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167 Cards in this Set
- Front
- Back
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What are three things that can occur with an over reactive immune system? |
Allergies, anaphylaxis, auto-immune diseases. |
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What are examples of immunodeficiency's (under reactions of the immune system)? |
HIV, AIDS |
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Examples of auto-immune diseases: |
MS, parkinsons, Crohn's, Type 1 diabetes, Ulcerative colitis. |
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What is an antigen? |
A foreign substance that elicits an immune response. |
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What is an allergen? |
An antigen that causes an allergic reaction |
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What is an antibody? |
A Y shaped protein that is produced by the body's immune system in response to an antigen. (IgE for allergies) |
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What is an example of a chemical mediator in an allergic reaction? |
histamine or serotonin |
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Urticaria AKA: |
Hives- red, raised skin welts, 5mm in diameter, itchy |
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Examples of atopic dermatitis: |
eczema, pruritus, erythema, exudation- initially affect body creases (elbow and knee) |
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What is Angioedema? |
Rapid edema of the dermis, sub-Q, mucosa and submucosal tissues (when your lips and face swell from an allergic reaction) |
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What is allergic rhinitis? |
red, itchy, watery eyes. Sneezing, congestion, runny nose. Itchy or sore throat, post-nasal drip, cough. Itchy ears, buzzing sound |
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What are allergic shiner? |
dark circles under the eyes |
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What is an allergic salute? |
A crease across the bridge of the nose |
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What is asthma? |
smooth m.s constriction and bronchiole edema which results in decreased bronchiole diameter and increased mucus production. |
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What are the most common allergens for anaphylaxis? |
1. parental antibiotics (penicillin, cephalosporins) 2. IV contrast material 3. insect bites (bee, wasp, yellow jacket, hornet) 4. Food (peanuts, shellfish) |
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What are the most common areas affected by anaphylaxis? |
skin(80-90%) respiratory system (70%) GI (30-45%) Heart and vasculature (10-45%) CNS (10-15%) Usually 2+ are involved |
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What are S&S of anaphylaxis of skin? |
hives, itchiness, flushing |
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What are S&S of anaphylaxis of resp system? |
SOB, wheezes, stridor (throat is closing), hoarseness, pain with swallowing, cough |
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What are S&S of anaphylaxis of GI? |
crampy abdominal pain, diarrhea, vomiting |
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What are S&S of anaphylaxis of heart and vasculature? |
fast or slow HR, low BP |
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What are S&S of anaphylaxis of CNS? |
light headedness, loss of consciousness, confusion, headache, anxiety |
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What are the 3 big problems with anaphylaxis? |
1. peripheral vasodilation: vessels become dilated causing decreased BP and increased HR 2. Increased capillary permeability: histamine promotes vascular permeability and causes dilation of capillaries. This allows plasma to leak into interstitial spaces causing edema. And decreased cardiac output 3. Smooth muscle constriction: histamine causes smooth m.s contraction, especially in bronchial tree |
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How much time do you have to respond to anaphylaxis of IV medication? |
5 minutes |
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How much time do you have to respond to anaphylaxis of insect stings? |
10-15 minutes - circulatory collapse could occur |
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What can occur with food anaphylaxis? |
Respiratory arrest |
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What are the EASI medications given for anaphylaxis? |
E=Epinephrine(IV, IM, SQ A= antihistamines (H1- diphenhydramine. H2- Ranitidine S= steroids (hydrocortisone) I= inhalers(Salbutamol), IV fluid |
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What is Allergenimmunotherapy? |
the repeated administration of allergen vaccines to allergic individuals in order to provide long term relief of symptoms. |
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When changing a dressing on a pressure ulcer, a nurse notes necrotic wound tissue. Based on this assessment finding the nurse anticipates that the Dr will order? a. wound incision and drainage b. wound culturing c. wound debridement d. wound irrigation and antibiotic |
c. wound debridement |
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What clinical manifestations would the nurse expect to find in a pt who has superficial thrombophlebitis? a. redness noted along the vein b. induration noted along the vein c. warmth palpated along the vein d. tenderness on palpation of the vein e. diminished pulses in the affected extremity f. dilated blue coloured veins |
a, b,c,d |
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The nurse knows that a 45 y.o with severe HTN will experience increased workload of the heart due to which of the following? a. increased after load b. increased cardiac output c. overload of the heart d. increased preload |
a. increased after load - HTN increases after load as the left ventricle has to work harder to eject blood against vasoconstriction. |
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A pt has a TURP for BPH and is currently being treated with a continuous bladder irrigation. He's complaining of an increase in severity of bladder spasms. What interventions should the nurse do first? a. administer an oral analgesic b. stop the irrigation and call the Dr. c. administer a bellodonna and opium suppository as ordered by the Dr. d. Check for the presence of clots and make sure the catheter is draining properly |
d. check for the presence of clots and make sure the catheter is draining properly |
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A pt with chronic pyelonephritis is preparing to be discharged from the hospital. What is the most important information for the nurse to tell the pt? a. stay on bedrest for up to 2 weeks b. use analgesia on a regular basis for up to 6 months c. have a urine culture every 2 weeks for up to 6 months d. antibiotic tx may be needed for several weeks or months |
d. antibiotic tx for several weeks or months |
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A pt with Crohn's disease experiences 20 watery stools a day. When assessing the pt the nurse would anticipate which finding? (select all that apply) a. tenting skin turgor b. decrease HR c. dilute urine d. elevated BP e. lethargy |
a. tenting skin turgor e. lethargy |
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A pt asks the nurse "What is the different between RA and OA?" What is the most appropriate response? a. OA is gender specific, RA is not b. OA is a systematic disease, RA is localized c. OA is a localized disease, RA is systemic d. OA has dislocations and subluxations, RA does not |
c. OA is localized, RA is systemic |
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The nurse is teaching her pt about gout. She is teaching about limiting purine-rich foods. Which foods should the pt avoid? Select all that apply. a. bananas, wine and cheese b. milk, ice cream, vegetables and yogurt c. anchovies, sardines and kidneys d. sweetbreads and lentils e. meat and dried fruits |
c. anchovies, sardines and kidneys e. meat and dried fruits |
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A pt has experienced a brain stem infarction. It is most important for the nurse to assess the pt for: a. aphasia b. bradynea c. contralateral hemiplegia d. numbness and tingling to the face and arm. |
b. bradynea - the brain stem affects resp center |
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A pt with a suspected PE is brought to the ER complaining of SOB and pleuritic chest pain. Select all of the assessment data that would support this diagnosis? a. low grade fever b. thick green sputum c. bradycardia d. tachycardia e. blood-tinged sputum |
a.low grade fever d.tachycardia e.blood tinged sputum |
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This time spent with the pt helps to establish a level oftrust and confidence with the ptwith will help ease anxiety: This is during what preoperative stage? |
Pre-operative stage |
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How does a obesity affect theperioperative experience? |
¤Decreased wound healing by decreased blood perfusion. Decreased effectsof anesthesia. |
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How can pressure ulcers inunderweight pt’s be prevented? |
Padding bony prominences. Pre-op teaching of diet. Caffeine is adiuretic (more risk for falls). Also leeches out calcium from bones. |
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What dietary habits may affectrecovery? |
High in protein to promote tissue healing. |
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During what preoperative stages should pain assessment be done? |
During all preoperative stages |
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How soon pre-op should a pt quit smoking? |
6 weeks |
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Postoperativedelirium (falsely labelled senility or dementia) can occur with: |
dehydration, hypothermia, and adjunctive medications |
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Renal dysfunction contributes to: |
Fluid and electrolyte imbalances Increased risk of infection Coagulopathies Impaired wound healing Altered response to drugs andtheir elimination |
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Why wouldn't you give a diabetic pt insulin the morning of the surgery? |
The pt is NPO |
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How does malnutrition affect the pt's post-op experience? |
Need to increase protein intake- this will affect wound healing and the pt will be at risk for infection |
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What does SSI stand for? |
surgical site infection |
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How does obesity affect the pt's perioperative experience? |
delayed wound healing time |
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How does pulmonary disease affect the pt's perioperative experience? |
respiratory depression - decreased ventilation |
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How does cardiovascular disease affect the pt's perioperative experience? |
decreased perfusion to extremities, tissues, hemorrhage, fluid imbalances, shock, blood clots, risk of MI, risk of infection and inflammation |
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How does renal insufficiency affect the pt's perioperative experience? |
excretion of electrolytes and waste products, fluid overload, renal failure with <30mL/hr of urine production |
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Why wouldn't you shave the pt's hair prior to surgery? |
This could cut the pt and they could be at risk for infection prior to surgery |
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When should the pt shower prior to sx? |
The day before |
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What are the 2 goals of intraoperative care? |
1. pt safety 2. maintain homeostasis |
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What does the circulating nurse do? |
stay out of sterilefield-document all nursing care (not sterile) |
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What does the scrub nurse do? |
scrub in (gown and glove) assistas needed |
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What does the surgical technician do? |
assisting role, counting sponges |
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What components are included in the triad of anesthesia? |
muscle relaxation, analgesic, unconsciousness |
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What is a complication of anesthesia? |
hypothermia |
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What is a requirement to be d/c from hospital after receiving an epidural? |
Urinating- epidurals can cause urinary retention. Over 6-8 hours without urinating requires catheterization. Need >30mL/hour for proper kidney function |
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True or false: you need extra training to remove an epidural? ? |
True
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What do epidurals decrease? |
BP |
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How often are VS taken after epidural anesthesia is administered? |
Every 3 mins for first 15 minutes |
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What are the 4 possible complications from local or regional anesthesia? |
1. anaphylaxis 2. Incorrect delivery technique 3. Systemic absorption 4. Over dose |
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How do you treat the complications from local or regional anesthesia? |
Establish airway Give O2 Notify surgeon Fast acting barbiturate |
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What could happen if you do not treat a toxic reaction from local or regional anesthesia? |
unconsciousness, hypotension, apnea, cardiac arrest, and death |
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What nursing assessments need to be done after conscious sedation? |
LOC, O2 sats, ECGs, VS every 3 minutes for 1st 15 minutes |
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Autologous |
Client donates their own blood |
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Allogenic |
Client receives blood from the community |
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What does PACU stand for? |
Post-anesthestic care unit |
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What is the first sense to come back after anesthesia? |
Hearing |
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What is atelectasis? |
collapse of alveoli |
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What are the 2 most common causes of hypoxemia? |
atelectasis and bronchospasm |
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What is a sign of atelectasis? |
crackles |
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What are signs and symptoms of bronchospasm? |
wheezing, dyspnea, use of accessory muscles, hypoxemia, tachyepnea |
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What are the 3 immediate alterations in cardiovascular function? |
hypotension, HTN, arrythmias |
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What is the most common cause of hypotension? |
Unreplaced fluid and blood loss |
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What are the causes of hypertension? |
stimulation from pain, anxiety, bladder distention, or resp compromise |
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What is the most common cause of post-op agitation? |
Hypoxemia |
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When do you need the most pain medication after surgery? |
12-36 hours after sx |
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Why do you give O2 when the pt has hypothermia? |
The pt is likely shaking and shivering, this takes energy. |
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When could fluid deficits occur after sx? |
inadequate fluid replacement and decreased cardiac output and tissue perfusion |
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When could fluid overload occur after sx? |
IV fluids administered too rapidly, chronic cardiac or renal disease, pt is older |
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When could hypokalemia occur after sx? |
urinary or GI losses - effects contractility of heart |
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What is syncope? |
Fainting |
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What could syncope indicate after sx? |
decreased cardiac output, fluid deficit, deficit in cerebral perfussion. Occurs b/c of postural hypotension on ambulation, and is common in immobile and elderly
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What is wound dehiscence? |
partial/total separation of the wound |
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What is wound evisceration? |
When an organ protrudes out |
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How many bones in the human body? |
206 |
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Synarthrodial: |
immovable |
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amphiarthrodial |
slightly movable |
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diarthrodial/synovial |
freely moveable |
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What is osteomyelitis? |
A severe infection of the bone, bone marrow and soft tissue surrounding. |
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What does sequestra mean? |
surrounded by pus |
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What does involucrum mean? |
new bone growth |
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How long is acute osteomyelitis? |
less than 1 month |
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How long is chronic osteomyelitis? |
Longer than 1 month |
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True or false: X-rays can show osteomyelitis? |
False- only show if it's been 2+ weeks |
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What are some complications of osteomyelitis? |
septicemia, septic arthritis, pathological fractures b/c of weakened bone, squamous cell carcinoma. |
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What is osteoporosis? |
a chronic, progressive metabolic bone disorder (low bone mass [osteopenia], structural deterioration of bone tissue) |
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Which bone disorder is called the "silent thief"? |
Osteoporosis |
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True or false: gout is a type of arthritis? |
True |
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What is the most prevalent type of arthritis in Canada? |
osteoarthritis |
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What is the major S&S of osteoarthritis? |
pain |
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Which is a systemic autoimmune disease: rheumatoid arthritis or osteoarthritis?? |
RA |
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What is a typical S&S of RA? |
stiffness in the morning that doesn't resolve within 30 minutes. Usually symmetrical S&S |
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What is sjorgren's syndrome? |
seen in 10-15% of RA pt's. diminished lacrimal/salivary glands |
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What is Felty's syndrome? |
severe nodule forming RA that causes: splenomegaly, pulmonary disease, blood disorders, eye disorders, lymphadenopathy |
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True or false: X-rays show RA |
False, they are inconclusive |
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True or false: there is a cure for RA |
False, no cure and no known cause (autoimmune disorder) |
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RA is the inflammation of what tissue? |
connective tissue |
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What is gout? |
an increase in uric acid production, lack of secretion of uric acid by kidneys, excessive intake of foods high in purine |
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What increases your risk for gout? |
HTN, prolonged fasting, drug use |
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Difference btwn acute and chronic phases of gout? |
acute: affects 1 joint, triggered by trauma, sx, alcohol or infection. chronic: affects multiple joints, |
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What does the psoas muscle do? |
holds up the bladder |
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What are the adrenal glands important for? |
hormone function |
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Other than urine production, what else does the kidney do? |
Produces RBC, activates vitamin D, secretes renin |
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What 3 structures make up the urethrovesical unit? |
bladder, urethra, pelvic floor muscles |
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What problems with voiding do men have with enlarged prostate? |
starting their flow |
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what are the clinical manifestations of a lower UTI? |
urinary urgency, hematuria, pelvic pain |
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Why are UTI's common in diabetics? |
The sugar attracts bacteria, and they are immunocompromised |
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What is the different btwn upper and lower UTI? |
lower is in the bladder, upper includes ureter, renal pelvis. |
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What is a complicated UTI? What is an uncomplicated UTI? |
A 2ndary UTI. A UTI in an otherwise healthy urinary tract |
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Initial vs recurrent UTI |
recurrent is 2 or more in a year and antibiotics don't work |
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what is cystitis? |
inflammation in the bladder |
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S&S of upper UTI: |
abdominal pain, flank pain, fever, chills |
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Lower UTI S&S: |
asymptomatic, dysuria, urgency, frequency, hematuria, burning on urination, foul smelling urine, confusion (elderly) |
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What is Pyelonephritis? |
inflammation of the renal collection system/renal pelvis. Usually caused by bacteria or an enlarged prostate |
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S&S of acute and chronic pyelonephritis: |
fatigue, chills, fever, vomiting, flank pain. |
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What is glomerulonephritis? |
inflammation of the glomeruli |
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Urinary tract calculi AKA: |
kidney stones |
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Are kidney stones more common in men or women? |
men |
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What are kidney stones formed from? |
mineral salts in the body tissues |
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Stones greater than what size are not likely to pass through the ureter? |
4mm |
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What are 3 possible causes of kidney stones? |
concentrated urine urinary stasis urinary infection |
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S&S of kidney stones: |
abdominal pain, hematuria, N&V, cool and moist skin from shock, UTI, fever and chills |
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What is benign prostatic hyperplasia? |
an enlarged prostate gland |
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Does BPH have a link to prostate cancer? |
No |
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What are the risk factors for BPH? |
family history, diet, enviro, obesity |
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What areas does pelvic inflammatory disease affect? |
fallopian tubes, ovaries and pelvic peritoneum |
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What is the usual cause of PID? |
STIs, child birth, pelvic sx, pregnancy terminations |
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True or false: PID is the #1 cause of infertility? |
True |
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Clinical manifestations of PID? |
lower abdominal pain, pain or spotting during intercourse, purulent drainage, |
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Complications of PID? |
ectopic pregnancies, infertility, chronic pelvic pain, |
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What is endometriosis? |
presence of endometrial tissue on the outside of the cavity - the tissue shouldn't be outside the uterus- the endometrial tissue reacts to hormones just as it does in the uterus |
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What age group does endometriosis affect? |
20-30's and those that haven't experienced a full-term pregnancy- more prevalent in Asian women |
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S&S of endometriosis: |
dysmenorrhea, infertility, pelvic pain, irregular bleeding, back pain, painful BMs |
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What are 2 parts of peripheral vascular disease? |
Peripheral arterial disease
peripheral venous disease |
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What are S&S of DVT? |
tenderness swelling warmth fever pinkish, purple color to leg |
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What is the tx for DVT? |
bedrest, elevate limb, compression stockings, encourage fluids, ambulate is possible, ROM activities Meds: anticoagulants, antiplatelets (minitor PTT, and INR) |
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What is peripheral arterial disease (PAD)? |
affects arteries in the neck and abdominal and extremities a progressive narrowing of arteries atherosclerosis is a major cause (60-80 y.o) |
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What are the risk factors for PAD? |
smoking, high cholesterol, HTN, diabetes, stress, family hx |
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What is an aneurysm? |
an outpunching/ dilation of arterial wall |
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What is a true aneurysm? |
wall of the artery forms and aneurysm, but at least 1 layer is still intact. Can be fusiform or saccular |
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What is a false aneurysm? |
a disruption of layers in arterial wall. Bleeding |
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What is AAA? |
Abdominal aortic aneurysm. often asymptomatic, abdominal/back pain and audible bruits |
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What is an aortic dissection? |
It is not an aneurysm. Most common in thoracic aorta Results from a tear in initial lining of arterial wall Blood enters btwn intimal and media layers Described as a stabbing pain. |
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What are acute arterial ischemic disorders? |
They are caused by embolisms, thrombus, and narrowing diminished arterial flow to distal arteries |
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What is the difference btwn a thoracic aortic aneurysm and an abdominal aortic aneurysm? |
thoracic: deep, chest pain, distended neck veins, edema of head and arms abdominal: often asymptomatic, abdominal/back pain, audible bruit |
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What is peripheral venous disease? |
primarily affects lower extremities. disorder of the veins |
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What is venous thrombosis? |
formation of a clot, inflammation of a vein |
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What are the S&S of PVD? |
numbness/tingling in toes and feet, shooting/burning pain in neuropathy, thin and shiny and taught skin, loss of hair to lower legs, diminished or absent pulses, |
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What is Raynaud's phenomenon? |
Changes in color of hands and feet. A vaso-spastic disorder Changes color from white to blue to red White: decreased perfusion Blue: cold or numb Red: re-perfusion |
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What is Virchow's triad? |
1. venous stasis (damage to the valves) 2. endothelium damage (trauma) 3. hyper coagulability (hematological disorders-oral contraceptives) |
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What is thrombophlebitis? |
inflammation of a vein |
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Would a pt have hyperglycaemia or hypoglycaemia with ketoacidosis? |
hyperglycemia BG levels would be >14.9 |
