RBC
females 4.2-5.4 millionmales 4.7-6.1 million
decrease RBC
anemia
WBC
5,000-10,000
elevated WBC
infection
decreased WBC
immunosuppression
Iron
females 60-160 mcgmales 80-180
elevated iron
hemochromatosis, iron excessliver disorder, magaloblastic anemia
decreased iron
anemia or hemorrhage
platelets
150,000-4000,000
increased platelets
malignancy or polycythemia vera
decreased platelets
autoimmune diseasebone marrow suppression or enlarged spleen
Hbg
females 12-16males 14-18
decrease Hgb and Hct
anemia
Hct
females 37%-47%males 42-52%
anemia in childrenS & SX:
pallor, brittle spoon shaped nailsirritability, muscle weaknesssystolic heart murmur, enlarged heart, HF
iron supplements
give 1 hr before or 2 hr after antacid to prevent malabsorptN/D and constipation common at start of therapyuse straw for liquid iron to prevent staining of teeth
aPTT
1.5-2X control range of 30-40 secondstest clotting factors and monitor heparin therapy
increased aPTT
hemophiliadisseminated intravascular coagulation DICliver disease
PT
11-12.5 seconds, 85-100%
increased PT time
evidence of deficiency or clotting
decreaed PT time
evidence of vit K excess= bleed out
acute hemolytic blood transfusion reactions
**low back pain, TACHYcardia, HYPOtension
febrile reactions
30 min-6 hr after transfusion-chills, fever, flushing, headacheuse WBC filter, administer antipyretics
mild allergic reactions
during or up to 24hr after transfusion- itching, urticarial, flushingadminister benadryl
anaphylactic shock
wheezing, dyspnea, cyanosis, hypotensionmaintain airway, admin O2, IV fluids, antihistamines, corticosteroids and vasopressor
fluid overload
HYPERtension, jugular vein distention, peripheral edemaorthopnea, crackles at base of lungssudden anxiety
sepsis and septic shock
#NAME?
if disseminated intravascular coagulation (DIC)
admin heparin in early stage-blood products and clotting factors in late stage
PICA
eating things like soil, chalk, for at least 1 month
parenteral iron
given Z track
erythropoietin - epoetin alfa (epogen, Procrit)
used to increased production of RBCmonitor increase in BP, Hgb, Hct
folic acid
turn urine dark yellownecessary for new RBC
hypovolemia causes
peritonitis, ascites, burns , NPO
causes of dehydration
hyperventilationDKA tube feeding without sufficient water intake
subjective and objective HYPOvolemia
Hyperthermia, Tachycardia, HYPOtensiondecreased central venous pressurehypoxiathirst, dizziness, N/V, -poor skin turgor, tentin
lab test hypovolemia
increased: HCT, specific gravity, NA, protein, BUN, glucose
Hypervolemia causes
HF, cirrhosis, increased gluccorticosteroidshypertonic fluids
S & SX HYPERvolemia
bounding pulse, increased CVP, HYPERtension, confusion, muscle weakness, ascites, diminished breath sounds, distended neck veins
lab test HYPERvolemia
Decreased: HCT, BUN, electrorespiratory alkalosis PaCO2 less than 35, increased PH
notify doctor if
weight gain 1-2 lb/24 or 3 lb in a wk
foods high in potassium
avocados, broccoili, dairy products, dried fruit, cantaloupe, bananas
HYPOcalcemia
positive chvosteks ( facial twitching)positive trousseau (hand/finger spasm with blood pressure cuff inflation
excess caffeine causes excretion
calcium in urine
secondary osteoporosis results from
hyperparathyroidism, long term corticosteroid long term anticonvulsant (Dilantin)manifestations: kyphosis
stages of grief
1. denial 4. depression 2. anger 5. acceptance 3. bargaining
theophylline
relaxation of bronchioles causing bronchodilator oral used to control asthma or COPDtherapeutic range 5-15avoid in HTN, liver and kidney dysfunction
theophylline interactions
caffeine
glucocorticoids: beclomethasone- inhalation prednisone- PO
prevent inflammation, suppress airway mucus production
leukotriene (monelukast)
suppressing inflammation, bronchoconstriction's, airway edema, mucus production
digoxin
makes the heart beat stronger and regular rhythmtherapeutic 0.5-2.0
S & SX of dig tox
fatigue, weakness, vision changes, GI effectsinfuse over 5 min
hemophilia
difficulty controlling bleedingX linked recessive disorderjoint pain and stiffness, impaired mobility, easy bruising slurred speech
lab test indication of hemophilia
prolonged aPTTavoid unnecessary needle sticks, apply pressure for 5 mins after needle sticksmonitor for occult blood
DDAVP
synthetic form of vasopressin increases plasma factor VIIInot for hemophilia B
acute hemolytic blood transfusion reactions
**low back pain, TACHYcardia, HYPOtension, hemoglobinuria,
ICP
10-15 mm Hg
mannitol
osmotic diuretic treat cerebral edema
phenytoin (Dilantin)
prophylactically to prevent or treat seizures
crainiotomy
removal of nonviable brain tissue that allows for expansion or removal of epidural or subdural hematomas
KUB (kidneys, urter, bladder
determines size shape and position of structures
cystoscopy
use a scope to visualize the bladder and urthera
reflex incontinence
Reflex - The involuntary loss of a moderate amount of urine usually without warning due tohyperreflexia of the detrusor muscle, usually from altered spinal cord activity.
treatment for urinary infections
gentamycin and Keflex take with food may change urine odor and report loose stools
TCA (nortriptyline (pamelor)
helps relieve urinary incontinence -cause dizzinessmonitor BP, don't take with MAOI
phenazopyridine (pyridium)
treats urinary spasms, analgesicwont treat infection only bladder discomfortliver and renal contraindication take with food and change urine organge
interventions for reflex incontinence
Bladder compression techniques (Credé, Valsalva, double-voiding, splinting) to help clientsmanage.
ORCHIECTOMY
removal of testes
BPH
impaired outflow, fam Hx, -urine hesitancy and retention, plainless hematuria
TRUS
diagnosis and R/o BPH
ways to reducuse prostatic fluids
frequent ejaculation
TURP
using a scope inserted though urethra and trims away excess prostatic tissue, enlarging passage through prostate
CBI
irrigation to keep clots from forming, if bright red blood or clots increase rate
intervention for CBI obstruction
1. turn off CBI2. irrigate with 50 mL of irrigant sol with lg piston syringe3. contact doc if cant dislodge clot
expectations of D/c of CBI
red in color, expect 150-200 output every 3-4 hrscontact doc if cant void
discharge instructions after TURP
avoid sex 2-6 wks, 12+ glasses of water of day, avoid caffeine, expect pink urine
abnormal PSA
less than 4
DRE signs of prostate CA
hard palpable irregular
fluoxetine (prozac
monitor tremors, AE: headache, urinary freq, hypotension-agitation, confusion, anxiety, hallucination (Serotonin syndrome
tonsilectomy
milk products coat throat causing coughing; coughing should be avoidedadmin pain on a reg sched or 1st 24 hrs to prevent breakthrough pain
hypovolemic shock
cool clammy skin
mannitol
direurtic
anaphylactic reaction
wheezing, rah
ataxia
involuntary movement
digoxin
monitor HR
digoxin tox
nausea, muscle weakness, diarrhea
IVP
admin lasix
estrogen
helps prevent osteroposis
estradiol SE
headaches and HTN
epi
teaching: report chest pain, increases work load and O2 demand can result in angina
NPO
can cause dehydration and low grade fever
hemolytic blood reaction
**low back pain, tachycardia, hypotensiokn
structure audit
eval of avail resources
precess audit
examine how nursing care is provided
prospective audit
performance on a new
valporic acid
monitor LFT
chlorpromazine (haloperidol)
decrease hallucinations teach: sips fluids freq, minimize sun exposure
cyclophosphamide
maintain hydration with liberal intakedoesn't affect glucose
dehiscence
stay with client, 2. place saline over organs, 3. put in supine 4. take vitals
overdose of valporic acid
pulmonary edema
amitriptyline (TCA)
anticholinergic effect, (dry mouth, constipation, take with or after foods, avoid tyramine, -turns urine blue green
neurtopenia
restrict visitors, avoid fresh flowers
stroptkinase
thrombolytic drug
cranial nerve VII
hearing impairment
CNIX
swallowing
verapamil effects if taken with grapefruit juice
constipation, hypotension, bradycardia, FVE
clozapine
weight gain, hyperglycemia, ortho BP
hypermagnesium
initiate cardiac monitoring
foods high in mg
meat, nuts, whole grain cereal
gastric lavage
left side lying to prevent regurgitation of contents can use sterile water, tap or NS
misoprostol
reduces gastric acidtake preg test before starting treatment-avoid mg causes diarrhea
UTI
pyelonephritis- WBC
trachea care steps
1. suction (80-120)2. clean cannula3. rinse stoma site4. change ties
BRAT is contraindicated in
diarrhea
vacuum assited birth complication
cervical laceration
retained placenta
common in preterm births
endometrial infection common with
prolonged ROM
what is expected after delivery
elevated temp
late deceleration and variable decels
side lie position and DC oxytocin
terbutaline
muscle relaxant decrease contractions during preterm labor
nalbuphine
opioid pain relief during labor
mgso4
muscle relax, decrease contractions during labor
oxytocin
stimulates contractionsused for bleeding and boggy uterus
theophylline tox
anorexia**hypotension, tachycardia
adverse effect of theophylline
albuminuria
echopraxia
repeating what a person says
neologism
pt makes up works only they understand
clang assoc
uses words that sound alike
pap detects what
cervical cancer; not ovarian cancer
protein
required for tissue repair
vitamin A
promotes wound healing
RA
apply cold therapy, no narcotic analgesicavoic purines in gout ( organ meat and chicken, can have citrus fruit)
when is Braxton hicks expected by
28 wks
evidence of ICP
memory losslie at 30 degree angle
signs of bacterial meningitis
nuchal rigidity ( reduction of flexion in the neck)kernigs sign
kernigs sign
patient put knee at 90 degree angle if cant extend straight and pain its positive
peripheral arterial disease
lotion to prevent cracked feet claudication when walking and stops after rest
hypothyroidism
coarse dry hair, bradycardiaperiorbital edema (swelling around eyes)
hyperthyroidism
tremors, wght loss, exothalamus,
sudden abdomen pain relief indication of
ruptured appendix and peritonitis
pneumothorax expect
subcutaneous emphysema, trach deviation,
pneumonia expect
acute confusion (delirium)
flail chest
paradoxic movement
core pulmonale
distended neck veins
sealed radiation implant
visitors maintain 6 ft from pt
dehydration
increases urine specific gravity (1.003-1.030
agranulocytosis
decreased WBC
clonidine (HTN med)
s. E. constipation, dry mouth
fidelity
fulfill commitment
nonmalefience
do no harm
justice
treat fairly
cardiac tamponade
pulse paradoxus, muffled sounds
tube feed for infants
10mL/min
newborn temp
36.5-37.2
MAOIs
metallic taste
tyramine foods
aged cheese (cheddar, blue cheese, swisscured meats (salami, sausages, pepperoni)sauerkraut, soy sauce, shrimp sauceyeast, fava beans,
flumazenil counteracts
benzodiazepine OD
acetyleysteine counteracts
acetaminophen OD
atropine counteracts
cholinesterase inhibitor OD
acute angle glacoma
sharp pain radiates through eye
physiological normal age changes
increase BP, decrease lung expansiondecrease CO