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NR 463 Exam 2 Flashcards

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1
Q
  1. What should you monitor for in a casted extremity?
  2. When should you notify HCP
  3. What is a client with osteoporosis at risk for?
A
  1. Pain, Swelling, Discoloration, Tingling, Numb, Cool, diminished pulse
  2. Circulatory compromise
  3. Pathologic fractures
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2
Q
  1. What diagnosis can an xray detect dec bone density?
  2. When can an Xray detect bone loss
A
  1. Osteoporosis
  2. 25-45%
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3
Q
  1. 3 Factors that regulate calcium in the body
  2. Asorption of vitamind D is increased by..
  3. Which type of drug decreases calcium absorption?
A
  1. Parathyroid hormone, Vitamin D, Calcitonin
  2. PTH
  3. Glucocorticoids
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4
Q
  1. What foods can interfere with calcium absorption?
  2. Hypercalcemia tx
A
  1. Spinach, Whole grain cereal, Bran
  2. fluids, loop diuretics, phosphates, glucocorticoids, calcitonin, bisphophonates
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5
Q
  1. How does calcitonin work?
  2. Why take bisphophonates
A
  1. inhibits osteoclasts (dec bone resorption), inhibits tubular resorption of CA & inc calcium excretion
  2. postmenopause, glucocorticoid induced, paget’s disease, hypercalcemia
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6
Q
  1. Adverse effect of aldendronate (fusomax)
  2. What is a class of agents known as selective estrogen receptor modulator?
A
  1. Esophagitis (bone resorption inhibitor)
  2. Raloxifene (Evista)
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7
Q
  1. Antiresorptive therapy drugs x4
  2. Risk factor for osteoporosis
A
  1. Estrogen, Raloxifene, Biphosphanates, Caclitonin
  2. Smoking, >65w, >75m, dec estrogen, low weight, Caucasian/Asia, sedentary, glucocorticoids, antiseizure, family hx, alcohol
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8
Q
  1. Diagnostic screening used for osteoporosis?
  2. Osteopenia T-score
  3. Osteoporosis T-score
A
  1. Dual Energy Xray Absorptiometry Scan (Bone Mineral Density)
  2. -1 to -2.5 (drug therapy
  3. >-2.5 (high risk fracture)
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9
Q
  1. Patien Ed for Alendronate
  2. Why take with Vit D & Ca supplements
A
  1. Take med with 8oz of water upon arising, upright 30 min prior, notify HCP for jaw pain, vomit, ab pain
  2. building blocks, healing.
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10
Q
  1. Nonpharm prevention bone loss
  2. Types of Exercises
  3. Ca foods
A
  1. quit smoking, exercise, diet, vit D/Ca
  2. Weight bearing, 30 min 3x/wk
  3. Milk, cottage cheese, yogurt, dark greens
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11
Q
  1. Protein foods
  2. Vit D foods
  3. Therapeutic communication lifestyle changes
A
  1. meat, cheese nuts
  2. dairy, salmon, mackerel, tuna, sardines, mushrooms
  3. Let patient choose with problem to approach first
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12
Q
  1. Patho of OA
  2. What are osteophytes
  3. OA joints affected x5
A
  1. DJD, Cartilage erosion, Bone overgrowth, Spurs (osteophytes)
  2. Irregularity of joint surface and narrowed spaces
  3. Hips, knees, hands, feet, spine
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13
Q
  1. OA Characterists
  2. OP characteristics
A
  1. not systemic, external, painful
  2. systemic, internal bone changes (porous, fragile), painless
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14
Q
  1. Risk Factor for OA
  2. Meds for OA
  3. Patient Ed for NSAIDS
A
  1. Joint use/stress, trauma, obesity, age, femal >50
  2. NSAIDS
  3. with food, gi bleeding, tarry stools
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15
Q
  1. Celebrex Concerts for OA
  2. TKA education
A
  1. Bleeding, cardiac (mi, stroke, thrombosis)\
  2. relieves pain, improves ROM, correct deformity.
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16
Q
  1. Nonpharm procedures for OA
  2. Risk factors for hip fracture
A
  1. Rest, heat/cold, exercises (swimming), Cane, yoga, lose weight, reduce hazards
  2. age, falls, gender, postmeno w/o HRT, dec estrogen, smoking sedentary, cortico, antimetabolite, RA, longterm PPI
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17
Q
  1. Enoxaprin/Warfarin post op hip fracture
  2. Use of metal pins, screws, rods, plates to immobilize fracture
A
  1. dec risk for DVT/PE
  2. Open Internal Fixation (ORIF)
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18
Q
  1. Intraoperative Blood Salvage, infusion of own blood
  2. Risks for infusion of own blood
A
  1. collected in a cell saver, must be infused within 6 hours, 50% rbcs are saved
  2. not the same as donor, circulatory overload, bacterial contam
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19
Q
  1. Hip Post op Complications
  2. Blood Loss Assessment
A
  1. Peripheral neurovascula dysfxn, fat emboli, bleeding, atelectasis, pneumonitis, DVT/PE, dislocation, infection, pressure ulcer
  2. Dressing drainage, VS- BP drop, HR high, Occult stools, bleeding at other sites, neuro/pain
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20
Q
  1. Goals for alignment post op hip
  2. Wound infection assess
A
  1. abduction w/ pillows, must preved adduction of hip joint, HOB
  2. LOC, VS q4h, , CBC, nutrition
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21
Q
  1. Immobility complication prevention
  2. What is pulmonary hygiene/toilet
  3. What factor contributes risk for infection, bleeding, anemia
A
  1. pain, stools softener, high protein, zinc, calcium, mag, ACEK, ROM, ADLs, Ted hose, Skin care, Reposition q 2h, Pulmonary toilet
  2. IS, DB/C, breath sounds
  3. Methotrexate, leucopenia, thrombocytopenia, anemia, chronic immunosuppression from steroid tx.
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22
Q
  1. Nutrition post op hip
  2. What can blood loss indicate
A
  1. limit kcal 1400-1600, high protein, calcium, Vit C, iron, glucosamine, folic acid, methotrexate.
  2. ferrous sulfate supplement/iron
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23
Q
  1. tPA stands for
  2. What does AKA stand for
A
  1. tissue plasminogen activator- thromoblytic
  2. Above the Knee Amputation
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24
Q
  1. What is hyperbaric treatment delivered
  2. What does hyperbaric tx optimize
A
  1. an enclosed chamber at increased pressure (high than sea, underw dive)
  2. hypoxic tissue, hyperoxygenates.
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25
Q
  1. Amputation grief/loss considerations
  2. What is an important assessment post amputation
  3. What is prone position
A
  1. explain procedure, simply, resources (children), case mgmt, chaplain
  2. Pain
  3. lying on stomach
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26
Q
  1. Why would surgeon order prone position for amputee
  2. Intervention for amputee
A
  1. prevention of hip contractures (hardening of muscle)
  2. diabetes consult, long acting insulin, family coop for nutrition restriction, PT consult to increase activity/expend calories
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27
Q
  1. Assessment of dressing of amputee
  2. Risk factors
  3. Why should you inquire about tighter glucose control
A
  1. snug to prevent edema but not tight for circulation, edema, erythema, amount/drainage
  2. Diabetes, atherosclerosis,
  3. To facilitate wound healing
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28
Q
  1. GERD
  2. Hiatal Hernia
  3. Peptic Ulcer Disease
A
  1. backward flow of gastric contents into esophagues, inappropriate closure of esophageal sphincter
  2. Stomach into esophagus through an opening in the diaphragm
  3. Erosion of GI mucosa from HCL acid and pepsin
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29
Q
  1. Gi Bleeding
  2. Peritonitis
  3. Inflammatory Bowel diseases
A
  1. Loss of blood from GI tract
  2. inflammation of peritoneum (lining the cavity of the abdomen and covering the abdominal organs.)
  3. chronic inflamed, exacerbation/remissions
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30
Q
  1. Intestinal Obstruction
  2. Colorectal Cancer
  3. Ostomy
A
  1. mech/nonmech occulsion of the instestinal lumen
  2. cancer in the intestine
  3. surgical creation of a fecal diversion
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31
Q
  1. Diverticulosis/itis
  2. GERD causes
A
  1. saccular dilations or outpouching of the mucosa of the colon
  2. incompetent les, hernia, obesity, prego, smoking, caffeine, choco, peppermint, high fat, age
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32
Q
  1. Hiatal Hernia Causes
  2. Peptic Ulcer Causes
A
  1. inc intraab pressure, obesity, prego, ascite, tumor, intensie phys exertion
  2. Acid, H.Pylori, stress, Genetics, smoking, alcohol, coffee, ASA, NSAIDS, steroids
33
Q
  1. GI bleed causes
  2. Peritonitis
A
  1. esophagitis, varices, mallory weiss tear, smoking, alcohol, NSAIDS, Steroids
  2. Appendix rupter, gallbladder, diverticulum perforated ulcer, trauma, infection, mal position g-tube, infection post op
34
Q
  1. Inflammatory bowel causes
  2. Bowel Obstruction causes
A
  1. autoimmune, env’t, hygine, bacteria, jewish, stress, high fat, meat, NSAIDS, teens
  2. intussussception, tumor, neuro,par ileus, mesenteric infarction, emboli, thrombosis, hernia, mech adhesions
35
Q
  1. Colon cancer causes
  2. Diverticular disease causes
A
  1. obesity, family hx, men, smoking, sedentary, alcohol, red meat, polyps
  2. constipation, high intra luminal pressure, low fiber, refined carbs, farting, ab pain, peritonitis, fistulas
36
Q
  1. Crohn’s Disease
  2. This device treats problems in the upper GI & uses an endoscope
  3. Pre Procedure how long NPO status
A
  1. autoimmune, ulcerations, skip lesions, chronic
  2. Esophagostroduodenoscopy
  3. 6-8 hours
37
Q
  1. Type of Sedation before EGD
  2. Position pre-procedure
  3. What should you monitor w/ EGD
A
  1. Conscious with anesthetic spray
  2. left side for saliva drainage
  3. airway, pulse ox
38
Q
  1. Signs of perforation
  2. Post EGD NPO status
  3. What about NG tube?
A
  1. pain, bleeding, difficulty swallowing, temp
  2. 1 to 2 hours, until gag reflex returns
  3. Will have blood drainage and should not be touched!
39
Q
  1. What should you assess post EGD
  2. What color is stool
A
  1. Abdomen distention, impaction.
  2. White for 72 hours
40
Q
  1. Fluid Volume Deficit, S/Sx
  2. FVD- hematocrit
  3. FVD- CBC levels
A
  1. increase RR, Seizure, Thready pulse, Low BP
  2. Increased
  3. low
41
Q
  1. Maslows hierarchy of needs
  2. Nursing Process remember
A
  1. ABC, HR, Nutrition, Elimination, Safety
  2. ADOPIE
42
Q
  1. S/Sx GERD (just like Hiatal Hernia)
  2. Foods to avoid if you have GERD
  3. Most common surgical intervention
A
  1. > 2/wk occurence, heartburn, epigastric pain, dyspepsia (upper ab), regurg, swallowing, hypersalivation
  2. pepermint, chocolate, coffee, fried, carbonated bev, alcohol, smoking
  3. Laparoscope
43
Q
  1. Gi disease with high fiber diet x3
  2. Meds to avoid with GERD
  3. When should you take PPI w/ GERD
A
  1. GERD, Diverticular, Crohn’s
  2. NSAIDS, anticholinergics
  3. Before the first meal of the day
44
Q
  1. What is Nissen Fundoplication?
  2. What should you assess with this procedure
  3. Risks with Laparoscopic Procedures
A
  1. wraps gastric fundus around teh sphincter of the esophagus, by laparoscopy
  2. infection, F&E, respiratory
  3. Gastric, splenic injury, infection, pneumothorax
45
Q
  1. What is an arterial GI Bleed
  2. Coffee Ground GI bleed
  3. What is a melena GI bleed
A
  1. bright red in contact with HCL acid
  2. Vomitus, in the stomach for time
  3. slow bleed from upper GI, sticky, digested food
46
Q
  1. Best tool to diagnose a GI bleed
  2. What is a risk in a GI bleed
A
  1. Endoscopy (or angiography, invasive)
  2. Peritonitis and perforation
47
Q
  1. Assessment for a GI bleed
  2. First line treatment
  3. Other treatments
A
  1. Signs of shock, bowel sounds, abdomen, IV line, Isotonic saline with packed RBCS, oxygen, urine output (catheter)
  2. Endoscopic within 24hrs
  3. IV bolus of PPI prior to endoscopy, epinephrine, H@ receptors
48
Q
  1. Gastric PUD
  2. Duodenal PUD
  3. What is hematemesis
A
  1. ulcer of mucosal lining that extends to submucosal
  2. break in the mucosa of the duodenum (upper GI bleed)
  3. vomiting blood
49
Q
  1. When does pain strike for gastric ulcer?
  2. When does pain strike for duonela ulcer?
A
  1. 30-60 min after meal (hematemesis)
  2. 1.5-3hr after a meal, at night , relieved by eating(melena)
50
Q
  1. Meds for a PUD
  2. Surgical Procedure- PUD, Bill Roth I
  3. Billroth 2
A
  1. H2, PPI, Antacids, Anticholinergic (reduc g. motility), Mucosal barrier protectant, prostaglandins
  2. Partial gastrectomy, distal portion of stomach is removed, connect to duodenum
  3. reamining connected to jejunum, lower portion of stomal is removed.
51
Q
  1. Post gastrectomy assessments
  2. How long for NPO status
  3. Complication w/ gastrectomy
A
  1. VS, fowlers, FE, bowe sounds, NG tube
  2. 1 to 3 days post procedure, until peristalsis returns
  3. Dumping, hem, diarrhea, hyplgyc, b12 deficiency
52
Q
  1. What is dumping sydnrome
  2. Complications of PUD general
  3. Hypovolemic Shock Priority
A
  1. undigested contents of your stomach move too rapidly into your small bowel. 30 min after eating
  2. bleeding, perforation, g. outlet obstruction, intractable disease
  3. Airway, IV cath, oxygen, elevate feet, VS q5, Meds
53
Q
  1. What is Borborygmi?
  2. Perforation S/Sx
  3. If untreated what can occur
A
  1. loud gurgles, hyperperistalsis
  2. Gastric, spillage of contens into peritoneal cavity, upper ab pain, radiates to the back, Boardlike abdomen (NG, IV)
  3. Peritonitis
54
Q
  1. Sliding Hiatal Hernia
  2. Rolling Hernia
  3. Tx for Hernia
A
  1. slides while supine, goes back standing. COMMON
  2. roll up thru diaphragm form a pocket along esophagus. URGENT
  3. Herniotomy, Gastropexy, Antireflux surgery (nissen, Toupet)
55
Q
  1. S/Sx of peritonitis
  2. Care priorities
A
  1. fever, cloudy outflow (early), rebound ab tender, malaise, nause/vomiting
  2. If bleeding report HCP, C/S test Antibiotics, IV line, Pain, Knee flexed position, Sedative, I/Os, Frequent VS, Antiemetics, NPO status, NG, low flow ox,
56
Q
  1. Complications of peritonitis
  2. Diverticulosos vs, Isis
  3. S/Sx of Diverticular Disease
A
  1. shock, sepsis, ARDS, heat can cause rupture of appendix
  2. Indigestid food, asymptomatic
  3. LLQ pain increase when coughing, elevated temp, N/V, fart, Distention, bloody stools
57
Q
  1. Diet therapy for diverticular Disease
  2. Care
A
  1. fluids 300 mL, soft high fiber food, AVOID seeds, BRAN
  2. Bed rest, NPO/clear liquids, fiber when inflammation resolved, monitor for perforation, hemorrhage, fistula, abscess.
58
Q
  1. S/Sx of intenstinal obstruction
  2. Assemnt
  3. Ab Assess
A
  1. Colicky ab pain, N/V, distention, Borborgymi–eventually diminish
  2. Location, duration, intensity, frequency. I/Os, (no bile acid)
  3. sounds, character, location, scars, massess, measure girth, signs of guarding
59
Q
  1. Tx Obstruction
  2. High obstruction
  3. Low Obstruction
A
  1. colonoscope, can remove polyps and destroy tumor (non surgical), oral care
  2. Alkalosis
  3. Acidosis
60
Q
  1. Unique s/sx for crohns
  2. Unique s.sx for ulcerative
  3. Both
A
  1. weight loss, clubbing
  2. toxic megacolon
  3. systemic problems liver failure, blood, diarrhea, cramping, nutrition disorder
61
Q
  1. Meds for colitis
  2. Highest Priority Post Surgery
  3. Skin Care
A
  1. Aminoslaicylate, antimicrobial, corticosteroids, immunosepprasants, methotrexate, sulfasalazine (need folic acid)
  2. TCDB
  3. Plan water, no soap, sitz baths, tucks pads
62
Q
  1. Nursing Dx for Colitis
A
  1. Diarrhea r/t bowel inflammation, intestinal hyperactiv
  2. Imbalanced nutrition r/t decreased absorption
  3. Ineffective coping r/t disease
63
Q
  1. Outcomes for colitis
  2. Purpose of NG tube
  3. If NG tube is not working
A
  1. Decrease in the number of diarrha, maintain body weight, free from pain, effective coping
  2. Absent bowel sounds, perofration to provide cont aspiration, relieve discomfort
  3. reposition tube and check for placement
64
Q
  1. Most common Symptom of Colorectal Cancer
  2. What is the Gold Standard for C.Cancer
A
  1. Blood in the stools, ab distention late sign
  2. colonoscopy, entire colon examination
65
Q
  1. How often should patient get screened for cancer?
  2. After procedure small amount of blood comes out?
  3. When does stoma start fucntioning
A
  1. Regulalry after age 50
  2. Normal due to vascularity
  3. When peristalsis returns
66
Q
  1. Pale Stoma
  2. Dusky Blue Stoma
  3. Balck Stoma
  4. Edema
A
  1. Anemia
  2. Ischemia
  3. Necrosis
  4. Obstruct// Allergy to food, gastroenteritis.
67
Q
  1. Affected by osteoporosis
  2. What is the first manifestation?
  3. Other manifestation
A
  1. Spine Hip Wrists
  2. Back Pain, spontaneous fractures
  3. unbalanced, kyphosis,
68
Q
  1. Osteoporosis Fall Precautions
  2. Meds for Osteoarthritis
  3. Nursing Care OA
A
  1. Side Raile, Cane, firm mattress, avoid alcohol coffee
  2. Tylenol, NSAIDS, muscle relaxants for spasma, Coticosteroid injection, Paraffin dips
  3. Keep linen of feet and legs, spint or brace until inflammation subsides
69
Q
  1. Post Op Meds for TKA
  2. Nursing Care
A
  1. Anticoag, analgesic, parenteral antibiotic, PCA, NSAIDS (Warfarin starts surgery day)
  2. TDB, CPM 24-48 hours post op
70
Q
  1. What are you worrie dabout with fractures
  2. Most important assessment
  3. How?
A
  1. Compartment Syndrome
  2. Neurovascular
  3. Sensation, motor, pain, temp, cap refill, color, peripheral pulses, edema
71
Q
  1. S/Sx Fracture
  2. What is a fat embolism
A
  1. Localized pain, inability to bear weight, crepitation, erythema, edema, bruisins,g muscle spasm
  2. fat globule release into blood stream. Clien tiwth long fractures
72
Q
  1. 5 Priority Nursing Actions for Fat Embolism
  2. purpose of traction
A
  1. Notify HCP, Oxyge, Fluids, VS, RR, Intubate,
  2. proper bone aligment, reduce muscle spasm
73
Q
  1. Traction assessment
  2. Can you relieve traction
A
  1. pulley are not obstructed, knots in the rope to prevent slipping, color motion sensation of affected extremity, REEDA, ensure weights hang freely
  2. Not without HCP order
74
Q
  1. What position post op for amputation
  2. What type of therapy helps phantom pain?
  3. First nursing intervention
A
  1. Prone, prevents hip contractures
  2. Mirror therapy
  3. Relieve phantom pain, diversional activity
75
Q
  1. 1 lb =
  2. 1 kg =
  3. Drop factor Formula
A
  1. 16 Oz
  2. 2.2 kg
  3. Volume/Time x Drop Factor = flow rate
76
Q
  1. Calculating Dosage formula
  2. 1 oz, how manly mLs
  3. 1 tsp, how many mL?
  4. 1 tbsp
A
  1. Desire/Available x amount
  2. 30
  3. 5
  4. 15
77
Q
  1. Calcium
  2. Magnesium
  3. Sodium
A
  1. 8.6 - 10
  2. 1.6 - 2.6
78
Q
  1. K
  2. Sodium
  3. Bicarb
A
  1. 3.5 - 5
  2. 135 - 145
  3. 22 -29
79
Q
  1. Hematocrit
  2. Hemoglobin
  3. Platelets
  4. PTT
A
  1. 45%
  2. 12 -15
  3. 150,000-400,000
  4. 9.5 - 11.8

Nursing school pt 3 (13 decks)

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