Final Exam Blueprint Flashcards
priorities of care for patient with peripheral neuropathy
SAFETY
assess sensation, mobility, wounds
avoiding extreme temperatures, soaking feet, and poorly fitting shoes
teach patients to check their feet DAILY
which organ is most affected by blood glucose?
brain
cannot store glucose and uses a LOT for functioning, so important to maintain blood glucose control
s+s of DKA, what type of onset + associated with which DM?
- rapid onset
- CBG >300
- ketones in urine
- acidosis (low pH)
- kussmaul breathing
type 1
interventions for DKA
- ABC (don’t intubate b/c kussmaul helping to blow off CO2)
- telemetry
- fluids (NS for CBG >250, D5 1/2 NS CBG <250)
- potassium (slowly to prevent heart issues)
s+s of HHS, what type of onset + associated with which type of DM?
- gradual onset
- CBG >600
- profound dehydration
- hyperosmolar state (>320)
type 2
higher mortality rate
interventions for HHS
- ABC
- telemetry
- fix osmolarity SLOWLY (avoid neuro complications)
- fluids (1/2 NS b/c of osmolarity)
would you expect weight loss or weight gain with DKA? why?
would you expect hypo or hypertension?
weight loss b/c of hyperglycemia –> body breaking down fat –> diuresis
HYPOtension b/c of fluid loss
DM diagnostic for fasting glucose
> 126 on 2+ occasions
DM diagnostic for HgA1C
> 6.5%
DM diagnostic for non fasting glucose
> 200 w/symptoms of hyperglycemia
DM diagnostic for glucose tolerance test (preggos)
> 200
and increased risk of developing TIIDM later on
what is normal fasting glucose? and when is best time to take this?
80-110
morning labs after NPO
what is normal HgA1C?
<4-6%
what is HgA1C that indicates risk of Diabetes?
5.7-6.4%
re: urinalysis, what would you see present in urine with early stage diabetic nephropathy?
albumin
s+s of hyperglycemia
“hot and dry, sugar’s high”
kussmaul breathing, weight loss, 3 P’s, fatigue, hypotension, blurred vision
s+s of hypoglycemia
“cool and clammy, need some candy”
diaphoretic, tremors, tachycardia, irritability, confusion, hunger, fatigue, nausea
what are the 3 P’s r/t hyperglycemia and describe why they occur (KISS)
- polyphagia: cells starving
- polyuria: diuresis r/t hyperglycemia
- polydipsia: secondary to polyuria and dehydration
compare type 1 DM with type 2 DM
- type 1: autoimmune, beta cells destroyed + don’t produce insulin; complication: DKA
- type 2: insulin resistance; often treated with lifestyle mods + oral drugs, sometimes insulin; complication: HHS
expected ABG values for DKA
pH low (<7.35) CO2 low (<35) HCO3 low (<22)
expected lab findings for pyelonephritis
- WBCs elevated
- presence of RBCs in urine
- presence of bacteria in urine
- culture: E. coli
deficiencies for hypoparathyroidism
- vitamin D
- Calcium
- magnesium (maybe)
- PTH
comfort interventions for post lithotripsy
pain management: ice packs, tylenol, NSAIDs
dietary restrictions for acute glomerulonephritis
K+ and protein
how should fluids be increased with acute glomerulonephritis?
output from the day before + 500-600mL
s+s of hypothyroidism
- low HR, BP, RR
- fatigue
- sleeping a lot
- anorexia
- weight gain
- intolerance to cold
- depression
- thickened tongue (changes in speech)
- edema in eyes/face
- dry skin
T3 + T4 levels for:
hypothyroidism
hyperthyroidism
hypo = low = low T3+T4
hyper = high = hight T3+T4
s+s of hyperthyroidism
- high HR, BP, RR
- intolerance to heat
- insomnia
- weight loss
- excess hunger
- dry brittle hair
- hot, moist skin
- irritability
- tremors
- diaphoresis
main complications/manifestations of FES
- brain: HA, confusion, seizure, altered LOC
- lungs: dyspnea, breathlessness, tachypnea how it’s similar to PE
- skin: petechiae
(up to 72 hours after long bone fracture or hip/knee arthroplasty)
s+s of PE
- dyspnea
- low O2
- tachypnea
s+s of acute glomerulonephritis (5)
- fluid overload issues*
1. edema
2. BP
3. decreased urination
4. weight gain
5. respiratory issues
what history is good to collect for acute glomerulonephritis?
recent infection (strep within 10 days)
how would we know acute glomerulonephritis is resolving and patient is getting better?
weight loss, less edema, increased urine output, no respiratory issues
3 body systems mainly affected by malignant hypertension
- brain (stroke)
- kidneys (failure)
- heart (failure)
what s+s would you see in the brain related to malignant hypertension?
- change in LOC
2. HA
what s+s would you see in the kidneys related to malignant hypertension?
- uremia
- decreased GFR
- increased BUN/creatinine
what s+s would you see in the heart related to malignant hypertension?
- EKG changes
- dyspnea
- fluid retention/weight gain
what is tx for malignant hypertension? how slow should we do this?
reduce BP with antihypertensives
25% reduction in 2-6 hrs
s+s of hyperparathyroidism
“mneumonic” + it’s s+s, plus 3 extras
= hypercalcemia (serum)
= hypocalcemia (bones)
“bones, grones, stones, moans”
bone fractures, GI issues (constipation, N/V), kidney stones, irritability, lethargy, confusion
waxy pallor, weakness, cardiac issues
patient teaching for hyperparathyroidism (3)
- 3-4L H2O/day
- injury prevention (b/c of hypocalcemia in bones)
- monitor cardiac fxn
s+s of PKD
- HTN
- Edema
- distended abdomen
- pain
- low GFR
- increased BUN/creatinine
- kidney stones
- dysuria
- nocturia
- foul smelling urine
- cola colored urine
- bloody urine
- cysts in other areas of body
re: PKD and cysts forming in other areas of the body, what’s our concern with the brain? what might be a s+S of this?
aneurysm
HA!
what is an early sign of PKD?
+ what is a late sign of PKD?
early: nocturia (can’t regulate urine)
late: edema (periorbital edema is an example –> notify provider)
dull and aching pain with PKD could indicate what?
pressure on organs
kidneys can grow to be the size of a football!
sharp + intermittent pain with PKD could indicate what?
cyst rupture
sodium intake with PKD:
early:
late:
early: moderate intake
late: limit (<2.5g per Messer/<2g per Iggy)
what is the common indicator for thyroid storm?
fever: 1 degree increase should be reported!!!!!
what are other s+s of thyroid storm (aside from fever) (5)
+ what can this lead to?
- tachycardia
- HTN (SBP 200)
- tremors
- anxiety
- GI issues
…….can lead to seizure + death
death from thyroid storm is often related to what?
high BP –> MI, stroke, seizure
priority actions for thyroid storm (5)
ABC
- airway
- cardiac monitor
- decrease BP + HR (meds - thyroid + BP)
- reduce fever (tylenol + ice packs)
- fluids
normal calcium level
8.5-10.5
s+s of hypocalcemia (10) + your priority concern
“CATS”
- convulsions
- arrhythmias
- tetany
- stridor / spasms
- trousseau’s sign
- chvostek’s sign
- tingling/numbness
- cramps
- seizures
- irritability
priority: AIRWAY (stridor)
what is trousseau’s sign?
hand spasm when BP cuff inflated
what is Chvostek’s sign?
face spasm when tapped on cheek
s+s of hypercalcemia
“bones, grones, stones, moans”
- bone fractures + pain
- GI issues: constipation, N/V
- kidney stones
- irritability, coma
- weakness
- cardiac issues
glucose admin for:
- alert + oriented:
- obtunded w/IV:
- no IV access:
- alert: oral glucose
- obtunded w/IV: IV D50
- no IV: IM or subQ glucagon
according to messer, “if patient has an acute change in mental status, we should do what 2 things?”
- check CBG
- give IV D50
quickest option
if patient is NPO, what insulin would we hold and not hold?
hold: short acting
keep giving: basal
T score for osteoporosis
-2.5 or lower
T score for osteopenia
-1 to -2.5
risk factors for colon cancer
- age
- genetics
- IBD
- sedentary lifestyle
- diet high in fat + low fiber
- smoking
- ETOH
- obesity
blood transfusion musts……
- verify order + consent
- patient ID w/type and crossmatch
- 2nd nurse or BCA
- large gauge (18 is preferred)
- NS + blood filter tubing only
- start within 15 mins
- finish in 4 hrs
- stay with patient 1st 15 minutes
- monitor frequently
restrictions after mastectomy
- no heavy lifting
2. no BP readings or venipuncture or anything invasive on that arm or arms
patient education for gout
- drink plenty of fluids
- avoid foods high in purine (oily fish, fish with bones, organ meat, shellfish)
- avoid ETOH, ASA, diuretics, stress
- consume citrus foods
what is common cause of sensorineural hearing loss?
noise pollution (loud machinery, frequent exposure) + ear probing
when do we use abduction pillow with hip replacement surgery?
posterior approach
+ confused older adult is good candidate as well
restrictions post hip replacement
- don’t cross legs
- avoid hip rotation
- avoid extreme bending at waist
- keep knees 90 degrees
- abduction pillow for posterior approach
press fit vs cement press for hip replacement
- press fitted takes longer to heal/form around bone: NWB immediately after (lasts longer so usually used for younger folks)
- cement press: weight bearing immediately after (older folks bc doesn’t last as long)
s+s of osteoarthritis
- pain after activity
- relief after rest
- stiffness
- large, hardened joints (Heberden’s: distal/Bouchard’s: proximal)
- crepitus
- decreased ROM –> muscle atrophy
normal magnesium (Iggy/Messer)
1.5 - 3
normal phosphorus (Iggy/Messer)
2 - 4.5
normal BUN (Iggy/Messer)
8-20
normal creatinine (Iggy/Messer)
0.6-1.5
normal albumin (Iggy/messer)
3- 5.5
seizure precautions (5)
- airway kit
- suction
- O2
- bed lowered + locked
- IV access
what is most common cause of embolic stroke?
atherosclerotic plaque breaking off
a fib
what is our assessment priority for stroke patient?
ABC
can they maintain an airway? (aspiration + dysphagia)
what is early sign of increased ICP (after stroke)
changes in LOC
what is late sign of increased ICP (after stroke)
pupil constriction + cushing’s triad (HTN, wide pulse pressure, bradycardia)
after stroke, we should ensure SBP doesn’t exceed what?
180
osteomyelitis priority
prevent worsening –> gangrene and amputation
antimicrobial therapy on board ASAP!!!!
if there is a trauma fracture, what framework should you think in?
ABC
ex: chest fracture –> think airway/breathing
priority assessment for fracture
CMS: circulation, movement, sensation
post fracture, numbness + tingling could be a sign of what?
neurovascular compromise/compartment syndrome
s+s of acute compartment syndrome
6 P’s
- pain
- poikilothermia
- paralysis
- paresthesia
- pallor
- pulselessness
education for glaucoma
- avoid anything causing increased IOP
- treat early (annual eye exams)
- eye drop management: wash hands, conjunctival sac, occlude tear duct to avoid systemic absorption
patient education with retinal detachment surgery/repair (4)
- avoid rapid/fine eye movements (reading)
- wear eye patch + rest
- monitor for infection
- inform them it can happen again
education how to avoid UTIs
- urinate after sex
- dry, cotton breathable underwear
- hand hygiene
- wipe front to back
- HYDRATE (2-3L/day)
UTI prevention with DM
- blood glucose control
2. avoid urinary retention (drugs, holding urine, etc)
re: TB testing, what is screening vs definitive diagnosis?
screening: PPD
definitive: sputum + culture
re: PPD test, positive reading of these values for which type of populations?
> 15mm:
10mm:
5mm:
> 15: general public w/no risk factors
> 10: LTCF, homeless, crowded living situations, HCW
> 5: HIV, immunocompromised, recent exposure to active TB
what does BNP signify? what is normal?
stretch of the heart (r/t HF)
normal <100
s+s of Right sided HF (7)
- edema
- weight gain
- hepatomegaly
- ascites / abdominal distention
- JVD
- bounding pulses
- respiratory issues (most common cause of right sided HF is left sided HF)
s+s of left sided HF (8)
= oxygenation + perfusion issues
- fatigue
- weakness
- low urine output
- pallor
- weak pulse
- SHOB
- dyspnea
- crackles
education for person with COPD (8)
- small, frequent meals with high calories, low carbs
- pulmonary hygiene
- hydration
- exercise w/rest breaks
- smoking cessation
- breathing techniques: pursed lip + diaphragmatic
- O2 therapy PRN
- premedicate before meals
what should a person avoid with diverticulitis?
nuts
fruits with seeds
no fiber with acute inflammation
s+s of Chron’s (9)
including lab findings
- cobblestone appearance
- abd pain (RLQ + umbilicus)
- steatorrhea
- fistula + abscess (fever)
- weight loss
- diarrhea
- deficiencies in folic acid + B12 + electrolytes
- low H+H
- low albumin
priority of care for pt with influenza
= supportive
- O2 PRN
- raise HOB
- fluids
- ABX if needed
- antipyretics
- rest
what precautions should person with influenza be on?
droplet
some complications of chronic bronchitis (5)
- mucus/congestion
- infection
- impaired gas exchange
- dysrhythmias
- cor pulmonale
common cause of stress incontinence + what is intervention?
- pregnancy
- obesity
- low estrogen (loss of tone in pelvic floor)
= weak pelvic floor muscles
intervention: kegel (strengthen pelvic floor)
common cause of overflow incontinence + what is intervention?
obstruction (BPH)
intervention: remove obstruction, pharmaceuticals
common cause of urge incontinence + what is intervention?
bladder irritants
intervention: avoid irritants + train bladder
common cause of functional incontinence + what is intervention?
loss of functional or cognitive ability - cannot get to toilet in time
intervention: treat cause, indwelling catheter, habit training, help people get to toilet, containment
what diagnostic tool for consciousness would we used for stroke patient?
Glasgow coma scale
15 = highest score = fully awake patient
what diagnostic tool could be used to determine the deficits after a stroke?
NIH SS
PNA manifestations (10)
- crackles
- chest pain/dyspnea
- SHOB
- fever (maybe)
- malaise
- tachypnea
- tachycardia
- chills
- hypoxia
- cough
PNA interventions (10)
- raise HOB
- O2 therapy if needed
- ABX
- antipyretics
- fluids
- rest
- hand hygiene
- oral care
- pulmonary hygiene
- mobility
