Final Flashcards
DM: Describe the impact of illness on a patient with Diabetes Mellitus
Illness, stress, and infection increase the body’s insulin requirement. The patient should increase the frequency of blood glucose testing and urine testing for ketones. Adequate fluid intake should be consumed to prevent dehydration. The patient should take the normal insulin dose and notify the HCP for ketones or continued high blood glucose levels.
DM: Hypoglycemic patients may become lethargic and unarousable. What is the best treatment in this case?
A patient who shows these types of symptoms due to a hypoglycemic event should be given D50 IV. Hypoglycemic patients who are less symptomatic should be given food and drink with sugar and protein.
DM: Diabetes is a common diagnosis across the lifespan. Describe the difference between type 1 and type 2 diabetes mellitus
Type 1 DM is irreversible, typically occurs in children and young adults and is associated with little to no insulin production. Type 2 diabetes is associated with lifestyle and is reversible.
DM: What is the rationale for measuring a patient’s HgbA1c?
HgbA1c is used to measure the average blood sugar over a period of up to 3 months. Diabetic patients should be instructed that a healthy A1c is below 6.5%.
DM: Describe which type of insulin is best for initial treatment of diabetic ketoacidosis and the rationale
Regular insulin is classified as a short-acting insulin. It can be given intravenously with an onset of action of less than 30 min. This is the insulin that is most appropriate in emergency situations of severe hyperglycemia or diabetic ketoacidosis.
DM: Discuss the importance of foot care in patients with diabetes
Patients with diabetes are at high risk of slow healing injuries especially in lower extremities. They should be reminded to do regular inspections of any cuts or bruises on the feet.
DM: Describe the clinical manifestations of hypoglycemia
Manifestations of hypoglycemia include sweating, tachycardia, tremors, palpitations, hunger, and anxiety.
DM: Indicate the components of reversing a DM2 diagnosis
Diet, exercise and weight loss may be sufficient treatment for patients with Type 2 diabetes. For some patients, weight loss & exercise may eliminate the need for medications.
DM: Describe the 3 P’s commonly seen in DM
Polyuria is the medical term for excessive urination, which is one of the classic symptoms of uncontrolled diabetes. Polydipsia refers to excessive thirst. Polyphagia refers to excessive hunger.
When prioritizing care, the nurse knows to consider this patient first.
Hemodynamically unstable
Resp: A pt with thick mucus secretions is educated to increase fluid intake. What is the rationale?
Increasing fluid intake will thin secretions and make them easier to excrete.
Resp: The nursing priority for any assessment, and especially when there is known respiratory compromise is:
Hemodynamics- Airway, Breathing, Circulation (ABCs)
Resp: A pt with any disease process or treatment that contributes to immunocompromise is at highest risk for:
acquiring opportunistic infection like pneumonia
Resp: The nurse is admitting a patient with community-acquired bacterial pneumonia and determines that their respiratory status is stable. What is the next priority action?
Administer the first dose of IV antibiotic therapy
Resp: List at least 3 nursing interventions that should be used for patients at risk for developing pneumonia
- Turn, cough, deep breath
- Use of an incentive spirometer
- Regular ambulation if possible
- Encourage fluid intake
Resp: Describe hospital (HAP) & ventilator-acquired pneumonia (VAP)
Pneumonia that develops after at least 48 hrs of hospitalization is considered a HAP. Pneumonia that occurs at least 48 hrs after intubation is a VAP.
Resp: Describe the latent phase of TB
TB is considered latent when the virus lives in the body but is not growing, is not spreadable, and does not cause symptoms
Resp: The type of drug that is most effective in the treatment of persistent asthma
Inhaled corticosteroids are more effective in improving asthma than any other drug and are indicated for all patients with persistent asthma.
Resp: Describe the rationale for teaching patients to rinse their mouths after using an inhaler for asthma.
Inhaled corticosteroids can cause oral candidiasis which leaves white patches on the tongue and cheeks.
Resp: The rationale for recommending pursed lip breathing to patients with COPD.
Pursed lip breathing is a technique that prolongs exhalation and maintains positive airway pressure
Resp: why might a pt with COPD also have peripheral edema?
Right ventricular failure (Cor Pulmonale) causes peripheral edema secondary to pulmonary hypertension
Resp: Why is it so important to provide oral care to patients with artificial airways?
Patients with artificial airways are at an increased risk of acquiring pneumonia. This is called hospital-acquired pneumonia or ventilator-acquired pneumonia.
Resp: Airborne precautions include which specific type of room if one is available?
Negative Pressure Room
Resp: Describe the purpose of using short-acting beta2 agonist like Albuterol
Albuterol is an inhaled short-acting beta2 agonist (beta2-adrenergic agonist) used as a rescue medication to relieve an acute asthma attack. Albuterol dilates the airways, decreases wheezing, and improves oxygenation.
Resp: Which type of respiratory illness changes the appearance of the chest and why?
Clients who have COPD use accessory muscles to assist with respiratory effort. The use of those accessory muscles causes the chest wall to eventually increase in anterior-posterior diameter, making it appear barrel shaped.
Resp: The most effective primary care method of preventing community-acquired pneumonia is?
Pneumococcal vaccine
Resp: Diagnoses such as TB and COVID require which type of isolation?
Airborne precautions are used for patients with airborne diseases like TB and COVID.
Resp: Why Pts should be cautioned about the overuse of albuterol inhalers.
Overuse of albuterol can cause rebound bronchoconstriction
Resp: Describe the relationship of O2 and CO2 in patients with COPD
Pts with severe COPD are considered CO2 retainers, meaning that they are not able to blow off CO2 appropriately and high amounts of supplemental O2 can lead to respiratory acidosis.
Resp: Describe the pathology of cor pulmonale in COPD patients
COPD–>RV enlargement–>pulmonary hypertension–>RV failure
Blood flow through the heart
Start: right atrium > tricuspid valve > right ventricle > pulmonary semilunar valve > pulmonary arteries > lungs > pulmonary veins (right and left) > left atrium > mitral valve > left ventricle > aortic valve > aorta > arteries > capillaries > veins > inferior vena cava/ superior vena cava back to the: right atrium
CV: The nursing priority when starting a patient on a new anti-hypertensive medication
Patient safety. Anti-hypertensives can cause a patient to become hypotensive and require careful observation when initiating the medication.
think through this with hemodynamics as your guide
CV: Describe the use of Troponin as a diagnostic marker
Cardiac troponins start to elevate 4-6 hours after a myocardial injury and are highly specific to the myocardium, therefore it is the preferred diagnostic marker for myocardial infarction.
CV: A pt is experiencing crushing chest pain. Describe why administering Nitroglycerin SL is the nursing priority.
Nitro is a vasodilator and in the event of an MI, the priority action is to relieve the chest pain by promoting vasodilation.
CV: JVD is associated with which cardiac problem
Right sided heart failure
CV: Indicate the importance of strict I&O’s with CHF patients
Patients with congestive heart failure are at risk for fluid volume overload due to the poor pumping mechanism of the heart.
CV: Describe the rationale for obtaining a 12-lead EKG on a patient with elevated potassium
Elevated potassium poses a risk for dysrhythmias as well as cardiac arrest. Therefore, the nurse should obtain a 12-lead ECG to monitor for cardiac changes.
CV: Describe the use of Lisinopril and the side effects
Lisinopril is an ACE inhibitor used to treat hypertension.
Side Effects:
Angioedema- swelling of the mouth (this is a priority as swelling of the mouth can compromise airway)
Dry Cough
Nausea
Nasal congestion
CV: Aspirin can be used for many purposes. Describe it’s use for cardiac patients
Aspirin is an antiplatelet aggregate used to decrease the likelihood of blood clotting. It also is used to reduce the risk of a second heart attack or stroke by inhibiting platelet aggregation and reducing thrombus formation in an artery, a vein, or the heart.
CV: What is the rationale for using caution when delivering IV fluids to a patient with heart failure?
Patients in heart failure are at risk for fluid volume overload so IV fluids should be used with caution
CV: Cardiac catheterization requires access through a major vessel. With this in mind, describe the assessment of a post-cath patient
The priority for post-cath patients is to achieve and maintain hemostasis. This includes checking the site for bleeding and hematoma, checking pulses distal to the access site, keeping the affected limb secure, and managing vital signs
CV: Why might a patient with advanced peripheral artery disease have pain in their legs?
Intermittent claudication is ischemic pain that occurs early in PAD. As PAD progresses, the client will experience pain even at rest due to ischemia of the distal extremities. The client might describe this pain as a persistent burning or aching pain that often awakens the client at night.
CV: Why might a patient with heart failure who is experiencing dyspnea show signs of confusion or mental status change?
Heart failure may lead to excess fluid volume, making it difficult effective gas exchange to occur and the patient may become hypoxic which can cause confusion
CV: Describe the risks that come with using Furosemide (Lasix) for patients with heart failure
Furosemide is a loop diuretic that inhibits the reabsorption of sodium and chloride and results in diuresis (excessive urination), which decreases potassium through excretion in the distal nephrons. Hypokalemia is an adverse effect of furosemide.
CV: Describe the difference between primary and secondary hypertension
Primary hypertension is not associated with any other underlying disease process and has no specific cause. Secondary hypertension is due to another disease process.
CV: Describe the risk factors for coronary artery disease
Diabetes, smoking, sedentary lifestyle, each can cause compromise to the vasculature, particularly, the coronary arteries. African Americans are at a higher risk of developing CAD.
CV: Describe the criteria needed to deliver a second dose of Nitroglycerin for acute chest pain
The nurse must wait 5 minutes from the first dose before giving a second sublingual nitroglycerin to a patient who does not have complete chest pain relief and who’s vital signs remain stable.
CV: Cardiac output and Systemic vascular resistance are the components of:
Blood pressure
CV: The nurse is likely to see which EKG deviation for a patient experiencing chest pain related to a myocardial infarction
ST segment elevation. This is also called a STEMI
CV: Patients with PVD have an increased risk of developing a DVT. Describe the nursing assessment for a potential DVT
Measure, record and compare right and left calf and thigh circumferences to monitor for changes. The client should be on bedrest , and the extremity pillow under knees. Manipulation of the affected extremity should be avoided to prevent disruption and embolism of the clot.
CV: Describe the differences between systolic and diastolic heart failure
Systolic heart failure is indicated by a low ejection fraction
Systolic heart failure occurs as a result of an ineffective pumping mechanism
Diastolic heart failure typically maintains a normal ejection fraction
Diastolic heart failure occurs when the left ventricle becomes smaller in size and does not fill with adequate volume
Onc: Antiemetics are often used to help patients who experience which side effect to chemotherapy?
Nausea and vomiting
Onc: What is the rationale for teaching a patient receiving radiation therapy for bladder cancer, to clean the perineal area well after each bathroom use?
Radiation to the abdomen will affect organs in the radiation path, such as the bowel, and cause frequent diarrhea. Careful cleaning of this area will help decrease the risk for skin breakdown and infection.
Heme/Onc: Describe thrombocytopenia and risks associated with it
The reduction of platelets below 150,000 can cause an increased risk of bleeding.
Onc: Describe why neutropenia is a priority for a nurse to communicate to a provider.
Neutropenia indicates that the patient is at high risk for infection and needs immediate actions to diagnose and treat the cause of the leukopenia
Onc: Describe why fresh flowers and other organic plants may be restricted for patients undergoing treatment for cancer
Clients who are receiving chemotherapy and radiation therapy are likely to become immunocompromised as a result of neutropenia, a decreased white blood cell (WBC) count. Because micro-organisms are likely to be present on fresh flowers and plants, immunocompromised clients are instructed not to accept such gifts into the room. In addition, the client is instructed to eat only thoroughly cooked meats and thoroughly washed fruits and vegetables. Immunocompromised clients are more susceptible to infection and illness from food-borne bacteria than other clients.
Onc: When should self testicular exams be done in order to achieve most accuracy?
After a bath or shower when the scrotal skin is relaxed.
Heme: Promoting & maintaining oxygenation, keeping RBCs hydrated, managing pain, and promoting neurological function are all goals of nursing interventions for what disease process?
Sickle cell anemia/sickle cell crisis
Heme: Pernicious anemia prevents the absorption of what?
Vitamin B12 or Cobalamin
Heme: What neuromuscular symptoms are common in someone with pernicious anemia?
weakness and paresthesia of extremities
Blood: B12 injections are commonly given to treat which type of anemia?
Pernicious
Heme: People with this type of anemia are at increased risk for infection due to pancytopenia.
Aplastic anemia
HIV: Is an HIV positive person less or more likely to receive routine medical treatment? Why?
Less likely. HIV positive people may feel stigmatized and marginalized, making them less likely to seek routine medical care.
HIV: An involuntary loss of 10% or more of body weight is part of which complication in an HIV positive person?
HIV Wasting Syndrome
HIV: What can a nurse to do promote complete compliance to the treatment regimen of an HIV positive person?
Communicate with the person in a non-judgmental, therapeutic manner
HIV: When explaining treatment to a newly diagnosed HIV person, what one thing would you emphasize to achieve the goal for treatment?
Complete compliance to antiretroviral treatment regimen
HIV: When an HIV positive person has a the routine lab, viral load test, what is being measured?
HIV-RNA levels and the body’s response to the infection
Hep: Several disease processes may cause jaundice. What causes jaundice?
Jaundice is caused by the elevation of bilirubin level associated with red blood cell hemolysis.
How does OBESITY contribution to other diseases?
- insulin resistance- decrease the effects of insulin
- pain-causes knee, hip, and low back pain
- joints- decrease joint mobility and flexibility
- respiratory- leads to and increased work of breathing, wheezing, rapid shallow breathing, sleep apnea
- cardio- leads to HTN, tachycardia, dysrhythmias, stroke, increased LDL, decreased HDL
CKD: Describe an AV graft and how to assess one for patency
An AV graft is similar to an AV fistula, but uses a synthetic graft. Both are assessed for patency using touch to feel a thrill and auscultation to hear a bruit.
CKD: What manifestation would indicate that a peritoneal dialysis patient may have peritonitis?
Peritonitis is an inflammation of the peritoneum and a major complication of peritoneal dialysis. Purulent drainage from the PD catheter would indicate that the nurse should notify the doctor immediately.
CKD: Normal BUN range is 8-20
Normal Creatinine is 0.5-1.5
Chronic kidney disease causes what disruption to these normals and why?
In CKD, the kidneys are not excreting toxins effectively and the BUN and Cr would become elevated
CKD: Urea is a biproduct of protein breakdown. Why is this important to patients with chronic kidney disease?
The kidneys do not excrete urea and can cause uremia
Chronic Kidney Disease: Describe the symptoms of hypervolemia
Dyspnea
Pitting edema
Crackles in the lungs
Hypertension
Jugular vein distension
CKD: Describe the electrolyte imbalances that occur with chronic kidney failure
risk for hypocalcemia due to an alteration in the conversion of vitamin D by the kidneys.
risk for hyperphosphatemia due to a reduction in excretion of phosphorous by the kidneys.
risk for hypernatremia, edema, and hypertension due to sodium retention.
CKD: Discuss the importance of daily weights in patients with chronic kidney disease
Patients with CKD are at risk of hypervolemia and the best way to determine fluid volume overload is to perform daily weights at the same time each day, with similar clothes on, with the same scale, and after the patient voids.
Mscskl: What assessment findings would indicate further investigation of possible post-operative infection?
Elevated temperature
Purulent drainage from incision
Redness around incision
Warm/hot tissue around incision
Mscskl: What activity is likely to exacerbate a herniated lumbar disc and cause increased pain?
Bending or lifting
Mscskl: Compartment syndrome is a complication that can be identified through which nursing assessment?
Neurovascular assessment & Pain assessment
Mscskl: An emergency fasciotomy is done to treat which musculoskeletal complication?
Compartment Syndrome
Mscskl: When considering best outcomes for a elderly patient who has had orthopedic surgery, what priorities should a nurse consider?
Pain control Early mobility Nutrition Infection prevention Social support
Mscskl: Explain why people who endure limb amputation may need increased psychosocial support.
Phantom limb pain exemplifies the mind-body connection and can be psychologically disturbing for those who experience it.
Mscskl: Phantom limb pain can be treated with:
Pain medication
Mscskl: Describe the patient education for preventing hip flexion contractures following amputation
patients should avoid sitting up for prolonged periods of time
patients should be turned to prone position for 30 minutes at a time initially
The hip should be extended as often as possible
Mscskl: Describe the objective of using skeletal traction such as Buck’s traction and the nursing considerations
Objective:
Immobilize injured limb
Decrease muscle spasms
Reduce risk of further injury
Nursing considerations:
Weights of traction are always free hanging
Ropes are tight
Limb is secure
Skin is assessed regularly
Weights are only removed in the case of a life-threatening event
Mscskl: Describe fat embolism syndrome and why it is more common in skeletal injuries
Fat embolism syndrome occurs when fat particles from a fractured bone move into the vascular system and cause an occlusion. The symptoms are similar to a thromboembolism
GI: The cause of cholesterol gallstones
a metabolic imbalance between cholesterol and bile salts
GI: The biliary duct may become obstructed when the gall bladder is inflamed. What manifestation might you see with this complication?
Jaundice skin
Why should the nurse perform careful neurological assessment in and older adult experiencing a urinary tract infection?
Confusion is a common finding with UTI’s in older adults. The nurse should be careful to identify changes in mental status
GI: Describe the difference in manifestations between Upper and Lower GI bleeds
Upper GI bleed may have coffee-ground like emesis or drainage from an NG tube.
Lower GI bleed may have bright red blood (frank blood) in the stool
GI: Describe the assessment priority for a patient with a GI bleed in terms of hemodynamics
Patient’s with a GI bleed may be losing blood and therefore are at risk for hypovolemia
GI: Describe the manifestation of jaundice during cholecystitis.
Cholecystitis results in obstructed biliary ducts, which prevents bile flow into the duodenum and bilirubin accumulates in the blood, causing jaundice.
GI: The most common location to develop diverticula
Diverticula can develop anywhere in the GI tract, but they are most common in the left descending, sigmoid colon
GI: Priority intervention for peritonitis
Peritonitis can be life-threatening if treatment is delayed. Administering IV antibiotics should be the priority intervention.
GI: Clinical manifestations of Crohn’s (chronic inflammatory bowel disease) disease
Abdominal pain
Diarrhea
Fever
Weight loss
GI: Clinical manifestations of GERD
Pyrosis (heartburn)
Dyspepsia (indigestion)
Discomfort at night
GU: Pathophysiology of benign prostatic hyperplasia
increased size of the prostate gland which disrupts the outflow of urine from the bladder through the urethra
complication: UTI caused by urinary retention
GU: Measures to prevent urinary tract infections
- Proper perineal care
- Cranberry juice
- Proper antibiotic/antimicrobial use
GU: Bleeding and clotting are common complications following a TURP. What intervention is used as treatment?
Continuous bladder irrigation using a 3-way catheter
TURP: transurethral resection of the prostate
Normal Hemoglobin Values
Males: 14-18 g/dl
Females: 12-16 g/dl
