1. conductive hearing loss
Fluid behind ear drum/ trouble hearing- conductive hearing loss
Fluorescein stain
- corneal abrasion (scrape or scratch to the cornea r/t contacts lens or foreign body trauma- treatment hourly eye drops prescribed with steroid
.Mastoiditis
(infection located behind the ear) (S/S) monitor- death, brain abscess, meningitis
What is the prime way to prevent conjunctivitis
hand hygiene
Appropriate way to give insulin
Pinch the skin and put the needle in at a 45º angle
. T or F- Normal for pulses to be weaker in fractured extremities?
Normal for pulses to be weaker in fractured extremities? False (want them to be equal)
What is a sign of Hypocalcemia & is indicated by twitching of the facial muscles when tapping on face
Chvosteks sign
Ibuprofen can cause....
GI bleed !
These are signs of what in-balance diarrhea, headache, and nausea
Metabolic acidosis-
What is the number 1 indicator of an elderly patient with an UTI
confused
How many hours before surgery do you make someone NPO?
8 hours
. What is a prime way to avoid constipation after surgery?
Encourage patient to drink plenty of water post op, ambulation
. What labs do you monitor for aminoglycoside?
BUN, Creatinine
. What labs are increased with Rheumatoid arthritis?
CRP/ Sed rate
HIV classification based on-
CD4 T Cells, presence of AID defining illness, presence of symptoms
. What isolation precaution is MRSA and what do you wear?
MRSA- gown/gloves contact precaution
. what lab should be drawn after administration of Lovenox post op
platelets
T or F NMDS provide pain relief
F, No pain relief only paralysis
. What drugs are used for moderate sedation?
fentanyl, diazepam (monitor B/P and respirations)
What do you monitor when administering Morphine?
- monitor LOC and respiratory
. What is the Major thing you get during Pre-operation stage!!!!
Pre surgery- consent and right site
Classifications of surgery- Major
Involves extensive reconstruction or alteration in body parts, poses great risks to well-being.
Classification of surgery- Minor
Involves minimal alteration to body parts, often to correct deformities, minimal risks compared to major surgery.
Classification of surgery- Elective
Performed on the basis of client's choice, Not essential and not always necessary for health.
Classification of surgery- Urgent
Necessary for client's health, often prevents additional problems from developing (ex. Tissue destruction of impaired organ function), Not necessarily emergency
. Classification of surgery- Emerygency
Done immediately to save life or preserve function to a body part
Classification of surgery- Diagnostic
Surgical exploration that allows health care providers to confirm a diagnosis.
Classification of surgery- Ablative
Excision or removal of diseased body part
Classification of surgery- Palliative
Relieves or reduces intensity of symptoms, will not cure!
Classification of surgery- Restorative/reconstructive
Restores function or appearance to traumatized or malfunctioning tissues.
Classification of surgery- Procurement
Removal of organs and/or tissues from a person pronounced brain dead for transplantation into another person.
Classification of surgery- Cosmetic
Removal of organs and/or tissues from a person pronounced brain dead for transplantation into another person.
. Anesthesia classifications
P1- A normal healthy clientP2- A client with a mild systemic diseaseP3- A client with a severe systemic diseaseP4- A client with severe systemic disease that is a constant threat to lifeP5- A moribund client who is not expected to survive without the operationP6- A client declared brain dead whose organs are being removed for donor purpose.
How does the general drug induced state work?
the CNS nerve impulses to reduce pain
What is local anesthesia do?
drug induced state in which the peripheral or spinal nerve impulses are altered
what do you Prior to surgery- Diabetic patients
check sugar if low don't give insulin tell anesthesiologist
when administering fentanyl you must..
monitor respiratory, assess beforehand, mechanical intervention
. Hypoxia can be indicted by..
restlessness
. If during anesthesia state you should have what on hand incase of decreased B/P?
(Epi-pen, narcan/ naloxone)
Succinylcholine can cause
Malignant Hyperthermia (dantrolene/ dantrium treatment)
29. What can occur with a fractured bone?
Fat embolism
If a patient has surgically placed pins..
make sure it's clean, watching for infection, no MRI
post-op hip surgery nursing interventions
high rise toilet, abduct pillow to prevent adduction, elevate heels, change positions slowly, couch and deep breathing q 2hrs (prevent atelectasis), promote mobility.
Contact precaution PPE-
gown/ gloves
Droplet precaution PPE-
Mask
Airborne Precaution
- N-95, gown, gloves
What are Opportunistic HIV infections
(thrush, candidiasis) on steroids (suppressed immune infection, finish course)
Non-specific inflammatory markers-
CSR and Sed Rate
Butterfly rash indicates
Lupus
What do you administer for Rash/ Hives late reactions
Rash/hives late reactions-
IM injection gage-
22g
Subcutaneous gage
25-27g 3/8-5/8
Subcutaneous-
Subcutaneous 25-27g ½-5/8
What do you do before giving antibiotics
Blood culture
IV insertion steps
Clean gloves, apply tourniquet, cleanse skin, pull skin taut, insert stylet at 45 degree angle bevel up, look for blood return, advance catheter only, remove stylet, release tourniquet, connect hub to primed extension set
Before giving narcotics-
assess vitals, respirations, and pain level
What you should inflate B/P cuff to for trousseaus-
10mmHg
Blood transfusions nursing interventions
B/P every 5 min for 15 mins, cross check order with 2 nurses
Mag and calcium =
same
Potassium and sodium=
opposite
Calcium and phosphate- =
inverse
universal donor blood type
Type O
universal receptor blod type
Type AB
Fluid volume excess indications
increased B/P, edema, thread pulses, crackles in lungs
Fluid volume excess indications
Fluid volume excess decrease B/P and weak pulses
Fish hook/ metal in the eye contraindications
no MRI only x-ray or CT scan
what is a indication of Diabetic Ketoacidosis (DKA)
Kussmauls respirations
Eye drop insertion-
assess bottle and tip, occlude tear duct, hold the bottle ½ to 3/4" above conjunctival sac making sure it doesn't touch anything, don't wipe eye after insertion.
When you get orders over the phone...
A doctor has 24 hrs to write an order but until then read back the order back to the doctor after you get consent.
Cataracts-
an opacity or cloudiness of the lens that distorts images
Macular degeneration-
deterioration of the macula affecting central vision
Neuromuscular blocking drugs (NMBDs)-
paralyze the respiratory muscle and ventilator put in place
T or F is malignant hyperthermia Hereditary-
T malignant hyperthermia is hereditary
T of F always recap needles after using
F, Never recap needles use safety
When do you use Z track method?
IM injections, Palpate for bony landmarks
Steps for Z track method-
Palpate for bony landmarks , Use ulnar aspect of non-dominant hand to pull skin and subcutaneous tissue 1-1.5" laterally to the side, Hold skin in this position until you have administered the injection, Hold syringe in dominate hand like a dart or pen insert needle, Aspirate for blood, If no blood appears inject medication slowly at rate of 1mL per 10 sec, Once medication is injected leave needle in location for 10 sec this allows the medication to disperse into the muscle
What do you use nystatin for
To treat fungal infections
What is Steven Johnson Syndrome
a rare, serious disorder of the skin and mucous membranes usually a reaction to medications
Liver function labs-
ALT, ASP, ALP
What is Super/supra-infection-
our body's defenses are reduced allowing diseases producing microorganisms to multiply and cause illness
What do you do when in contact with C Diff
bleach and wash hands no sanitizer
Chain of infection- Infectious agent
- bacteria, virus, fungi
Chain of infection Reservoir
- microorganisms multiply
Chain of infection Portal of exit-
blood, skin, and mucous membranes
Chain of infection Mode of transmission-
direct or indirect contact, airborne, droplet, vectors, vehicles
Chain of infection Portal of entry-
skin, mucous membranes, caths, GI, blood
Chain of infection- Host
pathogens/ organism lives
Atypical S/S infection in older adults-
confusion, incontinence, increase HR, agitation, and generalized fatigue
Raynaud's phenomenon-
body feels numb and cool in certain areas, cut off circulation
ESR (erythrocyte sedimentation rate)
Non-specific test for inflammation or infection-Various proteins are released into the blood in response to inflammation-ESR detects these proteins by measuring the rate at which it takes RBCs to separate from plasma>>high rate of separation indicates presence of these proteins
CRP (C-reactive protein)
more sensitive and responds faster than ESR , Used to diagnosis bacterial infections and inflammatory diseases
Cytotoxic reaction-
wrong blood during transfusion
A Vascular response causes.....
5 cardinal signs- increased blood flow
Isotonic solution (neither shrinks or swells)-
a. Have an osmolality close to the ECFb. Do not cause RBCs to shrink or swellc. Are indicated for intravascular dehydration
Hypertonic solution (shrink)
a. Have an osmolality higher than the ECFb. Indicated for intravascular dehydration with interstitial or cellular over hydrationc. To be used with EXTREME cautiond. High concentration of dextrose are given for caloric replacement such as intravenous hyper alimentation into a central vein for rapid dilution
Third-space shifting-
fluid accumulation in a compartment other than ECF or ICF, Requires a cellular membrane that allows water and fluid to enter but not exit
Antidiuretic hormone (ADH hormone)-
also referred as vasopressin: restores blood volume by reducing diuresis and increasing water retention, amount released depends on the body's need
Dehydration (S/S)
weakness, thirst, poor skin turgor, tachycardia, and hypotension
Osteoarthritis-
noninflammatory, localized, progressive deterioration and loss of cartilage and bone in one or more joints.
DVT lab values-
PT and INR lab values
What is HIV treated with
antiretroviral therapy
6 P's of compartment syndrome
a. Pain- out of proportion to the injuryb. Pressurec. Paresthesia- numbness or tingling to the extremityd. Paralysis- unable to move that extremitye. Pulselessnessf. Pallor-pale
CD4 cell count-
200-499 cells
External fixator-
pins or wires through the skin to bone
Opportunistic infection-
infections that occur more often or are more severe in people with weakened immune system than in people with healthy immune systems
Night sweats indicate
TB
what are some signs of altered mental status?
Hypoxia, dyspnea, tachycardia, chest pain
Trousseaus presents in which acid base in-balances?
metabolic/ respiratory alkalosis
Peri-op teaching-
cough and deep breathing q 2 hrs ( in through the nose and cough during exhale)
How to use incentive spirometer-
Take a deep breath in and let it out, hold breath for 3 seconds , 10 breaths every hour
What is the treatment for malignant hyperthermia
dantrolene/ dantrium treatment
What iso ordered if a patient comes in with a fish hook in his/her eye
X-ray
What do you teach someone with HIV
Take medications prescribed full dose, safe sex, partner, needle use.
What are some examples of opportunistic HIV infection
Kaposi's sarcoma, TB, Thrush.
T of F hemovacs are hooked up to suction?
False!!!
T or F Rheumatoid arthritis does not affect joints bilaterally
F
Loss of cartilage in bones
Osteoarthritis