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Exam 1-2 Review
includes Terms to Know, Meds at the top, Mods 1-8
| Question | Answer |
|---|---|
| Ipatropium | Relief of bronchoconstriction and reduce secretions in COPD; ADRs (Dry mouth, cough, headache, urinary retention, increased ICP); Rinse mouth after use, wait 5 min between inhalations, monitor for urinary issues in older pts, use cautiously w glaucoma |
| Gabapentin | to treat chronic neuropathic pain; ADRs (Dizziness, drowsiness, ataxia, suicide); Taper off slowly, avoid driving, monitor for CNS depression, monitor mood changes |
| Omeprazole | Treatment of GERD; ADRs (Headache, GI upset, C. diff infection (long-term use), Vit B12 deficiency); Take before meals, monitor for diarrhea or GI infections, assess long term use for bone loss and B12 levels |
| Atropine | Bradycardia, afib; ADRs(Tachycardia, dry mouth, blurred vision, urinary retention, constipation, tachypnea, hyperthermia); Monitor HR and BP, Neuro checks, Monitor I&Os, Encourage fluid intake, Avoid overheating |
| 3% NaCl | Given in SIADH for hyponatremia, Brain injury; ADRs (Fluid overload, pulmonary edema, hypernatremia, phlebitis); Monitor serum sodium levels, assess for crackles, edema, respiratory distress, central line is preferred, SZ precautions if sodium <120 |
| Metoprolol | Lowers HR and BP in HTN or tachycardia; ADRs (Bradycardia, hypotension, fatigue, depression); Monitor BP and HR before administering, hold if HR <50, or SBP <90, do not stop abruptly, watch for s/s of heart failure |
| Blood Products | Replacement therapy for many uses; ADRs (Acute hemolytic reaction, febrile, allergic reaction, sepsis, circulatory overload); 2 person consent, baseline vitals then q15 for first hour, prime with NS, stop if reaction occurs |
| Vasopressin | Synthetic ADH → treats central DI, Raises BP; ADRs (HTN, water intoxication, chest pain, headache, water intoxication); Monitor urine output, BP, and electrolyte levels, watch for drowsiness, restrict fluid intake, monitor ECG and chest pain |
| Nitroglycerin | Causes vasodilation of heart vessels in chest pain; ADRs(Headache, orthostatic hypotension, reflex tachycardia); Sit or lie down before administering, monitor BP, remove patches at night |
| Norepinephrine | Raises BP in HoTN; ADRs(HTN, arrhythmias, decrease perfusion to extremities, tissue necrosis due to extravasation); Admin via CL, monitor BP and perfusion, titrate per order |
| Furosemide | Treats fluid overload; (Hypokalemia, dehydration, hypotension, ototoxicity); Monitor electrolyte levels, admin IV slowly, daily wts and I&Os, encourage K+ rich foods |
| Insulin | Lowers blood glucose and treats hyperkalemia; ADRs (Hypoglycemia, hypokalemia, lipodystrophy); Check BG before giving, monitor got hypoglycemia s/s, have oral carbs or glucagon ready |
| Montelukast | Decreases bronchoconstriction and inflammation in allergic rhinitis, asthma, and exercise induced bronchospasm; ADRs (Headache, suicide, agitation, diarrhea, stomach pain, mild rash); Take daily in the evening, not for acute asthma attacks, monitor mood a |
| Corticosteroids | Suppresses the immune system and decreases inflammation for long-term management of chronic asthma and COPD, or short term symptoms; ADRs(Hyperglycemia, inc risk of infection, osteoprosis, GI bleeding); Taper off gradually, monitor BG and s/s of infection |
| causes of HYPOglycemia | diabetes meds, insufficient food intake, excessive workout, hormone imbalance, sepsis, kidney or liver dz |
| causes of HYPERnatremia | dehydration, DI, kidney issues, too much sodium intake, hormonal imbalances |
| causes of HYPOnatremia | fluid overload, SIADH, HF, CKD, cirrhosis, hormonal imbalance, meds |
| causes of HYPERkalemia | kidney issues, AKI, ESRD, meds, tissue damage, too much potassium, metabolic acidosis, HF, afib |
| causes of HYPOkalemia | potassium losing meds, vomiting, diarrhea, sweating, hormonal imbalance, metabolic alkalosis, insulin during DKA, alcoholism |
| causes of HYPERcalcemia | hyperparathyroidism, cancer, mdes, vit. D toxicity |
| causes of HYPOcalcemia | hypoparathyroidism, vit. D deficiency, CKD, mag deficiency, pancreatitis, blood transfusions, meds |
| causes of HIGH lactate | tissue hypoxia, impaired kidney or liver clearance, sepsis |
| causes of HIGH serum osmolality | dehydration, hypernatremia, hyperglycemia, uremia, alcohols or toxins, mannitol |
| causes of LOW serum osmolality | overhydration, SIADH, hyponatremia, Addison’s, hypothyroidism, renal failure |
| Causes of HIGH urine osmolality | dehydration |
| causes of LOW urine osmolality | overhydration, DI, diuretics, low solutes |
| causes of HIGH Urine specific gravity | dehydration, SIADH, HF, liver failure, shock, uncontrolled DM, proteinuria, contrast, IV mannitol |
| causes of LOW Urine specific gravity | overhydration, DI, diuretics, CKD, cold diuresis |
| what causes a positive blood culture? | infection |
| what causes a positive urinary analysis? | infection, kidney dz, DM, liver disease, hemorrhage |
| Ibuprofen (NSAID) | Pain, fever, and inflammation; ADRs (Peptic ulcers, GI bleeds, indigestion, kidney injury, fluid retention, HTN, bleeding, hepatitis, allergy, HA, dizziness); Give w/ food, Use PPIs, Monitor BUN, Creat., urine, BP, fluid status, LFTs |
| DIC | Serious bleeding and thrombotic disorder that results in clotting |
| Diffuse Coagulation | microclots caused by an underlying condition triggering widespread coagulation |
| Profuse Bleeding | from the depletion of clotting factors and platelets |
| Pathophys of DIC | Abnormal widespread activation of coagulation cascade → too much unnecessary fibrin production happening all over → clotting factors used up for unnecessary fibrin → not enough fibrin for needed clotting → lots of unnecessary clots and risk of bleeding |
| Pt is NOT BLEEDING...what do you do? | treat the underlying cause NOT DIC |
| Pt is ACTIVELY BLEEDING...what do you do? | use blood products in addition to treat the cause |
| DIC Collaborative Care | Assess for S/Sx of hemorrhage and hypovolemic shock Stabilize w/ O2 → monitor O2 sat & ABGs for hypoxemia (low blood oxygen) or S/Sx distress Control thrombosis & bleeding |
| DIC Bleeding Interventions | Use blood products For life-threatening hemorrhage: Fresh Frozen Plasma (FFP) → replaces all clotting factors, BUT NOT PLATELETS Cryoprecipate → replaces Factor VIII & fibrinogen Platelets RBCs |
| DIC Thrombosis Interventions | Heparin → use if reducing the clotting OUTWEIGHS the risk of further bleeding Antithrombin III (Atnativ) → use for Fulminant DIC (severe/sudden DIC), although it may ↑ risk for bleeding |
| Vaso-occlusive crisis | sickled cells clump together and results in ischemia, infarction, fever, pain, swelling, CVA |
| Sickle Cell Vaso-Occlusive Crisis Interventions | PAIN MANAGEMENT, Fluids, Rest, warm heat |
| Acute chest syndrome | an EMERGENCY and has s/s related to pneumonia; potential for PE |
| Sequestration | sickled cells are hemolyzed in the spleen; life-threatening pooling in spleen and infrequently in liver |
| Aplastic crisis | decreased production of RBCs and their short lives; decrease in reticulocyte count |
| Hyperhemolytic crisis | an acceleration of RBC destruction |
| Packed RBCs | used for the treatment of anemia usually when hemoglobin levels are less than 7-8 g/dL; just RBCs |
| Granulocytes | indicated for bone marrow transplant patients who develop bacterial or fungal infection not responsive to antibiotics; Can only be administered within 24 hours of collection from compatible donor |
| Platelets | thrombocytes |
| Plasma (Fresh Frozen Plasma - FFP) | liquid portion of whole blood that is separated from cells and frozen; LOTS OF CLOTTING FACTORS BUT NO PLATELETS |
| FFP Indications | Use for bleeding due to deficiency of some clotting factors, DIC, hemorrhage, liver disease, vitamin K deficiency, excess warfarin, correction of abnormal INR/PTT |
| Cryoprecipitates | derived from plasma; rich in clotting factors (especially factor VIII, XIII, and vWF); volume is usually 10 to 20 mL |
| Cryoprecipitate Indications | Use in hemophilia, DIC, liver disease or massive transfusion |
| Clotting Factors | clotting factor concentrates used for slow IV push |
| Albumin | regulation of passage of water and solutes through the capillaries due to oncotic pressure |
| Albumin Indications | Use for hypovolemic shock, hypoalbuminemia, after large volume paracentesis |
| Intravenous Immunoglobulins (IVIG) | concentrated fractionated blood component consisting of a diverse collection of antibodies |
| IVIG Indications | Pt is immunodeficient and cannot make their own antibodies; Pt immune system started attacking its own cells |
| Nursing Assessments | Color of pt,Lung sounds, WOB, Positioning (ie. tripod positioning), Heart rate, ABG or Venous BG, ABCs |
| Focused Nursing Assessments | Lung sounds; O2 levels; WOB (ie. use of accessory muscles, tripod positioning); Capillary refill |
| S/Sx of Asthma Attack | talks in phrases, prefers sitting to lying down, not agitated, ↑ respiratory rate, accessory muscles not used, pulse rate 100-120 bpm, O2 sat (on air) 90-95% |
| Acute Asthma Exacerbation/Attack Interventions | Start Tx w/ SABA 4-10 puffs by MDI w/ spacer Q20 minutes for one hour, States for adults → Prednisolone 1 mg/kg (max = 50mg), controlled O2 (if aval) for a target saturation 93-95%, Then continue Tx w/ SABA PRN → assess response at one hour (or earlier) |
| Severe Asthma Exacerbation/Attack Interventions | Maintain O2 > 90%; Medication administration (SABAs + Steroids); Auscultate lung sounds (silent chest [ominous sign]); Decrease pt anxiety/sense of panic |
| Goals for CF Patients | Airway, adequate nutrition, independence w/ ADLs, knows when to seek Tx, active participation in Tx |
| CF Patient Assessments | Procedure Tolerance, Self-Image, Normalization, adulthood transition, low bone density, genetic counseling, financial concerns |
| Psych + Therapeutic Support for Cancer Pts | actively listen to concerns, manage your own discomfort, be clear + repeat if necessary, provide written info |
| Coping w/ cancer + Tx | build trust, use touch, assist setting realistic goals + w/ planning, support usual lifestyle, maintain hope, reassure of ongoing support, offer support from survivors, provide phone contact between visits, care for Pt + family |
| chemotherapy | used to decrease number of cancer cells → inhibits cell replication; Chemo cannot distinguish between normal and cancer cells |
| Chemo PPE | Wear chemo gown, chemo gloves (double gloves), eye/face protection, N95 mask |
| radiation | damages the DNA → irreversible change that caused cell death |
| Radiation Indications | Commonly used for primary tumors, palliation of metastatic lesions |
| Chemo/Radiation Interventions | Monitor CBC especially RBCs, neutrophils, platelets; “Nadir” - lowest blood cell counts (riskiest time) - usually 7-10 days after therapy |
| Neutropenia complications in cancer Pts | high risk for infection → sepsis → death; Neutropenia + fever = EMERGENCY |
| bone marrow suppression (myelosuppression) | low WBC, RBC, and platelets → risks for infection, anemia, bleeding, fatigue |
| Spina Bifida CYSTICA Nursing Assessment | Assess those with hydrocephalus and shunts; Monitor s/sx of IICP (Irritability, Decreased LOC, Bulging fontanelle), signs of infection (Fevers, Poor feeding, vomiting, Seizures, decreased consciousness, Inflammation along shunt, Abdominal distention |
| Cerebral Palsy Nursing Assessment | delay in gross motor movement, abnormal motor performance , Alterations in muscle tone, Abnormal postures, Reflex abnormalities, speech/hearing/vision/ cognitive impairments, Swallow, sucking, feeding, Incontinence, Poor dental hygiene |
| Spina Bifida Cystica Pre OP Assessment | Keep sac moist and sterile, meticulous skin care, protect it from feces and urine keep newborn in a prone position w/ legs in abduction, Keep in isolette, Institute latex precautions (more likely to have an allergy), Educate and support the family |
| Spina Bifida Cystica Post OP Assessment | Assess surgical site and head circumference (no fluid buildup), Monitor VS and neuro VS, Encourage contact with parents/caregiver → SKIN TO SKIN, Positioning, Skin care |
| Spina Bifida Cystica Complication Management - Hydrocephalus | Tx = Shunts AKA permanent ventriculostomy |
| CP Tx + Management | Interprofessional team approach, Patient and family should set functional goals that are realistic and periodically reevaluated |
| CP Meds | Pain meds, Botulinum toxin A (botox) (Blocks nerve activity in the muscles and reduces spasticity), Baclofen (Decreases spasms and spasticity, PO or larger w/ pump), Benzos (spasticity), Antiseizure (comorbidity), constipation meds |
| CP Interventions | Dental hygiene, G Tube feeds, Frequent rest periods due to energy used for ADLs, Safety issues (falls, lack of mobility, handling), Multidisciplinary involvement, Braces, Constipation, Chronic respiratory infections, Skin issues Behavioral issues |
| Disadvantages for Pts w/ Disabilities | poor communication, compromised care, negative attitudes, fear about hospitalization |
| Sepsis | a life-threatening condition caused by a dysregulated host response to infection, resulting in organ dysfunction |
| Pathophys of Sepsis | Usually begins as a fungal or bacterial infection Gram - organisms: K. pneumoniae, P. aeruginosa, E. coli Gram + organisms: S. aureus, Strep. Aureus |
| Sepsis Risk Factors | Older age, Pregnancy, Immunosuppression, Comorbidities (COPD, CF, DM, cancer, etc.), Unfinished medication therapy, Invasive medical devices (catheters, ET tubes, IVs, PICCs, etc.), CKD, Surgical patients |
| Sepsis Clinical Manifestations | Confusion or AMS, HoTN, Tachypnea, Fever, Malaise, Tachycardia, Hyperglycemia, Edema |
| Sepsis Management | Stabilize BP, Fluid Resuscitation, Vitamin C, Antibiotics, Oxygen and Ventilation, Education, Labs, Screening/Assessment |
| Prerenal AKI Causes | ↓ CO (Cardiogenic shock, Dysrhythmias, HF, MI) ↓ PVR (Anaphylaxis, Neuro injury, Septic shock) ↓ renovascular flow (Embolism, Thrombosis Hypovolemia (Burns, Dehydration, Excessive diuresis, V/D, Hemorrhage, ↓ albumin) |
| Intrarenal AKI Causes | Interstitial Nephritis (Allergies to abx, NSAIDs, ACEIs, Viral, bacterial, fungal infections) Nephrotoxic injury (Chem exposure, Drugs: gent, ampho B, Crush injury) Other (AGN, Malignant HTN, prerenal ischemia, Thrombosis, Pregnancy toxicemia, SLE) |
| Postrenal AKI Causes | BPH, Bladder Cancer, Calculi Formation, Neuromuscular disorders, Prostate Cancer, SC disease, Strictures, Trauma (back, pelvis, perineum) |
| Oliguric Phase - AKI Clinical Manifestations | Urinary changes < 400 mL/day, Fluid volume, Metabolic acidosis, Sodium balance, Potassium excess, Hematologic disorders, Waste product accumulation, Neuro disorders |
| Oliguric Phase General Info | Occurs in first 1-7 days The longer this phase, the worse the prognosis If ischemia is the cause, oliguria occurs in 24 hrs Nephrotoxic drugs may take 7 days |
| Diuretic Phase - AKI Clinical Manifestations | Urinary changes 1-5L/day, Major fluid + electrolyte changes, HoTN, Hypovolemia, ↓ Na + K |
| Diuretic Phase General Info | May last 1-3 wks Osmotic diuresis from ↑ blood urea + inability to concentrate urine Tubules can excrete waste but cannot concentrate urine |
| Recovery Phase - AKI | Begins when the GFR increases BUN + Creatinine ↓ May take 12 mos to stabilize No recovery = ESRD |
| AKI Nursing + Collaborative Care | Treat cause Fluid restriction Nutrition (Diet, PN) Monitor for HYPERkalemia Calcium supplement, phosphate binding agents Hemodialysis or CRRT Prevention and early recognition Fluid + electrolyte management Risk for infection Recovery is variable |
| CKD Clinical Manifestations (Psych, Neuro, Ocular, CV, Pulm, GI) | Psych (Anxiety + Depression) Neuro (Fatigue, HA, sleep issues, peripheral neuropathy) Ocular (HTN retinopathy) CV (HTN, HF, CAD, pericarditis, PAD) Pulm (Pulm edema, pneumonia) GI (Anorexia, N/V, GI bleeds, gastritis) |
| CKD Clinical Manifestations (Skin, M/S, Endo/Repro, Metabolic, Hemato) | Skin (Pruritis, Bruising + Dry, scaly skin) M/S (calcifications, Osteomalacia, Osteitis fibrosa) Endoc/Repro (Hyperpara, Thyroid issues, no menses, ED) Metabolic(Carb intolerant, HLD) Blood (Anemia, bleeding, infection) |
| Peritoneal Dialysis (PD) Characteristics | Done at home or hospital; CKD - long-term, two types- Continuous ambulatory PD (CAPD), Automated PD |
| PD Nursing Considerations | Instill, dwell, drain, Diasylate should be warmed before instillation, ASEPTIC technique, Move side to side or gentle massage to aid w/ draining |
| PD Complications | Peritonitis, Bleeding, Hernias, Pleural effusions, Bronchitis, Protein loss |
| Hemodialysis (HD) Characteristics | Done outpatient or hospital; CKD or AKI- emergency HD for AKI must have an HD catheter; Uses arteriovenous fistulas + grafts; Temporary venous catheter (Soft, flexible attached to Y hub, looks like a central line but catheter is WHITE) |
| CRRT Characteristics | In-hospital only - ICU; CKD or AKI; For hemodynamically unstable Pts, safer than HD, Requires an HD catheter, fistula or graft |
| Ethical + Legal Issues in End of Life Care | Pts and families struggle w/ many decisions during illness and dying experience Decisions should be based on wishes and values Decisional capacity Ability to consent to or refuse care; understand information and have capacity to reason |
| Organ Transplant Pre-Op Nursing Care | Emotional and physical prep - Stress that dialysis may be needed; Immunosuppressive drugs + infection prevention ECG, Chest XR, Labs |
| Organ Transplant Post-Op Nursing Care DONOR | Monitor renal function Monitor HCT Experience more pain than recipient Acknowledge their gift |
| Organ Transplant Post-Op Nursing Care RECIPIENT | Fluid + electrolyte imbalance is first priority, large volumes of urine may be produced soon after, Avoid dehydration, Assess for hyponatremia and hypokalemia, Monitor urine output and maintain catheter patency |
| Patient education for Organ Recipients | s/sx of rejection + infection, surgical complications, follow-up care |
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