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Concepts 2 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Normal Ranges for RBC, Platelet, WBCs

A

RBC: 4.7-6.1 (males); 4.2-5.4 (females)
Platelet: 150000-400000
WBC: 5000- 10000

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2
Q

Hematocrit and Hemoglobin normal range

A

Hematocrit (% of RBC in blood)-36-48
Hemoglobin (amount of protein in RBC)—12-16

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3
Q

Hematocrit to Hemoglobin ratios

A

Normal 3:1
Dehydration/Hypovolemia: >3:1
Fluid Overload: <3:1

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4
Q

3 blood products used for excessive blood loss

A

Packed RBCs (also for anemia)
Platelets (also for coagulation so give before PRBCs)
Albumin

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5
Q

3 blood product used for coagulation problems

A

Fresh Frozen Plasma
Platelets
Clotting Factors (Factor VIII)

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6
Q

3 kinds of blood donations

A

Autologous (own blood collectedprior to procedure; eliminates compatibility problems)

Donor Blood

Intraoperrative blood salvage (blood recycled and retransfused)

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7
Q

How does compatibility testing look for the following blood products?

  • Packed RBCs
  • Platelets
  • Plasma
  • cryoprecipitate
  • albumin
A
  • Packed RBCs (ABO and Rh)
  • Platelets (ABO and Rh but ABO does not have to match)
  • Plasma (ABO)
  • cryoprecipitate (neither)
  • albumin (neither)
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8
Q

Nursing Care: Pre- blood transfusion (7 general)

A
  • ensure consent given
  • prime setup w/ NS
  • use 18 gauge or larger needle
  • use special tubing and separate line for Blood transfusion (usually has filter to retain clots)
  • get labs and vitals
  • get hx of reactions
  • Verify donor’s/recipient’s blood for compatibility with ABO and Rh compatibility, andexpiration w/ TWO nurses
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9
Q

What are two pre-transfusion medications?

A

diphenhydramine
Acetaminophen

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10
Q

Nursing Care: During blood transfusion (3 general)

A
  • Document Vitals and monitor for complications (allergic, hemolytic, febrile, overload)
  • Begin transfusion slowly, and stay with patient first 15 to 30 minutes
  • Blood products should be infused within 4 hours or you need new blood
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11
Q

Blood Transfusion Complications: Hemolytic

Signs and symptoms (6)

A
  • Tachypnea
  • Chills
  • Fever
  • Sudden Back Pain
  • Nausea
  • Anxiety
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12
Q

Blood Transfusion Complication: Hemolytic

Nursing Care (4)

A
  • Stop Transfusion Immediately!!!
  • Saline infusion in separate line from blood
  • Save blood bag
  • Notify blood bank and HCP
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13
Q

Blood Transfusion Complication: Febrile

Signs and Symptoms (5)

A
  • Chills
  • Tachycardia
  • Fever ( increased temp of 1 degree (F) or 0.5 (C))
  • Hypotension
  • Tachypnea
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14
Q

Blood Transfusion Complication: Febrile

Nursing Care (3)

A
  • Stop Transfusion Immediately!!!
  • Saline infusion in separate line from blood
  • Administer antipyretics
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15
Q

Blood Transfusion Complication: Allergic

Signs and Symptoms (5)

A

Itching
Urticaria
Dyspnea
Wheezing
Chest tightness

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16
Q

Blood Transfusion Complication: Allergic reaction

Nursing Care (3)

A
  • Stop Transfusion Immediately!!!
  • Saline infusion in separate line from blood
  • give diphenhydramine
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17
Q

Blood Transfusion Complication: Fluid Overload

Signs and Symptoms (7)

A

Dyspnea
Chest tightness
Tachycardia
Tachypnea
Sudden crackles
Bounding Pulses
Anxiety

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18
Q

Blood Transfusion Complication: Fluid Overload

Nursing Care (4)

A
  • Monitor VS
  • Slow infusion rate,
  • Administer diuretics
  • may give fluid volume expander (Hespan) prior to treatment
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19
Q

4 drug Treatments for Anemia

A
  • Iron Ferrous sulfate (take with meals w/ vitamin C)
  • Epoetin alfa (Erythropoietin)
  • vitamin B12
  • Folic acid
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20
Q

How do Cancer cells grow compared to benign?

A

Cancer cells grow by invasion with loose adherence and no contact inhibition while benign cells grow by expansion

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21
Q

Initiation Stage of Cancer Developments

What is it?
What is the result? (2)

A
  • it is a change in gene expression caused by carcinogens (anything that damages cellular DNA causing loss of cellular regulation )
  • results in loss of suppressor gene function OR proto-oncogene activation to oncogene status
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22
Q

Promotion Stage of Cancer Development

What is it? (3)

A
  • Enhanced growth of an initiated cell by promoters(body proteins or hormones)
  • consists of latency period b/w initiation and development of overt tumor
  • stage where people recognize issue
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23
Q

Progression Stage of Cancer Development

2 steps for tumor to become health problem

A
  • vascularization
  • genetic mutations (driver mutations (selection advantages) AND passenger mutations (helpful to identify cancer in targeted therapy))
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24
Q

Metastasis stage of Cancer development

Difference b/w primary tumor and secondary tumors

A
  • Primary tumor: original group of cancer cells and defines the type of cancer individual has even if metastasis occurs
  • Secondary/metastatic tumors ( Blood borne or Lymphatic spread)
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25
Q

What is TNM System?

A

staging system for cancer

T: primary tumor, # denotes size or local extent(0-4)

N: Regional lymph nodes involvement (0-3)

M: Distant metastasis (0 or 1)

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26
Q

Grading of Cancer Cells

What is it? Difference b/w high and low rating?

A
  • Compares appearance and activity of cancer cell with normal parent tissue to determine aggressiveness and sensitivity to treatment

o Grade 1 =resemble normal cells (well differentiated)
o Grade 4= poorly differentiated (aggressive)

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27
Q

Ploidy of Cancer Cells

What is it? How does it relate to malignancy?

A
  • classifies # and appearance of tumor chromosomes as normal or abnormal
  • Degree of aneuploidy increases with malignancy
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28
Q

Cancer Staging

What is it?

Difference b/w Clinical, Surgical, and pathologic staging

A

determines exact location of cancer and whether metastasis has occurred

Clinical staging: assess patient’s symptoms, tumor size and tumor spread

Surgical staging: assess tumor size, #, sites and spread via inspection at surgery

Pathologic staging: determines tumor size, number, sites, and spread via pathologic exam of tissues from surgery (most definitive staging)

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29
Q

CAUTION (Seven Warning Signs of Cancer

A

Changes in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in the breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in a wart or mole
Nagging cough or hoarseness

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30
Q

Primary prevention of Cancer (5)

A

Use sunscreen (skin)
Avoid tobacco and asbestos (lung)
Limit alcohol to < 1 ounce a day
Limit sexual partners and use safe sex
Remove “at-risk” tissue (moles, breast or colon polyps)

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31
Q

Chemopreventions for cancer

2 for colon
2 for breast
1 for prostate
1 for cervical

A

▪ Aspirin and celecoxib (colon cancer)
▪ Vitamin D and tamoxifen (breast cancer)
▪ Lycopene (prostate cancer)
▪ HPV vaccine (cervical)

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32
Q

5 secondary prevention for Cancer ( and ages)

A

o Annual mammography for women 40-54 yrs
o Annual clinical breast exam for women over 40 yrs (every 3 years for women 20-39)
o Annual fecal occult blood test for all adults
o Digital rectal exam for men over 50 yrs
* PSA test

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33
Q

Radiation Therapy: External Beam

3 things to note

A
  • Patient is not radioactive or a hazard to others once treatment is complete
  • small tattoos of ink mark the tumor location
  • Radiation delivered from source outside patient
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34
Q

Radiation Therapy: Brachytherapy

3 things to note

A
  • Patient is radioactive and emits radiation for a period of time
  • Patient potential hazard to others until source of radiation is removed
  • Radiation source is in direct, continous contact with tumor
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35
Q

Radiation Therapy side effects

5 localized
3 systemic

A

localized at site of radiation
- hair loss
- dermatitis (redness, rash, skin desquamation)
- inflammatory response
- tissue fibrosis or scarring
- DNA mutation

Systemic
- fatigue
- Severe NVD
- hematuria

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36
Q

Radiation Therapy

6 patient education

A
  • Avoid skin irritation and friction from cloths
  • Avoid deodorant and lotions on days of treatments
  • Avoid sun exposure to irradiated area
  • Wash irradiated area with mild soap and water but avoid skin scrubbing
  • Fatigue can be reduced with exercise and sleep
  • Regular dental visits, saliva substitutes, lozenges, mouth rinses are helpful for radiation to head or neck
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37
Q

Radiation Therapy

10 nursing Care

A
  • Assign the patient to a private room with a private bath.
  • Place a “Caution: Radioactive Material”
  • Wear a dosimeter film badge to measure radiation exposure
  • Wear a lead apron while providing care. Always keep the front of the apron facing the source of radiation (do not turn your back toward the patient).
  • Do not perform patient care if pregnant
  • Limit each visitor to 1 half-hour per day.
  • Be sure visitors stay at least 6 feet from the source.
  • no children under 16 can visit
  • Never touch the radioactive source with bare hands. In the rare instance that it is dislodged, use long-handled forceps to retrieve it
  • keep all linen and dressing in room until all radioactive source removed
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38
Q

Chemotherapy-Induced Neutropenia

3 preventions/treatments for neutropenia

A

o Drugs with similar nadirs (time when bone marrow activity and WBC counts are at their lowest) avoided in combo therapy
o Dose-dense chemotherapy: giving chemotherapy rounds closer together, supplemented with bone marrow growth factors
o Growth factors to stimulate bone marrow production of granulocytes

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39
Q

5 Signs and Symptoms of neutropenia’s

A

cough
dysuria
pain or drainage around IV site
Fever
Fatigue (may be only symptom)

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40
Q

7 Nursing Care for Neutropenia

A
  • Place the patient in a private room whenever possible.
  • Ensure that the patient’s room and bathroom are cleaned at least once each day.
  • Use strict aseptic technique for all invasive procedures (avoid if possible)
  • Keep frequently used equipment in the room for use with this patient only (e.g., blood pressure cuff, stethoscope, thermometer).
  • Visitors with signs or symptoms of illness should be restricted.
  • Monitor the WBC count daily.
  • Restrict fresh flowers and potted plants in the patient’s room.
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41
Q

6 Nursing Care for Thrombocytopenia

A
  • use a lift sheet when moving and positioning the patient in bed.
  • Avoid IM injections and venipunctures or use smallest gauge. If platelets are <50,000, invasive procedures may be postponed.
  • apply pressure to areas of bleedning
  • Apply ice to areas of trauma.
  • Avoid trauma to rectal tissues (no enemas; lubricate for suppositories)
  • For mouth care, use soft-bristled toothbrush or tooth sponges; Do not use water-pressure gum cleaners; make sure dentures fit and do not irritate the gums.
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42
Q

10 Patient Education for Thrombocytopenia

A
  • Use an electric shaver.
  • Use a soft-bristled toothbrush.
  • No aspirin or salycilate
  • Avoid hard or hot foods that would scrape or burn the inside of your mouth.
  • Check your skin and mouth daily for bruises; swelling; or areas with small, reddish-purple marks (petechiae)
  • Avoid rectal pain (anal, use stool softeners)
  • Do not wear clothing or shoes that are tight or that rub.
  • Avoid blowing your nose or placing objects in your nose. If you must blow your nose, do so gently without blocking either nasal passage.
  • Avoid activities that increase the pressure in your brain.
  • wear shoes with firm soles whenever ambulating.
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43
Q

Chemotherapy-induced Nausea and Vomiting

prevention/treatment

A

antiemetic therapy i.e. 5-HT3 antagonists given prior to nausea or vomiting beginning and continued even when appears controlled

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44
Q

Chemotherapy-induced Mucositis

5 Prevention/treatment

A
  • Oral cryotherapy with ice water or ice chips can prevent (patient should suck ice chips before, during, and after rapid infusions)
  • Frequent mouth assessment
  • Salt and baking soda rinse
  • Non-alcohol-based mouth rinse throughout day and night
  • Soft-bristled toothbrush or disposable mouth sponges
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45
Q

Chemotherapy-Induced Alopecia

4 prevention/treatment

A
  • Scalp cooling during chemo
  • Avoid direct sunlight on scalp with hat or head covering
  • Use sunscreen due to increased sun sensitivity
  • Pick wig prior to treatment beginning to cope with body image issues
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46
Q

5 Patient Education for at-home oral chemotherapy

A

o Use small paper cup and use mouth to get pill from cup (do not touch drug)
o Store drug separate from other drugs
o Do not take missed doses once remembered
o Do no flush oral drugs in toilet
o Dispose of oral drugs by returning to dispensing pharmacy

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47
Q

How is Cancer pain treated? (3)

A
  • multimodal analgesia (NSAIDs, opioids, antidepressants)
  • PCA pump
  • Around the clock dosing
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48
Q

6 P’s of arterial insufficiency

A

Pain
Pallor
Pulselessness
Poikilothermic (cold)
Paralysis
Parathesis

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49
Q

Stable vs unstable Angina

What is angina?
What is stable angina?
What is unstable angina?

A

Angina is when oxygen supply < myocardial demand

Stable angina is relieved by rest, sublingual nitrogen or aspirin

Unstable angina is chest pain with extra symptoms, not relieved by nitroglycerin

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50
Q

8 Signs and symptoms of unstable angina/ MI

A
  • wheezing or SOB
  • weight gain of 3 pounds a week (1-2 pounds overnight)
  • dizziness or faintness
  • cool, diaphoretic skin
  • Nausea and vomiting
  • S3 gallop
  • increased temperature
  • palpitations
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51
Q

STEMI vs NSTEMI MI

Differences on ECG
Recommended treatment

A

STEMI: ST elevation due to rupture of fibrous atherosclerotic plaque

NSTEMI: ST depression and T wave inversion due to myocardial ischemia

PCI is recommended within 90 minutes of arrival to hospital for STEMI to due revascularization

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52
Q

How are the following affected by MI?

  • Lipids
  • C-reactive protein
  • B-type natriuretic peptide
  • Troponin I and T
  • Creatine kinase-MB
A
  • Lipids (total and LDL increased, HDL decreased)
  • C-reactive protein - increased
  • B-type natriuretic peptide -increased
  • Troponin I and T AND Creatine kinase-MB – increased and specific cardiac markers of MI
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53
Q

5 Nursing Care for Report of Chest Discomfort in ER

A
  • Do pain analysis and get vitals every 5 minutes after medication administration
  • Obtain a 12-lead ECG within 10 minutes of report of chest pain.
  • Give aspirin
  • Administer supplemental oxygen therapy to maintain an oxygen saturation greater than 90%.
  • Stay with the patient if possible.
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54
Q

What is Percutaneous Coronary Intervention?

3 parts

A

3 parts: clot retrieval, coronary angioplasty ( inflated balloon catheter to push artery plaque against vessel wall), and stent placement ( prevent reocclusion)

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55
Q

7 nursing care for PCI

A
  • check if allergic to contrast dye (iodine) or shellfish
  • keep leg straight
  • keep HOb less than 30 degrees
  • watch for bleeding and hypokalemia (back pain = retroperitoneal bleeding)
  • have patient avoid coughing and sneezing
  • give anticoagulants during procedure and antiplatelets after procedure
  • maintain hydration (b-c dye can damage kidney so give adequate fluids)
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56
Q

Nitroglycerin (vasodilator)

Indication (2)
Action
Side effects (3)
Nursing Care (5)

A

Indication: angina, heart failure

Action: reduces preload and afterload

Side effects: headaches, hypotension, reflex tachycardia

Nursing Care
- do not give with PDE5 inhibitors
- remove patch for 12-14 hrs a day and rotate sites
- apply patch to clean hairless area
- give one tablet every 5 minutes until 3 tablets
- give w/ CCB or betablocker to prevent reflex tachycardia

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57
Q

Aspirin and Clopidogrel (Antiplatelet)

Side effects (2)
Nursing Care

A

Side effects: tinnitus (aspirin), bleeding risk

Nursing Care
- take w/ food

58
Q

Warfarin (anticoagulant)

Labs
Antidote
Nursing Care (5)

A

Labs: INR
Antidote: vitamin K
Side effects: bleeding

Nursing Care
- discontinue heparin 3-4 days after starting
- limit vitamin K (green leafy vegtables, liver, soybeans)
- avoid NSAIDs, antidepressants, corticosteroids,
- taper drug before discontinuing
- bleeding percautions

59
Q

Heparin or enoxaparin (Anticoagulant)

Lab
Antidote
Side effect
Nursing Care (2)

A

Lab: monitor aPTT or anti-Xa

Antidote: protamine sulfate

Side effects: thrombocytopenia

Nursing Care
- bleeding precautions (electric razor, soft toothbrush)
- taper drug

60
Q

Digoxin (cardiac glycoside)

Indication (3)
Action
Lab changes (3)
Side effects (5)
Antidote
Nursing Care (2)

A

Indication: heart failure, a-fib, PAC

Action: increase contractility (inotropic), reduce heart rate (chronotropic), reduce AV node conduction (dromotropic)

Lab changes: hypokalemia, hypomagnesium, hypercalcemia,

Side effects/toxicity : dysrhythmias, Anorexia, muscle weakness, vertigo/confusion (elderly), halos and vision changes

Antidote: antigen binding fragments

Nursing Care
- take apical HR prior to administration (do not give if HR < 60)
- take with potassium supplements or food

61
Q

tPA (thrombolytic/fibrinolytic )

Indication
Action
Side effects
Nursing Care

A

Indication: MI

Action: dissolves thrombi to restore myocardial blood flow

Side effects: bleeding

Nursing Care:
- give within 30 minutes of hospital arrival for STEMI

62
Q

Carvedilol, metoprolol, atenolol (beta blockers)

Indications (4)
Action
Side effects (3)
Nursing Care (3)

A

Indication: hypertension, heart failure, dysrhythmias, angina

Action: negative chronotropic, dromotropic, inotropic

Side effects: bradycardia, heart failure, hypoglycemia (and masks hypoglycemia)

Nursing Care
- assess HR and BP (hold if HR < 50 or BP <90)
- avoid sudden withdrawal
- Avoid antacids

63
Q

Amiodarone (Potassium Channel Blocker)

Indication
Action
Side effects (5)
Nursing Care (3)

A

Indication:dysrhythmias (a-fib, v-fib)

Action: slows ventricular conduction to convert A-fib to NSR

Side effects: ARDS, blue-gray skin discoloration, hypotension, bradycardia, corneal microdeposits

Nursing Care
- test pulmonary function prior to treatment
- give with food
- avoid grapefruit juice and St. John’s wort

64
Q

Verapamil (Calcium Channel Blocker)

Indication (3)
Action: (3)
Side effects (4)
Nursing Care (2)

A

Indication: dysrhythmias (a-fib, SVT), angina, hypertension (useful in CKD to improve kidney perfusion)

Action: peripheral vasodilation AND negative dromotropic and chronotropic

Side effects: gingival hyperplasia, prolonged PR (AV block), facial flushing/ increased heat perception, reflex tachycardia

Nursing Care
- prevent reflex tachycardia by giving w/ beta blocker
- avoid grapefruit juice and St. John’s wort

65
Q

Furosemide, hydrochlorothiazide (diuretics)

Indication (3)
Action
Side effects (5)

A

Indication: heart failure, hypertension, chronic kidney disease

Action: increase sodium and water excretion

Side effects: hypokalemia, hypotension, hyperglycemia, hyperuricemia, ototoxic (furosemide)

66
Q

Furosemide, hydrochlorothiazide (diuretics)

Nursing Care (4)

A

Nursing Care
- Monitor for hypokalemia (dysrhythmias, muscle twitching, thready pulse, polyuria, hypoactive bowels)
- Give with potassium-rich food (citrus fruits, potatoes, bananas) (not in chronic kidney disease)
- Give in morning (no doses after 3pm)
- not useful in end-stage kidney disease

67
Q

Atorvastatin, Simvastatin (HMG-CoA reductase inhibitors)

Indication (3)
Side effects (3)
Nursing Care (2)

A

Indication: heart failure, hypercholesterolemia, peripheral artery disease

Side effects: hepatotoxic, rhabdomyolysis, cataracts

Nursing Care
- avoid grapefruit juice
- increases bleeding risk when combined with warfarin

68
Q

Captopril (ACE inhibitors)

Indication (2)
Side effects (5)
Nursing Care (2)

A

Indication: heart failure (drug of choice), kidney disease with hypertension

Side effects: angioedema, cough, hyperkalemia, hypotension, metallic taste

Nursing Care
- take on empty stomach
- avoid NSAIDs and potassium supplements

69
Q

Phosphate binders (Ex. Calcium acetate, calcium carbonate, lanthanum carbonate, sevelamer)

Indication
Action
Side effects (3)
Nursing Care (2)

A

Indication: chronic kidney disease for hyperphosphatemia

Action: form insoluble calcium-phosphate complex to prevent hyperphosphatemia

Side effects: constipation, hypophosphatemia (weakness, slow or irregular pulse, confusion), hypercalcemia

Nursing Care
- do not take within 2 hrs of other drugs
- take with meals

70
Q

Erythropoietin-Stimulating Agents (Ex. Epoetin alfa)

Indication
Signs of Toxicity (4)
Nursing Care

A

Indication: prevent or correct anemia via stimulation of RBC

Side of toxicity: chest pain, seizures, rapid weight gain, skin rash or hives

Nursing Care
- check Hgb regularly b-c may overproduce RBCs leading to MI risk

71
Q

Losartan (ARBs)

Indication
Side effects (3)

A

Indication: heart failure (drug of choice)

Side effects: angioedema, insomnia, hypotension

72
Q

6 Signs and Symptoms of Left-sided Heart Failure

A
  • Weakness/ Fatigue
  • Dizziness
  • Confusion
  • Pulmonary Edema (frothy, pink sputum, dyspnea, crackles)
  • S3 gallop (due to early diastolic filling)
  • Oliguria (nocturia at night)
73
Q

5 Signs and Symptoms of Right-sided Heart failure (cor pulmonale)

A
  • Distended neck veins
  • Increased abdominal girth (ascites)
  • Hepatomegaly (liver engorgement)
  • Weight—the most reliable indicator of fluid gain or loss
  • Peripheral pitting or dependent edema
74
Q

Systolic vs Diastolic heart failure

A

Systolic: reduced ejection fraction (< 40%) which increases preload and afterload

Diastolic: stiffened ventricles prevents sufficient blood flow and leads to inadequate cardiac output

75
Q

Best diagnostic for Heart Failure

A

Echocardiography to detect decreased ejection fraction

76
Q

MAWDS for Heart Failure Education

A

Medications:
* Take medications as prescribed and do not run out.
* Know the purpose and side effects of each drug.
* Avoid NSAIDs to prevent sodium and fluid retention.

Activity: Stay as active as possible but don’t overdo it.

Weight: Weigh each day at the same time on the same scale to monitor for fluid retention (3 lb in a week or 1 to 2 lb overnight)

Diet:
*Limit daily sodium intake to 2 to 3 g as prescribed.
* Limit daily fluid intake to 2 L.

Symptoms:
* Note any new or worsening symptoms and notify the HCP immediately

77
Q

Labs Changes Heart Failure

  • BNP
  • Urinalysis
  • HgB/Hct
A
  • BNP increases
  • Urinalysis shows microalbuminuria and high specific gravity
  • low Hct from hemodilution of fluid excess
78
Q

EKG normal ranges

PR interval
QRS complex
QT interval

A

PR Interval = 0.12-0.20 seconds (start of P to start of Q)

QRS complex = 0.04-0.10 seconds (start of Q to end of S; w shaped)

QT interval = less than 0.44 seconds (start of Q to end of T)– naturally longer in women

79
Q

EKG Wave (what do they represent)

P wave
QRS Complex
T wave
U wave

A

P Wave- atrial contraction (depolarization); deformity = problem with atrium i.e a-fib does not have p waves

QRS Complex- ventricular contraction (depolarization); deformity = problem with ventricles

T Wave- ventricular repolarization

U wave: late ventricular repolarization

80
Q

EKG Normal Rates

-SA node
-AV node
- Purkinje fibers

A

EKG Normal Rates

  • SA node (60-100 bpm)
  • AV node (40-60 bpm)
  • Purkinje fibers (20-40 bpm)
81
Q

5 Steps to read 6-second EKG

A
  1. Heart rate (count Ps for atrial rate, count R waves for ventricular rate, count QRS complexes for general rate)
  2. Heart rhythm (measure from R-R; regular if intervals different by less than 3 small boxes)
  3. P wave analysis (should be present, regular, 1-1 P wave: QRS ratio, round and upright)
  4. PR interval analysis (0.12-0.20) – increases with AV blocks
  5. QRS analysis (0.04-0.10)– dysrhythmias if missing complexes or irregular pattern
82
Q

Sinus arrhythmia

What is it?
EKG Change

A
  • variant of NSR due to intrathoracic pressure during breathing OR due to digoxin or morphine
  • Shortest PP or RR intervals vary at least 0.12 seconds from longest PP or RR interval
83
Q

Causes of ST segment changes

Elevation (3)
Depression (3)

A

ST elevation due to MI, pericarditis, hyperkalemia

ST depression due to hypokalemia, MI, ventricular hypertrophy

84
Q

6 Signs and Symptoms of Supraventricular Tachycardia (SVT)

A
  • Rapid pulse (>150 bpm) and palpitations
  • dizziness
  • anxiety
  • chest pain
  • dyspnea
  • p wave buried in EKG
85
Q

5 treatments for SVT

A
  • Valsalva maneuver (cough or bear down)
  • Adenosine
  • Beta Blockers
  • Calcium Channel Blockers (verapamil or diltiazem)
  • cardioversion
86
Q

Atrial Fibrillation EKG Change

A
  • No clear P waves b-c rapid impulses from atrial tissues
87
Q

Signs and symptoms of Atrial Fibrillation (3 non EKG signs)

A
  • thrombus formation (stroke risk if failure to rescue)– speech alterations
  • irregular apical pulse
  • poor perfusion
88
Q

Treatment for A-fib (2 groups)

A
  • Antiarrhythmics (Diltiazem, Amiodarone, metoprolol, lanoxin)
  • Anticoagulants (Heparin, enoxaparin, Warfarin)
89
Q

4 Nursing Care for A-fib

A
  • Apply oxygen
  • Keep the head of the bed elevated unless patient is very hypotensive
  • Notifying the HCP or Rapid Response Team
  • get 12 lead EKG
90
Q

7 signs of poor perfusion

A
  • Fatigue/ Weakness
  • Shortness of breath
  • Dizziness/syncope
  • Anxiety
  • Palpitations
  • Chest discomfort or pain
  • Hypotension
91
Q

Serum Creatinine (range: 0.6-1.2)

When is it increased? (2)
When is it decreased? (2)

A

Increased w/ kidney impairment (due to reduced GFR) and increased muscle mass

Decreased w/ old age and decreased muscle mass

92
Q

BUN (range: 10-20)

When is it increased? (7)
When is it decreased? (2)

A

Increased
- kidney or liver disease
- dehydration or poor kidney perfusion
- infection/ stress
- high protein
- steroids
- GI or other bleeds
- old age

Decreased
- malnutrition
- liver AND kidney dysfunction

93
Q

BUN/creatinine ratio (range: 6-25, prefer 15.5)

What does it determine?
When is it increased? (5)
When is it decreased? (1)

A
  • determines if non-kidney factors responsible for high BUN
  • increased w/ fluid volume deficit, high protein, obstructive uropathy, catabolic state, kidney disease
    -decreased w/ fluid volume excess
94
Q

Cystatin-C

What is it?
When is it increased?

A

-measures GFR; not influenced by BUN and creatinine factors
- increased in CKD

95
Q

Blood osmolarity (range: 280-300 mmol/kg)

What is it?
How is it maintained?
When is it increased?

A
  • overall concentration of particles in blood indicating hydration status
  • maintained by ADH/ vasopressin release
  • increased in older adults
96
Q

Urinalysis: Specific gravity (range: 1.005-1.030; usually 1.010-1.025)

When is it increased? (4)

A

Increased: dehydration, poor kidney perfusion, excess vasopressin/ADH (SIADH, stress, surgery), heart failure.

97
Q

Urinalysis: Specific gravity (range: 1.005-1.030; usually 1.010-1.025)

When is it decreased? (6)

A

Decreased: old age, chronic kidney disease, diabetes insipidus, malignant hypertension, diuretics, lithium toxicity

98
Q

Protein in Urinalysis (Range 0- 8)

When is it increased? (4)

A

stress, infection (will be negative after infection resolved), recent strenuous exercise, Chronic kidney disease (albuminuria)

99
Q

Urinalysis: Red Blood Cells (RBCs) (range 0-2 per high-power field)

When is it increased? (4)

A

Increased: menses, trauma (catheterization,tumor, stones), glomerular or bleeding disorders, cystitis

100
Q

Urinalysis: White blood cells (WBCs) (range 0-4 per low-power field)

When is it increased? (3)

A

Increased: infection or inflammation in the kidney and urinary tract, kidney transplant rejection, or exercise.

101
Q

Uremia symptoms of Chronic Kidney Disease (9)

A
  • Azotemia (buildup of nitrogen-based wastes in blood)
  • metallic taste in mouth
  • anorexia
  • muscle cramps
  • Uremic lung (thick sputum, less coughing, tachypnea, fever, pleural friction rub)
  • hiccups/ yawning/ deep sigh
  • paresthesia
  • uremic frost on skin (evaporated crystals cause severe itching)
  • noticeable jaundice
102
Q

Kidney Changes in Chronic Kidney Disease (2)

A
  • hypertrophy of nephrons (to maintain homeostasis)
  • fixed osmolarity of urine (dilute) followed by oliguria (due to inability to dilute urine
103
Q

Electrolyte changes in Kidney disease (4)

A
  • hypernatremia (due to fluid retention)
  • hyperkalemia (when urine output falls under 500 mL/24 hr)
  • hyperphosphatemia and hypocalcemia
104
Q

Metabolic acidosis and Chronic Kidney Disease

What is the cause?
What is the compensation?

A

Cause: reduced bicarbonate reabsorption and excess H+

Compensation: Kussmaul breathing (tachypnea and hyperpnea)

105
Q

3 effects of phosphorus and calcium imbalance in Chronic Kidney Disease

A
  • Renal osteodystrophy: bone mineral loss (S/s: bone pain, spinal sclerosis, fractures, bone density loss, osteomalcia, decreased height (due to compacted vertebrae))
  • Metastatic calcification: crystals from calcium-phosphorus deposit in kidneys, heart , lungs, blood vessels (atherosclerotic plaques), joints, eyes (conjunctivitis, brain))
  • Itching
106
Q

Cardiac changes in Chronic Kidney Disease (4)

A
  • Hypertension ( dysfunction of RAAS = cycle of vasoconstriction)
  • hyperlipidemia
  • heart failure (heart must work harder)
  • Uremic cardiomyopathy and pericarditis (uremic toxic to heart)– may have narrow pulse pressure, friction rub
107
Q

GI Changes in Chronic Kidney Disease (3)

A
  • Uremic fetor -> halitosis or stomatitis
  • Peptic ulcer disease w/ ulcers cause erosion of blood vessels -> hemorrhagic shock
  • Uremic colitis w/ watery diarrhea or constipation
108
Q

Neurological Changes in Chronic Kidney Disease (2)

A
  • Uremic encephalopathy: Lethargy, seizures, coma; weakness in upper and lower extremities
  • Peripheral neuropathy: sensory changes in a glove-and-stocking pattern over hands and feet
109
Q

Hematologic/immunity changes in Chronic Kidney Disease (3)

A
  • Anemia (due to decreased erythropoietin production – S/s: fatigue, pallor, lethargy, weakness, SOB, dizziness
  • Impaired platelet function due to increased bleeding or bruising (S.s: petechiae, purpura, nose or gum bleeds, melena (black tarry stools i.e. intestinal bleeding))
  • Disrupted WBC production and function from uremia
110
Q

Patient Education for Chronic Kidney Disease (urination) -2

A
  • Drink 1 to 2 L of water a day to flush out wastes
  • Avoid sugary, high-calorie drinks (prevent sugar-induced urination and weight gain)
111
Q

Skin changes in Chronic Kidney Disease (6)

A
  • Yellowish or darkening to brown or bronze due to pigment deposition
  • Sallowness (faded suntan) due to anemia
  • Decreased turgor and skin oils
  • Severe pruritus
  • Uremic frost (layers of urea crystals from evaporated sweat)
  • ecchymosis or purpura (purple patches and rashes)
112
Q

How are the following labs/imaging tests used in Chronic Kidney disease

  • BUN and serum creatinine
  • Albumin-to creatinine ratio
  • Kidney ultrasound
A
  • BUN and serum creatinine = presence and degree of uremia in late stages
  • Albumin-to-creatinine ratio = function and damage determination
  • Kidney ultrasound or CT scan = rule out obstruction and show kidney size (shrinks from atrophy and fibrosis in end-stage kidney disease)
113
Q

Nursing Care for Managing Fluid Volume (5)

A
  • daily weights (same scale, clothes, time and after voiding)
  • strict I & O monitoring
  • use graph for trends ( 1 L water = 1 Kg)
  • Distribute fluids throughout day if restricted
  • Monitor for S/s of fluid overload q4h ( including narrow pulse pressure, change in LOC, headache, pulmonary edema)
114
Q

Nursing Care for Pulmonary Edema (5)

A
  • High-fowler position with oxygen
  • IV furosemide for diuresis
  • IV morphine and nitroglycerin to reduce pulmonary pressure and myocardial oxygen demand via vasodilation
  • Measure urine output hourly
  • Monitor vital every two hours (every hour w/ nitroglycerin and morphine due to hypotension risk)
115
Q

Preventing Injury in Chronic Kidney Disease (2)

A
  • Keep an eye out for drug complications (due to reduced excretion)- need less Magnesium (no antacids w/ magnesium), insulin ( excreted slower so higher risk of hypoglycemia), anticoagulants
  • Lift with lift sheet vs pulling due to fracture risk
116
Q

Nutrition in Chronic Kidney Disease

What needs to be restricted? (4)
What needs supplementation? Why?

A

Limit protein, potassium, sodium, phosphorus

Supplement vitamins and minerals esp iron (due to anemia) and dialysis may remove water-soluble vitamins

117
Q

Benign Prostate Hyperplasia

Main Complications (Acute(1) vs Chronic (3))

A

Acute urinary retention: bladder outlet obstruction due to large prostate so unable to void

Chronic urinary retention: leads to reflux and hydroureter and hydronephrosis

118
Q

Benign Prostate Hyperplasia

Signs and Symptoms (6)

A
  • Urinary frequency or urgency
  • Distended bladder (Sensation of incomplete bladder emptying)
  • Nocturia
  • Overflow incontinence (Postvoid (after voiding) dribbling or leaking;
  • Hematuria
  • urinary stasis and hesitancy (straining to start stream) leads to UTIs and bladder calculi
119
Q

Purpose of the following Lab/diagnostics in BPH

  • Prostate-specific antigen (PSA) test
  • Serum acid phosphatase level
  • Biopsy
  • Transrectal ultrasound (TRUS)
A
  • Prostate-specific antigen (PSA) test: screening purposes; rule out prostate cancer
  • Serum acid phosphatase level: elevated in patients who have metastasized prostate cancer
  • Biopsy: performed if life expectancy > 5 to 10 years, and if needed to confirm a histologic diagnosis
  • Transrectal ultrasound (TRUS) (more common in the United States) – done before biopsy
120
Q

Purpose of the following Lab/diagnostics in BPH

  • Cystoscopy
  • Urodynamic pressure
  • Bladder scan
A
  • Cystoscopy: used to view the interior of the bladder, the bladder neck, and the urethra; used to study the presence and effect of bladder neck obstruction
  • Urodynamic pressure-flow studies: helpful in determining if there is urine blockage or weakness of the detrusor muscle
  • Bladder scan: measures residual urine
121
Q

Behavioral Modification for Benign Prostate Hyperplasia (3)

A
  • Avoid drinking large amounts of fluids in short period of time or right before bed
  • Limit caffeine and alcohol due to diuretic effects
  • Avoid drugs that cause urinary retention i.e. anticholinergics, antihistamines, antipsychotics, muscle relaxants
122
Q

Finasteride or dutasteride (5-alpha reductase inhibitor)

Indication
Action
Side effects (3)
Patient Education (2)

A

Action: reduce prostate size

Side effects: ED, decreased libidio, orthostatic hypotension

Nursing Care
- may take 6 months for an effect
- teratogenic so no pregnant partners

123
Q

Alpha blockers (doxazosin or tamsulosin)

Indication
Action
Side effects (3)
Patient education (1)

A

Indication: BPH

Action: relax smooth muscle in bladder neck

Side effects: orthostatic hypotension, reflex tachycardia, syncope

Patient Education
- take at nighttime

124
Q

Patient Education after TURP (6)

A
  • do not swim or bath with catheter
  • do not try to void around catheter (urge to void will be present)
  • increase fluid intake (2-2.5 L) to prevent dysuria
  • temporary incontinence post-op will resolve
  • sex is okay (may have retrograde ejaculation)
  • do kegels to regain voluntary elimination
125
Q

Post-Op Nursing Care for TURP (7)

A
  • Keep leg straight if catheter is taped to thigh or abdomen
  • Help patient ambulate early
  • Monitor and document the color, consistency, and amount of urine output PRN or q2h
  • For output, subtract amount of irrigating solution from urinary drainage bag
  • Check the drainage tubing frequently for external obstructions (e.g., kinks) and internal obstructions (e.g., blood clots, decreased output)
  • Assess the patient for reports of severe bladder spasms with decreased urinary output, which may indicate obstruction.
  • Use continuous irrigation with NS
126
Q

3 Complications of TURP

What to do about them?

A
  • TURP syndrome –Due to irrigation fluid being over absorbed ( S/s: headache, SOB, hypertension, bradycardia, ST elevation, wide QRS, inverted T wave)
  • Arterial bleeding = bright red or ketchup like clots—Need to notify surgeon immediately and irrigate catheter w/ normal saline
  • Venous bleeding = burgundy – need to Inform surgeon and monitor hemoglobin and hematocrit
127
Q

Preoperative care for TURP (3)

A
  • Assess patient anxiety
  • Correct any misconceptions about surgery
  • Remind patient to discontinue anticoagulants several days prior to surgery
128
Q

When is surgery indicated for BPH? (5)

A
  • Acute urinary retention (AUR) due to obstruction
  • Chronic UTIs secondary to residual urine in the bladder
  • Hematuria
  • Hydronephrosis
  • Persistent pain with decrease in urine flow
129
Q

Transurethral resection of the prostate (TURP):

What is it?
What is the disadvantage?

A

TURP is the gold standard of prostate surgery; enlarged prostate is removed through endoscopic instrument
Disadvantage is that only small pieces are removed

130
Q

Preventing Complications in Vascular Catheter (Hemodialysis) - 4 tips

A
  • Assess the access site regularly with vital signs
  • Use aseptic technique to dress site and access catheter
  • Do not use catheters for blood sampling, IV fluids, or drug administration
  • Place heparin or heparin/saline dwell solution after hemodialysis treatment
131
Q

Preventing Complications in AV graft or fistula (Hemodialysis) - 8 tips

A
  • Prepare skin w/ 2% chlorhexidine
  • B/w hemodialysis sessions, patient should wash area w/ antibacterial soap and rinse with water
  • Avoid constrictive devices such as BP cuffs, tourniquets, venipuncture in same extremity
  • Rotate needle insertion sites w/ each hemodialysis treatment
  • Palpate for thrills and auscultate for bruits over the vascular access site q4h while patient awake
  • Encourage routine range-of-motion exercises and elevate extremity
  • Do not carry heavy objects with extremity with access device
  • Do not to sleep on Vascular access device or put body weight on it
132
Q

Contraindications for Hemodialysis (3)

A

any severe cardiac, vascular or bleeding diseases

133
Q

Contraindications for Peritoneal Dialysis (4)

A
  • Extensive peritoneal adhesions or fibrosis
  • active inflammatory GI disease (diverticulitis, IBS)
  • Ascites or massive central obesity
  • Recent abdominal surgery
134
Q

Procedure for Peritoneal Dialysis vs hemodialysis

A

In peritoneal, dialysate does fill-dwell-drain cycle in peritoneum of abdominal cavity

In hemodialysis, dialysate is filtered through AV graft, fistula, or vascular catheter through osmosis and diffusion across semipermeable membrane

135
Q

Complications of Hemodialysis (6)

A
  • Disequilibrium syndrome
  • Muscle cramps and back pain
  • Headache
  • Itching
  • Hemodynamic and cardiac effects (hypotension, cell lysis contributing to anemia, cardiac dysrhythmias, intracranial hemorrage)
  • Anemia
136
Q

Disequilibrium Syndrome

Cause
Signs and symptoms (6)
Prevention

A

Cause: Due to rapid reduction in electrolytes and other particles after hemodialysis (rare)

S/s: mental status changes, seizures, fatigue, headaches, nausea and vomiting, coma

Prevention: reduced blood flow at onset of symptoms

137
Q

2 main Complications of Peritoneal Dialysis

Signs of each
Prevention for each

A

Peritonitis (main complication of PD)
S/s: cloudy dialysate, fever, abdominal tenderness general malaise
Prevention: sterile technique b/c due to connection site contaminations

Bowel perforation or inflammatory bowel disease
* Signs: brown effluent
* Prevent with high-fiber diet, stool softeners, enemas

138
Q

Complications of Peritoneal Dialysis (6)

A

Pain
Leakage of Dialysate fluid
blood clot
Protein loss
peritonitis
bowel perforation or inflammatory bowel disease

139
Q

Nursing Care for Hemodialysis (8)

A
  • Weigh the patient before and after dialysis.
  • Hold certain drugs prior to dialysis and give after dialysis
  • Be aware of reactions that occurred during previous dialysis treatments.
  • Monitor vitals and neurologic status throughout treatment
  • Assess serum laboratory tests to evaluate effectiveness of treatment in removing wastes and achieving desired outcomes (e.g., fluid and electrolyte balance, reduction of uremia).
  • Warm Dialysate (not in microwave)– also do this for peritoneal dialysis to decrease discomfort
  • Give anticoagulation therapy to prevent clotting
  • keep patient supine in low fowler (esp in peritoneal dialysis to prevent leakage at site)
140
Q

5 Reasons for Dialysis

A

ESKD
Pulmonary edema
Severe uncontrollable hypertension
Symptomatic hyperkalemia with ECG changes
Drug Overdoses

Concepts 2 (4 decks)

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