Med/surg #2

Front 1

1 Liter equals

Back 1

2.2 kilograms=1 pound

Front 2

When caring for a pt with Fluid imbalances what should you monitor?

Back 2

Daily weights and skin assessment and care (test skin turgor) I and O's, Cardiovascular and respiratory changes.

Front 3

Signs and Symptoms of ECF volume excess

Back 3

Jugular vien, peripheral edema, bounding pulses, polyuria, crackles in the lungs, pulmonary edema, weight gain

Front 4

Sign and Symtoms of ECF volume deficit

Back 4

Decreased skin turgor, thirst, dry mucous membrances, drowsiness, weight loss, decreased urine output

Front 5

Treatment for ECF Deficit

Back 5

Balanced IV solutions, lactated Ringer's and Isotonic sodium chloride.

Front 6

Treatment for ECF Excess

Back 6

Diuretics and fluid restriction are the primary treatment

Front 7

NG Tube with ECF Excess

Back 7

No water to flush NG tube, use saline to flush

Front 8

Hypernatermia manifestations

Back 8

dry swollen tounge, sticky mucous membranes, Posteral hypotension, weight loss, intense thirst, confusion

Front 9

Normal Sodium Level

Back 9

135-145

Front 10

Hypernatermia causes

Back 10

IV fluids: hypertonic solutions, Hypertonic tube feedings, Diabetes insipidus, primary hyperaldosteronism, cushing syndrome

Front 11

Treatment of Hypernatremia

Back 11

Treat with IV fluids such at 5% dextrose in water, and diuretics, deitary sodium intake restriction

Front 12

Hyponatremia causes

Back 12

GI losses, NG suction, renal losses, diuretics, adreal insufficiency, wasting renal disease, Fasting diets, burns, heart failure, primary hypoaldosteronism

Front 13

Hyponatremia clinic manifestations

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Confusion, disoriention, irritability, personality changes, tremors, cold clammy skin, headache, coma, death without treatment

Front 14

Hyponatremia treatment

Back 14

fluid restrictions and small amounts of hypertonic solutions

Front 15

When giving hypotonic solutions what should you monitor for?

Back 15

Fluid volume overload and pulmonary edema, crackles in the lungs, edema

Front 16

Normal Potassium levels

Back 16

3.5-5.0 mEq/L

Front 17

Hyperkalemia causes

Back 17

rapid parenteral administration, excess potassium intake,acidosis, crush injury, tumor lysis syndrome, renal disease

Front 18

Hypokalemia causes

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GI losses, Dialysis, renal losses, diuretics, magnesium depletion, Increased insulin, Alkalosis, starvation

Front 19

Hyperkalemia clinical manifestations

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irritability, anxiety, abdominal cramping, paresthesias, weakness in lower extremities, cardiac arrest, irregular pulses

Front 20

Hypokalemia clinical maifestations

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Fatigue, leg cramps, soft flabby muscles, weak irregular pulses, hyperglycimia

Front 21

Most common cause of hyperkalemia

Back 21

renal failure

Front 22

ECG changes Hyperkalemia

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Tall peaked T wave

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ECG chages Hypokalemia

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Presence of U wave

Front 24

Hyperkalemia treatment

Back 24

Diuretics (kexalat), dialysis, IV insulin, IV calcium gluconate, monitor for cardiac changes

Front 25

Hypokalemia treatment

Back 25

IV Pump potassium, only give 10-20 mEq, DO NOT PUSH, monitor site every hour for phlebitis and infiltration, provide teaching on high potassium food (potatos, bananas)

Front 26

During what electrolyte imbalance should you monitor digoxin levels?

Back 26

Hypokalemia, digoxin levels can become toxic

Front 27

Normal Calcium levels

Back 27

8.5-10.5 mc/100mL

Front 28

Hypercalcemia causes

Back 28

Multiple myeloma, prolonged immobilization, hyperparathyroidism, vitamin D overdose, Thiazide diuretics, acidosis

Front 29

Hypercalcemia manifestations

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depressed reflexes, decreased memory, confusion, anorexia, bone pain, fractures, stupor, coma

Front 30

Hypercalcemia treatment

Back 30

loop diuretics (lasix), hydration 3000-4000 mL of fluids daily

Front 31

Hypocalcemia causes

Back 31

chronic kidney disease, elecvated phosohorus, hypoparathyroidism, loop diuretics, pancreatitis, alcoholism

Front 32

Hypocalcemia manifestations

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anxiety, numbness and tingling of extremeties, Chvosteks or Trousseaus sign, laryngeal spasm, tetany

Front 33

Hypocalcemia treatment

Back 33

Oral or IV supplements, foods high in calcium, cannot give calcium IM, monitor for hyperventilation of precent respiratory alkalosis

Front 34

Why Monitor Calcium levels after thyroid or neck surgery?

Back 34

because of the proximity of the surgery to the parathyroid glands which monitor the bodies calcium levels

Front 35

Normally if Calcium goes up..

Back 35

Phosphate goes down and vise versa

Front 36

Hyperphosphatemia causes

Back 36

renal failure, chemotherapeutic agents, fleets enema, excessive ingestion (diary products) Large vitamin d intake

Front 37

Hyperphosphatemia manifestations

Back 37

hypocalcemia, tetnay, deposition of calcium

Front 38

Hyperphosphatemia treatment

Back 38

restrict dairy intake, hydrations, fix hypocalcemia

Front 39

Hypophosphatemia causes

Back 39

malabsorption syndrome, glucose administration, total parenteral nutriton, alchohol withdrawal, recovery from deabetic ketoacidosis

Front 40

Hypophosphatemia manifestions

Back 40

confusion, coma, muscle weakness, cardia problems r/t stroke volume decreased, osteomalacia

Front 41

Hypophosphatemia treatment

Back 41

Oral or IV supplements

Front 42

Normal phosphorus level

Back 42

3.0-4.5 mEq/100 mL

Front 43

Hypomagnesemia

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seen in alchohol abuse, treated with foods high in magnesium (green veggies, nuts, bananas, chocolate) slow IV, to fast can lead to cardiac arrest

Front 44

Hypermagnesemia

Back 44

Manifests flacid muscles, pts with renal failure should not take mediations with magneseium in them, pts with kindey dysfunction will require dialysis for excretion

Front 45

Normal Magnesium level

Back 45

1.7-2.2 mg/dL

Front 46

Normal PH

Back 46

7.35-7.45
Below 7.35= acidosis
Above 7.45= alkalosis

Front 47

PaCO2

Back 47

32-48 mm Hg

Front 48

HCO3

Back 48

22-26 mEq/L

Front 49

PaO2

Back 49

80-100 mm Hg

Front 50

Respiratory acidosis

Back 50

HYPOventilation, CO2 build up, PaCO2 above 48, PH below 7.35

Front 51

Respiratory acidosis S/S

Back 51

drowsines, disorientation, headache, decreased B/P, warm flushed skin, dysrhythmias, HYPOventilation

Front 52

Respiratory alkalosis S/S

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Light-headed, confusion, tachycardia, tingling extremities, hyperreflexia, HYPERventilation

Front 53

Respiratory alkalosis labs

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HYPERventilation
PaCO2 below 32
PH above 7.45

Front 54

Metabolic acidosis

Back 54

HCO3 below 22
PH below 7.35
Bicarbonate deficit

Front 55

Metabolic acidosis S/S

Back 55

drowsiness, confusion, low BP, Kassmaul respirations (rapid deep breathing)

Front 56

Metabolic alkalosis

Back 56

Los of acid or increase in bicarbonate
HCO3 above 26
PH above 7.45

Front 57

Metabolic alkalosis S/S

Back 57

dizziness, nervousness, tachycardia, anorexia, muscle cramps, hypoventilation, seizures

Front 58

Metabolic alkalosis causes

Back 58

prolonged vomiting or gastric suction, ingestion of baking soda

Front 59

Metabolic acidosis causes

Back 59

Ketoacid accumulation in diabetic ketoacidosis, and lactic acid accumulation with shock are examples

Front 60

Primary post op care for Radical or midified neck dissection

Back 60

Airway and breathing x 24 hours

Front 61

S/S of Head and Neck Cancer

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Sometimes a painless bump in the mouth, usually no symptoms in the early stages, late stages S/S dysphagia, decreased tounge movement, airway obstruction.

Front 62

Risk factors for Laryngeal cancer

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prolonged use of tobacco and alcohol, a diet poor in fruits and vegetables and infection of HPV, Men are at greater risk then women

Front 63

Nursing goals for laryngeal cancer

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Nutritional therapy, Patent airway, no spread of cancer, no complication r/t surgery/therapy, minimal to no pain, ability to communicate, acceptable body image

Front 64

Nursing for unstable laryngeal patients

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Assess the need for suctions, suction when needed, maintain cuff infation at 20-25 cm h2o, assess tracheostomy, assess swallowing ability, avoid asperation, educate pt on care of trach

Front 65

S/S Osteoarthritis

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Joint pain, worse with use of joint, Deformity: Heberden and Bouchards nodes, stiffness for 30 minutes in the morning, but loosens up throughout the day.

Front 66

DIP and PIP in Osteoarthritis

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usually occurs in the fingers, thumb, weight bearing, foot, and cervical and lower lumbar vertebrae

Front 67

Diagnostic studies for Osteoarthritis

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CT, MRI, xrays, and synovial fluid

Front 68

Osteoarthritis Treatment

Back 68

Rest and joint protection, heat and cold applications, nutrion and exercise, drug therapy

Front 69

Osterarthritis Nursing care

Back 69

Assessment: Can pt preform ADL's? Make sure pt wears supportive shoes, uses night lights, no throw rugs

Front 70

Rheumatoid Arthritis S/S

Back 70

Rheumatoid nodules, sjogrens syndrome, and Felty syndrome

Front 71

Manifestations of Rheumatoid Arthritis

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Joint destruction, flexion contraction and deformitites, decreased grasp strength, nodular myositis and muscle pain, cataract development, nodule ulceration

Front 72

Diagnostic tests for RA

Back 72

RF (Rheumatoid factor, ESR & CRP-inflamation/infection, ANA (antinuclear antibodies)

Front 73

Side effect of Methotrexate (Rheumatrex)

Back 73

Birth defects, must take OCPs when using this

Front 74

Side Effect of Hydroxychloroquine (Plaquenil)

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Retina Changes, visual disturbances

Front 75

Sife Effect of Prednisone or Deltasone

Back 75

prolonged use can lead to osteoporosis and avascular necrosis

Front 76

Treatment for RA

Back 76

Health promotion, ambulatory and home care, rest, joint protection, heat and cold therapy, psychologic support

Front 77

Septic arthritis

Back 77

Infectious or bacterial arthritis cause by microorgansims in the joint

Front 78

Septic arthritis S/S

Back 78

Fever, pain, joint inflammation, chills, erythmea, usually in a large joint, hip or knee

Front 79

Septic arthritis Diagnostic test

Back 79

Arthrocentesis and culture of the synovial fluid and blood cultures

Front 80

Treatment/Nursing care in septic arthritis

Back 80

Assess and monitor joint inflammation, pain, and fever, immobilization of affected joints, use resting splints or traction, gentle ROM exercises

Front 81

Reactive arthritis

Back 81

More common in men, associated most commenly following Chlamydia trachomatis.

Front 82

Reactive Arthritis S/S

Back 82

usually asymmertric, usally in lower extremities and toes, lower back pain, mucocutaneos lesions, ulcerations on the tongue

Front 83

Diagnostic tests for Reactive Arthritis

Back 83

Elevated ESR

Front 84

Reactive arthritis treatment

Back 84

for pt and sexual partner(s) treat with doxycycline daily for up to 3 months, PT may help

Front 85

Lyme Disease

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A spirochetal infection caused by Borrelia burgdorferi and transmitted by a deer tick bite.

Front 86

Lyme Disease S/S

Back 86

Erythema migrans (EM) A skin lesion with a bright red border and central clearing. Flu like symptoms

Front 87

Lyme Disease Diagnostic Tests

Back 87

Two Step Confirming tests, ELISA and Western blot

Front 88

Lyme Disease Treatment

Back 88

Oral Antibiotics, doxycycline, Ceftin, and amoxicillin, IM Antibiotics if illness is it later stages, pt teaching

Front 89

Gout

Back 89

Caused by increase of uric acid producetionm under excreation of uric acid by the kidneys or increased intake of purrines in diet (Shell fish, asparagus, beans, pork, beef)

Front 90

Gout S/S

Back 90

Can occur in up to 4 joints in the acute phase, joints are tender and cyanotic, usually in the great toe.

Front 91

Gout Diagnostic Studies

Back 91

Elevated uric acid levels, Synovial fluid asperation soudium present, 24 hour urine for uric acid levels elevated

Front 92

Gout Treatment

Back 92

Immobilization of effected joints, no pressure on joints family education of the chronic issues, and to avoid food with purines and alchohol, drug use (niacin, aspirin, diuretics) and starvation.

Front 93

Systemic Lupus Erythematosus (SLE)

Back 93

is a multisystem inflammatory autoimmune disease.

Front 94

SLE S/S

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Butterfly rash, photosensitivity, oral ulcers, arthritis, serositis, renal disorder, neurologic disorder: seizure, antinuclear antibody

Front 95

SLE Diagnostic Studies

Back 95

H & P, antibodies, CBC, LE cell prep, xray, ecg

Front 96

SLE Treatment

Back 96

Pain managment, adhere to therapeutic regimen, demonstrate awareness of and avoid activites that cause exacerbation

Front 97

Systemic Sclerosis

Back 97

is a disorder of connective tissue characterized by fibrotic, degenerative, and occasionally infammatory changes in the skin

Front 98

Systemic Sclerosis S/S

Back 98

C- Calcinosis
R- Reynauds phenomenon
E- Esophageal dysfunction
S- Sclerodactyly
T- Telangiectasia

Front 99

Systemic Sclerosis Diagnostic studies

Back 99

Elevated creatinine levels in pts with CREST, distal esophogeal hypomobility

Front 100

Systemic Sclerosis Treatment

Back 100

Joint ROM for plan of care, protect fingers and toes from cold (reynauds phenomenon) eating small frequent meals