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Med-Surg II > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

multiple sclerosis

A

Myelin sheath destroyed (like rubber outside of phone charger)
Nerves not making smooth changes into muscle

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2
Q

parkinson’s disease

A

Center of balance and sensation are off
Rigidity
Can’t spontaneously put one foot in front of the other
Lots of concentration and thinking for simple tasks

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3
Q

CNS function

A

controls most body functions, including awareness, movements, sensations, thoughts, speech and memory

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4
Q

peripheral nervous system

A

broken down into somatic and autonomic

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5
Q

somatic nervous system

A

controls body movements that are under our control such as walking.

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6
Q

autonomic nervous system (and major organ)

A

further divided into sympathetic and parasympathetic
ADRENALS!

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7
Q

chain ganglia vs collateral ganglia

A

chain: spinal nerves and nerves in thoracic cavity
collateral: abdomen and pelvis

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8
Q

cerebrovascular disorder

A

functional abnormality of the CNS that occurs when blood flow to the brain is disrupted
Stroke is a major example
financial impact is profound

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9
Q

What is agnosia?
A. Failure to recognize familiar objects perceived by the senses
B. Inability to express oneself or to understand language
C. Inability to perform previously learned purposeful motor acts on a voluntary basis
D. Impaired ability to coordinate movement, often seen as a staggering gait or postural imbalance

A

A

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10
Q

nonmodifiable risk factors of cerebrovascular disorders

A

age (>55), male, black

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11
Q

manifestations of an ischemic stroke

A

Symptoms depend on the location and size of the affected area
Numbness or weakness of face, arm, or leg, especially on one side
Confusion or change in mental status
Trouble speaking or understanding speech
Difficulty in walking, dizziness, or loss of balance or coordination
Sudden, severe headache
Perceptual disturbances

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12
Q

hemiplegia vs hemiparesis

A

hemiplegia: complete paralysis
hemiparesis: partial weakness

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13
Q

dysarthria

A

difficulty speaking due to weak speech muscles

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14
Q

hemianopsia

A

only seeing on one side

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15
Q

TIA

A

Temporary neurologic deficit resulting from a temporary impairment of blood flow
“Warning of an impending stroke”

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16
Q

how to treat and prevent irreversible deficits

A

diagnostic workups

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17
Q

how to diagnose TIA

A

CT scan, cerebral angiography, lumbar puncture if CT is negative and ICP is not elevated to confirm subarachnoid hemorrhage

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18
Q

what to treat with TIA

A

vasospasm, increased ICP, hypertension, potential seizures, and prevention of further bleeding
Deliberate CALM care!!

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19
Q

cardiac endarterectomy

A

removes buildup from carotids
carotids feed brain with blood supply
hemorrhage is bad
can mess up shoulder

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20
Q

what to do for carotid stenosis and afib

A

carotid: carotid endarterectomy
afib: anticoags and antihypertensives

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21
Q

medical management in acute phase of stroke

A

prompt diagnosis and treatment
thrombolytic therapy
pt monitoring
watch for bleeding
elevate HOB unless contraindicated
maintain airway and ventilation
continuous hemodynamic monitoring and neuro assessment

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22
Q

hemorrhagic stroke caused by

A

spontaneous rupture of small vessels r/t hypertension
ruptured aneurysm
intracerebral hemorrhage r/t amyloid angiopathy
arterial venous malformations (AVMs)
intracranial aneurysms
medications such as anticoagulants
ICP increases caused by blood in subarachnoid space
Compression or secondary ischemia from perfusion & vasoconstriction causes injury to brain tissue

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23
Q

manifestations of hemorrhagic stroke

A

similar to ischemic
severe HA
early and sudden changes in LOC
vomiting
bleeding

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24
Q

assessment of pt recovering from ischemic stroke (acute phase)

A

ongoing frequent monitoring of systems esp neuro (CHECK AROUSAL LEVEL)
LOC
symptoms
speech
pupil changes
I&O
BP maintenance
bleeding
O2 sat

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25
Q

nursing care after acute phase

A

Mental status
Sensation/perception
Motor control
Swallowing ability
Nutritional and hydration status
Skin integrity
Activity tolerance
Bowel and bladder function
Get men ready to pee again once they’re stable enough to stand

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26
Q

preventing joint deformities in stroke pts

A

turn and position in correct alignment q2h
use splints
passive or active ROM 2-5x/day
prevention of flexion contractures
prevention of shoulder abduction
do not lift by flaccid shoulder
quad setting and glute exercises
assist patient OOB ASAP
ambulation training

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27
Q

nutrition for stroke pts

A

Consult with speech therapy or nutritional services
Have patient sit upright, preferably out of bed, to eat
Chin tuck or swallowing method
Use of thickened liquids or pureed diet
Ice chips bad!!

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28
Q

when to perform neuro checks for pt with hemorrhagic stroke

A

q2-4h

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29
Q

assessment of pt with hemorrhagic stroke

A

Altered LOC
Sluggish pupillary reaction
Motor and sensory dysfunction
Cranial nerve deficits
Speech difficulties and visual disturbance
Headache and nuchal rigidity
Other neurologic deficits

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30
Q

3 complications of hemorrhagic stroke

A

Decreased cerebral blood flow
Inadequate oxygen delivery to brain
Pneumonia

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31
Q

5 complications of ischemic stroke

A

Vasospasm
Seizures
Hydrocephalus
Rebleeding
Hyponatremia

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32
Q

goals of hemorrhagic stroke

A

Improved cerebral tissue perfusion
Relief of anxiety
The absence of complications

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33
Q

aneurysm precautions

A

Provide a non-stimulating environment, prevent increases in ICP, prevent further bleeding:
Absolute bed rest with HOB 30 degrees
Avoid all activity that may increase ICP or BP; Valsalva maneuver, acute flexion or rotation of neck or head
Stool softener and mild laxatives so they don’t bear down
Non-stimulating, non-stressful environment; dim lighting, no reading, no TV, no radio
Visitors are restricted

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34
Q

early identification of stroke (interventions)

A

Call RRT (neuro)
Initiating stroke algorithm
The National Institutes of Health Stroke Scale (NIHSS)
labs prior to CT (CBC, BMP, coags, T&S)

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35
Q

stroke scale values

A

0 = no stroke
1 to 4 = minor stroke
5 to 15 = moderate stroke
16 to 20 = moderate to severe stroke
21 to 42 = severe stroke

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36
Q

Airway in pts with decreased LOC and interventions

A

Patients with decreased LOC have increased risk of airway compromise due to loss of protective reflexes and oral-pharyngeal reflexes
Nursing Interventions:
HOB > 30 degrees
Suction prn
O2 saturation assessment

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37
Q

S&S of dysphagia

A

ASPIRATION RISK
Weak or absent gag reflex
Drooling
Excessive chewing
Difficulty pushing food to back of mouth
Dysarthria (difficulty speaking)
Listen to the voice
Gurgle, wet, weak, hoarse, strident
Paresthesia of face, lips, tongue

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38
Q

what is aspiration

A

Aspiration is defined as the inhalation of either oropharyngeal or gastric contents into the lower airways

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39
Q

modified massey bedside swallow test

A

must be completed and documented w date and time for all rule out strokes and TIAs prior to any oral intake
complete within 24hrs of admission or new onset TIA/CVA
can’t just document +/-
nurses do this test
when in doubt, keep pt NPO

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40
Q

aspiration PNA

A

Aspiration of colonized oropharyngeal material (food, secretions)
Often polymicrobial
Pulmonary inflammation
pts look very sick

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41
Q

CXR shows what in aspiration pts

A

infiltration of dependent portion of lungs
cloudy, can’t identify outline of lobes

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42
Q

effective oral care does what 5 things

A

Reduces bacteria
Increases appetite
Increases alertness
Increases salivary flow
Reduces pneumonia incidence

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43
Q

diagnosis of aspiration PNA

A

Fever >100 F
WBC > 10,000 (know normal WBC)
Rales
+ sputum culture
Productive cough
PaO2 <70 mmHg
CXR + for new infiltrate

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44
Q

how to manage reflux

A

positioning
feeding/diet changes
meds such as antacids, PPIs, histamine blockers, prokinetics, physical barriers

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45
Q

nursing interventions for dysphagia

A

NPO
Swallow evaluation
Ensure appropriate diet (puree, mechanical soft)
Feed in upright position
For pts with hemiplegia or paresis, place food on unaffected side
If “pocketing” of food occurs, have patient sweep mouth with finger to remove

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46
Q

when can tPA be given

A

within 3hrs of stroke onset

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47
Q

5 assessment for tPA

A

monitor for bleeding
maintain BP
neuro status (for re-embolization or bleed)
no SCD or BP cuff for 24h
no heparin for 24h

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48
Q

what to use for non-tPA eligible pts

A

Early ASA therapy is recommended (150- 325mg)
Pts w/ restricted mobility
Prophylactic low-dose SQ Heparin or LMWH or IPC (intermittent pneumatic compression)

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49
Q

blood pressure management for stroke pts

A

aggressive efforts to lower blood pressure may decrease perfusion pressure and may prolong or worsen ischemia
hypertension in the setting of hemorrhagic stroke should always be managed
Parameters for BP management can vary depending on if patient is a candidate for t- PA

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50
Q

fever in stroke pts

A

mild hypothermia in the brain is neuroprotective, hyperthermia accelerates ischemic neuro injury
give antipyretics and find source of fever

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51
Q

antithrombotics for day 2 post CVA/TIA

A

ASA
Aggrenox
ASA & dipyridamole
Coumadin
Plavix
Ticlid
IV Heparin
LMWH – full dose

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52
Q

afib and ischemic CVA meds

A

long term coumadin (INR 2.5 [2-3])
ASA 75-325 mg/day if coumadin contraindicated

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53
Q

first thing we look at with people with impaired LOC

A

verbal response and alertness

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54
Q

lethargy

A

drowsy, awakens to stimulation

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55
Q

obtunded

A

difficult to arouse, needs constant simulation to FOLLOW SIMPLE COMMAND

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56
Q

stupor

A

arouses to vigorous, continuous stimulation
CAN’T FOLLOW A SIMPLE COMMAND
can be from increased ICP
severe impairment to brain circulation
immediate intervention
may become comatose and exhibit abnormal motor responses
if goes to irreversible coma, brainstem reflexes are absent, respirations are impaired, may be braindead)

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57
Q

akinetic mutism

A

Unresponsiveness to the environment, makes no movement or sound, sometimes opens eyes

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58
Q

PVS

A

no cognitive function but has sleep-wake cycles

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59
Q

locked in syndrome

A

inability to move or respond except for eye movements (up and down not side to side)
lesion in the pons!

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60
Q

GCS score interpretations

A

9-15: mild-mod injury
3-8: major injury

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61
Q

GCS eye

A

4- Spontaneous
3- Loud voice
2- Pain
1- None

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62
Q

GCS verbal

A

5- Normal conversation
4- Disoriented conversation
3- Non coherent
2- No words, only sounds
1- None

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63
Q

GCS motor

A

6- Normal
5- Localized to pain
4- Withdraws to pain
3- Flexion
2- Extension
1- None

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64
Q

changes in LOC can indicate what 7 things?

A

Hypoxia
Hypercarbia
Hypotension
Drug related
Hypothermia
Postictal state
Hypoglycemia

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65
Q

complications of change in LOC

A

resp distress/failure
PNA
aspiration
pressure ulcers
DVT
contractures

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66
Q

fixed and dilated pupils

A

herniation syndrome

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67
Q

posturing in relation to PVS

A

high potential for PVS in pts who posture and have adequate perfusion and oxygenation

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68
Q

spastic muscles

A

generally accompanied by rigidity, muscle is in a state of contraction, muscle spasm may be present

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69
Q

decorticate (plantar, legs, arms, hands)

A

plantar flexed (outward)
legs internally rotated
arms flexed and adducted
hands flexed
BETTER PROGNOSIS

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70
Q

decerebrate (plantar and arms/hands)

A

plantar flexed (outward)
arms adducted, extended, pronated, and hands flexed outward

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71
Q

DTRs and which is superficial

A

triceps, biceps, brachioradialis, patellar, and achilles tendon
plantar is superficial

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72
Q

in who is Babinski normal

A

children <2

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73
Q

cushing’s triad

A

Increased SBP with a widening pulse pressure
Bradycardia
Bradypnea

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74
Q

cushing’s triad caused by?

A

increased ICP
late sign of herniation syndrome

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75
Q

normal ICP

A

1-15 mmHg

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76
Q

herniation syndrome

A

Occurs when cerebral pressure is not exerted evenly
One portion of the brain herniates into another
Supratentorial and infratentorial
Caused by cerebral edema or mass
Neuro changes can be slow or rapid
Call family to establish baseline

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77
Q

maintenance of clear airway for altered LOC patient

A

may be orally or nasally intubated, can cause accumulation of secretions which need to be removed
frequent monitoring and lung sounds
positioning to accumulate secretions and prevent obstruction
HOB elevated 30, lateral or semi-prone
suctioning, oral hygiene, CPT

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78
Q

how to protect eyes in pt with altered LOC

A

clean with saline-soaked cotton balls
artificial tears
cautious w eye patches because cornea may contact patch

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79
Q

fluid status and body temp with altered LOC

A

watch fluid status, turgor, INO, labs, IV and tube feedings
adjust temp and cover pt
monitor temp frequently

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80
Q

diarrhea may result from what 3 things

A

infection
meds
hyperosmolar fluids (TPN)

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81
Q

mood if patient arouses from coma

A

may have period of agitation (low stimulation)

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82
Q

monro-kellie hypothesis

A

Dynamic equilibrium of intracranial pressure
Limited space in skull, so increase in any components causes change in volume of others
compensation by displacing or shifting CSF
increasing absorption or minimizing production of CSF
minimizing blood volume

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83
Q

increased ICP causes what

A

decreased cerebral perfusion, ischemia, cell death, and further edema
may result in herniation

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84
Q

autoregulation in the brain

A

the brain’s ability to change the diameter of blood vessels to maintain cerebral blood flow

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85
Q

decreased and increased CO2 in relation to blood vessels

A

decreased: constriction
increased: dilation

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86
Q

early manifestations in increased ICP

A

changed in LOC
change in condition
Restlessness, confusion, increased drowsiness, increased respiratory effort, purposeless movements (loss of spontaneous movement), hemianopsia, lost taste for sweet and salty, pulse and pulse pressure changes
Pupillary changes and impaired ocular movements
Weakness in one extremity or one side
Headache: constant, increasing in intensity, or aggravated by movement or straining

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87
Q

late manifestations of increased ICP

A

Respiratory and vasomotor changes
Cushing triad: bradycardia/pnea, HTN
Projectile vomiting
Further deterioration of LOC
Going from stupor to coma
Hemiplegia, decortication, decerebration, or flaccidity
Respiratory pattern alterations including cheyne-stokes breathing and arrest
Loss of brainstem reflexes: pupil, gag, corneal, and swallowing

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88
Q

diabetes insipidus

A

Decreased secretion of ADH
Excessive urine output
Decreased urine osmolality
Serum hyperosmolality
Give IV fluids, electrolyte replacement and desmopressin (synthetic vasopressin)

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89
Q

SIADH fluid restriction

A

<800ml/day

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90
Q

interventions for increased ICP

A

resp status and lung sounds
head in neutral position and elevated 0-60 to promote venous drainage
avoid hip flexion, valsalva, abd distention, or stimuli
monitor fluid status, I&O every hr in acute phase
strict asepsis

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91
Q

craniotomy

A

opening of the skull

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92
Q

craniectomy

A

excision of portion of the skull

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93
Q

cranioplasty

A

repair of cranial defect with metal or plastic plate

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94
Q

burr holes

A

circular openings for exploration or diagnosis to provide access to ventricles or shunting procedures, aspirate a hematoma or abscess, or make a bone flap

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95
Q

preop meds for increased ICP

A

corticosteroids, fluid restriction, hyperosmotic (mannitol), diuretics
antibiotics
diazepam for anxiety

96
Q

care of pt undergoing intracranial surgery

A

Assess dressing and for evidence of bleeding or CSF drainage from nares or intracranial drain, may look orange or yellow
monitor fluid status and labs

97
Q

how often to check VS and neuro for intracranial patients

A

every 15 mins to an hour

98
Q

when does cerebral edema peak

A

24-36 hours

99
Q

HOB to maintain cerebral perfusion

A

0-30

100
Q

turning and repositioning/breathing intracranial patients

A

q2h
use incentive spirometer
humidify oxygen

101
Q

interventions for intracranial pts

A

Monitor I&O, weight, blood glucose, serum and urine electrolyte levels, and osmolality, and urine specific gravity
prevent infection by assessing incision site, CSF leak, don’t do anything to increase ICP, asepsis!

102
Q

causes of seizures

A

Cerebrovascular disease
Hypoxemia
Fever (childhood)
Head injury
HTN
CNS infections
Metabolic and toxic conditions
Brain tumor
Drug and alcohol withdrawal
Allergies

103
Q

assessment of HA

A

Include medication history and use
Persons undergoing a headache evaluation require a detailed history and physical assessment with neurologic exam to rule out various physical and psychological causes
Diagnostic testing may be used to evaluate underlying cause if there are abnormalities on the neurologic exam
Find out about predecessors, new meds being used, history of drug abuse

104
Q

meds for migraines and cluster headaches

A

abortive medications instituted as soon as possible with onset

105
Q

heat and cold for what type of headache

A

heat for tension
cold for migraine

106
Q

CN I

A

olfactory (smell)
offer patient something to smell

107
Q

CN II

A

optic (vision)
snellen chart with and without aids
ask when patient sees you wiggling your fingers at side of their head
ishihara plates for color blindness
ask which finger is moving in each quadrant
PERRLA

108
Q

CN III

A

oculomotor (eyelid movement, pupil reflex, coordinated movement of eyes)
6 cardinal points in H pattern without moving head
PERRLA
look for failure to move, nystagmus, drooping, double vision

109
Q

CN IV

A

trochlear (eyelid movement, pupil reflex, coordinated movement of eyes)
6 cardinal points in H pattern without moving head
PERRLA
look for failure to move, nystagmus, drooping, double vision

110
Q

CN V

A

trigeminal (face sensation, corneal reflexes, chewing)
sensory: cotton and pin near jawline, cheek, and forehead; cotton on cornea should make pt blink
motor: open mouth against resistance or pretend to chew, left index finger on pt chin and strike with tendon hammer, slight protrusion of jaw

111
Q

CN VI

A

abducens (eyelid movement, pupil reflex, coordinated movement of eyes)
6 cardinal points in H pattern without moving head
PERRLA
look for failure to move, nystagmus, drooping, double vision

112
Q

CN VII

A

facial (face movement, taste, salivation)
raise eyebrows, close eyes, keep closed against resistance
puff cheeks and show teeth
taste

113
Q

CN VIII

A

vestibulocochlear/acoustic (hearing and balance)
whisper test
rinne test (tuning fork on mastoid and next to ear, ear should be louder)
weber test: fork on center of forehead, should sound same in each ear

114
Q

CN IX

A

glossopharyngeal (throat sensation, taste, movement of tongue for swallowing/gag reflex, phonation)
swallow or elicit gag reflex
phonation by listening to vocal sounds
assess taste

115
Q

CN X

A

vagus (throat sensation, taste, movement of tongue for swallowing/gag reflex, phonation)
swallow or elicit gag reflex
phonation by listening to vocal sounds
assess taste

116
Q

CN XI

A

spinal accessory (some neck movement and shoulder)
shrug shoulders and turn head against resistance

117
Q

CN XII

A

hypoglossal (tongue movement)
stick out tongue and check for deviations

118
Q

right sided CVA

A

left paralysis
spacial difficulties
impulsive behavior
poor judgment
time blindness

119
Q

left sided CVA

A

right paralysis
difficulty knowing left and right
slow cautious movements
impaired cognition
dep and anxiety

120
Q

warning signs of chemo toxicity

A

loss of appetite
fatigue
SOB

121
Q

what med to give before chemo

A

benadryl corticosteroids

122
Q

platinum based chemo

A

neuropathy!!

123
Q

chemo and thrombocytopenia

A

noooo!

124
Q

supportive care for palliative

A

Insertion of gastric feeding tube
Placement of central venous access device
Prophylactic surgical fixation of bones at risk for pathologic fracture

125
Q

intrathecal chemo

A

injected in spinal column

126
Q

Central vascular access device (VAD) administration

A

Placement in large blood vessels
Frequent, continuous, or intermittent administration
Can be used to administer other fluids (blood, electrolytes, etc.)
Minimize discomfort and emotional distress!
Avoid continuous punctures through peripheral lines

127
Q

intraarterial regional chemo

A

Delivers drug through arteries supplying tumor

128
Q

intraperitoneal regional chemo

A

Delivers drug to peritoneal cavity for treatment of peritoneal metastases with 1-2L of fluids for 1-4 hours then drained. Heated intraperitoneal chemotherapy (HIPEC), done for liver or colon cancer that metastasized into peritoneal cavity

129
Q

intrathecal/ventricular regional chemo

A

Involves lumbar puncture & injection of chemo into subarachnoid space

130
Q

intravesical bladder regional chemo

A

Agent added to bladder by urinary catheter and retained for 1 to 3 hours

131
Q

acute chemo toxicity

A

Anaphylaxis, hypersensitivity, extravasation (comes out of the blood vessel and goes into tissue), anticipatory nausea, vomiting, dysrhythmias

132
Q

delayed effects of chemo toxicity

A

Nausea and vomiting, mucositis (mucus membranes break down), alopecia, skin rashes, bone marrow depression, altered bowel function, neurotoxicities (especially with platinum-based chemo)

133
Q

chronic chemo toxicity

A

Damage to heart, liver, kidneys, and lungs
Can immediately develop after treatment and manifest months later
SE can be in more than one category, long lasting ones can have effects on patient’s survival

134
Q

platinum based chemo for what types

A

bladder, lung, testicular, and ovarian

135
Q

topoisomerase inhibitors for what type of cancer

A

ovarian, colon, small cell lung

136
Q

vinca alkaloids for what type of cancer

A

solid tumors
leukemia, lymphoma, hodgkin lymphoma

137
Q

antifolates for what type of cancer

A

sarcomas, carcinoma, ALL lymphoma, non-neoplastic like immunosuppression

138
Q

treatment induced effects of chemo (bone marrow suppression)

A

monitor CBC, neutro, PLT, RBC, nadir in 7-10 days so space out chemo q2w, neutropenia, anemia, fatigue, thrombocyto, infection, sepsis, hemorrhage

139
Q

treatment induced effects of chemo (mucosal lining disturbances)

A

stomatitis, mucositis, esophagitis, N/V/D/C, dysgeusia, hepatotoxicity)

140
Q

treatment induced effects of chemo (skin changes)

A

erythema, flushing, hyperpigmentation
acral erythema, alopecia
rashes, dryness, finger and toenail discoloration
peeling (macerated) skin
caused by normal RBCs being destroyed
Especially the ones rapidly proliferating like bone marrow, GI lining, bone, skin, and nails

141
Q

when is nutritional counseling indicated after chemo

A

when 5% weight loss noted

142
Q

diet for chemo pts

A

Soft, non irritating, high-protein & high-calorie foods should be eaten throughout the day.
avoid extreme temps, tobacco, alcohol, spicy/rough foods
nutritional supplements
biweekly weights
10lb weight loss=hard to maintain nutritional status
monitor albumin and prealbumin

143
Q

causes for fatigue in chemo pts

A

anemia
accumulation of toxic substances after cells are killed
need for extra energy to repair and heal body tissue
lack of sleep from drugs

144
Q

pulmonary effects of chemo

A

immediate effects can be alarming because they mimic symptoms that precipitated the cancer diagnosis
Pneumonitis, pulmonary fibrosis, pulmonary edema, hypersensitivity pneumonitis, interstitial fibrosis & pneumonitis produced by an inflammatory reaction or destruction of alveolar-capillary endothelium are all possible
Cough, dyspnea, pneumonitis, pulmonary edema

145
Q

treatment of pulmonary effects of chemo

A

bronchodilators
expectorants/cough suppressants
bed rest
oxygen

146
Q

primary cause of death of chemo

A

infection in lungs, GU, mouth, rectum, peritoneal, blood
occurs from ulceration, compression of vital organs, and neutropenia

147
Q

3 obstructive emergencies of chemo

A

SVC syndrome
spinal cord compression
third space syndrome

148
Q

SVC syndrome and S&S

A

obstruction by tumor or thrombus by lung cancer, non-hodgkins lymphoma, and breast cx
Facial and periorbital edema
Distention of veins of head, neck, and chest
Seizures
Headache
Confusion and disorientation
mediastinal mass seen on chest xray

149
Q

what increases risk of SVC syndrome and treatment

A

presence of a central venous catheter & previous radiation therapy to the mediastinum
radiation therapy or chemo to site of obstruction

150
Q

spinal cord compression and S&S

A

tumor in epidural space of spinal cord
Intense, localized, persistent back pain
Motor weakness
Sensory paresthesia and loss
Change in bladder or bowel function

151
Q

third space syndrome, S&S, and treatment

A

Shifting of fluid from vascular to interstitial space
Signs of hypovolemia including hypotension, tachycardia, low central venous pressure, and decreased urine output
Treatment: replacement of fluids, electrolytes, and plasma protein
hypervolemia can occur from treatment

152
Q

5 metabolic emergencies by production of ectopic hormones

A

SIADH
hypercalcemia
tumor lysis syndrome
septic shock
DIC

153
Q

SIADH

A

abnormal or sustained production of ADH
cancer cells manufacture, store, and release it
chemo agents stimulate release

154
Q

SIADH S&S

A

Weight gain without edema, weakness, anorexia, N/V, personality changes, seizures, oliguria, decreased reflexes, coma, hyponatremia

155
Q

SIADH treatment

A

Treat underlying malignancy & correct the sodium- water imbalance (fluid restriction, oral salt tablets or isotonic [0.9]) saline and IV administration of 3% sodium chloride solution.
Furosemide (Lasix) may also be a helpful treatment in the initial phases.
Demeclocycline (Declomycin) may be needed on an ongoing basis
Monitor sodium level because sometimes SIADH…? I’m assuming SIADH causes hyponatremia

156
Q

what 2 things contribute to or exacerbate hypercalcemia

A

immobility and dehydration

157
Q

S&S of hypercalcemia

A

Apathy, depression, fatigue, muscle weakness
ECG changes, polyuria, nocturia, anorexia, N/V

158
Q

tumor lysis syndrome

A

rapid destruction of large numbers of cells
increased serum phosphate causes decreased calcium
can cause biochem changes resulting in renal failure
can be fatal
prevent renal failure and serious electrolyte imbalance
usually 24-48h after chemo and lasts a week

159
Q

hallmark signs of tumor lysis syndrome

A

hyperuricemia
hyperphosphatemia
hyperkalemia
hypocalcemia

160
Q

infiltrative emergencies in chemo pts

A

cardiac tamponade and cardiac artery rupture
sometimes in head and neck cancer, risk

161
Q

S&S of cardiac tamponade

A

heavy feeling in chest, SOB, tachycardia, coughing, difficulty swallowing, hoarse, perspiring a lot, uncomfy and anxious

162
Q

cardiac artery rupture

A

Invasion of artery wall by tumor
Erosion following surgery or radiation
Bleeding can manifest as
minor oozing or spurting of blood in case of a blowout pressure should be applied

163
Q

surgical management of carotid artery rupture

A

ligation of the carotid artery above and below the rupture site and reduction of local tumor

164
Q

what hormones do the renal system release (what do the hormones help with)

A

RBC production
bone metabolism
BP control

165
Q

physical structure of ureters

A

wide then thinner, where stones get stuck

166
Q

gerontological considerations of renal and urinary

A

GFR decreases (causing more effects of meds bc they can’t excrete them as well)
diminished osmotic stimulation (hypernatremia and FVD)
structural (tumor) or functional changes to bladder (incontinence or BPH)
FEWER NEPHRONS

167
Q

lining of bladder is?

A

VERY VASCULAR

168
Q

hallmark sign of upper UTIs like pyelonephritis

A

fever or chills

169
Q

when would a patient be on a long term catheter

A

paralyzed, BPH, PVS or coma, MS, any neuro problem that interferes with message telling brain “I have to void”

170
Q

how do drugs affect urine output

A

tobacco/nicotine vasoconstricts, alcohol suppresses ADH

171
Q

nephrotic syndrome is what kind of defect

A

structural

172
Q

gout and urinary

A

buildup of uric acid crystals, very painful when they lodge in a joint, can get it anywhere

173
Q

kidney pain physical exam and clini manifestations

A

CVA tenderness (dull, severe, sharp, colicky)
N/V, diaphoresis, shock -> obstruction, stone, blood clot, pyelonephritis, trauma

174
Q

bladder pain physical exam and clini manifestations

A

suprapubic (intense with voiding and full bladder)
urgency, pain at the end of void, straining ->infection, tumor, interstitial cystitis, overdistended bladder

175
Q

uteral pain physical exam and clini manifestations

A

CVA, flank, lower abd, labium (severe, sharp, stabbing, colicky)
N/V, paralytic ileus -> ureteral stone, stricture, blood clot

176
Q

prostate pain physical exam and clini manifestations

A

perineum, rectum (vague discomfort, feeling of fullness, back pain)
suprapubic tenderness, obstruction, hesitancy, frequency, urgency, nocturia -> prostate ca, prostitis

177
Q

urethral pain physical exam and clini manifestations

A

MALES: from penis to meatus
FEMALES: urethra to meatus
frequency, urgency, dysuria, nocturia, urethral discharge -> infection, irritation of bladder neck, foreign body

178
Q

interstitial cystitis

A

not a bladder infection, inflammation of lining of bladder that comes and goes, resembles infection but cultures are (-). Bleeding and pain when urinating, looks like pyelonephritis. Treated with steroids.

179
Q

where is the labium

A

right above the hip

180
Q

frequency

A

urinating > q3h

181
Q

hesitancy

A

difficulty initiating voiding

182
Q

enuresis

A

involuntary voiding during sleep

183
Q

oliguria

A

urine output <500 ml/day

184
Q

anuria

A

urine output < 50ml/day

185
Q

encopresis

A

stool at night

186
Q

urine specific gravity range

A

1.010-1.025

187
Q

normal serum creatinine

A

0.6-1.2

188
Q

normal BUN

A

7-18
8-20 in pts >60

189
Q

cystoscopic examination

A

metal rod with clip at the end goes in penis for biopsy
leads to hematuria

190
Q

interventions before urinary tract testing

A

use correct terminology in a way pt will understand
encourage fluid intake unless contra
reduce discomfort like sitz baths
analgesics and antispasmodics
assess voiding and hygiene

191
Q

pyridium

A

antispasmodic
turns urine orange/red
very potent
same as uristat but higher concentration

192
Q

postop management of kidney surgery

A

Potential hemorrhage and shock
Widening pulse pressure
HR increases then decreases
Pallor
Nausea
potential abd distention from bleeding and paralytic ileus (use blakemore sengsten tube [black and weighted])
potential infection and thrombus that can turn into PE

193
Q

complications of kidney surgery

A

bleeding , pneumonia, infection, and DVT

194
Q

drains after kidney surgery

A

pt goes home with them
hand suction on JP drain, should first be blood, then serosang, then sero
tubes sutured in

195
Q

causes of uro and nephrolithiasis

A

hyperparathyroidism
renal tubular acidosis
cancers
granulomatous (sarcoid, TB) increase Vit D
Excessive Milk and dairy
myeloproliferative disease

196
Q

diagnosis of uro an nephrolithiasis

A

x-ray, blood chemistries, and stone analysis; strain all urine and save stones

197
Q

possible reasons for stone development

A

-deficiency of citrate, Mg, nephrocalcin, and uropontin (prevents crystallization)
-dehydration (binging alcohol)
-certain conditions like infection, urinary stasis, periods of immobility
-increased calcium concentrations in blood and urine

198
Q

Causes of Hypercalcemia and Hypercalciuria

A

hyperparathyroidism
renal tubular acidosis
cancers
granulomatous (sarcoid, TB) increase Vit D
Excessive Milk and dairy
same as causes of uro and nephrolithiasis

199
Q

med management of kidney stones

A

allow stone to pass
pain management
hot bath or moist heat to flank
ten 8oz glasses of water a day
urine output 2L/day
strain urine
NO OPIOIDS, use toridol (antiinflammatory)

200
Q

gerontologic consideration for kidney stones (temperature)

A

normal looking temperature like 99 is bad
normally they’re a bit colder like 97 so 99 can be sepsis
not good outcome

201
Q

dietary teaching for uric stones

A

low purine diet, no shellfish, mushrooms

202
Q

dietary teaching for cystine stones

A

low protein

203
Q

dietary teaching for oxalate stones

A

no spinach, strawberries, rhubarb, chocolate, tea, peanuts, and wheat bran

204
Q

bladder cancer risk factors

A

> 55
male
smoking (tobacco)
environmental carcinogens
recurrent or chronic UTIs
high urinary pH
bladder stones
high cholesterol
pelvic radiation therapy
cancers of nearby areas

205
Q

S&S of bladder cancer

A

Visible painless hematuria (most common symptom)
Frequency and urgency secondary to infection
Any alteration in voiding pattern
Pelvic or back pain with metastatic

206
Q

surgery for bladder cancer

A

transurethral resection or fulguration, cystectomy (simple or radical)
Conduit to bypass bladder (connects kidneys to skin)

207
Q

urinary diversion reasons

A

Bladder cancer or other pelvic malignancies
Birth defects, trauma, strictures, neurogenic bladder, chronic infection or intractable cystitis
Used as a last resort for incontinence

208
Q

types of urinary diversion

A

Cutaneous urinary diversion: ileal conduit, cutaneous ureterostomy, vesicostomy, nephrostomy

Continent urinary diversion: Indiana pouch, Kock pouch, ureterosigmoidostomy

209
Q

pt teaching of urinary ostomy

A

changing appliance, controlling odor, managing the ostomy appliance, cleaning and deodorizing the appliance, continuous care

210
Q

BPH manifestations

A

those of urinary obstruction, urinary retention, and urinary tract infections (due to urinary stasis)

211
Q

treatment of BPH and SE

A

alpha-adrenergic blockers, alpha- adrenergic antagonists, antiandrogen agents (-zosins)
Finasteride
Catheterization if unable to void
Prostate surgery
antiadrogen causes gynecomastia and facial feminization

212
Q

risk factors of BPH

A

Estrogen and testosterone play a role
smoking, Etoh, obesity, sedentary lifestyle, HTN, CVD, DM, Western diet; increase fat, animal protein, refined carb

213
Q

S&S of BPH

A

Frequency, urgency, nocturia, hesitancy, decreased force of stream, incomplete void, straining, dribbling, urinary retention, recurrent UTI
fatigue, anorexia, nausea, vomiting, pelvic discomfort

214
Q

diagnosis of BPH

A

voiding diary
health/family hx
DRE: large, rubbery, non-tender, gloved hand goes in to feel for prostate
PSA: prostatic specific antigen
American urological association scoring to help grade severity of symptoms
UA, culture
Ultrasound

215
Q

management of BPH

A

Meds: alpha-adrenergic blockers alfuzosin, terazosin
5-alpha-reductase inhibitor finasteride
saw palmetto (can mask serious problem) little data to support but often taken by pt.
Minimally invasive: transurethral microwave heat treatment (TUMT) transurethral needle ablation (TUNA)

216
Q

surgery for BPH

A

Transurethral resection of prostate (TURP)
watch catheter
lots of bleeding, should look pinkish but not red red
if clots r there, should be small enough to pass

217
Q

three way system for bladder irrigation

A

irrigating bladder wall, VERY vascular so try to minimize bleeding

218
Q

risk factors of prostate cancer

A

increasing age, familial predisposition, and African-American race

219
Q

manifestations of prostate cx

A

Early disease has few/no symptoms
Symptoms of urinary obstruction, blood in urine or semen, painful ejaculation
Symptoms of metastasis may be the first manifestations
Back pain usually brings person in to hospital
EARLY SCREENINGS VITAL

220
Q

prostate cx treatment

A

Watchful waiting
Radiation Therapy
Brachytherapy: putting radioactive seeds into the site
Hormonal strategies
Chemotherapy
Regional: radioactive liquid in bladder, must hold it for 1.5-2 hours. Very uncomfortable because they want to urinate

Surgical- Prostatectomy
Radical prostatectomy
Cryosurgery
TURP

221
Q

S&S of prostate cx

A

signs of obstruction:
Difficulty and frequency of urination
Urinary retention
Decrease force of stream
Painful ejaculation (prostate, not urinary!)
Blood in urine or semen
Hematuria if cancer of urethral or bladder

signs of metastasis:
back or hip pain, anemia, weight loss, spontaneous fractures

222
Q

assessment of prostate cx

A

DRE: hard, fixed (not mobile) stony prostate
Elevated PSA or velocity of PSA
Usually presents with LUTS (lower urinary s/s)
Ultrasound, needle biopsy
Bone scan, MRI to look for mets

223
Q

complications of prostate cx

A

Hemorrhage and shock
Infection
DVT
Catheter obstruction
Sexual dysfunction

224
Q

what to watch w prostate cx surgery

A

fluid balance!

225
Q

what do bladder spasms cause in prostate surgery pts

A

feelings of pressure and fullness, urgency to void, and bleeding from the urethra around the catheter
use meds and warm compresses/sitz baths
analgesics
walk dont sit!
prevent constipation
irrigate catheter

226
Q

pt teaching after prostate surgery

A

Sometimes clamp off bladder so urine builds up, helps them regain sensation
Information that regaining control is a gradual process (dribbling may continue for up to 1 year depending upon type of surgery)
perineal exercises
avoid straining, heavy lifting, and long car rides for 6-8w
fluids! no coffee, alcohol or spice
urologist for sex questions

227
Q

testicular cancer risk factors

A

undescended testicles, positive family history, cancer of one testicle, Caucasian-American race

228
Q

manifestations of testicular cancer

A

painless lump or mass in the testes
(painful is infection)

229
Q

treatment of testicular cancer

A

orchidectomy, retroperitoneal lymph node dissection (open or laparoscopic), radiation therapy, chemotherapy

230
Q

Nitrates in urine

A

E.coli in pyelonephritis

231
Q

How long should u fast before cerebral angio

A

8-10h

232
Q

Hyperuricemia value

A

> 7

233
Q

Hyperphosphate level

A

> 4.5

234
Q

3 meds to dry secretions when dying

A

Scopolamine
Glycopyrrolate
Hyoscyamine

235
Q

How to treat acute hypercalcemia

A

Hydration (3 L/day) and bisphosphonate therapy

236
Q

Tumor lysis syndrome med

A

use allopurinol/zyloprim to decrease uric acid

Med-Surg II (5 decks)

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