New Information Flashcards
1
Q
Txt of PE
A
Bed rest with affected leg elevated, decrease pain and administer anticoag
vit k
warfarin
thrombin (enoxaparin)
limit leafy green maintain
target INR
bleeding precautions
fibrinolytics like tPA, pulmonary embolectomy may be performed
Inferior vena cava filtration
(Avoid crossing legs, leg pain numbness indicate neurovas impaired) to prevent clots from getting into pulmonary system.
2
Q
Treatment meds for CHF
A
Ace inhibitors *DOC - RILS
Supress Angiotensin 1 from 2 > Arterial dilation and increase stroke volume.
S/E - Nagging cough
Arbs - Sartans
Block 2 , decrease arterial resistance and BP
Beta
First line therapy to ace
relax , decrease bp, afterload, workload.
Both ace and arbs block aldosterone - we lose sodium and water and retain potassium! *both ARBS AND ACE contraindicated in Pregnancy
Digoxin (0.5-2)
for sinus rythm
in combo with Ace, arbs, beta, diuretics
contraction stronger, hr slower, co up, kidney perfusion up.
Dig tox - early n/v anorexia - late arrythmia vision changes electrolyte problems hypokal and dig
- Dig is held if pulse is <90-100 for infants and for children <70
- If dose is missed do not give an extra dose or increase dose
- give water or brush teeth after administration
3
Q
Filgrastim Med (Onco)
A
Used prophylactically or when theres an infection
4
Q
meds for ulcerative
A
abx steriods biologics and immunomodulators (mab) aminosalicylates (zide and zine) - ZINE - Drink 8 glasses of water - Photosensitivity - folic acid - take supplement - life threatening - agranulocytosis report fever or sore throat - Stevens johnson - client should stop if rash appears
5
Q
Basal Long acting
A
NPH - immediate acting - 2X a day 18hrs
peak 4-12 hrs
GARGLINE - Once daily 24hrs
no peak
6
Q
Postprandial short acting
A
Regular - peak 2-4 hrs best used iv dka - Sliding scale Lispro/aspart/ Glulisine Peaks - 30 mins - 3 hrs - 45-75 mins best for postmeal hypergllycemia
7
Q
Adrenergic blocker S/e (Gastro)
A
Ending in SIN
Relaxes smooth muscle
- causes orthostatic hypotension, esp first dose
- at bedtime, change position slowly and avoid medications that also increase muscle relaxation
- ejaculatory dysfunction
8
Q
Arrythmias
A
Vtach
- can be pulseless or have a pulse to treat, it is based on pulse so assess pulse. Assess signs of hypotension , altered LOC, signs of shock etc.
Vfib
Asystole
9
Q
ADHD
A
They have trouble paying attention, experience difficulty organizing tasks
Nursing intervention;
- calm, structured organized environment
- Written chart of list of daily activities
- limit guests to avoid over distraction
10
Q
Newborn CPR
A
- neck slightly extended , place blanket or towel roll under newborn shoulder elevate chest 3/4 1 inch
11
Q
Juvenile Idiopathic Arthritis
A
- Risk for deconditioned
- tire quickly
- low impact , weight bearing, nwb exercises - rom exercises and stretching.
12
Q
FTT
A
- <80% OF IDEAL WEIGHT
- Domestic violence
- Caregiver -ve attitude towards food
- Poverty or food security
- Disordered Feeding (unstructured meal time)
13
Q
Reye Syndrome
A
- recent viral infection - varcilla influenza
- lethary, encep, altered hepatic fx. elevated ammonia
- Development of this syndrom is increased with the use of aspirin
14
Q
Ectopic Pregnancy
A
S/s
- Lower abd pain, pelvic pain
- spotting, mass on pelvic exam
- Rupture causing maternal hemorrhage
- HR elevated
- dizziness, referred shoulder pain
Txt: Surgery
15
Q
St. John’s Wort
A
Used to treat depression, it may interact with other medications such as SSRI’s and MAOI. leading to dangers condition called Serotonin Syndrome
Excessive serotonin can be mild to severe
- mild shivering and diarrhea
- severe muscle ridgidity , fever and seizures
16
Q
PKU
A
Can cause intellectual disability
Avoiding high protein foods, help maintain levels in a safe range.
17
Q
What is the serum alpha fetoprotein test?
A
tests for neural tube defects
18
Q
What are group b strep testing for ?
A
Routinely 35-37 weeks ges, determining if abx needed to prevent neonatal infx.
19
Q
DNR
A
Always stop
20
Q
Jtube management
A
Hand hygiene
Pull plug and pour into urine specimen or plastic cup
empty drain q4-12 hrs unless it is 1/2 full.
compress the bulb side to side
clean spout wit alcohol
21
Q
VRE AND MRSA, CDIF - CONTACT PRECAUTIONS
A
Private room, or semi private w/ same infection dedicated equipment wear gloves person hand hygiene wear gown place notice essentials inside room
22
Q
Hawthorn
A
Heartfailure
23
Q
Black cohosh
A
Hot flashes
24
Q
Older Adult Women
A
Major health risk Osteo and Heart Disease
Biphosphonates - decrease bone resorption so that loss of bone density is minimized -take with empty stomach 30 min before other drugs full glass upright
calcium and vit d required
HRT improves osteoperosis but increases thrombotic complications such as leg swelling
25
Endotrach Suctioning
```
Hand hygiene
Oral care
Preoxygenate with 100%
advance catheter
Suction only while withdrawing
Sterile tech
<10 seconds
```
26
Urinary Catheter
Client with urinary obstruction or retention
perioperative use such as urologic surgery
prolonged immobilization
improve end of life comfort
facilitate healing
27
Impetigo
Highly contagious bacterial skin infection
honey comb crust
from hot weather
s/s burning itching
```
txt
hand hygiene before and after touching
isolating person's clothing
keeping infected person's nails short
avoiding close contact for 24-48 hrs
cover affected area w/ gauze
```
28
Nephrostomy
A procedure that removes kidney stones
client experiencing left flank pain requires
- gentle irrigation, aseptic tech
29
Oliohydraminos
```
Minimal amniotic fluid, usually declining after 41 weeks
major complications
- pulmonary hypoplasia
- possible resuscitation
- umbilical cord compression
- req' additional personnel
```
Continuous fetal monitoring and cord compression
30
Tb Medications
Rifampin
- changes in body fluids, tears can turn red
- wear eyeglasses instead of soft contact lenses
- women should use nonhormonal birth control
31
SSRI's complications
- tine's
| - causes sexual dysfunction
32
Bells palsy teaching
- eye care, patch at night, w/ artificial tears
| - oral care and chew unaffected side
33
What is sjogren?
Autoimmune exocrine glands wbc attacking
s/s
- dry eyes and mouth
- ulcers
- dental caries, and thrush
txt
- eye drops
- sugarfree or artificial saliva, vag lubricants
- freq dental visits
- mild soap
- avoid decongestants as they further irritate
34
How to insert enema
- left lateral
- right knee flexed
- insert tube tip directed to umbilicus
- slow rate if abd cramping noted
- room temperature
35
Assessment of feedings
- assess for intolerance q4hrs , abd distension
- tube placement
- hob >30
- endotrach cuff 25 cm low cuff increases risk for aspiration
- suction secretions
- caution with sedatives
- avoid bolus tube
36
What is acute-closure glaucoma?
- Re immediate medication intervention.
- s/s: sudden onset severe eye pain
- reduced central vision
- blurred vision
- ocular redness
- halos around lights
37
Valsalva manuever contraindications
- ICP
- Stroke
- Head Injury
- Heart Disease
- Glaucoma
- Eye Surgery
- Abd surgery
- liver cirrhosis
38
In emergency, trach outside hospital
Two spare trachs should be carried one same size one smaller.
39
What is uterine inversion ?
Postbirth complication
- fundus collapses into cavity causing
- hemorrhage and shock
treatment: oxytocin
40
How to measure fundal height
- 12 weeks its at symphysis pubis
- 20-22 weeks at umbilicus
- 36 xyphoid
41
Bronchoscopy Procedure
- Mild Sedation
- Topical anesthetic- to prevent laryngospasm
Complication
- blood tinged is COMMON but BRIGHT RED indicates hemorrhage
- hemopytsis, hypoxia, low bp, laryngospasm and brady
42
How to do a peak flow meter
- Position indicator on flow meter at lowest
- inhale deeply
- exhale as quickly
- repeat procedure 2 more times with a 5 to 10 second rest
- Record the highest of the three measured
43
Scabies
person to person contact
- intense itching
Txt:
- all persons in close contact should receive treatment
- apply to all skin surfaces
- belongings should be washed in hottest for >3 days
44
What is Histoplasmosis
Opportunistic fungal infx from bird or bat droppings inhaled
| - life threatening infx in immunocompromised individuals
45
How to do a clean catch urine
- Hand Hygiene
- spread labia
- cleanse vulva
- initiate urinary stream before passing container
46
What to do when status elipticus occurs?
Iv rectal benzo
47
What to remove when person is unconscious and put in a mechanical ventilator
- assess for med alert devices
- remove personal belongings
- remove tampons, jewelry, contacts
48
Working with an interpreter
- address directly
- short sentences
- ask one q at a time
- hold a preconference to review goals
49
Peripheral IV Catheter Infections can be reduced by
- Clean with chlorhexidine friction
- Secure with sterile, semi permeable dressing
- access ports cleaned with alcohol swabs
- replacement is 72-96 hrs unless sign of infx/
50
Influenza is for?
Healthy clients 2-49
- contra: immunocompromised
- pregnant
- age <2 years
51
HHNK
```
Cause:
- Extreme Hyperglycemia
- osmotic diuresis
- type 2 diabetes
s/s
- altered mental status
- gradual onset
- hyperventilation
- abd pain less common but common in keto
```
52
What is polycythemia vera
Too many RBC CELLS
- Risk for clots/ dvt
- Itching
Treatment
- adequate fluid intake
- elevate legs
- wear support stockings
- avoid iron rich foods
53
Sterile Field
- Hand Hygiene
- Sterile gauze package ungloved
- Open Gauze package 15 cm above sterile field
- Place gauze dressing more than 1" from the edge of the sterile field
- Use sterile NSS recap that was opened <24hrs ago
54
Broca Aphasia
- Effort sensible speech short, limited sentences and can comprehend speech, frustrated when speaking
55
Ruptured Membrane PH
Bluish color or any type of blue
- BUT, a false positive may be from serum prostatic fluid
- recent intercourse
56
Separation anxiety alleviation
- encouraging fav toys
- establish a daily routine
- provide opportunities to play
- phone calls
- providing support when child is upset
57
Herpes medication
Teach:
- use gloves when applying topical medication to avoid spreads
- complete abstinence when active lesions are present
58
Low sat after general anaesthesia
head tilt chin lift to open airway
59
Management of an asthma attack
- high dose of inhaled SABA (albuterol) 20 min
- ipratropium - 20 min
- Systemic corticosteroids (solumedrol)
- Long aging salmeterol is not indicated for emergency use
60
what drug to reverse opiods?
naloxone
61
what drug to reverse diazepine?
Flumazenil
62
TB Screening
1ml Tb , 27 gauge 1/4 inch
- left forearm face upward
- 1 inch below insertion pull skin taut
- insert parallell to skin 10 degree bevel up
- advance tip into dermis outline of bevel should be visible , small wheal
- remove do not rub
- circle area w pen
63
ADHD Meds
```
Ritalin, Methylphenidate treats narcolepsy and adhd
Common s/e:
- loss of appetite = weightloss
- important to compare weight and height
- increased BP and tachy
```
64
Rheumatoid Arthritis
inflam in synovial joint leading to
- fibrosis which is pain and deformity affective ADL
Symptom management:
- ROM
- Heat packs and stiff joints and ice packs
- Plan frequent rest periods
65
Major Depressive disorder
```
Experience symptoms everyday for atleast two weeks
SIGECAPS
- Sleep
- Interest deficit
- Guilt
- Energy Deficit
- Concentration Deficit
- appetite
- Psychomotor
- Suicidal
```
66
CPR Adults and Pregnant
Chest compressions 2in or 5 cm
30 compressions followed by 2 rescue breaths
- continuous compressions and 10 breaths/min
- 100-120 min
Pregnant
- place on sternum slightly higher
- uterus should be displaced to the left , rolled blanket or wedge under right hip
- if no circulation after 4 min emerg csection is intitated and should be delivered with in 5 min
67
How to use the cardioversion?
- ensure synchronizer is turned on before they leave the unit
68
What is an important for bed bugs ?
Wash clothes in hot water and store in tightly sealed plastic bags
69
What is Necro. entero? and what is an important ns intervention in regards to it.
Common with preterm infants, causing inflammation and ischemic tissue. It is important to measure abd girth and assess if it is worsening.
- place in supine, undiapered
- avoid rectal temp
70
Growth hormone replacement is for?
- an option for children not growing according to standards
| - sub q everyday
71
What is rotavirus?
Contagious diarrhea for children less than 5 years old transmitted through fecal-oral route
- cannot bee treated with abx bc it is viral
vaccination is important and monitoring dehydration
- can contaminate through objects
72
What is scarlet fever?
Group A strep infex
- distinctive rash on neck and chest resembling a bad sunburn
dx: rapid strep antigen test
73
Can warfarin and Heparin be given at the same time?
Yes, because warfarin takes 48-72 hrs , overlap is required for 5 days until INR reaches therapeutic level
74
How to do reconstitution ?
- HH
- withdraw air from the vial
- inject dilutent into the air
- roll between palms of hands to mix
- withdraw reconstituted med
- label syringe
75
What is west nile and how to prevent it?
Mosquito-borne (encephalitis)
- avoid mos and use a repellent
- wear long sleeves light colored
- avoid dawn and dusk
76
How to Z track
- Pull the skin 1-1/2
- Hold skin taut 90 degree
- Inject medication slowly while maintaining traction slow injection
- wait 10 sec after injecting then withdraw
- release the hold on the skin
- apply gentle pressure at site but do not massage
77
What are teratogenic meds?
```
doxycycline
isotrentoin (accutane)
ace inhib
lithium
warfarin
phenytoin
```
78
Purse breathing technique
Inhale 2 sec through nose with mouth closed
| exhale 4 seconds through pursed lips
79
Developmental dysplasia
- Occurs between <2-3 months when a person has extra lingual folds in the leg and laxity hip joint
- pelvic tilt is noted when the child learns how to walk
80
What must you ensure when it is a forcep/extract delivery
- pt bladder is empty
- monitor contractions
- document equipment applied
- FUNDAL PRESSURE SHOULD NEVER BE DONE
81
Important factors of Long acting controlled release drugs?
Dose should be given regularly to maintain therapeutic level for chronic pain, even when pain is not reported.
82
Important factor for immediate release opiods
May require break through.
83
What is macular degeneration?
Progressive incurable. loss of central vision but can see peripherally
84
What are small flashes of light associated with?
Retinal detachment
85
Inability to see close up?
Presbyopia
86
Poor peripheral vision?
Tunnel vision
87
When a client has >15mm TB
Client is positive but was exposed and developed antibodies
88
What is your surgery prep as a nurse?
- be a witness
- verify client is NPO and voids prior to surgery
- Informed consent
89
When is a venturi mask utilized?
It provides high flow oxygen for
tachpnea is present
hypox
most appropriate for COPD
90
When is a nasal cannaula utilized?
for normal vitals not prefferable for COPD
91
When is non-rebreathing mask utilized?
To deliver 60-90% oxygen short term, forlow sats.
- asthma
- pneumonia
- trauma
- sepsis
NOT copd
92
How to use a fire extingusher?
```
PASS
pull pin
aim to spray
squeeze handle
sweep the spray
```
93
What to do when someone has a blood transfusion allergy?
stop the infusion
initiate normal saline
maintain IV access
Prevent hypotension and vascular collapse.
All over things like
call doctor, monitor vs, labels, collect urine and return tubing are all after
94
What is priapism?
Painful erection related to sickle cell anemia
95
What are your preterm labour meds?
administer:
- im antenatal
(sones) glucocorticoids
- abx
- iv mag sulf
96
Neurological Assessments that are concerning
- Cannot flex the chin toward the chest
- new onset of right arm drift
- pupils greater than 8
- babinski reflex present
97
How to Deal with Syphillis in pregnancy?
Syphillis can cross the placenta
- if the client is allergic to penicillin, desensitization is recommended
- all clients are screened and rescreened during third trimester
98
What to do when shoulder Dystocia occurs?
- document the event
- perform mcroberts maneuver
- legs flexed onto abdomen / supra pubic pressure
- request additional help
99
what is cranial nerve 1
olfactory
100
Cranial nerve iii ?
motor of the eye
101
cranial nerve ii?
optic nerve and sensory , the persons to see objects in field
102
Cranial nerve vii?
facial movements - smile frown etc.
103
ABGs to be taken on mechanical vent pt what should you not do?
Avoid suctioning or changing oxygen
104
Intradermal angles
5-15 degrees do not massage
105
Sub q angles
90 degrees or 45
106
IM angles?
client should be positions supine, prone or side lying, knee and hip flexed
107
Pressure injury stages
Stage 1 - skin intact
stage 2 - shallow, partial skin loss red or pink
stage 3 - full thickness skin loss fat but not tendon muscle or tunnleing
stage 4 "" but tunneling may have occurred
108
What causes PVCs or Ventricular bigminy
Caused by
- hypokalemia
- exercise
- stress
- hypoxia
- Fever
- stimulants
109
Which insulins can be mixed and how to do it first
NPH and any regular doses such as aspart or lispro
- inject clear air first with the NPH
- inject air into the regular then take the dose from the regular and continue to the NPH
110
What is a synchronized cardioversion defib?
Its a low electrical pulse, resets the heart to a more slower regular rhythm. It must be set to 'sync' to prevent R on T
111
How often is ostomies changed?
every 5-10 days to prevent irritation
112
What is the normal ABG for someone with COPD?
Elevated PaCO2 decreased PaO2
| Abnormal - PaO2 less than 60.
113
Prevention of DVT
Anticoag
Compression stockings
Feet flex - exercises
Ambulation
114
Things to note when administering potassium
i/o, lab work
>10 is not acceptable
cardiac monitor
expect burning
115
Which clients pregnant nurses cannot care for due to potential to cause fetal abnormalities ?
```
Taxoplasmosis
Other [varicella]
Rubella
Cytomegalovirus
Herpes
```
116
When someone requires CPR near a pool?
Dry the area around , move away from large bodies of water
| remove transdermal patch
117
What are your restraint rules?
Hrly neurovascular checks
brief release every 2 hrs
offering fluids every 2 hrs/ bathroom
118
Fetal Scalp Electrode is contraindicated for:
Blood borne disease mothers, because it increases risk for fetus - hep b, hiv
