nur131 exam 1
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| bp on children 3yrs and older |
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| head circumference on children up to 2 yrs |
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| general guidelines for PA | flexibility, several obs at once, least distressing first, use games, dolls, kind but firm, painful last
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| general guidelines for PA II | safety, sit on parents lap, adolescents may not want parents in room,
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| general guidelines for PA III | ask permission to treat, into yourself, explain what ur doing, call child by name
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| the nurse obtains vs from a 1 year old, which are normal |
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| specific protection, immunizations, smoking cessations, decreasing pollution, fluoridation program, communicable desease, nutrition | primary prevention
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| early diagnosis and tx, screening, surgical intervention, prevent further complications | secondary prevention
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| have problem, tx to maximize their remaining capacities, rehab, teach insulin use, | tertiary prevention
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| family assess factors | family structure, health status, communication,parent understanding of growth and development, spiritual beliefs, socioeconomic status
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| characteristics of healthy families | communicate openly, flexible role assignments, agree on basic principles, members volunteer to assist
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| family risk factors | conflict in marriage, adolescent parents, violence, ill child, substance abuse
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| family stressors | time, separation, money, health, transportation, work, disability
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| coping strategies | identify strengths, reliance on family group, use of humor, links to community help,
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| the stage of family development is always determined by the age of the oldest child |
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| 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.
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| 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
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| stage3; families with preschoolers | socialize children, parents and children adjust to separation. growth and development, accidents, poison prevention, communicable disease
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| 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.
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| 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.
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| 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
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| stage 7; middle aged families | reinvest in couple identity, development of new interests,death of older generations. loss, grief, health promotion and illness prevention.
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| stage 8; aging families | leave work to retirement, prepare for own death, loss of spouse or siblings, peers. optimal wellness in illness
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| sequential reaction to cell injury, dilute/neutralizes the inflammatory agent, removes necrotic materials, establishes an environment suitable for healing/repair | inflammatory response
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| cardinal signs of inflammation | pain, swelling, heat, redness, loss in functioning
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| clean wound w little loss of tissue, rapid healing w minimal inflam | primary intention, primary union
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| wounds from trauma, ulceration, inf, lost of exudate, gaping of wound edges | secondary intention, granulation
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| greater granulation, greater risk of inf, late suturing and more scarring | tertiary intention, secondary suture
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| causes redness and heat | vasodilation of bv
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| causes edema and pain from pressure | increase in capillary permeability
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| strengthens a blood clot and traps bacteria in wound. prevents spread | fibrin
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| accumulation of neutrophils, monocytes, leukocytes | cellular response
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| at injury site first, phagocytize debris, exudate | neutrophils, phase 1
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| monocytes clean up crew till clean, hang out longer | cellular response phase 2
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| kill foreign cells, produce antibodies | lymphocytes
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| released for allergic reactions, control histamine | eosinophils
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| carry heprin increase w any inflam response | basophils
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| cause vasodilation | prostaglandins
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| stimulate chemotaxis | leulotrienes
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| contraction of smooth muscle, dilation of bv = pain | kinins
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| cause onset of fever | cytokines
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| benefits of fever | increased killing of microbes, release of lymphocyts and phagocytosis
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| disadvantages of fever | dehydration, seizures
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| first 3-5 days, swollen, fibrin clots | initial phase
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| immature connective tissue cells secrete collagen. surface epithelium at wound edges | granulation phase
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| scar contraction, scar appears pale and avascular | maturation phase
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| factors that impair wound healing | age, malnutrition, obesity, impaired oxygenation, smoking, drugs, diabetes, radiation, wound stress
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| after surgery what CBC lab report what blood cell would be elevated | neutophils
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| an immediate threat to survival. Ex; obstructed airway | first priority need
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| an actual problem that pt or family request help with. ex; pain med | second priority need
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| a relatively urgent actual or potential problem that pt or family dont recognize. ex; monitoring for post op complication | third priority need
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| an actual or potential problem that pt or family may need help with in the future. ex; discharge planning teaching needs | forth priority setting
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| 6 pt rights for meds | right pt, med, time, dosage, route, documentation
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| steroids and stress increases BG |
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| med to decrease stress ulcers and stomach acid prior to surgery | prilosec, previd
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| tape wed rings on, prosthetic to family, hospital protocol, hearing aids in to follow direction give back after surgery. |
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| 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,
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| scrub nurse | prep room, dress others, prepares in sterile field,instrument, passes instruments, counts, tracks solutions, blood loss, reports amounts of meds
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| anesthesiologist | manage pt unconscious, pain, cardiopulmonary resuscitation, problems in pulmonary care, critically ill pts in special care units
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| RN first assist | handling tissue, using instruments, providing exposure to the surgical site, assisting with hemostatsis, and suturing
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| surgeon | preoperative hx, physical assessment, surgery, preoperative testing, pt safety, management in the OR, post op management of pt
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| sterile zone | below shoulders to above waist, do not turn back, reach over, 1/4"-1/2" edge around equipment
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| loss of consciousness and sensation | general anesthesia
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| loss of sensation to a region of body wo loss of consciousness | regional anesthesia
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| block the initiation/transmission of autonomic, somatic sensory, somatic motor impulses | local anesthesia
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| used as local anesthesia on skin | EMLA cream
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| used to put pt into a pleasant sleep | fentanyl-opoids
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| an antianxiey drug and amnesiac. premed before surgery | versed-benzodiazepines
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| cause paralysis to prevent the pt from moving, muscle relaxation | neuromuscular blocking agents
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| prevent n/v | antiemetics=droperidol
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| used for aspiration prophylaxis | H2 receptor blockers
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| ABCs | airway, breathing, circulation
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| pts needs in PACU | neurological=LOC, sensory and motor status, safety, dressings, pain, n/v
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| caused by mucus blocking bronchioles, crackles, from shallow breathing d/t pain | atelectasis- use inspirex, turn, cough, deep breathe, ambulation
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| how to cough | hold pillow onto wound/stomach 3 deep breaths than big cough
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| pt blue, poor ;ulse ox, stabbing pain in chest, rapid breathing | pulmonary embolism (clot in pulmonary aterial system)use O2 raise HOB, anticoagulant
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| low BP, urine output of < 30cc/hr, concentrated dark, fast thready pulse, disorientation | hypovolemic shock-IV fluids, tell dr
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| 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,
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| obtain cerebrospinal fluid for analysis | lumbar puncture-pt empy bladder, side lying, needle thru 1-2 lumbar vertebrae, pain down leg, monitor for HA
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| 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.
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| insertion of arthroscope into jt to visualize structure | arthroscopy-outpt, strict asepsis used, local or general anesthetic, explain post procedure restrictions
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| 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
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| slow nono inflammatory disorder of synovial jts and formation of new tissue in response to cartilage destruction | osteoarthritis-disorder of overuse
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| highest risk for osteoarthritis | slender, female, Caucasian, smokers and steroid users
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| calcium, vit D help prevent osteoparosis |
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| risk factors for osteoparosis | trauma to jt, decreased estrogen, ligament injury w quick stops, frequent kneeling
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| reconstruction or replacement of jt | arthroplasty
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| Used to maintain abduction in a client who has had a THR | foam abductor pillow?
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| A complication that may occur if a client is immobile following orthopedic surgery. | deep vein thrombosis?
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| 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?
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| A sign of a femoral neck fracture. | shortening and external rotation of the affect limb?
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| A allergy that would make it dangerous to have a mylogram | seafood or iodine
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| A sign of a herniated cervical disk. | pain and numbness in the arm and hand?
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| The main reason for performing a total knee replacement | osteoarthritis of the knee?
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| Exercises that start the first day after TKR | isometric quadriceps setting exercises?
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| A machine used to promote joint flexibility by using continuous passive motion | CPM machine? continuous passive motion
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| Used in the care for a client who has had bone grafting to correct bone deficiencies after discharge | knee immobilizer?
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| Things that must be avoided for 6 weeks after THR | extremes of internal rotation and 90-degree flexion?
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| 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?
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| The type of total hip replacement that has an extended recovery period | noncemented hip replacement?
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| The type of hip replacement given to younger clients | non cemented hip replacement?
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| Emphasized by all the definitions of pain | subjective nature of pain?
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| Caused by damage to the somatic or visceral tissue | nociceptive pain?
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| Caused by damage to the peripheral nerves or central nervous system | neuropathic pain?
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| Pain scale most commonly used to assess pain in infants and children | FLACC pain scale?
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| Pain that lasts for longer than 3 months | chronic pain?
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| Nausea, vomiting, constipation, respiratory depression, and pruritus | side effects of morphine?
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| Instructions given to clients receiving patient controlled anesthesia | only the patient should push the PCA button?
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| An effect that occurs when morphine is used over a long period of time | building up a tolerance to morphine?
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| Drugs that a client receiving NSAID’s for pain should not be on | any type of anticoagulant?
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| Maximum dose of acetaminophen that can be given in 24 hours | 4 gm’s
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| Signs of compartment syndrome | numbness and tingling, pain, pressure, pallor, paralysis, pulseness?
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| caused by compression of the medial nerve | carpel tunnel syndrome
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| signs of carpal tunnel syndrome | tap on median nerve tingling, phalens sign tingling when hands are dropped into full flexion.
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| spinal surgery care | pillow under knees and between legs for side lying, N, bladder probs, resp distress, numbness, tingling
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| crutch up steps | advance on good foot and bring bad foot
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| cane usage | cane opposite affected leg
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| walker usage | walker with affected leg
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| pain that is tenderness or increased pain away from the area of injury or disease involving visceral organs | referred pain
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| pain that is gone over time as recovery happens, can identify precipitating event | acute pain
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| delivers analgesia directly to the surgical site | stryker pain pump-causes deterioration of jts
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| interrupts generation of never cells by altering the flow of sodium into the nerve cells | local anesthesia
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| non pharmacological methods of pain control | closing the gate w massage, exercise, TENS, acupuncture, heat therapy, cold therapy
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| nondrug cognitive therapies | relaxation, distraction, hypnosis
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| child doses are calculated by wt |
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| increased BUN | impaired renal func, sepsis, inc protein intake, starvation, dehydration
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| increase in creatinine | impaired renal func, 10:1
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| PSA | prostate specific antigen. need more than one test inc w prostate cancer
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| KUB | anteroposterior film of kidneys, ureters and bladder. evals: urinary calculi and masses
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| IVP | IV inj of medium then xrays to eval stones masses hematuria obstruction
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| retrograde pyelogram | stones, contrast adm directly into urinary tract during cystoscopy. evals ureters, renal pelvic and calices. caution pt allergic to iodine
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| cystogram | stress incontinence, contrast into bladder via cathe, evals UTIs, refulx, hematuria, trauma, surgical healing, stress incontinence
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| voiding cystogram | contrast into bladder pics taken while void. evals urethral stricture, fistula, trauma, diverticul.um or tumor
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| prostate scan | fleets enema 45 min prior, transducer probe inserted 4-5 in into rectum
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| 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,
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| 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
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| biopsy is for cancer |
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| urodynamic studies | eval voiding dysfunction r//t the lower urinary tract
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| rectal exam | male: evals prostate, Female: evals sphincter tone
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| indwelling cathe | inc fluids, cathe bag below bladder, wash perineal area 2xday, prevent trauma to urethra, prevent obstruction of blow to collection bag.
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| indwelling cathe needs to be removed asap. used bladder scan to determine residual |
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| painless hematuria is main symptom, predisposing factor is smoking | bladder cancer
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| obstructions TUR and Fulguration | transuretheral resection destruction of tissue by electrical current thru electrodes in direct contanct w the growth
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| partial cystectomy | isolated tumors that cant b treated w TUR, bladder capacity of 60cc, bladder tissue expands over months to 200-400cc
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| radical cystectomy and urinary diversion | whole bladder, urethra, uterus, fallopian tubes, anterior segment of vagina, prostate and seminal vesicles removed, tumors, congenital defects,
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| ileal conduit | portion of intestine used to form stoma, urine continuously flows to collection bag, done pts w less 1-2 years to live
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| indiana pouch | large reservoir under skin, drain w cath q 3-4 hr, 800cc capacity,
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| orthotopic bladder | bladder made of intestine, may need to cathe, may have incontinence
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| ng tube removes content so bowels have no matter to eliminate |
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| 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,
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| first symptom of primary uretheral tumors | hematuria
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| urolithiasis (urinary caluli) | from urinary stasis, decreased fluids and inc solutes.
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| types of calculi | calcium, oxalate, uric acid, struvite, cystine and zanthine
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| clinical manifestations of urolithiasis | severe sudden pain, nv, temp. diagnotic tests: KUB, IVP, cysto
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| tx of urolithiasis | inc fluids, dec pain, prompt tx of UTIs, modify diet, lasers, ultrasonic waves, external sound waves
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| URINARY REFLUX | from congenital abnorm, chronic bladder inf (scar tissure), outlet obstr,
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| tx for urinary reflux | re implantation of ureters
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| postop urinary reflux | urethral or SP cathe splints ureter to heal, prevents obstruction, drains urine
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| urinary retention | post void residue of 100cc, dribbling from detrusor muscle failure, anesthesia, rectal/vaginal prolapse, poor bladder muscle tone
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| tx for urinary retention | cholinergic meds to stimulate bladder contractions, urethral dilations,
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| surgical tx of retention | done if structural defect is found, remove enlarged prostate,
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| BPH | benign prostatic hyperplasia, inc number of normal cells in the prostate
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| clinical manifestatoins | come slow, dec size/force of urine stream, hesitancy, urgency,m nocturia, incomplete emptying, leakage
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| first symptom of primary uretheral tumors | hematuria
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| urolithiasis (urinary clculi) | from urinary stasis, decreased fluids and inc solutes.
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| types of clculi | calcium, oxalate, uric acid, struvite, cystine and zanthine
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| clinical manifestations of urolithiasis | severe sudden pain, nv, temp. diagnostic tests: KUB, IVP, cysto
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| tx of urolithiasis | inc fluids, dec pain, prompt tx of UTIs, modify diet, lasers, ultrasonic waves, external sound waves
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| URINARY REFLUX | from congenital abnorm, chronic bladder inf (scar tissure), outlet obstr,
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| tx for urinary reflux | reimplantation of ureters
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| postop urinary reflux | urethral or SP cath splints ureter to heal, prevents obstruction, drains urine
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| urinary retention | post void residue of 100cc, dribling from detrusor muscle failure, anesthesia, rectal/vaginal prolapse, poor bladder muscle tone
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| tx for urinary retention | cholinergic meds to stimulate bladder contractions, urethral dilations,
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| surgical tx of retention | done if structural defect is found, remove enlarged prostate,
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| BPH | benign prostatic hyperplasia, inc number of normal cells in the prostate
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| clinical manifestations | come slow, dec size/force of urine stream, hesitancy, urgency,m nocturia, incomplete emptying, leakage
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| medical tx of BPH slow growth | proscar (finasteride) dec BPH takes 6-12 months
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| medical tx of BPH relax prostate muscle | Flomax (tramsulosin) Hytrin (terazosin), Dibenzyline,
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| medical tx of BPH for relief of retention | catheterization
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| surgical management of BPH | TURP most common-gold standard
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| post op BPH | monitor bleeding, bladder irrigation, pain management
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| post op teach BPH | no straining during deification, prevent constipation, avoid caffeine, pelvic exercises, ED, follow up, elevated temp, bleeding, signs of UTI
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| physiological differences in children urinary | shorter urethra, complete bladder control isnt until 4-5 yrs, infants cant concentrate urine
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| how kidney is getting waste out of blood is by what lab results | blood urea nitrogen and serum creatinine
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| reasons why children get UTIs | obstructions r/t congenital abnorms, urinary stasis, shorter urethra, inf, reflux, sexual activity
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| clinical assessments | fever, urine culture, urine must b refriged in 10 min, ultrasound for structural issues
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| undescended testes | cryptorchidism
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| ventral opening and curve to penis | hypospadias
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| dorsal opening, rarer | epispadias
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| surgery 6-12 months, no circ foreskin used for repair |
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| surgical care | pressure dressing, stent or closed urinary drainage system, inc hydration, limit activity, meds, no straddling
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| hydrocele
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| no opening to penis | phimosis
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| testicular torsion
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| bladder extrophy
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| more porus basement membrane, proteinuria, hyperalbumineria, reatian Na/H2O, vasocontriction, from strep throat | acute glomerular nephritis
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| leukocytes on the basement membrain of nephron, H2O and Na retention, HTN, dec urine output | nephrotic syndrome
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| assessment finding for AGN | TEA/COKE COLOR URINE, HEMATURIA, PALE SKIN, DEC URINE OUTPUT R/T DAMAGE
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| assessment finding for nephrotic syndrome | generalized edema, ascites, poor appetite, fatigue, cloudy foamy pee, dec UOP trapped in cells
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| lab findings for AGN | hemoturia, proteinuria, serum compliment C3, inc BUN/creatinine, serum k
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| lab findings for nephrotic syndrome | protein in urinalysis, dec albumin and serum protein, inc hematocrit, Hbg normal
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| medical mangement of agn | antihypertensivers, sometimes antibiotics, no salt diet
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| medical mangement of Nephrotic syndrome | corticosteroids (prenisone), antibiotics, diuretics, anti coag, lipid lowering, no salt diets
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| ns care for AGN | check st daily, exact i/o, BP, LOC,
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| 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
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| med that can change your mood and dont give at bed time | prednisone
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| nephrotic syndrome pts are given prednisone and pen for prophalactic | can get pneumonia easily
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| absence of urine production or a urinary output of less than 100 mL/day. changes in urinary volume | anuria
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| is painful or difficult urination; irritative and obstructive manifestations | dysuria
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| is the inability to voluntarily control the discharge of urine, irritative and obstructive manifestations | incontinence
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| is delay or difficulty initiating urination. irritative and obstructive manifestations | hesitancy
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| is diminished amount of urine in a given time (24 hr urine output of 100-400 mL),changes in urinary volume | oliguria
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| is a large volume of urine in a given time and may indicate diabetes mellitus. changes in urinary volume | polyuria
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| is the inability to urinate even though the bladder contains an excessive amount of urine. obstructive manifestations | retention
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| is the sudden, strong, or intense desire to void immediately and is commonly accompanied by frequency. irritative and obstructive manifestations | urgency
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| is blood in the urine, which can indicate cancer of the genitourinary tract, abnormal urine findings | hematuria
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| is the presence of albumin (a water-soluble protein which is most abundant in blood plasma) in the urine, abnormal urine findings | proteinuria
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| 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
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| 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
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| is an increased incidence of urinating (< 2hr intervals between voids) irritative and oabstructive manifestations | frequency
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| is the abnormal presence of a sugar, especially glucose, in the urine; abnormal urine findings | glycosuria
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| is the presence of an excessive number of WBCs in the urine (>5/hpf) and can indicate UTI or inflammation abnormal urine findings | pyuria
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| determines the amount of urine remaining in the bladder after urination. obstructive manifestations | residual
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| CCMS | (clean catch midstream)
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| Urinary retention is determined by measuring the postvoid residual (PVR) with the use of a bladder scanner. |
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| first empty bladder collect voids for 24 hours, put on ice | 12-24 hours
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| sterile clean void catch and sensitivity testing to see what antibiotic will work | C&S
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| EXAM II external intact skin, mucous membranes, tearing, sneezing, coughing | first line of defense (immune response)
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| kill foreiegn substance, antibodies, immune complex to destroy antegen | 2nd line of defense (internal defenses)
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| protein produced in response of viruses | interferon (nonspecific immune)
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| cellmediated production of lymphocytes, react to viruses fungi parasites foreign tissues and other antigens | specific immune funcitons
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| plasma lymphocytes (B cells) in response to an antigen | humoral immunity
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| immunoglobulin that crosses the placenta, secondary immune response | IgG
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| lines mucous membranses protects body surfaces | IgA
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| primary immune response, forms antibodies to ABO blood antigens | IgM
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| on lymphocyte surface differentiation of B lymphocytes | IgD
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| allergic reaction symptoms, fixes to mast cells and basophils, defend against parasitic inf | IgE
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| reacts to antigen, long lived, exposure ot environmental antigen or vaccines, produces antibody | active immunity
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| antibody transfer from one to another. most maternal antibodies are gone in infant about 8-9 months | passive immunity
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| infants dont show signs of inf until later, more rapid spread |
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| immune response to an antigen occurs with | second exposure
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| severe immediate hypersensitivity response | anaphylaxis
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| histamines released causing vasodilation, broncho constriction and increased capillary permeability | anaphylaxis
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| urticaria | hives
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| NS interventions for anaphylaxis | airway, tourniquet(snake bite), adm epinephrine
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|
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| number one intervention for communicable diseases | hand washing, cough into tissue
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| viral exanthem fever drooling, vesicular exanthem on palms and bottom of feet, droplet spread | coxsackie A-16 hand, foot and mouth
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| viral exanthem slapped cheek appearance, malaise, mild fever, lacy maculopapular rash on trunk and extremities in 1-4 days | fifths disease
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| 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
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| 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
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| 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
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| initial stage of a disease | prodome
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|
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| 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
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|
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