informed consent
A Paracentesis is an invasive procedure. Make sure the client has an ______ ______`
peritoneal cavity or abdomen
Paracentesis collects fluid from where
measure abdomen, weigh, and take vital signs. Have client void to empty bladder
What to do before Paracentesis?
sitting on edge of bed
What position should the client be in during a Paracentesis
monitor vital signs, measure fluid collected, apply sterile dressing to insertion site, and monitor bleeding
make sure urine is not bloody
What do you do after a Paracentesis
dopamine
Parkinson's disease is caused by a depletion of _______
bradykinesia, tremors in hands and feet at rest, rigidity, shuffling steps, loss of balance
What are the signs of Parkinson's disease?
slow, progressive
Is Parkinson's disease slow or fast?
assess near status and swallowing ability, safety assist with ambulation, encourage fluids, high-calorie and fiber meals, low-protein diet
What are the nursing interventions for Parkinson's disease
Anti-parkinson's, and anti-cholinergics
What medications are prescribed for Parkinson's disease
fiber, constipation
When taking anticholinergics, clients should increase _______ to avoid _________
blurred vision, dry mouth, photophobia, tachycardia
What are other side effects of anticholinergics?
levodopa or carbidopa-levodopa
What medication is given to replace dopamine?
MAOIs
Do not take dopamine replacement medications with _______, as this may cause a hypertensive crisis
low-protein
teach clients taking Parkinson's drugs to follow a _____ ______ diet.
B6, which blocks the medications effect
what vitamin should be avoided in the diet while on antiparkinson drugs
H.Pylori
What bacteria is most responsible for peptic ulcers?
gastric and duodenal
Where are the most peptic ulcers found?
coffee ground
When a client has ulcers, what will their vomit look like?
black tarry
When a client has ulcers, what will the stool look like?
NSAIDs
What medication should be avoided in patients with ulcers?
no
is tylenol (acetaminophen) a NSAID?
H2 blockers and proton pump inhibitors
What type of medication will be given to decrease gastric acid production in duodenal ulcers?
zantac (ranitidine)
tagamet (cimetidine)
What are medication examples of H2 blockers?
generic ending in"-zole"
nexium (esomeprazole)
protonix (pantoprazole)
Prilosec (omeprazole)
What medications are examples of proton pump inhibitors?
antacids
______ are prescribed to neutralize gastric acid
smoking and alcohol
What should you teach clients who have ulcers to avoid?
lower extremities
Peripheral arterial disease (PAD) is an occlusive disease of the _____ _____
below
does the damage to surrounding tissue occur above or below arterial occlusions in PAD?
no, it would be absent
Would you feel a pulse in a leg with PAD?
hairless, cool, pale, thick toenails
What would the leg look in a patient with Peripheral arterial disease
muscle pain from decreased blood supply; pain comes and goes
What is intermittent claudication?
smoke, wear tight clothes, apply direct heat to legs
What do you teach clients with Peripheral arterial disease NOT to do?
exercise, inspect skin daily, and take prescribed medication
What do you teach clients with Peripheral arterial disease to do?
bypass surgery, angioplasty
What procedures improve Peripheral arterial disease?
brown/purple discoloration, edema, weeping fluid
What does a leg with a venous occlusion look like?
epinephrine, norepinephrine
Pheochromocytoma is a tumor that produces an excessive amount of _______ and ________
adrenal
Pheochromocytoma is a problem with the ______ gland?
sustained hypertension, H/A sweating, weight loss, hyperglycemia
Clients with Pheochromocytoma will experience
surgical removal of one or both adrenal glands
Treatment of Pheochromocytoma is
glucocorticoid replacement
What will the patient need to take after Pheochromocytoma surgery?
inflammation of vein
What is phlebitis?
red, warm, painful area, streaks up the arm
What does phlebitis look like?
remove the IV, apply warm towel, assess for infection
What is the treatment for phlebitis?
When the placenta detaches itself from the uterine wall
What is abrupt placenta
the placenta is covering or near the cervix, blocking opening to vagina
What is placenta Previa
sudden, PAINFUL, bleeding with contractions and uterine tenderness
What are the signs and symptoms of abruptio placenta
sudden, PAINLESS, bleeding, bright red in color
usually in third trimester
What are the signs and symptoms of placenta previa?
frequent vitals, fetal ultrasound, fetal heart monitoring
Both conditions (placenta previa and abruptio placenta) require what three interventions?
placenta previa
What condition has more bleeding? placenta previa or abruptio placenta
abruptio placenta
Which condition will create a rigid, board-like abdomen? placenta previa or abruptio placenta
disseminated intravascular coagulation (DIC)
abrupt placenta causes which blood clotting disorder?
a vaginal exam
if a pregnant client is bleeding vaginally, what must you NEVER do?
fluid
Pleural effusion is the collection of ______ in the pleural space
Sharp pain on inspiration, SOB, tachycardia, decreased breath sounds, x-ray needed to confirm
What are the signs of Pleural effusion?
find the cause, monitor breath sounds, high fowler's position thoracentesis
What is the treatment for Pleural effusion?
chest tube
After a thoracentesis is performed, what may be needed temporarily?
diuretic
What medication do you give if the fluid is not a large enough amount to perform a thoracentesis?
disorder that results in increased number of erythrocytes, leukocytes, and platelets
result= thick blood
What is polycythemia vera?
headache, SOB< weakness
What will the client with polycythemia vera complain of?
purple/red complexion, enlarged spleen, increased hemoglobin
on assessment of a patient with polycythemia vera; what will you find?
increased
with polycythemia vera, will clot time be increased or decreased?
phlebotomy (blood draws several times a year)
What is the main treatment of polycythemia vera?
any traumatic event can cause PTSD
What causes Post-traumatic Stress Disorder (PTSD)
nightmare, anxiety attacks, sleep disturbances, memory loss, or hyper vigilance
What are the signs associated with PTSD?
true; patients will isolate themselves
true or false? these clients will often seem detached
substance abuse
Clients with PTSD are at an increased risk for ______ ______
therapy to discuss feelings
anxiety/depression meds
support groups
What is the treatment for PTSD
negative, positive
*RhoGam prevents the mom from developing antibodies against future Rh-positive babies
RhoGam is given to pregnant clients who are Rh ________ but whose baby is Rh ______
28 weeks gestation and within 72 hours after delivery (given twice)
When is RhoGam given?
yes, if pregnancy is > 13 weeks
Do you give RhoGam if the client has a miscarriage?
no, never. or to the father
Do you give RhoGam to the infant?
drugs given to stop preterm labor
What are tocolytics?
It's Not My Time
What is the mnemonic used to remember the four drugs that can be used for preterm labor?
Indomethacin (NSAID)
Nifedipine (CCB)
Magnesium Sulfate
Teributaline
What drugs do the letters "Its not my time" stand for?
fetal heart rate/ maternal vital signs
When giving tocolytics, what must you monitor continuously?
urine output, deep tendon reflexes, and respirations
Magnesium sulfate will decrease ____ ____, ____ ____ _____ and _________
tachycardia
If a client is given terbutaline, watch for _______
quinolone, tetracyclines
"Think two QTs say no to QBs
What two drugs do you never give to a pregnant client?
2,1
The umbilical cord in a newborn has _____ arteries and _____ vein.
VEAL- CHOP
VEAL = CHOP
variable decelerations=
cord compression
early decelerations=
head compression
acceleration=
Oxygenation is OK
Late decelerations=
placental insufficiency (BAD)
hearing
presbycusis is a form of ______ loss
yes
is presbycusis a natural process?
high
in presbycusis _______ voice tones are hardest to hear
facing them, encourage them to wear hearing aid
How should the nurse communicate with the presbycusis patient?
red, warm, intact skin that doesn't blanche
How would you describe a stage 1 pressure ulcer?
looks like a sunburn
What is an example of a stage 1 pressure ulcer?
superficial damage to the skin (epidermis or dermis)
there will be a break in the skin
How would you describe a stage 2 pressure ulcer?
abrasion, blisters, shallow craters
What is an example of a stage 2 pressure ulcer?
skin is deeply damaged, does not extend through fascia
How would you describe a stage 3 pressure ulcer?
deep crater
What is an example of a stage 3 pressure ulcer?
skin is deeply damaged, wound shows muscles, tissues, and ligaments
How would you describe a stage 4 pressure ulcer?
turn patient q two hours; keep skin clean and dry; proper diet and hydration; inspect skin and document
What are some nursing interventions to precent pressure ulcers from developing?
external (outside body) -beam and sealed
internal (inside body)
What are the types of radiation therapy?
alopecia, fatigue, skin irritation
What are the side effects of radiation therapy?
unsealed soap, water; pat dry
clients receiving beam radiation therapy should wash the area with ?
room, bathroom
Clients receiving radiation therapy need private _______ and _________
pregnant women or small kids
no ____ _____ or _____ ______ can come visit radiation therapy patients
yes, 7-10 days after removal
Can a woman with a removed cervial radiation implant have sexual intercourse?
vasospasm of arteries of the upper/lower extremeties
What is raynaud's disease?
fingers, toes, and cheeks
What body parts are most affected by raynaud's disease?
numbness, tingling, and swelling; area may feel cold
What does the raynaud's disease client feel?
monitor pulses, vasodilators, avoid cold and stress, quit smoking, wear warm clothes
What is the treatment for raynaud's disease?
no, this is painless
Will clients experience pain if the retina detaches?
yes, this is an emergency
is retinal detachment a serious condition?
blurred vision, floaters, flashes of light, black spots
What are the signs of a detached retina?
surgery to reattach retina
what is the treatment for a detached retina?
cover both eyes with patches
no coughing, sneezing. strict bed rest, keep head of bed elevated
What are the nursing interventions for retina detachment?
true
true or false? rheumatoid arthritis is a chronic systemic inflammatory disease that affects the joints
fatigue, weight loss, low-grade fever
what are other clinical symptoms associated with rheumatoid arthritis?
no, it can occur at any age
is there a particular age group that is affected by rheumatoid arthritis?
rheumatoid factor
what factor will be found in the blood of a client with rheumatoid arthritis?
erythrocyte sedimentation rate
in rheumatoid arthritis ______ _____ ______ will be elevated in the blood
joints in the hands, wrists, feet, elbows, shoulders
which joints are mostly affected by rheumatoid arthritis?
bilaterally - both hands, feet, knees, etc.
will the joints in rheumatoid arthritis be affected unilaterally or bilaterally?
deformities
due to inflammation of the synovial membranes in rheumatoid arthritis, which damages cartilage, joint ____ are seen
NSAIDS
________ are the primary drug therapy for rheumatoid arthritis
yes, activity helps the pain
should you encourage rheumatoid arthritis patients to exercise?
to keep the client safe
if your client is having a seizure, what is the main goal?
mark the time and note client behavior
What documentation should you do for a patient who is having a seizure?
no, do not restrain
should you restrain a client for safety during a seizure?
turn head to the side, lie bed flat, pad head with pillow
What should you do to a client during a seizure?
no, never do this
Should you put anything in the client's mouth to prevent the client from swallowing his/her tongue
varicella
Shingles (herpes zoster) is a viral infection cause by what virus?
itching vesicles grouped together on top of a red rash, painful to touch, low-grade fever, malaise
What are the signs of herpes zoster?
the vesicles contain fluid that transmits the virus
how are shingles spread?
along a dermatome
where is the rash of shingles usually located?
an area of skin that gets all of its innervations by a single spinal nerve
what is a dermatome?
face, trunk, back
What are some areas of dermatomes?
unilateral
will the rash and vesicles of shingles be unilateral or bilateral?
respiratory isolation
what are the isolation precautions for herpes zoster
analgesics
supportive care
cool compresses
try to keep vesicles intact
What is the treatment for shingles?
scarring
What may be seen after the vesicles of shingles have healed?
recessive; most commonly seen in African Americans
is sickle cell anemia autosomal trait recessive or dominant?
a child receives the gene from both parents
How is sickle cell anemia inherited?
6-20 days; normal is 120
how long do sickle cell RBCs live compared to normal RBC's?
anemia
what does the short life of RBCs in sickle cell anemia put patient at risk for
hemoglobin - shows anemia sickle testing of blood
What test determines sickle cell anemia?
sickle cell crisis or vast-occlusive crisis
the acute exacerbation of sickle cell anemia is called ____ _____ ____
dehydration
the most common cause of sickle cell anemia exacerbation is
clot
dehydration causes the sickled blood to do what?
hydrate with oral and IV fluids, give O2 to increase tissue perfusion, a blood transfusion may be needed;
give pain meds- very painful
How do you treat a sickle cell crisis?
hydrate with IV fluids;
remember, during a crisis the blood is clumped together, so the goal is to decrease the viscosity of the blood.
O2 will not reverse the cause; it will only prevent more clumping
During a sickle cell crisis, which intervention is done first - give O2 or hydrate with IV fluids?
1. inform client about procedure and indication
2. gather supplies
3. wash and dry hands
4. use universal precautions - wear gloves (some nurses don't, and it's not cool)
5. apply tourniquet
6. locate a vein
7. clean the area with alcohol
8. position and
What is the correct order of starting an IV
skin
______ can never be considered sterile, only clean
back
NEVER turn your _____ on a sterile field
no, because once the gloves touch the mask they are no longer sterile
If a nurse has on a face mask and sterile gloves, is it okay to adjust the face mask with a gloved hand?
waist, shoulders
a sterile gown is only sterile from the ______ to _______
wet
if a sterile wrapper becomes _____ the entire package is no longer sterile
antipsychotics
Tardive dyskinesia is a side effect of what medication?
chewing motion w/ mouth, tongue sticking in and out, involuntary movement of arm/leg
what will you see in Tardive dyskinesia?
anti- parkinson's
what class of medications can you give to decrease the effects of Tardive dyskinesia?
veins
a clients total parenteral nutrition nutrients are supplied through ______
if GI tract wasn't working properly
why would a client need TPN?
blood sugars, due to dextrose in TPN
What needs to be monitored closely in a patient on total parenteral nutrition?
hyperglycemia due to gradual increased rate of infusion
if TPN, is suddenly increased, client is at risk for what?
hyperkalemia, hypermagnesmia, hyper-phosphatemia
What electrolyte balances can TPN cause?
every 24 hours
How often do you change the TPN bag?
none, never do this
What medications can be hung with TPN tubing?
to decrease risk for sepsis TPN increases risk of bacteria to form in tubing
Why must TPN tubing be changed daily?
infection
elevation in temperature is a sign of?
to prevent rebound hypoglycemia
Why must TPN be gradually decreased?
10% dextrose water
If TPN is unavailable, which IV fluid can be hung as a temporary substitution?
a surgical procedure that creates an open airway in the trachea
What is a tracheostomy?
upper airway obstructions (increased mucous)
What are the indications for a tracheostomy?
a stoma
What is the created opening of a tracheostomy called?
an obturator, a stiff plastic device used for inserting the inner cannula
What must the nurse always have at the bedside of a tracheostomy patient?
sterile
is suctioning a client with a trach a clean or sterile procedure?
hyperoxygenare with 100% O2
what should the nurse always do before suctioning a client with a trach?
no, this can cause damage to the client
should suction be applied DURING insertion of the catheter
deoxygenate with 100% O2 2-3 times during inhalation
What should the nurse always of after suctioning a client with a trach?
keep airway open by reinserting obturator or grabbing retention sutures. give O2 if airway lost
If a client coughs strongly and the trach becomes dislodged, what is the initial nursing action?
no, it should be deflated so as not to block airway
If a client is NOT on a ventilator but has a trach, should the inner cuff be inflated
to treat bacterial infections, most commonly UTIs
what is trimethoprim-sulfamethoxazole (bactrim) medication used for?
kidney or liver failure
What are the contraindications for taking bactrim?
steven-johnson syndrome
The severe inflammation skin disorder caused by bactrim is called ____ ____ _____
severe skin lesions; blisters; swelling of throat, lips, tongue; fever; headache; rash
*lesions can be internally on organs as well
During the allergic reaction steven-johnson syndrome, what will you see?
mycobacterium tuberculosis
What organism is the cause of tuberculosis? (TB)
productive cough, night sweats, chills, weight loss, low-grade fever
What are the signs of active TB?
mantoux, also called PPD
The _____ test is administered by injecting a small amount of tuberculin intradermally
10
The Mantoux test is considered positive if the induration (raised skin) is greater than ____ mm.
airborne
What are the appropriate isolation precautions for a patient with tuberculosis
6
The client's negative pressure room should have ____ fresh air exchanges per hour for tuberculosis?
ST- streptomycin
R- rifampin
I- isoniazid
P- pyrizinamide
E- ethambutol
S.T.R.I.P.E is the mnemonic fo rate TB antibiotics. What are those medications?
peripheral neuritis
What is the most common side effect of TB antibiotics
muscle ache, GI disturbances, dizziness
What are the other side effects of TB antibiotics?
red or orange
What colors will rifampin turn urine, sweat, and tears?
B6
When taking TB antibiotics, what vitamin will be depleted?
alcohol
teach the client to avoid _____ to reduce the risk of hepatotoxicity while on TB antibiotics
drug-induced
Clients taking TB antibiotics are at risk for ____ ____ hepatitis
3
how many consecutive sputum cultures need to be negative for the client to be non-contagious?
cause unknown
What is the cause of ulcerative colitis?
inflammatory bowel disease affecting the large intestine/rectum
What is the pathophysiology of ulcerative colitis?
abdominal pain, bloody diarrhea (20 stood/day) nausea/vomiting, weight loss
What are the signs or complaints from clients with ulcerative colitis?
colonoscopy
How is ulcerative colitis diagnosed?
corticosteroids to reduce inflammation, removal of large intestine and rectum
What are the treatments for ulcerative colitis?
ileostomy
What will the client need after ulcerative colitis surgery?
low fiber; teach clients to avoid fiber, fatty/greasy foods to decrease diarrhea. teach clients to avoid alcohol (ETOH) and caffeine, but increase fluid intake
What is the most appropriate diet for a patient with ulcerative colitis?
A, D, E, K
What are the fat soluble vitamins?
B(2, 6, 12), C, Folic Acid
What are the water-soluble vitamins?
stored
Water-soluble vitamins cannot be ____ in the body by the liver
K
Which vitamin is important in clotting blood?
green, leafy vegetables
What are important food sources of vitamin K?
vitamin A
This vitamin is important in monitoring eye sight?
oranges, dark green, leafy vegetables
What are important food sources of Vitamin A?
Vitamin B12 (will see paresthesia in hands and feet with this deficiency)
In pernicious anemia, the missing intrinsic factor inhibits absorption of what vitamin?
Vitamin C
Iron supplements should be taken with what vitamin to promote absorption
Saturday worship, NO ETOH, no pork, sometimes no meat, baptism as adult
What to know about adventists?
no pork, do not do an autopsy
What to know about muslims?
religious leader is called rabbi, not priest.
Only other Orthodox Jews can touch the dead.
What to now about orthodox jews?
religious leader is called priest. infant baptism, call before death for last sacrament
What to know about romancatholics?
Do NOT give the body a full bath (clean visible soil)
raise head of be to 30 degrees and place palms down to prevent discoloration.
put in dentures if any.
properly ID the body
maintain vital organs/skin
integrity remove IV/tubes; replace with band-aids u
How would you do post-mortem care?
1. wash hands
2. gown
3. mask
4. goggles (if needed)
5. gloves
How to put PPE on, in order
1. gloves
2. goggles (if needed)
3. gown
4. mask
5. wash hands
How to take OFF PPE, in order
pretend you are standing with hands above head and dress from bottom up
When putting PPE on, pretend what?
alphabetically
When taking PPE off, take off in what order?