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NUR 141 EXAM 2

QuestionAnswer
LPNs care for persons who are... well, ill but stable, injured, convalescent, handicapped
LPNs work under... own license and supervision, can not delegate tasks to unlicensed personnel
most facilities LPN does not... start IVs, give IVP or IBPB meds, work with central lines, take verbal orders
LPN duties caths, dressings, tube feedings, wound irrigation, med adm (not IV), pre-post mortom care
LPNs can direct, assign and supervise aides in extended care facilities
PT does motor
OT does upper extremities and ADLs
ST does swallowing, speaking
"study learning principles"
domains of learning cognitive, affective, psychomotor
cognitive intellectual-understanding of risks and s/s of low blood sugar
affective emotions, attitudes, values= values blood sugar control and health promotion
psychomotor acquiring skills-can use glucometer to check blood sugar level
pain is the physical sensation, suffering is the emotional response to pain
pain lasting > 3 months chronic, vs can b normal
sudden pain acute, inc in BP and vs
nocioceptive pain caused by damage to tissue, heals quicker
nocioceptive somatic pain superficial (sharp, burning, prickly), deep (aching, throbbing)
nocioceptive visceral internal organs (referred pain) cramping, pressure
nocioceptive pain responds to opioid and non opioid meds
neuropathic pain caused by damage to nerves or CNS (numbing, burning, stabbing)
causes for neuropathic pain trauma, inflam, metabolic disease, ETOH, inf. Not well controlled by opioids alone.
incident pain is ambulation, change in posiiton
pattern of pain onset, duration, breakthrough pain
non opioids for mild/mod pain, nonsalicylate, salicylate, NSAIDS
nonsalicylate acetminophen-analgesic, antipyretic, hepatic toxicity
salicylate ASA-analgesic, antipyretic, antiplatelet, antinflamm
NSAIDS losts of side effects
characteristics of nonopioids analgesic ceiling, no tolerance/dependence to, OTC, opioid sparing
opioids bind to CNS receptors for mod/severe pain, no ceiling
opioids to avoid propoxyphene (seizures), meperedine (neurotoxicity)
side effects of opioids contstipation, N/V, sedation, resp depression, itching, urinary retention, confusion
adjuvants for opioids corticosteroids, antidepressants, antizeizure, GABA receptor agonists, alpha adrnergic agonists, local anesthetics, cannabinoids
corticosteroids dec edema/inflam. SE=dose/duration dependent
antidepressants inhibit reuptake of serotonin &/or norepinepherine higher levels in synapse. inhibits pain impulses. good for neuropathic pain
antiseizure affect peripheral nerves &CNS, good for neuropathic pain, gabapentin (neurotin), pregabalin (Lyrica)
GABA receptor agonists muscle spasms
marrinol pot in pill form
a chart of conversion for other meds that do same thing equianalgesic dosing
PCA pumps are a high risk for resp depression
Tolerance chronic exposure dec effect of drug. rotate
physical dependence expected, experience withdrawl s/s when blood level drops. Taper off.
addiction powerful drive to take substance for reasons other than the therapeutic purpose. Seeking SE instead of therapeutic effects
cancer pain acute/chronic, r/t desease/tx,
palliative care focus on pain control in incurable conditions
hospice end of life care, focus on comfort/quality of life vs quantity
ethical concern with hospice hasten death
nutrition in >50 yo women=1920, men=2300, need more vit D, B12, protien, fat, CHO, fluids
dehydration in tne elderly purposely avoid fluids, loose sense of thirst, forget to drink, can get fluids on their own
lack of nutrition in elderly poor fitting teeth, taste/swallowing impaired, vision, constipation
white patches in mouth leukoplakia
red velvety patches erythroplackia
precursor to esphageal cancer pharynxesphogitis from reflux
cancer that is mastatic at time of dx esophageal cancer, to brain, lungs; removal of esophagus, stints, survial<20%,
after removal of esophagus NG tube (do not touch), I/O, VS, pain, mobility, DB, cough
sign of fever, severe pain and NG contents change after esophagus removal a leak
pts with inc temp after surgery ateloactisis=DB and cough
gall stone blocking duct can cause pancreantitis
lab the is relased with injury LDL
lab the inc w other organ dmage AST
lab that is liver specific ALT
all fluids of body have billirubin except CSF
hep A & E trans w fecal oral
hep B trans w body fluid, blood
hep C trans blood
hep D only have w B
drug of choice for liver disease aldactone
what are some contributing causes for cirrhosis of liver ETOH, hep C 7 B, chronic inflam, billary cirosis, obstructions
what labs are for cirrhosis of liver ALT, LDH, bilirubin, albumin, amonia, PT
assessment data for cirrhosis liver pain, fatique, brusing, acetises, LOC, what have been exposed to
what orders with sirrhosisi of liver daily st, liver biopsy, parancitisis,, vit K, folic acid, thymiane, DTs, diuretics
wat liver does stores carbs, protein, 1st pass, responsible for clotting factors, detoxes at 1st pass
must have PT prior to liver biopsy want good clotting: after biopsy ly on R side
break down of protein = amonia
jaundice bilirubin is x3, clay stools, tea urine, skin itches, anorexic, fatique
ETOH need thyamine and folic acid
common hepatotoxins isoniazid, acetaminophen, thiazides, tetracycline, methotrexate, ETOH, poisons, heavy metals
pt adm w RUQ pain N/V, sudden onset, ate shell fis. wat tests dr order hepatits profile (hep A)
how is HBV trans blood, body fluid
how is HCV trans blood (transfission, neeedles)_
how protect yourself from transmission hep B vac
hep B more than C can cause liver cancer
causes of pancreatitis obstruction, EToh, gall stones, billiary tract disease
assessment data for pancreatitis pain, N/V, fever, HTN, vs, left upper gastric pain
lab teszts for pancreatitis amalyse, lipase, BG
gall stone blocking duct can cause pancreantitis
lab the is relased with injury LDL
lab the inc w other organ dmage AST
lab that is liver specific ALT
all fluids of body have billirubin except CSF
hep A & E trans w fecal oral
hep B trans w body fluid, blood
hep C trans blood
hep D only have w B
drug of choice for liver disease aldactone
what are some contributing causes for cirrhosis of liver ETOH, hep C 7 B, chronic inflam, billary cirosis, obstructions
what labs are for cirrhosis of liver ALT, LDH, bilirubin, albumin, amonia, PT
assessment data for cirrhosis liver pain, fatique, brusing, acetises, LOC, what have been exposed to
what orders with sirrhosisi of liver daily st, liver biopsy, parancitisis,, vit K, folic acid, thymiane, DTs, diuretics
wat liver does stores carbs, protein, 1st pass, responsible for clotting factors, detoxes at 1st pass
must have PT prior to liver biopsy want good clotting: after biopsy ly on R side
break down of protein = amonia
jaundice bilirubin is x3, clay stools, tea urine, skin itches, anorexic, fatique
ETOH need thyamine and folic acid
common hepatotoxins isoniazid, acetaminophen, thiazides, tetracycline, methotrexate, ETOH, poisons, heavy metals
pt adm w RUQ pain N/V, sudden onset, ate shell fis. wat tests dr order hepatits profile (hep A)
how is HBV trans blood, body fluid
how is HCV trans blood (transfission, neeedles)_
how protect yourself from transmission hep B vac
hep B more than C can cause liver cancer
causes of pancreatitis obstruction, EToh, gall stones, billiary tract disease
assessment data for pancreatitis pain, N/V, fever, HTN, vs, left upper gastric pain
lab teszts for pancreatitis amalyse, lipase, BG
what DO for pancreatitis morphine, dilaudid, NPO, NG tube, previcid, Zofran
pancreas endo/exocrine secretes insulin, glucagon, digestive enzymes
pancreatitis tx NPO (cant excrete lipase,amalace until gone), NGT, morphine, fluid, low fat, bland, pancreatic enzymes, cant drink again or will b back in hosp
tests for a DM pt DM diet, insulin, fluids, A1c
pts on beta blockers are tachy
repeated hypoglycemia causes memory loss
diabetic ketoacidosis only occurs in type 1
somogyi effect caused by too much insulin, tto much insulin at night
dawn phenomenon hypergycemia d/t coungterregulatory hormones, hormone imbalance
DM and renal failure go together
DM causes dec in motility give Regalan 1/2 hr before meals to inc motility
A1C 4-6 non diabetic
if hypoglycemic give.. no candy bars (too much fat, delays absorption)
if hypoglycemic give... 15-20gm x15min, 6 oj, 4 cola, 8 milk, 3 glucose pills, 5 lifesavers, 1 dry toast, 1/2 c ice cream
what drug you cant give with a dye study metforman
medulla adrenal gland (sympathetic NS) epinephrine, norepinephrine
Cortex adrenal gland mineralcorticoids, glucocorticoids, androgens,
too many mineralcorticoids, glucocorticoids, androgens = cushings-pituitary (inc cortisol)
too little mineralcorticoids, glucocorticoids, androgens = addisons-adrenal (dec cortisol)
cushings syndrome is caused from too much steroids (prenidone) brusing, muscle waste, fatty, poor wound healing, moon face, moods up/down, anmenorea, impotent, gynomastia
side effects of steroid therapy osteoparosis, fat to belly, cataracts, moon face, muscle atrophy, DM. diet dec Na, inc Ca
goup of disorders caused by impared DNA synthesis Megaloblastic Anemia
Megaloblastic anemia causes defective RBC maturation, large RBCs, the RBC have fragile cell membranes which are easily destroyed
Instrinsic factor is secreated by gastric mucosa
Need IF to absorb cobalamin (B12)
Absence of intrinsic factor pernicious anemia-onset after 40yo, large RBCs, dec B12 levels, SERUM FOLATE IS NORMAL,
parietal cell function test with radioactive cobalamin adm shillings test
Upper GI and biopsy of gastric mucosa test for pernicious anemia can cause inc risk of gastric cancer
assessment finding for pernicious anemia sore tongue (red, beefy/shiny), N/V, abd pain, weakness,
drug therapy for pernicious anemia dietary B12 doesnt work...use parenteral, intranasal, sublingual.
increased production of RBCs and impaired circulation dt inc blood viscosity Polycythemia
chronic chromosomal mutation with inc RBCs, WBCs and platelets Polycythemia Vera
Hoypozia driven, inc O2 demand secondary polycythemia
ns assessment for polycythemia Plethora (ruddy complexion), intermittent claudication (pain in butt, back of legs at rest)
managemnt of primary polycythemia vera phlebotomy, monitor i/o, RBC, WBC, platelets, active/passive leg exercises, amb when ordered.
amb would not be ordered due to clots
managment of secondary polycythemia control chronic pulmonary disease, no smoking, high altitudes
prehypertension SBP 120-139, DBP 80-89
HTN inc risks for MI, hear failure, stroke, renal disease, silent killer, unknown cause
target organ diseases for HTN heart, brain, pere\ipheral vascular disease, kidney, eyes
HTN heart disease CAD, L ventricular hypertrophy, heart failure
HTN cerebrovascular disease stroke, 4 times more likely to have one
HTN peripheral vascular disease speeds up atherosclerosis in peripheral blood vessels
atherosclerosis can lead to PVD, aortic aneurysm, aortic dissection intermittent claudication
death of nephrons from narrowing of the arteries and arterioles nephrosclerosis, leading cause of ESRD
labs for nephrosclerosis albumin, proteinuria, hematuria, elevated BUN and creatinine
s/s HTN fatigue, reduced activity tolerance, dizziness, palpitations, angina dyspnea
ns mangement of HTN inc fiber, dec fat, inc water, dec salt, dec wt
fall in bp when a person stands orthostatic hypotension
3 factors of orthostatic hypotension cardiac func, vascular status, intravascular blood and fluid volumes
orthostatic vs bp from lying to sitting to standing q 2 min. SBP inc by 20, DBP inc by 10 and HR inc by 20
2 main actions of antihypertensives dec CO or reduce systemic vascular resistance (the squeeze of vessels
pts on thiazide should eat foods rch in potassium
pt taking thiazides should avoid what OTC NSAIDs-dec diuretic effects
monitor what for loop and K+ sparing diuretics orthostatic hpyotension, hypokalemia, i/o, wt
pt taking aldoctone (aldosterone receptor blockers) should not eat fruit w potassium
avoid what with catapres (adrenergic inhibitors) any sedative
pt on lopressor (beta blocker) requires monitoring of BP and P
pt on Apresoline (direct vasodilators)and urine is brown and 1+ edema on ankle what going on rapidly progressing glomerilonephritis
side effect of Vasotec (ACE inhibitor) dry hacking cough, in the lungs causes cough. angioedema
swelling of face and tongue angioedema, allergic reaction from ACE-inhibitors
pt on Cozzar (angiotension II receptor blocker) still has high BP med takes days to weeks to work
elevated BP w a specific cause that can b identifies and corrected secondary HTN
causes of secondary HTN MAO inhibitors w tyramine foods (wine, cheese, cured meats), estrogen replacement therapy, the pill, NSAIDS
clinical finding of secondary HTN hypokalemia, abd buit, variable BPs w tacy, sweating, tremors, fam hx of renal disease
CAD fatty deposits on aterial wall that cause inflam "hrdening of the arteries"
dec risk for CAD diet, lifestyle, exercise, no smoking, no ETOH
causes of CAD cholesterol>240, SBP>160, >1 pack a day smoker
CAD med that causes Rhabdomyolosis statins
rhabdomyolosis breakdown of skeletal muscle, products get caught in kidneys and cause renal failure
common side effects of niacin itching, hot flashes
fibric acid derivative increase the effects of coumadin
bile acid sequestrants interfere with absorption of digozin, thiazide diuretics, warfarin, penicillins
cholesterol absorption inhibitors should not be use with what condition liver impairment
natural lipid lowering agents niacin, garlic, omega-3 fatty, psyllium, soy, phytosterols (nuts, seeds), red yeast rice
leading cause of death CAD
chest pain angina pectoris-caused by dec supply of oxygen to heart muscle
noncardiac factors that dec O2 to myocardial cells anemia, asthma, COPD
noncardiac factors that inc O2 demand of myocardial cells anxiety
cardiac factos that dec O2 to myocardial cells coronary attery spasm, thrombosis, dysrhymias, heart failure
cardiac factors that inc O2 demand of myocardial cells aortic stenosis, cardiomyopathy, tachy
type of Angina Chronic Stable Angina-secondary to CAD, tx w rest and nitrate
type of angina Prinzmetals angina-occurs at rest due to coronary artery spasm. tx w Ca Channel blockers
Chronic stable angina pain at rest in neck, jaw, shoulders, arms, between shoulders lasts 5-15min.
manifestations of CAD tend to occur during early morning after wakening
questions for chest pain Precipitating evens, Quality of pain, Radiation of pain, Severity of pain, Timing
tx for chronic stable angina Antiplatelet/anticoagulant, ACE, antiotension receptor blocker; B-adreergic blocker (BP); Cigarette smoling, calcium channel blockers, cholesterol; Diet, DM; Exercise, education; Flu vacc
unstable angina at rest, worsening pattern,
nitro pain should be relieved in 3 min and last for 30-60min. can give another 5 mins apart x3.
nitro can cause dec BP and HA due to vasodilation
teaching of nitro accessible at all times, keep in dark bottle, replace q 6 mths, under tongue, feel tingle, no ED drugs, change positions slowly, HA
sustained ischemia causing myocardial death Myocardial infarction (MI) by thrombus, pain not relieved
cardiac disorder that impairs the ability of the ventricle to fill with or eject blood Heart failure
why HF instead of CHF not all pts have volume overload at the time of intial or subsequent evaluations
s/s HF ventricular dysfunction, reduced exercise tolerance, diminished quality of life, shortened life expectancy
most common reason for hospitalization adm in adults >65yo HF
two most common causes of L sided failure systolic failure, distolic failure
systolic failure most common, L ventricle fails to contract/pump dec ejection fraction ends up w pulmonary congestion. listen to lungs
diastolic failure ventricls stiffen, dec filling, selling feet, some lung congestion
sign of L sided heart failure no urinary output
right sided failure R ventricle fails pump enough blood to meet body needs, ventricle cant accept all the blood returning to the heart.
s/s of R sided failure backs up into veins/capillaries, edema, dry lungs, generalized edema
Heart failure assessment Fatigue, Activities limited, Chest congestion/cough, Edema, SOB
Heart failure assessment dec blood flow to extremities less hair, chest pain, dusky cool skin, edema, tachycardia, SOB
s/s R sided HF Jugular vien distention, pedal edema, wt gain, fatigue, dependent bilat edema, URQ pain
s/s L sided HF crackles, changes in mental status, confusion, restlessness, weak, dyspnea, shallow resp, SOB in recumbant, cry hacking cough, nocturia
1+ edema mild pitting, slight indentation, no perceptible swelling of the leg
2+ edema moderate pitting, indentation subsides rapidly
3+ edema deep pitting, indentation remains for a short time, leg looks swollen
4+ edema very deep pitting, indentation last a long time, leg is very swollen
digoxin (Lanoxin) dec and strengthens heart beat, check apical HR (>60) prior to adm
digoxin toxicity yellow vision, halos. anecdote=digibindIV
tx for heart failure diuretics (K+ waisting loops) watch electorlytes (K+, Na), morphine for pain causes vasodilation of lungs to inc capacity
major cause of PAD athrerosclerosis
drug for intermittent claudication trental, pletal
tx for PAD Trental, Pletal, walking, inspect feet, exercise till discomfort than rest start again
surg tx for PAD percutaneous transluminal ballon angioplasty, atherectomy (remove plaque), peripheral artery bypass w graft, endarterectomy (remove plaqe from artery), amputation
thrombosis and fibrosis occur inside the vessel causing exchemia Buerger's Disease
Buerger's Disease obstruction of small arteries, loss of phlanges, stop smoking
episodic vasospastic disorder fo small cutaneous arteries of fingers and toes Raynaud's phenomenon, 15-20 yo women.
second leading cause of cancer in women breast cancer, 1st is lung
increased exposure to estrogen causes breast cancer
breast cancer tumors are hard, circular, dimpling, immovable, non tender, large
risk for endometrial cancer having 1 or more 1st relative w oravrian cancer, too much extrogen
beta blockers cause ED
S/S prostate cancer painless enlargement, heaviness, dragging sensatoin
most dangerous rooms for elderly kitchen, bathroom, bedroom
medication risks absorption, distribution, biotransformation, excretion
medication errors polyphrmacy, living alone, inadequate education, inadequate finances, medication regime understanding. 60% take meds wrong
drug toxicity earliest sign.. mental confusion
4 types of extrapyramidal reactions. Early onset.... acute dystonia (severe spasm), Parkinsonism (mask face, drooling, tremors, shuffling, stoop, pill rolling), Akethisia (pacing, squirming)
late onset tardive dyskinesia (tongue, face, swallowing dec) not reversiable
insulin reaction speech disorder, slurring, confusion, disorientation. elderly w beta blockers have hpyoglycemic unawareness
fluid filled sac that cushions a jt. can become inflamed bursa-bursitis
attaches muscle to bone tendon-tendonitis is from overuse
inflammation of muscle myositis
RICE rest, ice, compression, elevation. Ice no more than 20min
tx for swelling and effusion aspiration and rice
infection in bone osteomyelitis by staff aureus
most common osteomyelitis indirect via blood stream from elsewhere in body
direct osteomyelitis contamination from surgical site, fx, DM foot ucler
bone deterioration osteoporosis-deficit in bone replacement
ostoporosis bone density test, post menopausal, kyphosis, fx, pain, Ca+vitD, no salt, caffeine, WB exercise, fosomax, evista
rehabilitation begins the first day
loss of motor function paralysis
lesser degree of paralysis paresis
paralysis-legs lower body paraplegic
paralysis all 4 limbs tetraplegic
brain thru spinal cord upper motor neuron
spinal cord to muscle lower motor neuron
sensory impulse to corn, motor neuron, muscle or gland motor reflex arc
sacral reflex arcs intact sacral sparing
proprioception ur understanding where ur limbs are
cervical injury C1-2=freq fatal (vent dependant; C3-4 vent dependent, diaphragm weak; C5: if can shrug shoulders, no vent, only diaphragm to breath, no intercostals, has shoulder/elbow func, most common cervical injury
thoracic/lumbar:paraplegic T1-6 confined to WC; T6down=parapareiss, WK, braces, they shake; above S2=reflex present for bowel/bladder emptying, S2-4, reflex arc destroyed
impaired resp-vent C1-4 frequent pulmonary inf, assisted cough, breathing exercises, possible phrenic nerve stim
impaired O2 transport:immobility TEDS to prevent pooling, no IMs below injury, ROM q 8*
Bladder problems above S2 (UMN)Reflexic bladder Hypertonic, <150CC capacity, reflex voiding, urgency, frequency, stroke trigger areas
Badder problems S2-4 Areflexic reflex destroyed, hypotonic,>500cc residual(cant empty), overflow voiding, crede or St cath
Bowel problems above S2 (UMN) Reflexic spastic bowel, dulcolax suppos, digital stim
Bowel problems S2-4 (LMN) Areflexic Atonic bowel, enemas, digital removal,
sexuality above C5 and up, women use birth control (not pill)
exaggerated ANS response to stimuli Autonomic dysreflexia
autonomic dysreflexia pt w lesion above T6 (often due to full bladder or bowel)can last 6yrs after injury.
s/s autonomic dysreflexia generalized vasoconstriction first then sudden severe HTN. HA, brady, inc BP, dec P
autonomic dysreflexia can result in CVA, SAH, seizure and death
Ns intervention for autonomic dysreflexia fast action..raise HOB (90*), BP,check for full bladder, bowel, UTI, kinked cath, use anesthetic lubricant for digital stim and cath,
device that prevents neck flexion halo traction
musculo-skeletal changes in the elderly primary dec muscle mas/strength, jt mobility, shoulder width, disc space mineral loss in bones, fat to belly
musculo-skeletal changes in the elderly secondary unsteady gait, osteoporosis, fax, curvature of spine, osteo arthritis
inflammation of freely moveable jts, bilateral, symmetric, poy-arthritis in all extremities Rheumatoid arthritis-autoimmune disease, genetic, rheumatoid factor present
systemic symptoms of RA fever, wt loss, fatiue, feneralized aching, early morning stiffness, tachy, weakness, anemia
local s/s of RA jts stiff, pain, edema, prosimal finger jts enlarged, swan neck deformity, nodules on extensor surfaces
who are more susceptible for getting RA Pima and Chipawa tribe women
meds for RA DMARDS (Methotrexate #1), NSAIDS, asprin (enteric coated 4-6gm), Anit inflams (Prednisone),
Ns interventions for RA pain, inflam, ROM warm H2O therapy, own ADLs, assistive devices, splints for extension not flexion
removal of synovia, reduces inflam and helps maintain jt func synovectomy
jt replace ment arthroplasty
cut bone to change alignment or correct deformity osteotomy
fusion of jt arthrodesis
chronic inflam autoimmune disease (vascular and connective tissue) systemic lupus erythematosus-multi system disease, reversible form, poly arthritis, red butterfly rash
what caused lupus procame
dx of lupus +LE cell prep and ANA, Anti-DNA, Anti-Smith (most dx)
inflam disease of voluntary muscle polymyositis-degeneration of muscle fibers. tx high dose steroids
s/s of polymyositis muscle weakness, difficulty moving/swallowing, symmetrical, includes polyarthritis, arthralgias and Raynauds
polymyositis with rash, dermatomyositis-more prone to malignancy with in 5 yrs. tx high dose steroids
disease that affects jts and surrounding tissue, loss of srticular cartilage in WB jts osteoarthritis (DJD) from over use
s/s of DJD pain, stiffness in jts after rest, crepitation, Bouchard(PIP) and Heberden(DIP)nodes
tx for DJD tylenol (4gm),
metabolic disorder, too much uric acid gout-no meat, alcohol
3 causes of gout poor renal excretion of uric acid, metabolism of purine, inc in uric acid production,
s/s of gout crystals in tissues cause pain (jts/kidneys), red swollen jts,
swollen red great toe podagra
meds for gout culchasine, fluids, uloric, cozar and zyloprim together
tx for gout meds, ice, elevate, uric acid levels, foot craddle
benign bone tumor osteoma
malignant bone tumor osteosarcoma-young males 10-25yo and fatle, pain swelling in knee
dx of bone tumors ALK phos and Ca will be inc, CAT scan, PET, MRI, biopsy
complications of amputations hemorrhage, edema, contractures, inf
care for amputations no elevations, chair rest x1hr, prone 3-4xdaily, monitor stump for bleeding, body image
Created by: vstein