Med Surg I Exam 1 Flashcards

Question

KSAs

Answer 1

Knowledge, skills, attitudes | SPEAKUP

Answer 2

``` Formal communication between health care team .....Situation .....Background .....Assessment .....Recommendation ```

Answer 3

``` Right task...................drug Right circumstances....time Right person...............person Right communication...medication Right supervision.........route ```

Answer 4

Emphasis on documentation (Knowledge, skills, attitudes)

Answer 5

electronic health record

Answer 6

electronic patient record

Answer 7

electronic medical record

Answer 8

radio frequency identification

Answer 9

55-60% body weight children 50-55% body weight healthy older adults ECF 1/3 body (20% body wt: 15L) ISF 2/3 body (40% body wt: 25L)

Answer 10

Ventricle too weak Blood backs up into venous system Venous hydro pressure rises Reverse filtration

Answer 11

Proteins increase pressure .....keeps fluid in cells .....pulls fluid into cells

Answer 12

by controlling urine retention/ excretion

Answer 13

phosphorus/ potassium

Answer 14

Sodium/ chloride

Answer 15

another ion has to go (potassium)

Answer 16

secreted by adrenal cortex when ECF sodium decreases (prevents water/ sodium loss)

Answer 17

Vassopressin, produced in the brian/ stored in posterior pituitary gland Hypothalamus release control; act on kidney tubules; permeable water reabsorption

Answer 18

1. opposes aldosterone 2. secreted in response to increased blood volume/ pressure: stretch in heart tissue 3. inhibited reabsorption Na/ glomerular filtration increased

Answer 19

3.0-4.5 mg/dl

Answer 20

Blood V monitored by kidney Bp/bv/o2/osmolarity-kidney secrete renin-angiotensinogen conv to angiotensin I-ACE conv to angiotensinogen II Vasoconstriction

Answer 21

Waste and by-products of protein metabolism: kidney

Answer 22

blood urea nitrogen protein breakdown metabolite | kidney or liver

Answer 23

provide care to patients BEFORE a respiratory or cardiac arrest occurs, intervenes rapidly when needed for pt's who are beginning to decline....does not replace the Code Team who responds to pt arrests

Answer 24

Hypotonic Hypertonic Isotonic (most common type/ only from the ECF)

Answer 25

pt is in shock or highly stressed/dehydration (SNS) | Process can be disrupted: ACE inhibitors/ ARBs (angiotensin receptor blockers)

Answer 26

cognitive muscle nerve conduction

Answer 27

cardiac function ( all body functions are affected)

Answer 28

nerve conduction (Parathyroid)

Answer 29

Every hour

Answer 30

Every 4 hours

Answer 31

Every hour

Answer 32

forehead or sternum

Answer 33

daily weights

Answer 34

bowel sounds, heart rate, rhythm, and quality; and muscle strength

Answer 35

IV therapy

Answer 36

the inflammation of a vein caused by mechanical, chemical, or bacterial irritation

Answer 37

occurs when IV solution leaks into the tissues around the vein

Answer 38

deficient fluid volume, risk for deficient fluid volume, excess fluid volume, risk for imbalanced fluid volume

Answer 39

risk for aspiration (risk factor: temporary loss of gag reflex) risk for injury (risk factors: complication of pneumothorax and laryngeal edema, hemorrhage)

Answer 40

SOB that occurs when lying down but is relieved by sitting up

Answer 41

emphysema and chronic bronchitis, characterized by bronchospasm and dyspnea. "Not reversible" and increases in severity over time, eventually leading to respiratory failure

Answer 42

chronic disease with intermittent "reversible" airflow obstruction and wheezing

Answer 43

``` Pitch: High Amplitude: Loud Duration: Inspiration

Answer 44

``` Pitch: Moderate Amplitude: Moderate Duration Inspiration=Expiration Quality: Mixed Normal location: Over major bronchi where fewer alveoli are located posterior, between scapulae (especially on the right); anterior, around upper sternum in first and second intercostal space. ```

Answer 45

Pitch: Low Amplitude: Soft Duration: Inspiration>Expiration Quality: Rustling, like the sound of the wind in the trees. Normal Location: Over peripheral lung fields where air flows through smaller bronchioles and alveoli.

Answer 46

No significant restrictions in normal activity. Employable, Dyspnea occurs only on more-than-normal or strenuous exertion.

Answer 47

Independent in essential ADLs but restricted in some other activites. Dyspneic on climbing stairs or on walking on an incline but not on level walking. Employable only for sedentary job or under special circumstances.

Answer 48

Dyspnea commonly occurs during usual activities, such as showering or dressing, but the patient can manage without assistance from others. Not dyspneic at rest; can walk for more than a city block at own pace but cannot keep up with others of own age. May stop to catch breath partway up a flight of stairs. Is probably not employable in any occupation.

Answer 49

Some dependence needed with essential ADLs such as dressing and bathing. Not usually dyspneic at rest. Usually restricted to home. Dyspneic on minimal exertion. Minimal or no activities outside of home.

Answer 50

Struggles with breathing all the time. Dependent on help for most needs.

Answer 51

Fine crackles, Fine rales, High-pitched rales (all happen either early or late inspiration). Coarse crackles, Low-pitched crackles (more common on expiration but may be present during early inspiration). Associated with Asbestosis, Atelectasis, Interstitial fibrosis, Bronchitis, Pneumonia, Chronic Pulmonary Diseases, Tumors, Pulmonary Edema.

Answer 52

Wheeze (audible during either inspiration, expiration or both). Rhonchus (Audible during both inspiration and expiration louder during expiration). Associated with Inflammation, Bronchospasm, Edema, Secretions, Pulmonary vessel engorgement (as in cardiac "asthma", Thick tenacious secretions, Sputum production, Obstruction by foreign body, Tumors.

Answer 53

Heard during both inspiration and expiration generally at the end of inspiration and the beginning of expiration. Associated with Pleurisy, Tuberculosis, Pulmonary infarction, Pneumonia, Lung Cancer.

Answer 54

Change: Loss of elasticity, Decreased turgor, Decreased oil production Result: Skin becomes an unreliable indicator of fluid status, especially the back of the hand. Dry, easily damaged skin.

Answer 55

Change: Decreased glomerular filtration, Decreased concentrating capacity. Result: Poor excretion of waste products. Increased water loss, increasing the risk for dehydration.

Answer 56

Change: Decreased muscle mass. Result: Decreased total body water. Greater risk for dehydration.

Answer 57

Change: Diminished thirst reflex Result: Decreased fluid intake, increasing the risk for dehydration.

Answer 58

Change: Adrenal atrophy Result: Poor regulation of sodium and potassium, predisposing the patient to hyponatremia and hyperkalemia.

Answer 59

``` Smoking history Childhood illnesses (asthma, pneumonia, Communicable disease, Hay fever, Allergies, Eczema, Croup, Cystic fibrosis). Adult illnesses ( Pneumonia, Sinusitis, TB, HIV and AIDS, Diabetes, Hypertension, Heart disease, Influenza, Surgeries of upper or lower resp. system, Recent weight loss, night sweats, Geographic regions of recent travel, Occupation and leisure activities. ```

Answer 60

It records the maximum amount of air that can be exhaled as quickly as possible after maximum inspiration. Purpose: Gives and indication of respiratory muscle strength and ventilatory reserve. FVC is often reduced in obstructive disease (because of air trapping) and in restrictive disease.

Answer 61

Records the maximum amount of air that can be exhaled in the first second of expiration. Purpose: FEV1 is effort dependent and declines normally with age. It is reduced in certain obstructive and restrictive disorders.

Answer 62

Is the ratio of expiratory volume in 1 sec to FVC. Purpose: This ratio provides a much more sensitive indication of obstruction to airflow. This ratio is the hallmark of obstructive pulmonary disease. It is normal or increased in restrictive disease.

Answer 63

Records the forced expiratory flow over the 25%-75% volume (middle half) of the FVC. Purpose: This measure provides a more sensitive index of obstruction in the smaller airways.

Answer 64

Is the amount of air remaining in the lungs after normal exiration. FRC test requires use of the helium dilution, nitrogen washout, or body plethysmography technique. Purpose: Increased FRC indicates hyperinflation or air trapping, which may result from obstructive pulmonary disease. FRC is normal or decreased in restrictive pulmonary diseases.

Answer 65

is the amount of air in the lungs at the end of maximum inhalation. Purpose: Increased TLC indicates air trapping associated with obstructive pulmonary disease. Decreased TLC indicates restrictive disease.

Answer 66

Is the amount of air remaining in the lungs at the end of a full, forced exhalation. Purpose: Is increased in obstructive pulmonary disease such as emphysema.

Answer 67

reflects the surface area of the alveolocapillary membrane. The patient inhales a small amount of CO, holds for 10 sec, and then exhales. The amount inhaled is compared with the amount exhaled. Purpose: DlCO is reduced whenever the alveolocapillary membrane is diminished, such as occurs in emphysema, pulmonary hypertension, and pulmonary fibrosis. It is increased with exercise and in conditions such as polycythemia and congestive heart disease.

Answer 68

Amount of O2 is 24% for 1L/min. increases 4% each L/min up to 6L/min = 44%. Ensure that prongs are in the nares properly. A poorly fitting nasal cannula leads to hypoxemia and skin break down. Apply water-soluble jelly to nares PRN. This prevents mucosal irritation related to the drying effect of oxygen; promotes comfort. Assess the patency of the nostrils. Congestion or a deviated septum prevents effective delivery of oxygen through the nares. Assess the pt for changes in respiratory rate and depth. The respiratory pattern affects the amount of O2 delivered. A different delivery system may be needed.

Answer 69

40%-5L/min, 45%-50%-6L/min, 55%-60%-8L/min. Be sure mask fits securely over nose and mouth. A poorly fitting mask reduces the FiO2 (Fraction of inspired oxygen) delivered. Assess skin and provide skin care to the area covered by the mask. Pressure and moisture under the mask may cause skin breakdown. Monitor the pt closely for risk for aspiration. Mask limits the pt's ability to clear the mouth, especially if vomiting occurs. Provide emotional support to the pt who feels claustrophobic. Emotional support decreases anxiety, which contributes to a claustrophobic feeling. Suggest to the healthcare provider to switch the pt from a mask to the nasal cannula during eating. Use of the cannula prevents hypoxemia during eating.

Answer 70

60-75% at 6-11L/min, a L flow rate high enough to maintain reservoir bag 2/3 full during inspiration and expiration. Make sure that the reservoir does not twist or kink, which results in a deflated bag. Deflation results in decreased O2 delivered and rebreathing of exhaled air. Adjust the flow rate to keep the reservoir bag inflated. The flow rate is adjusted to meet the pattern of the pt.

Answer 71

80-95% FiO2 at a liter flow high enough to maintain reservoir bag 2/3 full. Interventions as for partial rebreather mask; this pt requires close monitoring. Monitoring ensures proper functioning and prevents harm. Make sure that valves and rubber flaps are patent, functional, and not stuck. Remove mucus or saliva. Valves should open during expiration and close during inhalation to prevent dramatic decrease in FiO2. Suffocation can occur if the reservoir bag kinks or if the o2 source disconnects. Closely assess the pt on increased FiO2 via non-rebreather mask. Intubation is the only way to provide more precise FiO2. The patient may require intubation.

Answer 72

Hoarseness, Change in resp. pattern, Persistent cough, Blood streaked-sputnum, Rust-colored or purulent sputum, Frank hemoptysis, chest pain or tightness, Soulder, arm, or chest wall pain, Recurring pleural effusion, pneumonia, bronchitis, Dyspena, Fever associated with one or two other signs, Wheezing, Weight loss, Clubbing of fingers.

Answer 73

``` Primary Tumor (T) Tx Primary tumor cannot be assessed T0 No evidence of primary tumor Tis Carcinoma in situ T1, T2, T3, T4 Increasing size and/or local extent of the primary tumor. ``` Regional Lymph Nodes (N) Nx Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1, N2, N3 Increasing involvement of regional lymph nodes Distant Metastasis (M) Mx Presence of distant metastasis cannot be assessed M0 No distant metastasis M1 Distant mestastasis

Answer 74

24-50% FiO2 with flow rates usually 4-10L/min; provides high humidity. Perform constant surveillance to ensure an accurate flow rate for the specific FiO2. An accurate flow rate ensures FiO2 delivery. Keep the orifice for the Venturi adaptor open and uncovered. If the Venturi orifice is covered, the adaptor does not function and oxygen delivery varies. Provide a mask that fits snugly and tubing that is free of kinks. FiO2 is altered if kinking occurs or the mask fits poorly. Assess the pt for dry mucous membranes. Comfort measures may be indicated. Change to a nasal cannula during mealtime. O2 is a drug that needs to be given continuously.

Answer 75

excessive vomiting, prolonged gastric suctioning

Answer 76

``` <136 GI Causes: vomiting diarrhea GI Suction profound sweating excess water intake (water intoxication) Low sodium diet Congestive Heart Failure (dilutes Na+) ```

Answer 77

lethargy muscle cramps Heart Attack Decreased LOC-level of consciousness

Answer 78

weak irregular pulse arrhythmia-common cause of death LOC-from nervous system conduction problems Muscle weakness (bowel function too) digoxin effect- K+ defiency enhances dig action decr K+ makes digoxin more efficient

Answer 79

the major anion of the extracellular fluid (ECF) and works with sodium to maintain ECF osmotic pressure. important in formation of hydrochloric acid in stomach

Answer 80

Inadequate renal function (normal kidney doesn't allow excess serum K) K supplements with diuretic therapy Tissue injury/strenuous exercise-release K from cells Acidosis- K rises in acidosis so body can excrete H ions. Cell destruction- burns, tramatic injury, tumor lysis syndrome,tissue catabolism (fever, sepsis). Hypoaldsteronism and hemolysis

Answer 81

``` bradycardia, hypotension, increased intestinal motility (diarrhea) respiratory distress ECG changes hyperreflexia or areflexia (flaccid) ```

Answer 82

weak irregular pulse arrhythmia-common cause of death LOC-from nervous system conduction problems Muscle weakness (bowel function too) digoxin effect- K+ defiency enhances dig action decr K+ makes digoxin more efficient

Answer 83

malnutrition, diarrhea, Celiac or Crohn's disease, ethenol ingestion, some drugs (diuretics, some antibiotics, cisplatin)

Answer 84

increased mg intake (antacids and laxatives), decreased kidney excretion of mg due to kidney disease

Answer 85

increased mg intake (antacids and laxatives), decreased kidney excretion of mg due to kidney disease

Answer 86

<3.0 decreased absorption of phosphorus Increased excretion of phosphorus Intracellular phosphorus shift

Answer 87

``` when deficiency is prolonged/severe related to decreased amounts of ATP (adenosine triphosphate) decreased energy metabolism other electrolyte imbalances elevated Ca+ levels ```

Answer 88

Cardiac: decr.-stroke volume, cardiac output, peripheral pulse weak/ineffective contractions Musculoskeletal: Acute: generalized weakness-skeletal muscles -->muscle breakdown-->respiratory muscles-->respiratory failure Chronic: most evident in skeletal-->decr in bone density CNS: noted with severe hypophosphatemia-->irritability-->seizures-->coma

Answer 89

``` >4.5 kidney disease cancer tx incr phosphorus intake hypoparathyroidism ```

Answer 90

center on hypercalcemia-incr. membrane excitability

Answer 91

Active You need your respiratory muscles to contract negative pressure occurs

Answer 92

Passive Muscles relax positive pressure occurs

Answer 93

seen in neuromuscular, central nervous, and intestinal systems. hyperactive, deep tendon reflexes, numbness, tingling, psychological depression, psychosis, confusion, constipation, anorexia, nausea, abdominal distention

Answer 94

Excessive use of Diuretics, Digitalis Alkalosis GI loss: prolonged vomiting, diarrhea, laxative abuse or nasal gastric suctioning (bile and GI secretions are rich in K) Too much insulin Steroids promote K excretion and Na retention (aldosterone, Cortisol) Hyperaldosteronism (save Na to preserve fluid)

Answer 95

Weak irregular pulse Arrhythmia LOC- from nervous system conduction problems Muscle weakness (bowel function too) "Digoxin effect"- K deficiency enhances dig action-toxicity.

Answer 96

stronger than normal stimulus required to elicit a response, Cardiac slows down, bradycardia, peripheral vasodilation, hypotension. drowsy, lethargic, coma

Answer 97

1. Painful muscle spasms 2. Neuromuscular changes ...........tingling, numbness (paresthesias) ...........Trousseau's sign/ Chvostek's sign 3. Cardio changes ..........heart rate faster/ slower: thready weak pulse ..........hypotension/ prolonged ST/ QT intervals 4. Intestinal changes ..........increased peristalsis ..........painful abdominal cramping 5. Skeletal changes ..........osteoporosis/ weak bones/ easy fractures ..........decreased height/ collapsing vertebrae

Answer 98

1. Inadequate oral intake Ca/ vitamin D 2. Kidney complications 3. Diarrhea 4. Malabsorption 5. Wound drainage 6. Hyperproteinemia 7. Alkalosis/ citrate/ mithramycin/ penicillamine 8. Immobility/ parathyroid destruction

Answer 99

``` 1. Cardio changes ..........increased heart rate/ blood pressure ..........dysrhythmias 2. Neuromuscular changes ..........muscle weakness ..........confusion/ lethargy/ coma 3. Intestinal changes ..........decreased peristalsis ...........const., anorexia, nausea, vomiting, pain ```

Answer 100

1. Excessive oral intake of calcium 2. Excessive oral intake of vitamin D 3. Kidney failure 4. Use of thiazide diuretics 5. Hyperparathyroidism 6. Malignancy 7. Hyperthyroidism 8. Immobility 9. Dehydration

Answer 101

conivaptan (Vaprisnol) tolvaptan (Samsca) Can be used to alleviate hyponatremia due to fluid excess.

Answer 102

Furosemide: high ceiling loop diuretic

Answer 103

Lithium | demeclocycline (Declomycin)

Answer 104

Hypotonic IV solution 0.225% sodium chloride | Furosemide and bumetadine (Bumex): when caused by poor Na secretion by kidney

Answer 105

K excretion/ Na retention

Answer 106

Aids transport into cell/ binds to decrease serum level

Answer 107

Makes digoxin increases more efficient

Answer 108

spironolactone (Aldactone, Novospiroton) triamterene (Dyrenium) amiloride (Midamor)

Answer 109

Osteoblasts and osteoclasts

Answer 110

furosemide (Lasix, Furoside

Answer 111

plicamycin (Mithracin) | penicillamine (Cuprimine, Pendramine)

Answer 112

Phosphorus, calcitonin (Calcimar), biphosphonates (etidronate), prostaglandin synthesis inhibitors (aspirin, NSAIDs)

Answer 113

Bicarbonate HCO3

Answer 114

``` ..specific ..measurable ..attainable ..realistic ..timed ```