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Exam 2 Blueprint Flashcards

1
Q

Signs and symptoms of covid and the flu

A

Fever/chills
Cough
SOB / difficulty breathing
Fatigue
Sore throat
Runny or stuffy nose
Muscle pain / body aches
Headache
Vomiting
Diarrhea
Change in / loss of taste or smell (Covid)

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2
Q

Indications of severe covid 19

A

Elevated C-reactive protein (CRP) and D-dimer
(Higher of these = worse prognosis)

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3
Q

Types of flu vaccines and who each is for

A

High dose = x4 antigen - 65 & older
Inactivated (IIV4) = quadrivalent - general population
Recombinant (RIV4) = egg free - 18 & older, egg allergy
Live attenuated (LAIV4) = nasal spray - NOT for:
- adults 50 and older
- pregnant women
- Hx of allergic reaction to vaccines
- immunocompromised
- people who have taken influenza antivirals within 48 hrs
- caregivers for immunocompromised

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4
Q

Treatment of the flu

A

Antivirals within 24-48 hours of symptoms
Tamiflu - oral, IV (usually IV)
Relenza - inhaled
Teach pts prevention of complications and what symptoms to look for that will warn them of complications

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5
Q

Pt teaching for at home flu management

A

Stay home
Rest
Keep warm
Drink fluids - stay hydrated
Light foods
Do not smoke
Cover coughs and sneezes

To manage symptoms:
Take acetaminophen/NSAIDs
Fever reducers
Gargle; lozenges

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6
Q

Non-pharmacologic nursing management of sinusitis

A

Drain obstructed sinuses
Humidification
Saline irrigations
Hot wet packs over sinus area
Increase fluids
Neti pot

Surgery (if unresponsive to conservative treatment)

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7
Q

Medications for sinusitis management

A

Antibiotics: amoxicillin x2 weeks
Decongestants: pseudoephedrine (Sudafed)
Expectorants: guaifenesin (Mucinex)
Nasal corticosteroids: Fluticasone
Saline nasal spray
OTC analgesics: Tylenol, Advil
Antihistamines (if r/t allergies): Loratidine (Claritin)

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8
Q

Post op nursing care for sinusitis surgery

A

Ice packs (to reduce swelling)
Oral hygiene (b/c dry mouth)
Saline nose spray (no steroids)
Change “mustache” dressing prn
Limit Valsalva maneuver for 2 wks (no coughing, blowing, lifting >20 lbs)
Semi Fowlers position
Eat soft foods
Analgesics - Avoid NSAIDS (risk of bleeding)

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9
Q

S/S of pneumonia

A

Cough
*Fever, chills
Dyspnea
Tachypnea
Hypoxemia
Pleuritic chest pain
Green, yellow, or rust colored sputum
Change in mentation (for older or debilitated pts)
- (restless, lethargic, or confusion)
Tachycardia
Fatigue
HA
Poor appetite

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10
Q

Symptoms of pneumonia on head to toe assessment

A

Fine or coarse crackles
Bronchial breath sounds (in wrong areas)
Pleural friction rub
Increased fremitus (over consolidated areas)
Dullness to percussion if pleural effusion
Splinting
Accessory muscles

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11
Q

Types of pharmacologic treatment for pneumonia

A

Analgesics
Antipyretics
Expectorants
Antivirals or antibiotics (depending on cause)

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12
Q

Types of antibiotics used to treat pneumonia

A

Vancomycin (Macrolide) - red man syndrome
Levofloxacin (Levoquin, fluroquinolone) - tendon rupture
Ceftriaxone (Rocephan, cephalosporin) - if allergic to penicillin
(IV first, then PO when pt is more stable)

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13
Q

Pneumonia vaccine recommendations for adults

A

PCV15, PCV20
PPSV23 (Pneumovax 23)

1 dose PCV 15 or PCV20 then 1 year later, 1 dose PPSV23
For adults 19-64 with chronic diseases and all adults >65

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14
Q

Prevention of pneumonia in at risk patients

A

Supplemental O2
C/DB, IS
BID oral hygiene
Therapeutic positioning (elevate HOB 30 degrees, sit up for all meals, reposition every 2 hours)
Rest & activity / early ambulation
RT: postural drainage and chest percussion

Adequate hydration
High calorie, small, frequent meals

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15
Q

Partial laryngectomy post op care

A

*High Risk for aspiration
IV fluids initially
NG tube initially
Tracheostomy x 2-5 days
Risk for ineffective airway clearance
Start with semi solids/puréed
HOB up
Head flexed slightly forward
Have suction available

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16
Q

Total laryngectomy post op care

A

IV fluids initially
NG tube initially
NPO 1-2 weeks (due to swelling)
Tracheostomy permanently
Speech altered permanently
HOB up
Have suction available
Teach pt: can’t taste/smell, blow nose, Valsalva
Teach: stoma care

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17
Q

Laryngectomy post op care in general

A

Keep patent airway!
Optimize oxygenation
Maintain nutrition (And treat malnourishment that these pts often suffer from)
Enteral feeding (via NGT then PEG tube) may be utilized during this process

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18
Q

Post op care for the tracheostomy after a laryngectomy

A

Pain management
Monitor wound, flap, reconstructive tissue for hemorrhage or wound breakdown
Assess pt’s body image/self esteem
Promote communication
- speech and language rehab

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19
Q

Methods of communication for pts after laryngectomy

A

In hospital: communication boards

TracheoEsophageal Puncture (TEP):
- one way valve to prevent aspiration
- pt blocks opening with finger

Esophageal Speech:
- pt burps out sound
- takes a long time to learn

Electronic Larynx:
- can use immediately after surgery
- easy to learn
- mechanical sounding voice

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20
Q

How is a tuberculin skin test read?

A

Site is assessed for induration 48-72 hours later
Presence of induration at injection site = TB antibodies

induration >15 mm in low risk individuals
Induration >5 mm in immunocompromised individuals

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21
Q

Benefits of taking TB blood test instead of skin test

A

BCG vaccine may cause false positive reaction to skin test, but Quantiferon Gold will not

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22
Q

What is a chest X-ray used for diagnosing in TB?

A

It is not diagnostic, but it can show:
Upper lobe infiltrates
- cavity infiltrates
- lymph node involvement
- pleural and/or pericardial effusion

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23
Q

What is a sputum test used for with TB?

A

For testing if TB is still contagious in pts with active TB
Once 3 negative sputum samples in a row, pt can be taken off airborne precautions

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24
Q

How is TB transmitted?

A

*Mycobacterium tuberculosis
- Spreads through small airborne particles that enter lungs and travel to alveoli after someone coughs, sneezes, speaks, sings, or laughs
- Can be suspended in air for minutes to hours
- Requires close, frequent, or prolonged exposure
- NOT spread by touching, sharing food utensils, kissing, or other physical contact

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25
What happens after TB particles are inhaled?
Droplets lodge in bronchioles and alveoli (infection stops) Local inflammatory reaction occurs Ghon lesion forms (calcified TB granuloma *hallmark) Only 5-10% develop active TB When infection is latent, infection is walled off and further spread is stopped
26
Isolation precautions for pts with TB
Airborne isolation: - Private room with negative pressure - airflow exchanges every hour Healthcare workers fit tested for model of: - HEPA mask, N-95, or respirator Teach pt to prevent spread (covering mouth, hand washing) Pt wears surgical mask if transported outside of room Considered infections for first 2-3 weeks after starting tx
27
1st line drugs used to treat TB
Isoniazid Rifampin Pyrazinamide Ethambutol
28
Side effects of Isoniazid (INH)
Causes B6 to drop, need vitamin B6 supplement Can cause hepatitis, monitor liver function (avoid alcohol, meds that affect liver function)
29
Side effects of Rifampin
Causes red-orange body fluids Can cause hepatitis, monitor liver function (avoid alcohol, meds that affect liver function)
30
Side effects of Pyrazinamide (PZA)
Sun burn Can cause elevated uric acid - swollen, painful joints Can cause hepatitis, monitor liver function (avoid alcohol, meds that affect liver function)
31
Side effects of Ethambutal (EMB)
Can cause eye/vision problems Can cause elevated uric acid - swollen, painful joints
32
How long does drug therapy last for TB?
Treatment aggressive and has 2 phases Initial 8 weeks Followed 18 weeks of tx For a total of 6-12 month treatment
33
Why is noncompliance with TB drug therapy such a big issue?
Multi drug resistance Tx failure (Govt funded program to assure compliance)
34
S/S of lung cancer
Persistent cough (not responsive to PNA tx) Blood-tinged sputum Dyspnea Wheezing Chest pain Late: Fatigue, weight loss, N/V Dysphagia Superior vena cava syndrome
35
Differences between small cell and non-small cell lung cancers
Small: aggressive, always systemic/metastasis (20%) Non-small: squamous cell, adenocarcinoma, large cell Slower growing, uses TNM staging (80%)
36
Treatments for small cell lung cancer
Chemotherapy Prophylactic cranial radiation
37
Treatment for non-small cell lung cancer
Surgery (tumor, lobectomy, pneumonecomy) Radiation Chemotherapy Immunotherapy Targeted therapy
38
Diagnostic tests for urine to detect urinary health conditions
Serum BUN & creatinine Urinalysis (specific gravity) Culture & sensitivity Clearance studies
39
Normal SG of urine
1.005-1.030
40
Normal pH of urine
4.6-8
41
Normal Protein amount in urine
0-8 mg/dL
42
Normal amt of WBC in urine
0-4
43
Normal amt of RBC in urine
0-2
44
Urinalysis should be negative for:
Glucose Ketones Bilirubin Casts Crystals Nitrates (released by bacteria) Leukocyte esterase
45
Diagnostic procedures for bladder that require IV contrast dye
Intravenous urography Cystogram Renal scan Angiography/arteriogram
46
What is a Cystogram?
Contrast used to view bladder via scope and cath
47
Nursing considerations for cystoscopy
Surgical consent needed Pt will be NPO Can be done as out pt *Expect pt to have pink urine, but should have no frank bleeding or clots
48
What is cystoscopy used for?
Used for diagnosis and tx of stones, tumors, large prostate
49
How is an angiography/arteriogram done?
Contrast used to visualize renal arteries: used in combo with other diagnostic/treatment procedures
50
Nursing considerations for a pt having a renal biopsy Greatest risk from the procedure
Procedure performed percutaneous lay Pt will be NPO prior Check coagulation studies Prone position *Greatest risk is bleeding post procedure (*Need to monitor urine for bleeding, monitor for increased HR or decreased BP)
51
S/S of a typical UTI
Frequency *Dysuria Urgency (Pain upon urination)
52
S/S of complicated cystitis (UTI)
*Fever/chills *N/V *Malaise *Flank pain *CVA tenderness (upper uti) *Urine with sediment, blood, odor
53
What would make a UTI considered complicated?
Any male with a UTI If UTI turns to upper UTI
54
Pt teaching for cystitis (UTI)
Alteration in urinary elimination pattern: - force fluids - avoid soy, tomato, spicy food Pain - warm sitz bath Knowledge deficit r/t hygiene - cleanse front to back - avoid irritating substances - avoid tight fitting clothing
55
UTI drugs
*Antimicrobials: - sulfonamides (Bactrim) - Fluoroquinolones (Ciprofloxacin) Urinary *antiseptics: - Macrodantin Bladder *analgesics: - pyridium *Antispasmodics: - Ditropan - Urogesic blue
56
Reasons pt would have a catheter
Hematuria (monitoring for) Obstruction Urologic surgery Decubitus ulcer (incontinent/immobile) Intake and output (strict measurements) No code / comfort care Immobility / physical constraints
57
What is pyelonephritis?
Infection of the renal parenchyma and collecting system
58
Emergency renal disorder
Hydronephrosis
59
What is hydronephrosis?
Dilation of kidney due to obstruction causing hydroureter / reflux
60
What is a hydroureter?
Dilation or ureter due to obstruction, causing urethral stricture
61
Major concern for hydronephrosis
Renal failure
62
Symptoms of hydronephrosis
Pain No urine in bladder
63
Risk factors for bladder cancer
#1 = tobacco use Exposure to toxins
64
Pharmacologic treatment of bladder cancer
Prophylactic immunotherapy with BCG Multi-agent chemotherapy, radiation therapy
65
Clinical manifestations of PKD
Pain Nocturia Enlarged kidneys Enlarged abdomen Infections HTN Hematuria Constipation
66
Patient teaching for CKD
Is inherited so 1/2 of offspring will have PKD Pt is at high risk for injury/trauma Teach pt knowledge about disease Help pt and family with coping Do not need dialysis until stage 5
67
Risk factors for renal calculi
Stasis of urine Trauma to urinary lining Offensive metabolic disease (chronic) - gout, Hypercalcemia Not normal pH Excess solute concentration Dehydration Family history Obesity Diabetes Diet
68
What are kidney stones called?
Nephrolithiasis
69
What are stones in ureters called?
Ureterolithiasis
70
Complications of kidney stones
Urinary tract obstruction = Emergency and must be treated to preserve kidney function
71
Pt teaching for urolithiasis
Hydration: - about 3L/day for ambulatory pt. - goal = UOP 2L/day Mobility Nutrition: - calcium stones = decrease sodium - uric acid stones = decrease purine/organ meats, poultry, fish
72
Nursing actions for urolithiasis
*Strain all urine Pt will have acute pain when stone is moving Pt may have altered nutrition Pt is at high risk for infection Teach pt about prevention and follow up care Help pt manage pain with drug therapy, *lithotripsy
73
What is lithotripsy?
Treatment for urolithiasis that uses shockwaves to break up renal calculi Pt is placed under spinal or general anesthesia *Need to monitor pt for bruising, which is common
74
What is a nephrostomy tube?
Tube placed in pelvis of kidney temporarily for ureteral obstruction
75
Nursing management of nephrostomy tubes
*Irrigate with less than 5 mL (*sterile procedure, need order) *Keep bag below kidney *Do not clamp Check for urine flow and make sure *no tubing kinks
76
S/S of BPH
Urinary retention Overflow urinary incontinence Possible sexual dysfunction Nocturia Frequency Hesitancy Intermittence Dribbling Sensation of incomplete emptying Diminished force and caliber of stream
77
What does a prostate feel like in a pt with BPH?
Uniform Elastic Nontender Enlarged
78
Management of BPH
Watchful waiting (teach pt how to avoid over-distended bladder) Pharmacologic management to slow hyperplasia Thermotherapy Lasers Surgical management
79
Types of drugs used for BPH
5-alpha-reductase inhibitors Alpha1-adrenergic antagonist ED drugs: PDE-5 inhibitors
80
Examples of 5-alpha-reductase inhibitors for BPH
Finasteride (Proscar) Dutasteride (Avodart)
81
Function of 5-alpha-reductase inhibitors
Shrinks prostate gland to improve urinary flow
82
Example of alpha1-adrenergic antagonists for BPH
Tamsulosin (Flomax)
83
Function of Tamsulosin (flomax) for BPH
Relaxes bladder neck muscles and smooth muscle fibers of prostate, making it easier to urinate
84
ED drugs (PDE-5 inhibitors) examples for BPH
Sildenafil (Viagra) Tadalafil (Cialis)
85
Function of viagra and cialis
Relax smooth muscle, vasodilation
86
Pt teaching for pts taking viagra and cialis
Avoid alcohol and high fat meals *hypotension after taking - *cannot take nitro or related drugs!
87
Indications for BPH surgery
Acute urinary retention Chronic UTIs secondary to residual urine Hematuria Hydronephrosis Bladder neck obstruction
88
Minimally invasive therapy for BPH
Thermotherapy: - Transurethral needle ablation - Transurethral microwave therapy - Transurethral vaporization of the prostate Lasers - cut, cauterize, vaporize - photoselective vaporization of prostate (PVP) Less risk b/c IV anesthesia (no general or regional) and blood loss is minimal
89
Gold standard prostate therapy
TURP (Transurethral resection of the prostate) Chip away at prostate through urethra
90
Preoperative pt teaching for BPH surgery (TURP)
- Possibility of indwelling 3-way catheter with continuous bladder irrigation for about 24 hrs (CBI) - Some hematuria and clots are normal initially - Verify meds that have anticoagulant effects have been stopped
91
Nursing actions for a pt who had TURP
Monitor catheter for patency and hematuria - *Keep free of clots - *Assess for bladder spasms (treat with meds) - If catheter becomes obstructed: - Turn off CBI - Irrigate catheter w/ 30-50mL NS - large piston syringe - Notify MD immediately if obstruction not resolved - Monitor for S/S of infection (cloudy urine, fever) - Prevent complications of immobility - Pain management
92
Nursing actions involving CBI
Irrigation and urine will be draining out, need to chart it, empty it, etc. If put in 2,000 mL irritant and 3,000 mL comes out, pee = 1,000 mL If less than amt put in comes out = problem
93
S/S of prostate cancer
Burning or pain with urination Inability to urinate (acute urinary retention) or difficulty starting to urinate Frequent or urgent need to urinate Trouble emptying bladder completely *Gross, painless hematuria *Continual pain in lower back, pelvis, hips, or thighs = metastases
94
Diagnostics for prostate cancer
PSA test and DRE for pts age 50 at average risk Biopsy if: - PSA levels are continually elevated or abnormal DRE - to confirm diagnosis
95
How is a biopsy for prostate cancer performed?
Transrectal ultrasound procedure (TRUS) Using MRI with US = newer technique CT scans and bone scans for metastasis
96
Hormone therapy used to treat prostate cancer
Androgen synthesis inhibitors
97
Androgen synthesis inhibitor used for prostate cancer
Leuprolide acetate (Lupron)
98
Function of Leuprolide acetate (Lupron)
For advanced prostate cancer - Suppresses release of LH, FSH, & reduces testosterone levels
99
Side effects of leuprolide acetate (Lupron)
CAD HLD Osteoporosis Hot flashes Decreased libido ED
100
Androgen receptor blocker used for prostate cancer
Flutamide (Eulexin) For metastatic prostate cancer
101
Function of Flutamide (Eulexin)
Prevent testosterone & DHT from binding to receptors at tumor sites
102
Side effects of flutamide (Eulexin)
CAD HLD Osteoporosis Gynecomastia Hot flashes Loss of libido (Rarely - fatal liver toxicity)
103
Pharmacologic therapy for ED
PDE-5 inhibitors - Sildenafil (Viagra) - Tadalafil (Cialis)
104
Side effects of PDE5 inhibitors
Headaches Leg/back pain Dyspepsia Flushing Nasal congestion Rare: blurred or blue-green vision, sudden hearing loss, priapism (seek immediate medical attention)
105
Function of PDE-5 inhibitors
Smooth muscle relaxation and vasodilation
106
What meds should pt avoid while taking PDE-5 inhibitors?
Vasodilators, nitrates, alpha-adrenergic blockers (for at least 24-48 hrs, depending on which drug was taken)

Med Surg (12 decks)

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