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Random 4: hurst Flashcards

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1
Q

Anhedonia

A

loss of pleasure

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2
Q

as depression lifts, what happens to suicide risk?

A

it increases. they might now have energy to take action

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3
Q

ask suicidal ppl 3 Q’s

A

do you have a plan?
what is the plan?
how lethal is the plan?

do they have access to plan?

watch for…
> isolation, writing will, giving things away…

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4
Q

ECT treatments

A

> induce tonic clonic seizures for severe depression

> atopine is given so dont aspirate

> need signed consent

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5
Q

Echolilia

A

hear word and repeat it

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6
Q

Neolgisn

A

make up own words that have special meaning

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7
Q

what adult would hae lanego?

A

Anorexia nervosa

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8
Q

bulemia nervosa

A

> allow 30 min to eat
sit with PT at meals and observe for 1 hr after
build self-esteem

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9
Q

why do you give benzos for alcohol withdrawal?

A

they act as a sedative and anticonvulsion

Ex. Chlordiazepoide (Librium), Ativan, Diazepam (valium), lorazepam (ativan)

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10
Q

CIWA

A

tx begins with score 8-10

score 20 = ICU

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11
Q

Disilfiram

A

Antabuse

> must sign a consent bfr this can be given
stay away from alcohol when taking

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12
Q

Glomerulonephritis

A 
> imflam from strep infection
> tired = toxins 
> increased BUN craitinine 
> flank pain 
> blood in urine and protein

> tx: get rid of strep

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13
Q

how to determine fluid replacement>

A

fluid replace = 24 hrs fluid loss + 500mls

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14
Q

increased BUN =

A

decreased protein for all kidney probs

except in nephrotic syndrome&raquo_space;>

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15
Q

Nephrotic syndrome

A

> inflam = big holes = decreased albumin = edema

> circulating vol decreases so dehydrated but into tissues

> kidneys sense decresed vol and RAAS kicks in
Aldosterone is produced and more Na and water retained but no protein to hold it in vas space

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16
Q

anasarca

A

generalized edema

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17
Q

probs associated to protein loss

A

> thrombosis
increased cholesterol and triglycerides (liver compensate and makes more albumin plus these)

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18
Q

S and S of nephrotic syndrome

A

> proteinuria
edema
hyperlipidema
hypoalbuminemia

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19
Q

tx nephrotic

A 
> diuretics
> ACE inhibitors - to block aldosterone 
> albumin 
> prednisone 
--> to shrink holes. causes imunosuppressed

> decreased Na and increased protein
anticoagulation
dialysis

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20
Q

why does renal failure PT have anemia?

A

bc not enough erythropoietin produciton–> stimulate RBC production

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21
Q

S and S renal failure

A

> Itching skin (frost uremic)–> provide good skin care
increased K+ bc cant excrete = metabolic acidosis

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22
Q

2 phases of renal failure

A
  1. Oliguric phase- decreased op. PT had FVE. K+ increases

2. Diuetic phase- sudden onset. OP goes up. PT into FVD and K+ goes down

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23
Q

what do you watch closely during hemodialysis

A

electrolytes and BP

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24
Q

what drugs do you hold prior to dialysis?

A

anything cleared by kidneys

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25
Q

how do you assess for patency for vascular access device

A

> thrill- cat purr palpation
bruit- turbulent blood flow

Feel thrill hear bruit

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26
Q

PD ppl need to increase what in diet?

A

protein and fiber

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27
Q

kidney stones

A

(urolithiasis, renal calculi)

> increased WBC in urine
hematuria&raquo_space;>

> give ondansetron and NSAIDS/opioids

> ESWL = extracorporeal shock wave lithotripsy

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28
Q

what does it mean if an adult has a + babinski?

A

toes curl up.

= problem in central nervous system (tumor?), brain, spinal cord, MS (damage to mylin sheath), ALS (lou G disease; Amylotropic lateral sclerosis. death of nerves controling voluntary muscles.

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29
Q

what test to be used for diagnostic for neural assess?

A
  1. CT -dye need consent
  2. MRI- no dye
  3. Cerebral Angiography with X-ray - use dye through femoral artery
    > iodine based dye, PT needs to be well hydrated
    > watch BUN, creatinine and hold metformin
    > allery shell fish and iodine

After:
> bedrest 4-6 hrs
> hemorrhage
> Embolus? watch for changes in LOC, weakness, paralysis

  1. EEG- electroencephalography -
    > record electrical activity in the brain
    > diagnose seizure disorders
    > evaluate LOC and denentia, coma, brain death, sleep disorders
    >hold sedatives. need full brain activity, no caffeine, NOT NPO
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30
Q

lumbar puncture

A

> in the subaracnoid space
lie flat 2-3 hrs after
increase fluids to replace
HA most common complication. increased when PT sits up

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31
Q

normal ICP

A

0-15mm Hg

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32
Q

cushings triad from?

A

increased ICP

  1. systolic pressure with widening pulse >60
  2. slow full bounding pulse
  3. irreg resps, cheyne stokes
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33
Q

posturing from increased ICP

A

notice posturing can be increased ICP

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34
Q

Decorticate

A

arms flex inward and bent toward body, legs extended

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35
Q

Decerebrate

A

all 4 extremities in rigid tight extension. WORST

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36
Q

complications of ICP

A
  • brain herniation
  • SIADH
  • DI
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37
Q

treat ICP

A 
> O2
> maintain adequate perfusion: isotonic
> dobutamine (inotropic)- improve contractility
> norepi- prevent hypotension 
> keep temp < 38
> elevate HOB
> avoid restraints, bladder distension, hip flexion, valsalva, no sneeze
> limit suction
> space nursing interventions 
>Glasgo --> if below 8 = intubate

> dexamethasone - deceases cerebral edema

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38
Q

Autonomic dysreflexia

A

hyperreflexia. T6 and up
This occurs as response from the sympathetic nervous system to stimulus that happens below lesion

> Severe HTN
> HA
> bradycardia
> nasal stuffy
> flushing, sweating 
> blurred vision 
> anxiety

From: noxious stimuli, constipation, distended bladder

Tx: sit them up to lower BP, treat cause

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39
Q

Pancreatitis

A
  1. Endocrine - insulin

2. Exocrine - Digestive enzymes

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40
Q

types of Pancreatitis

A
  1. Acute - gallbladder disease or alcohol

2. Chronic- alcohol

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41
Q

S and S pancreatitis

A 
> pain increases with eating 
> ascities 
> rigid board-like abd (think bleed) 
> bruising at umbilicus (Cullens) and Flank (Turners) 
> fever, inflam, jaundis
> hypotension (bleeding or ascites)
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42
Q

4 major functions of the liver

A
  1. detox
  2. blood clotting
  3. metabolize drugs
  4. synthesis of albumin
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43
Q

if your liver is sick

A

decrease meds to 1/2 bc they wont be metabolized

avoid narcotics

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44
Q

what happens to protein>

A

breaks down to ammonia–> liver converts amonia to urea–> kidneys excrete uria

If uria buids up in blood can = hepatic coma

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45
Q

hepatic coma

A

decreased LOC

> ataxis liver flap
> diff to awake
> hand writing changes
> decreased reflexes
> EEG changes 
> Fetor - breath smells like ammonia 
> GI bleed
46
Q

treat liver ppl

A

> lactulose decrease ammonia
cleansing enema
saline lavage - blood out of stomach

47
Q

where are the bleeding esophageal varicies?

A
  1. stomach
  2. rectum
  3. esophagus >

Tx: Octreotide –> lowers BP in the liver

48
Q

colonoscopy

A

Ulcer colitis and crohns

CF diet 12-24 hrs prior
NPO- 6-8 hrs prior

No NSAIDS prior for a few days

> give laxatives and enemas to clear path

> drink: polyethylene glycol

> sedated

> watch for perforation post-op- shouldnt have pain after

49
Q

colon probs eat

A

low fiber - limit GI motility to save fluid

50
Q

when would you notify MRP for chest tube drainage?

A

> 100mls in 1 hr and if color changes to bright red

51
Q

TX: for tension pneumothorax

A

large bore needle into 2nd intercoastal space to allow excess air to escape

52
Q

open pneumothorax

A

gun or stab:

> get PT to inhale and valsalva to increase thoracic pressure and plave gauze on 3 sides

53
Q

flail chest

A

occurs with multiple rib fx

PEEP:
use + end expiratory pressure–> PT on ventilator
> on end expiration the vent puts pressure into lungs to keep alveoli open

54
Q

Classic use for PEEP

A

Acute Respiratory Distress Syndrome ARDS

55
Q

BiPAP

A

+ pressure airway

used for ARDS for ppl with COPD, HF

56
Q

CPAP

A

continuous pressure airway for inhail and exhail

57
Q

D-dimmer

A

for clotting. is increased with pulm emboli

58
Q

PTT

INR

A

30-40 sec

2-3 sec

59
Q

what hormone makes you stop period?

A

progesterone

60
Q

goodell’s sign

A

softening of the cervix 2nd month

61
Q

Chadwicks sign

A

blueish color vaginal mucosa and cervix (week 4)

vasocongestion

62
Q

Hegars sign

A

soften of lower uterine segment (2-3 month)

63
Q

fetal heart beat

A

10-12 weeks

64
Q

greavidy

A

number of times someone has been pregnant

65
Q

parity

A

number of pregnancies that have reached 20 weeks

66
Q

viability

A

24 weeks

67
Q

TPAL

A

Term
Preterm
Abortion
Living children

1st tri: 1-13 weeks
2nd tri: 14-26
3rd tri: 27-40

68
Q

Naegele’s rule for due date expectancy

A

first day of last period. Add 7 days. Subtract 3 months and add 1 year

+/- 2 weeks

69
Q

Increase calories

A

> 300/day after 1st trimester.
adolescent 500

> 500 for breastfeeding mothers

increase protein to 60 grams / day

70
Q

weight gain

A

> 4 lbs in 1st trimester

> 1 lb/ week 2nd trimester

> no more than 1 lb/ week in 3rd trimester

71
Q

exercise

A

dont let HR >140 BPM

72
Q

smoking causes

A

SGA baby

73
Q

how often prenatal visits>

A

first 28 weeks = once/month

28-36 weeks = 2/month

36-delivery = once/week

74
Q

fetal movement

A

Quickening

16-20 weeks

75
Q

fetal HR

A

2nd tri = 120-160

110-120 worried and watching

<110 panic

76
Q

PIH

A

preg induced HTN

check protein in urine

77
Q

how is fetal position determined?

A

Leopolds manouver

have PT void first

78
Q

Lightening

A

2 weeks before term

head drops

79
Q

Iscchial spine

A

= 0
-1 toward vagina
+1 toward belly button

80
Q

when should mom go to hosp?

A

when contractions are 5 min apart or membranes rupture

81
Q

non-stress test

A

want to see two or more accelerations of 15 BPM with fetal movement and lasts about 15 sec

heart should come back within 2 min

> want this test to be reactive POSSative

82
Q

BPP

A

Biophysical Profile Test

> last trimester or 32-34 weeks in high risk preg

measurements done by US: 2 points for each
6 = worry

  1. HR- was NST reactive?
  2. muscle tone- 1 flexion/extension in 30 min
  3. movement- 3 x in 30 min
  4. breathing- at least once in 30 minutes
  5. amniotic fluid
83
Q

CST

A

contraction stress test: oxytocin challenge

> want non-reactive result NEG test

> perform on high risk pregnancies : preeclampsia, maternal DM, or placental insufficent

> Determine if baby can handle stress of uterine contraction

> perform after 28 weeks

84
Q

deceleration

A

HR decreases but causes hypoxia

early deceleration = not bad. Physiological hypoxia from fetal head compression

Do NOT want to see late deceleration = uteroplacental insuff

variable deceleration = bad umbilical cord compression

85
Q

Epidural Anaestesia

A

does not go into spinal fluid

> give at stage 1 or 3-4 cm dilation
can cause hypotension monitor
–> bolus 1000mls NS/RL if need be

86
Q

contraction rate

A

want 1 Q 2-3 min that last 60 sec long

87
Q

when to discontinue oxytocin

A

if contractions too close together or

last too long or

fetal distress

88
Q

fundal height

A

immediate after birth is 2-3 fingers below Umbili

a few hrs after it rises 1 finger above

will distend 1 finger / day (involution)

89
Q

clots

A

no bigger than nickle

90
Q

diurese

A

24 hrs post-delivery

91
Q

mastitis

A

usually 2-4 weeks

> penicillin ok while breast feeding
heat
feed baby more frequently
offer bad breast first

92
Q

APGAR

A

1 and 5 min

appearance- color
pulse
grimace- irritability
activity- muscle tone
resps

want 8-10 score

> Erythromycin for eyes (Neisseria gonococcus and chlamidia)

> Vit K = Phytonadione IM promotes clotting factor

93
Q

cord care

A

dries and falls off om 10-14 days

94
Q

why do babies hypoglycemia

A

bc they are not getting glucose from mother

95
Q

diagnose Rh incompatibility

A
  • Indirect Coombs - mother measures antibodies in blood

Direct coombs - baby cord blood to see if there are antibodies stuck to RBCs

96
Q

when is RhoGAM given

A

Rho(D) immune/globulin

given with any bleeding episode. Destroys fetal cells that get into mothers blood before antibodies are formed

97
Q

Hydatiform mole

A

no fetus. benign neoplasm

> uterus enlarges too fast
confirmed with US
need D and C
do not get preg. Dr. wants to follow to make sure not malignant. Will measure hCG weekly unitl normal for up to 6 months

98
Q

tx for ectopic pregnancy

A

Methotrexate to stop growth of embryo

99
Q

placenta previa

A

placenta implanted wrong

> begins to separate when cervix begins to dilate
decreased O2 to baby

> > painless bleeding in 2nd half of pregnancy

> C-sec

100
Q

abruptio placenta

A

placenta implanted normal, but separates prematurely

> may be partial or complete

causes:
> MVA, violence, previous C-sec, membranes rupture (rapid decompression), drugs, smoking…

> rigid board-like abd with or without vag bleeding
abd pain and increased uterine tone
diff to palp fetus

> > > C-sec!
NO VAG exams

101
Q

incompetent cervix

A

cervix dilates prematurely in 4th month of preg

> weight of baby causes cervix to prematurely dilate
painles

Tx: purse string (cerclage) at 14-18 weeks reinforce cervix

102
Q

hyperemesis gravidarum

A

related to high levels of esterogen and hCG

> will have decreased K+ d/t vomit, but decreased urin op
will have ketones in urine

> NPO 48hrs
IVF 3000mls in 24hrs
vitamins
6-8 small meals.day

103
Q

preeclampsia

A
  • Proteinuria»,
  • edema,
  • increased BP»> after 20 weeks

130/90- 150/95 (mild)

> sudden weigh gain, swollen/edema
HA, blurred vision, seeing spots
hyper-reflexia
clonus –> seizure

104
Q

severe preeclampsia

A

160/110 documented 6hrs apart

> give Mg sulfate
- acts like sedative, anticonvulsive, vasodilates (increase renal profusion)
- simple salt solution. Fluid goes back into vascular space and out of tissues, kidneys will diurese
when using Mg- labor will stop

N: check Mg toxicity Q2-3 hrs
> BP, resps, DTRs and LOC
> urine OP

If diastolic >100 give apresoline (hydralzine)

> > > > > DELIVER BABY»»>

105
Q

eclampsia

A

when mother has a seizure

everything bad can happen!

106
Q

PIH

A

preg induced HTN after 20 weeks

Key: proteinuria

107
Q

Premature labor

A

20-37 weeks

108
Q

give what for preterm labor?

A

Terbutaline- helps with breathing

Mag sulfate

Betamethasone - give IM to mom. 2 inject 24 hrs apart
> stimulate maturation of babies lungs

109
Q

shoulder dystocia

A

> bracial plexus injury to baby
Erb’s palsy
hypoxia = cerebral palsy and asphyxia
broken clavical

> Robbert’s maneuver- hyperextend legs

110
Q

GBS

A

Group B streptococcus

> culture around 35-37 weeks and at delivery

Random NCLEX (6 decks)

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