FINAL 222 !! Flashcards
Management of Small Pox
Doesnt respond to antibx, passed by air droplet, obtainted by hanglind contamintaed materials
Clean everywhere/wear everything = private room, resp protection, gown, gloves and mask.
If exposed to radioactive dust, what do you do?
Place pt in shower.
signs and symptoms of peritonitis
Abd pain, tenderness over involved area, rebound tenderness, muscle rigidity, muscle spasm, fever, abd distention, nausea, vomiting, tachycardia, tachypnea, ascites
S/S of dumping syndrome
Generalized weakness, sweating, palpitations, dizziness/lightheadedness, abd cramping, borborygmi (stomach gurgles heard w/o stethescope), urge to defecate, urge to lay down. Epigastric fullness. Lasts about an hour.
MNGMNT calls for a decrease in intake rate. high fat, high protein, low carb.
What to do for client during dumping syndrome?
Have them lie down afer eating,
Care of pt with TPN
VS Q4-8, daily weights, monitor insertion site for development of bacterial or fungal growth, check BS Q4-6, begin infusing slowly and wean off slowly, infuse with a pump only, change bag and tubing Q24hrs
nursing care for peptic ulcer disease
Adequate rest, bland diet(6 small meals/day), H2 blockers(pepsid) and PPI(protonix, prilosec, prevacid), antacid, antibx for H pylori (need multiple antibx=biaxin, amoxicillin, tetracyclin, PCN)
H2 receptor antagonists
Pepsid=decreases acid secretion in the sotach by sinding to an enzmye on the parietal cells.
used for PUD
Proton pump inhibitors (PPI)
block ATPase enzyme that is important for the secretion of HCL acid. more effective then H2 blockers in decresing gastric acid secretion
Prilosec, prevacid, protonix, nexium
used for PUD
anticholinergic drugs
used occasionally for PUD, decreases vagal stimulation of HCL acid
s/e=dry mouth, flushing, thirst, blurred vision, tachycardia, dilated pupils
Cytoprotective drugs
Carafate (COATS) used for short term tx - covers the ulcerm protecting it from acid, used for esophagus, duodenum and stomach, accelerates ulcer healing, action is most effective at a low pH- give 30 min before or 30 min after an antacid
post op EGD
ausculate bowel sounds and do a complete abd assessment, keep NPO until return of gag reflex, use warm NS gargles for sore throat, check temp q 15-30 min for 1-2 hrs (spike in temp=perforation)
S/S of cirrhosis
EARLY=anorexia, heartburn, n/v, changes in bowel habits, pain-dull heavy in RUQ, fever, weight loss, fatigue, hepatomegaly, splenomegaly. Clay colored stool.
LATE=jaundice, edema, ascites, thrombocytopenia, leukopenia, anemia, coagulation disorders, angiomia,palmar, erythema, enecphalopathy, peripheral neuropathy, hyperaldosteroneism.
What to teach pt prior to fecal occult blood test
to avoid red meats, and NSAIDS 7 days prior to the exam.
Crohns diet
high in veggies, B12 IM or via nasal inhalers. high-cal protein shakes.
high-calorie,high vitmain, high-protein, low residue, milk-free.
Nursing care for crohns pt
maint fluid and electrolyte balance w/ IV therapy, maintain activity/rest balance bypacing activites and taking frequent breaks, promote effective coping by encouraging the expression of feelings.
Drug therapy=antimicrobial agents, corticosteriods, immunosupressants, immunodulators, TPN.
Managment of ulcerative colitis
high cal, high protein, nonspicy foods, caffeine-free, low residue (BRAT diet)
- low residue provides foods high in fiber = decreases fecal matter. (bananas, hard-boiled eggs, chicken, toast, rice, applesauce.
eat small frequent meals, vitamin and iron supp.
Corticosteriods for Ulcerative colitis (UC)
oral prednisone (mild and moderate UC)
retention enemas (deliever drugs into the desecending colon and beyond)
monitor for cushing syndrome (moon face buffalo hump), HTN, hirsutism, and mood swings
Immunosupressive drugs for UC
6-mercaptopurine, 6-MP
s/e bone marrow suppression, infection (take with food and mike, increase fluids 1800-2400 ml/d to decrease nephrotoxicity)
med for refactory UC
remicade - monoclonal antibody against TNF
This will increase when a small bowel obstruction is resolving.
hunger
care of pt with gout
Monitor serum uric acid levels (treatment effectiveness), cradle on foot of bed (keep heavy blankets off toes).
Teach pt to avoid excessive alcohol drinking, as well as
Home care instructions for pt w/ systemic lupus erythematous
avoid sun, wash w mild soap, avoid lotions, plaquenil (antimalarial for skin lesions) - decreases the absorption of UV light to the skin- decreasing rash, gey eye exam q6 months (causes retinal toxicity)
meds for back pain
Analgesics (NSAIDS), muscle relaxants (flexeril)
Post op laminectomy
compare neuromuscular assessment with pre-op findings(report any numbness/tingling), assess for bowel and bladder function, place pillow between the legs and log roll as one unit (use turn sheet)
post op management of AKA (above the knee amputation)
avoid sitting in chair for >hr, avoid pilllows under surgical extermity to prevent flexion contracture, lie on abd for 30 mins 3-4 times/d, position the hip in extension while prone.
compression banage immediately after to surgery, adm meds for phantom pain.
Teach pt to: avoid dangling limb, active ROM to all joints, crutch walking (dont exceed longer then 5 mins to avoid edema), limb care, recognition of complications (infection and hemorrhage)
Teaching crutch use
Teach client to use short strides, look ahead, not at feet. dont rest armpits on the crutch-can cause axillary damage.
predisposing factors to pelvic inflammatory disease (PID)
young female <24, multiple sex partners, new sex partner, chlamydia can be unknowingly transmitted during intercourse. Partner may have urethritis.
predisposing factors to development of cervial cancer
unprotected sexual intercourse with multiple partners, early age of sexual activity, twice as high in african americans, having HPV, smokers
post mastectomy
semi-fowlers with arm on pillow, flexion.extension of fingers immediatley, stress importance of wearing well fitted prosthesis, elevated affected side with distal joint higher than proximal, watch for edema on affected arm, limit arm exercises 24hrs post op, adduction and external rotation arm exercises after wound has healed.
if there is lymph node dissection - venapuncture and BP cuffs are not allowed on the affected arm.
Wear gloves when gardening.
Teach to rotate shoulder, Teach exersise like walking hand up wall or brushing hair.
If you see the NA applying heat intervene. Heat is contraindicated.
predisposing factors r/t breast cancer
female, age over 50, family history of breast CA, estrogen replacement thearapy for menopause.
post op vag hysterectomy
monitor for bladder distention (may have to straight cath)
post op abd hysterectomy
leg exercises and early post op ambulation tp prevent DVT and pneumonia.
Path of endometriosis
ectopic endometrial tissues “menstruate” – blood collects in cystlike nodules (bluish-black color) called chocolate cysts – rupture – acute pain – irritation – formation of adhesions – fix the affected area to a new site.
pt teaching r/t csytocele
kegal exercises can help treat them, use a pessary - ring like device placed in vag to support structures, helps alleviate discomfort, better bladder control, less urinary incontinence.
If TPN mixture is above 20% concentration use which line?
If TPN is below 20% concentration use which line?
Above 20% use a Central line.
If the mixture is in less than 20% glucose then use a periheral line.
Why is an xray used to verify TPN line placement?
To prevent chance of pneumothorax. Xrays is used to verify placement
Patient teaching for cirrhosis management
No drug use or ETOH. Low Sodium High Potassium, I&O, Daily weights, High Calorie diet. Protein may be restricted, Monitor for bleeding, Rest and teach safety.
Lab values related to cirrhosis
Increase in ALT, AST, PT, INr, And NH4
Decrease in RBC, WBC, Platelets, Albumin, H&H
Increase in Creatanin
Decrease in NA
Increase in Billirubin in Serum, urine and stool
How is Hepatitis B transmitted
Body Fluid transmission, Needle sticks, Sharing IV drugs. Sexually transmitted, Remains contagious for months to years.
NURSES MUST BE CAREFUL WHEN CHANGING BED PANS.
Hepatitis A Transmission
Spread Oral to fecal route. Seen in high rates in instituitional inmates, male homosexuals, Poor populations.
Genital herpes teaching
They dont need to come in contact with the virus for reoccurrence to happen.
Avoid all sexual contact when lesions are present to avoid transmission of the virus.
Recurrent episodes may be triggered by emotional stress and menses.
Drugs used to treat genital herpes
No cure, Acyclovir(Zoviraz) shortens teh duration of attacks. (antiviral)
Treat with antiviral agents
What can happen if chlamydia is left untreated
can result in PID and infection of the epididymis, eptopic pregnanct, men and women can become infertile.
