Med Surg Exam 4 Flashcards
This infection can cause jaundice and flu-like symptoms initially and can lead to cirrhosis of the liver and liver cancer.
Hepatitis B
Men rarely have symptoms from this protozoan parasite, but women may have a frothy, yellow-green, foul-smelling vaginal discharge.
Trichomoniasis
This virus causes intermittent outbreaks of blisters on or around the genitals. Outbreaks may decrease, but the infection cannot be eliminated with medications.
Genital Herpes
Some types of this virus can lead to genital warts or cervical cancer.
Human Papillomavirus
Usually with mild or no symptoms, this bacterial infection (the most common bacterial STD) can lead to pelvic inflammatory disease and infertility.
Chlamydia
The nurse recognizes that this test is the best indicator of kidney function.
Creatinine
What are the 3 blood tests that are done to check kidney function?
Serum Creatinine, Blood Urea Nitrogen (BUN), and BUN/Creatinine Ratio
What is creatinine?
It is the by product of protein or muscle break down. This is filtered by the kidneys and excreted in the urine. These levels (0.5-1.2 mg/dL) are usually constant. Increased levels show there is kidney impairment, trauma, or increased protein in the diet.
What is BUN?
It is the by product of protein breakdown in the liver. Kidneys filter this and excrete it into the urine. If levels are high it could mean there is renal or hepatic failure. If low it could mean malnutrition.
What is the normal range of BUN?
10-20mg/dL
What is the BUN/creatinine ratio?
It is a test that can determine if there are factors other than renal failure causing a high BUN, like low cardiac output or RBC destruction.
What is urine suppose to be like?
It is suppose to look like straw yellow, clear, and no odor present.
What is the pH of urine suppose to be?
The average is 6 but can range from 4.6-8
What is the specific gravity of urine suppose to be?
It is suppose to be 1.005-1.030. Water is only 1.
How much glucose should there be in the urine?
There should be none present. If there is glucose present it could mean the glucose levels are high in the blood.
How many ketones are suppose to be in the urine?
None
Is protein suppose to be in the urine?
No, if it is present it could mean there is damage to the kidney.
How much blood is suppose to be in the urine?
None.
What reasons would there be RBCs in the urine?
Pt could have a catheter, tumor, stones, trauma, glomerular disorders, cystitis, or bleeding disorders.
What reasons would there be WBCs in the urine?
and infection or inflammation anywhere in the renal/urinary tract, renal transplant rejection, fever, or exercise.
What is BPH?
It is Benign Prostatic Hyperplasia, it causes problems with urine flow due to the prostate being enlarged causing the urethra to close off.
What is continence?
This is the control a person has of when and where they want to urinate. This is a learned behavior.
What is incontinence and what causes it?
This is the involuntary loss of urine which could be severe enough to cause social or hygienic problems. This can be caused by adding stress to the bladder (coughing, sneezing, jogging, or lifting). People can also be incontinent because they cannot suppress the signals (urge) in the bladder that are sent to the brain saying it is time to urinate, this causes them to go frequently without being able to hold it before finding an appropriate place to go.
What is mixed incontinence?
It is when there is more than one type of incontinence involved. Usually this is stress and urge incontinence combined.
What is overflow incontinence?
This is when the bladder becomes over distended and a small amount of urine leaks out.
What is functional incontinence?
This is caused outside of any factor dealing with the bladder. An example would be a patient with dementia not knowing he/she needs to urinate.
How do drugs contribute to urine incontinence?
opioid analgesics- decrease the pts level of consciousness and the urge to void, and contribute to constipation.
Diuretics- cause frequent voiding
Anticholinergic drugs- affect cognition and ability to void.
How does disease contribute to urine incontinence?
Cerebrovascular accidents- decrease mobility, sensation, or cognition.
Arthritis- decreases mobility and causes pain.
Parkinson disease- causes muscle rigidity and an inability to initiate movement.
How does depression contribute to urine incontinence?
It decreases the energy necessary to maintain continence.
Decreased self-esteem and feelings of self-worth decrease the importance to the patient of maintaining continence.
How does inadequate resources contribute to urine incontinence?
pts who need assistive devices may be afraid to ambulate without them or without personal assistance.
Products that help pts manage incontinence are often costly.
No one may be available to assist the pt to the bathroom or help with incontinence products.
What is pylenophritis?
It is a bacterial infection in the kidney and renal pelvis.
What are key features of pylenophritis?
Fever person actually looks sick Chills Tachycardia and tachypnea Flank, back, or loin pain Tender costal vertebral angle (CVA) Possible death
What is cystitis?
This is a bladder infection.
What are key features of cystitis?
Frequency, Urgency Suprapubic pain Burning upon urination Hematuria fever nausea vomiting
What is urethritis?
It is the inflammation of the urethra.
How do you prevent a UTI?
Drink 2-3 L of fluid every day
Drink cranberry juice to acidify urine.
Be sure to get enough sleep, rest, and nutrition
Clean the perineum from front to back.
Avoid bubble bath, nylon underwear, and scented toilet paper. Wear loose-fitting cotton underwear.
What is the biggest risk factor for UTIs?
Foley-catheter
What is erythropoietin?
This is a hormone produced in the kidney. It is released when oxygen levels are low in the kidneys (indicates anemia). It enters the blood stream and attaches to receptors in the bone marrow, stimulating it to produce RBC’s.
What is Renin?
It is an enzyme that is released by the kidneys to increase blood pressure by converting angiotensinogen to angiotensin I which is then converted to angiotensin II. This constricts the blood vessels causing the BP to increase.
Angiotensin II also stimulates aldosterone to be released causing the kidneys to reabsorb sodium with water following. This increases the fluid levels in the body and increases the BP.
What is Retention of Urine?
This is the inability to empty the bladder. A person may be able to urinate but may have trouble starting a stream or emptying the bladder. This could cause a person to urinate frequently.
What is the Glasgow Coma Scale used for?
To determine the level of consciousnesses
What are the three areas the Glasgow coma scale focuses on?
Eye opening (1-4) motor response (1-6) verbal response (1-5) 15 is highest score and is normal
What can a CT scan show?
structure of the brain, vascular system, and fluid. Can show tumors, infarction’s, hemorrhage, hydrocephalus.
How to instruct patient before a ct scan?
get informed consent for contrast die, assess for allergies to shellfish or iodine, Ask patient if they are on Metformin…this drug must be held 24 hr before and 48 hr after contrast die.
What can an MRI show?
tumors, intracranial aneurysms, and abnormalities in the brains biochemical processes such as epilipsy, alzheimers, and stroke
What do you need to tell patient before and MRI?
That you cannot wear ANY metal (earrings, tongue-rings, belly button rings, etc.) and they may feel claustrophobic since you are lying in a small tube. If so they can request a mild sedative.
What does an EEG show?
the electrical activity of the brain
What is an EEG used to detect?
origin of seizure activity, diagnose sleep disorders, determine brain death. Abnormal results can also show attention problems, head injury, seizure disorders, drug or alcohol abuse, and migraine headaches.
How do you prepare a pt for and EEG?
explain to them that there will be wires attached to their head (will not hurt), so they need to have clean hair. Do not drink any caffeine, and withhold CNS stimulants or depressants. Only withhold anticonvulsants if doctor says to.
A pt is complaining of intense pain on one side of the head, worse with light or movement, and nausea….what could it be?
migraine headache. Usually last from 4 - 72 hours
Who are affected by migraines the most?
they run in families, and women are affected more than men (of course)
How can a person tell when a seizure or migraine is coming on (sometimes anyway)?
they experience an aura…a feeling that is it about to happen. with migraines, they can sometimes see an aura (visual changes, flashing lights, double vision).
what is a seizure
sudden, uncontrolled electrical discharge in the brain that can cause a change in LOC, motor or sensibility, and/or behavior. If cause is found, it can be treated and patient never has another one
what is epilepsy?
a disease, if a person has two or more seizures. A chronic disorder, unprovoked seizure activity occurs.
what is the difference between generalized seizures and partial seizures?
generalized involve both hemispheres of the brain, partial involve only one hemisphere of the brain.
what is the difference between tonic/clonic and absence seizure?
Tonic/clonic is the stiffening and jerking motions, absence is when the person just sort of stares off into space
What are the 4 cardinal signs of Parkinsons disease?
tremor, rigidity, bradykinesia or akinesia (slow movement/ no movement), and postural instability.
What are the chemicasl in the brain that are causing Parkinsons symptoms
Acetylcholine (ACh) and dopamine. They need to be in balance, and in Parkinsons, there is not enough dopamine to inhibit the actions of ACh.
What is a transient ischemic attack (TIA)?
temporary blockage of blood flow to the brain, anywhere from 15 - 60 minutes. It is reversible and there is no permanent damage. Can be a warning that a stroke is coming.
What is a stroke?
complete blockage of blood flow to the brain (ischemic), or a hemorrhagic stroke where bleeding occurs in brain…permanent damage occurs.
What is one thing that can cause a blood clot to travel to the brain causing stroke?
A-fib
What diagnostic test is used to determine if a stroke is ischemic vs hemorrhagic?
CT scan
What is the diagnosis of Alzheimers disease based on?
symptoms only
what is the first symptom usually seen in Alzheimer’s?
short term memory loss
What are some symptoms of Alzheimer’s?
impaired cognition, disorientation to time, place and event, agitation, gets lost, speech and language deficits, incontinent, trouble sleeping
What is “sundowning” referring to?
Increased confusion at night or when there is inadequate lighting. Also can happen when the patient is excessively fatigued. Patient may wander and become lost.
What is mammography used to screen for?
Breast cancer
What age is recommended for baseline mammogram?
40 yearly thereafter
How should a patient prep for a mammogram?
no lotions, deodorants, creams
What is a PSA test screening for?
blood test that test for a prostate specific antigen which can indicate prostate cancer
How should a patient prep for a PSA test?
no ejaculating 24 hours prior to test
What does a PAP test screen for?
abnormal cell growth which can indicate cervical cancer
How should a patient prep for a PAP ?
no douching or sex 24 hours prior to test
When should women start PAP screening?
Within 3 years of becoming sexually active or 21 years of age
What is fibrocystic breast condition?
Benign condition
Is fibrocystic breast cancerous
No. It doesn’t increase your risk either
When is fibrocystic breast worse?
during monthly menstrual cycle
When does fibrocystic breast condition get better?
with menopause the symptoms subside
What is endometriosis?
Uterine tissue that grows outside the uterus
When is endometriosis worse?
It inflames as you get closer to your menstrual cycle
What is gonorrhea?
Bacterial STD 2nd most common curable
What is chlamydia?
Bacterial STD 1st most common
How do you treat gonorrhea and chlamydia?
antibiotic
What is PID?
Pelvic Inflammatory Disease-can damage reproductive organs- resulting from gonorrhea and chlamydia can lead to sepsis and death
What is HPV?
Human Pampilloma Virus-can lead to cervical cancer
How do you transmit HPV?
Sexual contact
What is a symptom of HPV?
genital warts
Is there a vaccine for HPV?
Yes. Gardisil
What is a symptom of gonorrhea and chlamydia?
vaginal discharge. But most can be asymptomatic. Leads to spread of it.
What is genital herpes?
Contagious viral STD Is a lifelong virus two types blisters/sores
How do you transmit genital herpes?
close contact
What is phimosis?
when the foreskin cannot be retracted
What is paraphimosis?
when the foreskin cannot be returned to proper position-can result in tissue death
How often should Testicular and Breast self exams be completed?
monthly
Thick gelatin that fills space behind the lens (transmits light, maintains placement of the retina, gives eyeball spherical shape)
Vitreous humor
External layers of the eye
Sclera, Cornea
myopia
Nearsighted: vision up close is good, vision far away is poor
Hyperopia
Farsighted: vision far away is good, vision up close is poor
presbyopia (hyperopia)
Loss of close up vision
Astigmatism
lens surface is uneven and bent or wrinkled
Changes in eye with aging
Appearance; eyes appear to be sunken, sclera yellows, dry eyes
Characteristics; muscle strength reduced, lens hardens, cataracts form, pupil more constricted
Vision assessment tools
Snellen chart, refraction test, ophthalmascopic
20/20
Normal chart reading; client can read at 20 ft what average person reads at 20 ft
20/200
legal blindness; client can read at 20 ft what average person can read at 200 ft
opacity of the lens, distorts image on retina, less visual acuity, is painless, occurs gradually, 85% of people 80 and over have this
cataracts
Exacerbation of cataract development
aging, diabetes, chronic exposure to sunlight, chemical toxicity, trauma to the eye, drugs (steroids), congenital
Early stages of cataracts
blurred vision, decreased color perception
Late stages of cataracts
diplopia, reduced visual acuity progress to blindness, absence of red reflex, presence of white pupil
Diagnostics/ medical management of cataracts
Ophthalmoscope, slit lamp exam, removal of clouded lens, replacement of lens
Post op cataract management
eye patches, dark glasses, night time eye shielding, antibiotic ointment
Activities that increase intraocular pressure
bending from the waist, sneezing, coughing, blowing the nose, straining during bowel movement, vomiting, keeping head in dependent position, wearing tight shirt collars
What are appropriate postoperative expected oucomes for the patient who has undergone surgery for cataract removal
a. pain early after surgery accompanied by nausea and vomiting
b. change in visual acuity accompanied by tearing and redness
yellowish drainage and photophobia
mild itching and bloodshot appearance
D. mild itching and bloodshot appearance are considered to be normal postoperative outcomes for this patient. Pain early after surgery may indicate Increased intraocular pressure or hemorrhage. Change in visual acuity, accompanied by tearing and redness, and yellow drainage and photophobia can be signs of infection.
Leading cause of preventable blindness in 10% of persons older than 80, caused by an obstruction in the ooutflow of aqueous humor from the posterior to the anterior chamber, blocked flow causes increased IOP
Glaucoma
Etiology of glaucoma
narrow angles between the anterior iris and the posterior cornea, shallow anterior chambers, or thickened iris that causes angle closure on dilation
glaucoma pathophysiology
over-production of aqueous humor, backup of fluid compresses retina and optic nerve, pressure on blood vessels depriving nerve cells of oxygen, photoreceptors die and blindness occurs (blocked flow, high IOP intraocular pressure)
Increased occurrence of glaucoma in what factors?
family history, eye trauma, diabetes, age
Type of glaucoma characterized by angle closure, closed angle, narrow angle
Acute (closed angle glaucoma) sudden onset, stimulated by darkness, emotional stress, mydriatic (dilating) drugs, atropine, and is a medical emergency.
Type of glaucoma characterized by open angle and is the most common form
Chronic open angle glaucoma
Acute (closed) angle glaucoma signs and symptoms
sudden decrease in visual acuity, excruciating pain/ headache, brow pain, nausea, vomiting
Acute (closed) angle glaucoma treatments
Miotics: meds to constrict iris, delay in treatment leads to blindness in hours to days
Miotic
little word: little pupil
Mydriatic
big word: big pupil
This is cranial nerve 1
Olfactory-smell
This is cranial nerve 2
Optic-vision
This is cranial nerve 3
Oculomotor-eye movement up and down
This is cranial nerve 4
Trochlear-eye movement four corners
This is cranial nerve 5
Sensory-skin sensation of face, scalp, mucus membranes of mouth and nose
This is cranial nerve 6
Abducens-eye movement side to side
This is cranial nerve 7
Facial-smile
This is cranial nerve 8
Vestibulocochlear-hearing, balance
This is cranial nerve 9
Glossopharyngeal-swallow
This is cranial nerve 10
Vagus-
This is cranial nerve 11
Accessory-shrug shoulders
This is cranial nerve 12
Hypoglossal-stick out tongue
Frontal lobe of the brain is responsible for?
voluntary muscle movements, higher function like speech and thought. controls mood, planning for future, setting goals and judgement
Parietal lobe is responsible for?
spatial awareness receives and processes information about temperature, taste, touch, and movement from rest of body Reading and arithmetic processed here
Temporal lobe is responsible for?
Hearing, memory and language
Occipital lobe is responsible for?
Visual information
