s/s of Diabetic ketoacidosis (DKA)
Table 38-6, p.871, text p.873 --> Headache; Weakness; Hunger (polyphagia); Pallor; Irritability; Lack of muscle coordination; Apprehension; Shakiness; Diaphoresis with cool, clammy skin; Blurred vision; Rapid heartbeat; Confusion; Coma (late).
Function of aldosterone
p.821 ---> "The chief mineralocorticoid is aldosterone, which promotes conservation of water by acting on the kidney to retain sodium in exchange for potassium, which is excreted in the urine.....Without the mineralocorticoids, a person would die within 3
Cognitive function of ALS
p.559-560. -->"Some patients may notice difficulty swallowing and speaking clearly because of oropharyngeal weakness.....Mental depression is relatively common as a result of the unrelenting progression of muscle weakness and atrophy. Death is usually due
Hyperopia
p.594-595, Figure 27-1 B --> "Farsightedness....The lens is too close to the retina; light rays converge at a point beyond the retina.
Meningitis
p.541-542 --> "..inflammation of the membranes covering the brain and spinal cord and is caused by an infectious agent. Viruses, bacteria, and fungi can cause meningitis."
Read up on these pages about positive Brudzinski's sign, Kernig's sign, etc...just
s/s brain tumor
p.539-540 -->"...the patient may first show personality changes, disturbances in judgment and memory, loss of muscular strength and coordination, or difficulty in speaking clearly. Headache awakening the patient is a key sign!!!! Vomiting, visual problems
s/s closed head injury
p.500-501 --> "Concussion is the term used to describe a closed head injury in which there is a brief disruption in level of consciousness...A closed injury is one in which the scalp and skull remain intact, but the underlying brain tissue is damaged....T
s/s Diabetes Insipidus (DI)
p.835-836 --> "The patient experiences profound diuresis (production of a largeamount of urine), often as much as 15-20 L in every 24 hr period. Other s/s include thirst, weakness, and fatigue, often from nocturia (urination at night). Signs of deficient
Homans sign
p.900 --> "A positive Homan' sign may indicate development of thrombophlebitis." Homans' sign: Pain on passive dorsiflexion of the foot; a sign of thrombosis of deep calf veins. (Glossary).
VS normal ranges
Normal vital sign ranges for the average healthy adult while resting are:
�Blood pressure: 90/60 mm/Hg to 120/80 mm/Hg
�Breathing: 12 - 18 breaths per minute
�Pulse: 60 - 100 beats per minute
�Temperature: 97.8 - 99.1 degrees Fahrenheit / average 98.6 deg
Potential complications for surgery
p.77 --> "Potential intraoperative complications of surgery include: Infection; Fluid volume excess or deficit; Hypothermia; Malignant hyperthermia; Injury related to positioning...Counts of sponges, needles and instruments are performed to verify that no
Use of anti-anxiety agent before surgery
p.72--> "Reduce anxiety and promote a restful state
s/s hypothermia
p.1027 -->"Symptoms of hypothermia range from mild shivering and complaints of feeling cold and loss of coordination to eventual loss of consciousness and a deathlike appearance. In severe hypothermia, the body's protective mechanisms will drastically slo
Stress incont
p.777-779 -->"stress incontinence that occurs with exercise, laughing, or coughing may be corrected by exercises to strengthen the pelvic floor muscles" There's lots to read in those 3 pages...go for it.
Incarcerated hernia et possible complications
p.663-664 --> "The flow of intestinal contents can be blocked by an incarcerated hernia, and cause symptoms of intestinal obstruction. THis is an emergency because when the blood supply is restricted, part of the intestine may die..." No coughing...no lif
Malignant hyperthermia
p.93 -->"Malignant hyperthermia is a life-threatening complication of general anesthetic agents, including halothane, isoflurane, enflurane, and succinylcholine. MH occurs from a biochemical reaction in genetically predisposed persons; Signs of MH include
diverticulitis- why to seek tx
p.668 --> Diverticulitis of the intestine produces symptoms of diarrhea or constipation, acute severe left lower abdominal pain, fever, and rectal bleeding. The condition may be complicated by intestinal obstruction or by peritonitis if the intestinal wal
Pelvic inflammatory disease (PID) s/s
p.939 --> "severe abdominal and pelvic pain and fever, frequently accompanied by a foul-smelling purulent vaginal discharge, and the woman appears acutely ill. Chronic PID usually causes backache, a feeling of pelvic heaviness, and disturbances in menstru
Quadriplegic/tetraplegic
p.492 --> "A newer term for quadriplegia is tetraplegia." They are the same.
s/s cholecystitis - bile - color of stool
p.692 --> "Light-colored stool, dark urine, or yellow tint to the eyes or skin as these signs may indicate obstruction to the flow of bile
Benign Prostatic Hyperplasia (BPH) s/s
p.927 -->"The patient begins to experience difficulty in urinating, evidenced by a decrease in the caliber of the stream of urine, hesitancy, and dribbling after voiding. There may be frequency, nocturia, and urgency due to irritation of the distended bla
pyelonephritis
p.788 -->"Acute pyelonephritis is an infection of the kidneys. It is thought to occur when bacteria from a bladder infection travel up the ureters to infect the kidneys. A frequent cause of pyelonephritis is an obstruction, causing stasis of urine and sto
TPN - monitor for what?
p.660 --> "TPN is essentially a form of IV feeding...The patient is weighed daily and provided frequent mouth care.
Kidney stone s/s et why we would tx a lodged stone - what are we trying to prevent
p.792-793 --> "Some renal stones do not cause noticeable symptoms and can be passed without the person being aware of them. Others may lodge in the renal pelvis and cause symptoms only after the destruction of kidney cells...Pain is typically felt in the
Bowel obstruction s/s & reason it must be treated
p.668-668 --> "...sharp, brief pains in the upper abdomen. Frequent bowel sounds are high pitched above the point of obstruction, and bowel sounds are absent below the obstruction. Other symptoms include vomiting, with rapid dehydration and only slight ab
Bs - how long to you listen in each quadrant?,
p.632 --> "For bowel sounds to be considered absent, it is necessary to verify that no sounds are heard after listening in each of the four quadrants for 5 minutes.
epidural hematoma DI s/s
??? p.501 talks about epidural hematoma....but I don't see the relation to Diabetes Insipidus.....
STI's - reason woman is more at risk
p.939 --> "During and after the sexual act, male secretions and semen are in contact with female mucous membranes for a period of time longer than female secretions are in contact with male mucous membranes. Therefore women have an increased risk for STI.
age related changes to male reproductive system
p.920 --> "There is decreased sperm production, but fertility remains intact. Ejaculate volume decreases. After age 60, the cycle of sexual response lengthens. Arousal takes longer and more direct penile stimulation may be needed; the firmness of the erec
age related changes to urinary system
p.766 --> "Kidney function begins to lessen after age 45, and renal blood flow and GFR gradually decrease to about half the rate of a young adult by age 65. In the male, the prostate gland hypertrophies with age and can cause varying degrees of obstructio
age related changes to menopause
p890 --> "The ageing process--as well as the decrease in estrogen levels--can cause thinning of the vaginal walls (atrophy(, dryness, and itching of the vagina (pruritus). These changes may result in painful sexual relations (dyspareunia) and can also lea
risk factors for surgery in older adults
p.84 --> "Providing adequate pain control for older patients has been shown to prevent respiratory complications because- with pain controlled- patients with breathe more deeply and are able to follow instructions for respiratory care." "The risk of hypov
Autonomic dysreflexia with spinal cord injury - initial s/s.
p.514-514 --> "The AD response is potentially dangerous to the patient, because it can produce vasoconstriction of the arterioles with an immediate elevation of blood pressure. The sudden hypertension can, in turn, cause a seizure, retinal hemorrhage, or
Risk for older adults cranial bleed - why?
p.501 --> "The brain atrophies with age and does not take up as much space in the cranial vault. This allows for more movement and more potential for torn vessels and contusions on the brain when an accident occurs that involves a head injury.
Sucking chest wound
p.1025 -->"In the field, emergency medical personnel will cover a sucking chest wound at the end of a forceful expiration with an occlusive dressing- that is, one made of plastic wrap, aluminum foil, Vaseline-covered gauze, or any other material that seal
choking victim that can still cough
p.1032 --> "If the person is conscious and able to cough or speak he may not need assistance in expelling the object from his throat. In this situation, encourage him to cough rigorously and breathe as deeply as he can.
patient control of diabetes
p.857-877 --> Diet, Exercise, Increasing Food Intake During Exercise, Oral Hypoglycemic Agents, Insulin Therapy, Insulin Pump. This is pretty much all of chapter 38. Anyone remember specifics from the past exams?!
evacuation in a facility after a tornado
p.1000 --> "If advised to evacuate the area, residents should gather essential belongings, medications, pets, and keepsakes and leave immediately. If tornado sirens are sounded, people should take refuge in a basement or in an inner room without windows,
Decreasing patient temperatures quickly
p.211 --> "Cold water is contraindicated because rapid cooling can induce shivering, which can drive the temperature back up
Exacerbation of MS
p.557, Table 25-2 --> "Relapsing remitting (most common type): Clearly defined relapses of acute worsening neurologic function. Partial or complete recovery occurs in remission period. Relapsing progressive: Disease steadily worsens from onset, but there
Bell's palsy
p.548 --> "Bell's palsy is weakness or paralysis of the muscles supplied by the facial nerve. It usually affects only one side of the face, and usually occurs in people over age 30...It is thought to be caused by edema and ischemia that compresses the fac
Administration of potassium iodide
p.1010 --> "Radioactive iodine exposure is treated with potassium iodide, an isotope-specific blocking agent, to prevent the thyroid cancer this type of radiation causes.
Abdominal gas after surgery
p.635 --> "When you feel the need to expel gas, do so; do not hold back.
Coughing after abd sx
p.71 --> "A small, firm "coughing pillow" can be made by folding a bath towel or a light blanket and securing it inside a pillow case with the ends tucked inside over the towel or blanket...Splint the abdominal or chest incision...Take a deep breath throu
Positioning after surgery,
p.503 --> "Positioning the patient according to written orders from the attending surgeon. Make no exceptions. Positioning is important to prevent added increases in ICP. Keeping the neck in midline and preventing excessive hip flexion to promote venous d
Hypoxia
p.260 --> "Hypoxia: A broad term meaning diminished availability of oxygen to the body tissues."
p.274 --> "Hypoxia, which is an oxygen deficit in the tissues, produces a loss of energy because it causes a disturbance in cellular metabolism. Patients with
preparing for "bloodless" surgery
p.64-65, [Focused Assessment: Preoperative Data Collection] "When assessing the presurgical patient, any significant deviations from normal range should be brought to the attention of the surgeon...elevated temperature..patient's usual bp reading is neces
Diving accident
p.2019 -->"Motor vehicle accidents are the leading cause of accidental death in the United States. Improper driving, which is responsible for almost 90% of all accidents, can be caused by the influence of alcohol and/or drugs, fatigue, excessive speed, di
Feeding dysphagia pt
p.491, Table 22-9 --> "For patient with dysphagia who can take oral feedings: Serve semisoft foods. Provide six small meals per day; provide nonstressful atmosphere with few distractions for mealtime. Teach to sit upright with head slightly forward and ne
Self feeding if hemi-plegic
Doesn't that kind of go with "Feeding dysphagia pt" question? Setup food where it can be reached with nonflaccid limb. High Fowler's position. Position maintained for at least 30 mins after a meal....
Visually impaired
p.578-579 --> "When a pt is visually impaired, the nurse must plan extra time to assist with personal care, to allow the pt to perform as much self-care as possible...using the "clock" method for placement of food on the plate.
ROM of immobilized pt
p.178-179 --> Prevents contractures and muscular atrophy. Prevents decreased cardiac output.
Spinal anesthesia
...
Sprain tx
p.734 --> "RICE...rest, ice, compression, and elevation. Apply ice immediately after injury and for 24-72 hours. Apply the ice bag for 10-20 mins every 1-2 hours during the day.
Tx if child takes too much aspirin
I miss this one on the exam. Wasn't the correct answer something like "induce vomiting"?
positioning of unconscious pt
p.493 --> recovery position? Roll onto side.
bacterial meningitis
p.542 --> "Bacterial meningitis frequently follows an upper respiratory infection...The most outstanding symptom of meningitis is the sudden onset of fever and a severe and persistent headache that is greatly aggravated by moving the head..pain and stiffn
Hemodialysis - hold anti-coags why?
p.805 --> Hold anti-coags, because "The problems that a patient on hemodialysis may experience..platelet abnormalities that produce bleeding tendencies.
Liquid lax
??? p.631 --> "When laxatives are administered in liquid form, the patient can drink them more easily if they are chilled or poured over ice.
Buck's traction positioning
p.740 --> "Buck's extension is a simple skin traction that is used to treat muscle spasms from fractures of the hip or femur, preoperatively, and for dislocation of the hip.
Parkinson's nursing Dx
p.552 --> "MRI scans of the brain may be performed to rule out other neurologic disorders...SPECT can display the reduced uptake of dopamine.
Bladder training
p.811 --> "Bladder training for incontinence is a prime consideration."
p.494 --> "A bladder training program usually begins with a 2-hour schedule or toileting.
Hypothalamus injury
p.104 --> Hypothalamus controls temperature regulation....so if it is injured or impaired, temperature regulation is inhibited.
why would you move a MVA pt?
p.1021 --> "Do not move the victim UNLESS he is in immediate danger or until you have immobilized injured parts.
Pt hasn't voided since surgery 10 hours ago?
p.92, Table 5-2 --> "Encourage voiding [put on bedpan], catheterize if unable to void within 8 hours per order; medicate to increase urinary sphincter tone as ordered.
Fall w/ fx
p.737, Box 33-1 "The elderly person is more at risk of sustaining a fracture because of decreased reaction time, failing vision, lessened agility, alterations in balance, and decreased muscle tone, all which predispose to falls. Nurses should assess for f
S/P crani
p.503 --> "the patient who underwent a craniotomy is in the intensive care unit for continuous monitoring. Essentially, care will be the same as that for any patient in danger of increasing ICP...Positing the pt according to written orders from the attend
A1c ranges
p.828 --> "Normal value: 3.9%-5.2% (of total hemoglobin)" I don't remember this from a previous exam...Anyone?
Evaluation of a closed head injury
p.500 --> Evaluate level of consciousness (LOC), amnesia regarding the occurrence, and headache. Underlying brain tissue is damaged; there may be contused areas or hematoma.
Evaluation of clear drainage form nose/ear r/t head injury
p.502 --> "Otorrhea and rhinorrhea should be tested to determine if there is a CSF leak. Testing with a Dextrostix will determine whether glucose is present; the presence of glucose indicates cerebrospinal fluid....If the fluid from the ear or nose is tin
height and weight before surgery
p.64 --> "Height and weight are measured and charted before surgery so the anesthesiologist can accurately calculate anesthetic dosages.
Romberg's test
p.585 -->"This is a test of equilibrium. The patient stands with the feet together, the arms out to the sides, and the eyes open. The nurse notes ability to maintain an upright posture without swaying. The patient is then asked to close the eyes and postu
Babinski - what does it mean.
p.480 --> "elicited by scraping an object such as a key along the sole of the foot. In a normal response to this stimulus, the toes will bend downward. In a positive Babinski's reflex, the great toe bends backward (upward) and the smaller toes fan outward
Bun normal range
p.767 -->"The normal adult range for BUN is 10-20 mg/dL...An increase in BUN or serum creatinine can be a signal of decreased kidney function.
Homan's sign
Homan's sign: Pain on passive dorsiflexion of the foot; a sign of thrombosis of deep calf veins. (Glossary)
Increased bilirubin - color of urine
p.339 --> "If hemolysis is occurring, the urine will often contain bilirubin, giving urine a brown tea color.
carotid US - when do we tx medically/surgically
???
VP shunt
p.541 --> For a complication of Hydrocephalus "Obstruction of CSF flow may require placing a shunt to reduce CSF pressure and prevent increased ICP. A shunt is a tube placed in a ventricle and attached to a small manual pump that moves excess CSF fluid fr
genital herpes - when are they able to resume sexual activity
[Chapter 41] Should wait to outbreak over....but always use protection.
GERD diet and lifestyle changes
p.646 --> "The diet should exclude foods that cause sphincter relaxation...Avoid any food in the diet that increases gastric acid and causes pain. Avoid high-fat and spicy foods, including garlic. Do not eat large meals; instead, eat 4-6 small meals a day
HIV compliance with meds
...
Addison's disease - corticosteroids
Treatment will usually involve corticosteroid (steroid) replacement therapy for life. Corticosteroid medication is used to replace the hormones called cortisol and aldosterone that your body no longer produces.
administration of eye ointment
p.578 --> "Apply a thin ribbon of ointment along the entire length of the conjunctival sac." From the inner to outer.
most common MS
p.557 --> "Relapsing remitting
wearing jewelry during sx
p.72 --> "Explain why all jerwlry must be removed for safety due to electrocautery used during surgery and the danger of an electrical burn from conduction of electricity through metal...If a wedding band is to be worn to surgery, tape the ring to the fin
Viagra
p.925 --> Sildenafil (Viagra) "Side effects can include headache, dyspepsia and nasal congestion. Contraindicated in patients taking nitrates and patients with hypertension or retinopathy. Usually taken 1/2 to 4 hr before sexual stimulation. Viagra can ca
Cialis
p.925, Table 40-2 --> Tadalafin (Cialis): longer lasting [taken one hour before intercourse]
hiatal hernia diet and why
p.646 -->"The patient is instructed not to eat within several hours of going to bed. Intake of alcohol, chocolate, caffeine, and fatty food is limited, and smoking should be avoided. Ingestion of fats relaxes the sphincter, allowing reflux. Occasionally a
Stress on gi system can cause what et why?
p.623 --> "Psychological and emotional stresses greatly influence appetite and motility of the stomach and intestines. The secretion of digestive juices in amounts sufficient for the breakdown of food is regulated in part by the emotions. Excessive stimul
OC benefits/risks
p.883&886 --> "most popular method of reversible hormonal contraceptive. OCs are effective if used properly, and offer noncontraceptive benefits- relief from breast tenderness, bloating, and PMS symptoms.....Not recommended for women older than 35 who smo
post op cataract pt
p.600 --> Read the "Patient Teaching- General Care After Eye Surgery"..."Patient adherence to the schedule for postoperative medications is critical to preventing complications and promoting healing.
probiotics
p.636 --> "When probiotics ("friendly" bacteria that are normally present in the intestinal tract) are used in conjunction with rehydration therapy, risk for diarrhea and duration of diarrhea are reduced.
Reason for decreased protein in diet for liver issues
p.622 --> "The liver is instrumental in protein metabolism, converting certain amino acids into different ones as needed for protein synthesis"...if there are issues with the liver it cannot metabolize large amounts of protein without poor metabolism or f
TURP - clots after procedure
p.928 --> "To decrease clot formation, the bladder irrigation flow rate is adjusted to keep the urine diluted to a reddish pink, clearing to a pink tinge within 48 hours. SOme pieces of tissue and small clots may be seen in the drainage. Additional interm
conception enhancers
p.889 --> "Using water-soluble lubricants during intercourse..Recommending that the male partner avoid environments that cause high scrotal temps, such as saunas, or using a laptop computer on the lap for long periods, since these can reduce sperm product
reduce strain on eyes
...
measures to decrease fatigue in MS
p.559 --> is worsened by heat (e.g., a hot shower, hot weather, or high humidity may induce or worsen symptoms).
Measures/diet to prevent urinary frequency
p. 774 --> "Excitement, anxiety, and fear can produce increased frequency of urination. Caffeine and other diuretics found in foods and drinks and an increased intake of fluid can increase the number of times a person must urinate.
correct condom
...
Diabetes insipitus
Diabetes insipidus: Occurs as a result of decreased production of the antidiuretic hormone (ADH) and is characterized by the production of copious amounts of dilute urine. (Glossary).
glandular production of epinephrine/norepinephrine
p.820, Table 36-1 --> "The gland, Adrenal medulla, produces Epinephrine and Norepinephrine. Targets heart, blood vessels, liver, adipose tissue. Principle actions: helps cope with stress; increases heart rate and bp; increases blood flow to skeletal muscl
only endo/exocrine gland
...
genetic risks with Huntington's disease
p.562 --> "Genetic transmission is by an abnormal gene on the short arm of chromosome 4. It is an autosomal dominant disorder, meaning that 50% of the children of a person who has the disease will inherit it. If a child does not inherit the disease, the g
Parkinson's Disease
p.551 --> "It is a progressive disorder, beginning rapidly at first and then advancing more slowly. It affects more men than women and occurs most frequently after age 60...The onset of PD is gradual and may involve only one side of the body initially. A
seizures r/t stroke
p.534 --> "Seizures are a common complication of a stroke because neural pathways are interrupted when blood flow is blocked or there is irritation of the cerebral cortex from an intracerebral bleed. The type of seizer depends on the area of the brain inv
sympathetic/parasympathetic nervous system
...
carpal tunnel syndrome
p.736 --> "Carpel tunnel syndrome is a nerve problem that occurs when the median nerve is compressed as it passes through the carpel tunnel in the wrist....Repetitive movements of the hands and wrists, particularly with constant flexion of the wrist, are
frequent uti's
...
gallstones - repeated attacks can cause what?
p.691 --> "chronic cholecystitis is unbearable upper right quadrant pain (biliary colic). The pain sometimes is referred to the back at the level of the shoulder blades. Attacks can occur as frequently as daily or may not appear but once every year or so.
age related changes to respiratory system
p.260 --> "The decrease in the immune system's efficiency makes the elderly more susceptible to upper respiratoy infections. Aging results in a decreased cough reflex nad an increased potential for aspiration. Osteoporosis may cause kyphosis, which imping
adrenal medulla gland - what does it secrete
...
endocrine d/o causes
p823 --> "Endocrine disorders are caused by an imbalance in the production of hormone or by an alteration in the body's ability to use the hormones produced. Dysfunction can occur at any point in the production-secretion feedback regulation cycle. Primary
androgenic hormones
p.821 --> "The adrenal glands also secrete small amounts of androgenic hormones, which have effects similar to those of the male and female sex hormones." p.847 --> "The insufficiency of the androgenic hormones can be compensated for by the ovaries and te
Before any pain meds are administered to a pre-op pt, make sure consent is signed!
...
Good Samaritan Law
p.1020 --> Laws the protect medical personnel from liability when rendering emergency medical care for victims of accidental injury...Individuals who offer care are held to the standard of care consistent with their level of training.
STI's Reportable to the local Health Department
p.960 --> "Syphilis, gonorrhea, chlamydia, chancroid, lymphogranuloma venereum, hepatitis B, PID, HIV infection, and AIDS
Difference between an emergency et disaster
p.997 --> "A disaster exists when the number of casualties exceeds the resource capabilities of the area; thus the community's existing emergency resources may be overwhelmed.
Goals of anesthesia
p.75 --> "The goals of anesthesia administration are to (1) prevent pain; (2) achieve adequate muscle relaxation; and (3) calm fear, ease anxiety, and induce forgetfulness of an unpleasant experience.
appropriate cane lengthe
p.731 --> "The cane is the right length if the handgrip is at HIP LEVEL and the elbow is bent at a 30-degree angle when weight is placed on the cane. It should be used on the good side unless the physician orders otherwise.