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Pharm > CLINICAL APPS FINAL > Flashcards

CLINICAL APPS FINAL Flashcards

1
Q

Chemo

A

N/V
muscositis
metallic taste
nutrition is important

Nurse must be certified
Large bore need is needed

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2
Q

Radiation

A

don’t remove the temporary tattoo

avoid sunlight

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3
Q

Thrombocytopenia

A

decreased platelets (150-450 normal range)
Risk for hemorrhage
Teach: soft bristle, electric razor, be careful ambulating

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4
Q

Neutropenic

A

overproduction of amature white cells.
Prevent infection: hand hygiene, avoid people, don’t eat fresh fruits and veggies, do not garden
Kids: monitor temp

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5
Q

Infection risk of chemotherapy

A

Bone marrow suppresion

Neutropenia

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6
Q

Anemia, thrombocytopenia risk

A
  • bone marrow suppresion
  • impaired clotting
  • chemo induced n/v (CINV)
  • chemo induced pheripheral neuropathy (CIPN)
  • mucositis
  • alopecia
  • cognitive changes
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7
Q

Teaching for cancer

A

No fruits and veggies (fresh)

  • hand washing education
  • electric razors only
  • soft bristle toothbrush
  • mucositis

chemo- risk for infection, anemia, and thrombocytopenia.
pancytopenia = LOW everything
chemo brain
chemo kills all cells, not just cancer cells

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8
Q

Anemia

A

reduction in the # of RBCs, amount of HGB or HCT.

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9
Q

Anemia common causes

A

SCD, immunohemolytic anemia, iron deficiency anemia (nutrition related, vitamin B12 deficiency, folic acid deficiency, aplastic anemia, post-op anemia

in the elderly: most likely due to nutrition deficiency

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10
Q

Anemia s/s

A

lethargic

fatigue

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11
Q

Leukemia

A

loss of normal cellular regulation leading to uncontrolled production of immature WBCs (“Blast” cells) in the bone marrow.

May need a bone marrow transplant - Risk for infection

low platelet count common
avoid rectal temps
assess IV for bleeding

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12
Q

Multiple Myeloma

A

WBC cancer that involves mature B lymphocyte called a plasma cells that secrete antibodies.

Cells overgrown in the bone marrow

When they become cancerous they produce excessive antibodies called GAMMA GLOBULINS —> this leads to few RBCs, WBCs, and Platelets

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13
Q

Multiple Myeloma s/s

A

anemia
risk for infection
bleeding

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14
Q

Thrombocytopenia

A

reduced platelets

ex: Autoimmune (Idiopathic) Thrombocytopenia purpura (ITP)

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15
Q

Autoimmune (Idiopathic) Thrombocytopenia purpura (ITP)

A

circular platelets reduced even though platelet production is normal = platelets clump together leading to few platelets in circulation.

Blood will fail to clot when trauma occurs.
Tissue becomes ischemic –> can lead to RF, MI, Stroke

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16
Q

Blood transfusion and Hemolytic reaction

A

given over 3 hours

Hemolytic reaction- w/ PRBCs transfusion will cause fever, chills, red urine (hemoglobinuria), and itching

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17
Q

Arterial Blood Gases- Normal values

A

pH 7.35-7.45
pCO2 35-45
HCO3 21-28

O2 sat 94-98%

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18
Q

*Causes of Respiratory acidosis

A

COPD
Pneumonia
Atelectasis (collapsed lung)
Decreased resp stimuli (Anesthesia, Drug overdose)

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19
Q

*Respiratory acidosis s/s

A

“I can’t breath”

  • hyperventilation –> Hypoxia
  • rapid, shallow respirations
  • headache
  • hypErkalcemia
  • dysrhythmias (^K+)
  • dyspnea
  • low BP w/ vasodilation
  • muscle weakness, Hyperreflexia
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20
Q

Causes of Metabolic acidosis

A

DKA
Severe diarrhea
Renal failure
Shock

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21
Q

Metabolic acidosis s/s

A 
headache
decreased BP
hypEkalemia 
muscle twitching
warm, flushed skin (vasodilation)
changes in LOC (confusion, ^ drowsiness)
N/V
diarrhea 
Kussmaul respirations (compensatory hyperventilation)
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22
Q

What goes up in acidosis

A

potassium levels (Hyperkalemia)

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23
Q

Hyperkalemia can cause

A

muscle weakness
potentiall life-threatning cardiac dysrhytmias
cardiac arrest
watch for oliguria (decreased urine output)

dehydration can cause hyperkalemia

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24
Q

causes of Respiratory alkalosis

A

hyperventilation (anxiety, PE, fear)

mechanical ventilation

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25
Q

Respiratory alkalosis s/s

A 
seizures
deep, rapid breathing
lethargy & confusion
light headedness 
hyperventilation
N/V
tachycardia 
HypOkalemia 
numbness & tingling of extremities 
low or normal BP
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26
Q

causes of Metabolic alkalosis

A

severe vomiting
excessive GI suctioning
diuretics
excessive NaHCO3

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27
Q

Metabolic alkalosis s/s

A 
restlessness followed by lethargy
dysrhytmias (tachycardia)
compensatory hypoventilation 
confusion ( decreased LOC, dizzy, irritable)
N/V
diarrhea
tremmors, muscle cramps, tingling of fingers and toes 
HypOkalemia
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28
Q

Foods high in potassium

A

orange juice, organ meats, fish, fresh fruits, dried fruits, beef, chicken, pork, milk, vegetables, salt substitutes

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29
Q

in ABGs what compensates first?

A

lungs

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30
Q

Echocardiography

A

non-invasive (like an ultrasound)

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31
Q

Cardiac Magnetic Resonance Imaging (MRI)

A

may use contrast or iodine (look for shellfish allergies) also look for kidney function before test.

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32
Q

Infective Endocarditis- infection priority and management

A

*Priority = dyspnea
Prophylactic antibiotics before procedures such as dentist
Can be cause from IV drug use

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33
Q

Rheumatic fever

A

caused by untreated strep infections –> leads to damaging of Mitral and Aorta valves.

treat strep quickly and take all of the antibiotics

affects: joints, skin, brain, seroud surfaces, and heart

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34
Q

Rheumatic heart disease

A

caused by rheumatic fever.

swishing heart sounds
echo typically ordered
permanent valve damage (Mitral and Aorta)

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35
Q

Nephrotic syndrome

A

kidney disorder that causes the body to excrete too much protein in the urine

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36
Q

Nephrotic syndrome clinical state

A 
Proteinuria
Hypoalbuminemia
Hyperlipidemia
Edema
Massive urinary protein loss
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37
Q

Nephrotic syndrome lab finds

A 
Massive proteinuria on dipstick
GFR normal or high 
Total serum protein low, albumin low
Serum sodium low
Platelets may be elevated 
Hemogloin and Hematocrit normal or elevated
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38
Q

Complications of nephrotic syndrome include

A

infection
circulatory insufficiency
thromboembolism

(episodes often happen with viral or bacterial infection)

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39
Q

What is important to monitor in nephrotic syndrome

A

Strict I&O are essential, may be difficult to obtain in young children.

Infection is a constant source of danger to edematous children, particularly for those receiving corticosteroid therapy

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40
Q

what vaccine is recommended for children with nephrotic syndrome

A

pneumonia vaccine

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41
Q

VEAL CHOP

A

Variable decelerations = Cord compression (not okay)
Early decelerations = Head compression (okay)
Accelerations = Okay to have
Late decelerations = Placental insufficiency

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42
Q

Leopold maneuvers

A

palpate uterus through abdomen to determine fetal lie, fetal attidue, and the point of maximal impulse (PMI)

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43
Q

Point of maximal impulse (PMI)

A

where the FHR can be heard the loudest, where we place the external transducer to monitor FHR

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44
Q

Whats expected for FHR

A

HR or 110-160 bpm
moderate variability
excelerations may be present or absent
early decelerations may be present or absent

We DO NOT want to see Late decelerations or Variable decelerations in FHR

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45
Q

Excelerations

A

temorarily increase in FHR above baseline

its reassuring and no interventions are needed

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46
Q

Bradycardic FHR excelerations

due to:
interventions:

A

FHR below 110 bpm for at least 10 minutes

Due to: utero placenal insufficiency, umbilical cord prolapse, maternal hypotension, analgesic medications

Action: place pt in side lying position, administer oxygen, and notify provider

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47
Q

Tachycardic FHR excelerations

due to:
Inerventions:

A

FHR above 160 for longer than 10 minutes

Due to: infection, cocaine use, dehydration

Action: administer antipyretics, administer oxygen, possible IV fluid bolus

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48
Q

Early decelerations

Due to:
Intervention:

A

slowing of baby heart rate during contraction.

Due to compression of head when mother is having a contraction, this is an expected finding no interventions are needed.

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49
Q

Late decelerations

Due to:
Intervention:

A

slowing of babies HR after contraction hs started and it has prolonged time before it returns to baseline.

Due to: utero placental insufficiency

Action: place pt in side lying position, administer IV fluids, D/C oxytocin, administer oxygen, palpate uterus for tachysystole (more frequent/intense contractions), and notify physician.

50
Q

Variable decelerations

Due to:
Intervention:

A

transient variable slowing of the FHR

Due to: umbilical cord compression

Action: place pt in knee-chest position or reposition from side to side, D/C oxytocin, administer oxygen

51
Q

Reye’s syndrome

A

disorder defined as toxic encephalopathy associated with other characteristic organ involvement

most cases follow common viral illness:

  • influenza
  • varicella

parents should be taught to read labels for hidden salicylates

52
Q

Characteristcs of Reye’s syndrome

A

fever
profoundly impaired consciousness
disordered hepatic function

53
Q

Reye’s syndrome s/s

A 
irriabile
confusion
excessive vomiting
seizures
loss of conciousness
54
Q

Reye’s syndrome risk factors

A

children given aspirin for fever / viral infections have increased risk

55
Q

Reye’s syndrome diagnosis

A

liver biopsy and CSF analysis (to rule out meningitis)

56
Q

Reye’s syndrome nursing care

A

measures to decrease ICP (HOB 30 degrees)

administer mannitol (diuretic)

monitor for bleeding (prevent hemorrhaging)


57
Q

APGAR scoring

A 
Appearance (skin color)
Pulse (HR)
Grimace (reflex irritability)
Activity (muscle tone)
Respiratory (effort)

performed at 1 and 5 minutes after birth –> and 10 minutes if score is 6 or less

58
Q

care of patient in 1st stage of labor with variable decelerations

A

position mother on side lying position (lateral)

59
Q

reportable STIs

A

Chlamydia
Syphilis
Gonorrhea

60
Q

Chorio

A

bacterial infection in the amnion, most often occurs after ROM and labor has occurred.

women with chorio can develop bacteremia.

61
Q

What increases the risk for Chorio

A

multiple vaginal exams
internal monitoring devises
prolonged rupture of membranes

62
Q

Chorio risk for mom and baby

A

Cesareans can lead to abscess and pelvic infections

Neonatal risk: pneumonia, meningitis, and bacteremia. Death is more likely in the preterm newborn

63
Q

Chorio treatment

A

bc of risk to mother and newborn quick tx with antibiotics are necessary

Ampicilin and Gentamycin are typically given

64
Q

Newborns average BP

A

systolic BP 60-80

diastolic BP 40-50

65
Q

Caput succedaneum

A

generalized edematous area of the scalp, most often of the occiput.

the edematous area extends across the suture lines

66
Q

Cephalohematoma

A

is a collection of blood between the skull bone and the periosteum.

it is usually resolved in 2-3 weeks. It does NOT cross the suture lines.

67
Q

The AAP recommends introduing solid foods at how many months? and what should the first foods be?

A

6 months

first foods should include: meats and iron and zinc fortified cereal. It is best to wait 3-5 days before introducing a new food.

Fruit juice should not be introduced before 6 months of age

68
Q

Rh incompatibility (isoimmunization)

A

Only Rh-positive offspring of Rh-negative mother are at risk

if fetus is Rh positive and mother is Rh-negative, mother forms antibodies against fetal blood cells.

69
Q

babies weight gain per week at first

A

5-7 ounces per week

70
Q

doubling of birth weight by age

A

6 months

71
Q

Tripling of birth weight by age

A

1 year

72
Q

Heart increases by __ inch per month x 6 months

A

1 inch

73
Q

Growth in “_____” rather than gradual pattern

A

“spurts”

74
Q

Grasping objects (fine)

A

ages 2-3 months

75
Q

Transfering objects b/w hands (fine)

A

age 7 months

76
Q

Pincer grasp (fine)

A

age 10 months

77
Q

Removing objects from container (fine)

A

age 11 months

78
Q

Building tower of two blocks (fine)

A

age 1 year

79
Q

Rolling over (gross)

A

age 5 months: abd to back

age 6 months: back to abd

80
Q

Sitting (gross)

A

age 7 months

81
Q

Crawling (gross)

A

age 6 to 7 months

82
Q

Creeping (gross)

A

age 9 months

83
Q

walking with assistance (gross)

A

age 11 months

84
Q

walking alone (gross)

A

age 1 year

85
Q

object permanence is seen in the development of seperation anxiety at _____ months of age a critical part of parent-child seperation

A

4-8 months

86
Q

s/s of ICP in children under 2

A 
irritability, poor feeding
high-pitched cry, difficult to soothe
Fontanels: tense, bulging
Cranial sutures: seperated
Eye: setting-sun sign
Scalp veins: distended
87
Q

s/s of ICP in children

A 
headache
forceful vomiting
seizures
drowsiness, lethargy
diminished physical activity
inability to follow simple commands
*Paradoxical chest movement
88
Q

Late signs of increasing ICP

A 
bradycardia
decreased motor response to command 
decreased sensory response to painful stimuli 
alteration in pupil size and reactivity 
extension or flexion posturing
decreased consciousness
coma
89
Q

what is contraindicated for ICP

A

lumbar puncture

90
Q

Bacterial meningitis

A

acute inflammation of the meninges and cerebrospinal fluid (CSF)

Initiate droplet precautions

dont need to measure head often –> Pupil change present better to assess

91
Q

Bacterial meningitis diagnostics

A

lumbar puncture

92
Q

Signs bacterial meningitis is getting worse

A 
extreme irritability
seizures
confusion
hallucination
drowsiness or coma
photophobia
93
Q

Non-bacterial meningitis

A

Diagnosis: based upon CSF findings
onset is abrupt or gradual

Manifestions: headache, fever, mailase

Tx: primarily symptomatic

94
Q

Growth plate injuries

A

weakest point of long bones: The cartilage growth plate (epiphyseal plate)
frequent side of damage during trauma
may affect future bone growth

95
Q

Castings

A

caution parents not to use a hair driver to dry cast

96
Q

Bryant traction

A

the pull is only one direction
skin traction is applied
childs trunk with the buttocks raised slightly off the bed provides the counter traction

97
Q

Bucks traction

A

used primarily for short term immobilization

98
Q

Russel traction

A

uses skin traction on the lower leg with a sing under the knee.
Two lines of pull are produced

99
Q

What fracture is usually a sign of child abuse

A

spiral fractures

100
Q

Petechiae

A

Mascular- flat rash
Papular- raised rash
Hyperbaric chamber for therapy

101
Q

Mechanical forces create ulcers

A

pressure
friction
shear

102
Q

Stage 1 pressure injury

A

skin intact, does not blanch

103
Q

Stage 2 pressure injury

A

skin not intact, partial thickness loss

104
Q

Stage 3 pressure injury

A

full thickness skin loss, bone, tendon and muscle not exposed

105
Q

Stage 4 pressure injury

A

full thickness skin loss with exposed or palpable bone, muscle or tendon

106
Q

Prostitis

A

inflammation of the prostate gland

teach pt that he is at risk for UTI

107
Q

Varicocele can cause what

A

infertility as well as undescended testes

108
Q

Males:

A

last prostate exam and PSA test

testicular cancer not painful so sometimes hard for males to know they have it.

109
Q

Sensory perception concept example: Glaucoma

A

increased occular pressure
cupping and atrophy of optic disc

ppl with cataracts should NOT drive

110
Q

Symptoms of Glaucoma

A

headache or brow pain
N/V
colored halos around lghts
sudden blurred vision with decreased light perception

111
Q

types of glaucoma

A

primary open- angel glaucoma

angle- closure glaucoma

112
Q

Post surgical care for glaucoma patients

A 
antibiotics given SubQ
eye is unpatched, discharge usually occurs within 1 hour
dark glasses required
instill antibiotic-steroid eye drops
mild itching normal
pain indicated complications
reduced IOP
prevent infection
assess for bleeding
113
Q

should cataracts be painful?

A

cataracts do not cause pain but glaucoma does

114
Q

if an external ear is deformed, assess for..

A

kidney and urinary tract problems bc these develop in the embryo at the same time

115
Q

hearing lose can be divided into three types

A
  1. conductive- difficulty in the external ear or the middle ear
  2. sensorineural- difficulty in the inner ear or the acoustic nerve
  3. mixed conductive-sensorineural- combo of the two
116
Q

kawasaki disease

A

damage to vessels that cause clumping (clots)

meds given: aspirin or heparin

117
Q

tetrology of fallot teach:

A

during tet spells: knees to chest to help circulation

118
Q

digoxin toxicity

A

bradycardia and vomiting

119
Q

s/s of CHF disease

A

edema
SOB
fluids in lungs (crackles)

meds: diuretics and digoxin

120
Q

Epiglottisis

A

barky cough
dont use tongue depressor
priority is airway and O2

Pharm (6 decks)

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