Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key


Play button


Play button




Click to flip

449 Cards in this Set

  • Front
  • Back
  • 3rd side (hint)
patent ductus arteriosus is failure of the fetal ductus arteriosus (artery connecting the aorta and pulmonary artery) to close within the first week of life. The continued patency of this vessel allows blood to flow from the higher pressure pulmonary artery, causing a left-to-right shunt
What is this?
defects with increased pulmonary blood flow
What is this?
Tetralogy of Fallot
1. ventricular septal defect
2. pulmonic stenosis
3. overiding aorta
4. right ventricular hypertrophy
What are the 2 classifications of congenital heart disease?
Acyanotic & Cyanotic
What is responsible for Acyanotic?
-increased pulmonary blood flow
-obstruction to blood flow from ventricles
What defects cause increased pulmonary blood flow?
-Atrial septal defect
-Ventricular septal defect
-Patent Ductus Arteriosus*
-Atrioventricular canal
What defects cause obstruction to blood flow from ventricles?
-Coarction of aorta*
-Aortic Stenosis
-Pulmonic Stenosis
What happens with cyanotic?
-decrease of pulmonary blood flow
-mixed blood flow
What defects cause a decrease in blood flow?
-Tetraology of Fallot*
-Triscuspid atresia
What defects cause mixed blood flow?
-Transposition of great arteries*
-total anomalous pulmonary venous return
-truncus arteriosus
-hypoplastic left heart syndrome
Nutritional state:
failure to thrive or poor weight gain is associated with heart disease
-cyanosis is a common feature of congenital heart disease, and pallor is asscociated with poor perfusion.
Chest deformities:
An enlarged heart sometimes distorts the chest configuration
Unusual pulsations:
visible pulsations of the neck veins are seen in some patients.
Respiratory excursion:
this refers to the ease or difficulty of respiration (tachypnea, dyspnea, presence of expiratory grunt)
Clubbing of fingers:
this is assoicated with cyanosis
palpation and percussion: these maneuvers help discert heart size and other characteristics (thrills) associated with heart disease
heart rate and rhythm:
-listen for fast heart rates (tachycardia), slow heart rate (bradycardia), or irregular rhythms
-character of heart sounds: listen for distinct or muffled sounds, murmmurs, and additional heart sounds
What are causes of CHD?
-infections; Rubella
-metabolic disorders; diabetes, PKU
-drugs; alcohol
-peripheral conditions; increased maternal age, premature birth, high altitude
Common Pathology of CHD:
-anatomic defect: VSD, ASD, PDA
-hemodynamic alteration: Right to Left shunt-cyanotic
Left to right shunt-acyanotic
-altered tissue oxygenation: characterized as cyanotic or acyanotic defects based on systemic effects.
What is Patent Ductus Arteriosus?
Failure of the fetal ductus arteriosus (artery connecting the aorta and pulmonary artery) to close within the first weeks of life. The continued patency of this vessel allows blood to flow from the higher pressure aorta to the lower pressure pulmonary artery, causing a left-to-right shunt
[increase in pulmonary blood flow]
The additional blood is recirculated through the lungs and returned to the left atrium and left ventricle. The effect of this altered circulation is increased workload on the left side of the heart, increased pulmonary vascular congestion and possibly resistance, and pontentially increased right ventricular pressure and hypertrophy.
What are the clinical manifestations?
Patients may be asymptomatic or show signs of CHF. There is a characteristic machinery-like murmur. A widened pulse pressure and bounding pulses result from runoff of blood from the aorta to the pulmonary artery. Patients are at risk for bacterial endocarditis and pulmonary vascular obstructive disease in later life from chronic excessive pulmonary blood flow.
Medical Management:
-administration of indoethacin (prostaglandin inhibitor) has proved sucessful in closing a patent ductus in premature infants and some newborns
Surgical Management:
surgical litigation of the patent vessel via a left thoracotomy
What is Tetralogy of Fallot?
Includes four defects:
1. ventricular septal defect
2. pulmonic stenosis
3. overiding aorta
4. right ventricular hypertrophy
[decrease in pulmonary blood flow]
What are the clinical manifestations of Tetralogy of Fallot?
Infants: some infants may be acutely cyanotic at birth; others have mild cyanosis that progresses over the first year of life as the pulmonic stenosis worsens. There is a characteristic murmur. There may be acute episodes of cyanosis and hypoxia, called blue spells or tet spells. Anoxic spells occur when the infant's oxygen requirements exceed the blood supply, usually during crying or after feeding.
-knee chest position
-meds; morphine, oxygen
What is Coarction of the Aorta?
Localized narrowing near the insertion of the ductus arteriosus, resulting in increased pressure proximal to the defect (head and upper extremities) and decreased pressure distal to the obstruction (body and lower extremities)
[obstruction of blood flow from ventricles]
What are the clinical manifestations of COA?
may be high blood pressure, bounding pulses in arms, weak or absent femoral pulses, and cool lower extremities with lower blood pressure.
-reduce the severity of CHF: Digoxin, Lasix, Alddactone
What is Transposition of the great arteries?
The pulmonary artery leaves the left ventricle, and the aorta exits from the right ventricle, with no communication between the systemic and pulmonary circulations.
[mixed blood flow]
Associated defects such as septal defects such as septal defects or patent ductus arteriosus (PDA) must be present to permit blood to enter the systemic circulation and/or the pulmonary circulation for mixing of saturated and desaturated blood.
Assessment Findings:
-cyanosis from birth and tachypnea (worsen w/ crying)
-gallop rythm
-murmurs of ASD,VSD,PDA, loud S2
-diminished exercise tolerance
Medical Management:
Prostaglandin E to temporarily increase blood mixing if systemic and pulmonary mixing is inadequate
What is Rheumatic Fever?
-an inflammatory disease that occurs after infection with group A ß-hemolytic streptococcal pharyngitis
-it involves the joints, skin, brain, serous surfaces, and heart
What is the most signifigant complication of RF?
cardiac valve damage (referred to as rheumatic heart disease)
Major Manifestations:
Carditis-tachycardia our of proportion to degree of fever, cardiomegaly, muffled heart sounds, pericardial friction rub, chest pain
polyarthritis-swollen, hot, red painful joints, after 1-3 days affects different joints, favors large joints-knees, elbows, hips, shoulders, wrists
erythema marginatum-erythematous macules with clear center and wavy, well-demarcated border, transitory, nonpruritic, primarily affects trunk and extremities (inner surfaces)
chorea-sudden aimless, irregular movements of extremites, involuntary facial grimaces, speech disturbances, emotional lability, muscle weakness; muscle movement exaggerated by anxiety and attempts at fine motor activity; relieved by rest
subcutaneous nodes: nontender swelling, located over bony prominences, may persist for some time, then gradually resolve
Minor Manifestations:
Collaboration Care:
-Eradicate hemolytic strep
-prevent permanent cardiac damage
-palliation of symptoms
-prevent recurrence
-penicillin is the drug of choice, with erythromycin as a substitute in penicillin-senstive children
-Salicylates are used to control the infammatory process, especially in the joints and reduce the fever and discomfort
Children who have had acute RF are susceptible to recurent RF:
-should be followed medicaly for at least 5 years
-children and families must be aware of the need for continuing antibotic prophylaxis for dental work, infection, and invasive procedures
Interventions during home care are primarily concerned with:
providing rest and adequate nutrition
One of the most disturbing and frustrating manifestation of the disease is:
chorea-the onset is gradual and may occur weeks to months after the illness; it sometimes occurs in children who have not been dx w/ RF
What is Endocarditis?
An infection of the valves and inner lining of the heart.
-especially affects children with valvular abnormalities, prosthetic valves, recent cardiac surgery with invasive lines, and rheumatic heart disease with valve involvement
organsims may enter the bloodstream from any site of localized infection; most common portals of entry are oral from dental work, UTI, cardiac surgery
Clinical Manifestations:
onset usually insidious
-unexplained fever (low grade and intermittent)
-weight loss
characteristic findings caused by extracardiac emboli formation: splinter hemorrhages (thin black lines) under the nails, osler nodes (red, painful intradermal nodes found on pads of phalanges), Janeway lesions (painless hemorrhagic areas on palms and soles), petechiae on oral mucous membranes
may be present: congestive heart failure, cardiac dysrhythmias, new murmur or change in previously existing one
Therapeutic Management:
Treatment should be instituted immediately and consists of administration of high doses of appropriate antibiotics intravenously for 2 to 8 weeks
Involves administration of prophylactic antibiotic therapy 1 hour before procedures known to increase the risk of entry of organisms.
Acyanotic: obstruction to blood flow from ventricles
Coarction of the Aorta
Cyanotic: Mixed blood flow
Transposition of the Great Vessels
Abnormal oening between the atria, allowing blood from the higher pressure left atrium to flow into the lower pressure right atrium.
Atrial Septal Defect (ASD)
Defects with increased pulmonary blood flow
Because left atrial pressure slightly exceeds right atrial pressure, blood flows from the left to the right atrium, causing an increased flow of oxygenated blood into the right side of the heart.
-Despite the low pressure difference, a high rate of flow can still occur because of low pulmonary vascular resistance and the greater distensibillity of the right atrium, which further reduced flow resistance.
Clinical Manifestations:
Patients may be asymptomatic. They may develop congestive heart failure. There is characteristic murmur. Patients are at risk for atrial dysrhythmias (probably caused by atrial enlargement and stretching of conduction fibers) and pulmonary vascular obstructive disease and emboli formation later in life from chronic increased pulmonary blood flow
The liquid, fatty fluid that precedes mother milk is called
Important because
High in nutrition and natural antibodies
Breast Cancer mostly found what part of breast
Upper outer quadrant
Cancer causing stuff is called
Tetrogenic Agents
Diabetes caused by insulin resistance, mostly obese people get it
Type 2 Diabetes
Name some causes of congenital heart disease (CHD)
Infections (rubella), radiation, metabolic disorders, drugs/alcohol, peripheral conditions (maternal age. Premature etc.)
BPH is
Benign prostatic hyperplasia
Procedure to fix
A heart disease caused by a fistula between left and right atrium
ASD (atrial Septal defect) YOU HEAR A MURMUR!
Cyanotic or a cyanotic
Acyanotic (mixed blood but with some o2)
A heart disease caused by a fistula between aorta and the pulmonary artery is called
PDA patent ductus arteriosus
Cyanotic or a cyanotic
Acyanotic (mixed blood but with some o2)
A heart disease caused by a fistula between left and right ventrical is called
VSD Ventricular Septal defect. MOST COMMON!
Cyanotic or a cyanotic
Acyanotic (mixed blood but with some o2)
Congenital heart disease: 4 things wrong, kid often squats ……..
Tetralogy of Fallot
Cyanotic or a cyanotic
Congenital heart disease: aorta and pulmonary artery are interchanged and there is a atrial fistula
Transposition of the great vessels
Cyanotic or a cyanotic
Obstruction of blood leaving the heart, acyanotic, can be
Coarctation of the aorta
Lack of o2 to heart resulting in ischemia of heart muscle is called
Myocardial Infarction
s/s acyanotic
Cool to touch
s/s cyanotic
Blue lips and cool to touch
Name some nursing diagnosis related to heart disease
-altered nutrition
-altered growth
-ineffective family coping
A possible heart disease related to URI (strep)
Rheumatic fever
Infection of the heart valves and lining is called
Bacterial endocarditis
Male sex hormone
Artificial detour of ureters from kidney to intestines to bypass bladder is called
Ileal Conduit
Dialysis through a semi permeable intestinal membrane is called
Peritoneal Dialysis
How long is the post partum period
6 weeks, 42 days
Jaundice is caused by
Too much bilirubin
And treated with
Uv light
Neonatal period is
4 weeks
When is Apgar score performed
1-5 minutes after birth
Good score is
4-6 means
Moderate resuscitative efforts
What medication is administered
Vitamin K, eye antibiotic, Hep if parents agree
Site of injections is
Vastus lateralis
Can you put it in IV
Vitamin K because
Baby does not have enough clotting factor
Eye medication because
Ophthalmia neonatorum (infection gonorhorreal/chlamydial)
Circumcision care
Check for bleeding/infection, prevent diaper to touch penis (fold it). No Vaseline with plastabell
First feeding not larger than
1 oz/30cc
First feeding can be
Breast milk/sterile water/formula/sterile glucose
First milk is called
When does discharge planning start
At admission
Engorgement is
Feeling of tension in breast
Cured by
Feeding baby
If no breastfeeding
Do not touch/irritate
After pains are caused by
Uterine cramps
Last normally not longer than
48 hours
The process where the reproductive organs return to normal size after the baby is born is called
Discharge from uterus during postpartum is called
If red (1/3 days post partum)
Lochia rubra (ruby red)
If pink or brown (3-10 days post partum)
Lochia Serosa
If white after 10-14 days
Lochia Alba
Top of uterus is called
Nägele's rule is
subtracting 3 months and adding 7 days and 1 year if appropriate to the first day of a pregnant woman's last menstrual period
Fertilization takes place in the
Pregnancy lasts
280 days/ 40 weeks
Low amniotic fluid could mean
Renal problems for baby
Rh test is called
Coombs test
5 digit system is
1. Gravida
2. Term
3. Para
4. Abortion
5. Living children
Supine hypertension caused by
Laying supine for a while, pressure on descending aorta and Vena Cava: lay on side for a while will help
Anemia if
Hgb is = or smaller than 11
Interventions during labor
-emotional support
-supportive environment
-physical care to provide comfort/hygiene
-explain procedures
-Identify everything that will interfere with labor (voiding, privacy, moving, ambulation etc.)
-Encourage verbalization of fears etc.
monitor progress of labor
Rupture of the fetal membranes is called
Amniotomy can be AROM/SROM
Withdrawal of amniotic fluid from the sac for testing is called
Time from conception to delivery is called
Other word for pregnant woman, relates to # of pregnancies
And if a woman is more than one time pregnant
never delivered a baby
Para is
Past pregnancy continued to viable period, twins count as one para
So primapara is
Woman who had one pregnancy and delivered after the period of viability
Gravida, Term, Para, Abortion, living children
Normal term
38-42 weeks
Post term is
More than 40 weeks
Maternal weight loss
Decreased uterine seize
Decreased amniotic sac (kidney problems baby)
Large infant
Postpartum hemorrhage and infection
Under 37 weeks
LBW, inadequate lung development
Lightning means
Decreased abdominal distention due to uterine and fetal descent (2-3 weeks before delivery)
The appearance of the fetal scalp at the vaginal orifice in childbirth is called
The process of the cervix/cervical canal thinning and shortening is called
The process of the cervix/cervical canal expanding or enlarging from 0-10cm is called
Position of the fetus head in the true pelvis (-3-+3) is called
Station (0 = engaged)
IUGR means
Intro-uterine growth restriction (lack of oxygen, smoking, drugs, placenta previa)
Neonate is
First 28 days of life
Chadwicks sign is
purple color of vaginal walls
Possible signs of pregnancy are
-absence of menstruation
-breast tenderness
Probable signs
Pregnancy test/Chadwicks, Goodells and Hegar’s signs
Positive signs
Quickening means
First movement (feels like gas, 4th month)
With cephalic birth, what part of head first?
Surgical incision of the perineum during delivery is called
Normal FHR
Three stages of delivery are
First: - dilation
- early latent phase
- mid/active phase
- transitional phase (most dramatic)
second : delivery, usual 30 minutes to 3 hours
Third stage: delivery of placenta (2 to 20 minutes)
Nursing assessment stage
Membrane status
True/false contraction
Color of amniotic fluid if ruptured
Vaginal exam for effacement, dilatation, presentation, position, station
Nursing interventions during labor include
- providing support to mother and supporter
- maintain a supportive environment
- giving physical care to provide comfort
- explain all procedures
- identify everything that may interfere with labor (voiding, privacy, moving)
- provide encouragement
- encourage verbalization of fears and concerns
- continually monitor progress of labor
The first thing the nurse does after the water breaks
Check FHR (because umbilical cord could be under pressure
Early decelerations: nursing intervention
Position change (not benign)
Early decelerations: what causes it
Head compression, means baby is in position!
Variable decelerations: nursing intervention
Position change (not benign)
Variable decelerations can point to
Cord compression
Late decelerations: nursing intervention
02 mask (8-10 liters)
How does the fetus adapt to birth stress
FHR goes up
Pushing/breathing during contractions…how
At beginning of contraction two cleansing breaths, at peak of contraction push, with breathing, at end of contraction two more cleansing breaths
Contra-indications for epidural
- allergy
- maternal refuse
- antepartum hemorrhage
- bleeding disorder/anti coagulant therapy
- infections at the injection site
- maternal hypotension
First stage of labor: cervix open in three stages:
Latent 0-3 cm contractions 5-30 minutes apart 30-45 sec long
*Risk Factors for CAD
Cholesterol, elevated serum lipids (LDL/HDL), smoking, weight, stress, HTN, DM
-age, race, gender, family hx; (genetics)
Angina is defined as “An oppressive pain in the chest that is caused by inadequate blood flow and oxygenation to the heart muscle.”
Which diabetes: weight gain, blurred vision, slow to heal, UTI’s, spontaneous abortion
What is the leading undiagnosed cause of depression and suicide in the elderly???
Myxedema (long hypothyroidism)
s/s of hypothyroidism
Everything is slow: weak heart, depressed, constipation, high LDL, dry skin, thick tongue, croaky voice, cold skin, cold intolerant
Severe or long standing hypothyroidism is called
Non pitting edema, especially in hands, feet, subclavicular fossae, slurred speech, hoarseness
What can happen if Myxedema is severe
Coma : hypothermia, hypoventilation, lactic acidosis, hypotension
What can provoke this
Narcotics or sedatives
Most common cause of hypothyroidism
Atrophy of the thyroid gland or in developing countries: lack of iodine in diet
How do you care for someone with hypothyroidism: assessment
- weight gain
- mental changes
- slurred speech
- cold intolerance
- thick, dry skin
- constipation
- Dyspnea
How do you care for someone with hypothyroidism: diagnosis
- hypothermia
- imbalanced nutrition (more than required) hypometabolism
- constipation
- activity intolerance (low metabolism)
- disturbed thought process (diminished cerebral bloodflow)
activity intolerance (low metabolism)
What is the most common cause of hyperthyroidism
Graves disease
What is Graves’ disease
Autoimmune disease marked by thyroid enlargement and excessive thyroid hormone secretion
What age and sex are most affected by hyperthyroidism?
women age 30-50
What is Thyrotoxicocis
It refers to the physiologic effects of hypermetabolism that results from excess circulating levels of T4 T3 or both
s/s of hyperthyroidism
Hypermetabolic, no sleep, weight loss, palpations, SOB,
Treatment for hyperthyroidism is
Radioactive iodine, irradiation of gland, Propranolol, surgery
A thyroid disease with as a sign goiter
Graves disease
How do you take care of someone with hyperthyroidism: assessment
objective: hyperthermia, palpitations, exopthalmos, blinking, diaphoretic, thin nails, thick velvety skin, clubbing, tachypnea, tachycardia, bounding pulse, increased bowel sounds
How do you take care of someone with hyperthyroidism: diagnosis
- imbalanced nutrition (less than body requirement): hypermetabolism
How do you take care of someone with hyperthyroidism: interventions
normal hyperthyroidism is home care but if they have acute Thyrotoxicocis:
- place patient in cool quit room
- change bed linens regularly if diaphoresis
- encourage exercise
- restrict visitors who upset patient
- establish a supportive, trusting environment
Thyroid storm is
Extreme hyperthyroidism on persons with undiagnosed or undertreated thyroid disease (because of stress/trauma)
Other name is
Thyrotoxic crisis
Dehydration, tachycardia, heart failure, HYPERTHERMIA, agitation, delirium, fever : EMERGENCY
An autoimmune diseases: not enough cortisol but also associated with Hashimoto’s disease, pernicious anemia, idiopathic hypoparathyroidism
Addison’s disease
What is wrong?
Addison's disease is a severe or total deficiency of the hormones made in the adrenal cortex, caused by a destruction of the adrenal cortex
What hormones are produced in adrenal glands
cortisol and aldosterone
Weakness, fatigue, anorexia, hypoglycemia
Na down, K up so beware of Hyponatremia and hyperkalemia
Add corticoidsteroids and salt to diet
How do you take care of someone with Addison’s …assessment
- vital signs
- fluid volume deficit
- electrolyte imbalances (N & K)
- daily weights
- understanding of medication
Remember Addison’s and salt
ADDisons ADD salt
A disease caused by increased levels of cortisol is called
Cushing’s disease
How do you take care of someone with Addison’s …..?diagnosis
risk for imbalanced nutrition: less than body requirement (loss of appetite)
How do you take care of someone with Addison’s …interventions
- avoid stress
- I/O daily weights
- Teach: medication compliance
- Keep quit , safe, low stress environment
- Give medications
3 kinds of diabetes are
- DM I
- gestational diabetes
Characteristics of type 1
- abrupt onset
- primary defect of Beta cells
- always insulin dependent
- prone to develop Ketoacidosis
- affects mostly teens
- decrease in size and number of Islet cells
Type two is caused by
insulin resistance
- no ketosis/Ketoacidosis
- insidious onset
- usually not insulin dependent
- mostly after 40 years
- often obese
What race/group is most likely to get type 1
Caucasian (western Europe)
What race/group is most likely to get type 2
Native American, Hispanics
Which one is linked to lower economic status
Type 2
What does the lack of insulin do to your body
- glucose is not taken in by hepatic and skeletal muscles
- glucose accumulates in blood and spills in urine
- fluid shifts : dehydration, thirst, blurred vision
- breakdown of fat & protein: weight loss: ketosis METABOLIC ACIDOSIS
Which diabetes: confusion, weight loss, ketone bodies in blood, paresthesia
Type 1
What can happen to nails of people with diabetes
Harden, yellow
Diagnosed with diabetes if
Blood level glucose over 126 x 2 readings
Diabetes: weird behavior can be sign of
Hypoglycemia treat with glucose
Treatment of type 1 is
What adrenal disease: NA up.
Cushing’s (water retention)…cushion …..
What adrenal disease: NA down
Addison’s ….add salt………………….
Treatment of type II
Insulin sensitizers / insulin/ diet/ exercise
s/s of hypoglycemia
Irritable, hunger, fatigue, vision problems, pallor, tremor, anxiety, confusion, poor judgment seizure, coma
If you doubt between hypo and hyper treat like
Acetone breath, malaise, dry mouth could be sign of
Diabetic Ketoacidosis
Treat it with
Insulin, IV fluids and might need dialysis
A diabetic coma with sever dehydration BG level 600-200 could be
Hyperosmolar hyperglycemic non-ketotic syndrome (HHNKS)
Could happen to
Diabetes II, undiagnosed, too much sugar
Night time hypoglycemia with morning hyperglycemia released to epinephrine and GH is called
Somogyi phenomenon
Night time snack or less insulin
And same thing without night time hypoglycemia is
Dawn phenomenon
Pm insulin
Most common complication of diabetes is
Diabetic neuropathy: may be reversible
Wrist drop, paresthesia, amyotrophy
Vascular disease related to long high glucose levels
Microvascular disease
Can progress in
Microangiopathy (hypoxia/ischemia )
Blurred vision, spots on retina can be
Diabetic retinopathy
Proteinuria with diabetes can be sign of
Diabetic nephropathy
More common in type
Macrovascular disease most common in type
Related to
Obesity: CVA, MI, atherosclerosis
Leading cause of amputations is
Peripheral vascular disease (peripheral…end of limb)
What are the different insulin types?
- rapid acting (Lispro/Humalog)
- short acting (regular, R)
- intermediate lasting (NPH)
- long lasting (Humulin U)
- premixed combinations of NPH/regular
What is the only kind you can administer IV
What is an insulin reaction?
It is another name for hypoglycemia or they mean that you get a little redness/swelling at the injection site
How do you give insulin correctly
Clean skin, give in abdomen, 2 inch right/left off belly button, check right amount/type, and test blood glucose first if needed.
DKA is
Diabetic ketoacidosis is a complication of diabetes caused by the buildup of by-products of fat metabolism (ketones), which occurs when glucose is not available as a fuel source for the body.
s/s DKA
Frequent urination or frequent thirst for a day or more
Treatment of DKA
The goal of treatment is to correct the elevated blood glucose level by giving additional insulin, and to replace fluids lost through excessive urination and vomiting. If ketoacidosis is severe, hospitalization is required to control the condition. Insulin replacement will be given, fluid and electrolytes will be replaced, and the cause of the condition (such as infection) will be identified and treated.
Nursing assessment for DKA and HHNS are
- bloodglucose and count, PH of blood, urinalysis
- physical exam, heart, respiration, LOC
Nursing interventions for DKA and HHNS are
- insulin!!!! Regular through IV if possible
- Fluid replacement (more in DKA)
- Electrolyte replacement (K)
- Assessment for mental status
- Record I/O
- Asses bloodglucose
- ECG monitoring
- Asses respiratory status
- PH les than 7: administer sodium bicarbonate
HHNS what is it
Hyperosmolar Hyperglycemic Nonketotic Syndrome, or HHNS, is a serious condition most frequently seen in older person it occurs more often in people with type 2. HHNS is usually brought on by something else, such as an illness or infection. In HHNS, blood sugar levels rise, and the body tries to get rid of the excess sugar by passing it into the urine. The body makes lots of urine at first, and the patient has to go to the bathroom more often. Polydipsia because of the urination!
Physical findings in these patients
Blood sugar level over 600 mg/dl
How does it differ from DKS
The difference between DKS and HHNS is that
Hyperglycemia s/s
Polyphagia (frequent hunger, especially pronounced hunger)
Normal bloodglucose is
70-105, some say 80-100 mg/dl
Critical levels are
<50 or >400 mg/dl
Hypoglycemic s/s
Mild Signs Include:
Headache, hunger, sweating, nervousness, problems staying focused, mood changes, and weakness.
Moderate Signs Include: Heavy sweating, increasing weakness, heart palpitations, memory loss, double vision, problems walking, and numbness in the area of the mouth and (possibly) the fingers.
Severe Signs Include: Seizures, fainting, muscle twitching, and passing urine unexpectedly.
The two types of DM I are
- immune mediated (viral or infection, triggers antibodies against insulin and destroy insulin producing cells, symptoms appear after 90% is destroyed)
- non-immune (more common in Asian, African-American)
Prone to develop
Nursing management related to stroke
maintain stable or improve LOC
attain maximum physical function
attain maximum self care-abilities and skills
maintain stable body functions (bladder control)
maximize communication abilities
maintain adequate nutrition
avoid complications
maintain effective personal and family coping
s/s hemorrhaging stroke
worst headache ever
Modifiable risk factors for stroke
HTN (#1)
High serum lipids
heart disease
Oral contraceptives
Other word for stroke
cerebrovascular accident (CVA),[
s/s Ischemic stroke
- muscle weakness (hemiplegia)
- numbness
- reduction in sensory or vibratory sensation
- In most cases, the symptoms affect only one side of the body. The defect in the brain is usually on the opposite side of the body
- altered smell, taste, hearing, or vision (total or partial)
- drooping of eyelid (ptosis) and weakness of ocular muscles
- decreased reflexes: gag, swallow, pupil reactivity to light
- decreased sensation and muscle weakness of the face
- balance problems and nystagmus
- altered breathing and heart rate
weakness in sternocleidomastoid muscle (SCM) with inability to turn head to one side
See above, watch for HTN, respiratory distress, difficulty swallowing, incontinence, nausea, vomiting vertigo
So priority
- airway /oximetry/o2
- CT scan
- Risk for falling
- Remove dentures
- Elevate HOB
- Ischemic: anticoagulants
- Siderails
- Glasgow coma scale
- VS
- Motor/sensory functions
- Pupil reaction
- O2
- Cardiac rhythm
- Reassure family
What is Myasthenia gravis
a neuromuscular disease leading to fluctuating weakness and fatiguability. At about 14 cases per 100,000 (in the U.S.), it is one of the lesser known autoimmune disorders. The antigens and basic disorder mechanisms are known. Weakness is caused by circulating antibodies that block acetylcholine receptors or the MuSK protein at the post-synaptic neuromuscular junction, inhibiting the stimulative effect of the neurotransmitter acetylcholine. Myasthenia is treated with immunosuppression, cholinesterase inhibitors and, in selected cases, thymectomy.
Primary manifestation is
Fluctuating weakness (goes away with rest)
Often first seen at
Eyes (eyelids)
Other visible things
Difficulty swallowing, speaking, breathing
Yes but with exacerbations and remissions
Nursing assessment
- severity determined by fatigability
- coping abilities
- understanding disorder
- RR, O2, ABG, pulmonary function test
- Respiratory distress
Nursing diagnosis
- ineffective breathing pattern (weak intercostal muscles)
- ineffective airway clearance (impaired cough and gag reflex)
- impaired verbal communication (weakness of mouth, larynx, lips)
- impaired nutrition (less: swallowing is hard)
- disturbed sensory perception (visual: eyelids droop)
- activity intolerance (muscle weakness)
- disturbed body image
What is in the Glasgow Coma scale
Best Eyes
Best Verbal response
Best motor
15 is
8 or less is
Coma (8=intubate)
3 is
Respiration: cycles of hyperventilation and apnea
Cheyne Stokes
Cushing triad indicates
Cushing triad is
Signs of increased intracranial pressure:
Rising temperature could mean
Increased metabolic rate of the brain (dysfunction of hypothalamus or brainstem)
ICP can be caused by
Trauma, hemorrhage, tumors, hydrocephalus, edema, inflammation
Earliest indication of ICP is
Declining LOC (tired, weak, headache)
Other s/s
Headache, Abnormal respirations , Widening pulse pressure
- prevent hypoxia: makes ICP worse (CO2 widens veins: more pressure)
- elevate HOB 30-40%
- prevent flexion of hips and neck
- mechanical ventilation if needed to keep Paco2 30-35
- prevent shivering (maintain body temperature)
- lower environmental stimuli (dark room/low visitors, quiet)
a syndrome of massive imbalanced reflex sympathetic discharge occurring in patients with spinal cord injury (SCI) above the splanchnic sympathetic outflow (T5-T6) started sympathetic visceral sign
Autonomic dysreflexia or Hyperreflexia
What happens
Episodes of hypertension, sweating, slow heart beat and severe headaches may occur spontaneously in these patients, with variable severity. Treatment is aimed at controlling the blood pressure and the associated symptoms.
- Blood pressure and pulse measurement
- Investigation of systemic causes of autonomic dysreflexia
- Urinary catheterization
- Nonpharmacologic management of elevated blood pressure through lateral tilt or upright positioning and loosening clothing or constrictive devices
- Pharmacologic management for elevated blood pressure (nitropatch etc)
- Management of symptomatic hypotension (leg elevation, intravenous fluids, adrenergic agonists such as norepinephrine)
- Patient and caregiver education about autonomic dysreflexia
Emergency interventions with spinal injury
What is spinal shock
a temporary, sudden condition following transection of the spinal cord that is characterized by muscular flaccidity and loss of motor reflexes in all parts of the body below the point of transection
spinal shock: what happens to muscles
- paralyzed
- flaccid
- reflexes are absent
Spinal shock ends when
Reflexes return
Encephalitis is
an acute inflammation of the brain, commonly caused by a viral infection. Brain damage occurs as the inflamed brain pushes against the skull, and can lead to death. Patients with encephalitis suffer from fever, headache, vomiting, confusion, drowsiness and photophobia. The patients could also suffer from weakness, seizure, and less commonly, stiffness of the neck.
is the inflammation of the membranes (meninges) covering the brain, usually due to bacterial infections elsewhere in body that has spread into the blood and into the cerebrospinal fluid (CSF).
Parkinson’s disease is
is a degenerative disorder of the central nervous system that affects the control of muscles, and so may affect movement, speech and posture. The primary symptoms are the results of excessive muscle contraction, normally caused by the insufficient formation and action of dopamine, which is produced in the dopaminergic neurons of the brain.
It is often characterized by muscle rigidity, tremor, a slowing of physical movement (bradykinesia). (2 of the 3=diagnosis)
Typical complications
- dysphagia
- pneumonia
- UTI’s
- Skin breakdown
Typical drug
Important nutritional factors
Nursing goals of Parkinson’s
- maximize neurological function
- maintain independence ADL as long as possible
- optimize psychosocial well being
Nursing diagnosis
- impaired physical mobility
- impaired verbal communication
- imbalanced nutrition: less
- deficient diversional activities
Nursing interventions
- assist with ambulation
- Rom exercises
- Teach walking etc
- Allow enough time for communication
- Encourage deep breaths before speaking
- Alternatives for communication (pictures etc)
- Watch for aspiration
- Soft food, thickener
- Provide diversional activities
What is Alzheimer’s
is a neurodegenerative disease characterized by progressive cognitive deterioration together with declining activities of daily living and neuropsychiatric symptoms or behavioral changes. It is the most common cause of dementia.
Nursing goals for care giver
- Reduce stress
- Maintain personal health
- Cope with long term effects on caregiver
- Coping enhancement: social and community interventions, support groups
- Anticipatory guidance: teach what to expect to patient and family
- Cognitive stimulation: remind on where and when, exercise mind etc
- Fall preventions: remove small rugs, get good lights in hallways, bedside urinal etc.
- Assist with bathing etc
The list is endless see page 1592/93/95
Legal description of blindness
Best visual acuity w/ corrective lenses in the better eye of 20/200 or less or visual acuity of <20 degrees of the visual field in the better eye
Assessment of eye
- pupils round and equal, reacting to light
- sclera is white
- cornea is transparent
- red reflex with ophthalmoscope
Cataracts are
Opacity of the lens that distorts image projected on retina, can cause blindness
After cataract surgery
- avoid rubbing/straining
- avoid rapid eye movements
- avoid sneezing/coughing
- wipe fluids with sterile cottonball from inner side to outside of eye
- use eye shield at hospital
Glaucoma is
Increased intraocular pressure due to inadequate drainage of aqueous humor from the canal of Schlemm or overproduction of aqueous humor.
Interventions acute glaucoma
- administer medication
- prepare for peripheral iridectomy
Breast cancer acute interventions
- knowledge deficit
- fear
- body image
What about arm after mastectomy
- exercise !, watch for lymphedema
CAD is
Coronary artery disease
Modifiable risk factors CAD
- cholesterol
- serum lipids (LDL/HDL)
- smoking
- stress
- DM
Non-modifiable risk factors
- age
- race
- gender
- family
Ischemia is
is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue.
Infarction is
necrosis of tissue due to upstream obstruction of its arterial blood supply. It is the culmination of ischemia.
ACS is
Acute coronary syndrome
Angina is
Oppressive pain in the chest that is caused by inadequate bloodflow and oxygenation of the heart muscle
Most common complication of MI
Nursing diagnosis CAD
- pain
- ineffective tissue perfusion
- anxiety
- activity intolerance
- ineffective therapeutic regimen management
Main risk factors MI
- DM
- Age
s/s right CHF
Edema in extremities
s/s left CHF
Pulmonary edema/SOB starts left, goes right!
Nursing diagnosis CHF
- activity intolerance
- excess fluid volume
- disturbed sleep pattern
- impaired gas exchange
- anxiety
- deficient knowledge
Drug of choice for pain with pulmonary edema is morphine because
Decrease preload and Afterload and relief of pain/anxiety
Check what labs when pt is on diuretics
Modifiable risk factors for HTN
- sodium in diet
- alcohol
- smoke
- DM
- Serum lipids
- obesity
Non-modifiable risk factors for HTN
- age
- gender
- race
- family hx
Main risk factors for HTN
- ethnicity
- sedentary lifestyle
- socioeconomic status
- stress
Complications of HTN to what organs
- brain (stroke)
- heart (CAD)
- kidneys
- eyes
Diagnostic studies for HTN
- hx and physical
- BP measure in both arms
Use arm with highest reading as main arm to measure and let pt rest before measurement
Nursing diagnosis HTN
- ineffective health management
- anxiety
- sexual dysfunction
- ineffective therapeutic regimen
- disturbed body image (after amputation)
Risk factors for PAD are
- smoking
- Hyperlipidemia
- hypertension
- DM
- Age over 40hyperjomocystinemia
The pain in muscles that is gone after resting is called
Intermittent claudication
Is it reproducible?
Other s/s
Skin shiny, no hair, low peripheral pulses, feet can get red, pain with exercise
Important nutritional/lifestyle advice
- diet low in cholesterol (less than 200 mg/day)
- decrease intake of saturated fat
- use soy instead of animal proteins
- exercise at least 3 x 30 minutes a week
- stop smoking
What to asses
- DM
- Smoking
- Hypertension
- Hyperlipidemia
- Obesity
Important interventions after acute PAD (peripheral artery disease)
- Avoid knee-flexed position (except exercise)
- Turn patient regular
- Check pulses
- check sensitivity of extremity
2 kinds of thrombosis in extremities
- deep vein
- superficial
Directly after DVT important
Bedrest, leg up, heparin to prevent cloths to travel through body
Blood test Heparin
Blood test Coumadin
Typical s/s anemia include
- palpitations
- Dyspnea
- Diaphoresis
- Jaundice
- Pallor
- Pruritus
- Increased HR
- Systolic murmurs
- Angina
- MI
Common anemia of elderly
Iron deficient anemia
Cobalamin is
Vitamin b 12
In a severely anemic patient, the nurse would expect to find
Dyspnea and tachycardia.
What is the definition of GFR?
The definition of GFR is the volume of fluid filtered from the renal glomerular capillaries into the Bowman's capsule per unit time
How is it measured
Creatinine clearance is used to measure GFR.
(inflammation of the bladder) it is a lower urinary infection
(inflammation of the kidney) is an upper urinary infection
(inflammation of the urethra) is a lower urinary infection
What is the difference between a complicated and uncomplicated UTI?
Uncomplicated (simple) infections occur in healthy urinary tracts and do not spread to other parts of the body. They usually go away readily with treatment.
Most common calculi is
Calcium oxalate
Best prevention
Drink enough / A diet low in protein, nitrogen and sodium intake.
s/s of calculi are
Abdominal flank pain
Renal colic
Nursing care for urinary tract calculi
- prevention of stones occurring (drink fluids)
- dietary restrictions teaching (purines/oxalates)
- turn immobile pt Q 2h
- pain management/medication
- monitor urine PH, I/O
- strain urine to catch stone
Difference between lower and upper UTI is
Upper is kidney and ureters
Order of assessment of the abdomen is
1. Inspect
2. Auscultate
3. Percuss
4. Palpate
More woman than man have UTI why
Shorter urethra
Preventative measures are
- wipe front to back
- drink a lot
- urinate after intercourse
- sterile procedure catheters etc
- empty bladder completely
- empty bowl regularly
- drink cranberry juice
s/s UTI
A strong urge to urinate that cannot be delayed which is followed by a sharp pain or burning sensation in the urethra when the urine is released. Most often very little urine is released and the urine that is released may be tinged with blood. The urge to urinate recurs quickly and soreness may occur in the lower abdomen, back, or sides. Urine can smell or look different.
Most common bacterial agent in UTI is
What is different with the elderly
Signs are the same as others but:
Patient can be confused
Unexplained low-grade fever
Change in odor or appearance of urine
Advantage of hemodialysis
- Rapid fluid removal
- Rapid removal of urea and creatinine
- Effective K removal
- Less protein loss
Home dialysis possible
Disadvantage of hemodialysis
- Vascular access problems
- Dietary and fluid restrictions
- Extensive equipment needed
- Hypotension during procedure
- Surgery for access placement
- Specially trained personnel needed
- Self image problems with access
Advantage of peritoneal dialysis
- less diet restrictions
- less complicated
- short training
- home dialysis possible
- good for diabetic patient
Disadvantage of peritoneal dialysis
- Peritonitis
- Protein loss
- Self image problems
- Hyperlipidemia
- Surgery for placement
- Catheter can migrate
What are some nutritional considerations for the patient in CRF on hemodialysis
- no protein restriction (protein is lost in dialysis)
- eat enough carb and fat
- fibers in diet (often constipated)
- no potassium/sodium rich foods
- Iron supplements
s/s appendicitis
Pain (RLQ)/anorexia/nausea/vomiting
Nursing management appendicitis
Before surgery: NPO, no laxatives/ice pack
Erickson: infant
Trust vs mistrust
Erickson: toddler
Autonomy vs. shame and doubt
Erickson school aged kid
Industry vs. inferiority
Erickson adolescent
Identity vs. role confusion
Major roles of pediatric nursing is
Promotion of wellness and disease prevention
Other factors
- metabolism
- sleep and rest
- speech and communication
Young child has to go to hospital, how long before hand will you tell
2-3 days before
Nephrotic syndrome is
Nephrotic syndrome is a disorder where the kidneys have been damaged, causing them to leak protein from the blood into the urine. It is a fairly benign disease when it occurs in childhood.
s/s of nephrotic syndrome
Proteinuria, hypoalbuminemia ,Hyperlipidemia
Nursing diagnoses
- risk for fluid deficit/excess
- altered nutrition
- risk for impaired skin integrity
- activity intolerance
- body image disturbance
Nursing assessment
- daily weights
- I/O
- Urine tests
- Measure abdomen
- Asses for pallor, edema, fatigue
Bed rest, corticosteroids (edema), good nutrition, increased activity if possible, family teaching
Glomerulonephritis (GN) is bacterial, viral or parasitic pathogens),
a primary or secondary autoimmune renal disease characterized by inflammation of the glomeruli. It may be asymptomatic, or present with hematuria and/or proteinuria (blood resp. protein in the urine
Most common in children
Acute poststreptococcal glomerulonephritis
More boys than girls: school age
- irritable, fatigue, lethargic
- pallor, high BP, weight gain
- Oliguria, hematuria
- Hx of strep infection
Urine lab
Elevated BUN & creatinine levels
Nursing diagnosis
- fluid volume excess
- activity intolerance
- altered patterns of urinary elimination
- altered family process
- vitals
- fluid status, electrolytes
- complications?
Nursing management;
- Administer medication (calcium channel blockers, B-blockers, ACE blockers if condition is severe
- Antibiotics
- Anticonvulsants
- Diet with no added salt
If edema/hypertensive?
Sodium restrictions
Nursing care
- quiet play activities
- refer to social services
- teaching: stress, complications, home care, diet, medications
Wilms tumor is
Wilms tumor is a neoplasm of the kidneys that typically occurs in children. It is also known as a nephroblastoma
Do NOT palpate abdomen
Important after surgery
Deep breathing etc
Family care
- shock to family
- asses understanding
- provide support
- allow to express feelings
- play therapy regarding kids attitude to surgery
Barlow maneuver is
Flex legs breast
Hypospadias is
Meatus below the glans
Epispadias is
Meatus on dorsal surface of penis
What is cystic fibrosis
A common hereditary disease that affects the entire body, causing progressive disability and early death. Difficulty breathing is the most common symptom and results from frequent lung infections, which are treated, though not always cured, by antibiotics and other medications. A multitude of other symptoms, including sinus infections, poor growth, diarrhea and infertility, result from the effects of CF on other parts of the body
Further more
Increased viscosity of mucous secretions
What electrolytes are involved
Chloride and Sodium
Sweat test
Why not possible on babies
Not enough sweat
- abdominal distention/ vomiting/ failure to pass stools
- dehydration/large bulky stools (stinky)
- weight loss/ wheezing/coughs
- salty skin
At assessment you find a firm, olive like, movable mass in the RUQ of a baby, what could that be?
Pyloric Stenosis
What is Retinoblastoma?
-most common congenital malignant intraocular tumor of childhood primarily in children younger than 5 years
What causes Retinoblastoma?
caused by a mutation in a gene and my occur sporadically or be inherited -develops when the mutated gene is unable to produce the natural signals to stop the growth of retinal cells
What is Conjunctivitis?
Inflammation of the conjunctiva from virus or bacteria
What are the clinical manifestations?
red, blood vessels swollen -sticky, with a discharge, which is worse in the morning -itchy or painful
Therapeutic Management/ Nursing Care:
-bacterial is treated with antibiotic
What is Otitis Media?
Inflammation/infection of the middle ear
Who is at risk?
smokers in the house -bottle fed babies
Otitis Media and infant feeding methods
-Breastfed infants have a lower incidence than formula-fed infants. Breastfeeding may protect infants against respiratory viruses and allergy because breast milk contains secretory immunoglobulin Ig A, which limits the exposure of the eustachian tube and middle ear mucosa to microbial pathogens and foreign proteins. Reflux of milk up the eustachian tubes is also less likely to occur in breastfed infants because of the semivertical positioning during breastfeeding
What is a myringotmy?
-A surgical incision of the eardrum, may be necessary to alleviate the severe pain on Acute Otitis Media
Types of Head Injury: Concussion-
-most common, transient and reversible neuronal dysfunction, with instantaneous loss awareness
Types of Head Injury: Contusion-
visible bruising and tearing of cerebral tissue
What is Spina Bifida?
Myelomeningocele is a complex malformation of the spinal cord, nerve roots, meninges, vertebral bodies, and skin.
What is a neural tube defect?
NTDs constitute the largest group of congenital anomomalies that is consistent with multifactorial inheritance.
What is spina bifida oculta?
refers to a defect that is not visible externally. It occurs most commonly in the lumbosacral area (L5 and S1) SB occulta may not be apparent unless there are associated cutaneous manifestations or neuromuscular disturbances.
What is spina bifida cystica?
Refers to a visible defect with an external saclike protrusion. -The two major forms of SB cystica are Meningocele, which encases meninges and spinal fluid but no neural elements, and Myelomeningocele, which contains meninges, spinal fluid, and nerves
Is it possible to detect SB prenatally?
yes, fetal ultrasound and elevated concentrations of alpha-fetoprotein (AFP), a fetal specific gamma-globulin, in amniotic fluid may indicate presence of ancephaly or myelomeningocele.
Nursing Care:
sterile, moist covering with normal saline
the widespread use of folic acid of childbearing age is expected to significantly decrease the incidence of SB.
Nursing management of DVT includes
foot of bed elevated and bed rest
What is lightening and when does it usually occur…
when baby drops into pelvis, about 1-2 wks before delivery
The RN teaches pt. with diverticulosis to include what in diet…
increase fiber, increase fluids, and bulk laxatives
Name 2 to 3 causes of DKA…
infection, illness, stress
20. Quadriplegic with diaphoresis, flushed face, BP of 230/100, Pulse: 40, what complication should be suspected…
autonomic dysreflexia
A maternity cycle is divided into 3 periods, intrapartum begins and ends when..
onset of labor to delivery of placenta
Hemoglobin of 8.2 , what nursing care is essential…
assess for tachycardia, hypotension and O2 sat
What labs should be monitored with MI is suspected…
CK-MB, troponin- both elevated. Troponin is predictive of MI
.A woman pregnant with 2 girls, 1 boy, 1 miscarriage, what is G/P…
G 5, P 3
RN teaching adolescent with history of seizures about medicines should reinforce avoiding what with meds…
4 s/s of hypothyroidism…
wt. gain, decrease in VS, constipation, decrease concentration, dry brittle nails
A common serious complication of rheumatic fever…
cardiac valve damage
What is the proper method to perform fundal check on a patient postpartum…
use 1 hand to support the lower portion of uterus
Following upper endoscopy, an essential, very important assessment of will include…
gag reflex prior to admin of anything PO
Mother entered 2nd stage of labor. Stage begins with complete dilation of the cervix and ends with…
delivery of the baby
To prevent reoccurrence of renal calculi, RN teaches…
maintain fluid intake (2000-3000)
. After removal of Wilm’s tumor what tx are required…
chemotherapy and radiation
3 chronic complications associated with DM…
retinopathy, PVD, CAD, neuropathy, renal disease
2 Risk Factors of glaucoma…
Family history, increased intraocular pressure, age (45-65
8 hours following delivery of baby, the assessment of fundus should be…
firm and at umbilicus
Pregnant woman asks about sexual activity, the nurse states only reason to avoid sexual activity would be…
vaginal bleeding
. Name 2 important complications after a heart cath that the nurse should be alert for…
bleeding and cardiac arrhythmias
Pt’s cervix is dilated 9cm and 80% effaced, membranes just ruptured, 1st intervention…
assess FHR and then assess amount and color of fluid
State 3 facts about colostrums…
slightly yellow, antibodies, high protein, high fat
.To assess AV fistula patency, the RN will…
feel the thrill, hear the bruit
Stages of vaginal discharge during postpartum
Rubra, serosa, and alba (know the length of each stage)
A client recalls smelling unpleasant odor prior to a seizure…
4 s/s of hypoglycemia…
sweating, nausea, hunger, confusion, cool/pale skin
If a patient is experiencing laryngeal stridor and cramps in the hand, the RN suspects…
When comparing CVA with a TIA, the RN understands that….
TIA is intermittent while CVA is spontaneous