Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
88 Cards in this Set
- Front
- Back
List the three levels of disaster management
|
Disaster preparedness, disaster response,disaster recovery
|
|
Define shock
|
Wide spread reduction of tissue perfusion, which leads to generalized impairment of cellular function
|
|
what causes shock?
|
hypovolemia
|
|
What interveentions is used to restore cardiac output when hypovolemic shock exists?
|
Rapid infusion of volume-expanding fluids
|
|
Cardiogenic shock
|
release of endotoxins by bacteria which act on nerves i vascular spaces in the periphery,causing vascular pooling, reduced venous return,and reduced cardiac output and resulting in poor systemic perfusion
|
|
In cardiognic shock, the administration of volume-expanding fluids, and what intervention can the nurse expect to perform in the event of such an occurence.
|
Quick restoration of caria output an issue perfusion
|
|
List five assessment finding that occur in most shock victims.
|
Tachycardia; tachypnea, hypotension, cool clay skin; decrease in urinary output
|
|
What is the normal CVP for an adult?
|
4 to 10 cm of H20
|
|
Once circulatig volume is restored, vasopressors may be prescribed to increase venous return. List the main drugs that are used.
|
Epinephrine(Bronkaid), dopamine(Dopram, dobutamineDobutrex), norepinephrine(Levophed), or isoproterenol(Isuprel
|
|
What is the established renal output per hour?
|
30ml/hr
|
|
List four measurable criteria that are the major expected outcome of a shock crisis
|
BP mean of 80 to 90mmHg; PO2>50mmHg
CVP above 6cm of H2O urine output at last 30ml/hr |
|
Define DIC
|
A coagulation disorder in which there is paradoxical thrombsis and hemorrhage
|
|
What is the effect of DIC on PT, PTT, platelets, FSPs(FDPs)?
|
Prothrombin time,prolonged
partial thromboplastin time prolonged platelets, decreased fibrin split products, increased |
|
What drug is used to treat DIC?
|
Heparin
|
|
Name four nursing interventions to prevent injury in clients with DIC.
|
Gentle provide oral care with mouth swabs. Minimaze needle sticks and use the smallest gauge possible when injections are necessary. Eliminate the number of BP measurements taken by cuff. Ur gentle suction to revent trauma to mucosa. Apply pressue to any oozing site.
|
|
What Po2 value indicate hypoxemia?
|
Below 50 mmHg
|
|
What blood value indicates hypercapnia?
|
Pco2 above 45 mmHg
|
|
Identify the condition that exists when the Po2 is less than 50mmHg and Fi02 is greater than 60%
|
Hypoxemia
|
|
List three symtoms of respiratory failure in adults
|
Dyspnea/tachypnea; intercostal and sternal retractions; cyanosis
|
|
List four common causes of respiratory failure in children
|
Congential heart disease; infection or sepsis; rspiratory distress syndrome; aspiration;fluid overload
|
|
Type of shock. relat to external or internal blood loss or fluid loss (the most common cause of shock
|
Hypovolemic
|
|
Type of shock .
related to ischemia or impairment i tisse resulting from MI, serious arrhythmia, or heart failure.All of these cause decreased cardic output |
Cardiogenic
|
|
Type of shock.
Related to allergens (anaphylaxis), spinal cord injury, or priphral neuropathies, all resulting in venous pooling and decreased blod return to the heart, which decreases cardiac output over time. |
Vasogenic
|
|
Type of shock.
related to toxins released by bacteria, which cause vacular pooling,diinshed venous return, and reduced cardiac output |
Septic
|
|
What percentage of O2 should a child receive in severe respiratory distress receive?
|
100%
|
|
Is an unexpected, castrophic pulmonary complication occuring in a person with no previous pulmonary problems?
|
ARDS
|
|
Condition--_____Lowered Po2, not very responsive to high concentrations of O2, often need intubation and mechanical ventilation with positive end-expiratory pressure(PEEP)
|
ARDS
|
|
The instillation and maintnence of small amounts of air into the alveolar sacs to prevent the from collapsing each time the client exhales. The amount can be set by the ventilator and is usually around 5 to 10 cm of water
|
PEEP--positive end expiratory pressure
|
|
What is the first priority when a client with an unwitnessed cardiac arrest is found?
|
Begin CPR
|
|
Define myocardial infarction
|
Necrosis of the heart muscle due to poor perfusion of the heart
|
|
What criteria should alert a criteria with known angina who takes nitroglycein tablets sublingually to cal the EMS
|
Unrelieved chest pain after nitroglycerin
|
|
After calling for help and asking someone to ial for emergency services, what is the next action of CPR?
|
Call fr hel and begin CPR. For unresponsive ifants and children, CPR should b performed for 1 minute before placig a 911 call for help.
|
|
True or false? In feeling for the presence of a carotid pulse, no more than 5 seconds should be used
|
False. Palpate for no more than 10 seconds, recognize that arrhythmias or bradycardia could be occuring
|
|
During one rescures CPR, what is the ratio of compression to ventialtions for an adult and child.
|
Adult: 30:2 x 5 cycles
Child 15:2 for a child or neonate with two rescuers |
|
What is the first drug most likely usied for an hospital cardiac arrest?
|
Epinephrine
|
|
A client in cardiac arrest is noted on the bedside monitor to be in pulseless ventricular tachycardia. What is the first action that should be taken?
|
Defibrillation
|
|
True or False:
A precordial thump is a routine activity for an in-hospital cardiac arrest. |
false. A thump is indicated only in pulseless VT or VF or when ventricular asystole on monitor responds to a thump with a QRS cmplex
|
|
How would a nurse assess theadeqaucy of compressions during CPR?. How would the nurse assess the adequacy of ventilation during CPR?
|
Check for a pulse, watch or chest excursions and ascultate bilaterally for breath sounds
|
|
If a person is choking, when should the rescurer intervene?
|
When the person points to his or her throat and can no longer cough, talk, or make sounds.
|
|
One should never make a blank sweep into the mouth of a choking child or infant.Why?
|
Because acidosis should b relieved with improved ventlation; bicarbonate can actually contribute to increased CO2.
|
|
Regulate calcium and phosphorus balance
|
Parathyroid
|
|
Secrete aldosterone which causes sodium retention ( which causes water retention) and potassium excretion
|
Adrenal glands
|
|
Secretes antiduretic hormone (ADH), which causes the body to retain water
|
Pituitary
|
|
Composition of ECG:
Represents depolarization of the atrial muscle. Should be rounded and without peaking or notching |
P wave: atrial systole
|
|
Composition of ECG:
Prepresents depolarization of the ventricular muscle. Normally follows P wave |
QRS complex: ventricular systole
measured from the beginning of the QRS to the end of the QRS (normal <0.11 sec.) |
|
Composition of ECG:
Represents repolrization of the ventricular muscle. Follows QRS complx Usually is slightly rounded, without peaking or nothching |
T wave: ventricular diastole
|
|
Composition of ECG:
Represents early ventricular repolarization. Is measured from th end of the S wave to the beginning of the T wave. |
ST segment
|
|
Composition of the ECG:
Represebts the time required for the impukse to travel from the atria (SA node), through the A-V node, to the Purkinje in the ventricles. s measured from the P wave to the beginning of the QRS complex A-V ndal function 0.12-0.20 |
PR interval
|
|
Composition of ECG:
Is not always present Is most prominent in the presence of hypokalemia |
U wave
|
|
Composition of ECG:
Represnts the time required to completly depolarize and repolarize the ventricles. Is measured from the begining of the QRS complex to the end of tht T wave |
QT interval
|
|
What modalities are associated with gate control pain theory?
|
Massage, heat and cold, acupuncture, TENS
|
|
How does past experience with pain ifluence current pain experience?
|
The more pain experienced in childhood, the greater the preception of pain in adulthood or current pain experience.
|
|
What modalities are thought to increase theproduction of endogenous opiates?
|
Acupunture, administration of placebos, TENS
|
|
What six factors should the nurse iclud in assessing pain?
|
Location, intensity, comfort measures, quality, chronology, and subjective view of pain
|
|
What mechanisms is involved in the reduction of pain through the administratio of nonsteriodal antiinflammatory medication?
|
NSAIDa act by a peripheral mechanism at the level of damaged tissue by inhiitig prostaglandin synthesis and othe chemical mediators involved in pain transmission
|
|
If narcotic agonist/antagonist drus are administered to a client already taking narcotic drugs, what may be the result?
|
Intiation of withdrawal symptoms
|
|
List four side effects of narcotics medications,
|
Nausea, vomiting; constipatio, CHN depression; respiratory depression
|
|
What is the antidote for narcotic-induced respiratory depression?
|
Narcan ( Naloxone)
|
|
What is the first sign of tolerance to pain analgesics?
|
decreased duration of drug effectiveness
|
|
Which route of administration for pain meications has the quickest onset and shortest duration?
|
Intravenous push, or bolus
|
|
List six modalities that are considered noninvasive, nonphamacologic pain relief measures.
|
Heat and cold application; TENS; assage; distraction; relaxation techniqus' biofeedback techniques.
|
|
List four common symptoms of pneumonia that the nurse might note on a physical exam.
|
Tachypnea, fever with chills, productive cough, bronchial breath sounds
|
|
State four nursing interventions for assisting the client to cough productively
|
Encourage deep breathing; increase fluid intake to 3 1/day;use humidity to loosen secretions; suction airway to stimulate coughing
|
|
What symptoms of pneumonia might the nurse expect in an older adult?
|
Confusion, lethargy, anorexia, rapid respirator rate
|
|
What should the O2 flow rate be for the clent with COPD?
|
Between 1 to 2 liters per nasal cannula; too much O2 may eliminate the COPD client's stimulus to breathe. A COPD client has a hypoxic drive to breathe.
|
|
How does the nurs prevent hypoxia during suctioning?
|
Deliver 100% oxygen (hyperinflating) before and each endotacheal suctioning
|
|
During mechanical ventilation, what are three major nursing interventions?
|
Monitor client's respiratory status and secure connections;establish a communication mechanism with the client; keep airway clear by coughing and suctioning
|
|
When examining a client with emphysema, what physical findings is the nurse likely to see?
|
Barrel chest, dry or productive cough, decreased breath sounds, dyspnea, crackles in lungs fields.
|
|
What is the most common risk factor associated with lung cancer?
|
Smoking
|
|
Describe the properative nursing care for a client undergoing a laryngectomy.
|
Involve family and client in anipulation of tracheostomy equpiment before surgery; plan acceptable communications methods; refer to speech pathologist; discuss rehabilitation program
|
|
List five nursing interventions after chest tube insertion
|
Maintin a dry occulsive dressing on chest tube. Keep all tubing connections tight and taped.Monitor client's clinical ststus. Encourage the client to breath deeoply periodically. Monitir the fluif drainage an mark the time of measurement and fluid level.
|
|
What immediate action should the nurse take when a chest tube becomes disconnected from a bottle or suction apparatus? What should the nurse do if the chest tube accidently removed from the client?
|
Place the end of the tube in asterile water container at a 2 cm level. Apply an occlusive dressig and notify health care provider.
|
|
What instruction should be given to a client following radiation therapy?
|
Do not wash off lines; wear soft cotton garments; avoid use of powders and creama on radiation site.
|
|
What precautions are required for clients with TB when placed on respiratory isolation?
|
A mask for anyone entering the room;private room; client must wear msk leaving room
|
|
Lit four components of teaching for the client with tuberculosis
|
Cugh into tissues and dispose immediately into special bags. Long-term need for daily medication.Good handwashing technique. Report symptoms of deterioration.i.e.,blood in scretions.
|
|
Accumulation of waste products from protein metabolism is the primary cause of what?
|
Uremia
|
|
Protein must be resticted under what condtion?
|
Chronic renal failure CRF
|
|
What is most often used as an indicator of the lvel of protein consumption?
|
GFR glomerular filtration rate
|
|
Differeniate between acute renal failure and chronic renal failure.
|
Acute renal failure ofn reversible, abrupt deterioration of kdney fuctin. Chronic real failure: irreversile, slow deterioration of kidney fnton characteized by increasig BUN and creatnine. Eventually dialysis is required.
|
|
During the oliguic phase of renal failure , protein should be severely restricted. What is the rationale for this restriction?
|
Toxic metabolites that accumulate in the blood (urea,creatinine) are derived mainly from protein catabolism.
|
|
Identify two nursing interventions for the client on hemodialysis.
|
Do not take BP or perform venipunctures on the arm with the AV sunt, fistula, or graft. Assess access site for thrill nd bruit.
|
|
What is the highest priority nrig diagnosis for the clients in any type of renal failure?
|
Risk for imbalanced fluid volume
|
|
A client in renal failure asks why he is being give antacids. How should the nurse reply.
|
Calcium and aluminm antacids bind phosphates nd help to keep phosphates for being absorbed into blood stream,therby peventing rising phosphate levels; must be taken with food
|
|
List four essential elements of a teaching plan for clients with frequent urinary tract infections.
|
Fluid itake 3 l/day, good handwashing; void every 2 to 3 hours during waing hours; take all prescribed medications ;wear cotton undergarments
|
|
What are the most important nursing interventions for clients with possible renal calculi?
|
Straining allurine is the most important. Other interventions include accurate intake and output documentation and administering analgesics a needed
|
|
What discharge instructions should be given to a client who has had urinary calculi?
|
Maintin high fluid intake of 3 o 4 l/day. Pursue follow-up care (stones tend to reoccur). Follow prescribed diet based on calculi content. Avoid supine position.
|
|
Following transurethral resection of the prostate gland (TURP), hematuria should subsie by what post-operative day?
|
The fourh day
|
|
After the urinary catheter is removed inthe TURP client, what are three priority nursig actions?
|
Cotinued strict I&O. Cotinued observations for hematuria. Infom clint burning and frequency may last for a week
|