random 1 Flashcards
When the pH goes up?
So does the PT (but then K+ goes down hypoK+) >hyperreflexia > irritable > tachypnea > tachycardia > borborygmi > seizure (suction)
when the pH goes down?
so does the PT. K+ goes up > hypo reflexia > bradycardia > lethargy/ obtunded > paralytic ileus > coma > resp arrest (ambu bag)
Kussmals resps:
MAC Kussmal
Metabolic ACidosis
when will is be metabolic alkalosis?
with prolonged vomiting or suctioning. Lose K+
what to do for high pressure ventilation alarm
triggered to increased resistance
> unkink tubing
empty water condensation in loops
suction mucus secretions–> get them to cough, turn and change position first
what to do for low pressure vent alarm
triggered to decreased resistance (air getting in too easy)
> reconnect tubing
extubation or decannulation (loss of airway)
senses FiO2
plug sensor back into wire hole?
what do you do for someone who is in denial after grief and loss
support it. dont confront it like substance/alcohol abuse
a codependent person lakes what and gets what out of catering to a dependent?
lacks self-esteem
gets a sense of “do good” for doing for the dependent
warnicke-Korsakoff?
alcohol withdrawl
warnicke- encephalopathy
korsekoff- psychosis
amnesia with confabulation- loss memory. makes up stories and believes them.
Nurse- dont confront. they think its real REDIRECT and RECHANNEL
Prevent with Thymine B1
Antibuse or Revia
> drugs for alcohol abuse
aversion therapy
wont start working for 2 weeks
avoid everything with alcohol
what are all the uppers?
> caffeine > cocaine > LSD/PCP > methamphetamine (cough syrup) > adderall (ADD)
S & S of uppers
everything goes up.
> watch out for seizure (have suction at bedside)
S & S of downers
everything goes down
> watch out for resp arrest (ambu bag)
upper withdrawals
downer wd’s
looks like downers S & S
looks like uppers S & S
which 2 situations would resp arrest and depression be highest priority?
upper withdrawal and downer overdose
seizures**
new born drug addict
high for 24 hrs. then withdrawal.
what is delirium Tremens DT
withdrawal up to 24 hrs
72 hrs later some get confusion with withdrawal
> very unstable and can die
NPO / restraints / strict bedrest / danger
what do both alcohol WD and DT PTs get?
antiHTN
tranquilizer
B1
what are aminoglycosides?
Antibiotics when nothing else works. Big guns. mean olg mycin
** have mycin its mean, have thomycin its average
route IM or IV
what toxic effects for aminoglycosides
- ototoxicity - cranial nerve 8
2. nephrotoxicity- monitor creatinine
what do you use for hepatic encephalopathy or pre-op bowel prep?
Neomycin and Canamycin
route PO bc these drugs are not absorbed PO. ppl will just poop out and with it take ammonia with it.
wont have toxic effects PO
what is trough and peaks?
what is narrow range?
trough- lowest in blood right bfr drug given
peak- drug level highest in blood
check when therapeutic range is narrow.
Ex. dig 0.125-0.25
when do you draw troughs?
30 min bfr drug is given
any route
when do you draw peaks?
depends on route:
SL- 10-15 min after given
IV- 15-30 min after given
IM- 30-60 min after given
how long until antidepress begin to work?
2-4 weeks
Calcium Channel Blockers
Like valium for the heart “dipine” verapamil, cardiazem(can be IV drip)
A- antihypertensive. relax heart and blood vessels
AA- anti-anginals. relax heart and decrease O2 demand
AAA- anti-atrial arrhythmia (wont treat ventricular stuff)
CCB’s side effects
Headache
Hypotension
Hold CCB if systolic < 100
what would V.Fib look like?
chaotic squiggle line. no pattern
Fror V.Fib you D.Fib (shock)
V. tachycardia
sharp peaks, could be up or down and there is a pattern.
if the question says something about a P wave then…
it is taking about atrial. rule out vent
if has a QRS
its ventricular
what heart meds for ventricular?
lidocane
amioderone
what heart meds for atrial?
A- adenocard. push in 8 seconds. when you slam fast they go into asystole but they come out!
B- BB’s olol
C- CCB’s
D- Digitalis (Lanoxin)
meds for Asystole
Epi and Atropine in this oder
if broken seal in chest tube do…?
- clamp
- cut tube from broken device
- put end of tube in sterile water (BEST)
- unclamp to reestablish water seal
when is a heart defect trbl?
when it starts with T
blood is shunted right to left = blue
all heart defect kids will have murmurs
Tetralogy of Fallot
VarieD PictureS Of A RancH
VD = ventricular defect PS = pulmonary stenosis OA = Overriding Aorta RH = Right hypertrophy
contact precautions:
fecal-oral: > C.diff > Hep A > staph > RSV (kids lick toys) > Rotavirus (infant diarrhea)
gloves/gown
private room if poss
dropplet
travel 3 feet. > menmengitis > Hep-flu B (epiglottitis) > Rubella > mumps > pertussis
mask
eyewear
airborne
> TB
herpes Zoster
varicella Zoster
neg pressure
N95
what order do you put on PPE?
gown
mask
goggles
gloves
what order do you take off PPE?
gloves
goggles
gown
mask
crutches
up with the good leg, crutches follow.
down with the bad leg.
2-4 = even number of limbs, 4= severe
3 = odd, weight bear allowed
swing through- NWB
what is non-psychotic?
someone that is reality based and has insight to their problem. all their senses are same as mine.
nurse intervention for non-psychotic?
Good therapeutic communication
“I hear that you are feeling down”
can you tell me more?
PT might be feeling depression.
Polycythemia
chronic myeloproliferative disorder where the bone marrow makes too many RBC’s
> can occur in someone who has COPD d/t hypoxemia
> PT can develop blood clots
> PTs receive periodic phlebotomy (remove 300-500mls of blood to get hct <45%)
when to report platelet when on heparin infusion?
when platelets decrease > or = 50% from PTs baseline
HIT, heparin induced thrombocytopenia
what to do with elevated BUN?
increase IV fluids
normal Hct
117-173
plt
150,000-400,000
allergies caused by
IgE
Von Willebrand
bleeding disorder from deficient vW factor which helps with clotting
> can use untranasal desmopressin or topical thrombin)
> major will need vEF replacement
Epinephrine
stimulates both alpha and beta-adrenergic receptors, dilates bronchial smooth muscle (beta 2), and provides vasoconstriction (beta 1)
IM better than SC
repeat Q 5-25 min
albuterol
broncodilator
diphenhydramine
antihistamine
modifies the hypersensitivity reaction and relieves puritis
why wouldnt you give nitroglycerine for anaphylacitc shock?
decreases BP for already low BP
morphine is also avoided bc it can make puritis and hypotension worse.
treating hypoglycemia without checking BS
15-20g of quick acting carbs. repeat 15 min as needed.
> careful not too much or could rebound into hyperglycemia.
> 1 tbs honey/syrup, 4 tbs jelly, 4-6 oz juice, 8 oz low-fat milk
metabolic syndrome
3 or more to diagnose
puts PTs at high risk for stroke, DM, and cardiovas disease
effects: > waist circumference > BP > triglycerides >150 > HDL < 40/50 > glucose > or = 5.6
We Better Think High Glucose
Acromegaly
over production of GH
lymph node after mastectomy
0.5-1.0cm = normal
mobile, firm and non-tender = normal
hard and fixed could = malig
thyroid storm
hyperthyroid = graves from stress
> fever
tachycardia
elevated BP
anxious, trembling, restless
malignant hyperthermia
perioperative setting from anesthesia
Seritonin syndrome
when PT overdose on antidepressant that would increase seritonin
what to check after thyroidectomy if twitching and tingle around mouth
Calcium
normal is 8.6-10.2
tetany
+ trousseau and chvostek
cushing
excess corticsteroids (esp glucocorticoids/cortisol)
> admin steroids hydrocortisone/prednise
RAIU test
give low dose radioactive iodine (high dose given if cancer to kill thyroid tissues)
scan performed: > take preg test prior > hold thyroid meds 5-7 days prior > NPO for 2-4 hrs prior > remove dentures/jewlery > drink plenty of fluids after > will be awake > no breastfeeding
hyperthyroid
> eat high cal diet 4000-5000
> increase protein and carbs
avoid high fiber
> avoid stimulants and spicy food
fruity breath and increased resps for PT with DM
DKA
> check BS
> start IV infusion reg insulin
> IV bolus of NS
nurse must start IV bolus first bc need to treat dehydration.
Insulin pulls water, K+, and glucose into cells which could exacerbate vascular dehydrate and imbalance electrolytes
why do you give a PT a bag to breath into if hypervent
to decrease CO2 being lost. leads to resp alkalosis
DKA characterized by?
> hyperglycemia
> ketosis (break down fat)
> acidosis
SLE causes
systemic lupus erythmatosus (autoimmune) = chronic inflam
> malar rash (face) butterfly > pleuritis/ pleural effusion > pericarditis/ pericardial effusion > nephrotic/ nephritis > arthritis > DVT
for hyperparathyroidism
regulate Ca levels in blood
phalen’s maneuver
diagnose carpal tunnel in wrist
Romberg test
neurological exam to assess vestibule function, and vision (balance)
acanthosis nigricans
hyperpigmentation and skin thickening on neck and axilla d/t insulin resistance (diabetic dermopathy or metabolic syndrome)
BMI
18.5-24.9 = normal
fasting total cholesterol
< 200
diet highest risk for macrocytic anemia
B12 and folic acid deficient
B12 from animal foods
Vegans- no meat
lacto-vegaterian
eat milk products
lacto-ovo = eat eggs
DI
insuff ADH from manipulation of pit gland
autonomic neuropathy for DM
AUTO- invol body movements :
> BP, HR, perspire, sex function, digestion
nerve damage. causes posteural hypotn
> take BP sitting and standing.
who is at greatest risk for a PE?
post-major surgery
SIADH
d/t head injury
excess ADH = water absorption from kidneys
low serium osmolality, low serium Na, urine op decreased and concentrated = high specific gravity
altered mental status, easy bruising and hair loss =
liver disease
HHS
hyperosmolar hyperglycemic state
> DM2
> can produce enough insulin to prevent DKA, but not enough to prevent HHS, osmotic diureses, and extracellular fluid deficit
BS > 33.3
eventually causes neurological manifestations
radiation exposure
> affects tissues with fast proliferate.
> oral mucosa, GI tract and bone marrow.
TB info
a PT with Latent TB is at increased risk of conversion to active TB if they start taking prednisone (or other steroids)
sulfasalazine
GI anti-inflam
for IBD
peaked T-waves indicate
hyperkalemia
> would be hyper in DKA only because of extracellular shift and not because of urine loss (initially)
epistaxis
nose bleed
neutropenia is determined when ?
count below 1.0 x 10(9)… or 1,000
pheochromocytoma
tumor in the adrenal medulla = excess catecholamines = paroxysmal hypertensive crisis
> give nitroprusside to vasodilate and bring BP down
PT risk for stroke
Psychotic
< someone who does not have insight and is not reality based.
< they are either having delusions, hallucinations or illusions
delusions
< false fixed beliefs.
< no sensory component
Paranoid. grandiose, somatic (body can do things that they actually cant)
hallucinations
all sensory
auditory, visual, tactile
illusions
also sensory. misinterpret of reality
3 kinds of psychosis
- functional
- dementia
- psychotic delirium
functional
schizo, schizo, major, manics
< (schizo-effective disorder)
< bipolar is only psych in the manic phase
< nurse: teach reality
4 steps to teaching reality:
- acknowledge feelings
- presenting reality- I know that the voices are telling you, but I do not hear voices…
- set a limit- that topic is off limits
- enforce the limit- I see you are too ill to be reality based, we can try again later. only end the conversation.
dementia
< brain damage, stroke, organic brain syndrome, senile
< these ppl cannot learn reality
< Nurse:
- acknowledge feelings
- redirect them
psychotic delirium
< temp, sudden, often d/t chemical imbalance in body
< drugs: intox on uppers/wd from downers, overdose, post-op, UTI, thyroid storm, adrenal crisis, steroid rage
< nurse: remove harm and keep them safe
- acknowledge their feelings
- reassure them- say its temp and it will go away
ex. those ppl over there are plotting to kill me
psychizo-
dementia-
delerium tremons-
P- I see that you are feeling scared, the reality is those ppl are not saying they are going to kill you. this conversation is over
D- i see that you are scared. why dont we go somewhere else.
DT- I see that you are scared. you are safe. this is a symptom of your illness and it will eventually go away.
narrowed self-concept
dont want to leave there room
N: I see that you are comfortable. you can leave your room when you want.
if depressed (not major)
N: I see that you are depressed, but it is time to get up and shower. breakfast is at 0900. its 0830, you have 1/2 hr.
