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150 Final
Chronic Final
| Question | Answer |
|---|---|
| Normal BP | <120/<80 |
| Prehypertension BP | 120-139/80-89 |
| HTN, stage 1 | 140-159/90-99 |
| HTN, stage 2 | >160/>100 |
| Primary HTN | No specific etiology, 90-95% |
| Primary HTN-r/t | age, gender, family hx, ethnicity, sedentary lifestyle, socioeconomic status, stress, obesity, alcohol, smoking, diabetes, elevated lipid levels, high sodium diet |
| Secondary HTN | specific cause identified & corrected, 5-10% |
| Secondary HTN-r/t | renovascular, Cushing’s disease, oral contraceptives, primary aldosteronism, renin secreting tumors, pheochromocytoma |
| Most common causes of secondary HTN | renal parenchymal & renovascular disease |
| HTN-Clinical manifestations | h/a, epistaxis, dizziness, weight changes, DOE, diaphoresis, palpitations, visual disturbances |
| Target Organ disease-organ most impacted by high BP | heart |
| HTN-Lifestyle modifications | weight reduction, moderate ETOH intake, regular physical activity, decrease Na intake, adequate potassium/calcium/magnesium intake, stop smoking |
| DASH | ^fruits & veggies (10-11 servings), decreased fats (26%,<10%saturated), low fat dairy products, <3,000mg NaCl/day |
| HTN-Meds | diuretics, adrenergic inhibitors, vasodilators, ACE inhibitors, ARBs, CCBs |
| Furosemide/Lasix(loop diuretic) | give undiluted, 20mg/min, use w/in 24h |
| Hydrochlorothiazide/HCTZ-SE | hyperglycemia, hyperuricemia, hypokalemia, ortho hypotension, dry mouth, thirst, n/v, blurred vision, photosensitivity |
| Metoprolol/Lopressor (adrenergic inhibitor)action | beta-adrenergic blockers, decrease HR/CO, decrease renin release from kidney |
| Adrenergic Inhibitors | Alpha 1 receptor blockers, dilate blood vessels, 1st dose phenomenon, NA and fluid retention w/ ^ doses |
| 1st Dose Phenomenon | 1st dose or dose^ leads to Hypotension |
| “Prils” action | vasodialate, decrease aldosterone, ACE in the lining of blood vessels, ACE block enzyme that converts A-I to A-II |
| ACE-SE | angioedema (life-threatening-tongue swelling), hypotension(1st dose effect), hyperkalemia(monitor potassium), cough |
| LV Failure-S&S | lungs; fatigue, SOB, dyspnea, DOE, orthopnea, paroxysmal nocturnal dyspnea, cough, crackles, edema, weight gain |
| RV Failure-S&S | secondary to LV failure; venous congestion, edema, dependent edema, pitting edema, sacral edema, peri-orbital edema, ascites, anasarca, distended neck veins, hepatomegaly, nocturia, weight gain |
| HF-Diagnosis | CXR, Echocardiogram-EF<50%, BNP-^w/ cardio issues>100 |
| Systemic Lupus Erythematous | diffuse connective tissue disorder, autoimmune, secondary to genetics, hormonal, environmental, chemical or med induced |
| SLE-S&Sx | fever, fatigue, weight loss, arthritis, pleurisy, pericarditis, skin rashes, all body systems may become infected |
| SLE-Manifestations | characteristic skin changes, butterfly rash, malar rash, red/purple/scaly, inflamed appearance |
| SLE-Pharmacology | Corticosteroids-mainstay of therapy, decrease tissue inflammation, topical for dermatologic therapy, oral low dose maintenance therapy, IV high dose for exacerbation |
| Corticosteroids-SE | glaucoma/cataracts, fluid retention, ^BP, mood swings, weight gain, hyperglycemia, ^risk infections, loss of calcium, cushingoid features |
| Magnesium | 1.3-2.3mg/dL, ^in CKD, mag & potassium go together-change mag to change potassium |
| PVD-Causes | pump failure, obstructed vessels, aging process, obstructed lymphatic vessels |
| PVD-Assessment | 6 Ps-pain, pallor, pulselessness, paresthesia, polar, paralysis |
| PVD-Arterial Characteristics | Paresthesia, dependent cyanosis, gangrene of toes/feet, decreased peripheral pulses, thick/brittle nails, pallor on leg elevation, instructed to walk 30min/day to the point of pain |
| Assessing ABI | Ankle BP/Brachial BP, WNL: 1.0 |
| PVD-Medications | Anticoagulants-Heparin, Lovenox, Antiplatelets-asprin, enteric-coated asprin-325mg/162mg/81mg, Plavix |
| Diabetes-Risk Factors type 2 | sedentary lifestyle, HTN/CAD, Elevated lipids, GDM, Newborn wt>9lbs |
| Sick Day Rules | insulin as usual, BG more often, ^fluids, rest, contact HCP for persistent S&S/BG >250 |
| Diabetes-Exercise | decreases need for insulin, if BS is low exercise makes it lower, eat before exercise & have snack handy |
| Hypoglycemia-S&Sx | shaky, sweaty, hungry, headache, dizziness, pale, mood change, confusion, nightmares, BG45-60mg/dL |
| Diabetes HbA1c | >6.5% |
| Hypoglycemia-Tx | oj, milk, pb (hot & dry, sugar’s high-cold & clammy, needs some candy) |
| DKA S&S | dehydration, excessive urine, thirst, acetone breath, vomiting, abd pain, Kussmaul's respirations, BG>300mg/dL, pH <7.35, HCO3 low |
| DKA Therapy | insulin, rehydrate, electrolyte replacement, potassium |
| HHNK S&S | similar to DKA except, absence of ketone production, BG >600mg/dL |
| Buerger’s Disease | autoimmune vasculitis, men, tobacco, bluish discoloration in big toe |
| Mitral Valve Heart Disease-Risk Factor | infection? |
| Mitral Valve Disease-S&Sx | mitral click, fatigue, anxiety, no Sx |
| Mitral Valve-after surgery | Warfarin/Coumadin-LIFELONG |
| Oxygenation Assessments | 6 Ps-pain, pallor, pulselessness, paresthesia, polar, paralysis |
| Diverticulitis-Nutrition | initially clear liquid diet, high fiber/lowfat, no nuts/popcorn/seeds/etc |
| Lab tests for Hepatitis | LFT,PT, serum bilirubin, serum protein, serum ammonia |
| AST/ALT | 10-40 |
| PT | 12-16sec |
| Serum Bilirubin | 0-0.9mg/dl(over 1-jaundice) |
| Serum Protein | 6.0-8.4 |
| Serum Ammonia | 15-90 |
| Albumin | 3.5-5.5g/dl |
| Liver Biopsy-Nursing Responsibility | check labs/consent, per/post VS, instruct pt to inhale/exhale-hold breath, needle inserted btw 6th & 7th rib, position on R-pillow to costal margin, remain in position, avoid coughing/straining |
| Hepatitis A | fecal-oral, shellfish, mild flu-like sx |
| Hep A-Nursing Mgmt | prevention (handwashing), sm freq meals, 2,000-3,000cal/restrict fat, do not force feed, I&O, no alcohol, vaccine |
| Hep C | IV drug use/needlesticks, most common chronic blood-borne infection, blood trans & sexual contact, most common reason for liver transplant, 15-160day incubation, assoc w/ HIV, 40-59yrs/africian americans, often no signs/sx |
| CKD-Potassium Assessments | ^in CKD, norm is 3.5-5mEq/L |
| CKD-Hemodialysis Labs | GFR, BUN, Creatinine, 24h Urine for CrCl, Albumin, Hgb&Hct, K, Na, Ca, Mg, P,TSAT |
| GFR | 120mL |
| BUN | 10-20mg/dL |
| Creatinine | 0.7-1.4mg/dL |
| Creatinine Clearance | 75-125mL/min |
| Hemoglobin | 12-18gm/dL |
| Hematocrit | 35%-52% |
| Albumin | 3.5-5.5g/dL |
| Potassium(K) | 3.5-5mEq/L |
| Sodium(Na) | 135-145mEq/L |
| Calcium(Ca) | 8.6-10.2mg/dL |
| Magnesium(Mg) | 1.3-2.3mg/dL |
| Phosphorus(P) | 2.5-4.5mg/dL |
| TSAT | >20% is target for CKD |
| Parkinson’s-S&Sx | gradual onset, dysphagia, drooling, risk of aspiration and choking, tremor, rigidity, and bradykinesia, asymmetric onset, resting tremor, shake while walking |
| Addison’s Crisis-Priority Nursing Diagnosis | Shock, fluid vol deficit/dehydration |
| Cushing’s Assessments | excessive adrenocorticol activity, pituitary tumors, ^secretion of glucocorticoids, ^sex hormones, buffalo hump, moon face, facial hair, truncal obesity, ecchymosis |
| MG-Medical Emergencies | Myasthenic Crisis & Cholinergic Crisis, both characterized by respiratory difficultyrespiratory failure |
| MG-Diagnosis | Tensilon test: obvious ^ increase in strength after administration is + for MG |
| Myasthenia Gravis | autoimmune disease, S&Sx: diplopia (double vision), Ptosis(drooping eyelid), weakness ^ w/ activity-decreases w/ rest, difficulty speaking-chewing-aspiration, respiratory failure |
| Myasthenic Crisis | due to infection, ^stress, not enough drugs on board, ^ muscle weakness & difficulty breathing,Tx: ^cholinergic agents |
| Cholinergic Crisis | drug overdose, excess stimulation of PNS, abdominal cramps, diarrhea, excessive oral secretions, difficulty breathing, muscle weakness |
| Cholinergic Crisis Implications/Tx | monitor heart rate, stop cholinergic agents, give anticholinergic-atropine, mechanical ventilation |
| HIV-Infection Control for Nurses | Handwashing!, No recapping, touching sharps box, leaving things on bedside |
| HIV-CD4#s-Normal | 300-2000/cubic mm blood |
| Concern w/ CD4# | <200 & opportunistic inf |
| HIV-EIA | enzyme immunoassay detects presence of antibodies that indicate HIV inf |
| HIV-High Risk Groups | Men w/ men, Injection drug users, ^heterosexual, ^women of childbearing age, ^African americans, ^Hispanic |
| HIV-Transmission Edu | Primarily sexual contact, sharing needles/syringes/inj equip, mother to child, HCW needlesticks |
| HIV-Opportunistic Inf | pneumonia, bacterial, fungal candida, fungal, viral, protozoal, malignancies |
| Stroke/CVA-Priority Nursing | aspiration prec; no straws, HOB^, consistency of thickening, food on unaffected side |
| Stroke/CVA-Risk Factors | TIA, african american, atrial fib |
| COPD-ABGs | Respiratory Acidosis |
| pH | 7.25-7.35 |
| CO2 | 35-45 |
| HCO3 | 22-28 |
| PO2 | 80-100 |
| SaO2 | 95-100 |
| Gout-Nutrition Guidelines | No Purine-turkey, pork roast, wine, shellfish, sardines, organ meats |
| Angina-nursing mngmt | maintain bedrest(Fowler’s), O2 as ordered, monitor for pain |
| Angina-pt teaching | rest if pain, avoid sudden exertion, exposure to cold, tobacco, limit OTC meds that ^heart rate/BP(“drines”,caffeine), low-fat/high fiber diet |
| Rheumatoid Arthritis-S&Sx | joint swelling, tenderness, erythema, warmth, decreased mobility, deformity |
| Theophylline Levels | check for toxicity, 5-20mcg/mL is therapeutic, >20 is toxic, may see CNS/cardiac effects w/ toxicity |
| Rationale for use of Anti-gout Meds for CHF & Renal Insufficiency | NSAIDS should not be given b/c they decrease renal perfusion, Corticosteroids manages HTN & proteinuria |
| MS-S &Sx | depends on amount of demyelination, fatigue, weakness, loss of balance, muscle spasticity, visual disturbances, depression |
| MS-Temperature | heat slows nerve conduction, aggravates sx-cool/cold ^ nerve conduction, improves sx |
| RA-Methotrexate | antineoplastic agent, ulcerative stomatitis, leukopenia, thrombocytopenia, h/a, |
| MS-Pharmacology | corticosteroids for acute exacerbations, interferon/Avonex, Baclofen/Lioresal for ROM |
| Parkinson’s-Pharmacologic therapy | Dopaminergic drugs-^levels of dopamine in a variety of ways |
| Parkinson’s-Levodopa/Larodopa | Most effective agent for tx of Parkinson’s, precursor to dopamine, ½ life 180 min, less effective over time/more pronounced side effects, SE: dyskinesias/motor fluctuations |
| Parkinson’s-Carbidopa/Lodosyn | Inhibits enzyme AADC, more levodopa reaches brain |
| Parkinson’s-Levadopa/Carbidopa(Sinemet) | Hallmark of therapy, controlled release, give w/ food but no high protein meals, store in tight/light resistant containers |
| Parkinson’s-Anticholinergic therapy-Benzotropine/Cogentin | rare, not w/ elderly, controls tremor & rigidity of Parkinson’s, SE: can’t see, can’t pee, can’t spit, can’t shit |
| Parkinson’s-Dopaminergic Agonists-Ropinirole/Requip | mimic dopamine, restless leg, often used w/ younger pts |
| Parkinson’s-MAO-B Inhibitors-Rasagiline/Azilect | ^ dopamine in brain, inhibit metabolism of dopamine by MAO-B, food/drug interactions-Tyramine(aged cheese, meat, chocolate)-Hypertensive Crisis! |
| RA-Adalimumab/Humira | DMARD-injectable pen: stop change of joints, risk for infection, risk for other immunocompromised probs |
| ALS-Mobility Loss | Hazards of immobility: bed sores/skin integ, wasting, contractures, osteoporosis, respire/pneumonia, risk for aspiration, DVT |
| Ulcerative Colitis-S&Sx | exacerbations/remissions, diarrhea, LLQ abd pain, tenesmus, rectal bleeding, anemia, cramping, malnutrition, arthritis, skin lesions, ocular disorders, oral lesions/ulcers |
| Crohn’s Disease-Labs to Monitor | occult stool, steatorrhea, CBC-anemia/leukocytosis, sed rate ^ |
| Crohn’s-IV Med | Flagyl-candida, nausea-drug interactions: ^blood thinning effects of Coumadin |
| Nicotine-Adverse Effects | ^HR, ^BP, coronary artery constrict, ^risk of CAD/sudden cardiac death, ^catecholamines |
Created by:
neffielewis
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