Review Flashcards
1
Q
Pre-op cerebral angiogram
A
allergy to iodine?
check kidney function
take off jewelry
NPO 4-6 hrs before
sedation before and during procedure
edu SE of dye: metallic taste, warm sensation over face, jaw, tongue, lip and behind ears
2
Q
post- op cerebral angiogram
A
inspect insertion site and distal extremities for pedal pulses, color and warmth
3
Q
Electroencephalography (EEG)
A
assess electrical activity of brain
4
Q
pre-op Electroencephalography (EEG)
A
wash hair
encourage sleep deprivation
doesnt need to be NPO
NO stimulants 12-24hr before
5
Q
during procedure of Electroencephalography (EEG)
A
takes 1 hr
flashing lights may be used
pt may be asked to hyperventilate (increases electrical activity in brain)
6
Q
Post op Electroencephalography (EEG)
A
normal activity resumed
assess GCS
7
Q
Glass coma scale (GCS)
A
assesses LOC
<8 severe TBI
9-12 mod TBI
>13 minor TBI
8
Q
ICP
A
monitor device inserted into cranial cavity that records pressure
risk for infection
9
Q
signs of increased ICP
A
Irritability early sign
HA
Decreases in LOC
pupil abnormality
cheyne stokes, hyperventilate or apnea
abnormal posturing (decorticate or decerebrate)
cushing triad (severe HTN, widened pulse pressure and Bradycardia)
10
Q
Normal ICP
A
10-15
11
Q
Lumbar puncture (spinal tap)
A
sample of CSF to diagnose syphilis, MS, meningitis and infection
12
Q
preop Lumbar puncture (spinal tap)
A
void before
position on one side in cannonball or stretch over bedside table
13
Q
post op Lumbar puncture (spinal tap)
A
lay flat
monitor for HA (CSF leak)
give pain meds and fluids
if HA- give epidural blood patch to seal hole in dura
14
Q
MRI
A
Assess for allergy to iodine/shellfish
check kidney function
check for Closter phobia
remove jewelry
ask if any metal implants (IUD has metal)
give earplugs (MRI is loud)
15
Q
S/S of nociceptor pain
A
damage to tissue
throbbing, aching, localized
16
Q
S/S neuropathic pain
A
Shooting, burning, pins and needles
17
Q
AE of opioids
A
resp depression
constipation
urinary retention
ortho hypotension
18
Q
Viral meningitis
A
most common
subsides on own- no abt
19
Q
Bacterial meningitis
A
requires abt
high mortality rate
contagious (droplet)
vaccine to prevent (Hib in children and MCV4 in adults)
20
Q
S/S of meningitis
A
nuchal rigidity (neck stiffness)
photophobia
fever/chills
AMS
Positive kernings sign (pain w/ leg extension)
positive brubenskis sign (flexion of neck with leg flexion)
21
Q
Meningitis Dx
A
lumbar puncture - decreased glucose and cloudy CSF
Clear fluid= viral meningitis
elevated protein and WBC
22
Q
Nursing interventions for meningitis
A
droplet precautions until after abt tx for 24hrs
quiet, dim lit room
elevate HOB 30
Avoid coughing and sneezing (can increase ICP)
seizure precautions
23
Q
Meds for bacterial meningitis
A
Ceftriaxone, cefotaxime in combo with vanco
anticonvulsants (phenytoin)
for people who have been in contact: cipro, rifampin, or ceftriaxone
24
Q
Risk factors for seizure
A
fever
cerebral edema
infection
exposure to toxins
brain tumors
hypoxia
alcohol and drug withdrawal
electrolyte imbalance
25
Tonic clonic seizures
tonic phase: stiffness and loss of consciousness
clonic phase: 1-2 min of rhythmic jerking of extremities
postictal phase: confused and sleepy
26
absent seizures
more common in children
resemble daydreaming:
blank stare, eye fluttering, lip smacking, picking at clothes
27
myoclonic seizures
brief jerking or stiffening of extremities
28
atonic seizures
loss of muscle tone
results in falling
29
status epilepticus
repeated seizure activity within 30 min of single seizure lasting >5 min
medical emergency
30
Nursing interventions during seizure
turn pt to side
NOTHING in mouth
loosen clothing
never restrain them
clear area to avoid injury
31
Parkinsons disease
too little dopamine and too much acetocholine
32
S/S of parkinsons disease
tremors
muscle rigidity
shuffling gait
bradykinesia
mask like expression
drooling with difficulty swallowing
33
Medications for parkinsons disease
sinemet
benztropine (anticholinegic)
34
Alzheimers meds
donepezil: prevents break down of ACH and increases the amount of ACH
35
Multiple sclerosis (MS)
no cure
common for relapse and remitting
36
Risk factors for MS
emotional stress
pregnancy
fatigue
extreme temps and overexertion
37
S/S of MS
diplopia (change in peripheral vision)
tinnitus
vertigo
decreased hearing acuity
dysphagia
muscle weakness
nystagmus (fluttering of the eye)
B & B dysfunction
38
Meds for MS
Azathioprine and cyclosporine's - reduces relapses (Monitor for HTN and infection because its an immunosuppressant)
39
Amyotrophic lateral sclerosis (ALS)
neurological disorder: deterioration and death of motor neurons
death usually occurs within 3-5 yrs of manifestation
40
S/S of ALS
affects men more than women (40-70)
fatigue
muscle weakness
muscle atrophy
dysphagia
dysarthria
41
Lab tests for ALS
Increased Crt kinase lvl (CK-BB)
42
Riluzole
Med for ALS
slows down deterioration of motor neurons by decreasing release of glutamic acid
must be taken early in disease
adds 2-3 months of life
43
Nursing considerations for Riluzole
monitor liver function
assess for dizziness, vertigo and somnolence
44
edu for Riluzole
avoid alcohol
take q12hrs
store away from bright lights
45
Myasthenia Gravis
autoimmune disease
severe muscular weakness
worsens with increased activity
46
S/S of Myasthenia gravis
progressive muscle weakness
diplopia
difficulty chewing and swallowing
resp dysfunction
incontinence
ptosis (drooping of eyelids)
47
Nursing interventions for myasthenia gravis
small, frequent, high calorie meals when meds are at peak
lubricating eye drop in morning and ointment at night if unable to close eyes
48
Meds for myasthenia gravis
pyridostigmine and azathioprine
49
pyridostigmine
increases muscle strength
50
Nursing considerations for pyridostigmine
assess for hx of seizures
use in caution with hx of asthma and cardio disease
51
Plasmapheresis
for Myasthenia Gravis
removes circulating antibodies from the plasma
done several times over a period of days
52
Edu for migraines
avoid foods high in tyramine: pickles, caffeine, beer, wine, aged cheese, artificial sweeteners
53
Macular degeneration
central loss of vision
no cure
#1 cause of vision loss >60yrs old
54
Risk factors for macular degeneration
Smoker
HTN
female
55
S/S of macular degeneration
blurred vision
lack of depth perception
loss of central vision and blindness
56
Risk factors for cataracts
DM
smoking
eye trauma
chronic corticosteroid use
advanced age
57
S/S of cataracts
decreased visual acuity
blurred vision
diplopia
glare and light sensitivity
halo around eyes
progressive and painless loss of vision
absent red reflex
58
Edu for cataracts
wear sunglasses
avoid activities that increase IOP (bending, sneezing, coughing, straining, restrictive clothing and sex)
report pain and N/V (increased IOP)
59
Normal IOP
10-21
60
glaaucoma
disturbance of the functional or structural of the optic nerve
61
Open angle glaucoma
most common
angle between iris and sclera
aqueous humor outflow is decreased due to blockage in eyes causing rise in IOP
62
Closed angle glaucoma
less common
IOP rises suddenly
angle between sclera and iris closes suddenly which causes increased IOP
63
S/S of open angle glaucoma
HA
mild eye pain
loss of peripheral vision
decreased accommodation
elevated IOP
64
S/S of closed angle glaucoma
Rapid increase of IOP
decreased or blurry vision
halos around lights
pupils non reactive to light
severe pain and nausea
photophobia
65
tonometry
measures IOP
66
emergency tx for closed angle glaucoma
IV mannitol- decreases cerebral edema and pressure
67
Menieres disease
excessive fluid in ear (usually one sided)
68
S/S of menieres disease
vertigo
tinnitus
HA
N/V
hearing loss
69
Tx for menieres disease
Low Na diet and diuretics
70
Signs of left sided stroke
LEFT=LANGUAGE
aphagia
alexia (reading difficulty)
paralysis of right side of body
71
Signs of right sided stroke
RIGHT=RECKLESS
impaired visual and spacial awareness
altered perception of deficits (overestimation of abilities)
one sided neglect syndrome (cannot see, feel or move affected side so unaware of its existence)
poor impulse control and judgement
72
Nursing interventions for Stroke
Monitor for fever= increased ICP
Assess swallowing and gag reflex before feeding
homonomous hemianopsia (loss of same visual field in both eyes)- scan area before walking and eating
73
Tx of stroke
Anticoagulants are NOT RECOMMENDED
Antiplatelets- ASA
Thrombolytics given within 4.5 hrs of initial sx
74
Risk factors for spinal cord injury
males 16-30
high risk activities
alcohol or drug abuse
falls in older adults
75
S/S of Spinal cord injury
absent DTR
flaccidity of muscles
shallow resp
hypotension
dependent edema
loss of temp regulation
flaccid bladder, intermittent cathing (lower spinal injury)
spastic bladder and indwelling cath (upper spinal injury)
76
Meds for spinal cord injury
steroids- decrease spinal cord edema
vasopressors (norepinephrine and dopamine)- for hypotension
antimuscarinic (atropine)- bradycardia
plasma expanders (dextran)- hypotension
muscle relaxant (baclofen and dantrolene)
stool softeners
vasodilators (hydralazine and nitro)
77
S/S neurogenic hock
bradycardia
hypotension
flaccid paralysis
paralytic ileus
loss of reflex below injury
78
autonomic dysreflexia from spinal cord injury
extreme HTN
HA
pallor below injury
blurred vision
sweaty
restless
N/V
piloerection (goose bumps)
79
PaCO2
35-45
80
HCO3
21-28
81
Preop bronchoscopy
assess allergies and if theyre on any anticoagulants
remove dentures
NPO 8-12 hrs before
82
Post op Bronchocopy
Assess LOC
cough/gag reflex needs to return before oral intake
normal findings- dry throat and SCANT bloody sputum
83
positioning for thoracentesis
client sits upright
84
S/S of pneumothorax
deviated trachea
pain increases on exhalation
affected side doesnt rise and fall when breathing
increased HR
Raid shallow breaths
nagging cough
feeling of air hunger
85
Chest tube disconnection
from patient- exhale and cough and occlusive dressing taped on 3 sides
from drainage system- place end of tube in sterile water
86
tension pneumothorax caused by
prolonged clamping
kinks in tube
obstruction of tube
87
S/S of tension pneumothorax
tracheal deviation
absent breath sounds on one side
distended neck vein
resp distress
asymmetry of chest
cyanosis
88
Chest tube removal nursing interventions
pain med 30 min before
pt takes deep breath, exhale and bear down
petroleum gauze dressing
CXR as ordered
89
Nasal cannula
24-44% o2
1-6 L
90
simple face mask
40-60% o2
1-6L
91
partial rebreather mask
60-75% o2
6-11 L
keep reservoir bag from deflating by adjusting o2 flow rate
92
nonrebreather
80-95% o2
10-15 L
highest o2
keep 2/3 of bag full
93
Venturi mask
24-55%
2-10L
most precise
94
S/S of oxygen toxicity
nonproductive cough
substernal pain
nasal stiffness
N/V
fatigue
HA
sore throat
hypoventilation
95
Low pressure alarm on vent
disconnected
cuff leak
tube displacement
96
high pressure alarm on vent
excessive secretions
pt bitibg tube
kinks in tube
coughing
pulm edema
bronchospasm
pneumothorax
97
S/S of pneumonia
chest discomfort from coughing
confusion from hypoxia
fever
SOB
crackles and wheezes
98
medications for asthma
Albuterol (rescue, watch for tremors and tachycardia)
ipratropium (anticholinergic)
Salmeterol (beta 2 agonist)- prevents asthma attacks
99
S/S of COPD
Dyspnea upon exertion
crackles and wheezes
Rapid and shallow resp
using accessory muscles
barrel chest or increased chest diameter
hyperrosonance on percussion due to trapped air
clubbing of fingers
Resp acidosis
100
Theophylline
methylxanthines
relaxes smooth muscle of bronchi
for COPD
101
S/S of TB
night sweats and low grade fever
persistent cough >3 wks
purulent/bloody sputum
fatigue
wt loss
anorexia
102
Isoniazid
For TB
take on empty stomach
liver and kidney toxic
Give Vit B6 to prevent neurotoxicity
dont drink alcohol
103
Rifampin
For TB
Liver toxic- report jaundice
urine and secretions are orange
interferes with contraceptives
104
Pyrazinamide
For TB
liver toxic- report jaundice
drink extra fluids
No alcohol
105
Ethambutol
For TB
Visual acuity tests
not for children <13
report changes in vision ASAP
106
Risk factors for Pulmonary embolism
long term immobility
oral contraceptive use
tobacco use
obesity
surgery
HF or chronic Afib
Long bone Fx
107
S/S of pulmonary embolism
anxiety
pain on inspiration
dyspnea, air hunger
petechiae over chest and axillae
sweaty
tachypnea
tachycardia
hypotension
pleural friction rub
108
pneumothorax
air or gas in the pleural space that causes lung collapse
109
Flail chest
paradoxal chest movement
from multiple rib Fx
one side of chest unable to expand
110
CK-MB
0%
ELEVATED 4-6 Hrs for MI
111
Troponin T
norm <0.2
112
Troponin I
norm <0.03
113
Myoglobin
norm <90
114
S/S of cardiac tamponade
hypotension
JVD
muffled heart sounds
paradoxical pulses
115
implanted port
only accessed through huber (noncoring) needle
116
phlebitis S/S
redness at site
pain/burning
vein indurated (hard) - red streak or cordlike
117
Tx of phlebitis
dicontinue IV
Warm compress
restart with new tubing
118
Catheter thrombosis/emboli
Check if tip is intact, then D/C
if tip broken off, apply tourniquet high on extremity and prepare for surgery
119
infiltration
fluid leak into surrounding SQ from improper IV insertion or tape too tight becoming a tourniquet
120
Tx of infiltration
remove using direct pressure with gauze sponge until bleeding stops
apply cool compresses
elevation is optional
avoid starting IV in same extremity
121
Tx of Sinus bradycardia
only tx if symptomatic
atropine and isoproterenol
pacemaker
122
tx of Afib
amiodarone, adenosine, and verapamil
synchronized cardioversion
123
Vtach tx
has pulse: amiodarone, adenosine, verapamil and synchronized cardioversion
no pulse: amiodarone, lidocaine, epinephrine and defib
124
Vfib tx
Amiodarone, lidocaine, epinephrine and defib
125
pre op cardioversion
with afib, if no known duration, must take anticoagulants 4-6 wks before cardioversion to prevent dislodgment of clots
126
Post op pacemaker placement
minimize movement by applying sling
assess for hiccups- may indicate pacemaker pacing the diaphragm
127
Pt edu for pacemaker
no contact sports or heavy lifting for 2 months
dont place magnetic fields directly over pacemaker: garage door openers, burgalar alarms, speakers, generators
inform dentist about pacemaker
avoid MRIs and imaging
inform airport about pacemaker- will set alarm off
128
post op peripheral bypass graft
bedrest for 18-24 hrs with leg kept straight
discourage sitting for long periods of time
apply antiemetic stockings to promote venous return
129
variant angina
occurs during periods of rest
130
alteplase
thrombolytic
131
S/S of left sided HF
Dyspnea
orthopnea (SOB when lying down)
nocturnal dyspnea
fatigue
displaced apical pulse (hypertrophy)
gallop (s3)
pulmonary congestion
pink frothy sputum
AMS
oliguria
132
S/S of Right sided HF
JVD
ascending dependent edema
abdominal distention
fatigue
weakness
nausea/anorexia
nocturnal polyuria
wt gain
liver enlargement
133
S/S of pericarditis
chest pain
friction rub heard in the lungs
SOB and pain relieved when sitting or leaning forward
134
S/S of myocarditis
tachycardia
murmur
friction rub heard in lungs
cardiomegaly
chest pain
dysrhythmias
135
S/S of infective endocarditis
fever
flu like symptoms
murmur
petechiae
positive blood culture
splinter hemorrhages
136
peripheral arterial disease (PAD)
atherosclerosis in lower extremities
137
Risk factors of PAD
HTN
hyperlipidemia
dM
smoking
obesity
138
S/S of PAD
Burning, cramping and pain in legs during exercise (intermittent claudication)
pain relieved by placing feet in dependent position
cap refill >3 sec in toes
decreased/non palpable distal pulses
loss of hair on lower calf
thick toenails
pallor when elevating extremity
dependent rubor
ulcers and gangrene of toes
139
Pt teaching for PAD
dont cross legs
dont wear restrictive clothes
warm environment
insulated socks
avoid stress, caffeine and nicotine
140
PVD
problem with blood flow returning to the heart
141
varicose veins
enlarged veins in lower extremities- visible just below skin
pt reports muscle cramps after sitting and pruritis
142
virchows triad
hypercoagulability
impaired blood flow and damage to blood vessels
143
Risk factor for varicose veins
women >30 with occupation that has prolonged standing
pregnancy
obesity
144
Venous thromboembolism (VTE)
calf or groin pain, tenderness and hardness over involved vessel
warmth and sudden edema
145
venous insufficiency
brown discoloration along the ankle that extends up calf, edema and stasis ulcers
146
Nursing interventions/teaching for DVT and VTE
Avoid using knee gatch or pillow under knees
intermittent/continuous warm moist compresses
DONT massage the affected extremity
thigh high compression or antiembolism stockings
147
Nursing interventions/teaching for venous insufficiency
elevate legs several times a day for 15-30 min
avoid crossing legs and wearing tight clothing
apply compression stockings after legs have been elevated and when swelling is at a minimum
148
Hypertensive crisis S/S
severe HA
Extremely high BP (>240/120)
Blurred vision
dizziness
disorientation
149
RBC
4-6 mill
150
plt
150-400
151
Hgb
12-18
152
Hct
37-52%
153
PT
11-12.5
154
aPTT
30-40 sec
155
INR
2-3
156
Blood transfusion administration nursing interventions
large bore IV 20 gauge
prime tubing with 0.9% NS
Y tubing
157
Hemolytic reaction from blood transfusion
fever
lower back pain
tachycardia
flushing
hypotension
chest tightening
tachypnea
Nausea
158
mild allergy to blood transfusion
itchy
urticaria
flushing
Give benadryl
159
Risk factors for DIC
septicemia
cardiopulmonary arrest
hemorrhage
160
S/S of DIC
unusual spontaneous bleeding from gums or nose
oozing, trickling blood from incision or any puncture
petechiae or ecchymosis
tachycardia, hypotension and sweaty
161
Nursing interventions for DIC
avoid NSAIDS
give O2
avoid Valsalva maneuver
bleeding precautions (no needles)
162
S/S of fluid deficits
tachycardia
thready pulse
hypotension
tachypneic
hypoxic
fatigue, confusion
thirst N/V
oliguria
163
S/S of FVO
tachycardia
bounding pulses
HTN
tachypnea
weight gain, ascites
dyspena
crackles
edema, pale and cool
Distended neck vein
164
S/S of hyponatremia
Hypothermia
tachycardia
rapid thready pulse
hypotension
HA, fatigue
abd cramping and hyperactive bowel sounds
165
S/S of hypernatremia
hyperthermia
tachycardia
hypotension
muscle twitching
increased motility, abd cramping
166
S/S of hypokalemia
weak, irregular pulse, tachycardia
hypotension
respiratory depression
inverted T wave, ST depression
ileus
polyuria (diluted)
167
Foods high in potassium
avocados
broccoli
dairy
dried fruit
cantaloupe
bananas
potato's
168
S/S of hyperkalemia
flaccid paralysis
restlessness, weakness
irritability
peak T waves, widened QRS
diarrhea
169
Tx for hyperkalemia
calcium gluconate
give insulin with dextrose
170
S/S of hypocalcemia
paresthesia of fingers and lips (early)
muscle twitches
hyperactive DTR
Positive Chvosteks and Trousseaus
decreased HR and BP
hyperactive bowel sounds
171
S/S of hypomagnesemia
muscle tetany (contraction)
hyperactive DTR
paresthesia
hypoactive bowel sounds
172
ABG BABY
ACID====BASE
Ph: 7.35-7.45
PCO2: 45-35
HCO3: 22-26
173
What can cause respiratory acidosis
respiratory depression
airway obstruction
inadequate chest expansion
PE
inadequate ventilation
174
S/S of respiratory acidosis
tachycardia
tachypnea
dysrhythmias
anxiety
irritable
shallow and rapid respirations
pale/cyanotic
175
What can cause respiratory alkalosis
hyperventilation
salicylate toxicity
hypoxemia from asphyxiation
176
S/S of respiratory alkalosis
tachypnea
tingling
numbness
palpitations
dysrhythmias
rapid deep respirations
177
What can cause metabolic acidosis
DKA
Lactic acidosis
kidney failure
diarrhea
178
S/S of metabolic acidosis
bradycardia
weak peripheral pulses
hypotension
tachypnea
dysrhythmias
kussmaul respirations
flushed, warm and dry
179
What can cause metabolic alkalosis
oral ingestion of antacids
loss of gastric secretions
N/V
180
S/S of metabolic alkalosis
tachycardia
hypotension
dysrhythmias
numbness, tingling
tetany
muscle weakness
181
AST
5-40
Elevation with hepatitis or cirrhosis
182
ALT
8-20
elevated with hepatitis or cirrhosis
183
amylase
56-90
elevated with pancreatitis
184
lipase
0-110
elevated with pancreatitis
185
bilirubin
0.1-1
186
albumin
3.5-5
187
Ammonia
15-45
188
preop barium swallow GI series
clear liquid diet
no smoking or chewqing gum (increases peristalsis)
NPO after midnight
189
post op barium swallow GI series
stools may be white for 24-72 hrs
report abd fullness, pain or delay in return to brown stool
190
TPN nursing interventions
Change tubing and solution bag q24hrs even if not empty
filter added to tubing
use mask when changing central line
check BS q4-6 hrs
10% dextrose if TPN empty and no replacement bag yet
191
paracentesis pre op
void before procedure
review vitals, wt and abd girth
192
post op paracentesis
record wt, vitals and abd girth to compare with preprocedure results
193
S/S of dumping syndrome
cramps
diarrhea
tachycardia
dizziness, fatigue
194
Pt teaching for dumping syndrome
restrict fluids with meals
195
NG tube decompression post op
for obstruction
xray to verify placement
assess bowel sounds and girth
encourage ambulation
196
Ileostomy
watery stools
197
Stoma care
cut wafer 1/8 bigger than stoma
avoid foods that cause odors: fish, eggs, asparagus, garlic, beans and dark green veggies
avoid foods that cause gas: dark green veggies, beer and dairy products, soda, corn
198
Nursing interventions for GERD
avoid large meals, eating before bedtime
remain upright after eating
avoid tight fitting clothing
lose weight
sleep on right side
199
S/S of PUD
ingestion: heartburn, bloating, N/V
pain
200
gastric ulcer
pain 30-60 min after meals
rarely occurs at night
pain worse when eating
201
duodenal ulcer
pain 1.5-3 hrs after eating
often occurs at night
may be relieved by eating or antacids
202
Bowel perforation
rigid abd
hyperactive-diminished bowel sounds
rebound tenderness
203
Med for IBS-C
Lubiprostone
204
Med for IBS-D
alosetron
205
Obstipation
inability to pass stool or gas for >8hrs
abd distention
high pitched bowel sounds at site of obstruction and hypobowel sounds below obstruction
206
large intestinal obstruction S/S
ribbon like stools
intermittent abd cramping
abd distention
metabolic acidosis
207
ulcerative colitis
inflammation of rectum and sigmoid colon
abd cramping
LLQ pain
anorexia
fever
abd distention
diarrhea 15-20 times a day with blood, mucous or pus
208
Crohns disease
inflammation of GI tract at distal ileum
fistulas common
RLQ pain
fever
abd distention
high pitched bowel sounds
steatorrhea
about 5 loose stools a day
209
diverticulitis S/S
LLQ pain
N/V
fever, chills
tachycardia
210
Pt teaching for Ulcerative colitis and crohns disease
eat diet high in protein and calories and low in fiber
take multivitamin that contains iron
small frequent meals
211
Pt teaching for diverticulitis
clear liquid diet until sx subside
low fiber diet
avoid seed, nuts and popcorn
limit fat intake to 30%
212
S/S of peritonitis
Rigid abd
N/V
Rebound tenderness
fever
tachycardia
213
Cholecystitis
inflammation of gallbladder mostly caused by gallstones
214
S/S of cholecystitis
sharp RUQ pain that radiates to right shoulder
N/V after eating high fat foods
dyspepsia (ingestion), eructation (belching), and flatulence
jaundice
clay colored stools
fatty stools
dark urine and pruritis
215
extracorporeal shock wave lithotripsy
breaks up stones with shock wave
moderate sedation and ECG monitoring
bruising at site is normal
hematuria post procedure normal
216
post op cholecystectomy
shoulder pain is normal
217
T-tube
placed in common bile duct after cholecystitis
record drainage: initially bloody and then green-brown bile colored
more than 400ml drainage in 1st 24 hrs normal
report drainage >1000 ml
clamp tube 1-2hrs before and after meals
usually in for 1-2 weeks
218
S/S of pancreatitis
epigastric pain radiating to back, left flank or left shoulder
N/V
turner sign (ecchymosis on the flanks)
cullens sign (bluish gray periumbilical discoloration)
generalized jaundice
ascites
tetany
219
Nursing interventions for pancreatitis
NPO, TPN or jejunum feedings
give antiemetics
insert NG tube for decompression
no alcohol
give pancreatic enzymes
220
Pt teaching about pancreatic enzymes
sprinkle on non-protein foods
drink full glass of water after pancrelipase
wipe lips and rinse mouth after taking
221
Hep A
fecal-oral route
222
Hep B
from blood, unprotected sex, infant born to infected mother, injection drug user
223
Hep C
From drug abuse, sexual contact
224
S/S of hepatitis
flu like sx
fever, clay colored stools
jaundice
225
Med for Hep C
peginterferon and ribavirin
226
post necrotic cirrhosis
caused by viral hepatitis or meds or toxins
227
laennecs cirrhosis
from chronic alcoholism
228
Biliary cirrhosis
from chronic biliary obstruction or autoimmune disease
229
S/S of Cirrhosis
pruritis
confusion or difficulty thinking
GI bleeding
ascites
jaundice
petechiae
palmar erythema
spider angiomas on nose, cheek, upper thorax and shoulders
dependent edema of extremities and sacrum
fector hepaticus (fruity breath)
230
Crt
0.6-1.2
231
BUN
10-20
232
Cystography
discovers abnormalities of bladder wall
NPO after midnight
233
post op cystography
monitor urine color-pink tinged okay
irrigate cath with NS if blood clots or if UO is decreased/absent
burning sensation normal- drink more fluids
234
disequilibrium syndrome
caused by rapid decrease of BUN and circulating volume
can cause cerebral edema and increased ICP
235
S/S of disequilibrium syndrome
N/V
change in LOC
seizure
agitation
236
Peritoneal dialysis
report signs of infection/peritonitis- fever, bloody, cloudy or frothy dialysate return
keep outflow bag lower than pts abdomen
give enema before to clear bowel
warm solution before to prevent cramping
237
Early signs of organ transplant rejection
fever
hypertension
pain at transplant site
238
hyperacute organ rejection
within 48 hrs after surgery
fever, HTN, pain at transplant site
surgeon will remove the donor kidney
239
acute organ rejection
within 1 wk-2 yrs
oliguria, anuria, low grade fever, HTN, tenderness over sight, fluid retention
increase doses of immunosuppressive medications
240
chronic organ rejection
gradually over months or years
azotemia, fluid retention, electrolyte imbalance and fatigue
dialysis may be required
241
glomerulonephritis
inflammation of glomeruli caused be streptococcal infection
immune disease
242
S/S of glomerulonephritis
decreased UO
smoky/coffee colored urine
wt gain
SOB
orthopnea
mild to severe HTN
243
Urinalysis for glomerulonephritis
proteinuria
hematuria
cell debris
increased urine specific gravity
244
Prerenal AKI
volume depletion
occurs before damage to kidney
245
Intrarenal AKI
direct damage to kidneys from lack of oxygen
NSAIDS, antibiotics and contrast dye
246
Postrenal AKI
obstruction of structures leaving the kidney
stone, tumor, bladder atony or BPH
247
Risk factors for chronic kidney disease
DM
chronic glomerulonephritis
nephrotic meds or chemicals
HTN- african americans
autoimmune disorders (lupus)
248
S/S of chronic kidney disease
lethargy
FVO
HTN
dysrhythmias
HF
orthostatic hypotension
crackles
tachypnea
pruritis
uremic frost
249
Nursing interventions for chronic kidney disease
limit protein intake
restrict Na, K, Ph and Mg
diet high in carbohydrates and moderate fats
250
Pyelonephritis
upper UTI usually caused by e coli
251
S/S of pyelonephritis
chills, fever
N/V
costovertebral tenderness (most common)
tachycardia
tachypnea
HTN
flank and back pain
252
S/S of renal calculi
flank pain that radiates to abdomen, sacrum, testes or vulva
urinary frequency or dysuria
fever
sweaty, pallor
N/V
tachycardia
tachypnea
oliguria/anuria
hematuria
253
nursing intervention for renal calculi
strain urine to check for stones and save for lab analysis
encourage ambulation to promote passage
254
purine containing foods
increase uric acid production
organ meats
poultry
fish
gravies
red wine
sardines
255
Screening guidelines for HPV
starts at 21
21-29: PAP q3yrs, HPV if abnormal PAP
30-65: PAP AND HPV q5yrs
>65: D/C if normal screen every time
256
mammogram teaching
avoid using deodorant, lotion or powder in armpits or on breast
257
menorrhagia
excessive bleeding during period, possibly with clots for 7 days
258
common causes of amenorrhea
low % of body fat in women who work out
women who over exercise
anorexia nervosa
259
S/S of PMS
irritability
impaired memory
depression
poor concentration
mood swings
binge eating
breast tenderness
bloating
wt gain
HA
back pain
260
endometriosis
overgrowth of endometrial tissue that expans outside uterus
common cause of infertility
261
menopause
complete when no period for 12 months
262
S/S of menopause
hot flashes and irregular menses
vaginal dryness
mood swings
decreased bone density
263
Pt teaching for menopause
quit smoking
avoid knee high stockings and clothing/socks that are tight
report unilateral leg pain, edem, warmth and redness
avoid sitting for long periods of time
take short walks throughout the day
264
Cystocele
protrusion of posterior bladder through anterior vaginal wall
265
rectocele
protrusion of anterior rectal wall through the posterior vaginal wall
266
risk factors for cystocele
obesity
adv age
chronic constipation
fam hx
vaginal childbirth
267
risk factors for rectocele
obesity
aging
family hx difficult
vaginal childbirth
forceps deliver
268
fibrocystic breast condition
non-cancerous
fibrosis (connective tissue) and cysts develop
269
S/S of fibrocystic breast condition
breast pain
tender lumps in upper outer quadrant
270
Dx and Tx of fibrocystic breast condition
U/S of breast
needle aspiration to alleviate pain due to fluid buildup
271
PSA
Elevation means possible prostate enlargment/BPH- digital rectal exam necessary
increases with age
normal: 2.5-4
272
digital rectal exam
reveals an abnormality, and location of potential cancerous prostate lesions - confirmed by biopsy
273
Routine digital rectal exams
yearly for men >50
before 50: african american men and men with hx of prostate cancer
274
BPH S/S
urinary frequency and urgency
incomplete emptying bladder
urinary hesitance
dribbling post-void
nocturia
diminished force of stream
straining with urination
painless hematuria
275
meds for BPH
tamsulosin and finasteride
276
TURP
procedure for BPH
277
post op BPH
indwelling 3-way catheter
Continuous bladder irrigation
pink or lighter colored urine is normal - wine colored is NOT
if clots appear, increase CBI rate
if cath is obstructed- turn off CBI and irrigate with 50ml in large piston syringe -notify surgeon if unable to dislodge
278
pt teaching for TURP
Drink 12 or more 8 oz of water daily
avoid stimulants- caffeine and alcohol
normal to feel the urge to urinate often
279
arthroscopy
visualization of internal structures of joint- most common in knee or shoulder joints
not for pts with infection in joint or unable to bend joint at at least 40 degrees
280
nuclear scans
bone scan to visualize entire skeletalsystem
radioactive material injected 2-3hrs before scanning
can detect tumors, fx and diseases of the bone
281
dual x-ray absorptiometry
estimates density of pts bone mass
hip or spine
determines presence of osteoporosis
282
electromyography
determines presence and cause of muscle weakness
thin needles placed in muscle and attached to electrode- electrical activity recorded during muscle contraction
283
arthroplasty
surgical procedure to repair damaged joints of hip and knees
284
pt presentation who need arthroplasty
pain when bearing wt on joint
joint crepitus amd stiffness
joint swelling
285
pre op arthroplasty
give epoetin alfa to increase hgb
286
Contraindications of arthroplasty
UTI because may cause prosthesis to fail
arterial impairment to affected extremity
comorbid condition: Uncontrolled DM, HTN and osteoporosis
287
pt teaching before arthroplasty
donate blood before (autologous donation) for postprocedural
scrubbing surgical site with prescribed antiseptic soap night before and morning of
288
Post op knee arthroplasty
continuous passive motion (immediately after surgery, provide motion in knee to prevent scar tissue forming)
flexion of knee limited due to flexion contraction- avoid knee and pillows behind knee
cold packs to reduce inflammation
289
S/S of PE
dyspnea
tachycardia
pleuritic chest pain
290
Pt teaching post op hip arthroplasty
prevent DVT- PE possible
encourage plantar flexion, dorsiflexion and circumduction exercises
early ambulation
Supine HOB elevated, affected leg in neutral position
place pillow or abduction device between legs
dont turn pt to affected side
no crossing legs
report acute onset of pain, reports of hearing a pop, internal rotation of affected extremity or shortened extremity
externally rotate toes
elevated seating/raise toilet
291
nursing interventions for traumatic amputation (ex. car accident)
elevate above heart
wrap severed extremity in dry sterile gauze and place in sealed plastic bag
submerge bag in ice water and send with pt
292
tx for phantom limb pain
gabapentin
betablockers
massage, heat
push limb down toward bed
293
osteoporosis
low bone density
294
risk factors for osteoporosis
female
lean body figure
hx of smoking and high alcohol intake
excessive caffeine consumption
lack of physical activity
295
S/S of osteoporosis
reduced ht
acute back pain after lifting or bending
hx of fractures
296
Nursing interventions for osteoporosis
Calcium and Vit D supplements(take with food)
encourage wt bearing exercises to improve strength
prevent falls
297
meds for osteoporosis
calcitonin- decreases bone reabsorption
estrogen
raloxifene- decreases osteoclast activity
alendronate- decreases # of osteoclast
298
closed/simple fx
dont break through skin
299
open/compound fx
break through skin
300
comminuted fx
multiple fx lines, splitting the bone in several pieces
301
compression fx
usually in spine- common in osteoporosis
302
oblique fx
across the bone
303
spiral fx
twisting motion
common with physical abuse
304
Cast care
apply ice for 24-48 hrs
plaster cast- use palms, not fingers until dry
elevate cast above heart first 24-48 hrs to prevent edema
no objects under cast
COOL air from hair dryer is okay
305
skin traction
decreases muscle spasms and immobilize extremity before surgery
bryants traction and bucks traction
306
bryants traction
used for congenital hip dislocation in children
307
bucks traction
used post op for hip fx for immobilization of adult clients
308
skeletal traction
pulling force applied directly to bone by weights attached to rope
skeletal tongs (garden-wells)
femoral or tibial pins (steinmann pins)
15-30 lb of weight
monitor for loosening of pins and tenting of skin at pin site (skin rising up pin)
chlorhexidine used to clean pins
one cotton tip swab for each pin to prevent cross contamination
309
halo traction
ensure wrench to release the rods is attached to vest when using halo traction in event CPR is needed
310
compartment syndrome
Pain, pallor, pulselessness
intense pain when passively moved
311
fat embolism
most common in hip and pelvis
occurs within 48 hrs following long bone fx or with total joint arthroplasty
312
S/S of fat embolism
dyspnea
chest pain
decreased o2
decreased mental acuity (early)
resp distress
tachycardia
tachypnea
fever and cutaneous petechiae (late)
313
S/S of osteomyelitis
bone pain that is constant
erythema and edema at site
fever (may not see in older adults)
leukocytosis and possible elevated sedimentation rate
314
Tx of osteomyelitis
3 months IV abt
surgical debridement possible
hyperbaric oxygen therapy
unsuccessful tx= amputation
315
osteoarthritis
progressive deterioration of articular cartilage
316
S/S of osteoarthritis
joint pain and stiffness
crepitus in one or more of affected joints
enlarged joint r/t bone hypertrophy
heberdens nodes (enlarged at distal interphalangeal joints)
bouchards nodes (located at proximal interphalangeal joints)
usually overweight
317
Nursing interventions forosteoarthritis
heat to alleviate pain and ice to reduce inflammation
splint for joint protection and use of larger joints
elevated toilet, shower bench, long handled reacher and shoehorn
pain with activity- relief at rest
318
Rheumatoid arthritis S/S
swelling
redness, warmth
pain at rest or after immobility
affects all joints
usually underweight
swan neck a boutonniere deformities on hand
319
Acute chest syndrome
Caused by respiratory infections and debris from sickled cells
320
Pt teaching after modified radical mastectomy
Drain will remain in place for 1-3 weeks
Will be removed when there is 25ml output or less in 24hrs
321
4 point gait
Bear weight on both legs
Alternate leg with opposite crutch so 3 points are always on floor
322
3 point gait
Bear all weight in one foot while using both crutches
Affected leg never touches ground
323
2 point gait
Partial weight bearing on both feet
Crutch moves with opposite leg
324
Walker instructions
Walker height should be at clients wrist while standing straight
325
Cane instructions
Cane is on strong side
Move cane first, then affected leg, then strong leg past the cane
326
Wound irrigation
Use piston syringe or sterile straight cath for deep wounds with small openings
5-8 psi of pressure
30-60ml syringe with 19 gauge needle is 8 psi
327
Hemolytic reaction S/S
Chills
Fever
Low back pain
Tachycardia
Hypotension
Chest pain
Tachypnea
Nausea
Anxiety
Impending sense of doom
328
Erythropoietin
Increases RBC production
Monitor for hypertension
Monitor Hgb and Hct twice a week
329
TPN teaching/nursing considerations
Tubing has filter to collect particles
Change bag q24hrs even if not empty
No adding anything to the bag
Sterile technique- mask
Check glucose q4-6hrs for first 24 hrs
If oily appearance or layer of fat on top (cracked solution) DONT USE
Room temp
