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ADULT2 TEST 3 > TEST 3 > Flashcards

TEST 3 Flashcards

1
Q

Strain

A

muscle pull or tear of ligaments and tendons

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2
Q

Sprain

A

Twisting, stretching or tearing of ligaments

Ex: Knee strain

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3
Q

RICE

A

Rest, Ice, Compression, Evelate

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4
Q

Severe burning pain, frequent changes in skin from hot and dry to cool and clammy shiny skin that is growing more hair in the injured extremity

A

CRPS- complex regional pain syndrome

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5
Q

When is heat advised in a patient who has sprain or contusion

A

after 2 days since inflammation is no longer likely to increase. Heat relives localized edema and improves circulation

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6
Q

What is a late sign of compartment syndrome

A

pulselessness- it signifies lack of distal tissue perfusion

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7
Q

Which factor may contribute to compartment syndrome?

A

Hemorrage

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8
Q

how long does a plaster cast need to dry

A

72 hour

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9
Q

Plaster cast

A

needs 72 hours to dry, be careful when handling to avoid pressure points

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10
Q

Fiberglass cast

A

Dries within 15 minutes, light weight and does give off heat while drying, water proof liner

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11
Q

6 P’s

A 
Pallor
Pulselessness
Paresthesia
Paralysis
poikilothermia
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12
Q

It is important to call your provider when having a cast if..

A

you notice cyanotic, skin breakdown, notice soft spots around cast, drainage and odor

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13
Q

Fat embolism syndrome:

A

Occurs at the time of a fracture, fat globules can diffuse from the marrow into the bloodstream and block off the lungs, kidneys and brain.

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14
Q

Highest risk for FES

A

fracture of long bones, hips, crash injuries, multiple fractures

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15
Q

S/S of FES can occur…

A

12-72 hours after

tachycardia, SOB, confusion, chest pain, cyanosis, petechiae from nipple to face, high ESR

MEDICAL EMERGENCY–>SUPPLY OXYGEN

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16
Q

What labs should be monitored with a fracture,

A

6 P’s, coagulation labs, vital signs, know weight baring status

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17
Q

DIC

A

widespread hemorrhage, microthrombosis with ischemia, bleeding from mucous membranes, ventricular sites, GI and urinary.

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18
Q

Bucks traction

A

skin traction, make sure there is no pressure ulcers that occur, teach patients to try and shift weight in bed, look for nerve damage of circulation problems.

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19
Q

Bucks traction is used for

A

Lower limb extremities to help with pain!

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20
Q

PET scan

A

used to assess cancer and metastasis. Forms “hot spots” in an event of a tumor. Have the patient be NPO for 4-6 hours before. Must lie still for 90 minutes.

Uses a radioactive substance

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21
Q

Ventilation Perfusion Lung Scan (assesses and primarily used for…)

A

assesses the blood flow and airflow in the lungs

Primarily used for pulmonary embolis

Measure the amount of radiopaque substance in the lungs (normal should be 1:1)

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22
Q

What is the purpose of a bronchoscopy?

A

diagnosis of lung conditions–biopsy–> treatment of lung conditions such as removal of small lesions,

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23
Q

Bronchoscopy provides a direct visualizations of..

A

the lungs and airways by fiber optics

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24
Q

Nursing care for bronchoscopy..

A

NPO for 6 hours, pre op meds, intra procedure: conscious sedations monitoring, spray zylocaine.

NPO until gag reflex returns, VS stable.

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25
Q

Complication of bronchoscopy

A

hemorrage and aspiration

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26
Q

Sputum culture:

A

best early in the morning, patient should rinse mouth with water but not brush teeth since it can affect the results, clear nasal mucus by blowingn ose, take 2 of 3 deep breaths and cough deeply from the diaphragm, expectorate into sterile specimen container.

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27
Q

Antibiotic therapy should be on hold until a sputum culture is given TRUE OR FALSE

A

TRUE- YOU CANNOT TELL WHICH BACTERIA IT IS IF AB IS TAKEN BEFORE

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28
Q

Thoracentesis

A

diagnostic test given to assess the presence of infectious organisms or cancer cells. Treatment for large pleural effusions that diminish lung function

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29
Q

Hgb value

A

12-16

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30
Q

Hct

A

35-50

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31
Q

platelet count

A

150,000-400,000

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32
Q

What might be elevated in COPD?

A

H&H

Elevated H&H with COPD because the body is trying to compensate. The body doesn’t have enough oxygen so it is made more .

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33
Q

WBCS will be elevated if…

A

inflammation or infection

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34
Q

Neutrophils

A

Acute infection

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35
Q

Lymphocytes will be elevated if..

A

chronic or inflammation

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36
Q

Monocytes will be elevated..

A

in bacterial infections but will be later

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37
Q

Eosinophils will indicate

A

allergies

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38
Q

Bands can indicate

A

immature WBC

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39
Q

RBC and H&H can be indicated in

A

respiratory disorders

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40
Q

Low H&H you would worry about..

A

poor oxygenation

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41
Q

Atelectasis is when

A

there is closure or collapse of the alveoli,

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42
Q

Atelectasis is commonly seen in what type of patients (3).

A

elderly, post op, bed ridden

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43
Q

what is key to not getting atelectasis..

A

PREVENTION (using IS, T, C, DB, early ambulation, getting out secretions, increase fluids)

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44
Q

Signs and symptoms of atelectasis

A

low grade fever, cough, sputum production, tachypnea, diminished breath sounds, fine crackles.=, dyspnea, cyanosis, pleual pain in severe cases.

can occur 48 hours post op

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45
Q

What is the most common type of atelectasis

A

obstructive, this occurs when patients are not deep breathing, and can be due to mucus and alveoli not being filled

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46
Q

XR for atelectasis shows :

A

patchy, airless or consolidated areas

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47
Q

Pneumonia can occur due to

A

atelectasis

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48
Q

Exudate can be formed from..

A

WBC, RBC, Fibrin

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49
Q

Bacterial pneumonia S/S:

A

pleuritic pain, chills, fever, cough with purulent sputum, cyanosis, dyspnea, fine crackles, diminished lung sounds, wheezes, friction rub

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50
Q

Viral pneumonia S/S:

A

HA, fever, fatigue, malaise, aching, dry cough

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51
Q

Hospital acquired pneumonia can occur within how many days?

A

48 hours after admission

most often gram negative

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52
Q

Bronchopneumonia

A

patchy areas of consolidation, can occur in both lungs

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53
Q

lobar pneumonia

A

entire lobe is consolidated (one love) such as Right lower lobe pneumonia

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54
Q

general signs and symptoms of pneumonia

A 
fever
sob
fine crackles
tachypnea
increase pulse and RR
consolidation- sputum 
dullness in percussion
pleuritic pain
egophony
confusion in elderly
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55
Q

How do we diagnose pneumonia

A

ABG, XR, labs, h&p, bronchoscopy

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56
Q

pulmonary embolism

A

pleuritic pain, SOB, cough, hemoptysis, dypnea, tachypnea, anxiety, tachycardia, diaphoresis, hypoxemia, syncope, shock

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57
Q

Diagnostic test for PE

A

XR, ABG, ECG, CT, pulmonary angiography, ventilation/ perfusion scanner, d-dimer

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58
Q

PE medication:

A

anticoagulants: 5-7 days such as heparin
Coumadin 3-6 months
Thrombolytics: streptokinase

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59
Q

Complications for bucks traction:

A

infection, skin intergrity, UTI, respiratory issues, mental health issues, muscle atrophy, constipation, aspiration, osteoporosis

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60
Q

surgery for highest risk for DVT

A

Total knee replacement

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61
Q

stage 1: primary infection of AIDS

A

Window period 1A:
period from infection exposure to appearance of antibodies, tests negative for antibodies, may have symptoms but not be associated with HIV, (fever, fatigue and rash)

Stage 1B: antibodies begin to develop in 2-3 weeks, CD4 count >500

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62
Q

Stage 2: Latent phase of HIV

A

200-499 CD4 count. or CD4 and t-lymphocytes 14-28%
Tests positive for HIV
Cd4 and t-lymph fall overtime
symptomatic conditions develop that are NOT associated with AIDS

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63
Q

Stage 3: AIDS phase

A
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64
Q

At CD4 count of

A

immune system is compromised

stage 3

Remains stage 3 even if Cd4 and T cells increase with treatment

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65
Q

Is HIV screening recommended for all persons seeking evaluation and treatment for STIs

A

YES

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66
Q

Does HIV testing need to be voluntary and free of coercion

A

yes. patient must not be tested without their knowledge!!! Do not convince, bribe or make them take the test

67
Q

Before testing for HIV

A

patient must give consent

68
Q

If a positive HIV antibody test is confirmed, there will need to be a supplemental test given such as

A

EAI test–if comes back positive do second test for Blot test. Do not repeat EAI test

69
Q

ONLY the patient can tell someone their results

A

TRUE

70
Q

EAI test will tell you whether..

A

you have antibodies

71
Q

Blot test

A

will be done second to confirm the diagnosis

72
Q

OraQuick

A

onyl takes 20 minutes and is reliable, in-home HIV test

73
Q

CD4 tells you..

A

what stage you are in, how bad it is and what is your therapy.

indicates the level of immune dysfunction

74
Q

Viral load

A

measured HIV RNA of plasma, for those whose EAI TEST came back negative

75
Q

What happens if the patient gets tested with EAI test and it comes back positive

A

do the blot test

76
Q

If the patient gets tested for EIA test and it comes back negative..

A

Viral load (RT-PCR)

77
Q

Despite the HIV infection, this does not mean that the patient particularly has AIDS

A

TRUE

78
Q

window period for HIV

A

may be between 3 weeks to 6 months

79
Q

What is the greatest challenge for therapy for HIV

A

compliance. Are they being compliant with meds?

80
Q

PCP (pneumocystitic pneumonia)

A

clinical manifestation of HIV/AIDS
Most common life threatening condition
Definitive diagnosis: sputum induction, bronchoalveolar lavage, biopsy,

may have nonspecific symptoms such as nonproductive cough, fever, chills, dyspnea, chest pain

81
Q

oral candidiasis

A

clinical manifestation of AIDS

may progress to the stomach and esophagus, treat with mycelex, swish and swallow (ketoconazole), nystatin

82
Q

Diarrhea

A

clinical manifestation of AIDS

Realted to HIV infection enteric pathogens

83
Q

Wasting syndrome

A

10% weight loss and chronic diarrhea and chonic weakness with fever and absence of other cause, protein energy malnutrition, anorexia, diarrhea, GI malabsorption, lack of nutrition

84
Q

Kaposis sarcoma

A

Clinical manifestation of AIDs

cutaneous lesions that may involve multiple organ systems, biggest concern is skin integrity, lesions cause discomfort, disfigurement, ulcerations and potential for infection. Can cause hemorrhage and avoid scratching skin since it can become infected

85
Q

B-Cell lymphomas can be..

A

a side effect of HIV

86
Q

HIV encephaly

A

manifestations of HIV

progressive, cognitive and behavioral motor decline. Probably directly related to HIB infection, get baseline LOC, patient can develop lesions on the brain and can make them confused

DEPRESSION

87
Q

Nursing assessment for HIV

A

assess: knowledge, skin integrity, respiratory function, nutrition status, fluid and electrolytes

assess risk factors

88
Q

Assessing for skin integrirty in HIV patients

A

check perianal area, mouth for ulcerations, infected areas and bony areas, culture wounds for infections

89
Q

Assessing respiratory status in HIV patients

A

check sputum, color, SOB, chest pain, tachypnea, breath sounds.

monitor with : ABG, XR, pulse ox, pulmonary function test

90
Q

Fluid and electrolyte imbalance

A

assess for muscle twitching, irregular pulse, nausea and vomiting, shallow respirations

91
Q

Ineffective airway clearance in HiV

A

pneumonia, TB, weakness and poor cough therefore they cannot get out the secretions. Also cant control the saliva. Something can be stuck in the trachea and you cannot get it out.

92
Q

If a patient is immunocompromised and in stage 3

A

arrange for a portable XR machine to be used in the patients room. DO NOT HAVE THE PT LEAVE THE ROOM

93
Q

interventions for skin integrity for HIV

A

reposition patient ever 2 hours,
pressure reduction devices
perianal skin care- cleaning after voiding

94
Q

Interventions for usual bowel patterns

A

do not eat raw fruits and veggies, carbonated beverages, foods of extreme temperatures, spicy foods

Eat small frequent meals

95
Q

lower UTI

A

cystitis-bladder
Prostatitis- prostate
Urethritis- urethra

96
Q

Upper UTI

A

pyelonephrotic- kidneys

97
Q

Complicated UTI

A

UTI with kidney stones or renal failure or lead to something else. Foleys like a permanent foley or paraplegics who use foleys all of the time

98
Q

uncomplicated

A

just UTI lower or upper

99
Q

urethrovesical reflux

A

coughing, sneezing, straining forces urine into the urethra. When pressure is back to normal the urine flows back into the bladder, also bringing bacteria from the urethra

100
Q

ureterovesicular or vesicoureteral reflux

A

backward flow of urine from the bladder into both ureters

101
Q

women bacterial count for uropathogenic bacteria

A

10^5

*only if you see these results you will do a urine culture. If less than you arenot doing a urine culture. Urine culture is done to determine which type of bacteria it is

102
Q

men bacteria count for uropathogenic bacteria

A

!0^4

103
Q

transurethral route

A

most common route of infection.. ascending infection

104
Q

bloodstream

A

route of infection, hematogenous spread septic

105
Q

uncomplicated UTI

A

may be asymptomatic, burning on urination, frequency, urgency, nocturia, incontinence, suproaubic or pelbic pain, hematuria

106
Q

Complicated

A

asymptomatic if they have bacteruria, gram negative sepsis with shock (generally they can have tachycardia, fever, hypovolemia, urosepsis

107
Q

Patient has low grade fever, altered LOC, incontinence

A

gerontolic considerationn

108
Q

teach patients about urine sample

A

front to back wiping, catch midstream, no gloves for the patient

109
Q

Medical management

A

longer medication courses for men since they are less susceptible to UTI

110
Q

!!relieving pain in UTI

A

AVOID coffee, tea, citus drinks, alcohol, pop

drink WAWA!!!

frequent voiding every 2 houra

antispasmodic agent

111
Q

cath care:

A

empty bag every 8 hour
inspect urine, color odor constitency
maintain a closed system
secure cath to prevent movement so the cath isnt sliding in and out
perform meticulous daily care with soap and water

112
Q

Patient recovering from a UTI

A

BATHE IS NOT THE ANSWER

shower rather than bathe

after each bowel movement, clean the perineum and urethral meatus from front to back.

Drink liberal amounts of fluid

void every 2-3 hours

vitamin c (ascorbic acid or cranberry juice)

113
Q

acute pyelonephritis

A

inflammation of renal pelvis and kidney.

114
Q

chronic pyelonephritis

A

inflammation and scarring and intestinal tissue.

115
Q

common cause of CRF

A

chronic pyelonephritis

116
Q

may develop from hypertension, vascular changes, obstruction

A

chronic pyelonephritis

117
Q

clinical manifestations for acute pyelonephritis

A

acutely ill, chills, fever, leukocytosis, bacteriuria, pyuria, low back pain, n&v, headache, malaise, painful urination

118
Q

Chronic pyelonephritis

A

asymptomatic, fatigue, headache, poor appetite, polyuria, excessive thirst, weight loss over a long period, renal failure

119
Q

Acute pyelonephritis: assessment

A

UA and culture, ultrasound and CT

120
Q

Chronic pyelonephritis-assessment

A

Cr clearance, BUN, creatinine levels

121
Q

diagnostics for urolithiasis and nephrolithiasis

A

KUB- abdominal xr

ultrasound- if it was thought that there was fluid buildup

ct and mri

122
Q

lithotripsy can cause

A

bruising and irritation on whichever side was treated

123
Q

percutaneous nephrolithotomy

A

invasive. generally not done that often

124
Q

medical management for calculi

A

thiazide diuretics- reduces Ca excretion in urine, allopurinol for uric acid, potassium citrate for uric acid, nsaids

INCREASE FLUIDS TO 2L A DAY

125
Q

calcium stone restriction

A

protein and soium

126
Q

uric acid stones restriction

A

low purine diet (shell fish, anchovies, asparagus, mushrooms, organ meat)

127
Q

cystine stones restriction

A

low protein diet

128
Q

oxalate stones

A

low oxalate diet (strawberries, chocolate, spinach, rhubarb, tea, peanuts)

129
Q

complications of a sstone

A

infection, urosepsis, obstruction

130
Q

nursing interventions for calculi

A

relieve pain, continue care, self care, education, monitor and manage potential complications

131
Q

Patient teaching for kidney stones

A

signs and symptoms to report.

urine pH monitoring

avoid protein intake, restricted to 60g/day

sodium intake 3-4 g/day

low calcium diets are not recommended

avoid intake of oxalate

drink every 1-2 hours

drink 2 classes of water at bedtime

avoid activities leading to sudden increase in temp (excessive sweating causing dehydration)

132
Q

cystocele

A

downward displacement of the bladder into the vaginal orifice

133
Q

rectocele

A

upward pouching of the rectum that pushes up to the posterior wall of the vagina forward

134
Q

enterocele

A

protrusion of intestinal wall into the vagina

135
Q

Clinical manifestations for all 3..

A

sensation of pelvic pressure or fullness down below, urinary problems (incontinence, urgency, frequency) back or pelvic pain

136
Q

rectocele

A

has rectal pressure as an additional symptom to unusual urination pattern such as incontinence, back or pelvic pain and fullness

137
Q

Non surgical management for cystocele, enterocele,

A

kegels, pessary- treatment for prolapse of uterus

138
Q

kegel exercises

A

important to strengthen the pelvic floor muscles, Sustain contraction for 10 seconds, perform 30-80 X a day

139
Q

Pessary

A

inspected annually by the doctor. in place to support uterus, rectum, bladder in place

140
Q

Uterine prolapse

A

when structures that support the uterus weaken (from childbirth) allowing the uterus to work its way down the vaginal canal.

HAVE PT DO KEGELS, pessary

hysterectomy can be done

141
Q

symptoms of uterine prolapse are aggravated when a woman:

A

coughs, lifts heavy objects (nothing more than 10lbs), stands for long periods of time, normal activities such as walking up stairs

142
Q

what can happen as a result of getting a hysterectomy

A

you can develop a cystocele

143
Q

Those having a rectocele repair may need to know that BEFORE surgery …

A

a laxative and cleaning enema may be prescribed

144
Q

what position for surgery for uterine prolapse or hysterectomy

A

lithotomy with special attention to the placement of legs which can easily develop a blood clot. MOVE BOTH LEGS DOWN AT THE SAME TIME

145
Q

POST-OP care for hysterectomy, cystocele, rectocele, etc surgeries

A

void a few hours after surgery for cystocele

if no void and reports pain after 6 hours- indwelling cath may be indicated for 2-4 days. CALL DOCTOR IF NO VOID IN 6 HOURS

After each BM, perineum may be cleanred with saline solution and dried with sterile absorbent material if an incision was made

ice pack applied locally. 20 min on 20 min off

146
Q

What to report after surgery of cystocele, rectocele, , etc.

A

report pelvic pain, unusual discharge, personal hygeine, vaginal bleeding, ( a little blood in the beginning is normal but by the time of arriving home there should be NONE)

147
Q

Hysterectomy (3 types)

A

subtotal, total and radical

148
Q

surgical approaches for hysterectomy

A

laparoscopic- small holes
vaginal
abdominal-incisions, transverse and vertical

149
Q

subtotal hysterectomy

A

uterus is removed but cervix is spared

150
Q

total hysterectomy

A

removal of cervix and uterus

151
Q

radial hysterectomy

A

removal of uterus as well as the surrounding tissue, including the upper third of vagina and pelvic lymph nodes

152
Q

hysterectomy preop management

A

prevention of DVT
discontinue anticoagulants
pregnancy is ruled out on day of surgery
prophylactic ab agents may be administered

153
Q

postop management for hysterectomy (risks)

A

major risk are infection and hemorrage, DVT

voiding problems may occur due to edema or nerve loss

154
Q

oophorectomy

A

surgical removal of ovaries. Can be done alone or as part of a hysterectomy

155
Q

Salpingectomy

A

surgical removal of fallopian tube- often related to tubal pregnancies

156
Q

indications for a hysterectomy

A

fibroids, pelvic pain, uterine prolapse, pelvic prolapse, uterine bleeding, malignancy, endometriosis

157
Q

nursing interventions for patients undergoing hysterectomy

A

relive anxiety- allow pts to express feelings, provide emotional support

Improve body image- listen and address concerns, provide appropriate reassurance, address sexual issues

158
Q

Nursing Intervention: relieving pain ofr hysterectomy

A

post op pain and discomfort can be relieved with PCA pump, analgesics

When there is return of bowel sounds- may begin soft diet

159
Q

do not stuff pillows behind the knees when preventing a venous thromboembolism

A

TRUE

160
Q

after a hysterectomy, patient must pee before discharge

A

TRUE

161
Q

why do we not want post op hysterectomy patients to drive

A

in the event of a car accident the steering wheel can hit the area causing hemorrage

162
Q

lambskin condoms will not protect against HIV

A

TRUE- nonlatex condoms will not protect someone from HIV

163
Q

Spiral fractures occur when..

A

often occur when the body is in motion while one extremity is planted.

164
Q

FES can occur within how many hours

A

12-72

ADULT2 TEST 3 (1 decks)

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