FINAL Flashcards
Risk factors for impaired thermoregulation
age (elderly or really young)
obesity
cognitive impairment
working environments
first thing to do if someone is suffering from hypo/hyperthermia
get them out of that cold or hot environment immediately
what to do for a patient suffering from hyperthermia in order
- remove clothes
- mist them with water
3 fans
How to treat frostbite
warm blankets warm IV fluids warm humidified oxygen DO NOT RUB Loosley dress with sterile dry gauze and separate fingers
The patient is suffering from: projectile vomiting decreased LOC headache confusion has unequal pupils
what do you suspect?
Increased intracranial pressure
Components of the glasgow coma scale
eye response
motor response
verbal response
risk factors for CAD
Increased LDL Low HDL smoking HTN Obesity sedentary lifestyle excessive alcohol age genetics
Pt presents with decreased urine output Fluid volume overload HTN hyperkalemia what do you suspect?
renal disease
S/S of renal disease
decreased urine output
fluid volume overload
HTN
hyperkalemia
S/S of increased intracranial pressure
projectile vomiting irritability decreased LOC headache confusion unequal pupils
Dietary considerations for RENAL FAILUREpatients
restrict potassium foods
Phos needs to be restricted but they usually get pills for that
Can a patient with CAD have orange juice or potato chips?
NO
Diarrhea
abd pain
bloody stool are all S/S of what?
Crohn disease, ulcerative colitis, and diverticulitis
If a pt with crohn’s disease, ulcerative colitis, and diverticulitis have diarrhea, abd pain, and/or bloody stools should they still call the doc?
YES
What kind of diet should a patient with diverticulosis be on?
high fiber to prevent diverticulitis
What kind of diet should a patient with diverticulitis be on?
low fiber
A patient with Crohn’s, ulcerative colitis, or diverticulitis should decrease what during flare ups?
fiber
Dehydration peritonitis anemia sepsis electrolyte imbalance malnutrition and ruptured bowel are all complications of what?
crohn’s, ulcerative colitis, and diverticulitis
patient has a ridgid or board like abdomen what do you suspect?
peritonitis
patient has fatigue, weakness, dry mucous membranes, dehydration, orthostatic hypotension, and presents to the ER with ShOB what do you suspect?
anemia
S/S of anemia
weakness fatigue dry mucous membranes dehydration orthostatic hypotension pale skin always cold
S/S of sepsis
changes in LOC
fever
vital sign changes (BP drops)
decreased urine output
What can trigger sickle cell crisis
strenuous exercise infection surgery smoking drugs dehydration anything that increases need for oxygen
treatment and interventions for sickle cell crisis
teach light exercise: walking or yoga ensure they drink plenty of water esp before exercise warm compresses never cold admin oxygen pain management
If a sickle cell pt is in labor what should you have ready??
oxygen and IV fluids
S/S of leukemia
bleeding
infection
anemia
effects all blood cells
Interventions for leukemia
neutropenic precautions
teach pt and family no fresh flowers, fruits, veggies, no deli meats
stay away from sick people
avoid large crowds
no rectal temps, soft toothbrush or washcloth, fall precautions, use an electric razor, no safety razor, no flossing
premedicate with antibiotic to go to dentist
S/S of cirrhosis
clay colored stools
decreased LOC
jaundice
RUQ pain
complications from Cirrhosis
esophageal varices
clotting defects
encephalopathy
ascites
S/S of Hep B
fatuige
nausea
vomiting
can be asymptomatic
Can someone with an active hep infection receive the Hep B vaccine
NO
Why would someone need to take lactulose?
Cirrhosis and/or high ammonia level
side effects of lactulose?
dehydration
low potassium
Desired effect of lactulose?
bowel movement
Nursing considerations for lasix
strict I&O daily weights check potassium give in morning check BP do not give if low increase potassium in the diet
Side effects of lasix
blurred vision dizziness polyuria hypotension FVD hypokalemia
If a pt’s apical pulse is less than 60 should you give the patient their digoxin?
NO
sign of digoxin toxicity
halos around lights
When does a pregnant woman get rhogam?
when she is Rh neg at 28 wks and after birth
after anything that could have meant contact with Rh positive blood
sign of carbon monoxide poisoning
cherry red mucous membranes
priority for burn patients, what to monitor for?
airway!
Monitor for wheezing, stridor, black around mouth or nose
How many times should a patient use an incentive spirometer in an hour
10
WBC count
5,000-10,000
Hgb
M: 14-18
F: 12-16
Plt count
150,000-400,000
Normal potassium levels
3.5-5.3
S/s of hyperkalemia
bradycardia or other arrhythmias nausea intestinal cramping diarrhea anxiety muscle weakness numbness or prickly sensations flaccid paralysis
S/S of hypokalemia
Weak, rapid irregular pulse low BP anorexia nausea vomiting decreased DTR fatigue muscular weak cramps numbness abd distention peristalsis ileus
Sodium levels
135-145
artichoke avocados bananas cantaloupe cassava dried fruits grapefruit honey dew jack fruit kiwi kohlrabi lima beans mango meats milk dried peas and beans nuts oranges/orange juice papaya peaches pears plantains pomegranate potatoes (white and sweet) prunes/prune juice pumpkin rhubarb salt substitute spinach sunflower seeds Swiss chard tomatoes/tomato juice vegetable juice winter squash
potassium rich foods
potassium-rich foods
artichoke avocados bananas cantaloupe cassava dried fruits grapefruit honey dew jack fruit kiwi kohlrabi lima beans mango meats milk dried peas and beans nuts oranges/orange juice papaya peaches pears plantains pomegranate potatoes (white and sweet) prunes/prune juice pumpkin rhubarb salt substitute spinach sunflower seeds Swiss chard tomatoes/tomato juice vegetable juice winter squash
Order to don PPE
handwashing gown mask eyewear hair cover shoe cover gloves
when taking off PPE
remove gloves gown eye wear mask hair covering shoe covering handwashing
warfarin antidote
vitamin K
heparin antidote
protamine sulfate
what to do to prevent an air embolism?
when starting an IV tell them to hold their breath and be still
Common abuse in older adults and children
malnutrition
Tylenol antidote
acetelysine
medications containing tylenol
Lortab, Percocet, hydrocodone, Vicodin
what labs to watch for someone taking tylenol
blood sugar
liver enzymes
what can you not have when taking xanax?
grape fruit juice
when should you give xanax?
at bed time
how long should you take xanax?
it is for short term use
how should you adjust xanax?
half a dose in the morning and half a dose at night
angina that occurs with moderate exertion in a pattern that is familiar to the patient. pain is predictable and lasts only a few minutes. can usually be relieved by resting and nitro
stable angina
angina that increases unpredictably in frequency or that occurs with less exertion, at rest, or during sleep. not relieved by rest or medication.
unstable angina
what kind of angina is more likely to lead to a heart attack?
unstable angina
who shouldn’t be taking aspirin?
those under 18
anyone with asthma
what kinds of foods should be avoided when taking aspirin?
foods that acidify urine
foods that acidify urine
cheeses corn cranberries eggs fish grains (breads and cereals) lentils meats nuts (Brazil, filberts, walnuts) pasta plums poultry prunes rice
what kinds of foods are these
cheeses corn cranberries eggs fish grains (breads and cereals) lentils meats nuts (Brazil, filberts, walnuts) pasta plums poultry prunes rice
foods that acidify urine
patient presents with lack of energy flat affect appear depressed loss of interest in hobbies
avolition
what kinds of patients might present with avolition?
older clients
patients with terminal illness’
schizophrenic
behavioral health patients
barriers to healthcare
language
economics
geography
who should not be taking benedryl
children under 4
mothers who are breastfeeding
those with acute angle glaucoma
Who is at risk for Wernicke’s encephalopathy?
alcoholics
What does an alcoholic’s diet need to be high in to prevent Wernicke’s encephalopathy
Thiamine
high thiamine foods
cereal (whole grain and enriched)
meats (esp pork)
fresh veggies (loss is variable during cooking)
should an alcoholics’ thiamine levels be checked if they look healthy?
yes
What is a red tipped thermometer used for?
rectal use
how long after eating, drinking, or smoking should you check a patients temp?
30 mins
What can cause a stroke?
lack of oxygen to the brain due to ischemia due or a brain hemorrhage
a lack of oxygen to the brain due to ischemia due or a brain hemorrhage can cause a what?
stroke
FAST for a stroke
Facial features
arm weakness
Speech
Time to call 911
patient presents with
weakness, change in facial features, speech, paralysis, dizziness, trouble walking, severe headache with no known cause, lack of balance and coordination, sudden confusion, sudden trouble seeing in one eye or both
What do you suspect?
stroke
S/S of a stroke
weakness, change in facial features, speech, paralysis, dizziness, trouble walking, severe headache with no known cause, lack of balance and coordination, sudden confusion, sudden trouble seeing in one eye or both
if the stroke is on the stoke is on the left side of the brain then what side is affected
right side
if the stroke is on the right side of the body then what side is affected?
left side
when a patient presents to the ER with a stroke you should monitor their face for what?
symmetry and asymmetry
What stage of Alzheimer’s is this?
forgetfulness
forgetfulness of glasses or wallet, no memory problems
stage 2 of Alzheimer’s
stage 1 of Alzheimer’s
no apparent manifestations
the following is what stage of Alzheimer’s
mild cognitive decline
(inability to plan, decreased attention, unable to remember names, difficulty in social or work situations)
Alzheimer’s stage 3
The following is what stage of Alzheimer’s
mild to moderate cognitive decline
(withdrawn, obvious memory loss, limited knowledge, difficulty performing task planning or organizing, depression and social withdrawal)
Alzheimer’s stage 4
the following is what stage of alzheimer’s
moderate cognitive decline
(inability to recall important details such as address, telephone, schools, assistance with adls become necessary, disorientation and confusion as to time and place)
Alzheimer’s stage 5
the following is what stage of alzheimer’s
moderate to severe cognitive decline (late-stage)
(loss of awareness to recent events, can recall the name but not hx, significant personality changes, wandering behavior, x1 w/adls, the normal sleep cycle is disrupted, increased episode of incontinence
Alzheimer’s stage 6
The following is what stage of alzheimer’s
severe cognitive decline
(inability to respond to environment, speak, control movement is lost, unrecognizable speech, incontinence, inability to eat w/o assistance and impaired swallowing, ataxia)
Alzheimer’s stage 7
positive S/S of schizophrenia
hallucinations and delusions
negative symptoms of schizophrenia
apathy, flat affect, anhedonia
how often should circulation be checked or the patient be allowed to stretch when they are in restraints?
every 2 hr
What should happen before applying restraints
all less restrictive methods should be exhausted
how should you release restraints?
one arm at a time
how often should a new order be required for restraints
within 24 hrs
where should soft restrains be fastened to?
side rails
how does the body respond to stress
lower immune system, interfere with sleep patterns, hard to concentrate, raises BP
Know the correct way to count respirations
you better not tell that patient you’re counting their respirations mary. 12-20 resp
PT/Coumadin/Warfarin
10-13 sec
APTT/Heparin
25-35
INR for no anticoag tx
0.9-1.1
INR for pt receiving anticoag tx
2.5-3.5
peripheral pulse sites
temporal carotid brachial radial femoral popliteal
is the apical pulse a peripheral pulse
NO
what can make getting a peripheral pulse difficult?
low perfusion
if you’re allergic to amoxicillin then you can’t take what?
penicillin
if you’re allergic to penicillin then you can’t take what?
amoxicillin
How can nitro be given
sublingual
IV
Transdermal
How many times can nitro be given sublingually before calling 911
3
once every 5 min
patient presents with:
chest pain, ShOB, dizziness, nausea, sweating, left arm pain and jaw pain
what do you suspect?
classic MI
classic S/S of MI
chest pain, ShOB, dizziness, nausea, sweating, left arm pain and jaw pain
patient presents with
heartburn, epigastric pain, fatigue, abd pain
what do you suspect
non-classic MI
who is more likely to die from a heart attack?
a woman
how do women present with heart attacks
fatigue
shoulder blade discomfort
ShOB
Epigastric pain
What are some major injuries that a pt might sustain in a MVC?
head trauma, paralysis, ICP, fracture amputations
What is the priority after an MVC
check the perfusion
bipolar/mood stabilizer. prevents/decreases incidences of acute manic episodes
Lithium
side effects of lithium
lack of coordination
dizziness
drowsiness
S/S of lithium toxicity
vomiting diarrhea slurred speech lightheadedness decreased LOC decreased coordination drowsiness muscle weakness tremor or twitching
when should you call the doc when taking lithium?
fever
vomiting
diarrhea
what are mistaken perceptions of reality?
illusions
Who might present with illusions
schizophrenic patients
early stage hypoxia
restlessness tachycardia tachypnea dyspnea increased agitation anxiety diaphoresis retractions headache
late-stage hypoxia
restlessness stupor dyspnea decreased respirations bradycardia cyanosis
hgb male
14-18
hgb female
12-16
increased hgb indicates what
chronic hypoxia
decreased hgb indicates what?
anemia or blood loss
what are hallucinations?
are false sensory perceptions that can affect all 5 senses
most common hallucinations
auditory and visual hallucinations
what kinds of patients present with hallucinations
schizophrenia
normal blood sugar ranges
70-100
if a patient’s blood sugar is below 70 what do you do?
give OJ sugared candy, peanut butter crackers, glucose tabs, milk
if pts blood sugar is above 100 what do you do?
give insulin
insulin drip
more fluids or IV fluids
an eating disorder that causes lack of appetite
anorexia
most common eating disorder
obesity
caloric dysfunction
overeating obesity
an eating disorder where the patient is afraid to eat because of fear of gaining weight
anorexia nervosa
an eating disorder that consists of binge eating and self-induced vomiting or laxatives
bulimia nervosa
what drug is used to decrease the severity of HF and used to increase cardiac output
digoxin
what should you check before giving digoxin
the apical pulse
why should you withhold Dig
low BP
pulseless than 60
where is the apical pulse
fifth inner midclavicular space
S/S of dig toxicity
vomiting abd pain green halos around objects anorexia nausea arrhythmias visual disturbances
random blood glucose test
70-100
glucose tolerance test
140-199 pre-diabetes
over 200 indicates diabeties
fasting glucose
100-125 prediabetes
126 or higher is diabetes
Ha1C
normal less than 5.7
prediabeties 5.7-6.4
higher than 6.4 is diabetes
s/s of hypoglycemia
faintness, hunger, sweating, irritability, trembling, low urine output, lethargy, cool clammy skin
patient present with irritable mood swings isolation feeling hopeless suicidal ideations PMS
what do you suspect
depression
what is the most important thing to ask a depressed patient?
if they have had suicidal or homicidal thoughts
who is most at risk for depression
older adult patients
PMDD mostly affects women when?
the second half of their menstrual cycle
is dementia a disease?
NO a symptom
S/S of dementia
short term memory loss long term memory misplaced items agitation repeat of questions delusions hallucinations aphasia unable to communicate needs
causes of dementia
medications
chronic alcoholism
neurological infections
head injuries
can dementia be reversed if r/t head trauma
no
can dementia be reversed if r/t medications
yes
what are delusions?
fixed false beliefs that cannot be changed by logic or factual proof
how may delusions present
patients my exhibit delusions of grandeur, persecution, or guilt
s/s of colon cancer
blood, black or black tarry stools, if closer to anal opening brighter red
testing or screening for colon cancer
guiac or occult blood stool
colonoscopy w/ biopsy
sigmoidoscopy w/ biopsy
guiac testing my give a false positive if
the pt has had red meat within 3 days
what is the goal of cognitive-behavioral therapy?
trying to change mindset of thinking of themselves to more positive thinking
what is a priority consideration of COPD patients
do not turn their O2 above 2L
what is the normal O2 levels for a CPOD patient
88-92%
a medication used to decrease positive symptoms of schizophrenia?
clozapine
side effects of clozapine
seizures
drowsiness
orthostatic hypotension
What is a high-priority side effect of clozapine?
neuroleptic malignant syndrome
fever
respiratory distress
tachycardia
an increase of neutrophils indicates?
infection
an increase of basophils can indicate?
hyperthyroidism,
bone marrow disorder,
ulcerative colitis
an increase of lymphocytes indicates?
viral infection
chronic bacterial infection
leukemia
an increase of eosinophils indicates?
allergic response
some leukemias
an increase of Monocytes indicates?
chronic inflammatory disorders
some leukemias
a test used to break down white blood cell count is?
CBC w/ differential
a low fat, low cholesterol diet is needed for a patient with?
CVD/CAD
what risk factors can be controlled with CAD/CVD?
diabetes mellitus hypertension elevated serum levels elevated LDL excessive alcohol use obesity sedentary lifestyle emotional stress tobacco use second-hand smoking
what cannot be controlled with CAD/CVD
Age
ethnicity
gender
genetics
when do you start to see the therapeutic effects when on medications for CAD/CVD?
4-6 weeks
other than medications what are some other therapeutic measures for CAD/CVD?
Smoking cessation
exercise
diet (what kind?)
what kind of medications are used for CAD/CVD?
anti-platelet nitrates ace inhibitors calcium channel blockers beta-blockers anti-ischemic agents statins
an antidepressant used to help with smoking cessation and cessation of bedwetting is what?
Bupropion (Wellbutrin)
what are the positive effects of Wellbutrin?
fewer withdrawal symptoms
helps improve depression
what are the negative effects of Wellbutrin?
Suicidal thoughts
possibly uncontrolled behaviors
who needs to be cautious when taking beta-blockers?
elderly
pregnant women
breastfeeding women
who should avoid Benadryl?
children >4 y.o
Acute angle gluacoma patients
breastfeeding women
what are some side effects of Benadryl?
urinary retention photosensitivity tinnitus dry mouth Drowsiness
LACK OF MOTIVATION AND ENERGY
US CURRENTLY IS?
AVOLITION
cheeses corn cranberries eggs fish grains (bread and cereals) lentils meats nuts (Brazil, filberts, walnuts) pasta plums poultry prunes rice
foods that acidify urine.
what foods should be avoided when on Aspirin?
Foods that Acidify Urine.
