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random 3 (hurst) Flashcards

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1
Q

adosterone found? does what?

A

in adrenal gland (steroid, mineralcorticoid)

when blood vol gets low, aldosterone is secreted and and kidneys retain Na and water

cushings too much
addisions too little

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2
Q

ANP found? what does it do?

A

artial natretic peptide

artium of heart

when volume increases, atrium stretches and releases ANP which causes kidneys to excrete Na and water

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3
Q

ADH found? does what?

what causes?

what is the drug name?

A

Antidiuretic hormone in pituitary

ADH = H2O

makes you retain water

< often cause of head trauma or sinus injury.
< increased ICP can = ADH prob

< vasopressin

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4
Q

ADH problems:

Too much

A

< causes water retention. FVE

< SIADH–> often caused by lung tumor!

< too many letters = too much water

< urine concentrated bc not peeing. makes Na and USG increase
< blood is dilute bc too much fluid. Hct is decreased

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5
Q

ADH too little

A

< causes diurese. lose water.

< DI. think shock!!!

< urine is dilute and blood is concentrated.

< Na and urine specifc grav goes down
< Hct goes up

< use vasopressin

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6
Q

normal CVP

A

2-6 mmHg

5-10 cm H2O

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7
Q

bed rest…

A

induces diueses by increasing ANP and decreasing production of ADH

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8
Q

renal failure think…

A

shock first!!!!

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9
Q

isotonic

A

NS, D5W, RL, D5 1/2NS

do not use on PT HTN or renal failure

can cause HTN, FVE or hyperNa

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10
Q

Hypotonic

A

D2.5W,
1/2 NS
.33% NS

< rehydrates but doesnt stay in vas space

< use if HTN, renal, or cardic disease

< water moves out of vas space and into cells

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11
Q

hypertonic

A

all others and TPN

Use for 3rd spacing and hypoNa (edema, burns, ascites)

returns fluid to vascular space.

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12
Q

Mg

A

< does the opp of prefix.
< sedative
< 1.3- 2.1

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13
Q

PTH pulls Ca from

A

bones to blood

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14
Q

Calcitonin pulls CA from

A

blood to bones

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15
Q

sodium polyesterene sulfonate

A

Kayexalate

for hyperkalemia

give enema or PO. will exchange K+ ions for Na ions in the GI tract. will have Na prob then but you can treat with fluids then.

takes a bit longer than Glucose and insulin. Insulin pushes glucose and K+ back into cells and out of blood

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16
Q

if giving potassium… causes?

must have?
never?

A

causes GI upset and burns veins

must have good urine output. make sure to watch otherwise they will retain K+

never push IV K+

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17
Q

restless and tachycardia think?

A

hypoxic first!

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18
Q

systolic < 90 =

A

inadequate perfusion to vital organs

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19
Q

what do you use to determine PTs fluid vol is adequate?

IV fluids to maintain OP?

A

urine output

> 0.5mls/kg/hr

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20
Q

what immunizations would you give after a burn?

A
  1. tetanus toxoid - active immunity.
    > takes 2-4 weeks to develop own immunity
  2. immune globulin- passive immunity.
    > immediate protection
    > inject antibodies until body has time to make own.
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21
Q

what is released into blood from muscles post burn

A

myoglobin fro damaged muscles. Makes the urine red/brown and can clog the kidneys.

Call MRP

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22
Q

what might be ordered to flush out the kidneys?

A

mannitol- flushes out debri

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23
Q

how long after burn will PT start to diurese?

A

24 hrs when fluid return to vascular space.

need to watch for FVE then

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24
Q

what happens to the K+ in burn victim?

A

it increased d/t cellular lysis.

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25
Q

burn ppl will get NG tube bc?

A

they will have decreased motility and could develop paralytic ileus

PTs need more calories and increased protein

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26
Q

what lab would you look at to ensure proper nutrition?

A

PRE-ALBUMIN, albumin and total protein

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27
Q

what type of isolation for PT with burn?

A

protective

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28
Q

first thing you do for an electrical burn?

A

24 heart monitor

PT at risk for V. Fib

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29
Q

what is brachytherapy?

A

internal radiation. get radiation close to Ca tissue

> PT emits radiation for period of time and is a hazard to others

Sealed- emits radiation but body fluids are safe
> temp or permanent implant

Unsealed- PT and body fluids emit radiation
> IV or PO

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30
Q

Nurse: precautions with radiation

A

Time, distance, shielding

> wear a film badge
visitors 30 min at a time and stay 6 feet away

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31
Q

External radiation

A

focused beam of high energy to body

> PT not radioactive
will be noticed on skin. PT will have altered taste
>N: good skin care
FATIGUE

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32
Q

chemotherapy

A

Ca drug. most IV port. Vesicant drug can cause necrosis

STOP infusion if extravasate

determined by:
> which phase of cell, time, growth fraction, tumor burden

> given Q 3-4 weeks

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33
Q

most common body systems affected by chemo?

A
  1. blood
  2. GI
  3. Integument (skin.hair)
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34
Q

Precautions for chemo Nurse:

A

isolation gown

2 pairs chemo gloves

goggle and/or mask if splashing

dispose in yellow bins

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35
Q

types of transplants for Ca

A
  1. bone marrow

2. stem cell

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36
Q

number 1 cause of Ca related death

A

infection

watch Absolute Nutropenia Count (ANC) and slight increase in temp (> 38), can cause sepsis

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37
Q

neutropenia precautions for Ca PT

A

all general infection precaution plus:

> VS Q4H min
> antimicrob soap
> private room no visitors 
> no invasive procedures 
> to tylenol
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38
Q

thyroid gland produces:

A

T3
T4
Calcitonin (decreases serium Ca by taking Ca from blood and pushing back to bones)

> needs iodine to make

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39
Q

hyperthyroid T4 and TSH?

A

increased T4 and decreased TSH

can be confused with mania

40
Q

best drug for hyperthyroid

A
  1. methimazole- stops thyroid from producing hormones

and propylthiouricil

> used pre-op to stun thyroid

  1. iodine compound- give with straw. stains teeth
  2. BB- supportive therapy
  3. radioactive therapy- one dose. destroys cells
    > follow radioactive precautions for 1 week after
    > watch for thyroid storm!!! increased: HR, BP and TEMP x 100
41
Q

hypothyroid

T4? TSH?

A

can be confused with depression

> T4 down
TSH up

Tx: give synthroid on empty stomach

42
Q

parathyroid probs

A

> produces PTH which pulls Ca from the bones and puts into the blood = increase Ca in blood

> too much PTH = too much Ca

43
Q

hyperparathyroid =

A

hypercalcemia and hyperphosphate = sedated

> might have to have partial parathyroidectomy
watch for decreased Ca = tetany and tight ridged muscles

44
Q

hypoparathyroid =

A

hypocalcemia and hypophosphate = not sedated

> give IV Ca
give phosphorus binding drugs
–> Ca acetate or elsalvemere

45
Q

pheochromocytoma

A

benign tumor on adrenal medula that secretes epi and norepi in boluses

46
Q

how to diagnose pheochromocytoma

A

check catecholimine levels using:
1. Vanillylmandelic test- dont eat anything with vanilla, coffee, banana, Vit B, juice
> 24 hr urine collect. throw out first urine and keep last void.
> avoid anything that can increase epi/norepi (stay calm)

  1. matanepherine- check epi in blood
47
Q

adrenal cortex

A

Glucocorticoids, mineralcorticoids and sex hormones

48
Q

what do Glucocorticoids do? 4

A

(cortisol) prednisone
1. change your mood

  1. alter defense mechanism:
    > immunosuppressed = high risk for infections
  2. break down fats, proteins and carbs
  3. inhibit insulin = hyperglycemic (increase BS)
    > N: glucose monitor

ACTH- adrenocorticotropin hormone from pit gland stimulates adrenal cortex to make cortisol

49
Q

what do mineralcorticoids do?

A

Aldosterone: make you retain Na and water and lose K+

Too much:
FVE and decrease K+

Too little:
FVD and too much K+

50
Q

sex hormones

A

test, estrogen and progesterone

Too much:
> hirsutism, acne, irreg periods

Too little:
> decreased pubic/pit hair and libido

51
Q

adrenal cortex problems =

A
  1. not enough steroids
  2. shock
  3. hyperK+
  4. hypoglycemia
52
Q

addisons disease

A

not enough steroids. adrenal cortical insuf.

> less aldosterone = lose Na and water and increase K+

> S and S:
decreased Na, increased K+, hypoglycemia, hypotension

tx: combat shock, increase in diet, I and O’s

Meds: prednisone
» Fludrocortisone is aldosterone

53
Q

addison crisis

A

severe hypotension and vascular collapse

54
Q

cushings

A

too many steroids
Gluco- cortisol: think of what the man looks like
> hyperglycemia
> depresion

sex: oily skin

mineral: aldosterone
> retaining Na and water
> decreased K+

Diet:
increased K+, decreased Na, increased protein and Ca (steroids decrease Ca)

55
Q

what does insulin do

A

carries glucose out of the blood and into the cell.

if no insulin, glucose builds up in the blood and not in the cells. blood becomes hypertonic and pulls fluid into the vascular space.

kidneys filter excess glucose and fluid (polyuria and dipsia).

cells are starving so they start to break down protein and fat = ketones (acids). = Kussmauls

56
Q

polyuria think?

A

SHOCK

57
Q

metformin

A

> reduces glucose production and enhances hoe glucose enters the cell

> does not stimulate the release of more insulin so do not see hypoglycemia

> any Surgery or Radiologic procedure that involves contrast dye = must discontinue Met and resume 48hrs post procedure when kidney function has returned to normal and creatinine is normal.

58
Q

Pts should eat when insulin is at its?

A

PEAK

59
Q

HbA1c

A

glycosylated HGb blood test > or = to 6.5% = diagnose for DM

average of what BS has been over the past 3-4 months

60
Q

DKA can happen?

treat?

A

T1DM

can happen at first time hyperglycemic or DM PT with any infection or skipping insulin

> IV insulin = decreased blood sugar and K+ by driving back into the cell from vascular space.
watch K+ and monitor ECG. could develop arrhythmias
I and O
ABG- metabolic acidosis
START with isotonic IV fluids first until sugar is down to 13.9-16.7 then switch to D5W
MRP will want to add K+ to IV at some point

61
Q

HHNK

A

like DKA but no acidosis

> no fat breakdown = no ketones = no fruity breath = no kussmals

T2DM

62
Q

Preload

A

the amount of blood returning to the heart from vena cava

> stretch = release of ANP
stretch = more power

63
Q

Afterload

A

pressure (resistance) in aorta and periph arteries the left vent has to pump against

> HTN causes ++ resistance = HF and puml edema
high afterload decreases CO and forward flow

64
Q

CO

A

HR x SV

tissue perfusion depends on CO

65
Q

3 arrhythmias that are always a big deal

A
  1. pulseless V.tach
  2. V. Fib
  3. Asystole
66
Q

chronic stable angina

Tx: 4

A

ischemia that leads to pain most often d/t exertion.

  1. relieved by rest and/or nitro SL
  2. BB (prevention)- decreases BP, P and myocardial contractility
  3. CCB (prevention)- dipine, Verapamil, Diltiazem
    > causes vasodilation to arterial system and coronary arteries
  4. ASA (acetylsalicylic acid) antiplatelet-
  5. Cardiac Catheterization- most invasive
67
Q

Nitroglycerine

A

causes venous and atrial vasodilation which will decrease preload and afterload. Also dilates coronary arteries.

> take 1 Q5 min x 3 doses.
dark glass bottle

> PT will get a HA

> manipulating someones BP is considered unstable>

68
Q

cardiac catheterization

A

> ask if allergy to shellfish or iodine
check kidney function
PT will feel flushing, warm sensation, maybe palpitations

> assess all P’s 5 after
bed rest flat 5-6 hrs
watch for bleeding

69
Q

unstable chronic angina

A

impending MI/ acute coronary syndrome

> can have ischemia and/or necrosis
can come on without cause
nitro will not relieve pain

70
Q

Women presenting with MI

A

> less than man
epigas discomfort
jaw pain
pain btwn shoulders

Woman triad
> indigestion
> chronic fatigue
> SOB

71
Q

Elderly MI

A 
> SOB number 1
> cold/clammy
> vomiting
> ECG changes
> CO decreasing
72
Q

diagnostics for MI

A
  1. CPK-MB (creatine kinase)- cardiac specific iso-enzyme increases with damaged cardiac cells
    > elevates in 3-4 hrs and peaks in 10-24hrs
  2. Troponin- increases from myocardial damage
    > elevates in 3-4 hrs and remains elevated for up to three weeks
    > most sensitive!!!
  3. Myoglobin- increases in 1 hr and peaks in 12 hrs.
73
Q

Epi

Amioderone

A

Vassopressor

Anti-arrhthmic

For V.Fib and pulseless V.Tach are resistant to tx. Also for fast arrhythmias

74
Q

what meds are used for chest pain when in ED?

A

MONA

  1. O2
  2. ASA chewable
  3. Nitro
  4. Morphine
75
Q

thrombolytics

A

Alteplase- dissolve clot

> give within 6-8 hours of stoke. The sooner the better.

> mjr complication = bleeding. dont give if bleeding

> N: during or after admin we take bleeding precautions

76
Q

what meds for bleeding precautions?

A
  1. anticoagulants/platelets
  2. antithrombotics- end “aban” “atran” rivaroxiban
  3. Tylenol

NO ABGs with thrombolytics

77
Q

PCI

A

percutanious Coronary Intervention

> major complication is MI

> need anti=platelet meds
> ASA
> clopidogrel (plavix)

78
Q

Widow maker

A

Left coronary artery occlusion = sudden death

79
Q

diagnose HF

med Tx: for HF

A
  1. BNP

> secreted by ventricular tissues in heart when vol and pressure are increased

  1. CXR- heart will be enlarged
  2. Echocardiogram- looks at pumping action/ ECG (electrocardiogram)
    > echo = US/ ECG = 12 lead
  3. know that New York Heart association = number 4 is the worst

Tx: ACE, ARBs, Digoxin, Diuretics

80
Q

ACE and ARBs

A

both block aldosterone. Then losing Na and water and increasing K+.

81
Q

A PT with HF will be sent home on?

A

An ACE inhib and/or BB

bc these drugs decrease the workload on the heart by vasoconstricting (decrease afterload)

82
Q

Digoxin

A

watch for toxic

> norm: 0.5-2.0

> simus rhythm or A.Fib
stronger contraction and decrease HR = slow rate, more time for vents to fill

> needing loading (larger dose/s)

> bfr admin always check APICAL pulse (5th intercoastal space)

> hypokalemia + Dig = toxicity
any electrolyte imbalance can cause Dig toxic

83
Q

S and S of Dix toxicity

Early:

Late:

A

Early: anarexia, N/V

Late: arrhythmias, visual changes (halo around lights, yellow/purple)

84
Q

diuretics

A

decreases preload and fluid retention

Take daily weights –> report gain of 2-3 lbs /day

85
Q

If fluid retention think

A

HF

86
Q

what else can you do for HF?

A

> low Na diet
elevate HOB
daily weight
pacemaker (SA node) increased HR with symptomatic bradycardia

87
Q

most common complcation post-op for pacemaker is

A

displacement

> perform passive ROM to prevent frozen shoulder
dont raise arm above shoulder height

PT:check HR/pules daily, carry ID card, AVOID electromagnetic feilds and MRIs

88
Q

loss of capture

A

no contraction to follow stimulus

89
Q

firing at inapprop times =

A

failure to sense

90
Q

who is at risk for pulm edema?

A

Young/old
IV fluids fast
HF or RF ppl

91
Q

pulm edema what do you see?

A

productive pink froth sputum
cough…

give O2 and keep stats above 90

> give diuretics

92
Q

pulm edema what do you do

A
  1. furosemide- push slow to avoid ototoxic or bumetenide
  2. nitro- to vasodialte and decrease CO
  3. Morphine- vasodilate, decrease preload and afterload
  4. Nesiritide - vasodialtes and has a diuretic effect (counteracts BNP)
    » if on this drug–> turn off 2 hrs prior to drawing a BNP»
93
Q

If in HF, what possition?

A

> want legs to dangle to pool fluid and upright

94
Q

Cardiac Tamponade

A

20-50mls around sac

> CVP will be increased but BP will be decreased d/t CO dropping&raquo_space;> hallmark for CT

> neck vains distended but lung sounds clear

> shocked
narrowed pulse pressure&raquo_space;> = CT
widened pulse pressure&raquo_space;> = increased ICP
(diff between systolic and diastolic) 40-60 normal
< 40 = narrow
60 = wide

Tx: pericardiocentesis/ surgery

95
Q

intermitt claudication is hallmark sign for what?

A

Arterial Disease

no blood getting to extreamities d/t atherosclerosis
> numb/pain/cold/no pulse palp…
> atrophy, bruit, nail/skin changes/ ulcerations, no leg hair

96
Q

we elevate

A

veins

97
Q

we dangle

A

arteries

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