Final Exam Review Flashcards
what does the acronym SIRS stand for?
systemic inflammatory response syndrome
how does SIRS differ from sepsis
sepsis has to have a confirmed infection
What included in the sepsis one hour bundle?
-drawing lactate level and blood culture
-administering broad spectrum antibiotics
-administering IV fluids (for lactate 4 mol)
-giving vasopressor if needed (to maintain a MAP of 65)
What lab value is most indicative of sepsis?
increased lactate
What can be found around a surgical site that will indicate infection
redness
Is serous drainage from a surgical site expected?
yes
Before administering antibiotics for sepsis, we must ensure
blood cultures were drawn
A urinary output of 15 mL is indicative of what
organ dysfunction
What is the most effective way to stop the spread of infection
hand hygiene
What are risk factors for developing sepsis?
being above 80, DM, post surgery
What is an example of a modifiable risk factor for cardiovascular disease
smoking, diet, sedentary lifestyle, psychological variables (stress)
what does the P wave on an EKG represent
atrial depolarization
What does the QRS complex represent on an EKG
atrial repolarization and ventricle depolarization
What is a normal cholesterol level
less than 200
What is the correct sequence of atrial conduction through the heart
SA node, AV node, bundle of HIS, purkinje fibers
What is the preferred diagnostic test for DVT
venous duplex ultrasound
When should we monitor levels of IV unfractionated heparin
at least daily
6 hours after initiation
6 hours after any dosage changes
Assessment findings of DVT include
unilateral pain, warmth, redness, swelling
-has a sudden onset of pain
when calculating heart rate on a strip, we should determine there are how many large boxes (as in how many equal 6 seconds)
30 (or three tick marks at the top)
Normal sinus rhythm has a heart rate between
60-100
What is the normal value for the PR interval
0.12-0.2
What is the normal value for QRS interval
0.06-0.10
What is the normal value for the QT interval
less than 0.44 seconds
sinus bradycardia has a heart rate of
less than 60
What are prevention measures for DVT
early ambulation, SCDs, compression stockings, fluids, calf pump exercises, anticoagulant therapy
What lab is indicative of cardiac damage
troponin
What can be used for treatment of sinus bradycardia
IV atropine, oxygen, and IV fluids
What drugs are dabigatran, rivaroxaban, apixaban, and edoxaban
oral anticoagulatns
What is the benefit of using oral anticoagulants
allow for fixed doses without frequent lab monitoring
A patient was given benzocaine prior to bronchial surgery, the nurse knows the patient is at risk for?
methemoglobinemia
What is methemoglobinemia
when hemoglobin in the cell no longer works. leads to chocolate colored blood and decreased oxygenation
What is the antidote for methomeglobenemia
IV methylene blue
Should a rapid response be called for a patient with methomeglobinemia?
YES
oxygen and sitting them up will not help. crash cart has the antidote
What is a complication of tension pneumothorax
deceased cardiac output
Why does tension pneumothorax cause decreased cardiac output
when blood vessels in the lungs are collapsed there is not enough blood return to the heart. decreased heart filling –> decreased cardiac output
What is the best method to confirm placement of a chest tube
X-ray
When a patient presents to the ED with a chest trauma, what should the nurse address first?
-chest expansion
-capillary refill
-PERRLA
-orientation
chest expansion
What is the ABCDE method of treating emergency chest trauma s
airway, breathing, circulation, disability (LOC), exposure (removing clothes)
What does it mean to assess the airway in ABC
making sure it is patent and not closed
What does it mean to assess breathing in ABC
assessing breath sounds and chest expansion
What does it mean to assess circulation in ABC
check capillary refill
Following a lung biopsy, which assessment finding would require immediate follow-up?
increased temp
productive cough
incisional discomfort
absent breath sounds
absent breath sounds
What is tidaling?
when the water seal container of a chest tube rises and falls with inspiration and expiration
is tidaling a normal finding?
yes
is continuous bubbling in the water seal container considered a normal finding?
No, may indicate air leak
the absence of tidaling in the water seal container may represent
fully expanded lung, obstruction in the chest tube
Are we allowed to milk the tube of a chest tube?
no
What is flail chest
paradoxical chest wall movement
You are caring for a patient in respiratory distress, o2 sat 89%, RR 30. What is the best course of action?
apply oxygen
reposition
encourage IS use
notify provider
apply oxygen
Hyperparathyroidism can put the patient at risk for?
fractures
Why does hyperparathyroidism increase risk for fractures?
causes calcium to leave the bone and enter the blood stream (hypercalcemia)
Grave’s disease is a type of autoimmune disorder that causes
hyperthyroidism
What are s/s of hyperthyroidism/ Grave’s
heat intolerance, weight loss, increased appetite, insomnia, tachycardia
If TSH is elevated, T3 and T4 are
decreased
If T3 and T4 are elevated, TSH is
decreased
Would TSH or T3 be elevated in hypothyroidism
TSH
a patient with parathyroid hormone deficiency would have increased or decreased calcium levels/
decreased
What is thyroid storm?
When patients with hyperthyroidism enter an acute attack causing release of too many hormones at once
What is the best indicator for thyroid storm
increase in fever
Most common causes of thyroid storm
trauma, infection, vigorous palpation of goiter
Will patients in thyroid storm be hyperthermic or hypothermic
hyperthermic
Following a thyroidectomy, it is important for the nurse to inspect
behind the clients neck
What is an important complication of thyroidectomy
hemorrhage
What are trousseaus and chvostek signs
indicators for hypocalcemia
How to test for chvostek sign
tap the face and see if there are spasms
How to test for trousseau’s sign
use a blood pressure cuff and see if the wrist curls
A positive trousseaus sign indicates
hypocalcemia
What is the most severe form of hypothyroidism
myxedema coma
Myxedema coma is precipitated by
stress
What are s/s of myxedema coma?
bradycardia, hypotension, respiratory failure
Following a thyroidectomy, it is important to monitor for?
airway patency
What can damage the airway following a thyroidectomy?
nerve damage, hypocalcemia induced tetany, edema
If a patient develops stridor after a thyroidectomy, the nurse knows this is caused by
swelling
Is stridor after a thyroidectomy an emergency?
yes! notify provider as soon as possible
If a patient develops stridor after a thyroidectomy, the nurse should
contact provider and prepare for intubation
A patient with hypothyroidism will be prescribed
levothyroxine
to prevent thyroid crisis in a patient with hyperthyroidism, the nurse can?
encourage rest, keep environment quiet, room away from nurses station, limit visitors, provide cooling blanket
What should you tell a patient regarding diabetes management and sick days?
take insulin as prescribed
How often should a patient with diabetes take their blood glucose while sick
q 2-4 hours (more than normal)
What should the blood glucose range be for a patient with diabetes in the hospital
140-180
Should a diabetes patient who is sick remain NPO?
No, this can cause hypoglycemia
If a patient with diabetes is alert and oriented, but a blood sugar of 60, what is the best action
administer 15 g of oral carbohydrates
If the blood sugar is 51-70, how many carb snacks should we give
15 g carb snacks
If the patient has a BG of <50 but is alert and oriented, how many carb snacks should we provide
30 g carb snack
What is the ideal target range for BG at home (for diabetes)
70-110
What are examples of a 15 g carb snack
4 sugar cubes, 4 tsp of sugar, 1 tbs honey/syrup, 120 mL fruit juice, 5 hard candies
If a patient is not awake or alert, has an IV site, and is hypoglycemic we should administer
IV dextrose
If a patient is not awake or alert, no longer has IV, and is hypoglycemic we should administer
IM glucagon
After administering IM glucagon, what is the next nursing action?
turn them on their side (glucagon causes them to throw up and we do not want them to aspirate)
what are signs of diabetes type 1
abrupt onset, increased thirst, hunger, weight loss, and urination
What are signs of diabetes type 2
frequently no symptoms, thirst, fatigue, blurry vision
In a patient with type 1 diabetes, what is a sign of hyperglycemia
confusion, polyuria, hunger, tachypnea
What are complications of a client with DKA and on IV insulin
hypokalemia, hypoglycemia
What is the onset of regular insulin
30 minutes
If given regular insulin, it is important that the patient eats within
30 minutes
We should tell those with type 2 diabetes that exercise
can have a hypoglycemic effect, so they may need less insulin
What are the places insulin can be administered?
back of arms, abdomen, thigh, buttocks
Insulin is given at a 90 degree angle unless
there is not enough subcutaneous tissue (then it is 45)
How often should someone with diabetes check their feet
daily
If someone with diabetes cannot see their feet, what can they do
have someone else look, use a mirror
How should a patient with diabetes wash their feet
with lukewarm water and soap. dry thoroughly
Are nurses allowed to cut the toenails of patient with diabetes
no (let podiatry do it)
Should a patient with diabetes go barefooted?
no
What are signs and symptoms of a ureteral stone
severe pain, nausea, vomiting, pallor, clammy skin
Pyelonephritis is
infection of the kidneys
Pyelonephritis can be caused by
reflux of urine from the bladder
What is the most common cause of UTI and pyelonephritis
e - coli infection
What are sx of pyelonephritis
flank pain, fever, chills, anorexia with or with out vomiitng
What is the most common cause of kidney stone
dehydration
what is a common complication of chronic kidney disease
anemia
For patients with polycystic kidney disease, it is important that they monitor their
blood pressure and daily weight
A woman is more at risk for cystitis because
their urethra is close to the rectum
a client with uric acid stones should decrease the intake of
purine
Examples of purine sources
organ meats, poultry, fish, red wines, sardines, and gravies
Is pink-tinged urine expected following a cystoscopy?
yes
Following a cystoscopy, the patient should report
dark red urine (indicate of bleeding)
Following cystoscopy, patients should increase fluid intake in order to
decrease dysuria
is a patient NPO before a cystoscopy?
yes, NPO at midnight
What is a normal WBC count level
5-10,000
what is a CAUTI
catheter associated urinary tract infection
A catheter should only be in place for
no longer than medically needed d
Following a kidney biopsy, the patient should be on
strict bedrest
Following a kidney biopsy, what may be indicative of bleeding
flank pain, hematuria, on the bed
What to do with a limb that has been cut off in the community
put in watertight sealed bag, place in ice water
If a limb is amputated in the community, the patient should hold the limb
above the heart if possible
What is the purpose of bucks’ traction
reduce muscle spasms
Special considerations for skeletal traction
frequent pin care to reduce infection
What is most indicative of fat embolism
petechiae on the chest
What are other s/s of fat embolism
hypoxemia, dyspnea, tachycardia, agitation, headache
What is an impacted bone fracture
when the ends are jammed together
What is a comminuted fracture
the impact fragments bone into several pieces
What causes flail chest
when 3 or more ribs are broken in 2 separate places
What is the biggest indicator of tension pneumothorax
tracheal deviation
A transverse fracture is a break that goes
straight across bone shaft
an oblique fracture is a break that goes
through the bone shaft at an angle
What can help prevent flexion contracture
lie prone every 3 h for at least 20-30 min
What surgery causes flexion contracture the most
total knee arthroplasty
above the knee amputation
How long do we elevate the limb following a total knee arthroplasty
only the first 24 hours
What should we always ensure in patients with bucks and skeletal traction
make sure they are free hanging and not on the bed
What assessments should be made by the nurse while in Bucks and skeletal traction
skin color, temperature, distal pulses, capillary refill, movement, and sensation
signs of compartment syndrome
6 P’s
-pulselessness
-paralysis
-paresthesia
-paleness
-pain greater than expected
-paralyzed
What is phantom limb pain
limb pain felt in an amputated body part
what medication is most appropriate for phantom limb pain
iv calcitonin
where does pain from carpals tunnel occur
thumb, first two fingers and palm
What test is done for carpal tunnel
Phalen’s test
What is the phalen’s test
flexion of the wrist assessing for paresthesia
What does RICE stand for
rest, ice, compression, elevation
What age does GERD mostly occur
middle aged and older adults
How to reduce the contributing factors of GERD
-eat small frequent meals
-remain upright after eating
-avoid triggering foods
What foods should be avoided in GERD
-spicy foods, tomatoes, citrus foods, caffeine, alcohol, carbonated beverages, chocolate
What medications can be used to treat GERD
PPI’s (-azole) antacids, H2 blockers (famotidine)
Symptoms of sliding hernia
GERD symptoms (dyspepsia, regurgitation, dysphagia, belching, chest pain)
Symptoms of rolling hernia
fullness after eating, breathlessness, feeling suffocated
Why is an NG tube placed after fundoplication
prevent wrap from becoming too tight around esophagus
Initial drainage from NG tube after fundoplication
dark brown with old blood
8 hours after fundoplication, NG tube drainage should appear
yellowish green
why is it important to ensure an NG tube is anchored properly after insertion
re-insertion could cause perforation
risk factors for developing esophageal tumors
smoking and obesity
-malnutrition, untreated GERD, alcohol
What is Barrett’s epithelium
-caused by GERD
-premalignant esophageal cells
Many ulcers in PUD are caused by
H. pylori
What drug would the nurse expect to be ordered in a patient with postoperative ileus
alvimopan
A small bowel obstruction is likely to cause severe electrolyte imbalances due to
profuse vomiting (can contain fecal matter)
Does a large bowel obstruction have major fluid and electrolyte imbalances
no , vomiting occurs much less
Key characteristic of large bowel obstruction
ribbon shaped stool
Risk factors for colorectal cancer
FAP, > 50, genetics, family history, smoking, obesity
What are biggest indicators for colorectal cancer
rectal bleeding, change in stool consistency, anemia
Anemia in colorectal cancer is likely to cause e
fatigue
ABD pain and fullness are signs of colorectal cancer? T or F
true
Does colorectal cancer cause weight gain or weight loss
weight loss
Patient education for FOBT
-no NSAIDs or anticoagulants 7 days before
-no red meat, aspirin, or vitamin C (350mg) 3 days before
How many stool samples are needed for a FOBT
2-3
FIT vs FOBT
FIT is not altered by medications or foods
Best method for treating CRC
surgery to remove the tumor
How should a healthy stoma appear
reddish pinks and moist (small bleeding expected first 6-8 wks)
why is it important to remeasure the stoma q week for the first 6-8 weeks
stoma shrinks in size
How long after colostomy should it begin functioning
2 - 3 days
Stool from ascending, transverse, and descending colostomy
ascending: liquid
transverse: pasty
descending: more solid
Initial cause of appendicitis includes
hard pieces of stool
What is ulcerative colitis
edema and inflammation of the colon
Where does ulcerative colitis occur
rectum and rectosigmoid colon
Crohn’s disease occurs in
the entire GI tract (mouth to anus)
Crohn’s disease contains ____ which are openings in body parts that shouldn’t be there
fistulas
Signs of peritonitis include
ABD pain, ABD tenderness, ABD distention, rigid and boardlike, bowel sounds diminishing
Where does appendicitis pain occur
RLQ
Why are enemas and laxatives contraindicated in appendicitis
cause appendix to rupture, increasing risk for peritonitis
What type of foods should those with diverticular disease avoid? Why?
seeds, nuts, corn, popcorn, figs
-these may block diverticulum and cause diverticulitis
Priority nursing action for patient with gastroenteritis
fluid replacement
-could be IV fluids
-could be oral gatorade or pedialyte
Rigid-board like abdomen, fever, tachycardia, fever, nausea, vomiting are signs and symptoms of
peritonitis
What foods should be avoided in celiac’s disease
barley, rye, wheat
Complication of ulcerative colitis includes
low hemoglobin and hematocrit (due to bloody stools)
Which is not a s/s of crohns disease
-anemia
-weight gain
-diarrhea
-weight loss
-RLQ pain
weight gain
Crohns disease diet
low in fiber, raw vegetables, and lactose
Famotidine, used to treat PUD, should be taken
at night
Sepsis in the older adult may present as
confusion, AMS, incontinence
what is qSOFA
used in non-icu settings
-systolic < 100
-AMS
-tachypnea >22
A qSOFA score of __ requires more testing
2
a SOFA score of ___ indicates a greater risk of poor outcomes in the ICU
greater than 1
What are symptoms of bradycardia
syncope, confused, CP, hypotensive
Patients with bradycardia may require laxatives because
straining to defecate is a form of valsalva maneuver (which causes bradycardia)
Those with sinus tachycardia are going to be at risk for
low cardiac output
VTE’s risk factors include
virchow’s triad
-hypercoagulability (oral contraceptives)
-venous stasis (immobility)
-injury (prostate surgery/smoking)
What is Homan’s sign? is it best practice
test used to assess for DVT in the calf, this is NOT USED
Two diagnostics for VTE
venous duplex ultrasound, d-dimer
LMWH patient education
-how to self administer injection
(enoxaparin)
Heparin toxicity antidote
protamine sulfate
Warfarin toxicity antidote
vitamin k
patient teaching for warfarin
-eat consistent amounts of vitamin K
-electric razor, medical alert bracelet
Unfractionated heparin adverse effect
fatal agranulocytosis (do not administer if platelets < 150,000)
What chest injury is mostly cause by rapid deceleration event like MVA
pulmonary contusion
Pulmonary contusion causes hemorrhage to occur between the alveoli, resulting in
decreased breath sounds, decreased gas exchange, hypoxemia
If laying patients with pulmonary contusion on their side, they should be placed
good lung down
What is flail chest
3 or more fractures ribs occurring in 2 or more places
Flail chest increases patient risk for
paradoxical chest wall movement, tachycardia, cyanosis, hypotension,
What is the hallmark symptom of tension pneumothorax
tracheal deviation to unaffected side, absent breath sounds, respiratory distress
Can patients smoke or use a bronchodilator before pulmonary function test
No smoking 6-8 h, no bronchodilator 4-6 h
symptoms of pneumothorax, pleural effusion, and hemothorax
asymmetrical chest wall expansion, diminished breath sounds
What are the most important nursing consideration for thoracentesis
-patient must stay completely still
-monitor for pneumothorax post procedure
How much fluid is allowed to be taken during thoracentesis
1,000 mL
What is the name for crackles felt underneath the skin during pneumothorax
subcutaneous emphysema/ crepitus
After bronchoscopy, the patient must be NPO until
the gag reflex is returned
After lung biopsy, it is important to obtain an x-ray to assess for
presence of pneumothorax formation
What are the two types of NPPV
CPAP and BiPAP
CPAP vs BiPAP
BiPAP has two levels: different for inspiration and expiration
CPAP maintains one level throughout
How much water must be kept in the water seal container of the chest tube
2 cm
What are the only reasons we can clamp a chest tube
-checking for air leak
-changing the tubing
-removing
What should we do if the chest tube is pulled out
place tube in two inches of sterile water, clamp with hemostats, cover site with sterile gauze
During transport, the chest drainage system should remain
upright and below the level of the chest
If output for a chest tube is greater than ___ , contact provider
70
Most patients with type 2 diabetes have this comorbidity
metabolic syndrome
Metabolic syndrome includes
abdominal obesity (35 or 40 in), hyperglycemia (fasting > 100), hypertension (systolic 140, diastolic 90), hyperlipidemia (triglycerides 150 or more)
Other risk factors for diabetes type 2
family hx, AA/hispanic/Pacific Islander, high birth weight babies, PCOS
A1C level for diabetes
6.5 or greater
Patients with diabetes should maintain an A1C of
7.0 or below
Patients with diabetes should avoid these foods
empty calories (candy and soda), trans and saturated fats, high alcohol consumption
After exercise, why should diabetics check glucose more frequently
they may need decreased insulin doses
Exercise education for patients with diabetes
-neuropathy: be cautious of activities that can cause falls
-retinopathy: no raising BP due to risk of hemorrhage or retina detachment
What would inhibit a person with diabetes from exercising
blood glucose not within 100-250, ketones in the urine
What is the most common oral anti diabetic medication
metformin
Metformin will decrease the blood levels of
folic acid and vitamin B
Basal and bolus insulin doses
basal: set dose
bolus: short acting and taken at meal times
When should a sick patients with diabetes notify their provider
-ketones in urine 24 h
-glucose > 250
after 2 treatments
-hypoglycemia
Hallmarks of DKA (seen in type 1)
-BG >300
-fruity breath
-Kussmauls (deep and rapid)
-ketones in urine
-metabolic acidosis
Hallmarks of HHS (seen in type 2
-bg > 600
-frequent urination, dehydration
why are BUN and creatinine elevated in DKA and HHS
-dehydration
should patients with diabetes ever go barefoot
no
How to prevent diabetic retinopathy, nephropathy and neuropathy
-maintain glucose levels within normal limits
Diabetic nephropathy disease progression can be slowed by
ACEs(-pril) and ARBS (-sartan)
What endocrine gland is the master gland
pituitary gland
Hypopituitarism, caused by decreased growth hormone, can lead to
decreased bone density and increased risk of fractures
Hallmark symptoms of acromegaly
enlarged face hands and feet
coarse facial features
vision and voice changes
enlarged organs
how to test for acromegaly
growth hormone supression test
-oral glucose given, if GH doesn’t change = acromegaly
Acromegaly is treated with dopamine agonists, bomocriptine mesylate and cabergoline, what adverse reactions can these cause
chest pain, dizziness, watery nasal drainage = CSF leak
After hypophysectomy, we should monitor patients for
-nucchal rigidity and headache = meningitis
-watery nasal drainage and increased swallowing (halo sign or glucose present) = CSF leak
treatment for CSF leak
bedrest
Pt education for hypophysectomy
no bending at waist, no coughing/sneezing/blowing nose/ brushing teeth
Most important thing to monitor in patients with hyperthyroidism
increase in temperature (could indicate progression to thyroid storm)
symptom specific to grave’s disease
exopthalamus
Hyperthyroidism is treated with methimazole and propylthiouracil, what are patient teaching points for these medications
-they suppress immune system so avoid large crowds, monitor for infection
Patient teaching for radioactive iodine
-sit while urinating
-flush 2-3 tiems
-avoid contact with pregnant and children one week
-do not share utensil
Following a thyroidectomy, a patient experiences tingling in the mouth/toes/fingers, what should the nurse prepare to administer?
IV calcium gluconate
(pt has hypocalcemia)
expected lab values with hypoparathyroidism
decreased PTH, calcium and magnesium
increased phosphorus
expected lab values with hyperparathyroidism
increased PTH, calcium, and magnesium
decreased phosphorus
Hyperparathyroidism increases clients risk of
hypercalcemia –> kidney stones, fractures
What is lugol’s solution
treatment for hyperthyroidism (drink through straw 10-14 days before surgery)
if serum calcium levels increase, PTH
decreases
if serum calcium levels decrease, PTH
increases
Calcitonin use
decrease calcium levels
Decreased levels of estrogen put the female client at risk for
osteoporosis
Kyphosis puts the patient at risk for
falls
common cause of osteomyelitis
animal bites, open fractures
Post-operative osteomyelitis can result from surgically implanted fixation devices. what pathogen causes this
MRSA
What medications treat MRSA
iv vancomycin, dabtomycin, linezold
ABX therapy for osteomyelitis may be longterm and often requires placement of
PICC lines
(6 weeks iv abx, then 4-6 wks oral)
Hyperbaric oxygen therapy can be used to
promote wound healing in pts with osteomyelitis
complete vs incomplete fractures
complete is entire width of the bone
closed vs open/compund fractures
open/compund protrudes out of the skin
Simple vs comminuted fractures
comminuted can have multiple fracture lines
Displaced vs non displaced fractured
displaced the bone fragments do not stay in alignment
Compression fractures are usually seen in the ___ and are most common in what population?
spine ; older adult
Pathologic/spontaneous fractures are caused by
osteoporosis
oblique fractures
break at an angle
complications of fractures
DVT, fat embolism, compartment syndrome, infection
What is the earliest sign of compartment syndrome
paresthesia
What is the treatment for compartment syndrome
fasciotomy
Chronic complication of fractures
avascular necrosis , chronic pain
Why should NSAIDs be avoided in patients with a fracture
delay bone healing
What is open reduction vs closed reduction
open reduction is surgically resetting, closed reduction is pulling the bones back into alignment
Plaster casts are used less often because
-they take 24 hours to dry
(smell musty while drying as well)
Fiberglass casts are more utilized because
-they weigh less
-dry much faster
If someone has a wound under their cast, or still have severe swelling, what may the provider do
cut a window in the cast or cut the top to allow for swelling
Patient education for casts
-report any tingling, cold digits, paralysis (may indicate compartment syndrome)
-do not stick things in cast
Skeletal traction requires what to prevent infection
frequent pin care
What to do if an amputaiton happens in the community
-assess ABC
-sterile dry gauze
-apply pressure and elevate above heart
-do not remove gauze
Treamtent for Phantom limb pain
-iv calcitonin
-tens unit
-gabapentin (nerve pain)
-beta blockers (dull burning)
How long do we elevate the stump after amputation
24 hours only
Complications of amputation
-neuroma
-flexion contractures
how to prevent flexion contracture
-do not elevate after 24 h
-ROM exercises
-turning
-lying prone
-firm patress
Why do we do the figure 8 dressing after amputation
compress bottom of stump to shape it for prosthesis
treamment for carpal tunnel
-wear brac
-NSAIDs
-surgery
Treatment for sprain
RICE
Hallmarkers for cystitis infection on a UA
-leukocyte estrerase, nitrites, WBC, RBC, casts
Creatinine cannot be altered by other disease processes other than kidney dysfunction. T or F
true (why creatinine is the best indicator of kidney dysfunction)
Education for 24 hour urine
-begin after your first void
-keep on ice
-get every single drop
the bacteria that causes UTI and pyelonephritis
e-coli
IF patient hasn’t voided in 6h, the nurse should
obtain bladder scanner
a kidney ultrasound requires ____ ml of fluid before examination
500-1000
What is a KUB
x-ray of kidneys, ureters, and bladder
Which kidney diagnostic test measures for GFR
renal scan
Is pink-tinged urine after cystoscopy an expected finding?
yes
Patient education before and after cystoscopy
-npo, bowel prep before
-increase fluids after
a voiding cystourethrography uses contrast dye to assess for
back flow of urine to the kidneys (takes x-ray during voids)
After kidney biopsy, the pt must remain on strict bedrest ofr
2-6 hours
Why is it important to monitor BP in someone receiving kidney bipsy
HTN increases risk of bleeding, complication of kidney biopsy is hemorrhage
Sx of UTI
-cloudy/foul smelling urine
-frequency, urgency, burning while peeing
-pain with urination
-abdomen pain (from bladder spasms)
number one way to prevent CAUTI
hand hygien
Sx of pyelonephritis
-chills, fever, CVA tenderness, flank pain, nausea, vomiitng
Complications of chronic pyelonephritis
-increase BUN and creatinine
-hyperkalemia
-hyponatremia
acute glomerulonephritis is commonly caused by
strep infection
Chronic glomerulonephritis symptoms
-HTN, fatigue, protein and blood in urine, edema, electrolyte imbalances, decreased GFR
ABX used to treat UTI, pyelonephritis, glomerulonephritis
trimethoprim, trimethoprim/sulfamethoxazole, nitrofurantoin
urinary analgesic used for UTI
phenazopyridine (will turn urine orange or red)
Most common cause of renal calculi
dehydration
symptoms of kidney stones
severe, sudden pain, flank pain, abdomen pain, urinary frequency, nausea, vomiting
-cholicky pain: comes and goes
Patient education for lithotripsy
strain urine after
Nursing interventions for nephrostomy tube
-drain 4-5 times a day
-change bag 3 times week
-avoid bathing, swimming pools, and hot tubs
priority for polycystic kidney ydiseae
maintaining hypertension
sx of PKD
-distended abdomen, abd pain, HTN, constipation,headaches, foul odor = infection, edema
Why should we use NSAIDs cautiously in PKD?
reduce blood flow to kidney y
Patients with PKD should limit
aspirin, protein and sodium
pts with glomerulonephritis should restrict?
-sodium, water, potassium, and protein
elevated amylase and lipase can indicate
acute pancreatitis
Frequent vomiting causes what acid-base imbalance
alkalosis
Frequent diarrhea causes what acid base imbalance
acidoss
What is an acute ABD series
x-ray of the client’s chest, abdomen while supine, abdomen while sitting
Pre and post nursing interventions for EGD and ERCP
pre: no NSAIDs/anticoagulants for one week, NPO
post: assess gag reflex
Severe adverse reaction of colonoscopy
bowel perforation –> abdominal guarding and tenderness
Clients may eat a soft diet a few days prior, avoid NSAIDs, take colase, and must do bowel prep for colonoscopy. T or F
true
What diagnostic test is most accurate for GERD
pH monitoring (monitors pH level for 24-48 hours)
Is volvulus risk low for sliding or rolling (paraesophageal) hiatal hernia
sliding
What surgery can be done to treat hiatal hernia
Nissen fundoplication
Pre and post nursing interventions for LNF
-pre: stop smoking, lose weight
-monitor NG and chest tube, eat soft diet, continue anti-reflux meds for one month
Pre interventions for esophagectomy
-stop smoking 2-4 weeks before
-do pulmonary strengthening
Why is respiratory care so important with esophagectomy
they are on ventilation first 16-24 h after procedure
Are we allowed to irrigate NG tube after esophagectomy
NO
Post surgical complications for esophagectomy
-cardiovascular (hypotension)
-wound management (prevent anastomosis)
-NG tube (no irrigation or oral care important)
-nutriton (J tube until no anastomotic leak is confirmed)
Causes of acute gastritis
alcohol, caffeine, coffee
Chronic cause of gastritis
h . pylori
Will acute or chronic gastritis include symptoms of pain, dyspepsia, hematemesis, and melena?
acute
Chronic gastritis does not produce symptoms until
ulceration occurs –> leading to N/V and pain
Chronic gastritis leads to deficiency in what vitamin?
b12
Gastritis can be treated with mucosal protectant medications such as
sucralfate and carolfate
Symptoms of peptic ulcer disease
epigastric tenderness and pain, dyspepsia
Ulceration of an ulcer in PUD can lead to
peritonitis (rigid boardlike abdomen and fever)
What are the three types of ulcers in PUD
stress, gastric, duodenal
Stress ulcers are more likely to cause
bleeding
What type of peptic ulcer occurs 30-60 min after food, is rarely worsened by food ingestion, and has hematemesis?
gastric
what type of peptic ulcer causes hyper secretion, is relieved by food, has melena, and occurs 1.5 hours after a meal?
duodenal
Most common complications of ulcer
perforation, pyloric obstruction, bleeding
What is the urease breath test?
-test for h.pylori, can be used to diagnose peptic ulcer disease and gastritis
What antibiotics can be used to treat H.pylori
clarimycin and amoxicillin
Early symptoms of gastric cancer
dyspepsia, abdominal discomfort, epigastric and back pain
Late symptoms of gastric cancer
N/V, weight loss, iron deficiency anemia
Largest complication of gastrectomy
dumping syndrome
patient education on how to prevent dumping syndrome
avoid fluids with meals, eat high protein-high fat low carb diet, small and frequent meals
Early sx of dumping syndrome
vertigo, achy, syncope, pallor, diaphoresis, desire to lay down
Late sx of dumping syndrome
sx of hypoglycemia: dizziness, diaphoresis, confusion, palpitation
Causes of mechanical obstruction
tumors, scarring, adhesions, volvulus
Causes of non-mechanical obstruciton
decreased peristaltic functions
Complications of small and large bowel obstruction
hypovolemia, acid-base imbalances, sepsis
Why do we insert an NG tube for obstruction
decompression
CRC signs and symptoms can vary based on
location
symptoms of right sided CRC
weight loss
symptoms of transverse colon CRC
dark red blood, abdominal pain, using BR more often
Rectosigmoid colon cancer
-change in stool, blood
After a colon resection, what may the patient have
temporary or permanent colostomy
timeline for abdominoperineal resection
wound may drain for 1-2 months, complete healing does not occur for 6-8 months
IBS diagnostic
hydrogen breath test
IBS - c medications
psyllium hydrophilic muciloid, linaclotide
IBS- d medications
loperamide antidiarrheal, psyllium, alosetron (used cautiously in women)
A hernia is caused by
weakness in abdominal wall
strangulated hernia is caused by
coming through bowel wall and twisting
s/s of hemorrhoids
bright red blood, itching, swollen/distended veins
untreated peritonitis can lead to
sepsis
If our patient has knees flexed in a fetal position and pain relief, this is an identifier for
peritonitis
Peritonitis can cause elevated ____ and ____ due to
BUN and creatinine ; hypovolemia
After abx solution is irrigated into client with peritonitis, this is the priority nursing actions
keep them sat up to keep drains draining properly
Order of symptoms for appendicitis
abdominal pain –> nausea vomiting
What is McBurney’s point
where the pain of appendicitis localizes to
Can we give a client with appendicitis laxatives or enemas
NO, increases risk of rupturing
Order of symptoms for gastroenteritis
nausea / vomiting –> abdominal pain –> diarrhea
Patients with gastroenteritis are very at risk for this electrolyte imbalance due to excessive diarrhea
hypokalemia
Antidiarrheals should be used sparingly in gastroenteritis because
lomotil is habit forming, may cause toxic megacolon
What disease produces 10-20 liquid, bloody stools a day
ulcerative colitis
Why can patients with ulcerative colitis develop anemia
chronic bleeding from ulcers
Which disease process causes 5-6 loose, non bloody, steatorrhea stools
crohns disease
Other than abdominal pain, will ulcerative colitis cause any physical assessment abnormalities
no
Albumin, hemoglobin, and hematocrit are increased or decreased in ulcerative ecolitis
decreased
What diagnostic can be used for ulcerative colitis
MRE
What is an MRE diagnostic test
NPO 4-6 hours before, glucagon subcutaenous injection administered, allows for bowel to tbe seen
Diagnostic test to show ulcerative colitis vs crohn’s
contrast via barium enema
Medications for ulcerative colitis and crohns disease
aminosalicylate: sulfasalazine, mesalamine
Glucocorticoids: prednisone
Antidiarrheals: loperamide (Immodium), diphenoxylate hydrochloride, atropine sulfate (Lomotil)
Immunomodulators: adalimumab
Client educations for adalimumab
avoid large crowds / infected people
What foods should a client with ulcerative colitis avoid
corn, pepper, carbonation, smoking, nuts
Two common problems for Crohn’s disease
malabsorption, fustila formation
Folic acid and b12 will be high or low in crohns disease
low –> pernicious anemia
Why is nutritions os important with crohns disease
-heals promote healing of fistulas
can we give enemas to people with diverticulitis
no (may cause perforation and peritontonitis)
