Why does the patient develop the symptoms of hyperthyroidism?

Too much T3 T4-- too much energy

What happens to the workload of the heart in hyperthyroidism?

Increase the pulse and BP. When the pulse and BP is increase it increase the workload of the heart.

Explain how the antithyroid drugs work?

Stops Thyroid From working. Propacil, PTU, Tapazol.

Why does the hyperthyroid patient have to be put on beta blockers? How does this help the patient?

Decrease HR/BP, decrease anxiety.

What is one of the major complications of radioactive iodine?

Reverse opposite effect, could cause "thyroid storm" (is a rebound effect)

Why do we give iodine compounds preoperatively?

Decrease vascularity, decrease chance of hemorrhage.

When a patient has had a thyroidectomy, why is it so important for them to have neck support.

We do not want to stress the suture lines

Why do we check for bleeding behind the neck with a thyroidectomy patient?

This is where the pooling could occur.

Why do we keep a trach set at the bedside with a thyroidectomy patient?

Needed for emergency airway- Laryngospams could occur.

Why do we assess for parathyroid removal in the thyroidectomy patient?

B/C they are close to the thyroid, could have been accidentally removed.

How do you assess for parathyroid removel?

Watch for muscle rigidity-- tight muscles, tetany. Look for S/S of Hypocalcemia.

What are the S/S of hypothyroidism

Fatigue, GI slow, increase weight, slow speech, cold.

Hypothyroidism present at birth.

How to you treat hypothyroidism?

Give thyriod hormones-- synthroid, proloid, cytomel.

Why do you have to worry about the bones of a patient with hyperparathyroidism?

B/C calcium is being pulled from the bones, put into blood, osteoporosis.

What type of symptoms will they exhibits

DTR's increase--- muscle tone is tight, rigid, laryngospams, Trouss +, Chov +

Why dose the hypoparathyroid patient need a quiet environment?

To reduce stimuli-- they are at risk for seizures.

Why does a hypoparathyroid patient need a trach tray next to the bed.

To provid emergency airway incase of larngospams

Why is it important that the hypoparathyroid patient have a diet that is limit in phosporus.

Serum phosporus is high already.

Explain how amphojel works for the hypoparathyroid patient

Amphojel binds to the phosporus which makes the phosporus go down and calcium go up.

When a patient has pheochromocytoma, what is the major problem they have.

Problem with the adrenal medulla-- benign tumor that secrete norepinephine that maks blood pressure increase and heart rate increase.

What is the major diagonostic test for the pheochromocytoma? Explain?

VMA-- Vanylmandelic acit test-- 24 hour urine specimen, looking for increase levels of epi / norepi

What is the four major actions of glucocorticoids?

Changes in mood, breakdown proteint and fat, alter defense mechanism. (suppress immune system), inhibits insulin.

What is another name for glucocorticoids, mineralocorticoids or sex hormones?

steroids. adrenocorticotropin hormones (ACTH) cortisol.

Why do steroids drive your blood sugar up?

They inhibit insulin ---> blood sugar goes up.

If a patient is making to much aldosterone, what is going to happen to the vascular space? Explain Why?

Blood volume goes up, retaining NA and H2O

Explain breifly the basic pathophysiology of Addison's Disease.

Body does not have enough steriods (aldosterone) -- Na and H2O is lost -- K+ is retained (think about shock and hyperkalemia)

What are the S/S of hyperkalemia?

Muscle weakness, decrease bowel sounds, anorexia, GI upset, arrythmias

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Nclex II-- Endocrine

Question	Answer
List the major symptoms of hyperthyroidism?	Nervous, decrease weight, hot, sweaty, increase appt, fast GI, Increase BP, irritable, decrease attention spam.
What is another name for hyperthyroidism?	Graves Disease
Why does the patient develop the symptoms of hyperthyroidism?	Too much T3 T4-- too much energy
What happens to the workload of the heart in hyperthyroidism?	Increase the pulse and BP. When the pulse and BP is increase it increase the workload of the heart.
What do you have to have in your diet to make thyroid hormones?	Iodine
Explain how the antithyroid drugs work?	Stops Thyroid From working. Propacil, PTU, Tapazol.
Give examples of the antithyroid drugs?	Propacil, PTU, Tapazol.
Why do you have to give Iodine compounds in milk or juice and use a straw.	B/C they stain teeth.
Why does the hyperthyroid patient have to be put on beta blockers? How does this help the patient?	Decrease HR/BP, decrease anxiety.
How does radioactive iodine work?	Destroys thyroid cells
What is one of the major complications of radioactive iodine?	Reverse opposite effect, could cause "thyroid storm" (is a rebound effect)
When someone has been given radioactive iodine, what do you expect to happen to their thyroid hormone levels?	Decreases
When a patient has been placed on an antithyroid, what do you except to happen to theis thyroid hormone level?	Decreases
Why do we give iodine compounds preoperatively?	Decrease vascularity, decrease chance of hemorrhage.
When a patient has had a thyroidectomy, why is it so important for them to have neck support.	We do not want to stress the suture lines
How do you want a thyroidectomy patient to be position. Explain	Fowlers--- decrease edema
Why do we check for bleeding behind the neck with a thyroidectomy patient?	This is where the pooling could occur.
Why do we keep a trach set at the bedside with a thyroidectomy patient?	Needed for emergency airway- Laryngospams could occur.
How do you assess for recurrent laryngeal nerve damage in the thyroidectomy patient?	Listen for horseness.
Why do we assess for parathyroid removal in the thyroidectomy patient?	B/C they are close to the thyroid, could have been accidentally removed.
How do you assess for parathyroid removel?	Watch for muscle rigidity-- tight muscles, tetany. Look for S/S of Hypocalcemia.
What are the S/S of parathyroid removal?	Any Signs of hypocalemia.
What is another name for hypothyroidism.	Myxedema
When someone has hypothyroid, what has happened to there thyroid level.	Decrease.
What are the S/S of hypothyroidism	Fatigue, GI slow, increase weight, slow speech, cold.
What is cretinism?	Hypothyroidism present at birth.
How to you treat hypothyroidism?	Give thyriod hormones-- synthroid, proloid, cytomel.
When a patient has started on drug therpy for hypothyroidism, is it temporary or permanent?	Permanent
When someone is hyperparathyroid, what is the major electrolyte imbalance they have?	Hypercalcemia
Why do you have to worry about the bones of a patient with hyperparathyroidism?	B/C calcium is being pulled from the bones, put into blood, osteoporosis.
Why does the hyperparathyroid patient have kidney stones?	to much calcium in blood.
What is the major eletrolytes imbalance a hypoparathyroid patient will have.	hypocalcemia
What type of symptoms will they exhibits	DTR's increase--- muscle tone is tight, rigid, laryngospams, Trouss +, Chov +
Why dose the hypoparathyroid patient need a quiet environment?	To reduce stimuli-- they are at risk for seizures.
Why does a hypoparathyroid patient need a trach tray next to the bed.	To provid emergency airway incase of larngospams
Why is it important that the hypoparathyroid patient have a diet that is limit in phosporus.	Serum phosporus is high already.
Explain how amphojel works for the hypoparathyroid patient	Amphojel binds to the phosporus which makes the phosporus go down and calcium go up.
When a patient has pheochromocytoma, what is the major problem they have.	Problem with the adrenal medulla-- benign tumor that secrete norepinephine that maks blood pressure increase and heart rate increase.
What happes to thier blood pressure and Pulse. (pheochromcytoma)	Increase.
What is the major diagonostic test for the pheochromocytoma? Explain?	VMA-- Vanylmandelic acit test-- 24 hour urine specimen, looking for increase levels of epi / norepi
What is the four major actions of glucocorticoids?	Changes in mood, breakdown proteint and fat, alter defense mechanism. (suppress immune system), inhibits insulin.
When you hear the word mineralocorticoid, what is the major word you need to think of?	Aldosterone.
How does aldosterone work.	Makes you retain Na and H2O
What is another name for glucocorticoids, mineralocorticoids or sex hormones?	steroids. adrenocorticotropin hormones (ACTH) cortisol.
Why do steroids drive your blood sugar up?	They inhibit insulin ---> blood sugar goes up.
If a patient is making to much aldosterone, what is going to happen to the vascular space? Explain Why?	Blood volume goes up, retaining NA and H2O
Explain breifly the basic pathophysiology of Addison's Disease.	Body does not have enough steriods (aldosterone) -- Na and H2O is lost -- K+ is retained (think about shock and hyperkalemia)
When you think of Addison's disease, what is the chemical told you to focus on?	Aldosterone
What is the major electrolyte imbalance a patient with Addison Disease will have.	Hyperkalemia
What are the S/S of hyperkalemia?	Muscle weakness, decrease bowel sounds, anorexia, GI upset, arrythmias
Could the addison's disease patient also have a life threating arrthmia? if so why?	Yes, too much k+
Does the Addison disease pateint have too many steriods in their blood or not enough steroids in their blood.	Not enough
Why does Addison diease patient have trouble with shock?	Losing volume, not enough Aldosterone
Why does the Addison's disease patient need more sodium in thier diet.	To retain volume in thier vascular space. (they're losing thre NA.)
Why is I & O such an important nursing intervention with the Addison's disease patient?	Because the patient has severe fluid volume problems.
Is the Addison's disease patient in a fluid volume deficit of fluid volume excess?	Deficit
What happens to the Addison's disease patient's blood pressure.	Decrease
When a patient has Cushing's syndrome, explain briefly, in your own words, what they will look like?	Moon face, buffalo hump, women with male traits, FVE, skinny arms / legs, large abdomen.
When a patient has cushing's syndrome, do they have too many steroids or not enough.	To many.
Why does the cushing syndrome patient experiene the following? Growth arrest, Increase risk of infection, Hyperglycmia, Psychosist, Depression....	to much glococoricoids.....
is the cushing syndrome patient in a fluid volume deficit or excess.	Excess.
Why does the cushing's syndrome patient develop high blood pressure.	Fluid volume excess.
Why does the cushing syndome patient develop Congestive heart failure?	Because they are in FVE.
When a patient has cushing's syndrome, thier serum potassium level goes down, Why?	Because they have to much aldesterone. (retain to much NA and H2O and lose k+
Why does the cushing' syndrome pateint need more calcium in thier diet.	Because steriods decease serum calcium level by making you excrete it through the GI tract.
Why does the cushing's syndrome patient have ketones in their urine and glucose in their urine.	Sugar~~~ B/C insulin is inhibited and blood sugar increase and excess spills into the urine. Fat is being broke down and this is producing ketones.
Does th cushings syndrome patient need to be low-soduim diet or a high sodium diet? Explain?	Low, NA makes you retain h2o. this patient doesnt need more fuild retention b/c they are already in excess.
Why does the cushing's syndrome patient not have protein in their urine? Is it normal to have Protein in the urine.	It's not normal. You only have protein in your urine if you have glomerular damage. The cushing's patient does not have glomelar damage.
In a diabetic patient, what is absent that makes their blood sugar go up?	Insulin
What is the normal action of insulin? (how does it work)	Carries Glucose out of the vascular space to the cell. Decrease the blood sugar.
In the diabetic patient, why does the glucose build up in their blood.	Because their is no insulin
In the diabetic patient, why does their body start breaking down protein and fat.	The cells are starving for energy, so we try to get energy forother places.
Anytime you break down fat, you are going to get production of what.	Ketones.
Ketones are what?	Acid
What is the major acid base imbalance the diabetic patient can develop and explain why?	Metabolic acidosis. B/C fats are being broken down for energy, which makes ketones, which make the blood more acid.
why does the diabetic deveop the following syptoms. A Polyuria B. WT loss C Polydypsia D. Polyphagia	A. Kidneys are trying to get rid of excess glucos. b. Losing lots of fluids. C. they have excessive thirst from FV lose.D. thy are hungr, bc brain cells are hungry.
Explain how oral hypoglycemia agent work and give examples.	They stimulant the pancreas to make insulin. Micronase, Diabeta, glucotrol
Why will an oral hypoglycemia agent not work in a type 1 diabetics.	Because they dont prduce insulin, not een with a stimulation. Pancreas is not working. TYPE 1
Why does TYPE II diabetic have problems with wounds that will not heal or repeated vaginal infections?	Blood suga are high and bacteria can grom rapidly.
What is the common treatment for TYPE II diabetcs.	Diet and exercise Oral Agents Insulin
In treatment of a diabetic, why do we have to limit the protein in their diet.	B/C of possible kidney damage. Diabetics tend to have kidney damage and excess glucose destorys vascularity in kidney's. We always limit protein with kidney problems.
Why are diabetrics prone to Coronary Artery Disase.	There is a lot of glucose in the system and it deposits just like fat. (arteriosclerosis occurs)
How can a highfiber diet benefit a diabetic patient?	Helps maintain steady blood sugar level by slowing the absorbtion of glucose in the GI tract and preventing glucose sikes.
When the diabetic patient exercises, why do they have to worry about hypoglycemia and how can hey prevent it.	Exercise lowers blood sugar, eat fruit , low fat milk.
Why is it important that a diabetic patient exercise when thier blood sugar is at its highest?	To prevent hypoglycemia.
Whn you start giving a patient insulin, what is going to happen to their blood sugar.	Decrease.
When your give somebody insulin, why should they not have ketones and glucosein their urine?	B/C insulin should lower BS. Therefore there shouldnt be any excess to spill into the urine. Also insulin should prevent fat being broken down.
If you are giving somebody insulin and they do have glucose and ketones in their urine, what needs to be done to the dose of the insulin.	Increase.
Why do we draw up regula insulin first.	Draw up the clear regular insulin up first to prevent contamination of the regular insulin with the med. or long acting insulin (cloudy). REMEMBER CLear/Regular insulin is the only insulin tht can be given IV.
What is the only typ of insulin that can be give IV?	CLear / Regular.
Explain the peaks of the three different classes of Insuin?	Rapid~~~ 2-4 hours. Intermediate (NPH)7-12 or 8-12 Long Acting (protamine Zinc) 18+ or 16-18
When insuli is at its Peak, that means the insulin is working really hard; therefore what is going to happen to the blood sugar at the peak time?	Decreas~~ Risk for hypogycemia
When patient have given themselves insulin, they need to know when insulin peaks B/C what is the major complication of the peak time.	Hypoglycemia.
How can this complication be prevented?	Inform patient to eat, take regular insulin, and eat healthy snacks.
Why is it so important that the injection sites the diabetic uses be rotated.	To prevent tissue damage, lipodystrophy decrease absorptions.
What is going to happen toanybody's blood sugar when they are sick or stressed.	Increase.
When a diabetic is sick, their blood sugar is going to goup, therefore what do they need to do with the dose of their insulin.	Increase.
If a diabetic patient gets sic andthey do not increase the dose of their insulin, what are they going to go into. (major Complication)	DKA
Do we aspirate insulin? Why?	No~~~ Tissue damage.
What are some general S/S of hypoglycemia and what is the immediate nusing actions?	Shaking, weak, decrease LOC, cool clammy skin, nervousness, Increase pulse, nausea, sweating, HA..... Simple Sugar.
After a patient has experienced hypoglycemia and they have drank a coke or eaten some candy or whatever, what do they need to do next? Explain Why?	Eat complex card and protein. (peanut butter and crackers, cheese and crackers)~~~ SO blood sugr wont drop again, drink milk.
Why is hypoglycemia considered to be more dangerous then hyperglycema?	Brain can die
Are D50W and injectable glucagon temporary or premanent increase in the blood sugar.	Temporary.
If you walk into a diabetics patient's room and they are unconscious, do you treat the patient like they are hypo or hyper.	Hypo.
YOu give an unconscious patient an amp of D50W B/C you think they are HYPO. The patient should start to wake up. When they are awake, what should you get tem to do.	EAT!!!!
Why is it so important that a diabetic patient eat regulatly and take their insulin Regularly.	To prevent HYPO, and keep their BS within Normal range.
Why does the diabetic patient sometimes develop Kussmaul's respirations?	They are trying to blow off CO2 to compensate for the acidosis.
Explain the basic patho behind diabetic ketoacidosis.	Not enough insulin-- blood suger increases- polyuria, polydypsia, polypahgia-- fat breakdown (acidosis) -- Kussmauls resp.
When a patient has diabetic ketoacidosis, why is it so important that we measure the blood sugar and the potassium hourly?	Because insulin grabs the sugar and k+ and carries it out ot the vascular space. Worry about hypo kalemia and hypoglycemia.
When you give somebody insulin, what do you except it to do to their blood sugar? Explain Why?	Decrease- insulin drops the blood sugar.
When you give someone insulin, what do you except it to do to theirserum potassium level. Explain why	Decrease- B/C insulin make K+ leave the serum and go into cell.
Why is it so important that we montior the diabetic ketoacidotice patient's EKG so Closely.	For hyporkalemia; chance of arrythmias
Why are we measuring hourly output on the diabetic ketoacidosis patient.	B/C polyuria could turn to oliguria then anuria (renal failure)
When you get a diabetic ketoacidosis patient into the hospital, they may have polyuria, anuria or oliguria. Please Explain, in the proper sequence, why the patient starts with polyuria, then converts to oliguria and anuria.	Polyuria- tring to get rid of sugar in the body. Polyuria cause vascular volume to decrease. Kidneys aren't being perfused as well so Oliguria occurs and possibly anuria could occur.
When a patient has Oliguria and Anuria, what do you really have to start to worry about and why?	Kidney failure-- B/C the kidneys aren't perfused properly.
When a DKA patient presents to the emergency room, are they in a fluid volume deficit or a fluid volume excess? Explain Why?	Deficit-- the patient has lost so much volume (polyuria)
When you get the diabetic ketoacidosis patient into the emergency room, why do we start normal saline?	Patient is in fluid volume deficit.
How does normal saline work?	since normal saline is isotonic, it will go in the vascular space and stay and build up.
What could the patients blood sugar be with DKA	Increase > 400
When you get the DKA patient into the emergency room, you are going to see the doctor order IV push insulin, therefore, what is going to start happening to the blood sugar rapidly?	Decrease
When the blood sugar drops to about 300 (i know this is still too high), why do we switch the IV fluids to D5W in place of normal saline?	To prevent throwing the patient into hypovolemic state.
How could you throw a DKA patient into HYPO?	By decreasing the blood sugar rapidly with insulin.
Diabetic patient have problems with their vascular system, Why? Give examples.	They have pood circulation everywhere due to sugar deposition. Sugar deposits like fat (retinopathy, kidney problems, nerve damage, amputation)
Explain foot care throughtly.	Clip nail straight across, be careful with lotion, inspect feet each day, dry inbetween toes very well, wear leather shoes all the time.
What is cardiac output?	The amount of blood being pumped out of the LV
If your cardiac output is decrease, do you perfuse as well as you normally do?	NO
If you are taking care of a patient with decrease cardiac output, what is going to happen to their level of consciousness.	Decrease.
Could they start complaining of chest pain?	Yes
Why does a patient's (whose cardiac output is low) skin feel cool and clammy?	Because there is no perfusion. (perpheral vasoconstriction in an effort to shunt blood to vital organs)
When you are taking care of a patient what has decrease cardiac output, why do they get short of breath and have wet lung sounds?	The heart is not pumping the fluid out of the body, so it backs up to the lungs.
When you are taking care of a patient who has decrease cardiac output, why do their peripheral pulses diminish?	Because the heart is not pumping out to the periphery
What is going to happen to the urine output when you have a patient who has decrease CO?	Decrease, No pressure.
When you have a patient with decrease CO, why does their blood pressure drop?	Becuase the heart is not pumping out as much volume. Less volume= less pressure.
How will bradycardia affect cardiac output?	Decrease, B/C heart is not pumping out much volume, heart is pumping slowly.
How can tachycardia (I.E. heart rate > 150) affect cardiac output?	Decrease ventricles cant fill up; dont have time to fill b/c heart is beating to fast.
When someone has had an MI, how can this affect cardiac output and why?	CO decrease, Dead mucsle doesnt pump well.
If my blood pressure is really high, how will this affect cardiac output and why.	Decrease-- Heart cant pump as much blood out against the high pressure.
What is preload.	The amount of blood in the right side of the heart.
If you increase preload, what do you do to the workload of the heart.	Increase
List some ways preload can be increase.	Trendelenburg position, hyervolemia, supine, evelate legs
List some ways preload can be decrease.	Standing upright, hypovolemia, less volume, lower legs, raise HOB
Expain afterload in your own words.	Amount of pressure in the aorta that the ventricle has to pump against.
If you increase afterload, what do you do to cardiac output.	Decrease
if cardiac output is decrease, that means the blood is not moving forward. If the blood isnt moving forward, then it has got to go backwards, so therefore where is it going to wind up?	Lungs
What is angina?	Decreased blood flow to the myocardium--> ischemia
explain the pain a patient has with angina?	Blood flow decreases (decreased O2) and causes chest pain (pressure sensation)
Why is nitroglycerine given?	to relieve the pain-- vasodilates which increase blood/ O2 to heart.
When you give somebody nitroglycerine, more ___________ is going to get to the heart.	Blood flow --- O2
How do you teach a patient to take their nitroglycerine?	1 every 5 min. X 15 mins (max 3 doses)
Why should nitroglycerine burn.	Some nitroglycerine burns and that is normal
What is a common and expected side effect of nitroglycerine.	Headache
When you give somebody nitroglycerine, are they going to vasconstrict of vasodilate? therefore what is going to happen to their blood pressure?	Vasodilate--- Decrease
Why do patients with angine need a beta blocker? List several example?	They decrease workload of the heart and decrease contractilly; decrease blood pressure. Inderal--lopressor.
Why do angina patient need calcium channel blockers? List several examples?	Decrease blood pressure, decrease workload of heart. Verapamil, Calon, Procardia. These drugs also dilate CA which enhances blood flow to the heart.
What is angioplasty and what is the major complication of angioplasty?	Balloon to open coronary arteries to enhance blood flow__ MI
Why is it so important that the angina patient avoid isometric exercise, overeating, caffeine, or any drugs that increase the heart rate and avoid cold weather.	Because overwork the heart.
Why is it so important that the angina patient rest frequently.	to decrease the work load of the heart.
Is it okay for a patient with angina to take their nitroglycerine prophylactically?	Yes.
Before they take their nitroglycerine, should the patient sit down or stand up? Explain?	Sit down, nitroglycerin makes them dizzy; they may faint.
With a MI, why does the patient have necrosis?	B/C of decreased blood flow and oxygen to the myocardium
Will rest or nitroglycerine relieve MI pain?	NO
Explain how MI pain feels?	Severe, non-stop pain; chest pressure; radiation to the left arm and jaw.
Why does an MI patient get cold, clammy, and their BP drop.	Decrease CO (dead tissue doesn't pump well.)
Why does the MI patient's white count go up?	Inflammatory response.
Why does their temperature go up?	Inflammatory response
Explain Cardiac enzymes and include: A why do we have to draw the isoezymes? B. Tell me the time frame for which these peack (CPK LDH)C. Troponin	A. Determine if heart mucsle, skeletal or brain affected. B. CPK- increase 4-6 peaks 18-24 LDH- detects 48-72 hours back C. high specificity for MI cell injury; always normal in non-cardiac muscle diseases, elevate sooner and stays elevated.
When a patient has had a MI, what is the drug of choice?	Nitroglycerin
When a pateint in having an MI, whta arrhythmia are they at very high risk for?	V-fib V tec
When a pateitn goes into V-fib, what is the priority nursing action?	D-fib
What drug is sometimes started IV on a MI patient to prevent things like PVC or V tach or V fib?	Lidocaine.
When a patient is given lidocaine, why can they develop neuro changes?	TOXICITY
If a MI patient performs the valsalva, which nerve can be stimulate	Vagus
If you stimulate the Vagus nerve long enough, what is going to hjappen to the heart rate?	Decrease
What happens to the size of the complex when the vagus nerve is stimulated.	Widens ---> could lead to Asystole
When a patient goes into a thuird-degree block, what are the major drugs that are used.	Atropine/ EPI -- Pacemaker
How fo thrombolytics work? Give me three examples of common Thrombolytics.	They dissolve the clot that is blocking blood flow to the heart muscle. They decrease size on the infarction. Streptokinase, TPA, Eminase
What is the major complication of a thrombolytic.	Hemorrhage.
Before you give a thrombolytic, you are supposed to get a good history. What did I tell you to focus on (what type diseases or Illnesses)	Any past bleeding problems, stroke, pregnancy, surgery, bleeding ulcers.
After someone has received a thrombolytic, why is it so important that we decrease puncture sites.	To prevent hemorrhage. They will bleed anywhere they have been stuck.
Why is it so important that you ask if they are allergic to iodine before they go for a heart Cath.	Because contrast dye is used and it contain iodine.
Any time you have a patient who is injected with iodine-based dye, what is the common complaint the patient will have.	Warm/flushing/ sweating
When a patient has a heart cath, they will have a puncture site. Where might that puncture site be?	Femoral/ brachial
In post-cardiac cath, you have to watch the puncture site closely. What are we watching it for?	Bleeding and hematoma.
When a patient has had a heart cath, you have a pertinent nursing assessment you need to do distal to the insertion site. Explain.	Assess circulation. Pulse, Skin temp, cap refills, skin color
What is your natural pacemaker.	SA node.
Can electrical part of your heart be working and the mechanical not.	Yes, but not for long.
Explain the diffecrence between a demand and a fixed pacemaker.	Demand- kicks in only when the patient needs it to Fixed-- fires at a fixed rate constantly
You really need to get worried about a pacemaker malfunctioning when the rate of the pacemaker does what?	If rate decrease any.
Why is it so important that we immobilize the arm on the affected side after pace maker insertion?	The wires need time to embed in the heart; if the arm is moving too much the wires (leads) could pull out
Why does the patient need to check their pulse everyday?	Make sure the pace maker is staying in range.
Why does the pacemaker patient have to avoid microwave and MRI?	Can alter or damage pacemaker.
What are the major symptoms of Left sided failure and explain why?	Dyspnea, cough, pulonary congestion, blood tinged sputum, restlessness, tachycardia; blood backs up into lungs.
Why does a patient in left sided failure have restlessness and tachycardia?	Because they become hypoxic
Why does a patient with left sided failure have nocturnal dyspnea?	When they lie down more blood can go back into there heart and lungs.
Why does the patient with left sided failure basically have pulmonary symptoms?	Blood is backing up into the lungs.
What is the other name for left sided failure?	CHF
What are the major symptoms of right sided failure.	Enlarge organs, edema. wt gain, distended neck veins, ascites, blood backs into the venous system engorging everything.
When a patient is in right sided failure, is the blood backing up into the arterial system or the venous system.	Venous
What does a Swan Ganz cath measure inside the heart	Pressure
s the volume is building up in the right side of the heart, what measurement (in regard to the Swan) are going to be affected and why?	Any pressure reading on the right side of the heart. More volume= More pressure.
What is the wedge pressure?	Indirect reading of the left side of the heart (left sided pressure)
What does the wedge pressure tell you about?	PRessure in left side of heart.
If a patient's wedge pressure is increasing, that means volume is building up in the left side of the heart. when volume is building up in the left side of the heart, that puts the patient at risk for developing what?	Pulmonary edema
Wht is a A line?	Arterial line-- in artery-- measures cont BP on a monitor.
What is an Allen's test?	Check for alernate circulation prior to inserting A-line.
Why is it so important that the distal circulation be checked when a patient has an A-line? Explain your checks that you are going to do (nursing assessment)	Skin temp, color, pulse, cap refills. these need to be checked because the A-line could decrease heart perfusion so the line is normally placed in the radial artery.
if an A-line is accidently pulled out, what is the first thing that needs to be done.	Apply pressure.
When a patient has an A-line, pressure has to be kept on the infusion bag. why? what would happen if you didnt keep pressure on the infusion bag?	To prevent backflow of the arterial blood. If you didnt place pressure on the flush bag, the high pressure of the artery would force blood back up through the tubing and fill the flush bag with blood
Why does the patient in heart failure develop cardiomegaly?	Because the heart muscle is pumping so hard, it hypertrophies.
Explain how digitalis works.	slows down the heart rate which give the ventricles more time to fill with blood. then the heart can squeese down with the stronger contraction on more blood; therfore is increase cardiac output.
When you slow down someone';s heart rate, you give the ventricvles more time to do what?	Fill with blood.
When your heart squeezes down with more force and strength and on more blood, what is going to happen to CO? what is going to happen to kidney perfusion?	CO increase. Kidney Increase.
Anytime you increase kidney perfusion, what is going to happen to urine output?	Urine output will increase as well
When you start giving a patient Digoxin, should their cardiac output fo up or down.	UP
When you increase a patient cardiac output, what is actullay happening inside the heart.	more blood is being ejected for the left ventricles to the systemic circulation.
When you increase a patient cardiac output, should they appear better oxygenated or less oxygenated.	better oxygenates.
When you start giving somebody Dig, we expect their card output to increase; therefore, what happen to their. LOC, lung sounds, uring output, skin, peripheral pulse, BP.	Loc~ Increase Lungs~ should be dry Urine ~ increase Skin~ warm Peripheral~ should improve BP ~ should go up
Why does a CHF patient need Lasix.	To decrease the circulating volume
When a patient goes on a low sodium diet and bedrest, what might happen to them.	Diuresis may occur
Why do we give diuretics in the morning?	So the patient will not be up all night.
Why is it so important that a CHF patient weigh themselves everyday?	To monitor themselves for Fuild retention.
If a CHF patient notices thier WT increasing, what could that put them at risk for?	Pulmonary edema.
What is pulmonary edema.	The sudden onset of fluid accumulation in the lungs leading to severe hypoxia.
How does a patient develop pulmonary edema?	The left ventricle is failing so the blood is not being pumped forward into the systemic circulation; therefore, the blood backs up into the lungs.
What are the major S/S of pulmonary edema?	Sudden onset, breathlessness, hypoxia, pink frothy sputum, Tachycardia.
When does pulomonary edema usually occur and why?	at night- because lying down preload icreases so we are dumping more blood into the right side of the heart and into the lungs.
Why is the patient in pulmonary edema, restlessness, and anxious.	Hypoxia.
Why is it so important what we hurry up and decrease the circulatingvolume in the pulmonary edema patient.	Becuase they cant handle the volume of blood in there lungs.
When a patient is in pulmonary edema, why do we give them digoxin?	Given to strenthen the contraction more and increase cardiac output.
When a patient is in pulmonary edema, why do we give them Aminophylline?	Aminophylline is a bronchodilator given to help the patient breath better.
What are some of the common side effects of Aminophylline?	Nervousness and Thachycardia.
When a patient is in pulmonary edema, why do we give them morphine.	To vasodilate; therefore decreasing preload and afterload; and to decrease anxiety.
How much morphine do we give them?	2 Milligrams
When a patient is in pulmonary edema, why is it important that you sit them up with their legs down.	To decrease venous return
What is one quick check you can do on patients to see if they are going into pulmonary edema?	Lung sounds
When you are taking care of a patient who is at risk for pulmonary edema, why do we use 10 inch blocks?	To enhance pooling of blood in lower extremities; decrease of venous return.
Why are the elderly, the very young, MI patient or kidney patients at risk for going into fluid volume overload or pulmonary edema?	B/C there patient may not have the ability to pump extra fluid or to excrete extra fluid.
What is intermittent claudiction?	The pain that develops as a result of inadequate oxygenation in an extremity associated with arterial problems
Explain how intermittent claudication develops?	When oxygenated blood cannot get to an area, the patient is going to switch in that extremity from aerobic metabolism to anaerobic metabolism. the product of anaerobic metabolism is a buildup of lactic acit. the lactic acid is what promotes the pain.
When a patient has as arterial problems, that means the oxygen/blood are having a hard time getting to the tissue, so therefore different S/S develop. Explain ?	Coldness, numbness, decrease pulse, atrophy of the extremity occur because oxygenated blood is not getting to the extremity. You may even see ischemia and gangrene
Could a patient with an arterial proiblem develop ischemia and necrosis in the affected extremity? Explain?	Yes-- B/C oxygenatated blood is not getting to an area.
How will angioplasty help an arterial problem.	will restore oxygenated blood flow to an area. (opens up the artery)
Whether you are studying buerger's or raynaud's, what is the key word that I told you to remember.	Vasoconstriction
In buerger's and raynard's, there is significant vasoconstriction. What type of things bring on the vasoconstiction in Buerger and raynards?	Emotional upset, smoking, coldness.
Explain the nursing care for someone with buergers and raynard?	Buerger- excellent foot care- avoid cause. Raynards- avoid cause.
What is the most important thing to teach your patient about beuergers and raynaud's -- to avoid the ___________?	Cause
Why does Buergers patient have to do such excellent foot care?	Foot care is appropriate with any perpheral vascular.
When a patient has a venous disorder, are they having trouble with oxygenation of the affected extremity?	NO
Explain or list some different venous problem a patient can have.	Phlebitis, thrombophlebitis, DVT
Do you elevate venous disorders or lower venous disorders (such as affected extremity)	Elevate
Explain the pathophysiology behind venous disorder?	The blood can get to the area. the problem is once it gets there it cannot get away. so you get stagnation of blood flow in one area.
Why does a patient with a venous disorder need heparin?	To decrease the chance of a new clot forming and to keep the present clot from getting bigger.
How do TED hose help venous disorder?	They enhance venous return, decrease pooling
When taking care of a patient with a venous disorder, do you use warm moist heat or cold wet packs.	Warm moist heat to decrease imflammation
What is a thoracentesis?	Removal of fluid from the pleural space.
When a patient is having a thoracentesis, where is the fluid being removed from.	Pleural spaces.
What is the pleural space?	It is the potential space between the visceral and parietal pleural
When the pleural space fills with fluid, what happens to the lungs?	Collapse
Any time you are pulling fluid from the patient body (thoracentesis, paracentesis, foley cath) you are pulling the patient at risk for going into fluid volume deficit or fluid volume excess.	Fluid volume deficit anytime you pull fluid from the body the vascular space could deplete.
There is a possiblity with a thoracentesis that a pneumothorax could occur. why?	B/C the doctor could puncture all the way into the lungs.
What has happened when a patient needs a chest tube?	The lung could collapsed.
Chest tube have a water seal., first of all, what is the purpose of the water seal and what would happen if there was no water seal? Also in chest tubes, the chest bottle will have an air vent at the top os the bottle. what ist he purpose of the air vent	Promote one-way flow of air. Broken outside air can go into pleural space. To let air that comes out of the pleural space escape from the bottle.
When a patient has a chest tube, you should see fluctuation of the fluid in the water seal tubing. what does this fluctuation mean.	A good connection
When a patient has a chest tubes, hopefully the lung should do what?	Re-Expand.
What would you do if the tubing became disconnected.	Hook it back up unless you happen to have a sterile connector in the room. Then you would use the brand new sterile connector
What would happen if the water seal in the chest system is broken?	Air from the outside environment would rush into the pleural space and re-collapse the lung.
If a break in the chest system occurs, air from the outside can rush into the pleural space and cause what life threatening complication.	pneumothorax
What is the first thing the nurse should do if the chest tube is accidnetly dislodged from the patient.	Place your hand over the insertion site.
How can dehydration promote an embolus?	Blood becomes thck and could form a clot.
How can venous stasis promote a pulmonary embolus?	B/C a thrombus can from and dislodge and go to the lungs.
How can birth control pills promote a pulmonary embolus.	Bith control pills make your blood get thick.
When a patient has a pulmonary embolus, why does their pulse go up.	Hypoxia.
When a patient has a pulmonary embolus, describe their chest pain.	Sharp, stabbing
When a patient has a pulmonary embolus, the blood pressure is going to go up in their lungs. What effect will that have on the right side of the heart.	It will increase the work load of the right side of the heart.
With a pulmonary embolus, the patient will have fever and their WBC will go up. Why?	inflammation
Why does the PO2 go down with a pulmonary embolus?	Hypoxia
What type of line will be put into the patient to monitor the right side of the heart.	Swan-Ganz Cath
How will heparin help the patient who has developed a pulmonary embolus?	Will decrease the formation of new clots and keep the clot that has already developed from getting any larger.
What is a hemothorax?	Blood in the pleural space.
What is a pneumothorax.	Air in the pleural space.
When blood or air or fluid accumulates in the pleural space, what is going to happen to the lungs.	Collapse
What should you do if a patient presents with a penetrating object to the chest.	Leave it in place.
What is a tension pneumothorax.	The pressure has accumulated in the pleural apce and has collasped the lungs and pushed everything to the opposite side.
With a mediastinal shift, what will happen to the trachea.	Tracheal Deviation.
When a patient has an open pneumothorax, you are supposed to put a piece of petroleum gause over the are. How many sides are taped down? Why do we leave one side open.	Three- The fouth side acts as a air vent. There is a chance there is some air that will need to come out so you will have to leave a way for it to come out.
When a patient has a fractured sternum or ribs, why are the respirations so shallow? what acid base imbalance will this put them at risk for?	Becuase it hurts, Resp acidosis
With a fractured sternum or ribs, why do we give non-narcotic analgesics.	Do not want to depress the respirations even more.
With a fractured sternum or ribs, why is the patient put on a ventilator with PEEP?	To expend the chest to realign ribs.
What is PEEP?	Positive and Expiratory pressure.
What is CPAP	Cont Positive Airway Pressure.
What is the major difference between the two (PEEP and CPAP)	PEEp exerts pressure at the end of exhalation and CPAP is pressure throughout the breathing cycle.
What is flail chest.	Multiple rin fractures
What is paradoxical chest wall movement?	When your chest does not rise and fall symmetrically; you are said to have a seesaw chest.
Why does the patient with flail chest develop paradoxical chest wall movement?	Because of the broken ribs.
What is the definition of cardiac tamponade?	When fluid is accumulating in the pericardial sac.
With cardia tamponade, the blood pressure goes down and the CVP goes up. Explain Why?	Blood pressure goes down because of hemorhaging. CVP goes up b/c as the sac fills around the heart, this puts pressure on the heart, squeezing the heart. Therefore the pressure inside the heart goes up making CVP go up
Why do the heart sounds sound muffled with cardiac tamponade.	B/C of all the blood surronding the heart.
With cardia tamponade, why does a patient go into shock.	B/c of the hemorrhaging.
What is the name of the bacteria that causes TB?	Mycobacterium Tuberculosis
What type of light will kill TB?	Ultraviolet light
Explain the skin test for TB?	An interdermal is injected and a wheal should form. if a wheal does not form the test has to be repeated.
when someone has a positive skin test, what does that mean,	It means the patient has been exposed.
One of the major drugs used for TB in INH (isoniazid). What is the major side effect? and what vitamin can be given to prevent that major side effect?	Peripheral neuritis Vitamin B
When a patient is on INH, what lab work has to be monitored.	Liver enzymes
When a patient is on INH, what should be eliminated from their diet.	Alcohol
What are the major side effect of Rifampin.	Fever- body fluid turn red or orange.
What lab work should be monitored with rifampin?	Liver enzymes
When a patient is on streptomycin, what are two possible side effects.	Ototoxcity and nephrotoxicity
How would you monitor for these side effects.	Nephrotoxicity- BUN and creat Ototoxicity- hearing(ringing and pain in ears)
What is the major cause for glomerulonephritis?	Streptococcus
When a patient has glomerulonephritis, are they in a fluid volume deficit or a fluid volme excess.	Fluid volume Excess
When a patient has glomerrulonephritis, why do they develop malaise and headache?	Build up of toxins.
When a patient has glomerulonephritis, why does their urine output go down?	Because the kidneys are failing
When a patient has glumerulonephritis, why does their BUN and Creatinis go up?	They are unable to excrete the urea and creat throught the kidneys.
When a patient had glomerulonephritis, why do they get protein in the urine?	B/C the glomerulus has holes in it, so protein can leak out.
Explain CVA tenderness.	This is cost vertebral angle tenderness. it is when you tap over the kidneys and tenderness occurs.
In glomerulonephritis, why doe sthe blood pressure go up?	Retaining fluids.
And what will happen to the urine specific gravity?	Increase
In glomerulonephritis, why are the patient's red blood cells affected?	Erthropoietin can be altered.
With any typr of kidney disease, it is not uncommon for the BUN to be elevated; therfore, why do we limit the protein in the diet.	Because protein makes your urea level in your blood go up.
If you gave a patient with any type of renal disease protein in their diet, what will happen to the BUN?	Increase.
Why does the glomerulonephritis patient need bed rest.	For diuresis
When determining fluid replacement for a renal disease patient (glomeronephritis), you always give them what they lost in a 24 hour period, plus 500cc. WHta is the purpose of adding 500cc.	To account for the insensible fluid loss.
Once diuresis begins in glomerulonephitis, will the patient be at risk for a fluid volume deficit or fluid volume excess.	FVD.
When a patient is in the acute stages of glomerulonephritis, do you think their serum potassium level will be increased or decreased? what about the Magnesium? What about the phosphorus level?	All will be increased, due to the kidneys not being able to excrete
When a patient had nephorotic syndrome, what is the major element that is leaking out into their urine?	Protein
What will protein and albumin hold onto in the vascular space.	Fluid
If a patient does nto have protein a=or albumin in their vascular space (blood) what is going to happen to all the fluid that is supposed to stay in their vascular system?	Goes out into the interstitial space tissue.
How does this affect the vascular space.	Decrease the volume in the vascular space.
Therefore, will the nephrotic syndrome patient (in the acute stages) be in a FVD of FVE	FVD
When a patient has nephrotic syndrome, they develop total body edema. what is the proper term for total body edema.	Anasarca
When a patient has nephrotic syndrome, it is not uncommon for them to be placed on prednisone. WHy?	to decrease inflammation; to decrease the size of the holes in the glomerulus so protein can no longer leak out.
Does the nephrotic syndrome patient need a high sodium diet ot a low sodium diet?	Low sodium diet is needed to decrease futher edema
Does the nephrotic syndrome patient need a high protein diet or a low protien diet. Explain?	High protein diet to help offset the amount of protein is losing through their glomerulus
How can brady cause renal failure.	Decrease perfusion
How can hypovolemia cause reanl failure.	Decrease perfusion
How can shock cause renal failure	Decrease perfusion
How can decrease cardis output cause renal failure.	Decrease perfusion
How can glomerulonephritis, nephrotic, or diabetes cause renal failure.	Vascular damage.
How can the kidney stone cause renal failure	Urine can be trapped in the kidney
How can ureteral swelling cause renal failure	urine can be trapped in the kidney
How can a tumor or an enlarged prostate cause renal failure.	Urine can be trapped in the kidney
When a patient is in renal failure, why does the BUN and creatinine go up?	B/C the patient is unable to excrete urea and the creatinine.
What happens to the specific gravity in renal failure?	It usually goes up, but it can also become fixed. when is becomes fixed this means that the patient's urine specific gravity doe nto respond to high volumes of fluids or restriction of fluids. It stays the same.
Why can a renal failure patient become anemic?	B/C erythropoietin can be altered.
Why can a renal failure patient's blood pressure go up?	B/C they are retaining fluids.
Why does the renal failure patient at risk for CHF?	B/C they are retaining fluids.
Why does the renal failure patient develop anorexia, Nausea and Vomiting?	B/C the build up of toxins.
Why does the renal failure patient develop an itching frost?	Urea builds up in the blood and eventually accumulates on the skin
Why does a renal failure patinet have to worry about osteoporosis?	B/C the renal failure patient retain phosphorus; therefore, that makes them excrete their calcium, which lowers the serum calcium then the patient starts pulling from the bones.
There are two phases of renal failure. the first phse is an oliguric phase. if a patient is oliguric, what has happened to the urine output.	Urine output has decrease.
Why does the oliguric patient go into a FVE	Retaining fluids.
Why does a oliguric patient develop hyperkalemia?	unable to excrete potassium
The second phae of renal failure is called the diuretic phase. When a patient is diuresing, what has happened to their urine utput.	Increase
Why will a patient who is diuresing go into a fuild volume deficit?	Losing Volume
If a patient goes into a fluid volume deficit, what will happen to theis blood pressure.	Decrease.
What will happen to their hreat rate? Explain why?	Increase- trying to compensate for the decrease in volume
When a patient is diuresing, their serum potassium level goes doen (hypokalemia) Explain Why	B/C potassium is being excreted through the kidneys.
if a patient is allergia to Heparin, they cannot be hemodialyzed.	B/C heparin is used during the procedure.
Is hemodialysis done everyday?	no
Does the patient who is being hemodialyzed have to watch what they eat and drink in between treatments?	Yes, B/C between treatments the ptient is unable to excrete excess electrolytes and fluids.
Explain the basic nursing care for acirculatory accesee (A-V shunt, fistula, or graft)	No BP , no punctures in that extremity, do not wear a watch on that extermity, check it for adequate crculation
Explain in your own words what peritoneal dialysis is?	Fluid is instilled into the abdomen. Fluid stays in for a period of time, the it is drained out of the abdomen, along with the excess electrolytes and toxins.
When a patient is having peritoneal dialysis, where is the fluid goin into?	Abdomen- peritoneal cavity.
What wuld you do if you instilled 1000 cc of fluid into the peritoneal dialysis pt and only 700 cc came back.	Turn the patient from side to side or reposition.
Wha should the drainging of peritoneal dialysis look like.	Clear or straw color.
What are the S/S of infections with the peritoneal dialysis.	Cloudyor dark fluid return.
When a patient has capd for their renal failure, why do they have to increase protein and fiber in their diet.	The patint needs protein B/C protein can leak into the peritoneal cavity during the procedure. the patient needs fiber B/C of the constipatin problems tey have due to decrease peristalis.
When a patient has CAPD, why do they have a constant sweet taste and why do they have anorexia.	The dialysate tha is used is a high glucose content
What are the major signs of kidney stones.	Hematuria and pain
Wha is the number one thing you need to remember with kidney stones.	Fluids Fluids Fluids
Explain in your own words a 24 hour urine.	Discard the first voiding, keep all urine for the next 24 hours in a specal sontainer and save the last void.
A creatinine clearance test requires what type of urine specimen?	24 hour urine.
Do thy use dye with a KUB	not usually- it is just an xray.
When a patient has an IVP (intravenos Pyelgram), exactly wht is this x-ray looking at?	Kidneys, ureters and bladder.
Does an IVP use dye? if so, what had you better ask the pt if they are allergic to?	Yes, Iodine.
Wha does a cystoscopy look at specifically.	Urethra and bladder.
Wht is the normal pre-procedue activities for a cytoscopy.	Sedative and topical anesthetic.
Explain the post procedure S/S pot- cystoscopy?	Watch for urine retention, burning in common for a couple of days due to urethra irritation, and blood tinged urine is okay for a day or so.
Why is the serum creatinine not affected by what we eat?	Because creatnine is constantly produced in out bodies due to skeletal muscle breakdown
What type of specimen do you have to have to test a creatnine level on a patient?	Blood
Is the BUN affected by wht we eat?	Yes.
Why cant a patinet with CHF or Poor kidney have whole blood.	B/C they cannot handle the volume of blood. They hav to have packed red blood cells.
Why do we have to agitate platelets when we are administering them.	B/C the will aggregate together.
Why do we give albumin or dextran in shock? Howd these work?	These are forms of protein which will hold fluid in the vascular space.
What should yo do if your patinet begins o have a transfusion reations.	Stop the blood; start some saline.
Once you get the blood from the blood bank, how long do you have to get it hanging?	30 mins.
How long do you have to get it infused.	4 hours
Explain themajor symptoms of febrile or septic blood transfusion reaction.	Feb- sudden chills and fever, HA, Flushing, Anxiety TX: Antipyretics. Septic: Low blood pressure and shock. TX: IV antibiotics and symtomatic treatment.
Explain the major S/S of an allergic reaction with a blood transfusion	Symptoms -- flushing, itching, urticaria, hives. TX; Benadryl
What are th major symptoms you need to watch for that would indicate a patient is having a hemolytic reaction during a blood transfusion	Back pain is number one, Chills, fever, flusing, increase pusle,increase RR, BP decrease.
Why for hemolytic reactions occur.	Incopatible blood. Stop the blood, start the saline, get a urine specimen, save the blood, call the dr, call he bld bank, get vitalsigns and prepare to flush out the kidneys with mannitol.
Why do we give mannitol when a patient is having a hemolytic reaction?	To flush out the kidneys.
Anytime a pt is having a transfusion reaction, what type of specimen should be obtained promptly.	Urine
In Sickle cell, what is happening to the red blood cells and why?	Te shape of the red blood cell is changing doe to hypoxia.
Are patinet who have sickle cell hypoxic	Yes
Why do sickled cells become tangled so easily.	Due to the shape, they start hanging together.
Why is a sickle cell pt always anemic.	B/C their red blood cells sickle. so their red blood count decrase.
Why does a sickle cell patient become Jaundice.	Jaundice develope when th overabundance of sickle cells ae fragile and rapidly destroyed in circulation releasing the bilirubin.
Why does a sickle cell ptient develop heart problems.	since the patient is hypoxic they stay tachy most of the time; therefore, this stresses the heart.
Why does a sickle cell patient develop ischemia or infarction in extremities.	little clot can form and cut offcircultain to an area.
Why does the sickle cell patient develop pain or have pain and swelling.	B/C the cell can cut off circulation to an area.
Why does the sickle cell patient have to be on folic acid.	To help them make red blood cells.
What types of things will bring on a crisis in the sickle cell patient? Explain Why	Any type of stress which increase oxygen demand; decrease O2 concentration causes the sickle process.
What should be done duig a crisis?	Hydration in No 1, oxygen will be needed, blood tranfusions will be neeed, bedrest and decrease pain.
What is thecommon cause of death for a sickle cell patiet?	Infection.
What is anemia?	A decease in red blood cell.
When you do not have enoug red blood cells, the patient will be hypoxic. Why?	There's not enough RBC's to carry the oxygen
How can hemorrhage cause anemia.	Losing red blood cells.
How can poor nutrition cause anemia?	no formingred blood cell.
How can decreased erythropoietin cause anemia.	With out erthropoietin, immature RBC cannot mature.
When a patient is anemic, why does their heart beat faster. Tachy	B/C they are hypoxic
When a patient is anemic, why do theyget short of breath.	B/C they're hypoxic
When a patinet is anemic, why do they have a plae conjunctiva?	They do not have enough RBC.
Why do anemic patint develop heart problems.	Heart is always stressed due to chronic hypoxia
Why do anemic patients feel weak and tired.	hypoxia
Patient with iron deficient anemia develop poor red blood cells (anemia) due to the fact that they do not have enough iron in their diet. what are some foods tht are high in iron.	Organ meat, egg yolk, seafood, legumes, green leafy, dried fruits, almonds
What can be given with iron to increase the absorption?	Vitamin C
What is some major side effect of iron (ferrous sulfate)	GI upset & constipation
What can iron do to your teeth?	Stain
What does Iron do to he stool.	Makes stool very dark
Whydo we give iron IM Z-track method.	We want to trap the injection fluid deep into the muscle. We do not want it leaking out of thetissue- it can stain the skin.
When a patient has had pernicious anemia, what vitamin are thy deficit in?	B-12
Afte wha surery can a patient develop pernicious anemia?	Gastectomy- b/c they have lost their intrinsic factor. W/O intrinsic factor you cannot absord oral b-12; therefore yo would not develop normal RBC
What are the two odd signs you get withpernicious anemia?	Red swallow tongue and neuro changes.
What is the major dianostic test for pernicious anemia.	Schilling test.
Will the schilling's test tell you about any othe type of anemia beside pernicious anemia?	No
Whyare IM injections of b-12 effective wit pernicious anemia. why does oral b-12 not work in thi patient.	Because they canabsorb IM b-12 W/O intrinsic factor. W/O intrinsic factor you cannot absorb b-12; therefore you would not develop normal RBC
What is the first thing you need to think of when you thinkof leukemia?	Large amounts of immature WBC.
When a patient has leukemia, they are at high risk for infection. Why.	B/C they cant fight infection with Immature WBC.
Why does the leukemic patient develop anemia.	B/C there are so many immature WBC, there's no room for RBC.
Why does the leukemic patient develop thrombocytopenia?	There is no room for platelets.
Why do we need to avoit IM injections in the Leukemia patient?	B/C they dont have enoug platlets; therefore they will bleed int he muscle.
Why does the leukamia patient need to avoid aspirin?	You wont want to give anythin to them that woul promote moe bleeding.
Why does the leukemia patient need bedrest.	Bed rest is needed due to decreased RBC (hypoxia) and also to prevent trauma.
Why does the leukemia patient need PRBC's.	to replace RBC- to fight anemia.
Why does the leukemia patien need platelets?	to replace RBC- to fight anemia
Why does the leukemia pt develop weakness and fatigue?	Hypoxia.
WHy does the leukemia patiet have S/S such as bleeding, bruises, or petechiae.	Decrease platelets.
Hemophilia is an inherited disease. Does it affect males or females?	Males.
Who is the carrier and the transmitter of hemophilia.	Females.
Hemophiliacs aresometimes called "free bleeders". Explain the major syptoms a hemophiliac will have.	Large spreading bruises. May blee into the joit or into the muscle of the G tract.
When a patient is having bleeding into the joints, what is teprope term for this?	Hemarthrosis
Why does the hemophiliac patiet need to void aspirin and IM Injections.	They dont need anything that is ging to increase their bleeding episodes.
Why is dental hygiene so important with a hemophiliac.	They dont need to have freq dental work due to the chances of hemorrhage.
What are somethings yu would teach a hemophiliac in regard a day to day living?	Avod trauma; ibuprofen is fine for minor aches and pains; avoid forceful nose blowing; coughing and straining; use electric razor and soft toothbrushes.
Why is it so important tha fractures be immobilized as soon as possible.	Toprevent furthur trauma.
What tye of emboli do yu worry about with a fractue.	Fat
What would you do if patient came in with an open fracture.	Cover it with somethin sterile.
Explain Neuro checks?	Check pulses, color, movement, sensaion, capillary refills, skin temperature.
There are two parts to a neuro check. A. what is the neuro component? B What is the vascular Component?	A. movement and sensatin. B. Vascular- cap refills, skin temp, color pulse
Give S/S of a fat embolus?	Petechiae over the chest, conjuctive hemorrahages, patchy infiltrations on the chest xray, usually occurs within first 36 hours of an injury.
What is compartment syndrome?	When circulation is being cut off to an extermity.
If you suspect a compartment syndrome, what should you do first.	Loosen the cast.
Cast care: Ice pack on the side	We dont want to indent the cast.
Cast care: no indentation	Could cause pressure sores unde the cast.
Cast care: Use the palm for the first 24 hours.	To prevent indentions
Cast care: Keep uncovered and dry	To allow heat to escape.
Cast care: Dont rest cast on hard surface or sharp edge.	To derease indentations or damage to the cast
Cast care: Cover cast close to thegroin with plastic.	Keep it clean
Cast care: Elevate	Elevate to decrease edema
When a patient with an orthopedic injury complains of pain, what is the first thing you should do?	Neurovascular check
What are some of the purpose of traction?	To realign bones; to decrease muscle spasms and to immobilize
Wt on traction should hang freely. Explain why?	If the Wts are not hanging freely then th amount of traction bein applied is not what the dr has ordered.
What is skin traction? Give examples?	the skin has not been penetrated. bucks traction and russell traction are examples.
What type of assessment is very important when a patient has skin traction?	Skin, because the skin is being pulled on.
What is skeletal traction? Explain	Prolonged traction using pins and wires. Steinmann Pinns or a Halo vest.
Explain how to do pin care.	Use sterile tech; remove the crust.
When a patient has a total hip replacement, there are some important things to remember about positioning. A Neutral rotation B. Limit flexion C. extension D. Abducton	A. Internal rotation or external rotatin cold dislocate. B. dislocate the hip C. extension minidislocation d. Keeps the balls of the hips in the socket.
Discuss the general nursing care fot someone with the continuous passive motion machine.	Assess the degree of flexion the machine is exerting ; assess the patient pain level and tolerance of the machine.
What are some good exercises for the total hip replacement patient?	Isometrics such as gluteal and quadriceps/ sqeezing; rocking in a rocking chair; walking and swimming.
Why is it so important that the total hip replacement patient avoid flexion?	The hip could be dislocated.
Give examples of things a total hip replacement patient should avoid specifically relate to flexion?	Bending over, sitting in a low chair climbing stairs.
Why is it important that we keep a tourniquet at the bedside with amputation?	In case of hemorrhage.
Why is elevation so important with an amputation?	To decrease edema and bleeding?
What can we do in the amputation patient to prevent hip and knee contractures?	Extend the joint-- prone position is a good position to extend the hip and knee.
What is phantom pain?	Pain that is experrienced in the amputated extremity. the pain is real.
Describe the nursing care with someone with phantom pain.	Diversional activity and pain meds are given.
Rheumatoid arthritis is an altered immune response. what are some S/S of rheumatoid Arthritis.	Swollen joints, fatigued, increase WBC, reddened fingers dur inflammatio, morning stiffness. (lasting longer then 30 mins) and a low grade temp.
With rheumatoid arthritis, what happens to the pain with stress?	Increase
Is rheumatoid arthritis seen more in males or females?	Females
List the S/S separately and explain why the patient develops each symptom.	All S/S are from inflammation. Morning stiffness, motion pain, tenderness in at least the joint, swelling of at least one joint.
Why are rheumatoid artritis patient places on aspirin, prednisone, or NSAID's?	To decrease inflammation.
Why is it so important that the rheumatoid arthritis patient's joint stay in proper position?	B/C the joints tend to contract with inflammation.
Why is rheumatoid arthritis pt placed on Chemotherpy?	To decrease the immune system, since it is a "immune" response.
Why is wt loss so important with the osteoarthritis patient?	To decrease the stress on weight -bearing joints, particularly the knees.
What is the difference in rheumatoid arthritis and osteoartritis?	Rheumatoid arthritis is an immune response whereas osteoarthritis is a degenerative disorder.
What is the genetal treatment forosteoarthritis? Explain why	Lose wt, non-steroidal, steroids and rest.
What is gout?	When uric acit crystals accumulate in an area of little blood flow.
What are S/S of gout?	Pain, redness, inflammation
Wha are the three major drugs used for gout? Explain how they work?	Colchicine to decrease pain and swelling; Zyloprim to decrease uric acid levels and probenecide to decrease uric acid level.
What diet change chould thegout pateint make.	Decrease proteins and purines. Need to eat alkaline ash foods like milk potatoes citruses.
Why is it soimportant tha the gut patient drinks lots of fluids,decrease alcohol, and avoid becoming dehydrated?	To flush out the uric acid crystals. Alco hol promotes diurese and when you become dehydrated uric acid crystals ten to accumulate and promote an attack.
When performing an assessment on theneuro patient, what is most important.	LOC
What is the pulse pressure?	Difference in systolic and diastolic blood pressure.
What happens to the pulse pressure with increased intracranial pressure.	It widens
I a neuro patiet complains of a headache, what would this man.	increase intracranial pressure.
Explain the doll's eye reflex.	When the eye move the opposite way that the head is turned. Assesses brain stem funtions.
Explain the ice watr calorics test.	When ice water instille into he ear canal by the physician to assess brain stem function. Normal response would be to look towards the painful stimuli.
Explain thebabinki and what is the difference for a child less than one year of age and anyone grater tha one year of age.	When the bottom of te foot is stroked yo and you watch to see what the toes are going to do. in child less that 1 yr a positive Babinski is ok. + toes fan out, over 1 we want toes to curl in.
When a patient is having a CT of the head, is it okay for them to talk?	No
Can a CT scan be done with conrast medium (dye)	Yes.
Can a patient become claustrophobic with a CT scan.	Yes.
What type of patient cannot tolerate an MRI scan.	Claustrophobic.
Explain everything that you would teach a patinet about an MRI.	They will be in a closed space; need to lie still, they will hear a clanging sound, they can talk to others while they are in the tube, no metal object are allowed in the tube.
What is cerebral angiography?	It is an x-ray of cerebral circulation using dye.
When a ptient is having cerebral angiography, what artey do hey go through.	Usually femoral.
What othe procedure did we use the femoral artery for?	Heart cath.
Why is it so important tht a patient who is about to have cerebral angiography be well hydrated.	to help the patiet excrete the dye throhg the kidneys.
Why is it so important that we assess theperipheral pulses before cerebral angiography?	Post-procedure we will be needing to check the circulation in the extremity tomake sure clots didnt form distal to the punture sight. so baseline data should be collected pre-procedure.
When a patient is having a cerebral angiography, it is not uncommon for tem to complain of a warmth in the face. Explain why	the dye causes a flushed feeling.
It is important that you ask this patient who is about to have cerebral angiography if they are allegic to something. What is it.	Iodine.
Explain the post procedue care for the cerebral angiography patient and explain why?	Same as heart cath. Check peripheral circulation, keep extremity still. Clot formation, decrease movement to decrease hemorrhage chances.
Why is it important that we watch for an embolus afte cerebral angiography? Explain what you would watch for specifically in your patient.	B/C clots could form and go to the brain. WEre lookingfor change in LO and any motor or sensory deficits and one sided weakness or paralysis.
What is a myelogram?	An xray of the sub-arachnoids space.
When a patient has a myelogram, are we getting into the cerebrospinal fluid?	yes.
What is the pre-procedure care for a patiet who is about to have a nyelogram.	Patient will be NPO and have a light sensative.
Why is it so imporant in myelogram patient that we increase the fluids.	To help the patient get rid of the dye. Dye is ecreted in the kidneys. Also to help replace cerebral fluids.
What are some gereral symptoms of meningitis.	fever, chills, HA,vomitting, stiff neck.
Why is the patient who has had a myelogram or any procudure where you have gotten into ceebrospina fluid at risk for meningitis.	B/C the meninges have been punctured into, so an infection cold have been introduced.
What is an EEG	Electroencephalogram.
What is the preprocedure care for a patient who is going to have an EEG	Hold sedatives, no caffeeine, do not make patient NPO.
If a patient were about to have an EEG, what would you tell them about the procedure.	They will be asked to lie quietly, first; then they may be asked to do such things as hyperventilate during the procedure.
When a patient shaving a lumbar puncture, do we get into cerebrospinal fluid.	Yes.
What are some reasons for doing a lumbar puncture?	to check for lood, to measure pressure and to obtain a specimen.
How do you positin a patient for a lumbar punctur?	Left side in te fetal position or propped up over the bedside table.
Why doyou put athem in this position?	We want to arch the back to increase the space in between the discs and to thin out temeninges.
What sould cerebrospinal fluid look like.	Clear and colorless.
What is the post procedure care of a lumbar puncture? Explain why?	We want the patient to be on bed rest, lying flat so a seal can form at the puncture sight. patient should drink many fluids. we should check the dressing to make sure it is not wet.
Wha is the most common complication of a lumbar puncture.	Headache.
How is this complicatin treated.	Bed rest, fluids, pain meds, and blood patch may need to be dne.
What is the fatal complication of a lumber puncture.	Herniation.
If a patiet has an epidural hematoma, explain the sequence of event that will occur and why thepatient has these changes.	Pt loses consciousness, then wakes up afte going through a recovery period. butthen the bleeding in the head increase, the pt starts having neuro changes and they possibly will pass ot again.
What is the treatment for an epidural hematoma?	Stop the bleeding; control the ICP
When a patient has a subdural hematoma, explain the sequence of event that can occur. (s/s)	subdural hematoma, it can be acute and choronic. Acute = rapid bleeding. Choronic= my look like a storke.
What is one of th emost important things you need to rememer with a scalp injury	Fight infectons.
What is n open head injury.	Thats when the meninges have been broken andthere is direct entry into the brain.
What is a close injury?	Meninges have not been broken.
WIth which fracture is thepatient most at risk forinfection?	Open
Explain s/s of a basal skull fracture.	Bleeding in the eyes, ears, nose, and throat.
When a patient has a basal skull fracture. Where isthe fracture.	Base of the skull
What is battle sign.	Bruising on the mastoid; indicates basic skull fractue.
What is raccoon eyes.	Bruises around the eyes.
What is cerebrospinal rhinorrhea.	Leakage os CSF from the nose.
Explain the S/S of a concussion.	May become unconscios for a couple of second or may just get dizzy for a couple of seconds or see spots.
If a patiet has been diagnosed with a concussion, what things should you teach before the go home.	be aware of S/S such as difficulty awakening or speaking confusion severe headaches, vomitting, pulse chages, unequal pupils or one sided weakness.
IS it okay for a concussion patient to go home alone?	no.
What a trauma ptient comes into the emergency roo, why do we have to assume a C-spine injury is present.	B/C with any trauma we assume thec-spine is injust until proven other wise.
Why is it so important to keep the body in perfect alignment after trauma.	to protect the cerical spine and spinal cord.
How do you tell CSF from other drainage.	it will test positive for glucose and form a halo on a sheet or pillowcase.
When you have ahead injered patient, why is it so important that we keep the environment quiet.	to decrease the stimuli which could initiate seizures.
When yo have a head injured patient, why do we have to pad the side rails?	We have to worry about seizures.
What a neuro patient, why do we want to avoid narcotics?	B/C we dont want to maskneuro checks.
Wht happens to ICP when the patient sits up and lies down?	When the patient sits up, ICP goes down, when they lie down, ICP goes up.
What is posturing?	A sign of severe nuero damage.
Explain the two different types of postering.	Decerebrate- Outwards (worsttype) Decorticate- Inwardly flexed
When a patient is posturing, what happens to their caloric needs.	Increase.
Why are osmotic diuretice used in the treatment of ICP? Explain exactly how they work.	To pull fluid off te brain. Osmotic diuretics pull fluid off te brain into te vascular system nd the excess fluid is excrete through the kidneys.
When a patient is on an osmotic diuretic,they better have teo organs that are working perfectly. What are they?	Heart and kidneys.
What would be a potential ursing diagnosis for a patien receiving an osmotic diuretic.	Potential for fluid volume deficit.
Why are patient with ICP given steroids.	to decrease cerebral edema.
How can hypeventilation decrease ICP.	Hyperventailation causes cerebral vasoconsriction and decrease cerebral blood flow to decrease ICP
What would happen to the ICP if te temp were to exceed 100.4	ICP would go up
When taking care of ahead injured patient with ICP why is it so important that you space yur nursing interventions?	Everytime you do something to a hed injured patient, ICP goes up
What is the purpose of a barbiturate induced coma.	to decrease cerebral metabolism there fore decreaseing ICP
Why is it so important to restrict the fluids in a head injured patient?	too many fluds will increase ICP
What should you restrict the fluids to? (how many CC per day)	1200-1500 cc per day
Why do we avoid restraints, bowel and bladder distension, hip flexion, valsalva, isometrics, suctioning and coughing in te head injured patiet.	all these things increase ICP
If a patient were t become bradycardic, wha would happen to cerebral perfusion? Explain why?	Decrease B/C not as much blood would be pumping,pe out by the LV; therefore not as much blood would make it to he brain.
If te patient develop an increase blood pressue, what will happen to cardiac output? Explain how this would affect cerebral perfusion?	The higher the blood pressure is, cardiac output goes down; therefore not as much blood would make it to the brain.
What is a major risk whe a patient has an ICP monitoring device.	Infections.
Why is it so important ta we keep the connections tight on an ICP monitoring device and also why is it so important to keep the dressing dry?	To decrease chace for infection
Wha is Myasthenia gravis.	Defect in impulse transmission
When a patient has impulse problems, what is going to happen to their moscle tone.	Muscle tone decrease.
Explain the s/s og myasthenia and explain why the patient develops these symptoms.	Extrema muscle weakness tha increased with effrt and eases with rest; there is symmetrical involvement,diplopia, pitosis, sleepymask-like expression, dysphonia, chewing and swallowing problems. Diaphragm and resp muscle problems.
Tensilon is used to help diagnose myasthenia gravis. explain what will e done.	Tensilon increase nerve impulse. the patient will be injected with tensilon and if they have Myasthenia they wil improve immediately.
Why are prostigmin ad mestinon used to treat myasthenia gravis?	These drugs increase acetylcholine concentration at the myoneural junctions to facilitate transmission of impulses across the nerves therefore increasing muscle tone.
Why do we give steroids to the myasthenia patient?	Myasthenia is thought to be an autoimmune problem, therefore steroids are given t decrase the immune reasponse.
Why do we have to worry abot aspiration with the mysthenia gravis patient?	B/C the patint may notbe able to swallow.
Why do we need to worry about airway with myasthenia gravis patient?	B/C the resp muscle could become affected.
If a patient with myasthenia gets too tired or takes an over the counter medicine, what cold happen.	These things could promote a crisis.
Wht is the difference in temyasthenia crisis and a cholinergi crisis? How do you differentiate them?	MG has no had enough meds. CHO has had to much. inject Tensilon, improves it is MG, worst it is CHO
When a patient is in a crisis with Myasthenia,why would you prepare them for a ventilator?	B/C pf the progressive decreas tne in respiratory.
What is the pre-procedure care for a patient who is going to have an upper GI.	The patiet will be NPO past midnight. No smoking.
Yo are taking care of a patient who is going t have an upper GI. Explain what is going to happen to the ptient.	The patient will have to swallow a dye and xray will be done.
YOur patient is goingto have a barium enema. what is he preprocedure care?	Clear liquids, laxatives or enemas until clear, somethines they have to drink a large volume of fluids to flush ot the GI tract.
Hw would you describe a barium enema to a patient	Just like an enema andxray will be taking.
Why is it so important tht the patient have a bowel movement after a barim enema?	B/C we dont want the bariu to stay in the body.
What is the preprocedure care of a gastroscopy? Explain to your patint to except if they are going t have a gastroscopy.	NPO- pre, they will besedated; a tube wiull be placed in the thraot and through the esophagus into the stomach.
When a patient has a gastroscopy, they have to be NPO until their gag reflux returns. Why	B/C we dont wantthem to aspirate.
Wha would be a major sign of perforation post gasteoscopy?	Pain
You patient is going to have a liver biopsy. What clotting studies should be checked? Please explain why?	PT PTT- one of the main funtions of te liver isto help with clotting. fter puncturing into theliver there is a chance our blood may not clot as quickly as it should.
Why is it so important that vital signs be checked pre-liver biopsy?	We are worried about hemorrhage.
How is a patient positioned during a liver biopsy.	On their back with the right arm behind the head.
Ho is a patint post liver biopsy? Explain Why	on the right sideto hold pressure.
Why dos the patient have to exhale and hold while the physician is puncturing into te liver.	To get te diaphragm out o the way
What is a paracentesis?	Removal of fluid from the peritoneal cavity
When a patient is having a paracentesis, what postion doyou put them in.	Sit them up.
Why is it important that the paracentesis patient void pre-procedue.	dont want to puncture the bladder.
Why is it so important to monitor the vital signs pre and post paracentisis?	Because you are worried about throwing the patinet into a FVD
During a paracentesis, the patient could be thrown into a FD or FVE	FVD
What are two major functions of the pancrease	Enocrine- Insulin; Exocrine- digestive enzymes.
What is a major cause of pancreatitis?	Gall bladder disease and alcoholism.
How can gallbladder disease cause pancreatitis	A gallstone can block the pancreatic duct trapping the enzymes inside the pancrease.
Pancreatitis: Abdominal Distentin and ascites	A large pancreas
Pancreatitis: Abdominal mass Rigid board like abdomen	Possible hemorrhage.
Pancreatitis: Jaundice	Liver involvement
Pancreastitis: Brusing Fever	Inflammation
Pancreatitis: Hypotension	Bleeding or ascites.
Pancratitis: Serum lipase and amylase (up or Down) WBC, Blood sugar, SGOT, SGPT	All will increase.
Pancreatitis: PT, PTT (shoter or Prolonged)	Polonged.
Pancreatitis: Serum bilirubin (u or D)	Increase
Pancreatitis: H/H (up or down)	Increase if dehydrated Decrease is bleeding.
Why do we give the pancreatitis patient steroids.	To decrease inflammation.
Why do we give the pancreatitis patient anti-cholinergic drugs.	TO dry secretions
Why do we give the pancreatitis patient tagament and antacids.	to decrease acid in the stomach.
Is it possible that a pancrestitis patient might have to have insulin? Explain Why?	Yes, because the pancrease is altered.
Why does the respiratory statue have to be monitored specifically for the pancreatitis pt.	Because, the ascites could be pressing up on the diaphragm.
What is a peitoneal lavage and how does the pancreatitis patient can get into? Explain?	In lavage, you instill fluid into the abdomen and then drain it back into if it comes back pink tinged. it helps ID internal bleeding.
What is the major eletrolyte imbalance a pancreatitis patient can get into? explain?	Hypocalcemia- te pancreas is filled with calcium, but when is starts digesting itself we lose our calcium; therefor the serum calcium goes down.
Wht are the dietary changes needed for the pancreatisit patient?	Clear liq, increase food slowly, no stimulating foods. freq small meals, high carbohydrates for energy
Wht is cirrhosis?	Liver cells are destory an are replaced with connective and sca tissue; threfore the blood pressure in the liver ges up and the ptient has portal hypertension.
When a patient has cirrhosis, what happens to the bloodpressure oin their live and wat is the proper term for this.,	Increase-- Portal hypertension
Explain the S/S of cirrhosis and also explain why the patient deelops each symptom.	Firm, nodular liver. abdomnal pain, chronica dyspepsia. Changes in bowel habit, ascites.
Why does the cirrhosis patient sometimes develop hepatic encephalopathy and come.	A build up of ammonia.
Why are we worried abut I and O and daily wts wit the cirrhosis patient?	B/C we have a ptient with FV problems due to the ascites.
why is rest so important with a cirrhosis patient?	To rest the liver.
Why are we worried about prevention of bleeding in the cirrhosis patient.	B/C the liver is altered; therefore the patient is high for hemmorrhage.
Why do we measure the abdominal girth in the cirrhosis patient and what will it tell us?	Measuring to see how much fluid is accumlating in their abdomen. Incidates Vacular volume is going down.
Where is the first place a cirrhosis patient might develop jaundice.	Sclera
When jaundice gets to the skin, what is one of the major nusring diagnosis?	Alteration in skin integrity.
Why do you have to avoid narcotics in any liver problem.	B/C the liver cannot metabolize narcotics.
When a patinet has a liver disease, what should be done with protein in the diet.	Decrease.
Why does the liver patinet need a low-sodium diet.	To decrease ascities.
What chemical builds up in the blood that makes a patient go into a hepatic coma.	Ammonia.
How did that chemical develop	B/C the liver is unable to convert ammonia to urea.
What are symptoms of hepatic coma? Explain why the patient develops these symptoms.	Minor mental changes. Decrease LOC, Asterixis, Decrease reflexes.
What are the two major drugs used in hepatic coma? Explain why?	Neomucin and Lactualose b/c they decrease Ammonia.
If a patient is in hepatic failure and eats protein, what is going to happen to the ammonia level in their blood? Explain Why?	Increase b/c the liver cannot convert ammonia to urea.
What are bleeding esphageal varices.	Protruding vessels in the esophagus waiting to rupture.
Why does a patient develop bleeding esophageal varies?	The back pressure in the liver forces the vessels in the esophagus to protrude.
Why is oxygen important with a patient who has bleeding esophageal varices.	Because the patient is anemic and we want what few red blood cells they have to be hyper-oxygenated.
Explain how Vasopressin works.	It decrease the blood pressure in the liver and hopefully the bleeding will subside.
What is one of the complications of giving vasopressin?	Cause vasoconstriction in other parts of the body.
What is another name for vasopressin	Pitressin
Why does the patient with bleeding esophageal varices need a Sengstaken Blakemore tube	To hold pressure on the bleeding varices.
What is the nursing care associated with a Sengstaken Blakemore tube.	Keep scissor at the head of the bed. make sure the tube is not coming out. mark the tube at the nares and observe maintenance of the tube position.
What is the difference in ulcerative colitis and Crohn's Disease.	Ulcerative colitis is a LG intestine disease. Chron'e disease is a small intestine disease.
What are the symptoms of ulcerative colitis and crohns disease?	Diarrhea, rectal bleeding, wt loss, vomitting, cramping, dehydration, blood in stool, anemia, rebound tenderness and fever.
What is another name for Crohn's	Regional Enteritis
When a patient has ulcerative colitis or Crohn's disease, do they need a high fiber or low fiber diet? Why?	Low fiber diet b/c a high fiber diet would increase motility
Why does the patient with ulcerative colitis or chorn's need to avoid cold foods, and smoking?	These will increase motility.
What is one of the major antibiotics given for ulcerative colitis an Crohns's disease? How does this drug help?	Gantrisin which is a sulfonamide (antibiotic) to decrease infecton and inflammation.
Why does the patient with ulceratie colitis of Crohn's diseas need steroids.	To decrease inflammation
Why does the patient with ulcerative colitis or Crohns disease possibly need psychotherapy?	Many believe that there might be an emotional base to these disease
What is the surgical treatment for ulcerative colitis?	Thy may do a total colectomy or a Koch's Pouch or they could just remove the part that is damaged are re-hookup eveyhing else.
What is the surgical treatmn fo Crohn's Disease?	May remove the entire smallintestines or only the affected area.
When a patient has an ileostomy, what will the drainage be like.	Continuous liquid drainage.
Why should an ileostomy patient need to avoid rough foods or high fiber foods?	These will increas motility and therefore make the patient lose even more water.
Why does the ileostomy patient need Gatorade.	To replace fluid and eletrolytes.
Why is the ileostomy patient at risk for kidney stones.	B/C they are always a little dehydrate.
When a patient has an ileostomy, what eletrolytes are they losing a lot of?	Potassium.
Explain the nursing care for a colostomy.	Bowel training and irrigation will be needed.
Why does a patient develop appendicitis.	B/C the appendix fills with bowel conent and becomes inflamed and can rupture.
Explain the major symptoms o appendictis?	Right lowe quadrant pain and an elevated WBC; may have some nausea and vomiting and rebound tenderness.
Why do we avod giving an enema to a patient twho has appendicitis?	B/C we do not want to repture the appendix.
When a patient has had anyabdominal sugery, what is the postion of choice and why?	Elevate the head of the bed and to decrease stress on the suture line.
Explain symptoms of peptic ulcers.	Burning pain in th mid- epigastic area. The pain may go all the way through to the back.
Why do we give the peptic ulcer patient anatacids. What type of antacids would be best-- Liquid or tablet.	To decrase acid-- liquid to coat the stomach.
Why do we give the patient with peptic ulcer disease H-2 receptorantagonist? List some example.	To decrase acid -- Tagamet, pepcid, zantac.
Why do we give the peptic ulcer patient Carafate?	To form a barrier over the wound so acid cannot get on the wound.
Why is it important that the peptic ulcer patient decrease stress.	Because stress increase stomach acid.
Why is it important that the peptic ulcer patient stop smoking.	Smoking increase stomach acid.
Explain what you would teacha paptic ulcer patient about diet?	Eat wht you can tolerate bt avoid extra spicy foods.
What is the difference in a pepotic ulce and a duodenal ulcer.	The locations
What is dumping syndrome?	When the stomach empties too rapidly after a gastrectomy gastic bypass.
After wht surgery does a patient get dumping syndrome?	Gastrectomy, Gatic Bypass.
What are the symptoms of dumping syndrome	Fullness, palpitations, faintness, weakness cramping and diarrhea.
What are he major nursing interventions for a patient who has dumping syndrome.	Lie back when eating the lie flt after meals; drink fluids between meals; do not drink fluids with meals.
Wht is a hiatel hernia?	Whenpart of the stomach moves up into the thoracic cavity.
What are the major symptoms of a hiatal hernia	Heartburn, regurgitation, difficulty swallowing.
What are the major nursing interventions for a patiet who has a hiatal hernia?	Sit up after meals an elevate the head of the bed. We are tying to keep the stomach down in the abdominal cavity.
What is another nae for hyperalimentation?	TPN
Why does a ptien whois receiving hyperalimentation need a centralline.	B/C they re so many particls in hyperalimentation that it will eat up peripheral veins.
Why do we discontinue hyperalimentation gradually?	To avoid throwing the patie tinto hypoglycemia. Hyperalimintation solutios are packed with glucose.
Why is it so important that we monitor daily WT in the hyperal patient?	B/C hyperal is a nutritional substance, we want the ptient to gain wt or at least maintain theblood sugar within a normal range.
The hyperal ptient may have to start taking insulin. WHY?	B/C hyperal has such a high glucose load in it they may need additional insulin to maintain the blood sugar within a normal range.
When a patient is on hyperal we check their urine everyday. What are some things you should be checking it for?	Checking urine fr glucose and ketones.
Why is it so important that we not mix hyperal ahead of time.	B/C the patient needs will change every single day, we monitor te electrolytes daily to determine what he patietneeds for the next 24 hors.
Why does hyperalimentation need to be on a pump?	B/C it s full of eletrolytes.
Why is it so important that home TPN patient emphasize handwashing?	To prevent infection.
If you were going to help a doctor insert a central line, what should you do first.	We need to get some fluids spiked and primed and ready to go.
How should we position your pateint?	The patient is placed in trendelenburg positin (to Distend the jugula and subclavian veins.
Where does the central line go?	Jugular vein or subclavian vein.
If air gets into your central line, what is going to happen? What position should you place the patient in?	The air will go into the right atrium and down to the lungs (pulmonary embolus); therefore the patient should be placed on their left side to prevent forward movement of the air.
After the central line has been inserted, we always get a chest x-ray. what two things are we checking for in this chest xray?	Placement and Pneumothorax.

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