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Medsurg-pharm final

Med surg and pharm final study guide

Multiple Myeloma Cancer of the bone marrow, tumors within the marrow; multiple areas; tumors within the muscles are the most difficult to fight.
Signs and Symptoms of Multiple Myeloma Bone pain (intense)espsecially, anemia, recurrent infections, weakness, fatigue
Maslows heirarchy of needs; Five levels are.. physiologic, safety and security, love and belonging, self esteem, self actualization.
Physiological needs("The Physical needs") are classified as... The needs for oxygen, fluids,nutrition, life-sistaining enviormental temperature, elimination, shelter, rest and sex. Physilogic needs are the most fundamental because they sustain life. Individuals cannot live without air, water, and food.
Safety needs are classified as... Security, protection from harm, and freedom from anxiety and fear, can be addressed.People need order and structure in their lives, and illness or disease can be very disruptive.
Love and Belonging needs are classified as..... Feeling loved by one's family and friends and accepted by one's peers and community. R/T self esteem, which is essential for carrying out health-promoting behaviors.
Self Esteem needs are classified as... Feeling good about oneself and feeling that others hold one in high regard. Individuals with high self esteem feel confident about themselves and confident that they are appreciated by others; low self-esteem may feel helpless and inferior.
Self-actualization or self fulfillment, the highest level of Maslow's hierarchy. Characterized by what traits? ability to solve problems, willingness to accept suggestions and criticism from others, broad interests, good communication skills, self confidence and good self esteem, maturity and desire for new experiences and knowledge.
Autologous use your own bone marrow stem cell transplant ; products coming from own body (skin grafts, blood)
1st step in reaching pt adaptability is to determine? Pt developmental age ad coping mechanism they have successfully used and the adaptability to use new one... TEACH NEW!!
A pt is anxious and feels they have no control and in adequate because of hospitalization, what does the nurse encourage? Encourage daily self care from the pt, allow the pt to participate.
1st s/s of emminant respiratory arrest in an asthmatic pt?? No sounds and decreased wheezing....
An improvement of asthmatic pt's condition respiration rate increases to at least 16 a minute
What does an increased PaCo in a COPD pt mean? The nurse recognizes what?? The pt ventilation and perfussion is becoming balanced; becoming healthier..
CO2 and Bicarbanates are.. the acid in the blood; acidic blood
1st intervention for a pt with dyspnea elevate the pt HOB 10 degrees or semi-fowlers
Rule of nines in burn victims?? Extremities= 9 each; Truck/back= 18 each; Groin= 1; Example: both legs chest burned 56%..
Hodgkins Disease AKA Hodgkin's Lymphoma; common in women in the 20's a cancer of the lymphatic system, which is part of the immune system. In Hodgkin's disease, cells in the lymphatic system grow abnormally & may spread beyond the lymphatic system. As the disease progresses it comprimises bodies ability to fight infection
S/S of Hodgkin's Disease Initial s/s a similar of the flu(fever, fatigue, night sweats), eventually, tumors develop. Lymph enlargement (hallmark finding), Reed steinburg cells and afte biopsy.
Non-Hodgkins second most common cancer; found in AIDS patients
Autoimmune disorders disorders that go against the body's own tissue; body breaks down it's own natural defense.
Purpura red/reddish purple skin lesion caused by low platelet count and clotting problems; blood leaks outside the blood vessel.
Neutropenia autoimmune disorder caused by lack of WBC's and decreased bone marrow production; Pt has an increased risk of infection.
Neutropenia s/s fever, pain, swelling; autoimmune reaction with SLE, Rheumotoid arthritis, chemotherapy, radiation, certian meds (Zidovidine)
Diffusion Higher to lower- particles move randomly in all directions- only takes place in respiratory; the movement of gas exchange. Diffusioin is how the O2 is transported in the blood.
Filtration Transfer of water and solutes thru a membrane; high to low only in the kidneys..
Osmosis Only in the presense of water- goes from high to low; low to high. water draws sodium into tissue cells only by osmosis-"edema" less concentration to more fluid balance.
Durable POA financial
Medical POA medical decision provided to someone who can make them for you if your unable
Active Transport carrier proteins used to transport substances across cell membranes; from low to equal/high
Comatose Pt cannot be aroused even by powerful stimuli
Lethargic no energy, altered LOC; weak and tired
Somnolence unnatural drowsiness
Azotemia accummulation of nitrogenous compounds in the blood
General adaptation syndrome- 3 stages Alarm reaction- flight/fight, response to stress.Resistance Stage- adapted to stressor.Exhaustion Stage- body drained of energy.
Pt with neutropenia (low WBC count) with an increased risk of infection, what rational is used. infection free enviornment for pt including pt free of staff contact.
Conscious sedation call the DR. if pt is not able to become aroused; overdose likely 1st priority; monitor v/s post re gain cosciousness
With a post op pt , prevent DVT's by.. Ambulate the pt or dangle pt; Get the pt up, turn, coughing and deep breathing.
Whena pt is cheduled for amliver biopsy, what hom emeds should the nurse be concerned with? Asprin
Post op pt's superpubic area is distended. Pt has no voided for 9 hours, 1st Nursing action should be? Offer a urinal/ bed pan, get pt up to BSC or bathroom- if not successful inform charge nurse.
Kidney's reabsorb H2O, when absorption is more than normal, urine will be less concentrated. Normal Specific Gravity of urine is 1.01- 1.025
How much urine should a patient be voiding per hour before potassium can be hung? 30 cc/hr
Greiving process "Kubbler Ross" 1-Denial-refuses to accept the loss;pt & family2-Anger- pt becomes angry with dx/situation3-Bargaining-Pt is willing to do anything to avoid dying; try to bargain4-Depression-realization loss is final;there is no hope5-Acceptance-Pt @ peace
Sensory changes during the death process hearing last to leave and the 1st to return
Triad of COPD Asthma, Emphysemia, Chronic Bronchitis
Advanced Directives (Full code, DNR, Chemical code) Full code- everything done to substain life.DNR- no actions takenChemical Code- no drug, no compression, no defib's.
After pt has gastrointestinal surgery,pt will have what in place? NG tube
What are the s/s of anaphalaxis shock? Bronchospasms, Cardinal Vascular Collapse
If a pt is stuperous and/or withdrawls from painful stimuli. Pt does not appear conscious, pt is considered? Semi-comatose
Ulcerative mouth disease Mucous sloughs off; pt wont want to eat, spicy food hurts
Plan of care for a pt with HIV always use aseptic technique
Pt with high levels of ammoniaa with Liver encephalopy pt will need seizure precautions.
Cushing Triad- Late s/s of increased ICP Hypertension, bradycardia, widening pulse pressure.
Before pt under goes a liver or spleen scan, the nurse must explain the procedure to the pt and... assess for allergies to contract
Thrombophlebitis Varicose Veins
Pneumothorax collapsed lung
Urinary incontinence never a normal state
Post residual voiding pt goes to void normally then straight cath performed for residual..
Types of incontinence- have to go frequently and stress incontinence..Intervention to help pt void; have pt stand up right
Metabolic Acidosis Low Ph, Normal CO2
Metabolic Alkalosis High Ph, Normal CO2
Respiratory acidosis Low Ph, Low Co2
Respiratory Alkalosis High Ph, High CO2; common cause of hyperventilation.
Vitamin D helps absorb calcium---> Vitamin D is the Intrinsic factor in the gut
Calcium and Phospherus bind together when they bind together, the bone wull hold onto the calcium.
Healthy bone marrow with chemotherapy; increased risk of? increased risk of infection
The tumor staging T3 N2 M3 means? 3 tumors, 2 lymph nodes, 3 metastisized to 3 organs..
If pt has PRN order for Morphine q 3-4 hrs and 2 hr and 45 min has passed, pt c/o pain, what intervention is used? Give the pain medication and call DR. and let him know pt is having break thru pain symptoms.
Potassium Most abundant inner cellular electrolyte; a decrease causes cardiac arrythmias; potassium maintains fluid osmolarity and volume in the cell.
Sodium 135-145 good; most abundant extracellular electrolyte. Water follows sodium; water draws sodium in to tissue onl by osmosis, primary electrolyte.
Chloride active transport carrier of sodium. assist in regulation osmotic pressure between compartments. Regulates acid base balances
Calcium 99% is in matrix of the bones. Promotes normal transmission of nerve impulses and normal muscle contraction.
Glumerulonephritis Filtration problems- blood cannot be filtered out, blood in urine.Dx tests- BUN, creatine clearence, and serum creatine
Magnesium 50-60% bone intracellular- vital to cellular function.
Kidneys the main regulators of fluid balance by using renin, aldosterone and antidiuretic hormones; BP falls, renin produced aldosterone, produced when renin is present by adrenal.
Electrolyte imbalances- 2 main electrolytes that cause of problems are sodium and potassium; an imbalance has occurred
Urinary incontinence; Post urinary void straight cath used after pt has void voluntarily to check for residual urine.
Urinary Incontinence; Bladder Training Scheduled toileting routine with scheduled fluid intake. Positive reinforcement-> pt is encouraged to delay voiding until scheduled time q 2-3 hrs. Awake time gradually increased..
Urinary Incontinence: types of incontinence Urge- involuntary loss of urine shortly after a strong urge to urinate; results are overactive bladder muscle.Overflow- involuntary loss of urine with overdistended bladder; small amounts of urine lost off and on, can cause kidney damage.
Urinary Incontinence: Types of incontinence CONTINUED!! Stress- loss of urine due to physical causes exercise, sneezing, coughing.Functional- person voids inappropriately b/c of inability to get to toilet, usually R/T confusion, immobility, or enviornment.
Self Catheterization Bladder drained q4h..Greater than 500ml in less then 4h, less than 200ml, greater than the length of time between caths.
N.I. to voiding incontinence education,bladder training, check for skin breakdown and risk of infection.
Cerebrovascular Accidents- A&P of the brain Central structure includes cerebrum, brainstem, cerebellum 2 hemispheres- left dominant controls the right brain covered by cortex.
BrainStem- mid-brain, pons, medulla controls vital basic functions (resp, heart rate, LOC)
Cerebellum used information recalled from cerebrum muscles, joints, inner ear to coordinate balance.
Cerebrum initiation of movements, sensory input recognition, regulation of endocrine and autonomic functions.
Cerebrovascular Accidents (CVA)- stroke or brain attack.S/S- numbness, weakness of face, arms or legs of one side, sudden confusion, trouble speaking, walking, dizziness, severe headache
Transient Ischemic Attacks (TIA)- temp neuro deficit caused by impaired cerebral blood flow. May be occluded by spasms fragments or blood clots. 85% blocked before s/s appear-a warning sign for full blown stroke in near future. lasts <24hrs w/ s/s lasting a few min-24h w/no perm. effect
Safety Side up. Bed in low position. Call light in place. Bed alarm possible. Monitor pt position, turn regularly
Risk factors of a stroke. Patho- HTN, cardiac disease, DM, HYPO TN, Migraine headache, increased risk of blood clotting 51-74yo, Family Hx, Sickle Cell, leukemia.Lifestyle- excessive alcohol consumption, cig smoking, obesity, high fat diets, drug abuse.
Renal Failure patho- any condition that decreases blood flow to the kidney's that impairs renal function* Acute or Chronic based on onset and reversibility*
Acute Renal Failure-Rapid onset (1-7 days) reversible likely can be prerenal, intrarenal, and postrenal. PreRenal- decreased blood flow to glomeruli- BP has to be > 70IntraRenal- toxic agents, kidney infections occlusions of arteries, DM, trauma to kidneys.PostRenal-obstruction around the kidneys, calculi in ureters-urine backs up.
4 stages of acute renal failure Onset, oliguria, diuresis, recovery
Acute Renal Failure Stage 1, Onset onset- 1-3 days, increased BUN, increased serum creatine, No decrease in urine output
Acute Renal Failure Stage 2, Oliguric urine output decreases to 400ml/ day or less. Lasts up to 14 days. Pt is hypervolemic, urine osmality decreases,serum osmality increases, waste products remain.
Acute Renal Failure Stage 3, Diuretic Urine output exceeds 400ml/ day up to 4L/ day. Few waste products excreted and accumulates regardless of voided amounts. Kidney function are beginning to return.
Acute Renal Failure Stage 4, Recovery Renal Recovers, labs are normal, 1-12 months
Chronic Renal Failure- Not correctable, nephrons are destroyed. Most pts have HTN and hypervolemia- CHF results. Azotemia- 1st sign- increased nitrogen waste in blood. Kidney unable to concentrate wrine, potassium retained. Results in Hyperkalemia which cause the most life threatening of chronic renal failure. Cardiac problems can occur.
Blood Transfusions- Reactions Hemolytic- ABO incompatible. S/S- chills, fever, nausea, dyspnea, chest pain, hypo TN, N.I. stop tranfusion and call DR.Anaphylactic reaction to plasma proteins-S/S- urticaria, wheezing, dyspnea, hypo TN
Blood tranfusion S/S- Lower back pain, fever that wont budge, general body rash
Nursing Interventions for s/s during blood transfusion: Stop transfusion, discontinue line, same line and blood. Flush the port cap and dont reuse start another I.V.
Endocrine Gland and tissue that make and store, secrete chemical hormones.
Pituitary Gland- two lobes, Anterior lobe and Posterior lobe- Anterior lobe secretes- GH, ACTH, TSH, FSH, LH, PROLACTIN, MSH.Posterior lobe (smaller lobe) secretes-Oxytocin- contract uterus, release of breat milk; ADH-Vasopressin, reabsorption of water from renal tubules of kidneys
Gigantism Early in childhood/ puberity before growth plates close- stimulated by too much growth hormone(GH) Hyper pituitary!!
Acromegaly More common but more rare. 40's & 50's usual onset. Bone does get bigger just thicker and wider. Affects cardio, digestive, nervous, and genitourinary systems. Hyper pituitary!!
Cushings syndrome excessive corticosteriods (cortisol) due to overproduction of adrenocortisol hormones from internal ot external causes- excess of ACTH from pituitary tumor. Adrenal hyper secretes..
Cushings Syndrome-S/S, DX, TX- S/S- appearance changes-*moon face*, obesity, facial redness, purple striae, hirsutism (hair increase), menstrual problems, muscle wasting, HTN, irritable, insomniaDX- 24h urine, CT scan for tumorTX- Drug therapy, radiation, surgery
Nursing Dx with Cushings Syndrome Disturbed thought process- personality changesRisk for skin impairment- skin fragilityDisturbed body image- Obesity, moon face** Teach to avoid people with infections b/c of increased bleeding and fractures can occur.
Emergencies (Cardiac arrest, Respiratory arrest, Cardio-pulmonary arrest) Cardiac Arrest- absense of heart beatRespiratory Arrest- Absense of respirationsCardio-pulmonary Arrest- Absense of Heart rate and Respirations.
Nursing Interentions for "ARRESTS" Assess ABC, initiate CPR, Assess for uncontrolled bleeding, assess for injuries systematically (head to toe), check for medical alert bracelet/tag..
Hypoxemia Low O2 level in blood ( decreased 92%)
Asthma- Airway inflammation caused by triggers( allergies, irritants, GERD, infection, or increased exercise) S/S- dyspnea, productive cough, wheezing, tachycardia, tachypnea.N.I- Monitor resp rate, pattern, give O2, Support pt in fowlers, give ordered broncho-dilators,assess for adverse reactions.
Shock- results from acute circulatory failure; inadequate tissue perfusion impaired cellular metabolism. S/S-tachycardia, weak pulse, air hunger @ 1st then increased resp rate with shallow breathing, decreased BP, Skin cool/moist then sweaty, cyanosis of lips/nail beds, mentally restless then listless, confusion, unconscious, polydipsia.
Nursing Interventions for Shock: Get medical help, give O2, ABC's, if bleeding- control with pressure, maintain target organs, keeppt still and calm, position flat, keep pt temp balanced, withhold fluids.
CHF- heart fails to pump effectively, bloodbacks up into vascular of lungs producing congestion S/S of Left sided Heart Failure- anxious, pale, tachycardia, HTN, BP, SOB, lungs reveal wheezing, crackles, dyspnea, cough, edema in extremities.S/S of Right sided heart failure- JVD, increased central venous pressure, abd distention, dependent edema
Cardiac Catheter:Post complications- bleeding, hemato- formation, infection, emboli-thrombus risks Catheter is passed thru a vein or artery and dye injected. assess for allergies. Tell pt what to expect, NPO before procedure, signed consent req'd!N.I- Check puncture site, maintain pressure if nec., mv/s, extrermity pulses of affected, bedrest
Cardiac Enzymes- Creatine Phosphokinase (CPK-MB) increase indictative of damage to myocaridal cells. Increased 4-6hrs after MI.
Cardiac Enzymes- Troponin: Protein involved with cardiac muscle contraction- Trop T & Trop I specific to cardiac muscle are released into the circulation after an acute myocardial infarction after onset of symptoms (3-6hrs) peak @ 24hrs.
Cardiac Enzymes- MyoGlobin Cardiac protein released after MI after 1-4 of onset of s/s strenous exercise, renal failure are common triggers- Skeletal muscles also use myoglobin.
Angina- Chest pain, tx with nitroglycerin. Most common s/s of CAD-> demand for O2 exceeds the O2 being delivered- Heart is starving for O2 S/S- burning, squeezing, smothering. Pain goes to arm, shoulder, jaw. Pt can be sweaty, dyspnea, N/V.Unstable angina- more severe. Pain with rest not relieved by nitrogycerin, is unpredictable.
Myocardial Infarction- MI- death of myocardial tissue due to prolonged lack of blood and O2 supply. Risks include obesity, smoking, hyperlipidemia, HTN, Family Hx, Male, DM, Lazy life style- most can be changed for prevention. Occlusion of artery, ischemia results. S/S- pain, heavy pressure pain, sweaty, lightheaded, N/V, Skin cold & clammy.DX- lab markers- Troponin released.Complications of MI- dysrhythmias, heart failure, shock, thromoembolism, ventricul aneurysm/ rupture
Respiratory Disorders- Suctioning tracheostomy techniques- to remove excess mucous secretions to improve gas exchange do the following: give O2 prior to prevent disruption of airflow, Limit each pass to 10 sec, let pt rest briefly, encourage deep breaths, rinse cath in sterile saline, watch pt responses, stop if tachycardia or resp distress develops, document amount, color, odor
Asthma and Emphysema are COPD- aveoli does not work properly- too much CO2
Emphysemia- degenerative- enlargement of the airways beyond terminal bronchioles, Pink & Puffy S/S- dyspnea on exertion, or at rest. Pt thin and uses accessory muscles to breath, pt appears with barrel chest, depression/irritability common.DX- pulm function testTX- O2 therapy, Drug therapy( Broncho-dilaters, inhalors)
7 Warning Signs of Cancer *CAUTION* Change in bowel/bladder habitsA sore throat doesnt healUnusual bleeding/ dischargeThickening or lump in breast or elsewhereIndigestion or difficulty swallowingO Change in wart/ moleNagging cough/ hoarseness
Breast exams Ages 20-39- breast exam by DR. q3 yrs, self exams monthlyAges- 40>- annual mammogram, annual DR exam, Monthly self breast exam.
Testicle Exams- best to do during or right after hot shower or bath,examine one at a time, feel for any lumps, bumps along the front of sides. Lumps may be small as a piece of rice or a pea. Monthly. Over 50 undergo annual rectal exam and PSA. Men are at high risk should start screening at 40.
Pap smears every year, 18 and up or sexually active, annually
Colonoscopy 50>, fecal test every year, 10 years minimum.
Chemotherapy- chemical agents "antineoplastics" used to destroy cancer cells-can be curative. Bone marrow suppression is the most adverse efect of chemo. Most dangerous. Protect pt from infection.N/V- most distressing, give antiemetics.Neutropenia- WBC decreases- protect pt.
Increased intracranial pressure- pressure exerted on the cranium (tumor) S/S: Abnormal posturing- abnormal flexion in upper extremities-lower extended, increased BP. Late signs- pulse, resp pattern, BP changes S/S: LOC most reliable due to extremely sensitive to O2 levels in the blood, pressure cause O2 to decrease. LOC changes, see agitation, drowsy, unresponsiveness. Changes in pupil- dilation occurs/fixed- no reaction to light. Altered motor function.
Spinal Shock an immediate, transient response to injury in which reflexes below the injury. Temporarily ceases- 30-60 min after injury. During spinal shock paralysis or flaccid had no tone- spastic involuntary movement to extremities occur.
Autonomic Dysreflexia- most serious. Danger of spinal cord injured pt- autonomic nervous system exaggerates its response to painful stimuli- @ T6 or increased level. S/S: severe HTN (can cause seizure/stroke), flushing, profused sweating, headache severe, bradycardia.
LOC classifictations-Somnolence, Lethargy, Stupor, Semicomatose. evaluate pt for orientation to person, place, and time. If pt respond o only physical stimuli-LOC is impaired.
Somnolence unnatural drowsiness- sleepiness
Lethargy Excessive Drowsiness
Stupor decreased response with decreased motor spontanity
Semicomatose- in a stupor but arousable assess pupils, assess neuromuscular response, assess vital signs
Hypo Volemic Shock circulatinf cloob volume inadequete to maintain O2 supply to body tissue. Blood volume falls caused by hemorrhage, severe diarrhea/vomiting, excessive sweating.
Cardiogenic Shock Heart fails to pump, result decrease cardiac output, impaired tissue perfusion. Most difficult to treat.S/S: tachycardia, thready, weak, air hunger, hypotension.TX: give O2, IV fluids
Shock occurs due to cardio system failing to function adequately due to an... Due to an alternation in one of the 4 vital components circulation blood; Myocardial contracts blood flow, vascular resistance.
Systemic Lupus Erythemateous (SLE)- Autoimmune disease- pt can have long periods of remission.S/S: fatigue, malaise, fever, anorexia, nausea, weight loss, joint pain Hallmark sign- Butterfly rash across bridge of nose and cheeks, skin sensitivity.Life threatening: Inflammation of kidney,heart and lungs results in organ failure.N.I-> Monitor pain, pt avoid prolonged sunlight exposure, use SPF 15
Positive Homan's Sign Blood clot in venous stasis blood possible. *Pain in Calf*
Thrombophlebitis- inflammation of veins with formation of blood clots-usually after lengthy surgery. S/S: extremity edema, warm tender pain, see veins through skinN.I-> Monitor V/S, TED hose prevents, Homan's Sign test, monitor for pain
Hemothorax- Blood in pleaural space with pneumothorax- caused by torn/lacerated blood vessels, lacerated lung tissue, lung malignancy, pulmonary embolus, anticoagulant therapy. N.I: Monitor resp distress due to tachycardia, dyspnea, cyanosis, restlessness and anxiety. Inspect trachea for shift, Run ABG for hypoxemia, assess pt fears and pain management.
Pneumothorax- accumulation of air in plural cavity-collapse of lung..2 types: Tension- air enters with inspiration/ no escape; Open- chest wound allows air in/out freely. S/S: Dyspnea, tachycardia, tachypnea, restlessness, pain, anxiety, decreased movement of chest wall, diminished breath sounds on injured side, cyanosis progressesN.I-> Monitor resp distress, tachycardia, dyspnea, cyanosis
Hemorrhage- Loss of 1 liter or more of blood.S/S: obvious bleeding, cool, sweating, pale, skin, thready pulse, rapid respiration, decreased alertness. Internal Hemorrhage-S/S: abdominal distention, pain, hematemesis or dyspnea.N.I-> direct continuous pressure elevate
HIV/AIDS- transmitted by blood and body fluids. 5 major categories of transmission: Male to male sexual contact, injection drug use, male-female contact, mother-child transmission, blood tranfusion and unknown cause CD4 count normal 600-980 cells/mm; Full blown AIDS= CD4 under 200; viral load describes how much virus is found in blood, use universal precautions.
Stages of HIV infection (Initial, Latent, 3rd, AIDS) Initial: 4-8 wks from time of exposure (s/s-flu like);Latent: lasts 2-12 yrs, CD4 resting (inactive), virus replicating CD4 high in lymph but low in blood.3rd: pt gets oppurtunistic infections CD4 below 500-last 2-3yrs
AIDS CD4 <200 end with death within 1 year usually due to infection- pneumonia leads the causes.Kaposis sarcomia- lesions due to cancer of the skin.
Type 1 Diabetes- Insulin dependent, attributed to genetics- pancreas produces no insulin. Glucose levels elevated due to lack of insulin to place glucose into the cells. S/S: Polyuria, polydipsia, polyphagia, wt loss, fatigue, increased infection, rapid onset, early onset, before 15 yrs mostlyNormal BS 115-140Acceptable BS-140-160
Type 2 Diabetes- non dependent, casued by genetics, lifestyle, obesity, HTN, infections onset. Latin American increased risk 300% more likely. S/S: wt gain, vision problems, slow onset, polyuria, polydipsia, polyphagia, fatigue, increased UTI,family hx, slowed healing wounds, numb feet, dizziness.N.I-> Pt education, lifestyle changes, BS monitoring, increased exercise, monitor I/O
Diabetes Insipidus (DI)- Pituitary disorder due to ADH production and kidneys dont respond or inadequate ADH secreted results in very large amounts of urine excreted- diluted urine tubules do not reabsorb excessive water diuresis occurs. Dehydration can occur. S/S: Dehydration, hypo TN, tachycardia and thirst, skin turgor decreases, fainting episodesN.I-> Monitor urine output, changes in thirst and urine, palpatations.
DKA- *life threatening emergency, no insulin*-Hx of febrile illness, GI upset. Blood viscosity thickens, body burns fat/muscle for glucose store. Puts off ketones as by product (acidosis), loss of lean muscle mass S/S: 1st- Fruity breath, anorexia, headache, fatigue. 2nd- tachycardia, 3 P's, hypo TN, Acidosis, BS >300, Blurred Vision, Kussmual resp (late sign)N.I -> Monitor hydration, give insulin, v/s, fluid replacement.
HHNKS- Diabetic Coma, due to high glucose >600 no ketones,no kussmaul respirations,no fruity breath, no GI symptoms
Hypoglycemia-low BS caused by too little food, too much insulin, increased exercise. Onset sudden, can reach insulin shock BS < 70. S/S: shaky, tachycardia, sweaty, anxious, dizziness, hunger,blurred vision, H/AN.I -> Give pt 10-15gm of quick carbs
Insulin Therapy_RAPID ACTING Humalog; NovalogOnset: <15 minPeak: 1-2 hrsDuration: 3-4 hrs
Insulin Therapy- Short Acting *Regulars* Humalin R; Novalin ROnset: 30 min-1 hrPeak: 2-3hrsDuration: 3-6hrs
Insulin Therapy- Intermediate Acting (NPH)- give in morning ot bedtime, give snacks in the evening NPH-Onset: 2-4 hrsPeak: 4-10 hrsDuration: 10-16 hrs
Insulin Therapy- Long Acting. * Not given in the morning.*( Ultra Lente, Lantus) Ultra Lente:Onset: 4-8 hrsPeak: noneDuration: 24-36 hrsLantus:Onset: 1-2 hrsPeak: noneDuration: 20-24 hrs
Foot care in a Diabetic Pt: Check feet daily, wash feet daily, dry completely, trim toe nails straight across or see foot DR, always wear shoes, no temp extremes, no lotion between the toes.
Liver disease: examine abdomen,measure abdominal girth with tape measure, mark pt, remeasure as needed. Pharm concerns: Live processes all drugs so toxicity is high with liver disease. If kidneys arent doing their job, it can put the liver on overload and cause liver damage or damage to the rest of the body.
Liver- Largest Organ.. Bile produced, maintains blood glucose, metabolizes proteins and lipids, detoxes blood and aids in blood coagulation- helps develop antibodies for immunity, metabolizes hormones.
Liver Biopsy:Open Biopsy- incision madeNeedle Biopsy- needle inserted with ultrasound. Pt in supine with right arm behind head.N.I -> Pt lies on right side after procedure.
Liver enzymes: Bilirubin, Serum enzymes( AST,ALT, LDH), serum protein
Liver Scan: radio active chemical IV given, collects in liver, scans for tumors and abcesses Pt fasts 4-6 hrs pre-scan, Assess the pt. Post procedure education: wash hands thoroughly when voiding for 24 hrs, fluid encouraged.
Hepatitis- inflammed liver Bile channels compression damages cells that produce bile. Causes increased bilirubin and jaundice. Blood flow through liver impaired causing portal hypertnesion and possible ascites.
S/S of hepatitis; many pt's have none but the phases:(pre-icteric, icteric, post-icteric) Pre-icteric Phase: Malaise, fever, H/A, Right abdominal pain, anorexia, N/V.Icteric phase: Jaundice, clay stools, dark urine, pruritis (bile salts under skin).Post-Icteric Phase: liver enlargement, fatigue, malaise.
Cirrhosis- degeneration/ destruction of liver impaired blood flow and lymph fluids. 4 types: alcoholic, post necrotic, bilary, cardiac.S/S: wt loss, unexplained fever, fatigue, dull pain/heaviness in right quadrant, Nausea, vomiting, diarhhea, jaundice, neuropathy, confusion, decreased LOC.
Hepatic Encephalopathy- Liver cannot detox ammonia. S/S: cognitive disturbances, decreased LOC, changes in motor function, can lead to coma. N.I -> Seizure precautions, drug therapy,pt education on low protein diet
Digestive Disorders: Occult Blood Testing- used to detect blood in stools, not visible with the naked eye. Pt teaching includes: do not use toilet paper, turn specimen in immediately. Pt should not eat red meat for 2-3 days prior to test. Pt should not take ASA, Vitamin C, Anticoagulants, or Steriods.
Gastrointestinal Tubes: used to deliver feedings or keep the digestive tract empty or decompressed.
Gastrointestinal Decompression- used for the relief or prevention of distention: Tube thru nostril into stomach and sttached to suction. Common tube used is the LEVIN!!Post-Surgery: pt usually has a nasogastric tube for decompression.
Dumping Syndrome- occurs with rapid feedings of too concentrated of a formula: S/S: Pt will have cold sweats, abdominal distention, Hypo TN, tachycardia, Nausea and Diarrhea.
TPN- purpose to rest digestive tract by giving nutrients directly into the blood stream, placed in vein to the heart. Allows rapid dilution of the concentration, prevent blood clots, can be used long term. Monitor BS levels.Prevent Infection: DO NOT turn off machine ot give meds --> CAN BE FATAL..
Appendicitis-inflammation of appendix: DX test: WBC increase > 10,000 Occurs when opening to large intestine is blocked by feces, tumors, etc. Bacteria infections from the digestive tract.S/S: pain in epigastric region then moves to lower right quadrant. Temp may rise, Nausea, Vomiting.Assess pt pain and tx
Cholecystectomy-most frequently used tx for cholelithiasis (bad gallbladder): Post-op: pain relief, V/S, breath sounds, assess for bleeding from dressing if theres an incision.
Murphy Sign: Pt cannot take deep breath when two fingers pass below hepatic margin.
3 of the following factors cause clients to have fluid volume deficit EXCEPT... a surgical procedure
Evaluating pt for fluid volume problems.. I/O, Skin, Weight, Answer not high calorie
Isotonic Solution is same as.... osmotic pressure of body fluids
Regulation of fluid balance is done by.. Kidneys and circulatory system
Two major hormones that affect Fluid balance are... Aldosterone and antidiuretic
Pyridium: Urinary anesthetic and turns urine a reddish color.
TURP measurement, What is collected in bag? subtract fluids that were infused. IV and irrigation.
Burn Pt- 1st 18 hrs fluid volume shifts and in 18-36 hrs, shifts back.... To keep regulated, you must urinate a least 30cc an hour or kidneys are in trouble..
For specific gravity, If 1.35, urine concentration is high. Concentrations over 1 measures impurities. Look for WBC, RBC, Proteins and glucose <-- none of these should be in urine...
For eczema in small children.. Keep skin clean and dry
Skin psoriasis is... red lesions with silvery scales
Your the 1st @ the scene, pt has fallen of of a telephone pole, what do you suspect 1st? Cardiac Arrest
A burn victim has a foul smell and color, what do you suspect? Infection, which is a problem
In the Final stages of bone fracture healing, you will see.... Mature Bone cells
Pt with a total hip replacement, you must keep.... abduction pillow between legs until the surgeon says remove it.
Pt will gout has pain in right big toe due to uric acid buildup after hip surgery, opiates are used for the pain. What is the side effect? Constipation
With an open reduction internal fixation, pt is at risk for.. fat emboli..
Pt with a new DX of asthma, pt education.... Avoid Stimuli
With a short arm cast check for.. Color and Temperature of the fingertips.
With asthma, pt will have... inflammation and edema of the respiratory tract.
Heparin- anticoagulant that prvents clotting.Thrombolytics- meds that break up clots.. ASA...antiplatelet prevents from agrregating.DIC stops clotting, Factor 8
Corticosteriods education Take all of them and DO NOT stop abruptly
23 year old admitted with enlarged lymph nodes, decreased RBC, Thrombocytopenia, decreased mature WBC, what is suspected? Acute Leukemia
If a pt's PEG tube is not bubbling (tidaling) than it is leaking
With pleurisy or inflammation of the pleural space, the pt will experience? lots of chest pain, like leather rubbing together.
Are open headed injuries or closed headed injuries more serious? Open headed
A pt with increased ICP, you will see? Change in V/S, altered LOC,presense of deviation from normal posture.
Hematological petichaie and ecchomoysis are signs of?? Pernicous anemia
With hodgkin's disease, you will check for? Reed steinburg cells
In home health, the way to manage pain control is... continued constant pain control.
When dying, two biggests fears are?? loneliness and pain; *In dealing with the grief and terminally ill,be a compassionate nurse!!
With HIV, if your CD4 is below 200, your are considered what? full blown AIDS..
Antineoplastic is.. cancer agent that inhibits the maturation or reproduction of malignant cells.
Adrenergics... Sympathomimetics. Epinephrine- controls hemorrhage. Used for glaucoma(decreases aqueous formation) and decreases mucous secretions..
Cholinergics.... Acetocholine- used for glaucoma(increases aqueous outflow)
Nurse hangs an IV bag with sodium, potassium, chloride. which are all known as..... electrolytes
Chemical agent to treat cancer is known as... antineoplastics
Pt takes a thiazide diuretic which depletes? Potassium
What food would you encourage with hypokalemia? Oranges
What is a decrease in the production and excretion of urine? Oliguria
Prothrombin, PTT and bleeding time are known as... clotting factors
When giving eye drops, where in the eye are they given? lower conjunctival sac
Zovorax (acyclovir) is known as.... an anti-viral
a Microorganism unable to grow without oxygen is known as.... anaerobic
To administer epinephrine parentally that nurse would obtain.... a tuberculine syringe
A drug the removes and dissolves excessive growth of the epidermis is known as... kerolytic. Side effect is photosensitivity.
Use of a chemical agent in treatment of a disease is known as.. chemotherapy
A class of drugs that causes tachycardia, palpitations and tremors are... Sympathetic- adrenergic
Nasal decongestant act 1st by shrinkning mucous membranes. After 3rd day, rebound congestion can occur and cause... Paradoxical Effect
Phenazipyridium is an AZO dye urinary anesthetic causing... orange, red urine and staining
Albumin in the urine is known as.... Proteinuria
An Anti-psoriasis medication that cannot be used during pregnancy is... Methotrexate (antineoplastic), used for cancer also
Drug used for tx of Parkinsons disease is.. L-dopa; Side effects include: migraine, hypertension, angina, cardiac arrythmias.
Patient teaching of beta blockers.. DO NOT STOP ABRUPTLY
Meds that reduce production of bacteria? Bacteriacidal
Purpose of bronchodilators is to.... Decrease Air Flow Resistance
Gold Salts are used in the TX of.... Rheumatoid Arthritis
What is the main drug used for Arthritis? ASA (asprin)
Side effects of Epoieten Alfa include? Hypertension, especially in dialysis patients; Flu-like symptoms, GI effects, Rash, Chest Pain
(Epoietin Alfa)-> Epogen/ Procrit are... colony stimulator regulates production of blood cells, stimulates the bone marrow to produce more red blood cells.
When Epogen is given.... Must be kept in refrigerator until administration. Given at room temperature and DO NOT SHAKE.
Specific Gravity is 1 (water)... 1.35 is more concentrated
When giving Heparin, DO NOT... massage the injection site
In the 2nd half of pregnancy, DO NOT GIVE.. Tetracycline
Inflammation of the vein is... Phlebitis
Thrombolytics (3 types of blood thinners): Anticoagulant- HeparinAntiplatelets- ASA (asprin)Clot Busters- Thrombolytics
What will happen to a pt that has increased heart rate, a decreased BP while on thrombolytics? Pt is bleeding. decreased BP, increased heart rate, feeling dizzy, confused, looks pale.
The antidote for Heparin is... Protamine Sulfate
A pt taking ASA is experiencing tinnitis(ringing of the ears), what does this indicate? ASA overdose -->OTOTOXICITY; Asprin can also cause gastric irritation
S/S to check for when takin ototoxic drugs... In children recieving antibiotic Gentamycin--> A hearing test is given; When older adults are takin Gentamycin--> If UTI's or experiencing tinnitis, notify physician for possible deafness.
What do you give for an overdose of a Cholinergic Drug? Atropine
When giving an oral anticoagulant, check for.. Bruising and bleeding
When monitoring for bleeding, what tests will be done? PT and INR... PT is the best indicator..
The treatment of Gout is... Allopurinal(Zyloprim)
With Parkinson's disease, what transmittor is the pt low on? Dopamine
Mast cell stabilizers, leukotrine inhibitors are the treatment for... Asthma
With Chronic Mylegenous, lypphacytic in children, it produces... acute enlarged lymph nodes, decreased RBC, Thrombosytopenia, decreased WBC. Acute leukemia is controlled with Chemo.
An Increase in liver enzymes AST, ALT, LDH are known as.. Hepatotoxicity
Isonozid is an anti-tuberculosis drug taken for 6-12months to prevent development.... Sdie effects include: nausea, vomiting, diarrhea, dizziness, blurred vision, hepatic toxicity.<--potentiated by dilantin... Alternative drug is Rifompin: Side effect is rash..
Coumadin is used to.. decrease clots..Taken orally..Observe for CVA- they dont dissolve they interfere with coagulation as a prophylaxis. Perform INR test..
Antidote for Coumadin... Vitamin K
Drugs that may increase steriods... NSAIDS, alcohol, tricyclic antidepressants, acetaminophen, estrogen, corticosteriods
Heparin is given how? IV
Side effects of Heparin? Blood in urine (hematuria), minor bleeding (petechiae, epistaxis, and bruising)
Hydantoin agents are... Dilantin- anticonvulsantsPhenytoin- control seizuresSide effects: CNS, GI, Gingiual hyperplasia (overgrowth of gum disease), skin disorder
Drug therapy for acute renal failure will include: Lasix
Opiods are controlled substances... Side effects include: sedation, headache, dizziness, hypotension, flushing, rash, pruritis
Opiods are contraindicated with: Head injury, cardiac disease, opiod antagonist (Narcan), cerebral edema (causes confusion and decreasing consciousness)
Normal Prothrombin is... 11-12.5
Normal INR is... .7- 1.8
Drug used to produce bone marrow production of RBC... EPOGEN
Adverse reaction of Epogen is.... Hypertension, headache, arthralgia (joint pain)
Thromboplastin, Prothrombin and Fibrogen are... Clotting Factors
ASA over the counter may cause.. Bleeding
If taking oral anticoagulant (Coumadin), what test will be given? PT, test shows the therapeutic level
What is the most serious complication of Coumadin? Bleeding
Thrombolytics (clot dissolvers) are used for what? DVT, massive pulmonary emboli, acute MIA.
What is the antidote for Thrombolytics? Amino caproic acid( Amicar)
TX for polycythemia... Phlebotomy about 500-2000ml..
When Hodgkins disease is suspected, what will you be looking for when the biopsy is performed on the lymph nodes? Reed SteinBurg Cells.
Best time to administer oral Iron preparations? 1 hr before meals, take vitamin C (OJ) enhances iron absorption, DO NOT TAKE WITH ANTACIDS, When taking iron preparation liquid use a straw to avoid staining teeth.
Agents used to promote natural defenses and increase WBC? Immunotherapy; which boost natural defenses. Folic acid, B12, Procrit
Poitin Alpha (Procrit): Colony stimulator regulates production of RBC
Cation- Positively charged ion
Anion- Negatively charged ion
Adrenergics- Mimic sympathetic nervous system
T-Cells- Cell mediated; killer cells
B-Cells- Antibody mediated
Decreased WBC= Leukopenia
Normal urine specific gravity is... 1.010-1.025
Created by: CarrieSue89
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