D Flashcards
What is another name of Buerger’s disease?
Thromboangitis obliterans
Which extremities are affected most often?
Lower only
Which sex deos it affect most often?
Males
The group with the highest incidence of Buerger’s disease is ______.
Smokers
Upon walking the patient with Buerger’s experiences _______ ________.
Intermittent Claudication
What is intermittent claudication?
Pain in calf upon walking
A first-degree burn is pale or red?
Red
A first-degree burn has vesicles? (T/F)
False
A second-degree burn is pale or red?
Red
A second-degree burn is dull or shiny?
Shiny
A second-degree burn has vesicles? (T/F)
True
A third-degree burn is white or red?
White
A third-degree is wet or dry?
Dry
Of first, second and third degree burns which has less pain? Why?
Third degree burns, nerve damage has occurred.
For what purpose do you use the rule of nines?
To estimate the percentage of body surface burned; is NOT used for children.
In the rule of nines, the head and neck receive _____; each arm receives ____
9%, 9%
In the rule of nines, the front trunk gets _____, the posterior trunk gets ______, each leg gets _____, and the genitalia gets ____.
18%, 18%, 18%, 1%
What is the only IM given to a burn patient?
Tetanus toxoid-if they had a previous inmmunization;
Tetanus antitoxin-if they have never been immunized before (or immune globulin).
In the emergent phase do you cover burns? (in the field)
Yes, with anything clean and dry.
Should you remove adhered clothing?
No
Name the 3 phases of burn.
3 Phases:
Shock,
diuretic,
recovery
Fluid moves from the _____ to the _____ _____ in the shock phase.
Bloodstream, interstitial space
The shock phase of the burn is potassium increased or decreased? Why?
Increased, because of all the cells damaged- the K+ is released from damaged cells.
What acid-base disorder is seen in the shock phase of a burn?
Metabolic acidosis
What is the #1 therapy in the shock phase?
Fluid replacement/resuscitation
What is the simple formula for calculating fluid replacement needs in the first 24 hours after a burn?
4 ml x Kg x % burned per day
i.e.: 70 Kg with 50% burn
3 x 70 x 50 = 10,500 mL
If the MD orders 2,800 cc of fluid in the first 24 hours after a burn, one- ______of it must be infused in the first eight hours.
Half (or 1,400 mL)
What blood value will dictate IV flow rate?
The hematocrits
How will you know the patient has entered the fluid mobiliation or diuretic phase?
The urine output will increase.
How long does the fluid mobilization or diuretic phase of a burn last?
2 to 5 days
In the diuretic phase, K+ levels fall or rise?
Fall
REMEMBER: diuresis always causes hypokalaemia
If the nurse accidently runs the IVs at the shock phase rate during the diuretic phase the patient will experience ____ _____.
Pulmonary Edema
The burn patient will be on _____ urine output and daily ______.
hourly, weight
Sulfamylon cream causes the patient to experience what?
A burning sensation
Silver nitrate cream _____ the ______.
Stains, skin
Pain medication should be administered _____ minutes before ______ care.
30 minutes, before wound care
When using silver nitrate on a burn, the dressing must be kept ________.
wet
What is Curling’s ulcer? Why do burn patients get it? What drug prevents it?
It is a stress GI ulcer that you get with any severe physical stress.
It is prevented with H2 receptor antagonist (-tidine) and proton pump inhibitors (-zole).
“Neoplasm” refers to both benign and malignant tumors. (T/F)
True
Which type of tumor is more likely malignant? Differentiated or Undifferentiated?
❌Undifferentiated is worse
(highly differentiated is best to have).
When cancer spreads to a distant site it is called ____________?
Metastasis
The cause of cancer is known. (T/F)
Partially true, but we still don’t know a lot.
A person should have a yearly exam with cancer detection over the age of?
40
In general, cancer drugs have side effects in which three body systems?
GI,
hematologic (blood),
integumentary (skin)
What are the three most common chemotherapy GI side effects?
Nausea and vomitting,
diarrhea,
stomatitis (oral sores)
Clients receiving chemotherapy must be NPO. (T/F)
False
It is permissible to give Lidocaine viscous before meals if the patient has painful stomatitis. (T/F)
True
With what solution should the client with stomatitis rinse after meals?
Hydrogen peroxide
Name the 3 hematologic side effects of chemotherapy.
Thrombocytopenia
Leukopenia
Anemia
Which cells are low in thrombocytopenia?
Platelets
What drug should not be given to the patient with chemotherapeutic thrombocytopenia?
Aspirin
When should the nurse withhold IM injections in the client on chemotherapy?
Only when their platelet count is down.
What are the 3 objective symptoms/signs of thrombocytopenia?
Epistaxis, ecchymosis, petechiae
What is epistaxis?
Nose bleeds
What is ecchymosis?
Bruising
What is petechiae?
Small dot-like pinpoint hemorrhages on the skin
What blood cell is low in leukopenia?
White blood cells
When the Absolute Neutrophil Count ANC is below ______ the person on chemotherapy will be placed on reverse isolation.
500
What is the #1 integumentary side effect of chemotherapy?
Alopecia
What is alopecia?
Hair loss
The hair loss due to chemotherapy is usually temporary. (T/F)
True
Can scalp tourniquets prevent chemotherapy alopecia?
In some cases, yes
Can ice packs to the scalp prevent chemotherapy alopecia?
In some cases, yes
CD ranks ______ among the leading causes of maternal death.
4th
What is the #1 cause of CD of pregnancy?
Rheumatic heart disease
Pregnancy requires a ______ increase in the cardiac output.
30-50%
What is the #1 cause of maternal death in CD of pregnancy?
Decompensation
What is meant by decompensation?
Failure of the heart to maintain adequate circulation.
What will you see when you observe the neck of a client with CD of pregnancy?
Distended neck veins-JVD
What will you hear when you auscultate the heart of the client with CD of pregnancy?
Murmurs
What will you hear when you auscultate the lungs of the client with CD of pregnancy?
Crackles-rales
If the client with CD of pregnancy experiences sudden heart failure what is the MOST common thing you will see?
Sudden onset of shortness of breath-dyspnea
What is the #1 treatment of CD during pregnancy?
Rest
What are the three most common drugs given to women with CD in pregnancy?
Diuretics, Heparin, Digitalis
Why are diuretics given to women with CD of pregnancy
To promote diuresis, which will lower circulation blood volume, decrease preload, decrease the amount of blood the heart pumps.
Why are anticoagulants (heparin only) given to women with CD of pregnancy?
To prevent thrombophlebitis due to venous congestion, usually in legs.
Why is digitalis given to women with CD of pregnancy?
To increase the strength of the heart and to decrease the rate, rests the heart while making it more efficient.
Can a woman with CD of pregnancy be given analgesics during labor?
Yes, in fact they should be given analgesics, may get too anxious which is bad for the heart.
Can morphine be given to a woman with CD during labor?
Yes, even though it negatively affects the fetus, remember morphine decreases preload and pain which rests the heart.
What is the most common dietary modification for the woman with CD who shows signs of decompensation?
Decreased sodium, decreased water (restriction)
Is a C-section mandatory for delivery of a woman with CD of pregnancy
No
Second to rest, what is very important treatment for CD of pregnancy?
weight control
How long must the woman with CD of pregnancy be on bed rest after delivery?
At least one week
What nutrients should be supplied in the diet of this woman?
Iron, folic acid,
prevent anemia (anemia always makes the heart work more).
What are the two most common subjective complaints of the woman who is decompensating during labor?
SOB
palpitations
In addition to the things you assess for in every woman during labor, what additional assessment must you make for a woman with CD?
You must assess lung sounds frequently
How often must you assess the lung sounds during the first stage of labor? During active labor? During transition labor?
Every 30 to 10 minutes
In which position should a woman with CD labor be?
Semi recumbent, HOB up
The nurse should limit the client’s efforts to ____ _____ during labor when CD is present.
Bear down
CARE OF THE CLIENT WITH A CESIUM IMPLANT FOR CANCER OF THE CERVIX
What is the big danger to staff when caring for a client with cesium implant?
Radiation hazard
CARE OF THE CLIENT WITH A CESIUM IMPLANT FOR CANCER OF THE CERVIX
What are the three principles to protect yourself from radiation hazard?
Time, distance, shielding
CARE OF THE CLIENT WITH A CESIUM IMPLANT FOR CANCER OF THE CERVIX
Will the woman with a cesium implant have a Foley?
Yes
CARE OF THE CLIENT WITH A CESIUM IMPLANT FOR CANCER OF THE CERVIX
From where should the nurse provide care to the client with cesium implant?
The HOB
How can the woman with cesium implant move in bed?
Only from side to side
CARE OF THE CLIENT WITH A CESIUM IMPLANT FOR CANCER OF THE CERVIX
What four symptoms should be reported to the physician?
- Profuse vaginal discharge,
- elevated temp,
- nausea,
- vomiting (these indicate infection and perforation)
CARE OF THE CLIENT WITH A CESIUM IMPLANT FOR CANCER OF THE CERVIX
Should pregnant staff care for a client with a cesium implant?
No
CARE OF THE CLIENT WITH A CESIUM IMPLANT FOR CANCER OF THE CERVIX
Can the woman with a cesium implant have the HOB elevated?
Yes, only 45° maximum.
CARE OF THE CLIENT WITH A CESIUM IMPLANT FOR CANCER OF THE CERVIX
From where should the nurse talk to the client?
The entrance to the room.
CARE OF THE CLIENT WITH A CESIUM IMPLANT FOR CANCER OF THE CERVIX
Is bed rest necessary when a woman has cesium implant in place?
Yes, absolute bed rest
CARE OF THE CLIENT WITH A CESIUM IMPLANT FOR CANCER OF THE CERVIX
What type of diet is this woman on?
Low residue
CARE OF THE CLIENT WITH A CESIUM IMPLANT FOR CANCER OF THE CERVIX
No nurse should attend the client more than ______ hours per day.
One half hour
CARE OF THE CLIENT WITH A CESIUM IMPLANT FOR CANCER OF THE CERVIX
What would you do if the implant came out?
Pick it up with forceps only- never touch with hand even if you are wearing gloves.
CARE OF THE CLIENT WITH A CESIUM IMPLANT FOR CANCER OF THE CERVIX
Should the nurse provide perineal care for No, risk of radiation hazard the client with an implant?
No, risk of radiation hazard
What part of your hand do you use to handle a wet cast?
The Palm
Upon what do you support a cast while it dries?
Pillows (no plastic covers)
How long does it take a cast to dry?
24 hours
Should you cover a wet cast?
NO
Should you use a heat lamp or hair dryer or fan to help dry a cast?
NO- heat lamp and hair dryer
YES-fan
What signs or symptoms would you report if they were present after cast application?
Numbness, tingling, burning, pallor, unequal or absent pulses, unequal coolness.
If there is inflammation under a cast, it will be evident in a ______ spot.
“Hot”
To prevent irritation of the skin near the edges of a cast the edges should be ______.
Petaled
What type of cast causes cast syndrome?
A body cast
What causes cast syndrome?
Anxiety and stress leading to sympathoadrenal shut-down of the bowel.
What is the #1 symptom of cast syndrome?
Nausea and vomiting due to bowel obstruction
What is the #1 treatment of cast syndrome?
NPO, and NG tube for decompression
A dry cast is gray or white?
White
A dry cast is dull or shiny?
Shiny
A dry cast is dull or resonant to percussion?
Resonant
Traction is used to ______ a fracture, relieve ______ ______ and prevent de- __________.
Reduce and immobilize; muscle spasm; deformities
Can skin traction be removed for skin care?
Yes
Can the client be removed from skeletal traction?
No
Name 3 types of skin traction.
Bucks, Bryants, Pelvic
Name 3 types of skeletal traction
Cranial tongs, Thomas splints with Peason attachments, 90E to 90E
What type of traction is most commonly used for hip fracture in adults?
Bucks
What type of traction is most commonly used for hip fracture in children?
Bryants
In what position should the bed be if the patient is in pelvic traction?
Semi-fowlers with knee gatched
To insure that Bryant’s traction is working the child’s hip/sacrum should be ______.
Off the bed enough to slip a hand between the sacrum and the bed.
What is the advantage of balanced counteraction?
You can easily move the patient around in bed.
Patients in Russell’s traction are particularly prone to ______.
Thrombophlebitis
When a patient is in a Buck’s traction they may turn to the ______ side.
Unaffected
Define cataract.
Opacity of the crystalline lens
Is surgery done immediately upon diagnosis of cataract?
No, they usually wait until it interferes with activities of daily living.
What three most common visual defects occur with cataract?
Cloudiness,
diplopia (double vision),
photophobia (sensitivity to light)
What are the two common treatments of cataract?
- Laser,
- surgical removal.
Surgery called intraocular or extraocular lens extraction
What does the eye look like when a client has cataracts?
Cloudy, milky-white pupil
What will the client be wearing after cataract removal?
A protective patch/shield on the operative eye for 24 hours,
then a metal shield (AT NIGHT only) for 3 weeks.
When the client asks about the use of glasses or contacts after cataract surgery what would you say?
If an intraocular lense is implanted, they will NOT need glasses. If no lense is implanted, then contacts will be fitted 3 mths post- operatively.
What will be a high priority nursing diagnosis for a client post cataract surgery?
Safety
Should the client ambulate independently after cataract surgery?
No, depth perception is altered.
What positions are to be avoided after cataract surgery?
Lying face down. Also, do not lie on operative side for a month.
What are the post-operative signs of hemorrhage into the eye?
Severe pain, restlessness
What movements are to be avoided after cataract surgery?
Coughing, sneezing, bending at the waist, straining at stool, rubbing or touching eyes, rapid head movements.
What positions are okay after cataract surgery?
Do not lie on operative side; do lie on back.
Should you use talcum powder with a post- operative cataract client?
No, may cause sneezing; also should avoid pepper.
What are the three signs of increased intraocular pressure?
Pain (moderate to severe), restlessness, increased pulse rate.
What is a major objective in caring for a client after surgical cataract removal?
To prevent pressure in or on the eyes.
When the lens is to be extracted for cataract what drugs are given pre-operatively?
Mydriatics, dilators, antibiotic drugs (gtts)
What three drugs are given post-operatively?
Stool softeners,
antiemetics,
analgesics (mild to moderate)
Give five causes of cataract?
- Injury,
- congenital,
- exposure to heat,
- heredity,
- age
