Exam 2 Flashcards
Burns, GU, MH, GI, ABX
What are the four types of burns?
Thermal, Radiation, Electrical, Chemical
What are characteristics of a first degree burn?
Epidermis only, mild, NO BLISTERS, skin pink and dry.
What are characteristics of a second degree burn?
Deeper skin layers, red, painful, BLISTERS
What are characteristics of a third degree burn?
Very deep layers and bone, dead tissue, skin non-blanchable, skin graft is needed,
Describe the “Rule of Nines” when calculating body surface area for burns.
Head: Total - 9% (Front - 4 1/2, Back - 4 1/2)
Chest: Total - 18% (Front - 9, Back - 9)
Abdomen: Total 18% (Front - 9, Back - 9)
Groin: Total 1%
Arm (Single): Total - 9% (Front - 4 1/2, Back - 4 1/2)
Leg (Single): Total - 18% (Front- 9, Back- 9)
What are the stages of burn care?
Resuscitative/Emergent Phase
Acute Phase
Rehab Phase
What are the main concerns in the resuscitative/emergent phase of burn care?
Respiratory Distress
Hypovolemic Shock (Give Lots of Fluids!!)
Compartment Syndrome
What is the Parkland Formula for calculating fluid replacement in burn victims?
4mL x BSA(%) x Weight (kg)
Give half of the solution over the first 8 hours
Give the other half over the next 16 hours
What is an obvious sign of carbon monoxide poisoning?
Bright red lips.
In the acute phase of burn victims, what is the main concern?
High risk for infection! (along with pain management and wound care)
In the rehab phase of burn victims, what are main concerns?
Prevent scarring
Work with physical therapy
High protein diet
Coping with negative emotions (anger/sadness about body image etc)
What is an Escharotomy in a burn victim?
Surgical procedure; SUPERFICIAL incision made to relieve pressure from edema.
What is a Faschiotomy in a burn victim?
DEEP surgical incisions to relieve pressure from edema.
What should the nurse do before starting any patient on antibiotics?
Obtain culture and sensitivity test.
ABX: Penicillins (B-Lactams)
TREATS: Anthrax, Syphilis
- Interfere with bacteria cell wall synthesis
- Avoid in patients with mono
- Do not give with cephalosporins if pt allergy is present
- Can treat anthrax and syphilis
ABX: Cephalosporins
TREATS: MRSA, Penetrate CSF
- Starts with Cef-
- Can treat MRSA
- Can cause nephrotoxicity
ABX: Macrolides
TREATS: Lots of things Macro = big = big spectrum (respiratory, skin, soft tissue, sexually transmitted, H. pylori and atypical mycobacterial infections)
- azithromycin, erythromycin
- can cause hepatic dysfunction
- decreases PCN & Clindamycin effects
ABX: Oxazolidinones
TREATS: Bacterial Infections (including staphylococci, streptococci and pneumococci)
- can cause eye issues (zolid -> lid -> eye)
- can cause thrombocytopenia
- can cause serotonin syndrome (temp, diarrhea, agitation, dilated pupils)
ABX: Lincosamides
TREATS: C-Diff, Acne, Infections
- clindamycin; linomycin
- can cause pancytopenia (all blood counts are LOW)
ABX: Glycopeptides
TREATS: C-Diff & Other Infections
- Vancomycin, Telavacin, Oritavancin
- Vancomycin can cause Red Man Syndrome if infused too quick (pt turns red, itchy, flushed) and nephrotoxicity
When should the nurse draw a vancomycin trough?
30 min before next dose of vancomycin
ABX: Tetracycline
TREATS: Chlamydia, Syphilis, Gonnorhea (Cycle = Cycle through men = STDs)
- Tetracycline, Demeclocycline, doxycycline, minocycline, tigecycline (end in -cycline)
- Can cause tooth discoloration
- Avoid dairy/iron/antacids
ABX: Aminoglycosides
TREAT: SEVERE infections of the abdomen and urinary tract
- Tobramycin, Gentamicin
- Can cause ototoxicity and nephrotoxicity
- Ends in -cin
ABX: Fluoroquinolones
TREATS: Variety of infections; respiratory and UTI, Skin
- ends in Floxacin
- tendon rupture
- treat UTIs, Anthrax, PNA, skin infections
ABX: Sulfonamides
TREATS: Lots of Infections everywhere
- starts with SULF
- can cause crystalluria
- increase fluids
ABX: Nitroimidazoles
Treats: H-Pylori and C-Diff
- ends in ZOLE
- treats H. Pylori and C-Diff
- don’t take with alcohol (severe vomiting)
What are the THREE general adverse reactions to ABX?
- Allergy/hypersensitivity
- Superinfection (2ndary infection from being on ABX)
- Organ Toxicity
What are the two types of UTIs?
Upper UTI - Nephritis
Lower UTI - Bladder/Prostate/Urethra
Which type of UTI is uncomplicated?
Lower UTI, treated easier and responds better to tx
What is the most common cause of UTIs in hospitals?
Urinary Catheters
What is the most common type of UTI Infection?
Ascending Infection
In the gerontologic population, what are signs & symptoms of a suspected UTI?
Altered mental status, lethargy, agitation, confusion, new incontinence
What are common ABX for UTI treatment?
- TriMETHOprim/SulfaMETHOxazole (Has “METHO” in it)
- Fosfomycin
- Nitrofurantoin
- Cephalexin
- Ceftriaxone
Remember: Metho-Fosfo-Nitro-Cephf = UTI TX!
What is Pyridium and what is a common side effect of it?
Anti-spasmatic, orange pee! Avoid citrus
In what time frame should a patient void after a catheter is removed?
6-8 Hours
What are the types of urinary incontinence?
Stress - happens with physical exertion (exercise, coughing, etc)
Urge - overactive bladder, strong urge to urinate, large amounts
Functional - due to medications or other health problems not related to bladder/urethra
Overflow - dribbling of urine caused by abnormal detrusor muscle contractions
Mixed - Mix of the above
What medicines can help with incontinence?
- Anticholinergics
- Antidepressants
- Psuedoephedren Sulfate
Urinary tract stones are _______ based.
Calcium
What are clinical manifestations of urinary stones?
- Pain (Flank = Kidney Stones)(Lower ABD = Ureter Stones) can be wave-like, spasms when stone is moving.
- N/V/D
- ABD Pain
What are nursing interventions for urinary stones?
- pain management, control it
- keep patient hydrated
- have patient pee at least 2L daily
What is cystitis?
Inflammation of the bladder usually due to infection
Patients on ABX can get what type of UTI?
Fungal UTI (check their current med list)
In older women, what hormone replacement can help reduce the risk of UTIs?
Estrogen
What are the main symptoms of UTIs?
Frequency, Urgency, Dysuria (pain while urinating)
Erectile Dysfunction can be managed with what type of drugs?
PDE-5 Inhibitors (Phosphdiesterase Type 5 Inhibitors) such as:
- Slidenafil (Viagra)(24Hr)
- Vardenafil (Levitra)(24Hr)
- Tadalafil (Cialis)(36 Hr)
Mneumonics:
Slide-in ;)
Vard = Hard
Tada! Erection
PDE-5 Inhibitors for erectile dysfunction are contraindicated with _________?
Nitrates (leads to dangerous hypotension)
What is Benign Prostatic Hyperplasia (BPH)?
Nonmalignant enlargement of the prostate.
What does BPH cause?
- Increased residual urine
- Acute/chronic urinary retention
What are some BPH assessments?
Urinary problems such as: frequency, urgency, nocturia, reduce stream velocity, strain to start urinating, incomplete bladder emptying, hematuria, dribbling
What drugs can help treat BPH symptoms?
- 5-ARI (5 alpha reductase inhibitors)
- end in -ride - A-1SBA (Alpha-1 selective blocking agents)
- end in -sin
What should people with BPH do for non-surgical interventions?
- avoid alcohol/caffeine and diuretics
- voide as soon as urge felt
- avoid anticholinergics/antihistamines
- release of prostatic fluid
What is a common side effect for patients who have had a TURP, or transurethral resection of the prostate to treat BPH?
Retrograde ejaculation
What is the second most common type of cancer that affects men above age 65 worldwide?
Prostate Cancer
What is the best cure for prostate cancer?
Surgery!
What medication can help block uptake of androgen by the prostate to help with prostate cancer?
Flutamide (Eulexin)
In what population is testicular cancer more common in?
HIV population
What age range does testicular cancer normally affect males?
Ages 20-35 years old
What is the most common of all psychiatric illnesses?
Anxiety; affects women more than men. (2:1 ratio)
What is anxiety? Is it good or bad?
- Emotional response to stress, or external pressure.
- Mild anxiety is normal and healthy, increases problem solving and learning potential
- Moderate/Severe anxiety decrease thinking capacity, learning ability, and can cause physical symptoms
- Panic is most severe form of anxiety, unable to think logically, or at all, loss of control, needs immediate intervention
Patients must have at least ____# of symptoms to have panic disorder
at least 4 symptoms or more
What interventions should a nurse provide for patients with anxiety/panic disorder?
- coping techniques
- medications such as SSRI’s and anxiolytics
- decrease intake of stimulants
- teach square breathing technique or pursed lip breathing technique when patient is at low anxiety levels
Patients who have post-traumatic stress disorder have symptoms that are ___________?
- present for 1 month or longer
- interfere with daily life
- occur at any age, at any time
- may have self-harm ideations or behaviors
What are some anxiety and panic disorder treatments, what are they used for, and why?
- Cognitive therapy changes thought process
- Behavior therapy teaches coping mechanisms and breathing techniques
- Pharmacological Therapy: Anxiolytics (Benzos), Antidepressants (SNRIs, SSRIs, Tricyclic), Antihypertensives (situational anxiety)
What is somatic symptom disorder?
Patient feels like something physically wrong with them, dramatic behavior and worry a lot.
- Pt spends money on diagnostic testings
What is Illness Anxiety Disorder (Hypochondrasis)
Patients think they are ill with a severe disease, common in OCD people, doctor shopping may occur, fear persists despite no symptoms or reassurance they are not sick
What is conversion disorder?
- Loss or change in body function that cannot be medically explained. (Blindeness, Deafness, Paralysis, etc)
- Labelle Indifference = Pt not concerned about severe symptoms
- Resolves in 1-2 weeks or when anxiety is gone.
- Results from anxiety converting to physical symptoms.
What is Factitious Disorder? (Formerly Munchausen Syndrome)
- Intentional faking of symptoms
- May harm themselves or others via proxy (Example: Mom makes child sick for attention and sympathy for herself)
What happens in Dissociative Disorders?
- Patient splits from reality and enters a fantasy-like land
- Not a conscious choice!
What is dissociative amnesia?
- Inability to recall personal information
- Brought on by severe stress
What is dissociative amnesia with Dissociative Fugue?
- Patient wanders, wakes up somewhere with no recollection of events
What is Dissociative Identity Disorder (Multiple Personality Disorder)?
- Patient has two or more personalities that exist within them
- Personalities are unique and used as coping mechanisms
- Results from severe trauma\
- Patient can function normally if personalities aren’t destructive
- Safety is highest priority, high risk of self-harm in these patients
What is depersonalization-derealization disorder?
- Depersonalization: Feelings of detachment from one’s own body, changes in self-awareness, unreal feeling in body
- Derelization: objects in the environment are perceived as altered in size and shape, other people perceived as automatic or mechanical.
What does the term ‘Anorexia’ mean?
Prolonged loss of appetite
What is Anorexia Nervosa?
- Fear of obesity and grossly distorted body image, refusal to eat
- occurs mostly in females
What is Bulemia Nervosa?
- Binging and Purging of food
What is a common eating disorder treatment?
Behavior Modification!
Cachexia
Ill health, muscle and weight loss
Steatorrhea
Oily, smelly stools that may float
Amylase
Enzyme that converts starch and glycogen into simple sugars
Lipase
Pancreatic enzyme that catalyzes breakdown of fats into fatty acids and glycerol
Ammonia
Nitrogen and hydrogen, smelly colorless gas
Hepotomegaly
Enlarged Liver
Splenomegaly
Enlarged Spleen
ALT Test
Blood test checks for liver damage (high levels = damage)
AST Test (SGOT)
Blood test checks for liver damage (high levels = damage)
Dyspepsia
Indigestion, pain, discomfort in upper abdomen
BMI
Body Mass Index (Weight in KG divided by Hieghtin m^3)
Albumin
Protein that keeps fluid from leaking out of blood vessels (Important for tissue growth, repair, nutrients)
Cholesterol
Lipid molecule:
- LDL = Bad cholesterol <189
- HDL = good cholesterol < 150
Edentulous
Tooth loss
Refeeding Syndrome
Metabolic disturbance in starving patients due to the re-introduction of nutrients and electrolytes
Overweight BMI
BMI of 25-29
Obesity BMI
Above or equal to 30
What does an anorectic drug do?
Reduces appetite
Dumping Syndrome
Food moves too quickly from stomach into small bowel (usually happens after gastric bypass or stomach removal surgery)
What are normal BUN and Creatinine levels?
BUN: 7-20
Creatinine: 0.6-1.3
What are the functions of the GI System?
Digestion
Absorption
Elimination
When a patient gets any type of GI testing done with contrast, what should the nurse monitor for?
Kidney Function
Patients having an MRI need to complete an MRI checklist, which assures that they have no ___________ on or in them.
Metal
Patients who are getting an upper or lower GI need to have a _____ diet the after midnight, the night before the test.
NPO
What does an Upper GI test detect?
Tumors, ulcers, varicies, enteritis, malabsorption
What does a Lower GI test detect?
Tumors, lesions, polyps
What does a CT scan detect?
Appendicitis, Diverticulitis, Enteritis, Ulcerative Colitis, Diseases of the liver, kidney, spleen, pancreas and pelvic organs
What does a PET scan detect?
Cancers! (Shows spots better than a CT scan)
What does an EGD, or Esophagogastroduodenoscopy, detect?
Bleeding, Upper GI Cancers
What does an ERCP, or endoscopic retrograde cholangiopancreatography, test do?
Treats problems with pancreatitis and bile ducts
What does a colonoscopy detect, how is it performed, and what should the nurse monitor for?
Test used to detect cancers, remove polyps, treat bleeding, assess inflammatory bowel disease via scope inserted through rectum.
- NPO
- Monitor for cardiac changes/problems (Vagal Response)
What is a PEG tube?
Surgically created stoma on patients stomach, used for feedings, medications, fluids
What is parenteral nutrition?
Nutrients given via IV to help muscle mass, healing.
What is bariatric surgery and what nursing care is associated with it?
Gastric Bypass (food skips stomach and duodenum and goes straight into jejunum) and Lap Band (decreases stomach size)
NSG Care:
- Watch for dumping syndrome (pallor, tachy, N/V)
- Avoid NSAIDS
- Vitamin Replacements
What are antihistamines/anticholinergic medications and what are some side effects?
- They are antiemetics
- Promethazine & Hydroxyzine (Antihistamines)
- Scopolamine (anticholinergic)
- Anticholinergic side effects include drowsiness, dry mouth, blurred vision, constipation, dry skin, hot, blinde, red pallor, Loopy
What is a nursing consideration for the dopamine antagonist promethazine?
GIVE SLOWLY through IV!
What causes dopamine antagonists to have increased CNS side effects?
Taken with alcohol or narcotics increases the CNS effects, avoid!
What does the antiemetic/serotonin antagonist Ondansetron treat?
Emesis from Chemotherapy!
What does the antiemetic/Cannabinoids such as Marinol treat?
N/V from cancer treatment, don’t use in psych disorder patients.
What is Metoclopramide (Reglan) used for?
Post-Op Emesis, Chemo Emesis, GI Motility
-Headache/Sedation/Diarrhea side effects
What are corticosteroids used for in GI?
Small dose for chemo emesis
What are some osmotic laxatives and how do they work?
- Max Citrate, Max Ox, Glycerin, Lactulose
- Pull water into colon and increase water in feces
- Can cause hypotension
What are some stimulant laxatives and how do they work?
- Bisacodyl, Senna, Castor Oil (Castro was a B.S. leader who stimulated trade bans)
- irritates nerve endings in intestinal mucosa to increase peristalsis
What are some bulk forming laxatives and how do they work?
- Psyllium, Polycarbophil, Polyethylene glycol (Starts with P!)
- Absorbs water into intestines to increase bulk
- GIVE WITH WATER/JUICE, DRINK ASAP
What are some emollient laxatives and how do they work?
- Docusate, Mineral Oil
- Docusate prevents constipation decreases straining by increasing water absorption. Stool softener
- Mineral Oil lubricates!
What are antacids and what do they do?
- Sodium Bicarb, Calcium Carb, Mag Hydrozide, Aluminum Hydrox)
- Neutralize hydrochloric acid in stomach
- take 1-3 hours AFTER meals
What are H2 blockers and what do they do?
- cimeTIDINE, famoTIDINE, RaniTIDINE
- reduces gastric secretions and concentration
- take before meals
What are PPIs and what do they do?
- omePRAZOLE, esomePRAZOLE, pantoPRAZOLE, LansoPRAZOLE
- PP = Prazole!
- suppresses gastric secretions better than H2 blockers, has worse side effects though
- take BEFORE meals
What is Sulcrafate and what does it do?
- Pepsin inhibitor
- Covers and protects the ulcer, does not neutralize or decrease acid
- give on empty stomach
What is Misoprostol and what does it do?
- supresses gastric seceretions, increases protective mucosa
- CATEGORY X IN PREGNANCY
- Give if patient is on long term NSAIDs
