Exam 1 Flashcards
1
Q
D5W
A
isotonic, used to KVO, supplies 170 calories/liter, excessive infusion can cuase hyponatremic encphalopathy and death from brain swelling
2
Q
NS
A
isotonic, used to expand plasma volume, provide Na & Chloride, used for burns, GI fluid loss, metablic alkalosis, NO CALORIES
use caution with CHF pts
3
Q
LR
A
isotonic, used for correction of metabolic acidosis, diarrhea, burns, fluid of choice for acute blood loss, NO CALORIES
4
Q
D5 1/3 NS
A
isotonic, used to replace fluid and electrolytes, supplies 170 calories/liter
5
Q
D10W
A
hypertonic, used when TPN is interrupted & until it is restarted, supplies 340 calories/liter
6
Q
D5LR
A
hypertonic, used to replace gastric fluid loss, 170 cal/liter, dont use on liver disease pt
7
Q
D5NS
A
hypertonic, used to replace fluid and electrolytes, supplies 170 cal/liter
8
Q
D5 1/2 NS
A
hypertonic, used to replace fluid and electrolytes, 170 cal/liter, prepackaged availble with 20 mEq KCL
9
Q
1/2 NS
A
Hypotonic, used to replace fluid & electroylets, no calories
10
Q
pH
A
7.35-7.45
11
Q
PaCO2
A
35-45
12
Q
HCO3
A
22-26
13
Q
PaO2
A
80-100
14
Q
SaO2
A
96-100
15
Q
myoglobin
A
men less than 92, women less than 76
16
Q
TNI
A
less 0.4
17
Q
BNP
A
less 100
18
Q
Triglycerides
A
less 150
19
Q
Cholesterol
A
less 200
20
Q
HDL
A
more than 45
21
Q
LDL
A
less than 130
22
Q
PTT
A
21-35 sec
23
Q
PT
A
10-14 sec
24
Q
INR
A
1
valves or ortho pts 2-3
25
digoxin
0.8-2
26
Na
135-145
27
K
3.5-5.0
28
Cl
95-105
29
Mg
1.2-2.5
30
BUN
7-20
31
Creatinine
0.5-1.4
32
Hgb
13-16 or 12-15
33
Hct
41-50 or 36-44
34
RBC
4-5.5
35
Platelet
100-450 K
36
Ca
8.8-10.3
37
Glucose
60-110
38
HgA1C
less 6%
39
WBC
4500-10000
40
bronchidilators
decrease bronchospasm
41
beta adrenergic agonists
relax bronchial smooth muscle, decrease airway resistance
| ex. albuterol, atrovent, symbicort, advair, xopenex
42
anti-cholinergic
inhibit cholinergic receptors on bronchial smooth muscle
| ex. atrovent, spiriva
43
inhaled corticosteroids
anti-inflammatory, decrease mucus secretion
| ex. pulmicort, flovent, advair, symbicort
44
leukotriene modifiers
decrease production of mucus/edema of airway wall
| ex. singulair
45
ACE Inhibitor
prevent conversion of angiotensin I to II; decrease peripheral artery resistance
-pril
46
ARB's
block vasoconstricting & aldosterone effects on angiotensin II by blocking itat AT1 receptors in vascular smooth muscles causing vasodilation
-sartan
47
Beta Blockers
block beta 1 in the myocardium & beta 2 in bronchial & vascular smooth muscle, decreases HR, CO & contractility
-olol
48
calcium channel blockers
inhibit flow of extracellular calcium across cardiac cell membranes & vascular tissue, relax arterial smooth muscle, decrease HR
-pine
49
insulin
helps with the passage of glucose, K, Mg across cell membranes, controls storage and metabolism of carbs, proteins & fats, promotes conversion of glucose to glycogen in the liver
50
somogyi effect
rebound hyperglycemia associated with chronic excessive insulin dosages, may need to increase intake or lower insulin does at night
51
down phenomenon
abnormal early morning increase in blood sugar, usually between 0200-0800, can be from insufficient insulin at night, incorrect med dose, or carbs at bedtime
52
lipodystrophy
depression at injection site due to break down of adipose tissue and not rotating injection sites
53
lipohypertrophy
accumulation of subQ tissue at injection site due to not rotating sites
54
rapid insulin
Humalog
onset 10-20 minutes
peak 1-3 hours
duration 3-5
55
short acting insulin
Humulin
onset 30-60 minutes
peak 1-5 hours
duration 6-10 hours
56
intermediate insulin
NPH
onset 1-2 hours
peak 6-14 hours
duration 16-24 hours
57
long acting insulin
Lantus
onset 1 hour
peak non
duration 24 hours
58
what insulin is IV only
regular
59
Heparin
blocks conversion of prothrombin to thrombin & fibrinogen to fibrin, prevents formation of new clots & extension of existing clots
* check platelets, S/sx bleeding
* SE: pruritus & buring at injection site
60
system of pt care delivery tht\at focuses on the achievment of outcomes within approp. time frames and resources
case mangagement
61
ensures the quality \, efficiency and cost effectiveness of services provided, manage 100% of all hospitialized pts
clinical case mangaement
62
stresses collar\boration between the individual pt, family, Mds, and other health care providers
community case management
63
what is the mission of community case management
encourage wellness and prevent illness
64
if a pt needs more than one home visit per week can they use community case management
no,
65
does community case management need a MD order
no but it is recommended
66
what are the key elements of patient centered medical home
facilitates communication and collaboration among providers, improves pt care outcomes, reduces health care expenditures
67
requires killed care, acute illness or acute exacerbation of illness, requires intermittent or \frequent visits, homebound clients
home health
68
is a Md order required for home halth
yes, along with authorization from the payer (insurance)
69
te ICU is designed to observe the vital function of
ventilation, circulation, assimulation, elimination
70
what is required in an ICU Rn
anticipate needs, eye for detail in observations of the process necessary to life, has the ability to deal with critical situations with speed, precision, and accuracy
71
Critical care nursing
holistic and family approach, high burn out rate, most common cause is emotional overload
72
pt conditions admitted to critial care units
severe trauma, mahor surgery with high risk surgical pts, MI, CVA, GI hemorrhage, dialysis, special procedures
73
what is the last sense to leave a pt
auditory
74
a reduction in the degree of sensory input
sensory deprivation
75
Sx of sensory deprivation
loss of sense of time, delusions, illusions, hallucinations, restlessness, psychosis sx
76
excessive sensory stimuli
sensory overload, caused by tension and anxiety increase when exposed to continuous periods of time without adequate rest
77
pts who are prone to sensory deprivation or overload are
very young, old, post-op, unconcious
78
altered emotional state occuring in a highly stressful enviornment
ICU syndrome/psychosis
79
how can you prevent ICU syndrome/psychosis
clock, calender, tret pt as individual, allow to make decisions, touch, visting hours
80
high priority
life threatening
81
intermediate priority
do not directly threaten a persons life although may result in unhalthy physical or emotional consequesces
82
low priority
problems that the person can handle themselves, require minimal assitance
83
the process of assigning work from one organizational level to another or superior to subordinate
delegation of authority
84
obligation, what must be done to complate a task
responsibilty
85
power to make final decision and give command
power
86
accepting ownership for the results or lack therof
accountability
87
preparing scheme for doing
planning
88
controlling use of time
time management
89
each person remains accountable for the work delegated
principle of delegation
90
nursing process
assessment, evaluation, nursing judgement
| may not be delegated
91
a tool which can be used to delegate effectively
job descriptions
92
freedom to act within est. guidelines
authority
93
steps to help in better delegation
think before you delegate, be specific when you delegate, monitor the results, give praise
94
5 rights of delegation
task, circumstances, person, direction, supervision
95
normal breath sounds are
soft and breezy
96
discontinuous breath sounds
only heard either during inspiration or exhalation
97
abnormal breath sounds are also called
advantisous
98
crackes/rales
pneumopina or atelctesis, deflated or blocked airways, heard in the bases of lungs
99
wheeze
high pitch musical, constriction of airways, COPD, asthma
100
rhonnci
snoring, disappears after cough, cystic fibrosis, COPD
101
strider
hear without stehascope, loud high pitch croup, epiglitis
102
plural friction rub
creacking door, caused by pleural viseral rub, VERY PAINFUL
103
absent
silent
104
cutting back on activities
radical surgery
105
S1
Lub, mitral and tricuspid closing, found 5th intercostal space midclavicular line
106
S2
second intercoastal space, right sternal border, Dub, diastolye, simi lunar valve, hear with radial pulse
107
S3
,abnormal heart sound, ventricular gallop, common in children, sounds like ken-tuck-ey, early diastolye, associated with valve disfunction
108
S4
abnormal heart sounds atrial gallop, Ten-nes-see, hear before S1, late diastolye, seen in MI, angina, HTN, CAD, aortic dysfunction
109
murmur
sound like whoosh, fell a thrill, hear a brue
110
thrill and bruie
a turbulant blood flow found in both dialstole and systolic
111
chart a murmur
grade it I/VI, II/VI, etc.
| I/VI is barely audible, III/VI sounds same as S1/S2, Vi/VI dont need a stethscope to hear (loud with palpable thrill
112
first level priority
airway problems, breathing, cardiac or circulation, VS concerns
113
secondary level priority
LOC chane, untx medical problems, acute pain, abnormal lab values, risks of infection
114
third level priority
lack of knowledge, activity, rest, family coping
115
consists of clarification, simplification, organization, and rationalization of ideas
critical thinking
116
venous insufficency
pooling of blood = valve problem, S/sx of edema, guarder sign, irregulaar ulcers with discharge, puritis, pain relieved by walking, dependent cyanosis, skin will feel warm to touch,
117
arterial insufficnancy
absent or diminsihed pulses, cool to touch, sluggish cap refill, dependent rubor, elevation pallor, pins and needles, decrease sensation
118
proactive approach, prevent adverse events
early nure intervention team
119
reactive approach, rapid immediate care to unstable pt
tapid response team
120
pain during ambulation
claudacation
121
direct percussion
tapping directly on skin
122
indirect percussion
tapping on hand that is directly on the skin
123
blunt percussion
strike with ulnur surface of your hand, used to ID the size, loaction and density, helps to determin if the mass is air filled, solid or fluid filled
124
tempany
high pitch, over abdomen (WNL)
125
resonance
low pitch normal sound over hallow organs such as lung
126
hyper resonance
loud booming sound heard over hyper inflated lung such as empazema
127
dull
soft thud like, heard over all dense organs
128
flattness
soft and high pitched, heard over bones, tumors
129
normal size of pupils are
3-5-cm
130
5 P's of Nural assemssemtn
paralysiss, pulses, pain, pallor, parasteshia (numbness)
131
crainal nerves
olfactory (smell) sensory
optic (sight) sensory
occular motor (movement of eyes, pupils) Motor
troclear (movement of eyes) motor
trigeminal (chewing, feeling on face) m & s
Abducens (movement of eyes) motor
Facial (smiling, taste) S&M
Accustic (hearing & equillibrium) S
Glossopharangeal (tasting, swallowing, gag reflex) S&M
Vagus (tasting, swallowing, gag reflex) S&M
Spinal accessory (neck, tripezious, sternoclaidomastoid muscles) M
Hypoglossal (stick your toungue out) M
132
why are vascular access devices used
to have IV access for over 7 days
133
Glascow coma scale
```
standardized tool, quick and easy
check eye opening, motor response, verbal response
15 fully intact
4-7 unconscious/coma
0-3 deep coma
```
134
an indwelling IV catheter inserted centrally or peripherally and threaded into the superior vena cava and right atrium
central catheters
| *can cause arrhythmias or valve damage
135
decortication
injury is above brain stem, flexed, not good
136
decerabration
extended, injury involves the brain stem
137
placed directly into vessel, placed in a large vein such as jugular vein or neck or the femoral vein in the groin, temporary, sutured to skin at insertion side
non-tunneled central catheter
138
surgically tunneled through tissue into vein, has a cuff that stimulates tissue growth, needed for long period of time, MD must remove
tunneled central catheter
139
permanent device that consists of 2 parts, a catheter attached to a small reservoir and a single or double lumen, surgically inserted and removed
implanted port
140
for all assesments besides GI
inspect, palpate, percuss, auscultate
| GI: inspect, auscultate, palpate then percuss
141
speed shock with access device
pushing a med too fast, S/Sx severe HA, chest pain, arrhythmias, death
142
can a parent/surrogate decision maker refuse a blood transfusion
no
143
contains red blood cells, white blood cells, and platelets
whole blood
144
PRBCs
whole blood, removed plasma, used to raise Hct & Hgb while minimizing volume increase
145
plasma
contains albumin, fibrogen, globulins, and other clotting factors
146
FFP
plasma frozen within hours of donation, must be thawed before use
147
platelets
small cellular components of blood that help the clotting process by sticking to the lining of blood vessels
148
cyroprecipitated, AHF
removed from plasma by freexing and then slowly thawing the plasma, rich in clotting facots
149
leukopenia
total WBC less than 4,000
150
with the Rh system what can Rh- not recieve
+ blood
151
with the Rh system what can Rh + recieve
any blood
152
with group O blood who can you donate to, who can you recieve blood from
can donate to anyone
| recive only from O
153
with group A who can you donate to, who can you recieve blood from
can donate to A, AB
| recive from O, A
154
with group B who can you donate to, who can you recieve blood from
can doante to B, AB
| recieve from B, O
155
with group AB who can you donate to, who can you recieve blood from
can donate to AB
| recieve from A, B, O, AB
156
one unit of RBC will increase your Hgb how much
1 g/dl
157
blood product to unit time
hang within 30 minutes from arrival to floor, complete transfusion within 4 hours from lab (or it can f\grow bacteria)
158
what is used to prime the blood tubing before the blood arrives
ONLY NS
| new tubing is to be used with every transfusion
159
Blood transfusion procedure
VS prior, start at 50 ml/hr for 1st 15 minutes, then increase up to 125 ml/hr, monitor BVS Q 15 minutes
160
acute hemolytic reaction
low back pain, chills, pain at IV site, hypotension
161
febrile non hemolytic reaction
chills, increase of temp over 2 degrees, seen with mult transfusions of 5 or more
162
circulatrory overload reaction
cough chest and back pain, dyspnea, cyanosis, crackles
163
htn
150/90
