MedSurg (ATI) Flashcards

pts
Terms Definitions
what are the ABCDE's of emergency are?
Airway/neck/spine
Breathing
Circulation
Disability
Exposure
Heat stroke presentation and Tx
hypotension, tachypnea, tachycardia, anxiety, confusion, bizarre behavior, seizures, coma.

Tx w/ rapid cooling measures
Frostbite presentation and Tx
white, waxy; may be full- or partial thickness;
Tx w/ warm waterbath (38-41 C), pain meds, and tetanus shot
define Cardiac Arrest
sudden cessation of breathing and adequate circulation of blood

= no pulse and no breathing
without sufficient O2 supply, the brain will suffer cell anoxia within how many minutes?
within 4-6 minutes
goals for management of cardiac arrest include...?
- rapid ID of S&S
- initiate circ and resp support
- activate EMS
- use emergency equipment
- stabilize pt
- Dx and Tx
Chain of survival involves...?
- early activation of EMS
- early CPR/defib
- early ACLS
10 most common causes of Pulseless Electrical Activity (PEA):
- hypovolemia (low volume)
- hypoxia (low oxygen)
- hydrogen ion excess (acidosis)
- hyper-/hypo-kalemia (high/low K+)
- hypothermia (low body temp)
- taking drugs (overdose)
- tamponade (cardiac)
- tension pneumothorax (oneway valve in pleural cavity)
- thrombosis (pulmonary)
- thrombosis (coronary)
10 most common causes of Pulseless Electrical Activity (PEA):
5 H's and 5 T's
Meds for VF or pulseless VT:
(BEV LAMP)
- Bicarbonate
- Epinephrine
- Vasopressin
- Lidocaine
- Amiodarone
- Magnesium sulfate
- Procainamide
Defibrillator Steps:
1. turn on defibrillator
2. select energy lvl ~ 200 J
3. "lead select"
4. apply gel to paddles
5. position paddles on pt
6. check monitor display and assess rhythm
7. "Charging, Stand clear!"
8. press charge
9. "Shock on 3. One, I'm clear. Two, you're clear. Three, everybody's clear"
10. apply 25 lb pressure on both paddles and shock
11. check monitor for rhythm
Proper CPR steps (list 9)
1. check for unresponsiveness
2. call for help
3. position client
4. open airway
5. check for breathing
6.perform ventilations
7. check circulation (pulse)
8. start compressions
9. check for spontaneous pulse
What are the normal ranges for ABG?
pH: 7.35-7.45
PaO2: 80-100 mmHg
PaCO2: 35-45 mm Hg
HCO3: 22-26 mEq/L
What is Allen's test?
Allen's test verifies patency of radial and ulnar circulation.
- compress both ulnar and radial arteries while client forms fist
- have client relax and let go of one artery, hand should turn pink
- repeat and let go of other artery
how long should pressure be applied on a puncture site for a patient receiving anti-coagulant therapy?
20 minutes
what S&S should be reported to the doc following an arterial puncture?
ashen fingers and hand
what are the early S&S of hypoxemia?
- tachypnea
- tachycardia
- restlessness
- pallor
- HTN
- resp distress
what are the late S&S of hypoxemia?
- confusion and stupor
- cyanosis
- bradypnea
- bradycardia
- hypotension
- cardiac dysrhythmias
what are the S&S of oxygen toxicity?
- nonproductive cough
- substernal pain
- nasal stuffiness
- N/V
- fatigue
- HA
- sore throat
- hypoventilation
why be careful of giving too much oxygen to COPD patients?
they rely on their low levels of arterial oxygen to drive their breathing
suctioning should not exceed how many seconds?
15 seconds
what do you do for ventilator patients right before you suction?
hyperoxygenate w/ 100% FiO2
what is a contraindication for a bronchoscopy?
severe tracheal stenosis
what 2 things do you check for before giving anesthetic agents to patients?
pt allergies & presence of dentures
contraindication to chest tube insertion and thoracentesis?
severe thrombocytopenia (due to risk for excessive bleeding)
what do you do first if the chest tube tubing becomes disconnected?
place tubing in sterile water to restore water seal
S&S of pneumothorax?
(similar to CHF in older adults)
dyspnea, JVD, pallor, coughing
instruct the patient to do what during a chest tube removal?
perform valsalva maneuver (or take a deep breath and hold it)
Assessment findings of pleural effusion?
- decreased breath sounds
- dull percussion sounds
- decreased chest wall expansion
- pain
Amount of fluid removed via thoracentesis is limited to how much at a time?
1 L (to prevent cardiovascular collapse)
How to position a patient for thoracentesis?
Sit upright with arms and shoulders raised and supported on pillows on overbed table (also no talking or coughing unless instructed)
Manifestations of shock?
- hypotension
- reflex bradycardia
- diaphoresis
- faintness
indications for thoracentesis:
transudates
- CHF, cirrhosis, nephritic syndrome
exudates
- empyema, pna
chest trauma
- lung/heart surgery, blunt/crushing injury
client position for thoracentesis:
sitting upright w/ arms and shoulders raised and supported on pillows on overbed table.
No coughing or talking
after thoracentesis, place pt on which side and for how long?
place pt on unaffected side for 1 hr.
post-thoracentesis CxR is for?
to r/o pneumothorax and check resolution of effusions
T/F. It is important to assess the trach pt for risk for aspiration.
True.
what type of trach provides a seal between the upper and lower airway and is used for pts receiving mechanical ventilation?
cuffed trach
what type of trach is used for kids under 8 yrs and for those who can protect the airway from aspiration?
uncuffed trach
what type of trach is used for pts with long or extra-thick necks?
single-lumen tube
what type of trach is used permanently?
metal trach
for cuffed trachs, keep pressure below what level to reduce risk of tracheal necrosis due to prolonged compression of tracheal capillaries?
below 20 mm Hg.
provide trach care how often?
Q8h.
what vent mode provides preset ventilator rate and tidal volume but requires pt to initiate breaths?
AC (assisted control) mode
what is SIMV mode?
SIMV (Synchronized Intermittent Mandatory Ventilation) has present vent rate and tidal volume. The pt can initiate breaths but tidal volume depends on client's effort. If pt does not initiate breaths, the vent takes over but synchronizes with pt's breathing pattern.
What is PSV mode?
Pressure Support Ventilation mode. Present pressure delivered during spontaneous inspiration to reduce work of breathing. The pt controls rate and volume. Often used as a weaning mode. However, PSV doesn't guarantee minimal minute ventilation and is often combined with other modes (SIMV, AC).
What is PEEP?
Positive End Expiratory Pressure. Used to increase functional residual and improve oxygenation by opening collapsed alveoli. Must be used in combo with AC or SIMV, can't be used alone. It decreases CO and may cause trauma to lung tissue caused by high tidal volumes and increased ICP.
high pressure alarm sounds on the vent indicates?
- pt biting the tube
- need for suctioning
- kinks in tubing
low pressure or low volume sounds on the vent indicates?
- tubing disconnections
- air leaks around cuff
3 characteristics of Asthma:
- edema
- bronchoconstriction
- secretions
what test is the most accurate for diagnosing asthma and its severity?
PFT (pulmonary function test)
a decrease in FEV1 or PERF by how much is common for asthma pts?
15-20% below the expected value
Albuterol: class
short-acting beta agonist
(provides rapid relief for asthma)
Ipratropium (Atrovent)
anticholinergic: blocks parasympathetic NS and allows for sympathetic NS to exert its effects such as bronchodilation.
theophylline (Theo-dur)
methylxanthine - bronchodilator (cousin of caffeine)
Prednisone class and side effects
corticosteroid (antiinflammatory): Side effects include immunosuppresion, fluid retention, hypgerglycemia, hypokalemia, and poor wound healing.
Montelukast (Singulair)
Leukotriene antagonist
cromolyn sodium (Intal)
mast cell stabilizer
Status Asthmaticus: what is it and what to do when it happens?
life-threatening; often unresponsive to common tx.
Prepare for emergency intubation and potent systemic bronchodilators like epinephrine as well as systemic steroid therapy.
COPD encompasses 2 diseases:
- emphysema
- chronic bronchitis
What is emphysema?
loss of lung elasticity that results in destruction of alveoli
- hyperinflation
- resp acidosis
What are the leading risk factors for developing COPD?
1. smoking
2. Alpha-antitrypsin (AAT) deficiency
3. air pollution
T/F. Most people with emphysema also have chronic bronchitis.
True
What is used to classify COPD as mild to very severe?
FEV to FVC ratio.

smaller ratio = worse COPD
Why monitor H&H in COPD pts?
to recognize polycythemia (compensation to chronic hypoxia)
Provide COPD pts with 2-4L/min O2 via NC. For pts with chronic hypercarbia, provide more or less O2 and why?
less. because low O2 levels are needed to drive their breathing.
what is Cor Pulmonale?
Right-sided heart failure.
- blood flow through lungs is hard
(resulting from alveoli stiffness or airway collapse)
- thickens right side of heart
- poor oxygenation
characteristics of PNA?
inflammation of lungs that results in:
- edema
- exudate
PNA: what are the 8 risk factors?
- age
- infections
- smoking
- aspiration
- chronic lung probs
- immobility
- mechanical ventilators
- immunocompromised status
what does high-Fowler's position help with?
breathing and air exchange
what kind of O2 therapy is prescribed for pna?
heated and humidified O2
why give corticosteroids for pna?
decreases airway inflammation
5 side effects of corticosteroids:
- immunosuppression
- fluid retention
- hypgerglycemia
- hypokalemia
- poor wound healing
diminished or absent breath sounds could indicate?
atelectasis
two common manifestations of pna in older adults?
- confusion
- hypoxia
how long does it take for pts exposed to pathogens to exhibit S&S of infeciton?
1-2 days
ghon tubercles are a characteristic of what infection?
TB
T/F. A person with TB is not contagious until S&S are present.
TRUE
TB skin test will be positive how long after exposure to TB?
2-10 weeks.
TB dx is confirmed by what?
Positive sputum culture.

- sputum smears (acid-fast) only shows how infectious it is.
the best sputum samples should be taken when?
Early morning.
- first morning specimens are the most accurate.
4 things to consider when taking Isoniazid (INH)?
- watch for hepatitis
- watch for neurotoxicity
- take on empty stomach
- take Vit B6 to prevent toxicity
Rifampin (RIF):
2 things about RIF?
- orange/reddish pee, sweat, tears
- watch for hepatotoxicity
Pyrazinamide (PZA):
watch for what when taking this drug?
hepatotoxicity
Ethambutol (EMB):
watch for what when taking this drug?
changes in visual acuity
Streptomycin: watch for what when taking this drug?
ototoxicity
encourage foods rich in what 3 things for TB pts:?
- protein
- iron
- Vit C
TB pts are no longer considered infectious after how many negative sputum cultures?
3
Hallmarks of ARDS:
- hypoxemia that does not improve with oxygen therapy
- extensive pulmonary edema (whiteout on x-ray)
decreased UO with tall peaked T waves indicate:
hyperkalemia
describe second degree AV block (type I):
when PR intervals progressively lengthen and some P waves are not followed by QRS complexes.
(P waves are regular)
Expect what if pt is malnurished and is breaking down fats for energy?
ketones in urine
Why be sure to take calcium and thyroid hormone supplements several hours apart?
calcium reduces absorption of thyroid hormones.
But thyroid hormones do not increase need for calcium.
T/F. Thiazides reduces renal excretion of calcium.
T.
So need less calcium supplementation.
high BS, hx of pituitary tumor, and osteoporosis may indicate:
Cushings
What blocks coagulation by enhancing the inhibitory effects of antithrombin, which prevents conversion of prothrombin to thrombin and fibrinogen to fibrin?
Heparin
What interferes with the hepatic synthesis of Vit. K-dependent clotting factors, thereby reducing the supply of coagulation factors II, VII, IX, and X?
Warfarin/Coumadin
modes of Hep B transmission:
- blood
- semen/vaginal fluids
- saliva
- NOT by tears, urine, or sweat
T/F. Acoustic neuroma results in reversible hearing loss.
False.
It is permanent irreversible damage to CN VIII.
What is a life-threatening finding in an asthma pt that suggests severe airflow obstruction?
silent chest
T/F. Traction pins should be covered with dressing and changed daily.
False.
Traction pin sites should be covered initially, but then should be exposed to air. Rinsing with sterile saline is ok.
How can cardiac cath result in intrarenal renal failure?
the dyes used can be nephrotoxic
What distinguishes MI from angina pectoris?
Rest and Nitroglycerine do not relieve MI pain.
topical glucocorticoids do WHAT to the skin?
- THINS the skin
- DOES NOT darken skin.
T/F. Constant bubbling in a chest tube closed water-seal system is normal.
False.
Intermittent bubbling is normal.
Constant bubbling indicates air leak --> tension pneumothorax.
T/F. Use salt substitutes for chronic renal failure pts.
False.
Salt substitutes contain high K+.
Why do chronic renal failure pts need folic acids supplements?
to treat anemia because their erythropoietin production is inadequate.
an aura precedes what type of seizure?
partial.
common findings for acute renal failure:
- high K+, P, and Na+
- low Ca++
- fluid volume overload
- increased BUN & Cr
- metabolic acidosis (high H+)
- UO under 400ml/day (oliguria)
- anemia
name 3 nephrotoxic drug groups:
- NSAIDS (e.g. ibuprofen)
- Aminogylcosides (e.g. gentamycin)
- ACE inhibitors (e.g. catopril)
must administer tPA drug for CVA victims within how long of onset?
3 hours
what is tPA?
tissue plasminogen activator, a clot buster.
extreme paralysis is an indication of CVA in which hemisphere?
right
what's Guillain Barre?
- postinfection polyneuritis
- autoimmune disorder that attacks mainly Schwann cells and destroys their myelin sheaths.
what characterizies guillan barre?
- ascending flaccid motor paralysis
- loss of sensory function
- loss of DTR's
- weakness before paralysis
- loss of respiratory muscle control
what are some systemic effects of guillain barre?
- loss of sphincter control
- bladder/bowel retention
- sweating, sputum
- SIADH
which two CN's are not affected by Guillain barre?
CN I - olfactory
CN II - optic
how do you diagnose guillain barre?
- lumbar puncture
- PFT
- EMG
- CBC/ABG's
what is one cardio side effect of Timolol?
brady.
check pulse rate.
T/F. Simple seizures do not involve a change in consciousness.
True.
Complex seizures involve a change in awareness/consciousness.
What 6 metabolic abnormalities can result in seizures?
- uremia (ARF)
- hepatic failure
- PKU (phenylketouria) due to lack of a hepatic enzyme (genetic)
- nutritional deficits
- drug/alcohol w/drawal
- drug/alcohol use
What is Myasthena Gravis?
autoimmune disorder that affects skeletal muscles that manifests in weakness and fatigability.
Name 4 disorders associated with Myasthenia Gravis:
- rheumatoid arthritis
- SLE
- ulcerative colitis
- pernicious anemia
manifestations of myasthenia gravis:
- ptosis (drooping eyelid)
- dysphagia
- neck weakness, head bob
- muscle weakness
- even respiratory failure/arrest
which protein marker gives you the earliest diagnosis for an MI?
followed by what else?
myoglobin (peaks 3-15 hrs)
followed CK-MB (1-2 days)
which marker is a very sensitive indicator of MI? how long does it remain elevated for?
troponin.
it's more specific than CK-MB, and remains elevated for 7-10 days.
Normal BUN range:
10-25 mg/dl
normal Creatinine range:
0.6-1.2 (1.5) mg/dl
normal Na+ range:
135-145 mEq/l
normal K+ range:
3.5-5.0 (5.5) mEq/L
normal Mg+ range:
1.5-2.5 mEq/L
normal Ca++ range:
9-11 mEq/L
normal albumin range:
3.8-4.5 g/dl
normal Cl- range:
96-106 mEq/L
normal Hgb range:
12-18 g/dl
normal Hct range:
38-54%
normal WBC range:
4-11 billion/L (10^9/L)
full blown AIDS CD4+ level:
less than 200
normal APTT range:
30-45 sec
normal PT range:
12-15 sec
normal plt range:
150-400 billion (10^9)
normal INR:
1-2
normal phosphate level:
2.8-4.5 mEq/L
normal CD4+ range in healthy adult:
400-1600
diabetes is diagnosed when fasting blood sugar is at what level?
126 or higher
ARF leads to metabolic acidosis or alkalosis?
metabolic acidosis due to retained H+
normal urine specific gravity range:
1.001-1.030
normal CVP range:
3-7 mmHg
or 4-10 cm Water
normal MAP range:
80-100 mmHg
normal EF:
>75%
what does CVP tell us?
right atrial pressure &
right ventricular end diastolic volume.
What 3 things are elevated in the blood for Cushings?
- cortisol
- blood sugar
- Na+
What 3 things are decreased in the blood for Cushings?
- K+
- Ca++
- ACTH
What 4 things are elevated in the blood for Addison's?
- K+
- Ca++
- BUN
- Creatinine
What 4 things are decreased in the blood for Addison's?
- cortisol
- aldosterone
- Na+
- blood sugar
For Cushings and Addisons, which one results in fluid volume overload and which one results in dehydration?
Cushings --> HTN, fluid overload
Addisons --> dehydration
What is the vasopressin test used for and what does it do?
SubQ injection of vasopressin:
- if produces increased specific gravity, then you have central DI.
- if produces no increase in sp gr, then it's nephrogenic DI.
What is the UO like for DI?
5-20 liters per day.
What is DDAVP for?
desmopression acetate (Vasopressin in liquid form) is for ADH replacement.
Why is tegretol used for DI?
it's an ADH stimulant.
Is vasopressin therapy lifelong for DI pts?
yes, its lifelong.
T/F. encourage DI pts to use mouthwash in response to thirst.
False. Encourage them to drink WATER.
tall peaked T wave, prolonged PR interval, and widened QRS indicate:
HYPERkalemia
flattened T wave, depressed relfexes, flabby muscles, parasthesia, and hyperglycemia indicate:
HYPOkalemia
lethargy, depressed reflexes, stupor/coma, N/V, fractures, and shortening of ST segment and QT interval indicate:
HYPERcalcemia
numbness/tingling around mouth, hyperreflexia, tetany, seizures, and elongation of ST segment and QT interval indicate:
HYPOcalcemia
What are the "groans, moans, bones, stones, and overtones" for HYPERcalcemia:
constipation, psychotic noise, bone pain, kidney stones, and depression/confusion.
one major characteristic of HYPOmagnesemia:
neuromuscular and CNS HYPERirritability.
one major characteristic of HYPERmagnesemia:
depressed neuromuscular and CNS function
phosphorous levels are opposite of what levels in the blood?
calcium (via PTH action)
KCL supplements should never exceed what rate?
should NOT exceed 10-20mEq/hr
what is used to treat severe hyperkalemia?
IV calcium gluconate
(to reverse membrane excitability)
what is used to moderate hyperkalemia?
IV insulin and glucose
T/F. Never give Calcium IM.
True.
give orally w/ Vit D.
T/F. Loop diuretics are used for hypercalcemia.
True.
always assess which 3 electrolytes together?
K+, Ca++, and Mg++
main CNS characteristics of dehydration/hypovolemia:
restlessness, irritability
main CNS characteristics of hypervolemia:
headache, lethargy, confusion
what is pheochromocytoma?
tumor of adrenal gland --> excess epinephrine and NE (catecholamines)
why should you avoid abd pressure, such as abd palpation for a pheochomocytoma pt?
intra-abd pressure can cause hypertensive episode.
what is VMA?
VMA (vanillylmandelic acid test) = 24hr urine collection for catecholatmines, metanephrine, and VMA.
What are nursing implications for VMA testing?
- restrict caffeine, vanilla, licorice for 2-3 days in advance
- hold aspirin and anti-HTN meds
- maintain moderate acitivity
What is a Clonidine supression test?
Used to determine if pt has pheochromocytoma.
Clonidine (Catapres) is supposed to suppress catecholamine release.
3 diagnostic tests for pheochromocytoma:
- VMA
- Clonidine
- phentolamine (Regitine)
How is Regitine (phentolamine) used to diagnose pheochromocytoma?
It is diagnostic if administration of Regitine (an alpha blocker) causes rapid decrease in systolic BP of 35 mmHg or more and diastolic BP of 25 mmHg or more.
T/F. After bilateral adrenalectomy, glucocorticoid and mineralocorticoid replacement is required for pts with pheochromocytoma for LIFE.
True.
it is lifelong.
S&S of hypoglycemia:
- cool, clammy skin
- sweating
- anxiety, irritability, blurred vision
- weakness, seizures
S&S of hyperglycemia:
- hot dry skin
- no sweating
- N/V, abd pain
- Kussmaul's breathing (fruity breath)
if hypoglycemic pt is unconscious, give what? via what route?
give Glucagon SubQ or IM.
what do you advise for diabetic women of childbearing age who are on oral antidiabetic meds and are also using oral contraception?
Oral antidiabetic meds may reduce blood lvls of some oral contraceptives, so they may need additional contraceptions methods.
What drink should diabetics avoid in their diet, esp when taking oral antidiabetic meds?
Avoid alcohol.

(to avoid disulfram-like rxn)
4 things to watch out for when on oral antidiabetic meds:
- avoid alcohol
- monitor renal fxn
- monitor liver fxn
- oral contraception less effective
which insulin cannot be mixed with any other type?
Lantus/Glargine (long-acting)
besides, foot ulcers, cardio problems, and blindness, what else can diabetes result in?
kidney failure
What is HHNS?
hyperglycemic-hyperosmolar nonketotic syndrome.

BS>600, dehydration, absence of ketosis. Life threatening.
most common cause of DKA:
infection.
(others include illness, surgery, trauma, and stress)
HHNS is more common in what kind of people?
older adults and people w/ untreated type 2 DM.
DKA is more common in what kind of people?
type 1 DM pts.
T/F. There is an absence of ketones as well as acidosis in HHNS.
True.
T/F. SIADH results in renal reabsorption of sodium and water.
False.
SIADH leads to renal reabsorption of water (ADH effects) and excretion of sodium (RAAS suppression)
early S&S of SIADH include:
HA, muscle cramps, weight gain, weakness
Very late S&S of SIADH include:
confusion, Cheyne-Stokes respirations, seizures, coma
moderate progression of SIADH can result in what S&S?
personality changes, HYPOreflexia, N//V
What 2 meds can be given to treat SIADH by blocking renal response to ADH?
- demeclocycline (Declomycin)
- lithium
what's Cretinism?
state of severe hypothyroidism in infants.
hypothyroidism occurs more often in what kind of people?
women in their 40s and 50s.
Is serum cholesterol decreased or increased in hypothyroidism?
increased.
T/F. Anemia commonly accompanies hypothyroidism.
True.
what kind of drugs is contraindicated for a pt with hypothyroidism?
CNS depressants, barbiturates, sedatives, etc.
Is levothyroxine (Synthroid) for HYPO- or HYPER- thyroidism?
for HYPOthyroidism.
Is thyroid hormone therapy lifelong or temporary?
lifelong.
what kind of diet for hypothyroidism?
low calorie, high bulk (for constipation)
is cold intolerance a characteristic of HYPO- or HYPER- thyroidism?
HYPOthyroidism.
5 S&S of myxedema coma:
- depressed respirations
- stupor (cerebral hypoxia)
- hypothermia
- bradycardia (low CO)
- hypotension
T3 and T4 secretion is regulated by what gland?
anterior pituitary
the thyroid gland produces which 3 hormones?
- T3
- T4
- calcitonin
TSH is secreted by which gland?
anterior pituitary
what does calcitonin do?
prevents bone resorption and keeps blood calcium lvls low
what's the most common cause of hyperthyroidism?
Graves dz
Why is PTU given for hyperthyroidism?
blocks thyroid hormone synthesis
T/F. Pts with hyperthyroidism often experience decreased appetite.
False.
They experience increased appetite, but their fast metabolism keeps their weight down.
what is thyroid storm?
a sudden surge of large amts of thyroid hormones into bloodstream (a medical emergency!)
6 S&S of thyroid storm:
- hyperthermia
- HTN
- tachydysrhythmia
- delirium
- vomiting
- abd pain
goiters appear in HYPO or HYPER thyroidism?
HYPERthyroidism
why watch for hypocalcemia following a thyroidectomy?
it may indicate that the parathyroid glands are damaged.
what do you give in case of hypocalcemia?
IV calcium gluconate.
how many milliliters of drainage do you expect in the 1st 24hrs following a thyroidectomy?
50ml
what position do you keep the pt following a thyroidectomy?
high fowlers (to promote venous return)
how do you check for laryngeal nerve damage in pts following a thyroidectomy?
ask the pt to speak as soon as they awaken from anesthesia.
what do you do to prevent hemorrhage in pts following a thyroidectomy?
avoid neck flexion/extension and always align neck with body
what do you monitor for in hypocalcemia?
tingling of fingers and toes, spasms, and convulsions
do you experience constipation or diarrhea with colon cancer?
you may experience either one or both.
S&S of colon cancer:
- fatigue
- weight loss
- abd distension, bloating
- constipation, diarrhea, change in bowel habits
- anemia
what 3 things should pts avoid in their diet 48 hours prior to FOB testing?
- meats
- NSAIDs
- Vit. C
what is the definitive test for colorectal cancer?
colonoscopy/sigmoidoscopy
what color should stomas be?
reddish pink
pts with strong hix of colorectal cancer shoulud reduce intake of what 2 things?
- fats
- meats
which positions should the pt use during a paracentesis?
either:
- supine or
- upright with arms over bedside table and legs dangling
volume of fluid removed during paracentesis should no more than how much?
no more than 1L (1kg, or 2.2lb)
what do you measure before and after a paracentesis?
abd girth
what do you monitor throughout the paracentesis procedure?
respiration rate
monitor for which 3 complications following a paracentesis?
- shock
- peritonitis
- perforated bladder
which serum level can drop dangerously low following a paracentesis?
serum albumin
what is the primary risk factor for development of esophageal varices?
portal HTN
name 2 conditions that can result in portal HTN?
- alcoholic cirrhosis
- viral hepatitis
what is the most serious complication of esophageal varices?
hypovolemic shock
what's the most definitive test for diagnosing peptic ulcers?
EGD =
esophago-gastro-duodenoscopy
how is Sucralfate (Carafate) different from other antacids?
give 1 hr before meals instead of 1-3hrs after meals.
what types of food should a pt with dumping syndrome avoid?
avoid milk, sweets, sugars (e.g. fruit juice, sweetened fruit, milk shakes, honey, syrup, jelly)
what are 3 complications of dumping syndrome to watch out for?
- postprandial hypoglycemia
- malnutrition
- F&E imbalance
3 characteristics that set small bowel obstruction apart from large bowel obstruction:
- spasmodic colicky pain instead of constant diffuse pain
- visible peristaltic waves rather than significant abd distention
- sudden projectile vomiting that relieves pain rather than infrequent vomiting
Differentiate WBC count for appendicitis and peritonitis.
Usually,
10-18 x10^9/L for appendicitis
>20 x10^9/L for peritonitis
Differentiate temperature levels for appendicitis and peritonitis.
Usually,
low fevers (<101) for appendicitis
higher fevers (>101) for peritonitis
Differentiate diet prescriptions for IBD versus diverticulitis.
- low fiber diet for IBD
- high fiber diet for diverticulitis
Difference in age of pts with IBD versus pts with diverticulitis:
- IBD: age 15-40, younger
- Diverticulitis: usually over 50
Major complication for ulcerative colitis:
toxic megacolon
major complication for Crohn's dz:
fistulas
T-tube drainage range:
- initially may be up to 500ml/day, then gradually decrease overtime.
- NEVER >1L/day
major complication of casts:
compartment syndrome
major evidence that points to compartment syndrome:
unrelieved pain or pain that is out of proportion to the injury.
- other points include paresthesia, pallor, diminished pulses
major complication of tractions:
osteomyelitis
what characterizes osteomyelitis?
bone pain that is worse with movement
- other signs include fever, edema, and erythema
the primary concept of pin care to avoid cross-contamination is:
use one cotton tip swab per pin
(cotton swab soaked with peroxide or iodine)
what are 3 LATE signs of neurovascular compromise in a pt with a cast/splint/traction?
polar - cool/cold fingers/toes
paralysis of fingers/toes
pulses - weak
what are 3 EARLY signs of neurovascular compromise in a pt with a cast/splint/traction?
pain - not relieved w/ elevation or meds
paresthesia - numbness or tingling
pallor - cap refill time >3 sec, blue fingers/toes
name 3 differences between osteoarthritis and rheumatoid arthritis.
- RA is bilaterally symmetrical, OA is not
- RA pain after rest, OA pain with movement
- RA is autoimmune, OA is not
should hormone replacement therapy (HRT) be used on a short-term or long-term basis?
short term, generally <5 years
what is considered excess vaginal postop bleeding following a hysterectomy?
more than 1 saturated pad per 4hrs
what characteristics differentiate BPH from prostate cancer during an digital rectal exam?
BPH: enlarged but elastic
Prostate Cancer: hard, irregular
what kind of catheter is used following a prostatectomy or a TURP?
an indwelling 3-way catheter
when do you increase bladder irrigation rate?
when you see bright red blood clots flow out (you need to dilute it)
what is continuous bladder irrigation for?
to keep catheter free of obstruction and to keep the irrigation pink or lighter.
what is the normal PSA level?
<4 ng/ml
what is the priority nursing action immediately following a prostectomy?
maintaining continuous bladder irrigation
what should a woman not use prior to a mammogram?
talcum powder or deodorant
when should a baseline screening mammogram be done?
age 40
what are Miotics for and what side effect does it cause?
used for Glaucoma

side effect = blurred vision
what happens to the CNS with multiple sclerosis?
plaque deposits in the white matter that damages myelin sheaths
what's used for definitive diagnosis for MS?
MRI brain and spine (for plaques)
What kind of precaution should be used for pts with chicken pox (Varicella)?
airborne
What kind of precaution should be used for pts with TB?
airborne
What kind of precaution should be used for pts with disseminated varicella Zoster?
airborne
What kind of precaution should be used for pts with measles (Rubeola)?
airborne
What kind of precaution should be used for pts with HIB?
droplet
What kind of precaution should be used for pts with pertussis?
droplet
What kind of precaution should be used for pts with mumps?
droplet
What kind of precaution should be used for pts with Rhinovirus?
droplet
What kind of precaution should be used for pts with rubella?
droplet
What kind of precaution should be used for pts with scarlet fever?
droplet
What kind of precaution should be used for pts with C. Diff?
contact
What kind of precaution should be used for pts with congenital rubella?
contact
What kind of precaution should be used for pts with Hep A?
contact
What kind of precaution should be used for pts with shingles?
contact
What kind of precaution should be used for pts with impetigo?
contact
What kind of precaution should be used for pts with MRSA?
contact
What kind of precaution should be used for pts with herpes simplex?
contact
What kind of precaution should be used for pts with rabies?
standard
What kind of precaution should be used for pts with rheumatic fever?
standard
What kind of precaution should be used for pts with West Nile fever?
standard
acute glomerulonephritis usually commonly follows what illness?
strep throat
what is used to confirm or rule out diagnosis of glomerulonephritis?
renal biopsy
what is nephrotic syndrome?
glomerular capillary damage resulting in loss of serum proteins and decreased serum osmotic pressure.
3 characteristics of nephrotic syndrome:
- proteinuria
- HYPOalbuminemia
- edema
what happens to serum cholesterol, triglycerides, and LDLs in nephrotic syndrome?
they're all elevated
Laryngeal cancer usually affects what gender and age?
men over 60
3 top risk factors for laryngeal cancer?
- tobacco
- alcohol
- harmful chemicals (chronic exposure)
encourage what kind of diet for laryngeal cancer pts?
high protein and high calories
T/F. Pts who undergo total laryngectomies will lose their natural voices.
True.
If a nodal neck dissection (radical neck) is done for laryngeal cancer, what happens to the shoulders following surgery?
shoulders drop because CN XI (spinal accessory nerve) is cut.
what's a cordectomy?
excision of a vocal cord
aspiration can lead to the development of what respiratory condition?
pneumonia
what is the leading cause of cancer-related deaths?
lung cancer
what type of lung cancer is fast growing and almost always associated with the hx of smoking?
small cell lung cancer
most lung cancers belong in which category
(small cell or non-small cell?)
non-small cell
The TNM system for staging lung cancer stands for what?
T = tumor
N = nodes
M = metastasis
what kind of respiratory S&S do you expect to find in lung cancer pts?
- persistent cough w/ or w/o rust/blood-colored sputum
- dyspnea
- unilateral wheezing
- chest wall pain
what kind of diet is prescribed for lung cancer pts?
high protein
high calorie
T/F. superior vena cava syndrome is a medical emergency.
True.
What are early signs of Superior vena cava syndrome?
facial edema, tightness of shift collars, nosebleeds, peripheral edema, and dyspnea
what are late signs of superior vena cava syndrome?
mental status changes, cyanosis, hemorrhage, and hypotension.
what's the most common cause of pulmonary embolism?
DVT
T/F. Oral contraceptives and estrogen therapies are risk factors for PE.
True.
What is commonly used to diagnose PE?
CT scan
How do the ABG's change as a PE progresses?
1st respiratory alkalosis (initial hyperventilation)
2nd respiratory acidosis (due to hypoxemia)
T/F. Onset of S&S for PE is slow.
False.
Onset of S&S for PE is sudden and rapid.
6 common S&S of PE:
- Dyspnea, air hunger
- tachycardia
- tachypnea
- Anxiety
- decreased O2 sat
- hypotension
why are streptokinase and alteplase used for PE?
used as fibrinolytic therapy to break up blood clots
what's the highest nursing priority for a pt with PE?
Oxygen therapy
crystalloids are used to:
restore intravascular volume and prevent shock
dobutamine is used to:
improve cardiac contractility
T/F. Recent surgery is a contraindication to fibrinolytic therapy.
True.
classification of acute respiratory failure (ARF) is based on what?
ABG's
what ABG values indicate ARF?
PaO2 <60 & SaO2 <90%
or
PaCO2 >50 & pH <7.30
T/F. Clients w/ ARF are always hypocapneic.
False.
Client with ARF are always hypoxemic.
T/F. ARDS is a state of ARF.
True.
mode of transmission for SARS is:
droplet
5 ARDS indicators:
- persistent hypoxemia despite administration of 100% O2
- decreased pulmonary compliance
- dyspnea
- bilateral pulmonary edema that is noncardiac
- dense pulmonary infiltrates ("ground glass" on CxR)
T/F. surfactant activity is reduced in ARDS.
True.
which setting on mechanical ventilator is used to prevent alveolar collapse during expiration?
PEEP
T/F. PEEP can lead to increased cardiac output.
False.
PEEP increases intrathoracic pressure and leads to decreased cardiac output.
what needs to be done to confirm hemothorax?
thoracentesis
in tension pneumothorax, tracheal deviation occurs on which side?
deviates to the unaffected side
Distinguish pneumothorax from hemothorax by percussion:
pneumothorax = hyperresonnance

hemothorax = dull
T/F. Increased cardiac output resulting in HTN is a possible complication of pneumothorax.
False.
Increased intrathoracic pressure with decreased CO resulting in HYPOtension is a possible complication of pneumothorax
What's a definitive sign of tension pneumothorax?
tracheal deviation.
for chest tubes, the water seal should be maintained at what level?
2 cm
T/F. continuous bubbling is expected with a water seal chamber.
False.
Tidaling is expected, but continuous bubbling is a sign of air leak.
Taking nitrates along with Viagra can cause what serious problem?
severe hypotension
T/F. Use lotions on dry skin following radiation to prevent cracking.
False.
Using lotions on the dry skin patches caused by radiation can further irritate the skin.
Taking aluminum-containing antacdis concurrently does what to Ciprofloxacin absorption?
decreases Cipro absorption
ostmomy bags should be cut how much larger than the stoma?
1/16 to 1/8 in larger than the stoma
T/F. Hyperkalemia decreases GI motility.
False.
HYPOkalemia decreases GI motility.
T/F. An adverse rxn of furosemide is HYPOnatremia.
True.
What's the normal rate for chest tube drainage?
100ml/hr or less.

Report to physician if >100ml/hr.
T/F. Increased ESR occurs with any inflammatory process.
True.
how much fluid can be taken out during a paracentesis?
- Usually limited to 1L in a short period of time.
(Slow drainage can be used to take out >1L of fluid over several hours.)
what is Cushing's triad and what does it indicate?
Cushing's triad:
- widened pulse pressure
- bradycardia
- irregular respiratory rate

== indicates increased ICP
what color is a full thickness burn?
cream, tan, brown, black
what color is a 3rd degree burn?
white, charred-looking
describe a 2nd degree burn?
red, blistered
describe what a 1st degree burn looks like:
red, no blisters, dry
T/F. in treating a burn victim, remove ALL clothing from the burnt areas.
False.
Remove only those pieces of clothing that is not sticking to the skin. If it sticks, don't remove.
what type of MI is associated with heart failure?
anterior MI
(causes L ventricular dysfxn)
what helps the burning pain after an IM injection?
warm compress
tracheal shift in 3 kinds of pneumothorax:
- simple pneumothorax: usually no shift
- tension and hemothorax: shift to contralateral (unaffected) side
T/F. the paralysis that accompanies Guillian barre is temporary.
True.
T/F. Pts who are about to undergo EGD's should be on a 24 hr clear liquid diet and have GI cleansing prior to the procedure.
False.
GI tract cleansing and a clear liquid diet are interventions for a client having a lower GI tract procedure, not an upper GI procedure.

- the client should be NPO for 6-12 hours prior to an EGD.
do pts with chronic renal failure have HYPO- or HYPER- calcemia?
HYPOcalcemia
(due to hyperphosphatemia)
what is extracorporeal shock wave lithotripsy and to include in discharge teaching?
- for renal calculi
- instruct to intake lots of fluids to flush out fragments
what kind of isolation precaution is needed for SARS?
airborne and contact
A pt with cirrhosis is prescribed lactulose for what? what do you monitor for to make sure it's working.
- to decrease serum ammonia levels
- you monitor for LOC
Addison's disease is a form of what condition?
adrenal insufficiency
T/F. Addison's disease is autoimmune.
True.
What is secondary adrenal insufficiency?
lack of hormones (e.g. ACTH, CRH) from the hypothalamus or pituitary that regulate steroid production in the adrenal glands
what causes malignant hyperthermia/hyperpyrexia?
adverse reaction to certain anesthesia
what are 5 S&S of malignant hyperthermia?
- muscular rigidity
- tachycardia
- hyperthermia
- hypercapnia
- red-brown urine
the neuromuscular blocking agent succinylcholine is a trigger for what dangerous condition?
malignant hyperthermia
blood test results for malignant hyperthermia would reveal:
- high K+, P, CK, & myoglobin
- low Ca++
- acidosis
what is autonomic dysreflexia?
a medical emergency characterized by a massive SYMPATHETIC discharge that can occur in association with spinal cord injury or disease (e.g. MS)
what are S&S of autonomic dysreflexia?
- high BP (often >200)
- intense headaches
- profuse sweating
- feeling of doom
- goosebumps
- nasal stuffiness
- facial erythema
T/F. aluminum overload causes constipation.
True.
T/F. Organ donation must be completed within 24 hours of patient death.
False. It should be completed within 72 hours. Some can be stored for longer.
Why is surgical removal of breast cancer tumor not suggested in case of superior vena cava syndrome?
surgical removal is too invasive and may increase intrathoracic pressure, which worsens the superior vena cava syndrome.
Why is chemotherapy not used in the case of superior vena cava syndrome caused by breast cancer tumor?
chemo does not shrink size of tumor, it only halts the growth.
/ 384
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