Exam1 Flashcards
Conflict is not always __[1]__, and you should not always___[2]___ the source of the conflict.
Don’t Behave; Instead __[3]__.
1-Bad
2-Confront
3-React
What is the DESC script and what is it’s purpose?
DESC script is a tool to help resolve/manage conflict “you” have with another.
D-Describe the situation
E-Express your concerns
S-Suggest alternatives
C-Consequences; state them
What is the LEEN script and what is it’s purpose?
LEEN script help resolve conflict “someone else” has with you.
L-Listen
E-Empathize “That’s understandable”
E-Explain “The reason I did _____ is b/c…”
N-Negotiate “Lets agree on ______”
—Kurt Lewin’s Change Theory—
Change should always be __[1]__.
All change should be __[2]__, and not __[3]__.
All those to be affected should be __[4]__.
1-Gradual
2-Planned
3-Sudden/Sporadic
4-Involved
Define the 3 stages of change…
Unfreezing?
Moving?
Refreezing?
Unfreezing: desiring/planning to change.
Moving: Implementing the change
Refreezing: Change is accepted and stabilized
What is ADPIE and what does it stand for?
It's an acronym to describe the nursing process. A-Assess D-Diagnose P-Plan I-Implement E-Evaluate
The major difference between Problem solving and Decision Making is….?
With problem solving, there is ALWAYS and problem to address.
Exploring, analyzing, prioritizing, explaining, deciding, and evaluating are all concepts involving what?
Tools for critical thinking.
S/S of TB
10
afternoon fever, night sweats, chills productive cough (3+weeks) may be streaked with blood nausea, anorexia, anorexia,lethargy, irregular menses SOB, pleuritic chest pain
Describe Latent TB
Pt. has been exposed to and infected with TB.
Immune system (Active T’s and macrophages) have encapsulated TB bacteria in a granuloma
TB cannot multiply, but it is viable inside granuloma.
+ ppd, -ve CXR, -ve sputum/smear
not contagious
Tx for LTBI
isoniazid for 9 months
What is Quantiferron Gold Test?
Blood test for TB - will get results in 24 hours
What is DOT?
Why done?
direct observational therapy-watching someone take their meds,
It ensures compliance,
outpatient basis - may be only way to reach homeless population
Cons of DOT
Cost
manpower - 1 nurse to 1 pt.
List 4 drugs to Tx active TB & for how long?
Route?
isoniazid (INH), pyrazinamide (PZA), rifampin, ethambutal for 9-18 months PO
Rifampin used to Tx (a) ?
side effects? (b)
a. active TB or latent TB resistant to INH
b. NAUSEA
hepatotoxicity - hepatitis
skin, sweat, tears, urine orange
decreases contraceptive effects
thrombocytopenia
Isoniazid used to Tx (a) ?
side effects? (b)
active TB (in combination with 3 other drugs) or latent TB
b. NAUSEA
hepatotoxicity - hepatitis
NO alcohol
2nd line drugs to Tx TB?
Streptomycin
fluoroquinolones
Ethambutol used to Tx (a) ?
side effects? (b)
active TB (in combination with 3 other drugs)
NAUSEA
ocular toxicity & red/green color disturbances
(Less toxic to liver than other TB Tx)
pyrazinamide (PZA), used to Tx (a) ?
side effects? (b)
active TB (in combination with 3 other drugs)
NAUSEA
hepatotoxicity - hepatitis
reason TB still exists
noncompliance with meds
Tx for resistant strands of TB
newer rifamycins, rifabutin, and rifapentine
Dx for pt with TB symptoms
Place PPD
CXR
Sputum sample for culture x 3 & AFB test x 3, QFT,
can a CXR Dx TB?
No - only support Dx - definitive is +ve Sputum sample x 3 & AFB test x 3
If Pt. has had a + PPD in past can you place another?
NO! - do CXR
Diet for TB pts
High Protein & High VIT B & C
Nursing support for TB
Diet, airborne precautions, IV fluids- if dehydrated
Risk Populations for contracting TB
immunocompromised - HIV, Young, elderly
low socioeconomic status - access/affordability
living in close proximity - long term care
define anergy
cannot mount an immune response to an Ag. Often seen in elderly with weak/deteriorating immune systems
How is TB spread
airbourne - droplet nuclei
typically within 6” of infected persons mouth to transmit
travels further if Cough, laugh, sneeze, sing, speak.travels in body via lymphatics
lobes of lungs most affected by TB and why?
upper - more oxygen, M. tuberculosis is aerobic
What is secondary TB?
If had TB more likely to get it again (Possibly reactivation of encapsulated bacteria)
When is a PPD read?
(24 - silvestri) 48 - 72 hours
How many -ve sputum samples are required to say a pt. with TB is no longer infectious?
3 consecutive
ND for TB
ineffective breathing pattern nutrition - insufficient to meet needs fatigue knowledge deficit non-compliance social isolation
Pt. Teaching for TB
Medication compliance! Side effects of meds dipose of tissues in plastic bag wash hands airborne precautions (wear mask when out of isolation diet - protein, vit B & C
List the 5 components of the ventilator bundle
wash hands & no rings for patient care HOB elevated >30 degrees remove subglottic secretions (suction) Oral care Q12H w/ chlorhexidine Chlorhexidine mouth wash B4 intubation
Is it acceptable to implement 3/5 steps in a bundle?
NO! - bundles are all or nothing
What is ventilator bundle designed to reduce?
VAP which has up to a 40% mortality rate
Which has greater incidence of infection peripheral IV or central line? & why? (2 reasons)
CL
pt. with CL tend to be sicker and thus more susceptible to infection
A CL tends to be accessed more frequently
List the 5 components of the central line bundle
hand hygiene dress for success scrub the right way choose the best target clean claves well
CL insertion - what is meant by dress for success?
Hand hygiene 1st
hat
mask
sterile gown & gloves
What is used to scrub CL ?
Chlorahexidine gluconate 30 sec + air dry
choose the best target to insert CL & why?
SUBCLAVIAN non -tunneled
internal jugular = higher incidence of infection
femoral = risk DVT
Is it best to use a multi-lumen CL or single lumen & why?
Single Lumen.
Multi- lumen CL increase infection risk 3.4 x
2 conditions associated with VAP
acute respiratory distress syndrome
acute lung injury
Surgical safety checklist is performed at 3 points list them:
B4 anesthesia
B4 skin incision
B4 leaving OR
What is a “bundle”
3-5 EBP solutions designed by the CDC to solve to persistent safety problems.
Clean claves well - how?
scrub top and sides with an alcohol wipe
S/S of Lupus (SLE)
butterfly rash on nose, endocarditis, arthritis, glomerulonephritis, anemia, osteonecrosis, musc atrophy, fever and fatigue, may have reynauds due to lack of blood flow to extremeties, serositis-inflammation of stomach lining, decreased immune sys d/t disease and tx of disease, eventually neuro problems and seizures d/t dec 02 to brain
who is most likely to get lupus?
Usually AA women in child bearing years (20-40yrs)
What is Lupus (SLE)?
Autoimmune Disease; DNA attacks nucleus of their own DNA, chronic progressive, inflammatory connective tissue disorder that can cause major body organs and systems to fail, has spontaneous remissions and exacerbation’s due to stressors, autoimmune complexes block vessels and tend to be attracted to glomeruli of kidneys
Can those with Lupus get pregnant?
Yes; but not recommended unless
<10mg of steroids/day is used and Lupus has been stable for over a year
-Cytotoxic drugs have been stopped for over 6 months
-immune complexes can block bloodflow to baby, postpardum period is very stressful and can cause exacerbation
Labs/Diagnostics for Lupus?
- ANA-antinuclear antibody-shows body is in autoimmune process
- Elevated ESR- shows inflam, elevated
- CRP-inflam in body,
- CBC- inc WBC
- Anti DNA is more specific for lupus
- AND must be symptomatic, need 4 of 11 criteria
What is type 4 hypersensitivity?
Delayed hypersensitivity
- ex. Ppd, delayed poisen ivy reaction, insect stings, TISSUE Transplant rejection
- Cell Mediated T-Cells
What is type 3 Hypersensitivity?
Immune complex form in blood and get stuck in small vessels such as joints
- ex. Lupus, RA
- Humoral B-cells
What is type 2 Hypersensitivity?
Cytotoxic
- ex: hemolytic transfusion reaction-the body is being introduced to antibodies that are unlike our own. Can do additional screening, can add filter to blood, and can give meds like benadryl or steroids to reduce response.
- ex: Good pasture, graves.
- Humoral B-cells
What is type 1 Hypersensitivity?
- IgE mediated reaction occurs where there is exposure to antigen, most serious type-can cause anaphalaxis.
- Histamine is released, causes capillaries to leak, causing excess mucus production, mucosal edema, nasal drip, bronchoconstriction, wheezing, can be inhearited.
ex: allergies, poisen ivy, asthma. can be inhaled, injested, or injected - Humoral B-cells
What is TNM?
Tumor: size or direct extent of the primary tumor
Node: degree of spread to regional lymph nodes
Metastasis: presence of distant metastasis
What is the current survival rate of those with lung cancer?
What is the most common type of lung cancer?
- 14% in 5 years and care is typically palliative
- Non-Small cell Lung Cancer NSCLC
What are the diagnostics for Lung cancer?
- CXR; Most ID’d here
- CT Scan; ID’s lesions more clearly
- Fiberoptic Bronchoscopy; Allows Direct visualization of the trachea-bronchial. Specimen can be obtained during procedure
- Thoracoscopy & VAT(Video assisted Thoracoscopy); ID’s Meatstasis
S&S of Lung cancer?
Hoarseness or changing voice Chest pain Cough that doesn't go away Coughing up blood Fatigue Losing weight without trying Loss of appetite Shortness of breath/change in pattern Wheezing
What are the different chest tube chambers (1-3) purpose?
➢Chamber 1: collects the fluid draining from the patient
➢Chamber 2: water seal that prevents air from entering the patient’s pleural space
➢Chamber 3: suction control of the system
•If you knock it over and it spills into other chambers… Change the system
At what point should you notify the Dr. regarding chest tube drainage?
•IF >75-100mls/hr; Notify Dr.
What is the max amount of fluid that should be removed during a Thoracentesis?
•Usually only 1000-1200mLs
What is a Pleurodesis?
- Talc powder that Seals a Plural effusion
* Used to instill Chemo
A Reduction in either the number of red blood cells, the amount of hemoglobin, or the hematocrit is known as?
Anemia
This common type of anemia that can result from blood loss, poor intestinal absorption, or inadequate diet. In Children it’s caused by impaired absorption, increased growth demands, and poor eating patterns. In pregnant women it is depleted due to fetus demands
Iron deficiency anemia
This type of anemia is caused by Poor intake, small bowel resection, tapeworm, and overgrowth of intestinal bacteria. S&S include: Confusion/change in LOC in severe cases Depression Loss of balance Numbness and tingling of hands and feet Diarrhea or constipation Fatigue, lack of energy Loss of appetite Pale skin Problems concentrating Shortness of breath, mostly during exercise Swollen, red tongue or bleeding gums
Vitamin B12 deficiency anemia
Lack of intrinsic Factor leads to this form of anemia.
Pernicious Anemia
This deficiency anemia is similar to VitB12 deficiency but with out the nervous system S&S and is usually caused by Poor nutrition, Malabsorption, or drugs.
Folic Acid anemia
Required for RBC formation and maturation
Dosage is 1-5mg/day (2mg/day for pregnant women)
With this type of anemia Pancytopenia is common b/c this anemia is the results from the failure of bone marrow to make RBC’s.
Aplastic anemia Treatment can include: Blood transfusions Immunosuppressive therapy Splenectomy.
This disease is b/c of a defect in the hemoglobin S cell causing it to become misshapen.
•These cells can clump and occlude small vessels
•Repeated Blockages over time can cause damage to spleen, heart, kidney, brain, bones, and retina.
Sickle Cell Disease
Things that can trigger a Sickle Cell Crisis?
•Stress, Rapid Temp change, Trauma, Exercise
These are all S&S of what disease? ➢Tachycardia ➢Dyspnea at rest ➢Jaundice ➢Blurred Vision ➢Headache ➢Irritability ➢Depression ➢Sensitivity to cold/ Renaud’s Disease ➢Weight Loss ➢Lethargy ➢Bone Pain
Sickle Cell Disease.
What are the Laboratory assessments for Sickle Cell?
➢Review all meds in past 24hrs ➢Hemoglobin S (HbS) ➢Number of RBCs with permanent sickling ➢Hemaglobin/Hemocrit decreased ➢Total bilirubin increased ➢Total white blood cells ➢Children/New born- Definitive test for SC or the trait is hemoglobin electrophoresis using cord blood. ➢Sickle Cell Turbidity test (Sickledex) quick screening for children over 6 months
What is the “Cancer” Drug used for those that qualify who have Sickle cell disease? What does it do? And why would someone not qualify?
Hydroxurea
•Stimulate sFetalhemaglobin , Decreases reactive neutrophil count, increases erythrocyte volume/hydration, Decreases adhesion of sickle cells to endothelium.
Those w/already decreased WBC lvl
What are the Non-Drug interventions for Sickle Cell?
•Hematopoetic Stem cell Transplantaion •Hydration •Oxygen therapy •Transfusion therapy (Used cautiously to avoid Iron overload)
What are the Drug-related interventions for Sickle Cell?
•Hydroxyurea •Percocet •Oxycontin •Penecillin •Folic Acid •In the Acute setting: ➢Dilaudid ➢Morphine ➢Toradol
This is the most common Sickle cell manifestation seen in Children. Where does it mostly take place?
-Vaso-occlusive Cris-
-In Joints; mainly Hands/Feet
(Can cause Hypoxia)
This is a cancer that results in the over production of RBC’s. What is the major cause of death in these Pt’s?
-Polycythemia Vera
Also produces excessive leukocytes/platelets
-Stroke
What is the treatment for Polycythemia Vera?
- Phlebotomy; RBC removal (2-5/week)
- Hydration; I&O
- anticoagulants
This cancer is at type of cancer with uncontrolled production of immature white blood cells/Blast Cells in the bone marrow.
-Leukemia
-Acute myelogenous Leukemia:
is cancer of the myeloid celss that produce RBC’s/WBC’s/Platelets
What is the definitive test for leukemia? Where is it performed?
- Bone marrow Biopsy/aspiration
- Taken from ilac crest/sternum
What is the major cause of death in those with leukemia?
Infection (Usually on Neutropenic Precautions)
Contamination from yourself/Normal Flora?
Contamination from others/environment?
- Autocontamination
- Cross-contamination
What is the purpose of the Induction, Consolidation, Maintenance steps in drug therapy for those w/Leukemia?
-Induction therapy
•Goal is to put Pt in remission immediately
•Highest dosage is used that the Pt can tolerate
•If working improvement in 2-3 weeks
-Consolidation therapy
•Started after remission is achieved
•Goal is to cure the disease
•May be some of the same Rx used during induction just different dosages
-Maintenance
•Treated w/lower doses of the same drugs used during induction for a long period of time
What is GVHD? And how do you know when it’s “not” working?
- Graft versus host disease
- Rash, Peeling of palms, Fatigued, Pt Feels sick/as though nothing has changed
What do neutropenic precautions incude?
•No fresh uncooked foods
•Strict Handwashing
•No vistors sick/under 16
•No live plants/fresh flowers
•No stagnant water
•Stool softeners to prevent straining
•no rectal temps
•always suspect sepsis w/fever; emergency
•monitor wound drainsites
(May not be puss b/c not enough WBC’s)
•Monitor WBC count
(@20,000 Pt is considered septic)This Cancer starts in a single lymph node or a single chain of lymph nodes? (usually Cervical)
Who does it usually affect?
- Hodgkins Lymphoma
- Affects any age group; peaks in Male teens/young adults 15-35, and adults between 50-60 yrs old
This is a bleeding disorder caused by a congenital X-factor deficiency of clotting factor 8 or 9.
How is it treated?
Who does it usually affect?
- Hemophilia
- Prophylactic doses of Factor 8 or 9
- Seen in Children; Primarily Males
Interventions for anaphylactic shock?
➢ABC’s Patent airway
➢Admin high-flow O2
➢Establish IV (18ga)
➢Remove insect stinger if present
➢Epinephrine SubQ/IM
•1st vasoconstricts THEN Vasodialates
•Causes Bronchodialation
➢Nebulized albuterol
➢Benedryl IM/IV
➢IV Corticosteroids
•Stabilizes cap walls; fluid shifts out of the vascular space.
➢If hypotensive; Recumbent, elevate legs, Dopamine, volume expanderswhat is Raynaud’s phenomenon?
Vasoconstriction of the periphery associated with Lupus; Immuno-complexes accumulate in periphery causing vasoconstriction
(Same accumulation can occur anywhere like in the brain causing siezures)
This is an Inflammation of serous body tissues like lung heart and the peritoneal abdomen.
Serositis
How is Lupus diagnosed? What tests help diagnose it?
-Diagnosed via elimination.
-Skin biopsy (for Cutaneous only)
-ANA (Antinuclear antibody) elevated
•Measures antibodies in the blood; indicative of autoimmune
-ESR (erythrocyte sedimentation rate) elevated
-C-reactive Protein
•Abnormal protein that binds to dead/dying cells; marks inflammation
What are the Drugs used to treat Lupus?
-Tylenol/NSAIDS (1st Choice)
➢steroid therapy
➢Immunosuppressive agents
•Ex: Methotrexate, Cytoxan, Imuran
➢Anti-Malaria
•Ex: Plaquanil
➢If it progresses to Lupus Nephritis:
•Cellcept; New drug/less toxicWhat differentiates benign lumps in the breasts from Breast cancer?
Cancer is usually non-mobile, non-tender/ irregularly shaped.
(Can metastasize; Usually to bone, lungs, brain, & Liver.
This type of cancer is the most malignant form of breast cancer and has a stippling/porous appearance b/c cancer cells are blocking lymph channels
Inflammatory BC
skin has Peau d’orange appearance
Early breast cancer detection relys on a “3 Pronged Approach” What does this entail?
-Mammography; 1/yr beginning 40yrs old; 1/3yrs 20-30 yrs old
-Breast self examination; Clock, Wedge, Circular methods
Clinical Breast exam; if you have Hx: Have mother/sister/daughter with it; Risk doubles.
Drugs used for breast cancer?
•Tamoxifen: Blocks estrogen receptors
•On it for 5yrs
•Decrease of visual acuity
•Monitor 4 DVT, stroke, Pulmonary embolism
•Fareston: anti-estrogen agent
•Evista:
Used 4 bone loss; reduces risk for Breast cancer
Tools for critical thinking?
- E
- A
- P
- E
- D
- E
Exploring analyzing prioritizing explaining deciding evaluating
