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NUR 131 Exam 1

nur131 exam 1

bp on children 3yrs and older
head circumference on children up to 2 yrs
general guidelines for PA flexibility, several obs at once, least distressing first, use games, dolls, kind but firm, painful last
general guidelines for PA II safety, sit on parents lap, adolescents may not want parents in room,
general guidelines for PA III ask permission to treat, into yourself, explain what ur doing, call child by name
the nurse obtains vs from a 1 year old, which are normal
specific protection, immunizations, smoking cessations, decreasing pollution, fluoridation program, communicable desease, nutrition primary prevention
early diagnosis and tx, screening, surgical intervention, prevent further complications secondary prevention
have problem, tx to maximize their remaining capacities, rehab, teach insulin use, tertiary prevention
family assess factors family structure, health status, communication,parent understanding of growth and development, spiritual beliefs, socioeconomic status
characteristics of healthy families communicate openly, flexible role assignments, agree on basic principles, members volunteer to assist
family risk factors conflict in marriage, adolescent parents, violence, ill child, substance abuse
family stressors time, separation, money, health, transportation, work, disability
coping strategies identify strengths, reliance on family group, use of humor, links to community help,
the stage of family development is always determined by the age of the oldest child
stage 1; marriage, joining of families, the beginning family reestablish couple identity, realign relationships with extended family, make decisions regarding parenthood family planning and nutrition.
stage 2; early childbearing integrate infants into the family unit, accommodate new parenting role, division of labor, maintain the marital bond, accommodate grandparent role. infant care, child development, safety
stage3; families with preschoolers socialize children, parents and children adjust to separation. growth and development, accidents, poison prevention, communicable disease
stage 4; families with school age children children develop peer relations, parents adjust to their children's peer and school influences. behavioral problems, communicable disease, physical and emotional problems, vision and hearing.
stage 5; families with teens allowing adolescent to develop increased autonomy, parents refocus on career issues, parents shift toward concern for older generation. puberty, peer pressure, stds, substance abuse.
stage 6; families as launching centers (late teen/young adult) parents and young adults establish, independent identities, parents renegotiate the marital relationship. young adult: motor vehicle accidents, substance abuse, coping with stressors. parents: egocentric, preparing for healthy old age
stage 7; middle aged families reinvest in couple identity, development of new interests,death of older generations. loss, grief, health promotion and illness prevention.
stage 8; aging families leave work to retirement, prepare for own death, loss of spouse or siblings, peers. optimal wellness in illness
sequential reaction to cell injury, dilute/neutralizes the inflammatory agent, removes necrotic materials, establishes an environment suitable for healing/repair inflammatory response
cardinal signs of inflammation pain, swelling, heat, redness, loss in functioning
clean wound w little loss of tissue, rapid healing w minimal inflam primary intention, primary union
wounds from trauma, ulceration, inf, lost of exudate, gaping of wound edges secondary intention, granulation
greater granulation, greater risk of inf, late suturing and more scarring tertiary intention, secondary suture
causes redness and heat vasodilation of bv
causes edema and pain from pressure increase in capillary permeability
strengthens a blood clot and traps bacteria in wound. prevents spread fibrin
accumulation of neutrophils, monocytes, leukocytes cellular response
at injury site first, phagocytize debris, exudate neutrophils, phase 1
monocytes clean up crew till clean, hang out longer cellular response phase 2
kill foreign cells, produce antibodies lymphocytes
released for allergic reactions, control histamine eosinophils
carry heprin increase w any inflam response basophils
cause vasodilation prostaglandins
stimulate chemotaxis leulotrienes
contraction of smooth muscle, dilation of bv = pain kinins
cause onset of fever cytokines
benefits of fever increased killing of microbes, release of lymphocyts and phagocytosis
disadvantages of fever dehydration, seizures
first 3-5 days, swollen, fibrin clots initial phase
immature connective tissue cells secrete collagen. surface epithelium at wound edges granulation phase
scar contraction, scar appears pale and avascular maturation phase
factors that impair wound healing age, malnutrition, obesity, impaired oxygenation, smoking, drugs, diabetes, radiation, wound stress
after surgery what CBC lab report what blood cell would be elevated neutophils
an immediate threat to survival. Ex; obstructed airway first priority need
an actual problem that pt or family request help with. ex; pain med second priority need
a relatively urgent actual or potential problem that pt or family dont recognize. ex; monitoring for post op complication third priority need
an actual or potential problem that pt or family may need help with in the future. ex; discharge planning teaching needs forth priority setting
6 pt rights for meds right pt, med, time, dosage, route, documentation
steroids and stress increases BG
med to decrease stress ulcers and stomach acid prior to surgery prilosec, previd
tape wed rings on, prosthetic to family, hospital protocol, hearing aids in to follow direction give back after surgery.
circulation nurse in nonsterile field,prepares room, stock items for surgery, check equipment, identifies and admits pt to OR, assess pt physical/emotional status,apply monitoring devices, assist w anesthesia, documents intraoperative care, counts, accompanies pt to PACU,
scrub nurse prep room, dress others, prepares in sterile field,instrument, passes instruments, counts, tracks solutions, blood loss, reports amounts of meds
anesthesiologist manage pt unconscious, pain, cardiopulmonary resuscitation, problems in pulmonary care, critically ill pts in special care units
RN first assist handling tissue, using instruments, providing exposure to the surgical site, assisting with hemostatsis, and suturing
surgeon preoperative hx, physical assessment, surgery, preoperative testing, pt safety, management in the OR, post op management of pt
sterile zone below shoulders to above waist, do not turn back, reach over, 1/4"-1/2" edge around equipment
loss of consciousness and sensation general anesthesia
loss of sensation to a region of body wo loss of consciousness regional anesthesia
block the initiation/transmission of autonomic, somatic sensory, somatic motor impulses local anesthesia
used as local anesthesia on skin EMLA cream
used to put pt into a pleasant sleep fentanyl-opoids
an antianxiey drug and amnesiac. premed before surgery versed-benzodiazepines
cause paralysis to prevent the pt from moving, muscle relaxation neuromuscular blocking agents
prevent n/v antiemetics=droperidol
used for aspiration prophylaxis H2 receptor blockers
ABCs airway, breathing, circulation
pts needs in PACU neurological=LOC, sensory and motor status, safety, dressings, pain, n/v
caused by mucus blocking bronchioles, crackles, from shallow breathing d/t pain atelectasis- use inspirex, turn, cough, deep breathe, ambulation
how to cough hold pillow onto wound/stomach 3 deep breaths than big cough
pt blue, poor ;ulse ox, stabbing pain in chest, rapid breathing pulmonary embolism (clot in pulmonary aterial system)use O2 raise HOB, anticoagulant
low BP, urine output of < 30cc/hr, concentrated dark, fast thready pulse, disorientation hypovolemic shock-IV fluids, tell dr
evaluates electrical potential associated w muscle contract. seeing if muscles are working correctly, used to obtain info about motor neuron disfunction electromyogram (EMG)-pt awake, supine, some discomfort from needle, avoid caffeine for 24hr,
obtain cerebrospinal fluid for analysis lumbar puncture-pt empy bladder, side lying, needle thru 1-2 lumbar vertebrae, pain down leg, monitor for HA
inj of radiografic contrast medium into sac around nerve roots to show the bone affecting never roots. myelogram w or wo CT. monitor for spinal HA, pt not preg, not allergic to iodine or shellfish.
insertion of arthroscope into jt to visualize structure arthroscopy-outpt, strict asepsis used, local or general anesthetic, explain post procedure restrictions
use of radio waves/magnetic field to view soft tissue magnetic resonance imaging (IM)- painless, pt lie still, no metal or implants, may cause claustrophobia
slow nono inflammatory disorder of synovial jts and formation of new tissue in response to cartilage destruction osteoarthritis-disorder of overuse
highest risk for osteoarthritis slender, female, Caucasian, smokers and steroid users
calcium, vit D help prevent osteoparosis
risk factors for osteoparosis trauma to jt, decreased estrogen, ligament injury w quick stops, frequent kneeling
reconstruction or replacement of jt arthroplasty
Used to maintain abduction in a client who has had a THR foam abductor pillow?
A complication that may occur if a client is immobile following orthopedic surgery. deep vein thrombosis?
An extremely serious condition in which increased pressure in an area enclosed by muscle causes decreased capillary perfusion. A common site is a fractured tibia. compartment syndrome?
A sign of a femoral neck fracture. shortening and external rotation of the affect limb?
A allergy that would make it dangerous to have a mylogram seafood or iodine
A sign of a herniated cervical disk. pain and numbness in the arm and hand?
The main reason for performing a total knee replacement osteoarthritis of the knee?
Exercises that start the first day after TKR isometric quadriceps setting exercises?
A machine used to promote joint flexibility by using continuous passive motion CPM machine? continuous passive motion
Used in the care for a client who has had bone grafting to correct bone deficiencies after discharge knee immobilizer?
Things that must be avoided for 6 weeks after THR extremes of internal rotation and 90-degree flexion?
The complication of a THR that can occur if an abductor pillow is not used, or the client goes to extremes of internal rotation, or 90-degree flexion dislocation of the hip?
The type of total hip replacement that has an extended recovery period noncemented hip replacement?
The type of hip replacement given to younger clients non cemented hip replacement?
Emphasized by all the definitions of pain subjective nature of pain?
Caused by damage to the somatic or visceral tissue nociceptive pain?
Caused by damage to the peripheral nerves or central nervous system neuropathic pain?
Pain scale most commonly used to assess pain in infants and children FLACC pain scale?
Pain that lasts for longer than 3 months chronic pain?
Nausea, vomiting, constipation, respiratory depression, and pruritus side effects of morphine?
Instructions given to clients receiving patient controlled anesthesia only the patient should push the PCA button?
An effect that occurs when morphine is used over a long period of time building up a tolerance to morphine?
Drugs that a client receiving NSAID’s for pain should not be on any type of anticoagulant?
Maximum dose of acetaminophen that can be given in 24 hours 4 gm’s
Signs of compartment syndrome numbness and tingling, pain, pressure, pallor, paralysis, pulseness?
caused by compression of the medial nerve carpel tunnel syndrome
signs of carpal tunnel syndrome tap on median nerve tingling, phalens sign tingling when hands are dropped into full flexion.
spinal surgery care pillow under knees and between legs for side lying, N, bladder probs, resp distress, numbness, tingling
crutch up steps advance on good foot and bring bad foot
cane usage cane opposite affected leg
walker usage walker with affected leg
pain that is tenderness or increased pain away from the area of injury or disease involving visceral organs referred pain
pain that is gone over time as recovery happens, can identify precipitating event acute pain
delivers analgesia directly to the surgical site stryker pain pump-causes deterioration of jts
interrupts generation of never cells by altering the flow of sodium into the nerve cells local anesthesia
non pharmacological methods of pain control closing the gate w massage, exercise, TENS, acupuncture, heat therapy, cold therapy
nondrug cognitive therapies relaxation, distraction, hypnosis
child doses are calculated by wt
increased BUN impaired renal func, sepsis, inc protein intake, starvation, dehydration
increase in creatinine impaired renal func, 10:1
PSA prostate specific antigen. need more than one test inc w prostate cancer
KUB anteroposterior film of kidneys, ureters and bladder. evals: urinary calculi and masses
IVP IV inj of medium then xrays to eval stones masses hematuria obstruction
retrograde pyelogram stones, contrast adm directly into urinary tract during cystoscopy. evals ureters, renal pelvic and calices. caution pt allergic to iodine
cystogram stress incontinence, contrast into bladder via cathe, evals UTIs, refulx, hematuria, trauma, surgical healing, stress incontinence
voiding cystogram contrast into bladder pics taken while void. evals urethral stricture, fistula, trauma, diverticul.um or tumor
prostate scan fleets enema 45 min prior, transducer probe inserted 4-5 in into rectum
cystourethroscopy and urethroscopy preop; URINALYSIS, PERMITS, iv FLUIDS, Intraop: anesthesia, lithotomy, postop: inc fluid intake, assess bleeding, monitor for inf, warm baths, NSAIDS for dysuria, cath for retention,
Ureteroscopy, Nephroscopy, Ureterorenoscopy preop; URINALYSIS, ANTIBIOTIC, npo, permits, intraop: anesthesia, trendelenburg position, Postop: perforation, inf, renal colic and bleededh, ureteral sten may be left in for at least 48 hrs, inc fluid intake , cont prophylactic antibiotics
biopsy is for cancer
urodynamic studies eval voiding dysfunction r//t the lower urinary tract
rectal exam male: evals prostate, Female: evals sphincter tone
indwelling cathe inc fluids, cathe bag below bladder, wash perineal area 2xday, prevent trauma to urethra, prevent obstruction of blow to collection bag.
indwelling cathe needs to be removed asap. used bladder scan to determine residual
painless hematuria is main symptom, predisposing factor is smoking bladder cancer
obstructions TUR and Fulguration transuretheral resection destruction of tissue by electrical current thru electrodes in direct contanct w the growth
partial cystectomy isolated tumors that cant b treated w TUR, bladder capacity of 60cc, bladder tissue expands over months to 200-400cc
radical cystectomy and urinary diversion whole bladder, urethra, uterus, fallopian tubes, anterior segment of vagina, prostate and seminal vesicles removed, tumors, congenital defects,
ileal conduit portion of intestine used to form stoma, urine continuously flows to collection bag, done pts w less 1-2 years to live
indiana pouch large reservoir under skin, drain w cath q 3-4 hr, 800cc capacity,
orthotopic bladder bladder made of intestine, may need to cathe, may have incontinence
ng tube removes content so bowels have no matter to eliminate
total cystectomy w urinary diversion preop: clear liq 1-3days, laxatives nite before, antibiotics, NPO. postop:assess stoma q hrx24, and q 8 hrs for patency, report if stoma is grey/blue, NPO untill bowel sounds, I/O q hr,
first symptom of primary uretheral tumors hematuria
urolithiasis (urinary caluli) from urinary stasis, decreased fluids and inc solutes.
types of calculi calcium, oxalate, uric acid, struvite, cystine and zanthine
clinical manifestations of urolithiasis severe sudden pain, nv, temp. diagnotic tests: KUB, IVP, cysto
tx of urolithiasis inc fluids, dec pain, prompt tx of UTIs, modify diet, lasers, ultrasonic waves, external sound waves
URINARY REFLUX from congenital abnorm, chronic bladder inf (scar tissure), outlet obstr,
tx for urinary reflux re implantation of ureters
postop urinary reflux urethral or SP cathe splints ureter to heal, prevents obstruction, drains urine
urinary retention post void residue of 100cc, dribbling from detrusor muscle failure, anesthesia, rectal/vaginal prolapse, poor bladder muscle tone
tx for urinary retention cholinergic meds to stimulate bladder contractions, urethral dilations,
surgical tx of retention done if structural defect is found, remove enlarged prostate,
BPH benign prostatic hyperplasia, inc number of normal cells in the prostate
clinical manifestatoins come slow, dec size/force of urine stream, hesitancy, urgency,m nocturia, incomplete emptying, leakage
first symptom of primary uretheral tumors hematuria
urolithiasis (urinary clculi) from urinary stasis, decreased fluids and inc solutes.
types of clculi calcium, oxalate, uric acid, struvite, cystine and zanthine
clinical manifestations of urolithiasis severe sudden pain, nv, temp. diagnostic tests: KUB, IVP, cysto
tx of urolithiasis inc fluids, dec pain, prompt tx of UTIs, modify diet, lasers, ultrasonic waves, external sound waves
URINARY REFLUX from congenital abnorm, chronic bladder inf (scar tissure), outlet obstr,
tx for urinary reflux reimplantation of ureters
postop urinary reflux urethral or SP cath splints ureter to heal, prevents obstruction, drains urine
urinary retention post void residue of 100cc, dribling from detrusor muscle failure, anesthesia, rectal/vaginal prolapse, poor bladder muscle tone
tx for urinary retention cholinergic meds to stimulate bladder contractions, urethral dilations,
surgical tx of retention done if structural defect is found, remove enlarged prostate,
BPH benign prostatic hyperplasia, inc number of normal cells in the prostate
clinical manifestations come slow, dec size/force of urine stream, hesitancy, urgency,m nocturia, incomplete emptying, leakage
medical tx of BPH slow growth proscar (finasteride) dec BPH takes 6-12 months
medical tx of BPH relax prostate muscle Flomax (tramsulosin) Hytrin (terazosin), Dibenzyline,
medical tx of BPH for relief of retention catheterization
surgical management of BPH TURP most common-gold standard
post op BPH monitor bleeding, bladder irrigation, pain management
post op teach BPH no straining during deification, prevent constipation, avoid caffeine, pelvic exercises, ED, follow up, elevated temp, bleeding, signs of UTI
physiological differences in children urinary shorter urethra, complete bladder control isnt until 4-5 yrs, infants cant concentrate urine
how kidney is getting waste out of blood is by what lab results blood urea nitrogen and serum creatinine
reasons why children get UTIs obstructions r/t congenital abnorms, urinary stasis, shorter urethra, inf, reflux, sexual activity
clinical assessments fever, urine culture, urine must b refriged in 10 min, ultrasound for structural issues
undescended testes cryptorchidism
ventral opening and curve to penis hypospadias
dorsal opening, rarer epispadias
surgery 6-12 months, no circ foreskin used for repair
surgical care pressure dressing, stent or closed urinary drainage system, inc hydration, limit activity, meds, no straddling
no opening to penis phimosis
testicular torsion
bladder extrophy
more porus basement membrane, proteinuria, hyperalbumineria, reatian Na/H2O, vasocontriction, from strep throat acute glomerular nephritis
leukocytes on the basement membrain of nephron, H2O and Na retention, HTN, dec urine output nephrotic syndrome
assessment finding for nephrotic syndrome generalized edema, ascites, poor appetite, fatigue, cloudy foamy pee, dec UOP trapped in cells
lab findings for AGN hemoturia, proteinuria, serum compliment C3, inc BUN/creatinine, serum k
lab findings for nephrotic syndrome protein in urinalysis, dec albumin and serum protein, inc hematocrit, Hbg normal
medical mangement of agn antihypertensivers, sometimes antibiotics, no salt diet
medical mangement of Nephrotic syndrome corticosteroids (prenisone), antibiotics, diuretics, anti coag, lipid lowering, no salt diets
ns care for AGN check st daily, exact i/o, BP, LOC,
ns care for nephrotic syndrome check daily wt, abd girth, exact i/o temp, limit visitors, keep isolated, be creative with getting pt to eat
med that can change your mood and dont give at bed time prednisone
nephrotic syndrome pts are given prednisone and pen for prophalactic can get pneumonia easily
absence of urine production or a urinary output of less than 100 mL/day. changes in urinary volume anuria
is painful or difficult urination; irritative and obstructive manifestations dysuria
is the inability to voluntarily control the discharge of urine, irritative and obstructive manifestations incontinence
is delay or difficulty initiating urination. irritative and obstructive manifestations hesitancy
is diminished amount of urine in a given time (24 hr urine output of 100-400 mL),changes in urinary volume oliguria
is a large volume of urine in a given time and may indicate diabetes mellitus. changes in urinary volume polyuria
is the inability to urinate even though the bladder contains an excessive amount of urine. obstructive manifestations retention
is the sudden, strong, or intense desire to void immediately and is commonly accompanied by frequency. irritative and obstructive manifestations urgency
is blood in the urine, which can indicate cancer of the genitourinary tract, abnormal urine findings hematuria
is the presence of albumin (a water-soluble protein which is most abundant in blood plasma) in the urine, abnormal urine findings proteinuria
are abnormal stones formed in body tissues by an accumulation of mineral salts, and are usually found in various locations of the biliary and urinary tracts. abnormal urine findings calculi
are molds of renal tubules formed by deposits of mineral or other substances (such as protein, WBCs, RBCs, bacteria, and noncellular substances) on the walls of the renal tubules. abnormal urine findings casts
is an increased incidence of urinating (< 2hr intervals between voids) irritative and oabstructive manifestations frequency
is the abnormal presence of a sugar, especially glucose, in the urine; abnormal urine findings glycosuria
is the presence of an excessive number of WBCs in the urine (>5/hpf) and can indicate UTI or inflammation abnormal urine findings pyuria
determines the amount of urine remaining in the bladder after urination. obstructive manifestations residual
CCMS (clean catch midstream)
Urinary retention is determined by measuring the postvoid residual (PVR) with the use of a bladder scanner.
first empty bladder collect voids for 24 hours, put on ice 12-24 hours
sterile clean void catch and sensitivity testing to see what antibiotic will work C&S
EXAM II external intact skin, mucous membranes, tearing, sneezing, coughing first line of defense (immune response)
kill foreiegn substance, antibodies, immune complex to destroy antegen 2nd line of defense (internal defenses)
protein produced in response of viruses interferon (nonspecific immune)
cellmediated production of lymphocytes, react to viruses fungi parasites foreign tissues and other antigens specific immune funcitons
plasma lymphocytes (B cells) in response to an antigen humoral immunity
immunoglobulin that crosses the placenta, secondary immune response IgG
lines mucous membranses protects body surfaces IgA
primary immune response, forms antibodies to ABO blood antigens IgM
on lymphocyte surface differentiation of B lymphocytes IgD
allergic reaction symptoms, fixes to mast cells and basophils, defend against parasitic inf IgE
reacts to antigen, long lived, exposure ot environmental antigen or vaccines, produces antibody active immunity
antibody transfer from one to another. most maternal antibodies are gone in infant about 8-9 months passive immunity
infants dont show signs of inf until later, more rapid spread
immune response to an antigen occurs with second exposure
severe immediate hypersensitivity response anaphylaxis
histamines released causing vasodilation, broncho constriction and increased capillary permeability anaphylaxis
urticaria hives
NS interventions for anaphylaxis airway, tourniquet(snake bite), adm epinephrine
number one intervention for communicable diseases hand washing, cough into tissue
viral exanthem fever drooling, vesicular exanthem on palms and bottom of feet, droplet spread coxsackie A-16 hand, foot and mouth
viral exanthem slapped cheek appearance, malaise, mild fever, lacy maculopapular rash on trunk and extremities in 1-4 days fifths disease
exanthem 6-18 mts most common age, sudden high fever 3-5 days, malise, but play ok, rash fades 24 hours Roseola infantum, sixth disease, herpes virus 6
viral, inc 7-14 days, infectious period lasts 1-2 weeks, high fever, rash begins behind ears fot to feet, turns brown, coplia spots in mouth on buccal mucosa, droplet transfer rubeola, measles
inc 14-21 days, naso pharangeal secretions, low fever, rash. inf 7 days before and 14 days after rash, petechiae on soft palate rubella, german 3-day measles
initial stage of a disease prodome
inc 3 wks, inf 7 days before and 9 days after, airbone, salivary secretions, fever HA, malaise, parotid gland swelling Mumps, MMR shot at 12-15 mths
Created by: vstein