse supervision
NOT IN THE NCLEX WORLD!
Contractions occurring at 2-4 minute intervals lasting 50-60 seconds are seen in the ____ phase of labor
active
contractions occurring at 5-30 minute intervals and lasting 10-30 seconds are seen in the _____ phase of labor
latent
contractions occurring at regular 2-3 minute intervals and lasting 1-2 minutes are seen in the _____ phase of labor
transition
the nurse should ___ document in a note that an incident report was completed
should NOT
is massaging the injection site appropriate after a SQ injection?
no
hypercalcemia –> nurse should encourage
movement
increase fiber to prevent constipation
fluids (at least 3L/day) to prevent exacerbation, especially fluids with Na in it
administer zoledronate
zoledronate is a biphosphonate drug that inhibits the action of osteoclasts and therefore _______ serum Ca+2 levels
reduces
rhabdomyolysis results in ____ breakdown and can lead to ________ putting the kidneys at risk for an AKI
muscle breakdown
myoglobinuria
need to keep the client hydrated and a UO of 200-300 mL/hr
creatinine kinase vs. creatinine
creatinine kinase- evaluates muscle function
creatinine- evaluates renal function
amylase is released by the
pancreas
monitored in pancreatitis
relief of severe ABD pain radiating to the back by sitting forward with knees bent is seen in a client with
acute pancreatitis
scabicide should be applied to the
neck and down
not on the face or scalp
cushings triad for increased ICP S&S
HTN (widened pulse pressure)
bradycardia
bradypnea (irregular)
*opposite of shock
other S&S: weakness, lethargy, HA, vomiting, blurred vision, changes in behavior
in _____ patients, the sclera and buccal mucosa will be yellow in color
hepatitis
a AKI patient is at risk for_______
hyperkalemia
AKI patients should avoid: potatoes, raisins, bananas because they are high in
potassium
pasta is a good source of caloric needs and energy for patients with an
AKI
low in K+ and meeds needs
acute osteomyelitis
bone pain, redness, swelling
ABX tx at home
elevated BNP indicates
congestive heart failure
released from ventricles when not performing well
<100 normal
excess fluid volume r/t increased venous pressure and decreased renal perfusion secondary to heart failure
thyroid crisis post op thyroidectomy
first 12 hours post-op
S&S of hyperthyroidism are exaggerated
S&S: N/V, severe tachycardia, severe HTN, hyperthermia up to 106F
S&S of hypothyroidism- expected findings
cold intolerance, constipation, depression
cataracts cause vision to appear
cloudy
glaucoma causes a gradual loss of
peripheral vision
with a , ______ ________ there is a sudden loss of partial or complete vision in one eye
detached retina
change in central vision described as blurry or distorted describes
macular degeneration
maternal ______ with possible reduction in placental perfusion is most likely to occur within the fist 15 minutes after initiating an epidural or injection of intermittent boluses
hypotension
formoterol is a long-acting
bronchodilator
imipramine
tricyclic antidepressant
increase serotonin in brain
take at night to prevent daytime drowsiness and aid in sleep
masks and oxygen concentration
partial rebreather mask delivers 60-90% oxygen
venturi mask delivers high flow oxygen (40%)
non-rebreather mask delivers 60-90% oxygen
simple face mask doesn’t provide a precise percentage of oxygen
what is a common complication of oxygen therapy in very low birth weight preterm newborns?
visual impairment or blindness d/t injury of developing retinal blood vessels is sometimes precipitated by high levels of oxygen
what kind of exercises do you want for osteoporosis therapy
weight-bearing
medicare uses a fixed reimbursement amount based on assigned
diagnosis-related groups, regardless of patient’s length of stay or use of services
diagnosis-related group reimbursement group is based on case severity, rural/urban/regional costs, and teaching costs, not national averages
hypotension with a narrow pulse pressure is a clinical manifestation associated with
cardiogenic shock
ex: 100/88
how to prevent tumor lysis syndrome
administer high rate of fluids and sodium bicarbonate to prevent effects of tumor lysis syndrome (hyperkalemia, hyperuricemia, cardiac failure, renal failure)
eschar is
a thick, leathery coating caused by acid or heat exposure
liquefaction necrosis indicates
chemical burn process is continuing
intact blisters indicate a ______-________ thermal injury
partial thickness
primary open angle glaucoma is
painless
ophthalmic drops are prescribed and clients need to know how to use them
check meds they take to see if any increase intraocular pressure
constipation prevention
exercise 3x/week
avoid caffeine, tea, cola
drink 3 quarts fluids/day
consume 20-30g fiber/day
diarrhea, HTN, emesis are side effects of
opioid withdrawal
-rebound effects
diverticular disease dietary recommendations
high fiber, 8 8 ounces of water/day, limit red meat, low fat diet to reduce risk of constipation
avoid alcohol- irritate GI tract lining
diverticula are little pouches that form in the colon. when they become inflamed, it is diverticulitis
type 2 diabetes drugs: metformin, glipizide, repaglinide, miglitol
Metformin, a biguanide, controls blood glucose levels in type 2 diabetes by inhibiting glucose production in the liver and increasing insulin sensitivity in body tissues.
Glipizide, a second-generation sulfonylurea, controls blood glucose levels in type 2 diabetes by stimulating pancreatic beta cells to secrete insulin.
Repaglinide, a meglitinide, controls blood glucose levels in type 2 diabetes by stimulating pancreatic insulin secretion.
Miglitol, an alpha-glucosidase inhibitor, controls blood glucose levels in type 2 diabetes by delaying absorption of complex carbohydrates in the intestine. This delays carbohydrate digestion after meals slowing glucose entry into the systemic circulation.
lead poisoning screening
begins at 12 months for low risk clients, repeat at 24 months
high risk infants screened at 6 months
magnesium sulfate is used for
electrolyte replacement or anticonvulsant
not an analgesic!
early signs of peanut allergy
urticaria (red, itchy welts on skin), wheezing, dyspnea
hiatal hernia mimics symptoms of
gastric reflux
bulging of top of stomach above the diaphragm
CT bubbling in the control chamber
The third compartment, the suction control chamber, applies suction to the chest drainage system. Bubbling is an expected finding. If no bubbling is seen in the suction control chamber, (1) there is no suction, (2) suction is not high enough, or (3) the pleural air leak is so large that suction is not high enough to evacuate it.
adenosine adm for SVT
1-3 second injection + 20cc NS flush
magnesium IV is given for
torsades de pointes
what drug can be used after epi in a cardiac arrest with a patient with V fib or V tach?
amiodarone
antiarrhythmic
atropine is only used in
symptomatic bradycardia
side effects of anticholinergic medications
pupil dilation/blurred vision, xerostomia/dry mouth, constipation/reduced bowel tone and motility, urinary hesitancy and retention
does not cause paresthesia (pins & needles sensation)
should insulin glargine be mixed with other insulins?
no, needs to be a separate injection because it is long acting
contrast is toxic to what organ
kidneys
inform provider before cardiac cath if creatinine clearance is decreased
risk factors for fetal macrosomia
maternal obesity, gestational diabetes
fat baby
severe hypokalemia and use of oxycodone may cause paralytic ileus resulting in
absent bowel sounds
adverse reaction of oxycodone
fast acting insulin
clear
- rapid acting insulin: lispro, aspart, glulisine
- short acting insulin: regular insulin (still considered fast though)
rapid acting insulin:
onset: 10-30min
peak: 0.5-4 hours
duration 3-6 hours or less
time of adverse reaction: mid morning
need to eat with 5-15 mins of administation
regular insulin (short acting)
clear
only type of insulin used in pumps and administered IV
can be mixed with intermediate acting insulins, just not long-acting.
draw up: “clear before cloudy” –> draw up regular insulin first then NPH
onset: 30-60 min (if adm IV- onset 10-30 min)
peak: 2-5 hours
duration: 6-10 hours
client needs to eat within 20-30minutes of injection time
intermediate acting insulin
cloudy (contains protein that prevents body from breaking it down right away)
draw up: “clear before cloudy” –> draw up regular insulin first then NPH
NPH (cloudy), insulin detemir (clear)
onset: 1-2/3-4 hours
peak: 6-14/12-24hours
duration: 16 hours, 18-24 hours
time of adverse reaction: early evening
administered once/day and can be given after meals
S&S hypoglycemia
nervousness, tremors, confusion, sweating, tachycardia
slow-acting (long-acting) insulins
glargine, insulin detemir (intermediate to long-acting)
onset: 3-4 hours
peak: no peak/6-8 hours
duration: 24 hours/varies, 6-24 hours
cannot be mixed with other insulins
both clear solutions
given HS (at bedtime)
combination insulin
short and intermediate acting
pre-mixed NPH + regular with percentages of each
pre-filled syringes, mixed solutions that you just draw up
onset: 0.5 hours or sooner for 75% short acting
peak: 2-12 hours
duration: 20-24 hours
insulin precautions- what medications increase and decrease insulin needs
thiazide diuretics, glucocorticoids/cortisone, thyroid meds, estrogen elevate glucose levels –> increased insulin needs
tricyclic antidepressants, MAO inhibitors, aspirin, anticoagulants –> decrease insulin needs
illness and stress increase glucose and therefore insulin needs are increased
oral hypoglycemics
T2DM
used in conjunction with insulin as well if needed (if diet-controlled is insufficient)
-when T2DM under stress/illness/trauma/surgery, increased insulin needs and need to be on a sliding scale insulin
S&S: hypoglycemia, GI upset, skin reactions
considerations: take before breakfast (with food if severe GI upset), avoid alcohol (metformin- life threatening lactic acidosis or sulfonylureas- significant GI distress, HA)
-sulfonylureas: glyburide, glipizide, glimepiride
works by increasing secretion of insulin and increasing body’s sensitivity to insulin
-biguinide: metformin
works by decreasing hepatic production of glucose/decrease intestinal glucose absorption
*contrast and alcohol can cause severe lactic acidosis when on metformin
*severe diarrhea needs to let provider know
-alpha-glucosidase inhibitors: Acarbose, Miglitol
works by preventing absorption of carbs in intestines
-thiazolidinediones: Pioglitazone, Rosiglitazone
-incretin modifiers or mimics
work by increasing insulin secretion and decreasing glucagon secretion
normal wedge pressure
4-12 mmHg
what do you do with elevated wedge pressure?
diuresis
normal 12 hour newborn assessment findings
acrocyanosis (blue hands and sometimes feet) for up to 24 hours
cyanosis Apgar score of “1” and color should return after blanched
apneic periods < 20 seconds
tachypnea (greater than 60 breaths/min)
signs of newborn respiratory disress
nasal flaring, retractions, cyanosis, grunting, seesawing (abdomen lifts and chest sinks –> indicates airway obstruction)
post-term neonate assessment findings
skin cracked and peeling
absent vernix (white, cheesy substance protecting the baby’s skin in womb)
deep plantar creases
preterm neonate (<34 weeks gestation) assessment findings
little ear cartilage and remains folded
thick covering of vernix (white, cheesy substance protecting the baby’s skin in womb)
few creases on foot
lanugo present (fine, soft hair covering body)
full-term neonate assessment findings
full term newborn- ear returns to normal position immediately
some peeling and cracking of skin mainly in areas with creases
little vernix except small amount in creases (white, cheesy substance protecting the baby’s skin in womb)
lanugo (fine, soft hair covering body) may be present- usually sheds by 32-36 weeks. small amount may be present on upper back and shoulders, ears or side of forehead
70% of digoxin is excreted in the
kidneys
monitor for renal failure
Cr=7 indicates digitalis toxicity (same thing as digoxin toxicity)
weakness, acute pain, joint swelling, cyanosis/jaundice are S&S of
sickle cell crisis
weakness- pain/anemia
cyanosis-hypoxia
jaundice- RBC destruction
swelling of joints- blood vessel occlusion at joint
priapism (persistent erection) can occur in men
eating with a tracheostomy
deflate the trach cuff before giving solid foods helps the client swallow
client should have thickened fluids rather than thin fluids to reduce risk of aspiration
tracheostomies should only have an inflated cuff when
used for mechanical ventilation and the client is at risk of aspiration of saliva/fluids
if speech pathology approves to eat, then deflate cuff and provide solid foods/thickened liquids
foods high in vitamin K such as spinach, broccoli, and beef antagonize the effects of
warfarin
however, the intake of vitamin K must be consistent until the INR ration is therapeutic
left lateral recumbent position is best for
inserting a rectal tube
follows normal curvature of the rectum and sigmoid colon
what fluids would you anticipate giving a client with hypernatremia?
5% dextrose (D5W)
NS and LR have sodium in it. D5W dilutes excess serum sodium
tPA requirements
normal platelet range (150-400)
GI/urinary bleeding within last 21 days, prior intercranial hemorrhage, is a contraindication
IV tPA can be administered within 3-4.5 hours from symptom onset
interarterial tPA infusion can be administered for up to 6 hours after onset of stroke symptoms
intracranial surgery, stroke or serious head injury in previous 3 months is a contraindication
suction pressure for newborn
60-100 mmHg
advance catheter 3-5 inches into nose
psyllium is a
bulk forming laxative prescribed to help prevent bowel contents from accumulating in the diverticulum
side effects of prednisone
hunger, potassium depletion, weight gain, hyperglycemia, HTN
no raw fruit or vegetables, or cheese may be brought into a
protective isolation room (neutropenic precautions)
steroid inhalers (beclomethasone)
rinse mouth after using to prevent thrush
use a spacer to prevent bronchospasm
use albuterol first before using steroid inhaler
cystectomy
removal of bladder and urine drains into ileal conduit
clopidogrel is an
antiplatelet drug
SOB during pregnancy could indicate
respiratory tract infection or cardiac disease
chlordiazepoxide is used in alcohol withdrawal to prevent
anticonvulsant
seizures, brain injury, and delirium tremors
fluoxetine and citalopram
SSRI
antidepressant
stabilize mood and anxiety
disulfiram can be used in acute alcohol withdrawal after the initial detoxification in order to remain
abstinence
phenytoin is an
anticonvulsant
newborn findings: smooth and transparent skin, abundant lanugo on back, slow recoil of pinnae, absent plantar creases indicate the newborn is ________ and should monitor the baby for _______
pre-term (<32 weeks gestational age)
respiratory distress syndrome d/t immature lungs and insufficient surfactant
bread, vegetables and legumes are high in
fiber
S&S of acute leukemia
petechiae orthostatic hypotension joint pain weight loss tachycardia
hypoglycemic agents
reverse severe hypoglycemia (insulin reaction)
glucagon- stimulates liver to change glycogen to glucose
S&S: N/V, hypotension, bronchospasms
IM/SQ. IV
onset: 15 mins, can repeat in additional 15 mins
administer additional carbohydrates after giving glucagon to prevent subsequent hypoglycemic reactions
who’s at risk for chronic kidney injury (intrarenal)
ischemia, toxic medications (ABX, iodine contrast media, chemotherapy), muscle trauma (breakdown), transfusion reactions, SLE, glomerulonephritis, DM
postrenal= obstruction
problems that result from CKD
azotemia (nitrogen waste increase) and resulting uremia (S&S renal failure) then ESRD (cannot sustain life without intervention)
kidneys can no longer concentrate urine, causing a fixed urine specific gravity (doesn’t adjust to the needs of the body), increase BUN, increase serum Creatinine, decrease urinary output
S&S: fluid volume overload, metabolic acidosis (decreasing mental and cardiac function, kussmaul respirations- trying to blow off CO2) , hyperkalemia, HYPERphosphatemia, HYPOcalcemia (increases risk of bone fracture), hypermagnesemia, , hyponatremia (early)/hypernatremia (later), stomatitis, N/V, PUD, HTN, HF, pericarditis (d/t increased metabolic byproducts), HLD, anema (decreased erythropoeitin), pruritis, uremic frost (whitis color) oozing through skin- toxic to skin, increased WBC with infection, decreased RBC,
implementations for CKD
epoetin alfa (human erythropoeitin to increase RBC production), iron preparations (for anemia), Vitamin D and phosphate binder medications (aluminum hydroxide), peritoneal/hemodialysis
protein is restricted depending on severity and if dialysis is used
sodium, phosphorus and potassium are restricted and vary based on urinary output
immunocompromised!
changes in bone structure and possible alterations in neurological function
antihistamines for itching, avoid drying soaps, uremic frost- frequent cool wash cloths or rinses to get rid of it
AKI
reversible if caught soon enough, but could become chronic
S&S: rise in serum creatinine and decrease urinary output
who’s at risk for developing an AKI?
prerenal: dehydration, decreased CO (decreased perfusion of kidneys secondary to CO), renal artery narrowing, shock (shunting blood away from the kidneys)
intrarenal: ischemia, toxic medications (ABX, iodine contrast media, chemotherapy), muscle trauma (breakdown), transfusion reactions, SLE, glomerulonephritis, DM
postrenal: blockage causing urine to backup into the kidneys causing injury –> BPH, prostate cancer, urinary calculi, renal tumors, renal trauma, hydronephrosis
Problems that can occur from an AKI
HF, HTN, pericardial effusion, anemia, hyperkalemia, hypocalcemia, hyperphosphatemia, hypermagnesemia, UTIs, respiratory infections
3 stages of renal failure
oliguric phase
diuretic phase
end stage (ESRD, or recovery)
oliguric phase of AKI (1/3)
HTN, edema, weight gain (increased blood volume) oliguria (< 400mL/day) within one week of onset (longer this occurs, more damage can occur), metabolic acidosis (bicarbonate is not reabsorbed- may see decreased mental function and bradycardia as a result), hyperkalemia (weakness, ECG changes), hypermagnesemia (bradycardia, hypotension, decreased muscle weakness), lethargy and fatigue progress to more serious symptoms
diuretic phase of AKI (2/3)
increase in urinary output (up to 5L/day) with very dilute urine- can’t concentrate urine anymore so it lets it all go
hyponatremia (confusion, muscle weakness, hypotension, decreased pedal pulses)
clients can recover from this phase and fluids/electrolytes will slowly return to normal
urinalysis
URINALYSIS
- urine specimen (voided, clean-catch or midstream, catheterized, 24-hour urine)
- color, clarity (cloudy= infection or sediment)
- specific gravity (1.01-1.03), pH (4.6-8)- infection, A/B balance, diet can affect pH
- hyperglycemia –> glucose in urine
- ketones seen only in acidotic or fasting states
- proteins seen in small amounts normally. increased amounts with kidney disease or preeclampsia
- RBC- small amounts normal, large amounts indicate urinary calculi, infection, or trauma
- WBC- very small amounts normally, large amounts indicate infection or inflammation
- bacteria- normally <1000 colonies/mL. if increases= UTI, C&S needs to be completed
urine culture and sensitivity
used to determine if bacteria is present in the urine
- identifies number and types of pathogens
- sensitivity tests (which ABX is effective against a particular pathogen)
- midstream or clean catch or catheterized specimen
- early AM specimen (most concentrated)
- transport to laboratory
do not start ABX until culture is taken!
cystometrogram (CMG)
- evaluates sensory and muscle
- function of bladder
- fluid instilled into bladder
- sensation evaluated
- pressure inside bladder measured
- risk for UTI
creatinine clearance
- 24 hour urine specimen
- void at beginning of collection (then it starts after the first void)
- collect urine at end of collection period
- serum creatinine level is taken after the specimen collection to measure the creatinine clearance
- calculated value
- normal values
women: 85-125mL/min
men: 95-140mL/min (more muscle and form more creatinine)
cytoscopy
- bladder examined
- biopsies
- urinary calculi
- bladder catheter insertion
- anesthetic
- post procedure: urine characteristics, frequency, ABX, contact if bright red urine or abnormal
IV pyelography
- evaluation of kidneys, ureters, bladder
- IV injection of contrast media
- prior to procedure: bowel prep, iodine or shellfish allergies, assess renal function (can’t do this if kidneys are too damage), want to know if client is on metformin
- procedure: salty taste in mouth, warm feeling during dye injection (normal)
- post-procedure: increase oral intake (want to flush out contrast ASAP), assess for allergic reaction
respiratory acidosis has a high _____
PCO2
metabolic acidosis has a low ______
HCO3
respiratory alkalosis has a low _____
PCO2
metabolic alkalosis has a high ______
HCO3
digoxin
increases contractility of heart to increase CO
HR decreases, heart is less stretched and BP may decrease d/t less sympathetic stimulation
decrease SA node automaticity, decrease AV node conduction, increase ventricular automaticity –> HR decreases
*adverse effect: increased risk of ventricular dysrhythmias
second line tx for HF d/t toxicity and
