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ATI Med/surg PN 9.0

Study the entire PN Adult Medical Surgical ATI 9.0 book

The Papanicolau (Pap) test is used for Identifying precancerous and cancerous cells of the cervix
The Human Papilloma Virus (HPV) test is used for Identifying HPV infections that can lead to cervical cancer
Women should begin screening for cervical cancer at what age? 21
From age 21 to 29, how often should women have pap tests? Every three years
Is an HPV test necessary for women in their twenties? Not unless they have an abnormal Pap test
Age women should get Pap and HPV tests every 5 years 30 to 65
When should women older than 65 continue testing? If diagnosed with cervical precancer
Time when women should not schedule Pap/HPV testing Menstruation
What should a woman avoid 24 hours before a Pap/HPV test? Vaginal medications, douching, and sexual intercourse.
Position to have client assume for Pap/HPV testing Lithotomy
A colposcopy is The examination of the tissues of the vagin and cervix using an electric microscope.
Best time to perform a colposcopy Early phase of the menstrual cycle, approximately one week after start of menses.
Does a woman need to empty her bladder before an endometrial biopsy? Yes
Rapid plasma regain (RPR) is a test used to detect what? Syphilis
The enzyme immunoassay (EIA) test and the Western blot assay are used to detect what? HIV
What tests confirm genital herpes? Herpes viral culture, polymerase chain reaction (PRC) test, antibody test
Prior to a mammography, what should a client avoid? The use of deodorant, lotion, or powders in the axillary region or on the breasts
Should pregnant women get mammograms? No.
Define hysterectomy Removal of the uterus.
Define bilateral saplingo oophorectomy Removal of the ovaries and the fallopian tubes
What is removed during a total hysterectomy? Uterus and cervix
The procedure where a woman's uterus is removed, but the cervix is left intact. Subtotal hysterectomy
What is removed during a panhysterectomy? Uterus, cervix, ovaries, and fallopian tubes
A radical hysterectomy is the removal of the uterus, cervix, ovaries, fallopian tubes, upper part of the vagina, adjecent tissue, and what? Lymph nodes
What is a leiomyoma? A benign fibroid tumor
Excessive post-hysterectomy bleeding is indicated by what? More than one saturated pad in four hours.
If a woman has her ovaries removed, it can send her in to what? Menopause
The average age of menarche in the U.S. 13 years old.
What marks the first day of the menstrual cycle? First day of menses.
Typically occurs 14 days after the first day of menses. Ovulation
Occurs 14 days after ovulation. Menstruation
Median age of onset of menopause 51 years old.
Define dysmenorrhea Painful menstruation
Term used for excessive bleeding during menstruation. Menorrhagia
Term used for bleeding between times of normal menstruation. Metrorrhagia
Define amenorrhea Absence of menses
Difference between premenstrual syndrome and premenstrual dysphoric disorder PMDD is more severe and interferes with a woman's ability to carry out her daily activities.
Define endometriosis an overgrowth of endometrial tissue that extends outside the uterus. (Fallopian tubes, ovaries, pelvic cavity)
Elevated CA-125 is an indicator for these two female reproductive system disorders Cervical cancer and endometriosis
Spironolactone (Aldactone) is used to treat what symptoms of PMS and PMDD? Bloating and weight gain
Leuprolide (Lupron) is a synthetic luteinizing hormone. Why would it be given to a woman with endometriosis? It suppresses estrogen and testosterone production, which promotes atrophy of ectopic tissue.
Define menopause Cessation of menses.
What indicates that menopause is complete? Absence of menses for 12 months.
Two vasomotor symptoms of menopause: Hot flashes and irregular menses
Seven genitourinary symptoms of menopause Atrophic vaginitis, shrinking of labia, decreased vaginal secretions, dyspareunia, increased vaginal pH, vaginal dryness, incontinence
Define dyspareunia Painful intercourse
Three psychologic symptoms of menopause: mood swings, changes in sleep patters, and decreased REM.
Menopause causes HDL to ____ and LDL to ____. Decrease; Increase
In menopause, skin becomes more/less elastic? Less
During menopause, hair loss is evident in which two areas? Head and pubic area.
What hormone therapy will be included for a menopausal woman who still has a uterus? Estrogen and Progestin
What hormone therapy will be included for a menopausal woman who does not have a uterus? Estrogen
Maximum length of time for hormone therapy 5 years
Hormone therapy client education related to cardiovascular side effects Smoking cessation; avoid restrictive socks/clothing; report unilateral leg pain, edema, warmth, and redness; avoid sitting for long periods of time; move and stretch legs and ankles; monitor for sx stroke and MI
What are two complications of hormone replacement therapy for the menopausal woman? Embolic complications (MI, stroke, venous thrombosis), cancer.
A protrusion of the posterior bladder through the anterior vaginal wall Cystocele
A protrusion of the anterior rectal wall through the posterior vaginal wall Rectocele
Risk factors for cystocele Obesity, advanced aged, chronic constipation, family history, vaginal childbirth, multiparity, increased abdominal pressure, hysterectomy
Risk factors for rectocele pelvic structure defects, obesity, aging, family history, difficult vaginal childbirth necessitating repair of a tear, forceps delivery, previous histerectomy
Diagnostic procedures for a cystocele pelvic examination, bladder ultrasound, urine culture, voiding cystourethrography
Diagnostic procedures for a rectocele pelvic examination, rectal examination, barium enema
Therapeutic procedures for vaginal wall atrophy intravaginal estrogen (Premarin cream), bladder training, vaginal pessary, kegel exercises
When a patient has a vaginal wall repair, why is it important to administer stool softeners/laxatives and cough suppressants? To avoid straining
Define fibrocystic breast condition A noncancerous breast condition where fibrosis and cysts develop in the breasts.
Risk factors for fibrocystic breast condition premenopausal status, hormone therapy, caffeine consumption
Aspects of health and wellness Physical, emotional, social, intellectual, spiritual, occupational, environmental
Define Triage Ensuring clients with highest acuity needs receive the quickest treatment
The stages of the five-level system of triage Resuscitation, emergent, urgent, nonurgent, minor.
Explain resuscitation level of triage requires immediate treatment to prevent death
Explain emergent level of triage a life- or limb-threatening situation
Explain urgent level of triage Client should be treated soon, but that the risk is not life-threatening
Explain nonurgent level of triage Client can generally wait for an extended length of time without serious deterioration
Explain minor level triage non-life-threatening condition requiring simple evaluation and management of care
What does ABCDE stand for? Airway, breathing, circulation, disability, exposure
Describe Triage under mass casualty conditions Emergent/class I- red tag - immediate threat to life urgent/class II-yellow tag- major injuries that require immediate tx nonurgent/classIII-green tag-minor injuries expectant/class IV-expected or allowed to die
What is the purpose of a cerebral angiogram? Visualization of the cerebral blood vessels
Dye injected during a cerebral angiogram may cause what kind of side effects? a metallic taste in the mouth, warm sensation over the face, jaw, tongue, lips, and behind the eyes.
What is the purpose of a cerebral computed tomography (CT) scan? Provides cross-sectional images of the cranial cavity
If contrast dye is to be used, what assessment must be made? Check for allergies to shellfish or iodine.
What does an electroencephalography (EEG) do? Assesses the electrical activity of the brain and determines if there are abnormalities in brain wave patterns.
Describe patient teaching for an EEG Wash hair before and after procedure, wake up at 2 or 3 am the night before and stay awake for the rest of the night, avoid caffeine day of the test, withhold stimulants or CNS depressants or antiepileptic medication per the provider.
Define the Glasgow Coma scale A tool used to assess level of consciousness by neurologic function. Is reported as a number.
Best possible Glasgow Coma scale result: 15
Less than 8 on the Glasgow Coma scale is associated with what? Severe head injury and coma
The three areas assessed in the Glasgow Coma scale: Eye opening, verbal response, motor response
Describe a lumber puncture. A procedure during which a small amount of cerebrospinal fluid is withdrawn from the spinal canal and then analyzed to determine its constituents.
Describe the position of a client getting a lumbar puncture. Side-lying position with knees drawn up to chest. 'Cannonball'
What should the client do immediately following a lumber puncture, and why? Remain lying for several hours to allow the puncture site to clot and to decrease the risk of post-lumbar puncture headache.
What nursing action should be done if a client's lumbar puncture site begins leaking? Seal the puncture site, encourage the client to lie flat in bed, provide fluids, administer pain medications, prepare client for blood patch to seal the hole.
Describe the purpose of a magnetic resonance imaging (MRI) scan. To provide cross-sectional images of the cranial cavity.
What must be obtained from the client in order to use contrast dye? Signed informed consent
What do position emission tomography (PET), and single-photon emission computed tomography (SPECT) scans do? Produce three-dimensional images of the head. Images can be static to depict vessels or functional to depict brain activity
What is the purpose of a radiography (X-ray)? Capture images of the internal structures of an individual using electromagnetic radiation.
What substances increase pain transmission and cause an inflammatory response? Substance P, Prostaglandins, Bradykinin, Histamine
Serotonin and endorphins have what effect on the body? decrease pain transmission and produce analgesia
The four categories of pain. Acute, chronic, nocioceptive, neuropathic.
Describe acute pain. Protective, temporary pain that lasts less than 6 months, resolves with tissue healing.
Describe chronic pain Not protective, ongoing or frequently occuring. Lasts longer than 6 months. Does not end when tissue heals.
Describe nocioceptive pain. Occurs from damage to or inflammation of tissue outside of peripheral and central nervous systems.
Describe neuropathic pain. Arises from abnormal or damaged nerves.
The three types of nocioceptive pain. Somatic, visceral, cutaneous.
Describe somatic nocioceptive pain. Pain in bones, joints, muscles, skin or connective tissue.
Describe visceral nocioceptive pain. Pain in internal organs such as stomach or intestines. Can cause referred pain.
Describe cutaneous nocioceptive pain. Pain in the skin or subcutaneous tissue.
What is the PQRST pain assessment tool? Provocation, quality, region, severity, timing.
Three classes of analgesics. Nonopioids, opioids, and adjuvants.
Examples of nonopioid analgesics. Acetaminophen, NSAIDs, ASA
Examples of opioid analgesics. morphine, fentanyl, codeine
Examples of adjuvant analgesics. Carbamazapine, diazepam, amitripyline, hydroxyzine, dexamethasone, ondansetron, neurontin
What should the nurse monitor for in a patient receiving opioid analgesics? Respiratory depression, constipation, orthostatic hypotension, urinary retention, nausea/vomiting, sedation
What is meningitis? Inflammation of the meninges.
Signs of meningitis? Excruciating, constant headache; nuchal rigidity; photophobia, positive Kernig's sign, positive Brudzinksi's sign, hyperactive deep tendon reflexes, tachycardia, seizures, altered LOC.
Describe a positive Kernig's sign. Resistance and pain with extension of the client's leg from a flexed position.
Describe a positive Brudzinski's sign. Flexion of extremities occuring with deliberate flexion of the client's neck.
What position would you put a client with meningitis in, and why? Semi-fowlers, to decrease ICP.
Define seizure. Abrupt, abnormal, excessive, and uncontrolled electrical discharge of neurons within the brain that can cause alterations in the LOC and/or changes in motor and sensory ability and/or behavior.
Define epilepsy. A syndrome characterized by chronic recurring abnormal brain electrical activity.
The four phases of a tonic-clonic seizure. Aura, tonic phase, clonic phase, postictal phase.
Describe the aura phase of a seizure. Alteration in vision, smell or emotional feeling.
Describe the tonic phase of a seizure. Stiffening of muscles, loss of consciousness, cessation of breathing, dilated pupils, and development of cyanosis.
Describe the clonic phase of a seizure. Rhythmic jerking of the extremities, irregular respirations, biting of the cheek or tongue, and bladder and bowel incontinence may occur.
Describe the postictal phase of a seizure. Recovery of the seizure. May last several hours. Unconsciousness may last 30 minutes. client may have no memory of what happened just before the seizure.
Describe an absence seizure. Most common in children. Consists of a loss of consciousness lasting a few seconds, blank staring, and automatisms (movements that the client is unaware of)
Describe a partial or focal/local seizure. Seizure activity in one cerebral hemisphere.
Describe nursing care of a client experiencing a seizure. Protect from injury, provide privacy, assist to floor. Position on side, maintain patent airway. loosen restrictive clothing. Do not restrain. Do not stick anything in mouth.
When a client experiences a seizure, what information will the nurse document? Onset, duration, client findings/observations prior to, during and following seizure. LOC, apnea, cyanosis, motor activity, incontinence.
What nursing actions will be taken during the postictal phase of a seizure? Maintain client in a side-lying position. Check vital signs, check for injuries. Perform neurological checks. Reorient and calm client. Institute seizure precautions, determine possible trigger.
Describe status epilepticus. Prolonged seizure activity occuring over a 30 minute time frame.
Reference Range: pH 7.35-7.45
Reference Range: PaCO2 35-45 mm Hg
Reference Range: HCO3 21-28 mEq/L
Reference Range: SaO2 95%-100%
Reference range: Creatinine Kinase MB Isoenzyme 0% of total CK (30-170 units/L)
Reference range: Troponin T Less than 0.2 ng/L
Reference range: Troponin I Less than 0.03 ng/L
Reference range: Myoglobin Les than 90 mcg/L
Reference range: Cholesterol (total) Less than 200mg/dL
Reference range: HDL - Female 35-80 mg/dL
Reference range: HDL - Male 35-65 mg/dL
Reference range: LDL Less than 130 mg/dL
Reference range: Triglycerides - Male 40-160 mg/dL
Reference range: Triglycerides - Female 35-135 mg/dL
Reference range: Triglycerides - Adults over the age of 65 55-220 mg/dL
Reference range: RBC - Female 4.2-5.4 million/uL
Reference range: RBC - Male 4.7-6.1 million/uL
Reference range: WBC 5,000-10,000/uL
Reference range: MCV 80-95 mm3
Reference range: MCH 27-31 pg/cell
Reference range: TIBC 250-460 mcg/dL
Reference range: Iron - Female 60-160 mcg/dL
Reference range: Iron- Male 80-180 mcg/dL
Reference range: Platelets 150,000-400,000 mm3
Reference range: Hgb - Female 12-16 g/dL
Reference range: Hgb - Male 14-18 g/dL
Reference range: Hct - Female 37-47%
Reference range: Hct - Male 42-52%
Reference range: PT 11 -12.5 seconds
Reference range: aPTT 1.5-2 times normal range of 30-40 seconds
Reference range: INR (No coumadin therapy) 0.7-1.8
Reference range: INR (Coumadin therapy) 2-3
Reference range: INR (Valve replacement) 3-4
Reference range: D-dimer 0.43-2.33 mcg/mL 0-250 ng/mL
Reference range: Fibrinogen levels 170-340 mg/dL
Reference range: Fibrin degradation products <10 mcg/mL
Reference range: Serum Sodium 136-145 mEq/L
Reference range: Serum Potassium 3.5-5.0 mEq/L
Reference range: Serum Chloride 98-106 mEq/L
Reference range: Serum Calcium 9.0-10.5 mg/dL
Reference range: Serum magnesium 1.3-2.1 mEq/L
Reference range: Serum phosphorus 3.5-4.5 mg/dL
Reference range: Aspartate aminotransferase (AST) 5-40 u/L
Reference range: Alanine aminotransferase (ALT) 8-20 u/L 3.35 IU/L
Reference range: Alkaline phosphatase (ALP) 30-120 u/L 30-85 IU/L
Reference range: Amylase 56-90 IU/L
Reference range: Lipase 0-110 u/L
Reference range: Total bilirubin 0.1-1.0 mg/dL
Reference range: Direct conjugated bilirubin 0.1-0.1 mg/dL
Reference range: Serum BUN 10-20 mg/dL
Reference range: Serum creatinine - Male 0.6-1.2 mg/dL
Reference range: Serum creatinine - Female 0.5-1.1 mg/L
Reference range: Glomerular filtration rate >90 ml/min
How many stages of involvement in Parkinson's disease? 5
Parkinson's Disease stage 1 Unilateral shaking or tremor of one limb
Parkinson's Disease stage 2 Bilateral limb involvement
Parkinson's Disease stage 3 Bradykinesia
Parkinson's Disease stage 4 Tremors may dicrease, but akinesia and rigidity increase
Parkinson's Disease stage 5 Unable to stand or walk, is dependent for all care, may exhibit dementia.
Risk factors of Parkinson's Disease Age 40-70, male, genetic predisposition, exposure to toxins and chemical solvents, chronic antipsychotic medication use.
Describe the symptoms of Parkinson's Disease Stooped posture, shuffling gait, slow monotonous speech, 'pill-rolling' tremors, muscle rigidity, bradykinesia, masklike expression, drooling, cognitive impairement
Nursing actions for Parkinson's Disease Monitor swallowing and nutrition intake, promote client mobility, client communication, monitor mental and cognitive status
The most common medication used to treat Parkinson's Disease Levodopa/carbidopa (Sinemet)
What are complications of Parkinson's Disease? Aspiration pneumonia, altered cognition.
Risk factors for Alzheimer's Disease Advanced age, genetic predisposition (ApoE), environmental agents (herpes virus, metal, toxic waste), previous head injury, family history of of Alzheimer's or trisomy (Down syndrome)
Nursing interventions for Alzheimer's Disease Provide cognitive stimulation, memory training, avoid overstimulation, reality orientation (early), validation (late), self-care, speak directly, reduce agitation, provide routine, provide safe environment, alt. forms of communication, snacks
Goal of medication for Alzheimer's Disease Symptomatic relief, reduce anxiety, agitation, combativeness, and depression.
What do medications like donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne) do for Alzheimer's Disease Increase the availability of acetylcholine at neurotransmitter receptor sites in the CNS.
What is a stroke (CVA)? A disruption in the cerebral blood flow secondary to ischemia, hemorrhage, brain attack, or embolism.
Risk factors for stroke. Cerebral aneurysm, arteriovenous malformation, DM, obesity, HTN, atherosclerosis, hyperlipidemia, hypercoagulability, A-fib, use of oral contraceptives, smoking, cocaine use.
The three types of stroke. Hemorrhagic, thrombotic, embolic
This kind of stroke is secondary to a ruptured artery or aneurysm Hemorrhagic
This kind of stroke is secondary to the development of a blood clot on a atherosclerotic plaque in the artery. Thrombotic
This kind of stroke is secondary to an embolus traveling from another part of the body. Embolic
Symptoms of a left-hemispheric stroke Expressive and receptive aphasia, agnosia, alexia, agraphia, right extremity hemiplegia or hemiparesis, slow, cautious behavior, depression, anger, quick to become fustrated, visual changes such as hemianopsia.
Term for the inability to recognize familiar objects Agnosia
Term for reading difficulty Alexia
Term for writing difficulty Agraphia
Symptoms of right-hemispheric stroke Altered perception of deficits, one-sided neglect syndrome, loss of depth perception, poor impulse control and judgement, left hemiplegia or hemiparesis, visual changes such as hemianopsia.
Nursing care for the post-stroke patient. Monitor vital signs, oxygen therapy, monitor LOC, elevate HOB, initiate seizure precautions, assist with communication skills, assist with safe feeding, maintain skin integrity, prevent complications of immobility.
What is unilateral neglect? Loss of awareness of the side affected by the CVA. Client cannot see, feel, or move the affected side, and forget that it exists.
Triggers for multiple sclerosis relapse: Viruses and infectious agents, cold climate, physical injury, emotional stress, pregnancy, fatigue, overexertion, temperature extremes, hot shower/bath.
Objective symptoms of multiple sclerosis. Dysphagia, dysarthria, ataxia, nystagmus, cognitive changes, sexual dysfunction, elevated CSF protein and WBC, MRI reveals plaque of brain and spine, paresthesia,
Subjective symptoms of multiple sclerosis. Fatigue, pain, diplopia, Uhthoff's sign, tinnitus, vertigo, decreased hearing acuity, muscle spasticity, , bowel dysfunction, bladder dysfunction
What is Uhthoff's sign? A temporary worsening of vision and other neurological functions commonly seen in clients who have or are predisposed to MS, just after exertion or in situations where they are exposed to heat.
The term used to describe slurred, nasally speech. Dysarthria.
With ALS, death usually occurs from what? Respiratory failure.
Physical assessment findings of ALS muscle weakness beginning in one part of the body, muscle atrophy, dysphagia, dysarthria, hyperreflexia of deep tendon reflexes.
Organ function monitored during riluzole (Rilutek) treatment for ALS. Liver
Subjective data of myasthenia gravis. Progressive muscle weakness, diplopia, difficulty chewing and swallowing, respiratory dysfunction, bowel and bladder dysfunction, poor posture, fatigue after exertion.
Created by: bpeters