Final Study Guide Flashcards
WBC count
5,000 – 10,000
Platelet Count
150,000 – 400,000
Na normal value and function
135-145
“Excites”
Affects brain and nervous system
= changes in LOC/ seizures
Mg normal value and function
1.5-3.0
“calms”
Affects deep tendon reflexes
and smooth muscle
K normal value and function
3.5-5.0
“Excites”
Affects heart
Ca normal value and function
8.5-10.5
“Calms”
Affects nerves and muscles
ABG values
Ph: 7.35-7.45
PCO2: 35-45
HCO3: 22-26
PaO2: 80-100
SaO2: >95%
Blood sugar value
70- 130 mg/dL
Average Heart rate
Blood pressure
respirations
pulse
Heart rate: 60-100
Blood pressure: 120/80
Resp: 12-18
Pulse: 60-100
PT tests for
Clotting time test
PTT test for
Heparin
INR is used to detect affects of
Coumadin
BNP is used to look for
Heart failure
BUN test is used to detect
normal range <20
test for kidney damage
Troponin test is used to detect
myocardial infarction
CK/MB is used to detect
myocardial infarction
What does an elevated neutrophil count indicate
An acute (bacterial) infection
SIRS is initiated by what
a triggering event
All of the following are signs of systemic inflammation except:
Temperature above 101
elevated CRP level
Redness and edema at the injured site
WBC lab results of 17,000
Redness and edema at the injured site (SHARP: acute)
ABG value for Asthma Pt
Respiratory acidosis
ABG value for rapid breathing Pt
Respiratory alkalosis
ABG value for vomiting Pt
metabolic alkalosis
ABG value for diarrhea Pt
metabolic acidosis
ABG value for renal failure Pt
metabolic acidosis
S/S for PUD
Erosion of the stomach lining caused by H.Pylori
S/S
-epigastric or chest pain that starts about 2 hours after eating or in the middle of the night after the stomach lining is emptied.
-Pain relieved by eating
-Either heal themselves or get worse to the point of internal bleeding
Dangers of peptic ulcers: anemia, profuse bleeding, and stomach cancer
All are true about Coumadin except:
“avoid garlic, ginger, or ginseng they cause bleeding”
“Don’t take aspirin or ibuprofen for pain”
“You will need to have your blood drawn for a PTT test”
“Epistaxis and petechiae are signs that coumadin levels are too high”
“you will need to have your blood drawn for PTT test”
PTT test for heparin
All of the following are s/s of myxedema crisis except:
swelling of soft tissue
mental confusion
bulging eyeballs (exophthalmos)
low blood levels of thyroid hormones
bulging eyeballs (exophthalmos)
Myxedema is a sign of hypothyrodisim, exophthalmos is a sign of hyperthyroidism
What does bright red streaking of blood in the stool indicate
Non-emergent.
Hematochezia.
usually caused by hemorrhoid or anal fissure
3 Things to know about DIC
Occurs in 3 stages: Triggering, Clotting, and Hemorrhaging
Is life-threatening
s/s: bleeding from 3 unrelated spots
tests: low platelet count, and d-dimer test
Does FAS extend throughout pregnancy
(fetal alcohol syndrome)
Yes, it does
What is a hypertonic solution used for
Used for rapid fluid replacement, and for when tissue is over-hydrated
ex: 3% saline, 6% saline
What does an elevated lymphocyte count indicate
A chronic (viral) infection
What indicates an:
uncompensated
compensated
partially compensated
ABG value
Uncompensated: PH is out of wack and one other value is also out of wack
compensated: PH is normal and the others are out of wack
partially compensated: all are out of wack
What would you expect your HCT and sodium to be if you’re dehydrated?
would expect them to be high, dehydration = low plasma level = high concentration of HCT and Na
Characteristics of Hodgkin’s Lymphoma
-Presence of Reed-Sternberg cells
-Highly curable
s/s: painless swollen lymph nodes, weight loss, bone marrow damage
Tx:
Radiation therapy - localized
Chemotherapy – generalized
Immunotherapy (MAB drugs)
Bone marrow [stem cell] transplant
Complications of too many NSAIDS
they interfere with normal blood clotting
can lead to bleeding s/s
What does low Hgb count indicate
anemia
If a Dr. is asking for MCV, MCH, MCHC, RDW what is he asking for
He is testing for anemia
is pernicious anemia a cause of a low WBC count
no it is a lack of intrinsic factor = lack of B12 absorption = B12 helps make RBC
Immunity for varicella zoster (chicken pox) can be acquired how
Either naturally or artificially
Example of type 3 hypersensitivity
Immuno complex reaction
-Lupus
-Glomerulonephritis
-rheumatoid arthritis
What PPE would be used for the following:
Multidrug-resistant wound infection
Tuberculosis
Chicken Pox (varicella zoster)
meningitis
Contact
airborne
airborne
droplet
Difference between host and vector
Host: incubates and is where the agent reproduces
Vector: how the agent transmits/ Infects others
What is not correct in a myocardial infarction
“You will have permanent EKG changes due to scar tissue in your heart muscle”
“Your CRP levels will be monitored to assess for cardiac inflammation”
“Troponin levels are the first to raise in your blood after a heart attack”
“Elevated BNP indicates you have a prior attack”
Elevated BNP indicates you have a prior attack. BNP indicates heart failure not MI
S/s of left-sided heart failure
Left = lung
respiratory distress
* Exertional and nocturnal dyspnea
* Hemoptysis (blood-tinged sputum)
* Orthopnea
* Cough
* Cyanosis
Verapamil drug family
Calcium-channel blocker
s/s of arterial thrombus
5 P’s
pulse low or absent
no edema
pale or mottled color
cool to cold temp
sharp or numb pain
What is the highest nursing priority with septic shock
Circulation!
s/s for a pulmonary embolism
SOB
Chest pain
hypoxia
cough
pain on deep breath
Pleural effusion vs Pleural edema
effusion: is in the space, is able to be drained with a needle
Edema: in the tissue itself cannot be drained with needle
Emphysema may include any of the following changes except
-loss of elastic recoil after each breath
-increased PaO2
-increased lung compliance making it more difficult to take a breath
-permanent damage due to the inflammatory process in the lungs
Increased Pa02
When is a person most likely to develop atelectasis
soon after surgery or in patients who have limited mobility in the hospital (secretions build up in the lungs due to immobility).
Atelectasis= air sac cannot expand
all the following are true statements about lung cancer except
-lung cancer most commonly metastasizes to the kidneys
-tumors in the lungs can compress nerves or veins
-small-cell lung cancer is very aggressive and commonly metastasized to the brain
-lung tumors can increase the patient’s metabolism and cause muscle wasting
Lung cancer most commonly metastasizes to the kidneys.
How does kidney failure cause anemia
Kidneys produce erythropoietin which create RBC. Kidney failure = no erythropoeitin = no RBC
Nephrotic syndrome s/s
Nephrotic = only protein in urine
s/s edema, lack of protein in the blood = no water being pulled from tissue = pitting edema
2 ACE inhibitors
anything that ends in pril
-captopril
-lisinopril
etc.
All the following are true except
-antidiuretic hormone (ADH) decreases fluid retention
-aldosterone’s function is to spare sodium, thereby causing fluid retention
-angiotensin compensates for shock by causing vasoconstriction
-the kidney’s release renin in response to decreased perfusion
ADH decreases fluid retention
*ADH increases fluid retention
What are the s/s of acute tubular necrosis
central nervous system: change in LOC, confusion, delirium
oliguria or anuria (severe kidney damage)
full body edema
cardiac problems
fixed specific gravity
What are the risk factors of cholecystitis
6 F’s
forty
fertile
female
fat
family hx
fair
All of the following are true about chronic gastroesophageal reflux disease except
A flatter pillow at night will prevent heartburn
-go to the emergency department if you develop CP
-GERD can cause throat cancer if left untreated
-when you lift weights it’s best to not hold your breath during exertion
a flatter pillow at night will prevent heartburn
What are the s/s of liver disease
jaundice of skin and sclera (aka, icterus)
intense pruritus due to icterus
The difference between the 3 hepatitis
Hepatitis A: Oral fecal route, there is a vaccine.
Hepatitis B: Blood/ body fluid borne, there is a vaccine, can cause liver cancer
Hepatitis C: Blood/ body fluid borne, no vaccine available, may develop liver cancer
What are the similarities and differences between IBS and UC and Chron’s
IBS: a collection of symptoms, that causes no damage to the GI tract
UC: Large intestine only, affect mucosal region only
Chron’s disease: skip lesions and affects the entire bowel wall thickness
What causes dehydration in diabetes
Excess sugar in the urine takes water with it from tissues.
What is the treatment for diabetes insipidus
Medication and ISOTONIC fluid replacement to
reverse dehydration (possibly hypotonic if tissue
dehydration is severe
Inadvertent damage to the parathyroid glands may cause what
tetany and positive Chvostek’s sign
What are the differences between Addison’s disease and Cushing’s disease
Both to do with adrenal gland and cortisol production
Addison’s: hyposecretion, bronze skin, low b/p, low an, high potassium
Cushing’s: hypersecretion, moon face, buffalo hump, high b/p, high Na, low potassium
What vital signs are expected with pheochromocytoma
Tumor of the adrenal medulla that secretes excessive catecholamines (epinephrine/ norepinephrine/ dopamine) resulting in hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss
Based on the lab values: blood sugar 680, ketones 4.0, BUN 28, hematocrit 60, you know all the following statements are correct except
-the patient will be given insulin by IV infusion
-giving IV fluids is essential to reverse dehydration
-an arterial blood gas test will most likely indicate acidosis
-these findings indicate the patient’s diagnosis is a hyperglycemic hyperosmolar state
These findings do not indicate HHS but rather DKA because of the high measures of everything PLUS the presence of ketones
What vital signs do you expect of a pt with increased ICP
Hypertension (Widening Pulse Pressure - the difference
between the Systolic and Diastolic B/P increases)
-Bradycardia (reflexive slowing of the heart to compensate for
increased B/P)
-Hypoventilation (Respiration slows down) → Hypercapnia
(↑ CO2) which causes vasodilation leading to worse cerebral edema and increased ICP
What are the s/s of meningitis
Nuchal rigidity
throbbing headache
fever
photophobia
projectile vomiting
altered LOC
increased ICP
red purpuric or blotchy rashes that do not blanch
kernig’s sign and or brudzkinski’s sign
A person with a complete spinal cord injury at the level of T4 would have complete use of what limbs and be at risk for what
would have use of his arms but not his legs and be at risk of developing autonomic dysreflexia
What is the term for when the brain tissue is displaced past the midline toward the other side
herniation
Difference between hemorrhagic and ischemic stroke
hemorrhagic stroke: hypertension, aneurysm, or ruptured vessels, blood in cerebral spinal fluid. Rx: stop bleed, decrease ICP and vasospasm no anticoags
Ischemic: thrombi cause arterial occlusion = most common, has hx of TIAs, Rx: decrease edema and ICP
Human papillomavirus infection is associated with what type of cancer
HPV is associated with cervical cancer
what are the s/s of trichomoniasis
Green, frothy, foul smelling discharge
Testicular cancer
those with history of undedcended testicles as an infant are at highest risk, it has a high cure rate
Rx: orchiectomy
Prostate cancer
The most common male cancer in men over 50
Early stage: No initial s/s so prostate cancer has usually metastasized before discovered
Late stage: s/s can be similar to s/s of BPH (urgency, frequency, nocturia, hematuria, or blood In ejaculate)
DX: combo of PSA and DRE (PSA can be high in BPH and prostatitis)
What are the risks for developing priaprism
Sickle cell disease, cancers, neurologic disorder, can be caused by stroke or spinal cord injury
What does menometrorrhagia mean and what could it indicate
abnormally heavy bleeding at irregular intervals
can indicate uterine cancer
What are the s/s and treatment for the compartmental syndrome
Pain that can not be relieved by pain medication
Increased pain and numbness or tingling (paresthesia) are the EARLY SIGNS. Decreased pulses or
capillary refill, decrease in temp (cold) and color changes (pale or cyanotic) are LATE signs. Paralysis of the limb is the LAST sign. Compartments of the Lower Leg
tx: fasciotomy
Systemic lupus erythematosus is characterized by all the following except
-symptoms can be managed with steroids and immunosuppressant drugs
-the onset of lupus is always sudden with constant and consistent symptoms
-facial redness called a “butterfly rash” is a distinct sign of lupus
-the formation of autoantibodies and immune complexes are present in the body
The onset of lupus is always sudden,
Lupus is an autoimmune disease it is not suddenly onset
What is not correct about scoliosis
-scoliosis of the spine is damaging to the heart and lungs
-scoliosis usually becomes more prominent when the child reaches puberty
-this problem can shorten the person’s life to about 40 years of age
-correction of this condition involves a minor surgery with little potential for complications
Correction of this condition involves more than a minor surgery
which of the following is an incorrect statement about osteogenesis imperfect
-a child with OI may have blue sclera due to the inability of their body to synthesize collagen
-babies with OI can sustain fractures during the birthing process
-OI is primarily caused by maternal drug use during pregnancy
-children with OI have incomplete development of bones and ligaments resulting in smaller stature
OI is not caused by maternal drug use during pregnancy it is a hereditary diseae
All of the following are risk factors of osteoporosis except
family hx of osteoporosis
smoking, cola drinks, alcohol
menopausal women
hypercalcemia
hypercalcemia is not a rf
hypocalcemia is a rf
The syndrome of inappropriate adh is characterized by what
SIADH= salt is absent = drowning head or soaked inside
etiology: brain problem: injury/ stroke/ cancer
patho: increased ADH leads to water retention which leads to fluid overload and dilutional hyponatremia
s/s: concentrated urine, hyponatremia, cerebral edema
tx: hypertonic solutions
Heartburn that radiates to the jaw and between shoulder blades could mean what
myocardial infarction
What is not true about asthma
-the smooth muscle surrounding the alveoli constricts, limiting oxygenation
-the mucosa lining experiences severe inflammation
-the goblet cells within the mucosa lining produce excessive amounts of mucous
-too much carbon dioxide is exhaled due to hyperventilation and the patient experiences respiratory alkalosis
Too much carbon dioxide is not exhaled, when with asthma you have decreased respirations
What are the s/s of chronic bronchitis
hypersecretion of mucous. increase mucus production and the size & number of mucous glands along with damage to cilia that prevents movement of mucous out of the bronchus. Once clogged with mucus, the lungs are then vulnerable to
viral and bacterial infections, which over time distort and permanently damage the lungs’ airways.
Dx: cough for 3 months 2 years in a row
what is the most important concern in uncontrolled seizures
ABCs
sodium imbalance?
oxygen to brain?
What are the s/s of hypoglycemia, when is it most common?
CNS changes due to brain using glucose as its only source of energy, irritability, etc.
Cold and clammy needs some candy
Can occur when insulin lowers blood glucose too far.
Any of the following findings would be present in hypovolemic shock except
heart rate of 55 beats per minute
blood pressure 85/50
respirations 36 per minute
heart rate 115 beats per minute
The heart rate of 55 beats per minute, bradycardiac is not typical rather it is tachycardia that is associated with hypovolemic shock
What are the differences between peripheral arterial occlusive disease and deep vein thrombosis
PAO: 5 P’s, low or no pulse, cold temp, pale or mottled, pain is sharp and numb
DVT: SHARP, pulse is present, edema, pink or red color, hot temp, pain is aching or throbbing
what tests are used to diagnose an MI
Troponin and CK-MB
Chemical mediators are released from endothelial cells in blood vessels during inflammation
True
what is the biggest concern about systemic inflammatory response syndrome
circulation
what is the most appropriate precaution to take to prevent transmission of TB
airborne precaution, N95 masks
the primary purpose of the inflammation response is to what?
remove the injury-causing agent
What are the potential problems of decreased leukocyte formation
increase risk of infection
what is the difference between benign and malignant growths
Benign, solid borders, doesn’t metastasize, is a simple growth, pushes on surrounding organs
Malignant, non solid borders, metastasized, non palpable, sluffs off
s.s of autonomic dysreflexia
injury of T6 and above
below the injury it is vasoconstriction, pale, chicken skin, clammy
above injury it is vasodilated, red, flushed, warm
what can trigger the inflammation process
necrosis, the contents of the cell is excreted and cause an inflammatory response
what nursing interventions would likely be implemented to prevent increased intracranial pressure
raise the head of the patient
protect the airway, suction nearby
check frequently
what are the s/s and treatment of hyperparathyroidism
muscles are too calm, pathological fractures, (Same as Hypercalcemia –“calms too much”) lethargy, drowsiness, N/V, decreased deep tendon reflexes (DTR). And, as stated above, there is a greater risk for fractures because calcium has moved out of the bone into the blood
What is the highest priority in managing Crohn’s disease
Complications of Crohn’s Disease: Chronic
inflammatory condition of the bowel. The bowel wall becomes congested, thickened, leading development of abscesses and fistulas. Scar tissue interferes with the movement of chyme through the intestine and perforation or obstruction can occur. The chronic inflammation can lead to significant problems such as
- Malabsorption = anemia als omalabsorption of calcium = bone weakness
what bacteria is usually present in peptic ulcer disease
H. Pylori
What is the cause of ascites
Free Fluid in the abdomen caused by two problems:
#1- Portal hypertension increases capillary hydrostatic pressure (“PUSHES”
fluid out of vessels into the gut) and,
#2 – damaged liver does not synthesize serum protein decreased oncotic
pressure (no protein in vessels to “PULL” the fluid out of the gut back into the veins).
What does cancer in situ of the cervix mean
in situ means it is in the same layer of cells from which it originated so the cancer is still in the cervix
examples of chronic inflammatory response
rheumatoid artheritis
lupus
heart disease
precautions for Clostridium difficile
contact precautions (gloves gown etc)
meningitis precautions
droplet precautions mask and eye wear
Testicular torsion
urgent need for prompt and aggressive surgical treatment
s/s of candidiasis
thick white (creamy) or “clumpy” or “cottage-cheese looking” vaginal discharge, itching, redness, burning
pain with urination, dyspareunia
BHP and prostatitis can show high signs of what
Positive signs of prostate-specific antigen (PSA) levels
All of the following are correct about stds except
-a distinguishing feature of Trichomoniasis infection is green, foul-smelling vaginal discharge
-herpes simplex 2 can be found in either the mouth or genital area
-chlamydia and gonorrhea are often found together in the same person
-the tertiary stage (gumma formation) of syphilis is the most contagious of the three stages
The tertiary stage of syphilis is the only stage which is not contagious
what are some examples of the damaging effects of edema
a. Impaired blood flow (and O2 delivery)
b. Reduced local healing of tissue
c. Metabolic wastes cannot easily leave cells so
toxins build up.
d. Increases workload on the heart as it tries to
move fluid through the blood veins. More
pressure is required to push the excess fluid
which raises B/P → chronic hypertension.
Neutrophil count
47% - 63%
lymphocyte count
24% - 40%
hematocrit
37 – 50 %
hemoglobin
12 – 16.5
