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Pharm > Clinical Apps Final > Flashcards

Clinical Apps Final Flashcards

1
Q

Preferred diagnostic test for DVT?

A

Venous Duplex Ultrasonography

its a non-invasive ultrasound to assess the flow of blood through the veins of arms and legs

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2
Q

Management / Interventions for DVT

A 
Bed-rest w/ legs elevated 
Gradual ambulation as tolerated by pt
Change positions often
Compression hose
SCDs 
Leg exercises 
Adequate hydration
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3
Q

Patient education for DVT

A

Elevate legs when in bed or chair
Wear knee or thigh high compression stockings
Teach pt and family about anti-coagulation therapy
Avoid potentially traumatic events

DO NOT MASSAGE THE AFFECTED EXTREMITY- to prevent thrombus from dislodging and becoming an embolisms

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4
Q

Deep Vein Thrombosis (DVT)

A
  • Most common type of thrombophlebitis. Presents greater risk for PE.
  • With PE, a dislodged blood clot travels to the pulmonary artery
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5
Q

Where does DVT mainly occur

A

more common in lower extremities

can occur in upper arms from increased use of central venous devices

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6
Q

Classic S/S of DVT

A

calf or groin tenderness and pain and sudden onset of unilateral swelling of the leg

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7
Q

How will you assess a patient with DVT?

A
  • Assess cap refill
  • Assess skin –> color and temp will be red and warm
  • Peripheral pulses may be decreased or absent (doppler may be needed)
  • GENTLY palpate the site, observing for induction (hardening along the blood vessels and for warmth and edema)
  • Monitor for signs of PE –> dyspnea, chest pain, tachypnea, cough, temp, syncope
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8
Q

Other test that may be ordered for a patient with DVT?

A
  • MRI
  • Impedence Plethysmography -> measures change in blood flow through veins
  • D-dimmer test –> neg test can exclude a DVT without an ultrasound
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9
Q

How will DVT be treated?

A

*IV Anticoagulants (usually IV heparin and LMWH) typically followed by oral anti-coagulation with Warfarin (Coumadin)

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10
Q

Labs needed before starting DVT patient on IV unfractionated heparin.

A
  • aPTT
  • PT
  • INR
  • CBC
  • Platelet count
  • Urinalysis
  • Stool for occult blood
  • Creatinine
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11
Q

Management/Prevention of DVT

A 
Bed-rest w/ legs elevated 
Gradual ambulation as tolerated by pt
Change positions often
Compression hose
SCDs
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12
Q

Patient education for DVT

A

Elevate legs when in bed or chair
Wear knee or thigh high compression stockings

DO NOT MASSAGE THE AFFECTED EXTREMITY- to prevent thrombus from dislodging and becoming an embolisms

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13
Q

DVT risk factors

A

Smoking
Immobility
Oral contraceptives
Surgery

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14
Q

Autoimmune Thrombocytopenic Purpura

aka: Idiopathic Thrombocytopenia Purpura (ITP)

A

where the # of circulating platelets is greatly reduced, even though platelet production is normal.

pt with this makes an antibody against the surface of their own platelets

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15
Q

What causes ITP

A

cause unknown, viral infection suspected

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16
Q

Patients with ITP are at great risk for what

A

BLEEDING!

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17
Q

ITP is most common in who

A

Women ages 20-50 and people with autoimmune disorders

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18
Q

S/S in patients with ITP

A

**Symptoms first seen in the skin and mucous membrane

Large ecchymoses (bruises)
Petechial rash on arms, legs, upper chest, and neck
Mucosal bleeding occurs easily

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19
Q

What to assess in ITP patients?

A

ecchymoses (bruises)
petechial rashes
mucosa for bleeding

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20
Q

What test will be ordered for ITP patient?

A

Platelet count- will be low
Megakaryocytes in bone marrow- increased
Hct and HgB- will be low if bleeding episode occurs

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21
Q

Drugs to treat ITP

A

Drugs that suppress the immune function

Corticosteroids!
azathiprine (Imuran)
eltromopag
rituximab (Rituxan)

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22
Q

Treatment options for ITP patients

A

Drugs that suppress the immune function

Platelet transfusion- if platelet count is less than 10,000/mm3

Surgery: Splenectomy- for pts who do not respond to drug therapy

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23
Q

Patient education for ITP

A

Use electric razer
Use soft bristle toothbrush
Don’t floss
Don’t eat hard food/candy (ex: tortilla ships)
Have safe environment to protect from bleeding

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24
Q

Sickle Cell Disease (sickle cell anemia)

A

genetic hemoglobin disorder that results in chronic anemia, pain, disability, organ damage, increased risk for infection, and early death as a result of poor blood perfusion.

gets worse over time in adults

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25
Q

What do sickled cells do

A

they become rigid and clump together, causing RBCs to become “sticky” and fragile.

SCD results in formation of abnormal hemoglobin chains

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26
Q

Sickle cell crisis occurs from

A

occurs in response to conditions that cause local system Hypoxemia.

Examples:

  • Stress
  • Dehydration
  • Pregnancy
  • High altitudes
  • Smoking
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27
Q

Most common symptom of SCD crisis

A

PAIN!!

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28
Q

Cardiovascular changes in SCD

A

*Risk of high output heart failure r/t anemia
JVD
Murmurs

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29
Q

Respiratory changes in SCD

A

occurs over time, many SCD pts develop pulmonary hypertension and all are at risk for recurrent pneumonia

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30
Q

Skin changes in SCD

A

pallor
cyanosis
jaundice

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31
Q

Abdominal changes in SCD

A

damage to the spleen and liver

(which often occurs early from many episodes of hypoxia and ischemia

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32
Q

Kidney and Urinary changes in SCD

A

poor perfusion can lead to CKD

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33
Q

Musculoskeletal changes in SCD

A

joints may be damaged from hypoxic episodes

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34
Q

Central Nervous System (CNS) changes

A

assess for a “pronator drift” a bilateral hand grasps strength, gait, and coordination

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35
Q

How is SCD diagnosed

A

based on percentage of Hemoglobin S (HgS) on electrophoresis

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36
Q

Tests ordered for SCD patient

A
  • Percentage of HgS
  • Hematocrit- low
  • Reticulocyte count- high, indicating anemia of long duration
  • Total bilirubin level- may be high
  • Total WBC count- usually high
  • ECG- can show any heart damage
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37
Q

Drug therapy for SCD

A

Drug therapy for pts in crisis often starts with at least 48hrs of IV analgesics

  - morphine 
  - hydromorphone (Diladid)

hydroxyurea (Droxia)- may reduce # of sickling and pain episodes by stimulating fetal hemoglobin (HbF) production.

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38
Q

hydroxyurea (Droxia) for SCD

A

may reduce # of sickling and pain episodes by stimulating fetal hemoglobin (HbF) production.

is a teratogenic (can cause birth defects)

education sexually active women to use contraceptives while taking and 1 month after discontinuing.

39
Q

Nursing interventions for SCD

A 
Administer oxygen
Pain management
FLUIDS! oral and IV (no caffeine) 
Keep room warm or provide warm blanket
Prophylaxis drug therapy (dentist)
40
Q

SCD patient education

A
  • Infection prevention! good hand hygeine, know s/s of infection and when to seek medical help
  • drink plenty of fluids (avoid caffeine)
  • no smoking or alcohol
  • avoid high altitudes
  • get “flu-shot” yearly
  • encourage mild exercise when not in crisis
41
Q

Foods rich in folic acid

A
  • Green leafy vegetables (asparagus, artichoke)
  • Oranges
  • Beefy liver
  • Fortifies cereals and grains
42
Q

Foods high in potassium

A
  • Oranges, dried fruits, avocados, bananas
  • Tomatoes, broccoli dried peas
  • Whole grains
  • Meet and dairy products
43
Q

Foods high in fiber

A

Good for Colon Cancer

  • whole grains
  • apples
  • blue/black/straw-berries
  • dried beans/peas
  • figs/dates
  • kiwi
  • high fiber-cereal
  • brussel sprouts
  • carrots
44
Q

An early deceleration is sometimes called

A

the mirror image of a contraction

45
Q

Postpartum Hemorrhage (PPH)

A

loss of 500mL or more from vaginal birth and 1,000mL or more after cesarean birth.

46
Q

How will a PPH patient look/have

A
  • Boggy uterus
  • More than 1 pad saturated within first hour
  • Passage of large clots
  • Rising HR
  • Decreasing BP
  • Clammy, pale skin
  • Decreased urine output
47
Q

How / What will you assess in someone with PPH

A

MASSAGE THE FUNDUS

  • Check fundus for firmness, bleeding color, and amount
  • Assess vital signs
  • Assess bladder distention
48
Q

Four T’s of PPH

A

Trauma
Tone
Tissue
Thromin

49
Q

Labs ordered for PPH

A
  • PT
  • pTT
  • HcT
  • HgB
  • CBC
  • Platelet count
50
Q

Causes of early PPH

A

Inversion
Lacerations
Uterine atony
Incomplete separation of the placenta

w/in 24hrs after birth

51
Q

Causes of late PPH

A

Retained placental fragments (most common)
Endomitritis
Subinovolution

after 24hrs of birth but less than 6 weeks

52
Q

Drugs used to treat PPH

A

Drugs that cause contraction of the uterus:

  1. Oxytocin (Pitocin) -also decreases bleeding
  2. Misoprostol (Cytotec)
  3. Methylergonovine (Methergine) –> contraindicated for hypertension, preeclampsia, and cardiac diseases.

(these are given if uterus is hypotonic and Boggy)

53
Q

Surgery option for PPH

A

Hysterectomy- if bleeding cannot be stopped

54
Q

Patient education for PPH

A
  • Worn pt she’ll feel fatigued/exhausted and will need to limit physical activities
  • Need to increase dietary iron and protein intake and iron supplementation to rebuild lost red blood cell (RBC) volume.
  • Assess mothers anticipated level of support from family and friends.
55
Q

Those with celiac disease must be on what type of diet

A

gluten-free diet

ex: no wheat

56
Q

Those with cystic fibrosis can not

A

can not digest fat properly

57
Q

Post-op anemia symptom

A

fatigue

58
Q

Normal weight gain during pregnancy

A

25-35 lbs

59
Q

Clinical manifestations of Placenta Previa

A

painless bright red vaginal bleeding during the 2nd or 3rd trimester.

60
Q

Placenta previa

A

placenta is implanted in the lower uterine segment such that it completely or partially covers the cervical is or is close enough to the cervix to cause bleeding when the cervix dilates or the lower uterine segment effaces

61
Q

Clinical manifestation of Placenta abruption

A

vaginal bleeding, abdominal pain, uterine tenderness, and contractions.

62
Q

Placenta abruption

A

is the detachment of part or all of a normally implanted placenta from the uterus. Pain to shoulder

(Go to ER if there is decreased fetal movement)

63
Q

Drugs given for fetal lung maturity

A

Corticosteroids

-Bethamethasone and Dexamthasone

64
Q

Possible complication of Epidural anesthesia

A

Hypotension

-Pt is a major fall risk

65
Q

What do you do as soon as a newborn baby is born?

A

dry baby off bc they have trouble regulating temp

66
Q

What do you monitor when mag sulfate is used for preterm labor?

A

monitor for respiratory depression

67
Q

What do you NOT do with someone with placenta previa?

A

DON’T reach hand up bc placenta can rupture

68
Q

Expected finding in 39 week preeclampsia patient?

A

headache

69
Q

Preeclampsia antidote

A

calcium gluconate

70
Q

Anaphylactic reaction is bad is what is present

A

Stridor breathing

71
Q

Those in post-menopause are at risk for

A

fractures due to hormone imbalance

72
Q

Chlamydia

A

curable with antibiotics (partner too)

reported to CDC

73
Q

Symptom of intracranial pressure

A

restlessness

74
Q

Ultrasound can be used to see what

A

possible blood clot

75
Q

Whats worse Hypokalemia or Hyperkalemia?

A

Hypokalemia is worse because it can cause abnormal heart rhythms

important to monitor heart

76
Q

Teaching skin cancer prevention

A
  • Check skin monthly for changes
  • Wear sunscreen, even in non-sunny settings
  • No tanning
77
Q

Digoxin (Lanoxin)

A
  • used to treat heart failure
  • another RN must verify before administering
  • monitor HR –> don’t give is HR is less than 90 in baby

therapeutic level: 0.5-2

78
Q

Chemotherapy

A

kills all cells not just cancer cells

pt should report fever as it could be sign of infection

can have metal taste and “chemo brain”

79
Q

Patients receiving chemotherapy are at risk for

A

risk for:

  • anemia
  • infection
  • bleeding and clotting disorders
  • high risk for falls
80
Q

What should patients receiving chemotherapy avoid?

A
  • no razers (electric razers good)
  • no flossing (use soft bristle brush instead)
  • dont each fresh fruits/veggies bc of bacteria
  • avoid large crowds / people with infection
81
Q

Those receiving radiation should avoid

A
  • decrease sun exposure (try to go outdoors in the early morning or evening to avoid the more intense sun rays)
  • protect area by wearing clothing over it
  • avoid sunscreen/hard lotions
82
Q

Chemo precautions

A

should use a central port!

chemo meds are too thick for normal IV line and they can cause more issues (ex: extravasation)

83
Q

Candidiasis

A

fungal infection caused by yeast

Found in:

  • mouth
  • skin folds
  • genitals
84
Q

Why are gamma rays used most commonly for radiation therapy?

A

because of their ability to deeply penetrate tissues

85
Q

Most common side effect of radiotherapy

A

Radiation dermatitis- changes to the skin

86
Q

Skin protection during radiation therapy

A
  • use hand rather than washcloth when cleansing the therapy site to be gentler
  • wash irradiated area gently each day with either water or a mild soap
  • dry the irradiated area with patting rather than rubbing motions
  • wear soft clothing over area
  • avoid wearing belts, buckles, straps
87
Q

Extravasation

A

occurs when drug leaks into the surrounding tissues (infiltration)

careful monitoring of blood return and the access site is critical during chemotherapy administration to prevent this

antidote may be injected into the site of extravasation

88
Q

Extravasation can cause

A

pain
infection
tissue loss

89
Q

Pancytopenia

A

abnormally low level of all blood cell types produced by the bone marrow

  • RBCs
  • WBCs
  • Platelets

at worst called “nadir”

(injections given with TB syringe?)

90
Q

immunosuppressants

A

at risk for infection
most likely on steroids (glucocorticoids)
monitor glucose levels

91
Q

patient has ileus and has NG placed, 1200ml removed what should you monitor for

A

imbalance of decrease of K+ levels

92
Q

WBC range

A

4.5-11

93
Q

RBC range

A

men: 4.7-6.1
women: 4.2-5.4

94
Q

HELLP syndrome

A

Laboratory diagnostic variant of severe preeclampsia involves hepatic dysfunction, characterized by

Hemolysis (H)
Elevated liver enzymes (EL)
Low platelets (LP)

Pharm (6 decks)

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