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Med surg > Final exam > Flashcards

Final exam Flashcards

1
Q

S/S of increased ICP

A

decreased level of consciousness, sudden numbness and tingling, sudden trouble seeing in one or both eyes, sudden dizziness, sudden severe headache, cushing’s triad

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2
Q

cushing’s triad

A

widening pulse pressure, deep shallow respirations (CS), HTN, bradycardia

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3
Q

interventions for increased ICP

A

head midline, elevate HOB 30 degrees, hyper-oxygenate before suctioning, do not cluster activities, lights down low, discourage coughing

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4
Q

acute kidney injury

A

AKI is a reversible, sudden in onset disorder of the kidney that includes 50-95% of the nephrons, impacts many body systems, problems with elimination, fluid and electrolyte balances, and acid-base imbalance.

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5
Q

how much Cr is raised in AKI

A

.3mg/dl or a serum Cr rise of of 1.5 times more

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6
Q

complications of AKI

A

metabolic acidosis, hyperlipidemia, hyperkalemia, hyponatremia, hypocalcemia, hypophosphatemia, edema, heart failure, PE, pericarditis, mental status changes

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7
Q

Patient’s at risk for AKI

A

pre-existing reduced GFR, elevated Cr, diabetes, HTN, peripheral vascular disease, liver disease, CKD

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8
Q

how much fluid should a healthy adult be drinking in a day

A

2-3L of fluid a day

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9
Q

history questions for AKI

A

ask about recent surgery or trauma, transfusions, antibiotics, and NSAIDs

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10
Q

imaging for AKI

A

CT scan without contrast, ultrasonography, MAG3, kidney biopsy, cytoscopy,

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11
Q

nursing goals of AKI

A

prevent volume depletion and provide intervention early

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12
Q

Chronic kidney disease

A

CKD is a progressive, irreversible, kidney disease that results, has 5 stages, progresses into ESKD if not treated properly, 90-95% of the nephrons are included and it impacts all body systems and the kidney’s not recover

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13
Q

Patient ed for CKD

A

carefully manage fluid volume, BP, electrolytes, BUN and Cr, be alert to the general appearance of your urine, note any changes in its color, clarity, and odor, how much urine is passed, 1-2 L of fluid a day (water is the ideal fluid). Decreased Na, Ca and increased P, K,Mg

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14
Q

next steps for CKD

A

if it worsens dialysis is needed and a kidney transplant

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15
Q

hemodialysis nursing interventions

A

monitor perfusion, monitor for hypotension, high calorie foods, high protein diet, monitor Na, monitor BUN and Cr

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16
Q

prerenal causes of AKI

A

blood or fluid loss, hypotension, low EF and low CO, infection, liver failure, aspirin, ibuprofen, NSAIDs, severe dehydration

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17
Q

intrarenal causes of AKI

A

infection, ischemia, bleeding in the kidney, thrombi or emboli, HUS, sepsis, lupus, nsaids, antibiotics, chemo, ,

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18
Q

postrenal causes

A

cancer of the bladder, cervical, colon, prostate, enlarged prostate, kidney stones

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19
Q

IV solutions for AKI

A

isotonic (NS and LR) needed for a fluid bolus

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20
Q

diagnostic tests for AKI

A

GFR, ultrasonography, decrease in UO, urinalysis

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21
Q

fistula

A

used for HD and should be monitored for thrills, avoid putting any pressure on that arm

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22
Q

pre dialysis for HD

A

hold antihypertensives

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23
Q

post-dialysis for HD

A

monitor weight, fatigue, hypotension, headache, N and V muscle cramps and bleeding

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24
Q

intra-abdominal cath

A

used for PD, clean daily with soap and water, betadine to exit, aseptic technique, high risk for peritonitis

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25
Q

psychosocial for PD

A

body image changes and dialysis is needed daily

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26
Q

IV contrast dye test

A

discuss patients serum Cr, hold medications (metformin), provide hydration (4-5 hours of fluid with normal saline), re-evaluate serum Cr and GFR post exam

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27
Q

preventing UTIs

A

drink fluid liberally 2-3 L a day, be sure to get enough sleep and rest, wipe front to back, loose fitting cotton underwear, cranberry, no scented anything, empty the bladder before and after sex, topical estrogen to the perinium

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28
Q

peritonitis

A

infection when a patient is undergoing PD, the intra abdominal cath then produces an effluent that is cloudy, a fever, nausea, abdominal tenderness, when cloudy effluent is suspected get a sample and get it tested

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29
Q

hyperthroidism

A

most common cause is graves disease which results in decreased TSH which then overstimulates the thyroid which increases T3 and T4

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30
Q

S/S of hyperthyroidism

A

jitteriness, shakiness, nervous, irritability, rapid Hr - possible lead to Afib, feeling hot, weight loss, diarrhea or frequent stools, short menses

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31
Q

nursing interventions for hyperthyroidism

A

monitoring apical pulse, BP, and temp, report any palpitations, dyspnea, vertigo, or chest pain, monitor for thyroid storm (uncontrolled thyroid)

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32
Q

hypothyroidism

A

the most common cause is Hashimoto’s which then causes an increase in TSH and a decrease in T3 and T4

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33
Q

S/S of hypothyroidism

A

fatigue, lack of energy, weight gain, heavy period, constipation, cold, slowed thinking

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34
Q

nursing interventions for hypothyroidism

A

monitor for decreased BP, HR, and rhythm, observe for s/s of shock, orient the person to person, place, an ex-plain all of the procedures carefully, safe environment

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35
Q

patient ed for hypothyroidism

A

take meds as prescribed, Synthroid is w/o food. have a high protein and high fiber diet

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36
Q

cushings

A

a disease of the anterior pituitary gland that causes an increase in Na and Blood glucose and a decrease in K and Ca. The anterior pituitary gland releases too much acth which leads to hyperfunction of the adrenal gland

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37
Q

S/S of cushing

A

moon face, buffalo hump, truncal obesity, weight gain, HTN, cardiovascular system, bruising, petechiae, dependent edema, osteoporosis, thinning skin, straie, reduced immunity

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38
Q

nursing interventions for cushings

A

monitor for HF, correct fluid and electrolyte imbalances, restrict sodium intake, daily weight bearing exercises, prevention of infection, monitor for insulin resistance

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39
Q

patient ed for cushing

A

educate pt on sign and systems, restrict fluid and sodium

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40
Q

Addison’s disease

A

too little cortisol or and aldosterone which results in too little acth which means a decrease in Na and Blood glucose and an increase in K and Ca

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41
Q

Addisonian crisis

A

caused by stress, infection (wbcs), severe headache, abdomen, leg and back pain, hypotension, hyponatremia, hyperkalemia, shock, treat with hydrocortisone

42
Q

nursing intervention for addison

A

monitor labs and I/os, observe for addisonian crisis

43
Q

patient ed addison’s

A

taught to recognize crisis, carry hydrocortisone,

44
Q

cushing, HF, and renal

A

the retention of sodium can cause cardiac problems because the kidneys use the RAAS system which then has to work harder to compensate which can result in kidney dysfunction and then an ultimate lead to cardiac problems. So it is critical to get help before the disease progresses

45
Q

SIADH

A

syndrome of inappropriate ADH, wayyy to much ADH which then results in a decrease in serum sodium and an increase in ADH,

46
Q

assessment for SIADH

A

learn about any recent injuries, TB, cancer and drug use, GI disturbances, nausea and vomiting, weight gain

47
Q

nursing interventions for SIADH

A

restrict fluid, promoting the excretion of fluid, prevent injury, monitor neuro because decreased Na can lead to seizures, vasopressin and diuretics

48
Q

patient ed for SIADH

A

monitor fluids, increased Na intake

49
Q

lung cancer is a risk factor for SIADH

A

low urine concentration, increased sodium is all common in lung cancer patients, so it leads to fluid imbalances

50
Q

acromegaly

A

a disease of the anterior pituitary that results in a overproduction of growth hormone, typically caused by an adenoma on the pituitary gland

51
Q

assessment of acromegaly

A

overgrowth of bone and cartilage, carpel tunnel, thick, oily skin, enlarged lips, tongue and nose, deep voice, snoring, excessive sweating, fatigue, enlarged organs

52
Q

nursing considerations with acromegaly

A

support the patient with changes in appearance, promote a good body image, radiation therapy and surgery are all treatment

53
Q

patient ed post hyphosectomy

A

do not do anything that increases ICP, encourage deep breathing, avoid bending at the waist but to use your knees as a way to get down, avoid straining with a bowel movement, avoid brushing teeth for two weeks post op, saline rinses, monitor for fluid imbalance, vitals Q4.

54
Q

Transnasal, transphenoidial, hyphosectomy

A

minimally invasive technique used to remove pituitary adenomas, inserts an endoscope through the nose,

55
Q

Cushing lab values

A

hyperntremia, hyperglycemia, hypokalemia, Hypocalcemia

56
Q

Addison lab values

A

hypoglycemia, hyponatremia, hyperkalemia, hypercalcemia

57
Q

iron

A

a defiency is caused caused by bleeding, mensuration, GI, and pregnancy, patients need to eat foods high in iron and iron supplements, their poop might turn green and black, take iron with food, and eat leafy greens and meat

58
Q

blood administration

A

jehovah’s witness do not accept blood so autotransfusion is needed, two nurses need to be present watch for fever, watch tubing and patient’s response, do a full CBC post

59
Q

total hip arthroplasty

A

hip replacement, maintain correct positioning, supine positioning, pillow between the legs, do not sit or stand for long periods, use an ambulatory, do not overextend, resume sexual intercourse, report pain and swelling to the surgeon immediately, no leg crossing

60
Q

splinting

A

using a pillow over the incision prevents the site from opening up, stand prior to ambulation, when you breathe you need to hold the pillow over the site in order to prevent opening and infection

61
Q

opioid overdose

A

naloxone

62
Q

benzos overdose

A

flamanezil

63
Q

HgB

A

12-18

64
Q

WBC

A

5000-10000

65
Q

Cr

A

<2

66
Q

min urine output per hour

A

30-35

67
Q

platelets

A

150,000-450,000

68
Q

Na

A

135-145

69
Q

K

A

3.5-5

70
Q

preop tests that need to be communicated

A

urinalysis, blood type and screen, cbc, clotting study, BUN, Cr, pregnancy test

71
Q

bowel and bladder post-op

A

make sure there is presence of active bowel sounds, no abdominal distention or rigidity, decreased abdominal peristalsis look for a post-op ileus, passing of gas or a bowel movement pot op is ideal, monitor the abdomen, ensure adequate hydration, increased mobility, nonopioid pain management, gum chewing, drug therapy

72
Q

what does chemo affect on a blood levels

A

due to bone marrow suppression chemo reduces RBC, WBC, platelets which lowers clotting, immunity, and oxygenation

73
Q

alopecia

A

hair loss, avoid scalp injury and cope with body image changes

74
Q

impaired nutrition

A

work with a RD, making sure the patient does eat, no one size fits all diet

75
Q

mucositis

A

open sores in the mouth from chemo, frequent saline oral rinses, brush teeth gently after meals, crotherapy

76
Q

constipation

A

high fiber and adequate fluids, laxatives

77
Q

xerostomia and thick saliva

A

well hydrated, mouth rinses with tap water, mouthwash with no alcohol, going to the dentist

78
Q

chemotherapy

A

treatment of cancer with chemical agents, used to create survival time, given both IV and oral. Both are toxic

79
Q

safe handling IV chemo

A

assessing the picc line every hour, wear ppe, if you touch the solution with bare hands you need to was hands with soap and water for 5 minutes, double flush, no preggers

80
Q

abdominal paracentesis

A

used to remove the excess fluid from the abdomen (asities), uses a trocar needle and an ultrasound to remove the fluid, monitor vital signs, measure drainage, tell the patient to void prior, weigh the patient before and after

81
Q

WBC growth factors

A

neupogen is a great example. So chemo supresses the bone marrow and then the WBCs cannot create an immunity so neupogen comes around and stimulates WBC production which then causes the patient to be able to not be immunocompromised and be able to fight infections instead of getting neutropenic fever

82
Q

neutropenic fever considerations

A

patient gets their own room, change dressings daily, they get their own bathroom, own supplies, limit people in the room to healthy people, they are not in isolation, no pregnant women, inspect the patients mouth, monitor for fever, take a cbc daily, wash your damn hands

83
Q

oral chemo safe handling

A

still toxic, do not touch with bare hands, pour the med into the top and then into a cup and then drink from the cup, do not miss doses at all because of resistance, take separately than other drugs, do not crush or split the meds

84
Q

Hep B high risk groups

A

infants who are born to infected mother’s, Sex (MSM), blood, needles

85
Q

hep B modes of transmission

A

unprotected sexual intercourse, sharing razors and needles, birth, blood brothers, accidental needlesticks

86
Q

vaccine for hep B

A

Hep B vaccine, also prevents you from getting Hep D

87
Q

prevention of Hep B

A

wash hands, use a condom, avoid direct contact with blood and bodily fluids

88
Q

cirrhosis

A

extensive, irreversible scarring of the liver, usually caused by a chronic reaction to hepatic inflammation and necrosis

89
Q

labs for cirrhosis

A

alt, ast, bilirubin, ammonia

90
Q

cirrhosis can develop into

A

cancer of the liver

91
Q

things that can result because of cirrhosis

A

asities, portal HTN, splenomegaly, jaundice, pruritis, esophageal varices, caput medusae, hepatic encephalopathy

92
Q

assessment for cirrhosis

A

assess for yellowing of the skin, dry skin, purpuric lesions, ecchymosis, vascular lesions, asities, vitamin (ADEK)

93
Q

causes of cirrosis

A

alcohol, viral hepatitis, drugs and chemical toxins

94
Q

Nursing interventions cirrhosis

A

paracentesis, respiratory support, avoiding alcohol, high protein low sodium diet, BB, diuretics, fluid restrictions, and a liver transplant

95
Q

external beam radiation side effects

A

acute and long term site specific changes, local skin changes, hair loss, altered taste sensations, bone marrow supression

96
Q

brachytherapy

A

internal radiation, direct contact with the tumor

97
Q

nursing implications brachytherapy

A

private room and bath, keep the door shut as much as possible, lead apron when caring for patient, do not turn your back on the patient, no pregnant visitors, visitors get a one half hour visit a day, never touch with bare hands

98
Q

drug needed post thyroidectomy

A

calcium gluconate

99
Q

s/s of ovarian cancer

A

bloating, feeling full fast, abdominal pain, urinary urgency

100
Q

three diagnostic tests for ovarian

A

pelvic and rectal exam, Ca-125 blood test, transvaginal ultrasound

Med surg (2 decks)

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