Final Flashcards

Question

Chemotherapy-induced Mucositis 5 Prevention/treatment

Answer 1

* Oral cryotherapy with ice water or ice chips can prevent (patient should suck ice chips before, during, and after rapid infusions) * Frequent mouth assessment * Salt and baking soda rinse * Non-alcohol-based mouth rinse throughout day and night * Soft-bristled toothbrush or disposable mouth sponges

Answer 2

* Scalp cooling during chemo * Avoid direct sunlight on scalp with hat or head covering * Use sunscreen due to increased sun sensitivity * Pick wig prior to treatment beginning to cope with body image issues

Answer 3

Pain Pallor Pulselessness Poikilothermic (cold) Paralysis Parathesis

Answer 4

Angina is when oxygen supply < myocardial demand Stable angina is relieved by rest, sublingual nitrogen or aspirin Unstable angina is chest pain with extra symptoms, not relieved by nitroglycerin

Answer 5

- wheezing or SOB - weight gain of 3 pounds a week (1-2 pounds overnight) - dizziness or faintness - cool, diaphoretic skin - Nausea and vomiting - S3 gallop - increased temperature - palpitations

Answer 6

STEMI: ST elevation due to rupture of fibrous atherosclerotic plaque NSTEMI: ST depression and T wave inversion due to myocardial ischemia PCI is recommended within 90 minutes of arrival to hospital for STEMI to due revascularization

Answer 7

- D-dimer (identifies DVT) - Lipids (total and LDL increased, HDL decreased)- increased in peripheral artery disease - C-reactive protein - increased in MI - B-type natriuretic peptide -increased in coronary artery disease - Troponin I and T AND Creatine kinase-MB -- increased and specific cardiac markers of MI

Answer 8

3 parts: - clot retrieval to restore perfusion in CAD or PAD - coronary angioplasty ( inflated balloon catheter to push artery plaque against vessel wall), - stent placement ( prevent reocclusion)

Answer 9

Indication: angina, heart failure Action: reduces preload and afterload Side effects: headaches, hypotension, reflex tachycardia Nursing Care - do not give with PDE5 inhibitors - remove patch for 12-14 hrs a day and rotate sites - apply patch to clean hairless area - give one tablet every 5 minutes until 3 tablets - give w/ CCB or betablocker to prevent reflex tachycardia

Answer 10

Use: Peripheral artery disease, a-fib Side effects: tinnitus (aspirin), bleeding risk Nursing Care - take w/ food

Answer 11

Labs: INR Antidote: vitamin K Nursing Care - discontinue heparin 3-4 days after starting - limit vitamin K (green leafy vegtables, liver, soybeans) - avoid NSAIDs, antidepressants, corticosteroids, - taper drug before discontinuing - bleeding precautions

Answer 12

Lab: monitor aPTT or anti-Xa Antidote: protamine sulfate Side effects: thrombocytopenia Nursing Care - bleeding precautions (electric razor, soft toothbrush) - taper drug

Answer 13

- Weakness/ Fatigue - Dizziness - Confusion - Pulmonary Edema (frothy, pink sputum, dyspnea, crackles) - S3 gallop (due to early diastolic filling) - Oliguria (nocturia at night)

Answer 14

- Distended neck veins - Increased abdominal girth (ascites) - Hepatomegaly (liver engorgement) - Weight—the most reliable indicator of fluid gain or loss - Peripheral pitting or dependent edema

Answer 15

Systolic: reduced ejection fraction (< 40%) which increases preload and afterload Diastolic: stiffened ventricles prevents sufficient blood flow and leads to inadequate cardiac output

Answer 16

Indication: heart failure, a-fib, PAC Action: increase contractility (inotropic), reduce heart rate (chronotropic), reduce AV node conduction (dromotropic) Lab changes: hypokalemia, hypomagnesium, hypercalcemia, Side effects/toxicity : dysrhythmias, Anorexia, muscle weakness, vertigo/confusion (elderly), halos and vision changes Antidote: antigen binding fragments Nursing Care - take apical HR prior to administration (do not give if HR < 60) - take with potassium supplements or food

Answer 17

Indication: hypertension, heart failure, dysrhythmias, angina Action: negative chronotropic, dromotropic, inotropic Side effects: bradycardia, heart failure, hypoglycemia (and masks hypoglycemia) Nursing Care - assess HR and BP (hold if HR < 50 or BP <90) - avoid sudden withdrawal - Avoid antacids

Answer 18

Indication: heart failure, hypercholesterolemia, peripheral artery disease Side effects: hepatotoxic, rhabdomyolysis, cataracts Nursing Care - avoid grapefruit juice - increases bleeding risk when combined with warfarin

Answer 19

Indication: heart failure (drug of choice), kidney disease with hypertension Side effects: angioedema, cough, hyperkalemia, hypotension, metallic taste Nursing Care - take on empty stomach - avoid NSAIDs and potassium supplements

Answer 20

Indication: heart failure, hypertension, chronic kidney disease Action: increase sodium and water excretion Side effects: hypokalemia, hypotension, hyperglycemia, hyperuricemia, ototoxic (furosemide)

Answer 21

- Rapid weight gain (3lb in week or 1-2 lb overnight) - Decrease in exercise tolerance - Cold like symptoms - excessive nocturia (microalbuminuria and high specific gravity) - Development of dyspnea/angina at rest - Increased edema in feet, ankles, hands - Increased BNP level

Answer 22

PR Interval = 0.12-0.20 seconds (start of P to start of Q) QRS complex = 0.04-0.10 seconds (start of Q to end of S; w shaped) QT interval = less than 0.44 seconds (start of Q to end of T)-- naturally longer in women

Answer 23

P Wave- atrial contraction (depolarization); deformity = problem with atrium i.e a-fib does not have p waves QRS Complex- ventricular contraction (depolarization); deformity = problem with ventricles T Wave- ventricular repolarization U wave: late ventricular repolarization

Answer 24

EKG Normal Rates - SA node (60-100 bpm) - AV node (40-60 bpm) - Purkinje fibers (20-40 bpm)

Answer 25

1. Heart rate (count Ps for atrial rate, count R waves for ventricular rate, count QRS complexes for general rate) 2. Heart rhythm (measure from R-R; regular if intervals different by less than 3 small boxes) 3. P wave analysis (should be present, regular, 1-1 P wave: QRS ratio, round and upright) 4. PR interval analysis (0.12-0.20) -- increases with AV blocks 5. QRS analysis (0.04-0.10)-- dysrhythmias if missing complexes or irregular pattern

Answer 26

ST elevation due to MI, pericarditis, hyperkalemia ST depression due to hypokalemia, MI, ventricular hypertrophy

Answer 27

- Rapid pulse (>150 bpm) and palpitations - dizziness - anxiety - chest pain - dyspnea - p wave buried in EKG

Answer 28

- Valsalva maneuver (cough or bear down) - Adenosine (may cause asystole, bradycardia, hypotension) - Beta Blockers - Calcium Channel Blockers (verapamil or diltiazem) - cardioversion

Answer 29

- No clear P waves b-c rapid impulses from atrial tissues

Answer 30

- thrombus formation r/t blood pooling in atria (stroke risk if failure to rescue)-- speech alterations - irregular apical pulse (palpitations) - poor perfusion (weak pulses)

Answer 31

- Apply oxygen - Keep HOB elevated unless patient is very hypotensive - Notifying the HCP or Rapid Response Team - Give Antiarrhythmics (Diltiazem, Amiodarone, metoprolol, lanoxin) - Give Anticoagulants (Heparin, enoxaparin, Warfarin) - need 12 lead EKG

Answer 32

- variant of NSR due to intrathoracic pressure during breathing OR due to digoxin or morphine - Shortest PP or RR intervals vary at least 0.12 seconds from longest PP or RR interval

Answer 33

Indication:dysrhythmias (a-fib, v-fib) Action: slows ventricular conduction to convert A-fib to NSR Side effects: ARDS, blue-gray skin discoloration, hypotension, bradycardia, corneal microdeposits Nursing Care - test pulmonary function prior to treatment - give with food - avoid grapefruit juice and St. John's wort

Answer 34

Indication: MI Action: dissolves thrombi to restore myocardial blood flow Side effects: bleeding Nursing Care: - give within 30 minutes of hospital arrival for STEMI

Answer 35

- check if allergic to contrast dye (iodine) or shellfish - keep leg straight - keep HOB less than 30 degrees - watch for bleeding and hypokalemia (back pain = retroperitoneal bleeding) - have patient avoid coughing and sneezing - give anticoagulants during procedure and antiplatelets after procedure - maintain hydration (b-c dye can damage kidney so give adequate fluids)

Answer 36

Indication: heart failure (drug of choice) Side effects: angioedema, insomnia, hypotension

Answer 37

Indication: dysrhythmias (a-fib, SVT), angina, hypertension (useful in CKD to improve kidney perfusion) Action: peripheral vasodilation AND negative dromotropic and chronotropic Side effects: gingival hyperplasia, prolonged PR (AV block), facial flushing/ increased heat perception, reflex tachycardia Nursing Care - prevent reflex tachycardia by giving w/ beta blocker - avoid grapefruit juice and St. John's wort

Answer 38

- Ill s/s(Fever, chills, NV, malaise, fatigue) - Tachycardia and tachypnea - Flank, back, or loin pain - Tenderness at the costovertebral angle (CVA) - Abdominal, often colicky, discomfort - UTI signs (Burning, urgency, or frequency, nocturia) - Recent cystitis or treatment for UTI

Answer 39

- Hypertension - Inability to conserve sodium - Decreased urine-concentrating ability, resulting in nocturia - hyperkalemia - metabolic acidosis

Answer 40

microbial invasion of renal pelvis causing inflammatory response and fibrosis Result: AKI (decreased reabsorption and secretion) or CKD Key care - encourage fluids (2L/day) - give antibiotics - give acetaminophen > NSAIDS b-c does not affect kidney - may need surgery (reimplantation, urethroplasty, nephrectomy, pylolithotomy)

Answer 41

Increased w/ kidney impairment (due to reduced GFR) and increased muscle mass Decreased w/ old age and decreased muscle mass

Answer 42

Increased - kidney or liver disease - dehydration or poor kidney perfusion - infection/ stress - high protein - steroids - GI or other bleeds - old age Decreased - malnutrition - liver AND kidney dysfunction

Answer 43

Increased: dehydration, poor kidney perfusion, excess vasopressin/ADH (SIADH, stress, surgery), heart failure.

Answer 44

stress, infection (will be negative after infection resolved), recent strenuous exercise, Chronic kidney disease (albuminuria)

Answer 45

Decreased: old age, chronic kidney disease, diabetes insipidus, malignant hypertension, diuretics, lithium toxicity

Answer 46

- hypertrophy of nephrons (to maintain homeostasis) - fixed osmolarity of urine (dilute) followed by oliguria (due to inability to dilute urine

Answer 47

- hypernatremia (due to fluid retention) - hyperkalemia (when urine output falls under 500 mL/24 hr) - hyperphosphatemia and hypocalcemia

Answer 48

Cause: reduced bicarbonate reabsorption and excess H+ Compensation: Kussmaul breathing (tachypnea and hyperpnea)

Answer 49

* Renal osteodystrophy: bone mineral loss (S/s: bone pain, spinal sclerosis, fractures, bone density loss, osteomalcia, decreased height (due to compacted vertebrae)) * Metastatic calcification: crystals from calcium-phosphorus deposit in kidneys, heart , lungs, blood vessels (atherosclerotic plaques), joints, eyes (conjunctivitis, brain)) * Itching

Answer 50

- Hypertension ( dysfunction of RAAS = cycle of vasoconstriction) - hyperlipidemia - heart failure (heart must work harder) - Uremic cardiomyopathy and pericarditis (uremic toxic to heart)-- may have narrow pulse pressure, friction rub

Answer 51

* Uremic fetor -> halitosis or stomatitis * Peptic ulcer disease w/ ulcers cause erosion of blood vessels -> hemorrhagic shock * Uremic colitis w/ watery diarrhea or constipation

Answer 52

* Uremic encephalopathy: Lethargy, seizures, coma; weakness in upper and lower extremities * Peripheral neuropathy: sensory changes in a glove-and-stocking pattern over hands and feet

Answer 53

* Anemia (due to decreased erythropoietin production -- S/s: fatigue, pallor, lethargy, weakness, SOB, dizziness * Impaired platelet function due to increased bleeding or bruising (S.s: petechiae, purpura, nose or gum bleeds, melena (black tarry stools i.e. intestinal bleeding)) * Disrupted WBC production and function from uremia

Answer 54

* Yellowish or darkening to brown or bronze due to pigment deposition * Sallowness (faded suntan) due to anemia * Decreased turgor and skin oils * Severe pruritus * Uremic frost (layers of urea crystals from evaporated sweat) * ecchymosis or purpura (purple patches and rashes)

Answer 55

Nursing Care - Monitor for hypokalemia (dysrhythmias, muscle twitching, thready pulse, polyuria, hypoactive bowels) - Give with potassium-rich food (citrus fruits, potatoes, bananas) (not in chronic kidney disease) - Give in morning (no doses after 3pm) - not useful in end-stage kidney disease

Answer 56

* High-fowler position with oxygen * IV furosemide for diuresis * IV morphine and nitroglycerin to reduce pulmonary pressure and myocardial oxygen demand via vasodilation * Measure urine output hourly * Monitor vital every two hours (every hour w/ nitroglycerin and morphine due to hypotension risk)

Answer 57

Limit - protein (cause of waste buildup i.e uremia) - potassium (not needed if dialysis or producing urine) - sodium - phosphorus (to prevent renal osteodystrophy) Supplement vitamins and minerals esp iron (due to anemia) and dialysis may remove water-soluble vitamins

Answer 58

Indication: chronic kidney disease for hyperphosphatemia Action: form insoluble calcium-phosphate complex to prevent hyperphosphatemia Side effects: constipation, hypophosphatemia (weakness, slow or irregular pulse, confusion), hypercalcemia Nursing Care - do not take within 2 hrs of other drugs - take with meals

Answer 59

- do not swim or bath with catheter - do not try to void around catheter (urge to void will be present) - increase fluid intake (2-2.5 L) to prevent dysuria - temporary incontinence post-op will resolve - sex is okay (may have retrograde ejaculation) - do kegels to regain voluntary elimination

Answer 60

- Keep leg straight if catheter is taped to thigh or abdomen - Help patient ambulate early - Monitor and document the color, consistency, and amount of urine output PRN or q2h - For output, subtract amount of irrigating solution from urinary drainage bag - Check the drainage tubing frequently for external obstructions (e.g., kinks) and internal obstructions (e.g., blood clots, decreased output) - Assess the patient for reports of severe bladder spasms with decreased urinary output, which may indicate obstruction. - Use continuous irrigation with NS

Answer 61

* TURP syndrome --Due to irrigation fluid being over absorbed ( S/s: headache, SOB, hypertension, bradycardia, ST elevation, wide QRS, inverted T wave) * Arterial bleeding = bright red or ketchup like clots---Need to notify surgeon immediately and irrigate catheter w/ normal saline * Venous bleeding = burgundy -- need to Inform surgeon and monitor hemoglobin and hematocrit

Answer 62

- Prepare skin w/ 2% chlorhexidine - B/w hemodialysis sessions, patient should wash area w/ antibacterial soap and rinse with water - Avoid constrictive devices such as BP cuffs, tourniquets, venipuncture in same extremity - Rotate needle insertion sites w/ each hemodialysis treatment - Palpate for thrills and auscultate for bruits over the vascular access site q4h while patient awake - Encourage routine range-of-motion exercises and elevate extremity - Do not carry heavy objects with extremity with access device - Do not to sleep on Vascular access device or put body weight on it

Answer 63

- Extensive peritoneal adhesions or fibrosis - active inflammatory GI disease (diverticulitis, IBS) - Ascites or massive central obesity - Recent abdominal surgery

Answer 64

Cause: Due to rapid reduction in electrolytes and other particles after hemodialysis (rare) S/s: mental status changes, seizures, fatigue, headaches, nausea and vomiting, coma Prevention: reduced blood flow at onset of symptoms

Answer 65

Peritonitis (main complication of PD) S/s: cloudy dialysate, fever, abdominal tenderness general malaise Prevention: sterile technique b/c due to connection site contaminations Bowel perforation or inflammatory bowel disease * Signs: brown effluent * Prevent with high-fiber diet, stool softeners, enemas

Answer 66

* Weigh the patient before and after dialysis. * Hold certain drugs prior to dialysis and give after dialysis * Be aware of reactions that occurred during previous dialysis treatments. * Monitor vitals and neurologic status throughout treatment * Assess serum laboratory tests to evaluate effectiveness of treatment in removing wastes and achieving desired outcomes (e.g., fluid and electrolyte balance, reduction of uremia). * Warm Dialysate (not in microwave)-- also do this for peritoneal dialysis to decrease discomfort * Give anticoagulation therapy to prevent clotting * keep patient supine in low fowler (esp in peritoneal dialysis to prevent leakage at site)

Answer 67

Pain Leakage of Dialysate fluid Blood clot Protein loss peritonitis bowel perforation or inflammatory bowel disease

Answer 68

1. remove cap and shake inhaler 2. breathe out all the way 3. put mouth to inhaler and breathe in while pressing down on inhaler 4. remove inhaler and hold breath for 10 seconds 5. slowly breath out

Answer 69

- hypoxemia (maintain airway; give O2; monitor vitals q15 monitor for first two hrs) - aspiration (check for gag reflex (pt NPO till return), suction prn) - bleeding (hemoptysis) - infection - bronchospasm (indicated by stridor

Answer 70

Tachypnea Tachycardia Accessory Muscle Use Paradoxical chest movement (in on inspiration, out on expiration) Pursed lip breathing Pale skin Adventitious Breath Sounds Mucus/secretions

Answer 71

Cyanosis Clubbing of nails Barrel chest (emphysema) Orthopneic

Answer 72

pH: 7.35-7.45 CO2: 35-45 mm Hg pO2: 80-100 mm Hg HCO3: 21-28 mEq/L O2 sat: 95-100%

Answer 73

Respiratory Acidosis: pH < 7.35; CO2 > 45 Respiratory Alkalosis: pH > 7.45; CO2 < 35 Metabolic Acidosis: pH < 7.35; HCO3 < 21 Metabolic Alkalosis: pH > 7.45; HCO3 > 28

Answer 74

- use daily b-c max effectiveness w/ 48-72 hrs of continued use - Side effects: increase risk for infections (Candida albicans in mouth; URI if around people w/ one) - avoid Risky activities (fragile BVs increase risk for bruising and petechiae) - do not stop abruptly stop drug b-c it suppresses adrenal production of essential corticosteroids - take with food to reduce risk for GI ulceration

Answer 75

SABA - for acute relief LABA - for long term relief Anticholinergic - prevent COPD bronchospasm - carry at all times - S/s of overdose: blurred vision, eye pain, headache, nausea, palpitations, tremors, inability to sleep, dry mouth (increase fluids)

Answer 76

Mucolytics (Acetylcysteine, dornase alpha, guaifenesin) - thins secretions so easier to expectorate and cough up - guaifenesin can raise cough threshold Oxygen - Usually oxygen flow of 2-4 L/min via nasal cannula or 40% via venturi mask - ALL hypoxic patients should get oxygen therapy so SpO2 b/w 88-92%

Answer 77

Diaphragmatic/ abdominal breathing - Patient consciously increases movement of diaphragm while lying on back to relax abdomen Pursed-lip breathing - Mild resistance created by breathing through pursed lips to prolong exhalation and increase airway pressure - Delays airway compression and reduces air trapping

Answer 78

- Inspect insertion site( eyelets of tube should not be visible; s/s of infection (redness, purulent drainage, excess bleeding)) - Palpate Insertion Site (may have subQ emphysema if puffiness or crackling - Ensure Intact Dressing at Site - Assess/reassess Respiratory Status (breathing, pulse ox, breath sounds) - Observe Trachea (tension pneumothorax if shifted) - Assess/reassess Pain (give meds and reposition) - Encourage Cough, Deep Breathing, Incentive Spirometry

Answer 79

- Avoid kinks, Occlusions, or Loose Connections (should be straight) - Do NOT Strip/Milk Tubing - Keep Drainage System Below Level of Chest - Assess for “Tidaling” (water level rises inhalation and fall exhalation) - bubbling seen on exhalation, forceful cough, position changes (EXCESS BUBBLING = air leak) - Always have at least 2 cm of water to prevent air from returning to patient in water seal chamber - Limit clamping of a chest tube b-c will increase pressure in pleural space and may cause tension pneumothorax - No need to disconnect chest tube for transport - never let drainage come in contact w/ tubes (can cause tension pneumothorax)

Answer 80

- Tracheal Deviation - Sudden onset of increased dyspnea - O2 sat <90% - Drainage >70ml/hr (D) - Visible eyelets on chest tube - Chest tube falls out of the patient’s chest (first, cover the area with dry, sterile gauze) - Chest tube disconnects from the drainage system (first, put end of tube in a container of sterile water and keep below the level of the patient’s chest) - Drainage in tube stops (in the first 24 hours) - Drainage bloody after a couple days (drainage is always bloody in first few hrs)

Answer 81

Normal Range (70-110) Fasting plasma glucose (FPG) - >126mg/dL (8 hrs. after fasting, can have water while fasting) Oral glucose tolerance test (OGTT)- > 200mg/dL (2hrs after oral glucose test; pt fasts 10-12 hrs prior to test) Rapid glucose check - >200md/dL (Finger prick; no fasting required) Glycosylated hemoglobin (HbA1c) - >6.5 % (measures Average of blood glucose over 3 months, the lifespan of RBC b-c glucose binds to Hgb A)-- target <7% for diabetic

Answer 82

Onset: 15 min Peak: 30 min - 1.5 hr Nursing Care - used w/ longer-acting - meal must be eaten at time of injection

Answer 83

Onset: 1.5 hr Peak: 4-12 hr Nursing Care - covers insulin needs b/w meals or overnight - can be combined w/ rapid or short acting insulin (ALWAYS PULL UP SHORTER ACTING ONE FIRST TO AVOID CONTAMINATION) - appears white and cloudy

Answer 84

Onset: 30 min Peak: 2-5 hr Nursing Care - covers insulin needs for meal within 30-60 minutes - only insulin that can be given via IV (usually for DKA in ICU)

Answer 85

Onset: 1-4 hr Peak: none Nursing Care - give once daily at same time each day - never mix with another insulin - never give IV (always give subQ)

Answer 86

Hypoglycemia - prevent w/ sliding scale checks Lipoatrophy (uneven tissue) and Lipohypertrophy (lumps of fatty tissue) - prevent by rotating sites within same area of body to also prevent change in absorption rates Dawn phenomenon - 5-6am rise in glucose due to cortisol release - Prevention: Check blood glucose at bedtime and adjust insulin accordingly

Answer 87

- Tremors and lack of coordination - restless and irritability - Blurred vision (temporary) - Seizures -> coma - Excessive hunger - Cold, clammy skin - Pallor - CNS decline (headache, confusion, fatigue, drowsiness, depression, dizziness, slurred speech) - SNS activation (tachycardia, diaphoresis, nervousness, palpitations)

Answer 88

- Trim nails trimmed straight across w/ clippers or emery board - Inspect and wash feet daily with mild soap and warm water - Test water temperature with the arms or a thermometer before washing feet. - Do not soak the feet. - Pat feet dry gently, especially between the toes, - Avoid lotions between toes to decrease excess moisture and prevent infection. - Use mild foot powder (powder with cornstarch) on sweaty feet. - Do not use commercial remedies for the removal of calluses or corns (can increase risk for tissue injury and infection) - Separate overlapping toes with cotton or lamb’s wool. - Do not use hot water bottles or heating pads to warm feet. (use socks) - Avoid prolonged sitting, standing, and crossing of legs.

Answer 89

- Avoid open-toe, open-heel shoes - Leather shoes are preferred to plastic. - Wear shoes that fit correctly. - Wear slippers with soles - Do not go barefoot. - Wear clean, absorbent socks or stockings that are made of cotton or wool - Wear socks at night if the feet get cold.

Answer 90

- less insulin needed if exercising - Exercise (150/min/week at least 3 sessions a week) - Only exercise if glucose b/w 80-250 mg/dL (check glucose prior to exercise) - Do not exercise if ketones in urine - Consume carbohydrate snack prior to exercise IF 1 hr since last eating and high-intensity exercise planned

Answer 91

- Illness and stress can increase glucose levels so continue insulin even if not eating - Monitor blood glucose q2-4 hrs - Monitor urine for ketones q3-4 hrs or if blood glucose > 240 mg/dL - Drink 8-12 oz (240-260 mL) of sugar-free, non caffeinated liquid every hr OR Drink fluids w/ sugar if blood glucose low - Meet carb needs w/ soft food or liquids 6-8 times a day (Soft foods: custard, cream soup, gelatin, graham crackers)

Answer 92

- watch protein levels if kidney involved (aim for 15-20% of diet) - Eat at regular times and do not skip meals - eat consistent amounts of food - Avoid alcohol - Increase fiber for carb metabolism and cholesterol control - artificial sweeteners encouraged - Low fat diet but include omega-3 fatty acids in diet - If NPO, may still need insulin

Answer 93

If responsive - Simple Carbohydrates (6 crackers, 2 graham crackers, 4 oz fruit juice, 4 oz 2% milk; glucose tablets) - repeat if hypoglycemia persists - If hypoglycemia resolved and next meal > 1 hr away, take snack w/ carb and protein If unresponsive or seizing - 1 amp (50ml) dextrose 50% (D5W) IV push or 1mg glucagon SQ - place lateral to prevent aspiration

Answer 94

- monitor glucose (risk for hyperglycemia w/ TPN; risk for hypoglycemia if no TPN) - If TPN stops, give D10 to prevent hypoglycemia - Monitor labs (albumin, prealbumin, glucose) - regularly assess IV b-c risk for phlebitis/ infection w/ high glucose - prevent hypoglycemia by call pharmacy prior to bag running out

Answer 95

* Diagnostic: Determines origin and cause of disorder (ex. biospy, arthroscopy) * Curative: Repairs or removes cause to resolve problem(ex. removal of organ or tumor) * Reconstructive: Improves functional ability of abnormal body structure (ex. total hip/knee replacement) * Palliative: Improves quality of life, but does not cure (ex. ileostomy, stents, thoracentesis) * Cosmetic: alters/enhances personal appearance (ex. rhinoplasty, face lift) * Preventative: Prevents condition from developing (ex. prophylactic bilateral mastectomy) * Transplantation: Replaces malfunctioning structure (ex. heart/kidney transplant)

Answer 96

Elective- Can be scheduled (ex. cataract removal, joint replacement) Urgent - Must be performed in 24 hrs (ex. obstruction, kidney stones, fracture, cholecystitis) Emergent - Life-threatening so surgery ASAP (ex. wound, severe bleeding, aortic aneurysm, compound fracture, appendectomy)

Answer 97

- Antibiotics given within 1 hour prior to surgical incision.(Vancomycin and Fluoroquinolones=2 hours) - Prophylactic antibiotics should be discontinued within 24 hours of anesthesia end time (48 hours for CABG patients) (Reason for continuing antibiotics > 24 hours after anesthesia end time (48 hours for CABG patients) must have a physician documented infection) - Appropriate hair removal (clippers vs razor)- prevents infection - Normal patient temperature (36.0 C or greater) within 30 minutes prior to or 15 minutes after anesthesia end time - If beta blocker in hx, must continue day before surgery/ day of surgery AND post op day 1/post op day 2 (If not given, contraindications must be documented) - VTE (DVT) prophylaxis must be applied/administered within 24 hours prior to anesthesia start time or 24 hours after anesthesia end-time. - Foley discontinued by post-op day 2 or obtain physician order for specific reason to continue foley. - Cardiac Surgery patients require Controlled Postoperative Blood Glucose levels less than or equal to 180 within 18-24 hours after anesthesia end time

Answer 98

- Medical history (including renal, musculoskeletal, cardiac, pulmonary dz.) b-c these can increase risk for complications - hx of prostheses (do not place electrocautery pads on these area)

Answer 99

- Latex allergy cross sensitivity w/ avocado, banana, kiwi, strawberry allergies - Propofol allergy cross sensitivity w/ egg, peanut, and soy allergy

Answer 100

- Family History- (malignant hyperthermia, cancer, bleeding disorder) - Prescription drugs/OTC - Complementary/alternative practices (herbals, folk remedies) - Alcohol - DT if abrupt withdrawal - Substance abuse, tobacco use, marijuana use - smoking can increase risk for pulmonary complications

Answer 101

- Prior surgical procedures and how these were tolerated (previous complications, may increase anxiety) - Prior experience with anesthesia (e.g., difficulty being aroused after surgery, ongoing nausea and vomiting) - Prior experience with postsurgical pain control

Answer 102

- Chest X-ray (identify pneumonia, TB, HF, cardiomyopathy if hx of respiratory problems) - Electrocardiogram/EKG (if hx of cardiac disease or > 40 yrs) - CT/MRI- May be done for back surgery

Answer 103

* Hypokalemia (digoxin toxicity, slower recovery from anesthesia, cardiac irritability) * hyperkalemia (dysrhythmias) * Positive pregnancy test result (or patient report of actual or possible pregnancy) * Increased prothrombin time (PT), international normalized ratio (INR), or activated partial thromboplastin time (aPTT)

Answer 104

- usually NPO (no clear liquid <2 hrs, no food < 6 hr) to prevent risk for aspiration - No eating, drinking, smoking (increases gastric secretions), chewing gum or oral meds - may give drugs for some conditions (Beta blockers, respiratory, anticonvulsants, antihypertensives) w/ sip of water - may continue subQ insulin to prevent DKA (other antidiabetics are held)

Answer 105

- shower or bath w/ antiseptic - Clipping of hair with electric clippers (no razor) - surgeon must mark site while patient conscious - large bore IV placed (for meds and blood if necessary in emergencies)

Answer 106

Surgeon role - explain procedure and get informed consent prior to procedure Nurse role - sign as a witness to the signature on consent (not to patient's understanding) - clarify facts as needed - not responsible for providing detailed info about procedure

Answer 107

- Pts who cannot write (sign w/ X and two witnesses) - Pt w/o competence (legal guardian, POA or Court appointed advocate gives consent) - Pt w/ blindness (can sign w/ two witnesses) - Pt w/ hearing impairment or different language (can sign w/ qualified translator and another witness) - Life threatening (can’t give consent, unable to contact person with medical power of attorney-written consultation with 2 independent HCP required)-- does not override living wills/ advance directives

Answer 108

S/s: sudden swelling or dull ache in calf of one leg Prevention - Antiembolism stockings (TED Hose) and Sequential Compression Devices (SCD) - Anticoagulants (enoxaparin, heparin) within 24 hrs and continue for 14 days - Leg Exercises (practice prior to procedure) - Early ambulation (stimulates venous return) - do not place pillows under knees b-c reduces circulation

Answer 109

- ID band (name, hospital number, birthdate) - Removal of clothing (may leave underwear and socks for some surgeries, dentures, jewelry, piercings - Removal of prosthetics (limbs, eyes) - Removal of all metal (i.e., hairclips, pins) - can cause burns w/ electrical current - Nail polish/artificial nails (at least one clean) - Empty bladder - to prevent incontinence or overdistention

Answer 110

- Nausea/vomiting (risk for increased ICP or IOP, abdominal irritation, aspiration) - GI ulcers/bleeding - paralytic ileus (due to anesthetics, bowel handling during surgery, opioids, or SNS excitation from stress) - Constipation (due to anesthesia, opioids, decreased activity, decreased oral intake

Answer 111

Complications - Hyper/Hypothermia - Nerve damage/paralysis - Joint Contractures Prevention - early ambulation (prevents joint rigidity)

Answer 112

Purpose - remove fluid, air, blood, bile - prevent deep infection and abscess formation Expectations - drainage goes from sanguineous to serosanguineous to serous - surgeon changes first dressing Nursing Care - circle, date, time drainage on dressings - secure drains to pt's gown and not sheet or mattress

Answer 113

- Ask someone to notify Surgeon b-c SURGICAL EMERGENCY - Stay with patient and calm them - Do not attempt to reinsert the organ - Cover wound with pre-moistened saline non-adherent dressing or Moisten sterile gauze with sterile saline (STERILE TECHNIQUE) - Keep dressings moist (do not let dressing dry out) - Place supine position with hip and knees bent - HOB elevated 15-20 degrees - Pt NPO until issue resolved

Answer 114

* Explain procedure and verify consent given * Document patient allergies * Patient is NPO 4-8 hrs prior to procedure (and 2 hrs after until gag reflex returns) to prevent aspiration * Benzos or opioids given for sedation

Answer 115

Use: topical anesthetic used cautiously to numb oropharynx Complication: methemoglobinemia (conversion of hemoglobin to methemoglobin which does not carry oxygen so leads to tissue hypoxia)—less likely with lidocaine S/s: cyanosis after topical anesthetic, no response to supplemental oxygen, blood is chocolate-brown color Treatment: oxygen and IV of 1% methylene blue

Answer 116

- Positioning (HOB elevated, orthopneic ) - Effective and controlled coughing ( scheduled coughing in morning, prior to bed, and at meals) - Exercise conditioning (2-3 times a week of walking; resistive breathing, isocapnic hyperventilation machine) - Suctioning (only if weak cough, pulmonary muscles or inability to expectorate) - Hydration ( 2L of fluid a day)

Answer 117

* Collab w/ RDN for easy to chew and non-gas forming foods * High calorie, high protein * Plan biggest meal of day when pt most hunger and well rested * 4-6 small, frequent meals preferred to 3 large meals * Use breathing techniques and bronchodilators 30 minutes prior to meal to reduce bronchospasm * Avoid dry foods that stimulate coughing * Avoid caffeine that can increase urine output and lead to dehydration * Avoid drinking fluids before or during meals if early satiety

Answer 118

* Avoid rushing in morning b-c can increase dyspnea * Use energy conservation (plan and pace activities for best tolerance and minimum discomfort i.e. divide activities into smaller parts) * Avoid working w/ arms raised (raised arms reduce exercise tolerance b-c accessory muscles work to keep arms up instead of helping w/ breathing) * Do not talk during activities requiring energy (walking) * Avoid breath holding while performing any activity

Answer 119

- Presence of moderate to large urine ketones or ketonuria for more than 24 hr - Blood glucose > 250 mg/dL that does not resolve with treatment - Fever > 38.6° C (101.5° F), does not respond to acetaminophen, or lasts more than 24 hr - Feeling disoriented or confused - Experiencing rapid breathing - Persistent NVD - Inability to tolerate liquids - Illness >2 days

Answer 120

- Breathing exercises (expansion breathing, diaphragmatic breathing) - Incentive spirometry (seal lips, inhale, hold 3-5 sec, exhale to promote lung expansion) - Coughing and splinting (w/ bath blanket or pillow) q1-2 hrs (contraindicated in some surgeries) - give older adult low dose oxygen first 12-24 hrs - monitor O2, lung sounds q2-4 hrs for first 24 hr - positioning (side lying or semi fowlers) - suction PRN - early ambulation (lung expansion; turn q2h)

Answer 121

- If RR <10 breaths/min, may be anesthetic or opioid analgesic-induced respiratory depression - If rapid, shallow respirations, may be shock, cardiac problems, pain, increased metabolic rate - stridor or snoring may be due to airway obstruction - accessory muscle use may be excess anesthesia, airway obstruction, paralysis - spO2 < 95%

Answer 122

- assess LOC, awareness, motor/sensation, DTRs - If received sedation or general anesthesia in ambulatory setting, need another adult to drive them home

Answer 123

- Eye opening to command = arousability and wakefulness but not aware - back pain while coughing or straining = may be epidural hematoma - occipital headache = postdural puncture headache) - nuchal rigidity, high fever, acute confusion = meningitis

Answer 124

- give medication (ondansetron and dexamethasone) - Positioning (side-lying position, raise HOB)

Answer 125

- auscultate bowel sounds (no flatus or stool = paralytic ileus) - NGT insertion to decompress stomach - hydration (dehydration can decrease GI motility) - early ambulation (stimulates intestinal motility) - non opioid pain management - alvimopan – accelerates the time for GI recovery after some GI surgeries - metoclopramide- promotes peristalsis via stimulation of GI motility

Answer 126

- increased fiber - enemas - mild laxatives and bulk forming agents - hydration

Answer 127

- Decreased BP, pulse pressure, abnormal heart signs = cardiac depression, fluid volume deficit, shock, hemorrhage, effects of drugs - Increased pulses = hemorrhage, shock, pain - Pulse deficit (difference b/w apical and other pulses) = dysrhythmia - Bradycardia = hypothermia, anesthesia effect

Answer 128

- Urinary retention may be from pre-op drugs (atropine), anesthetics, manipulation during surgery - Report urine output of <30 mL/hr (may indicate hypovolemia or renal complications)

Answer 129

- check dressing and drainage (color, amount, consistency, odor) - change dressing w/ aseptic technique - splint incision to prevent evisceration or dehiscence - early ambulation (relieves pressure) - assess site prn or every shift for warmth, redness, drainage

Answer 130

- Large amount of sanguineous drainage = poor clotting and internal bleeding - Serosanguineous drainage after 5th day or increased amount = dehiscence sign - redness or swelling around incision, excess tenderness or pain on palpation, purulent odorous drainage = surgical site infection

Answer 131

* Hypoxemia (leads to polycythemia) * Acidosis (r/t CO2 retention and hyperinflation) * Respiratory infection (due to increased mucus; *pneumonia and influenza vaccines important*) * Cor pulmonale (right sided heart failure due to pulmonary disease leads to right ventricular hypertrophy and backup of blood into venous system; S/s: dependent edema) * Dysrhythmias (due to hypoxemia, drug effects, acidosis) * Respiratory Failure

Answer 132

- Fecal Impaction - Peritonitis (infection of peritoneal cavity) - Septic shock - Intra-abdominal pressure (Acute compartment syndrome)- esp if strangulated - perforation of intestine

Answer 133

- removes the sigmoid colon, rectum, and anus through combined abdominal and perineal incisions Indications: tumor, diverticulitis, bowel obstruction Nursing Care - NGT decompression until peristalsis returns post-op - examine stoma, skin around stoma - Assess the pouch system for proper fit and signs of leakage - Assess for signs of complications (unusual bleeding OR ischemia/necrosis (dark red, purplish, or black color; dry stoma)

Answer 134

- should be red pink, painless (black or purple = bad) - Protrudes 3 cm from abdominal wall (prolapse if more and treat like evisceration) - Functions in 2-3 days - heals in 2 months - Surrounding skin around should be intact, smooth, w/o redness or excoriation (no folliculitis or dermatitis)

Answer 135

- Hematochezia (bright red stools) -- lower GI bleed - Melena (black, tarry, or dark red sticky stools) - Upper GI Bleed (Dark blood) - shock (low hct/hgb, low BP, high HR, weak pulses) - dizziness, confusion, vertigo, syncope

Answer 136

- sudden sharp mid-epigastric pain spreads over abdomen (often radiates to right shoulder - peritonitis (infection w/ tender, rigid, boardlike abdomen AND rebound tenderness)- fetal position for relief - Shock manifestations (hypotension, tachycardia, dizziness, confusion)

Answer 137

* Use barrier skin cream * Empty pouch when 1/3 to 1/2 full * Assess stoma and change wafer and pouch weekly (wafer 1/8th wider than stoma) * Caution w/ high fiber foods b-c can cause gas and odor

Answer 138

Therapeutic Effect - controls viral replication to reduce viral load in 4 weeks and increases T-cell count - U=U (undetectable viral load (< 200 for > 6 months) = untransmittable via sex) Preparation - genosure resistance paneling (determine hypersensitivity to drugs to determine what to use

Answer 139

Initial Exposure Primary HIV (acute): flu-like symptoms within 4 weeks; antibodies in 1-6 months Asymptomatic HIV (seropositive): infectious but no evidence except positive HIV antibody test Symptomatic HIV: can be 10 yrs after initial exposure AIDS: diagnosis made if T-cell count is ever < 200 OR less than 14% OR opportunistic infection (diagnosis remains forever)

Answer 140

ELISA 1st generation (1980s): IgG 2nd generation (1991): IgG 3rd generation (1992): IgM & IgG Note * 1st-3rd gen need western blot after if positive b-c can indicate influenza as well * takes 3 months for antibodies to appear after antigen * takes 14-21 days for antibody to be detected and then 7 days for western blot to confirm

Answer 141

Process - Detects ANTIGEN & ANTIBODY via antigen/antibody immunoassay - If positive, use antibody differentiation immunoassay - If antibody differentiation immunoassay is negative or indeterminate, use nucleic acid test to determine if acute HIV infection (RNA present) Timing - detects HIV-IgM and IgG antibodies (positive in 21 days) - detects presence of p24 antigen (HIV capsid protein which is positive in 14 days)

Answer 142

- Parenteral (needle sharing; contaminated equipment w/ blood) - Perinatal (vertical; from placenta due to contact w/ maternal blood and body fluids or breast milk) - sexual (genital, oral or anal b-c exposure to mucous membranes) - esp. anal or male-to-female

Answer 143

Indication: use of HIV Antiretroviral drugs by HIV-uninfected adult to prevent infection Routine - once daily w/ prescription - Protection starts after 7 days of consistent dosing (can miss one and be okay; if miss > 2, need to wait 7 days for protection again) Concern: Black box warning for severe acute exacerbation of hep B Testing * Blood and urine testing plus liver and kidney function (test kidney q3 months) * other STI tests, hepatitis test * 4th gen HIV antigen/antibody testing to ensure HIV negative b-c not for HIV positive

Answer 144

* Standard Precautions (gloves for body fluids) * If sharps related; first wash wound for 1 full minute then contact employee health * If you perform exposure-prone procedures, know your HIV antibody status.

Answer 145

Indication: occupational exposure (sharps, body fluids of HIV positive pt w/ blood, broken skin or mucus membranes of HCP), nonoccupational exposure (consensual sexual exposure w/ person of unknown HIV status OR sexual assault) Routine - 3 drug regimen within 2-36 hrs of exposure for 28 days OR until HIV status negative - no prescription needed Testing - Periodic HIV testing at 1, 3, and 6 months - CBC, electrolytes, creatinine tests done 2 weeks after starting cART

Answer 146

Process - Measures actual amount of HIV viral RNA particles in 1 mL of blood to measure therapy effectiveness - positive within 10 days of exposure - takes 14 hrs for test to process Results * Uninfected adult: no viral load * Positive load: as little as 20 particles/mL or > 1 million particles/mL * Higher the load, higher risk of transmission Concern: some immune systems may suppress viral replication and cause false low; so 4th gen testing needed alongside viral load testing

Answer 147

Cause - Seen when CD4+ T-cell count rises, and immunity normalizes then becomes exaggerated - Result of T-cell recognizing opportunistic infections (esp TB) and sounding alarm about them s/s: inflammatory reaction (high fever, chills, maybe worsened disease) Treatment: short-term therapy w/ corticosteroids (Ideally treat Opportunistic infections prior to starting cART)

Answer 148

* Do not stop taking drugs or change therapy once viral load decreases b-c drugs are not a cure * Must take drugs correctly 90% of time (9 out of 10 doses on time and correct) - Do not miss, delay, or take lower than prescribed dose * Drug resistance r/t missed doses causing new resistant viral particles (Once resistant to a drug, that drug no longer able to be used b-c resistant virus is archived indefinitely in body) * many drugs cause liver toxicity (report to HCP any jaundice, NV, abdominal pain) * If pregnant, check w/ HCP because some drugs cause birth defects but other drugs can help reduce transmission to baby

Answer 149

* Temperature > 100° F (37.8° C) * Persistent cough (with or without sputum) * Pus or foul-smelling drainage from any open skin area or normal body opening * Presence of a boil or abscess * Urine that is cloudy or foul smelling or that burns on urination

Answer 150

* Avoid crowds and other large gatherings of people. * Do not share personal articles such as toothbrushes, toothpaste, washcloths, or deodorant sticks. * If possible, bathe daily, using an antimicrobial soap. If total bathing is not possible, wash the armpits, groin, genitals, and anal area twice a day with an antimicrobial soap. * Clean your toothbrush at least weekly by either running it through the dishwasher or rinsing it in liquid laundry bleach (and then rinsing out the bleach with hot running water) * Wash your hands w/ antimicrobial soap before you eat or drink, after touching a pet, after shaking hands with anyone, as soon as you come home from any outing, and after using the toilet. * Avoid eating or touching undercooked meat, fish, and eggs. * Wash dishes between use with hot, sudsy water or use a dishwasher. * Do not change pet litter boxes or play in gardens. If unavoidable, use gloves and wash hands immediately. * Avoid turtles and reptiles as pets. * Take your temperature at least once a day and whenever you do not feel well. * Avoid travel to areas with poor sanitation or primitive health care facilities

Answer 151

Thrombotic - Location: atherosclerosis of carotid and cerebral arteries esp bifurcation of carotid - Onset: slow and gradual w/ gradual progression of deficits Embolic - Location: clot breaks off and travels to cerebral arteries esp. due to a-fib - onset: sudden w/ immediate neurologic deficits

Answer 152

Vasospasms - causes constriction of cerebral artery leading to decreased blood flow at distal areas - can lead to subsequent strokes or seizure activity due to ischemia to cerebral tissue - within 4-14 days after stroke occurrence

Answer 153

Implication - high risk drugs that can cause bleeding included IC hemorrhage - aspirin (325 mg enteric coated) given within 24-48 hours of onset of stroke

Answer 154

Implication - relaxes smooth muscles of vessel walls - given to reduce incidence and severity of vasospasm rather than for HTN

Answer 155

Time - give within 3 hrs of initial stroke symptoms to reduce severity of neurological deficits in ED - can be given in 4.5 hrs sometimes Risks - bleeding esp IC hemorrhage

Answer 156

Facial Drooping Arm Weakness Speech Difficulty Time to call 911

Answer 157

- seen within 10 minutes in ED for stroke like symptoms (hx should not delay treatment) - glasgow and NIHSS assessments done routinely for patients admitted w/ stroke - Rule out pathophysiological causes (hypoxia and hypoglycemia)

Answer 158

- confusion (trouble speaking or understanding others) - numbness or weakness of the face, arm - trouble seeing in one or both eyes - dizziness, trouble walking, or loss of balance or coordination - severe headache with no known cause (esp. aneurysm r/t) - embolic stroke: new-onset heart murmur, dysrhythmias, HTN - hemorrhage subarachnoid: NV, photophobia, stiff neck, CN deficits

Answer 159

- decreases of 2 or more points on Glasgow coma scale - posturing (flaccid or extension) - pinpoint, dilated or nonreactive pupils - sudden changes in mental status (earliest sign of change in neurological status)

Answer 160

- Present one thought in a complete sentence - give one-step command - Face client and speak slowly NOT loudly - Repeat names of objects used on routine basis - Avoid yes/no questions b-c - patients may give automatic but incorrect responses to yes/no question - Use alt communication (flash cards, computer, picture or communication board) - do not rush patient when speaking

Answer 161

- right hemisphere = hemplegia to left side of body - left hemisphere = hemiplegia to right side of body - decreased blood flow to brainstem = total paralysis (quadriparesis) - Weakness (facial droop, arm or leg drift, hand grasp) - Ataxia (lack of muscle control and coordination affecting gait, balance, and ability to walk)

Answer 162

- VTE protocol (SCDs, position changes, ambulation) - assess patient's ability to perform ADL in home-setting - be aware of patient's extremities (do not pull) - position arm on pillow to prevent shoulder dislocation/subluxation - instruct all staff working with patient about any deficits in mobility to prevent harm to patient (no pulling affected extremity)

Answer 163

- Maintain NPO until SLP screen - Assess for gag reflex w/ small liquid - Assess mouth for increased drooping/drooling - Position patient upright before feeding/eating - Check diet orders (soft, mechanical soft thickened liquids) b-c thin cause more coughing) - Place food in back of mouth to prevent trapping in cheek - Monitor for s/s of aspiration (coughing, dyspnea, crackles) - stop feeding if patient coughs

Answer 164

Sensation - Numbness (Decreased sensation) - Unilateral Neglect (unaware of affected side) - vertigo Visual (r/t brainstem damage) - Ptosis (eyelid drooping) - Hemianopsia (blindness in half of visual field) - Nystagmus - tunnel vision - diplopia (double vision) - blurred

Answer 165

Visual - If pt has diplopia (double vision), patch over affected eye and change q2-4 hrs - place objects in visual field including yourself - If hemianopsia, patient should turn head back and forth to scan full visual range - patient should dress affected side first Memory - Establish structured, repetitious, and consistent routine - If memory problems, orient pt to month, year, day of week, and circumstances surrounding hospitalization

Answer 166

- Increased restlessness, irritability, and confusion - Headache - Projectile NV - Systolic BP >180 mm Hg /Diastolic BP > 110 mm Hg (OR sudden increase in BP - Change in speech pattern, dysarthria, aphasia - Sensorimotor changes (CN dysfunction, Ataxia) - Seizures (usually within first 24 hours after stroke)

Answer 167

- stay with patient and remain calm - prevent aspiration and keep airway clear (side-lying) - Make note of seizure (date, time, duration; characteristics) - call for another RN to get the antiepileptic drugs - Do not force anything into the patient’s mouth. - Remove any objects or restrictive clothes that might injure the patient. - Suction oral secretions if possible without force. - Do not restrain or try to stop the patient’s movement; guide movements if necessary.

Answer 168

- Unilateral neglect or inattention r/t hemianopsia - Lack of proprioception/body sense (unable to distinguish left/right or up/down) - problems w/ depth and distance perception - Disoriented to time and place - Personality changes (impulsivity and poor judgment)

Answer 169

- deficits in analytical skills - speech deficits (Aphasia (receptive, expressive or mixed), Dysarthria) - Apraxia (slow, cautious, hesitant behavior style) - personality changes (lacks initiative and anxious)

Answer 170

* Age older than 80 years * Anticoagulation therapy regardless of INR * Imaging evidence of ischemic injury w/ > 1/3 of the brain tissue supplied by the middle cerebral artery * Baseline NIHSS score > 25 * History of both stroke and diabetes * Evidence of active bleeding

Answer 171

- informed consent needed - given within 45 min of ED arrival - nurse monitor vitals before, during, and after admin (esp. BP) - q10-15 min during; q30 for 6 hrs after; q1h for 24 hr - If BP > 185/110 mm Hg, give IV antihypertensive (labetolol) before and throughout alteplase admin to maintain BP < 185/110 mm HG - avoid other invasive tubes (NG or catheters) until pt stable to prevent bleeding - 24 hrs - discontinue if NV, severe headache or severe HTN

Answer 172

Earliest sign - Decreased LOC-- earliest indicator Late signs - Pupillary changes: dilated and nonreactive pupils (“blown pupils”) or constricted and nonreactive pupils (very late sign) - Cushing triad (very late sign): Severe HTN, Widened pulse pressure, Bradycardia - Abnormal posturing (very late sign): Decerebrate or Decorticate

Answer 173

- ask HCP before taking any drugs (Oral contraceptives, OTC drugs) - wear medical identification bracelet, necklace, ID card - Avoid alcohol and excessive fatigue. - Avoid warfarin and phenytoin - Avoid grapefruit juice b-c can increase chance of drug toxicity

Answer 174

- Stroke - Brain Tumor - Trauma (head injury) - Metabolic disorders - Electrolyte disturbances - High fever (mainly children) - Substance abuse (acute alchol withdrawal)

Answer 175

* Hemorrhage esp in 24 hrs post-op serosanguineous drainage = normal * Respiratory distress (s/s laryngeal stridor, tracheal compression from hemorrhage) need suction, emergency trach, oxygen * Laryngeal nerve damage (s/s hoarseness and weak voice) * Thyroid storm (high fever, tachycardia, severe HTN)- uncommon * Parathyroid gland injury (hypocalcemia and tetany) need rescue calcium gluconate or calcium chloride

Answer 176

- Increased neuromuscular excitability; tingling, muscle spasm (particularly in hands, feet, and facial muscles), convulsions, tetany - intestinal cramping - hyperactive bowel sounds - prolonged QT interval -> cardiac arrest

Answer 177

- Monitor labs b-c treatment can induce hypothyroidism - Thionamide to induce euthyroid prior to surgery. - Iodine preparations to decrease thyroid size and vascularity (reduces risk of hemorrhage and thyroid storm) - Control HTN, dysrhythmias, tachycardia - High-protein, high-carbohydrate diet for weeks or days prior

Answer 178

* Monitor for complications (Monitor VS q15 minutes until stable then q30 minutes) – most important action (Temp increase of 1 F (1.8C) = thyroid crisis) * Assess level of discomfort and give pain meds. * Use pillow or hands to support neck and head (avoid neck extension) * Place in semi-fowler * Deep breath every 30 min to 1 hr. * Lifelong thyroid hormone replacement if total thyroidectomy

Answer 179

* Identify tools to mitigate errors, manage knowledge * Apply principles of life-long learning * Value nurse’s ability to identify, analyze, and participate in decision making process. * Recognize and embrace technology as data storage, collection, outcome monitoring and line of defense.

Answer 180

* Embrace change. * Drive technology * Consistent policy * Consistent advocacy * Share best practice * Evidence based practice * Intelligent solutions * Affordable and universal solutions

Answer 181

Nursing Diagnoses, Definition, and Classification (NANDA) - Communication method w/ nursing diagnostic labels - Differentiates nurse from physician (independent practice of nurse) Omaha system - 3 components * assessment (Document needs and strengths of clients) * intervention (multidisciplinary, research-based) * evaluation (measure client outcomes)

Answer 182

Nursing Intervention Classification (NIC) system * Interventions nurses do on behalf of clients * 7 domains: physiological, complex, behavioral, safety, health system, family, community Nursing Outcomes Classifications (NOC) system * Evaluates effect of nursing interventions * 7 domains: functional health, physiologic health, psychosocial health, health knowledge and behavior, community health, perceived health, family health

Answer 183

Nursing Management Minimum Data sets (NMDS) * Quantifies and qualifies nursing care * Elements: nursing care, service (unique identifiers), demographics Systematized Nomenclature of medicine (SNOMED) * Multilingual to provide consistent and uniform data worldwide National Database of Nursing Quality Indicators (NDNQI) system * Analyzes nursing care across different facilities to identify units w/ more incidents * monitors Nurse-sensitive outcomes (ex. Falls, ventilator-associated pneumonia, hospital acquired pressure ulcers, UTIs)

Answer 184

American recovery and reinvestment Act (Part A: Health Information Technology for Economic and Clinical Health (HITECH); Part B: financial incentives for EHR adoption) HIPPA * Established consequences of violating confidentiality. * Proper handling of electronic info: automatic signoffs, alarm motor devices, hierarchal and unique passwords, fax machines and shredders in secure areas * Never discuss client info in public OR w/ team members not involved in the patient’s care Technology Related Assistance for Individuals with Disabilities Act (AT act) * Ex. of assistive technology: screen readers, text-to-speech, text w/ symbols, auto summaries

Answer 185

A. Embedded medication alerts B. Immediate Access to digital x-rays. C. Use of phones that connect directly D. Integration of telehealth

Answer 186

B. Health Information Portability and Accountability Act (HIPAA)

Answer 187

B. Installing bar codes on medications with alerts for low supplies

Answer 188

B. Use an electronic drawing screen allowing the client to create pictures during an assessment.

Answer 189

B. Electronic collection of healing times of sacral wounds post-hyperbaric treatment, with and without antibiotic administration

Answer 190

A. Using translation software for a Spanish-speaking client who has a new diagnosis of acute renal failure C. Supplying the link to a website with a video demonstrating home care for a client after a knee arthroplasty D. Explaining the use of automatic email reminders to increase medication compliance E. Accessing an iPad to review side effects of medications with a client

Answer 191

I. have a higher percentage of hospital-acquired infections.

Answer 192

C. Delete the photo.

Answer 193

B. Agency for Healthcare Research and Quality (AHRQ)

Answer 194

C. Texting a picture of a client's wound from one nurse to another nurse related to wound care protocol

Answer 195

- Acetaminophen (Tylenol) drug of choice b-c noninflammatory - Topical analgesics (lidocaine, capsaicin) - Muscle relaxants for muscle spasms - Glucosamine (decrease inflammation) - Chondroitin (strengthening cartilage) - NSAIDs (diclofenac, Celecoxib)- temp relief - opioids (tramadol) - w/ caution b-c acute confusion risk

Answer 196

- Unilateral Synovitis (painful, red, warm, swollen joint AND stiff) - Crepitus (grating sound due to loosened bone and pieces of cartilage in synovial joint) - Heberden's nodes(distal) - Bouchard’s nodes(proximal) - Joint effusions (excess joint fluid) - Atrophy and contractures of skeletal muscle r/t disuse - Osteophytes (bone outgrowths)

Answer 197

- Rest (job change if repetitive work) - Positioning (Immobilization in functioning position) - Cold application fo synovitis - Heat application for pain, spasm, stiffness (15–20-min) - Weight Control to decrease stress on joints - Exercise (swimming, cycling, walking > running)

Answer 198

Hip dislocation - S/s: sudden difficulty bearing weight on the surgical leg, leg shortening or rotation, or a feeling that the hip has “popped” with immediate intense pain. - Keep legs abducted w/ abduction pillow to prevent leg crossing - Turn on unaffected side Neurovascular compromise - check 5 P’s (pulselessness, pallor, paresthesia, pain, paralysis) Venous Thromboembolism (to pulmonary embolism) – Main complication (PAC prevention) - subQ enoxaparin preferred for 10 days (contraindicated in the arm; must be deep abdomen) - ambulate 3x a day then SCDs Infection (surgical site, pneumonia, or sepsis) - Assess temp, WBC, incision, confusion q4h - Temp elevation 1-2° C post op can be problem and need to contact surgeon - do prophylactic antibiotics and CHG wipes

Answer 199

- Assess for infection (osteomyelitis), hemorrhage, neuroma, phantom pain, body image - proper positioning and active ROM to prevent flexion contractures - Assess perfusion (Popliteal pulse if BKA or Femoral pulse if AKA) - Reinforce dressing if bleeding - Refer to site as residual limb vs stump - PT wraps in figure 8 to shape and shrink residual limb for prosthesis fit - Manage phantom pain w/ AEDs (gabapentin, pregabalin) or antispasmodics (baclofen)

Answer 200

- - bilateral and symmetric Joint stiffness/pain triggered by stress, illness - Joint inflammation (Proximal interphalangeal (PIP) and Metacarpophalangeal (MCP)) - Generalized weakness and fatigue - Persistent Low-grade fever - Anorexia then Weight loss of 2-3 lb. - Paresthesia

Answer 201

- Deformities (boutonniere deformity of thumb, ulnar deviation of metacarpophalangeal joints, swan-neck deformity of fingers) - Severe inflammation and pain (TMJ or cervical joints involved) esp stiffness in morning - Fluid accumulation (hand, knees (bakers cysts)) - Sjogren syndrome (dryness in eyes, mouth, vagina) - Osteoporosis - Peripheral neuropathy - Vasculitis (Ischemic skin lesions (small, brownish, spots esp. on nail bed) - Cardiac complications (pericarditis, myocarditis) - Respiratory complications (pleurisy, pneumonitis, diffuse interstitial fibrosis, pulmonary hypertension, Fibrotic lung disease, felty syndrome) - Eye involvement (iritis, scleritis; reddened sclera or irregular shaped pupil) - Kidney disease

Answer 202

Use: RA Action: slow progression in 4-6 weeks Care - Avoid crowds and ill individuals - Monitor for elevated liver enzymes and serum creatinine - Avoid alcohol - Take folic acid to decrease side effects - do not take hydroxychloroquine if known cardiac disease or dysrhythmias.

Answer 203

Use: RA Action: slow progression via neutralizing biologic activity of tumor necrosis factor–alpha (TNFA), interleukins (IL), T-lymphocytes, or tyrosine kinase (TK) to decrease immune response and inflammation Care * Do not take if serious infection, TB, or MS b-c may exacerbate these problems. * avoid getting live vaccines. * avoid crowds and people with infections

Answer 204

- bone marrow suppression - pneumonitis (acute dyspnea and lung inflammation) - lymphoma - teratogenic (discontinue methotrexate 3m prior to pregnancy) - retinal damage - hydroxychloroquine (need eye exam q6m)

Answer 205

- Modifying Antirheumatic Drugs (DMARDs) – Methotrexate (Rheumatrex), Hydroxychloroquine (Plaquenil) - NSAIDs- for inflammation and pain - Biologic Response Modifiers (BRMs)- Etanercept (Enbrel), Rituximab (Rituxan), Adalimumab (Humira) - Glucocorticoids (Deltasone (Prednisone)) - decrease inflammation - Immunosuppressive Agents - Azathioprine (Imuran), Cyclophosphamide (Cytoxan)

Answer 206

- Thoracic kyphosis/ cervical lordosis - Reduced height (2-3 in in 20 yrs) - Acute sharp back pain after lifting/bending - Restricted movement (causing constipation, reflux, respiratory compromise) - Spontaneous Fractures r/t bone demineralization (esp. vertebrae, wrist, hip) - Frequent falls -> fear of falling

Answer 207

Use: osteoporosis or hypercalcemia prevention and treatment Action: slows bone resorption by binding with crystal elements in bone esp. spongy, cancellous bone tissue Contraindications - poor renal function - hypocalcemia - GERD - aspirin sensitivity (b-c can cause bronchoconstriction)

Answer 208

- esophagitis (esophagus ulcers or gastric ulcers) -> esophageal cancer - jaw osteonecrosis (need dental exam prior to starting) - a-fib (if fast IV) - acute kidney injury - severe musculoskeletal pain

Answer 209

- Take on empty stomach w/ full glass of water - Sit upright for 30-60 minutes after taking - has lifetime limit (2 yrs if bone loss maintained or density increases; 5 yrs otherwise) - let dentist know they are taking bisphosphonate prior to invasive procedures - give slow IV (over 25-30 min) to prevent a-fib

Final Flashcards

(233 cards)