Medsurg 3 part 5 Flashcards
1
Q
Dehydration: HR
A
increases
2
Q
Dehydration: pulses
A
weak
3
Q
Dehydration: BP
A
decrease
4
Q
Dehydration: RR
A
increase
5
Q
Assess older adult turgor at the __ or __
A
sternum or forehead
6
Q
BUN range
A
5 to 25
7
Q
2 biggest risks for fall in dehydrated pt
A
ortho hypo
AMS
8
Q
Major role of the nurse in periop is
A
communicating
9
Q
periop: assess the allergy to
A
pineapple/avocado (means latex allergy)
10
Q
a major concern of post op is
A
hypothermia
11
Q
malignant hyperthermia is a reaction to
A
anesthesia
12
Q
To prevent malignant hyperthermia assess for
A
family history
13
Q
In order to avoid electrical injury the pt must be
A
grounded
14
Q
Stop taking ___ 2 weeks before surgery
A
warfarin
15
Q
When considering anesthesia, assess for h/o
A
substance abuse
16
Q
If CO is less than __ you may need to cancel surgery
A
35%
17
Q
Before surgery the pt must be NPO for at least
A
8 hours
18
Q
___ intolerance inhibits healing
A
glucose intolerance
19
Q
Sequential pressure devices are contraindicated in
A
DVT
Vascular problems like PAD
20
Q
Different sized pupils after surgery could mean
A
he had a cerebral event
21
Q
Cancer surgery could be what category
A
palliative
22
Q
Random antiplatelets
A
Vit E
Garlic
23
Q
Laproscopic surgery has a risk for
A
damage to nearby structures
24
Q
Pre op: take a __ bath
A
chlorhexidine bath (but can’t use for face and genitals)
25
Pre op, what should you ask women
LMP
26
Lamenectomy
spinal surgery
27
Before lamenectomy, assess for
muscular strength and sensory function in LOWER body
28
Cardiac surgery, assess for
6 p's
29
If you can't find a pedal pulse,
use a doppler
30
Retinal detachment manifested by
disturbed visual field
It's an emergency
31
hemoglobin range
For men, 13.5 to 17.5
| For women, 12.0 to 15.5
32
autologous transfusion could cause
fever
33
Moderate sedation
pt can still respond
pt has cough and gag reflex
34
closed-angle glaucoma
bad pain
redness
put them in fowlers to decrease pressure
35
PACU priorities
```
Breathing
LOC
Check operation site
Connect to cardiac monitor
Vitals
```
36
Don't put a post op pt in the same room as
a vent pt
37
major risk for resp depression, should be assessed first
```
obesity
+
pain
+
opioid
Assess first
```
38
Hemovac- if you drain more than __ ml its an oh shoot
100 ml
39
NG tube can be flushed with
NS
40
Concern for a post op pt who smokes
slower healing
| dehiscence
41
What do you do for a dihiscence
cover with gauze soaked in saline
42
If Hg is less than __ you definitely need a transfusion
6
43
Types of transfusion reactions
febrile
hemolytic
allergic
fluid overload
44
a hemolytic transfusion reaction involves
antibody mismatch
45
you can't start the transfusion if the pt has a
temp
46
Transfusion: each unit causes the Hg to increase by
1
47
After a hemolytic reaction, the Hg will be
decreased
48
s/s of hemolytic reaction
decrease BP
increase HR
Hypoxemia
Flank pain (bc of myoglobin clogging kidney)
49
What do you do if there's a hemolytic reaction
stop infusion and start NS
50
If a pt is getting a transfusion but they have a weak heart,
give them lasix to prevent HF
51
Most common type of arthritis
OA
52
auditory finding of OA
crepitus
53
OA, if you touch the affected area you would find the patient has
mild tenderness
54
in OA the size of the joint is
enlarged
55
in OA the affected joints may “__” or “___ ___” as a result of advancing disease
lock or give way
56
where are Bouchard’s found?
proximal (b comes before h)
57
psychosocial consideration of OA
the pain may cause depression
58
OA lab tests
ESR
| hsCRP (high sensitivity c reactive protein)
59
techie tests for OA
MRI
| CT studies
60
is there a cure for OA
no
61
a modifiable risk factor that can decrease the impact of OA
weight loss
62
For OA is good to do ____ ___ exercise because leads to increased joint mobility, strengthens the joint’s supporting muscles, tendons, and ligaments
weight bearing
63
Cartilage growth can be stimulated by
exercise
64
___ is the key to successful treatment of OA
Education
65
OA treatment, you need to have a careful balance between
rest and exercise
66
OA, what kind of impact exercise should they do
low impact (like brisk walking)
67
OA, what kind of movement therapy?
Tai Chi
68
OA, a brace can be used to
reduce pain
69
If you need to immobilize a joint in someone with OA, the max time should be
1 week
70
OA, Heat applications help with
stiffness by collagen elasticity
71
OA, Cold applications are used less frequently than heat, and may be beneficial during (3 things)
episodes of acute inflammation,
immediately after exercise,
or for relief of spasms.
72
complication of Capsaicin cream:
can irritate skin
73
topical intervention for OA
Capsaicin cream
74
In OA, Capsaicin cream can be applied to the skin __ times
several times a day
75
anelgesic of choice of OA
Acetaminophen
76
OA clients should be switched to NSAID when pain becomes severe on maximum dose of Acetaminophen; for clients with history of GI upset, _____ should be used.
Celebrex
77
Intra-articular injection of a polysaccharide given to OA pts
Viscosupplementation
78
Dietary supplement that makes and repairs cartilage
Glucosamine
79
Dietary supplement that contributes to joint elasticity
chondroitin
80
SAM-e, s-adenosylmethionine contributes to the production of proteoglycans for
cartilage repair
81
SAM-e, s-adenosylmethionine are useful in __ OA only
early
82
arthroplasty
articular surface of a musculoskeletal joint is replaced, remodeled, or realigned
83
Arthroscopy
looking at the joint with a camera
84
Osteotomy
bone is cut to change it's length or alignment
85
RA: Systemic manifestations: ___ and ___ nodules
subcutaneous nodules and pulmonary nodules
86
RA: Systemic manifestations: something to do with blood vessels
vasculitis
87
RA: Systemic manifestations: something to do with scarring
interstitial fibrosis
88
RA: Systemic manifestations: something to do with the heart
pericarditis
89
One of the not obvious manifestations of RA
Anorexia
90
RA has especially bad swelling and stiffness in the
morning
91
Most commonly effected joints in RA
fingers, hands, wrists, knees and feet
92
RA can involve ___ deformity and ___ deformity
Swan-neck deformity
Boutonniere deformity
93
RA frequently affects the knees and feet, ___ cysts and ___ cysts , may develop behind the knee joint
Popliteal cysts and Baker’s cysts
94
2 RA syndromes
Sjőgren’s syndrome
| Feltys syndrome
95
gritty eyes
Sjőgren’s syndrome (in RA)
96
Combination of RA, splenomegaly, leukopenia, leg ulcers, lymphadenopathy, thrombocytopenia
Feltys syndrome
97
Anti-nuclear Antibody Testing (ANA) tests for
RA
98
Anti-nuclear Antibody Testing (ANA) positive result is
1:10 to 1:30
99
positive Rheumatoid Factor test
1:20
100
accurate detection of RA
Cyclic Citrullinated Peptide antibodies
101
C-Reactive Protein: ___ with active RA
elevated
102
X-rays of affected RA joints: Early disease
soft tissue swelling and effusions
103
X-rays of affected RA joints: Late disease
joint space narrowing and erosions
104
RA drug that modifies immune and inflammatory responses: may decrease disease activity
DMARDs
105
```
These are examples of
gold salts
antimalarial agents
Sulfasalazine
D-penicillamine
```
DMARDs
106
DMARDs are not able to
slow bone erosion or facilitate healing
107
RA Tx: Low-dose oral corticosteroids are used to
reduce pain and inflammation
108
The long-term effects of corticosteroid is associated with (just say them out loud)
```
poor wound healing,
increased risk of infection,
osteoporosis,
gastrointestinal bleeding,
hyperglycemia
Cushingoid appearance
```
109
drug for aggressive RA
Methotrexate (just call it Metho)
110
Methotrexate is usually given with
NSAIDs
111
Methotrexate SE's can be controlled by giving with
folic acid
112
w oncology pt the ___ acid is given as a rescue, NEVER concurrently
folic
113
RA: i____ exercises to improve muscle strength
Isometric
114
RA: Synovectomy—removal of synovia to maintain
joint function
115
RA: Arthrodesis — fusion of a joint for clients with bone loss; aids in
regaining some mobility
116
More than 90% of people w sle are
women
117
3 Drugs that can cause a syndrome that mimics lupus: (h.i.p.)
Hydralazine and INH and Procainamide
118
2 leading causes of death in SLE
Pneumonia and sepsis
119
One of the SLE neuro effects is
psychosis
120
which disease: blood counts: anemia, thrombocytopenia, neutropenia
SLE
121
SLE: serum protein electrophoresis test shows: increased ___ and decreased _____
increased gammaglobulin and decreased albumin
122
SLE tests of kidney involvement show: increases in serum ___ and ___
BUN and creatinine
123
SLE testing show increased muscle enzymes (such as ___) if muscle involvement is present.
CK
124
which disease has Urine with mild proteinuria, hematuria, and blood cell casts during exacerbations
SLE
125
Anti-nuclear antibody test (ANA) is to determine if
autoantibodies to cell nuclei are present in the blood
126
Anti-Sm antibody test to determine if there are antibodies to Sm, which is a ____ found in the cell nucleus
ribonucleoprotein
127
If the total blood complement level is low, or the C3 or C4 complement values are low and the person also has a positive ___, then
ANA
the dx is prob lupus
128
Low C3 and C4 complement levels in individuals with a positive ANA may signify the presence of active disease, especially ___ disease.
kidney
129
Disease activity correlates with a rise in: C__
CRP (C reactive protein)
130
Disease activity correlates with a rise in: E__
ESR
131
Disease activity correlates with a rise in: Anti-__
Anti-DNA
132
Disease activity correlates with a rise in: Liver and kidney function tests like ___ and ___
BUN and creatinine
133
Disease activity correlates with a rise in: CPK which is a
(muscle enzyme)
134
Disease activity correlates with a rise in: Urine ___ or __ casts
Urine protein or cellular casts
135
Disease activity also correlates with a fall in: C__
CBC
136
Disease activity also correlates with a fall in: _____ components
Complement components
137
Disease activity also correlates with a fall in: Serum ___
albumin
138
psychosocial goals for SLE
Reducing stress
Maintaining emotional well-being
139
Pharmacological treatment of SLE: 2 drugs for inflammation
NSAID
| Corticosteroids (prednisone)
140
Pharmacological treatment of SLE: prednisone per day initially for
severe exacerbation
141
Pharmacological treatment of SLE: Some clients require long-term steroids to manage symptoms and prevent major
organ damage
142
Pharmacological treatment of SLE: Anti-malarial example
Plaquenil
143
Pharmacological treatment of SLE: Plaquenil adverse rxns (2)
Renal toxicity and retinal damage
144
Pharmacological treatment of SLE: for lupus arthritis, skin rashes, mouth rashes, give the pt
Plaquenil
145
Pharmacological treatment of SLE: Other possible benefits of anti-malarials include
reducing the risk of blood clots
| lowering cholesterol levels.
146
Anti-malarials are generally not recommended for
pregnancy
147
shortly after starting treatment, there may be a temporary mild blurring of vision, which resolves on its own
Plaquenil
148
All cytotoxic immunosupressive drugs are thought to increase a person's risk for developing
cancer
149
These drugs are used for SLE; what class are they
azathioprine (Imuran)
cyclophosphamide (Cytoxan)
methotrexate
cyclosporine
Cytotoxic, or immunosuppressive
150
azathioprine SE
Allergic-type hepatitis, pancreatitis
151
cyclophosphamide SE
Alopecia, bladder complications (hematuria), sterility
152
methotrexate SE
Hepatic complications, lung toxicity, bone marrow depression
153
cyclosporine SE
hypertension and may lead to kidney damage.
154
Nursing care r/t medication regimen: Notify the HCP if platelets
75,000
155
Pulmonary ___ is a potential adverse effect of cyclophosphamide
fibrosis
156
End-stage lupus nephropathy are managed with dialysis or kidney ___
transplantation
157
There is an increased incidence of ___ among SLE clients on dialysis.
infections
158
SLE Clients are at risk for psychosis related to
inflammation of the central nervous system, and steroid use
159
SLE Clients may also have seizures, generally preceded by throbbing
headache
160
A shift to the __ (increased numbers of immature leukocytes) may be an early indication of infection
left
161
every six months, SLE pts should have
eye exams
162
Pregnancy and SLE
not contraindicated
