237 Study Cards Flashcards

Question

What is anemia?

Answer 1

Condition in which the hemoglobin concentration is lower than normal and reflects the presence of fewer than the normal number of erythrocytes within circulation. As a result, O2 delivered to body tissues is decreased. **By far the most common hematologic condition.**

Answer 2

* Hypoproliferative: caused by a defect in their production (marrow cannot produce adequate #s of erythrocytes * Hemolytic: By destruction of erythrocytes * Bleeding: by the loss of erythrocytes

Answer 3

* Heart failure * Paresthesias * Delirium

Answer 4

* A **diet lacking** in certain vitamins and minerals (such as iron, vitamin B12, folate, and iron) * **Family history** * **Excessive blood loss** due to injury, surgery, heavy menstruation * Age - **people over 65** are at risk * Chronic conditions (IBD, HIV/AIDS, cancer, autoimmune diseases, and **chronic kidney disease**) * **Mediterranean** origin * **Medications inhibiting effective absorption** of nutrients * **Alcoholism** affecting production of RBCs

Answer 5

* The **level of hemoglobin is lower than normal** in the circulation causing **less oxygen being delivered to the body tissues** * Many different types that can affect the reason as to why there is low hemoglobin: * Decreased erythrocyte (RBC) production due to **bone marrow damage** either due to medications, chemicals or lack of factors needed for RBC formation = hypoproliferative anemia * **Premature RBC destruction** -\> causing hemoglobin to be released into plasma -\> which is then converted into bilirubin causing the concentration within the blood to increase-\> leading to tissue hypoxia = known as **hemolytic anemia** * **Bleeding** causing a loss of RBCs

Answer 6

* The **more rapid** the anemia develops the **more severe** the symptoms. * A **healthy person** can **tolerate** as much as **50% gradual reduction**, where as the r**apid reduction can be tolerated to \>30%**. **30% rapid loss can cause vascular collapse**. * **Tachypnea** on exertion and **fatigue (most common)** * Those who are more active will have more significant symptoms. * Nausea, vomiting, malena * Neuro symptoms; weakness, ataxia, muscle pain * **Fatigue** * Jaundice with hemolytic anemia * General malaise * Tongue (smooth and red with iron deficiency anemia and beefy red and sore with megaloblastic anemia) * Cheilosis * Iron-deficiency may crave ice, starch, or dirt (pica) * Nails can become brittle, ridged, and concave

Answer 7

* History/Genetics of Anemia in family: * Sickle cell anemia * Appearance: * Pallor in hands, mouth, conjunctiva * Condition of nails * History of menstrual cycles for female patients * Vital signs: low BP, high HR (if related to bleeding), decreased Sp02 * Respiratory: dyspnea, tachypnea * Nutritional assessment * Looking for potential deficiency in iron, vitamin B12, and folic acid * Certain dietary approaches are at higher risk (e.g. strict vegetarians) * Health History * Medications (some can depress bone marrow activity, induce hemolysis, interfere with folate metabolism) * Alcohol use * Cardiovascular: * Distended neck veins, edema, chest pain on exertion, murmurs, gallops * Hypotension (below baseline) * Hypertension (above baseline) * GI system * Stool assessment for occult blood * Neurologic * Assess for peripheral numbness and paresthesias * Ataxia * Poor coordination * Confusion * Possibility of delirium

Answer 8

* Depends on the type of anemia (note: MCV measures the size and volume of red blood cells). * **Hypoproliferative** * Iron deficiency: decreased MCV, decreased reticulocytes * Vitamin b12: increased MCV * Folate deficiency: increased MCV * **Bleeding (RBC loss)** * Bleeding: decreased Hgb, Hct, and MCV * Increased reticulocytes * **Hemolytic** * Altered erythropoiesis: decreased MCV, increased reticulocytes * Drug induced anemia and autoimmune anemia: increased presence of spherocytes * Serum iron levels, total iron binding capacity. Vitamin B12 and folate levels. Haptoglobin and erythropoietin levels.

Answer 9

* Hemoglobin * Hematocrit * Reticulocyte count * RBC indices - mean corpuscular volume and red cell distribution width * Iron studies * Serum B12 and folate levels * Haptoglobin * Erythropoietin levels * Bone marrow aspiration * Endoscopy - GI Bleed??

Answer 10

* Transfusion of packed RBCs * Supplemental iron, vitamin B12, folic acid * Transfusions or IV fluid replacement to increase blood volume * Erythropoesis Stimulating Agents ( * O2 therapy * IV fluids

Answer 11

* Managing **fatigue** (MOST COMMON SYMPTOM) * Maintaining **adequate nutrition** (iron, B12, folic acid, and protein) * Maintaining **adequate perfusion** - replacing lost volume with transfusions or IV fluids. Supplemental O2 * Promoting **adherence with prescribed therapy** - Educate on purpose of med, how to take, over what time, and manage side effects. Consequences of stopping meds (corticosteroids) * Education on **taking iron on an empty stomach unless GI upset** * Taking a stool supplement * **Blood transfusion** * Monitoring for **signs and symptoms** of **heart failure**

Answer 12

* Assess insertion site for bleeding and/or drainage * Monitor for : * *Increased chest tightness* * *Uncontrollable cough* * *Blood tinged, frothy mucous* * *Sudden, uncontrollable pain* * *Signs of hypoxemia: increased respiratory rate, rapid pulse, anxiety, restlessness* * Nursing Assessments: * *Vital signs* * *Respiratory assessment (note any diminished breath sounds near the insertion site)* * Interventions: * *Oxygen, notify physician*

Answer 13

* *Monitor hemoglobin and ferritin levels* * *Vital signs to assess for hypoxemia* * *Supplemental oxygen and medications*

Answer 14

* *Prioritize activities and develop schedule with periods of activities balanced with rest* * *At least daily physical activity/exercise as tolerated*

Answer 15

* *Supplements: iron, folic acid, Vitamin B12* * *Protein rich diet – not tea and toast* * *Limit alcohol – inhibits absorption of nutrients and diminishes appetite*

Answer 16

* *Assess ability to maintain healthy diet once home – need family support? Meals on Wheels?* * *Affordability of supplements – need assistance?* * *Strategies to manage side effects of supplements (constipation with iron therapy)*

Answer 17

1. Make sure you **have the big picture** of all the **patient’s problems**. 2. Determine the **relationship among the problems**. 3. Setting priorities is a **dynamic, changing process**. 4. Develop a **multidisciplinary problem list**, and **refer to it frequently**.

Answer 18

1. Ensure patient and caregiver safety and prevent infection transmission. 2. Assign high priority to first-level priority problems. 3. Attend to second-level priority problems. 4. Address third-level priority problems.

Answer 19

The definition of clinical judgment used for this concept presentation is “an interpretation or conclusion about a patient’s needs, concerns, or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate by the patient’s response.

Answer 20

1. Differentiating between problems needing immediate attention and those requiring subsequent action 2. Deciding what problems must be addressed in the patient records

Answer 21

* ABC method * In emergency departments: life, limbs, and vision * Maslow's Hierarchy of Needs

Answer 22

Priority 1: Physiological needs - life threatening problems Priority 2: Safety and security Priority 3: Love and belonging Priority 4: Self-esteem Priority 5: Personal goals

Answer 23

**_A_**irway problems **_B_**reathing problems **_C**_ardiac and _**c_**irculation problems + **_V_**ital signs concerns (e.g., fever, hypertension, hypotension) **_L_**ab values that are life-threatening (e.g, low blood sugar)

Answer 24

* Mental status change (e.g., confusion, decreased alertness) * Medical problems requiring immediate attention (e.g., a diabetic who hasn't had insulin) * Pain * Urinary elimination problems

Answer 25

* Holistic view of the patient situation * Process orientation * Reasoning and interpretation * Ethical comportment

Answer 26

**Reflection-in-action** refers to the nurse’s understanding of patient responses to nursing actions **while care is occurring**. **Reflection-on-action** is consideration of the situation **after the patient care occurs**. In reflection-on-action, the nurse contemplates a situation and considers what was successful and what was unsuccessful.

Answer 27

* Immobilize a reduced fracture * Correct a deformity * Apply uniform pressure to underlying soft tissue * Support and stabilize weakened joints * Materials: nonplaster (polyurethane), plaster

Answer 28

* Cast care: keep dry; do not cover with plastic * Positioning: elevation of extremity; use of slings * Hygiene * Activity and mobility * Report the following signs and symptoms: pain not relieved by elevating cast limb or by analgesics; changes in sensation, movement, skin colour, or temperature; and signs of infection or pressure areas * Monitor neurovascular status and the potential for complications

Answer 29

* Assess and maintain adequate neurovascular status: * Assess circulation, sensation, and movement * Five P’s (pain, paresthesia, pallor, pulse, paralysis) * Notify physician at once of signs of compromise * Elevate extremity to heart level * Encourage movement of fingers or toes

Answer 30

* The application of pulling force to a part of the body * Promotes and maintains alignment of the injured part of the body * Surgical procedures such as open reduction with internal fixation (ORIF) have largely replaced the use of most forms of traction

Answer 31

* Traction must be continuous to be effective * Weights are not removed unless intermittent traction is prescribed * The patient must be in good body alignment in the centre of the bed * Weights must hang freely and not rest on the bed or floor * Prevent complications such as skin breakdown (repositioning), nerve damage, infection, circulatory impairment

Answer 32

Used to manage open fractures with soft-tissue damage Provide support for complicated or comminuted fractures

Answer 33

* Reassure patient concerned by appearance of device * Discomfort is usually minimal, and early mobility may be anticipated with these devices * Elevate to reduce edema * Monitor for signs and symptoms of complications, including infection * Provide pin care

Answer 34

Inability to move about freely.

Answer 35

* Slowed wound healing, abnormal labs, muscle atrophy, decreased subcutaneous fat * endocrine metabolism, calcium resorption, gastrointestinal function (constipation), negative nitrogen balance

Answer 36

atelectasis, hypostatic pneumonia, dyspnea, increased respiratory rate, crackles, wheezes, decreased air entry

Answer 37

* orthostatic hypotension * thrombus * embolus * pulmonary emboli * deep vein thrombosis (DVT)

Answer 38

* loss of endurance, strength, and muscle mass; * decreased stability and balance, * osteoporosis, * joint contracture

Answer 39

* urinary stasis * urinary tract infection * urinary retention * decreased bowel movements * distended bladder or abdomen * decreased bowel sounds * constipation * anorexia, decreased appetite * renal calculi, urinary tract infections

Answer 40

* ischemia * pressure ulcers

Answer 41

* Decreased social interaction * Social isolation * Sensory deprivation * Loss of independence * Role changes * Worry * Depression

Answer 42

* older adults due to physiological changes * acute and chronic conditions * chronic * injury/trauma

Answer 43

May interfere with their growth and development and intellectual and psychomotor functioning

Answer 44

* plaster * non-plaster * aircast * half slab * polyurethane (lighter)

Answer 45

* Compartment syndrome * Pressure injuries * Disuse syndrome

Answer 46

C - circulation S - sensation M - movement

Answer 47

**Limb-threatening** complication that occurs when **perfusion pressure** falls **below tissue pressure** within a closed anatomic compartment. Involves a s**udden and severe decrease in blood flow** to the tissues **distal** to an area of injury that results in **ischemic necrosis** if prompt, decisive intervention does not occur

Answer 48

* Pain * Paresthesia * Pallor * Paralysis * Pulselessness

Answer 49

* Reduce pressure by bivalving cast if full cast * posterior cast with tensor * fasciotomy

Answer 50

Halo traction

Answer 51

* Manage open fractures with soft tissue damage * Provide support for complicated or comminuted fractures

Answer 52

* Discomfort is usually minimal * Elevate the limb to reduce edema * Provide pin care * Monitor for signs and symptoms of complications

Answer 53

* Shock * Fat embolism syndrome (signs include: hypoxemia, neurologic compromise, petechial rash) * Acute compartment syndrome (MOST IMPORTANT sign is severe, unrelenting pain) - often occurs within 12 -24 hours * DVT and PE

Answer 54

* Delayed union and nonunion * Avascular necrosis * Reaction to internal fixation devices * Complex regional pain syndrome * Hetertrophic ossification

Answer 55

* Immobilization of fracture fragments * Max fragment contact * Sufficient blood supply * Proper nutrition * Exercise: weight bearing for long bones * Hormones: growth hormone, thyroid, calcitonin, anabolic steroids * Electric potential across fracture

Answer 56

* Over 40 years old * Bone loss * Avascular necrosis * Smoking * Comorbidities * Corticosteroids, NSAIDS * Extensive local trauma * Inadequate immobilization * Infection * Local malignancy * Malalignment of fracture fragments

Answer 57

* progressive peripheral arterial disease (MOST COMMON REASON) * fulminating gas gangrene * trauma * congenital deformities * chronic osteomyelitis * malignant tumour

Answer 58

* Hemorrhage * infection * skin breakdown * phantom limb pain * joint contracture

Answer 59

* Managing pain * Minimizing altered sensory perception * Promoting wound healing * Enhancing body image * Helping the patient resolve grieving * Promoting independent self-care * Helping the patient achieve physical mobility * Monitoring and managing potential complications * Promoting home, community-based, and transitional care

Answer 60

* Mobility limitations for life * No adduction (no crossing legs, use pillow to keep knees apart) * Hip cannot go below the knee * Use pillow between knees * No twisting so the hip does not dislocate

Answer 61

adults younger than 40 and men; also those with multiple fractures

Answer 62

* Respiratory signs including PAO2 less than 60 mm Hg, cough * Neuro changes * Cardio: techy, **chest xray shows snowstorm infiltrate** * Skin: pale, **petechial rash** occurs 2-3 days after symptoms begin * Critical assessment is in first 12-72 hours * **fever** greater than 39.5 * May find **fat in urine**

Answer 63

Check bilaterally and compare!

Answer 64

Every 2 hours

Answer 65

Never cross the affected leg when seated

Answer 66

✘Teaching is an **interactive process** that promotes learning. ✘Teaching and learning begin when a **person identifies a knowledge or skill deficit.** ✘Teaching is **most effective** when it addresses the **learner’s needs**, learning **style**, and **capacity.** ✘With successful teaching, **patients can learn new skills** or **change existing attitudes**.

Answer 67

* In patient education * **Create an environment** to facilitate learning. * Use a **patient-centered** approach *(include patient's perspective*) * Assess the **learning needs** of the patient (*what they know versus what I need them to know*) * Use the **most appropriate educational strategy**. * To be taught: information **needed by the patient and family** to make **informed decisions** regarding their care

Answer 68

Cognitive, affective, psychomotor

Answer 69

Includes all intellectual behaviors and requires thinking.

Answer 70

Expression of feelings and acceptance of attitudes, opinions, or values

Answer 71

Involves acquiring skills that require integration of mental and muscular activity

Answer 72

* Learning environment * Ability to learn * Emotional capability * Intellectual capability * Physical capability * Developmental stage * Learning in children * Adult learning

Answer 73

Timing is important. Must consider anxiety.

Answer 74

* Use **clear, concise descriptions** in the patient's **own language** * Provide **step-by-step instructions** for how to perform any procedure that the **patient or family** will be doing **independently**; reinforce explanation with **printed instructions** * **Identify precautions** to follow when performing self-care or administering medications * Review **signs and symptoms of complications** that a patient or family member needs to **report to a health care practitioner** * **List names and phone numbers** of **health care providers** and **community resources** that the patient or family member can contact * Identify any **unresolved problem**, including **plans for follow up** and **continuous treatment** * List **actual time of discharge**, **mode of transportation**, and **who accompanies** the patient

Answer 75

Begins at admission.

Answer 76

* Social motives * Task mastery motives * Physical motives * Motivation and social learning theory * Motivation and transtheoretical model of change * A patient-centered approach to patient education

Answer 77

* Maintaining and promoting health and preventing illness * Restoring health * Coping with impaired functioning

Answer 78

* Size (height and weight) * Strength * Coordination * Sensory acuity * Any physical condition (such as pain, fatigue, hunger) that depletes energy also impairs the ability to learn

Answer 79

* They can be independent, self-directed learners, but become dependent in new situations * Helps when they are encouraged to draw on past experiences to solve problems * Also good to collaborate with them on educational topics and goals * Address needs or issues that are important to the adult early on

Answer 80

A person's willingness or desire to learn; influences a person's behaviour.

Answer 81

* Precontemplation * Contemplation * Preparation * Action * Maintenance

Answer 82

L - Listen to patient needs E - Establish therapeutic relationship A- Adopt an intentional approach to every learning encounter R - Reinforce health literacy N - Name new knowledge via teach-back S - Strengthen self-management

Answer 83

* Learning needs * Ability to learn * Health literacy * Motivation to learn * Teaching environment * Resources for learning

Answer 84

* Definition: a patient’s ability to find, access, read, and understand reliable health information to make informed decisions about their health * Depending on their health literacy, patients can either be well informed or misinformed * In addition, patient information needs to be presented clearly, avoiding medical terminology, jargon, and acronyms

Answer 85

* *Deficient knowledge* * *Health maintenance* * *Health-seeking behaviours* * *Health self-management* * *Mastery of health-related skill* * When health care problems can be managed through education, the foci of patient education are *knowledge* and *skills.*

Answer 86

* Develops a teaching plan * Sets goals and expected outcomes * Works with the patient to select a teaching method * Developing learning objectives * Setting priorities * Timing * Organizing teaching material * Maintaining attention and promoting participation * Building on existing knowledge * Selecting teaching methods * Selecting resources * Writing teaching plans

Answer 87

Teaching approaches * Telling * Selling * Participating * Entrusting * Reinforcing

Answer 88

* One-on-one discussion * Demonstrations * Role playing * Simulation

Answer 89

* Paying attention to learning barriers * Illiteracy and learning disabilities * Health literacy * Sensory alterations * Language * Cultural diversity * Needs of patients with severe illness

Answer 90

* It is necessary to determine whether the patient has learned the material. * Demonstration of skill taught * Teach back of information learned * This helps to reinforce correct behaviour and change an incorrect behaviour. * May need to modify approach if further patient teaching is needed.

Answer 91

* **Purpose** of teaching session * Patient **engagement** * **Evaluation of patient learning** * Any **reinforcement** required

Answer 92

* Useful when there is limited information to be taught. Nurse outlines the task and fives instructions. No real opportunity for feedback.

Answer 93

* Sodium * Potassium * Calcium * Magnesium * Hydrogen ions

Answer 94

oChlorideo Bicarbonateo Phosphateo Sulfateo Proteinate ions

Answer 95

* adrenal insufficiency * water intoxication * SIADH, and * losses by vomiting, diarrhea, sweating, and diuretics and other certain medications

Answer 96

* poor skin turgor * dry mucosa * headache * decreased salivation * decreased BP (orthostatic) * nausea * abdominal cramping * and neurologic changes

Answer 97

* water restriction * sodium replacement * AVP receptor antagonists

Answer 98

* assessment and prevention * monitoring of dietary sodium and fluid intake * identification and monitoring of at-risk patients and the effects of medications (diuretics and lithium)

Answer 99

* excess water loss * excess sodium administration * diabetes insipidus * heat stroke * near-drowning in sea water * and hypertonic IV solutions

Answer 100

* thirst * elevated temperature * dry, swollen tongue * sticky mucosa * neurologic symptoms * restlessness; and weakness * Thirst may be impaired in the older adult or ill

Answer 101

: hypotonic sodium solution or D₅W (only if water needs to be replaced and not sodium)

Answer 102

* assessment and prevention * assess for over-the-counter (OTC) sources of sodium * offer and encourage fluids to meet patient needs * and provide sufficient water with tube feedings

Answer 103

GI losses, medications, alterations of acid--base balance, hyperaldosteronism, and poor dietary intake

Answer 104

fatigue, anorexia, nausea, vomiting, dysrhythmias, hypotension, muscle weakness, leg cramps, paresthesias, glucose intolerance, decreased muscle strength, and deep tendon reflexes (DTRs)

Answer 105

increased dietary potassium, potassium replacement, and IV for severe deficit

Answer 106

assessment (severe hypokalemia is life-threatening), monitoring of electrocardiogram (ECG), arterial blood gases (ABGs), I&O, and dietary potassium, and providing nursing care related to IV potassium administration

Answer 107

usually treatment-related, decreased renal excretion of potassium, rapid administration, and movement from ICF to ECF

Answer 108

cardiac changes and dysrhythmias, muscle weakness with potential respiratory and speech impairment, paresthesias, anxiety, and GI manifestations

Answer 109

monitor ECG, cation exchange resin (Kayexalate), IV sodium bicarbonate, IV calcium gluconate, regular insulin and hypertonic dextrose IV, and b₂-agonists; limit dietary potassium; and perform dialysis

Answer 110

assess serum potassium levels, mix well IVs containing K⁺, monitor medication effects, and initiate dietary potassium restriction and dietary teaching for patients at risk

Answer 111

vSerum calcium lower than 2.18 mmol/L

Answer 112

hypoparathyroidism, malabsorption, pancreatitis, alkalosis, massive transfusion of citrated blood, kidney injury, medications, other

Answer 113

: tetany, **circumoral numbness**, paresthesias, hyperactive DTRs, **Trousseau’s** sign, **Chovstek's sign**, seizures, respiratory symptoms of dyspnea and laryngospasm, abnormal clotting, and anxiety

Answer 114

IV of calcium gluconate, calcium and vitamin D supplements, diet

Answer 115

assessment as severe hypocalcemia is life-threatening, weight-bearing exercises to decrease bone calcium loss, patient teaching related to diet and medications, and nursing care related to IV calcium administration

Answer 116

2.6 mmol/L

Answer 117

malignancy and hyperparathyroidism, bone loss related to immobility

Answer 118

muscle weakness, confusion, incoordination, anorexia, constipation, nausea and vomiting, abdominal and bone pain, polyuria, thirst, ECG changes, and dysrhythmias

Answer 119

treat underlying cause, administer fluids, furosemide, phosphates, calcitonin, and bisphosphonates

Answer 120

assessment as hypercalcemic crisis has high mortality, encourage ambulation, fluids of 2.8 to 3.8 L/day, provide fluids containing sodium unless contraindicated and fibre for constipation, and ensure safety

Answer 121

vSerum magnesium level less than 0.75 mmol/L

Answer 122

alcoholism, GI losses, enteral or parenteral feeding deficient in magnesium, medications, rapid administration of citrated blood; contributing causes include diabetic ketoacidosis, sepsis, burns, and hypothermia

Answer 123

neuromuscular irritability, muscle weakness, tremors, athetoid movements, ECG changes and dysrhythmias, and alterations in mood and level of consciousness

Answer 124

diet, oral magnesium, and magnesium sulfate IV

Answer 125

assessment, ensure safety, patient teaching related to diet, medications, alcohol use, and nursing care related to IV magnesium sulfate

Answer 126

Hypocalcemia

Answer 127

Greater than 0.95 mmol/L

Answer 128

vThe abnormal cells have invasive characteristics and infiltrate other tissues. This phenomenon is **metastasis** – most commonly through lymphatic circulation

Answer 129

* Cell proliferation: uncontrolled growth, with the ability to metastasize, destroy tissue, and cause death * Cell characteristics: presence of tumour-specific antigens, altered shape, structure, and metabolism * Metastasis: * Lymphatic spread (most common) * Hematogenous spread * Angiogenesis * Carcinogenesis

Answer 130

Sepsis is defined as **life-threatening organ dysfunction** caused by a **dysregulated host response** to **infection**.

Answer 131

Septic shock is a subset of sepsis with **circulatory and cellular/metabolic dysfunction** associated with a **higher risk of mortality**

Answer 132

The qSOFA provides simple bedside criteria to quickly identify adult patients with suspected infection who are likely to have poor outcomes. This screening tool is positive in those with suspected infection and at least 2 of the following criteria: * Respiratory rate ≥ 22/min * Altered mental status * Systolic blood pressure ≤ 100 mmHg Positive screening should prompt further work-up for organ dysfunction and infection (if not already identified), and escalation of therapy or level of care

Answer 133

The Surviving Sepsis Campaign (SSC) Bundle (Levy, Evans, & Rhodes, 2018) Initiate promptly upon recognition of sepsis/septic shock. Prioritize resuscitation, diagnosis, and treatment by instituting the following interventions: * Measure lactate level (repeat lactate if initial lactate elevated [\>2mmol/L]). * Obtain blood cultures before administering antibiotics. * Administer broad-spectrum antibiotics. * Begin rapid administration of 30mL/kg crystalloid for hypotension or lactate  4mmol/L. * Give vasopressors if hypotensive during or after fluid resuscitation, to maintain mean arterial pressure  65mm Hg

Answer 134

septic shock

Answer 135

•Risk factors include patients with immunosuppression, extremes of age \< 1 and \> 65, malnourishment, chronic illness, invasive procedures, and emergent and/or multiple surgeries

Answer 136

Bacteremia, pneumonia, and urosepsis

Answer 137

gram-negative bacteria

Answer 138

antibiotic treatment

Answer 139

* SIRS- systemic inflammatory response syndrome * Sepsis * Septic Shock * MODS- multi organ dysfunction syndrome

Answer 140

Must meet 2 of the 4 criteria plus have clinical suggestion of possible SIRS * Temperature•\> 38•\< 36 * Heart Rate•\> 90 * Respiratory Rate•\> 20 or PaC02 \<32 * WBC\> 12,000 or \< 4,000 •\> 10% band cells * Acutely Altered Mental Status

Answer 141

* Blood cultures * Urinalysis and urine cultures * Wound culture * Sputum sample * Labs: CBC,PT, PTT, albumin, ALP, ALT, Bilirubin, Calcium, Urea, Creatinine, Electrolytes, Glucose, Lactate, Lipase, Magnesium * Chest x-ray SIRS criteria met plus a confirmed infection

Answer 142

* Sepsis * Decreased blood pressure * We fluid challenge the patient to increase the BP * Decreased organ function that is reversible

Answer 143

* Severe septic shock with organ failure * Liver failure * Other **organ failure** that is **not reversible**

Answer 144

* Oxygen therapy * Fluids - IV 30mL/kg * Vasopressors * Antibiotics

Answer 145

* Corticosteroids * Insulin therapy * Dialysis * Mechanical ventilation * Blood transfusions

Answer 146

60-65 mmHg

Answer 147

* Vasopressors * Vasoconstriction to elevate MAP through increasing the SVR * Stimulate alpha-1, beta-1, and beta-2 receptors in the body * Norepinephrine, epinephrine, vasopressin * Inotropes * Increase cardiac contractility (through increasing intracellular calcium) * Dopamine, dobutamine

Answer 148

Clostridium difficile

Answer 149

•Signs and symptoms usually occur 5-10 days after starting antibiotics, but may occur as soon as the first day or up to two months later

Answer 150

•Commonly affects older adults and individuals in hospitals and LTC

Answer 151

•Diagnosed with a stool test

Answer 152

* Watery diarrhea 10 to 15 times a day * Abdominal cramping and pain, which may be severe * Rapid heart rate * Fever * Blood or pus in the stool * Nausea * Dehydration * Loss of appetite * Weight loss * Swollen abdomen * Kidney failure * Increased white blood cell count

Answer 153

* Stop taking the antibiotic when possible * Other antibiotics: vancomycin (Vancocin HCL, Firvanq) or fidaxomicin (Dificid). Metronidazole (Flagyl) may be rarely used if vancomycin or fidaxomicin aren't available. * Surgery * Fecal transplant * Probiotics – may be controversial

Answer 154

* Fluid and electrolyte imbalances * Dehydration * Cardiac dysrhythmias * Skin breakdown

Answer 155

1. Distributive 2. Hypovolemic 3. Cardiogenic

Answer 156

* Early recognition; know when your patient is deteriorating * Do not wait to give antibiotics; even if pharmacy is closed, find a way

Answer 157

contact precautions

Answer 158

Soap and water (alcohol-based hand sanitizers are not as effective)

Answer 159

b) lungs It goes, lung, liver, GI system, kidneys

Answer 160

A narrowed or decrease pulse pressure e.g. 90/70 (20, so less than 40 mm Hg)

Answer 161

Crohn's is more systemic and can affect many other parts of the body.

Answer 162

lab values, intestinal biopsies, CT scan, and barium studies

Answer 163

* Perform health history to identify onset, duration, and characteristics of pain, diarrhea, urgency, tenesmus (cramping rectal pain), nausea, anorexia, weight loss, bleeding, and family history * Discuss dietary patterns, alcohol, caffeine, and nicotine use * Assess bowel elimination patterns and stool * Perform abdominal assessment

Answer 164

* Diarrhea * Acute pain * Deficient fluid * Imbalanced nutrition * Activity intolerance * Anxiety * Ineffective coping * Risk for impaired skin integrity * Risk for ineffective therapeutic regimen management

Answer 165

* Electrolyte imbalance * Cardiac dysrhythmias related to electrolyte imbalances * GI bleeding with fluid volume loss * Perforation of the bowel * Intraperitoneal infection * Complete large bowel obstruction * Peritonitis, abscess, and sepsis

Answer 166

* Attainment of normal bowel elimination patterns * relief of abdominal pain and cramping * prevention of fluid volume deficit * maintenance of optimal nutrition and weight * avoidance of fatigue * reduction of anxiety * promotion of effective coping * absence of skin breakdown * increased knowledge of disease process and therapeutic regimen, and * avoidance of complications * Emotional support from the family is critical post discharge

Answer 167

* Identify **relationship** between **diarrhea** and **food, activities, or emotional stressors** * Provide **ready access** to bathroom or commode * Encourage **bed rest** to **reduce peristalsis** * Administer **medications as prescribed** * Record **frequency, consistency, character, and amounts of stools**

Answer 168

* Understanding of disease process * Nutrition and diet (high protein, low residue, bland, high vitamin, etc.) * Medications

Answer 169

Enlarged prostate

Answer 170

Benign prostatic hyperplasia (BPH)

Answer 171

c) inflammation of all layers of intestinal mucosa

Answer 172

c) ulcerative colitis

Answer 173

b) The clusters of ulcers take on a cobblestone appearance.

Answer 174

d) osteoporosis

Answer 175

a) Intermittent pain

Answer 176

feelings of urgency, urinary obstruction, urinary retention, and urinary tract infections

Answer 177

* Pharmacologic: alpha-adrenergic blockers, alpha- adrenergic antagonists or a combination of both, and antiandrogen agents * Catheterization if unable to void * Prostate surgery

Answer 178

* **Hemorrhage** and **shock** – monitor catheter drainage system, monitor vital signs, administer fluids and blood * **Infection** – catheter care, antibiotic cream * **DVT**- compression stockings, encourage mobilization, assess leg circumference * **Catheter obstruction** – monitor catheter drainage system, irrigate the catheter

Answer 179

Transurethral resection of the prostate (TURP)

Answer 180

diabetes, hypertension, heart failure, acute dehydration

Answer 181

Diabetes and hypertension

Answer 182

* Fluid volume loss or excess * Anemia * Elevated serum creatinine, BUN, and decreased GFR (see stages page 1285) * Electrolyte abnormalities – most common hyperkalemia * Metabolic acidosis * Proteinuria

Answer 183

When the kidneys cannot remove wastes or perform regulatory functions

Answer 184

1. initiation 2. oliguria 3. diuresis 4. recovery (may take 3 - 12 months)

Answer 185

Weight 1-kg weight gain is equal to 1,000 mL of retained fluid

Answer 186

* Prerenal (hypoperfusion of the kidney) * Intrarenal (actual damage to kidney tissue) * Postrenal (obstruction to urine flow)

Answer 187

abnormal concentration of nitrogenous wastes in the blood

Answer 188

* Hypovolemia * Hypotension * Reduced cardiac output and heart failure * Obstruction of the kidney or lower urinary tract * Bilateral obstruction of renal arteries or veins

Answer 189

* Hemodialysis * Peritoneal dialysis (PD) * Continuous renal replacement therapies (CRRTs)

Answer 190

* Assess for signs and symptoms of fluid volume excess; keep accurate I&O and daily weight records * Limit fluid to prescribed amounts * Identify sources of fluid * Explain to patient and family the rationale for the restriction * Assist patient in coping with the fluid restriction * Provide or encourage frequent oral hygiene

Answer 191

* Depending on the time of hemodialysis will need to modify medication regimen as many medications are dialyzed out by the dialyzer. * You also need to **hold antihypertensives** before all dialysis as removing fluid causes **hypotension**

Answer 192

Increased BUN

Answer 193

* Involves both patient and family members * Considers the impact of illness on family, as well as patient * Provides a context for patient teaching and need for services

Answer 194

Negative family responses have been associated with negative patient outcomes, while supportive positive family responses are associated with positive patient outcomes

Answer 195

* Cultural identity * Rituals * Values * Level of involvement * Decision making * Spiritual beliefs * Traditional behaviors * Past medical experiences * Concurrent family stressors * Expectations for treatment *

Answer 196

* **Open visitation** policies but **need for respite** * **Educating the family** along with the patient * Helping families **access services**, **support groups**, and **natural support networks** * **Supporting** the **caregiver r/t discharge planning** (referrals to home care, community resources) * **Validating** and **normalizing emotions** * **Managing criticism** and **advice** from **less involved family members**

Answer 197

* Cellular phones * Skype, FaceTime * Twitter, Facebook, other social media * Caring Bridge * World wide web * YouTube * Informational videos

Answer 198

* Compromised family coping * Ineffective family therapeutic regimen management * Readiness for enhanced family processes * Readiness for enhanced relationship

Answer 199

* Family involvement increases likelihood of successful adaptation. * Development of appropriate nursing actions should be based on **mutually established goals**. * **Interventive questioning** sets up a sense of **ownership** and **self-efficacy** for families.

Answer 200

* Validating emotional responses * Summarizing each person’s viewpoint * Offering information – consequences of not following a healthy diet * Collaboration about possible solutions * Compromise: Healthy options that meet both their needs

Answer 201

* Not considering the context of the family situation (resources, distance, health state) * Taking sides – act as a mediator * Giving too much advice prematurely – gather as much information beforehand

Answer 202

the term family dynamics is defined as **interrelationships between** and **among** individual family members or “the **forces at work** within a family that **produce particular behaviors or symptoms**

Answer 203

The CFAM6 is widely used by nurses to assess families. The model is used to ask family members questions about themselves to gain understanding of the ***structure, development, and function*** at a point in time. Not all questions within the subcategories are asked at the first interview, and not all questions are appropriate for all families.

Answer 204

* Fell there is **hope** * Feel that hospital **personnel care** about the patient * Have a **waiting room near the patient** * Be **called at home about changes** in the patient's condition * Know the **prognosis** * Have questions **answered honestly** * **Receive info** about the patient **at least once per day** * Have explanations in **understandable terms** * Be allowed to **see the patient frequently**

Answer 205

* Respecting the patient’s goals, preferences, and choices * Attending to the medical, emotional, social, and spiritual needs * Using the strengths of interdisciplinary resources * Acknowledging and addressing caregiver concerns * Building mechanisms and systems of support

Answer 206

* Comprehensive care for patients whose disease is **not responsive to cure** * Care also e**xtends to the patient's family** * Palliative care emphasizes management of **psychological, social, and spiritual problems** as well as **control of pain** and other **physical symptoms**. The goal is to **improve quality of life** for persons who have a **life-limiting illness** that is usually **at an advanced stage** * This is a **comfort-focused approach** to care that **may be used with cure-focused treatment**

Answer 207

* The patient’s total care is best managed by an **interdisciplinary team** whose members **communicate regularly** * **Pain and other symptoms must be managed** * The **patient and the family** should be **viewed as a single unit of care** * Palliative care **may also occur in the home** – have palliative home care teams. * **Bereavement care must be provided to family members**

Answer 208

* Reflect on your **own experiences and values** concerning illness and death * **Deliver** and **interpret technical information** without hiding behind medical terminology * Realize the **best time for the patient** to talk **may be the least convenient for you** * Be **fully present** during all communications * Allow the **patient and the family to set the agenda** regarding the **depth** of the conversation * **Resist the impulse** to **fill “empty space”** * Allow the patient and family **sufficient time** to reflect and respond * Prompt gently * Avoid distractions * Avoid the impulse to give advice * Avoid canned responses * Ask questions * Assess **understanding**, both **your own and the patient’s** * Create an **appropriate time and space** for conversation * Be aware of **body language** * Enable the **patient or family to lead conversation** * Explore **what they know** or **their perceptions** * **Be comfortable with silence**, acknowledge and encourage * Provide information **at rate and depth** the patient and family are able to grasp

Answer 209

* Spirituality includes religion but is n**ot synonymous with religion** * Addressing spirituality is an important component of the care of the dying patient * How a person **derives meaning** and **purpose from life** * One’s **beliefs and faith** * Sources of **hope** * **Attitudes towards death**

Answer 210

The goal of symptom management is to completely relieve each symptom or, if this is not possible, to decrease the symptom to a level that the patient can tolerate

Answer 211

* Pain * Dyspnea * Fatigue * Anorexia, dehydration, and cachexia * Delirium and depression * Nausea

Answer 212

* To address distressing, intractable symptoms (dyspnea, delirium, seizures, etc.) * Imperative that preconditions have been met * Providing psychological support to the family is important * Provide rationale * Discuss with the family

Answer 213

* Refusal of food and fluids * Urinary output decreases * Weakness and sleep * Confusion and restlessness * Impaired vision and hearing, seeing things * Secretions in throat * Breathing pattern irregular with periods of apnea * Incontinence * Decreased temperature control

Answer 214

* Determination of death – auscultating breath and heart sounds * Pronouncement and death certificate * Body becomes bluish/dusky, mottling, waxen, cool, releasing of body fluids, gasping when turning * Wrapping the body (shrouding) * Securing all valuables (try to give to family beforehand) * Transport to the morgue/pick up by funeral home

Answer 215

Palliative sedation does not hasten dying

Answer 216

A disease process that begins when an abnormal cell is transformed by the genetic mutation of cellular DNA

Answer 217

lymph node

Answer 218

* Viruses and bacteria * Physical factors: ultraviolet rays of the sun, radiation, chronic irritation or inflammation * Chemical agents: tobacco, asbestos * Genetic and familial factors * Diet * Hormones * Role of the immune system

Answer 219

Primary prevention is concerned with reducing cancer risk in healthy people

Answer 220

Secondary prevention involves detection and screening to achieve early diagnosis and intervention

Answer 221

* Avoid known carcinogens * Lifestyle and dietary changes to reduce cancer risk * Public and patient education

Answer 222

* Identification of patients at high cancer risk * Cancer screening * Self-breast examination * Self-testicular examination * Screening colonoscopy * Pap test * Public and patient education

Answer 223

* Cure * Control * Palliation

Answer 224

* Diagnostic surgery * Biopsy: excisional, incisional, needle * Tumour removal: wide excision, local excision * Prophylactic surgery * Palliative surgery * Reconstructive surgery

Answer 225

Internal readiation

Answer 226

Yes: curative, controlling, and palliative

Answer 227

* Agents used to destroy tumour cells by interfering with cellular function and replication * Curative, control, or palliative

Answer 228

* Toxicity * GI effects: nausea and vomiting, diarrhea, mucositis, and stomatitis * Hematopoietic effects: myelosuppression * Renal damage * Cardiopulmonary system: potential cardiac toxicities * Reproductive system: potential sterility, potential reproductive cell abnormalities * Neurologic effects

Answer 229

* Patient and family education * Include restrictions and precautions * Skin care * Oral care * Protection of care providers

Answer 230

* Risk for infection * Impaired skin integrity * Impaired oral mucous membrane * Impaired tissue integrity * Imbalanced nutrition * Fatigue * Chronic pain * Anticipatory grieving * Disturbed body image

Answer 231

* **Bone marrow suppression** refers to a decrease in the ability of the **bone marrow** to manufacture cells (erythrocytes, leukocytes, thrombocytes) and is common with **chemotherapy.** * In addition to eliminating cancer cells, **chemotherapy** drugs eliminate normal cells that divide rapidly, such as hair and those in the **bone marrow** that form the different types of blood cells. * Does not affect already formed blood cells.

Answer 232

* Decreased production of platelets within the bone marrow (radiation or chemotherapy), * increased destruction of platelets (autoimmune disorders such as Immunologic Thrombocytopenic Purpura or Heparin induced Thrombocytopenia), * increased consumption of platelets (Disseminated Intravascular Coagulation, major bleeding)

Answer 233

* bleeding, petechiae, nasal and gingival bleeding, excessive menstrual bleeding, excessive bleeding after surgery or dental extraction, severe – spontaneous bleeding in the nervous or GI system

Answer 234

CBC and differential, bone marrow biopsy, manual examination of peripheral smear

Answer 235

platelet infusions, safety precautions

Answer 236

Atrial fibrillation

Answer 237

A condition in which the atria are contracting so fast – **greater than 350 bpm** – that they are unable to have adequate filling or contraction

Answer 238

Due to inadequate emptying, blood that remains in the atria is prone to forming clots, which increases the risk of thrombotic stroke or pulmonary embolus

Answer 239

listen to apical rate & palpate the radial pulse at the same time - should be equal – if not make physician aware

Answer 240

12 lead ECG

Answer 241

anticoagulants, beta blockers. Symptomatic: amiodarone, cardioversion

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