Theory final exam Flashcards
1
Q
PAD
A
peripheral arterial disease - partial or total occlusion of the artery
2
Q
PAD can cause
A
tissue damage
3
Q
most common cause of PAD
A
atherosclerosis
4
Q
which part of the body is most commonly affected by PAD
A
lower extremities
5
Q
PAD related to
A
cardiovascular and cerebrovascular disease
6
Q
PAD occurs earlier in
A
pt with DM
7
Q
hallmark of PAD
A
intermittent claudication
8
Q
what increases pain with PAD
A
elevating the extremity or placing it in a horizontal position
9
Q
Assessment of PAD
A
cold and pain with elevation
ruddy or cyanotic when placed in dependent position
prolonged cap refill
skin appears shiny, taut, and dry with no or little hair
bruit may be auscultated
muscle atrophy with prolonged ischemia
10
Q
diagnostics with PAD
A
doppler ultrasound, ankle-brachial index, treadmill testing
11
Q
ankle brachial index equation
A
ankle systolic/brachial systolic
12
Q
normal ankle brachial index
A
1-1.3
13
Q
management of PAD
A
reduce serum lipids, daily walking, stop smoking, healthy diet
14
Q
pharmacologic therapy for PAD
A
hemorrheologic or antiplatelet agents, vasodilators, or antihyperlipidemics
15
Q
pentoxifylline (trental)
A
increases flexibility of RBC and decreases blood viscosity
16
Q
surgical intervention of PAD
A
revascularization, endarterectomy, endovascular surgery
17
Q
arterial revascularization
A
arterial bypass and vascular grafting
18
Q
endarterectomy
A
surgery to remove fatty deposits (plaque) that are narrowing the arteries in your neck
19
Q
bypass graft
A
reroutes the blood flow around the stenosis or occlusion
20
Q
femoral -popliteal graft
A
Surgical procedure of choice if atherosclerotic occlusion is below the inguinal ligament in the superficial femoral artery. grafts may be synthetic or autologous
21
Q
post op disappearance of pulse
A
may indicate thrombotic occlusion of the graft—this is an emergency
22
Q
post op PAD surgery
A
ABI not recommended, monitor pulse, color and temp, and cap refill
23
Q
potential complications after PAD surgical repair
A
bleeding/hematoma and edema
24
Q
severe edema, pain and decreased sensation can be indication of
A
compartment syndrome
25
PAD home care
avoid pressure on affected extremity, avoid vigorous massage of extremity, avoid exposure to cold, constrictive clothing, and crossing legs, stop smoking
26
nursing diagnoses of PAD
ineffective peripheral tissue perfusion, activity intolerance, and chronic pain
27
aneurysms risk factors
age, male gender, HTN, CAD, family history, high cholesterol, lower extremity PAD, stroke, smoking, obesity
28
most abdominal aortic aneurysms occur
below the renal arteries
29
aneurysms are usually
asymptomatic until dissection or rupture occurs
30
classification of abdominal aneurysms
supra-renal, juxta-renal, and intra-renal
31
aneurysm repair
open repair surgery - done under general anesthesia
32
open repair of aneurysm can be
trans peritoneal or retroperitoneal
33
most common complication of endovascular repair of aneurysm
endoleak
34
endoleak
leak inside the vessels that allows blood to pool up
35
what med do pt need after endovascular repair
home meds and beta blocker
36
chronic bronchitis s/s
blue bloater - hypoxia, increase rr, increase CO2, clubbing
37
emphysema s/s
pink puffer- purse lip breathing, barrel chest, thin, decreased CO2
38
diagnostic procedures for COPD
CXR, peak expiratory flow rate, pulmonary function test, pulse ox, ABGs, CBC, sputum culture
39
FEV in COPD
low
40
pharmacologic management of COPD
bronchodilator, nebulizer inhalers (duoneb), corticosteroids, antibiotics, O2 therapy
41
surgical treatment of COPD
bullectomy, lung volume reduction surgery, lung transplantation
42
bullectomy
bullae are resected via thoracoscope
43
lung volume reduction surgery
procedure done via bronchoscope where a surgeon removes damaged parts of the lung to create more space for the lung to work better
44
single most important driver of ventilation
CO2 - supplemental oxygen may increase CO2 levels
45
most precise method of delivering exact amounts of O2
venturi mask
46
if COPD pt is in respiratory failure
begin high flow oxygen delivery regardless of history, obtain IV access, breathing techniques, and position
47
complications with COPD
resp. infections, heart failure, fluid retention, pneumothorax, pulmonary hypertension
48
open vs percutaneous tracheostomy procedure
open - performed in OR. percutaneous - usually performed at bedside in ICU
49
advantages of tracheostomy
decreases airway resistance, easier airway care, facilitates oral communication and speech, improves oral hygiene
50
outer cannula
fits into the stoma to keep it open
51
obturator
device that guides the outer cannula into the stoma during placement of the cannula
52
inner cannula
fits inside the outer cannula and can be removed for cleaning
53
what type of tube is used for patients who are ready for decannulation
cuff less tube with reusable or disposable inner cannula
54
if patient has metal tract tube they cannot get
an MRI
55
complications of trach
bleeding, infection, mucous plug, injury to laryngeal nerve, injury to esophagus, skin necrosis, false passage
56
what do you do is there is accidental decannulation
call rapid response, maintain an airway, and reinsert new tube if available
57
trach pt should always have
two tubes, one the size currently in the pt and one a size smaller
58
new trach tube care
do not change trach tape for at least 24 hr and physician will perform the first change 7 days after initial insertion
59
you need to bypass what when suctioning
bypass glottis to decrease cough reflex
60
what is lost when trach is in place
filtered, warm and humidifies air so the airway becomes drier and produces mucus scabs that can lead to infection, obstruction, and pneumonia
61
prevent crusting of trach through
proper humidification and hydration
62
what is used to wean the patient off the tracheostomy
decannulation cap
63
types of head and neck cancer
oral, salivary, laryngeal, nasopharyngeal, nasal cavity tumors
64
head and nick cancers are more common in
men than women
65
squamous cell carcinoma is more common in
smokers and drinkers
66
head and neck cancer risk factors
long periods of sun exposure, chewing tobacco, bad diet, breathing in chemical, genetic syndromes
67
leukoplakia is characterized by
irregular, smooth to thickened tissue on the tongue
68
erythoplakia is characterized by
smooth, velvety clinical presentation with a homogenous surface without ulceration
69
60-70% or oropharyngeal cancers are due to
HPV
70
clinical manifestations of head and neck cancer
ulcer or sore area in the head/neck, pain with chewing, trouble breathing, numb feeling in the mouth, unexplained loose tooth, persistent nose bleeds, constant sore throat, ear ringing, lump, pain
71
diagnosis of head/neck cancer
examination of mouth, throat, and neck, laryngoscopy, CT scan or MRI, PET scan
72
staging of head and neck cancer
TNM - tumor, number of nodes and location, and metastasis. stages 1-4
73
treatment options for oral cancer
surgery, radiation, or chemotherapy
74
transoral robotic surgery
removal of tumor during laryngeal cancer
75
total laryngectomy
open surgery to remove the entire larynx - stoma is created
76
radiation nursing care
adequate oral care because radiation causes dry mouth
77
nursing care of pt with trach stoma
wash stoma daily with moist cloth. clean edges with cotton swab dipped in mixture of hydrogen. remove inner cannula daily
78
larytube or larybutton
help keep the stoma open during early stages
79
blom singer laryngectomy tube
maintains latency of the trach after laryngectomy
80
diagnostics for asthma
CXR, measuring oximetry, H&P, pulmonary function studies
81
asthma care
identify and avoid triggers, pt teaching, meds
82
care for severe asthma exacerbation
SaO2 monitoring, ABGs, B2-adrenergic agonist, inhaled anticholinergic agents, oxygen, corticosteroids, IV fluids
83
teaching of inhaler
use spacer, Short acting beta agonist, clean unit to eliminate bacterial growth
84
singular
Leukotriene Pathway Inhibitor-Montelukast Sodium
85
three phases of a perioperative patient and what is our focus in each phase
preoperative- teaching and education, intraoperative- safety and sterile, and postoperative- pain management and prevention of complications
86
3 requirements of informed consent
adequate disclosure of diagnosis, purpose, and risks of treatment, understanding and comprehension, and consent given voluntarily
87
nurses role during informed consent
advocate, witness, appropriate person signs consent
88
consent may not be signed by a patient after
they have received narcotics or sedatives
89
living will vs durable power of attorney
living will - short period of time/more emergent. durable power of attorney - can have early in illness and covers longer period of time
90
pre surgical screening tests
chest x-ray, electrocardiography, urinalysis, and labs
91
presurgical labs
CBC, CMP, pregnancy test, PT/INR, PTT
92
nursing interventions for psychological needs of surgical patients
establish relationship, allow patient to verbalize fears, be prepared to response to questions about surgery
93
preoperative checklist
document diagnostic tests, document pre-op medication given, document VS, document safety data which includes 2 identifiers, jewelry removed, last void/meal, dentures removed, informed consent verified, patient allergies
94
SCIP protocol
antibiotic given 1 hour before surgery, glucose level below 200, hair removal, urinary catheter, beta blocker, VTE (anticoagulation) prophylaxis, temp management ( want temp in OR normal)
95
phases of general anesthesia
induction, maintenance, emergence
96
anesthetic complications
anaphylactic reactions from anesthesia or latex and malignant hyperthermia
97
malignant hyperthermia
problem with receptor on skeletal muscle causing major metabolic reaction. familial history important
98
malignant hyperthermia signs and symptoms
lactic acidosis, muscle contracture, hyperthermia. is important to identify early
99
malignant hyperthermia treatment
dantrolene - directly interferes with muscle contraction by inhibiting ion release from the sarcoplasmic reticulum
100
nurses job in the OR
universal protocol "time out", maintenance of sterile technique, patient monitoring, instrument and sponge count
101
common postoperative complications with respiratory
most common is atelectasis, pulmonary edema, aspiration, bronchospasm, hypoventilation, airway obstruction, pneumonia, hypoxemia
102
what measures can be taken to prevent SSI
prophylactic antibiotics, hair removal, glycemic control, maintaining drainage devices
103
dipstick urinalysis with presence of nitrates
indicated bacteriuria
104
dipstick urinalysis with blood
infection
105
dipstick urinalysis with ketones
dehydrated or DM
106
indications for catheter
acute urinary retention obstruction, Perioperative use in selected surgeries, Assist healing of perineal and sacral wounds in incontinent patients, Hospice/palliative/comfort care, Required immobilization from trauma or surgery, Chronic indwelling catheter on admission, Accurate measurement of urine output in critically ill patients in ICU
107
diagnostic test of pyelonephritis
elevated WC with increase in bands, leukocytes and WBC in urine (pyuria), positive urine cultures, positive blood cultures in bacteremia
108
ESRD
end-stage renal disease (ESRD)
109
what is the third leading cause of ESRD in the US
glomerulonephritis
110
causes of acute glomerulonephritis
streptococcal infections (strep throat) group A beta hemolytic strep, viral infection, impetigo, lupus, good pastures syndrome, Wegener's disease
111
therapeutic management of glomerulonephritis
focuses on symptomatic management - antibiotics, protein and fluid restriction, bedrest, monitors I&Os, plasmapheresis, dialysis
112
plasmapheresis
removal of harmful antibodies from the plasma
113
nephrotic syndrome
glomerulus becomes permeable to plasma protein
114
management of nephrotic syndrome
corticosteroids, control of DM, sodium restrictions and diuretics to control edema, and sure primary disease
115
Lithotripsy
most common treatment for kidney stones in the U.S. Shock waves from outside the body are targeted at a kidney stone causing the stone to fragment
116
percutaneous nephrolithotomy
minimally-invasive procedure to remove stones from the kidney by a small puncture wound through the skin
117
pyelolithitomy
surgical incision of the renal pelvis of a kidney for removal of a kidney stone.
118
renal calculi teaching
drink 2000-3000 mL of fluid daily, lower protein intake, limit soda, coffee, and tea, less than 2 g sodium per day, avoid sudden increase in temp, avoid oxalate/purine containing foods, strain all urine
119
ileal conduit
a system of urinary drainage which a surgeon creates using the small intestine after removing the bladder
120
Nephrostomy
a small tube inserted through the skin directly into a kidney. The nephrostomy tube drains urine from the kidney into an external drainage pouch. this is only temporary
121
diagnostics for BPH
DRE and PSA test
122
cystitis
bladder UTI
123
urethritis
urethra UTI
124
normal calcium levels
8.6-10.2
125
normal potassium levels
3.5-5
126
stomy bag needs to be changed
every 3-4 days
127
leading causes of amputation
infection, PAD, diabetes, trauma
128
Metacarpal
removal of the entire hand with the wrist still intact.
129
nursing goals of pt with amputation
Support psychological and physiological adjustment
Alleviate pain
Prevent complications
Promote mobility and functional abilities
Provide information about surgical procedure and treatment needs
130
_________ stump to decrease swelling
elevate
131
instruct patient after amputation to lie in _______ as tolerated at least twice a day
prone position
132
how to care for incision after arthroplasty
with soap and water
133
clinical manifestation of hip fracture
```
External rotation and shortening
Muscle spasm
Severe pain
Shock
No weight!
No walking!
```
134
complications of joint surgery
infection and DVT
135
5 Ps
pain, paresthesia, pallor, paralysis, pulselessness
136
oblique fracture
complete fractures that occur at a plane oblique to the long axis of the bone
137
comminuted fracture
a break or splinter of the bone into more than two fragments.
138
spiral fracture
is a type of complete fracture. It occurs due to a rotational, or twisting, force
139
complications of fractures
```
Compartment syndrome
Fat embolism
Deep vein thrombosis (DVT)
Complications of immobility
Complications of fracture healing
```
140
patient may become _______ ; ________ with a fat embolism
tachycardia and hypotensive
141
what do you need to do for compartment syndrome
Fasciotomy required to relieve pressure and Emergent surgery required to prevent loss of limb
142
myositis ossificans
bone forms within the muscle, and this occurs at the site of the hematoma
143
osteomyletitis
Inflammation of bone caused by infection, generally in the legs, arm, or spine.
144
sanguineous vs serous-sanguineous vs serous
sanguineous- red discharge (bleeding)
serous-sanguineous- pink discharge
serous- white discharge
145
CSM
C- color plus cap refil, pulse, and temp
S- sensation
M- ability to move
146
Hgb A1C levels
should be below or equal to 6.5
147
1 unit of insulin lowers blood glucose by about
50 mg/dL
148
regular insulin onset, peak, and duration?
onset - 30 minutes
peak - 2-4 hours
duration 6-8 hours
149
lispro
ultra short acting insulin that is given 15 minutes before meal and leak levels seen within 30 minutes
150
Lantus
called insulin Glargine - given once daily. provides a continuous low level of insulin secretion and cannot be mixed with any other insulin
151
most protocols define hypoglycemia as
below 70 mg/dl
152
mild symptoms of hypoglycemia
hunger, weakness, diaphoresis, dizzy, anxiousness, impaired vision, headache, and pounding heart
153
severe symptoms of hypoglycemia
mental status changes, coma, death, unconsciousness, seizures
154
mild/moderate hypoglycemia is defined as
FSBG 41-69 with or without symptoms
155
severe hypoglycemia is defined as
41-69 if patient has mental status change or is unconscious, or NPO or FSBG is 40 or less
156
glucagon
important hormone in carbohydrate metabolism that is released by the pancreas. helps maintain the level of glucose by causing liver to release its stored glucose.
157
what precaution should severe hypoglycemia patient be put on
seizure precautions
158
diagnostic test for meningitis
nasopharyngeal swab, test for kerning's and brundzinski's sign, x-rays, gram strain, cultures
159
brudzzinski's sign
severe neck stiffness causes a patients hips and knees to flex when the neck is flexed during meningitis
160
kerning's sign
severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed 90 degrees
161
bacterial meningitic labs
WBC- greater than 1000
protein - greater than 500
glucose - decreased
162
viral meningitis
WBC- 25-500
protein 50-500
glucose- normal
163
how do you rule out bacterial meningitis
lumbar puncture
164
meningitis vs encephalitis
patient with meningitis may be uncomfortable, lethargic, or distracted while encephalitis causes alteration in brain function
165
BP will be _____ during a hemorrhagic stroke
elevated
166
right hemisphere
attention span, impulse control, movement of left side, drawing skills, remembering visual object, face recognition, left side awareness, measuring distance of objects to body
167
left hemisphere
motor speech, expressive speech, movement of right side, emotion, math, writing, reading letters and numbers, recognizing objects, remembering written info
168
FAST
facial drop, arm weakness, speech difficulty, time to call 911
169
medications for seizures
Ativan if status epilepticus. tonic-clonic: dilantin, tegretol...
170
Guillain-Barre syndrome
acute, rapidly progressing motor neuropathy involving segmental demyelination of the nerve roots in the spinal cord and medulla
171
clinical manifestations of Guillain barre syndrome
paralysis that starts in lower extremities and ascends bilaterally, paralysis of respiratory muscles, difficulty swallowing and talking, facial flushing, hypotension
172
stages of Guillain Barre syndrome
acute, plateau, and recovery
173
treatment for Guillain Barre syndrome
respiratory support, corticosteroids, immunosuppressants, plasmapheresis
174
most common upper GI problem
GERD
175
most common cause of GERD
hiatal hernia
176
clinical manifestations of GERD
heartburn, dyspepsia, regurgitation, non cardiac chest pain, some respiratory symptoms
177
GERD is directly related to
esophagus cancer
178
diagnostics for GERD
EGD - esophagogaatroduodenoscopy, esophagram barium swallow, physical, or biopsy
179
treatment of GERD
medications: H2 receptor blockers, PPIs, cholinergic, antacids, motility enhancers
180
surgical procedures for GERD
laparoscopic - Nissen and toupet fundoplications
181
main causes of peptic ulcers
aspirin and NSAIDs
182
mortality is higher in which ulcers
gastric ulcers
183
gastric ulcer pain
burning gassy pain felt high in epigastric 1-2 hours after meal
184
duodenal ulcer pain
burning crampy upper abdominal pain usually 2-5 hours post meal
185
cholelithiasis
stones in the gallbladder
186
cholecystitis
inflammation of the gallbladder can be from gallstones or biliary sludge
187
cholelithiasis occurs when
the balance of cholesterol, bile salts, and calcium in solution are altered
188
initial clinical manifestations of gallbladder disease
indigestion, right upper quadrant pain, acute pain, V/N
189
total gallbladder obstruction clinical manifestations
jaundice, dark amber urine, clay color stools, pruritus, intolerance of fatty food
190
if ultrasounds is negative for gallstone diagnostic what is usually next
HIDA scan - cholescintigraphy
191
labs for gallstones
elevated WBC, elevated direct and indirect bilirubin, AST and ALT might be elevated
192
medical treatment for gallstones
NPO, medications, gastric decompression with BG tube, ERCP, surgery
193
ERCP
Endoscopic retrograde cholangio-pancreatography
194
open cholecystectomy
removal of gallbladder through right subcostal incision and T-tube inserted into the common bile duct which allows bile to drain
195
how can you increase comfort for pt with laprascopic
Sims position
196
#1 and #2 causes of pancreatitis
```
#1 - gallbladder disease
#2 - alcohol
```
197
clinical manifestations of acute pancreatitis
pain - epigastric and radiating to back left flank and shoulder, N/V, low grade fever, hypotension, tachycardia, jaundice, paralytic ileus, tetany
198
tetany
involuntary contraction of muscles - hypocalcemia
199
paralytic ileus
absent or decreased bowel sounds
200
blood test for acute pancreatitis
amylase and lipase will be elevated, elevated glucose, low calcium, increase triglycerides
201
position for comfort during pancreatitis
fetal, side-lying, HOB elevated, sitting up leaning forward
202
acute appendicitis clinical manifestations
periumbilical abdominal pain followed by anorexia, n/v, low grade fever
203
is a CT or MRI preferred with appendicitis
CT
204
crohns lesions are most common in the
distal ileum
205
ulcerative colitis happens in the
rectosigmoid colon and rectum - begins in the rectum
206
ulcerative colitis
bloody stools, left lower quadrant pain, diarrhea, weight loss not as common as crohns
207
crohns manifestations
diarrhea, abd pain, cramping, weight loss
208
inflammatory bowel disease pt need to be supplemented with
iron and B 12
209
avoid what foods with inflammatory bowel disease
lactose, high fat, cold foods and high fiber foods
210
risk factors of colorectal cancer
history of IBD, DM, smoking, alcohol, obesity, consuming more than 7 servings a week of red meat, family history, and KRAS gene mutation
211
clinical manifestations of colorectal cancer
iron deficiency anemia, rectal bleeding, abdominal pain, change in bowel habits
212
diverticulum is most common in
the sigmoid colon
213
what antibiotic do pt with diverticulitis usually get
flagyl
