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aa Orgo > Medsurg 3 part 5 > Flashcards

Medsurg 3 part 5 Flashcards

1
Q

Dehydration: HR

A

increases

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2
Q

Dehydration: pulses

A

weak

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3
Q

Dehydration: BP

A

decrease

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4
Q

Dehydration: RR

A

increase

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5
Q

Assess older adult turgor at the __ or __

A

sternum or forehead

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6
Q

BUN range

A

5 to 25

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7
Q

2 biggest risks for fall in dehydrated pt

A

ortho hypo

AMS

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8
Q

Major role of the nurse in periop is

A

communicating

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9
Q

periop: assess the allergy to

A

pineapple/avocado (means latex allergy)

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10
Q

a major concern of post op is

A

hypothermia

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11
Q

malignant hyperthermia is a reaction to

A

anesthesia

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12
Q

To prevent malignant hyperthermia assess for

A

family history

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13
Q

In order to avoid electrical injury the pt must be

A

grounded

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14
Q

Stop taking ___ 2 weeks before surgery

A

warfarin

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15
Q

When considering anesthesia, assess for h/o

A

substance abuse

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16
Q

If CO is less than __ you may need to cancel surgery

A

35%

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17
Q

Before surgery the pt must be NPO for at least

A

8 hours

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18
Q

___ intolerance inhibits healing

A

glucose intolerance

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19
Q

Sequential pressure devices are contraindicated in

A

DVT

Vascular problems like PAD

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20
Q

Different sized pupils after surgery could mean

A

he had a cerebral event

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21
Q

Cancer surgery could be what category

A

palliative

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22
Q

Random antiplatelets

A

Vit E

Garlic

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23
Q

Laproscopic surgery has a risk for

A

damage to nearby structures

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24
Q

Pre op: take a __ bath

A

chlorhexidine bath (but can’t use for face and genitals)

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25
Q

Pre op, what should you ask women

A

LMP

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26
Q

Lamenectomy

A

spinal surgery

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27
Q

Before lamenectomy, assess for

A

muscular strength and sensory function in LOWER body

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28
Q

Cardiac surgery, assess for

A

6 p’s

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29
Q

If you can’t find a pedal pulse,

A

use a doppler

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30
Q

Retinal detachment manifested by

A

disturbed visual field

It’s an emergency

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31
Q

hemoglobin range

A

For men, 13.5 to 17.5

For women, 12.0 to 15.5

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32
Q

autologous transfusion could cause

A

fever

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33
Q

Moderate sedation

A

pt can still respond

pt has cough and gag reflex

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34
Q

closed-angle glaucoma

A

bad pain

redness

put them in fowlers to decrease pressure

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35
Q

PACU priorities

A 
Breathing
LOC
Check operation site 
Connect to cardiac monitor 
Vitals
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36
Q

Don’t put a post op pt in the same room as

A

a vent pt

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37
Q

major risk for resp depression, should be assessed first

A 
obesity 
\+
pain
\+
opioid 
Assess first
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38
Q

Hemovac- if you drain more than __ ml its an oh shoot

A

100 ml

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39
Q

NG tube can be flushed with

A

NS

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40
Q

Concern for a post op pt who smokes

A

slower healing

dehiscence

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41
Q

What do you do for a dihiscence

A

cover with gauze soaked in saline

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42
Q

If Hg is less than __ you definitely need a transfusion

A

6

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43
Q

Types of transfusion reactions

A

febrile
hemolytic
allergic
fluid overload

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44
Q

a hemolytic transfusion reaction involves

A

antibody mismatch

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45
Q

you can’t start the transfusion if the pt has a

A

temp

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46
Q

Transfusion: each unit causes the Hg to increase by

A

1

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47
Q

After a hemolytic reaction, the Hg will be

A

decreased

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48
Q

s/s of hemolytic reaction

A

decrease BP
increase HR
Hypoxemia
Flank pain (bc of myoglobin clogging kidney)

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49
Q

What do you do if there’s a hemolytic reaction

A

stop infusion and start NS

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50
Q

If a pt is getting a transfusion but they have a weak heart,

A

give them lasix to prevent HF

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51
Q

Most common type of arthritis

A

OA

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52
Q

auditory finding of OA

A

crepitus

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53
Q

OA, if you touch the affected area you would find the patient has

A

mild tenderness

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54
Q

in OA the size of the joint is

A

enlarged

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55
Q

in OA the affected joints may “__” or “___ ___” as a result of advancing disease

A

lock or give way

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56
Q

where are Bouchard’s found?

A

proximal (b comes before h)

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57
Q

psychosocial consideration of OA

A

the pain may cause depression

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58
Q

OA lab tests

A

ESR

hsCRP (high sensitivity c reactive protein)

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59
Q

techie tests for OA

A

MRI

CT studies

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60
Q

is there a cure for OA

A

no

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61
Q

a modifiable risk factor that can decrease the impact of OA

A

weight loss

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62
Q

For OA is good to do ____ ___ exercise because leads to increased joint mobility, strengthens the joint’s supporting muscles, tendons, and ligaments

A

weight bearing

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63
Q

Cartilage growth can be stimulated by

A

exercise

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64
Q

___ is the key to successful treatment of OA

A

Education

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65
Q

OA treatment, you need to have a careful balance between

A

rest and exercise

66
Q

OA, what kind of impact exercise should they do

A

low impact (like brisk walking)

67
Q

OA, what kind of movement therapy?

A

Tai Chi

68
Q

OA, a brace can be used to

A

reduce pain

69
Q

If you need to immobilize a joint in someone with OA, the max time should be

A

1 week

70
Q

OA, Heat applications help with

A

stiffness by collagen elasticity

71
Q

OA, Cold applications are used less frequently than heat, and may be beneficial during (3 things)

A

episodes of acute inflammation,

immediately after exercise,

or for relief of spasms.

72
Q

complication of Capsaicin cream:

A

can irritate skin

73
Q

topical intervention for OA

A

Capsaicin cream

74
Q

In OA, Capsaicin cream can be applied to the skin __ times

A

several times a day

75
Q

anelgesic of choice of OA

A

Acetaminophen

76
Q

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.

A

Celebrex

77
Q

Intra-articular injection of a polysaccharide given to OA pts

A

Viscosupplementation

78
Q

Dietary supplement that makes and repairs cartilage

A

Glucosamine

79
Q

Dietary supplement that contributes to joint elasticity

A

chondroitin

80
Q

SAM-e, s-adenosylmethionine contributes to the production of proteoglycans for

A

cartilage repair

81
Q

SAM-e, s-adenosylmethionine are useful in __ OA only

A

early

82
Q

arthroplasty

A

articular surface of a musculoskeletal joint is replaced, remodeled, or realigned

83
Q

Arthroscopy

A

looking at the joint with a camera

84
Q

Osteotomy

A

bone is cut to change it’s length or alignment

85
Q

RA: Systemic manifestations: ___ and ___ nodules

A

subcutaneous nodules and pulmonary nodules

86
Q

RA: Systemic manifestations: something to do with blood vessels

A

vasculitis

87
Q

RA: Systemic manifestations: something to do with scarring

A

interstitial fibrosis

88
Q

RA: Systemic manifestations: something to do with the heart

A

pericarditis

89
Q

One of the not obvious manifestations of RA

A

Anorexia

90
Q

RA has especially bad swelling and stiffness in the

A

morning

91
Q

Most commonly effected joints in RA

A

fingers, hands, wrists, knees and feet

92
Q

RA can involve ___ deformity and ___ deformity

A

Swan-neck deformity

Boutonniere deformity

93
Q

RA frequently affects the knees and feet, ___ cysts and ___ cysts , may develop behind the knee joint

A

Popliteal cysts and Baker’s cysts

94
Q

2 RA syndromes

A

Sjőgren’s syndrome

Feltys syndrome

95
Q

gritty eyes

A

Sjőgren’s syndrome (in RA)

96
Q

Combination of RA, splenomegaly, leukopenia, leg ulcers, lymphadenopathy, thrombocytopenia

A

Feltys syndrome

97
Q

Anti-nuclear Antibody Testing (ANA) tests for

A

RA

98
Q

Anti-nuclear Antibody Testing (ANA) positive result is

A

1:10 to 1:30

99
Q

positive Rheumatoid Factor test

A

1:20

100
Q

accurate detection of RA

A

Cyclic Citrullinated Peptide antibodies

101
Q

C-Reactive Protein: ___ with active RA

A

elevated

102
Q

X-rays of affected RA joints: Early disease

A

soft tissue swelling and effusions

103
Q

X-rays of affected RA joints: Late disease

A

joint space narrowing and erosions

104
Q

RA drug that modifies immune and inflammatory responses: may decrease disease activity

A

DMARDs

105
Q 
These are examples of 
gold salts
antimalarial agents
Sulfasalazine
D-penicillamine
A

DMARDs

106
Q

DMARDs are not able to

A

slow bone erosion or facilitate healing

107
Q

RA Tx: Low-dose oral corticosteroids are used to

A

reduce pain and inflammation

108
Q

The long-term effects of corticosteroid is associated with (just say them out loud)

A 
poor wound healing, 
increased risk of infection,
 osteoporosis,
gastrointestinal bleeding, 
hyperglycemia 
Cushingoid appearance
109
Q

drug for aggressive RA

A

Methotrexate (just call it Metho)

110
Q

Methotrexate is usually given with

A

NSAIDs

111
Q

Methotrexate SE’s can be controlled by giving with

A

folic acid

112
Q

w oncology pt the ___ acid is given as a rescue, NEVER concurrently

A

folic

113
Q

RA: i____ exercises to improve muscle strength

A

Isometric

114
Q

RA: Synovectomy—removal of synovia to maintain

A

joint function

115
Q

RA: Arthrodesis — fusion of a joint for clients with bone loss; aids in

A

regaining some mobility

116
Q

More than 90% of people w sle are

A

women

117
Q

3 Drugs that can cause a syndrome that mimics lupus: (h.i.p.)

A

Hydralazine and INH and Procainamide

118
Q

2 leading causes of death in SLE

A

Pneumonia and sepsis

119
Q

One of the SLE neuro effects is

A

psychosis

120
Q

which disease: blood counts: anemia, thrombocytopenia, neutropenia

A

SLE

121
Q

SLE: serum protein electrophoresis test shows: increased ___ and decreased _____

A

increased gammaglobulin and decreased albumin

122
Q

SLE tests of kidney involvement show: increases in serum ___ and ___

A

BUN and creatinine

123
Q

SLE testing show increased muscle enzymes (such as ___) if muscle involvement is present.

A

CK

124
Q

which disease has Urine with mild proteinuria, hematuria, and blood cell casts during exacerbations

A

SLE

125
Q

Anti-nuclear antibody test (ANA) is to determine if

A

autoantibodies to cell nuclei are present in the blood

126
Q

Anti-Sm antibody test to determine if there are antibodies to Sm, which is a ____ found in the cell nucleus

A

ribonucleoprotein

127
Q

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

A

ANA

the dx is prob lupus

128
Q

Low C3 and C4 complement levels in individuals with a positive ANA may signify the presence of active disease, especially ___ disease.

A

kidney

129
Q

Disease activity correlates with a rise in: C__

A

CRP (C reactive protein)

130
Q

Disease activity correlates with a rise in: E__

A

ESR

131
Q

Disease activity correlates with a rise in: Anti-__

A

Anti-DNA

132
Q

Disease activity correlates with a rise in: Liver and kidney function tests like ___ and ___

A

BUN and creatinine

133
Q

Disease activity correlates with a rise in: CPK which is a

A

(muscle enzyme)

134
Q

Disease activity correlates with a rise in: Urine ___ or __ casts

A

Urine protein or cellular casts

135
Q

Disease activity also correlates with a fall in: C__

A

CBC

136
Q

Disease activity also correlates with a fall in: _____ components

A

Complement components

137
Q

Disease activity also correlates with a fall in: Serum ___

A

albumin

138
Q

psychosocial goals for SLE

A

Reducing stress

Maintaining emotional well-being

139
Q

Pharmacological treatment of SLE: 2 drugs for inflammation

A

NSAID

Corticosteroids (prednisone)

140
Q

Pharmacological treatment of SLE: prednisone per day initially for

A

severe exacerbation

141
Q

Pharmacological treatment of SLE: Some clients require long-term steroids to manage symptoms and prevent major

A

organ damage

142
Q

Pharmacological treatment of SLE: Anti-malarial example

A

Plaquenil

143
Q

Pharmacological treatment of SLE: Plaquenil adverse rxns (2)

A

Renal toxicity and retinal damage

144
Q

Pharmacological treatment of SLE: for lupus arthritis, skin rashes, mouth rashes, give the pt

A

Plaquenil

145
Q

Pharmacological treatment of SLE: Other possible benefits of anti-malarials include

A

reducing the risk of blood clots

lowering cholesterol levels.

146
Q

Anti-malarials are generally not recommended for

A

pregnancy

147
Q

shortly after starting treatment, there may be a temporary mild blurring of vision, which resolves on its own

A

Plaquenil

148
Q

All cytotoxic immunosupressive drugs are thought to increase a person’s risk for developing

A

cancer

149
Q

These drugs are used for SLE; what class are they

azathioprine (Imuran)

cyclophosphamide (Cytoxan)

methotrexate

cyclosporine

A

Cytotoxic, or immunosuppressive

150
Q

azathioprine SE

A

Allergic-type hepatitis, pancreatitis

151
Q

cyclophosphamide SE

A

Alopecia, bladder complications (hematuria), sterility

152
Q

methotrexate SE

A

Hepatic complications, lung toxicity, bone marrow depression

153
Q

cyclosporine SE

A

hypertension and may lead to kidney damage.

154
Q

Nursing care r/t medication regimen: Notify the HCP if platelets

A

75,000

155
Q

Pulmonary ___ is a potential adverse effect of cyclophosphamide

A

fibrosis

156
Q

End-stage lupus nephropathy are managed with dialysis or kidney ___

A

transplantation

157
Q

There is an increased incidence of ___ among SLE clients on dialysis.

A

infections

158
Q

SLE Clients are at risk for psychosis related to

A

inflammation of the central nervous system, and steroid use

159
Q

SLE Clients may also have seizures, generally preceded by throbbing

A

headache

160
Q

A shift to the __ (increased numbers of immature leukocytes) may be an early indication of infection

A

left

161
Q

every six months, SLE pts should have

A

eye exams

162
Q

Pregnancy and SLE

A

not contraindicated

aa Orgo (196 decks)

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