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1
Q

Atrial Natriuretic Peptide (ANP)

A

opposite of aldosterone - so causes the excretion of sodium and water
Is released as the heart is stretched to fix FVE

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2
Q

Antidiuretic hormone

A

causes you to retain WATER WATER WATER

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3
Q

With urine specific gravity, sodium, and HCT concentrated makes the #s go

A

up

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4
Q

With urine specific gravity, sodium, and HCT dilute makes the #s go

A

down

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5
Q

Not enough antidiuretic hormone

A 
Diuresis Water
Fluid Volume Deficit
Diabetes Insipidus - nothing to do with blood sugar
Blood Concentrated (so increased #s)
Urine Dilute (so decreased #s)
Increased urine output
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6
Q

When not enough antidiuretic hormone number one thing to worry about is?

A

shock

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7
Q

What are some potential causes of antidiuretic hormone problems

A

(anything that upsets pitutary gland)

craniotomy, head injury, sinus surgery, transphenoidal hypophysectomy

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8
Q

Any condition that can lead to and increase in ICP can lead to *

A

an antidiuretic hormone problem

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9
Q

Pt had transphenoidal hypophysectomy and voided 1300 ml worry about

A

pt getting diabetes incipidus and developing shock

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10
Q

If going into FVE where will you hear “wet” sounds first?

A

posteriorly in the bases of the lungs

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11
Q

If in FVE what happens to pulse

A

increases and will be full and bounding
the heart is now pumping harder to keep fluid moving forwards and not backwards (if goes backwards will lead to HF and pulmonary edema)

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12
Q

any acute weight gain is

A

water not fat

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13
Q

MORE VOLUME…. MORE

A

PRESSURE

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14
Q

If fluid retention then think what first? *

A

heart problem

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15
Q

Bed rest and diuresis

A

Bed rest induces diuresis by release of ANP (opposite of aldactone) and decreases production of ADH

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16
Q

Bed rest can increase risk for

A

DVT, dehydration, kidney stones, pneumonia, and constipation (all because bed rest causes diuresis and can go into FVD)

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17
Q

If pt on bed rest what is very important to do?

A

push fluids because bed rest induces diuresis

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18
Q

anytime you see an assessment or evaluation you should be looking for the presence or absence of

A

PERTINENT signs and symptoms

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19
Q

Give IV fluids slowly to

A

elderly, very young, and hx of kidney disease

can put in FVE very fast

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20
Q

If pt loosing fluid worry about

A

shock

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21
Q

Pts with ascites important problems

A

breathing problems (fluid pushing on diaphragm) and hypotension (fluid in wrong spot)

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22
Q

PID (particle induced diuresis) with diabetes

A

sugar particles have to come out in volume and is why the diabetic pt gets diuresis

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23
Q

When pt goes from polyuria to oliguria to anuria worry about

A

renal failure

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24
Q

with polyuria think what first?*

A

shock

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25
Q

FVD pts at risk for

A

orthostatic hypotension because there is less volume and less pressure

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26
Q

in FVD respirations are

A

increased because body thinks hypoxic so increases rate to fix hypoxia

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27
Q

Isotonic solutions

A

Normal Saline (0.9%), Lacted Ringers, D5W, D51/4NS

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28
Q

Uses for isotonic solutions:

A

N/V, burns, sweating, trauma

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29
Q

solutions with blood

A

NS

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30
Q

Best solution for shock

A

LR because has electrolytes

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31
Q

Do not use isotonic solutions with

A

HTN, cardiac disease, or renal disease

solutions can cause FVE, HTN, or Hypernatremia

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32
Q

Only solution that can cause hypernatremia

A

isotonic

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33
Q

Hypotonic solutions definition:

A

go into vascular space then shift out into the cells to replace cellular fluid
they rehydrate but do not cause hypertension (won’t increase bp because don’t stay in vascular space)

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34
Q

Hypotonic solutions:

A

D2.5W, 1/2 NS, 0.33% NS

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35
Q

Uses of hypotonic solutions

A

HTN, renal disease, cardiac disease, N/V, burns, hemorrhage, used for dilution with hypernatremia and for cellular rehydration

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36
Q

With hypotonic solutions watch for

A

cellular edema because this fluid is moving out into cells which could lead to FVD and decreased bp

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37
Q

hypertonic =

A

colloid

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38
Q

isotonic =

A

cyrstaloid

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39
Q

hypertonic solutions definition:

A

volume expanders that will draw fluid into the vascular space from the cell

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40
Q

hypertonic think!

A

packed particles

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41
Q

hypertonic solutions

A

D10W (sugar), 3% NS, 5% NS (salt), D5LR, D51/2 NS, TPN, Albumin

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42
Q

Uses of hypertonic solutions

A

hyponatremia, pt who has shifted large amounts of vascular volume to 3rd space, severe edema, burns, or ascites

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43
Q

a hypertonic solution will

A

return the fluid volume to the vascular space

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44
Q

with hypertonic solutions watch for

A

fluid volume excess
monitor bp, pulse, and CVP
especially with 3% NS or 5%NS

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45
Q

Insulin carries what into cell

A

glucose and potassium

so anytime give IV insulin worry about hypoglycemia and hypokalemia

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46
Q

hyperventilation and CO2

A

eliminate CO2

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47
Q

hypoventilation and CO2

A

retain CO2

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48
Q

causes of respiratory acidosis

A

(retaining CO2 and HYPOventilation)
mild abdominal incision (can’t take in deep breaths), narcotics and sleeping pills ( repress breathing), pneumothorax, collapsed lung, pneumonia (sticky secretions)

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49
Q

respiratory acidosis s/s

A

h/a, confused, sleepy
can go into coma
hypoxic (early s/s restless and tachycardia)

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50
Q

If restless pt think what 1st

A

hypoxia

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51
Q

to treat respiratory acidosis you

A

need to fix the breathing problem

so elevate bed, deep breathing, suctioning, voldyne

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52
Q

respiratory acidosis hypo/hyperventilating

A

hypo - retaining CO2 that’s an acid

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53
Q

respiratory alkalosis hypo/hyperventilating

A

hyper - losing CO2 (acid) and why alkalotic

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54
Q

respiratory alkalosis causes

A

hyperventilation
hysterical
acute aspirin overdose (stimulates respiratory center in the brain)
-pt breathing too fast and removing CO2

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55
Q

respiratory alkalosis s/s

A

lightheaded
faint
perioral numbness
numbness and tingling in fingers and toes

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56
Q

respiratory alkalosis treatment

A

breathing into paper bag to force back CO2

may sedate pt to decrease respiratory rate

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57
Q

metabolic acidosis causes

A

(too much hydrogen (acid) and too little bicarb (base)
DKA - body doesn’t have insulin to bring glucose into cells so breaks down body fats for energry leads to ketones (acids)
Starvation - starving for glucose so break down protein and produce ketones (acids)
Renal Failure - no longer can filter out acids or retain bases
Severe diarrhea - lower GI has lots of bases but when diarrhea loses bases

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58
Q

metabolic acidosis s/s

A

hyperkalemia - muscle twitching/weakness/flaccid, arrhythmias
increased respiratory rate - trying to blow off the acid
increased serum potassium level

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59
Q

see what kind of respirations with DKA

A

kausmals because the body has too much acid (resulting from ketones) and body tries to blow off CO2 to become less acidic

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60
Q

diarrhea what type of acid/base imbalance

A

metabolic acidosis

comes out of your acidosis

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61
Q

drug to help metabolic acidosis

A

IV push sodium bicarb - will not fix but buy time to figure out cause
will get pH back in normal range then figure out cause

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62
Q

metabolic alkalosis causes

A

loss of upper GI contents (acid in stomach)
too many antacids (so too much bases)
too much IV bicarb

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63
Q

metabolic alkalosis s/s

A

LOC alterations
serum K levels will go down
respirations will decrease to try to hold onto CO2

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64
Q

metabolic alkalosis treat with

A

potassium to replace lost

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65
Q

metabolic acidosis = (K)

A

hyperkalemia

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66
Q

metabolic alkalosis = (K)

A

hypokalemia

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67
Q

After a burn why does plasma seep out into the tissue?

A

increased capillary permeability (leaking) - the vessels are damaged from heat so thats why they leak
vascular volume is decreased so at risk for shock
occurs 1st 24 hours after burn

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68
Q

After a burn what happens to pulse and cardiac output

A 
pulse increases (because in FVD)
cardiac output decreases - because less volume
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69
Q

After a burn what happens to urine output

A

decreased because either kidneys trying to hold onto fluid or they aren’t being perfused (only takes 20 mins of poor kidney perfusion to have kidney necrosis)

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70
Q

After a burn why is epinephrine excreted

A

makes you vasoconstrict to shunt blood to vital organs and help to increase bp

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71
Q

After a burn why are ADH and aldosterone secreted?

A

aldosterone - retain Na and water
ADH - retain water
therefore blood volume will go up

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72
Q

problem with carbon monoxide

A

normally oxygen binds with hemoglobin but carbon monoxide travels much faster than oxygen therefore gets to hemoglobin faster and now oxygen can’t bind now pt is hypoxic

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73
Q

color of carbon monoxide pt

A

cherry red not blue

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74
Q

treatment for carbon monoxide poisoning

A

100% O2 - trying to increase the chances of O2 to bind with hemoglobin instead of carbon monoxide

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75
Q

What would MD do if pt has burns to chest/neck/face?

A

intabate! - do this before trach because less invasive

airway will swell then will have to trach so intabate before have to trach

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76
Q

Rule of Nines

A 
Head and neck 9%
Front of trunk 18%
Back of trunk 18%
Arms (each) 9%
Genitals 1%
Legs (each) 18%
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77
Q

Parkland formula

A

(4ml of LR) x (weight in kg) x (% of TBSA burned) = total fluid requirement for the 1st 24 hours after burn
1st 8 hours

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78
Q

Fluid therapy for burns depends on what

A

the time the injury occurred not when the treatment was started

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79
Q

restless burn pt means

A

inadequate fluid replacement, pain, or hypoxia

hypoxia is the priority, pain never killed anyone

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80
Q

in burn pts how would you tell if fluid volume is adequate -

A

urine output
not weight because burn pts getting fluids fast and causes an increase in weight gain which makes urine output a better indicator

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81
Q

Emergency burn management

A

put cool water! (not ice water - ice causes vasoconstriction)
remove jewelry to prevent swelling
place blanket to hold in body heat and keep out germs
remove non-adherent clothing and cover burn with a clean dry cloth

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82
Q

Shallow respirations means?

A

pt retaining CO2 and in respiratory acidosis

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83
Q

Test to take hourly to know if over doing fluid

A

CVP - right atrial pressure

will increase and the right atrium fills with fluid

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84
Q

Give what type of pain meds to burn pt

A

IV narcotics over IM

  1. act faster
  2. won’t have adequate perfusion to muscles
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85
Q

If a pt has a circumferential burn on their arm what should you be checking?

A

circulation!

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86
Q

Circulatory check:

A
  1. pulse
  2. skin color
  3. skin temp
  4. cap refill
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87
Q

escharotomy -

A

relieves the pressure and restores the circulation, cutes through the eschar

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88
Q

fasciotomy -

A

relieves the pressure and restores the circulation, but cut is much deeper into tissue than escharotomy, cut goes through the eschar

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89
Q

why when insert foley cath no urine returns?

A

kidneys are attempting to retain fluid or they aren’t being perfused adequately

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90
Q

If you see brown or red urine in burn pt what would you do?

A

call the MD
this happens because will have muscle and tissue destruction then myoglobin is released in urine, then worry about renal failure
want to increase fluids to flush out kidneys
mannitol used to flush out kidneys - exception to the no diuretics to burn pts

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91
Q

If no urine output or less than 30 ml/hour what would you worry about?

A

kidney failure

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92
Q

Why burn pt NPO and have an NG tube hooked to suction?

A

because they can develop a paralytic illeus - which could cause gastric secretions to build up in stomach and potential to aspirate

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93
Q

Why burn pts can get a paralytic illeus?

A

Decreased vascular volume - blood shunted to vital organs and gut not perfused
Decreased GI motility - normal stress response
Hyperkalemia - symptom of muscle weakness - intestines are smooth muscle

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94
Q

if pt doesn’t have bowel sounds, what will happen to the abdominal girth?

A

increases

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95
Q

Diet for burn pts

A

high protein and vitamin C*, need maximum nutrition - they are in a hypermetabolic states

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96
Q

NG tube removed when

A

hear bowl sounds

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97
Q

when start GI what should you measure to ensure the supplement is moving through GI tract

A

gastric residuals
Order to hold feeding if >50 - means parstolic activity is very slow so hold feeding and put residual back in to prevent fluid/electrolyte imbalances

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98
Q

lab work to ensure proper nutrition and a positive nitrogen balance?

A

prealbumin, total protein, or albumin

prealbumin - most sensitive indicator of overall nutritional status

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99
Q

what to do if burns on neck?

A

hyperextend the neck, head is back

no pillows, promotes chin-to-chest

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100
Q

what is eschar

A

necrotic dead tissue
has to be removed - new tissue can not regenerate if not removed
also, bacteria can grow in bacteria

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101
Q

If see skin graft hanging by sutures then

A

immediately put on sterile dressings and call MD

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102
Q

what to put on a donor site of skin graft

A

transparent dressing until bleeding stops, then can be left open to air

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103
Q

what to do first with a chemical burn

A

begin flushing for 15-20 mins

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104
Q

if eye burn then

A

take out contacts

flush immediately

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105
Q

1st thing to do with electrical burns

A

put on continuous heart monitor for 24 hours - at risk for ventricular fibrillation

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106
Q

with electrical burns how does kidney damage occur

A

the build up of myoglobin and hemoglobin

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107
Q

complications of electrical burns

A

kidney damage, cataracts, gait problems, and any NEUROlogical deficit

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108
Q

Monthly self breath exam after the age

A

over 20

7-12 days after period

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109
Q

Yearly clinical breast exam for women

A

> 40 years old
needed every 3 years for 20-39
Mammogram yearly at 40 (with 2 views of each breast)

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110
Q

What not to do before pap smear

A

douching or sex

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111
Q

Before mammogram instruct pt to not

A

have on lotion, powder or deodorant

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112
Q

When to have colonoscopy

A

at 50 then every 10 years after that

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113
Q

digit exam for men

A

yearly and yearly prostate specific antigen for me after age 50

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114
Q

testicular tumors grown between

A

15-36

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115
Q

Warning signs for cancer (CAUTION)

A 
Change in bowel/bladder habits
A sore that does not heal
Unusual bleeding/discharge
Thickening or lump in breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in wart or mole
Nagging cough or hoarseness
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116
Q

internal radiation

A

(brachytherapy) radioactive source is inside the pt and radiation is being emitted so hazard to others
Unseal - pt and body fluids emit radiation (hypothyriodism)
Sealed or solid - pt emits radiation body fluids don’t

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117
Q

When radiation implants pt should

A

rotate nursing assignments rotated daily so nurse not continuously exposed
nurse should only care for 1 pt with radiation implants

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118
Q

How to help prevent dislodgment of internal radiation implant

A

keep pt on bed rest
decrease fiber in the diet - will distend bowl and push out implant
prevent bladder distention - will put foley in

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119
Q

What do you do if the implant becomes dislodged and you can see it?

A

1st put on gloves
pick it up with forceps or tongs
place it in a lead lined container
leave it in room and call radiation to come and pick it up

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120
Q

external radation

A

(teletherapy, beam radiation)
s/e usually limited to exposed tissue
do not wash or put anything on markings unless MD ordered
protect site for 1 year after completion of therapy

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121
Q

when handling chemo nurses

A

need to be careful because chemo drugs can be absorbed through the skin and mucous membranes

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122
Q

vesicant

A

type of chemo that if extravasation (infiltrates) will cause tissue necrosis
have to stay with pt the whole time

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123
Q

extravasation

A

vesicant infiltration
s/s: pain, swelling, and no blood return
need to prevent

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124
Q

if extravasation occurs what do you do?

A

Stop the infusion, put ice packs on the promote vasoconstriction, and call MD

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125
Q

what to do when IV infiltrates

A

apply warm moist heat

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126
Q

water for pts that are immunospressed

A

do not leave sitting for longer than 15 mins

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127
Q

conization

A

when remove part of the cervix for pts with cervical cancer

this is for someone who wants to preserve part of their fertility but depends on stage of cancer

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128
Q

endometrial cancer -

A

uterine cancer

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129
Q

Major s/s for uterine cancer

A

post menopausal bleeding (50% chance)

teach pts if ever have bleeding after menopause to tell MD

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130
Q

total abdominal hysterectomy means

A

uterus and cervix only!!!

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131
Q

bilateral oophorectomy

A

ovaries removed

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132
Q

bilateral salpingectomy

A

tubes are removed

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133
Q

radical hysterectomy

A

may remove all of the pelvic organs

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134
Q

major complication with abdominal hysterectomy?

A

hemorrhage

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135
Q

major complication with vaginal hysterectomy?

A

infection

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136
Q

why avoid high fowlers with hysterectomy

A

because it makes blood pool to the pelvis

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137
Q

One thing for pt after surgery to prevent risk of pneumonia, thrombophlebitis, and constipation

A

early ambulation

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138
Q

pts with surgery for best cancer important to

A

elevate arm on affected side and they need to be taught to protect this arm - no bp, watch, or purse on arm, no IVs

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139
Q

know with surgery after breast cancer might have had to

A

removed lymph nodes and now swell (lymphedema) and lymph nodes purpose is to fight infection and promote drainage

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140
Q

where most breast tumors occur

A

tail of spence located in upper outer quadrant

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141
Q

hemoptysis and dyspnea are s/s of lung cancer but can be confused with

A

TB but TB has night sweats

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142
Q

after bronchoscopy could have

A

SQ emphysema - air under the tissues
feels like rice cripys sounds
EMERGENCY!

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143
Q

respiratory depression

A

depressed

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144
Q

sputum specimen

A

should take 1st in the morning
should be sterile - don’t want mouth touching cup
first the pt should rinse mouth out with water - to decrease the bacteria in the mouth

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145
Q

Lobectomy

A

part of the lung is removed
surgical side up
will have chest tubes

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146
Q

Pneumonectomy

A

entire lung is removed
position on affected side (surgical side down, good lung up) - so lung can expand and not get pneumonia
No chest tubes - because there’s no lung
Avoid lateral positioning (don’t turn all the way on their side) - can lead to mediastinal shift!!

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147
Q

total laryngectomy

A

removal of vocal cords, epiglottis, thyroid cartilage
because epiglottis is removed at risk for aspiration
pt will have a permanent trachostomy and breath out of stoma the rest of their life

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148
Q

post opp position after total laryngectomy

A

mid folwers

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149
Q

if emergency and have the options call MD or check VS

A

CALL MD

because this only gives you one option

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150
Q

side effect emergency of a total laryngectomy

A

rupture of innominate artery!

begins with bleeding massively from trach

151
Q

with a total laryngectomy ALL breathing is

A

done through the stoma

152
Q

If trach comes out

A

if can’t get new sterile trach then run and insert dirty trach
better to be alive with infection then dead infection free

153
Q

Bloom Singer device

A

connection is made between the trachea and esophagus
pt can insert soft plastic device and move air from lungs to trachea and then over to esophagus and out of mouth
tongue and lips can form words with the rush of air
nothing can be pulled from esophagus into lungs - so don’t have to worry about aspiration

154
Q 
Can pt with total laryngectomy:
whistle?
use straw?
smoke?
swim?
A

whistle? no
use straw? no
smoke? not recommended, but could
swim? no

155
Q

suctioning with total laryngectomy

A

sterile technique
hyperoxygenate before and after
stop advancing catheter when you MEET RESISTANCE* or pt coughs
apply suction on the way out
do intermittent suction no longer than 10 seconds
watch for arrhythmias

156
Q

If suctioning and heart rate drops

A

vagus nerve was stimulate, pt is not hypoxic

stop suctioning and hyperoxygenate

157
Q

Colorectal cancer most frequent site of metastasis

A

liver

so take bleeding precautions

158
Q

colectomy

A

part of the colon removed

may not need colostomy, depends on how much is removed

159
Q

abdominoperineal resection

A

removal of the colon anus, rectum

cannot take rectal temp *

160
Q

Can’t take rectal temp with which pts

A

abdominoperineal resection, thrombocytopenic, or immunosuppressed

161
Q

major symptom of bladder cancer

A

painless intermittent gross/microscopic hematuria

162
Q

illeal conduit

A

piece of the ileum is turned into a bladder
ureters are placed in one end is brought to the abdominal surface as a stoma
so urostomy!
need to flush out so drink lots of fluid (2,000-3,000)
now normal to have mucus - because bladder made from part of intestine
change appliance in morning (because output will be its lowest
Also, its ok to place a little piece of 4x4 inside the stoma during skin care to absorb urine just don’t forget to remove it

163
Q

after any urinary surgery with males chance of

A

impotent

164
Q

most common sign of prostate cancer

A

painless hematuria
(others: hesitancy, frequency, frequent infections - because can’t empty bladder completely, nocturia, urgency, dribbling)

165
Q

radical prostatectomy

A

biopsy must be done prior to surgery for confirmation of prostate cancer
take out the prostate and if pt is cancer free then no metastasis
may have erectile dysfunction due to pudendal nerve damage
may have incotinence
pt is sterile

166
Q

prostatectomy TURP

A

transurethral resection of the prostate
used to help urine flow NOT a cure for prostate
no incision
excessive bleeding complication - worried about clogging up kidneys so use continuous bladder irrigation to maintain patency and flush out clots

167
Q

Can you manually irrigate a catheter with a fresh surgery pt?

A

NEVER without MD order

168
Q

When walk into room assess tubing for kinks or bladder distention on pt 1st

A

bladder distention
always assess pt first
and always assess before implement

169
Q

bilateral orchiectomy

A

decreases testosterone

170
Q

most common s/s of stomach cancer

A

heart burn and abdominal discomfort

171
Q

gastrectomy

A

take out stomach but leave some if can
fowlers position
will have NG tube - do not reposition

172
Q

complications of gastrectomy

A

dumping syndrome

vitamin B12 deficient anemia

173
Q

no stomach r/t vitamin B12

A

no stomach then no instrinic factor then can’t absorb PO B12 can’t make good RBC so pt is anemic
will get B12 shots every week for a month then monthly after that

174
Q

Schilling’s Test*

A

measures the urinary excretion of vitamin B12 for diagnosis of PERNICOUS ANEMIA not iron deficiency

175
Q

You need what to produce hormones?

A

Dietary iodine (different than drug)

176
Q

Thyroid hormones give us

A

energy!

177
Q

Diagnosing graves disease

A

(Hyperthyroidism)
draw serum T4 levels -increased
thyroid scan - enlarged thyroid

178
Q

what must pts do prior to thyroid scan?

A

pts must discontinue any iodine containing medication 1 week prior

179
Q

eu =

A 
normal 
so euthyroid (normal thyroid)
180
Q

tyroidectomy pt care

A

Teach how to support neck because incision on front of neck and don’t want tension on suture lines
elevate HOB
check for bleeding behind the neck (pooling)
will need more calories
assess for recurrent laryngeal nerve damage by listening for hoarsness

181
Q

thyroidectomy can lead to what

A

vocal cord paralysis, if both then possibly airway obstruction will occur then require immediate trach

182
Q

When would you trach at bedside of thyroidectomy

A

swelling
recurrent laryngeal nerve damage (vocal cord paralysis)
hypocalcemia
- assess for parathyroid hormone by the s/s of hypocalcemia (not sedated, rigid and tight muscles) - could possibly have seizure

183
Q

People with hypothyroidism tend to have underlying

A

CAD

so monitor for chest pain and rhythm changes when giving meds that increase HR and BP

184
Q

the parathyroid secretes

A

parathormone which makes you pull calcium from the bones and place it in the blood

185
Q

if too much parathormone then serum Ca will

A

be high

186
Q

if too little parathormone then serum Ca will be

A

low

187
Q

partial parathyroidectomy

A

when take out 2 of your parathyroids to decrease PTH secretion
done when pt hyperparathyroid/hypercalcium/hypophastemia
monitor hypocalcium post opp (non sedated, rigid tight muscles)

188
Q

vanillylmandelic acid test

A

24 hours urine specimen is done to see if pt has pheocromocytoma (adrenal medulla problem)
looking for increased levels of epi and norepi
can’t have anything with vanilla in it for a wk prior
throw away first void and keep the last for 24 hours
have to remain calm for those 24 hours so that epi and norepi don’t increase

189
Q

even though the body secretes steroids normally the adverse effects are going to be more pronounced when the

A

pt is receiving PO or IV steriods

190
Q

too much aldosterone =

A

too much Na and Water
so FVE
decrease serum potassium

191
Q

not enough aldosterone =

A

decrease Na and water
so FVD
increase serum potassium

192
Q

hyperkalemia s/s

A

begins with muscle twitching, then weakness then flaccid paralysis

193
Q

Tx of Addison’s disease

A

Increase sodium in diet (processed fruit juice)

I&Os (this is a fluid problem)

194
Q

Addisonian Crisis =

A

severe hypotension and vascular collapse
can occur when stop taking steroids abruptly
have to taper steroids because body not making on steriods

195
Q

What happens with blood sugar with addison’s disease?

A

Will go do

normally steroids increase bs but now don’t have steroids

196
Q

If see fluid retention think what first?

A

heart problem and worry about pulmonary edema

197
Q

too many glucocorticoids s/s

cushing’s

A 
growth arrest
thin extremities/skin (lipolysis)
increased risk of infection 
hyperglycemia
psychosis to depression
moon faced (fat redistribution or fluid retention)
truncal obesity (fat redistribution; lipogenesis)
buffalo hump (fat redistribution)
198
Q

too many sex hormone s/s

cushing’s

A

oily skin/acne
women with male traits
poor sex drive (libido)

199
Q

libido

A

poor sex drive

200
Q

too many mineralocorticoids s/s

cushing’s

A 
(too much aldosterone)
high bp
CHF
weight gain
Fluid volume excess*
201
Q

if the pt has too much mineralocorticoid (aldosterone) the serum K level would be

A

low

202
Q

adrenalectomy

A

removal of adrenal glands

if both are removed will need lifetime replacement of steroids

203
Q

what type of environment for cushings pts

A

quiet because when steroids are messed up can’t handle stress

204
Q

diet for cushings pre-treatment

A

increase K decrease NA increase Protein increase CA

205
Q

steroids can cause what to develop

A

osteoporosis
because steroids decrease serum calcium by excreting it through the GI tract and then pull Ca out of the bones and make them brittle

206
Q

What could appear in cushings pt urine

A

glucose and ketones

NOT protein

207
Q

if their is protein in urine then

A

holes in glomerulus

208
Q

why diabetes polyuria

A

because too many sugar particles so PID (particle induced diuresis) kidneys try to excrete sugar and has to come out in volume so could lead to shocke

209
Q

why diabetes polydipsia

A

losing volume so now thirsty

210
Q

why diabetes polyphagia

A

cells are starving so they start breaking down protein and fat for energy and than leads to ketones

211
Q

Acid base balance for diabetes

A

Type I metabolic acidosis

Type II not acidosis - because not breaking down fats

212
Q

Pts with type II diabetes should be evaluated for

A

Metabolic syndrome (syndrome x) - know to teach how to decrease risk factor by lifestyle changes

213
Q

screen pregnant women for gestational diabetes at

A

24-28 weeks gestations

if mom has risk factors screen at first visit

214
Q

complications to baby of gestational diabetes

A

increased birth weight and hypoglycemia
(while baby in mom the baby’s pancreas is producing excess insulin because of increased blood sugar in mom, once born, baby still over producing insulin)

215
Q

protein diet for diabetes

A

limit protein to 10-20%

increase protein = increased workload on kidneys - diabetics tend to have renal disease

216
Q

why are diabetics prone to CAD?

A

sugar destroys vessels just like fat

need to keep sugar normal to save vessels

217
Q

fiber diet for diabetes

A

high fiber - slows down glucose absorption in the intestines, and eliminates the sharp rise/fall in blood sugar

218
Q

ketones in urine

A

body breaking down fat

lead to metabolic acidosis

219
Q

blood sugar and stress

A

increases so if not taken care of then DKA

ILLNESS=DKA

220
Q

rotation of insulin sites

A

rotate within an area first

221
Q

s/s of hypoglycemia

A

cold, clammy, confused, shaky, h/a, nervous, nauseated, increased pulse

222
Q

if hypoglycemic then

A

eat or drink simple sugar

(4-6 oz of juice, coke, or milk

223
Q

glucose absorption is delayed in foods with lots of

A

fat

224
Q

after pt hypoglycemic and bs is up what should they do

A

eat a complex carb and protein to keep from bottoming out blood sugar

225
Q

If totally unconscious pt then put what in mouth to increase bs

A

while pt on side in dependent position - honey, syrup, jelly, icing

226
Q

kussmaul’s respirations

A

trying to blow off CO2 to compensate for metabolic acidosis

in DKA

227
Q

DKA tx

A 
hourly blood sugar and potassium levels
IV insulin
ECG
Hourly outputs
ABGs (will be in metabolic acidosis)
IVFs - start with NS then switch to D5W when bs is 300 to prevent hypoglycemia
228
Q

Type I diabetes = DKA so type II =

A

HHS or HHNK

229
Q

diabetic foot care

A

cut toe nails straight, dry between toes, wear well fitting shoes, inspect feet daily, no chemicals on feet

230
Q

Diabetics are at increased risk for

A

infection because full of sugar and bacteria love sugar

231
Q

Weight _____ in mild depression

A

gain

232
Q

Weight _____ in severe depression

A

loss

233
Q

can people with depression make simple decisions?

A

no

234
Q

As depression lifts what happens to suicide risk

A

it does up

now they have the energy to complete the task

235
Q

do what to give depressed pts more time to process information

A

use silence!

236
Q

depressed pts and sleep

A

have difficulty falling asleep, staying asleep, or have early morning awakening

237
Q

depression + mania =

A

bipolar disorder

238
Q

with manic pt and their beliefs

A

let them know you accept that they need the belief but you do not believe it!

239
Q

manic pts are very

A

manipulative - it makes them feel powerful

240
Q

with manic pts you must

A

set limits and the staff must be consistent

241
Q

manic pts and staff

A

brief, frequent contact - too much intense conversation stimulates the pt

242
Q

when manic pts eat

A

walk with them, they will eat better

243
Q

what is important to do with schizophrenic pts

A

orient them frequently - pt may know person, place, and time, but still have delusions and hallucinations

244
Q

when pt in restraints check on them

A

every 15 mins and remember hydration, nutrition, and elimination
if pt can’t contract for safety have to be one on one

245
Q

make sure with paranoia pts you are

A

reliable!!
if you say you are going to do something then do it
always be honest!

246
Q

anxiety increases performance at ________

decreases at _______

A

increases at mild levels

decreases at high levels

247
Q

the pt who is anxious needs

A

step by step instructions - they can’t make simple decisions

248
Q

do you let OCD pts time for rituals

A

yes but decrease each time
never take away ritual without replacing it with another coping mechanism
if can’t perform ritual increased anxiety

249
Q

Stages of alcohol withdrawal

A

Stage I - Mild tremors, nervous, nausea
Stage II - increased tremors, hyperactive, nightmares, disorientation, hallucinations, increased pulse, increased bp
Stage III - MOST DANERGOUS, severe hallucinations, grand mal seizures

250
Q

for bulimic pts when eating

A

sit with them while eating and 1 hour after

251
Q

pts with panic disorder teach

A

that symptoms should peak within 10 mins

252
Q

preload =

A

amount of blood in right side of heart and the muscle stretch

253
Q

afterload =

A

resistance, pressure in the aorta and peripheral arteries that left vent has to pump against

254
Q

bradycardia and CO

A

decrease

255
Q

tachycardia and CO

A

decreases CO because don’t have time to fill up ventricles

256
Q

CO head to toe assessment if decreased

A 
decreased LOC (brain)
chest pain (heart)
short of breath and sound wet (lungs)
cold and clammy (skin)
UO decreases (kidneys) 
weak peripheral pulses

decreased perfusion why this happens

257
Q

if see change in rhythm do what first before call MD?

A

assess cardiac output (head to toe assessment)

258
Q

what relieves chronic stable angina

A

nitroglycerin and/or rest

(pain usually brought on by low O2 with exertion

259
Q

before cardiac cath need to make sure to ask if

A

allergic to shellfish /iodine

can cause renal failure because you excrete the dye through the kidneys

260
Q

post cardiac cath assess extremity distal to puncture site for

A 
(5 Ps)
pulslessness
pallor
pain
parethesia
paralysis 
(watch site for bleeding and hematoma formation)
keep flat and straight for 4-6 hours
261
Q

major complication from heart cath

A

bleeding!

262
Q

unstable chronic angina =

A

impending MI

263
Q

will rest or nitro relieve pain of MI/unstable angina

A

NO

264
Q

1 sign of MI in elderly

A

SOB

265
Q

ST elevation MI

A

pt having MI and goal to get them to the vath lab for PCI less than 90 mins*

266
Q

CP-MB

A

increases with damage to cardiac cells

elevates 3-12 hours and peaks in 24 hours

267
Q

which cardiac biomarker is the most sensitive indicator of MI

A

troponin and is good when pt delayed in seeking care

268
Q

negative myoglobin

A

good! not MI

269
Q

if pt in v fib then

A

defib! ASAP

do CPR inbetween

270
Q

if first shock doesn’t work and pt is still in vfib then what vasopressor do we give

A

epinephrine

271
Q

what antiarrythmic drugs commonly used to prevent second episode of v fib

A

amiodarone (cordarone) or lidocaine

272
Q

Order of drugs given for chest pain in the ED

A 
(oh a new method)
Oxygen
Aspirin (chewable)
Nitro
Morphine
273
Q

what about ABGs in bleeding precautions

A

Do not draw, decrease the # of puncture sites - so draw blood when starting IV

274
Q

PCI

A 
percutaneous coronary intervertion 
stents and angioplasty 
major complication MI
if any problems occur - go to surgery
IF CHEST PAIN - CALL ASAP - pt reoccluding
275
Q

s/s of HF

A

weight gain
ankle edema
shortness of breath
confusion

276
Q

left main coronary artery occlusion think

A

sudden death or widow maker!

277
Q

left sided HF

A 
blood not moving forward so goes backwards into lungs
pulmonary congestion
dyspnea 
cough 
blood tinged frothy sputum
restlessness
tachycardia
S3
orhtopnea
noctural dyspnea
278
Q

right sided HF

A 
blood not moving forward into lungs so moves back into venous system 
distended neck veins
edema
enlarged organs
weight gain
ascites
279
Q

systolic HF

A

heart can’t contract and eject

280
Q

diastolic HF

A

ventricles can’t relax and fill

281
Q

BNP

A 
diagnosis HF - secreted in heart when ventricular volumes and pressure are increased
stop nesiritide (Natrecor) 2 hours prior to drawing
282
Q

rights sided HF usually caused by

A

a lung problem especially hypoxia
pulmonary emboli
pulmonary HTN

283
Q

echocardiogram

A

looks at pumping action of heart

284
Q

diet for HF

A

low Na
decreases preload
watch salt substitutes ( have lots of K)

285
Q

HF pts should report weight gain of

A

2-3 lbs

286
Q

always worry if pt has pacemaker and the *

A

HR drops below set rate

ok for rate to increase but never decrease

287
Q

most common post opp pacemaker complication

A

displacement - wires pull out

need to immbolize the arm
ROM to prevent frozen shoulder
Don’t raise arm higher than shoulder

288
Q

if pacemaker pt and needs to talk on cell phone

A

talk on right side if pacemaker on left side

289
Q

pacemaker pts must avoid

A

MRIs
electromagnetic fields
will set off metal dector
teach how to check pulse everyday!

290
Q

ICD

A

implantable cardiac device

may be used to pace heart or used to defib people in V fib!!

291
Q

people at high risk for pulmonary edema

A

receiving IV fluids fast
young and old
hx of heart or kidney disease

292
Q

pulmonary edema

A 
fluid is back up into the lungs and heart unable to move volume forward 
breathless
restless/anxious
severe hypoxia
productive cough (pink frothy sputum)
293
Q

priority nursing action for pulmonary edema

A

admin high flow O2 and keep O2 sat above 90%

294
Q

position for pulmonary edema pt

A

legs down upright position - improves CO and promotes pooling of blood in lower extremities

295
Q

cardiac tamponade

A 
blood, fluid, or exudates have leaked into the pericardial sac that compresses the heart 
decreased CO
increased CVP
decreased BP
muffled heart sounds
distended neck veins 
narrowed pulse pressure
296
Q

hallmark signs for cardiac tamponade

A 
increasing CVP (because increase pressure from fluid) 
decreasing BP
297
Q

narrowed pulse pressure =

A

cardiac tamponade*

298
Q

widened pulse pressure =

A

increased ICP *

299
Q

tx for cardiac tomponade

A

pericardiocentesis to removed blood from around the heart

300
Q

intermittent claudication hallmark sign for

A

arterial disorder - only with arterial problems not vein

301
Q

arterial disorder

A

O2 not getting to tissues so

coldness, numbness, decreased peripheral pulses*, atrophy, bruit, skin/nail changes, and ulcerations

302
Q

elevate veins or arteries?

A

veins!!

303
Q

dangle veins or arteries?

A

arteries!!

304
Q

If artery problem know that

A

certain part of body not getting O2

305
Q

if descending lower back pain think

A

aorta blowing out

306
Q

artery disorders vs. venous

A

artery = intermittent claudication pain, decreased or absent pulses, pale extremity when elevated and red when lowered, cool temp, thin skin, loss of hair, thick nails, ulceration on toes, possible gangrene

vein = edema, brown pigment around ankles, thick skin, scarring, ulceration on ankles, compression used

307
Q

thoracentesis positioning if can’t sit up

A

good lung down HOB at 45

lay on unaffected side

308
Q

What is the purpose of the CDU?

A

It is to restore the normal vacuum pressure in the pleural space. The CDU does this by removing all air and fluid in a closed one way system until the problem is corrected.

309
Q

What is the purpose of the water seal?

A

This chamber contains 2 cm of water which acts as a one-way valve. In other words we are preventing backflow
so keeps fluid and air coming out and not going back into chest

310
Q

bubbling normal in water seal chamber

A

yes when pt coughs, sneezes or exhales

311
Q

tidaling

A

when see rise and fall of water in water seal as pt breaths

if stops then lung has re expanded

312
Q

for CDU record drainage

A

every hour 1st 24 hrs then every 8 hours

313
Q

pt with CDU notify MD if

A

drainage of 100 mL or greater in 1 hour and if there is a change in color

314
Q

What if my CDU falls over and the water leaks out or shifts to the drainage compartment?

A

Do whatever you can to re-establish the water seal.
Set CDU upright, check all the chambers, and fill the water seal chamber to 2 cm of water.
Have the client deep breathe and cough in case any air went into the pleural space. - will shoot out of tubing
If there is not water in the water seal chamber then air can do what? Collapse the lung

315
Q

if chest tubes accidentally pulled out

A

terile vaseline gauze taped down on 3 sides, otherwise every time they take a breath, they will pull air into the pleural space
Don’t pick air tight choice!!

316
Q

if see continuous bubbling in WATER SEAL chamber then

A

then you have an air leak in the system.
get MD ORDER to clamp to figure out where

continuous bubbling in suction chamber is normal

317
Q

hemothorax/peumothorax

A

blood or air accumulated in the pleural space and lung has collapsed
SOB
increased HR
Diminished breath sounds on affected side and less movement on that side
chest pain
cough

318
Q

tension pneumothorax

A

pressure built up in chest/pleural space and has collapsed the lung then pressure pushes everything to the opposite side (mediastinal shift)

319
Q

open pneumothorax

A

sucking chest wound
opening that allows air into pleural space
stabbing/shooting

take deep breath and hold or humm. - will increase the intra-thoracic pressure so no more air can get into body
then place petroleum guaze on 3 sides!
have sit up if possible to expand lungs
trauma pts stay flat unil evaulated for other injuries

320
Q

fractured ribs/sterum acid base imbalance

A

respiratory acidosis

321
Q

fail chest

A

multiple rib fractures
will see see saw chest thats opposite of normal breathing
stand at food of bed to see

322
Q

PEEP

A

at end of respiration the vent exerts pressure down into the lungs to keep alveoli open

323
Q

classic reason to use peep

A

ARDS

324
Q

biPAP

A

exerts different levels of positive pressure along with O2

used for ARdS, COPD, HF, sleep apnea

325
Q

CPAP

A

pressure is delivered continuously during spontaneous breathing for inspiration and expiration
obstructive sleep apnea

326
Q

anytime see PEEP, CPAP, biPAP, then priority is to

A

assess bilateral lung sounds every 2 hours!!

327
Q

if coding COPD then give

A

100% O2

328
Q

need to check for PE in post opp pt D dimer or VQ scan

A

VQ scan
D dimer will always be increased in post opp pt
(post opp pt will be clotting to decrease bleeding so dimers increased

329
Q

decrease risk of DVT

A

elevate extremities to increase venous blood return and decrease pooling
TED hose or SCD
warm moist heat to decrease inflammation
ambulation
hydration

330
Q

worry about what with fractures

A

compartment syndrome

331
Q

most important thing for ortho

A

neurvascular checkes: pulse, color, movement, sensation, cap refil, temp

332
Q

fractures and fat emboli

A

long bones (femur), pelvic fractures, and crushing injuries
petechiae and rash over chest
conjunctival hemorrhages
snow storm on CXR

333
Q

compartment syndrome

A

muscle becomes swollen and hard and the pt complains of severe pain that is not relieved by meds

334
Q

compartment syndrome what to do with cast

A

loosen (bivalvement) cast

be careful with choosing remove

335
Q

fasciotomy -

A

cut into tissue to relieve pressure and restore circulation

336
Q

pt with cast complains of pain then

A

medicate, elevate extremity, and cold packs

if these do not work then think complication

337
Q

what type of mattress for orthro pt

A

firm for support

338
Q

hip replacement positioning

A

neutral rotation toes pointed to celling
limit flexion want extension of hip
abduction - legs apart to keep hips in socket

339
Q

arthroplasty

A

total knee replacement

340
Q

amputations post opp

A

keep truniquet at bedside

do not elevate on pillow elevate foot of bed

341
Q

phantom pain

A

use diversional activity before give pills

342
Q

walking with a walker

A

walk into walker

343
Q

cruches and stairs

A

good leg up and down with bad

344
Q

canes used on

A

strong side of body

left sided stroke, cane in left hand

345
Q

fluid replacement for glomerulonephritis

A

24 hour fluid loss + 500 cc

346
Q

diet need for glomerulonephritis

A

decreases protein decreased sodium increased carbs

347
Q

limit protein with kidney problems except with

A

nephrotic syndrome**

348
Q

nephrotic syndrome treatment

A 
diuretics
ace inhibitors to block aldosterone secretion 
prednisone to decrease inflammation - shrink hole so protein can't get out
lipid lowering drugs
decrease Na 
increase protein*
anticoagulation therapy 
dialysis
349
Q

renal failure s/s

A 
increased creatinine and BUN
fixed specific gravity 
anemia 
HTN and HF 
itching frost 
hyperkalemia
metabolic acidosis 
hyperphosphemia so decreases calcium
350
Q

two phases acute renal failure

A

oliguric - decrease UO (100-400), FVE, hyperkalemia (not voiding)

diuretic - sudden onset, increasing UO, FVD (shock), hypokalemia

351
Q

for dialysis blood is removed through the

and return through the

A

removed from the arterial end and returned through the venous end

352
Q

drainage from peritoneal dialysis should be

A

clear

cloudy=infection

353
Q

CAPD vs CCPD

A

CAPD (continuous ambulatory peritoneal dialysis - done 4 times a day, 7 days a week
no arthritis pts or colostomy pts

CCPD (continuous cycle peritoneal dialysis) - done at night and exchanges while sleeping

354
Q

CRRT

A

continuous renal replacement therapy
done in ICU
never more than 80 mL of blood comes out of body at one time so doesn’t stress cardiovascular system

355
Q

dx for prancreatitis

A

increase serum lipase* and amylase

356
Q

for the pancreas pt want to keep stomach

A

empty and dry **

357
Q

pancreatitis pt tx

A 
decrease gastric secretions
pain meds
steroids to decease inflammation 
anticholinergics to dry up 
insulin
358
Q

if liver is sick #1 concern

A

bleeding*

359
Q

if sick liver what to do with meds

A 
decrease dosing 
(2x stronger now)
360
Q

never give what med to liver pts

A

tylenol - will become toxic
give acetylycsteine instead

also avoid narcotics!!*

361
Q

spleen enlargement means

A

the immune system is involved

362
Q

liver biopsy

A

pt supine with right arm behind head
exhale and hold breath - to get diaphragm out of the way
after put on right side
worried about hemorrhage

363
Q

liver diet

A

decreased protein*

364
Q

hepatic coma

A

protein breaks down into ammonia (liver is supposed to convert to urea) when sick liver can’t convert and ammonia builds up in blood
acts like a sedative and decreases LOC

365
Q

esophageal varices are only a problem when

A

they rupture

366
Q

sengstaken-blakemore tube

A

used to hold pressure on bleeding varices

keep scissors at bed in case blocks airway

367
Q

lay on what side to keep food in the stomach

A 
left = leaves it
right = releases it
368
Q

watch for what after colonoscopy

A

perforation

pain and unusual discomfort

369
Q

what side for enema and suppository

A

left side

370
Q

side of pain for appendicitis

A

right lower quadrant (MucBurney’s point)

371
Q

when on TPN check urine for what

A

glucose (increase bs) and ketones (body breaking down fats)

372
Q

when central line place do not flush fluids until

A

placement is checked with CXR

373
Q

if air gets into central line what side

A

left side trendelenburgg

NCLEX (7 decks)

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