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FUNDAMENTALS > Fundamentals Final(YOU GOT THIS!) > Flashcards

Fundamentals Final(YOU GOT THIS!) Flashcards

1
Q

How to care for orthostatic hypotension?

A
  • move patient slowly

- dangle feet at side of bed

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2
Q

First task on shift?

A

Get report(SBAR)

- updates
 - VS
- family issues
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3
Q

What to do after shift report?

A

review labs and medications

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4
Q

2 Delegation points of not delegating

A
  1. Dont delegate assessment

2. Dont delegate out of scope

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5
Q

What asessment is taken at beginning of shift?

What assessment is taken in middle of shift?

A

Head to toe assessment

Focused assessment

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6
Q

Who obtains VS when patient is out of ICU or surgery?

A

The Nurse

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7
Q

Prioritization

A

Stable vs unstable
ABCSPI (life threatening labs/VS after circulation)
How Old? When admitted? When was/is surgery? How many body systems involved?

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8
Q

What is a fever?

A

above 100.4 degrees

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9
Q

Infection indicators

prevention?

A

fever, increase WBC and RR, drainage, odor

hand hygiene, antibiotics/antibacterials

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10
Q

Putting PPE on order

Putting PPE off order

A

gown, mask, goggles, gloves

gloves, goggles, gown, mask

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11
Q

What does decreased bowel sounds indicate?

A

Ileus

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12
Q

TPN musts

A
  • 2RNS must check TPN
  • 10% dextrose if TPN runs out
  • check BG q6h
  • check placement of tubes by CXR and gurgling
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13
Q

Sleep interventions

Benzodiazapine?

A

teach to get to bed quickly, start low if elderly, environment is safe, BE CAUTIOUS of benzodiazapines in elderly, promote health habits

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14
Q

What to do if patient has skin wound?

A

turn patient
Eschar MUST be debrided
collect drainage for culture

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15
Q

How many L/min for face mask?

A

at least 5 L/min, 6-12 L/min

35-50%
easy to use and short term

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16
Q

How many L/ min for nonrebreather?

A

10-15 L/min

60-90%(high concentration)
reservoir bag must be inflated

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17
Q

How many L/min for nasal cannula?

A

1-6 L/min

24-44%
flow rates over 4/L min need humidification
easy, can talk and eat, comfortable

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18
Q

what is a vapotherm?

A

High flow nasal cannula, O2 is warm and humidified

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19
Q

What are venturi masks used for?

A

low concentration, specific amount

24-60%

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20
Q

What is a face tent used for?

A

Claustrophobic patients

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21
Q

Early S/S of hypoxia? Late?

A

Early: Fear,Anxiety,Tachycardia,not concentrated,dizzy,dyspnea,pale

Late: Decreased LOC, Fatigued, Cyanosis, Hypotension,

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22
Q

Inhaler Patient Teaching

A 
Rinse mouth after using MDI 
Shake 5-6 times
administer during inspiration
hold breath for 10 seconds
don't smoke 
clean equipment
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23
Q

How often are eye exams?

How often are ear exams?

A

q 2 years, or yearly if eye problems

yearly if in noisy environment

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24
Q 
Cheyne-Stokes=
Kussmaul=
Eupnea=
Tachypnea=
Bradypnea-
Apnea=
Hypernnea-
Orthopnea-
A 
Cheyne-Stokes= alternate between apnea and deep. respiratory center problem
Kussmaul=compensate for metabolic acidosis , deep and fast
Eupnea= effortess
Tachypnea= >20
Bradypnea= <12
Apnea= no breathing
Hypernnea- abnormally deep
Orthopnea- sitting up to breath
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25
Q

Different aphasias

A 
Expressive= understand but cant communicate, use pictures to communicate
Receptive= cannot understand
Global= both expressive and receptive
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26
Q

Cognitive patient teaching
Affective patient teaching
Psychomotor patient teaching

A 
Cognitive= knowledge
Affective= communication, care
Psychomotor= demonstration
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27
Q

Who gets consent for surgery?

Who is a witness and advocate of patient?

A

The Surgeon

The Nurse

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28
Q

How often to check 2 point and 4 point restraints?

A

2 point- q2h

4 point- every 15 minutes

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29
Q

Malpractice standards

A

Nurse had a duty
Duty was breached
Breach resulted in injury

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30
Q

UTI S/S, tests, interventions

A 
Dysuria
Hematuria
Pain
Frequency and urgency
Small Volumes
Increased RBC and WBC
fever
N/V

management: urinalysis, C&S
complications: pyelonephritis, drug tolerance, renal abcess

Interventions: assess VS, UA, C/S
administer antibiotics(trimethoprim/sulfamethoxazole), bladder analgesic(phenazopyridine/pyridium), atnispasmsic( Hycosamine), anticholinergicdrink fluids, cranberry juice
Teach to report S/S

prevention:

  • wipe front to back
  • drink fluids and cranberry juice
  • urinate before and after sex
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31
Q

CAUTI S/S, tests, interventions

A 
poor appetite
sudden incontinence
nocturia
dysuria
hematuria
confusion
Urosepsis (UTI found too late)
Pulse Rises, BP drops, shock, death

Meds: antibiotics (Sulfonamides, Fluoroquinolones, Penicillin, Cephalosporin)
bladder analgesics: phenazopyridine (pyridium)
Macrobid/Macrodine
Antispasmodic: Hyoscyamine
Anticholinergic

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32
Q

Urolithiasis (Kidneys stones) S/S, tests, interventions

A

Ca levels are high
pain
pallor(skin color)/diaphoresis(sweating)
N/V hematuria

Narcotics, NSAIDS, antiemetics(ondansetron), and Alpha adrenergic blockers(tamsulosin)
straining

Management: noncontrast CT, KUB, and ultrasound

Surgery: lithotripsy, ureteroscopy, stent or nephro tube)

Pre care: NPO, bowel prep, IV for sedation
Post care: hydrate, first urine is bloody, strain, possible bruising

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33
Q

Bladder Cancer expectation

risk factors

intervention

A

Painless Hematuria, increase in frequency and urgency, nocturia

Smoking

Create diversion to bypass bladder

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34
Q

Types of incontinence

A 
Stress: stretched/relaxed muscle (pregnancy)
Urge: irritants (caffeine, nicotine)
Overflow: enlarged bladder, diabetes
Functional: unable to reach bathroom
Reflex: spine or brain injuries
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35
Q

normal WBC value

A

5,000-10,000

Neutrophil:55-70%
Bands:3-5%
Eosinophils:1-4%
Basophils: .5-1%
Lymphocytes:20-40%
Monocytes: 2-8%
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36
Q

What to avoid if neutropenic/leukocytopenia?

A

NO fresh flowers, fruits, and veggies

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37
Q

function of HGB and hematocrit

A

Transport Iron

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38
Q

Low HCT indicates what?

A

Iron deficiency anemia

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39
Q

normal platelet value

A

150,000-400,000

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40
Q

normal RBC value

A
  1. 2-6.1 MILLION

4. 2-5.4 women) (4.7-6.1 for men

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41
Q

normal HGB balue

A

12-18

Men:14-18
Women:12-16

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42
Q

normal HCT value

A

37-52%

Men:42-52%
Women: 37-47%

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43
Q

rule of three

A

RGB X3 = HGB

HGB X3 =HCT

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44
Q

what dos thrombocytopenia indicate

A

bleeding, brusing

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45
Q

where do patients lose potassium?

A

In stool

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46
Q

Dilute Potassium? Give IV PUSH?

A

Yes, Dilute

NEVER give IV PUSH

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47
Q

What to watch for in EKG in hyperkalemia? In hypokalemia?

A

Peak T waves

U waves

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48
Q

What conditions shows Chvostek(face react) and trousseaus signs (hand react)?

A

Hypocalcemia and Hypomagnesemia

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49
Q

What does high BUN indicate?

A

Dehydration

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50
Q

Normal BUN value

A

10-20

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51
Q

Normal Creatinine Value

A

.5-1.1

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52
Q

Normal BG value

A

70-110

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53
Q

What to give patient if Blood glucose is low?

A

Insulin and D50

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54
Q

Normal HGB A1C value and function

A

4-5.9%

Control Diabetes

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55
Q

What med is regulated with PT? antidote? what to look at?

A

Coumadin/Warfarin

Vitamin K

look at INR

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56
Q

What med is regulated with PTT? antidote?

A

Heparin

Protamine Sulfate

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57
Q

What does acidosis indicate? alkalosis?

A

Acidosis indicates hyperkalemia

Alkalosis indicates hypokalemia

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58
Q

Normal pH

A

7.35-7.45

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59
Q

Normal paCO2

A

35-45

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60
Q

Normal HCO3

A

22-26

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61
Q

IVP knowledge/interventions

A

Know allergies to shellfish and iodine dye
NEED consent
Check BUN & Creatinine
HOLD metformin/glucophage when giving dye
NPO before and after

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62
Q

Renal arteriogram knowledge/interventions

A

Know allergies to shellfish and iodine dye
NEED consent
Check BUN & Creatinine
HOLD metformin/glucophage when giving dye
PT and INR
Check for bleeding at site

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63
Q

CXR knowledge/interventions

A

diagnose pneumonia, check line placement
pregnant?
NO consent

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64
Q

CT scan knowledge/interventions

A

Know allergies to shellfish and iodine dye
NPO
Claustrophobic?
Pregnant?

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65
Q

MRI knowledge/interventions

A

NO metal

Sedation if nervous

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66
Q

KUB knowledge/interventions

A

abdominal, look for NG tube placement

NO consent

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67
Q

Thoracentesis knowledge/interventions

A

NEED consent

sit up, arms out

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68
Q

Paracentesis knowledge/interventions

A

NEED consent

lay on back

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69
Q

PO route knowledge/interventions

A

do NOT crush enteric coated meds

first pass effect

70
Q

IM route knowledge/interventions

A

1 mL into Deltoid because only small amount
up to 2 mL in vastus lateralis(mid thigh)
up to 3 mL in ventrogluteal (hip)
shorter needle for deltoid

71
Q

what does PR stand for ?

A

Per rectum

72
Q

SubQ knowledge/interventions

A

Rotate sites, give .5-1 mL in shots

73
Q

SL (sublingual) knowledge/interventions

A

need moist mouth
NO food or drink after/during
Under tongue

74
Q

Buccal knowledge/interventions

A

No food or drink

75
Q

Order of meds for inhaler

A

Bronchodilator(albuterol) then Steroid

76
Q

Topical knowledge

A

rotate sites
wear gloves
bypass first pass effect

77
Q

Optic meds. knowledge/interventions

A

Pull down lower lid
hold pressure
wait between drops

78
Q

Otic meds knowledge/interventions

A

Adults: Pull up and back

Children under two: Pull down and back

79
Q

Intradermal degress

A

5-15 degrees

80
Q

Laxatives knowledge/interventions

A

AVOID long term use

81
Q

Different types of laxatives

A

metamucil- bulkforming
dulcolax(bisacodyl)- irritant
colace(sodium docusate)- emoliant(lubricant), stool softener

82
Q 
PPI suffix
function  
interventions
A

-prazole
inhibit gastric acid secretion

give in morning for prophylaxis(fight disease)

83
Q 
H2 Blocker Suffix
function
interventions
A

-dine
inhibit gastric acid secretion

Give at bedtime
avoid smoking and eating B12 foods

84
Q 
Benzodiazapines suffix
function
interventions
What is antidote?
A

-zepam and -zolam
Suppress CNS activity, Treat Anxiety

Check LOC and RR
Do NOT mix with alcohol
Do NOT stop abruptly

Antidote: Romazacom

85
Q

Narcotics/Opiates function
interventions
side effect
antidote

A

Treat Pain

check BP(BP typically drops), RR
side effect: constipation, urine retention, GI distress, Respiratory down

Antidote: narcan

86
Q

NSAID interventions

examples

A

watch for Ototoxicity and GI distress

aspirin
ibuprofen

87
Q 
Antiemetic
function
interventions
A

Prevent vomiting

No alcohol with phenergan
Monitor Hydration, I&O
Mouth Care

88
Q 
Antihistamine suffix
function
intervention
A

-ine
Prevent allergies

Cause drowsiness

89
Q 
Ace Inhibitor suffix
function
interventions
A

-pril
Relax veins to drop BP

Check BP prior to giving, do NOT give if too low
side effects:
-coughing
-fluid status altered
-promotes aldosterone
-potassium is retained (WATCH K Levels!)

90
Q

Beta Blockers suffix
function

interventions

A

-lol
Decrease BP by decreasing HR
Check HR & BP( if below 60 HOLD beta blocker)

91
Q

Loop Diuretics suffix

interventions

A

(-nide and -mide)
used for hypertensions
check fluid/electrolyte, I&O, and daily weight
(-lactone is K sparing)= spironolactone

92
Q 
Cardiac Glycoside suffix
function 
interventions
A

-xin (Digoxin)
Decreases HR and increases contractions(output)

Monitor HR and dont give below 60

93
Q

Antianginal (Nitroglycerine) function

A

dilate blood vessels, men should not be on viagra

94
Q

Antibiotics interventions

A 
check allergies
fluids
should not be exposed to sun
DO NOT STOP EARLY
TAKE FULL COURSE
95
Q

What is kayexelate?

A

Treat hyperkalemia, poops K out

96
Q

What is metformin?

A

Impacts kidney, hold on diagnostic tests

97
Q

Purpose of Half-life

A

Determine dosing

98
Q

Danger of protein binding

A

Increase risk of ototoxicity

more free drug

99
Q

Schedule II drugs:

A

Need prescription
NO call for refill
not a controlled substance

100
Q

Peak vs. trough

A

Peak is checked 60 minutes AFTER med is given

Trough is checked 30 minutes BEFORE Meds is given

101
Q

Needle size SubQ vs. IM

A

SubQ=25-27 (shorter gauge)

IM=21 (larger gauge)

102
Q

What labs are important to know kidney function?

A

BUN and creatinine

103
Q

What does High BUN indicate?

A

Dehydration

104
Q

What to do if Glucose is low? High?

A

Give D50

Give Insulin and D50

105
Q

What is HGB A1C?

A

test 3 month period(120 days) of RBC life

Treats diabetes

106
Q

How to catch Urinalysis?

A

Catch sterile technique, NOT by cup

107
Q

What diagnostic tests need consent?

A

IVP and Renal arteriogram

108
Q

Interventions for invasive diagnostic tests that use dye?

A
  • Check allergies to dye and shellfish
  • Check PT & INR (renal arteriogram)
  • Check BUN & Creatinine
  • Hold metformin if allergic
109
Q

Cataract deficit

A

Cloudy, opaque lens that distorts passage of light

110
Q

Glaucoma

A

Pressure against optic nerve, Halos seen

111
Q

Diabetic Retinopathy

A

Spotted Vision from edema

112
Q

Macular Degeneration

A

Decrease in central vision

113
Q

Altered attention

A

Short Attention Span

114
Q

Memory impairment

A

Head Trauma, meds

115
Q

Disorganized thinking

A

Delirium: Fast onset
Dementia: Slow onset
Sundowners

116
Q

How often are eye exams?

A

Every 2 years

Every year if eye problem

117
Q

How often are ear exams?

A

Yearly

118
Q

Acute Care checks

A

Orientation to environment
Safety measures
Controlling sensory stimuli

119
Q

Restorative Care checks

A

Promoting self-care safely

Socialization

120
Q

Kubler Ross Classical Behavioral stages

A 
Denial
Anger
Bargaining
Depression
Acceptance
121
Q

Grief Task Model

A

Acceptance of reality loss
Work through pan of grief
Adjust to environment
Relocate emotionally/move on

122
Q

Factors that Influence Grief

A 
Human Development
Personal Relationships
Nature of Loss
Coping Strategies
Socioeconomic Status
Culture &amp; Ethnicity
Spiritual/Religious Beliefs
Hope
123
Q

Difference between Living Will and Durable POA/Health Care Proxy

A

Living Will: Written instructions about treatments on how you want to be kept alive, or medical treatments
Durable POA: Name a person to make decisions when you are unable to do so

124
Q

Difference between Palliative and Hospice care

A

Palliative Care: Prevent, relief, reduce symptoms throughout entire course of illness
-Support Patient

Hospice is a multidisciplinary team that focuses on quality of life
-focus on quality of life
Hospice patients must be: 
1. Terminally ill
2. Insurance Covered
3. 6 months or less to live
125
Q

Different types of death

A

Death= Heart and lungs fail to function

Clinical Death= Heart, Lungs stop, no brain function
- brief time before organs die to perform CPR, not that effective

Brain death= Absence of brainstem reflexes(apnea, coma) heart & respirations stop
-can be on life support: ventilator and vasopressor to maintain heart and lung function

126
Q 
Strategies of Psychosocial Care
Grief and Mourning
Promote Spirituality
Communication
Provide Referrals
A

Grief and Mourning:
offer physical and emotional support. Provide presence
be realistic, accept situation
encourage reminiscence

Provide Spirituality:
find meaning in suffering without explaining loss
deal with it
look at hope

Communication:
remind family patient may still hear them

Provide Referrals:
Bereavement counseling

127
Q

Steps of postmortem care

A

Pronouncement of death by APN or MD
Prepare patient for family visit
Allow family to see patient in private, customs( Call Chaplain)
Family chooses funeral home; nurse notifies to pick up body
Offer family to pack belongings
Prepare for transfer. Funeral home will bring stretcher. If to hospital morgue, wrap in shroud and ID

128
Q

Core Elements of Framework

A

Caring, Connecting, and Empowering

129
Q

Professional Standards of Nursing

A 
Patient- Centered
Health Promotion
Teamwork/Collaboration
Informatics/Innovation
Evidence-based practice
Professionalism
Cultural competence
Quality &amp; Safety
130
Q

Elements of human, impact on environment of each

A 
Physiological
Psychological
Sociocultural
Spiritual
Environment
131
Q

Distressing symptoms at end of life

A

Assess patient
Educate Family & Patient
Assurance

132
Q

Antibacterial Interventions

A

Check allergy prior to administration
Obtain sample for culture prior to administration
Monitor labs (liver enzymes, kidney function, peak and trough)
Administer in relation to meals
Increase fluids
Monitor for S/S of allergies, toxicities, superinfection
Teach to take entire course as scheduled

133
Q

What antibacterials to check peaks and troughs?

A

Glycopeptides (vancomycin) and Aminoglycosides

134
Q

What diagnostic tests need consent?

A

IVP
Renal Arteriogram
CT scan

135
Q

What diagnostic tests do nurses check BUN & Creatinine?

A

IVP and CT

136
Q

What diagnostic test do nurses check PT & INR?

A

Renal Arteriogram, go into vessel

137
Q

If medication error, what steps do nurses take?

A 
Assess
Call
Report
Compute
(ACRC)
138
Q

Coumadin time

Heparin Time

A

11-12.5 seconds

30-40 seconds

139
Q

INR definition, values

A

time it takes blood to clot

  • Healthy: .8-1.1
  • Anticoagulants: 2-3
  • Atrial Fibrilation/Heart Valve: 3-4
140
Q

Circulatory Overload findings & interventions

A

Findings:
crackles
SOB
edema

Interventions:
elevate HOB
Reduce IV rate 
Monitor VS &amp; labs
Contact HCP
141
Q

Infiltration findings & interventions

A

Findings:
cool and taught(tight) skin

Interventions:
Stop, discontinue, start new IV
Apply warm/cold compress
elevate extremity

142
Q

Phlebitis findings & interventions

A

Findings:
redness, tenderness, pain, warm veins

Interventions:
Do NOT massage
apply warm compress
Stop, Discontinue, Start new IV
Contact HCP if needed
143
Q

Local Infection findings & interventions

A

Findings:
heat, redness, swelling, drainage

Interventions:
Culture drainage
Stop, discontinue, Start new IV
Notify HCP

144
Q

Bleeding findings & interventions

A

Findings:
fresh blood and pooling

Interventions:
Assess IV intact
Apply Pressure
Start new line if needed

145
Q

Isotonic Fluids

A

9%NS (dehydration)
D5W
LR

146
Q

Hypotonic Fluids

A

.45% NaCl (1/2 NS)

.2% NaCl (1/4 NS)

147
Q

Hypertonic fluids

A

D5NS
D10W
D5LR
3%NaCl (for hypernatremia)

148
Q

What is Intractable Pain?
Idiopathic pain?
Referred pain?

A

No treatment found
No cause found, hard to find
Shows up in different place

149
Q

What is Atelactasis?

A

Collapse of Alveoli

150
Q

S1 and S2?

A

S1: Mitral and Tricuspid close
S2: Aortic and Pulmonic close

151
Q

Urinary Acute Care meds

A

Antimuscarinics- treat overactive bladder
Antibacterials- treat UTI
Urinary analgesics- treat pain

152
Q

Urinary restorative Care

A 
lifestyles changes (diet- avoid caffeine, citrus, artificial sweeteners, spicy food)
Kegel exercises
bladder retraining
toilet schedule
intermittent catherization
153
Q

Diarrhea Care

A

MAINTAIN FLUIDS

bland diet

154
Q

Anti Diarrhea Meds

A

Opiates (Paragoric, Lomotil, Imodium(loperamide)
Adsorbents (Peptobismol, Kaopectate, Charcoal)
Normal flora (lactobacillus acidophilus, Kefir)

155
Q

Care for stoma

A

Odor Control

Body Image

156
Q

What does -scopy indicate?

A

Direct Visualization

157
Q

Ace Inhibitors

A

-pril
Capoten
Vasotec
Zestril

158
Q

Beta Blockers

A

-lol
Lopressor
Inderal
Coreg

159
Q

Antianginal

A

Nitrostat-SL
Nitrobid-ointment
Transderm nitro-patch
Nitroglycerin drip tidal-IV

160
Q

Cardiac Glycoside

A

-xin

Lanoxin/Digoxin

161
Q

Loop Diurectics

A

-mide & -nide
Lasix
Bumex

162
Q

Thiazide

A

-thiazide
HCTZ
Diuril

163
Q

K Sparing

A

-actone

Spirinolactone/aldactone

164
Q

H2 blocker

A

-dine
Axid
Pepcid
Tagamet

165
Q

PPI

A

-prazole
Nexium
Prilosec
Protonix

166
Q

Benzodiazapine

A

-zepam, -zolam
Ativan
Valium
Xanax

167
Q

Antiemetics

A

Phenergan(promethazine)
Zofran(Ondanstron)
Dramamine(Dimenhydrinate)

168
Q

Chest tube care

A 
Assess patient
Keep system upright and below insertion level
Assess tubes for kinks and loops
Monitor Drainage
Connections secure
KEEP PATIENT MOVING
169
Q

Antibacterial interventions

A 
Check allergies
Obtain sample for culture
Monitor Lab
Administer in relation to meals
Monitor for S/S of allergic reaction, toxicity, superinfection
Teach to take entire course
Increase Fluid intake
170
Q

Medications to check for peaks and trough

A

Glycopeptides (Vancomycin) & Aminoglycosides

FUNDAMENTALS (15 decks)

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