Final Exam Study Guide

Question 1

What are the general clinical manifestations of anemia?

Answer 1

• Decreased hemoglobin level
• Palpitations
• Dyspnea
• Fatigue
• Skin Changes (pallor, jaundice, pruritus secondary to bile salts)
• Cardiopulmonary manifestations: murmurs, bruit (d/t low viscosity of blood), risk for angina pectoris, MI, HF

Question 2

What are the treatments for anemia?

Answer 2

1. Oxygen Therapy
2. Blood Transfusions
3. Epoetin
4. Volume Replacement
5. Dietary and Lifestyle changes (iron best absorbed in acidic environment - best given with orange juice)
6. Assess for safety
7. Energy conservation

Question 3

Epoetin

Answer 3

Stimulates the bone marrow to produce RBCs

Question 4

Megaloblastic anemia

Answer 4

Caused by impaired DNA synthesis characterized by the presence of large RBC.
Includes Cobalamin Deficiency (includes pernicious anemia) and Folic Acid Deficiency

Question 5

What are the specific clinical manifestations of megaloblastic anemias?

Answer 5

• Sore Red Beefy and Shiny Tongue
• Anorexia
• N/V
• Abdominal pain
• Weakness
• Paresthesia of hands and feet
• Decrease vibratory and position senses
• Ataxia
• Muscle Weakness
• Confusion/dementia

Question 6

Collaborative Care for Megaloblastic Anemia includes

Answer 6

-Parenteral, intranasal administration of cyanocobalamin

Question 7

What are the clinical manifestations of myocardial infarctions?

Answer 7

• Pain is severe, immobilizing
• Not relieved by rest or nitrate administration.
• Described as heaviness, pressure, tightness, burning, crushing.
• N/V, fever
• Cardiovascular Symptoms: elevated HR, decrease BP and urine output, crackles, hepatic engorgement, peripheral edema

Question 8

What are the complications of MI?

Answer 8

• Arrhythmias (most common)
• CHF
• Cardiogenic Shock

Question 9

Collaborative Care for MI includes

Answer 9

1. Fibrinolytic therapy
2. Cardiac Catherization
3. Drug Therapy
4. Nutritional Therapy

Question 10

Fibrinolytic Therapy

Answer 10

Produces an open artery by lysis of thrombus to reprefuse the myocardium.

Question 11

How do you determine candidacy for fibrinolytic therapy?

Answer 11

Thrombolytic therapy is only indicated for patients with a ST Elevation Myocardial Infarction(STEMI).

Question 12

Aortic Aneurysms

Answer 12

Outpouching or dilation of aortic wall.

Question 13

What is the difference between a thoracic aneurysm and aortic aneurysm?

Answer 13

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Question 14

Clinical Manifestations for Aortic Aneurysm include

Answer 14

• Thoracic aortic aneurysms are often asymptomatic
• Deep, diffuse chest pain (d/t decreased blood flow to coronary arteries)
• Hoarseness
• Dysphagia
• Jugular venous distention (d/t decreased venous return)
• Edema of the face and arms
• Pulsatile mass in the periumbilical area
• Audible bruit
• Pain in abdomen or back
• Discomfort w/ or w/out alteration of bowel elimination

Question 15

Nursing Considerations for Aortic Aneurysms include

Answer 15

• Decrease risk factors associated w/ atherosclerosis
• Maintain BP
• Oxygen supply
• Prevention of infection / ABT
• Prevent paralytic ileus
• Monitor peripheral perfusion status
• Monitor renal perfusion
• Avoid heavy lifting 4-6 weeks post op.
• Monitor sign and symptoms of infections

Question 16

Thoracentesis

Answer 16

Removal of fluid using a large bore needle.

Question 17

How do you care for a client currently undergoing thoracentesis?

Answer 17

1. Clean with antiseptic solution.
2. Position patient bent forward for maximum lung expansion. (TRIPAD)
3. Local anesthetic is used.
4. Instruct patient not to talk or cough during procedure.

Question 18

How do you care for a client after thoracentesis?

Answer 18

• Observe for signs of hypoxia and pneumothorax.
• Verify breath sounds in all fields.
• Encourage deep breaths to expand lungs.
• Send labeled specimens to laboratory promptly for analysis.

Question 19

Pneumothorax

Answer 19

Presence of air in the pleural space causing restriction of lung expansion and collapse.

Question 20

How do you care for a patient with a pneumothorax?

Answer 20

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Administer O2
Position in semi-Fowler’s position
Prepare for chest tube insertion

Question 21

What is the pathophysiology of a pneumothorax?

Answer 21

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Question 22

Assessments: Pneumothorax

Answer 22

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Question 23

Diagnostics: Pneumothorax

Answer 23

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Question 24

What are some complications of a pneumothorax?

Answer 24

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Question 25

How do you care for a patient with chest tubes?

Answer 25

* Keep all tubing straight as much as possible below chest level * Keep all connections tight and sealed * Keep appropriate water level, use sterile water * Mark the time of measurement and fluid level * Observe air bubbling/ tidaling in water seal chamber * Bubbling is intermittent in water seal, if continuous determine leakage by momentary clamping tube distal from the patient until bubbling stops. * Monitor Vital Signs and chest Movement * Never elevate drainage to the level of patient’s chest * Encourage deep breathing and ROM to affected side * Do not strip or milk chest tubes * If drainage tube breaks place the distal end of the drainage tube in a sterile water at 2 cm level * Clamp with rubber stopper a bed side * Always have a vaselinize gauze at bedside to reinforce dressing if leakage is present.

Question 26

What are normal findings in a patient with chest tubes?

Answer 26

- Intermittent bubbling in the second chamber is normal during exhalation, coughing and sneezing - Continuous bubbling in third chamber is normal

Question 27

What are abnormal findings in a patient with chest tubes?

Answer 27

- Continuous bubbling in second chamber is abnormal | - No tidaling could indicate occlusion

Question 28

What factors indicate that the client may be ready to have a chest tube discontinued?

Answer 28

Chest tubes are removed when the lungs are reexpanded and fluid drainage has ceased or is minimal.

Question 29

Diverticulitis

Answer 29

Inflammation of one or more diverticular, resulting in perforation into the peritoneum.

Question 30

What is the collaborative care for diverticulitis?

Answer 30

- Uncomplicated diverticula: increase fiber in the diet - Bulk laxative - Increased fluid intake - Weight reduction - Prevent intra-abdominal pressure - NPO, bed rest - No “seeds” diet

Question 31

Crohn’s Disease

Answer 31

- Chronic non specific inflammatory disease of the bowel. - Cause is unknown. - Characterized by inflammation of segments of the GI tract.

Question 32

What is the collaborative care for Crohn’s Disease?

Answer 32

- Rest the bowel - Control Inflammation - Combat Infection - Correct malnutrition - Alleviate stress - Provide symptomatic relief -Drug therapy: sulfasalazine (decreases inflammation), corticosteroid (decreases inflammation) and flagyl (treats secondary infection)

Question 33

What are acute exacerbations of Crohn’s Disease?

Answer 33

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Question 34

What are complication of Crohn’s Disease?

Answer 34

- Perforation (w/ possible peritonitis) - Perianal abscess and fistulas - Strictures - C. Diff - Hemorrhage - Colonic Dilation (toxic megacolon)

Question 35

Cholelithiasis

Answer 35

Gallstones

Question 36

What are risk factors for cholelithiasis?

Answer 36

- Women >40 years of age - Oral contraceptives or Medications with high estrogen content - Sedentary Lifestyle - Obesity - Diet high in cholesterol and fat, low in fiber - Family hx of gallstones - Pregnancy - Diabetes - Rapid weight loss

Question 37

Acute pancreatitis

Answer 37

Acute inflammatory process of the pancreas

Question 38

What are clinical manifestations of acute pancreatitis?

Answer 38

- Abdominal pain - N/V - Hypotension, tachycardia (clinical manifestation of shock) - Jaundice - Decreased Bowel sounds, abdominal distention (d/t abdominal contraction from pain) - Grey Turner’s Sign (bluish, flank discoloration) - Cullen’s Sign (purplish discoloration of umbilical region)

Question 39

What are complications of acute pancreatitis?

Answer 39

Local: psuedocyst and abscess Systemic: pulmonary (Pleural effusion, atelectasis, pneumonia, acute respiratory distress syndrome, hypotension)

Question 40

What medications are used to treat UTIs?

Answer 40

Uncomplicated UTI: 1-3 days of ABT Recurrent/Uncomplicated UTI: 3-5 days of ABT Urinary analgesic

Question 41

What are the side effects of these medications used to treat UTIs?

Answer 41

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Question 42

What are post-op considerations for clients with a cystectomy and ileal conduit?

Answer 42

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Question 43

What are complications of lower urinary tract infections?

Answer 43

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Question 44

What is the collaborative care for a client with glomerulonephritis?

Answer 44

- Rest - Sodium Restriction - Antihypertensive Therapy - Diuretics - Low protein diet

Question 45

Define: “Rubor”

Answer 45

Redness of the skin.

Question 46

What should you teach a patient regarding diabetic foot care?

Answer 46

1. Wash feet daily with mild soap and warm water. First test water temperature with elbow. 2. Pat feet dry gently, especially between toes. 3. Examine feet daily for cuts, blisters, swelling, red, tender areas. 4. Use lanolin on feet to prevent skin from drying and cracking. Do not apply between toes. 5. Mild foot powder on sweaty feet. 6. Cleanse cuts with warm water and mild soap, covering with clean dressing. 7. Cut toenails evenly with rounded contour of toes. Do not cut down corners. Best time to trim is in shower or bath. 8. Avoid open toe shoes. Don’t go barefoot.

Question 47

How do you care for a patient in DKA?

Answer 47

- IV administration of rapid acting insulin - IV fluids, electrolyte Replacement, I&O - Labs: glucose, ketones in urine - ECG, Assess CV and Respiration - Ensure patent airway - O2 therapy - IV fluid resuscitation with 0.9% NaCl 1L/hr until BP is stable and urine output of 30-60 ml/hr - Insulin drip 0.1 u/kg/hr - Potassium to correct hypokalemia/Bicarbonate pH <7.0

Question 48

How do you care for a post-operative client with bilateral adrenalectomy?

Answer 48

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Question 49

Addisonian Crisis

Answer 49

A life threatening emergency caused by insufficient adrenocortical hormones or a sudden sharp decrease in these hormones.

Question 50

What are the clinical manifestations of Addisonian Crisis?

Answer 50

- Hyponatremia (sodium wasting d/t lack of aldosterone) - Hyperkalemia - Hypoglycemia (d/t lack of glucocorticoid production) - Dehydration - Fever - Weakness - Confusion (d/t hypoglycemia) - Circulatory collapse - V/D and pain in abdomen

Question 51

What is the collaborative care for Addisonian Crisis?

Answer 51

- Daily glucocorticoid replacement (2/3 on awakening in AM and 1/3 late in PM) - Fluid Replacement (large volume of NS and 5% dextrose): d/t dehydratation - Mineralocorticoids Replacement(once daily in the AM)

Question 52

Oncology

Answer 52

Understand the clinical manifestations and complications of various types of cancer discussed in class, including all collaborative care...

Question 53

What is the drug therapy for MI?

Answer 53

``` A. IV nitroglycerin B. Anti arrhythmic drugs C. Morphine Sulfate D. B-Adrenergic Blockers E. ACE inhibitors F. Stool softeners ```

Question 54

Clinical Manifestations of Mitral Valve Stenosis

Answer 54

Due to back up of blood flow in the left side of the heart you would have symptoms of left sided heart failure. • dyspnea • hemoptysis • palpitation / atrial fibrillation (atrium can’t empty efficiently causing enlargement leading to arrhythmias) • fatigue • murmur • chest pain • seizure (from possibility of thromboembolism) • stroke (same as seizure)

Question 55

Mitral Valve Regurgitation

Answer 55

Backward flow of blood from left ventricle to left atrium

Question 56

Clinical Manifestations of Mitral Valve Regurgitation

Answer 56

* pulmonary edema * thready peripheral pulses * cool clammy extremities * systolic murmur * weakness * fatigue * dyspnea, orthopnea, paroxysmal nocturnal dyspnea * peripheral edema (if it on the tricuspid and not mitral)

Question 57

Aortic Valve Stenosis

Answer 57

Shortening and thickening of the aortic valve.

Question 58

Aortic Valve Regurgitation

Answer 58

Backward flow of blood from the aorta into the left ventricle.

Question 59

Clinical Manifestations of Aortic Valve Regurgitation

Answer 59

Abrupt onset of profound dyspnea, chest pain, left ventricular failure and cardiogenic shock. Fatigue, exertional dyspnea, orthopnea, PND, water-hammer pulse, heaving precordial impulse, diminished or absent s1, s3 or s4. Soft high-pitched diastolic murmur

Question 60

Clinical Manifestations of Aortic Valve Stenosis

Answer 60

``` Angina Syncope Dyspnea on exertion Heart Failure Normal or soft S1, diminished or absent S2, systolic murmur, prominent S4 ```

Question 61

Collaborative Care for Valvular Heart Disease

Answer 61

* Prevent acquired rheumatic valvular disease * Hospitalization due to CHF and arrhythmia * Exercise plan to increase cardiac tolerance * Smoking cessation * Assist in planning for ADL * Prophylactic ABT to prevent endocarditis

Question 62

Isotonic Solutions include

Answer 62

* Normal Saline * Ringers * Lactated Ringer’s * Dextrose 5% in Water (D5W) * 5%Albumin * Hetastarch * Normosol

Question 63

Hypotonic Solutions include

Answer 63

* Half Saline (.45% NaCl) * 0.33%NaCl * Dextrose 2.5% in Water (D2.5W)

Question 64

Hypertonic Solutions include

Answer 64

* Dextrose 5% in Normal Saline * Dextrose in Lactated Ringer’s * 3% NaCl * 25% Albumin * 7.5% NaCl

Question 65

Mitral Valve Stenosis

Answer 65

Shortening, thickening of the mitral valve.