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Capstone Round 3 > Cumulative Review > Flashcards

Cumulative Review Flashcards

1
Q

MedSurg: Class I - IV (colored tags)

A

Penetrating head wound/Agonal breathing = black
Red = MI, chest wound
Yellow = fracture
Green = abrasion

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2
Q

Electroencephalogram Preparation

A

Wash hair

NOT NPO

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3
Q

Glasgow Coma Scale

A

15 ↑ = good
7 ↓ = bad (coma)
Motor = 6 pts

Eye spontaneous = 4 pts
Verbal = 5 pts

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4
Q

Meningitis - HiB vaccine is for which 3 people?

A

Common cause of bacterial meningitis

College kids
Diabetes Insipidus
SIADH

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5
Q

S/S Diabetes Insipidus

TX

A

Dilute (↓SG) polyuria with concentrated blood (↑ HH)

Replacement of nutrients

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6
Q

S/S SIADH
Controlled by what?

TX

A

Oliguia r/in retaining fluid. Hypervolemia and low sodium concentration (↓ Na)

Posterior pituitary

Fluid restriction, Oral Demeclocycline, and ↓ Na TX

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7
Q

FX Parkinsons

SFX Anti-Parkinson medications (Levodopa & Carbidopa, why together?)

A

↓ Dopamine, ↑ ACTh*

Shuffling gait
Abnormal movement
Tremors

Together r/in smaller dose needed

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8
Q

Medication for: Alzheimers

A

Donepezil - helps w/ short term memory loss

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9
Q

MS…?

A

Relapsing, remitting

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10
Q

2 S/S ALS (Lou Gehrig Disease)

A

Respiratory failure

Progressive weakness from bottom up

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11
Q

DX: Myastenia Gravis
ANTIDOTE:
C/B:

A

Tensilon/Edrophonium test
Atropine
↓ ACTh

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12
Q

Tensilon/Edrophonium Test

DX for:

A

Give tensilon to a pt experiencing Myastenia Gravis, if it gets worse (+), give atropine.

Cholinergic Crisis

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13
Q

FX: Atropine

A

TX Bradycardia and cholinergic FX

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14
Q

2 Medications for: Migraines
FX:
4 ADFX:

A

Sumatriptan (Imitrex)
Ergotamine
Vasoconstricts, r/in ↓blood flow to brain

N/V, headaches , photo phobia, aura

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15
Q

TX: Retinal Detachment

Is it painful?

A

Curtain over eyes

NOPE

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16
Q

2 Medications for: ↑ Increased Intra-ocular Pressure

A

Mannitol andAcetylzolamide

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17
Q

FX: Macular Degeneration

2 EDUCATION:

A

Loss of central vision*
No cure
Part of aging (common ↑ 60 y/o)

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18
Q

S/S: Open vs. Closed Glaucoma

A 
Open = common, loss of periphery w/ mild pain
Closed = SUDDEN OUCH (ICP ↑ 21 mm Hg)... results in severe pain* & Halo's around lights*.
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19
Q

4 Medications for: Open/Closed Glaucoma
1 EDUCATION:

TAMP

A

Timolol
Acetylzolamid
Mannitol
Pylocarpine

Wait 15 min between drops

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20
Q

3 S/S Meniere’s disease

2 Classes/Medications for:

A

Tinnitus, Vertigo, and Unilateral hearing loss

Anticholinergic and Antihistamine
Meclizine and Diphenhydramine

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21
Q 
Purpose of TX: Head injury
Positioning
Avoid
Maintain
Medication used:
A 
↓ ICP
Semi-Fowlers 30º, head midline
Flexion, extension, rotation
O2 levels (↓CO2 r/in ↑ICP)* = BAD
Pentobarbital
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22
Q

FX: Pentobarbital

A

Induce a coma which ↓ the metabolic demands of the body

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23
Q

FX: Stroke, LEFT vs. RIGHT

Who does swallow eval?
2 S/S Right sided to note.

A 
Left = speech, math, analytical, reading & writing*
Right = visual/spacial awareness, walking, impulse control*

It’s speech, no matter what.
Over estimating abilities, emotional stuff.

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24
Q

Key S/S Hypoglycemia

A

↓ LoC

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25
Q

4 S/S Spinal Cord Injury (AKA)

A

Neurogenic Shock
ALL ↓
Bradycardia, Hypotension, Bladder/paralytic ileus

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26
Q

FX: Autonomic Dysreflexia

4 S/S:

A 
Stimulation SNS (injuries above T-6 only)
Extreme HTN*
Blurred vision
Extreme headache
Diaphoresis
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27
Q

TX: Autonomic Dysreflexia

R/F:

A

Sit up, notify provider, figure cause
Check full bladder or fecal impaction

Retention, Impaction, and Tight Clothes can trigger

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28
Q

What to assess after a Bronchoscopy?

A

Gag reflex

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29
Q

FX: Thoracentesis
Pt Positioning:
Pt Education during:

A

Draining fluid out of lungs
Sitting (tripod) w/ arms over table
Don’t COUGH or TALK

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30
Q

2 Pre-Thoracentesis

A

Informed consent

Drain the bladder

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31
Q

Chest Tube 3 Chambers (2, 2, 3 NOTES per)

A

Right Side - Drainage
REPORT if ↑ 70mL/hr drainage
Mark drainage at least once per shift

Middle - Water seal (2cm)
Tidaling = OK, stop = obstruction
Continuous bubbling = leak

Left Chamber - Suction
Can be dry/wet
If it comes out, apply occlusive U dressing
If it fills, replace entire unit

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32
Q

Mechanical Ventilation: High pressure vs. Low pressure alarm

ALWAYS…?

A 
High = ↑ secretions, biting tubing, pulmonary edema, brochospasm, pneumothorax, or kinks in tubing
Low = cuff leak, disconnection, or displacement

ASSESS FIRST

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33
Q

2 DZ of COPD
Max O2 to give
How often Physiotherapy

A

Chronic Bronchitis & Empysema
2 L/hr
2 hrs AFTER meals

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34
Q

3 Breathing techniques: COP
2 Diet
How often to incentive spirometer

A

Pursed lip, abdominal, tripod
Small frequent, HiCalorie
10x an hour

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35
Q

Before administering antibiotics…?

A

Culture first

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36
Q

Precautions: TB

3 PPE

A

Airborne

Negative pressure, private room, N95

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37
Q

FX: Mantoux Skin Test

A

Read after 48 - 72 hours, if ↑ 10mm and hard = +

If pt has immunocompromised or has AIDS ↑ 5mm = +

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38
Q

+ Mantoux Skin Test Follow up (2)
Looking for…?
How often for sample?

A

Sputum sample + X-ray
+Acid fast in sputum
2 - 4 weeks, non-infectious after 3 NEGATIVE sputum cultures

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39
Q

How long to take TB meds?

Why so many at once?

A

6 months - 1 year

Prevent resistance strains

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40
Q

3 Medications for: TB

A

Rifampine, Isoniazid, Ethambutol

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41
Q

ADFX to report: TB medications

A

Rifampine - Hepatotoxicity
Isoniazid - Hepato/Neurotoxicity (don’t drink while taking)
Ethambutol - Vision problems

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42
Q

SFX Rifampine thats OK

A

Orange urine

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43
Q

R/F Pulmonary Embolism and 3 S/S of it.

A

Deep Vein Thrombosis

Unilateral swelling, redness,and pain

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44
Q

6 S/S Pulmonary Embolism

A

Dyspnea (SoB), Crackles, Cough, Tachycardia, Hypotension, Chest pain

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45
Q

Medication SUFFIX for Pulmonary Embolism?

A
  • ase drugs

example: Streptokinase

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46
Q

S/S and TX Pneumothorax

A

Trachea deviated to unaffected side

Tube high in lung to capture rising air

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47
Q

TX Hemothorax

A

Tube lower to capture draining fluids

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48
Q

2 Key S/S Cardiac Tamponade

A

Paradoxal Pulse = ↑ 10 mmHg of BP during inhalation from exhalation
Muffled ♥ Sounds

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49
Q

3 Cardiac Enzymes

A

Myoglobin - w/in first hour, but nonspecific to heart (general muscle damage)
Troponin - lasts longest in system (3 - 21 days)
CKMB - only pick if MB at end

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50
Q

4 Nurse Role: PICC Lines

A

Check w/ Chest X-ray before use
Flush w/ 10mL NSS (NOT HEPARIN)
Measure Cm exposed
Lasts 12 months, assess q8hrs

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51
Q

4 S/S: IV Phlebitis

2 TX:

A

Pain, lines, hardening of vein, red

Stop infusion, remove IV, apply warm compress

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52
Q

2 S/S IV Infiltration

2 TX:

A

Swollen, cool

Stop infusion, remove IV (ensure catheter intact), elevate extremity

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53
Q

3 S/S Air Embolism

2 TX:

A

SoB, Chest pain, cofusion

Left side Trendelenburg, give O2

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54
Q

2 Times to Defibrillate

1 Time NOT to Defibrillate

A

Pulseless V-Tach
V-fib
ALWAYS Asynchronous

A-fib, use Synchronous cardioversion

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55
Q

FX: Pacemakers

Pt arm position

A

On demand - should always keep HR at set level (if pt HR is ↓ it means it’s not working)
Arm down by side after insertion and then in a sling DO NOT RAISE for 1 -2 weeks

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56
Q

4 EDUCATION: Pacemakers

REPORT?

A

Will set off airport alarm
DO not get an MRI
OK Showering/bathing
OK using the microwave

Hiccups (stimulating diaphragm)

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57
Q

Entrance: Percutaneous Coronary Intervention
Check before OP:
Diet:

A

Entrance at femoral artery
Shellfish/Iodine allergy
Increase fluid intake

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58
Q

4 Nurse Roles: Percutaneous Coronary Intervention

A

Patient lay flat
Apply lots of pressure
Check distal pulses
Check for bleeding @ site

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59
Q

TX Angina
4 EDUCATION
Route?
2 SFX:

A

Nitro
Shave hair off placement spots, rotate sites, take off @ night or after 12 hrs, and reapply if it falls off.
Sublingual on ONSET, it not relieved in 5 minutes call 911 (up to 3 times)
Hypotension and Headaches

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60
Q

Stable vs. Unstable Angina

A 
Stable = goes away w/ rest
Unstable = does not and gets worse overtime
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61
Q

TX MI: MONA (Order ONAM)

A

Oxygen
Nitro
Aspirin
Morphine

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62
Q

7 MI Medications

BANKAAM!

A

Beta-Blockers -olols
Aspirin, Nitro, -Kinases
Anticoagulants/plateletes
Morphine

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63
Q

Lab used to indicate Heart Failure

A

Basic Metabolic Panel

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64
Q

2 S/S Right vs. 3 S/S Left Sided Heart Failure

A 
Right = peripheral edema and Jugular Vein Distention (JVD)
Left = Pink, frothy sputum, ANYTHING LUNG related, pulmonary edema
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65
Q

Medication for: Heart Failure
2 ADFX (REPORT?):
Diet:

A

Diuretics (Lasix) = ↓ preload
Hypokalemia - REPORT muscle weakness
Hyponatremia
Increase fluid intake

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66
Q

FX: Afterload

A

Resistance to get out of heart, arteries dilate to decrease this

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67
Q

3 Medications for: Decreasing afterload (↓ BP)

A

ACE Inhibitors (-prils)
Ca Chnl Blockers (-pines + Verapamil and Diltiazem)
Angiotensive 2 Blockers (-sartan)

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68
Q

3 ADFX:

ACE Inhibitors

A

Angioedema, Cough, ↑ Potassium

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69
Q

FX: Preload

Medication for:

A

Fluid that returns to the heart

Diuretics

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70
Q

FX: Digoxin
Check before giving:
4 S/S Toxicity:

A

Helps ♥ pump better
Check pulse is ↑ 60
N/V, anorexia, halo vision, slow HR

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71
Q

Digoxin Therapeutic/Toxic Range

What can ↑ this?

A

0.8 - 2.0 (↑ 2.4 = toxic)

Hypokalemia

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72
Q

2 TX: Venous Insufficieny

Ø TX:

A

Exercise and TED/SCD Stockings

Dangling legs will NOT help

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73
Q

TX: Arterial Insufficieny

Ø TX:

A

Dangling legs

Exercise is PAINFUL

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74
Q

EDUCATION: Valvular Heart Disease

A

Use antibiotics before going to the dentist

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75
Q

TX: Vaso-occlusive Crisis

A

Start IV then give pain meds

Otherwise, ABC

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76
Q

DX: HTN

5 Medications ofr:

A

↑ 140/90 (2 readings in 1 week to DX)
Beta-blockers (-olols) - vasodilate and slow HR
ACE Inhibitors (-prils)
ARBs (-sartans)
Ca Chnl Blockers (-pines) + Verapamil and Diltiazem
Diuretics

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77
Q

3 S/S HTN

A

Headache
Visual Disturbance
Dizziness

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78
Q

Class and FX: Clonidine

A

Alpha2-Agonist, r/in vasodilation which ↓ BP and ↓ peripheral vascular resistance

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79
Q

Class and FX: Doxazosin

2 TX:

A

Alpha1-Blocker, r/in dilated arteries to TX BPH (enlarged prostate) and urinary retention
Also a anti-Hypertensive

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80
Q

Medication for: Prostate Cancer

A

Loupron

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81
Q

FX of following Classes:

Beta1, Beta2, Alpha1, Alpha2

A

Heart (agonist ↑ HR, antagonist ↓ HR)
Lungs (agonist dilates, antagonists constricts)
Artery constriction (Dopamine)
Artery dilation, used for HTN (Clonidine)

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82
Q

FX of 2 Non-Selective BetaBlockers

Contraindication

A

Labetalol and Propranolol, slow the heart but also constrict the lungs

ASTHMA

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83
Q

3 Nurse Roles: Aneurysms

A

Control BP (keep low to prevent bursting)
Check pulses
Check urinary output

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84
Q

2 S/S Adominal Aortic Aneurysm

Nurse Role:

A

Flank/Backpain and sometimes a pulsating abdominal mass

DO NOT PALPATE

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85
Q

2 S/S Aortic Dissection

2 Nurse Roles:

A

Tearing ripping pain followed up hypovolemic shock

Keep close eye on vitals
Get a CT or X-Ray

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86
Q

4 Notes of: Decreasing ICP

A

DO NOT raise bed above 30º
DO NOT turn head
Calm environment
Hypercapnia r/in ↑ ICP so stay oxygenated!

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87
Q

Indications of: ↑ or ↓ Hct

♂/♀ Range

A

↑ Dehydrated or Polycythemia
↓ Blood loss or anemia

♂ 42- 52%
♀ 37 - 47%

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88
Q

Indications of: ↓ Hgb

♂/♀ Range

A

Blood loss or anemia

♂ 14 - 18
♀ 12 - 16

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89
Q

6 Nurse Roles: Blood Transfusions

A 
ALWAYS use NSS (never D5W)
ALWAYS used Y tubing with a filter
Take vital signs q15mins
Must be complete in 4 hours
Use 20 gauge to GIVE, 16 - 18 to TAKE
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90
Q

3 S/S Hemolytic Reaction to blood

A

Low back pain, Hypotension, flushing

91
Q

4 S/S Anaphylactic Reaction to blood

3 TX procedure

A

Itching, fever, chills, flushing

Stop infusion, assess vitals, send blood back to bank

92
Q

FX: Autologous Transfusions

A

Donating blood 5 weeks to 72 hrs prior to surgery

O can only get O
AB can get ANY

93
Q

Cow milk and children

A

Too much r/in iron deficiency anemia

94
Q

Pernicious Anemia

A

Lack of B12

95
Q

FX: Idiopathic Thrombocytopenic Purpura

Monitor for:

A

Autoimmune disorder when body destroys own platelets

Bleeding

96
Q

7 S/S HYPOvolemia

A 
Tachypnea
Tachycardia
Thready pulse
Hypotension
Diminished Cap refill
↑ HH
Orthostatic Hypotension
97
Q

7 S/S HYPERvolemia

A 
Tachypnea
Tachycardia
Bounding pulse
Hypertension
Edema
↓ HH
Distended Neck Veins
98
Q

Pancreatic Enzyme Ranges (Amylase/Lipase)

A

56 - 90/0 - 110

If they’re way out of line, probably the answer

99
Q

Albumin/PreAlbumin Ranges

A

3.5 - 5.0 (↓ = malnourished and r/o pressure ulcer if elderly)
15 - 35

100
Q

FX: High Ammonia

ANTIDOTE w/ Expected SFX

A

Hepatic Encephalopathy

Lactulose, a laxative which r/in pooping ammonia out (3 - 5 soft stools a day is expected)

101
Q

2 Pre-Colonoscopy Prep

A

NPO

Bowel Prep

102
Q

Nurse Role: Endoscopy (or Endogastroduodenoscopy)

A

Report cool clammy skin

This indicates hypovolemic shock b/c bowel perforation

103
Q

5 Nurse Roles: Total Parenteral Nutrition

A

NEVER Peripheral IV, only Central lines and PICC lines
▲ tubing q24hrs
Infused DW10 if next bag is not ready
Monitor blood sugar (for hypoglycemia) and electrolytes regularly
DO NOT USE if oily residual is in bag, should be uniform

104
Q

4 Nurse Roles: Paracentesis

A

Pee beforehand (general rule if poking, EXCEPT ultrasound)
Sit up
Measure abdominal girth BEFORE and AFTER
Watch Vitals

105
Q

2 Nurse Roles: Dumping Syndrome

A

Lay down

Tiny amounts of water NOT with meals

106
Q

3 Nurse Roles: Ostomies

A

Should be red, dark pink. REPORT pale pink or blue
▲ bag when 1/4 -1/2 full
Eat yogurt or put a breath mint in bag to help with smell

107
Q

Difference in output of Ileostomy vs. Colostomy

A 
Ileostomy = watery b/c upper GI
Colostomy = thicker b/c lower GI
108
Q

6 Foods that r/in ↑ odor of an Ostomy

A

Fish, Garlic, Eggs

Asparagus, Dark leafies, beans

109
Q

5 Medications Classes for: GERD

EDCUATION each:

A

Antacids - take 1 - 2 hours AFTER medications
PPIs (-zoles) - ↓ gastric secretion, long term use r/in B12 deficiency
H2-Agonists (-dines + Metoclopramide) - empties stomach quickly (useful for N/V)
Prokinetic (Reglan)
Sucralfate - protective coats the ulcer

110
Q

R/F Esophageal Varices:
↑ R/F of…
2 TX:

A

Portal HTN
Risk of bleeding
Beta-Blockers and Vaso-constrictors

111
Q

3 Types of Hernias

A

Hiatal - when stomach comes through diaphram r/n lung problems
Inguinal
Umbilicus

112
Q

5 S/S Ulcerative Colitis

A 
↑ ESR/C-Reactive Protein
High pitched bowel sounds
15 - 20 liquid bloody stools a day
Fever
Weight loss
113
Q

3 S/S Crohn’s Disease

A

↑ ESR/C-Reactive Protein

5 liquid, fatty foul smelling pus stools a day

114
Q

4 Medications for: Ulcerative Colitis and Crohn’s

Procedure to cure

A

Steroids
5-ASAs
Immunosuppresants
Antidiarrheals

Bowel Resection

115
Q

4 S/S Diverticulitis

Acute vs. Long term diet

A

LLQ pain… Tachycardia, Fever, chills, N/V

Acute = clear liquid, low fiber
Long = high fiber
116
Q

Pancreatitis Signs: Cullins and Turners

A 
Culens = brusing by the umbilicus (C by belly button)
Turners = turn on side to see brusing
117
Q

R/F Pancreatitis:

5 S/S

A 
Alcoholism
Epigastric pain that radiates to back
Pain w/ eating (make NPO once admitted)
Worsen when lying down, eating + drinking alcohol
N/V
118
Q

3 Lab Changes: Pancreatitis

A

↑ WBC
↑ Blood glucose (not releasing insulin)
↓ Ca and MG

119
Q

Hep A
Hep B
Hep C
4 Common S/S

A

Oral-fecal, contaminated food, vaccine available
Drugs, sex (blood/body fluids) vaccine given @ birth, 2 months, 6 months
Blood, drug abuse
Flu like symptoms, jaundice, dark urine, clay colored stools

120
Q

FX: Cirrhosis
6 S/S
TX Hepatoencephaloathy

A

Scarring of liver
Spider angiomas, Fruity Breath (Fetorhepaticus0, Petechiae, Jaundice, Ascites
Lactulose

121
Q

Expected Labs with Chronic Renal Failure

A

ALL HIGH EXCEPT CA
↑ K, Mg, P, Na
↓Ca

122
Q

FX: Addisons
Expected S/S:
4 Lab Changes
Medication for (and ADFX of):

A 
↓ ACth/Cortisol production
Orange skin
↑ potassium and calcium
↓ glucose and sodium
Prednisone (osteoporosis)
123
Q

FX: Cushing’s Disease
3 Expected S/S:
4 Lab Changes
Medication for:

A 
↑ ACth/Cortisol production
Round/Moon face
Buffalo Hump
Hirsutism
↑ glucose and sodium
↓ potassium and calcium
Spironolactone
124
Q

Range + 7 S/S Hypoglycemia

A 
↓ 70 mg/dL
Mild shakiness
↓ LoC
Sweating
Palpitations
Lack of coordination
Blurred vision
Cool, clammy skin
125
Q

8 S/S Hyperglycemia

A 
Polyphagia - hungry
Polydipsia - thirsty
Polyuria
Fruity breath (DKA)
Headaches, N/V, ab. pain, ↓ Loc
126
Q

5 S/S Diabetic Ketoacidosis

R/F, Type of Diabetes, Onset

A 
Kussmaul Respirations - Deep, rapid breathing
Metabolic acidosis
Fruity breath
↑ 300 mg/dL blood sugar
\+ Ketones in urine

Infection, TX it
Type 1, Rapid Onset

127
Q

2 S/S Hyperglycemic Hyperosmolar state

Type of Diabetes, Onset

A

↑ 600 mg/dL blood sugar
Dehyrdation r/t polyuria

Type 2, Gradual Onset

128
Q

4 Oral Medications for: Diabetes Mellitus Type 2

ADFX:

A

Acarbose - slows carbohydrate abosorption
Metformin - stops liver from producing glucose
Pioglitazone
Glipizide

GI issues, but Pioglitza r/in fluid retention

129
Q 
Diabetic Foot Care
How often to inspect?
Type of shoes
Type of socks
How to cut nails
Lotion?
Food Powder
A 
Inspect DAILY
Closed toed - NEVER barefoot
Cotton or wool
Straight across
NOT between toes
Mild if toes sweaty
130
Q

Diabetic Education:
Testing the water temperature
Exercise
What to watch in diet

A

Test with hands first
↓ BS so don’t use extra insulin
Carbohydrates

131
Q

7 S/S HYPOthyroidism
▲ TSH/T3/T4 levels

Medication for:

A 
Dry coarse hair
Periorbital Edema
Bradycardia
Cold intolerance
HYPOtension
Weight GAIN
Tired

↑ TSH ↓ T3/T4
Levothyroxine

132
Q

7 S/S HYPERthyroidism
▲ TSH/T3/T4 levels

2 Medications for:
Procedure for:

A 
Tremors
Bulging eyes
Tachycardia
Heat intolerance
HYPERtension
Weight LOSS
Graves, when BAD

↓ TSH ↑ T3/T4

PTU or Radioactive Iodine
Thyroid Removal

133
Q

ADFX: Thyroid Removal

A

Issue with parathyroid r/in ↓ Calcium levels and ↑ Phosphorus levels

134
Q

Burns: Rule of Nine

A 
9% for anterior/posterior of...
Chest
Abdomen
Legs
4.5% for anterior/posterior of...
arms
head
1% groin
135
Q 
S/S different burn Depths:
Superficial
Deep Partial
Full
Deep full
A 
pink/red
pink/red + blister, edema, pain
red/white + eschar, +mild edema- pain
black to white, - blisters, +severe edema - pain
BLACK, - edema
136
Q

Medication for: Burns

ADFX

A

Silvadine (Antibiotic)

Transiet Neutropenia

137
Q

What NOT to do with a Wilm’s tumor

A

Palpate it.

DO NOT, palpate it.

138
Q

3 EDUCATION: ↓ WBC r/t Cancer

A

No fresh fruits/veggies
Stay away from crowds
No lemon glycerin for mouth sores… but Peroxide?

139
Q

Prophylactic Medication for: Ulcers

Contraindication

A

Misoprostol

DO NOT GIVE IF PREGO

140
Q

Lordosis vs. Kyphosis

A

Sway back vs. Hunchback

141
Q

4 EDUCATION: Contraceptive Diaphragm

r/t Spermicide

A

Keep in for 6 hours post-sex (no more, no less)
Refit q2years
Refit if ▲ 15 lbs
Refit if have pregnancy

Should be reapplied for each sex session

142
Q

3 ADFX: The Pill

5 Contraindications

A

Chest pain
Headaches
HTN

Migraine Headaches
Smokers
Breast Cancer
Clots
Hx Stroke
143
Q

Depo-Provera Injectectable ADFX

A

↓ Ca, r/in osteomalacia (softening of bones)

144
Q

Intra-uterine Device (T device)
↑ 2 R/F:
2 REPORT:

A

Ectopic pregnancy and Pelvic Inflammatory Disease

Report FOUL smell or ▲ in string length

145
Q

Check for before: Histerosalpinography

Diet:

A

Check for allergies to shellfish/iodine

Increase fluid intake

146
Q

Post-Vasectomy

2 EDUCATION:

A

Must have several negative checks (or wait 3 months) before unprotected sex

147
Q

5 S/S Presumptuous Pregnancy

A 
N/V
Tender breasts
Quickening
Missed period
Urinary Frequency
148
Q

8 S/S Probable Pregnancy

A

+ Pregnancy Test
Abdominal Enlargement
+Hagar = softening/compression of lower uterus
+Chadiwck = blue cervix
+goodall = softening cervical tip
Ballottement = rebound of fetus
+Braxton Hicks = intermittent weak contractions

149
Q

3 S/S Positive Pregnancy

A

Baby born
Ultrasound to see + hear HR
Feeling of baby via Professional Leopold maneuver

150
Q

GTPAL

A 
Gravida - No. pregnancies
Term - Birthed ↑ 38 weeks
Preterm - 22 - 37 weeks
Abortion - miscariage or planned
Live children
151
Q

Indication for: Rhogam
DX:
FX:

A

Negative mom, Positive Baby
Test @ 28 weeks. If negative, GIVE.
Stop production of antibodies to protect second pregnancy

152
Q

FX: Coombs Test

If +?

A

ID moms who already have antibodies

+Test = no need for Rhogam

153
Q

Prego: When to glucose test
What test:
Range for Hyperglycemia:

A

24 - 28 weeks
1 hr glucose test
↑ 140 mg/dL

154
Q

Prego: Postitive 1 hr glucose test?

A

Do 3 hour, fasting required

Gestational diabetes confirmed if 2 readings are above 140

155
Q

Prego: Meaning of ↑↓: Alpha-Feta Protein

Length of test

A

↑ - neural tube defect
↓ down syndrome
15 - 22 weeks

156
Q

Prego: When to take Group Beta-Strep test

A

35 - 38 weeks

157
Q

Prego: HIV+ Mom

3 EDUCATION:

A

CAN’T deliver vaginally
CAN’T breast feed
anti-HIV meds OK while pregnant

158
Q

Prego: Rubella titer
2 EDUCATION:
2 SFX:

A

If negative, give AFTER baby is born
Wait 1 month to get pregnant after vaccine
Low grade fever, rash

159
Q 
Prego: Expected weight gain
1st trimester
2nd trimester and 3rd trimester
Normal weight
Over weight?
Under weight?
A 
1st = 2  - 4 lbs
2nd/3rd = 12 lbs per
Normal = 25 - 35 lbs
Over = 15 - 25 lbs
Under = 28 - 40 lbs
160
Q

Prego: ↑ Calories per day 2nd and 3rd trimester

↑ Calories when breastfeeding

A 
2nd = 300 - 350 cal
3rd = 450 - 500 cal
Bfeeding = 300 - 400 cal
161
Q

Prego: Counter to neural tube defects and N/V

A

folic acid and dry diet (no fluid with meals)

162
Q

Prego: What 4 not to eat?

What to INCREASE in diet?

A

Alcohol, caffeine, fats, spices

Iron

163
Q

Prego: Ultrasound

Nurse Role:

A

DO NOT drain blader

164
Q

Prego: Amniocentesis

3 Nurse Roles:

A

Drain bladder (getting poked)
15 - 22 weeks to determiner AFP results
LS ratio tests for fetal lung maturity

165
Q

Prego: 5 Complications w/ an Amniocentesis

A 
Preterm labor
Infection
Leakage of fluid
Amniotic Fluid emboli
Hemorrhaging
166
Q

Prego:
FX: Chorionic Vila Sampling (CVS)
When during pregnancy to do
Result timing

A

Sample portion of placenta aspirated through abdominal wall, tests for genetic abnormalities
Do at 10 - 22 weeks
Results rapid

167
Q

Prego:
Scoring: Biophysical Profile (BPP)
5 things it DX:

A

0 - 10 (↑ 8 OK ↓ 8 = worry about fetal asphyxia)

Reactive FHR, Fetal Breathing movement, Gross body movements, Fetal tone (flexed = good), Amniotic fluid volume

168
Q 
Prego:
FX: Non-stress test
Which trimester to do
Reactive Result?
2 EDUCATION:
A 
Measures FHR in r/t fetal movement
3rd trimester
FHR normal w/ moderate variability and early accelerations
It's non-invasive
If the baby ain't moving drink some OJ
169
Q 
Prego:
FX: Contraction Stress Test
Used for what 3 types of clients?
Negative Results
Positive Results
A

Invasive used of Oxytocin/Nipple stimulate to see how fetus will tolerate stress of labor
Used for pts who are at a HIGH RISK of DM, post-term pregnancies, or had a NON-REACTIVE stress test
Negative = good (no late decels on FHR)
Positive = late decels w/ 50% or more contractions

170
Q 
Prego:
Placenta Previa (Complete/Incomplete) vs. Abruptio Placenta
A 
Previa = painless, bright red
Complete = Cervix is covered by the placenta
Incomplete = partially covered cervix

Abruptio = painful, dark red
Leading cause of maternal death, IMMEDIATE C-Section/Transfusion necessary!

171
Q

5 R/F Abruptio Placenta

A

HTN, drugs, tobacco, car accidents, and multi-fetal pregnancies

172
Q

3 TX: Placenta Previa

A

Bedrest (monitor bleeding)

Steroids to mature babies lungs in preparation of early birth

173
Q 
Types of Abortions:
Threatened
Inevitable
Incomplete
Complete
Missed
A

Cervix closed, spotting + cramps
Cervix dilated, bulging membrane
Cervix dilated, fetal tissue passed + cramps, bleeding
GONE!!!
Cervix closed + fetus is… still in there? Dilation and Curettage needed

174
Q

2 S/S: Ectopic Pregnancy
FX of concern
Eliminates which contraceptive?
Medication for:

A

Unilateral stabbing pain in LLQ, referred shoulder pain
Fetus implants in fallopian tubes, life threatening
IUD (which also ↑ R/F of this coincidentally)
Methotrexate to dissolve pregnancy (it inhibits cell division)

175
Q

4 S/S Molar Pregnancy

A

+Pregnany Test but NO FHR
Prune discharge
Excessive vomiting
Rapid uterine growth

176
Q

3 TX Incompetent Cervix

A

Sew it up (cerclage)
Ultrasound to confirm short cervix
Remove cerclage at 37 weeks or at spontaneous birth

177
Q 
Prego: 
FX: Hyperemesis
5 S/S
2 Medications:
2 TX + 2 backups:
A

Constant N/V r/in ↓ BP, weight loss, dehydration, electrolyte imbalance, and ↑ SG
Ondansetron/Metoclopramide
Fluids + Vit B6

Corticosteroids and TPN

178
Q

Babies: PICA

A

Eating shit

paper, chalk, wood, clay

179
Q

Gestational HTN
When occurs:
DX:

A

After 20 weeks

BP ↑ 140/90, 2 times 4 - 6 hours apart in in a 1 week period

180
Q

Mild Preeclampsia

3 S/S

A

Elevated BP
Protein in Urine +1
Transient headaches

181
Q

Severe Preeclampsia

7 S/S

A

BP ↑ 160/100
Protein in Urine +3
Headaches w/ blurred vision
Epigastric pain

Edema, Hyperreflexia, Ankle clonus

182
Q

Eclampisa

A

All other preeclampsia S/S + seizures

183
Q

Prego: HELLP Syndrome 3 S/S

A

Hemolysis - jaundice/anemia
Elevated Liver Enzymes - AST/ALT
Low Platelets

184
Q

HELLP Syndrome
4 Antihypertensive Medications
1 Anticonvulsant

A

Methaldopa
Nephitopine
Hydrolozone
Labetolol

Mag Sulfate

185
Q

FX: Mag Sulfate
Therapeutic Range:
Antidote:

A

Prevent seizures
4 - 8 mg/dL
Calcium gluconate

186
Q

4 S/S Toxicity: Mag Sulfate

A

Ø deep tendon reflexes
low respirations
↓ LoC
↓ Urine output

187
Q 
FX these meds during  Pre-term labor:
Nephitopine
Mag Sulfate
Endomethasin
Betamethason
Tocolytics
A 
Ca Chnl blocker  - ↓ contractions
Relaxes smooth muscles of uterus
NSAID - blocks uterine contractions
Matures lungs
↑ HR and counters beta-blocking agents
188
Q

2 DX: Premature Rupture of Membranes (PROM)

A

Blue result from Nitrozine paper when incontact w/ amniotic fluid

+Ferning Test - fluid on slide looks like a fern

189
Q

4 TX Progression: PROM

A

Check FHR
Check for prolapsed cord
Monitor for foul smelling discharge
NO SEX, NO BATHS

190
Q

5 TX Progression: Prolapses Umbilical Cord

A 
Call for assistance
Sterile glove to push head off cord
Knee to Chest (all fours)
Trendelenburg
Sterile Saline gauze on exposed portion
191
Q

FX: Hyphema

A

Pooing of blood inside the anterior of the eye that r/in pain

192
Q

ADFX to REPORT: Lamotigine

A

Rash

Steven-Johnsons @ 2 - 8 weeks TX for a child

193
Q

FX: Presbyopia

R/F:

A

Far sightedness

Occurs w/ middle/old age

194
Q

Whistling in ear from hearing aid

What to wash it with

A

Caused by excessive wax obstruction or poor fitting

water

195
Q

R/F Chronic Otitis Media

A

Chronic nose irritant - nose is connected to middle ear

196
Q

4 EDUCATION: Metoprolol

A

Take radial pulse daily
Don’t suddenly stop
Chew sugarless gum b/c dry mouth

197
Q 
Child timings:
Sitting unsupported
Stranger Anxiety
Drinking from cup
2 Words
A

8 months
8 months
9 months
12 months

198
Q

ADFX: Theophylline
TX:

A

“Theo makes my ♥ race”
Everything ↑ (Tachycardia)
Asthma

199
Q

Dumping Syndrome

4 Diet ▲s:

A

HIGH protein and fat
LOW-MOD carbohydrate
LOW fiber
Ø fresh fruits/veggies

200
Q

2 R/F: Widened Pulse Pressure

A

Aortic Insufficiency

Hyperthyroidism

201
Q

3 S/S ESRF

A

Restless Leg Syndrome
Pruritus
Confusion

202
Q

Diet: Pancreatitis

203
Q

TX: Gangrene in lower extremity
FX:

A

Guilliotine

Procedure where the target is drained before amputation

204
Q

FX: Beclomethazone (QVAR)
ROUTE:
ADFX:

A

Anti-asthmatic
Inhaled
White coating in mouth (Candidiasis)

205
Q

3 EDUCATION: Plastibell circumcision

A

Loose diaper in front
Ring will fall off in a week
REPORT bleeding

Ø petroleum or anything
Ø wash penis warm water/mild soap unless healed for 5 - 6 days

206
Q

ADFX: Clozapine
Most common
2 Potential
EMERGENCY

A

Tachycardia
Anticholinergic + Neck rigidity
Agranulocytosis

207
Q 
Complications of:
Heroin
Alcohol
Cocaine
Marajuana
A

Dental Caries
Pancreatitis
Perforation of Nasal Septum
Permanent FX of short-term memory loss

208
Q

Yogurt and OJ r/t Potassium?

A

HAS IT

Not frozen veggies though!

209
Q

3 components of a Mental Status Examination

A

Ability to perform calculations
Recall ability
Level of Orientation

210
Q

3 ADFX to REPORT: Aldronate (Fosamax)

EDUCATION with taking:

A

Jaw Pain
Blurred Vision
Dysphagia

Stay upright fo 30 min post taking

211
Q

ADFX to report: Zileuton (Zyflo)

FX:

A 
Anti-asthmatic
Abdominal pain (r/t liver damage/hepatitis)
212
Q

Child: Age that they use both feet to traverse stairs

A

3 years old

at 4 they can use both feet separately

213
Q 
♥ DX tools for:
Degree of damage of MI
Location of MI
Size of MI
Coexistence of Pulmonary Congestion
A

Cardiaac Enzymes
EKG
Tomography
Chest-X Ray

214
Q

Expected urine output/kg/hr:
1 Year old
Adults

A

2 mL/kg/hr

15 mL/kg/hr

215
Q 
5 S/S False Labor:
Timing
Decreases with... 4?
where felt
▲ Cervix
A

Irregular, intermittent
↓ with walking, drinking water, peeing, sleeping
Lower back/above umbulicus
Ø significant ▲ or bloody show

216
Q

3 Stages of ONSET (1st stage) Labor

A

Latent
Active
Transition

217
Q

Onset Latent Labor:
Cervix
Behavior
Breathing

A

0 - 3 cm
Talkative/eager
Slow deep

218
Q

Onset Active LAbor:
Cervix:
Feeling:

A

4 - 7 cm

Helpless, anxiety, restlesss

219
Q 
Onset Transition Labor:
Cervix
Feelings (2)
Common S/S
Breathing
A

8 - 10 cm
Out of control/can’t continue + Urge to push/rectal pressure
N/V
Pattern paced

220
Q

2nd Stage Labor:

If Baby is OP or OA

A

OP - mom on all fours

OA - OK!

221
Q

3rd Stage Labor:

Delivery of…?

A

Baby or Placenta

222
Q

4th Stage Labor:
Deliver of…?
VS ▲?

A

Placenta

Vitals stabilize

223
Q 
Labor Pain TX:
Lower back pain
Opiods
Spinal
Epidural
A

Sacral Counter pressure
Monitor for respiratory depression
Monitor for respiratory depression (higher than epi)
Monitor for hypotension (counter w/ IV boluses)

Position for L side for ANYTHING

Capstone Round 3 (7 decks)

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