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Process 2 > Final Exam > Flashcards

Final Exam Flashcards

1
Q

nursing role in genetic counseling

A
  • taking family history and referring for further genetic counseling
  • explain purposes, risks/benefits of all screening and diagnostic tests
  • discussing costs, benefits, and risks of using health insurance, and potential risks of discrimination
  • Counsel the family that there are resources available- gvt assistance, medicaid, WICK, foodstamps
  • Because of HIPAA, we can’t tell anything to anyone about illegal immigrants, etc.
  • emotional support
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2
Q

appropriate weight gain during pregnancy

A

-Underweight (BMI

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3
Q

Interventions for preeclampsia

A
  • Clear the airway and administer adequate oxygen
  • Position mom on her left side and protecting her from injury
  • Suction equipment must be readily available to remove mouth secretions after seizures
  • IV fluids given after seizure to replace fluid
  • Mag is administered to prevent further seizures
  • FHR monitored closely
  • Mag level, respiratory rate, reflexes and urine output closely monitored
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4
Q

HELLP syndrome

A
  • H: hemolysis resulting in anemia and jaundice
  • EL: elevated liver enzymes resulting in elevated ALT and AST, epigastric pain, and N/V
  • LP: low platelets resulting in thrombocytopenia, abnormal bleeding and clotting times, bleeding gums, petechiae, and possibly DIC
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5
Q

management of HELLP

A
  • Lower BP with rapid acting antihypertensives,
  • prevention of convulsions with mag,
  • use of steroids for fetal lung maturity,
  • birth of infant
  • blood component therapy is transfused to address microangiopathic hemolytic anemia
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6
Q

Cardiac disorders in pregnancy

A
  • continue to take cardiac medications as prescribed

- Anything they have is going to get worse because of increased oxygen demand and change in blood flow

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7
Q

management of labor with nonreassuring heart tones

A
  • left lateral position
  • 8-10 L oxygen with nonrebreather
  • be prepared for delivery
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8
Q

management of shoulder dystocia

A
  • intervene immediately due to cord compression
  • perform McRobert’s maneuver (hyperflexing legs) and application of suprapubic pressure
  • assist with squatting position, hands and knees, or lateral recumbent position to free shoulder
  • anticipate c-section if no success in dislodging shoulders
  • after birth assess newborn for crepitus, deformity, Erb’s palsy, or bruising
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9
Q

induction vs augmentation

A
  • Induction: stimulating contractions via medical or surgical means
  • Augmentation: enhancing ineffective contractions after labor has begun
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10
Q

Pitocin doses and side effects

A
  • 0.5 mu/min, increase by 1-2 my/min q30-60 mins
  • postpartum hemorrhage: 10 units infused at 20-40 mu/min
  • side effects: increased uterine motility and painful contractions
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11
Q

postpartum expected assessment findings

A

BUBBLEEE:

  • Breasts (size, contour, engorgement): Check for cracks, redness, fissures, or bleeding, and note whether they are erect, flat or inverted
  • Uterus (height of fundus, firmness): Fundus should be midline and feel firm, boggy or relaxed is a sign of uterine atony; Fundus progresses downward at a rate of one fingerbreadth (1cm) per day after birth and should be nonpalpable by 10 days postpartum
  • Bladder (voiding, bladder emptying)
  • Bowels (bowel sounds, distention)
  • Lochia (amount, color, odor)
  • Episiotomy and perineum (lacerations, hematoma): Inspect for irritation, ecchymosis, tenderness, or hematomas
  • Extremities: Hypercoagulability
  • Emotional status: assess interaction with baby
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12
Q

Amounts of lochia

A
  • Scant: 1-2 inch stain and 10 mL loss
  • Light or small: 4 in stain or 10-25 ml loss
  • Moderate: 4-6 in stain and 25-50 ml loss
  • Large or heavy: pad is saturated within 1 hour after changing it
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13
Q

colors of lochia

A
  • Rubra: deep-red mixture to mucus, tissue debris, and blood that occurs for the first 3-4 days after birth… becomes paler and more serous after this
  • Serosa: second stage; pinkish brown; expelled 3-10 days postpartum
  • Alba: final stage; creamy white or light brown; 10-14 days, but can last 3 to 6 weeks postpartum
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14
Q

calories for breastfeeding

A

extra 300

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15
Q

patho of postpartum hemorrhage

A

Five T’s:

  • Tone: uterine atony, distended bladder
  • Tissue: retained placenta and clots
  • Trauma: vaginal, cervical, or uterine injury
  • Thrombin: coagulopathy (preexisting or acquired)
  • Traction: causing uterine inversion
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16
Q

Management of postpartum hemorrhage

A
  • massage boggy uterus to stimulate contractions and expression of any accumulated blood clots
  • administer Pitocin
  • fluid administration
  • monitor for s/s of shock
  • antibiotics for infection
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17
Q

management of postpartum affective disorders

A
  • baby blues: usually self-limiting and resolves within 2 weeks
  • PPD: symptoms last beyond 6 weeks and worsening; Combination of antidepressant medication, antianxiety medication, and psychotherapy in an outpatient and inpatient setting
  • postpartum psychosis
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18
Q

APGAR

A
  • heart rate
  • respiratory effort
  • muscle tone
  • reflex irritability (non; grimace; cough, sneeze, or cry)
  • color
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19
Q

IUD problems

A
  • Increases the risk of PID, uterine perforation, ectopic pregnancy, uterine expulsion, and bacterial vaginosis
  • Does not protect against STIs
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20
Q

infant nutrition

A
  • In the first 24 hours, looking for 1 pee and 1 poop or more
  • By 4-6 months their birth weight should be double
  • By 12 months their birth weight should be tripled
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21
Q

SGA Newborns: Common Problems

A
  • Perinatal asphyxia- more at risk for fetal demise
  • Difficulty with thermoregulation
  • Hypoglycemia
  • Polycythemia
  • Meconium aspiration
  • Hyperbilirubinemia
  • Birth trauma- less developed
  • More at risk for failure to thrive
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22
Q

LGA Newborns: Common Problems

A
  • Birth trauma- shoulder dystocia
  • Hypoglycemia
  • Polycythemia
  • Hyperbilirubinemia - jaundice
23
Q

nursing management of neonatal asphyxia

A

immediate resuscitation, continued observation, neutral thermal environment, blood glucose levels, parental support and education

24
Q

management of transient tachypnea of the newborn

A
  • Oxygenation
  • Supportive care
  • IV fluids or gavage feedings
  • Supplemental oxygen
  • Neutral thermal environment
25
Q

management of RDS

A

-Supportive care; close monitoring
-Respiratory modalities: ventilation (CPAP, PEEP); exogenous surfactant; oxygen therapy
-Antibiotics for positive cultures; correction of metabolic acidosis
(Strep B is a common infection to lose babes to)
-Fluids and vasopressors; gavage or IV feedings
-Blood glucose level monitoring
-Clustering of care; prone or side-lying position
-Parental support and education

26
Q

management of meconium aspiration

A
  • Suctioning at birth
  • Adequate tissue perfusion
  • Decrease in oxygen demand and energy expenditure
  • Neutral thermal environment
  • Parental support and education
27
Q

management of infants with diabetic mothers

A
  • Prevention of hypoglycemia (oral feedings, neutral thermal environment, rest periods)
  • Maintenance of fluid and electrolyte balance (calcium level monitoring, fluid therapy, bilirubin level monitoring)
  • Parental support and education
28
Q

types of surgery for breast cancer

A
  • modified radical mastectomy: most common; removal of all breast tissue and axillary lymph nodes; pectoralis major muscle remains intact
  • local breast conserving surgery (lumpectomy): used to diagnose
  • radical mastectomy: removal of all breast tissue, axillary nodes, and pectoral muscles
29
Q

Post-op mastectomy

A
  • assess for drainage
  • position in semi-Fowler’s and arm positioned so that each joint is higher than the one before it
  • no BP or injections on affected side
  • initiate arm exercises
30
Q

teaching for post-mastectomy

A
  • Watch for edema of affected arm
  • Lymphedema can occur any time after axillary node dissection
  • Discuss symptoms of recurrence and importance of making regular visits to the physician to monitor recovery and detect changes
  • Provide incision care with emollient as prescribed to soften and prevent wound contracture
  • Encourage the client to perform breast self-examination on the remaining breast
  • Do not let the affected arm hang dependent
  • Do not carry a purse over the affected arm
31
Q

postop for prostate cancer

A

Continuous Bladder Irrigation (CBI/ Murphy drip):

  • triple lumen catheter
  • provides continuous irrigation to prevent bleeding and to flush the bladder of tissue and clots after TURP
  • titrate CBI so the outflow is light pink without clots
32
Q

opioid you can use during labor

A

fentanyl

33
Q

nadir

A
  • the lowest ANC after myelosuppressive chemotherapy, targeted therapy, or radiation therapy that suppresses bone marrow function
  • 500 is the lowest ANC… 500-1500 is at risk
34
Q

PUSH scores

A
  • ulcers are categorized according to size, exudate, and type of tissue
  • 0 is healed
  • 17 is not healed
35
Q

Braden scale

A
  • Scores six subscales: sensory perception, moisture, activity-mobility, nutrition, friction, and shear
  • 18 is at risk
  • 12 or less is high risk of ulcer development
36
Q

excessive GH in children vs adults

A
  • children: gigantism

- adults: acromegaly

37
Q

hypophysectomy

A
  • removal of pituitary tumor

- done via transphenoidal surgery

38
Q

hypophysectomy complications

A
  • Stroke or blindness if nearby arteries are damaged
  • Temporary onset of diabetes insipidus, which usually resolves itself within 1 to 2 weeks of surgery
  • Possible damage to pituitary could cause hypopituitarism
39
Q

hypophysectomy postop care

A
  • Maintain adequate airway
  • Perform serial neuro assessments to identify changes in mental status
  • Elevate HOB 30-45 degrees to decrease edema and promote CSF flow to the lumbar cistern
  • Side lying position if unconscious to facilitate drainage
  • Avoid leaning forward, blowing nose or sneezing
  • Do not remove nasal packing until surgeon orders it
40
Q

priority tx with addisons crisis

A
  • Hypothermia is priority… fluids first
  • Hypotension second… epi, norepinephrine, dopamine
  • replace missing hormones
  • Put in recumbent position with legs elevated
41
Q

postop adrenalectomy

A
  • Vitals, central venous pressure, and urine output must be monitored frequently
  • s/s of hypocorticism must be assessed hourly for the first 24 hrs
  • IV glucocorticoids given as prescribed
  • Monitor for early indications of shock, infection, and alterations in blood glucose and electrolytes
  • Increased steroids to meet metabolic demands are needed if additional stress occurs
  • Room must be kept cool and patients clothing and bedding changed often if he or she perspires profusely (side effect of surgery on the adrenal gland)
  • Assess abdomen for distension and bowel sounds
  • Assess for s/s of adrenal crisis
42
Q

priority tx for myxedema coma

A

-levothyroxin

43
Q

postop thyroidectomy

A
  • reduction of stress and anxiety to avoid precipitation of thyroid storm
  • Attention to compromise of the airway by hemorrhage (could run down neck to behind the head/neck) or recurrent laryngeal nerve injury is emphasized
  • Maintained in semi-fowlers, with head and neck well supported
  • Hemovac may be in place for first 24-48 hrs
  • Check for dysphagia and hoarseness, signs of laryngeal nerve injury, and for bleeding and infection
  • Evidence of hypocalcemia resulting from unrecognized removal of the parathyroid glands must also be assessed
  • Monitor for resp distress
44
Q

metabolic vs respiratory acidosis/alkalosis

A
  • respiratory: pH is opposite from everything else

- metabolic: everything (including pH) goes the same direction

45
Q

endocarditis

A
  • infection or inflammation of the heart valves or of the lining of the heart
  • most commonly from Streptococcus viridans
46
Q

Natriuretic factors

A

NATRECOR (Nesiritide BNP): causes smooth muscle dilation and decreases workload of the heart by decreasing preload and afterload, decreasing BP by dilating arteries and veins

47
Q

ABGs

A
  • Measurement of the pH and partial pressures of dissolved gases (oxygen, carbon dioxide) of the arterial blood
  • Perform Allen’s test to assess collateral circulation before arterial puncture
  • Pressure should be maintained at the puncture site for a minimum of 5 minutes
48
Q

patho of pneumonia

A

Exposure to foreign matter -> inflammatory response -> capillary walls become ‘leaky’ -> fluid shifts from capillaries to interstitial space and then to alveoli -> alveoli fill with fluid -> lungs lose compliance -> VQ mismatch

49
Q

Treatment of TB

A

RIPES:

  • Rifampin
  • Isoniazid
  • Pyrazinamide
  • Ethambutol
  • Streptomycin
50
Q

asthma diagnostics

A

ABGs, IgE, sputum cultures, PFTs, chest x-rays

51
Q

PE diagnostics

A
  • Enhanced spiral computed tomography (CT) scan (specific for PE)
  • D-dimer test is elevated
  • Ventilation-perfusion scan (V/Q) is done for pts who cannot have contrast media
52
Q

pulmonary edema diagnostics

A

increase in B-type natriuretic peptide (BNP) levels to assess for HF (

53
Q

Cor pulmonale definition and s/s

A
  • right-sided hypertophy of the heart from pulmonary HTN
  • s/s: related to dilation and failure of the R ventricle with subsequent increase in intravascular volume and systemic venous congestion: S3, ECG – increased P wave amplitude, distended neck veins (JVD), hepatomegaly, ascites, epigastric distress, peripheral edema, and weight gain, dyspnea, orthopnea

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