Medsurg/OB final Flashcards
With continuous bladder irrigation, if the output is dark red, what do you do to the infusion?
Dark red = increase the rate
With continuous bladder irrigation, what should the output look like?
Light pink, few clots
How much drainage should be in the drainage bag for continuous bladder irrigation?
Drainage bag should be slightly more or equal to amount of solution infused
What are some risks with continuous bladder irrigation?
Infection – wash hands, empty bag when 1/2 full, keep ports sterile
Clot formation
Hemorrhage
Catheter obstruction– manually irrigate tubing
What is some teaching for a patient with continuous bladder irrigation?
Only take showers, no baths
Clean catheter site at least once a day with mild soap/water (pull downwards when cleaning)
No ointments or creams on catheter site
Drink at least 2L of water a day
Avoid alcohol + caffeine
When is continuous bladder irrigation used?
After TURP (transurethral resection of the prostate).
What age does benign prostate hyperplasia (BPH) affect?
Ages 40 and older
What are signs/symptoms of BPH?
Increased urinary frequency
Urine dribbling
UTI’s
Increased urinary urgency
What are risk factors of BPH?
Smoking
ETOH use
Obesity
Heart disease
Diabetes
With BPH, what would the results be from a DRE and PSA level draw?
DRE= large, rubbery, non-tender prostate gland
PSA level= above 4.0
What are medications used to treat BPH?
Tamsulosin = relax prostate
Finasteride = prevent conversion of Testosterone to DHT
What age does prostate cancer affect most men?
50 and above
What are some risk factors for prostate cancer?
African American heritage
Increased age
High fat/red meat diet
Family history of prostate cancer
What are some signs/symptoms of prostate cancer?
Increased difficulty and frequency of urination
Urinary retention
Hematuria
Painful ejaculation
Sexual dysfx
For prostate cancer, what would a DRE and a PSA look like?
DRE= stoney-hard/fixed lesion
PPSA level = > 4.0
What is TURP used to resolve?
Prostate Cancer and BPH
What are two treatment options for prostate cancer?
Prostatectomy and Androgen Deprivation Therapy (can cause hypogonadism/gynecomastia)
Orchiectomy = surgical removal of 1 or both testes
What are some nursing interventions for a patient with prostate cancer?
Administer opioid + non opioid analgesics for bone pain
Advise of erectile dysfx possibility following surgery
CAUTI education
Infection prevention
What is TURP syndrome?
Hypervolemia/Hyponatremia
- D/C irrigation
-Admin diuretics
-Change irrigation to 0.9% NS
-Monitor I/O
-Assess heart and lung sounds
What age does testicular cancer primarily affect?
Men aged 18-35
What are risk factors for testicular cancer?
Cryptorchidism
Caucasian American
HIV +
Exposure to environ. chemicals
How do you prevent testicular cancer?
TSE = Testicular Self Examination
When is the best time to perform a TSE & how often should they be done?
After warm bath/shower
Every month
What are signs/symptoms of testicular cancer?
Painless enlargement of testis
Heaviness in scrotum/groin/abdomen
What labs would be look for in testicular cancer?
AFP ( increased )
Beta HCG (increased )
Chest X ray (lung metastases)
Ultrasound/CT/MRI
What are a few treatment options for patients with Testicular cancer?
Orchiectomy (removal of testis)
Radiation
Chemotherapy
What are some things the nurse will want to review with a patient who is diagnosed with testicular cancer?
Banking sperm due to infertility
Address issues related to body changes/sexuality
Stop smoking, no ETOH, healthy diet
Birth Control use for 18-24 months following chemotherapy
Continue TSE monthly
What are some risk factors of urolithiasis?
Male gender
BPH
Dehydration
Urinary retention
A patient reports lower back/flank pain that comes in waves. They have a fever, hematuria, and very sweaty. Based on these signs/symptoms, what is a likely diagnosis?
Renal calculi
What are some considerations for a patient with urolithiasis?
Increase fluids ( 3L a day)
Increase ambulation
Strain urine
Tamsulosin (Flomax)
What should a patient with urolithiasis avoid?
Bed rest or massages
What bacteria is a common cause of glomerulonephritis?
Strep!
What would the urine and body look like in a patient with glomerulonephritis?
Frothy and cola-colored urine (due to proteinuria and hematuria)
Eyelid and angioedema (due to decreased albumin)
Headache/HTN
What is the difference between nephrotic syndrome and nephritic syndrome?
Nephrotic is without hematuria (no blood in urine) only protein (frothy/bubbly urine)
In glomerulonephritis, with the increased swelling/edema, what is one thing we must do for the abdomen?
Measure abdominal girth
With glomerulonephritis, what would labs look like? What labs would be drawn?
BUN & Creatinine (increased)
GFR (low)
Albumin (increased)
Antistrepolysin Titer ( + )
What is the treatment for glomerulonephritis?
Antibiotics
Corticosteroids
Diuretics + Antihypertensives
Albumin replacement
*Monitor K+ levels
What is a common cause and common concern for a patient with pyelonephritis?
Cause: Unresolved UTI’s
Concern: AKI
A patient comes in with a fever, flank pain/tenderness, N/V and is tachypnic. What is the likely diagnosis?
Pyelonephritis
What does pyelonephritis and glomerulonephritis have in common?
Both would show an increase in WBC
What can an AKI be caused by?
Pre-renal
Intra-renal
Post-renal injuries
What is the normal urinary output expected in adult patients?
30 mL/ hr
1-2 L a day
What are some signs/symptoms of AKI?
Oliguria ( < 400 mL/day)
Numbness/Tingling
Kussmaul respirations (metabolic acidosis)
Itching
FVE
How do we differentiate AKI from dehydration?
Fluid challenge test
What are some causes of CKD?
Chronic glomerulonephritis/pyelonephritis
DM
Hypertension
Nephrotoxic drugs
What are some signs/symptoms of a patient with CKD?
Headache
Anemia (due to RBC filtering out of kidney)
Proteinuria/Hematuria
Increased BP + K+
Increased weight/Edema
SOB
What are some treatment options for a patient with CKD?
Hemodialysis
Peritoneal dialysis
Vitamin C & D
Erythropoietin
Oxygen
BP meds (Ace inhib “-pril” or ARBS “-sartan”)
What type of diet should a patient with CKD be on?
Low protein, low Na+
What are the 4 phases of AKI?
- Oliguric ( <400 mL/day)
- Diuresis (> 400 mL/day) (1-3 weeks)
- Recovery (GFR returns to normal) ( 1yr + )
- Chronic Kidney Disease
What is the pathophysiology fir Amyotrophic Lateral Sclerosis?
Loss of motor neurons in spinal cord and brainstem causing
–Increased ( + ) Glutamate causing hyperexcitability
–Progressive muscle weakness
What body system is not affected in a patient with ALS?
Bladder and rectum/GI
What do Riluzole and Edavarone do and what disease are they for?
ALS
Edavarone- slows fx decline
Riluzole- slows deterioration of neurons
How is ALS diagnosed?
Electromyography
Muscle biopsy (decrease in fx motor units)
MRI- high signal intensity in corticospinal tracts
What neurotransmitter is decreased in Myasthenia Gravis?
Acetylcholine (causing muscle weakness)
When should medications for a patient with myasthenia graves be administered?
30-60 minutes before meals.
Explain the tensilon test. Purpose, procedure, outcomes
Purpose- Dx myasthenic crisis or cholinergic crisis
Procedure- Endrophonium administered
Outcomes- symptoms improve, pt is in myasthenic crisis. If not, pt in cholinergic crisis
(prepare as code, heart monitor necessary, Atropine at bedside)
What is administered to a patient in a confirmed cholinergic crisis?
Atropine! Prepare procedure as code. Heart monitor is necessary
What is the surgical treatment and medical treatment for a patient with myasthenia gravis?
Thymectomy (Acetylcholine antibodies released there)
Pyridostigmine + Neostigmine
Corticosteroids
Immunosuppresants
What neurotransmitters are affected in Parkinson’s disease?
Decrease in Dopamine
Increase of Acetylcholine
How is Parkinson’s disease diagnosed?
Over time with signs/symptoms. At least 3 must be noted
What is carvidopa + levodopa (sinemet) used for? Why is Entacapone included?
Parkinsons Disease
Levodopa crosses BBB
Entacapone allows Sinemet to last longer
What are some symptoms of parkinsons disease?
Cogwheel rigidity
Shuffling gait
Pill rolling
Expressionless face
Dystonia
Tremors at rest
What is the pathyphysiology for multiple sclerosis?
Autoimmune disease that affects the myelin sheath of the CNS. Inflammation and scarring of nerve creates lower nerve transmissions
What makes the symptoms of a patient with multiple sclerosis worse?
Heat/Infection/Stress/Overexertion
Name a few signs/symptoms of a patient with multiple sclerosis.
+ Rombergs sign
Lehrmittes sign (pain when moving neck)
Cognitive changes
Dizzy/diploplia
Dysarthria
What diagnostic procedure is performed in a patient with multiple sclerosis and what is the expected result of that procedure?
Cerebrospinal Fluid test (CSF)- Increase in IgG levels and protein
What are some treatment options for a patient with multiple sclerosis?
Interferon Beta 1a or 1b
(Avonex or Betaseron)
Corticosteroids
Glatiramer (Copaxone) (Immunomodulator-admin SQ)
What is a normal Hemoglobin and Hematocrit?
Hemoglobin
M- 14-18
F- 12-16
Hematocrit
M- 42-52%
F-37-47%
What is a normal WBC and platelet count?
WBC: 5-10,000/mm3
Platelet: 150,000-400,000/mm3
What does a low WBC and platelet count indicate?
WBC- immunosuppression
Platelet-Thrombocytopenia
What are manifestations of a patient with Iron deficiency anemia?
SOB
PICA
Pallor
Smooth/red tongue
Angular cheliosis
What are treatments and education for a patient with iron deficiency anemia?
Increase iron intake in diet/supplements, or IV ferrous sulfate
Iron causes GI upset
Take iron with Vitamin D to promote absorption
Use straw with oral iron due to staining teeth
What are some foods high in iron?
Beans, leafy veggies, lentils
What are nursing priorities for a patient with sickle cell anemia?
Pain management
Oxygen
Infection prevention
Fluids to maximize hydration + tissue perfusion
Who is at risk of sickle cell anemia?
African American males
Middle eastern/mediterranean
Tribal populations in India
Why is sickle cell anemia so serious?
Sickle shaped cells can pool in organs, occlude vessels, cause necrosis, and be very painful!
What is the cure for a patient with pernicious anemia?
Cycanobalan (IM B12 injection) b/c they lack intrinsic factor to absorb B12 via oral route
Could be caused by GI surgeries/issues, metformin/antacid/histamine uses
What are signs/symptoms of pernicious anemia?
Jaundice
Fatigue
ALOC
Vitiligo
Smooth/sore red tongue
What are risk factors for vitamin B12 deficiency?
Vegan diet, Pancreas & ileum diseases, impaired absorption in GI tract
What is the treatment for vitamin b12 deficiency?
Oral vitamin B12
Oral supplements with vitamins
Fortified soy milk
What is “Charcots Triad” and what disease process is this related to?
-Jaundice
-Fever
-RUQ pain
Choleangitis
What is the difference between cholelithiasis and choledocolithiasis?
Cholelithiasis- Stones in gall bladder
Choledocolithiasis- Stone in bile duct
What is one complication of choledocolithiasis?
Pancreatitis due to common bile duct obstruction
Choleangitis (inflammation)
What are signs/symptoms of cholelithiasis?
Jaundice/grey stools
RUQ pain, abdomen distension
Dark urine
Pain after fried/fatty meals
What are treatment options for Cholelithiasis and Choledocolithiasis?
ERCP/Lithotripsy to break up gallstones
IVF to flush out stones
Cholecystectomy
What would labs show in a patient with cholelithiasis or choledocolithiasis?
Bilirubin- Increased
WBC- Increased
PTT- Increased
H&H- Decreased
Vit. K- Decreased
What are nursing considerations for a patient with cholelithiasis or choledocolithiasis?
Rest
Analgesics
Low fat diet/low cholesterol
Semi fowlers position
Antibiotics
What is the difference between Cholecystistis and Choleangitis?
Cholecystitis- Inflammation of gallbladder
Choleangitis- Inflammation at site of obstruction (common bile duct)
What are signs/symptoms of cholecystitis and choleangitis?
Severe RUQ pain/epigastric pain referred to R shoulder/flank, clay colored stool, dark urine, diaphoresis, jaundice
What is the function of the liver?
A- Albumin
B- Bile
C-Clotting factors
What are signs/symptoms of cirrhosis?
Jaundice
Skin lesions
Ascites (r/t decreased albumin)
Fatigue
Hepatic encephalopathy
Edema
+ Chvostek sign
+ Trousseau sign
What would lab testing for a patient with cirrhosis look like?
Bilirubin- Increased
Ammonia- Increased
PTT- Increased
Albumin- Decreased
Blood Glucose- Decreased
What are signs/symptoms of pancreatitis?
Severe LUQ pain radiating to left shoulder/back
Cullens sign (around umbilicus)
Turners sign (on side)
Tetany (r/t decrease ca)
Jaundice
What diet should a patient with pancreatitis be on?
NPO — gradually increase to a bland or low fat diet
What would labs look like in a patient with pancreatitis?
Amylase- Increased
Lipase- Increased
WBC- Increased
Bilirubin- Increased
Glucose- Increased (insulin being released in bloodstream)
Platelets- Decreased
What medications would a patient with pancreatitis be recommended?
Digestive enzymes (pancrelipase, saliva substitute [Salivart])
Opioid Analgesics
IV fluids
Insulin
Antiemetics
What size gauge needs to be used for a blood transfusion?
22 gauge or larger ( 18G, 16G, etc)
How long should you remain with a patient when administering a blood transfusion?
First 15 minutes
Start transfusion slow (5mL/min)
How long do you have to initiate the blood transfusion after collecting the blood from the blood bank?
30 minutes
How long do you have to transfuse your blood completely?
4 hours after being hung
(change tubing after every 2 units)
What are signs of a transfusion reaction?
Fever, chills, respiratory distress, low back pain, nausea, pain at IV site, “feeling unusual”
What do you do in the event of a blood transfusion reaction?
- Stop transfusion
- Asses patients vitals
- Notify PCP
- Notify blood bank
- Send blood container and tubing to blood bank for repeat typing & culture
Why do you need a 2nd RN around for a blood transfusion?
They need to verify the labels, cross type and match, patient identification
What are signs/symptoms of metabolic acidosis?
Headache, confusion, increased respiration and depth, cold/clammy skin, cardiac arrhythmias
What is the treatment for metabolic acidosis?
Administration of Bicard
Hemodialysis
Peritoneal Dialysis
How does the respiratory system compensate for metabolic acidosis?
Hyperventilation (release CO2)
Charcoal
Insulin
Diuretics
What are signs/symptoms of metabolic alkalosis?
Tingling of the fingers/toes, Dizziness, tetany
What are causes of metabolic alkalosis?
Severe vomiting/gastric suctioning, diuretic therapy, bushings disease, intake of milk/calcium carbonate, K+ depletion
What are causes of metabolic acidosis?
Diarrhea, renal insufficiency/failure, lactic acidosis, aspirin poisoning, starvation, DKA
What are treatment options for metabolic alkalosis?
Fluids
PPI
Anti-emetic
Carbonic Anyhydrase Inhibitor
How does the respiratory system compensate for metabolic alkalosis?
Hypoventilation (decrease RR)
What are causes of respiratory acidosis?
Inadequate ventilation, pulmonary edema, pneumothorax, sleep apnea, acute respiratory distress, COPD, ALS, MS, MG
What are signs/symptoms of respiratory acidosis?
Increase pulse
Decrease BP
Decrease RR
ALOC
Increased ICP (headaches)
Cyanosis
Tachypnea
What are treatment options for respiratory acidosis?
Bronchodilators
Antibiotics for infection
Nebulizer/supplemental O2
Possible Narcan/thrombolytics/anticoags
Hydration (to loosen mucus)
What are nursing interventions for a patient with respiratory acidosis?
Pursed lip breathing
Encourage coughing
Encourage deep breathing
What are signs/symptoms of a patient with respiratory alkalosis?
Hyperventilation
-Lightheadedness
-ALOC
-Numbness/tingling
-Tinnitus
-Tachycardia
-Arrhythmia
Panic disorders, hypoxemia, aspirin intoxication, sepsis, inappropriate ventilator settings and hypokalemia are all causes of what?
Respiratory Alkalosis
How do we treat respiratory alkalosis?
Breathing techniques (paper bag breathing, box breathing, 4-7-8 method)
Antianxiety agents
K+
What is the difference in diagnostics of DI and SIADH?
DI- Low H20, Low ADH
SIAHD- High H20, High ADH
Compare the labs of someone with DI vs SIADH.
DI
ADH- low
Serum Osmo- high (>300)
Urinary output- low
Na+ - High
USG- Low
SIADH
ADH- high
USG- high
Serum osmo- low (<280)
Urine output- low
What is a diagnostic test used for diabetes insipus?
Water restriction test-
Patient will still be urinating hourly after water restriction
*Hourly assessments
**If pt becomes hypotensive & tachycardia, STOP test
What medications are used for diabetes insipidus?
Diabinese/Chlorpropramide
(watch for hypoglycemia)
Desmopressin/DDVP [Vasopressin]
(watch for hyponatremia/water intoxication) **Quick increase of BP, vasopressin shunts blood to organs
What are treatment options for SIADH?
Loop diuretics
Hypertonic IV solutions
Declomycin/Conivaptan/Tolvaptan (ADH inhibitor)
What are signs/symptoms of SIADH vs DI?
SIADH:
Hyponatremia (seizure/muscle cramping)
Decreased urine output (dark urine)
FVE (lung crackles)
Tachycardia
Thirsty
DI:
Polyuria (5-20L a day) (250mL/hr)
Polydipsia (VERY thirsty)
Decreased BP, Increased HR
Dehydration(dry mucous membranes, poor skin turgor)
Where is ADH released from?
Posterior pituitary (base of brain)
Where are glucocorticoids released from? (Cushings/Addisons)
Anterior Pituitary (base of brain)
What are the requirements to be diagnosed with diabetes?
Fasting plasma glucose:
> 126 mg/dL
Oral glucose test:
> 200 mg/dL
Hemoglobin A1C
> 6.5%
Casual Plasma Glucose
> 200 mg/dL
What is the pathophysiology for diabetes? T1 and T2?
T1- Destruction of pancreatic beta cells.
( - ) Insulin production & ( + ) glucose production by liver
T2- Insulin resistance
Impaired insulin secretion
Decreased sensitivity
What are treatments for DKA and HHS?
0.9% or 0.45% NS
Insulin with dextrose
(only regular insulin administered via IV)
What is the dawn phenomenon?
Morning hyperglycemia
What is the somogyi phenomenon?
Early morning hypoglycemia (2-3am)
What are some items to advise the patient regarding recent diagnosis of diabetes?
Alcohol & Exercise will decrease BG
Foot & eye care
Higher risk of infection
Surgery/stress/illness/infection will increase BG
In a patient with Type 2 DM, when should they take their oral antihyperglycemics?
Up to 30 minutes before meals
Name the rapid acting insulins & when food should be given
Lispro (Humalog)
Aspart (Novolog)
Glulisine (Apidra)
**Eat within 5-15minutes after admin
Name the short acting and intermediate acting insulin and when food should be given.
Short acting- Regular
(eat within 15 minutes)
Intermediate acting- NPH
(eat around onset-peak; 1-4 hrs)
What are the long acting insulins?
Glargine (Lantus)
Deter (Levemir)
Onset: 3-6 hrs, no peak
Compare the signs/symptoms of hypoglycemia and hyperglycemia/
Hypo:
Nervousness/confusion
Sweating/drowsiness
Slurred speech
Tachycardia
Hunger
“Cold & Clammy, needs some candy!”
Hyper:
Dry mouth
Blurred vision
Thirst/dry mouth
Deep, rapid breaths
Frequent urination
“Hot & dry, sugars high!”
What is the purpose of an amniocentesis?
Detect chromosomal abnormalities and hereditary metabolic defects. (confirm fetal abnormalities)
Requires an amniotic sac puncture & fluid analysis (fern test, blue nitrizine strip)
What medications would you administer for a post partum hemorrhage?
Oxytocin (Pitocin)
Misoprostol (Cytoctec) no cardiac issues
Dinoprostone (Prostin E2) no cardiac issues
Methergine not for pt with HTN
Prostaglandin (Cervidil)
Hemabate not for pt with asthma
Name the nursing interventions for a post partum hemorrhage
- IV fluids
- Fundal massage
- Admin uterotonic medications
- Weigh pads
- Bimanual compression/Internal uterine packing/balloon tamponade
(vitals Q 15-30 min)
Name the risk factors for post partum hemorrhage.
Uterine atony
Lacerations
Retained placenta fragments
Inversion of the uterus
Placenta Accreta
Hematomas
Coagulation disorders
LGA newborns
Induction of labor w/ oxytocin
Surgical births
Prolonged labor
How might a patient experiencing post partum hemorrhage appear?
Low BP, high HR
Quickly saturating pads
Boggy/spongy fundus
Complete the VEAL - CHOP acronym along with interventions for each letter.
Check with page in binder
Name some red flags of a sex trafficking victim.
Older boyfriend
New/expensive items
Separation from friends/family
Inconsistent injuries/explanations
Avoiding eye contact
Not wanting to provide personal info
Sudden academic decline
*Immigrant women/children with low education
Name some red flags for a pimp.
Easily jealous
Controlling/violent
Demanding about sex
Always knows how to make lots of money
Provide baseline baby vitals.
O2: 92% or above
Temp: 36.5-37.5
HR: 110-160
RR: 30-60
BG: 40
What is an amniotomy used for?
Deliberately rupturing membranes
How is an amniotomy performed?
Inserting a cervical hook (Amniohook) through the cervical os to deliberately rupture the membranes
What are risks associated with amniotomy?
Umbilical cord prolapse/compression
Maternal/Neonatal infection
FHR deceleration
Bleeding
Client discomfort
What color should amniotic fluid be? What does cloudy or green fluid mean?
Amniotic fluid should be clear
Green=Fetus has passed meconium secondary to transient hypoxia, prolonged pregnancy, cord compression, (IUGR), maternal HTN, diabetes, or chorioamnionitis
Cloudy/foul smelling= infection
What is important to check following an amniotomy?
FHR
Amniotic fluid characteristics
What are risk factors for amniocentesis?
Lower abdominal cramping (up to 48 hrs after procedure) (fetal loss)
Spontaneous abortion
Maternal/ fetal infection (fever)
Postamniocentesis chorioamnionitis
Fetal–maternal hemorrhage
Leakage of amniotic fluid
What is done following an amniocentesis procedure?
Pressure applied to site. No bleeding=sterile bandage
Possible RhoGAM admin
Assess maternal/fetal vital signs & FHR every 15 min-1hr post procedure
Observe the puncture site for bleeding/ drainage
What are signs/symptoms of preeclampsia?
HTN (160/110)
Proteinuria
Headache
N/V
Blurred vision
Hyperreflexia
How is preeclampsia managed?
No severe features:
Monitor BP + kick counts
Lay in lateral recumbent position
Diet w/o Na+ restriction + 6-8 oz glasses of water
Daily low dose aspirin
Severe features:
Aspirin therapy
Betamethasone (34 weeks or less)
Mg. Sulfate + Oxytocin
Antihypertensives
possible early delivery
What are the signs of Mg. Sulfate toxicity? What is the antidote?
Signs/Symptoms:
Diminished/absent reflexes (hyporeflexia)
Decreased RR
Oliguria
Serum Mg: >8 mg/dL
Antidote: Calcium gluconate
How is Magnesium Sulfate given?
IV in fusion pump.
Loading dose: 4-6g over 15-30 min.
Infusion: 1-2g/hr as continuous infusion
What is endometriosis? Signs and symptoms?
Endometrosis is a chronic inflammatory process where tissue implants outside of the uterus. (Increased risk of ectopic pregnancy)
Signs/Symptoms:
Infertility/Pelvic pain Painful menstruation/urination/intercourse
Painful bowel movements
Heavy menses
Irregular/frequent menses
Depression/Fatigue
Vaginal spotting/back pain
How is endometriosis diagnosed?
Pelvic exam-non specific pelvic tenderness
Laparoscopy- tissue biopsy
Pelvic/transvaginal ultrasound- rule out cysts/fibroids
What are nursing interventions for endometriosis?
Healthy lifestyle habits (diet, exercise, sleep, stress)
Support groups
Surgeries
Medications
(NSAIDS
Oral Contraceptives
Progestogens (Medroxyprogesterone)
Antiestrogens (Tamoxifen)
What is the temperature to watch for following a delivery?
> 100.4
