Mark Klimek Blue Book

Can the thigh EVER be used to obtain a blood pressure?

Yes, but this is rare.

Name the five/six essential nutrients

carbs, fats, proteins, vitamins, minerals, water

The major source of energy for the body is

carbs

carbs provide ____________ Kcalories per 1 gram

4

Sucrose is a sugar found in ____________ and _____________.

fruits, veggies

Lactose is a sugar found in ?

milk

What is glycogen?

It is a stored formed of glucose/energy manufactured by the liver

Is glycogen eaten in foods?

NO! It is a stored form of glucose MANUFACTURED by the liver.

When the body does not receive enough carbs it burns ___________ and _____________.

protein, fat

The most concentrated source of energy for the body is ___________.

fats

Fats provide ___________ Kcalories per 1 gram.

9

Fats carry vitamins

A,D,E,K (Remember FADE K!)

The nutrient needed most for growth and repair of tissues is _____________.

protein (second best is Vit C)

Proteins provide __________ Kcalories per 1 gram.

4

Vitamins and minerals provide energy for the body. (T/F)

False- they are necessary for a body's chemical reactions.

Water is present in ALL body tissues. (T/F)

True (even bone)

Water accounts for ________ to ___________% of an adult's total weight?

50 to 60%

Name the four basic food groups

Milk & Cheese, Meat & Legumes, Veggies & Fruits, Bread & Cereal

Water acounts for __________ to _________% of an infant's total weight?

70 to 75%

An individual is overweight if they are ________% above the ideal weight.

10

An individual is obese if they weigh ________% above the ideal weight.

20

What solution and material are used to cleanse the eyes of an infant?

Plain water, cotton balls, washcloths

Can you use cotton swabs to clean the eyes, nares or ears of an infant?

No, this is dangerous

Can you use the same cotton ball/washcloth edge for both eyes?

No, it would cross contaminate

Should you cover an unhealed umbilical site with the diaper?

No, fold the diaper down.

What temperature is appropriate for the water used to bathe an infant?

100 to 105

What is the #1 purpose of a tepid sponge bath?

Lower body temperature during fever.

How should the temperature of the water be tested if no thermometer is available?

Dropping water on inside surface of your forearm.

With which body part do you begin when bathing an infant?

Eyes always

When cleansing an infant's eye, cleanse from outer to inner canthus?

No, inner to outer

Should you retract the foreskin of a 5 week old male, uncircumcised infant to cleanse the area?

No, not until foreskin retracts naturally and without resistance- then it should be retracted, cleansed and replaced.

When sponge-bathing with tepid water the correct temp is _____________.

98.6 F

How long does it take for the umbilical stump to fall off?

7 to 14 days

The primary reason why an infant is draped during the bath is to provide privacy. (T/F)

False, the primary purpose of draping is to prevent chilling.

You may use friction to remove vernix caseosa from an infant's skin. (T/F)

False, it causes damage/bruising

What solution is commonly used for care of umbilical cord?

70% alcohol to promote drying (trend is toward soap and water)

What cranial nerve is affected in Bell's Palsy?

#7, facial nerve

What is the #1 symptom of Bell's Palsy?

One sided (unilateral) facial paralysis

Complete recovery from the paralysis of Bell's Palsy should occur in _______ to ______ months.

4 to 6

In addition to the facial paralysis, the sense of ______ is also affected.

taste

Will the patient be able to close their eye on the affected side?

no

Give three eye interventions for the client with Bell's Palsy.

Dark glasses, artificial tears, cover eye at night

As the prostate enlarges it compresses the ___________ and causes urinary ________.

Urethra, rentention

At what age does BPH occur?

men over 50 years of age

What does BPH stand for?

Benign Prostatic Hypertrophy

IN BPH the man has (increased/decreased) frequency of urination

increased

In BPH the force of the urinary stream is (increased/decreased).

decreased

The man with BPH has a _________-stream of urine

forked

The man with BPH has hesitancey. What does this mean?

Difficulty starting to void

Will the man with BPH have enuresis, nocturia or hematuria?

Enuresis-No, Nocturia-Yes, and Hematuria-Maybe

Enuresis

inability to control the flow of urine and involuntary urination

What is the best way to screen men for BPH?

Digital rectal exam

Should fluids be forced or restricted in BPH?

forced

What does TURP stand for?

Transurethral resection of the prostate

The most radical prostate surgery is the ____________ prostatectomy.

Perineal

What type of diet is used in BPH?

Acid Ash

Acid Ash diet

Decrease pH (makes urine acid)
Chz, eggs, Meat, fish, oysters, poultry, Bread, Cereal, Whole Grains, Pastries, Cranberries, Prunes, Plums, Tomatoes, Peas, Corn, Legumes.

What is the primary purpose of a 3 way continuous bladder irrigation (CBI) after TURP?

To keep the catheter clear of clots and to drain urine

What solution is used for CBI?

Normal saline (0.9 NaCl)

How fast do you run the CBI?

At whatever rate it takes to keep the urine flowing and free of clots

What drug is use to treat bladder spasm?

B&O suppositories (Belladonna & Opiates)

Should you take a rectal temp after prostatectomy? Give stool softeners?

No rectal temperatures, yes stool softeners

You should call the MD after TURP when you see _________ thick ________, _____________ clots, and ____________ urine drainage on the dressing.

Bright thick blood, persistent clots, persistent urine on dressing (don't call MD for transitory clots and urine on dressing.)

If you see an increase in blood content of urine coming out of the catheter, you would first ___________.

Pull carefully on the catheter to apply local pressure on the prostate with the Foley balloon.

If you see clots in the tubing you would first ____________.

Increase the flow-rate.

What exercises should the post prostectomy patient do upon discharge? Why?

Perineal exercises, start and stop stream of urine, because dribbling is a common but temporary problem post op

Will the post prostectomy patient be impotent?

If TURP, no impotence, if perineal prostatectomy, yes impotence

How often should the drainage bag be emptied?

Every 8 hours

What is the most common problem due to catheterization?

UTI

What is the most common organism to cause UTI with catheterization?

E. coli

What is the most common route for organisms to enter the blader when a catheterization is used?

Up through the inside of the catheter in the days following catheterization

Name foods that make acid urine

Cranberry juice, apple juice (avoid citrus juices- they make alkaline urine)

What is important about the level of the urinary drainage bag?

Never have the bag at a higher level than the bladder.

How is the catheter taped in a male client?

To the lateral thigh or abdomen

How is the catheter taped in a female client?

To the upper thigh

What urinary pH prevents UTI?

Acidity, low pH

Should the drainage bag ever touch the floor?

No

Is it ok to routinely irrigate indwelling catheters?

No

What agents are best for catheter care?

Soap and water

What is the most effective way to decrease UTI with catheters?

Keep the drainage system closed, do not disconnect junction of tubing

Give some signs of infection in a Foley catheter

Cloudy urine, foul smelling urine, hematuria

Is urinary incontinence an indication for catheterization?

No

Give three appropriate indications for bladder catheterization?

Urinary retention, to check for residual, to monitor hourly output

What are the top 2 diagnoses for a client with a catheter? Which is #1?

#1- Potential for infection; Potential impairment of urethral tissue integrity

What is systole?

The MAXIMAL force of blood on artery walls

What is diastole?

The LOWEST force of blood on artery walls

Accurate blood pressure is obtained by using a cuff that has width of __________ of the arm.

Two-thirds

Which artery is most commonly used to measure blood pressure?

Brachial

When pressure is auscultated the first sound heard is the ____________ measurement.

Systolic

The change in the character of the sounds is known as the ________

First diastolic sound

The cessation of sounds is known as the _________

Second diastolic sound

When 2 values are given in a blood pressure the first is the __________measurement.

Systolic

When 2 values are given in a blood pressue, the bottom number stands for the change in sounds or cessation of sounds?

Cessation of sounds

What is the normal adult blood pressure?

120/80

Abnromally high blood pressure is called____________.

Hypertension

What is the pulse pressure?

The difference between the systolic and the diastolic blood pressure

If you deflate a cuff TOO SLOWLY, the reading will be too high or low? Why?

High, venous congestion makes the arterial pressure higher (increases resistance)

If you use too narrow of a cuff the reading will be too high or low?

High

Vasoconstriction will ___________ blood pressure.

Increase

Vasodilation will ____________ blood pressure.

Decrease

Shock will ___________ blood pressure.

Decrease

Increased intracranial pressure will _________ the pulse pressure.

Increase or Widen

If my blood pressure is 190/110, what is my pulse pressure?

80 mmHg

What blood test must be done before a transfusion?

Type and cross match

What does a type and cross match indicate?

Whether the client's blood and donor blood are compatible.

What should the nurse measure before starting a transfusion?

Vital signs

With what solution should blood be transfused?

0.9 normal saline

How many nurses are requried to check the blood?

2 nurses

What happens when blood is administered with Dextrose IVs?

The cells clump together & don't flow well

If a transfusion reaction occurs what should the nurse do first?

Stop the blood flow & start running the saline

How long can a unit of blood be on the unit before it must be started?

Less than 1/2 hour

What should the nurse do with the IV line if transfusion reaction is suspected?

Keep it open with saline

If a transfusion reaction is suspected, what two samples are collected and sent to the lab?

Urine & blood

If a unit of blood is infused through a central line it must be__________.

Warmed

Which of the following are signs of transfusion reaction? Bradycardia, Fever, Hives, Wheezing,
Increased Blood Pressure, Low Back Pain

Low back pain, wheezing, fever, hives

What are three types of transfusion reactions that can occur?

Hemolytic, febrile, allergic

What would you do first if you suspected transfusion reaction?

Stop the blood and start the saline

What are the signs and symptoms of a hemolytic transfusion reaction?

Shivering, HA, low back pain, increased pulse & respirations, decreasing BP, oliguria, hematuria

What are the signs and symptoms of a febrile transfusion reaction?

Low back pain, shaking HA, increasing temperature, confusion, hemoptysis

What are the signs of symptoms of an allergic reaction to a transfusion?

Hives- uticaria, wheezing, pruritus, joint pain, (arthralgia)

Give three reasons for a blood transfusion

Restore blood volume secondary to hemorrhage, maintain hemoglobin in anemia, replace specific blood components

What does blood-typing mean?

Check for surface antigen on the red blood cell

When does typing and cross matching need to be done?

Whenever a client is to get a blood product. It is only good for 24 hours.

What does blood cross matching mean?

Mixing a little of the client's blood with the donor blood and looking for agglutination.

When are hemolytic transfusion reactions likely to occur?

In the first 10 to 15 minutes

When is a febrile reaction likely to occur?

Within 30 minutes of beginning the transfusion

What test identifies Rh factor?

Coombs test detects antibodies to Rh

What is the difference between whole blood and packed cells?

Packed cells don't have nearly as much plasma or volume as whole blood does

What would you do if the client had an increasing temperature and was to get blood?

Call the MD because blood is often held with an elevated temperature

How long should it take for one unit of blood to infuse?

From one hour to three hours

How long should you stay with the patient after beginning a transfusion?

At least 15 to 30 minutes

What blood type is the universal recipient?

AB

What blood type is the universal donor?

O

What is the routine for vital sign measurement with a transfusion?

Once before administration
Q15 x 2 after administration is begun
Q1 x1 after transfusion has stopped

What IV solution is hung with a blood transfusion?

0.9 normal saline (No glucose)

What gauge needle is used with a blood transfusion?

Large gauge, 18 gauge

What other things are appropriate after a reaction?

Call MD, get a blood sample, get urine sample, monitor vitals, send blood to lab

Can blood be given immediately after removal from refrigeration?

No, it has to be warmed first for only about 20 to 30 minutes.

With what solution & when should a breast feeding mother cleanse the areola?

Plain water, before & after each feeding

For a woman who doesn"t have retracted nipples, is towel drying or air drying better?

Air drying of the nipples is best

The goal is for the infant to breast feed for __________ minutes per side.

20

How does the mother break the suction of the breast feeding infant?

She inserts her little finger into the side of the infant's mouth

When should the breast feeding infant be burped?

After feeding from each breast

Assuming no mastitis, on which side should the breastfeeding begin?

Begin nursing on the side that the baby finished on the last feeding

How long can breast milk be refrigerated?

24 hours

How long can breast milk be frozen?

6 months

In what type of container should breast milk be stored?

Sealed plastic bags

Can you microwave frozen breast milk in order to warm/thaw it?

Never

Which two nutrients is breast milk lower in?

Fluoride and iron

What should you tell a breast feeding mother about her milk supply when she goes home from the hospital?

Milk should come in postpartum day 3. Breastrfeed every 2-3 hours to establish good milk supply.

Can a woman on oral contraceptives breastfed?

Should not use OCP during the first 6 weeks after birth because the hormones may decrease milk supply. Estrogen is not recommended. Non-hormonal methods are recommended. Remember, breastfeeding is an unreliable contraceptive.

What is another name for Buerger's disease?

Thromboangiitis obliterans

Which extremities are affected by it?

Lower only

Which sex does it affect the most often?

Males

The group with the highest incidence of Buerger's disease is __________.

Smokers

Upon walking the patient with Buerger's experiences _______ _________.

Intermittent Claudication

What is intermittent claudication?

Pain in calf upon walking

A first degree burn is pale or red?

Red

A first degree burn has vesicles (T/F)?

False

A second-degree burn is pale or red?

Red

A second-degree burn is dull or shiny?

Shiny

A second-degree burn has vesicles? (T/F)

True

A Second degree-burn is wet or dry?

Wet

A third-degree burn is white or red?

White

A third-degree burn is wet or dry?

Dry

A third degre burn is hard or soft?

Hard

Of first, second and third degree burns which has less pain? Why?

Third degree burns, nerve damage has occured

For what purpose do you use the rule of nines?

To estimate the percentage of body surface burned; is NOT used for children.

In the rule of nines, the head and neck receive _______: each arm receives_______.

9%, 9%

In the rule of nines, the front trunk gets_____, the posterior trunk gets_____, each leg gets ______ and the genitalia gets________.

18%, 18%, 18%, 1%

What is the only IM given to a burn patient?

Tetanus toxoid- if they had a previous immunization; tetanus antitoxin- if they have never been immunized before (or immune globulin)

In the emergent phase do you cover burns? (in the field)

Yes, with anything clean and dry.

Should you remove adhered clothing?

No

Name the 3 phases of burn

Shock, diuretic, recovery

Fluid moves from the___________ to the _______ in the SHOCK phase.

Bloodstream, interstitial space

The shock phase lasts for the first ________ to ________ hours after a burn.

24 to 48 hours

During shock phase of a burn is potassium increased or decreased? Why?

Increased, because of all the cells damaged- the K+ is released from damaged cells.

What acid-base disorder is seen in the shock phase of a burn?

Metabolic Acidosis

What is the #1 therapy in the shock phase?

Fluid replacement/resuscitation

What is the simple formula for calculating fluid replacement needs in the first 24 hours?

3cc X Kg X % burned per day

If the MD orders 2,800 cc of fluid in the first 24 hours after a burn, one-_____ of it must be infused in the first 8 hours.

Half (or 1,400 cc)

What blood value will dictate IV flow rate?

The hematocrit

How will you know the patient has entered the fluid mobilization or diuretic phase?

The urine output will increase

How long does the fluid mobilization or diuretic phase of a burn last?

2 to 5 days

In the diuretic phase, K+ levels fall or rise?

Fall- remember diuresis always causes hypokalemia

If the nurse accidentally runs the IVs at the shock phase rate during the diuretic phase the patient will experience?

Pulmonary edema

The burn patient will be on _______urine output and daily __________.

Hourly, weight

Sulfamyon cream__________.

Burns

Silver nitrate cream___________ the ________.

Stains, skin

Pain medications should be administered _______ before ________ care.

30 minutes, wound care

When using silver nitrate, the dressings must be kept __________.

Wet

What is Curlings ulcer? Why is it a problem in burn patients? What drug prevents it?

It is a stress GI ulcer, you get these with any severe physical stress. Tagamet, Zantac, Pepcid (any H2 receptor antagonist), Protonix Prilosec

In Abruptio Placenta, the placenta _______________ from the uterine wall ____________.

Separates, prematurely

Abruptio Placenta usually occurs in (prima/multi) gravida over the age of ____________.

Multigravida, 35 (HTN, trauma, cocaine)

How is the bleeding of Abruptio Placenta different from that in placenta previa?

usually pain; bleeding is more voluminous in previa

If you are the nurse starting the IV on the client with Abruptia Placenta, what guage needle should you use?

18 (in preparation to give blood if necessary)

How often should you measure the vital signs, vaginal bleeding, fetal heart rate during Abruptio Placenta>?

Q5-15 minutes for bleeding and maternal VS, continuous fetal monitoring, deliver at earliest sign of fetal distress

How is an infant delivered when Abruptio Placenta is present?

Usually C-section

Is there a higher or lower incidence of fetal death with Abruptio Placenta compared to Placenta Previa?

Highter

In what trimester does Abruptio Placenta most commonly occur?

Third

At what age are accidental poisonings most common?

2 years old

If a child swallows a potentially poisonous substance, what should be done first?

call medical help

Should vomiting be induced after ingestion of gasoline?

No- not for gas or any other petroleum products

When taking a child to the ER after accidental poisoning has occurred what must accompany the child to the ER?

the suspected poison

An elderly client is a (high/low) risk for accidental poisoning? What about a school age child?

high - due to poor eyesight, high

What types of chemicals cause burns to oral mucosa when ingested?

Lye, caustic cleaners

Children at highest risk for seizure activity after ingestion are those who have swallowed _____________ and ______________.

drugs, insecticides

Can impaired skin integrity ever be an appropriate nursing diagnosis when poisoning has occurred?

Yes, when lye or caustic agents have been ingested

What is the causative organism of acne?

P. acnes (propionibacterium acnes)

What structures are involved in acne vulgaris?

The sebaceous glands

Name 3 drugs given for acne?

Vitamin A, Antibiotics, Retinoids

Dietary indiscretions and uncleanliness are causes of acne?

False

What are the 3 causative factors in acne vulgaris?

Heredity, Bacterial, Hormonal

Uncleanliness is a cause of acne?

False

What is the most common retinoid given to people with acne?

Accutane

Accutane is an analog of which vitamin?

Vitamin A

What is the most common side effect of accutane? And what is most important in health teaching in adminstration?

Inflammation of the lips; Causes birth defects

What is the antibiotic most commonly given to clients with acne?

Tetracycline

How long will it take for the person to see results when acne is being treated?

4 to 6 weeks

Does stress make acne worse?

yes

How often should the client with acne wash his face each day?

twice a day

What instructions do you give to a client taking tetracycline?

Take it on an empty stomach and avoid the sunlight (photosensitivity)

What are comedones?

Blackheads and white heads

What virus causes AIDS?

HIV - Human immunodeficiency virus

The AIDS virus invades helper ____________.

T-lymphocytes (or CD4 cells)

AIDS is trasmissible through what four routs?

blood, sexual contact, breast feeding, across placenta in utero

HIV is present in all body fluids?

Yes, but not transmitted by all, only blood, semen and breast milk

Name the 5 risk groups for AIDS

Homosexual/bisexual men, IV drug users, hemophiliacs, heterosexual partners of infected people, newborn children of infected women

What is the first test for HIV antibodies?

ELISA

What test confirms the ELISA?

Western Blot

Which test is the best indicator of the progress of HIV disease?

CD4 count

A CD4 count of under __________ is associated with the onset of AIDS-related symptoms.

500

A CD4 count of under _______ is associated with the onset of opportunistic infections.

200

Give 6 symptoms of HIV disease.

Anorexia, fatigue, weakness, night sweats, fever, diarrhea

Which 2 classes of drugs are given in combination for HIV sero-positivity?

NRTI's (nucleoside reverse transcriptease inhibitors) and PI's (protease inhibitors)
They prevent viral replication.

NRTI (nucleoside reverse transcriptease inhibitors)

an antiviral drug used against HIV (is incorporated into the DNA of the virus and stops the building process; results in incomplete DNA that cannot create a new virus; often used in combination with other drugs)

PI's (Protease inhibitors)

most potent of antiviral meds, inhibit cell protein synthesis that interferes with viral replication, does not cure but slows progression of AIDS and prolongs life, used prophylactically, used in AIDS to decrease viral load and opportunistic infections

What do NRTI's and PI's do?

They prevent viral replication

What does the physician hope to achieve with NRTI's and PI's for HIV?

A delayed onset of AIDS for as long as possible (usually can delay onset for 10-15 years)

What is the most common NRTI used?

AZT (zidovudine)

What is the most challenging aspect of combination of drug therapy for HIV disease?

The number of pills that must be taken in 24 hours can be overwhelming. The frequency also makes it hard to remember-an alarm wristwatch is used.

Clients with AIDS (gain/lose) weight?

lose

The typical pneumonia of AIDS is caused by ___________ ____________.

Pneumocystic carinii

What type of oral/esophageal infections do AIDS patients get?

Candida

What is the #1 cancer that AIDS patients get?

Kaposi's sarcoma

Kaposi's sarcoma is a cancer of the ___________.

skin

T/F: AIDS patients get lymphomas?

True

What lab findings are present in AIDS?

Decreased RBC's, WBC's and platelets

If the AIDS patient has leukopenia they will be on _____________ ________________.

protective (reverse) isolation

Define Leukopenia

decrease in wbc, indicated viral infection

Without leukopenia the AIDS patient will be on ____________ precautions.

Standard precautions or blood and body fluid precautions

When the AIDS patient has a low platelet count, what is indicated?

bleeding precautions; No IM's, no rectal temperatures, other bleeding precautions

Does AIDS require a single room?

Yes - if WBC counts are low

When do you need a gown with AIDS?

If you are going to get contaminated with secretions

When do you need a mask with AIDS?

Not usually unless they have an infection caused by an airborne bug

When do you need goggles with AIDS?

Suctioning, central line start, arterial procedures

If an AIDS patient's blood contaminates a counter top, with what di you clean?

1:10 solution of bleach and water

Are all articles used by AIDS patients double-bagged?

no - only those contaminated with secretions

Can AIDS patients leave the floor?

Yes, unless WBC's are very low

Is dietary protein limited in AGN?

Not usually, however if there is severe azotemia then it may be restricted

Define azotemia?

nitrogenous wastes in the blood (increased creatinine, BUN)

What is the best indicator of renal function?

The serum creatinine

Do people recover from AGN?

Yes, the vast majority of all clients recover completely from it

How can AGN be prevented?

By having all sore throats cultured for strep and treating any strep infections

What is the most important intervention in treating AGN?

Bedrest - they can walk if hematuria, edema and hypertension are gone.

What is the most common dietary restriction for AGN?

Moderate sodium restriction. Fluid restriction is #2 if edema is severe.

What are the urinaysis findings on AGN?

Hematuria
Proteinuria +3 to +4
Specific gravity Up

How long after strep infection does AGN develop?

2 to 3 weeks after initial infection

How do you assess fluid excess in the child with AGN?

Daily weight

What organism causes acute glomerular nephritis?

Group A beta hemolytic strep

What happens to the kidney in AGN?

It becomes clogged with antigen-antibody complexes which then cause inflammation and loss of function.

How often are vital sign measurements taken in AGN?

Q4 hours with blood pressure

Will the client have hypo or hyper tension with AGN? Why?

Hypertension, because of fluid retention

What are the first signs of AGN?

Puffiness of face, dark urine

What are the three adult stages of development called

early adulthood, middle adulthood and later adulthood

What is the age range for early adulthood?

19 to 35 years of age

What is the age range for middle adulthood?

35 to 64 years of age

What is the age range for late adulthood?

64 years of age to death

What is the developmental task for early adulthood?

Intimacy vs. Isolation

What is the developmental task for middle adulthood?

Generativity vs. stagnation.

Intimacy vs. Isolation

Erikson's stage in which individuals form deeply personal relationships, marry, begin families

Generativity vs. Stagnation

Erikson's stage of social development in which middle-aged people begin to devote themselves more to fulfilling one's potential and doing public service

What is the developmental task for later adulthood?

Ego Integrity vs. Despair

Ego Integrity vs. Despair

(Erikson) People in late adulthood either achieve a sense of integrity of the self by accepting the lives they have lived or yield to despair that their lives cannot be relived

Time is too short to start another life, though I wish I could," is an example of ___________.

despair

If I had to do it over again, I'd life my life just about the same," is an example of ____ ____________

Ego Integrity

What does AKA mean?

Above the knee amputation

What does BKA mean?

Below the knee amputation

If the patient had an AKA they should lie ____________ several times per day.

prone (to prevent flexion contracture)

The #1 contracture problem in AKA is ____________ of the _____________

flexion, hip

What will prevent hip flexion contracture after AKA?

Lying prone several times a day

What is the #1 contracture problem after BKA?

Flexion of the knee

How do you prevent flexion contracture of the knee after BKA?

Remide the patient to straighten their knee constantly while standing

To prevent post-op swelling, the stump should be __________.

elevated

How long should the stump be elevated to prevent post op swelling?

12-24 hours

How often should a stump be washed?

daily

When a stump is wrapped, the bandage should be tightest _____________ and loosest _____________.

distally (far from the center), proximally (neareast to the point)

If after a right BKA, the client c/o pain in his right tow, he is experiencing _____________.

phantom limb sensation (which is normal)

When will phantom limb sensation subside?

in a few months

Name ways to toughen a stump so it will not breakdown due to the wear of the prosthetic leg?

push the stump against the wall, hitting it with a pillow

An aneurysim is an abnormal _______________ of the wall of a(n) artery.

widening (it is also weakening)

What artery is widened in a thoracic aneurysm?

the aorta

An aneurysm can result from an _____________ and from ____________.

infection, syphilis

The most common symptom of abdominal aneurysm is:

a pulsating mass above the umbilicus

Which aneurysm is most likely to have no symptoms?

the abdominal is most often "silent

Which vital signs are most important to measure in clients with aneurysm?

The pulse and blood pressure

An aneurysm will most affect which of the following, the blood pressure or the pusle?

the pulse (many times the aneurysm will rupture and much blood will be lost before the blood pressure starts to change.

What activity order is the client with an aneurysm supposed to have?

Bedrest. do not get these people up

If the client with aneurysm is physically unstable, should you encourage turning, coughing and deep breathing?

no, bedrest until the client is stable!

What class of drugs is the client with an aneurysm most likely to be on?

Antihypertensives

What is the BIG danger with aneurysms of any type?

Rupture, leads to shock and death

If an aneurysm is ruptured how would you know it?

decreased LOC (restlessness), tachycardia, hypotension - all signs of shock

If an aneurysm ruptures what is the #1 priority?

Get them to the operating room ASAP

Is there anything that can be done for the client with a ruptured aneurysm before they get to the operating room?

Yes, if available you can get them into antishock trousers but not if this causes a delay in getting them to the operating room

The post op thoracic aneurysm is most likely to have which type of tube?

Chest tube, because the chest was opened

The post op abdominal aneurysm repair client is most likely to have which type of tube?

NG tube for decompression of bowel

If you care for a client who is post-op for a repair of a femoral popliteal resection what assessment must you make every hour for the first 24 hours?

check the distal extremity (far from center) for color, temperature, pain and PULSE, also MUST document

What causes angina pectoris?

Decreased blood supply to myocardium, resulting in ischemia and pain

Describe the pain of angina pectoris

crushing substernal chest pain that may radiate

What drug treates angina pectoris?

Nitroglycerine

How do you tell if a client has angina or an MI?

the pain of the two is similar, the way to tell the difference is if nitro and rest relieve the pain. For angina, nitro and rest relieve the pain, for MI, nitro and rest do not relieve the pain

How many nitro tabs can you take before you call the doctor?

3

How many minutes should lapse between the nitro pills you take?

5 minutes - take one nitro tab every 5 minutes 3 times, if no relief, call MD

By what route do you take nitro?

sublingual

What is the action of nitro?

dilates coronary arteries to increase blood supply (O2 supply) and reduces preload.

What are the top 2 side effects of nitro?

headache and hypotension

What precaution must the nurse take when administering topical nitro paste?

wear gloves, nurse may get a dose of the med

Everyone with angina needs bypass surgery? t/f

False

Anorexics are usually __________ under the age of _____.

females, 25

The diagnosis is made when there is a weight loss of _______% or more of body weight.

15 (weigh < 85% of normal body weight), hospitalize if 30% weight loss

A major mental/emotional nursing diagnosis seen in anorexia nervosa is ___________.

Altered body image

The pulse rate of anorexics is tachycardic or bradycardic?

Bradycardic

List the most common gynecologic symptom of anorexia nervosa?

amenorrhea

What is found over the body of the client with anorexia nervosa?

lanugo (soft downy hair)

What is the top priority in the care of the client with anorexia nervosa?

intake of enough food to keep them alive, have them gain weight

The best goal to evaluate the progress of the client with anorexia nervosa?

an adequate weight gain

What is the apgar scale?

quick objective way to evaluate the vital functions of the newborn

When is apgar scoring performed on infants?

at one minute and again at 5 minutes after the birth

Name the 5 criteria that are recorded on an apgar scale

Cardiac status, respiratory effort, muscle tone, neuromuscular irritability, and color

The total apgar score can range from

0 to 10

The maximum score and infant can receive on any one of the criteria is

2

A 10 on the apgar means the baby is

in terrific health

A 0 on the apgar means the baby

is stillborn

On heart rate or cardiac status, a 2 means that the HR is above _______ BPM.

100

On the HR criteria an infant scores a "1" if their HR is _________ than 0 and ____________ 100

greater, less than

In order to score a 0 on HR the infant must have a rate of _________.

Zero

A high score of 2 is given for respiratory effort if the newborn_____________.

Cries vigorously

An infant is given a score of 1 if their respirations are _______ or ________.

Slow or irregular

An infant is given a score of 0 for respiratory effort if __________.

They do not breathe

In order to get a score of 2 on muscle tone the infant must_________________.

Move spontaneously (actively)

To get a score of 1 on the APGAR for muscle tone the newborn must place their extremities in _______________.

Flexion

A newborn receives a score of 0 on muscle tone when there is__________

No movement (limp)

To score the maximum of 2 points on nueromuscular reflex irritability the infant must ______________.

Cry

If the neonate ____________, they will score a 1 on neuromuscular irritability.

Grimaces

To receive a 0 on reflex (neuromuscluar) irritability the neonate must exhibit _______

No response

To score a maximum score fo 2 on color the child must be ____________.

Totally pink

If the child's _______ are ______ and the trunk -face abdomen are ________, the child scores 1 on color

Extremities are blue (cyanotic), Pink

To get a 0 on color the infant is

Totally blue, pale

Acrocyanosis

Temporary cyanotic condition, usually in newborns resulting in a bluish color around the lips, hands and fingernails, feet and toenails. May last for a few hours and disappear with warming.

Apendicitis is an _________ of the appendix due to __________.

inflammation, obstruction

Apendicitis occurs most in what age group?

15 to 35

What is the most common complication of appendicitis?

Peritonitis

Peritonitis

inflammation of the peritoneum

What is the first sign of appendicitis?

right upper quadrant pain

What follows the RUQ abd pain of appendicitis?

N/V

Where does the pain of appendicitis finally end up?

RLQ

What is the name of the RLQ abd pain where appendicitis pain finally localizes?

McBirney's point

What is present when rebound tenderness is present?

Peritoneal inflammation

What is the hightes that the temp will be in appendicitis?

102 F

What blood count is elevated in appendicitis?

WBC

What is the name for an elevated WBC?

Leukocytosis

What is the only treatment recommended for appendicitis?

surgery - appendectomy

Before the client with suspected appendicitis sees the physician what should be avoided?

pain meds, enemas, laxatives, food! NPO

To lessen pain place the client in ___________ position.

fowlers (a sitting position) (also use post op)

Never apply __________ to the area of the appendix.

heat (it causes rupture)

After appendectomy, document in the nurses notes the return of __________

bowel sounds (peristalsis)

What is the primary dietary prescription for calcium nephrolithiasis?

Low calcium diet

For the client with calcium nephrolithiasis the diet should be _________ash.

Acid

If the kidney stone is calcium phosphate the diet must be low in _____ too.

Phosphorous

The primary diet treatment for uric acid nephrolithiasis is _________ -________.

Low pruine

The client with uric acid nephrolithiasis should have a diet low in ___________.

Methionine

What is methionine?

The precursor of the amino acid cystine (precursor = material out of which something is made)

Name two foods high in methionine.

Milk, eggs

Clients with cystine nephrolithiasis should have a (n) _________ ash diet.

Alkaline

Increasing fluids to over 3000 cc per day is more effective in treating renal calculi ( kidney stones) than any dietary modification. (T/F)

True. It's more important to flush the urinary tract than worry about what you're eating.

Neoplasm refers to benign and malignant tumors. (T/F)

True

Which type of tumor is more malignant? Differentiated or undifferentiated?

Undifferentiated is worse to have (highly differentiated is better to have)

When cancer spreads to a distant site it is called?

Metastasis

The cause of cancer is known. (T/F)

False

A person should have a yearly work up exam for cancer detection over the age of __________.

40

In general, cancer drugs have side effects in which three body systems?

GI
Hematologic (blood)
Integumentary

What are the 3 most common chemotherapeutic GI side effects?

N/V
Diarrhea
Stomatitis (oral sores)

Clients receiving chemotherapy must be NPO. (T/F)

False

Is it permissible to give lidocaine viscous ac (before meals) if the patient has chemotherapeutic stomatosis? (T/F)

True

With what solution should the client with chemotherapeutic stomatitis rinse pc (after meals)?

H2O2 - hydrogen peroxide

What lubricant can safely be applied to the cracked lips of chemotherapy stomatitis?

K-Y Jelly

Name the 3 hematologic side effects of chemotherapy.

Thrombocytopenia
Leukopenia
Anemia

Which cells are low in thrombocytopenia?

Platelets

What drug should NOT be given to the patient with chemotherapeutic thrombocytopenia?

ASA (aspirin)

When should the nurse WITHHOLD IM injections in the client on chemotherapy?

Only when their PLATELET count is down.

What are the 3 objective symptoms/signs of thrombocytopenia? Hint: P.E.E.

Petechiae
Epistaxis
Ecchymosis

What is epitaxis?

Nose bleeds

What is ecchymosis?

Bruising

What is petechiae?

Small dot like pinpoint hemorrhages on the skin.

What blood cell is low in leukopenia?

White blood cells

When the Absolute Neutrophil Count ANC is below________ the person on chemotherapy will be placed on reverse isolation.

500

What is the #1 integumentary side effect of chemotherapy?

Alopecia

What is alopecia?

Hair loss

The hair loss due to chemotherapy is usually temporary? (T/F)

True

Can scalp tourniquets prevent chemotherapy alopecia?

In some cases, yes

Can ice packs to the scalp prevent chemotherapy alopecia?

In some cases, yes

CD ranks ________ among the leading cause of maternal death.

Fourth

What is the #1 cause of CD of pregnancy?

Rheumatic heart disease

Pregnancy requires a __________ increase in the cardiac output.

30-50%

What is the #1 cause of maternal death in CD of pregnancy?

Decompensation

What is meant by decompensation?

Failure of the heart to maintain adequate circulation.

What will you see when you observe the neck of a client with CD of pregnancy?

Distended neck veins -JVD

What will you hear when you auscultate the heart of the client with CD of pregnancy?

Murmurs

What will you hear when you auscultate the lungs of the client with CD of pregnancy?

Crackles-rales

If the client with CD of pregnancy experiences sudden heart failure what is the MOST common thing you will see?

Sudden onset of SOB (dyspnea).

What is the #1 treatment of CD during pregnancy?

Rest

What are the three most common drugs given to women with CD in pregnancy?

Diuretics
Heparin
Digitalis

Why are diuretics given to women with CD of pregnancy?

To promote diuresis which will:
-lower circulating blood volume
-decrease preload
-decrease the amount of blood the heart pumps.

Why are anticoagulants (heparin only) given to women with CD of pregnancy?

To prevent thrombophlebitis due to venous congestion, usually in legs.

Why is digitalis given to women with CD of pregnancy?

To increase the strength of the heart and to decrease the rate, rest the heart while making it more efficient

Can a woman with CD of pregnancy be given analgesics during labor?

Yes, in fact they should be given analgesics, may get too anxious which is bad for the patient

Can morphine be given to a woman with CD during labor?

Yes, even though it negatively affects the fetus, remember morphine decreases preload and pain which rests the heart.

What is the most common dietary modification for the woman with CD who shows signs of decompensation?

Decreased sodium, decreased water (restriction)

Is a C-section mandatory for delivery of a woman with CD of pregnancy?

No

Second to rest, what is very important treatment for CD of pregnancy?

Weight control

How long must the woman with CD of pregnancy be on bed rest after delivery?

At least one week

What nutrients should be supplied in the diet of the pregnant woman with CD?

Iron
Folic acid
Prevent anemia (anemia always makes the heart work more)

What are the two most common subjective complaints of the woman who is decompensating during labor?

SOB
Palpitations

In addition to the things you assess for in every woman during labor, what additional assessment must you make for a woman with CD?

You must assess lungs sounds frequently

How often must you assess the lung sounds during the first stage of labor? During active labor? During transition labor?

Every 30 to 10 minutes

In which position should a woman with CD in labor be?

Semi recumbent, HOB up

The nurse should limit the client's efforts to ________ ______ during labor when CD is present.

Bear down

What is the big danger to staff when caring for a client with cesium implant?

Radiation hazard

What are the three principles to protect yourself from radiation hazard?

Distance
Shielding
Time

Will the woman with a cesium implant have a foley?

Yes

From where should the nurse provide care to the client with cesium implant?

The head of the bed

How can the woman with cesium implant move in bed?

Only from side to side

What four symptoms in a patient with a cesium implant should be reported to the physician?

Profuse vaginal discharge
Elevated temp
Nausea
Vomiting
(these indicate infection and perforation)

Should pregnant staff care for a client with a cesium implant?

No

Can the woman with a cesium implant have the HOB elevated?

Yes, only 45 degrees maximum

From where should the nurse talk to the client?

The entrance to the room

Is bed rest necessary when a woman has cesium implant in place?

Yes, absolute bed rest

What type of diet is this woman with a cesium implant on?

Low residue (decrease bowel motility )

No nurse should attend the client with a cesium implant more than ____ per day.

1/2 hour

What would you do if the cesium implant came out?

Pick it up with forceps only - never touch with hand even if you are wearing gloves.

Should the nurse provide perineal care for the client with a cesium implant?

No, risk of radiation hazard

What part of your hand do you use to handle a wet cast?

The palm

Upon what do you support a cast while it dries?

Pillows (no plastic covers)

How long does it take a cast to dry?

24 hours

Should you cover a wet cast?

No

Should you use a heat lamp or hair dryer or fan to help dry a cast?

No heat lamp and hair dryer
Yes fan

What signs or symptoms would you report if they were present after cast application?

Numbness
Tingling
Burning
Pallor
Unequal or absent pulses
Unequal coolness

If there is inflammation under a cast, it will be evident in a _______ spot.

Hot

To prevent irritation of the skin near the edges of a cast the edges should be ____________.

Petaled

What type of cast causes cast syndrome?

A body cast

What causes cast syndrome?

Anxiety and stress leading to sympathoadrenal shut-down of the bowel

What is the #1 symptom of cast syndrome?

Nausea and vomiting due to bowel obstruction

What is the #1 treatment of cast syndrome?

NPO and NG tube for decompression

A dry cast is gray or white?

White

A dry cast is dull or shiny?

Shiny

A dry cast is dull or resonant to percussion?

Resonant

Traction is used to _______ and _______ a fracture, relieve ________ _______ and prevent ________.

Reduce and immobilize, muscle spasm; deformities

Can skin traction be removed for skin care?

Yes

Can the client be removed from skeletal traction?

No

Name 3 types of skin traction

Bucks
Bryants
Pelvic

Name 3 types of skeletal traction

Cranial tongs
Thomas splints with Peason attachments
90 degrees to 90 degrees

What type of traction is most commonly used for hip fracture in adults?

Bucks

What type of traction is most commonly used for hip fractures in children?

Bryants

In what position should the bed be if the patient is in pelvic traction?

Semi-fowlers with knee gatched

To insure that Bryant's traction is working the child's hip/sacrum should be _________

Off the bed enough to slip a hand between the sacrum and the bed.

What is the advantage of balanced counteraction?

You can easily move the patient around in bed

Patients in Russell's traction are particularly prone to ____________.

Thrombophlebitis

When a patient is in a Buck's traction they may turn to the _________ side.

Unaffected

Define cataract

Opacity of the crystalline lens

Is surgery done immediately upon diagnosis of cataract?

No, they usually wait until it interferes with ADLs .

What three most common visual defects occur with cataract?

Cloudiness
Diplopia (double vision)
Photophobia (sensitivity to light)

What are the two common treatments of cataract?

Laser, surgical removal. Surgery called intraocular or extraocular lens extraction

What does the eye look like when a client has cataracts?

Cloudy, milky-white pupil

What will the client be wearing after cataract surgery?

A protective patch/shield on the operative eye for 24 hours, then a metal shield (AT NIGHT only) for 3 weeks

When the client asks about the use of glassess or contacts after cataract surgery what would you say?

If an introcular lens is implanted they will NOT need glasses. If no lens is implanted, then contacts will be fitted for 3 months post-op, temporary thick glasses given immediately but will get a different prescription in 2 to 3 months

What will be a high priority nursing diagnosis for a client post cataract surgery?

Safety

Should the client ambulate independently after cataract surgery?

No the patient should not ambulate independently, depth perception is altered.

What positions are to be avoided after cataract surgery?

Lying face down. Also, do not lie on operative side for a month.

What are the post-operative signs of hemorrhage into the eye?

Severe pain
Restlessness

What movements are to be avoided after cataract surgery?

Coughing
Sneezing
Bending at the waist
Straining at stool
Rubbing or touching eyes
Rapid head movements

What positions are okay after cataract surgery?

Do not lie on operative side; do not lie on back

Should you use talcum powder with a post-operative cataract client?

No, it may cause sneezing; also should avoid pepper.

What are the three signs of increased intraocular pressure?

Pain (moderate to severe)
Restlessness
Increased pulse rate

What is the major objective in caring for a client after surgical cataract removal?

To prevent pressure in or on the eyes

When the lens is to be extracted for cataracts, what drugs are given preoperatively?

Mydriatics
Dilators
Antibiotic drugs (gtts)

What three drugs are given post-operatively for surgical cataract removal?

Stool softeners
Antiemetics
Analgesics (mild to moderate)

Give five causes of catarcts?

Injury
Congenital
Exposure to heat
Heredity
Age

Celiac's disease is a __________ disease

Malabsorption

The client with celiacs cannot tolerate___________.

Gluten

Gluten is a __________.

Protein

What does gluten do to the intestines of the client with celiac's disease?

It destroys the lining of the intestine.

The stools of a client with celiac's disease are ______, ______ and _____- _____.

Large
Greasy
Foul-smelling

Clients with celiac's disease do not absorb what mineral?

Iron

Clients with celiac's disease don't absorb fats; therefore they don't absorb _____ ______ ______.

Fat soluble vitamins

What are the four fat-soluble vitamins?

A,D,E,K

Malabsorption of which vitamin leads to bleeding disorder?

Vitamin K, remember do not mix up potassium with Vitamin K

What will the abdomen of clients with celiac's disease look like?

Distended with flatus

What is the #1 treatment of celiac's disease?

Gluten-free diet

Veggies are allowed or not allowed in diet of client with Celiac's disease?

Allowed

Fruits are allowed or not allowed?

Allowed

Grains of all kinds are prohibited. (T/F)

False

What grains are allowed in a gluten-free diet?

Rice and corn

What grains are not allowed in a gluten-free diet?

Wheat
Oats
Rye
Alfalfa
Barley

Are foods made with wheat, oat, or rye flour allowed?

No

Is milk allowed on a gluten-free diet?

Yes

Are meats allowed on a gluten-free diet?

Yes, but watch for breaded meats and hot dogs/lunch meats- may have grain in them and are not allowed

Are eggs allowed on a gluten-free diet?

Yes

Is commercial ice cream allowed on a gluten-free diet?

No, even though it is a milk product, commercial ice cream has GRAIN in it.

Are puddings allowed on a gluten-free diet?

No, for the same reason ice cream isn't.

Which soups are not allowed on a gluten free diet?

Creamed soups- these often have flour

The #1 problem with central lines ___________

Infection

How often should central line dressings be changed?

QOD- every other day

What type of dressing is applied to a central line insertion site?

Sterile occlusive

Can drugs be piggybacked into central --TPN?

No, use another lumen.

When changing central line tubing the patient should be told to_________?

Turn his head away from the site, hold breath, and perform the Valsalva maneuver

If a central line is found accidentally open the patient should be positioned on his ______ ______.

Left side

A CVA is a __________ of the brain cells due to decreased _____ _____ and ______.

Destruction; blood flow and oxygen

Women have a (higher/lower) incidence of stroke than men?

Lower

Name the three types of CVA

Embolus
Thrombus
Hemorrhage

Use of oral contraceptives increases the risk of CVA (T/F).

True

Chronic abuse of alcohol increases risk of CVA. (T/F)

False

Obesity increases risk of CVA (T/F)

True

Smoking increases the risk of CVA. (T/F)

True

Atrial fibrillation increases the risk of CVA (T/F)

True, emboli particularly

What is a TIA?

Transient Ischemic Attack
Warning sign of impending CVA (transient neurologic deficits of any kind can last 30 seconds to 24 hours)

Do patients experiencing a CVA have a headache?

Yes

The first sign of CVA is usually a___________.

Change in LOC

The activity order in early management of CVA is __________.

Absolute Bed Rest

The patient with a recent CVA is most likely to have fluids restricted or forced?

Restricted

How far should the HOB be up after CVA?

30 degrees

Can the stroke victim be turned side-to-side?

Yes

How often should the CVA patient be turned or repositioned?

Every 2 hours

The CVA patient should be turned onto his paralyzed side no longer than 2 hours. (T/F)

False, the patient should not be on their paralyzed side for more than 20 minutes.

ROM exercises should occur every 2 hours in CVA patients. (T/F)

False-- every 4 hours or 3 times a day is enough

To prevent urinary incontinence; the CVA patient should be catheterized. (T/F)

False- remember incontinence will never be allowed as a reason for catheterization

Which type of paralysis is typical of CVA- paraplegia, hemiplegia or quadriplegia?

Hemiplegia

What anatomical fact accounts for the left side of the body being controlled by the right brain?

The motor-pyramidal-tracts cross over to the other side (decussate in the medulla)

If the patient has right hemiplegia, he cannot move his ____ ____ and ____ ____ and the stroke was on the _________ side of the brain.

Right arm and right leg, left

What is hemianopsia?

Not being able to see one half of the field of vision.

The client with hemianopsia should be taught to ____________.

Scan

What is scanning?

Moving the head from side to side to see the whole field of vision.

If the client has right homonymous hemaniopsia, the food on the ____ side of the tray may be ignored.

Right

After meals, the nurse must always check _______ of the CVA client for _________.

Mouth (cheek), food

Should a CVA patient have all four side rails up at all times? Should they be restrained?

Side rails yes. Restraints- no, unless they are a danger to themselves or others

When a patient does not understand INCOMING language he is said to have ______ aphasia.

Receptive

When the CVA client understands your question but can't respond verbally correctly, he is said to have ___________ aphasia.

Expressive

What is global aphasia?

Both receptive and expressive

Aphasia is most common if the stroke occurred in the (dominant/non-dominant) hemisphere of the brain.

Dominant

How do you tell which side of the person's brain is dominant?

It is the side that controls their dominant hand, ie, a left handed person has a dominant right hemisphere and conversely a right hand person has a dominant left hemisphere

For which type of aphasia are slow, short, simple directions most useful?

Receptive

For which type aphasia is careful listening and needs anticipation most useful?

Expressive

The loss of the ability to perform purposeful, skilled acts, ie brushing teeth, is called __________.

Apraxia

Cytoxan cyclophosphamide

Hemorrhagic cystitis

Cisplatin

Peripheral neuropathy, constipation, ototoxicity

Bleomycin

Pulmonary fibrosis

Adriamycin

Cardiotoxicity

Vincristine

Peripheral neuropathy (foot drop, numbness and tingling, hoarseness, jaw pain)
constipation (adynamic ileus due to neurotoxicity)

DTIC- dome

Flu-like symptoms
Chemo-therapeutic Agent Toxicities

Methotrexate

Toxic to just about every organ except to heart, toxicity made worse with aspirin

The infant fears _________ most when hospitalized.

Separation from love object

The toddler fears _______ most when hospitalized.

Separation from family

The preschooler fears separation as well as _________ when hospitalized.

Mutilation- remember preschoolers have vivid imaginations...fantasy

The toddler and preschooler will think that illness is caused by_____________.

Something they did wrong.

The school-aged hospitalized child is afraid of separation from ___________.

Age group

The school-aged child perceives the cause of illness to to be external or internal?

External, she knows that illness is not a result of bad behavior.

The adolescent who is hospitalized fears separation from _________ and loss of ___________.

Peers, independence

Preschoolers may require physical restraint during painful procedures. (T/F)

True

Which age group engages in stalling tactics before painful procedures most?

School-Age

Which age groups are most likely to physically resist the nurse during procedures?

School-age, adolescents

Toddlers may require physical restraint for painful procedures. (T/F)

True

The meats that are highest in cholesterol are _________ meats.

Organ meats
liver, heart, brains, kidneys

The meats that are second highest in cholesterol are the ___________

Shell seafood- shrimp, crab, lobster

Egg white is (high/low) in cholesterol?

Low

Egg yolk is (high/low) in cholesterol?

High

The three meats lowest in cholesterol are _________, _________ and __________.

Chicken, pork, mutton

Milk is (high/low) in cholesterol.

Low

Is cheese high in cholesterol?

Only moderate, not really that high

Which oils are high in cholesterol?

Animal oils

Is cholesterol a triglyceride?

No

Do plant foods contain any cholesterol?

No, not many

What is otitis media?

Chronic infectious/inflammatory disease of the middle ear

Is otitis a disease of the adult or child?

Usually the child

What part of the ear is involved in otitis media?

Middle ear

What are the 2 common subjective signs of otitis media?

Hearing loss
Feeling of fullness in the ear

What are the 2 common objective signs of otitis media?

Hyperpyrexia (fever)
Drainage from ear

What commonly happens secondary to otitis media?

Perforation of the ear drum

Do all the children with otitis media need tubes in their ears?

No

What are the two most common medical treatments for otitis media?

Systemic antibiotics
Antibiotic ear drops

What is the most severe complication of otitis media?

Meningitis or mastoiditis

What is cholesteatoma?

An epidemial cyst in the ear highly associated with otitis media.

What are the restrictions to be followed when tubes are in a child's ear?

No swimming, no showering, no diving

What is cleft lip?

The lip is open to the nares

What is cleft palate?

The roof of the mouth is open to the nasopharynx.

Is it possible to have only one: cleft lip or cleft palate?

Yes, you can have one or or the other or both

When will the cleft lip be repaired?

Between 10 weeks and 6 months

When is cleft palate repaired?

Between 1 and 5 years of age

Why is cleft lip repaired early?

Feeding is easier after repair and appearance after repair is more acceptable to parents.

Describe the nipples on bottles used to feed babies with cleft lip?

Large-holed, soft nipples

The infant with cleft lip/palate needs more frequent ___________.

Bubbling, burping

Children with cleft lip/palate should be fed in what position?

An almost upright position

What is the #1 complication of cleft lip/palate?

Aspiration

Children with cleft lip and cleft palate have long-term problems _____, _____ and _____.

hearing
speech
teeth

In how many surgeries is cleft palate repaired?

Two surgeries
one at 12 to 18 months
the last at 4 to 5 years

Why is final repair of the palate delayed until 4 to 5 years?

Earlier surgery would interfere with tooth development.

How are cleft lip and cleft palate primarily treated?

Surgical repair

Is the infant restrained BEFORE repair?

No, just AFTER repair

Should children with cleft palate BEFORE surgery be allowed to cry? To breast-feed?

Yes, they can cry; may breast feed with simple cleft lip however palate interferes with feeding

AFTER repair of cleft lip is infant allowed to cry? To breast feed?

No, the infant should be held to PREVENT CRYING; the infant is not allowed to breast-feed because sucking is not good after lip repair.

After clep lip repair, what device will the baby wear?

A Logan bow

What is the purpose of a Logan Bow?

To prevent stress on the suture line

With what device will the infant be restrained?

Elbow restraints

How do you care for an infant with a Logan Bow?

Remove the gauze before feeding and cleanse after feeding with peroxide and saline.

Can cleft lip /palate babies sleep on their backs?

Yes

What position is contraindicated after cleft lip repair?

NEVER lie on their abdomen

What will be used to feed the infant after cleft lip repair?

A dropper/syringe with rubber tip to discourage sucking

What must the mother do after feeding the baby who has had cleft lip/palate repair?

Rinse the infant's/child's mouth with water

What is a colostomy?

A surgically created opening of the colon out onto the abdomen wall.

Name the 3 most common reasons for a colostomy.

Cancer
Diverticulitis
Ulcerative Colitis

What is meant by the term "temporary colostomy"?

A colostomy that is not intended to be permanent-- the bowel will be reconnected at a later date and the client will defecate normally

What is meant by the term "double barrel" colostomy?

A procedure where the colon is cut and both ends are brought out onto the abdomen.

Colostomies performed for cancer tend to be (temporary/permanent).

Permanent

Colostomies performed for a gunshot are usually (temporary/permanent)

Temporary

In a double-barrel colostomy, from which stoma (barrel) will the stool come out?

Proximal

A fresh new stoma is _________, __________ and __________.

Red, large, noisy

When a client voices embarrassment over the noises that their colostomy makes on the first post-op day, what would you say?

The noise will go away in a few days to a week.

What behavior on the part of the client is the BEST indicator that they have accepted their stoma?

When they do their own stoma care

By what day post-op should the client begin to take care of their own stoma?

By the 3rd to 4th day, they should be looking at it and asking questions by day 2.

The MORE colon is removed the more _________ the stool.

Liquid

What technique is used to remove feces and flatus from the bowel through a colostomy?

Colostomy irrigation

How many times per day will the client irrigate his colostomy?

Once

Which solution is used to irrigate a colostomy?

Tap water

How warm should the irrigation solution be?

Warmer than body temperature, ie, 99-100F

In what position should the client be when they irrigate their colostomy?

Sitting

Illeostomy

liquid stool
odor mild
stool very damaging to the skin
continuous drainage
high risk for fluid/electrolyte imbalances
incontinent
never irrigate

Transverse Colostomy

soft stool
typical stool odor
stool damages the skin
empties several times per day
may or may not be at risk for fluid/electrolytes imbalances
may irrigate

Descending Colostomy

formed stool
typical stool odor
stool doesn't irrigate unless diarrhea
predictable 2 to 3 times per day emptying
lowest risk for fluid/electrolyte imbalances
continent
do irrigate

CHF can be right-sided, left sided or both-sided. (T/F)

True- left sided usually comes FIRST

What does right sided CHF mean?

Right ventricle has decompensated
Dependent Edema (legs and sacrum)
Jugular venous distention
Abdominal distention
Hepatomegaly
Splenomegaly
Anorexia and nausea
Weight gain
Nocturnal diuresis
Swelling of the fingers and hands
Increased BP

What does left sided CHF mean?

Left ventricle has decompensated

CHF can result from MI. (T/F)

True

When cardiac output fails, name three ways the heart will try to compensate.

Ventricle hypertrophy
Dilate and heart rate will increase

What is meant by "cardiac decompensation"?

It means that the compensatory mechanisms - hypertrophy, dilation, tachycardia are not working and the heart has failed.

Name the three groups of drugs used to treat CHF?

Diuretics
Vasodilators
Digitalis

What is the activity order for clients with CHF?

Bed Rest

What special item do clients with CHF have to wear to decrease venous stasis in the legs?

TED hose

How often should anti-embolism hose (TED) be removed?

Daily

When during the day should TED hose be applied?

Before the client gets out of bed

Is it okay to use powder with TED hose?

Yes

Should you massage the calves of the client with CHF?

Never

Before you give digitalis, what action must you take?

Measure the apical pulse

If the adult client's apical pulse is below 60, what should you do?

Do not give digitalis
For a child don't give for a pulse under 70
For an infant don't give for a pulse under 90

What daily measurement best indicates the amount of fluid the client is retaining?

Daily weight

Should clients with CHF have a Foley catheter?

Yes, on diuretics and fluid balance is important

What complication is common in CHF?

Pulmonary edema

When the client is taking diuretics, what mineral is the CHF client most likely to lose?

Potassium--K+

You should tell the client with CHF to immediately report to his/her doctor if he/she gains _____pounds in one week.

Three

Name the four most common toxic effects of digitalis.

Anorexia
N&V-- very common
Yellow vision
Arrythmia

Should hearing aids be removed before going for surgery?

Yes, but just before surgery

Hearing aids are more useful in sensory or conductive hearing loss?

Conductive

Some women experience discomfort when wearing contact lenses during pregnancy or menstrual periods. (T/F)

True

Should a client sleep with the hearing aide in place?

No, a client should not sleep with a hearing aide in place.

What the two most common causes of whistling and squealing of a hearing aid?

Loose earmold
Low battery

What solution should be used to clean a hearing aid?

Soap and water

What solution is best to use if you intend to remove a client's contact lenses?

Sterile saline

Hearing aids make sounds more distinct and clear. (T/F)

False, they only amplify--make it louder, they do not clarify

Can you use alcohol on the earmold of a hearing aid?

No, it dries and cracks it

The connecting tube of a hearing aid can be cleansed with__________.

A pipe cleaner

What is the most common complication of malpositioned lenses in the comatose or confused patient?

Corneal ulceration

1 kg

1000 cc

1 inch

2.5 cm

1 ml

1 cc

1 tsp

4 to 5 cc

1 g

1000 mg

1 L

1000 cc

1 oz

30 cc

1 kg

2.2 lbs

1 tbs

15 cc

1 tbs

3 tsp

1 gm

15 gr

1 gr

60 mg

Cushings syndrome is __________ secretion of _______, _______ and _______ _______ by the _______ _______.

Oversecretion; glucocorticoids, mineralocorticoids, androgenic hormones; adrenal gland

In Cushings the blood sugar is (increased/decreased).

Increased

In Cushings the sodium level is (increased/decreased)

Increased

In Cushings syndrome, the client develops __________ face.

Moon

In Cushings syndrome, the trunk is ________ and the extremities are _________.

Obese, thin

What is seen on the abdomen of the patient with Cushings?

Striae--purple horizontal lines

Men with Cushings develop______________.

Gynecomastia

What is gynecomastia?

Female-type breasts

Women with Cushings develop?

Hirsutism
Amenorrhea

What is hirsuitism?

Hair where you don't want it

The Cushings syndrome patient will have a _________ on their upper back.

Buffalo hump

The patient with Cushings Syndrome will have (increased/decreased) blood pressure.

Increased, remember retaining water and sodium

The Cushings syndrome patient will have ________ natremia, _________kalemia and _______glycemia.

Hyper; hypo; hyper

Cushings clients will have (increased/decreased) resistance to infection.

Decreased

Chronic _____________therapy imitates Cushings.

Steroid

Cushings Man aka Cush Man

moon face with infection
buffalo hump on back
big trunk
thin extremities
loses potassium
keeps glucose and salt
has striations on abdomen and breasts

Is CF hereditary?

Yes

What glands are affected in CF?

Exocrine glands

What is the appearance of the stool in a client with CF?
remember the 4 Fs

Fat
Frothy
Foul-smelling
Floating
Steatorrhea

What are the top 2 nursing diagnoses for a client with CF?

Decreased airway clearance Alteration in nutrition or absorption

What is the classic test for CF?

Iontophoresis - sweat test

In which two systems/organs are the most problems in CF?

Lungs
Pancreas

How does the client evaluate the activity of their pancreas?

Observe stools for steatorrhea

What is the typical diet for CF client?

High calorie
High protein
Modified fat

The major problem in CF is _______________.

Increased viscosity of the secretions of exocrine glands lead to obstruction.

The most common intervention for the CF client with a diagnosis of decreased airway clearance is _________________.

Postural drainage

What vitamins need to be replaced in CF?

Fat soluble in water soluble form -- A,D,E,K

What do CF clients need to do (ingest) in hot weather?

Take NaCl tablets

The child with the diagnosis of CF probably had a history of _________ ________ at birth.

Meconium ileus-- bowel obstruction due to the thickness of the stool.

Why is the child with CF receiving pancreas/viokase/pancreatin?

They are enzymes which aid absorption of nutrients.

When should the child with CF take his pancreatin/viokase/pancreas?

With meals, so it is in the gut while the food is present, the whole purpose is to increase absorption of ingested food.

Define Cystoscopy?

Direct visualization of the urethra and bladder through a cystoscope.

What would you do if the client had any one of the following after cystoscopy: bladder spasm, burning, frequency?

Record it but no need to call the MD

What would you do if the client's urine was pink-tinged after cystoscopy?

Record it in the notes, no need to call the MD.

Is the client NPO before cystoscopy?

No, not unless a child with a general anesthetic-- in fact with adults you should encourage fluids.

Are enemas required before cystoscopy?

No, but may be ordered.

Should you encourage fluids after cystoscopy?

yes

Is a signed informed consent required for cystoscopy?

Yes

What vital sign changes are most ominous after cystoscopy?

A fall in the blood pressure and increase in the pulse-- increasing hemorrhage

Is the client sedated for a cystoscopy?

It is done under LOCAL anesthesia. General anesthesia may be used for a child.

What drugs are most commonly given before cystoscopy?

Valium or demerol

Increasing dietary fiber lowers the risk of ___________ of the __________.

Cancer, colon

Foods lose some or all of their fiber when they are ___________. ___________,____________ or__________.

Processed, cooked, peeled, refined

Whole grains and grain products are (high/low) in fiber.

High

Fruits are (high/low) in fiber.

High

Veggies are (high/low) in fiber.

High

Milk and milk products are (high/low) in fiber.

Low

Meats are (high/low) in fiber.

Low

Nuts, seeds, and legumes are (high/low) in fiber.

Low

Which has highest fiber? Grains, fruits, veggies, nuts.

Grains, especially bran

When a person increases fiber in the diet they should do so____________.

Slowly

Side effects of a high fiber diet include__________ and malabsorption of ____________.

Gas (flatus), minerals

Of milled bread, enriched bread, fortified bread and whole grain bread; which is highest in fiber?

Whole grain

What structures in the brain are most affected in Parkinson's?

Basal ganglia

The neurotransmitter imbalance that causes Parkinson's is a ______ in ______ ______.

Decrease, dopamine activity

What drugs can cause a Parkinson-like syndrome?

Haldol, major tranquilizers -- drugs that end in -azine

What is the classic motor manifestation of Parkinson's?

Pill-rolling and tremors

What type of rigidity is typical of Parkinson's?

Cogwheel

Parkinson's patients move fast or slow?

Slow

What type of gait is seen in Parkinson's?

Shuffling slow gait

Patient's with Parkinson's have ______ speech.

Monotone

Patients with Parkinson's tend to have constipation or diarrhea?

Constipation

Name four drugs used to treat Parkinson's.

Levodopa, Sinement, Symmetrol, Cogentin, Artane, Parlodel

In what type of chair should Parkinson's patients sit?

Firm, hard-backed

What time of day can be particularly dangerous for the Parkinson's patient?

Mealtime, due to choking

When a patient is taking Levodopa he should have assistance getting out of bed because...

Of orthostatic hypotension

What vitamin should patients on Levodopa avoid?

B6 pyridoxine

Levodopa should be given with or without food?

With

What might Levodopa do to patients urine?

Make it very dark

The tremors of Parkinson's will get better or worse when they purposefully move or perform a task?

Better, they tremor more when not performing an action

The client on a PCA pump is less likely to have post-operative complications than the client without a PCA pump. (T/F)

True, because the comfortable patient moves around more and is less likely to get thrombophlebitis, pulmonary embolus, fatigue, ileus and pneumonia

Clients with COPD are not good candidates for PCA pumps. (T/F)

True, due to the effects of narcotics on central respiratory control

Name the three most common uses of PCA techniques.

Post-operative pain, cancer pain, sickle-cell crisis pain

PCA pumps allow a more constant level of serum drug than conventional analgesia. (T/F)

True

A major disadvantage of PCA pump is that the client can take too much medication. (T/F)

False, it is not possible for the client to overdose due to the lock-out feature

Clients on PCA pumps use more medication than those receiving IM injections. (T/F)

False, they use less

A disadvantage of PCA pumps is that the client does not ambulate as early due to the machine. (T/F)

False, PCA clients ambulate earlier and they pull their machine with them.

When discontinuing a PCA infusion it is acceptable to discard the drug cartridge. (T/F)

False, the whole cartridge system must be returned to the pharmacy due to federal narcotic control laws.

Comfort range or relative humidity is...

30-60%

Which patients should be forbidden to smoke? Smoke alone?

Those with oxygen in the room, confused, sleepy, drugged clients

When applying restraints remember to...

Avoid bruising skin, cutting off circulation, accidental entangling

List ways to ensure privacy...

Use drapes and screens during care in semi-private rooms

Plastic pillow cases are ______. (disadvantages)

Hot and slippery

When using restraints with clients who object, don't forget about _____- _____.

False imprisonment

Individuals who are ill are ________ sensitive to noise than individuals who are well.

more

When you are not at the bedside the bed should always be...

In the lowest position

Can nurses be held liable for an accident resulting from a client not being told how to use the call light?

yes

Dangers associated with drafts are...

Circulation of micro-organisms on air currents

The first thing a nurse should do when a client objects to side rails is...

Explain why they are being used.

The comfort range of temperature is...

68 to 74 degrees

Is having the client verbally identify himself considered adequate safety?

No, only identification bands are acceptable.

Bed side rails should be up for the following individuals...

Elderly clients, unconscious, babies, young children, restless, confused

The symptoms of sensory overload and sensory deprivation are...

Fear, panic, depression, inability to concentrate, restlessness, agitation

If a family member asks to have the side rails down while they are in the room you should...

Remember that you are responsible for the client's safety-- not his family, it might be unwise to permit this

Pillows are sterilized between uses. (T/F)

False

What is the common name for pediculosis?

Lice

What is the common finding with pediculosis pubis?

Reddish-brown dust in the underwear

What common household solution is used to remove nits?

Vinegar. Nits are the eggs of lice that adhere to the hair shaft

What shampoo is used for lice?

Kwell

Where are head lice most commonly found?

At the back of the head and behind the ears

On what do lice feed?

Blood

After treatment how long do you have to inspect for lice?

Inspect for 2 weeks to be sure that they are all gone

What is the most common symptom of lice?

Itching

What is the most dangerous toxicity of Kwell?

CNS toxicity

What is the typical of the lesions of pemphigus?

Foul-smelling, blisters break easily, seen in the elderly, cause unknown

What is the characteristic lesion of pemphigus?

Large vesicular bullae

What are bullae?

Large blisters

What chemical is added to the bath water of a client with pemphigus?

Potassium permanganate

What precaution must be taken with potassium permanganate?

Be careful that no undissolved crystals touch the client; it will burn the skin

What is the typical skin care of pemphigus?

Cool wet dressing

What unusual nursing diagnosis is high priority in pemphigus?

Alteration in fluid and electrolyte balance

What are the top three nursing interventions in pemphigus?

Oral care, protection from infection, encouraging high fluid intake

What kinds of fluids will clients with pemphigus drink best?

Cold fluids

What drugs are most commonly used?

Steroids

Should steroids be given with meals?

Always

What is the #1 cause of death in pemphigus?

Overwhelming infection

Pemphigus

An acute or chronic disease of adults, characterized by occurence of successive crops of bullae that appear suddenly or apparently normal skin and disappear, leaving pigmented spots. It may be attended by itching and burning and constitutional disturbance

Peritoneal Dialysis (PD)

The removal of wastes, electrolytes and fluids from the body using peritoneum as dialysis membrane

When PD is being used the client must be on heparin. (T/F)

False, you do not need to be heparinized for peritoneal, but you do need to be heparinized for hemodialysis

How long does one episode/course of PD last?

Could be 10 hours

With PD there is a high/low risk of peritonitis?

High

When fluid accumulates in the abdomen during PD what problem does the client experience first?

Dyspnea - SOB or difficulty breathing, due to the inability of the diaphragm to descend

What nutrient is lost in highest amounts during PD?

Protein

Can a client who had recent bowel surgery get PD?

No

Should a client who is having breathing problems receive PD?

No

What body surface must be punctured to administer PD?

The abdomen

The solution introduced into the peritoneum during PD is called...

Dialysate

Before allowing the dialysate to flow into the peritoneal cavity it must be _____ to _____ temperature.

Warmed, body

Before PD it is important the client be...

Weighed, to assess water loss or gain

What force is used to introduce the dialysate into the peritoneum?

Gravity only, no pumps

How fast does the dialysate usually flow into the peritoneum?

In 10 minutes

How long is the dialysate allowed to remain in the peritoneum before it is drained out?

15-30 minutes

How long does it usually take for the dialysate to drain out of the peritoneum?

10 minutes: (10 minutes flow in, 30 minutes in abdominal cavity, 10 minutes flow out = total of 50 minutes)

If the dialysate does not drain out well, you would first...

Have them turn side to side

What color is the dialysate when it comes out?

Straw-colored - clear

Should you raise the HOB to increase drainage of the dialysate?

Yes

How often do you measure vital signs during PD?

Every 15 minutes during the first cycle and every hour thereafter

Can a client on PD: Sit in a chair? Eat? Urinate? Defacate?

Yes to all

If too much fluid is removed during PD, the client will experience...

Decreased blood pressure (hypotension)

If the client absorbs too much of the dialysate the client will experience...

Increased blood pressure (circulatory overload)

If the client complains of dyspnea during PD you would first __________, then __________.

Slow the flow, elevate HOB

If the client complains of abdominal pain during PD you would first...

Encourage them to move about

Cloudy drainage in the dialysate commonly means...

Peritonitis (Not good, call MD)

What would you do if you noticed a small amount of blood come out in the first few bottles that were infused?

Nothing, this is normal: the blood is due to the initial puncture of the abdomen

What precautions are important in the care of the client receiving PD?

Safety, because they get dizzy.

Is I&O important to record during PD?

Yes

How high should the dialysate bag be when its infused?

Shoulder height

What factor do clients with pernicious anemia lack?

Intrinsic factor. It has no other name.

What vitamin is not absorbed in a patient with pernicious anemia?

Vitamin B-12

What is another name for Vitamin B-12?

Extrinsic factor

Why isn't Vitamin B-12 absorbed in pernicious anemia?

Because these patients lack intrinsic factor

What happens when patients with pernicious anemia don't absorb Vitamin B-12?

Their RBC's do not mature and they become seriously anemic.

What other disease can be confused with pernicious anemia?

Angina pectoris

What are some classic and unique signs of pernicious anemia?

Beefy red tongue
Numbness and tingling of the hands
Sores in the mouth
Chest pain

What is the medical treatment for pernicious anemia?

IM injections of Vitamin B-12

How long must the client receive this medical treatment?

For the rest of life

Can we cure pernicious anemia?

No, just treat the symptoms.

What unique urine test is done to diagnose pernicious anemia?

The Schilling test

Is it okay to give B12 orally to a client with pernicious anemia?

No, it will never be absorbed due to a lack of intrinsic factor

What neurologic test do they do for this anemia?

The Romberg test (a test for balance), in normal people this test is negative, in the client with pernicious anemia this test becomes positive

What is conservation? In what stage does it develop?

When the child realized that number, weight, volume remain the same even when outward appearances change; Concrete Operational

What is the age range of formal operation thinking?

12-15

What is the sensori-motor stage of intellectual development?

It is the intellectual stage of children from birth to 2 years

What is the age range of concrete operational thinking?

7-11

What is the age range of pre-operational thinking? Hint: Think of PRE-schoolers.

3-6

What is the classic pattern in formal operational thinking?

Abstract reasoning

What is egocentricity? In what stage is it found?

The child views everything from his frame of reference, common in pre-operational thinking

In Placenta Previa the placenta is implanted _______ than it should be and lays over the ________ ________.

Lower, cervical os

What is the classic symptom of Placenta Previa?

Painless 3rd trimester bleeding (hint: Painless Placenta Previa)

In whom is Placenta Previa most likely to occur? Primigravida's or multigravida's?

Multigravidas

What is meant when the physician/nurse use the terms total (complete) or partial (incomplete) in reference to placenta previa?

Total or complete: placenta covers whole cervical opening
Partial or incomplete: placenta covers only part of the cervical opening

What are the 3 complications of placenta previa?

Shock
Maternal death
Fetal death

What is the best and safest way to confirm placenta previa?

Ultrasound

Should a woman with placenta previa be hospitalized?

Yes, always if bleeding

If a surgeon delays doing a C-section for Placenta Previa it is due to: (reason for delay).

Immaturity of the fetus (they will want the child to mature)

As soon as Placenta Previa is diagnosed, most pregnancies will be terminated via C-section if the fetus is mature. (T/F)

True

If a woman is admitted with active bleeding with Placenta Previa you should monitor fetal heart tones _________.

Continuously via fetal monitor

It is not necessary to use electronic fetal monitoring when there is active bleeding in Placenta Previa. (T/F)

False, infant must always be monitored

Will a woman with active bleeding in Placenta Previa be given any systemic pain relief during labor?

No, they don't want to depress the fetus

If you were told to start the IV on the woman admitted for Placenta Previa, what gauge needle would you use?

18 gauge, or any other large enough to administer blood

Pneumonia is an ______ in the ______ of the ______.

Infection, alveoli, lungs

Pneumonia is only caused by bacteria. (T/F)

False, it can be caused by viruses and aspiration.

Which blood gas disorder is most common in pneumonia?

Respiratory alkalosis, because the hyperventilation blows off more CO2, than the consolidation traps in the blood

What is polycythemia vera?

A blood disease in which there is an increase in erythrocytes, leukocytes and platelets

What is the typical complexion of a client with polycythemia vera?

Ruddy red, almost purple

What procedure is done to relieve symptoms in polycythemia vera?

Phlebotomy

What is phlebotomy?

Drain off 200-500 cc of blood from body (opposite of transfusion).

What type of diet will people with polycythemia vera be on?

Low iron

What are three signs of polycythemia vera?

Headache
Weakness
Itching

Is hemoglobin increased or decreased in this disease?

Increased

What oral problem will people with polycythemia vera have?

Bleeding mucous membranes

What organ will be enlarged in polycythemia vera?

The spleen, because it is destroying the excessive RBC's.

Due to increased destruction of RBC's seen in polycythemia vera what blood level will be increased?

Uric acid levels will be high (remember - uric acid levels are always high when cells are being destroyed as in hemolysis, chemotherapy or radiation therapy)

What drug is most commonly used in polycythemia vera?

Myleran -- (this is usually used for bone marrow cancer)

How often should the client cough and deep breath post-operatively?

Every 2 hours

How often should the post-operative patient turn?

Every 2 hours

How often should the patient use the incentive spirometer?

Every 1-2 hours

How often should the nurse auscultate the lung sounds post-operatively?

Every 4 hours

How often should the bedridden post-operative patient do leg exercises?

Every 2 hours

The post-operative patient should void by _____hours post-operatively or you must call the MD.

6 to 8

Will the typical post-operative client have lung sounds? Bowel sounds? Increased temperature?

Lung - yes; bowel sounds - no; Low grade temperature - yes

Unless contraindicated the patient should be out of bed no later than ______ hours post-operatively.

24

Deep vein thrombosis is most common in what type of surgery?

Low abdominal or pelvic

The most common complication of deep vein thrombosis _______ ________.

Pulmonary embolism

The best way to prevent thrombophlebitis is TED hose. (T/F)

False, ambulation/exercise are the best ways.

What is paralytic ileus?

Paralysis of the bowel due to surgery (common --especially in abdominal surgery)

If a post-operative patient complains of gas and cramping you should first _______ then ________.

Assess then ambulate

The typical post-operative inflammatory temperature elevation is in the range of ________.

99.8 to 101 degrees

The onset of post operative infection is on the ______ or ______ day post-operative day.

2nd or 3rd, never before that (remember elevated temperatures earlier than the 2nd post-operative day is NOT infection)

Define dehiscense

Separation of the incisional edges

Define evisceration

Protrusion of abdominal contents through a dehiscence.

What do you do for dehiscence?

Decrease HOB (but not flat); cover with sterile gauze moistened with sterile saline, call MD

What do you do, in order, for evisceration?

Decrease HOB (but not flat); cover with sterile gauze moistened with sterile saline, call MD

ante-

Before in time or place (ie. "antepartal - before giving birth)

Im-; in-

Not" or "into

intra-

Occurring within

inter-

Between

per-

Throughout, completely, a large amount

ec-

Out of

e-; ex-

Out from, away from, outside

iso-

A combining form meaning 'equal'

para-

Similar, beside

Pregnancy (decreases/increases) the body's insulin requirements.

Increases

Can pregnancy convert a non-diabetic woman into a diabetic?

Yes

What name is is given to diabetes that is brought on by pregnancy?

Gestational diabetes

Diabetes with pregnancy is (more/less) common as the woman ages.

More

What is the #1 cause of infant illness when the mother has diabetes?

Hypoglycemia

When is infant hypoglycemia most likely to occur during labor and delivery?

In the hours immediately following delivery

Hormones of pregnancy work against insulin. (T/F)

True

A sign of gestational diabetes is excessive (weight gain/weight loss)

Weight gain

(Obese/very thin) women are most likely to become diabetic during pregnancy.

Obese

In gestational diabetes the client experiences a (decrease/increase) in thirst

Increase (polydipsia)

In gestational diabetes the client experiences a (decrease/increase) in urine output.

Increase (polyuria)

Gestational diabetes is associated with what OB history?

Previous large baby (over 9 lbs), unexplained stillbirth, miscarriage, congenital anomalies

Women who have gestational diabetes tend to deliver infants who are (small/large).

Large for gestational age

Gestational diabetics tend to get ________ infections.

Monilial (yeast)

What test confirms the diagnoses of gestational diabetes?

3 hour glucose tolerance test

What are the two main treatment methods in gestational diabetes?

Diet, insulin

How often should a woman visit the doctor prenatally if diabetes is present?

Twice a month, then once per week in the 3rd trimester

How many pounds per week is the diabetic allowed to gain the 2nd and 3rd trimesters?

1 pound a week

Is severe carbohydrate restriction required in gestational diabetics?

No, it could lead to ketosis

Of protein, fat, and carbohydrates, which ones (percent-wise) increase in the diet of gestational diabetics?

Protein, fat

When is insulin used in the treatment of gestatinal diabetes?

When dietary control does not keep the blood sugar within normal limits

If insulin is used, the dose is the same in all 3 trimesters. (T/F)

False, it varies

Oral hypoglycemics should never be used during pregnancy. (T/F)

True, they cause birth defects (teratogenic)

When should a diabetic be delivered?

Between 37 and 39 weeks

What IV solution is used during labor for the diabetic?

D5W

The mother's insulin requirements will (fall/rise) markedly after delivery.

Fall

During pregnancy what complications is most dangerous for the fetus of a diabetic?

ketosis

If ketosis is a big problem for the baby during pregnancy what the big problem after delivery?

Hypoglycemia

Why is hypoglycemia such a dangerous problem?

Brain cells die without glucose, brain damage

(Multi/prima) gravida clients are most likely to get PIH.

Primagravida

Which age group(s) are most likely to experience PIH?

Patients under 18 and over 35

When does pre-eclampsia usually begin in pregnancy (week)?

After 20 weeks

Name the three symptoms of PIH.

Hypertension, weight gain (edema), proteinuria

If pre-eclampsia is mild will the woman be hospitalized?

No, just rest at home

What type of diet is indicated for a woman with pre-eclampsia?

Increased protein/normal salt intake (no restriction typically)

What measurement must the woman with pre-eclampsia make every day?

She must weigh herself

What is the activity order for a woman with severe pre-eclampsia?

Left side lying

What is the dietary order for the woman with severe pre-eclampsia?

Low salt, high protein

Are diuretics used for women with pre-eclampsia?

Yes

When a woman is hospitalized for severe pre-eclampsia the nurse should test...

#1 reflexes, the urine for protein

When pre-eclampsia gets worse the deep tendon reflexes will be (hyper/hypo) reflexia.

Hyper-reflexia

Pre-eclampsia makes the neuromuscular system more or less irritable?

More

What vision problem do women with pre-eclampsia have?

Blurred vision

What types of precautions will be in effect for a woman with severe pre-eclampsia?

Seizure precautions

Name 5 things included in seizure precations.

Suction machine in room O2 in room
Padded rails up X 4
Must stay on unit
Ambulation with supervision only
No More than 1 pillow

When is pre-eclampsia called eclampsia?

Once convulsions have occured

In eclamptic client what ominous sign almost always precedes a seizure?

Severe epigastric pain

What are the three major treatment objectives in eclampsia?

Decrease blood pressure
Control convulsions
Diuresis

The urine output of the eclamptic client will (decrease/increase).

Decrease

How would you palpate the uterus to see if the eclamptic woman was having contractions?

Place the hand flat on the abdomen over the fundus with fingers apart and press lightly

Premature rupture of membranes (PROM) is a ________ break in the amniotic sac __________ the _________ of contractions.

Spontaneous, before, onset

Usually labor starts within ________hours of rupture membranes.

24

What is the danger with PROM?

Infection

How would you tell if the woman with PROM had an infection?

Maternal fever
Fetal tachycardia
Foul smelling vaginal discharge

To test amniotic fluid the nurse should check the ________ of the fluid.

pH

Amniotic fluid is (acidic/alkaline)

Alkaline

Being alkaline means have a (high/low) pH

High

Amniotic fluid turns nitrazine paper deep _________ (color).

Blue

When PROM occurs, the age of the fetus must be determined. The best way to assess lung maturity is to check the ________ ratio.

L/S (lecithin/sphingomyelin)

An L/S ratio greater than _______indicates lung maturity.

2.0

If labor does not begin within ________ hours after PROM, labor will likely be induced.

24

If PROM occurs before viability, what is the typical management?

Termination of pregnancy

If PROM occurs after viability but before 36 weeks, what is the typical management?

Hospitalize, watch for infection, try to gain time for the infant to mature

If there are any signs of infection after PROM, what must occur immediately?

Delivery of fetus

PROM always occurs in a gush of fluid. (T/F)

False

The woman must avoid sexual intercourse if PROM has occurred. (T/F)

True

What does self-disclosure mean?

When the nurse tells the patient personal information about self.

Is it always bad for the nurse to self-disclose?

No, you can self-disclose as long as you do it cautiously and you are 100% sure it is therapeutic.

If the nurse uses self-disclosure it should be ______ and the conversation should be...

Short, quickly refocused back on the patient

Insight means the ability of the patient to ________his problem.

Understand

During what phase should the nurse examine his/her own feelings?

Pre-interaction phase

Flight of ideas is when the patient changes topics of conversation______.

Rapidly

The basis for a therapeutic nurse/patient relationship begins with the ______, self______ and ______ _______.

Nurse's, awareness, self understanding

What are the steps of the nurse/patient therapeutic relationship?

Pre-interaction phase
Orientation phase
Working phase
Termination phase

Should the nurse self-disclose if the patient asks the nurse to?

No, not unless it is specifically therapeutic.

The nurse should introduce information about the end of the nurse/patient relationship during the _____phase.

Orientation

Termination phase begins in the _______phase.

Orientation

Pulmonary edema is accumulation of _______in the lung.

Fluid

Pulmonary edema is a common complication of ______disorders.

Cardiovascular

Pulmonary edema usually results from ______ failure.

Left ventricular

What force causes the pulmonary edema in left ventricular failure?

Increased hydrostatic pressure in the pulmonary capillaries

Can letting IVs run too fast cause pulmonary edema?

Yes in the client with poor cardiovascular function

What are the four classic signs of pulmonary edema?

Dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, coughing

What is meant by dyspnea on exertion?

Shortness of breath when active.

What is meant by paroxysmal nocturnal dyspnea?

Sudden episodes of difficulty breathing

What is meant by orthopnea?

Shortness of breath when lying flat

Is heart rate fast or slow in pulmonary edema?

Fast, tachycardia

What will the nurse auscultate over the lungs when pulmonary edema occurs?

Crackles (rales)

When pulmonary edema is severe what does the sputum look like?

Bloody and frothy

What drug is used in pulmonary edema to reduce fluid in the lungs?

A diuretic (Lasix)

What drug is used to increase ventilation in clients with pulmonary edema?

Aminophylline (bronchodilator)

Is O2 given in pulmonary edema?

Yes

Since pulmonary edema is caused by left ventricular failure what drug is given?

Digitalis

Why is morphine given to clients with pulmonary edema?

To decrease apprehension and decrease preload, this rests the heart

If your client suddenly goes into pulmonary edema what would you do first?

Elevate the HOB, then increase O2, then call the MD

Pulmonary embolus is an obstruction of the pulmonary ______ bed by a dislodged _______ or foreign substance.

Capillary, thrombus

Where do the emboli that cause pulmonary embolus usually come from?

The legs

Besides a thrombus what else can cause an embolus in the lung?

Air, fat, tumor cells

What treatment modality can lead to pulmonary embolus?

Bed rest

What class of drugs can lead to pulmonary embolus?

Oral contraceptives

What heart problem can lead to pulmonary embolus?

Atrial fibrillation (RIGHT atrial fibrillation casues pulmonary embolus; LEFT atrial fibrillation causes cerebral embolus)

What genetic disorder can lead to pulmonary embolus?

Sickle cell anemia

What is the first sign of pulmonary embolus?

Dyspnea

The dyspnea of pulmonary embolus is accompanied by ____ _____.

Pleuritic pain

Does the heart rate increase or decrease in pulmonary embolus?

Increase

With severe pulmonary embolus the client will look as though they are __________.

In Shock

What are the two major treatments of pulmonary embolus?

O2, anticoagulants

Name the anitcoagulant given for immediate anticoagulation by IV or SQ route.

Heparin

A drug for long term anticoagulation in any disorder would be?

Coumadin

What two lab tests monitor coumadin therapy?

Prothrombin time (PT) and the INR

When coumadin is therapeutic, the INR should be between _______ and _______.

2.0 and 3.0

What is lovenox?

It is a low-dose Heparin used for anticoagulation in POST-OP THROMBOPHLEBITIS PREVENTION NOT USED FOR PULMONARY EMBOLUS

Heparin therapy is monitored by daily measurement of the _______.

PTT (partial thromboplastin time)

Effective heparin therapy rises the PTT to approximately _______ times normal.

2.5

Clients on heparin should use an electric razor or safety razor?

Electric razor

What is the best way to prevent pulmonary embolus in post-operative patients?

Early ambulation

Is it appropriate to massage the legs of the client to preven pulmonary embolus?

No, never

Heparin is used in the acute phase of pulmonary embolus. What drug is used for 6 months after pulmonary embolus?

Coumadin

Coumadin therapy is monitored by what daily test?

PT (prothrombin time)

What is pyelonephritis?

A bacterial infection of the kidneys

Which organism causes pyelonephritis?

E. Coli

Name the symptoms that pyelonephritis and cystitis have in common?

Frequency, urgency, burning, cloudy, foul smelling urine

What medical intervention is necessary in pyelonephritis?

IV antibiotics for one to two weeks, must get urine culture 2 weeks after antibiotic therapy is over

How does pyelonephritis differ from cystitis in meaning?

Cystitis means bladder infection; pyelonephritis means an infection of kidney pelvis

What causes or precedes pyelonephritis?

Cystitis always does

Will the client with pyelonephritis have daily weights?

Yes, as would any client with kidney problem

Name the five signs/symptoms that pyelonephritis has that cystitis does not have?

Fever, flank pain, chills, increased WBC, malaise

What is the BIG danger with pyelonephritis?

Permanent scarring and kidney damage

How is pyelonephritis prevented?

By preventing or treating all cystitis (UTI's)

Will the client with pyelonephritis have hematuria?

It is common but not always present

The patient with pyelonephritis will have (hypertension/hypotention)?

Hypertension

Where is the pyloric sphincter?

At the distal (duodenal) end of the stomach

What does stenosis mean?

Narrowed

What is done to correct pyloric stenosis?

Surgery (pyloromyotomy)

In what position should the child with Pyloric Stenosis be during feeding?

High fowlers

The feedings for an infant with pyloric stenosis should be thick or thin?

Thickened

What test is done to confirm a diagnosis of pyloric stenosis?

Upper GI series (barium swallow)

These infants are prone to develop ______ and failure to ______.

Dehydration, thrive

Why does the pyloric valve become stenosed in pyloric stenosis?

It hypertrophies

In what position should a child with pyloric stenosis be after a feeding?

Right side with HOB up

The infant with pyloric stenosis appears ______ even after vomiting.

Hungry

What do you see during and after feeding?

Peristaltic waves from left to right

Is vomiting projectile or non-projectile in patients with pyloric stenosis? Is the vomiting bile-stained or not bile-stained?

Projectile, not bile-stained

What assessment finding is found under the right rib cage?

An olive sized bulge (the hypertrophied pylorus)

The symptoms of pyloric stenosis mostly commonly appear at age ______ to _____.

4 to 6 weeks

Describe the typical child with pyloric stenosis.

Firstborn, full term, white, boys

For what reason are Montgomery straps used?

Permit you to remove & replace dressings without using tape (protects the skin)

Sutures in general are removed by the ___ day.

7th

Leaving a would open to air decease infection by eliminating what 3 environmental conditions?

Dark, warm, moist

To remove tape always pull (toward/away) from the wound.

Toward (this way you don't put pressure/pull on the suture line.)

Define contusion.

Bruise (internal)

Define debridement.

Removal of necrotic tissue from a wound.

What is the purpose of a wound drain?

Remove secretions from the area so healing occurs.

To prevent germs from getting into or out of a wound you should use what type of dressing?

An occlusive dressing

What solution is put onto the skin to protect it from the irritating effects of the tape?

Tincture of benzoin

With what is a round closed in first intention?

Sutures or steri-strips, staples

What is another name of second intention?

Granulation

When swabbing an incision you would start at the incision or 1 Inch away from the incision?

Start at the incision and move outward.

After you remove soiled dressings and before you put on the sterile dressing you must....

Wash your hands and put on sterile gloves

What is meant be the phrase "advance the drain 1 inch"?

You pull the drain out 1 inch.

After advancing a Penrose drain you (should/should not) cut off the excess drain?

Should

When a dressing saturated, germs can enter the wound from the outside. (T/F)

True, by a process called capillary action

When is a bad time to change dressings?

Mealtime

Define laceration.

Cut

Scoliosis is a ______ curvature of the ______.

Lateral, spine

Scoliosis is MOST common in the _______ and
______ sections of the spinal column.

Thoracic and lumbar

Scoliosis in the thoracic spine is usually convex to the
(left/right).

Right

Scoliosis in the lumbar spine is usually convex to the (left/right).

Left (*Hint: curve Left in Lumbar)

With which other two spine deformities is scoliosis
associated?

Kyphosis (humpback), Lordosis (swayback)

What is Kyphosis?

Humpback in the thoracic area

What is Lordosis?

Swayback in the lumbar region (Lumbar, Lordosis)

What is the difference between structural and
functional scoliosis?

Structural-you are born with; Functional-you get from bad posture

What age group should be routinely screened for
scoliosis?

Young teens

What are the 3 subjective complaints of clients with scoliosis?

Back pain, dyspnea, fatigue

What test/exam CONFIRMS the diagnosis of
scoliosis?

X-rays of the spine

What type of brace is most commonly used for
scoliosis?

Milwaukee

Name 4 exercises used to treat mild scoliosis.

Heel lifts; sit-ups; hyperextension of the spine; breathing exercises

What kind of treatment is done for severe scoliosis?

Surgical fusion with rod insertion

What type of cast is used post-operatively?

Risser cast

What kind of rod is used to "fix" curvature?

Harrington Rod

Scoliosis MOST commonly affects _____ _____
(type of clients).

Teenage females

How many hours a day should the client wear a
Milkwaukee brace?

23

What solution should be used on the skin where the
brace rubs?

Tincture of benzoin or alcohol,no lotions of ointments-you want to toughen the skin not soften it

Clients with a Milwaukee brace should avoid vigorous
exercise. (T/F)

True

After corrective SURGERY how is the client turned?

Log rolled (in a body cast)

How often should the neurovascular status of the
extremities of a client in a Risser cast be measured? Fresh post-operatively?

Every 2 hours

What is a common complication of a client in a body
cast (like a Risser cast)?

Cast syndrome

What is cast syndrome?

Nausea, vomiting and abdominal distention that can result in intestinal obstruction

What group of people get cast syndrome?

ANYONE in a body cast

What is the treatment of for cast syndrome?

Removal of the cast, NG tube to decompress, NPO

How would you, the nurse, assess for developing
cast syndrome?

Ask the client if they are experiencing any abdominal symptoms-keep track of bowel movements & passing flatus (if not having BMs or passing flatus, cast syndrome is suspected)

What causes cast syndrome, specifically in a Risser
cast?

Hyperextension of the spine by a body cast: the hyperextension interrupts the nerve & blood supply to the gut

The inheritance pattern of sickle-cell anemia is _____
_____.

Autosomal recessive

What does heterozygous mean?

It means you only have 1 defective gene from 1 parent.

People who are (hetero/homo) have sickle cell
trait.

Heterozygous

What does homozygous mean?

It means you have the defective gene from both parents.

People who are (hetero/homo)zygous have sickle cell
disease.

Homozygous

People with sickle cell TRAIT only carry the disease,
they DO NOT have symptoms. (T/F)

True-usually it has occurred that in times of SEVERE stress, the TRAIT does cause some symptoms but not usually.

What are the #1 and #2 causes of sickle cell crisis?

Hypoxia, dehydration

The most common type of crisis that occurs is a
______-______ crisis.

Vaso-occlusive

In vaso-occlusive crisis the vessels become
occluded with ______ ______.

Abnormal RBC's

The abnormal hemoglobin produced by people with
sickle cell anemia is called Hgb ______.

Hgb S-it "sickles

What shape does Hgb S make the RBC's?

Crescent-shaped

Why do the crescent-shaped RBCs cause occlusion
of the vessels?

They clump together and create a sludge.

What are the top 3 priorities in care of the client with
sickle-cell crisis?

Oxygenation, hydration, and PAIN control

What activity order will the client with sickle cell
CRISIS have?

Bed rest

Or Tylenol, Morphine, Demoral, Aspirin which is
NEVER given to a sickle-cell patient?

Aspirin-it can cause acidosis which makes the crisis and sickling worse

At what age is death most likely in sickle cell anemia?

Young adulthood

Sickle-cell anemia symptoms do not appear before
the age of ____ months due to the presence of _____ ______.

6; fetal hemoglobin

Sickle cell anemia is most commonly seen in
(blacks/whites).

Blacks

Should a child in sickle-cell crisis wear tight clothes?

No, it can occlude vessels even more.

Spinal cord injuries are more common in males. (T/F)

True

In what age range is spinal cord injury most common?

15 to 25

The #1 goal in emergency treatment of spinal cord
injury is...

Immobilization of the spine

When halo traction is being used to immobilize the
spinal cord the client is allowed to _______.

Ambulate

When the patient with spinal cord injury is in tongs or
on a stryker frame or on a circoelectric bed they are on......

Absolute bed rest

The 2 most common surgeries used to treat spinal
cord injury are ____ and ______.

Laminectomy and spinal fusion

What is spinal shock?

It is a common occurrence in spinal cord injury in which the spinal cord swells above and below the level in injury

When does spinal shock occur?

Immediately or within 2 hours of injury

How long does spinal shock last?

5 days to 3 months

When the spinal cord injury is at level of _____ to
_____ the patient will be a quadriplegic.

C1 to C8

When the spinal cord injury is between _____ and
_____, there is permanent respiratory paralysis.

C1 and C4

Can the patient with spinal cord injury at C7 level have
respiratory arrest?

Yes, because even thought his injury was below C4, spinal shock can lead to loss function above the level, however the will not be permanently ventilator dependent-he will breath on when once spinal shock goes away.

Spinal cord injury in the thoracic/lumbar regions result
in ___plegia.

Paraplegia

If airway obstruction occurs at the accident site and
you suspect spinal cord injury, what maneuver is used to open the airway?

Modified jaw thrust

In spinal cord injury never ______ the neck.

Move, hyperextend

How should you change the position of the spinal cord
injury patient after he has an order to be up? Why?

Slowly, because of severe orthostatic hypotension (they use a tilt table)

For the patient with neurogenic bladder you should
straight catheterize every ____ hours.

Every 6 hours

The patient with spinal cord injury will have
(flaccid/spastic) muscles.

Spastic

Name 3 drugs used to treat spasms.

Valium, Baclofen, Dantrium

What is automatic dysflexia or hyperreflexia?

A common complication of quadriplegics in response to a fulle bladder or bowel.

What are the vital sign changes seen in autonomic
dysreflexia?

Sweating, headache, nausea & vomiting, gooseflesh, and severe HYPERtension

What do you do first for the client experiencing
autonomic dysreflexia?

Raise HOB

What do you do secondfor the client experiencing
autonomic dysreflexia?

Check the bladder, check the bowel

Do you need to call the doctor for autonomic
dysreflexia?

No, only call the doctor if draining the bladder & removing impaction does not work

What is the #1 treatment for autonomic dysreflexia?

Drain the bladder, empty the bowel

What is the purpose of restricting activity after spinal
tap?

To prevent headache due to CSF loss

Should the client drink after a spinal tap?

Yes, encourage fluids to replace CSF

Do you need an informed consent for a spinal tap?

Yes

Should CSF contain blood?

No

Does the client have to be NPO before a spinal tap?

No

What is the normal color of cerebrospinal fluid?

Clear, colorless

Into what space is the needle inserted during a spinal
tap?

Subarachnoid space

Can the client turn side-to-side after a spinal tap?

Yes

In what position should the client be during a spinal tap?

Lateral decubitus (on their side) position and knees to chest

Identify the activity restriction necessary after lumbar puncture?

Lie flat for 6 to 12 hours

What are the 2 purposes of a spinal tap?

To measure or relieve pressure and obtain a CSF sample

Does the client have to be sedated before a spinal tap?

No

Antibiotic (Define)

A drug that destroys or inhibits growth of micro-organisms

Asepsis (Define)

Absence of organisms causing disease

Antiseptic (Define)

A substance used to destroy or inhibit the growth of pathogens but not necessarily their spores (in general safe to use on persons)

Disinfectant (Define)

A substance used to destroy pathogens but not necessarily their spores (in general not intended for use on persons)

Bactericide (Define)

Substance capable of destroying micro-organisms but not necessarily their spores

Bacteriostatic (Define)

Substance that prevents or inhibits the growth of micro-organisms

Anaerobe (Define)

Micro-organisms that do not require free oxygen to live

Aerobe (Define)

Micro-organisms requiring free oxygen to live

Pathogen (Define)

Micro-organism that causes disease

Clean technique (Define)

Practices that help reduce the number & spread of micro-organisms (synonym for medical asepsis)

Sterile (Define)

An item on which all micro-organism have been destroyed

Coagulate (Define)

Process that thickens or congeals a substance

Host (Define)

An animal or a person upon which or in which micro-organisms live

Portal of entry (Define)

Part of the body where organisms enter

Contaminate (Define)

To make something unclean or unsterile

Surgical asepsis (Define)

Practices that render & keep objects & areas free from all micro-organisms (synonym for sterile techniques)

Medical asepsis (Define)

Practices that help reduce the number & spread of micro-organisms (synonym for clean techniques)

Spore (Define)

A cell produced by a micro-organism which develops into active micro-organisms under proper conditions.

Which hand should hold the suction catheter? Which
should hold the connecting tube?

The dominant, the non-dominant

The nurse should use (medical/surgical) asepsis
during airway suction?

Surgical asepsis (sterile technique)

What kind of lubricant should be used on the suction
catheter?

Sterile water-soluble

Should the suction be continuous or intermittent?

Intermittent to prevent mucosal damage

For how long should suction be applied during any
one entry of the catheter?

10 seconds

How often should the nurse clear the tubing during
suctioning?

After each pass/entry/removal

Which way would you turn the client hear to suction
the right mainstem bronchus? The left mainstem bronchus?

To the left, to the right

The best client position during airway suctioning is _______.

Semi-fowlers

The suction should be delivered while
(inserting/removing) the catheter.

While removing the catheter

What outcomes would indicate that suctioning was
effective?

Clear even lung sounds, normal vital signs

How often should the client's airway be suctioned?

When it needs to be, for example moist lung sounds, tachycardia, restlessness (hypoxia), ineffective cough

The unconscious client should assume what position
during suctioning?

Side-lying, facing nurse

If not contraindicated, what action by the nursing
before suctioning would most likely reduce hypoxia during suctioning?

Administer a few breaths at 100% oxygen before beginning

What solution should be used to clear the tubing
during suctioning?

Sterile saline

With what size catheter should an adult's airway be
suctioned?

12 to 16 French

How much suction should be used for an infant?

Less than 80 mm Hg

How much suction should be used for a child?

80 to 100 mm Hg

How much suction should be used for an adult?

120 to 150 mm Hg

Do you assess for suicide potential whenever a
patient makes any statement about wanting to die or kill self?

Yes, in fact whenever a patient makes a statement about wishing or wanting to die or kill self you must ALWAYS AND FIRST assess for suicide potential*-stop everything and assess for suicide patient (except CPR, or course)

Children are at _____ risk for suicide.

Low

Adolescents are (low/high) risk for suicide.

High

Young adults are (low/high) risk for suicide.

High to moderate

People between 25 and 50 years are (low/moderate
/high) risk for suicide.

Low to moderate

People over 50 year are (low/high) risk for suicide.

High

The patient who has a definite plan is (low/high) risk
for suicide.

Moderate to high, depends upon feasibility and ease of plan

The use of pills makes the patient (low/moderate/high) risk for suicide.

Moderate

The patient who has NO definite plan is (low/high) risk
for suicide.

Low

The use of _____, _______, and ______ to kill self,
make high risk suicide.

Guns, ropes, knives

Who is at higher risk for suicide, a man or a woman?

Man

Of: married, divorced, and separated, which marital status is highest risk for suicide? Lowest risk of suicide?

Highest-separated then divorced
Lowest-married

The goal of action while the suicidal patient is still of
the phone is to get _______ person _______ the ______.

Another person on the scene (then immediately decreases risk) Remember: people who are alone are always high risk

What are the four classic suicide precautions?

Search personal belongings for drugs & alcohol, remove any sharp objects, remove any device for hanging or strangling; must be on constant one-to-one observation (NEVER out of sight)

Once the patient is admitted for attempted suicide should you ever discuss the attempt with them?

No, you should not focus on the attempt, focus on the present and future.

-pathy

Disease, suffering

-penia

Lack, deficiency of

-sect

To cut

-plast

Plastic surgery on a specified part

-sclerosis

Hardening of a tissue by: inflammation, deposition of mineral salt; an infiltration of connective tissue fibers

-centesis

A perforation or puncture

-genic

Produce, originate, become

-emia

Blood

-otomy

Butting

-pexy

Fixation of something

-atresia

Condition of occlusion

-desis

Binding, fusing

-cele

Combining form meaning a tumor or swelling or a cavity

-cis

Cut, kill

-rhapy; -rrhapy

Joining in a seam, suturation

-scope; -scopy

Instrument for observation

-osis

Indicates condition, process

-oma

Tumor

-ostomy

Surgical opening

-stasis

Stoppage

-itis

Inflammation

-ology

Study of; knowledge, science

-lysis

Breaking down

-ectomy

Surgical removal of

-tripsy

Crushing of something by a surgical instrument

-ase

Used in naming enzymes

-gram; -graphy

Write; record

Syphilis is sexually transmiteed. (T/F)

True

Syphilis first infects the _____ ______.

Mucous membranes

What are the stages of syphilis?

Primary, secondary, latent, late

Syphilis is a fatal disease if untreated. (T/F)

True

What organism causes syphilis?

Treponema palladium

What is the lesion like in primary syphilis?

The chancre (pronounced shanker)

The chancres of syphilis are (painful/painless).

Painless

Chancres disappear without treatment. (T/F)

True

Late syphilis attacks which 3 body organs?

Liver, heart, brain

What test CONFIRMS the presence of syphilis?

Dark-field illumination of the treponema palladium

What is the treatment of choice for syphilis?

Penicillin

Why is penicillin administered with Procaine?
With Probenecid?

Procaine makes the shot less painful; Probenecid blocks the excretion of penicillin

What is the most common sign of neurosyphillis?

Ataxia (gait problems)

Mastitis and breast engorgement are more likely to occur in (primipara/multipara).

Primipara

Where does the organism that causes mastitis come from?

The infant's nose or mouth

Which organism most commonly causes mastitis?

Staph

Prolonged intervals between breast-feeding (decrease/increase) the incidence of mastitis.

Increase

Can too tight bras lead to mastitis?

Yes, preventing emptying of ducts

Mastitis usually occurs at least _______days after delivery.

10

When mastitis is present the breasts are ________, _________, and __________.

Hard, swollen, warm

Mastitis is accompanied by a fever over _________.

102 degrees

If mastitis is caused by an organism, what causes breast engorgement?

Temporary increase in vascular and lymph supply to the breast in preparation for milk production

If mastitis occurs 1+ weeks after delivery, when does breast engorgement occur?

2 to 5 days after delivery

Does breast engorgement interfere with nursing?

Yes, the infant has a difficult time latching on (getting nipple in its mouth)

What class of drugs is used to treat mastitis?

Antibiotics

Antibiotics are used to treat breast engorgment? (T/F)

False

Application of (warm H2O compress/ice packs) is the preferred treatment for breast engorgement.

Ice packs to decrease swelling

The mother with mastitis should stop breast feeding. (T/F)

False, the mother must keep breast feeding. (Offer unaffected breast first)

If the mother has an open abscess on her breast, must not breast-feed. (T/F)

True

For breast engorgement, the non-breastfeeding mother should be told to express breast milk. (T/F)

No, that would increase milk production and would make the problem worse (warm compresses or warm shower to let milk "leak" is okay- Ice is best)

What is the best treatment for breast engorgement?

Breast-feeding - it will balance supply and demand

What is mastoiditis?

Inflammation/infection of the mastoid process

What is the most common cause of mastoiditis?

Chronic otitis media

What are 4 signs and symptoms of mastoiditis?

Drainage from ear, high fever, headache and ear pain, tenderness over mastoid process

What unusual post-operative complication can result from mastoidectomy?

Facial nerve paralysis due to accidental damage during surgery (law suit time!)

What should you do to assess for facial nerve paralysis post-mastoidectomy?

Have the patient smile and wrinkle forehead.

What is the medical treatment for mastoiditis?

Systemic antibitoics

What is the surgery for mastoiditis called?

Simple or radical mastoidectomy

Will a simple mastoidectomy worsen hearing?

No, a radical mastoidectomy may

Should the nurse change the post-mastoidectomy dressing?

No, reinforce it. Physician changes first post op dressing

What is a common side effect of mastoidectomy?

Dizziness (vertigo)

What is a major nursing diagnosis post-mastoidectomy?

Safety

In the chain of infection, hand washing breaks the mode of ____________.

Transmission

The best way to decrease nosocomial infection is sterile technique. (T/F)

False, hand washing is the best way.

Sterile gloved hands must always be kept above the waist. (T/F)

True

When putting on the second of a set of sterile gloves, you should grasp the cuff. (T/F)

False, reach under the cuff with the tip of the gloved fingers.

When putting on the first glove of a set of sterile gloves, you should grasp the cuff. (T/F)

True

When putting on the second glove of a set of sterile gloves, you must not use the thumb of the first hand. (T/F)

True

Airborne microorganisms travel on ________ or ______particles.

Dust or water

Another name for medical asepsis is...

Clean technique

Sensitivity (susceptibility) means...

The susceptibility of an organism to the bacterial action of a particular agent

When unwrapping a sterile pack how should you unfold the top point?

Away from you

Virulence means....

Ability of an organism to produce disease

Another name for surgical asepsis is...

Sterile technique

What is the best location in a client's room to set up a sterile field?

On the over-bed table

Medical aseptic technique are aimed at reducing the number of organisms (T/F)

True, doesn't eliminate all of it just decreases the number

What does bacteriostatic mean?

Having the capability to stop growth of the bacteria

What does bacteriocidal mean?

Having the capability to kill bacteria.

What does nosocomial infection mean?

Infection acquired through contact with contamination in the hospital

When pouring liquid onto a sterile field you should pour from a height of _____ to _____ inches above sterile field.

6 to 8

When you plan to use gloves for a procedure you do not need to wash hands before it. (T/F)

False, always wash even if you plan to use gloves

Culture means....

Growing colony of organisms, usually for the purpose of identifying them

Surgical aseptic techniques render and keep articles free from all organisms. (T/F)

True

You must never turn your back to a sterile field. (T/F)

True

What must you do if you reach across a sterile field?

Consider the area contaminated and not use the articles in the area

Micro-organisms grow best in a _______, _______, _______place.

Warm, dark, moist

It is common practice to regard the edges of any sterile field as contaminated. (T/F)

True, the outer 1 inch is considered contaminated. You must not touch it with your sterile gloves.

Immediately after opening a bottle of sterile water, can you pour it directly into a sterile basin?

No, you must pour a few cc's out of the bottle into a waste container before you pour into the sterile basin. (This is called "lipping" the bottle)

Which is the best method for identifying clients accurately?

By ID name-band

An emulsion is a mixture of ______ and ______.

Oil and H2O

Syrups and elixirs are of particular concern to diabetic clients because....

they contain sugars

Oral medications have a (faster/slower) onset of action that IM drugs.

Slower

Oral medications have a (shorter/longer) duration of action than IM medications.

Longer

How should drugs that stain teeth be administered?

By a straw

A drug given by a parenteral route acts outside the GI tract. (T/F)

True

Name the four most common parenteral routes of administrations.

SQ, IM, IV, ID (intradermal)

When blood is administered by IV, the needle/catheter should be ________gauge.

18 gauge

You can administer up to ____ cc of a drug per site by IM injection in adults.

3 cc

Children should receive no more than _______ cc per site by IM injection.

2 cc

The preferred IM injection site for children under 3 is the _________ ___________.

Vastus lateralis

Why is the dorsogluteal site not recommended for IM injection the children less than 3 years of age?

Because the muscle is not well developed yet.

Can 3 cc of fluid be administered per IM into the deltoid of an adult?

No, maximum of 1 cc

The #1 danger when using the dorsogluteal site for IM injection is___________.

Damage to the sciatic nerve

The preferred angle of injection to to be used for IM administration is___________.

90 degrees

The preferred length of needle to administer an IM injection is...

1 to 2 inch

The preferred gauge of needle for IM injection is...

21 to 22 gauge

Which type of medications are given by Z-track injection?

Irritating, staining

How long is the needle kept inserted during Z-track injection?

10 seconds

What must be done to the equipment before injecting by Z-track method?

Change the needle

When giving a Z-track injection, the overlying skin is pulled (up/down/medially/laterally).

Laterally

Subcutaneous injection must be given at 45 degrees. (T/F)

True (for boards), false- whatever angle gets it SQ without going IM

The preferred gauge of needle for injection for SQ injection___________.

25 gauge

The preferred length of needle for SQ injection is_________.

5/8 inch

The intradermal route is primarily used for ________ _________.

Skin testing

Name the two sites used for intradermal injection.

Inner forearm
Upper back

In general, the nurse should wear gloves when applying skin preparations such as lotions. (T/F)

True

After using nose drops, the client should remain ______ for _______ minutes.

Supine, 5

Strict aseptic techniques is required when administering a vaginal medication. (T/F)

False-- only "clean" technique or medical asepsis is necessary

Before administering vaginal medications the client is more comfortable if you ask them to _________ .

Void

After administration of a vaginal durg the client should remain _____ for______ minutes.

Supine, 10

Rectal suppositories with an oil base should be kept refrigerated. (T/F)

True

Strict sterile technique is required when administering a drug per rectum. (T/F)

False, clean or medical asepsis

The best way to ensure effectiveness of a rectal suppository is to...

Push the suppository against the wall of the rectum

A rectal suppository is inserted ______ inches in an adult and ________ inches in a child.

4,2

The client should remain supine for 5 minutes after having received a rectal suppository. (T/F)

False-- they should be lying on their side for 5 minutes, not supine

A suppository given rectally must be lubricated with a water soluble lubricant. (T/F)

True, lubricant fingers also

Eye medications can be given directly over the cornea. (T/F)

False, into the conjunctival sac, never the cornea; hold the dropper 1/2 inch above the sac

Eye drops should be placed directly into the _______ _______.

Conjunctival sac

To prevent eye medications from getting into the systemic circulation you apply pressure to the _______ for ______ seconds.

Nasolacrimal sac, 10 (press between the inner canthus and the bridge of the nose)

The eye should be irrigated so that the solution flows from outer to inner canthus. (T/F)

False, it must flow from inner canthus to outer (alphabetical: I to O)

If ear medications are not given at room temperature the client may experience...

Dizziness, nausea

To straighten the ear canal in the ADULT, the nurse should pull the pinna______ and ________.

Up and back

To straighten the ear canal in the young CHILD under 3 the pinna should be pulled _______ and ________.

Down and back

After receiving ear drops the client should remain in ________position for ________minutes.

Side lying, 5

How far above the ear canal should you hold the dropper while administering ear drops?

1/2 inch

Liquid doses of medications should be prepared at _______level.

Eye

Liquid drugs should be poured out of the side (opposite of/the same as) the label.

Opposite

It is safe practice to administer drugs prepared by another nurse. (T/F)

False

In order to leave drugs at the bedside you must have a physician's order. (T/F)

True

Young infants accept medication best when given with a _______.

Dropper

It is safe practice to recap needles after injection. (T/F)

False, Never re-cap

What do you do if you get blood in the syringe upon aspiration?

Remove the syringe immediately and apply pressure; you must discard the syringe and redraw medication in a new syringe

Tagamet

Give with meals, remember Zantac does not have to be given with meals

Capoten

Give on empty stomach, one hour before meals (antihypertensive)

Apresoline

Given with meals (antihypertensive)

Iron with nausea

Give with meals

Sulfonamides

Take with LOTS OF WATER regardless of whether you give it at mealtime or not -- Bactrim, Septra, Gantricin, ie, used to treat UTI

Codeine

Take with lots of water rergardless of meals -- to prevent constipation

Antacids

Give on empty stomach I hour ac and hs

Ipecac

Give with 200-300 cc water-- not related to mealtime -- this is an emetic (to make you vomit after ingestion of poisons -- don't give if the poisons were caustic, or petroleum based)

Rifampin

Give on empty stomach (anti-tuberculosis) remember Rifampin causes red urine

Non-steroidal anti-inflammatory drugs

Give with food (for arthrosis)

Aldactone

Give with meals (K--sparing diuretic)

Iron (without nausea)

Give on empty stomach with orange juice to increase absorption

Penicillin

Give on empty stomach

Erythromycin

Give on empty stomach (antibiotics)

Stool Softeners

Take with lots of water regardless of mealtim

Griseofulvin

Give with meals-- especially high fat meals (anti-fungal)

Tetracycline

Do not give with milk products, do not give to pregnant women or children before age 8 or damage to tooth enamel occurs

Theophylline derivative

Give with meals, ie, Aminophylline, Theodur (anti-asthmatic bronchodilator)

Steroids

Give with meals-- remember taper the patient off these drugs slowly

Pancreas pancreatin isozyme

Give with meals-these are oral enzymes used with children with cystic fibrosis to increase the absorption of the food they eat

Para-amino salicylate sodium (PAS)

Give with meals/food-- anti tuberculosis

Colchicine

Give with meals -- anti gout, remember if diarrhea develops, stop the drug

Thorazine

Take with LOTS OF WATER regardless of meals to prevent constipation.
All drugs that end in "-zine" are major tranquilizers that also cause Psuedo Parkinson's or extra-pyramidal effects.

Carafate and sulcrafate

Give on empty stomach 1 hour before meals and at bedtime -- remember these coat the GI tract and interfere with the absorption of other medications (give them by themselves)

Allopurinol

Give with meals and give with lots of water--anti uric acid--- used to treat gout and the purine build up seen in chemotherapy for cancer

Define Meniere's Disease

An increase in endolymph in the inner ear, causing severe vertigo.

What is the famous triad of symptoms in Meniere's?

Paroxysmal whirling vertigo -- sensorineural hearing loss--tinnitus (ringing in the ears)

Does Meniere's occur more in men or women?

Women

What should the client do if they get an attack?

Bed Rest

What safety measures should be followed with Meniere's?

Side rails up x 4, ambulate only with assistance

What age group in Meniere's highest in?

40 to 60

What can PREVENT the attacks of Meniere's?

Avoid sudden movements

What electrolyte is given to people with Meniere's?

Ammonium chloride

What is the surgery done for Meniere's?

Labyrinthectomy

What disease often follows labyrinthectomy?

Bell's palsy-- facial paralysis, will go away in a few months

What is the activity order after labyrinthectomy?

Bed rest

When surgery is performed for Meniere's, what are the consequences?

Hearing is totally lost in the surgical ear

What should the client avoid after labyrinectomy?

Sudden movements and increased Na food

What type of diet is the client with Meniere's on?

Low salt

What two classes of drugs are given in Meniere's?

Antihistamines and diuretics (Diamox)

Meningitis is an inflammation of the _______ of the _______ and spinal ___________.

Linings, brain , cord

Meningitis can be caused by _______, _____, and _____.

Viruses, bacteria, chemicals

The four most common organisms that cause meningitis are...

Pneumococcus
Meningococcus
Streptococcus
H. influenza

The child with meningitis is most likely to be (lethargic/irritable) at first.

Irritable

What visual symptom will the patient with meningitis have?

Photophobia (over-sensitivity to light)

What is the most common musculo-skeletal symptom of meningitis?

Stiff neck- nuchal rigidity

Will the patient with meningitis have a headache?

Yes

Kernig's sign is positive when there is pain in the _____ when attempting to straighten the leg with ____ flexed.

Knee; hip

What type of vomiting is present in meningitis?

Projectile

What is the definitive diagnostic test for meningitis?

Lumbar puncture with culture of CSF (cerebro-spinal fluid)

If the patient has meningitis, the CSF shows _______ pressure, _____ WBC, ______ protein, ______ glucose.

Increased, increased, increased, decreased

On what type of isolation will the patient with meningitis be?

Contact and respiratory precautions

How long will the patient with meningitis be on these precautions?

Until they have been on an antibiotic for 48 hours

The room of a patient with meningitis should be _______ and ______.

Dark and quiet

The client with meningitis can develop________.

Seizures

What is opisthotonos?

Arching of back (entire body) from hyperextension of the neck and ankles, due to severe meningeal irritation.

If a patient has opisthotonos, in what position would you place them?

Side-lying

Average duration of menstrual flow is _____. The normal range is _____ to ______ days.

5 days, 3 to 6

Average blood loss during menstruation is _____cc.

50 to 60 cc

Name the two phases of ovarian cycle.

Follicular phase (first 14 days)
Luteal phase (second 14 days)

In the menstrual cycle, day 1 is the day on which...

Menstrual discharge begins

How long does an ovarian cycle last?

Average of 28 days

How many days after ovulation does menstruation begin?

14 days

What hormones are active during follicular phase?

FSH and Estrogen

During the luteal phase of the ovarian cycle, which of the following hormones increase: estrogen, progesterone or LH?

Progesterone and LH

What is the major function of the luteal phase of the ovarian cycle?

To develop and maintain the corpus luteum which produces progesterone to maintain pregnancy until placenta is established.

If an ovum is fertilized during the luteal phase what hormone will be secreted?

HCG (human chorionic gonadotropin)

During menstruation, the average daily loss of iron is _____ mg.

0.5 to 1.0 mg

What occurs during the follicular phase of the ovarian cycle?

It accomplishes maturation of the graafian follicle which results in ovulation

What type of environmental modification is best for a migraine?

Dark and quiet environment

The long term treatment of migraine focuses upon...

Assessing things that bring on stress and then planning to avoid them.

What type of pain is typical of migraines?

Throbbing

Are migraines more or less common in men?

Less

Besides pain, people with migraines complain of what other symptoms?

Nausea, vomiting and visual disturbances

What are the processes occurring in migraines?

Reflex constriction then dilation of cerebral arteries.

Where is the pain of migraine most likely located?

Temporal, supraorbital

Name a drug given to treat migraine?

Sansert (methsergide), Cafergot
(Prophylaxis: Imipramine)

Are migraine headaches usually unilateral or bilateral?

Unilateral

When Inderal is given in migraine headache, it is used to prevent or treat an attack?

To prevent. It DOES NOT treat.

MS is a progressive _____ disease of the CNS.

Demyelinating

Myelin promotes _____, _____ _____ of nerve impulses.

Fast, smooth conduction

MS affects men more than women. (T/F)

False

What age group usually gets MS?

20 to 40

MS usually occurs in (hot/cool) climates .

Cool

What is the first sign of MS?

Blurred or double vision

MS can lead to urinary incontinence. (T/F)

True

MS can lead to impotence in males. (T/F)

True

Patients with MS should be taught to walk with a ____-____ gait.

Wide based

Why are Adrenocorticotropic Hormone (ACTH) and prednisone given during acute MS?

To decrease edema in the demyelination process

For acute exacerbations of MS _______ per IV is often used.

ACTH (Corticotropin)

What drug can be given to treat urinary retention in MS?

Urecholine, Bethanocol

Will the muscles of MS clients be spastic or flaccid?

Spastic

What three drugs can be given for muscle spasms?

Valium, Baclofen (Lioresal), Dantrium

Baclofen causes (constipation/diarrhea)

Constipation

Dantrium causes (constipation/diarrhea)

Diarrhea (hint: D's go together, Dantrium and Diarrhea)

Patient's with MS should have (increased/restricted) fluids.

Increased to dilute urine and reduce incidence of UTI.

The diet of a patient with MS should be ____--ash.

Acid

What major sense is affected most in MS (besides vision)?

Tactile (touch)-- they burn themselves easily

Which will bring on a MS exacerbation: over-heating or chilling?

Both will; but they tend to do better in cool weather (summer will always be a bad time for MS patients)

In Myasthenia Gravis (MG) there is a disturbance in transmission of impulses at the _____ _____.

Neuromuscular junction

The #1 sign of MG is ______ ______ _____.

Severe muscle weakness

What is the unique adjective given to describe the early signs of MG?

The early signs (difficulty swallowing, visual problems) are referred to a BULBAR signs.

MG affects men more than women. (T/F)

False, affects women more than men

When women get MG they are usually old or young?

Young

When men get MG they are usually old or young?

Old

What neurotransmitter is problematic in MG?

Acetylcholine

What class of drugs is used to treat MG?

Anticholinesterases

What ending do anticholinesterases have?

-stigmine

Are anticholinesterases sympathetic or parasympathetic?

Parasympathetic

Anticholestinesterases will have (sympathetic/cholinergic) side effects.

Cholinergic (they will mimic the parasympathetic nervous system)

What surgery CAN be done for MG?

Thymectomy (removal of thymus)

The severe muscle weakness of MG gets better with exercise. (T/F)

False, it is worse with activity

What will the facial appearance of a patient with MG look like?

Mast-like with a snarling smile (called a myasthenic smile)

If a patient has MG, what will be the results of the Tensilon Test?

The patient will show a dramatic sudden increase in muscle strength

Besides the Tensilon Test, what other diagnostic tests confirm a diagnosis of MG?

Electromylogram (EMG)

What is the most important thing to remember about giving Mestinon and other anticholestinerases?

They must be given EXACTLY ON TIME; at home, they might need to set their alarm

Do you give anticholestinerases with or without food?

With food, about 1/2 hour ac; giving ac helps strengthen muscles of swallowing

What type of diet should the patient with MG be on?

Soft

What equipment should be at the bedside of an MG patient?

Suction apparatus (for meals), tracheostomy/endotube (for ventilation)

Name the two types of crises that a MG patient can have.

Cholinergic (too much Mestinon)
Myasthenic (not enough Mestinon)

The #1 danger in both Myasthenic and Cholinergic crisis is _____ ______.

Respiratory arrest

What words will the client use to describe the pain of an MI?

Crushing, heavy, squeezing, radiating to left arm, neck , jaw, shoulder

What is an MI?

Either a clot, spasm or plaque that blocks the coronary arteries causing loss of blood supply to the heart and myocardial cell death

What is the #1 symptom of an MI?

Severe chest pain unrelieved by rest and nitroglycerine

Males are more likely to get an MI than females. (T/F)

True

Due to MI occurs within _____ of symptom onset in 50% of all patients.

One hour

What pain medication is given for the pain of a MI (Give three).

Morphine, Demerol, Nitroglycerine

What is the reason for giving post MI patients ASA?

To prevent platelets from forming clots in the coronary arteries

Name a new drug with anti-platelet activity.

Plavix

The three most common complications after MI are ____ _____,_____, and _______.

Cardiogenic shock, arrhythmia, CHF

Give another name for an MI.

Heart attack

What will the activity order be for the post-MI client?

Bed rest with bedside commode

What is the most common arrhythmia after a MI?

Premature ventricular contractions (PVCs)

What cardiac enzymes indicate an MI?

Elevated CPK, LDH, SGOT

What serum protein rises soonest after myocardial cell injury?

Troponin

Do people without cell damage have troponin in their blood?

No it is only present when myocardial cells are damaged.

How soon after cell damage does troponin increase?

As soon as 3 hours (can remain elevated for 7 days)

When will the client with an MI be allowed to engage in sexual intercourse after an MI?

6 weeks after discharge

Will fluid resuscitation (administering large amounts of IV fluid) treat cardiogenic shock?

No, you must use cardiac drugs (giving IVs and blood will not help this kind of shock)

Will the client with a MI be nauseated?...diaphoretic?

yes, yes

What will the extremities of the client with a MI feel like?

Cold, clammy

What is the permanent EKG change seen post MI?

ST wave changes

Of CPK and LDH which rises earliest?

CPK

What drug will be used to treat PVCs of MI?

Lidocaine

Will the client with a MI need 100% O2 for their entire stay in the hospital?

No, just moderate flow (42% or 3 to 6 liters for first 48 hours)

What information does the measurement of skin fold thickness yield?

The amount of body fat

In general, males have a higher risk of heart disease than females. (T/F)

True

Post-menopausal females have a lower risk of heart disease than males aged 25-40. (T/F)

False. They have a higher risk.

Family history of diabetes increases the risk fo heart disease. (T/F)

True

Family history of liver disease increases the risk of heart disease. (T/F)

False

Cigarette smoking increases the risk of heart disease. (T/F)

True

Oral contraceptives decrease the risk of heart disease. (T/F)

False, use increases the risk

Routine exercise decreases the risk of heart disease. (T/F)

True

What is done in a graft for hemodialysis?

A blood vessel is sutured between an artery and a vein.

What is done in an AV fistual?

A surgical anastomosis is made between the artery and a vein.

Does anything exit the skin in an AV fistula?

No

How long can an AV fistula be used?

Indefinitely

Who is the most likely to receive a graft for dialysis?

People with diabetes mellitus.

How often do clients with renal failure undergo dialysis?

3 times per week

Is hemodialysis short term or long term?

Both- but most short term dialysis is achieved by hemodialysis

How long does the average dialysis last?

4 to 6 hours

What are 3 ways to gain access to the circulation in hemodialysis?

AV shunt
AV fistula
AV graft

What is the most common site for an AV shunt?

Radial artery to radial vein

What should be avoided in the arm of the client with an AV shunt?

No venipuncture or blood pressure allowed in the arm with a shunt, graft or fistula.

What syndrome results when too much fluid is exchanged during hemodialysis too quickly?

Disequilibrium syndrome

What are the symptoms of disequilibrium syndrome?

Change in LOC
N/V
Headache
Twitching

Does anything exit the skin in an AV shunt?

Yes, the plastic tube that connects the artery and vein outside the arm

How long can AV shunt be used?

Just for a few weeks

Hemophilia is a ___________ disorder.

Bleeding

Hemophilia A is a deficiency of Factor # __________.

VIII

During an acute bleeding episode, you should apply________ for 15 minutes and apply________.

Pressure, ice

The inheritance patterns for hemophilia is:

Sex linked recessive

In hemophilia, the PTT is (up/down), the coagulation or clotting time is (up/down) and the platelet count is (up/down).

Up (increased or longer)
Up (increased or longer)
Neither (hemophilia does not affect platelets)

What does hemarthrosis mean?

Bleeding into the joints

During bleeding into the joints you should (mobilize/immobilize) the extremity.

Immobilize to prevent dislodging the clots that do form.

To treat hemarthrosis you should _______ the extremity above the __________.

Elevate, heart

What is the name of frozen factor VIII given to hemophiliacs?

Cryoprecipitate

Once you have stopped the bleeding into the joint, how long should the hemarthrosis patient wait before bearing weight or doing range of motion?

48 hours

What drug can you apply topically to stop bleeding?

Epinephrine, or topical fibrin foam

Which of these symptoms are NOT seen in hemophilia? Prolonged bleeding, petechiae, ecchymosis or hematoma?

Petechiae

Hepatitis is an _____, ______ disease of the _______.

Acute, inflammatory, liver

Hepatitis A,B,C and D are all (bacterial/viral) diseases.

Viral

An early sign of hepatitis A is ________.

Anorexia or fatigue

Early stage hepatitis often looks like the _______.

Flu

In later stages of hepatitis, the ______ turns dark.

Urine

What does pre-icteric mean?

The stage BEFORE the patient exhibits jaundice.

What is the icteric stage?

When the patient exhibits jaundice.

What skin symptoms do you see in hepatitis? (Give 2)

Pruritis (itching)
Jaundice (Both are due to bilirubin accumulation)

Which disease has more severe symptoms-- Hepatitis A or B?

Hepatitis B

Patients with hepatitis have an aversion to _________.

Cigarettes

In hepatitis the ________ are light colored.

Stools: remember the urine is dark and stools are light. (Bilirubin ends up in the skin and urine instead of the stool where it should have gone.)

What is the common name for Herpes Zoster?

Shingles

What type of rash occurs with shingles?

A vesicular rash over the pathway of a sensory nerve

How long does it take for shingles to heal?

30 days

Who is the most common subjective symptoms of shingles?

Pain, pain, Pain

What three drugs are given for shingles?

Acyclovir (anti-infective)
Tegretol (anticonvulsant--given to stabilize nerve cell membranes) Steroids (anti-inflammatory)

What other disease is related to shingles?

chickenpox

What organism causes shingles?

Varicella--herpes zoster

What is the #1 nursing diagnosis with shingles?

Alteration in comfort: pain, #2 Impaired skin integrity

Hepatitis A

Enteric precautions
Fecal/oral route of transmission
Incubates 3 to 5 weeks
Vaccine available (Can give immune globulin after exposure)
HAsAg (this is what the blood test show) Hepatitis A surface Antigen

Hepatitis B

Watch those needles
HBsAg (this is what blood tests show) Hepatitis B surface antigen
HBIG - vaccine
Vaccination available, can give immune globulin after exposure
Transmitted by blood and body fluids
Incubates 5 to 35 weks

Hepatitis C

Watch those needles
Incubates 2 to 23 weeks
Transmitted by blood only
No vaccine, immune globulin doesn't work

Which types of client should have their toenails trimmed only by an MD?

Diabetics, peripheral vascular disease, very thick nails

Two purposes of bed bath are...

Cleanses the skin
Provides comfort

The typical hospital client (should/should not) wear their dentures.

Should

What type of movement should be used for cleansing eyes?

Inner to outer canthus

Before applying elastic hose the nurse should...

Elevate the clients legs for 3 to 5 minutes to decrease venous stasis

Clients on what class of drugs should use an elastic razor?

Anticoagulants (heparin/coumadin/lovenox)

When a client is unable to hold his dentures firmly in his mouth, the nurse should...

Leave them out

How often should mouth care be performed for those clients on oxygen?

Every 2 hours

Should lemon and glycerine swabs be used to cleanse the mouth?

No, they are not cleansing agents. They are used AFTER cleansing as a moistening agent

How should a client's toenails be trimmed?

Straight across

Are nurses permitted to give perineal care to clients of the opposite sex?

Yes, nurses are permitted to give perineal care to clients of the opposite sex.

Clients on what type of therapy must use a safety blade razor (non electric)?

Oxygen therapy, since an electric razor could cause sparks

How should a nurse carry soiled linen?

In a neat bundle held away from the body.

When giving a bed bath, on which body party should the nurse begin to work?

The eyes

Give three reasons for giving a back rub.

Comfort
Stimulate circulation and muscles
Relaxation

The greatest danger in placing water in the mouth of the unconscious patient during oral hygiene is...

Aspiration

When shaving a client, water used should be more (hot/cold) than bath water?

Hot

What does evening or hour of sleep (HS) care consist of?

Oral hygiene
Washing face/hands
Back rub
Tightening linens

What is dentifrice?

Agents which promote adherence of dentures to gums, ie, Polygrip

What is sordes?

Crusts on the tongue and gums due to improper oral hygiene

What action will facilitate the trimming of brittle toenails?

Soaking in warm water

Should the client roll the elastic stocking down to wash legs? Why or why not?

No, it can cause a constricting band around the ankle/foot.

Elastic stockings should be removed for the bath. (T/F)

True

When should a patient put on TED hose?

Before getting out of bed (before the swelling occurs).

Hyperemesis Gravidarum is ______ and ________ vomiting that persists into the _____ trimester.

Severe and prolonged; 2nd trimester (normal vomiting should be gone before 2nd trimester)

Give three possible causes of hyperemesis gravidarum.

Pancreatitis
Multiple pregnancies
Hydatidiform mole

Has hyperemesis gravidarum ever been associated with mixed feelings about pregnancy?

Yes, increased incidence of it in women who are ambivalent about pregnancy

What are the two most common complications of hyperemesis gravidarum?

Electrolyte imbalance (dehydration)
Starvation

What is the initial diet order for clients with hyperemesis gravidarum?

NPO

Why are doctors cautious in using antiemetics to treat hyperemesis gravidarum?

They don't want to harm the fetus

What are the instructions given to clients recovering from hyperemesis gravidarum in relation to mealtime?

Remain seated upright for 45 minutes after each meal

What is the biggest challenge in nursing care of the client with hyperemesis gravidarum?

Getting them to eat

Hypertension is an ________ or sustained elevation in the (systolic/diastolic) __________.

Intermittent, diastolic blood pressure

Hypertension is often fatal if untreated. (T/F)

True

Hypertension is more common in blacks or whites?

Blacks

Aging decreases the risk of hypertension. (T/F)

False, it increases the risk

Obesity increases the risk of hypertension. (T/F)

True

Oral contraceptives (increase/decrease/do not effect) the blood pressure.

Increase

What four organs does hypertension affect the most?

Brain (stroke)
Eyes (blindness)
Heart (MI)
Kidney (renal failure)

How many measurements must be made before you can say a person has hypertension?

At least three

What blood pressure is considered to be hypertension?

Anything greater than 140/90 mm Hg

Which pressure is most damaging, an increased (systolic/diastolic)?

An increased diastolic

When a doctor takes three different blood pressure readings at different times, how far apart must the measurements be made?

At least one week

Can hypertension be cured?

No, just treated

What class of drugs is used to first treat hypertension?

Diuretics

Name the two most common dietary prescriptions used to treat hypertension?

Calorie reduction for weight loss
Sodium restriction

What two non-dietary lifestyle changes are used commonly to treat hypertension?

Decreases stress
Increase activity

When you take the blood pressure of the client with hypertension you would measure _____- _______, with the client _____, _______ and _______.

Both arms; lying, sitting and standing

What do caffeine and smoking do to blood pressure?

Increase it

What is the #1 side effect of antihypertensives?

Orthostatic hypotension (means you feel weak when you rise to a standing position because your blood pressure falls)

Would vasodilators or vasoconstrictors treat hypertension?

Vasodilators (decreases resistance)

Would sympathetic stimulators or sympathetic blockers treat hypertension?

Sympathetic blockers (decrease cardiac output and decrease resistance)

In hypovolemic shock there is a ________ in the circulating __________ volume -- this _______ tissue perfusion with ________.

Decrease; blood; decreases; oxygen

What gauge catheter would you use to start an IV in hypovolemic shock?

16 or larger

What is the #1 cause of hypovolemic shock?

Acute blood loss

What happens to the blood pressure in hypovolemic shock?

It decreases

What happens to the pulse pressure in hypovolemic shock?

It narrows (becomes a smaller number)

How do you calculate the pulse pressure?

You subtract the diastolic from systolic

If J. Doe's blood pressure is 100/60, what is his pulse pressure?

40 (100-minus 60 equals 40)

What is the normal pulse pressure?

40 (+ or -10)

In hypovolemic shock the level of consciousness (LOC) is (increased/decreased).

Decreased

Which heart rate is associated with hypovolemic shock, bradycardia or tachycardia?

Tachycardia

In hypovolemic shock the output of urine will be less than _______cc per hour.

25 to 30 cc

The client's skin will be _____, ______, and ________.

Cool, pale, clammy (due to arterial constriction to shunt blood from skin to vital organs)

Which acid-base disorder is MOST commonly associated with hypovolemic shock?

Metabolic acidosis (due to lactic acid accumulation- no oxygen = anaerobic metabolism)

Of all the following, which one(s) increase in hypovolemic shock? Blood pressure, output, heart rate, pH, LOC, pulse pressure, respiratory rate

Only the heart rate and respiratory rate

What are the first two sings of hypovolemic shock?

Change in LOC and tachycardia

What is the #1 medical treatment of hypovolemic shock

Replace blood and fluids

What are mast trousers?

Pneumatic device placed around the legs and lower body that is inflated to force blood centrally

Do clients in hypovolemic shock have to have a Foley inserted?

Yes, to measure urine output (when output is >30 cc per hour the shock has resolved)

In what position would you place a client in suspected hypovolemic shock?

On back with arms and legs elevated

How often are vital signs measured in hypovolemic shock?

Every 15 minutes

If the blood pressure (systolic) falls below 80 mmHg, what would you do first in hypovolemic shock?

Increase the oxygen flow rate

What is a hysterectomy?

It is surgical removal of the uterus

How long must a woman wait before having intercourse after hysterectomy?

4 to 6 weeks

Is the woman likely to have a foley catheter in after a hysterectomy?

Yes

Are enemas common before a hysterectomy?

Yes

What would you do if the client complains of flank pain (back pain) after hysterectomy?

Call the MD, probably had a ureter tied off accidentally in surgery

What are 2 common psychological reactions to hysterectomy?

Grief, depression

What causes thrombophlebitis after hysterectomy?

Venous stasis in the abdomen (the woman was in the vaginal lithotomy position for hours)

What sign would indicate the presence of thrombophlebitis?

A hard, red swelling in the posterior calf

Should you assess for Homan's sign?

No. Homan's sign is no longer recommended as a test for thrombophlebitis because it can cause a clot to embolize

How long does the woman have to be off oral contraceptives before hysterectomy?

Oral contraceptives should be discontinued 3 to 4 weeks preoperatively.

How long should a woman wait before lifting heavy objects after a hysterectomy?

2 months

How long does a lady have to wait before driving after a hysterectomy?

3 to 4 weeks

If the client complains of abdominal gas after a hysterectomy, the best intervention is.....

Ambulation

What are two major complications of a hysterectomy besides hemorrhage?

Thrombus and pulmonary embolus Urinary retention

What body position should be avoided after hysterectomy? Why?

Knee flexion (because it increases the chance of thrombophlebitis)

When will bowel sounds return after a hysterectomy?

After 24 hours but before 72 hours

Ectopic pregnancy is implantation of a fertilized ovum ________ the _________.

Outside, uterus

The most common site for ectopic pregnancy is in the _________ __________.

Fallopian tube - 90%

Have intrauterine devices to prevent pregnancy ever been linked to ectopic pregnancy?

Yes and so have pelvic infections.

What is the most common sign of fallopian tube ectopic pregnancy?

Unilateral pelvic pain

What is the most dangerous side effect/complication of fallopian ectopic pregnancy?

Rupture of the fallopian tube

If the fallopian tube ruptures due to ectopic pregnancy, nursing care is the same as that for___________.

Shock and peritonitis

The uterus feels _______ after rupture of a fallopian ectopic pregnancy?

Boggy- tender, also

The first sign that a fallopian ectopic pregnancy had ruptured is...

Sharp abdominal pain

Ectopic pregnancy is (usually/almost never) carried to term.

Almost never

The most common medical-surgical treatment for ectopic pregnancy is___________.

Surgical removal of fetus and some surrounding tissue

Name the surgery performed for an ectopic pregnancy.

Exploratory laparotomy

What is ECT?

The use of electrical shock current delivered to the brain to induce a seizure that treats depression.

The client is (awake/under local anesthesia/under general anesthesia) during ECT?

Under general anesthesia -- must be artificially ventilated

What conditions does ECT treat?

Depression primarily

Is an informed consent necessary for ECT?

Yes

Name the three most common complications of ECT?

Aspiration of emesis (most common) into the lung
Dislocations of joints
Fractures due to convulsion-- rare today

What class of drugs is given with ECT?

Muscle relaxant -- succinylcholine

What intellectual ability is impaired after ECT?

Memory

How long will a client's memory be impaired after ECT?

2 to 3 weeks

Immediately after ECT, how will the client normally act?

Drowsy
Dull
Apathetic

In what position should the client be immediately after ECT?

On their side-- to prevent aspiration

What typical pre-operative type of orders will be ordered before ECT?

NPO after midnight
Remove dentures
Client to void before surgery
Side rails up

The convulsion (seizure) that the electrical current produced is violent. (T/F)

False, it used to be, but it isn't any more with the use of muscle relaxants

What does an EEG measure?

Measures electrical activity generated by the brain

When are there activity restrictions after an EEG?

ONLY when sedatives are used, and then it's only necessary to keep side rails up.

Should the client wash his hair before an EEG?

Yes

What would you tell a client who says what if I get shocked during my EEG?

That is impossible since the test measures electrical activity coming FROM him, never to him.

Does a client have to be NPO before an EEG?

No, they should never be NPO, it could cause hypoglycemia and alter the EEG results.

What instructions are MOST important to give a client during an EEG?

Try not to move

What should the client do after an EEG?

Wash their hair

Should sedatives be given before an EEG?

Only if ordered as a pre-test medication.

How much sleep should the client get the night before an EEG?

At least 4 to 5 hours--unless it is a sleep deprivation EEG

Do you need a signed informed consent for an EEG?

No

Should caffeine be limited before an EEG?

Yes. It should be eliminated for 24 hours before the test.

What will excessively fatty stool be like?

Large, pale, foul smelling, greasy

What are the large, pale, foul smelling, greasy stools called?

Steatorrhea

Name the three types of parasites abnormally found in stool.

Roundworm
Tapeworm
Pinworm

What does occult blood in the feces mean?

Bleeding somewhere in the GI tract

Are fats a normal constituent of feces?

Yes but it should be WNL

A decrease in urobilin in stool results in stool that is______ ________.

Clay-colored

Name two things for which stool specimens are tested.

Occult blood, fat, ova and parasites

Is blood a normal constituent of feces?

No

What is melena?

A black, tarry stool indicating a GI bleed

What position is best for clients with emphysema under normal circumstances?

Semi-fowlers or higher

What flow rates of O2 are appropriate for the client with emphysema?

Low flow -- <2.5 L/min; never exceed 2.5L in COPD

If a client with emphysema has a severe dyspneic episode what position is best?

Sitting upright with arms folded on the overbed table

What will you observe on the hands of the client with emphysema?

Clubbing of the fingernail beds

In emphysema, the alveoli are over-_____ and under-______.

Over-enlarged, under-ventilated so that air is trapped in alveoli

The development of emphysema is most associated with a history of ___________.

Smoking

In emphysema, the appetite________ the weight ______ and the anterior-post diameter of the chest________.

Decreases, decreases, increases

What is the increase in anterior-posterior diameter of emphysema called?

Barrel chest

The person with emphysema have ________, _______lips and (slow/rapid) breathing.

Grunting, pursed, rapid

What dietary prescription is most appropriate for the client with emphysema?

Frequent small meals to prevent tiring

What fluid order should the emphysema client have?

3 liters of fluid per day (this is an increase)

The client with emphysema is (ruddy/pale/cyanotic).

Cyanotic

Hyperthyroid (High metabolism)

Graves Disease

High growth hormone in a child (give another name)

Gigantism

Over secretion of mineralcorticoids only (give another name)

Conn's disease

Low growth hormone (give another name)

Pituitary dwarfism

High growth hormone in an adult.

Acromegaly

Under-secretion of adrenal cortex

Addison's disease

Hypothyroidism in an adult.

Myxedema

Over secretion of adrenal cortex

Cushing's syndrome

Over secretion of adrenal medulla

Pheochromocytoma

Hypothyroid in a child

Cretinism

Oversecretion of ACTH

Cushing's disease

What is endometriosis?

Growth of endometrial tissue outside of uterus

Endometriosis most commonly occurs in women between ages of ______ and ________.

25 to 40

After menopause, endometriosis (decreases/increases).

Decreases

What is the MOST common side effect of endometriosis?

Dysmenorrhea (painful menstruation)

What is the major complication of endometriosis?

Infertility

What diagnostic procedure confirms the diagnosis of endometriosis?

Laparoscopy

What class of drugs is used to conservatively treat endometriosis?

Androgens

Which androgen drug is most commonly used to treat endometriosis?

Danazol

Women with endometriosis should be counseled to use (tampons/pads) during menstruation?

Pads only

Will client die of endometriosis? What would you say?

Not life-threatening

What advice is best for women with endometriosis who want to have children?

Do not postpone pregnancy, may not be able to have children

What is the #1 danger of epiglottitis?

Airway obstruction

Epiglottitis most commonly occurs in children from age ________ to ______.

1 to 8 years

What organism causes epiglottitis?

Hemophilus influenza B

What level of fever is present in epiglottitis?

Over 102 degrees

What symptoms are classic epiglottitis?

Muffled voice
Drooling
Stridor

Will a child with epiglottitis cough?

No, there will be a lack of spontaneous cough.

How will the child with epiglottitis breathe?

Leaned forward with flaring nostrils

If a child is suspected of having epiglottitis, should you put a tongue depressor in their mouth to look?

No, never put any instrument in the child's mouth unless you are prepared to do an immediate intubation.

Would you do a throat culture for a child with epiglottitis?

No, never put anything in their mouth.

If epiglottitis is suspected, what should the parents be told?

To take the child to the ER as soon as possible.

What drug is used to fight epiglottitis?

Penicillin, ampicillin

Children with epiglottitis often need a tracheotomy. What behavior would indicate the need for a tracheotomy?

Restlessness
Increased HR
Retractions

What is recommended for the prevention of epiglottitis?

All children two months and over should receive an H. influenza B vaccine.

Autonomy vs Shame and Doubt

Toddler

Industry vs Inferiority

School Age

18 to 25 years

Young Adult

Says "no

Toddler

Encourage creativity and collecting things

School Age

Give choices

Toddler

Centers on having basic needs met

Infancy

18 months to 3 years

Toddler

3 to 6 years

Pre-schooler

12 to 20 years

Adolescent

Initiative vs Guilt

Pre-schooler

6 to 12 years

School age

Trust vs Mistrust

Infancy

Peer group important

Adolescent

Encourage fantasy

Pre-schooler

Identity vs Role confrontation

Adolescent

Intimacy vs Isolation

Young adult

Birth to 18 months

Infancy

Define EGD

Insertion of a fiber optic scope to visualize the esophagus, stomach and duodenum

What can be done during an EGD besides visualization?

Remove polyps
Take specimens
Coagulate bleeding vessels

Can EGD be done on an uncooperative client?

No

Does client need to have side rails up after EGD?

Yes, until sedative effects of valium have worn off

Can an EGD be done on clients with GI bleeding?

Yes

Is the client sedated before EGD?

Yes, with valium (diazepam) or another sedative

What pre-test activities must be performed before the EGD?

Remove dentures and eyeglasses
Sign consent
NPO after midnight

When can an EGD client begin to eat after the test?

When gagg reflex returns (knocked out with xylocaine)

Is an EGD a fasting procedure?

Yes, after midnight

What drug is given to anesthetize the pharynx?

Xylocaine (a local anesthetic)

What are the complications of EGD?

Perforation of gut
Aspiration secondary to emesis Respiratory arrest (due to valium)

What two discomforts are common during an EGD?

Vomiting
Gagging

What is the most dangerous complication of EGD?

Secondary respiratory arrest (valium)

What is the most common complaint after an EGD?

Sore throat

Carbonic Anhydrase Inhibitors

Treat glaucoma
Decreases aqueous humor production
Diuresis
Diamox is an example

Anticholinergic

Dilates pupils
Causes photophobia
Used preoperatively for cataract removal
Don't use in glaucoma
Atropine is an example

Miotic

Constricts pupil; Timoptic
Pilocarpine are examples

Mydriatic

Tachycardia
Photophobia
Dilates pupil
Do not use in glaucoma
Neo-synephrine is an example

What do carbonic anhydrase inhibitors do to the eye?

Decrease production of aqueous humor and thus decrease intraocular pressure.

Name the most common side effect of carbonic anhydrase inhibitors?

Diuresis

Which two groups of these drugs cause photophobia?

Mydriatics
Anticholinergics

Which of these classes of drugs causes contact dermatitis?

Miotics

What do mydriatics do for the eye?

Dilate the pupil (My "D"riatic "D" for dilate)

What do miotics do for the eye?

Constrict the pupil

Name one mydriatic

Neo synephrine or Atropine

What do anticholinergics do for the eye?

Dilate the pupil
Cycloplegia
Paralyzes accommodation

What is cycloplegia?

Paralysis of the iris/pupil

Which two of these classes of drugs cause tachycardia?

Mydriatics
Anticholinergics (sympathetic effects)

What is the most common use for anticholinergics in the eye?

To cause cycloplegia
Dilation
Allowing eye exam

How should eye ointments be given?

Placed on the lower inner eye lid, then have client close eyes

Name two anticholinergics used in the eye.

Cyclogel, atropine

Name one carbonic anhydrase inhibitor

Diamox

How should the eye drops be given?

Place drops into the lower conjunctival sac

How is the flow of eye irrigational fluid directed?

From inner canthus to outer canthus

Name two miotics

Pilocarpine, Timpotic (or any drug ending in -lol)

Define nuclear family

A family of parents and their offspring

When does a nuclear family become an extended family?

When aunts or uncles or grandparents live with the family

In America, the family is the basic unit of society. (T/F)

True

Give the 2 major roles of the family in society

To protect and socialize

What percentage of North American families are single-parent?

50%

90% of single-parent families are headed by a ___________.

Female

In what step of the nursing process does the nurse ask the family about their beliefs on illness?

Assessment phase

What is the first thing a nurse must do to help families in crisis?

Nurse must first examine her own values

Anxiety-producing thoughts are called_____.

Obsessions

Repetitive actions designed to reduce anxiety are called_____.

Compulsions -- such as washing hands over and over, dusting furniture 3 hours per day, refusing to turn your back to anyone

Which defense mechanism is most closely associated with obsessive-compulsive disorder?

Displacement

Should you allow an obsessive-compulsive person perform their compulsive behavior?

Yes, give them time to do their ritual and try to set limit and redirect

Should you ever make an obsessive-compulsive person stop their compulsive behavior?

No, they will become very anxious

Is the patient with obsessive-compulsive disorder neurotic or psychotic?

Neurotic-- they know reality

Should you confront the obsessive-compulsive patient with the absurdity of their behavior?

No, just say things like :You washed your hands for so long you must have been very anxious.

What should you do if an obsessive-compulsive patient is always late due to their rituals?

Get them started earlier-- for example if they wash their hands for 1/2 hours before meals and are always late for breakfast, just get them started 1/2 hour earlier.

What are the two types of oral contraceptives?

Progestin only and combination progesterone and estrogen

How many days of the menstrual cycle do you take the progestin only pill?

All 28 days

How many days of the menstrual cycle do you take the combination pill?

You take it on days 5-24, but not on days 24-28 and 1-4 (8 days off)

How long before surgery must you discontinue oral contraceptives?

One week before surgery

If a women forgets to take pill one day, what should she do?

Take it as soon as she remembers it, and take next pill at regular time.

What if a woman forgets to take the pill for two days in a row? What should she do?

Take 2 pills a day for two days in a row and then resume normal schedule.

What should a woman do if she forgets to take her pill for 3 days or more?

Throw away pack and start new pack same day. use back-up contraceptive method for 7 days

If a woman doesn't stop oral contraceptives one week before surgery she is at risk for developing______.

Thrombophlebitis

People who smoke more than ______ cigarettes per day should not be on oral contraceptives.

15, because if you smoke you have constriction of vessels and this potentates the chances that a woman on oral contraceptives will get thrombophlebitis

If a women on oral contraceptives misses a period, should she still take pills?

Yes, however, if 2 missed periods occur,stop and have a pregnancy test.

Will breakthrough bleeding, nausea and vomiting and breast tenderness go away when a woman is on oral contraceptives?

Yes, after about 3-6 months of treatment.

Osteoarthritis is a ________ disease of the ______.

Degenerative, joint

Osteoarthritis is most commonly caused by the wear and tear of life. (T/F)

True

The most common symptom of osteoarthritis is ________ __________.

Joint pain

What two joints are most commonly affected in osteoarthritis?

knee and hip

To control the pain of osteoarthritis one should use heat or cold?

Heat

What three medications are used in osteoarthritis?

Aspirin, non-steroidal inflammatory (NSAIDs) Indocen, Ibuprofen, steroids

What do you observe on the fingers of the client osteoarthritis?

Heberden's nodes

Are Heberden's nodes painful?

Not in the beginning, can be later as swelling occurs

Are rest periods and range of motion exercises appropriate in the care of osteoarthritis?

Yes, rest is probably the most effective thing they can do.

The pain of osteoarthritis is usually better or worse with rest? With activity?

Better with rest, worse with activity

What age group gets osteoarthritis?

60-80 years old

Osteoarthritis is more common in females. (T/F)

False, it occurs with equal frequency

For cervical osteoarthritis the client should wear...

A cervical collar

What is arthroplasty

Joint replacement

What is arthodesis?

Joint fusion

What is otosclerosis?

Overgrowth of spongy bone in the middle ear that doesn't allow the bones of the middle ear to vibrate

What will the client with otosclerosis complain of besides hearing loss?

Buzzing or ringing, in the ears (tinnitus)

Do people have a loss of hearing with otosclerosis?

Yes

What is corrective surgery for otosclerosis called?

Stapedectomy

Should side rails be up after stapedectomy ?

Yes, client may feel dizzy

What should the client avoid post-stapedectomy?

coughing
sneezing
blowing nose
swimming
showers
flying

What warning should you give the client about getting up after stapedectomy?

Get up slowly

What should the client expect regarding hearing post-stapedectomy?

An initial decrease with the benefits of surgery noticeable in 6 weeks

What should the post-stapedectomy client do if he must sneeze?

Open his mouth, this de-pressurizes the middle ear.

What type of hearing loss is associated with otosclerosis?

Conductive

Which sex has a higher incidence of otosclerosis?

Women

Do hearing aids help in otosclerosis?

Yes

What will be the results of the Rinne test in otosclerosis?

Bone conduction will be better than air conduction

Is stapedectomy done under general or local anesthesia?

Local

If the client complains of decreased hearing after stapedectomy what would you say?

It is normal due to edema. The hearing will start to improve within six weeks.

Which side will the client be allowed to lie upon post-stapedectomy?

Depends on M: operative side promotes drainage, un-operative side prevents graft dislodgement. Don't make a big deal of position post-op

What two drugs are commonly give post-stapedectomy?

Codeine/Demerol for pain, Dramamine for dizziness

Cysts on the ovaries are usually malignant. (T/F)

False, usually benign

What is the #1 reason why MD's remove ovrian cysts?

Remove before they transform into malignancy.

Do small ovarian cysts cause symptoms?

No, only large ones

Common signs of large ovarian cysts are...

Low back pain
Pelvic pain
Abnormal bleeding

What does torsion of an ovarian cyst mean?

Twisting of cyst with interruption of its blood supply

What is the big danger from torsion?

Necrosis and rupture of ovary

What other disorders resemble rupture of ovarian cysts?

Appendicitis, rupture of a fallopian tube pregnancy

What affect do oral contraceptives have on ovarian cysts?

They cause it to stop growing and decrease in size.

What are the three most common signs of ovarian cyst rupture?

Pain, abdominal distention, abdominal rigidity

Compare signs of non-ruptured ovarian cysts with the sings of a ruptured ovarian cyst. (Give 3 for each)

Non-ruptured: low back pain, dull pelvic pain, abnormal uterine bleeding especially with menstruation
Ruptured: acute pain, abdominal distention, and abdominal rigidity

After surgery to remove an ovarian cyst the woman can return to normal activities between _______ to _______ weeks,

4-6 weeks

How soon after removal of an ovarian cyst can a woman resume sexual intercourse?

4-6 weeks

Should a woman douche after surgery to remove an ovarian cyst?

No, it is not good to douche on a regular basis, it destroys natural protective vaginal flora

What does lightening mean?

When the fetal head descends into the pelvis

When does lightening occur in pregnancy?

2-3 weeks before birth for primipara

What is the most common positive effect of lightening?

After it occurs the woman can breathe much easier

Name the two earliest signs that a woman is likely in labor.

Low back pain and show (blood-tinge mucous plug is passed)

What is the most RELIABLE or VALID indication that a woman is in labor?

The onset of regular contractions that result in progressive dilation/effacement of the cervix

What is the meaning of cervical effacement?

The cervix thins

Into how many stages is labor and delivery divided?

4

What is accomplished during the first stage of labor and delivery?

Full effacement and dilation

How long is the first stage of labor and delivery for a primagravida? For a multigravida?

12 hours, 6 hours

THe cervix is fully dilated when it is ______ cm.

10

The 2nd stage of labor and delivery accomplishes....

Delivery of the infant

The 2nd stage of labor and delivery begins with ______ and ends with _______ of the ________.

Full dilation, delivery, infant

The 2nd stage of labor and delivery lasts ______ hours for a primagravida and ______ hours for a multigravida.

1 1/2 hours, 1/2 hour

The 3rd stage of labor and delivery accomplishes...

Expulsion of the placenta

The 3rd stage of labor and delivery lasts...

Less than one hour

What occurs during the 4th stage of labor and delivery?

Recovery

When does the 4th stage of labor and delivery end?

2 hours after expulsion of the placenta

What is the average blood loss during labor?

500 cc

When the terminology "the three phases of labor" is used, what does it mean?

If the statement refers to phases of labor, it means the 3-step process of latency, followed by an active and transitional

Normal length of pregnancy is ______ to ______ days.

240 to 300

Pregnancy is divided into ____ trimesters.

3

During the first trimester the woman experiences decreased or increased vaginal secretions?

Increased

When are urine pregnancy tests positive?

At the time of the first missed period

Pregnancy tests test for the presence of what hormone?

HCG (human chorionic gonadotropin hormone)

Urine and blood pregnancy tests are enough evidence to be certain of pregnancy. (T/F)

False, these tests only suggest pregnancy

What is Hegar's sign?

Uterine softening

What is Chadwick's sign?

Blue-tint to the cervix

The first trimester goes from week _____ to week_____.

1, 13

The second trimester goes from week ____ to week ______.

14, 27

Which week can mother first feel the fetus move?

16th to 20th week (the end of the 4th month into the 5th month)

What is the word used to identify the feeling that the mother experiences when the fetus moves?

Quickening

The 3rd trimester goes from week _____ to week______.

28, 40

In which trimester does the woman most feel backache?

Third

Which trimester is the fetus most susceptible to effects of outside agents?

First

What is the name of the process in which outside agents cause birth defects in the fetus?

Teratogenesis

Which trimester is nausea and vomiting most common?

First

Which trimester do Braxton-Hicks contractions begin?

Third

In addition to the nares, where else should the nurse assess for skin irritation when nasal cannulae are in use?

Behind and on top of the ears

What are the two early signs of hypoxia?

Restlessness, tachycardia

What is the highest flow rate appropriate for nasal cannulae?

6 L/min

How often should the nares of a client with O2 by nasal cannulae be assessed for skin breakdown?

Every 6-8 hours

What is the maximal O2 flow rate for the client with COPD?

2 L/min

What are the signs of O2 toxicity?

Confusion, headache

What can happen if the client with COPD is given a high flow rate of O2?

They may stop breathing

What is the problem with giving high flow rates of O2 by nasal cannulae?

Dries the mucous membranes.

Can a client smoke in the room when the O2 is turned off?

No, the O2 delivery device must be removed from the wall or the tank out of the room before a client can smoke

When O2 is administered, it must be...

Humidified

Masks deliver higher or lower concentrations of O2 than nasal cannulae?

Higher

How often should the nurse check the flow rate of the O2?

At least once per shift

O2 is an explosive (T/F)

False, it does not explode-- it supports combustion

What is the #1 difference between sealed & unsealed
radiation?

Both are internal forms of radiotherapy however, in sealed, a solid object is placed in a body cavity; in unsealed a radioactive substance is injected in liquid form into a vein

What are the 3 principles the nurse uses to protect
self when caring for a client with a sealed radioactive implant?

Time, distance, shielding

What is another name for external radiation therapy?

Beam or X-rays

What is the difference between external radiation
treatment and internal radiation treatment?

In external the tumor is bombarded with x-rays & nothing is placed in the body; in internal there is some radioactive substance introduced into the body

Of sealed internal, unsealed internal, and external
radiation treatment, which is MOST dangerous for the nurse?

Sealed internal then unsealed internal, external radiation treatment is of no danger to the nurse unless the nurse is in the radiation treatment room during the treatment

Should pregnant nurses care for patient receiving
sealed internal radiotherapy?

Never. (Lawsuit time!)

Should pregnant nurses care for a patient receiving unsealed internal radiotherapy?

Maybe, as long as they don't contact body secretions.

What skin products should the patient receiving
external radiotherapy AVOID?

No ointments with metals like zinc oxide, no talcum powder

Describe the hygiene measures the you teach the
patient receiving external radiotherapy?

Use plain water only, no soaps, pat dry, can use cornstarch for itch

What are the major side effects of radiotherapy?

Pruritis, erythema, burning, sloughing of skin, anorexia, nausea & vomiting, diarrhea, bone marrow depression

When the patient is receiving radioactive iodine what
precautions is/are most important?

Wear gloves while in possible contact with urine, special precautions taken to dispose of the urine.

Rape is a crime of passion. (T/F)

False, it is a violent act

Most rapes occur involving two people of different
races. (T/F)

False, usually the same race

When must psychological care of the rape victim
begin?

In the emergency room

Name the two phases of Rape Trauma Syndrome.

Disorganization phase, re-organziation phase

Immediately after rape, a woman who is calm &
composed is adjusting well. (T/F)

False, calmness & a composed attitude are SIGNS of Rape Trauma syndrome, (calm person is just as disorganized as the crying and upset lady)

Name the 3 physical symptoms of Rape Trauma Syndrome.

GI irritability, itching or burning on urination, skeletal muscle tension* don't forget PAIN

Victims of rape often blame ___________.

Themselves

In the long term reorganization phase the woman is likely to
change ______.

Residence or/an telephone number

In the long term reorganization phase the woman is likely to
experience ____ during sleep.

Nightmares

In the long term reorganization phase the woman has 4
common fears. Name them....

1. Indoors or outdoors (depending on where the rape occured)
2. Being alone or in crowds
3. People being behind them
4. Sexual fears

Before evident from the woman's body can be gathered for rape, _____ _____ must be completed.

Consent forms

Should a female staff member be present when the rape
victim is being examined?

Always

The rape victim requires only a pelvic exam & a head to toe
exam is not done, so the client is not stressed. (T/F)

False, the exam is a very long, invasive head-to-toe exam

During exam the vaginal speculum is lubricated before it is
placed in the vagina? (T/F)

False, lubrication could alter the evidence

What drug is often used to prevent pregnancy after rape?

Kits approved by FDA:
Preven (levornorgestrel & ethinly estradiol) or Plan B: Levonorgestrel (less N&V)

When working with a rape victim they should be treated
with ________ and _________.

Dignity & respect

After rape, a woman needs follow-up exam/test for
_______ __________ ________.

Sexually transmitted disease (STD's), i.e: AIDS, gonorrhea, syphilis...

After discharge contact with the rape victim is maintained
via the _______.

Telephone

Raynaud's is an arterial or venous disease?

Arterial disease characterized by spasms

What part of the body is most affected by Raynaud's?

The fingers

Raynaud's affects males or females mostly?

Women (young)

What 3 things precipitate a Raynaud's attack?

Exposure to cold, emotional stress, tobacco use

The digits in Raynaud's are hot or cold?

Cold

What will the fingers look like?

Pale, sometimes blue

What will you find when you assess the legs of these patients?

Weak/absent pulses, cool, pale, loss of hair, shiny thin skin

What 3 sensations will the client experience?

Pain, numbness, tingling

What should the client with Raynaud's avoid?

Cold weather. (They should wear gloves & stop smoking)

In the recovery room (PACU) the patient should be positioned....

On either side

What reflex is commonly routinely tested in the recovery
room?

Gag reflex

When will the artificial airway be removed in the recovery room?

When the gag reflex returns

Vital signs are measured _______ in the recovery room.

Every 15 minutes

In the recovery room the head should be ....

To the side with the cheek & neck extended slightly down

In the recovery room the neck should be ...

Slightly extended

Can post-operative pain medications be given in the
recovery room?

Yes

Give 3 stages of acute renal failure.

Oliguric, diuretic, recovery

Define renal failure.

Inability of the kidney to excrete wastes & maintain fluid & electrolyte balance

What is the BIG danger in renal failure?

Hyperkalemia and it's effect on the heart

What is anuria?

Less than 50 cc of urine in 24 hours

What is oliguria?

Less than 500 cc of urine in 24 hours

What are the dietary modifications for the recovery phase of acute renal failure?

Increased carbohydrates, increased protein.

What are the dietary modifications for the diuretic phase of
acute renal failure?

Increased carbohydrates, increased protein. Moderate potassium & sodium. (May need to increase fluids in diuresis results in dehydration.)

What are the dietary modifications for the oliguric phase of
acute renal failure?

Increased carbohydrates, decreased protein, decreased sodium, decreased potassium, decreased water.

What causes the itching seen in renal failure?

Accumulation of wasted in the blood and the associated signs. This occurs in the end stage renal failure.

What is the first phase in acute renal failure?

The oliguric phase

In the oliguric phase, blood volume is ______, sodium is
_____, and potassium is ________.

High, high, high

How long does the oliguric phase last?

7-10 days

In the diuretic phase, blood volume is ______, sodium is
_____, and potassium is ________.

Low, low, low

How long does the diuretic phase last?

3-4 days, maximum time 2-3 weels

In the diuretic phase: urine output can=________ to
________ liters/24 hours.

4-5 liters per 24 hours

Which is more dangerous, oliguria or anuria? Why?

Oliguria, because since you are losing more fluids you are actually hemo-concentrating the hyperkalemia more

Respiratory Distress Syndrome occurs in full-term infants.
(T/F)

False, it occurs in premature infants

Respiratory Distress Syndrome hardly ever occurs after
week ____ of gestation.

37

Respiratory Distress Syndrome is also know as ....

Hyaline Membrane Disease (HMD)

The cause of RDS is a lack of _______.

Surfactant

Surfactant _____ surface tension inside ________.

Decreases, alveoli

Surfactant prevents the _________ of the alveoli.

Collapse

Lack of surfactant causes the neonate to lose lung capacity with each _______.

Breath

Death from Respiratory Distress Syndrome most
commonly occurs within _____ hours of birth.

96

Within in minutes of birth, what 3 respiratory difficulties
occur?

Retractions, nasal flaring, and grunting

What medication is given? By what route?

Survanta (Surfactant) via ET tube. Repeat doses are often required.

What acid/base disorder is seen in Respiratory Distress
Syndrome?

Respiratory acidosis (CO2 is retained)

What will you auscultate over the lungs of the neonate with
Respiratory Distress Syndrome?

Decreased lung sounds with crackles

What lab test assesses the risk of Respiratory Distress
Syndrome?

L/S ratio (Lecithin/Sphingomyelin ratio)

What L/S ratio indicated fetal lung maturity?

2/1

What other test is used to confirm fetal lung maturity?

Amniotic fluid is analyzed for presence of PG

Severe cases of Respiratory Distress Syndrome requires
ventilation with _________.

PEEP (Positive end expiratory pressure) & CPAP. (Continuous positive airway pressure), to keep alveoli open while on the ventilator. High frequency jet ventilation is sometimes used.

What may be added to the IV to correct the acidosis?

Bicarbonate

High flow rates of O2 delivered in Respiratory Distress
Syndrome can cause __________ __________.

Retrolental fibroplasia (an eye problem)

Retrolental fibroplasia can result in _________.

Blindness from retinal damage

High ventilatory pressures result in what chronic lung
problem?

Bronch-pulmonary dyplasia

At what time of year does rheumatoid arthritis flare up?

Spring

As with any inflammatory disease clients with rheumatoid
arthritis have a low-_________.

grade fever

What factor is present in the blood when the client has
rheumatoid arthritis?

The rheumatoid factor