Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Concepts 2 > Final > Flashcards

Final Flashcards

1
Q

Normal Ranges for RBC, Platelet, WBCs

A

RBC: 4.7-6.1 (males); 4.2-5.4 (females)
Platelet: 150000-400000
WBC: 5000- 10000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hematocrit and Hemoglobin normal range

A

Hematocrit (% of RBC in blood)-36-48
Hemoglobin (amount of protein in RBC)—12-16

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does compatibility testing look for the following blood products?

  • Packed RBCs
  • Platelets
  • Plasma
  • cryoprecipitate
  • albumin
A
  • Packed RBCs (ABO and Rh)
  • Platelets (ABO and Rh but ABO does not have to match)
  • Plasma (ABO)
  • cryoprecipitate (neither)
  • albumin (neither)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Nursing Care: Pre- blood transfusion (7 general)

A
  • ensure consent given
  • prime setup w/ NS
  • use 18 gauge or larger needle
  • use special tubing and separate line for Blood transfusion (usually has filter to retain clots)
  • get labs and vitals
  • get hx of reactions
  • Verify donor’s/recipient’s blood for compatibility with ABO and Rh compatibility, andexpiration w/ TWO nurses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are two pre-transfusion medications?

A

diphenhydramine
Acetaminophen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Nursing Care: During blood transfusion (3 general)

A
  • Document Vitals and monitor for complications (allergic, hemolytic, febrile, overload)
  • Begin transfusion slowly, and stay with patient first 15 to 30 minutes
  • Blood products should be infused within 4 hours or you need new blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Blood Transfusion Complications: Hemolytic

Signs and symptoms (6)

A
  • Tachypnea
  • Chills
  • Fever
  • Sudden Back Pain
  • Nausea
  • Anxiety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Blood Transfusion Complication: Hemolytic

Nursing Care (4)

A
  • Stop Transfusion Immediately!!!
  • Saline infusion in separate line from blood
  • Save blood bag
  • Notify blood bank and HCP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Blood Transfusion Complication: Febrile

Signs and Symptoms (5)

A
  • Chills
  • Tachycardia
  • Fever ( increased temp of 1 degree (F) or 0.5 (C))
  • Hypotension
  • Tachypnea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Blood Transfusion Complication: Febrile

Nursing Care (3)

A
  • Stop Transfusion Immediately!!!
  • Saline infusion in separate line from blood
  • Administer antipyretics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Blood Transfusion Complication: Allergic

Signs and Symptoms (5)

A

Itching
Urticaria
Dyspnea
Wheezing
Chest tightness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Blood Transfusion Complication: Allergic reaction

Nursing Care (3)

A
  • Stop Transfusion Immediately!!!
  • Saline infusion in separate line from blood
  • give diphenhydramine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Blood Transfusion Complication: Fluid Overload

Signs and Symptoms (7)

A

Dyspnea
Chest tightness
Tachycardia
Tachypnea
Sudden crackles
Bounding Pulses
Anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Blood Transfusion Complication: Fluid Overload

Nursing Care (4)

A
  • Monitor VS
  • Slow infusion rate,
  • Administer diuretics
  • may give fluid volume expander (Hespan) prior to treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

5 Types of Anemia

A
  • Blood loss
  • Bone Marrow Production (Aplastic)
  • Red Blood Cell Destruction (sickle cell anemia,
  • Nutrition Deficiency (iron, folic acid, or
    Vitamin B12 deficiency (pernicious)
  • Erythropoietin deficiency (Renal impairment)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

4 drug Treatments for Anemia

A
  • Iron Ferrous sulfate (take with meals w/ vitamin C)
  • Epoetin alfa (Erythropoietin)
  • vitamin B12
  • Folic acid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

CAUTION (Seven Warning Signs of Cancer

A

Changes in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in the breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in a wart or mole
Nagging cough or hoarseness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Radiation Therapy: Brachytherapy

3 things to note

A
  • Patient is radioactive and emits radiation for a period of time
  • Patient potential hazard to others until source of radiation is removed
  • Radiation source is in direct, continous contact with tumor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Radiation Therapy

6 patient education

A
  • Avoid skin irritation and friction from cloths
  • Avoid deodorant and lotions on days of treatments
  • Avoid sun exposure to irradiated area
  • Wash irradiated area with mild soap and water but avoid skin scrubbing
  • Fatigue can be reduced with exercise and sleep
  • Regular dental visits, saliva substitutes, lozenges, mouth rinses are helpful for radiation to head or neck
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Radiation Therapy

10 nursing Care

A
  • Assign the patient to a private room with a private bath.
  • Place a “Caution: Radioactive Material”
  • Wear a dosimeter film badge to measure radiation exposure
  • Wear a lead apron while providing care. Always keep the front of the apron facing the source of radiation (do not turn your back toward the patient).
  • Do not perform patient care if pregnant
  • Limit each visitor to 1 half-hour per day.
  • Be sure visitors stay at least 6 feet from the source.
  • no children under 16 can visit
  • Never touch the radioactive source with bare hands. In the rare instance that it is dislodged, use long-handled forceps to retrieve it
  • keep all linen and dressing in room until all radioactive source removed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

7 Nursing Care for Neutropenia

A
  • Place the patient in a private room whenever possible.
  • Ensure that the patient’s room and bathroom are cleaned at least once each day.
  • Use strict aseptic technique for all invasive procedures (avoid if possible)
  • Keep frequently used equipment in the room for use with this patient only (e.g., blood pressure cuff, stethoscope, thermometer).
  • Visitors with signs or symptoms of illness should be restricted.
  • Monitor the WBC count daily.
  • Restrict fresh flowers and potted plants in the patient’s room.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

6 Nursing Care for Thrombocytopenia

A
  • use a lift sheet when moving and positioning the patient in bed.
  • Avoid IM injections and venipunctures or use smallest gauge. If platelets are <50,000, invasive procedures may be postponed.
  • apply pressure to areas of bleedning
  • Apply ice to areas of trauma.
  • Avoid trauma to rectal tissues (no enemas; lubricate for suppositories)
  • For mouth care, use soft-bristled toothbrush or tooth sponges; Do not use water-pressure gum cleaners; make sure dentures fit and do not irritate the gums.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

10 Patient Education for Thrombocytopenia

A
  • Use an electric shaver.
  • Use a soft-bristled toothbrush.
  • No aspirin or salycilate
  • Avoid hard or hot foods that would scrape or burn the inside of your mouth.
  • Check your skin and mouth daily for bruises; swelling; or areas with small, reddish-purple marks (petechiae)
  • Avoid rectal pain (anal, use stool softeners)
  • Do not wear clothing or shoes that are tight or that rub.
  • Avoid blowing your nose or placing objects in your nose. If you must blow your nose, do so gently without blocking either nasal passage.
  • Avoid activities that increase the pressure in your brain.
  • wear shoes with firm soles whenever ambulating.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Chemotherapy-induced Nausea and Vomiting

prevention/treatment

A

antiemetic therapy i.e. 5-HT3 antagonists given prior to nausea or vomiting beginning and continued even when appears controlled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Chemotherapy-induced Mucositis

5 Prevention/treatment

A
  • Oral cryotherapy with ice water or ice chips can prevent (patient should suck ice chips before, during, and after rapid infusions)
  • Frequent mouth assessment
  • Salt and baking soda rinse
  • Non-alcohol-based mouth rinse throughout day and night
  • Soft-bristled toothbrush or disposable mouth sponges
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Chemotherapy-Induced Alopecia

4 prevention/treatment

A
  • Scalp cooling during chemo
  • Avoid direct sunlight on scalp with hat or head covering
  • Use sunscreen due to increased sun sensitivity
  • Pick wig prior to treatment beginning to cope with body image issues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

6 P’s of arterial insufficiency

A

Pain
Pallor
Pulselessness
Poikilothermic (cold)
Paralysis
Parathesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Stable vs unstable Angina

What is angina?
What is stable angina?
What is unstable angina?

A

Angina is when oxygen supply < myocardial demand

Stable angina is relieved by rest, sublingual nitrogen or aspirin

Unstable angina is chest pain with extra symptoms, not relieved by nitroglycerin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

8 Signs and symptoms of unstable angina/ MI

A
  • wheezing or SOB
  • weight gain of 3 pounds a week (1-2 pounds overnight)
  • dizziness or faintness
  • cool, diaphoretic skin
  • Nausea and vomiting
  • S3 gallop
  • increased temperature
  • palpitations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

STEMI vs NSTEMI MI

Differences on ECG
Recommended treatment

A

STEMI: ST elevation due to rupture of fibrous atherosclerotic plaque

NSTEMI: ST depression and T wave inversion due to myocardial ischemia

PCI is recommended within 90 minutes of arrival to hospital for STEMI to due revascularization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How are the following affected by perfusion?

  • D-dimer
  • Lipids
  • C-reactive protein
  • B-type natriuretic peptide
  • Troponin I and T
  • Creatine kinase-MB
A
  • D-dimer (identifies DVT)
  • Lipids (total and LDL increased, HDL decreased)- increased in peripheral artery disease
  • C-reactive protein - increased in MI
  • B-type natriuretic peptide -increased in coronary artery disease
  • Troponin I and T AND Creatine kinase-MB – increased and specific cardiac markers of MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is Percutaneous Coronary Intervention?

3 parts

A

3 parts:
- clot retrieval to restore perfusion in CAD or PAD
- coronary angioplasty ( inflated balloon catheter to push artery plaque against vessel wall),
- stent placement ( prevent reocclusion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Nitroglycerin (vasodilator)

Indication (2)
Action
Side effects (3)
Nursing Care (5)

A

Indication: angina, heart failure

Action: reduces preload and afterload

Side effects: headaches, hypotension, reflex tachycardia

Nursing Care
- do not give with PDE5 inhibitors
- remove patch for 12-14 hrs a day and rotate sites
- apply patch to clean hairless area
- give one tablet every 5 minutes until 3 tablets
- give w/ CCB or betablocker to prevent reflex tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Aspirin and Clopidogrel (Antiplatelet)

Use (2)
Side effects (2)
Nursing Care

A

Use: Peripheral artery disease, a-fib

Side effects: tinnitus (aspirin), bleeding risk

Nursing Care
- take w/ food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Warfarin (anticoagulant)

Labs
Antidote
Nursing Care (5)

A

Labs: INR
Antidote: vitamin K

Nursing Care
- discontinue heparin 3-4 days after starting
- limit vitamin K (green leafy vegtables, liver, soybeans)
- avoid NSAIDs, antidepressants, corticosteroids,
- taper drug before discontinuing
- bleeding precautions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Heparin or enoxaparin (Anticoagulant)

Lab
Antidote
Side effect
Nursing Care (2)

A

Lab: monitor aPTT or anti-Xa

Antidote: protamine sulfate

Side effects: thrombocytopenia

Nursing Care
- bleeding precautions (electric razor, soft toothbrush)
- taper drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

6 Signs and Symptoms of Left-sided Heart Failure

A
  • Weakness/ Fatigue
  • Dizziness
  • Confusion
  • Pulmonary Edema (frothy, pink sputum, dyspnea, crackles)
  • S3 gallop (due to early diastolic filling)
  • Oliguria (nocturia at night)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

5 Signs and Symptoms of Right-sided Heart failure (cor pulmonale)

A
  • Distended neck veins
  • Increased abdominal girth (ascites)
  • Hepatomegaly (liver engorgement)
  • Weight—the most reliable indicator of fluid gain or loss
  • Peripheral pitting or dependent edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Systolic vs Diastolic heart failure

A

Systolic: reduced ejection fraction (< 40%) which increases preload and afterload

Diastolic: stiffened ventricles prevents sufficient blood flow and leads to inadequate cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Digoxin (cardiac glycoside)

Indication (3)
Action
Lab changes (3)
Side effects (5)
Antidote
Nursing Care (2)

A

Indication: heart failure, a-fib, PAC

Action: increase contractility (inotropic), reduce heart rate (chronotropic), reduce AV node conduction (dromotropic)

Lab changes: hypokalemia, hypomagnesium, hypercalcemia,

Side effects/toxicity : dysrhythmias, Anorexia, muscle weakness, vertigo/confusion (elderly), halos and vision changes

Antidote: antigen binding fragments

Nursing Care
- take apical HR prior to administration (do not give if HR < 60)
- take with potassium supplements or food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Carvedilol, metoprolol, atenolol (beta blockers)

Indications (4)
Action
Side effects (3)
Nursing Care (3)

A

Indication: hypertension, heart failure, dysrhythmias, angina

Action: negative chronotropic, dromotropic, inotropic

Side effects: bradycardia, heart failure, hypoglycemia (and masks hypoglycemia)

Nursing Care
- assess HR and BP (hold if HR < 50 or BP <90)
- avoid sudden withdrawal
- Avoid antacids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Atorvastatin, Simvastatin (HMG-CoA reductase inhibitors)

Indication (3)
Side effects (3)
Nursing Care (2)

A

Indication: heart failure, hypercholesterolemia, peripheral artery disease

Side effects: hepatotoxic, rhabdomyolysis, cataracts

Nursing Care
- avoid grapefruit juice
- increases bleeding risk when combined with warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Captopril (ACE inhibitors)

Indication (2)
Side effects (5)
Nursing Care (2)

A

Indication: heart failure (drug of choice), kidney disease with hypertension

Side effects: angioedema, cough, hyperkalemia, hypotension, metallic taste

Nursing Care
- take on empty stomach
- avoid NSAIDs and potassium supplements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Furosemide, hydrochlorothiazide (diuretics)

Indication (3)
Action
Side effects (5)

A

Indication: heart failure, hypertension, chronic kidney disease

Action: increase sodium and water excretion

Side effects: hypokalemia, hypotension, hyperglycemia, hyperuricemia, ototoxic (furosemide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

7 signs of heart failure exacerbation

A
  • Rapid weight gain (3lb in week or 1-2 lb overnight)
  • Decrease in exercise tolerance
  • Cold like symptoms
  • excessive nocturia (microalbuminuria and high specific gravity)
  • Development of dyspnea/angina at rest
  • Increased edema in feet, ankles, hands
  • Increased BNP level
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

EKG normal ranges

PR interval
QRS complex
QT interval

A

PR Interval = 0.12-0.20 seconds (start of P to start of Q)

QRS complex = 0.04-0.10 seconds (start of Q to end of S; w shaped)

QT interval = less than 0.44 seconds (start of Q to end of T)– naturally longer in women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

EKG Wave (what do they represent)

P wave
QRS Complex
T wave
U wave

A

P Wave- atrial contraction (depolarization); deformity = problem with atrium i.e a-fib does not have p waves

QRS Complex- ventricular contraction (depolarization); deformity = problem with ventricles

T Wave- ventricular repolarization

U wave: late ventricular repolarization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

EKG Normal Rates

-SA node
-AV node
- Purkinje fibers

A

EKG Normal Rates

  • SA node (60-100 bpm)
  • AV node (40-60 bpm)
  • Purkinje fibers (20-40 bpm)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

5 Steps to read 6-second EKG

A
  1. Heart rate (count Ps for atrial rate, count R waves for ventricular rate, count QRS complexes for general rate)
  2. Heart rhythm (measure from R-R; regular if intervals different by less than 3 small boxes)
  3. P wave analysis (should be present, regular, 1-1 P wave: QRS ratio, round and upright)
  4. PR interval analysis (0.12-0.20) – increases with AV blocks
  5. QRS analysis (0.04-0.10)– dysrhythmias if missing complexes or irregular pattern
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Causes of ST segment changes

Elevation (3)
Depression (3)

A

ST elevation due to MI, pericarditis, hyperkalemia

ST depression due to hypokalemia, MI, ventricular hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

6 Signs and Symptoms of Supraventricular Tachycardia (SVT)

A
  • Rapid pulse (>150 bpm) and palpitations
  • dizziness
  • anxiety
  • chest pain
  • dyspnea
  • p wave buried in EKG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

5 treatments for SVT

A
  • Valsalva maneuver (cough or bear down)
  • Adenosine (may cause asystole, bradycardia, hypotension)
  • Beta Blockers
  • Calcium Channel Blockers (verapamil or diltiazem)
  • cardioversion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Atrial Fibrillation EKG Change

A
  • No clear P waves b-c rapid impulses from atrial tissues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Signs and symptoms of Atrial Fibrillation (3 non EKG signs)

A
  • thrombus formation r/t blood pooling in atria (stroke risk if failure to rescue)– speech alterations
  • irregular apical pulse (palpitations)
  • poor perfusion (weak pulses)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

6 Nursing Care for A-fib

A
  • Apply oxygen
  • Keep HOB elevated unless patient is very hypotensive
  • Notifying the HCP or Rapid Response Team
  • Give Antiarrhythmics (Diltiazem, Amiodarone, metoprolol, lanoxin)
  • Give Anticoagulants (Heparin, enoxaparin, Warfarin)
  • need 12 lead EKG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Sinus arrhythmia

What is it?
EKG Change

A
  • variant of NSR due to intrathoracic pressure during breathing OR due to digoxin or morphine
  • Shortest PP or RR intervals vary at least 0.12 seconds from longest PP or RR interval
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Amiodarone (Potassium Channel Blocker)

Indication
Action
Side effects (5)
Nursing Care (3)

A

Indication:dysrhythmias (a-fib, v-fib)

Action: slows ventricular conduction to convert A-fib to NSR

Side effects: ARDS, blue-gray skin discoloration, hypotension, bradycardia, corneal microdeposits

Nursing Care
- test pulmonary function prior to treatment
- give with food
- avoid grapefruit juice and St. John’s wort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

tPA (thrombolytic/fibrinolytic )

Indication
Action
Side effects
Nursing Care

A

Indication: MI

Action: dissolves thrombi to restore myocardial blood flow

Side effects: bleeding

Nursing Care:
- give within 30 minutes of hospital arrival for STEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

7 nursing care for PCI

A
  • check if allergic to contrast dye (iodine) or shellfish
  • keep leg straight
  • keep HOB less than 30 degrees
  • watch for bleeding and hypokalemia (back pain = retroperitoneal bleeding)
  • have patient avoid coughing and sneezing
  • give anticoagulants during procedure and antiplatelets after procedure
  • maintain hydration (b-c dye can damage kidney so give adequate fluids)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Losartan (ARBs)

Indication
Side effects (3)

A

Indication: heart failure (drug of choice)

Side effects: angioedema, insomnia, hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Verapamil (Calcium Channel Blocker)

Indication (3)
Action: (3)
Side effects (4)
Nursing Care (2)

A

Indication: dysrhythmias (a-fib, SVT), angina, hypertension (useful in CKD to improve kidney perfusion)

Action: peripheral vasodilation AND negative dromotropic and chronotropic

Side effects: gingival hyperplasia, prolonged PR (AV block), facial flushing/ increased heat perception, reflex tachycardia

Nursing Care
- prevent reflex tachycardia by giving w/ beta blocker
- avoid grapefruit juice and St. John’s wort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

S/s of Pyelonephritis

Acute (7)

A
  • Ill s/s(Fever, chills, NV, malaise, fatigue)
  • Tachycardia and tachypnea
  • Flank, back, or loin pain
  • Tenderness at the costovertebral angle (CVA)
  • Abdominal, often colicky, discomfort
  • UTI signs (Burning, urgency, or frequency, nocturia)
  • Recent cystitis or treatment for UTI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

S/s of Pyelonephritis

Chronic (5)

A
  • Hypertension
  • Inability to conserve sodium
  • Decreased urine-concentrating ability, resulting in nocturia
  • hyperkalemia
  • metabolic acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Pyelonephritis

What is it?
Result
Key Care (4)

A

microbial invasion of renal pelvis causing inflammatory response and fibrosis

Result: AKI (decreased reabsorption and secretion) or CKD

Key care
- encourage fluids (2L/day)
- give antibiotics
- give acetaminophen > NSAIDS b-c does not affect kidney
- may need surgery (reimplantation, urethroplasty, nephrectomy, pylolithotomy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Serum Creatinine (range: 0.6-1.2)

When is it increased? (2)
When is it decreased? (2)

A

Increased w/ kidney impairment (due to reduced GFR) and increased muscle mass

Decreased w/ old age and decreased muscle mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

BUN (range: 10-20)

When is it increased? (7)
When is it decreased? (2)

A

Increased
- kidney or liver disease
- dehydration or poor kidney perfusion
- infection/ stress
- high protein
- steroids
- GI or other bleeds
- old age

Decreased
- malnutrition
- liver AND kidney dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Urinalysis: Specific gravity (range: 1.005-1.030; usually 1.010-1.025)

When is it increased? (4)

A

Increased: dehydration, poor kidney perfusion, excess vasopressin/ADH (SIADH, stress, surgery), heart failure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Protein in Urinalysis (Range 0- 8)

When is it increased? (4)

A

stress, infection (will be negative after infection resolved), recent strenuous exercise, Chronic kidney disease (albuminuria)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Urinalysis: Specific gravity (range: 1.005-1.030; usually 1.010-1.025)

When is it decreased? (6)

A

Decreased: old age, chronic kidney disease, diabetes insipidus, malignant hypertension, diuretics, lithium toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Kidney Changes in Chronic Kidney Disease (2)

A
  • hypertrophy of nephrons (to maintain homeostasis)
  • fixed osmolarity of urine (dilute) followed by oliguria (due to inability to dilute urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Electrolyte changes in Kidney disease (4)

A
  • hypernatremia (due to fluid retention)
  • hyperkalemia (when urine output falls under 500 mL/24 hr)
  • hyperphosphatemia and hypocalcemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Metabolic acidosis and Chronic Kidney Disease

What is the cause?
What is the compensation?

A

Cause: reduced bicarbonate reabsorption and excess H+

Compensation: Kussmaul breathing (tachypnea and hyperpnea)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

3 effects of phosphorus and calcium imbalance in Chronic Kidney Disease

A
  • Renal osteodystrophy: bone mineral loss (S/s: bone pain, spinal sclerosis, fractures, bone density loss, osteomalcia, decreased height (due to compacted vertebrae))
  • Metastatic calcification: crystals from calcium-phosphorus deposit in kidneys, heart , lungs, blood vessels (atherosclerotic plaques), joints, eyes (conjunctivitis, brain))
  • Itching
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Cardiac changes in Chronic Kidney Disease (4)

A
  • Hypertension ( dysfunction of RAAS = cycle of vasoconstriction)
  • hyperlipidemia
  • heart failure (heart must work harder)
  • Uremic cardiomyopathy and pericarditis (uremic toxic to heart)– may have narrow pulse pressure, friction rub
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

GI Changes in Chronic Kidney Disease (3)

A
  • Uremic fetor -> halitosis or stomatitis
  • Peptic ulcer disease w/ ulcers cause erosion of blood vessels -> hemorrhagic shock
  • Uremic colitis w/ watery diarrhea or constipation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Neurological Changes in Chronic Kidney Disease (2)

A
  • Uremic encephalopathy: Lethargy, seizures, coma; weakness in upper and lower extremities
  • Peripheral neuropathy: sensory changes in a glove-and-stocking pattern over hands and feet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Hematologic/immunity changes in Chronic Kidney Disease (3)

A
  • Anemia (due to decreased erythropoietin production – S/s: fatigue, pallor, lethargy, weakness, SOB, dizziness
  • Impaired platelet function due to increased bleeding or bruising (S.s: petechiae, purpura, nose or gum bleeds, melena (black tarry stools i.e. intestinal bleeding))
  • Disrupted WBC production and function from uremia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Skin changes in Chronic Kidney Disease (6)

A
  • Yellowish or darkening to brown or bronze due to pigment deposition
  • Sallowness (faded suntan) due to anemia
  • Decreased turgor and skin oils
  • Severe pruritus
  • Uremic frost (layers of urea crystals from evaporated sweat)
  • ecchymosis or purpura (purple patches and rashes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Furosemide, hydrochlorothiazide (diuretics)

Nursing Care (4)

A

Nursing Care
- Monitor for hypokalemia (dysrhythmias, muscle twitching, thready pulse, polyuria, hypoactive bowels)
- Give with potassium-rich food (citrus fruits, potatoes, bananas) (not in chronic kidney disease)
- Give in morning (no doses after 3pm)
- not useful in end-stage kidney disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Nursing Care for Pulmonary Edema (5)

A
  • High-fowler position with oxygen
  • IV furosemide for diuresis
  • IV morphine and nitroglycerin to reduce pulmonary pressure and myocardial oxygen demand via vasodilation
  • Measure urine output hourly
  • Monitor vital every two hours (every hour w/ nitroglycerin and morphine due to hypotension risk)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Nutrition in Chronic Kidney Disease

What needs to be restricted? (4)
What needs supplementation? Why?

A

Limit
- protein (cause of waste buildup i.e uremia)
- potassium (not needed if dialysis or producing urine)
- sodium
- phosphorus (to prevent renal osteodystrophy)

Supplement vitamins and minerals esp iron (due to anemia) and dialysis may remove water-soluble vitamins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Phosphate binders (Ex. Calcium acetate, calcium carbonate, lanthanum carbonate, sevelamer)

Indication
Action
Side effects (3)
Nursing Care (2)

A

Indication: chronic kidney disease for hyperphosphatemia

Action: form insoluble calcium-phosphate complex to prevent hyperphosphatemia

Side effects: constipation, hypophosphatemia (weakness, slow or irregular pulse, confusion), hypercalcemia

Nursing Care
- do not take within 2 hrs of other drugs
- take with meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Patient Education after TURP (6)

A
  • do not swim or bath with catheter
  • do not try to void around catheter (urge to void will be present)
  • increase fluid intake (2-2.5 L) to prevent dysuria
  • temporary incontinence post-op will resolve
  • sex is okay (may have retrograde ejaculation)
  • do kegels to regain voluntary elimination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Post-Op Nursing Care for TURP (7)

A
  • Keep leg straight if catheter is taped to thigh or abdomen
  • Help patient ambulate early
  • Monitor and document the color, consistency, and amount of urine output PRN or q2h
  • For output, subtract amount of irrigating solution from urinary drainage bag
  • Check the drainage tubing frequently for external obstructions (e.g., kinks) and internal obstructions (e.g., blood clots, decreased output)
  • Assess the patient for reports of severe bladder spasms with decreased urinary output, which may indicate obstruction.
  • Use continuous irrigation with NS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

3 Complications of TURP

What to do about them?

A
  • TURP syndrome –Due to irrigation fluid being over absorbed ( S/s: headache, SOB, hypertension, bradycardia, ST elevation, wide QRS, inverted T wave)
  • Arterial bleeding = bright red or ketchup like clots—Need to notify surgeon immediately and irrigate catheter w/ normal saline
  • Venous bleeding = burgundy – need to Inform surgeon and monitor hemoglobin and hematocrit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Preventing Complications in AV graft or fistula (Hemodialysis) - 8 tips

A
  • Prepare skin w/ 2% chlorhexidine
  • B/w hemodialysis sessions, patient should wash area w/ antibacterial soap and rinse with water
  • Avoid constrictive devices such as BP cuffs, tourniquets, venipuncture in same extremity
  • Rotate needle insertion sites w/ each hemodialysis treatment
  • Palpate for thrills and auscultate for bruits over the vascular access site q4h while patient awake
  • Encourage routine range-of-motion exercises and elevate extremity
  • Do not carry heavy objects with extremity with access device
  • Do not to sleep on Vascular access device or put body weight on it
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Contraindications for Peritoneal Dialysis (4)

A
  • Extensive peritoneal adhesions or fibrosis
  • active inflammatory GI disease (diverticulitis, IBS)
  • Ascites or massive central obesity
  • Recent abdominal surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Disequilibrium Syndrome

Cause
Signs and symptoms (6)
Prevention

A

Cause: Due to rapid reduction in electrolytes and other particles after hemodialysis (rare)

S/s: mental status changes, seizures, fatigue, headaches, nausea and vomiting, coma

Prevention: reduced blood flow at onset of symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

2 main Complications of Peritoneal Dialysis

Signs of each
Prevention for each

A

Peritonitis (main complication of PD)
S/s: cloudy dialysate, fever, abdominal tenderness general malaise
Prevention: sterile technique b/c due to connection site contaminations

Bowel perforation or inflammatory bowel disease
* Signs: brown effluent
* Prevent with high-fiber diet, stool softeners, enemas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Nursing Care for Hemodialysis (8)

A
  • Weigh the patient before and after dialysis.
  • Hold certain drugs prior to dialysis and give after dialysis
  • Be aware of reactions that occurred during previous dialysis treatments.
  • Monitor vitals and neurologic status throughout treatment
  • Assess serum laboratory tests to evaluate effectiveness of treatment in removing wastes and achieving desired outcomes (e.g., fluid and electrolyte balance, reduction of uremia).
  • Warm Dialysate (not in microwave)– also do this for peritoneal dialysis to decrease discomfort
  • Give anticoagulation therapy to prevent clotting
  • keep patient supine in low fowler (esp in peritoneal dialysis to prevent leakage at site)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Complications of Peritoneal Dialysis (6)

A

Pain
Leakage of Dialysate fluid
Blood clot
Protein loss
peritonitis
bowel perforation or inflammatory bowel disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

How to use metered-dose inhaler (MDI)? (5 steps)

A
  1. remove cap and shake inhaler
  2. breathe out all the way
  3. put mouth to inhaler and breathe in while pressing down on inhaler
  4. remove inhaler and hold breath for 10 seconds
  5. slowly breath out
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

5 Potential complications after Bronchoscopy (and nursing care for each)

A
  • hypoxemia (maintain airway; give O2; monitor vitals q15 monitor for first two hrs)
  • aspiration (check for gag reflex (pt NPO till return), suction prn)
  • bleeding (hemoptysis)
  • infection
  • bronchospasm (indicated by stridor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Acute findings of Impaired Gas exchange (8)

A

Tachypnea
Tachycardia
Accessory Muscle Use
Paradoxical chest movement (in on inspiration, out on expiration)
Pursed lip breathing
Pale skin
Adventitious Breath Sounds
Mucus/secretions

95
Q

Chronic problems of impaired gas exchange (4)

A

Cyanosis
Clubbing of nails
Barrel chest (emphysema)
Orthopneic

96
Q

Normal ABG values

pH
CO2
pO2
HCO3
O2 sat

A

pH: 7.35-7.45
CO2: 35-45 mm Hg
pO2: 80-100 mm Hg
HCO3: 21-28 mEq/L
O2 sat: 95-100%

97
Q

ABGs: What do the following present as?

Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis

A

Respiratory Acidosis: pH < 7.35; CO2 > 45
Respiratory Alkalosis: pH > 7.45; CO2 < 35
Metabolic Acidosis: pH < 7.35; HCO3 < 21
Metabolic Alkalosis: pH > 7.45; HCO3 > 28

98
Q

Anti-inflammatory drugs for COPD

Corticosteroids (Beclomethasone, Prednisone)

5 patient education points

A
  • use daily b-c max effectiveness w/ 48-72 hrs of continued use
  • Side effects: increase risk for infections (Candida albicans in mouth; URI if around people w/ one)
  • avoid Risky activities (fragile BVs increase risk for bruising and petechiae)
  • do not stop abruptly stop drug b-c it suppresses adrenal production of essential corticosteroids
  • take with food to reduce risk for GI ulceration
99
Q

Bronchodilators for COPD

SABA (albuterol) -1
LABA (arformoteral) -1
Anticholinergic (ipratropium) -3

A

SABA
- for acute relief

LABA
- for long term relief

Anticholinergic
- prevent COPD bronchospasm
- carry at all times
- S/s of overdose: blurred vision, eye pain, headache, nausea, palpitations, tremors, inability to sleep, dry mouth (increase fluids)

100
Q

Other drugs for COPD

Mucolytics (Acetylcysteine, dornase alpha, guaifenesin) - 2
Oxygen - 2

A

Mucolytics (Acetylcysteine, dornase alpha, guaifenesin)
- thins secretions so easier to expectorate and cough up
- guaifenesin can raise cough threshold

Oxygen
- Usually oxygen flow of 2-4 L/min via nasal cannula or 40% via venturi mask
- ALL hypoxic patients should get oxygen therapy so SpO2 b/w 88-92%

101
Q

COPD: Breathing Exercises

  • Diaphragmatic/ abdominal breathing
  • Pursed-lip breathing (2)
A

Diaphragmatic/ abdominal breathing
- Patient consciously increases movement of diaphragm while lying on back to relax abdomen

Pursed-lip breathing
- Mild resistance created by breathing through pursed lips to prolong exhalation and increase airway pressure
- Delays airway compression and reduces air trapping

102
Q

7 Nursing Care for patient w/ chest tube

A
  • Inspect insertion site( eyelets of tube should not be visible; s/s of infection (redness, purulent drainage, excess bleeding))
  • Palpate Insertion Site (may have subQ emphysema if puffiness or crackling
  • Ensure Intact Dressing at Site
  • Assess/reassess Respiratory Status (breathing, pulse ox, breath sounds)
  • Observe Trachea (tension pneumothorax if shifted)
  • Assess/reassess Pain (give meds and reposition)
  • Encourage Cough, Deep Breathing, Incentive Spirometry
103
Q

9 Nursing Care for chest tube system

A
  • Avoid kinks, Occlusions, or Loose Connections (should be straight)
  • Do NOT Strip/Milk Tubing
  • Keep Drainage System Below Level of Chest
  • Assess for “Tidaling” (water level rises inhalation and fall exhalation)
  • bubbling seen on exhalation, forceful cough, position changes (EXCESS BUBBLING = air leak)
  • Always have at least 2 cm of water to prevent air from returning to patient in water seal chamber
  • Limit clamping of a chest tube b-c will increase pressure in pleural space and may cause tension pneumothorax
  • No need to disconnect chest tube for transport
  • never let drainage come in contact w/ tubes (can cause tension pneumothorax)
104
Q

9 Emergency Situations w/ Chest tube

A
  • Tracheal Deviation
  • Sudden onset of increased dyspnea
  • O2 sat <90%
  • Drainage >70ml/hr (D)
  • Visible eyelets on chest tube
  • Chest tube falls out of the patient’s chest (first, cover the area with dry, sterile gauze)
  • Chest tube disconnects from the drainage system (first, put end of tube in a container of sterile water and keep below the level of the patient’s chest)
  • Drainage in tube stops (in the first 24 hours)
  • Drainage bloody after a couple days (drainage is always bloody in first few hrs)
105
Q

Expected Glucose levels (what indicates problem?)

Normal range
Fasting glucose
Oral glucose test
Rapid glucose check
Glycosated hemoglobin (HbA1C)

A

Normal Range (70-110)

Fasting plasma glucose (FPG) - >126mg/dL (8 hrs. after fasting, can have water while fasting)

Oral glucose tolerance test (OGTT)- > 200mg/dL (2hrs after oral glucose test; pt fasts 10-12 hrs prior to test)

Rapid glucose check - >200md/dL (Finger prick; no fasting required)

Glycosylated hemoglobin (HbA1c) - >6.5 % (measures Average of blood glucose over 3 months, the lifespan of RBC b-c glucose binds to Hgb A)– target <7% for diabetic

106
Q

SubQ Insulin: Rapid Acting (aspart, lispro)

Onset
Peak
Nursing Care (2)

A

Onset: 15 min
Peak: 30 min - 1.5 hr

Nursing Care
- used w/ longer-acting
- meal must be eaten at time of injection

107
Q

SubQ Insulin: Intermediate Acting (NPH, Novolin 70/30)

Onset
Peak
Nursing Care (3)

A

Onset: 1.5 hr
Peak: 4-12 hr

Nursing Care
- covers insulin needs b/w meals or overnight
- can be combined w/ rapid or short acting insulin (ALWAYS PULL UP SHORTER ACTING ONE FIRST TO AVOID CONTAMINATION)
- appears white and cloudy

108
Q

SubQ Insulin: Short Acting (regular)

Onset
Peak
Nursing Care (2)

A

Onset: 30 min
Peak: 2-5 hr

Nursing Care
- covers insulin needs for meal within 30-60 minutes
- only insulin that can be given via IV (usually for DKA in ICU)

109
Q

SubQ Insulin: Long Acting (glargine, detemir)

Onset
Peak
Nursing Care (3)

A

Onset: 1-4 hr
Peak: none

Nursing Care
- give once daily at same time each day
- never mix with another insulin
- never give IV (always give subQ)

110
Q

3 Complications of Insulin therapy (and prevention)

What are they?
How can it be prevented?

A

Hypoglycemia
- prevent w/ sliding scale checks

Lipoatrophy (uneven tissue) and Lipohypertrophy (lumps of fatty tissue)
- prevent by rotating sites within same area of body to also prevent change in absorption rates

Dawn phenomenon
- 5-6am rise in glucose due to cortisol release
- Prevention: Check blood glucose at bedtime and adjust insulin accordingly

111
Q

S/s of hypoglycemia (9)

A
  • Tremors and lack of coordination
  • restless and irritability
  • Blurred vision (temporary)
  • Seizures -> coma
  • Excessive hunger
  • Cold, clammy skin
  • Pallor
  • CNS decline (headache, confusion, fatigue, drowsiness, depression, dizziness, slurred speech)
  • SNS activation (tachycardia, diaphoresis, nervousness, palpitations)
112
Q

Patient Education Diabetes: Foot care (11)

A
  • Trim nails trimmed straight across w/ clippers or emery board
  • Inspect and wash feet daily with mild soap and warm water
  • Test water temperature with the arms or a thermometer before washing feet.
  • Do not soak the feet.
  • Pat feet dry gently, especially between the toes,
  • Avoid lotions between toes to decrease excess moisture and prevent infection.
  • Use mild foot powder (powder with cornstarch) on sweaty feet.
  • Do not use commercial remedies for the removal of calluses or corns (can increase risk for tissue injury and infection)
  • Separate overlapping toes with cotton or lamb’s wool.
  • Do not use hot water bottles or heating pads to warm feet. (use socks)
  • Avoid prolonged sitting, standing, and crossing of legs.
113
Q

Patient Education Diabetes: Footwear (7)

A
  • Avoid open-toe, open-heel shoes
  • Leather shoes are preferred to plastic.
  • Wear shoes that fit correctly.
  • Wear slippers with soles
  • Do not go barefoot.
  • Wear clean, absorbent socks or stockings that are made of cotton or wool
  • Wear socks at night if the feet get cold.
114
Q

Patient Education Diabetes: Exercise (5)

A
  • less insulin needed if exercising
  • Exercise (150/min/week at least 3 sessions a week)
  • Only exercise if glucose b/w 80-250 mg/dL (check glucose prior to exercise)
  • Do not exercise if ketones in urine
  • Consume carbohydrate snack prior to exercise IF 1 hr since last eating and high-intensity exercise planned
115
Q

Patient Education Diabetes: Illness (5)

A
  • Illness and stress can increase glucose levels so continue insulin even if not eating
  • Monitor blood glucose q2-4 hrs
  • Monitor urine for ketones q3-4 hrs or if blood glucose > 240 mg/dL
  • Drink 8-12 oz (240-260 mL) of sugar-free, non caffeinated liquid every hr OR Drink fluids w/ sugar if blood glucose low
  • Meet carb needs w/ soft food or liquids 6-8 times a day (Soft foods: custard, cream soup, gelatin, graham crackers)
116
Q

Patient Education Diabetes: Nutrition (7)

A
  • watch protein levels if kidney involved (aim for 15-20% of diet)
  • Eat at regular times and do not skip meals
  • eat consistent amounts of food
  • Avoid alcohol
  • Increase fiber for carb metabolism and cholesterol control
  • artificial sweeteners encouraged
  • Low fat diet but include omega-3 fatty acids in diet
  • If NPO, may still need insulin
117
Q

Treatment for hypoglycemia

If conscious (3)
If unconscious (2)

A

If responsive
- Simple Carbohydrates (6 crackers, 2 graham crackers, 4 oz fruit juice, 4 oz 2% milk; glucose tablets)
- repeat if hypoglycemia persists
- If hypoglycemia resolved and next meal > 1 hr away, take snack w/ carb and protein

If unresponsive or seizing
- 1 amp (50ml) dextrose 50% (D5W) IV push or 1mg glucagon SQ
- place lateral to prevent aspiration

118
Q

Nursing Care for TPN (5)

A
  • monitor glucose (risk for hyperglycemia w/ TPN; risk for hypoglycemia if no TPN)
  • If TPN stops, give D10 to prevent hypoglycemia
  • Monitor labs (albumin, prealbumin, glucose)
  • regularly assess IV b-c risk for phlebitis/ infection w/ high glucose
  • prevent hypoglycemia by call pharmacy prior to bag running out
119
Q

Categories of Surgery

  • Diagnostic
  • Curative
  • Reconstructive
  • Palliative
  • Cosmetic
  • Preventative
  • Transplantation
A
  • Diagnostic: Determines origin and cause of disorder (ex. biospy, arthroscopy)
  • Curative: Repairs or removes cause to resolve problem(ex. removal of organ or tumor)
  • Reconstructive: Improves functional ability of abnormal body structure (ex. total hip/knee replacement)
  • Palliative: Improves quality of life, but does not cure (ex. ileostomy, stents, thoracentesis)
  • Cosmetic: alters/enhances personal appearance (ex. rhinoplasty, face lift)
  • Preventative: Prevents condition from developing (ex. prophylactic bilateral mastectomy)
  • Transplantation: Replaces malfunctioning structure (ex. heart/kidney transplant)
120
Q

Urgency of Surgery (3)

A

Elective- Can be scheduled (ex. cataract removal, joint replacement)

Urgent - Must be performed in 24 hrs (ex. obstruction, kidney stones, fracture, cholecystitis)

Emergent - Life-threatening so surgery ASAP (ex. wound, severe bleeding, aortic aneurysm, compound fracture, appendectomy)

121
Q

8 SCIP (Surgical Care Improvement Project) Data elements

A
  • Antibiotics given within 1 hour prior to surgical incision.(Vancomycin and Fluoroquinolones=2 hours)
  • Prophylactic antibiotics should be discontinued within 24 hours of anesthesia end time (48 hours for CABG patients) (Reason for continuing antibiotics > 24 hours after anesthesia end time (48 hours for CABG patients) must have a physician documented infection)
  • Appropriate hair removal (clippers vs razor)- prevents infection
  • Normal patient temperature (36.0 C or greater) within 30 minutes prior to or 15 minutes after anesthesia end time
  • If beta blocker in hx, must continue day before surgery/ day of surgery AND post op day 1/post op day 2 (If not given, contraindications must be documented)
  • VTE (DVT) prophylaxis must be applied/administered within 24 hours prior to anesthesia start time or 24 hours after anesthesia end-time.
  • Foley discontinued by post-op day 2 or obtain physician order for specific reason to continue foley.
  • Cardiac Surgery patients require Controlled Postoperative Blood Glucose levels less than or equal to 180 within 18-24 hours after anesthesia end time
122
Q

Preoperative Phase: Medical History (2)

A
  • Medical history (including renal, musculoskeletal, cardiac, pulmonary dz.) b-c these can increase risk for complications
  • hx of prostheses (do not place electrocautery pads on these area)
123
Q

Preoperative Phase: allergies (2)

A
  • Latex allergy cross sensitivity w/ avocado, banana, kiwi, strawberry allergies
  • Propofol allergy cross sensitivity w/ egg, peanut, and soy allergy
124
Q

Preoperative Phase: social and family history (5)

A
  • Family History- (malignant hyperthermia, cancer, bleeding disorder)
  • Prescription drugs/OTC
  • Complementary/alternative practices (herbals, folk remedies)
  • Alcohol - DT if abrupt withdrawal
  • Substance abuse, tobacco use, marijuana use - smoking can increase risk for pulmonary complications
125
Q

Preoperative Phase: surgical History (3)

A
  • Prior surgical procedures and how these were tolerated (previous complications, may increase anxiety)
  • Prior experience with anesthesia (e.g., difficulty being aroused after surgery, ongoing nausea and vomiting)
  • Prior experience with postsurgical pain control
126
Q

Preoperative Care: Imaging/Diagnostics testing (3)

A
  • Chest X-ray (identify pneumonia, TB, HF, cardiomyopathy if hx of respiratory problems)
  • Electrocardiogram/EKG (if hx of cardiac disease or > 40 yrs)
  • CT/MRI- May be done for back surgery
127
Q

Preoperative care: Labs that may contraindicate surgery (4)

A
  • Hypokalemia (digoxin toxicity, slower recovery from anesthesia, cardiac irritability)
  • hyperkalemia (dysrhythmias)
  • Positive pregnancy test result (or patient report of actual or possible pregnancy)
  • Increased prothrombin time (PT), international normalized ratio (INR), or activated partial thromboplastin time (aPTT)
128
Q

Preoperative Care: Nutrition and Diet (4)

A
  • usually NPO (no clear liquid <2 hrs, no food < 6 hr) to prevent risk for aspiration
  • No eating, drinking, smoking (increases gastric secretions), chewing gum or oral meds
  • may give drugs for some conditions (Beta blockers, respiratory, anticonvulsants, antihypertensives) w/ sip of water
  • may continue subQ insulin to prevent DKA (other antidiabetics are held)
129
Q

Preoperative Care: Integumentary (4)

A
  • shower or bath w/ antiseptic
  • Clipping of hair with electric clippers (no razor)
  • surgeon must mark site while patient conscious
  • large bore IV placed (for meds and blood if necessary in emergencies)
130
Q

Informed Consent

Surgeon role
Nurse Role (3)

A

Surgeon role
- explain procedure and get informed consent prior to procedure

Nurse role
- sign as a witness to the signature on consent (not to patient’s understanding)
- clarify facts as needed
- not responsible for providing detailed info about procedure

131
Q

Informed Consent

Variations (5)

A
  • Pts who cannot write (sign w/ X and two witnesses)
  • Pt w/o competence (legal guardian, POA or Court appointed advocate gives consent)
  • Pt w/ blindness (can sign w/ two witnesses)
  • Pt w/ hearing impairment or different language (can sign w/ qualified translator and another witness)
  • Life threatening (can’t give consent, unable to contact person with medical power of attorney-written consultation with 2 independent HCP required)– does not override living wills/ advance directives
132
Q

Postoperative care: VTE

S/s
Intervention (5)

A

S/s: sudden swelling or dull ache in calf of one leg

Prevention
- Antiembolism stockings (TED Hose) and Sequential Compression Devices (SCD)
- Anticoagulants (enoxaparin, heparin) within 24 hrs and continue for 14 days
- Leg Exercises (practice prior to procedure)
- Early ambulation (stimulates venous return)
- do not place pillows under knees b-c reduces circulation

133
Q

Patient preparation for Intraoperative (6)

A
  • ID band (name, hospital number, birthdate)
  • Removal of clothing (may leave underwear and socks for some surgeries, dentures, jewelry, piercings
  • Removal of prosthetics (limbs, eyes)
  • Removal of all metal (i.e., hairclips, pins) - can cause burns w/ electrical current
  • Nail polish/artificial nails (at least one clean)
  • Empty bladder - to prevent incontinence or overdistention
134
Q

Postoperative Care: GI

Complications (4)

A
  • Nausea/vomiting (risk for increased ICP or IOP, abdominal irritation, aspiration)
  • GI ulcers/bleeding
  • paralytic ileus (due to anesthetics, bowel handling during surgery, opioids, or SNS excitation from stress)
  • Constipation (due to anesthesia, opioids, decreased activity, decreased oral intake
135
Q

Postoperative Care: Neuromuscular

Complications (3)
Prevention

A

Complications
- Hyper/Hypothermia
- Nerve damage/paralysis
- Joint Contractures

Prevention
- early ambulation (prevents joint rigidity)

136
Q

Postoperative care: Drains and Dressings

Purpose (2)
Expectations (2)
Nursing Care (2)

A

Purpose
- remove fluid, air, blood, bile
- prevent deep infection and abscess formation

Expectations
- drainage goes from sanguineous to serosanguineous to serous
- surgeon changes first dressing

Nursing Care
- circle, date, time drainage on dressings
- secure drains to pt’s gown and not sheet or mattress

137
Q

Postoperative Care: Evisceration (8)

A
  • Ask someone to notify Surgeon b-c SURGICAL EMERGENCY
  • Stay with patient and calm them
  • Do not attempt to reinsert the organ
  • Cover wound with pre-moistened saline non-adherent dressing or Moisten sterile gauze with sterile saline (STERILE TECHNIQUE)
  • Keep dressings moist (do not let dressing dry out)
  • Place supine position with hip and knees bent
  • HOB elevated 15-20 degrees
  • Pt NPO until issue resolved
138
Q

Preparation for Bronchoscopy (4)

A
  • Explain procedure and verify consent given
  • Document patient allergies
  • Patient is NPO 4-8 hrs prior to procedure (and 2 hrs after until gag reflex returns) to prevent aspiration
  • Benzos or opioids given for sedation
139
Q

Bronchoscopy: Benzocaine

Use
Complication
s/s of complication (3)
Treatment of complication (2)

A

Use: topical anesthetic used cautiously to numb oropharynx

Complication: methemoglobinemia (conversion of hemoglobin to methemoglobin which does not carry oxygen so leads to tissue hypoxia)—less likely with lidocaine

S/s: cyanosis after topical anesthetic, no response to supplemental oxygen, blood is chocolate-brown color

Treatment: oxygen and IV of 1% methylene blue

140
Q

COPD: nonpharmacological management of impaired gas exchange (5)

A
  • Positioning (HOB elevated, orthopneic )
  • Effective and controlled coughing ( scheduled coughing in morning, prior to bed, and at meals)
  • Exercise conditioning (2-3 times a week of walking; resistive breathing, isocapnic hyperventilation machine)
  • Suctioning (only if weak cough, pulmonary muscles or inability to expectorate)
  • Hydration ( 2L of fluid a day)
141
Q

COPD: Weight loss prevention (8)

A
  • Collab w/ RDN for easy to chew and non-gas forming foods
  • High calorie, high protein
  • Plan biggest meal of day when pt most hunger and well rested
  • 4-6 small, frequent meals preferred to 3 large meals
  • Use breathing techniques and bronchodilators 30 minutes prior to meal to reduce bronchospasm
  • Avoid dry foods that stimulate coughing
  • Avoid caffeine that can increase urine output and lead to dehydration
  • Avoid drinking fluids before or during meals if early satiety
142
Q

COPD: Improving Endurance

Patient Education (5)

A
  • Avoid rushing in morning b-c can increase dyspnea
  • Use energy conservation (plan and pace activities for best tolerance and minimum discomfort i.e. divide activities into smaller parts)
  • Avoid working w/ arms raised (raised arms reduce exercise tolerance b-c accessory muscles work to keep arms up instead of helping w/ breathing)
  • Do not talk during activities requiring energy (walking)
  • Avoid breath holding while performing any activity
143
Q

Acute Complications of Diabetes (When to call HCP) - 8

A
  • Presence of moderate to large urine ketones or ketonuria for more than 24 hr
  • Blood glucose > 250 mg/dL that does not resolve with treatment
  • Fever > 38.6° C (101.5° F), does not respond to acetaminophen, or lasts more than 24 hr
  • Feeling disoriented or confused
  • Experiencing rapid breathing
  • Persistent NVD
  • Inability to tolerate liquids
  • Illness >2 days
144
Q

Postoperative Care: Respiratory Complications

Prevention (8)

A
  • Breathing exercises (expansion breathing, diaphragmatic breathing)
  • Incentive spirometry (seal lips, inhale, hold 3-5 sec, exhale to promote lung expansion)
  • Coughing and splinting (w/ bath blanket or pillow) q1-2 hrs (contraindicated in some surgeries)
  • give older adult low dose oxygen first 12-24 hrs
  • monitor O2, lung sounds q2-4 hrs for first 24 hr
  • positioning (side lying or semi fowlers)
  • suction PRN
  • early ambulation (lung expansion; turn q2h)
145
Q

Postoperative Care: Respiratory

Signs of complications (5)

A
  • If RR <10 breaths/min, may be anesthetic or opioid analgesic-induced respiratory depression
  • If rapid, shallow respirations, may be shock, cardiac problems, pain, increased metabolic rate
  • stridor or snoring may be due to airway obstruction
  • accessory muscle use may be excess anesthesia, airway obstruction, paralysis
  • spO2 < 95%
146
Q

Postoperative Care: Neurologic Complications

Prevention/Interventions (2)

A
  • assess LOC, awareness, motor/sensation, DTRs
  • If received sedation or general anesthesia in ambulatory setting, need another adult to drive them home
147
Q

Postoperative Care: Neurologic

Signs of Complications (4)

A
  • Eye opening to command = arousability and wakefulness but not aware
  • back pain while coughing or straining = may be epidural hematoma
  • occipital headache = postdural puncture headache)
  • nuchal rigidity, high fever, acute confusion = meningitis
148
Q

Postoperative Care: Nausea and Vomiting

Prevention/ treatment (2)

A
  • give medication (ondansetron and dexamethasone)
  • Positioning (side-lying position, raise HOB)
149
Q

Postoperative Care: Paralytic Ileus

Prevention/ Treatment (7)

A
  • auscultate bowel sounds (no flatus or stool = paralytic ileus)
  • NGT insertion to decompress stomach
  • hydration (dehydration can decrease GI motility)
  • early ambulation (stimulates intestinal motility)
  • non opioid pain management
  • alvimopan – accelerates the time for GI recovery after some GI surgeries
  • metoclopramide- promotes peristalsis via stimulation of GI motility
150
Q

Postoperative Care: Constipation

Prevention/Treatment (4)

A
  • increased fiber
  • enemas
  • mild laxatives and bulk forming agents
  • hydration
151
Q

Postoperative Care: Cardiovascular

Signs of Complications (4)

A
  • Decreased BP, pulse pressure, abnormal heart signs = cardiac depression, fluid volume deficit, shock, hemorrhage, effects of drugs
  • Increased pulses = hemorrhage, shock, pain
  • Pulse deficit (difference b/w apical and other pulses) = dysrhythmia
  • Bradycardia = hypothermia, anesthesia effect
152
Q

Postoperative Care: Kidney/Urinary

Signs of complication (2)

A
  • Urinary retention may be from pre-op drugs (atropine), anesthetics, manipulation during surgery
  • Report urine output of <30 mL/hr (may indicate hypovolemia or renal complications)
153
Q

Postoperative Care: Integumentary

Prevention (5)

A
  • check dressing and drainage (color, amount, consistency, odor)
  • change dressing w/ aseptic technique
  • splint incision to prevent evisceration or dehiscence
  • early ambulation (relieves pressure)
  • assess site prn or every shift for warmth, redness, drainage
154
Q

Postoperative Care: Integumentary

Signs of complication (3)

A
  • Large amount of sanguineous drainage = poor clotting and internal bleeding
  • Serosanguineous drainage after 5th day or increased amount = dehiscence sign
  • redness or swelling around incision, excess tenderness or pain on palpation, purulent odorous drainage = surgical site infection
155
Q

Complications of COPD (6)

A
  • Hypoxemia (leads to polycythemia)
  • Acidosis (r/t CO2 retention and hyperinflation)
  • Respiratory infection (due to increased mucus; pneumonia and influenza vaccines important)
  • Cor pulmonale (right sided heart failure due to pulmonary disease leads to right ventricular hypertrophy and backup of blood into venous system; S/s: dependent edema)
  • Dysrhythmias (due to hypoxemia, drug effects, acidosis)
  • Respiratory Failure
156
Q

Failure to rescue problems for Intestinal obstruction (5)

A
  • Fecal Impaction
  • Peritonitis (infection of peritoneal cavity)
  • Septic shock
  • Intra-abdominal pressure (Acute compartment syndrome)- esp if strangulated
  • perforation of intestine
157
Q

Colostomy

What is it?
Indications (3)
Nursing care (4)

A
  • removes the sigmoid colon, rectum, and anus through combined abdominal and perineal incisions

Indications: tumor, diverticulitis, bowel obstruction

Nursing Care
- NGT decompression until peristalsis returns post-op
- examine stoma, skin around stoma
- Assess the pouch system for proper fit and signs of leakage
- Assess for signs of complications (unusual bleeding OR ischemia/necrosis (dark red, purplish, or black color; dry stoma)

158
Q

Stomas: Expected Findings (5)

A
  • should be red pink, painless (black or purple = bad)
  • Protrudes 3 cm from abdominal wall (prolapse if more and treat like evisceration)
  • Functions in 2-3 days
  • heals in 2 months
  • Surrounding skin around should be intact, smooth, w/o redness or excoriation (no folliculitis or dermatitis)
159
Q

Signs of GI Bleeding (5)

A
  • Hematochezia (bright red stools) – lower GI bleed
  • Melena (black, tarry, or dark red sticky stools)
  • Upper GI Bleed (Dark blood)
  • shock (low hct/hgb, low BP, high HR, weak pulses)
  • dizziness, confusion, vertigo, syncope
160
Q

Signs of stomach perforation (3)

A
  • sudden sharp mid-epigastric pain spreads over abdomen (often radiates to right shoulder
  • peritonitis (infection w/ tender, rigid, boardlike abdomen AND rebound tenderness)- fetal position for relief
  • Shock manifestations (hypotension, tachycardia, dizziness, confusion)
161
Q

Stomas: Patient education (4)

A
  • Use barrier skin cream
  • Empty pouch when 1/3 to 1/2 full
  • Assess stoma and change wafer and pouch weekly (wafer 1/8th wider than stoma)
  • Caution w/ high fiber foods b-c can cause gas and odor
162
Q

CART therapy in HIV

Therapeutic Effect - 2
Preparation - 1

A

Therapeutic Effect
- controls viral replication to reduce viral load in 4 weeks and increases T-cell count
- U=U (undetectable viral load (< 200 for > 6 months) = untransmittable via sex)

Preparation
- genosure resistance paneling (determine hypersensitivity to drugs to determine what to use

163
Q

Stages of HIV (5)

A

Initial Exposure

Primary HIV (acute): flu-like symptoms within 4 weeks; antibodies in 1-6 months

Asymptomatic HIV (seropositive): infectious but no evidence except positive HIV antibody test

Symptomatic HIV: can be 10 yrs after initial exposure

AIDS: diagnosis made if T-cell count is ever < 200 OR less than 14% OR opportunistic infection (diagnosis remains forever)

164
Q

HIV testing

3 generations of ELISA
Notes (3)

A

ELISA
1st generation (1980s): IgG
2nd generation (1991): IgG
3rd generation (1992): IgM & IgG

Note
* 1st-3rd gen need western blot after if positive b-c can indicate influenza as well
* takes 3 months for antibodies to appear after antigen
* takes 14-21 days for antibody to be detected and then 7 days for western blot to confirm

165
Q

HIV testing: 4th Generation Testing (2010)

Process (3)
Timing (2)

A

Process
- Detects ANTIGEN & ANTIBODY via antigen/antibody immunoassay
- If positive, use antibody differentiation immunoassay
- If antibody differentiation immunoassay is negative or indeterminate, use nucleic acid test to determine if acute HIV infection (RNA present)

Timing
- detects HIV-IgM and IgG antibodies (positive in 21 days)
- detects presence of p24 antigen (HIV capsid protein which is positive in 14 days)

166
Q

HIV Transmission

Routes (3)

A
  • Parenteral (needle sharing; contaminated equipment w/ blood)
  • Perinatal (vertical; from placenta due to contact w/ maternal blood and body fluids or breast milk)
  • sexual (genital, oral or anal b-c exposure to mucous membranes) - esp. anal or male-to-female
167
Q

Pre Exposure Prophylaxis (PrEP) – ex. Truvada (tenofovir/emtricitabine) AND Discovy (emtricitabine/tenofovir)

Indication
Routine (2)
Concern
Testing (3)

A

Indication: use of HIV Antiretroviral drugs by HIV-uninfected adult to prevent infection

Routine
- once daily w/ prescription
- Protection starts after 7 days of consistent dosing (can miss one and be okay; if miss > 2, need to wait 7 days for protection again)

Concern: Black box warning for severe acute exacerbation of hep B

Testing
* Blood and urine testing plus liver and kidney function (test kidney q3 months)
* other STI tests, hepatitis test
* 4th gen HIV antigen/antibody testing to ensure HIV negative b-c not for HIV positive

168
Q

Recommendations for Preventing HIV Transmission by Healthcare Workers (3)

A
  • Standard Precautions (gloves for body fluids)
  • If sharps related; first wash wound for 1 full minute then contact employee health
  • If you perform exposure-prone procedures, know your HIV antibody status.
169
Q

Postexposure Prophylaxis (PEP)

Indication (2)
Routine (2)
Testing (2)

A

Indication: occupational exposure (sharps, body fluids of HIV positive pt w/ blood, broken skin or mucus membranes of HCP), nonoccupational exposure (consensual sexual exposure w/ person of unknown HIV status OR sexual assault)

Routine
- 3 drug regimen within 2-36 hrs of exposure for 28 days OR until HIV status negative
- no prescription needed

Testing
- Periodic HIV testing at 1, 3, and 6 months
- CBC, electrolytes, creatinine tests done 2 weeks after starting cART

170
Q

HIV: Viral load testing

Process (3)
Results (3)
Concern

A

Process
- Measures actual amount of HIV viral RNA particles in 1 mL of blood to measure therapy effectiveness
- positive within 10 days of exposure
- takes 14 hrs for test to process

Results
* Uninfected adult: no viral load
* Positive load: as little as 20 particles/mL or > 1 million particles/mL
* Higher the load, higher risk of transmission

Concern: some immune systems may suppress viral replication and cause false low; so 4th gen testing needed alongside viral load testing

171
Q

cART therapy: Immune reconstitution inflammatory syndrome (IRIS)

Cause (2)
S/s
Treatment

A

Cause
- Seen when CD4+ T-cell count rises, and immunity normalizes then becomes exaggerated
- Result of T-cell recognizing opportunistic infections (esp TB) and sounding alarm about them

s/s: inflammatory reaction (high fever, chills, maybe worsened disease)

Treatment: short-term therapy w/ corticosteroids (Ideally treat Opportunistic infections prior to starting cART)

172
Q

CART therapy in HIV

Patient Education (5)

A
  • Do not stop taking drugs or change therapy once viral load decreases b-c drugs are not a cure
  • Must take drugs correctly 90% of time (9 out of 10 doses on time and correct) - Do not miss, delay, or take lower than prescribed dose
  • Drug resistance r/t missed doses causing new resistant viral particles (Once resistant to a drug, that drug no longer able to be used b-c resistant virus is archived indefinitely in body)
  • many drugs cause liver toxicity (report to HCP any jaundice, NV, abdominal pain)
  • If pregnant, check w/ HCP because some drugs cause birth defects but other drugs can help reduce transmission to baby
173
Q

HIV: When to notify HCP (5)

A
  • Temperature > 100° F (37.8° C)
  • Persistent cough (with or without sputum)
  • Pus or foul-smelling drainage from any open skin area or normal body opening
  • Presence of a boil or abscess
  • Urine that is cloudy or foul smelling or that burns on urination
174
Q

HIV: Patient education w/ low WBC (T-cell < 800) - 11

A
  • Avoid crowds and other large gatherings of people.
  • Do not share personal articles such as toothbrushes, toothpaste, washcloths, or deodorant sticks.
  • If possible, bathe daily, using an antimicrobial soap. If total bathing is not possible, wash the armpits, groin, genitals, and anal area twice a day with an antimicrobial soap.
  • Clean your toothbrush at least weekly by either running it through the dishwasher or rinsing it in liquid laundry bleach (and then rinsing out the bleach with hot running water)
  • Wash your hands w/ antimicrobial soap before you eat or drink, after touching a pet, after shaking hands with anyone, as soon as you come home from any outing, and after using the toilet.
  • Avoid eating or touching undercooked meat, fish, and eggs.
  • Wash dishes between use with hot, sudsy water or use a dishwasher.
  • Do not change pet litter boxes or play in gardens. If unavoidable, use gloves and wash hands immediately.
  • Avoid turtles and reptiles as pets.
  • Take your temperature at least once a day and whenever you do not feel well.
  • Avoid travel to areas with poor sanitation or primitive health care facilities
175
Q

Thrombotic vs embolic ischemic stroke

Location
Onset

A

Thrombotic
- Location: atherosclerosis of carotid and cerebral arteries esp bifurcation of carotid
- Onset: slow and gradual w/ gradual progression of deficits

Embolic
- Location: clot breaks off and travels to cerebral arteries esp. due to a-fib
- onset: sudden w/ immediate neurologic deficits

176
Q

Risk of Hemorrhagic stroke: vasospasm (3)

A

Vasospasms
- causes constriction of cerebral artery leading to decreased blood flow at distal areas
- can lead to subsequent strokes or seizure activity due to ischemia to cerebral tissue
- within 4-14 days after stroke occurrence

177
Q

Medical Management: Stroke

Anticoagulants (ex. heparin, enoxaparin, warfarin, clopidogrel, aspirin)

Implications (2)

A

Implication
- high risk drugs that can cause bleeding included IC hemorrhage
- aspirin (325 mg enteric coated) given within 24-48 hours of onset of stroke

178
Q

Medical Management: Stroke

Nimodipine (CCB)
- Implication (2)

A

Implication
- relaxes smooth muscles of vessel walls
- given to reduce incidence and severity of vasospasm rather than for HTN

179
Q

Medical management: stroke

Alteplase (TPA; fibrinolytic)
- Time (2)
- Risk

A

Time
- give within 3 hrs of initial stroke symptoms to reduce severity of neurological deficits in ED
- can be given in 4.5 hrs sometimes

Risks
- bleeding esp IC hemorrhage

180
Q

FAST for Stroke

A

Facial Drooping
Arm Weakness
Speech Difficulty
Time to call 911

181
Q

Acute management of stroke (3)

A
  • seen within 10 minutes in ED for stroke like symptoms (hx should not delay treatment)
  • glasgow and NIHSS assessments done routinely for patients admitted w/ stroke
  • Rule out pathophysiological causes (hypoxia and hypoglycemia)
182
Q

Acute symptoms of Stroke (7)

A
  • confusion (trouble speaking or understanding others)
  • numbness or weakness of the face, arm
  • trouble seeing in one or both eyes
  • dizziness, trouble walking, or loss of balance or coordination
  • severe headache with no known cause (esp. aneurysm r/t)
  • embolic stroke: new-onset heart murmur, dysrhythmias, HTN
  • hemorrhage subarachnoid: NV, photophobia, stiff neck, CN deficits
183
Q

Neurological Status: When to notify HCP (4)

A
  • decreases of 2 or more points on Glasgow coma scale
  • posturing (flaccid or extension)
  • pinpoint, dilated or nonreactive pupils
  • sudden changes in mental status (earliest sign of change in neurological status)
184
Q

Stroke: Nursing care for Communication deficits (7)

A
  • Present one thought in a complete sentence
  • give one-step command
  • Face client and speak slowly NOT loudly
  • Repeat names of objects used on routine basis
  • Avoid yes/no questions b-c - patients may give automatic but incorrect responses to yes/no question
  • Use alt communication (flash cards, computer, picture or communication board)
  • do not rush patient when speaking
185
Q

Stroke: Motor deficits (5)

A
  • right hemisphere = hemplegia to left side of body
  • left hemisphere = hemiplegia to right side of body
  • decreased blood flow to brainstem = total paralysis (quadriparesis)
  • Weakness (facial droop, arm or leg drift, hand grasp)
  • Ataxia (lack of muscle control and coordination affecting gait, balance, and ability to walk)
186
Q

Stroke: Nursing care for mobility deficits (5)

A
  • VTE protocol (SCDs, position changes, ambulation)
  • assess patient’s ability to perform ADL in home-setting
  • be aware of patient’s extremities (do not pull)
  • position arm on pillow to prevent shoulder dislocation/subluxation
  • instruct all staff working with patient about any deficits in mobility to prevent harm to patient (no pulling affected extremity)
187
Q

Stroke: Nursing Care for Swallowing deficits (8)

A
  • Maintain NPO until SLP screen
  • Assess for gag reflex w/ small liquid
  • Assess mouth for increased drooping/drooling
  • Position patient upright before feeding/eating
  • Check diet orders (soft, mechanical soft thickened liquids) b-c thin cause more coughing)
  • Place food in back of mouth to prevent trapping in cheek
  • Monitor for s/s of aspiration (coughing, dyspnea, crackles)
  • stop feeding if patient coughs
188
Q

Stroke: Sensory deficits

Sensation - 3
Visual - 6

A

Sensation
- Numbness (Decreased sensation)
- Unilateral Neglect (unaware of affected side)
- vertigo

Visual (r/t brainstem damage)
- Ptosis (eyelid drooping)
- Hemianopsia (blindness in half of visual field)
- Nystagmus
- tunnel vision
- diplopia (double vision)
- blurred

189
Q

Stroke: Nursing care for sensory deficits

Visual - 4
Memory - 2

A

Visual
- If pt has diplopia (double vision), patch over affected eye and change q2-4 hrs
- place objects in visual field including yourself
- If hemianopsia, patient should turn head back and forth to scan full visual range
- patient should dress affected side first

Memory
- Establish structured, repetitious, and consistent routine
- If memory problems, orient pt to month, year, day of week, and circumstances surrounding hospitalization

190
Q

Stroke: Major complication

Increased ICP
- General Signs and symptoms - 7

A
  • Increased restlessness, irritability, and confusion
  • Headache
  • Projectile NV
  • Systolic BP >180 mm Hg /Diastolic BP > 110 mm Hg (OR sudden increase in BP
  • Change in speech pattern, dysarthria, aphasia
  • Sensorimotor changes (CN dysfunction, Ataxia)
  • Seizures (usually within first 24 hours after stroke)
191
Q

Nursing Care during seizure (8)

A
  • stay with patient and remain calm
  • prevent aspiration and keep airway clear (side-lying)
  • Make note of seizure (date, time, duration; characteristics)
  • call for another RN to get the antiepileptic drugs
  • Do not force anything into the patient’s mouth.
  • Remove any objects or restrictive clothes that might injure the patient.
  • Suction oral secretions if possible without force.
  • Do not restrain or try to stop the patient’s movement; guide movements if necessary.
192
Q

Symptoms of right-sided Stroke (5)

A
  • Unilateral neglect or inattention r/t hemianopsia
  • Lack of proprioception/body sense (unable to distinguish left/right or up/down)
  • problems w/ depth and distance perception
  • Disoriented to time and place
  • Personality changes (impulsivity and poor judgment)
193
Q

Symptoms of Left-sided Stroke (4)

A
  • deficits in analytical skills
  • speech deficits (Aphasia (receptive, expressive or mixed), Dysarthria)
  • Apraxia (slow, cautious, hesitant behavior style)
  • personality changes (lacks initiative and anxious)
194
Q

6 groups that cannot get fibrinolytics within 4.5 hrs

A
  • Age older than 80 years
  • Anticoagulation therapy regardless of INR
  • Imaging evidence of ischemic injury w/ > 1/3 of the brain tissue supplied by the middle cerebral artery
  • Baseline NIHSS score > 25
  • History of both stroke and diabetes
  • Evidence of active bleeding
195
Q

Medical management: stroke

Alteplase (TPA; fibrinolytic)
- Nursing care (6)

A
  • informed consent needed
  • given within 45 min of ED arrival
  • nurse monitor vitals before, during, and after admin (esp. BP) - q10-15 min during; q30 for 6 hrs after; q1h for 24 hr
  • If BP > 185/110 mm Hg, give IV antihypertensive (labetolol) before and throughout alteplase admin to maintain BP < 185/110 mm HG
  • avoid other invasive tubes (NG or catheters) until pt stable to prevent bleeding - 24 hrs
  • discontinue if NV, severe headache or severe HTN
196
Q

Stroke: Major complication

Increased ICP
- earliest sign - 1
- Late signs - 3

A

Earliest sign
- Decreased LOC– earliest indicator

Late signs
- Pupillary changes: dilated and nonreactive pupils (“blown pupils”) or constricted and nonreactive pupils (very late sign)
- Cushing triad (very late sign): Severe HTN, Widened pulse pressure, Bradycardia
- Abnormal posturing (very late sign): Decerebrate or Decorticate

197
Q

Antiepileptic drugs (ex. phenytoin, carbamazepine, valproic acid, gabapentin, levetiracetam)

Patient education (5)

A
  • ask HCP before taking any drugs (Oral contraceptives, OTC drugs)
  • wear medical identification bracelet, necklace, ID card
  • Avoid alcohol and excessive fatigue.
  • Avoid warfarin and phenytoin
  • Avoid grapefruit juice b-c can increase chance of drug toxicity
198
Q

Risk factors for Seizures (7)

A
  • Stroke
  • Brain Tumor
  • Trauma (head injury)
  • Metabolic disorders
  • Electrolyte disturbances
  • High fever (mainly children)
  • Substance abuse (acute alchol withdrawal)
199
Q

Complications of Thyroidectomy (5)

A
  • Hemorrhage esp in 24 hrs
    post-op serosanguineous drainage = normal
  • Respiratory distress (s/s laryngeal stridor, tracheal compression from hemorrhage)
    need suction, emergency trach, oxygen
  • Laryngeal nerve damage (s/s hoarseness and weak voice)
  • Thyroid storm (high fever, tachycardia, severe HTN)- uncommon
  • Parathyroid gland injury (hypocalcemia and tetany)
    need rescue calcium gluconate or calcium chloride
200
Q

Hypocalcemia symptoms (4)

A
  • Increased neuromuscular excitability; tingling, muscle spasm (particularly in hands, feet, and facial muscles), convulsions, tetany
  • intestinal cramping
  • hyperactive bowel sounds
  • prolonged QT interval -> cardiac arrest
201
Q

Total Thyroidectomy or Subtotal Thyroidectomy

Preoperative Care (5)

A
  • Monitor labs b-c treatment can induce hypothyroidism
  • Thionamide to induce euthyroid prior to surgery.
  • Iodine preparations to decrease thyroid size and vascularity (reduces risk of hemorrhage and thyroid storm)
  • Control HTN, dysrhythmias, tachycardia
  • High-protein, high-carbohydrate diet for weeks or days prior
202
Q

Total Thyroidectomy or Subtotal Thyroidectomy

Postoperative Care (6)

A
  • Monitor for complications (Monitor VS q15 minutes until stable then q30 minutes) – most important action (Temp increase of 1 F (1.8C) = thyroid crisis)
  • Assess level of discomfort and give pain meds.
  • Use pillow or hands to support neck and head (avoid neck extension)
  • Place in semi-fowler
  • Deep breath every 30 min to 1 hr.
  • Lifelong thyroid hormone replacement if total thyroidectomy
203
Q

Informatics: Quality and Safety Education for Nurses (QSEN) Initiative

4 attitudes

A
  • Identify tools to mitigate errors, manage knowledge
  • Apply principles of life-long learning
  • Value nurse’s ability to identify, analyze, and participate in decision making process.
  • Recognize and embrace technology as data storage, collection, outcome monitoring and line of defense.
204
Q

Informatics: Technology Informatics Guiding Education Reform Initiative (TIGER)

8 pillars

A
  • Embrace change.
  • Drive technology
  • Consistent policy
  • Consistent advocacy
  • Share best practice
  • Evidence based practice
  • Intelligent solutions
  • Affordable and universal solutions
205
Q

Informatics: Role of Uniform Taxonomies in Streamlining Processes

  • Nursing Diagnoses, Definition, and Classification (NANDA) - 2
  • Omaha system - 3
A

Nursing Diagnoses, Definition, and Classification (NANDA)
- Communication method w/ nursing diagnostic labels
- Differentiates nurse from physician (independent practice of nurse)

Omaha system - 3 components
* assessment (Document needs and strengths of clients)
* intervention (multidisciplinary, research-based)
* evaluation (measure client outcomes)

206
Q

Informatics: Role of Uniform Taxonomies in Streamlining Processes

  • Nursing Intervention Classification (NIC) system - 2
  • Nursing Outcomes Classifications (NOC) system - 2
A

Nursing Intervention Classification (NIC) system
* Interventions nurses do on behalf of clients
* 7 domains: physiological, complex, behavioral, safety, health system, family, community

Nursing Outcomes Classifications (NOC) system
* Evaluates effect of nursing interventions
* 7 domains: functional health, physiologic health, psychosocial health, health knowledge and behavior, community health, perceived health, family health

207
Q

Informatics: Role of Uniform Taxonomies in Streamlining Processes

  • Nursing Management Minimum Data sets (NMDS) - 2
  • Systematized Nomenclature of medicine (SNOMED) - 1
  • National Database of Nursing Quality Indicators (NDNQI) system - 2
A

Nursing Management Minimum Data sets (NMDS)
* Quantifies and qualifies nursing care
* Elements: nursing care, service (unique identifiers), demographics

Systematized Nomenclature of medicine (SNOMED)
* Multilingual to provide consistent and uniform data worldwide

National Database of Nursing Quality Indicators (NDNQI) system
* Analyzes nursing care across different facilities to identify units w/ more incidents
* monitors Nurse-sensitive outcomes (ex. Falls, ventilator-associated pneumonia, hospital acquired pressure ulcers, UTIs)

208
Q

Informatics: Legal Acts (3)

A

American recovery and reinvestment Act (Part A: Health Information Technology for Economic and Clinical Health (HITECH); Part B: financial incentives for EHR adoption)

HIPPA
* Established consequences of violating confidentiality.
* Proper handling of electronic info: automatic signoffs, alarm motor devices, hierarchal and unique passwords, fax machines and shredders in secure areas
* Never discuss client info in public OR w/ team members not involved in the patient’s care

Technology Related Assistance for Individuals with Disabilities Act (AT act)
* Ex. of assistive technology: screen readers, text-to-speech, text w/ symbols, auto summaries

209
Q

Which of the following support the integration of informatics into nursing practice to support safety in client care?(Select all that apply)

A. Embedded medication alerts
B. Immediate Access to digital x-rays.
C. Use of phones that connect directly
D. Integration of telehealth
E. Wireless Internet access for clients from the health care facility

A

A. Embedded medication alerts
B. Immediate Access to digital x-rays.
C. Use of phones that connect directly
D. Integration of telehealth

210
Q

Which of the following legislative acts stipulate that clients be allowed to see and make corrections to their health care records?

A. Health Information Technology for Economic and Clinical Health (HITECH) Act
B. Health Information Portability and Accountability Act (HIPAA)
C. American Recovery and Reinvestment Act (ARRA)

A

B. Health Information Portability and Accountability Act (HIPAA)

211
Q

Which of the following illustrates the integration of informatics into a health care system to support cost containment?

A. Offering free wireless Internet access to clients and visitors
B. Installing bar codes on medications with alerts for low supplies
C. Integrating an electronic health care record on a platform compatible with computers and tablets

A

B. Installing bar codes on medications with alerts for low supplies

212
Q

Which of the following illustrates the use of technology to improve communication with a client who is cognitively impaired?

A. Provide the client with an online video as a teaching aid that allows multiple viewings.
B. Use an electronic drawing screen allowing the client to create pictures during an assessment.
C. Offer translation software for the client.

A

B. Use an electronic drawing screen allowing the client to create pictures during an assessment.

213
Q

A health care facility recently opened a research department to collect and analyze data related to improved client outcomes. Which of the following examples represents integration of technology to support creation of scholarly knowledge?

A. Administration of an online survey for new nurses post-orientation regarding satisfaction with teaching methods
B. Electronic collection of healing times of sacral wounds post-hyperbaric treatment, with and without antibiotic administration
C. Piloting an instant messaging system between hand-held computers for nursing and pharmacy

A

B. Electronic collection of healing times of sacral wounds post-hyperbaric treatment, with and without antibiotic administration

214
Q

A nurse needs to determine the use of technology as an assistive device to facilitate discharge teaching for a client. Which of the following represents an appropriate application of technology in this situation? (Select all that apply.)

A. Using translation software for a Spanish-speaking client who has a new diagnosis of acute renal failure
B. Providing instruction for access to the facility’s free wireless Internet
C. Supplying the link to a website with a video demonstrating home care for a client after a knee arthroplasty
D. Explaining the use of automatic email reminders to increase medication compliance
E. Accessing an iPad to review side effects of medications with a client

A

A. Using translation software for a Spanish-speaking client who has a new diagnosis of acute renal failure
C. Supplying the link to a website with a video demonstrating home care for a client after a knee arthroplasty
D. Explaining the use of automatic email reminders to increase medication compliance
E. Accessing an iPad to review side effects of medications with a client

215
Q

The Centers for Medicare and Medicaid Services electronically reports specific quality outcome measures based on data collected from hospitals. These data allow the public to compare hospitals that

G. have the best health care providers.
H. have the most up-to-date surgical services.
I. have a higher percentage of hospital-acquired infections.

A

I. have a higher percentage of hospital-acquired infections.

216
Q

A nurse off duty receives a photo on her cell phone from a fellow nurse who is at work. The photo shows a celebrity receiving physical therapy. Which of the following actions should the nurse take first?

A. Make factual notes of the event that has occurred.
B. Notify nursing administration, explaining who sent the photo.
C. Delete the photo.

A

C. Delete the photo.

217
Q

Which of the following electronic resources should a nurse use to obtain clinical practice guidelines and interventions to reduce the risk of negative client outcomes while in a hospital?

A. Centers for Disease Control (CDC)
B. Agency for Healthcare Research and Quality (AHRQ)
C. Quality & Safety Education for Nursing (QSEN)

A

B. Agency for Healthcare Research and Quality (AHRQ)

218
Q

Which of the following uses of technology would constitute a violation of HIPAA?

A. Sharing a client’s lab results with a consulting provider via email on the health care facility intranet
B. Charting client data on an electronic health care record while at the bedside with family members present
C. Texting a picture of a client’s wound from one nurse to another nurse related to wound care protocol

A

C. Texting a picture of a client’s wound from one nurse to another nurse related to wound care protocol

219
Q

Osteoarthritis: Drugs for Pain (7)

A
  • Acetaminophen (Tylenol) drug of choice b-c noninflammatory
  • Topical analgesics (lidocaine, capsaicin)
  • Muscle relaxants for muscle spasms
  • Glucosamine (decrease inflammation)
  • Chondroitin (strengthening cartilage)
  • NSAIDs (diclofenac, Celecoxib)- temp relief
  • opioids (tramadol) - w/ caution b-c acute confusion risk
220
Q

Osteoarthritis: S/s (7)

A
  • Unilateral Synovitis (painful, red, warm, swollen joint AND stiff)
  • Crepitus (grating sound due to loosened bone and pieces of cartilage in synovial joint)
  • Heberden’s nodes(distal)
  • Bouchard’s nodes(proximal)
  • Joint effusions (excess joint fluid)
  • Atrophy and contractures of skeletal muscle r/t disuse
  • Osteophytes (bone outgrowths)
221
Q

Osteoarthritis: nonpharmacological management (6)

A
  • Rest (job change if repetitive work)
  • Positioning (Immobilization in functioning position)
  • Cold application fo synovitis
  • Heat application for pain, spasm, stiffness (15–20-min)
  • Weight Control to decrease stress on joints
  • Exercise (swimming, cycling, walking > running)
222
Q

Complications and Prevention for Hip Arthroplasty (4)

A

Hip dislocation
- S/s: sudden difficulty bearing weight on the surgical leg, leg shortening or rotation, or a feeling that the hip has “popped” with immediate intense pain.
- Keep legs abducted w/ abduction pillow to prevent leg crossing
- Turn on unaffected side

Neurovascular compromise
- check 5 P’s (pulselessness, pallor, paresthesia, pain, paralysis)

Venous Thromboembolism (to pulmonary embolism)
– Main complication (PAC prevention)
- subQ enoxaparin preferred for 10 days (contraindicated in the arm; must be deep abdomen)
- ambulate 3x a day then SCDs

Infection (surgical site, pneumonia, or sepsis)
- Assess temp, WBC, incision, confusion q4h
- Temp elevation 1-2° C post op can be problem and need to contact surgeon
- do prophylactic antibiotics and CHG wipes

223
Q

Amputation: Nursing Care (7)

A
  • Assess for infection (osteomyelitis), hemorrhage, neuroma, phantom pain, body image
  • proper positioning and active ROM to prevent flexion contractures
  • Assess perfusion (Popliteal pulse if BKA
    or Femoral pulse if AKA)
  • Reinforce dressing if bleeding
  • Refer to site as residual limb vs stump
  • PT wraps in figure 8 to shape and shrink residual limb for prosthesis fit
  • Manage phantom pain w/ AEDs (gabapentin, pregabalin) or antispasmodics (baclofen)
224
Q

Rheumatoid Arthritis: Early S/s (6)

A
    • bilateral and symmetric Joint stiffness/pain triggered by stress, illness
  • Joint inflammation (Proximal interphalangeal (PIP) and Metacarpophalangeal (MCP))
  • Generalized weakness and fatigue
  • Persistent Low-grade fever
  • Anorexia then Weight loss of 2-3 lb.
  • Paresthesia
225
Q

Rheumatoid Arthritis: Late s/s (11)

A
  • Deformities (boutonniere deformity of thumb, ulnar deviation of metacarpophalangeal joints, swan-neck deformity of fingers)
  • Severe inflammation and pain (TMJ or cervical joints involved) esp stiffness in morning
  • Fluid accumulation (hand, knees (bakers cysts))
  • Sjogren syndrome (dryness in eyes, mouth, vagina)
  • Osteoporosis
  • Peripheral neuropathy
  • Vasculitis (Ischemic skin lesions (small, brownish, spots esp. on nail bed)
  • Cardiac complications (pericarditis, myocarditis)
  • Respiratory complications (pleurisy, pneumonitis, diffuse interstitial fibrosis, pulmonary hypertension, Fibrotic lung disease, felty syndrome)
  • Eye involvement (iritis, scleritis; reddened sclera or irregular shaped pupil)
  • Kidney disease
226
Q

Methotrexate, Hydroxychloroquine (DMARDs)

Use
Action
Care (5)

A

Use: RA

Action: slow progression in 4-6 weeks

Care
- Avoid crowds and ill individuals
- Monitor for elevated liver enzymes and serum creatinine
- Avoid alcohol
- Take folic acid to decrease side effects
- do not take hydroxychloroquine if known cardiac disease or dysrhythmias.

227
Q

Etanercept, Rituximab, Adalimumab (BRMs)

Use
Action
Care (3)

A

Use: RA

Action: slow progression via neutralizing biologic activity of tumor necrosis factor–alpha (TNFA), interleukins (IL), T-lymphocytes, or tyrosine kinase (TK) to decrease immune response and inflammation

Care
* Do not take if serious infection, TB, or MS b-c may exacerbate these problems.
* avoid getting live vaccines.
* avoid crowds and people with infections

228
Q

Methotrexate, Hydroxychloroquine (DMARDs)

Toxic effects (5)

A
  • bone marrow suppression
  • pneumonitis (acute dyspnea and lung inflammation)
  • lymphoma
  • teratogenic (discontinue methotrexate 3m prior to pregnancy)
  • retinal damage - hydroxychloroquine (need eye exam q6m)
229
Q

Rheumatoid Arthritis: Drug Therapy (5)

A
  • Modifying Antirheumatic Drugs (DMARDs) – Methotrexate (Rheumatrex), Hydroxychloroquine (Plaquenil)
  • NSAIDs- for inflammation and pain
  • Biologic Response Modifiers (BRMs)-
    Etanercept (Enbrel), Rituximab (Rituxan), Adalimumab (Humira)
  • Glucocorticoids (Deltasone (Prednisone)) - decrease inflammation
  • Immunosuppressive Agents - Azathioprine (Imuran), Cyclophosphamide (Cytoxan)
230
Q

Osteoporosis: S/s (6)

A
  • Thoracic kyphosis/ cervical lordosis
  • Reduced height (2-3 in in 20 yrs)
  • Acute sharp back pain after lifting/bending
  • Restricted movement (causing constipation, reflux, respiratory compromise)
  • Spontaneous Fractures r/t bone demineralization (esp. vertebrae, wrist, hip)
  • Frequent falls -> fear of falling
231
Q

Bisphosphonates (ex. Alendronate (Fosamax) or (Fosamax plus D))

Use
Action
Contraindications (4

A

Use: osteoporosis or hypercalcemia prevention and treatment

Action: slows bone resorption by binding with crystal elements in bone esp. spongy, cancellous bone tissue

Contraindications
- poor renal function
- hypocalcemia
- GERD
- aspirin sensitivity (b-c can cause bronchoconstriction)

232
Q

Bisphosphonates (ex. Alendronate (Fosamax) or (Fosamax plus D))

Severe side effects (5)

A
  • esophagitis (esophagus ulcers or gastric ulcers) -> esophageal cancer
  • jaw osteonecrosis (need dental exam prior to starting)
  • a-fib (if fast IV)
  • acute kidney injury
  • severe musculoskeletal pain
233
Q

Bisphosphonates (ex. Alendronate (Fosamax) or (Fosamax plus D))

Nursing Care (5)

A
  • Take on empty stomach w/ full glass of water
  • Sit upright for 30-60 minutes after taking
  • has lifetime limit (2 yrs if bone loss maintained or density increases; 5 yrs otherwise)
  • let dentist know they are taking bisphosphonate prior to invasive procedures
  • give slow IV (over 25-30 min) to prevent a-fib

Concepts 2 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions