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NURS112 > Final > Flashcards

Final Flashcards

1
Q

Hydrostatic Pressure definition

A
  • Major force that pushes water and solutes out of vascular system at capillary level
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2
Q

What is oncotic pressure?

A

Pressure exerted by colloids in solution like protein

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3
Q

What causes movement of water out of the capillaries?

A
  1. Capillary hydrostatic pressure
  2. Interstitial oncotic pressure
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4
Q

What causes movement of fluid into the capillary?

A
  1. Plasma oncotic pressure
  2. Interstitial hydrostatic pressure
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5
Q

What causes edema?

A
  • Plasma to Interstitial fluid shift
  • Due to
    • Elevation of hydrostatic pressure
    • Decrease plasma oncotic pressure
    • Elevation interstitial oncotic pressure
  • Compression stockings can decrease peripheral edema
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6
Q

How can fluid enter the vascular space?

A
  • fluid drawn into plasma space whenever increase in PLASMA OSMOTIC/OSMOTIC pressure
    • Ex: administering colloids, dextran, mannitol, hypertonic solutions
  • fluid drawn from cells via osmosis
  • results in shrinkage of cells
    • EX: neurologic symptoms caused by altered CNS from brain cell shrinkage
      • Opposite is brain swelling
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7
Q

What effects can old age have on fluid in the body?

A
  • decrease
    • water conservation
    • GFR
    • Creatinine clearance
    • ability to concentrate urine
    • hormone changes: ADH/ANP
    • loss of moisture due to loss of SQ tissue
    • thirst mechanism
  • narrowed limits for excretion of H2O, Na, K, H+
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8
Q

What effect can prolonged NG tube suction have?

A

Decrease in Na+, K+, H+, and Cl-

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9
Q

Why would you give D5W?

A
  • Replace fluid loss/dehydration
  • Treat Hypernatremia
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10
Q

Why would you give 0.9% NS?

A
  • Blood Transfusion
  • Fluid challenge
  • Fluid replacement w/ DKA
  • Treat
    • Hypercalcemia
    • Hyponatremia
    • Metabolic Alkalosis
    • Shock
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11
Q

Why would you give LR?

A
  • Acute blood loss
  • Treat burns
  • Dehydration
  • Third spacing
  • Lower GI fluid loss
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12
Q

What is the osmolarity formula?

A

2(Na) + (Glucose)/18 + (BUN)/3 = serum osmolarity

Na decreases by 2 for ea 100 increase in glucose

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13
Q

How do you calculate MAP?

A

MAP = 1/3 (SBP) + 2/3 (DBP)

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14
Q

What are common bronchodilators used to treat respiratory problems?

A
  • Beta-agonists: “-iterol”
  • Anticholinergics: “-pium”
    • Bring down mucous production
  • Methloxanthines: “-phylline”
    • Raises HR, sympathetic response
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15
Q

What are common anti-inflammatory drugs for respiratory diseases?

A
  • Steroids: “-sone”
  • Leukotriene stablizer: “-lukast” (Singulair)
  • Mast Cell stabilizer: “-crome”
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16
Q

What is SIRS criteria?

A
  • Temp: <36, >38.5
  • WBC: <4, >12 (or >10%bands)
  • RR: >20
  • HR: >90
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17
Q

When do you treat a high BP in stroke patients?

A
  • Ischemic Stroke: BP >200/100
    • TPA candidate: >185/110
  • Hemorrhagic: >160/90
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18
Q

When does a patient qualify for TPA?

A
  • 3 hour treatment window
  • no recent major surgery or trauma
  • no recent hemmorhage or coagulopathy
  • BP <185/110
  • No seizure at onset
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19
Q

What is the RAAS?

A
  • Low BP signals kidneys to secrete renin
  • Renin stimulates production of angiotensingen>angiotensin 1
  • ACE convernts A1 to A2 in the lungs
  • Angio2 induces thirst, vasoconstriction, and production of aldosterone (anti-diuretic) from the adrenal glands
    • Aldo. signals kidneys to retain Na
    • All these mechanisms increase BP
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20
Q

How do you calculate CO?

A

CO = Stroke volume x HR

Normal is 4-8 L

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21
Q

What are some drugs used for HTN?

A
  1. Diuretics (HCTZ)
  2. ACE inhibitors (-prils)
  3. ARB’s (-artan)
  4. Alpha blockers (Clonidine)
    1. blocks receptors of vasoconstriction
  5. Calcium Channel Blockers (-pine)
    1. tells heart to not work so hard
  6. Beta blockers (-olol)
    1. Decrease HR, contractility
    2. Can hide hypoglycemia
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22
Q

Normal BNP

A
  • BNP: <100 pg/mL
    • Possible heart failure 100-300
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23
Q

Signs of diastolic failure?

A
  • LV: SOB, tachypnea, crackles
  • RV:anorexia, hepatomegaly, JVD
  • Thick walls of heart muscle
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24
Q

What are signs of systolic failure?

A
  • Thin walls
  • Weakness, fatigue, decreased exercise tolerance
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25
Q

Characteristics of arterial vascular disorders

A
  • Intermittent claudication
  • Rest pain @ night
  • Ischemia to a muscle group
  • Pain while walking same distance
  • Pain relieved by dangling foot
  • Pulse problems
  • Skin
    • Cool, dusky, hairless, thin, non-edematous
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26
Q

Characteristics of Venous disorders

A
  • edema
  • redness, dry, flaky skin, itchy
  • ulcers in lower 3rd leg
  • inactivity major risk factor
  • pulse present
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27
Q

What are the diagnostic tools for BPH?

A
  • Med hx
  • digital rectal exam
  • Labs
    • UA
    • BUN/Creat
    • PSA
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28
Q

What are the diagnostic tools for prostate cancer?

A
  • Digital rectal exam
  • PSA
  • Biopsy to fully diagnose
  • TR US
  • Blood work
  • Bone scan/CT/MRI/CXR/IVP
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29
Q

What are the diagnostic tests for Testicular Cancer?

A
  • Palpation of scrotum
  • US of testes
  • Bloodwork
    • AFP, LDH, hCG
  • CXR
  • CT chest/abd
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30
Q

What are the diagnostic tests for bladder cancer?

A
  • Cystoscopy
  • UA
  • IVP/Urogram
  • Pelvic Lymphandenectomy during Cystectomy
  • CT/MRI/CXR
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31
Q

What is the treatment for BPH?

A
  • Alpha Adrenergic Blockers (Relaxs smooth muscles)
    • Flowmax (tamsulosin)
    • Hytrin (terzosin)
    • Cardura (doxazin)
  • ​5-alpha reductase inhibitors (Blocks DHT - Testosterone conversion preventing progression and reducing size)
    • Proscar (finesteride)
    • Avodart (dutasteride)
32
Q

Surgical treatment options for BPH?

A
  • TURP
  • TUIP
  • TULIP
  • TUNA
  • Greenwave
  • Hyperthermia
33
Q

What is the treatment for prostate cancer?

A
  • Stages T1(hasn’t left prostate)/ T2 (slightly radiated off prostate)
    • Observation/waiting
    • Radical Prostatectomy
    • Radiation Therapy
      • SE: dysuria, frequency, hematuria, stricture
  • T3 (Left margin of prostate/ into seminal vesicle)
    • Experimental treatments only - radiation/hormone therapy
  • T4 (Invaded other structures, retroperineum, bladder)
    • Hormone (including bilateral orchiectomy)
      • Injections given q 3-4 months
      • decrease level of circulating testicular androgens
      • SE: hot flashes, decreased libido, mood swings, gynecomastia
    • Chemo
34
Q

Treatment for testicular cancer

A
  • Orchiectomy/radical o
  • Retroperitoneal LND
  • Post op
    • surviellance
    • radiation therapy
    • chemo
35
Q

Treatment for bladder cancer

A
  • TURBT
  • Laser Treatment
  • Chemo (Cisplatin, Taxol)
  • Intravesical immunotherapy w/ BCG (causes an immune response/inflammation of bladder walls killing cancer cells)
  • Radiation (5-8 weeks, Preferred to preserve bladder)
  • Radical Cystectomy w/ Urinary diversion
36
Q

Uses and precautions for 0.45%NS

A
  • HYPOTONIC
  • Treat DKA after NS but BEFORE D5W
  • replace gastric fluid loss from NG suction or vomiting
  • replace Na+ & Cl-
  • provide water replacement
  • Precautions
    • Cardiovascular collapse
    • Increase ICP
    • DONT use in liver, trauma, or burn patients
37
Q

Uses and precautions for D5W

A
  • ISOTONIC
  • Replace fluid loss/dehydration
  • Treat hypernatremia
  • Precautions
    • ​turns hypotonic
    • use cautiously w/ RENAL/CARDIAC pt
    • DON’T use for resuscitation to avoid hyperglycemia
38
Q

Uses and precautions for NS

A
  • ISOTONIC
  • Blood transfusion
  • fluid replacement w/ DKA
  • Treat: hypercalemia, hyponatremia, metabolic alkalosis, shock
  • Precautions
    • ​used as replacement for ECF
    • DONT use w/ heart, edema, hypernatremia pts to avoid fluid overloade
39
Q

Uses and precatuions for LR

A
  • ISO
    • Acute blood loss
    • treat burns, 3rd spacing, lower GI fluid loss, dehydration
  • Precaution
    • ​Similar to plasma in content
    • DON’T USE
      • RENAL to avoid hyperK
      • LIVER pts can’t metabolize lactate
      • PH >7.5
40
Q

Uses and precautions for D5 1/2NS

A
  • HYPER
  • Treats DKA AFTER NS& 1/2 NS
  • Prevent hypoglycemia
  • Precautions
    • ​In DKA patients, use only when BS fall <250mg/dl
41
Q

Uses and precautions for D5 NS

A
  • HYPER
  • Treat
    • Addisonian crisis
    • hypotonic dehydration
    • Syndrome of Inappropriate Anti Diuretic Hormone
    • Temporarily for shock when plasma expanders not available
  • Precautions
    • ​Chloride content higher than natural plasma content
    • DONT use in cardiac or renal due to r/o fluid overload
42
Q

Uses and precautions for D10W

A
  • HYPER
  • when nutrition w/ glucose required
  • provide water replacement
  • Precaution
    • ​Monitor glucose levels
43
Q

EKG pattern during hyper/hypokalemia vs. normal

A
  • Hypo: Prominent U wave, Shallow T wave
  • Hyper: Tall T wave
44
Q

Electrolyte disorder of Na

A
  • Hypernatremia
    • thirst, CNS deterioration, increased ISF
  • Hyponatremia
    • CNS deterioration
45
Q

Electrolyte disorder of Ca

A

Inverse relationship to Phosphorus

  • Hypercalemia
    • thirst, CNS deterioration, increased ISF, slows nervous system
  • Hypo
    • tetany, Chvostek’s/Trousseau’s sign, CNS/EKG changes
46
Q

Electrolyte disorder of K

A

Insulin drives K back into cells

  • Hyperkalemia
    • V-fib, HEART EKG changes, CNS changes
  • Hypo
    • Bradycardia, “,”
47
Q

Electrolyte disorder of Mg

A

HEART

  • Hypermagnesemia
    • loss of deep tendon reflexes
    • depression of CNS/Neuromuscular fxn
  • Hypo
    • hyperactive deep tendon reflexes, CNS change
48
Q

What are some medications for Diabetics aside from insulin?

A
  • Metformin (PO): Increases insulin sensitivity of cells so useful for TYPE 2 diabetics/insulin resistant diabetics. Only use on patients with good renal fxn. Works in liver to decrease glucose production
  • -ides (PO): Stimulates pancreas to secrete insulin; not effective for type 1; risk for hypoglycemia
  • Arcabose (PO): Inhibits gut enzyme responsible for breaking down carbs; take before meals
  • Rosiglitazone (Avandia): Not recommended for CVD/CHF pts due to risk of edema/increase fluid retention (muscle)
  • Incretin Enhancers (GLP-1): Increases insulin production in pancreas; decreases glucagon; increases satiety; delays gastric emptying
  • Sitagliptin (Januvia): Risk of hypoglycemia very low because drug only works w/ high serum glucose; increased fullness feeling;
49
Q

What is onset, peak, duration of rapid insulin?

A
  • Rapid (Humalog, Novalog)
    • Onset: 5-10mins
    • Peak: 1 hr
    • Duration: 2-4hrs
  • Inject w/n 15 mins BEFORE meal
50
Q

What is the onset, peak, duration of short/regular insulin?

A
  • Short/regular (Humulin, Novolin)
    • Onset: 30mins-2hrs
    • Peak: 2-4 hrs
    • Duration: 4-6 hrs
  • When given in AM, produces rxns before lunch
51
Q

What is the onset, peak, duration of intermediate/NPH insulin?

A
  • Intermediate/NPH (Humulin N/L)
    • Onset: 2-4 hrs
    • Peak: 4-10 hrs
    • Duration: 10-16hrs
  • When given in AM, produces rxns 2-3hrs before dinner
  • When given in PM, produces rxn 2am & 8am
52
Q

What is the onset, peak, duration of long acting insulin?

A
  • Long acting insulin (Humulin U, Lantus)
    • Onset: 1 hr
    • Peak: NONE
    • Duration: 18-24 hrs
  • When given in AM, produces rxns 2am & breakfast
53
Q

What is Osteoarthritis?

A
  • Localized inflammatory response
  • RISK FACTOR: WOMEN, 65+, familial tendency, obesity
  • rest allevieates symptoms
  • MANAGEMENT
    • improved mobility - low impact aerobics, rest/exercise balance, heat therapy, NSAIDs
    • fxnl independence - braces, glucosamine, chondroitin
    • Osteotomy: resection of bone deformity fragment
    • Arthrodesis: joint fusion, holding bone ends together
    • Total Arthroplasty: replacing arthritic bone w/ metal
54
Q

What is rheumatoid arthritis?

A
  • chronic systemic autoimmunde, inflammation
  • comes and goes
  • RISK FACTOR: FEMALE, 40-60, small joints
  • Pain at rest
  • Management
    • Education: Pain management, Rest/Activity Balance, Nutrition, Weightloss, Self care strategies, Medications
    • Work with OT
55
Q

What is the management for hip fractures?

A
  • Impaired mobility: weight bearing? (TTWB, PWB, WBAT)
  • Positioning: adductor pillow (not too tightly, watch peroneal nerve), NEVER internally rotate (adduct), no flexion past 90 degrees.
  • Mobile ASAP! Active ROM, PT referral, pain management
  • Anticoagulants to prevent PE or DVT, monitor for bleeds! FALL- screen for cerebral bleed!
  • Circulation, sensation! Check often! (pedal pulses, skin color, temp, dorsiflexion)
  • High risk for infection, OR tries to limit that by implementing laminar flow (highly filtered air supply), antibiotics
56
Q

What are the 5 stages of bone healing?

A
  • Bone Healing: ENSURE GOOD CIRCULATION
    • Hematoma formation: 1-3 days
    • Fibrocartilage formation: 3days to 2 wks
    • Callus: 2-6wks
    • Ossification: 3wks to 6mths
    • Consolidation/remodeling: 6months - 1 yr
57
Q

Management of MS trauma

A
  • Pain management
    • Associated with muscle spasms so give central/peripheral muscle relaxants (carisoprodol - Soma; cyclobenzaprine - Flexeril; methocarbamos - Robaxin)
  • Antibiotics (cefazolin)
  • Nutrition (protein, Vit BCD, calcium/phosphorus, 2k-3kmL fluid)
  • To relieve swelling elevate higher than heart for first 24-48 hours of cast
  • SPLINT FIRST IN CASE OF COMPARTMENT RISK
58
Q

Characteristics of visceral pain?

A
  • DEEP
  • sensitive to tension, ischemia, rapid enlargement of organs
  • dull achy
  • PNS (Decrease HR/BP)
  • steady or intermittent
59
Q

Pain patterns of the abdomen

A
  • Epigastric
    • stomach, gall bladder, liver, pancreas. Can be confused w/ cardiac-related pain
  • Umbilical
    • distal duodenum, jejunum, ileum, appendix, ovary, testes, upper ureter
  • Lower abdomen
    • colon, bladder, rectum, uterus, ovaries
60
Q

Characteristics of diverticulitis

A
  • inflammation of the small pouches of intestine
  • Acute pain LLQ
  • Palpable abdominal mass
  • systemic infection symptoms
  • TX
    • fiber/stool softener
    • antibiotics
    • possible colonostomy
61
Q

Characteristics of pancreatitis

A
  • inflammation caused by gallstone obstruction or chronic etoh intake
  • Elevated: lipase, amylase, lft, WBC, glucose
  • Steady, intense epigastric pain, radiates to back
  • N/V w/ no relief
  • Turner/cullen
  • R/o pleural effusion
62
Q

Characteristics of Paralytic Ileus

A
  • High pitched bowel sounds
  • Upper, mid, abd cramping
    • pain in waves
  • TX
    • decompress
    • parenteral fluids/nutrition
    • METOCLOPRAMIDE
      • stimulates peristalsis
63
Q

Types of GI bleeding

A
  • Hematemesis (blood in vomit), indicates bleeding above duodenal/jejunal junction. Coffe ground or red.
  • Melena (black, tarry feces) indicates bleeding below duodenal/jejunal junction
  • Hematochezia (fresh blood in feces) indicates bleeding in colon
64
Q

Diagnostic tools for GI bleeding

A
  • Orthostatic BP >10 drop, Increased pulse by 20
  • Labs
    • Increased INR/PTT
    • Decreased H/H and PLTs
    • BUN >40
    • +Guiac stool
  • Test w/ endoscopy or barium contrast
65
Q

Management of GI bleed

A
  • IV access
  • Check blood is ordered/avail
  • Upper GI
    • No Alch, ASA, Anticoags
    • Tx: pressure, sclerosis, banding, surgery, acid blockers, antibiotics
  • Lower GI - Surgery
  • Fluid electrolyte replacement
  • Skin Care
  • Bowel Rest
    • Clear fluids 1st 24 hrs post op
    • BRAT diet 24 hrs: bananas, rice, applesauce, toast
66
Q

Characteristics of Duodenal Ulcer

A
  • Higher incidence than gastric.
  • Risk factors:Protein rich meals, alcohol consumption, and vagal stimulation
  • Pain with empty stomach, may be helped w/ food or antacids
67
Q

Characteristics of Gastric Ulcers

A
  • break in mucosal barrier
  • incompetent pylorus = decrease in protective mucus
  • risk factors: smoking, steroids, NSAIDs, caffeine, alcohol, stress, gastritis
  • pain with eating, antacids ineffective
68
Q

Characterisitics of Gastritis

A
  • Epigastric discomfort
  • Hyperactive BS
  • Management
    • Remove cause/offending substance
    • Treat symptoms
    • Anti-emetics, antacids, Bowel rest w/clear fluids then slowly escalate to reg diet
69
Q

Characteristicis of cholecystitis

A
  • Cholelithiasis: gallstone in cystic duct or common bile duct
    • Midline epigastric pain, may radiate to intrasapular
  • Risk factors
    • Women>Men
    • 40’s-50’s
    • High fat diet
  • Late phase
    • RUQ pain
    • Elevated AST and Alk Phos
70
Q

Normal values for Chem panel

A
  • Cl: 95-110
  • CO2: 24-32
  • Crea: 0.5-1.3
  • Phosphorus: 3.0-4.5
  • Ca: 8.6-10.5
  • Mg: 1.2-2.0
  • Triglycerides: 35-160
71
Q

Normal values for liver panel

A
  • Total Proteins: 6.3-8.3
  • Amylase: 56-190
  • Lipase: 0-110
  • Troponin: <0.3
  • Myoglobin: 0-85
  • Albumin: 3.5-5.1
  • Alk Phos.: 20-180
  • T. Bili: 0.3-1.3
  • Lactate: 0.3-2.6
  • AST: 8-42
  • ALT: 10-60
72
Q

Normal values for blood panel

A
  • RBC: 4.5-5.3
  • Hgb: 13-16
  • Hct: 37-49
  • PLTs: 130-400
  • PTT: 23-33.5 (Hep)
  • PT: 11-12.5 (Coum w/ INR)
73
Q

Normal ABG values

A
  • PO2: 80-100
  • PCO2: 35-45
  • HCO3: 22-28
74
Q

What are the volumes for each type of O2 therapy?

A
  • Nasal Cannula: 1-6L
    • 24%-44%
  • Simple Face mask: 8-12L
    • 35%-60%
  • Partial Rebreather: 6-10L
    • 40-60%
  • Non Rebreather: 15L
    • 60-100%
  • Venturi
    • 24-65%

NURS112 (5 decks)

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