Complex Final Exam Old Info Flashcards
What color is sputum production with pneumonia?
thick, yellow-green
When should you do a sputum culture and sensitivity with pneumonia?
before antibiotics
What will a chest x-ray show with pneumonia?
consolidation/fluid build-up
What might ABG’s show with pneumonia?
hypoxemia, PaO2 <80
What position should a patient with pneumonia be placed in?
high fowlers
What antibiotics can be used for pneumonia?
penicillins, cephalosporins
What color is sputum production with TB?
purulent, blood tinged
How long does a cough last to be dx with TB?
3+ weeks
What is the priority intervention for TB?
preventing infection transmission
What precautions are used for TB?
airborne
What type of room should a patient with TB be in?
negative airflow
How many negative sputum cultures are needed to determine that you do not have TB anymore?
3
How often should you get sputum cultures?
every 2-4 weeks
What tests should be done before starting TB meds?
- liver
- vision
- hearing
What toxicity is common with all TB meds except ethambutol?
hepatotoxicity
What TB medication is neurotoxic, and what does this cause?
- isoniazid (TB)
- paresthesias of the hands/feet
What vitamin should you give for neurotoxicity?
B6
What happens to urine/secretions when taking rifampin (TB)?
turns orange
What TB med should vision changes be reported for?
ethambutol
Who can not be administered ethambutol?
patients <8 y/o
What is a normal PaO2 level?
80-100
What happens to the PaCO2 with respiratory acidosis?
increases, >45
What happens to the PaCO2 with respiratory alkalosis?
decreases, <35
What happens to the HCO3 with metabolic acidosis?
decreases, <22
What happens with HCO3 with metabolic alkalosis?
increases, >26
With asthma, what does silent chest indicate?
no lung sounds, obstruction
How can you tell an asthma attack is worsening?
unable to talk, cyanosis
What position should you place someone with asthma in?
high fowlers
What happens with emphysema?
- loss of lung elasticity
- CO2 retention
- respiratory acidosis
What happens with chronic bronchitis?
inflammation of the bronchi and bronchioles
What are signs with COPD that the brain is not getting enough oxygen (<88%)?
- confusion
- disorientation
- altered mental status
What color is sputum production with COPD?
rust colored
What position should you place someone with COPD in?
high fowlers
What breathing techniques should people with COPD do?
- abdominal breathing
- pursed-lip breathing
- TCDB
- incentive spirometer
What do respirations look like with COPD?
rapid, shallow, use of accessory muscles
Why should you increase calories with COPD?
there is increased work needed to breathe, so more calories are being burned
What type of meals should someone with COPD eat?
small and frequent with soft, easy-to-chew foods
What are the expected side effects of albuterol (COPD)?
tachycardia, tremors
What side effect of ipratropium (COPD) indicates toxicity?
palpitations
What is the therapeutic range of theophylline (COPD)?
10-20
In what order should you give meds for COPD?
B before C, bronchodilator before corticosteroid
What should you watch for with fluticasone and prednisone (COPD corticosteroids)?
- infection (immunosuppressant)
- black, tarry stools
- hyperglycemia
- weight gain
What diagnostic tests for HIV antibodies?
ELISA
What does the western blot tests do (HIV)?
confirms results after + ELISA test
What CD4 T lymphocyte level indicates severe HIV?
200
What precautions should be used for HIV?
standard unless bodily fluids are involved
What is the priority intervention for HIV?
preventing secondary infection
What happens to blood, vomit, and feces with HIV?
they are contaminated
What happens to healthy tissue with lupus?
gets inflamed and destroyed
What immunological tests are done for lupus?
- ANA
- dsDNA
When lupus affects the bones, what happens to the CBC?
pancytopenia
When lupus affects the kidneys, what happens to the BUN/creatinine?
increased
What is Raynaud’s phenomenon (lupus)?
pallor and cyanosis of the fingers
What is the first sign of lupus?
morning stiffness
What type of rash do you get with lupus?
butterfly rash
What are the 4 “A” symptoms of lupus?
- alopecia
- anorexia
- anemia
- arthraligia
What part of the GI tract does UC affect?
the rectum and sigmoid colon
Where do you have pain with UC?
LLQ
How many diarrheas can you have a day with UC, and what can they consist of?
- 15-20/day
- blood, mucus, pus
What part of the GI tract does Chron’s affect?
the whole GI tract
How many diarrheas can you have a day with Chron’s, and what can they consist of?
- 5/day
- mucus, pus
Where do you have pain with Chron’s?
RLQ
What levels should you assess for UC/Chron’s?
- albumin
- K
- Mg
- Vitamin B12
What foods should you avoid with UC/Chron’s?
- grains
- fruits/veggies
- seeds
- beans
What nutritional intake should you increase with UC/Chron’s?
protein and calories
What nutritional intake should you decrease with UC/Chron’s?
fiber (diarrhea)
What medications can you take for UC/Chron’s?
- sulfonamides
- corticosteroids
- immunosuppressants
- immunomodulators
- anti-diarrheals
What is cholelithiasis?
gallbladder stones
What is cholecystitis?
inflamed gallbladder
Where/how does the pain occur with gallbladder disease?
sharp, in RUQ, radiates to the right shoulder
What nutritional intake should you decrease with gallbladder disease?
- fat (dairy, fried food, chocolate, nuts, gravies)
- gas-forming foods (beans, cabbage, broccoli, cauliflower, coffee)
What nutritional intake should you increase with gallbladder disease?
- fat-soluble vitamins (A, D, E, K)
- bile salts (dark, leafy green veggies)
What does gonorrhea target?
male urethra, female cervix
What happens with urination in gonorrhea?
- dysuria
- pain w/ voiding
What symptoms are present in females with chlamydia?
- painful intercourse/voiding
- vaginal discharge
- lower abdominal pain
What symptoms are present in males with chlamydia?
penile discharge
What are the manifestations of genital herpes?
- pain, itching
- small red bumps
- white blisters
- ulcers
- scabs
What antibiotic is given for gonorrhea?
ceftriaxone IM
What antibiotics are given for chlamydia?
azithromycin or doxycycline
When can the patient resume sex after having chlamydia?
- 7 days
- after completion of meds
- negative test
Does acyclovir cure genital herpes?
no, it just relieves symptoms and decreases transmission
Is BPH a precursor for prostate cancer?
NO
What happens to urination with BPH?
- frequency
- urgency
- hesitancy
-incontinence - incomplete emptying
- post-void dribbling
- nocturia
- decreased force of the urinary system
- straining with urination
- hematuria
What does persistent urinary retention lead to with BPH?
frequent UTI’s
What is hydronephrosis (BPH)?
the backflow of urine into the ureters and kidneys that can lead to kidney damage
What lab levels are increased with BPH?
- WBC (systemic infection)
- BUN/creatinine (kidney damage)
What lab levels are decreased with BPH?
RBC (hematuria)
What is the level for PreHTN?
120-129/<80
What is the level for stage 1 HTN?
130-139/80-89
What is the level for stage 2 HTN?
> /= 140 / >/= 90
What lab level should you monitor with diuretics (HTN/HF)?
potassium (K)
What are the side effects of ACE inhibitors (HTN/HF)?
- angioedema
- cough
- elevated potassium
What should you watch for with beta blockers and ACE inhibitors (HTN/HF)?
redness, itching, rash
What should you monitor with beta blockers (HTN/HF)?
HR, SBP, glucose
What is the DASH diet for HTN?
- decreased sodium
- increased potassium and calcium
What foods are high in sodium?
- canned soups/sauces
- chips, pretzels
- smoked meats
- seasonings
- tomato juice
- processed foods
What fruits and veggies are rich in potassium?
- apricots
- bananas
- tomatoes
- potatoes
What does left-sided HF affect?
lungs
What does right-sided HF affect?
body
What color is sputum production in LHF?
pink and frothy
Which heart failure causes hepatomegaly and splenomegaly?
right
Which heart failure causes SOB, cough, crackles, and wheezing?
left
Which heart failure causes JVD and ascites?
right
When should you report weight gain with HF?
- 2 lbs/day
- 5 lbs/week
What position should you place someone with HF in?
high fowlers
What does the B-type natriuretic peptide do?
confirms HF dx
What do labs look like for LHF? (H&H, BUN/creatinine)
- decreased H&H
- increased BUN/creatinine
What do labs look like for RHF? (H&H, albumin, total protein)
- decreased H&H
- decreased albumin
- decreased total protein
What nutritional intake should be decreased with HF?
- sodium
- saturated fats
What nutrition intake should be increased with HF?
protein
What must be assessed before administering digoxin?
apical HR, hold <60
What can hypokalemia cause for digoxin?
toxicity
What is the normal digoxin level?
0.8-2
What are the signs of digoxin toxicity?
- confusion
- muscle weakness
- loss of appetite (N/V)
- fatigue
- yellow-green halos
What is the main cause of PAD?
smoking
How can you promote vasodilation with PAD?
provide a warm environment and insulated socks
What type of clothing should you wear for PAD?
non-restrictive
How should the legs be with PAD?
- not crossed
- can elevate for short time (not above the heart)
- dAngle
Can heat be directly applied to the affected extremity with PAD?
no, because sensitivity is decreased
Can the client be exposed to cold with PAD?
no
What will happen over the involved blood vessel with a DVT?
- warmth
- edema
- induration
- redness
Should you ambulate with a DVT?
NO
How should the legs be with a DVT?
- not crossed
- elevated above the heart
What type of compress should be used for a DVT?
warm, moist
What is a normal d-dimer?
- <500 ng/mL FEU
OR - < 250 ng/mL DDU
What does a venous duplex ultrasonography show for a DVT?
a picture of blood flow through the vessel
Should you massage a DVT?
NO
What do anticoagulants do for a DVT? (Heparin, Warfarin)
keep the clot from getting bigger and prevent the formation of new clots
What does alteplase do, and what should you watch for (DVT)?
clot buster, watch for bleeding
What are some clinical manifestations of HYPERthyroidism?
- heat intolerance
- weight loss
- diarrhea
- tachycardia
What are some clinical manifestations of HYPOthyroidism?
- cold intolerance
- weight gain
- constipation
- bradycardia
Which thyroid deficiency includes exophthalmos and goiter?
HYPERthyroidism
Which thyroid deficiency includes myxedema and what is it?
- HYPOthyroidism
- swollen face, hands, feet
What happens in myxedema coma (HYPOthyroidism)?
- hypotension
- bradycardia
- respiratory failure
- hypothermia
- hyponatremia
- hypoglycemia
- coma
How often should you palpate the thyroid with HYPERthyroidism?
once per shift
What medication should you not take with HYPERthyroidism due to an increase in T4?
aspirin
What should you do to room temperature with HYPERthyroidism?
decrease (heat intolerance)
What temperature change indicates a thyroid crisis?
an increase of 1 degree or more
What medications should you avoid with HYPOthyroidism due to an increased risk of respiratory depression?
CNS depressants
What should you do to room temperature with HYPOthyroidism?
increase (cold intolerance)
What nutritional intake should be increased with HYPERthyroidism?
calories, protein
What nutritional intake should be increased with HYPOthyroidism?
bulk, fiber
What nutritional intake should be decreased with HYPOthyroidism?
calories
What is a normal blood glucose level?
65-110
What is a hyperglycemic blood glucose level?
> 250
What are the 3 P’s of hyperglycemia?
polyuria, polydipsia, polyphagia
What is the skin like with hyperglycemia?
hot, dry
What is a hypoglycemic blood glucose level?
<70
What is the skin like with hypoglycemia?
cold, clammy
What are some manifestations of hypoglycemia?
- shakiness
- confusion
- diaphoresis
- tachycardia
What is the reference range of HA1C?
4-6%
What is the acceptable DM range of HA1C?
6.5-8%
What is the target goal of HA1C?
7%
What should patients with DM be able to do?
- self-monitor blood glucose (SMBG)
- self-administer insulin
What part of the body should those with DM inspect daily?
feet
Can people with DM massage their feet or put lotion between their toes?
NO
How should those with DM cut their toenails?
straight across
How should insulin be drawn up?
clear (short-acting) to cloudy (long-acting)
How often should BG be taken on a sick day?
every 3-4 hours
What should you drink every 30 minutes on s sick day (DM)?
4 oz sugar-free, noncaffeinated liquid
How should you get your carbs on a sick day (DM)?
through soft foods 6-8 times/day
At what BG level should you call the provider?
> 240
At what body temperature should you call the provider (DM)?
> 101.5 for over 24 hrs with no response to tylenol
What should you eat/ drink when experiencing hypoglycemia?
10-20g readily absorbable carbs
- 2-3 glucose tabs
- 4 oz juice
- 6-10 hard candies
What nutritional intake should you decrease with DM?
- saturated fats
- trans fats
- cholesterol
- simple carbs (refined grains, sugar)
What do omega-3 fatty acids do?
decrease cholesterol
What are the onset, peak, and duration of rapid-acting insulin (lispro, apart)?
O: w/in 15 mins
P: 1-2 hours
D: 3-4 hours
What are the onset, peak, and duration of short-acting insulin (regular)?
- O: 30-60 mins
- P: 2-4 hours
- D: 5-7 hours
What are the onset, peak, and duration of intermediate-acting insulin (NPH)?
- O: 2-4 hours
- P: 4-10 hours
- D: 10-16 hours
What are the onset, peak, and duration of long-acting insulin (glargine)?
- O: 3-4 hours
- P: none
- D: 24 hours
Which insulins should you give before meals?
- rapid (lispro, aspart)
- short (regular)
When should you give NPH insulin?
between meals, at night
When should you give glargine?
once daily at the same time
Metformin (T2D) can cause lactic acidosis. What are the symptoms of lactic acidosis?
- myalgia
- sluggishness
- somnolence
- hyperventilation
When should glipizide (T2D) be administered?
before meals
Why should you avoid alcohol with glipizide (T2D)?
disulfiram effect
What should you monitor with repaglinide (T2D)?
fluid retention and liver function
When should you take acarbose (T2D)?
with the first bite of each meal
When should you take pramlintide (T2D)?
right before each meal (SQ)
What are some foods that are high in calcium?
- milk products
- green veggies
- fortified OJ and cereals
- red and white beans
- figs
- broccoli
- kale
- grains
What are some foods high in vitamin D?
- fish
- egg yolks
- fortified milk and cereal
How often should someone with osteoporosis get sun exposure?
for 5-30 minutes 2 times/week
What does increased bilirubin cause in cirrhosis?
jaundice
- clay-colored stool
- dark urine
- yellow skin/sclera
What does increased ammonia cause in cirrhosis?
- hepatic encephalopathy: confusion
- asterixis (hand flapping tremor)
What does decreased albumin cause in cirrhosis?
ascites
How do you treat ascites?
paracentesis (drain 1L at a time)
What does portal vein HTN cause in cirrhosis?
- splenomegaly
- esophageal varices
What does increased estrogen cause in cirrhosis?
- palmar erythema
- gynecomastia
- spider angiomas
When splenomegaly occurs, WBC and PLT get trapped. What does this cause an increased risk for?
infection and bleeding
What labs do you need to look at before a liver biopsy, and why?
- H&H, PT/INR
- worried about hemorrhage/bleeding and coagulation
How much should the bed be elevated for someone with cirrhosis?
30 degrees with feet elevated
How should encephalopathy be treated in cirrhosis?
lactulose (excretes ammonia)
What are diuretics used for in cirrhosis?
ascites
What are beta blockers used for in cirrhosis?
portal vein HTN, varices, preventing bleeding
What nutritional intake should be increased with cirrhosis?
- protein (unless encephalopathy occurs)
- calories
- vitamin B, C, K supplements
What precautions should be used for hepatitis?
standard unless bodily fluids are involved
What are safe injection practices for hepatitis?
- aseptic technique
- sterile, single-use disposable needles/syringes
- single dose vials
- hand hygiene, PPE
What are the symptoms of hepatitis during the prodromal phase?
- flu-like
- body pains
- fatigue
- decreased appetite
- N/V
- adbominal and joint pain
What are the symptoms of hepatitis during the icteric phase?
jaundice
- dark urine
- clay-colored stool
- “i” yellowing
What are the risk factors for hepatitis A?
- ingestion of contaminated food/water/stool (SHELLFISH)
- close contact with the infected person
What are the risk factors for hepatitis B?
- unprotected sex with an infected individual
- infants born to infected mothers
What are the risk factors for hepatitis C?
- IV drug use
- blood/blood products
- organ transplants
- contaminated needles
Why was there such a high risk & prevalence of hepatitis C before 1992?
blood transfusions were unscreened before this time
What nephrotoxic meds should you avoid with chronic kidney disease?
NSAIDS
What should you teach a patient with CKD to monitor at home?
BP and weight
What electrolyte consumption should be decreased with CKD?
- sodium
- potassium
- phosphorus
What is the recommended daily protein before starting dialysis?
0.6-1.0g/kg/day
What is the recommended daily protein intake after starting dialysis?
1.2-1.5g/kg/day
For CKD, when should you give digoxin, and what should you do to the level?
- give after dialysis
- reduce the level
For CKD, what does sodium polystyrene (kayexalate) do and what should you restrict?
- increases the elimination of potassium
- restrict sodium
For CKD, what do calcium carbonate and vitamin D do, and when should you take them?
- stop phosphate absorption
- take with meals, 2 hrs away from meds
In CKD, when can furosemide not be used?
END STAGE
What is needed for hemodialysis?
vascular access
What should the temperature of the dialysate be in hemodialysis? In peritoneal dialysis?
- H: body temperature
- P: warmed, but not microwaved
For hemodialysis, what is disequilibrium syndrome?
a rapid decrease in BUN and circulating fluid volume
What electrolyte consumption should be decreased with hemodialysis?
- sodium
- potassium
- phosphorus
What nutritional intake should be increased with hemodialysis?
- calcium
- protein
- carbs
When would you do peritoneal dialysis?
- inability to tolerate anticoagulation
- difficulty with vascular access
- chronic diseases (DM, CHF, HTN)
What would an infected dialysate return look like?
bloody, cloudy, frothy
Peritonitis is a complication of peritoneal dialysis. What is peritonitis?
infection of the peritoneum
What should you do if protein loss is noticed after peritoneal dialysis?
increase protein and monitor albumin
Peritoneal dialysis can cause hyperglycemia and hyperlipidemia leading to HTN. What meds can be given?
- insulin
- anti-lipemics
- anti-HTN
How do you assess the thrill and bruit for an AV graft/fistula?
- feel/palpate the thrill (vibration)
- hear/auscultate the bruit (whooshing sound)
How is sinus tachycardia described?
fast but regular
What HR and BP show sinus tachycardia?
HR: >/= 150 bpm
BP: decreased, SBP <90
What can be used at home to test for atrial fibrillation?
Holter monitor
What medications can be used to treat sinus tachycardia?
ADENOSINE (restarts heart)
- beta-blockers: metoprolol
- CCB: verapamil, diltiazem
- pain meds
- antipyretics
What are those with atrial fibrillation at a huge risk for?
CLOTS
- MI
- PE
- CVA
- DVT
How is atrial fibrillation described?
rapid and disorganized
What medications/interventions can be used to treat atrial fibrillation? (ABCDE)
- anticoagulants
- beta-blockers
- cardiac ablation
- digoxin
- electro cardioversion
What do anticoagulants do in A fib?
prevent clots, but have a high risk for bleeding
What do beta blockers do in A fib?
slow HR
What does cardiac ablation do in A fib?
burns erratic cells
What does digoxin do in A fib?
slows and strengthens
What is electro cardioversion for A fib?
a baby shock to reset the SA node
What is the rate for A fib?
usually > 100
What is the rhythm for A fib?
irregular
Is there a P wave with A fib?
no
Is there a PR interval with A fib?
no
What does QRS look like in A fib?
normal
What is the rate for A flutter?
75-150
What is the rhythm for A flutter?
regular
Is there a P wave with A flutter?
no
Is there a PR interval with A flutter?
no
What does the QRS look like in A flutter?
normal
what medications can be given for atrial flutter?
AMIODARONE
- beta blockers
What are you worried about with atrial flutter?
rate control
