1
Q
generalized osteoporosis
primary
secondary
A
- a bit longer and more complex
- multiple structures
- causes: anemic states, drugs (steroids/heparin), dietary deficiency (scurvy, malnutrition, calcium
- both primary and secondary fall under this.Primary occurs in postmenopausal woman and in **70-80 year old men. Secondary results from past medical conditions. Prolonged mobility from spinal cord damage
- ***long term corticosteroid use
2
Q
regional osteoporosis
A
- *Also caused localized
- *Affects 1 bone or area
- *Traumatic fracture
- Characterized by arthralgia which migrates between the weight bearing joints of the lower limbs
- Causes: immobilization and disuse, reflex sympathetic dystrophy syndrome, transient regional osteoporosis (transient regional osteoporosis of the hip, regional migratory osteoporosis
- ***Decreased mobility for longer than 8-12 weeks can result from this type
3
Q
modifiable risk factors for osteoporosis
A
smoking
-more than 2 - 3 drinks alcohol
little to no exercise
High volume intake of carbonated drinks
4
Q
nonmodifiable risk factors
A
gender small framed/thin menopause **Protein deficiency **estrogen **Chronic low calcium or vitamin d
5
Q
diagnostic test for osteporosis
A
- Doctor will order bone density scan - measures bone mineral density
- BMD assessment by a DXA (dual energy xray absorptiometry) - measures bone mineral density
- Ct- can measure volume of bone density and strength of vertebral spine
6
Q
pharmacological management for osteomyeltis
A
4-6 weeks antimicrobical therapy more than 1 prescribed given at specific intervals to maintain therapeutic serum levels zoysn central line
7
Q
non pharm management for osteomyelitis and stump
A
mrsa precautions
stump elevation
line prone for 15 mins four times a day
hypobaric oxygen therapy
8
Q
E.B. asks you “What do they do with my leg after it is removed?” How do you respond?
A
It’s your choice on what you wish to happen after it is amputated. Some cultures decide to have the amputation stored for later burial or buried immediately. Other times, it can be donated for scientific research, or sent to biohazardous waste and is cremated.
Culturally component nursing care
9
Q
interventions for healing a stump
A
- Promote mobility as tolerated
- Assess for adequate tissue perfusion and hemorrhaging (pinkish color, warm but not hot)
- Vital signs, specifically pulses near the amputation site
- Monitor and treat pain
- Assess psychosocial needs (body image issues)
- Maintaining a healthy diet
- Exercise
10
Q
phantom limb pain
A
Phantom limb pain, although the limb is gone the nerve endings at the site of the amputation continue to send pain signals to the brain that make the brain think the limb is still there. Finding a treatment to relieve phantom pain can be difficult. Doctors usually begin with medications such as over-the-counter pain relievers, antidepressants, anticonvulsants, narcotics, NMDA receptor antagonists. Doctors may then add noninvasive medical therapies such as mirror box, acupuncture, repetitive transcranial magnetic stimulation, spinal cord stimulation. Surgery may be an option if other treatments haven’t helped, the only surgical option is brain stimulation.
11
Q
four major complications of acute fractures
A
infection
acute compartment syndrome
vte
fat embolism
12
Q
infections cm fracture
A
fever, high WBC, chills and sweats, SOB, inflammation, swelling
13
Q
acute compartment syndrome
A
pain due to reduced perfusion: pain severe despite being medicated, which causes further ischemia. Sensory perception deficits and paraesthesia. Pale color due to low perfusion and weak pulses. Cyanosis, tingling, and numbing can occur if not treated.
14
Q
vte cm fracture
A
SOB, rapid breathing, chest pain upper rib cage, heart rate increases, leg pain or tenderness of the leg or calf, edema to the LE
15
Q
fat embolism cm fracture
A
Dyspnea, increased RR, decreased o2 sat, tachycardia, confusion, chest pain
16
Q
delayed union
A
Fracture takes longer than usual to heal (longer than 6 months)
17
Q
nonunion
things to help
A
Fracture that never heals
- Electric bone stimulation and bone grafting can treat
- Low intensity pulsed ultrasound can promote healing to treat
- Can occur more frequently in older adults due to impaired healing process
- Can cause immobilizing deformity of the bone involved
18
Q
malunion
A
Fracture heals incorrectly
Can cause immobilizing deformity of the bone involved
19
Q
nonpharmacological interventions osteoarthritis
A
**Rest
**Balanced rest with exercises
Elevation ( only small pillows) slightly bent if not created flexion contractures
Diet
**Loose weight
**Brace (assistive devices)
**Thermal modalities and or ice ( whichever provides more relief)
**Keep extremity in function/ dependent positon
- cyrotherapy
20
Q
exercise plan osteoarthritis
A
- Start with short walks (aerobic), then make the walks longer distances or a quicker pace. Pay close attention to how the joint feels and what level of pain they are experiencing.
- National guidelines recommend 150 minutes per week (spaced out) of moderate intensity physical activity, plus 2 strength training sessions/ week. Examples include: brisk walking, slow biking, general gardening, and ballroom dancing
21
Q
pain meds for osteoarthitis
A
tylenol, lidocaine, tramadol, glucosamine with chondroitin
22
Q
rheumatoid factor clinical significance
A
Rheumatoid factor: measures the presence of unusual antibodies of the immunoglobulins G (IgG) and M (IgM) types that develop in a number of connective tissue diseases: many patients have an RA have a positive titer
23
Q
antinuclear antibody clinical significance (RA)
A
- measures the titer of a group of antibodies that destroy the nuclei of cells and cause tissue death in patients with autoimmune disease.
- If this test result is positive (a value higher than 1:40), various subtypes of this antibody are identified and measured.
24
Q
invasive diagnostic of ra
A
arthrocentesis
- invasive diagnostic procedure that may be used for patients with joint swelling caused by excess synovial fluid (effusion). Done as a diagnostic procedure. Can be done as a treatment modality
- The provider inserts a large-gauge needle into the joint (usually the knee) to aspirate a sample of synovial fluid and to relieve pressure caused by excess fluid. The fluid is analyzed for inflammatory cells and immune complexes, including RF. Fluid from patients with RA typically reveals increased WBCs, cloudiness, and volume.
- Patient nursing considerations are to teach the patient to use ice and rest the affected joint for 24 hours after arthrocentesis. Often the primary health care provider will recommend acetaminophen as needed for discomfort.
25
bucks traction
Buck’s traction is meant to keep the leg in an extended position by means of a longitudinal skin traction applied in one direction with a single pulley. This system is meant to help with fractures, realigns bones, helps correct contractures or deformities and is meant to immobilize the knee
26
bucks traction nursing considerations
- ensure that the weight bag is hanging freely, to not have the bag rest on the floor, if the rope becomes frayed, it must be replaced, the nurse should ensure that the rope is on the pulley track, and the nurse should make sure the bandages are free from wrinkles.
- Pulling force, pulls bones apart, decrease inflammation and destruction because bones are not being rubbed against
- (Buck) traction may be applied before surgery to help decrease pain associated with muscle spasm.
- Don't remove weights until surgery or physician order
27
early s/s of ra
```
Joint inflammation
Systemic low-grade fever
Fatigue
Weakness
Anorexia
paresthesias
```
28
complications of infusion therapy
- local
- systemic
- cvc dwell
29
local complications (infusion therapy)
- occur near catheter site
30
systemic complications infusion therapy
- involve entire vascular system
| - may affect multiple systems
31
cvc dwell complications infusion therapy
complications specifc to central line insertion or dwelling
32
examples of local complications iv infusion
- infiltration
- extravasation
- thrombosis
- site infection
- phelbitis
33
infiltration
complication: leakage of nonvesicant solution
causes
- inflammation
- puncture of opposite vessel wall
clinical manifestations
- skin- cool, tight, tender
- fluid leaking from the puncture site
interventions
- stop infusion, remove site
- elevate extremity
- cold compress
prevention
- stabilize catheter
- avoid pressure
- assess frequently
34
extravasation
complication
- leakage of vesicant solution
causes
- same as infiltration
clinical manifestations
- in attrition to those associated with infiltration
- blistering/ tissue sloughing
intervention
- stop infusion
- surgical intervention may necessary
prevention
- see infiltration
35
phlebitis
complication
- inflammation
causes
- mechanical- insertion technique
- chemical- fluid or medications
pathogenic-break in aseptic technique
clinical manifestations
- pain at site
- skin- red, inflammed, potentially hard
interventions
- remove site if possible
- head and elevate extremity
prevention
- choose smallest guage necessary
- avoid flexion sites
36
thrombosis
blood clot within vein
causes
- damage to endothelial linning
- traumatic or multiple venipunctrues
- too large a catheter for size vein
clinical manifestations
- swollen extremitiy
- tenderness/redness
slowed stopped infusion
interventions
- stop infusion, apply cold compress
- elevate extremity
- potential need for surgical intervention
prevention
- use ebp ventipuncture techniques
37
site infection infusion therapy
infection at insetion point, port pocket or sub c tunnel
causes
- break in aspetic technique
- lack of hand hygiene
clinical manifestations
- site- red swollen warm
- potential purelent or ordor
interventions
- clean exit site, remove catheter, send for culture, cover with dry sterile dressing
prevention
- aseptic technique
- hand hygiene
38
circulatory overload
| s/s
excess fluid in circulatory system
- infusion rate greater than pt. system can accommodate
- SOB, cough, increased bp
39
speed shock
- systemic reaction to rapid infusion of unfamiliar substances
- drugs reach toxic levels
- change in loc, irregular pulse, chest tightness
40
catheter embolism
- piece of catheter breaks off into circulation
- anything the damages catheter
- potentially life threatening
41
cvc migration
- Movement of catheter tip to another vein
- Changes in intrathoracic pressure
- Coughing, sneezing, heaving lifting
Clinical manifestations - dependent on vein migration
-
-STOP Infusion, Notify HCP
42
cvc dislodegemnt
- Movement of catheter from insertion site
- Inadequate catheter securement
- Changes external catheter length
- STOP Infusion, NEVER Readvance, Notify HCP
43
occlusion
- Lumen is partially or totally blocked
- Precipitate from medications, blood clots, inadequate flushing
- Increased resistance, difficulty administering fluids/drawing blood, infusion pump stops/alarms
- Administer appropriate medications to dissolve precipitate or blood clot
PREVENTION!!!
- FLUSH, FLUSH, FLUSH
Before, between and after
44
catheter related bloodstream infection
Occurs when pathogenic organism invades patients' circulatory system
Clinical Manifestations
- Fever, HA, Chills, malaise
Tachycardia, hypotension, decreased U/O
Treatment
- Determine Cause
- Infusate – change entire infusion system, send to lab
- Catheter – remove, send catheter tip to lab
PREVENTION
H.A.N.D.S
45
vascular access devices (VAD)
- peripheral IV therapy (PIV)
* short infusion catheter
- midline catheters
- central IV therapy (CVC)
* peripherally inserted central catheter (PICC)
* nontunneled central venous catheters
* tunneled central venous catheters
* implanted ports
46
peripheral IV therapy
components
position
size
duration
catheter components
- stylet (needle)-insertion
- cannula- continous access
position
- within peripheral vessels
size (gauge)
- 26 gauge (smallest) to 14 gauge (largest)
duration of uses
- rotate sites based on clinical indication
47
best practice considerations for peripheral IV therapy
- avoid areas of joint flexion
- choose mosy distal site possible
- avoid dominant side if possible
- do not use side of mastectomy, av fistula,, lympth node dissection or paralysis
- limit unsuccessful attempts to 2 per clinician
48
midline catheters
catheter components
- single or doible lumen
position
- inserted into median antecubital, basilic or cephalic vein
- tip resides no further than axillary vein
size
- 3-8 inches long
- 3-5 french
duration of use
- 6-14 days
49
best practice considerations for midline catheters
- do not infuse parenteral nutrition
- do not use to draw blood
- do not admin incompatible drugs if double lumen
50
central venous catheters
- VAD placed in central circulation
placement confirmation
- CXR
- magnet tip locator electrocardiogram
51
peripherally inserted central catheters (PICCC
component
position
size
duration
catheter components
- single dual or triple lumen
position
- basilic preferred, cephalic okay
- tip resides in SVC
size
- 18-29 inches
- 2-6 fr
duration
- months
52
best practice considerations for peripherally inserted central catheters (PICCC)
- contrats injection- power PICCC only
| - 10ml barrel syringes only
53
non tunneled
- inserted percutaneously
- cath exits skin near cannulation site
- subclavian or internal jugular
- resides in SVC or IVC
- short term use
- up to 5 lumens
54
tunneled
portion of catheter under subcu tissue
- seperates where catheter enters vein and exits skin
- reduces risk of infection
- long term use
- single dual or triple lumen
55
implanted ports
- long term use: 1 year +, chemo
catheter components:
- portal body, dense septum over a reservoir and catheter
- subq pocket house the port body
access
- no part of catheter is visible
- need non-coring needle
56
hypervolemia
results from too much fluid in body or dilution of electrolytes and rbcs
57
hypovolemia
not enough fluid in body, especially in the intravascular area
58
fluid deficit signs and symptoms
- thirst
- rapid weak pulse
- low bp
- dry skin and mucous membranes
- skin tenting
- increased temp
- decreased urine output: increase concentration/ specific gravity
- increase BUN
- increase HCT
59
fluid deficit interventions
MONITOR DAILY WEIGHT 1L=2.2LBS
- monitor intake and output
- treat underlying cause
- increase fluid intake: PO IV
- use caution with elderly pt
60
isotonic
what it does?
type of solutions
same concentration no fluid shift
- equal pressure inside and outside cell
- "stay where I put it"
- expands volume
- dilute meds
- fluid resuscitation
- .9 nacl
- lactated ringers
61
hypotonic
lower concentration- fluid shift out of vessel into cell
- less salt or more water than normal body fluids
- water leaves blood and into cells
- "goes out of vessel"
1/2 normal saline
D5W dextrose 5% water
could lead to vascular fluid depletion and cardiovascular collapse
62
hypertonic
- higher concentration- fluid shifts into vessel from cell s
- either more salt or less water than our own fluids
- water is removed pulled from cells and pulled into vascular
- can result in vascular overload and dehydration
- enters the vessel
used for na replacement
- volume replacement
D 1/2 NS
D5LR
63
fluid excess s/s
- bounding pulse
- elevated blood pressure
- respiratory changes
- weight gain
- edema
- increased urine output
- diluted/ decrease specific gravity
- decrease BUN decease NA
64
fluid excess interventions
- monitor dailey weight
- place in fowleys positon
- admin oxygen
- admin diuretics
- monitor I&O
- restrict fluid and sodium
65
hypernatremia interventions
diuretic
fluid
145 and up
- monitor VS
- daily weights
- monitor LOC
- I&O
- encourage fluids
medical
- loop diuretics: lasix
- NA free IVFs: D5W
66
hypokalemia interventions
- cardiac monitor
- D/C loop osmotic diuretics
- frequent iv assessment
- monitor renal function
- decrease dietary intake
medical
- PO admin
- IV admin: always dilute, never IVP, monitor for phlebiti
67
hyperkalemia interventions
- cardiac monitor
- d/c k+
- increased fluid intake
- dietary restriction
medical:
- admin loop/ osmotic diuretics
- kayexalate
- dialysis
- insulin: moves k + out of blood into cells
- calcium gluconate: counteracts myocardial effect of increase k+ levels
68
hypocalcemia interventions
- encourage PO intake
- monitor for neuromuscular changes
- trousseaus sign
- chvostek sign
- fall prevention
medical
- oral Ca with it D
- calcium gluconate
69
PaCO2 level
35-45 mm hg
70
HCO3 level
21-28 mEq/l
71
metabolic acidosis levels
ph <7.35
| hco3 <21
72
metabolic acidosis causes
- shock, poor circulation
- diabetic ketoacidosis
- renal failure
- diarrhea
73
metabolic acidosis s/s
- weakness
- lethargy
- confusion
- headache
- stupor/unconsciousness
- coma
74
metabolic acidosis treatment
- identify and treat underlying cause
- insulin
- dialysis
- iv bicarb and lactate
75
respiratory acidosis causes
- slow shallow respirations
| - respiratory congestion/ obstruction
76
respiratory alkalosis causes
- hyperventilation
- anxiety
- high fever
- overdose of asa
77
lungs- 2nd line
acidic: lungs blow off additional co2, rapid deep breaths
alkaline: conserve co2 via shallow breaths
78
Peripheral Arterial Disease (PAD)
affects arteries: blood vessels that carry blood away from the heart
79
peripheral venous disease
- affects veins: blood vessels that carry blood towards the heart
80
peripheral arterial disease
- Atherosclerosis – chronic, progressive arterial narrowing
- Results in reduced blood flow, ischemia develops
- Typically affects lower extremities
81
PAD risk factors
```
HTN
Hyperlipidemia
Diabetes
Smoking
Obesity
Sedentary Lifestyle
Family Hx
Female Sex
> 65 Years Old
```
82
subjective PAD
Intermittent Claudication
- Burning, cramping pain in legs during exercise
Numbness/burning sensation in feet when in bed
- Pain relief when in dependent position
83
objective PAD
- Decreased capillary refill
- Decreased/Non-palpable pulses
- Loss of hair on lower calf, ankle, foot
- Dry, scaly, mottled skin= robar
- Thick toenails
- Cold and cyanotic extremity
- Pallor of extremity with elevation
- Rubor (redness) of extremity
Ulcers
- End of Toes or Between Toes
- Pale w/ little granulation
* bad wound flow
84
6 p's of arterial disease
```
Pain
Pallor
Pulselessness
Paresthesia
Paralysis- numbness or tingling
Poikilothermia (coolness)
```
85
interventions of PAD
Promote Vasodilation
- Maintain warm environment, wear socks and avoid cold when possible
- Avoid caffeine and nicotine – cause vasoconstriction
Encourage Appropriate Positioning
- Do NOT cross legs
- Refrain from wearing restrictive garments: no ted stockings
- Cautiously elevate extremities
- Reduces swelling but above heart can cause significant slowing of arterial flow to feet
Medication Therapy
86
perioheral venous disease patho
Problems with the veins that interfere with adequate return of blood flow from the extremities which results in blood stasis
87
3 major disorders with pvd
Venous thromboembolism (VTE)
- Clot Formation
- Can break off (Emboli)
Venous Insufficiency
- Skeleton muscle doesn’t contract to help pump blood in veins
Varicose Veins
- Defective (Incompetent) Valves
88
subjective cues for PVD
Painful/fullness/heaviness in legs after standing
89
objective clues for pvd
- Calf or groin pain/tenderness
- Warmth, edema, changes in calf circumference
- Brown discoloration
- Distended visible veins
- Cramping Muscle Aches
- Ulcers @ Ankle
90
drug therapy changes for htn
- Individualized based on patient
- Often need two or more drugs for adequate control
- diuertics
- betablockers
- calcium channel blockers
- ace inhibitors
- ARBS
91
duiuretics htn
First drug of choice for managing HTN
| Decrease BP by reducing blood volume
92
diurtetics: potassium-sparing: Spironolcatone
diuretics: loop- furosemide
diuretics: thiazide: hydrochlorothiazide
diurtetics: potassium-sparing: Spironolcatone:
- Prevent reabsorption of Na in exchange for K
- Risk for hyperkalemia
diuretics: loop- furosemide & diuretics: thiazide: hydrochlorothiazide
- Prevent/decrease Na reabsorption and increase water and K excretion
- Use Cautiously in Older Adults: ↑ Risk for dehydration, orthostatic hypotension, falls
93
beta blockers htn
- Drug of Choice for patients with Heart Disease
- Decrease BP AND Slow HR by blocking sympathetic nervous system
Common Examples
- Atenolol
- Metoprolol
94
Beta Blockers: Atenolol & Metoprolol
- Use Caution: Diabetics – May affect glucose production
- Do NOT Administer
HR < 50 bpm
Systolic BP < 90 mm Hg
95
Calcium Channel Blockers
- In combo with thiazide diuretics first-line therapy for African American patients
- Decrease BP and HR by interfering with movement of calcium through cell membrane
* *Results in vasodilation and blocks sinoatrial (SA) and atrioventricular (AV)node conduction
Common Examples
- Amlodipine
- Diltiazem
96
Calcium Channel Blockers: Amlodipine& Diltiazem
- Monitor BP/Pulse before Administration
- Use Cautiously: HF Patients
- Avoid Grapefruit juice
97
ACE inhibitors
- Angiotensin-Converting Enzymes
- Used as single or combination agents
- Decrease BP by preventing conversion of Angiotensin I to Angiotensin II
Preventing Vasoconstriction
Common Examples
- Lisinopril
- Enalapril
98
ace inhibitors: Lisinopril & Enalapril
- Monitor for S/S of HF
Edema
- Report dry cough
Most common side effect
99
ARBS
- Angiotensin II Receptor Antagonists
- Decreased BP by blocking the vasoconstrictor Angiotensin II at various receptor sites
Common Examples
- Valsartan
- Losartan
100
ARBS: Valsartan & Losartan
- Use Cautiously: Impaired renal function
- Monitor for Signs of Angioedema
Dyspnea, facial swelling
101
PVD meds
anticoagulation
antiplatelet
thrombolytic
102
pvd meds: anticoagulation
- Prevent or delay coagulation → Preventing clot formation
- Also known as blood thinners
Examples
- Heparin – Monitor PTT
- Lovenox
- Coumadin – Monitor INR
- Eliquis
- Xarelto
103
pvd meds: antiplatelet
Decrease platelet aggregation → Prevent agglutination →Prevent clot formation
Example
- ASA- asprin
- Plavix
104
pvd meds thrombolytic
Dissolve or break up existing clots → Open vessel and help prevent future clot formation
Examples
- Heparin
- Lovenox
105
what is diabetes Mellitus
- common, chronic, complex disorder
- results from inability to produce insulin and the bodys resistance to insulin
- results in hyperglycemia
106
3 initial symtoms of dm
- polyuria
- polydipisa- thirst
- polyphagia
107
Diabetic Ketoacidosis (DKA)
- More Common in Type 1 Diabetics
| - Insulin deficiency → Cellular Starvation → Breakdown of Fats → Ketones → Acidotic State
108
Diabetic Ketoacidosis (DKA) Signs/Symptoms
- Nausea/Vomiting
- Excessive Thirst
- Kussmaul's Respirations
- Fruity Breath
- Changes in LOC
- Metabolic Acidosis
- BG > 300 mg/dL
109
Hyperglycemic Hyperosmolar Syndrome (HHS)
- More Common in Type 2 Diabetics
| - Insulin deficiency combined with profound dehydration → Blood Glucose Elevation
110
Hyperglycemic Hyperosmolar Syndrome (HHS) s/s
- Blurred Vision
- Headache
- Changes in Mental - Status
- Seizures
- BG > 600 mg/dL
111
diagnostic testing for dm
Glycosylated hemoglobin (A1C)
- Identifies average blood glucose over time
- Previous 120 days
- Reference Range 4 – 6%
- Diabetics: 6.5 – 8%
- Preference 7% or less
Fasting Blood Glucose (FBG)
- Two separate results >126 mg/dL
112
insulin
routes
sites
timing
- given for hyperglycemia
Administration Routes
- SQ
- IV
Sites
- Rotate frequently to prevent tissue damage
- Abdominal tissue provides fastest absorption
* Do NOT inject within 2-inches of umbilicus
Timing
- Onset – Time from administration to lowering of BG
- Peak – When insulin is working the hardest
* BG is at its lowest
- Duration – Length of time before all the insulin is used up
113
elective sugery
- planned for correction on a non acute problem
- time Is not an issue
ex) cataract removal, hernia repair
114
urgent surgery
- requires prompt intervnetion
- potentially life threatening if delayed more than 24 hr to 48 hour
ex) intestinal obstruction, bone fracture
115
emergent surgery
- requires immediate intervention
- life threatening consequences
ex) gunshot/stab wounds, severe bleeding, appendectomy
116
risk factors for surgical complications
- pregnancy
- respiratory disease
- cardiovascular disease
- diabetes
- liver disease
- kidney disease
- coagulation disorders
- medications
117
post op phase recognizing cues... at risk for
at risk for
- pneumonia
- shock
- cardiac arrest
- vte
- gi bleeding
- early recognition of assessment findings
- decrease potential for serious surgical complications
118
wound complications
- dehiscence- partial or complete separtion of the wound edges
- evisceration- protrusion of intestinal organs
119
informed consent
- ensure INFORMED conset is obtained
Surgeon:
- detailed description of the procedure
- obtains consent
nurse:
- verifies and clarifies facts
- confirms consent is signed, dates, and times
- may serve as witness
120
acute kidney injury
- rapid reduction in kidney function
- failure to maintain waste elimination, fluid and electrolyte balance and acid base balanc e
- occurs few hours or days
121
acute kidney injury serium creatinine
increase serum creatinine by .3 mg/dl
| - increase in serum creatinine to 1.5 times or more occurring in 7 days
122
acute kidney injury causes
- reduced perfusion to kidneys damage to kidney tissue, and obstruction or urine outflow
- RISK FACTORS INCLUDE: SHOCK, CARDIAC SURGERY, HYPOTENSION, PROLONGED MECHANICAL VENTILATION, SEPSIS
- OLDER ADULTS WITH DIABETES, HYPERTENSION, PERIPHERAL VASCULAR DISEASE, LIVER DISEASE, CKD
123
acute kidney injury physical assessment
- hourly urine output
- assess for fluid overload
- evaluate vital signs for hypoperfusion and hypoxemia
- build up of nitrogenous waste and decreased urine output
124
acute kidney injury lab assessment
- creatinine, BUN
- gfr lower than 60
- blood electrolyte values
- urine tests
- high sodium
- high potassium
- high phosphate
- high calcium
125
acute kidney injury intervention/ management
- avoid hypotension, maintain normal fluid fluid balance
- reduce exposure to nephrotoxic agents and drugs
- frequently monitor lab values
- closely watch I/o
- drug therapy
- nutrition
- kidney replacement therapy
126
chronic kidney disease lab assessment
- creatinine BUN
- sodium, potassium , calcium, phosphorus, bicarb
- hemoglobin and hematocrit
- GFR
- urinalysis
127
chronic kidney disease intervention
- managing fluid volume
- improving cardiac function
- enhancing nutrition
- preventing injury
- minimising psychosocial compromise
128
hemodialysis procedure
dialysis works by passive transfer of toxins by diffusion
| - be aware of blood clotting
129
hemodialysis precuations
- check pedal pulses and cap refil in arm with fistula or graft
- check for bruit or thrill by auscultating or palpating access site
130
hemodialysis access complications
- thrombosis
- stenosis
- infection
- aneurysm
- ischemia
hf
131
peritoneal dialysis procedure
- soft plastic tube is placed in pt. abdominal cavity
- sterile cleansing fluid put into catheter
- after filtering process is finsihed fluid leaves pt. body through catheter
132
types of peritoneal dialysis
- continuous ambulatory peritoneal
- intermittent peritoneal
- intermittent perutoneal
133
peritoneal dialysis complications
peritonitis
pain
do not microwave fluid
134
peritoneal dialysis nursing care
- assess vitals
- weigh pt. using same scale
- monitor pt. dry weight
- baseline lab test doen before and during
- check dressings
- measure and record overflow
135
stress incontinence
urine leaks out at times when your bladder is under pressure
| ex) coughing or laughing1
136
stress incontinence symptoms
post-void residual
pelvic exam
- loss of small amount of urine during physical activity or intraabdominal pressure (coughing, sneezing jumping, lifting, exercises)
- normal voiding habits
- postvoid residual usually less than or equal to 50ml
- pelvic exam= hypermobility or urethra or bladder neck with Valsalva maneuvers`
137
stress incontinence causes
- weakening of the bladder neck supports; associated with childbirth
- intrinsic sphincter deficiency
- acquired anatomic damage to the urethral sphincter
- vaginal prolapse from vaginal birth or aging
138
urge incontinence
when urine leaks as you feel a sudden urge to pee, or soon afterwards
139
urge incontinence causes
- idiopathic
- neurological disorders
- benign prostatic hypertrophy
- bladder irritants (artiical sweetners, caffeine, alcohol, citric, drugs, nicotine)
- bladder cancer
- medications that cause increased bladder contractibility
140
urge incontinence symptoms
- loss of urine preceded by a sudden and severe desire to pass urine
- nocturia
- may have loss of large amounts of urine with occurrence
141
overflow incontinence (reflex incontinence)
when your unable to fully empty your bladder which causes frequent leaking
142
overflow incontinence (reflex incontinence)causes
- urethral obstruction
- diabetic neuropahy
- some neurologic disorders
- medications side effects
143
overflow incontinence (reflex incontinence) symptoms
- bladder distension, constant dribbling of urine
- sense of incomplete emptying of the bladder
- pelvic discomfort
- palpable bladder
144
cystitis
inflammatory conditon of the bladder
| - usually refers to inflammation from infection of bladder
145
cystitis nonsurgical managment
- drug therapy
- fluid intake
- comfort measures such as pain relief
146
cystitis surgical managemnt
- treat conditions that increase risk for utis
- removal of obstructions
- removal of vesicoureteral reflux
- removal of calculi
147
cystitis health promotion and maintenance
- sterile technique when inserting catheters
- clean technique when using intermittent catheters at home
- single-use catheter recommended for home settings
- national pt. safety goal- CAUTI prevention: removal of catheter as soon as possible
- liberal intake of water
148
urolithiasis
presence of calculi in the urinary tract
149
urolithiasis managing pain (nonsurgical)
- drug therapy
| - lithotripsy
150
urolithiasis managing pain (surgical management)
minimally invasive surgical procedures
| - open procedures
151
urolithiasis preventing infection
- drug therapy- antibiotics
| - lab test (urine sample, C&S test, urine cultures)
152
urolithiasis preventing obstruction
- high fluid intake (3l/day or more)
- accurate measurements of intake and output
- drug therapy
- nutrition therapy/ diet modification
153
urinary incontinence planning and integrating (maintaining tissue integrity)
- reduce the risk for skin breakdown
- reduce the risk of pt. developing incontinece- associate dermatits
- educate the pt. on the possibility of using an external device
- discuss the possibility of absorbent pads and breifs with the pt.
- options for functional incontinence include intermittent or long dwelling catheter
154
Hospital incident commander-
Physician or administrator who assumes overall leadership for implementing the emergency plan
155
Medical command physician-
Physician who decides the number, acuity, or resource needs of patients
156
Triage officer-
Physician or nurse who rapidly evaluates each patient to determine priorities for treatment
157
Community relations or public information officer-
Person who serves as a liaison between the health care facility and the media
158
Role of Nursing in Health Care FacilityEmergency Preparedness and Response: Before
- Contribute to developing internal and external emergency response plans
- Consider security needs, communication methods, training, alternative treatment areas, staffing for high demand/surge situation, and requirements for resources, equipment, and supplies
- Participate in disaster drills and evaluate the outcomes, also assist with revising the plan of action if needed
159
who determines when to deactivate emergency response
incident commander
160
Psychosocial Response of Survivors
- Disaster experience can produce immediate and long-lasting effects
- Lifestyle, roles, routines drastically altered
- Coping ability are severely stressed
- Nurses help survivors adapt
- Monitor for signs of ASD or PTSD
- Impact of Event Scale- Revised (IES-R) questionnaire- can be used by nurses as an assessment tool when caring for survivors with symptoms of ASD and PTSD
161
Emergency Preparedness Plan
- Mandated by The Joint Commission (TJC)
- Accredited health care organizations take “all-hazards approach” to disaster planning
- Disaster drills take place for training
+ Planned based on risk assessment or vulnerability analysis
162
evacuation plan
part of a fire prevention and preparedness plans for health care facilities
163
Red
emmergent needing immediate attention (class 1)
164
yellow
can wait short time for care (class 2)
165
green
non urgent or walking wounded (class 3)
166
Black
expected (and allowed) to die or are dead) (class 4)
167
hospice
- Model for quality, compassionate care for people facing life-limiting illness or injury
- Often provided to those with terminal cancer, dementia, end-stage COPD, cardiac disease, neurologic disease
- not expected to recover
- less than 6 month to live
168
Palliative Care
- Philosophy of care for people with life-threatening disease
Goal is to improve quality of life for patient and family
- managing pain and illness
169
\
Durable power of attorney for healthcare (DPOAHC
aka healthcare proxy, healthcare agent, or surrogate decision-maker, makes health care decisions once the health care provider states that the person is unable to make his or her own health decisions
170
pneumonia (PNA)
- an infection that inflames the air sacs in one or both lungs
- airsacs may fill with fluid or pus
- causing cough with phlegm pus fever chills and difficulty breathing
171
pneumonia assessment recognize cues: risk factors
risk factors:
- AGE
- no vaccination
- chronic health problems
- use of respiratory equipment
- vaccination status
172
pneumonia assessment recognize cues: physical assessment and s/s: general appearance
- FLUSHED CHEEKS
- anxious look
- chest pain
- MYALGIA- pain in muscles
- headache
- chills
- fever
- cough
- tachycardia
- dyspna
- hemoptysis (blood sputum)
- SPUTUM- may have blood. color:yellow, green, brown, rusty, thick
173
pneumonia assessment recognize cues: physical assessment and s/s: respiraotry assessment
- breathing pattern
- use of accessory muscles
- positioning
- cough
- sputum assessment
- lung sounds (crackles)
174
pneumonia assessment recognize cues: physical assessment and s/s: vital signs
- increased respiration rate
- hypotension
- tachycardia
- dysrhythmias
175
asthma drug therapy
- control therapy drugs
- reliever drugs
- bronchodilators
- anti-inflammatory agents
176
control therapy drugs (used daily)
used to reduce airway sensitivity (responsiveness) to prevent asthma attacks from occurring and maintain gas exchange
- inhaled cortical steroid- reduce inflammation
177
reliever drugs
used to stop an attack
| - short acting bronchodilator
178
bronchodilators
induce rapid bronchodilation through relaxing the smooth muscle
179
what do anti-inflammatory agents do?
help to improve bronchiolar airflow and increase gas exchange
180
COPD planning and implementation
- improve gas exchange and reduction of carbon dioxide retention
- ensure consistent use of drug therapy, airway maintenance, monitoring, breathing techniques, positioning, effective coughing, oxyen therapy, exercise conditioning, suctioning, and hydration
- surgical intervention
- preventing weight loss
- minimizing anxiety
- improving endurance
- preventing respiratory infection
181
surgical intervention for copd
lung transplantation
| - lung volume reduction surgery
182
preventing weight loss for copd
dyspnea management
| food selection
183
improving endurance for copd
- energy conservation
184
COPD evaluating outcomes
- attain and maintain gas exchange at a level within his or her chronic baseline values
- achieve an effective breathing pattern that decrease the work of breathing
- maintain a patent airway
- achieve and maintain a body weight within 10% of his or her ideal weight
- have decreased anxiety
- increase activity to a level of acceptance to him or her
- avoid serious respiratory infections
185
PE analysis & prioritze
- hypoxemia due to mismatch of lung perfusion and alveolar gas exchange with oxygenation
- hypotension due to inadequate circulation to the left ventricle
- potential for excessive bleeding due to anticoagulation or fibrinolytic therapy causing inadequate clotting
- anxiety due to hypoxemia and life-threatening illness
186
lifestyle changes with pe
- smoking cessation
- reducing weight
- physically active
- herarin or indirect thrombin inhibitor
- IVC filter
187
if traveling with a pe
- drink plently of water
- change positions often
- avoid crossing legs
- get up from sitting for 5 mins each hour
188
managing hypoxemia in pe
- sudden onset of dyspnea: activate rapid response team
- apply oxygen, elevate the HOB and reassure the pt
- oxygen therapy
- monitor pt
- admin anticoagulation or fibronolytic therapy
189
managing hypotension in pe
- iv therapy (crystalloid substance) to restore plasma volume and prevent shock
- drug therapy with vasopressors (norepinephrine, epinephrine, dopamine) used if iv therapy doesn't work
190
controlling bleeding in pe
- assess for s/s of bleeding
- ensure correct dosage and timing of medication
- monitor, lab values (INR)
191
conditions favoring gastric ulcers
favoring the development of duodenal ulcers, which are normal diffusion of acid back into stomach tissues with increased secretions of gastric acid and increased stomach emptying.
- pain worse with food
192
complications of ulcers: Hemorrhage
- Occurs more often in patients with gastric ulcers and in older adults
- Patients have a second episode of bleeding if underlying infection with H. pylori remains untreated or if therapy does not include H2 antagonist
- Massive bleeding = vomiting bright red or coffee- ground blood (hematemesis)
- Minimal bleeding from ulcers = minimal occult bleeding in a dark, ”tarry” stool (melena), melena may occur with gastric ulcers, more common with duodenal ulcers
193
complications of ulcers: perforation
- Occurs when the ulcer becomes so deep that the entire thickness of the stomach or duodenum is worn away
- The stomach or duodenal contents can then leak into the peritoneal cavity
- Patients can experience sudden, and sharp pain, peritonitis infection, severe illness within hours, bacterial septicemia and hypovolemic shock, paralytic ileus
194
what kind of emergency is peptic perforation
surgical emergency and can be life threatening
195
ulcers of complications: pyloric (gastric outlet) obstruction (blockage)
where does it occur
symptoms
what occurs due to vomiting
- Occurs in small percentage of patients and manifests with vomiting caused by stasis and gastric dilation
- Obstruction occurs as the pylorus (the gastric outlet) and is cased by scarring, edema, inflammation, or a combination of these factors
- Symptoms of obstruction include abdominal bloating, nausea, and vomiting
- With persistent vomiting, metabolic alkalosis may occur due to loss of large quantities of acid gastric juice in the vomitus
- Hypokalemia may also occur from the vomiting or metabolic alkalosis
196
complications of ulcers: intractable disease
May develop from complications of ulcers, excessive stressors in the patient’s life, or an inability to adhere to long-term therapy
197
acute gastritis
- rapid onset of epigastric pain and dyspepsia
| - epigastric burning sensation referred to as heart burn
198
acute gastritis accompanied by
- gastric bleeding
| - Hematemesis- vomiting blood or melena (dark, "tarry" sticky stool
199
chronic gastritis assessment
may have few symptoms unless ulceration occurs
- nausea, vomiting, upper abdominal discomfort, periodic epigastric pain may occur after a meal, some patients have anorexia
200
acute gastritis treating
- treated symptomatically and with supportive care because the healing process is spontaneous and occurs within a few days
- Eliminate causative factor, which usually results in pain and discomfort being reduced
- A blood transfusion and fluid replacement may be given if bleeding occurs
- Drugs that block and buffer gastric acid secretions
- Consider Nutrition and Drug Therapy
- Nutrition
- Drug therapy
201
food to avoid in gastritis
- avoid caffeine
- highly acidic foods
- spicy foods
202
chronic gastritis treatment
- causative agent
- may require b12 for prevention or treatment of pernicious anemia
- H.Pylori infection
203
ulcerative colitis
Widespread chronic inflammation of the rectum and rectosigmoid colon
Can extend into entire colon
Has periodic remissions and exacerbations
204
physical assessment & s/s of uc
- May have low-grade fever
- Note any abdominal distention along the colon
- Assess for signs and symptoms associated with extraintestinal complications, such as inflamed joints and lesions inside the mouth
- Usually finding are nonspecific
205
ulcerative colitis lab assessment
- Hematocrit and hemoglobin
- Increased WBC, C-reactive protein, erythrocyte sedimentation rate (ESR) is consistent with inflammatory disease
- ***Low sodium, potassium, chloride
- ***Hypoalbuminemia
206
consider nutrional therapy and rest ulcerative colitis
- Patients with severe symptoms who are hospitalized are NPO to allow for bowel rest
- Consider foods that may increase diarrhea, cramping or GI symptoms
- During exacerbations, rest is encouraged
207
managing skin integrity
Consider ways to reducer skin irritation
- For leakage of stool, the patient can use an absorbent cotton or panty liner and for incontinence, pads can be used at night
208
diet for chrons
fistual management
- patient requires at least 3000 calories daily to promote healing of fistula
- Total enteral nutrition (TEN) or TPN may be needed
nutrition therapy
- bowl rest
- nutrition suuport with TPN
- Ensure & Sustacal
- advoid gi stimulatns
- relaxation therapies to relax the patient and soothe the GI tract
209
ulcerative colitis hypothesis
- Diarrhea due to inflammation of the bowel mucosa
- Acute or persistent pain due to inflammation and ulceration of the bowel mucosa and skin irritation inflammation
- Potential for lower GI bleeding and resulting anemia due to Ulcerative colitis
210
acute pancreatitis lab
**Amylase: elevated
**Lipase: elevated
Serum bilirubin and alkaline phosphatase: elevated
ALT: elevated
WBC: elevated
ESR: elevated
calcium and magnesium: decreased
211
acute pancreatitis promoting nutrtion
- **NPO status maintained in early stages of pancreatitis
- Antiemetics prescribed for nausea and vomiting
- Patients with severe pancreatitis who are unable to eat for 24-48 hours will need jejunal **tube feeding, patient should be weighed daily
- Once food is tolerated, patient should ***small, frequent, moderate to high carb, high-protein, low-fat meals, food should be bland with little spice, avoid caffeine containing foods and alcohol
- ***Monitor the patient beginning to resume oral food intake for nausea, vomiting, and diarrhea (if any of these symptoms occur, notify the PCP immediately)
- Nutritional supplements may be used to ***boost caloric intake, doctor may prescribe vitamin and mineral supplements
212
pancreatitis diet
- Main focus of nursing care is aimed at pain control by interventions that decrease GI tract activity, which *decreases pancreatic stimulation
- Fasting and rest, drug therapy, and comfort measures used to **decrease pain
213
chronic cholecystitis physical exam
afebrile
| - may have localized tenderness over a palpable gallbladder
214
chronic cholecystitis ultrasound
stones in gallbladder
- thickened gallbladder wall
- advanced cases contracted gallbladder
215
- Chronic cholecystitis symptoms
jaundice, clay-colored stools, and dark urine from biliary obstruction, icterus, steatorrhea (fatty stools)
216
diet teaching for cholecystitis
Avoid fatty foods, withhold food and fluid if nausea and vomiting occur
- NPO
217
managing fluid volume cirrhosis
Treat ascites, consider nutrition therapy (decrease sa), drug therapy, paracentesis, and respiratory support (02)
218
preventing hemmorrhage cirrhosis
- Monitor for esophageal varices by endoscopy
- because massive esophageal bleeding can cause rapid blood loss, emergency interventions are needed
- Prevent bleeding and infection, non-selective beta blocking agent to prevent bleeding, antibiotics used to prevent infection
- Endoscopic therapies include ligation of the bleeding veins or endoscopic sclerotherapy
- Transjugular intrahepatic portal-systemic shunt (TIPS)- procedure used for patient who have not responded to other modalities for hemorrhage or long-term ascites
- NGT, Packed RBCS, fresh frozen plasma, Dextran, albumin, and platelets may be needed
- Monitor vs every hour, PT, PTT, and INR
219
preventing or managing confusion in cirrhosis
Slow or stop increase of ammonia in the blood, assess and monitor neuro status, nutrition counseling and protein in diet, lactulose used to excrete ammonia in stool, nonabsorbable antibiotics if lactulose does not help
220
managing pruritus IN CIRRHOSIS
Avoid being too warm, moisture skin, avoid irritants to skin, cool compress and/or corticosteroid creams
221
lactulose
lactulose used to excrete ammonia in stool, nonabsorbable antibiotics if lactulose does not help
222
ascites
collection of FREE FLUID within the peritoneal cavity caused by increased hydrostatic pressure from portal hypertension
Med Surg 1
flashcards
Decks in class (25)
# Cards
-
infusion therapy46
-
fluid and electrolyte balance35
-
acid base balance29
-
urinary problems52
-
acute & chronic kidney disease51
-
end of life care33
-
emergency and disaster preparedness31
-
concepts of care for pt. requiring oxygen therapy or tracheostomy57
-
concepts of care for pt. with noninfectious lower respiratory problems47
-
Ch.28 concepts of care for pt. with infectious respiratory problems44
-
chapter 29: care of pt. with respiratory emergencies51
-
perioperative47
-
Care of Pt. with diabetes39
-
Care of Pt. with vascular problems61
-
care of pt. with stomach disorders37
-
care of pt. with noninflammatory intestinal disorders35
-
care of pt. with inflammatory intestinal disorders53
-
care of pt. with liver problems35
-
care of patients with problems of the biliary system36
-
rheumatoid arthritis26
-
osteopororis23
-
fracture29
-
osteomyelitis21
-
osteoarthritis20
-
Final Exam222
