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821 Cards in this Set

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____ is also called fibrocystic disease of the pancreas, mucoviscidosis
cystic fibrosis
causes generalized dysfunction of the exocrine (sweat) glands that affects multiple organ systems
cystic fibrosis
which nervous sys is affected in cystic fibrosis?
autonomic
what do kids w/cystic fibrosis retain?
NA+ and H2O
describe the secretions in cystic fibrosis?
thick and sticky rather than thin and slippery
how is cystic fibrosis passed down? who gets the most?
an autosomal recessive trait(both parents must carry).
white
cystic fibrosis is one the most common inherited diseases and occurs equally in both sexes?
info
life expectancy in cystic fibrosis?
20-30yrs
in cystic fibrosis the cumlative effect and may loose lung tissue, Cardic involvement, Cor Pulmonale.
info
what is the presenting s/s of cystic fibrosis?
Meconium ileus (bowel obstructed with meconium) at birth
describe skin in cystic fibrosis?
Salty taste on child's skin, bulky
dscribe stool in cystic fibrosis?
greasy foul-smelling stools that contains undigested food
(steatorrhea)
what causes the airway obstruction(chronic airway infection) in cystic fibrosis?
increased and constant production of mucus, little or no release of pancreatic enzymes (mucus plugging the pancreatic duct and its branches
why are stools foul smelling and contain undigested food in cystic fibrosis?
because pancreatic enzymes such as trypsinogen, lipase and amylase, do not reach the intestine to digest ingested nutrients
what nutrients are malabsorbed in cystic fibrosis?
fat, protein, and fat-soluble vitamins (A,D,E,K).
Fat malabsorption results in cystic fibrosis results bulky, grey or light colored stools called?
steatorrhea
protein malabsorption in cystic fibrosis results in ___?
failure to grow and gain weight
how is cystic fibrosis dx?
sweat chloride 2-5x normal (abnormally regulated chloride channel activity), stool specimen analysis indicated the absence of trypsin.
T/F Virtually all CF patients (95%) require pancreatic enzyme supplements due to an inadequacy of their own pancreatic secretions (High lipase preparations
T
what vit and diet for cystic fibrosis?
fat soluble, high protein
what maybe done in cystic fibrosis with ariway obstruction?
chest physiotherapy
(Flutter device helps aid in breathing and force secrections up)"percussion/clapping"
what meds maybe given in cystic fibrosis for airway obstruction and infection?
given how
mucolytic, bronchodilator (theophylline), antibiotic
nebulizer
how should po pancreatic enzymes be given in r/t meals
with meals
what lung condition is common in CF?
pneumothorax
____involves postural drainage and mechanical devices or hands
chest physiology(percussion/clapping)
congenital anomaly in which the esophagus and trachea don't separate normally
TRACHEO-ESOPAHGEAL FISTULA
the esophagus ends in a blind pouch, with the trachea communicating by a fistula with the lower esophagus and stomach
TRACHEO-ESOPAHGEAL FISTULA
feeding problems w/TRACHEO-ESOPAHGEAL FISTULA?
difficulty feeding, such as choking or aspiration, cyanosis during feeding
respirator problems with TRACHEO-ESOPAHGEAL FISTULA?
Respiratory distress to include tachypnea, cyanosis, sternal and substernal retractions
what prenatal problems are seen in tracheo esophageal fistula? why?
Maternal polyhydramnios (because fetus canÕt swallow amniotic fluid.)
how is tracheo esophageal fistula Dx?
abdominal x-ray shows the fistula and a gas-free abdomen
tx for tracheo esophageal fistula?
emergency surgical intervention to prevent pneumonia, dehydration, and fluid and electrolyte imbalances, maintenance of patent airway. Antibiotics as prophylaxis for aspiration pneumonia.
the proximal end of the esophagus ends in a blind pouch. Food can not enter the stomach via the esophagus
ESOPHAGEAL ATRESIA
s/s of ESOPHAGEAL ATRESIA?
excessive salivation and drooling due to inability to pass food through the esophagus. Regurgitation, possible aspiration
how is ESOPHAGEAL ATRESIA dx?
Newborns are fed first with a few sips of sterile water to detect these anomalies and to prevent the aspiration of formula or breast milk into the lungs
how is ESOPHAGEAL ATRESIA Tx?
surgical correction by anastomosing the esophageal ends. Repair is done in stages.
an obstruction of the bile ducts caused by their failure to develop normally in the fetus
BILIARY ATRESIA
s/s of BILIARY ATRESIA
Jaundice 2 weeks post-term
(maybe present at birth)
BILIARY ATRESIA May be progressive or intermittent
Slow or absent weight gain
info
describe urine in BILIARY ATRESIA
dark
what happens to the liver and spleen in BILIARY ATRESIA
Enlarged Spleen/Liver
describe stools in BILIARY ATRESIA
Pale or clay-colored. floating, foul-smelling stools
how might biliary atresia be dx?
Increased bilirubin in the blood and increased liver enzymes, abdominal ultrasound, HIDA scan, liver biopsy
the ________ to connect the liver to the small intestine, bypassing the malformed ducts, before the baby is 10 - 12 weeks old done in biliary atresia?liver transplant later prn
Kasai procedure
major nsg concern w/biliary atresia?
nutrition
With biliary atresia, not enough bile reaches the intestine to assist with the digestion of _____ in the diet
fats
____ & ___ deficiencies may occur due to liver damage in biliary atresia?
Protein,
vit
Children with ____ disease require more calories than a normal child because of a faster metabolism.
liver
partial or complete defect of the lip that results in failure of the upper lip to fuse
CLEFT LIP
cleft lip Can range from a simple notch on the upper lip to complete cleft from the lip edge to the floor of the nostril, on either side of the midline, rarely along the midline itsel
info
major concern w/cleft lip?
Increased risk for aspiration because of the increased open space in the mouth
T/F cleft lip may be determined by prenatal ultra sound
T
____ performed between birth and age 3 months in cleft lip to unite the lip and gum edges in anticipation of teeth eruption
Cheiloplasty
how is cleft palate dx?
mouth examination after birth if cleft palate is present without cleft lip
cleft palate repair surgery (staphylorrhaphy) scheduled for about 18 months to allow for growth of the palate and to be done before the infant develops _____
speech patterns
what infections must in infant be free of in cleft palate sx?
ear and respiratory infection
RF of pyloric stenosis?
what races gee less?
which sex?
3/1000
black and asian
4/1 m/f
T/F there is an Increase incident of pyloric stenosis in breast feed and young mothers
T
Hypertrophy and hyperplasia of the pyloric muscle leading to narowing, obstruction, inflammation and vomiting.
pyloric stenosis
when do s/s of pyloric stenosis show up?
after 2 wks
swhat happens @ 2-4 weeks in pyloric stenosis?
6wks?
regurgation
complete obstruction
#1 s/s o pyloric stenosis?
Projectile vomiting shortly after feeding
what other s/s of pyloric stenosis?
Vomitus non bilous and maybe blood tinged at times in pyloric stenosis, Failure to gain weight. Decreased stool. Dehydration. Abdomenal distention
what does palpation reveal in pyloric stenosis?
olive-shaped mass right of the umbilicus
Treatment for pyloric stenosis?
Pyloromyotomy
nsg int preop pyloric stenosis:Rehydration with ____ fluid. ____ to minmize vomiting: _____ feeding, Semi upright postion aka ____
IV
Feeding techniques
Slow
Portuguese sling
nsg int p/o pyloric stenosis:____ posit after feeding to facilitate gastric emptying, Minimal handling after ___
High Fowlers
feedings
what nsg care p/o pyloric stenosis?
Monitor VS, IV fluids, NG tubes
Parent education p/o pyloric stenosis?
diet from NPO to Clear liquids. Possible vomiting within 24 hour of surgery. Report all increase vomiting to MD.
_____ is a congenital birth defect that is the malformation of the bladder and urethra, in which the bladder is turned "inside out
Bladder Exstrophy
in bladder exstrophy the bladder does not form into its normal round shape but instead is ____ and exposed _____ the body
flattened
outside
what part of the bladder fails to form correctly in bladder exstrophy?
The lower portion of the bladder, a funnel-shaped bladder neck, made up of muscles that open and close the bladder, fails to form correctly
describe the genitalia, anus and cat in bladder exstrophy?
The urethra and genitalia are not formed completely (epispadius) and the anus and vagina appear anteriorly displaced
widely separated pelvic bones seen in bladder exstrophy?
diastasis
coplications of bladder exstrophy?
leaky urine; small bladder with retrograde urine = kidney infection/destruction
how many stages to sx repair in bladder extrophy?
when may sx take place?
3
as young as 48 hours old
describe the 1st stage in bladder extrophy sx?
The first stage involves internalization of the bladder and closing the abdomen
2nd stage of sx in bladder extrophy?
done between age 1 and 2 and involves repairing the epispadias and other genital abnormalities
3rd stage of sx in bladder extrophy?
done at around age 3 and involves reconstruction of the urinary tract including the bladder, and other structures of the urinary tract.
congenital anomaly of the penis. The urethral opening may be anywhere along the ventral side of the penis
HYPOSPADIAS
major problem w/hypospadias?
This conditions provides a shorter distance to the bladder, providing easier access for bacteria
how is hypospadias dx?
observation confirms aberrant placement of the opening
what should be avoided in hypospadias? why?
avoid circumsion (the foreskin may be needed later during surgical repair), no treatment, mild disorder
hypospadias procedure in which the urethra is extended into a normal position) to restore normal urinary function
Meatotomy
At age ____months surgery to release the adherent chordee (fibrous band that causes the penis to curve downward) in hypospadias?
12-18
with analgesics for postoperative pain relief and antispasmodic agents such as _____for postoperative bladder spasms in hypospadias.
propantheline
____ is a genetic disorder characterized by the growth of numerous cysts in the kidneys filled w/fliud?
POLYCYSTIC KIDNEY DISEASE
PKD cysts can slowly replace much of the mass of the kidneys, reducing kidney function and leading to ____?
kidney failure
T/F PKD May be inherited or may be acquired with kidney failure
T
s/s of PKD?
pain in the back and the sides, H/A, hematuria
how is PKD dx?
ultrasound
tx for PKD?
pain meds, antibiotics, anti-hypertensives, eventual kidney transplant/dialysis
_____ is a collection of serous fluid that results from a defect or irritation in the tunica vaginalis of the scrotum; 1% of adult men and most hydroceles are congenital and are noted in children aged 1-2 years of age
hydrocele
Chronic or secondary hydroceles usually occur in men older than _____ years
40
how is hydrocele dx?
enlarged scrotum; adult-onset hydrocele may be secondary to orchitis or epididymitis
______ of the bladder may lead to hydrocele
exstrophy
how are hydrocele tx?
hydrocele is treated through inguinal incisions with high ligation of the patent processus vaginalis and excision of the distal sac.
T/F prognosis for congenital hydrocele is excellent
T
increase in the amount of CSF in the ventricles and subarachnoid spaces of the brain
HYDROCEPHALUS
hydrocephalus is caused by an imbalance in the rate of production and the rate of absorption of ____
CSF
____ hydrocephalus is non-communicating, blocked by tumors, hemorrhage or structural abnormalities that causes fluid to accumulate in the ventricle
Congenital
s/s of hydrocephalus: ____ sound when the skull is percussed, _____scalp veins, _____-pitched cry, rapid increase in head circumference and full, tense, ____ fontanels, ____ of the brain.
cracked pot
distended
high
bulging
atrophy
Acute symptoms of hydrocephalus may include ____.
change in the neurological state and seizure activity
what does xray of the skull show in hydrocephalus?
thinning of the skull with separation of the sutures and widening of fontanels
tx for hydrocephalus?
shunt insertion to allow CSF to drain from the lateral ventricle in the brain
what meds maybe Rx for hydrocephalus?
Anticonvulsants for seizures (pheobarbital, diazepam and phenytoin
priority NX in hydrocephalus?
Risk for injury
a metabolic disorder that is caused by an enzyme deficiency resulting in the accumulation of phenylalanine and its metabolites (as phenylpyruvic acid) in the blood and their excess excretion in the urine, that is inherited as an autosomal recessive trait
PKU
what does PKU lead to?
severe mental retardation, seizures, eczema, and abnormal body odor unless phenylalanine is restricted from the diet beginning at birth
2 other names of PKU?
phenylpyruvic amentia, phenylpyruvic oligophrenia
goal of Tx in PKU?
Treatment is to lower pku levels to prevent mental retardation
foods to avoid in PKU?
no protein/milk/nutrasweet
Foods allowed in measured amounts in PKU?
fruits, vergatables, cerals and grains
T/FDiet is considered life long in PKU
T
____ or tri-somy 21 chromosomal aberration characterized by mental retardation, dysmorphic facial features.
down's
Most w/down's also have congenital ____ defects, are predisposed to ____ infections, chronic _____ leukemia, and have a weak immune response to infection
heart
respiratory
myelogenous
____ (marbling and speckling of the iris is a common s/s of downs
Brushfield's spots
other s/s of down's:,sensory? ___ nose and ears, mild to moderate retardation, ____ tongue, short stature with hands, ___ crease of palms, small head with slow brain growth, upward slanting ___
my__opia, cataracts, nystagmus, strabismus
flat
low-set
protruding
pudgy
simian
eyes
what is Tx of down's based on?
treatment for coexisting conditions (congenital heart problems, visual defects, or hypothyroidism
_____ results from an abnormal development of the hip socket
DYSPLASIA OF THE HIP
when does hip dysplasia occur?
It occurs when the head of the femur is still cartilaginous and the acetabulum (socket) is shallow
causes of hip dysplasia?
breech delivery, fetal position in utero, genetic predisposition, and laxity of the ligaments
how hip dysplasia dx?
increased number of folds on the posterior thigh of the affected side when the child is supine with knees bent, appearance of a shortened limb on the affected side, restricted abduction of the hip
___ sign (a click is felt when the infant is placed supine with hips flexed 90 degrees, knees fully flexed, and the hip brought into midabduction seen in hip dysplasia?
Barlow's
____ click is present. (It can be felt by the fingers at the hip area as the femur head snaps out of and back into the acetabulum seen in hip dysplasia?
Ortolani's
____ test is positive in hip dysplasia?
Trendelenburg's
what happens when the child stands on the affected leg in hip dysplasia?
the opposite pelvis dips to maintain erect posture
tx for hip dysplasia?
hip-spica cast or corrective surgery for older children
what type traction and diapering for hip dysplasia?, harness
Bryant's traction and triple-cloth diapering
what type harness for hip dysplasia to keep the hips and knees flexed and the hips abducted? how long
Pavlik
at least 3 months.
____ of the foot is turned inward and downward at birth and remains stuck in this position, resisting realignment.
CLUB FOOT -( Talepesis Equinovaus
____ is the most common disorder of the legs that children are born with. It can range from mild and flexible to severe and rigid.
club foot
The cause of club foot is not known, but the condition may be inherited in some cases
info
who gets club foot more?
male w/family hx
tx for club foot?
Gentle manipulation (stretching) and recasting occurs every week to improve the position of the foot
how many casts(tx) are usually necessary to tx club foot? how long does the final cast stay on?
5-10
3 wk
after club foot realignment, the correction is maintained with a special type of brace, consisting of shoes attached to a bar called _____
Dennis Browne
The best results are obtained when the dennis brown brace is worn nearly fulltime for ___months, and then at night and during naps for up to ____ years.
3
3
surgery if the manipulation process is not successful, or if the deformity returns. Continued evaluation is recommended until the foot is fully grown.(club foot)
info
____ more common and less severe, characterized by incomplete closure of one or more vertebrae without protrusion of the spinal cord or meninges
Spina bifida occulta
where is the dimple seen in spina bifida occulta?(),
found on the skin over the spinal defect
what neuro defects maybe seen in spina bifida occulta?
no neurologic dysfunction except occasional foot weakness or bowel and bladder disturbances
_____ is soft fatty deposits that maybe seen in spina bifida occulta?, ulcerations,
Port wine nevi
where is the tuft of hair commonly seen in spina bifida occulta?
the skin over the spinal defect.
what are the 2 types of spina bifida cystica?
Meninogocele, Myelomeningocele
___which usually has no neurologic dysfunction and a saclike structure protruding over the spine
Meninogocele
_____(the worse) has an external sac -usually at lumbar- that contains meninges, CSF, and a portion of the spinal cord or nerve roots
Myelomeningocele
s/s of spina bifida cystica?
hydrocephalus, permanent neurologic dysfunction (paralysis, bowel and bladder incontinence), possible mental retardation, clubfoot, curvature of the spine and Arnold-Chiari syndrome
an obstruction may prevent information from passing freely from around the brain into the spinal canal seen in spina bifida cystica?
Arnold-Chiari syndrome
what is used to show neural tube defect in spina bifida cystica?
amniocentesis and ultra sound
___ alpha-fetoprotein (AFP) levels in the mother's blood may mean spina bifida cystica?
elevated
____ measurement can be used to confirm the diagnosis of spina bifida cystica?
Acetylcholinesterase
nsg care in r/t infant and defect in spina bifida cystica?
handling the infant with care and not applying pressure to the defect
care of the sac in spina bifida cystica: Intact, Moist and warm, ____ position to prevent tension trauma to sac
prone
Post Op care in spina bifida cystica includes?
Montior for ICP. Measure head circumference daily to watch for signs of hydrocephalus
menigitis maybe seen in spina bifida, what s/s to look for?
nuchal rigidity and fever
what is the goal of sx in spina bifida?
Surgery whose goal is not to repair faulty spinal cord, but to preserve existing function
number 1 concern w/spina bifida?
prevent menigitis?
what is done in spina bifida if hydrocephalus is present?
shunt
T/F Women who have spina bifida and parents who have one affected child have increase risk of having children with neural tube defects.
T
children w/spina bifida greater risk for ___ allergy than the general population
latex
____can be achieve by self-catheterization for kids 6-7y/o w/spina bifida?
Continence
_____ and ____if prescribed are used to help children retain urine rather than dribbling in spina bifida?
Tofranil, Ephed II
what to do in r/t bm and o/p w/spina bifida?
Assist with bowel training program, stool softeners, supp or enemas, may be used, encourage intake of high fiber, high fluid diet;
neuromuscular disorder resulting from damage to or defect in the part of the brain that controls motor function. Common in children born prematurely and can not be cured
cerebral palsy(CP)
what is Tx of CP aimed @?
interventions that encourage optimum development
what are the five types of cerebral palsy
Ataxia, Athetoid, Spastic, Rigidity type, Mixed
CP that is uncommon, disturbances in movement and balance w/involuntary, incoordinate motion with varying degrees of muscle tension
Ataxia
what face and mouth problems in Ataxia CP?
. Facial grimacing, poor swallowing and tongue movements cause drooling and poor speech articulation
intelligence for ataxia CP?
average
most common CP where hyperactive deep tendon reflexes, rapid involuntary muscle contraction and relaxation
Spastic
Describe the legs and toes in spastic CP?
Child's legs are crossed and the toes are pointed down, so the child stands on his toes
CP w/rigid postures and lace of active movement
rigidity type
severe disability involving more than one type of CP
mixed
causes of CP?
anoxia before, during or after birth, infection and trauma
s/s of CP(all types)?
abnormal muscle tone and coordination, dental anomalies, mental retardation, seizures, speech, vision or hearing disturbances
____ studies determine the site of brain impairment in CP
neuroimaging
___ and ___ to R/o other causes of CP?
Cytogenic and metabolic studies
what meds to control spasticity and seizures in CP?
Muscle relaxants, anticonvulsants
___ is a genetic disorder that occurs only in males, marked by muscular deterioration that progresses throughout childhood. It is due to a defect on the X chromosome. There is no known cure
MUSCULAR DYSTROPHY
s/s of MD?
begins with pelvic girdle weakness, indicated by waddling gait and falling, cardiac or pulmonary failure, eventual muscle weakness and wasting
____ sign which is the use of hands to push self up from the floor seen in MD?
Gowers'
_____ demonstrates short, weak bursts of electrical activity in affected muscles in MD?
electromyography
what does Muscle biopsy show in MD?
varied muscle fiber sizes and fat and connective tissue deposits
tx for MD?
physical therapy, surgery to correct contractures, use of devices to preserve mobility.
what type diet?
high-fiber, high-protein, and low, calorie d
lateral curvature of the spine, common among females. Identified at puberty and throughout adolescence
scolios
____ involves an absence in the autonomic ganglia of the smooth muscle in a section of the large intestine, with resulting loss of peristaltic function in this part and dilatation of the colon proximal to the aganglionic part -- called also _____?
Hirschsprung's Disease
congenital megacolon
Tx for hirschsprungs
That non-functioning section of bowel is surgically removed to correct the problem
describe the sequence of problems in hirschsprungs
faliure of internal rectal sphincter to relax) > absents of peristaslsis > accumlation of intestinal contents > distention of bowel proximal to defect> megacolon
who gets hirschsprungs?
accounts for what % of neonate obstructions?
males and downs

25
s/s of hirschsprungs in neonate?
Faliure to pass meconium with 24-48 hours after birth; overflow type diarrhea
neonate:
what does the vomit look like in hirschsprungs?
does baby refuse to eat?
what happens to belly?
bile stained

yes
distented
s/s of hirschsprungs in infancy?
Constipation with explosive episodes of diarrhea,Abdomen distended
s/s of hirschprungs in childhood?
More Chronic Constipation, Ribbon like stools which are foul smelling, abdomen distended, Poor nourished child, Anemic
how is hirschsprungs dx?
X-Ray, Barium Enema
what does barium look like on xray?
white
Barium Enema {Barium is a dry, white, chalky, metallic powder that is mixed with water to make barium liquid. Barium is an x-ray absorber and appears white on x-ray film. When instilled via the rectum, barium coats the inside wall of the large intestine so that the inside wall lining, size, shape, contour, and the colon's atency are visible on x-ray
read over
what may result if barium is not eliminated from body?
constipation or impaction
___ to test neuro reflexes in hirschsprungs
Manometry
what does Rectal Biospy show in hirschsprungs?
Histologic evidence of aganglionic cell
what may be done for acute case of hirschsprungs?
Surgery with removal of aganglionic colon, temporary colostomy
pt teaching for chronic hirschsprungs?
stool softeners, Isotoinc enema, low residue diet to decrease bulk
Nursing interventions: Pre -Op in hirschsprungs?
Rehydration, informed consent, NPO and no rectal temps
Post Op care in hirschsprungs?
Monitor site, bowel sounds, rehydrate, NG Tube, Parent education regarding colostomy.
T/F Both parents must be carriers to have a child with tay sachs
T
Every on in 4 chance of having child with diease and a 2 in 4 chance of a child who is a carrier(tay sach)
info
Fatty substance called Ganglioside GM2 acculate in the nerve cells in the brain and the enzyme hexosamindiase A (Hex-A) is lacking to break GM2 down
tay sach's
Infants appear to be developing normally. As nerve cells acculate fatty material child starts to regress. loss of motor skills and mental function
tay sachs
what happens to pt in tay sachs? die by what age?
Tx?
child becomes blind, deaf, mentally retarded, paralyzed and non responsive to environment. 5y/o. none
the child w/tay sachs looks like a child w/____?
downs
Appearance of Downs Syndrome child: Occiptal Flat, Eyes slanted upward Bridge of Nose: flat Mouth: Small Tongue: Larger and protruding Ears: Low set Limbs: short Stature: short and stocky. Muscle tone: Hypotonic Transverse palamar crease on hands and feet
info but know
___ Midline defect of the abdominal wall that results in herination of the bowel and intrabdominal contents into the umbilical cord
Omphalocele
are Maternal AFP levels are elevated in omphalocele?
no
____ will develop within the omphalocele sac
Ascties
_____ causes an interruption of blood flow to the fingers, toes, nose, and/or ears when a spasm occurs in the blood vessels of these areas
Raynaud's Disease
what causes raynauds to flare?
cold or stress
describe the color in raynauds?
turns white, then blue, then bright red over the course of the attack
what other s/s may be seen in raynauds?
tingling, swelling, or painful throbbing
T/F attacks in raynauds may last from minutes to hours and the areas may develop infection and ulceration.
T
who gets raynauds more
female
what is Tx of raynauds centered around?
minimizing or preventing exposure to cold and vasodilating medications.
____ is when Classic Factor 8 defect.
Hemophilla B or ____defect "A" most common
Hemophilla A
Chirstmas Disease. Factor 9 defect
Both have similiar symptoms, but "B" is simpler and milder
info
Mothers are the carriers and the infant ___ are affected w/hemophilia
sons(X gene)
concern w/hemophilias
Bleeding around vital structures, even bleeding into brain
where is bleeding most commonly seen in hemophila? results in?
Hemarthorsis, bleeding into joints causing large joints and leading to decreased cartilage(arthritis)
interventions for active bleed in joint in hemophila?
rest joint and immobilize
what to do in hemophilia after bleed as stopped in joints?
gradual movement to prevent contractors
T/F platelets are normal in hemophilia
T
Drugs: Factor 8 : Humafac or Koate Factory 9: Prolox or Konyne.
info but know and look up
3 C's associated w/hemophilia?
cough, cyanosis, choking
_____occurs when the maternal antibodies attach to the Rh site on the fetal red blood cells making them susceptible to destruction by phagocytes
erythroblastcystosis fetalis
what happens in infant in erythroblastcystosis fetalis
The fetal system reponds by increased red bood cell production then rapid and early destruction of erythocytes results in a marked increase in immature RBC that do not have the functional capapbilities of matrue cells and results in mulitorgan failure
what are the risks to the infant in Rh incompatibility?
bleeding tendencies due to assoiated thrombocytopenia and hypoxic damage to the capillaries
how does baby get hypoglycemia in Rh incompatibility?
Also hyperplasia of the adrenal cortex and pancreatic islet,
hernia of a bladder and especially the urinary bladder into the vagina : vesical hernia
cystocele
a decrease in the # of platelets in the circulating blood, major concern is bleeding
Thrombocytopenia
disorder of young adults, presence of Reed-Sternberg cells, involves lymph nodes, spleen and liver, progress depends on stage of disease.
Hodgkin’s Disease
w/Lasix (furosemide) and Lanoxin (digoxin)what needs to be watched for?
potassium-wasting diuretics, high risk for hypokalemia. Mo nitor for decreased serum potassium levels.
– fatigue, anorexia, nausea, vomiting, muscle weakness, leg cramps, decreased bowel motility, paresthesia and dysrhythmias.
Hypokalemia
tingling of the fingers and toes
low Ca+
diarrhea and intestinal colic
hypoK+
Alupent (metaproterenol sulfate) is a ____
adrenergic type of bronchodilator
Vanceril (beclomethasone) is a ___
glucocorticoid(steroid)
which to give 1st bronchodilator or steroid? why?
bronchodilator.
The bronchodilator widens the air passages and allows the glucocorticoid to work more effectively
____– a bronchodilator for bronchitis, to relax relax smooth muscles of the bronchioles
Aminophylline (theophylline)
_____ causes orange-red discoloration of body fluids, should always be taken with food or antacids, doses sh ould not be doubled, take as directed by physician.
Rifadin (rifampin)
what R med if administered rapidly may cause tachycardia
theophyline
what med prolongs fibrin clot formation? affects which lab?
heparin
PTT (partial thromboplastin time
anticoagulant that prolongs prothrombin time (PT) for overdose, antidote is ?
coumadin
vit K
what med decreases platelet aggregation
Aspirin
necessary for formation of prothrombin and used as an antidote for Coumadin
vit K
– extremely low white blood cell count (WBC’s)
Neutropenia
dysrhymia that the result of an irritable myocardium and the hallmark is a wide, distorted QRS complex indicating abnormal conduction through the ventricles.
Premature ventricular contractions (PVCs
a progressively increasing P-R interval is indicative of a conduction defect through the AV node.
Second Degree AV block Mobitz Type 1
pain w/MI can not be relieved w/?
nitro
which cardiac enzyme is specific to the heart muscle and elevated levels indicates cellular necrosis or death
troponin 1
what is the goal of therapy w/nitro? does it affect dysrthymias?
goal of therapy is relief of pain. It dilates peripheral and coronary arteries, thereby increasing blood flow to the heart. Has no effect on dysrhythmias.
what is major problem w/chf?
primary problem is heart becomes an inefficient pump; blood and fluids back up into the lungs causing adventitious breath sounds
why do pt w/chf gain wt?
describe o/p in chf?
fluid retention.
< urinary output by day, and > output at night
what happens w/excess fluid in CHF when pt reclines?
reabsorbed and eliminated by the kidneys
As cardiac output falls in chf, blood flow to the kidneys ___ causing decreased glomerular flow. Kidneys interpret this as ____ and attempt to correct it by holding on to fluids
decreases
hypovolemia
in chf the Kidneys > production and release of ____ causing sodium retention
aldosterone
what med to control the dysrhythmias of MI? thrombolytic agent administered intravenously to loosen the clot blocking the coronary artery. Best within the first ___hours following onset of MI?
Activase (thrombolytic enzyme alteplase)
6
blocks beta-adrenergic stimulation and causes a decreased heart rate, blood pressure and decreases the force of myocardial contraction.
Inderal (propranolol)
___ is an adrenergic and increases blood pressure and heart rate
Epinephrine
how do Drugs that < peripheral arterial resistance affect afterload?
decrease
– resistance to blood flow
Afterload
– amount of blood ejected by the heart with each beat
Stroke volume
– filling pr essure of the heart
Preload
cardiac sx to assess extent and severity of coronary artery blockage? what is done w/results?
Cardiac Catheterization.
Medical mgmt, angioplasty or coronary bypass surgery based on results.
– indicates the lung has collapsed and will hear no air movement on auscultation.
Pneumothorax
Bronchoscopy – complications:
cyanosis, dyspnea, stridor, hemoptysis, hypotension, tachycardia, dysrhymias
hypoxemia, hypercapnia, dyspnea at rest and on exertion, O2 desaturation w/exercise and use of accessory muscles of respiration
COPD
what does cxr show in copd?
hyperinflated lungs due to trapped air
hallmark symptom is sudden onset of chest pain, dyspnea second most common symptom
pulmonary embolus
s/s of Pulmonary edema – symptoms include
crackles hea rd upon auscultation
characterized as an inflammation of the bronchioles, with air trapped in the small airways
asthma
hoarseness occurs early, because the tumor prevents the accurate approximation of the vocal cords during phonation, foul breath spitting up blood are late symptoms
laryngeal(voice) CA
Large extrinsic tumors produce difficulty and pain in swallowing. Nagging cough not related to this.
laryngeal(voice) CA
- post operative complication prevented by interventions such as deep breathing, coughing, turning, and using spirometer.
Atelectasis
- post operative complication due to depression of the gag reflexes during and immediately after general anesthesia.
Aspirtation Pneumonia
– heard over aortic area upon auscultation is sign of abnormal cardiovascular finding
Heart murmur
– heard over aortic area upon auscultation is sign of abnormal cardiovascular finding
Heart murmur
– pain produced by myocardial ischemia
Angina Pectoris
Abdominal aortic aneurysm – s/s include
pulsating abdominal mass, low back pain, lower abdominal pain.
Rheumatic endocarditis - caused by
Group A streptococcus organism
– potent inotropic agent that increases myocardial contractility, which leads to improved cardiac output and improved tissue perfusion
Intropin (dopamine hydrochloride)
At moderate doses, can maintain BP above 90 mmHg in pts with shock
Intropin (dopamine hydrochloride)
Also dilates the renal and mesenteric arteries, supporting renal perfusion
Intropin (dopamine hydrochloride)
High doses is a vasoconstrictor and may cause serious side effects, and not usually administered in high doses.
Intropin (dopamine hydrochloride)
the inability to absorb B12 due to a deficiency in intrinsic factor in the stomach
Pernicious anemia
___ attaches to B12 in the stomach and forms a complex that allows the vitamin to be absorbed in the small intestines.
Intrinsic factor
– bone scan to detect increased metastatic activity
Radioisotope
– is performed using the results of all diagnostic studies including tumor grading and tumor markers and determines the direction of the medical mgmt of a malignancy
Staging of a malignancy
- a malignant tumor developing in the uterus from trophoblast
Choriocarcinoma
Following the removal of a hydatidiform mole pt’s HCG levels should be monitored for ___yrs.
1 –2
Digitalis – pt experiencing sinus bradycardia relating to digitalis toxicity should be given ___
Atropine
what med blocks vagus nerve stimulation resulting in an increased heart rate
Atropine
- channel blocker will decrease heart rate
Calan (verapamil)
– an antidysrhythmic and used for tachyarrhythmias
Quinidine
a permanent urinary diversion wh ere a portion of the ileum is surgically resected and one end of the segment is closed.
Ileal conduit
The ___ are surgically attached to this segment in the ileum and the open end of the ileum is brought to the skin surface on the abdomen to form the stoma in ileal conduit?
ureters
– a tumor that arises from the sympathetic nervous system
Neuroblastoma
Most common form of extra-cranial solid tumor of childhood
Neuroblastoma
Neuroblastoma primarily affects what group?
peds
a malignant tumor of the kidney that primarily affects children and is made up of embryonic elements – also called nephroblastoma
wilm's tumor
s/s of wilm's tumor?
Hypertension and vomiting
- a sarcoma derived from bone or containing bone tissue, recurrent tumors may result in amputation -- called also
Osteosarcoma
osteogenic sarcoma
- a tumor that invades the shaft of a long bone and that tends to recur and metastasizes frequently to the lungs
Ewing’s sarcoma
- a neoplastic disease that is characterized by progressive enlargement of lymph nodes, spleen, and liver and by progressive anemia
Hodgkin’s Disease
– involves an absence in the autonomic ganglia of the smooth muscle in a section of the colon.
Hirschsprung’ s Disease
what is done in sx to fix hirschsprung's?
non-functioning section of bowel is surgically removed
____ is caused by congenital absence of ganglion cells in the muscular wall of the distal part of the colon with resulting loss of peristaltic function in this part and dilatation of the colon proximal to the aganglionic part.
called also
Megacolon
congenital megacolon
- an abnormal increase in the amount of cerebrospinal fluid within the cranial cavity that is accompanied by expansion of the cerebral ventricles, enlargement of the skull and especially the forehead, and atro phy of the brain
Hydrocephalus
priority NX for hydrocephalus? why?
risk for injury
change in the neurological state and seizure activity.
a metabolic disorder that is caused by an enzyme deficiency resulting in the accumulation of phenylalanine and its metabolites (as phenylpyruvic acid) in the blood and their excess excretion in the urine, that is inherited as an autosomal recessive trait, and that causes usually severe mental retardation, seizures, eczema, and abnormal body odor unless phenylalanine is restricted from the diet beginning at birth?
also called?
PKU
phenylpyruvic amentia, phenylpyruvic oligophrenia
– a sac-like structure outside the body and contains cerebrospinal fluid and the meninges
Myelomeningocele
– a sac containing cerebrospinal fluid and may contain the meninges, but does not contain neural tissue.
Meningocele
- hernia of a bladder and especially the urinary bladder : vesical hernia
Cystocele
a common disease especially in Caucasian populations that appears usually in early childhood, is inherited as a recessive monogenic trait, involves functional disorder of the exocrine glands, and is marked especially by faulty digestion due to a deficiency of pancreatic enzymes, by difficulty in breathing due to mucus accumulation in airways, and by excessive loss of salt in the sweat? aka?
CF
fibrocystic disease of the pancreas, mucoviscidosis
T/FAntineoplastic agents have more of an effect on the tumor cells than n ormal cells because of their rapid growth
T
Those normal tissue cells that are the most effected by chemo are bone marrow (seen in low blood counts), hair follicles (seen by way of hair loss) and the GI mucosal epithelium (accounting for nausea, vomiting, loss of appetite, and diarrhea).
info but KNOW
It is a very narrow margin deciding the right dose to use for destroying the tumor cells in order to have the lease affect on normal healthy cells.
info
Endocrine antineoplastic chemotherapy such as ____ is what is considered additive or ablative therapy
Tamoxifen
T/F tamoxifen is not a cure but provides palliative therapy as effectively as does an oopherectomy( removal of ovaries
T
when is tamoxifen most effective?
It is most effective when used to prolong disease free survival in breast cancer therapies.
It is important to be alert to the signs and symptoms that may accompany the use of antineoplastics such as increased fluid retention leading to CHF, as well as, increased susceptability to infe ctions due to immunosuppression. Additional medications may need to be given to help resolve CHF. Good handwashing techniques before and after giving care will help to reduce possible introduction of infection.
info but know
It is recommended that care be given to prevent undue cytotoxic exposure, by wearing disposable ____ gloves when handling the medication.
nonpermeable
– a disorder of diffuse activation of the clotting cascade that results in depletion of clotting factors in the blood
Disseminated Intravascular Coagulation (DIC)
describe how DIC occurs?
occurs when the blood clotting mechanisms are activated throughout the body instead of being localized to an area of injury. Small blood clots form throughout the body, and eventually the blood clotting factors are used up and not available to form clots at sites of tissue injury. Clot dissolving mechanisms are also increased
DIC may be stimulated by many factors including?
infection in the blood by bacteria or fungus, severe tissue injury as in burns and head injury, cancer, reactions to blood transfusions, and obstetrical complications such as retained placenta after delivery.
Risk factors for DIC are?
recent sepsis, recent injury or trauma, recent surgery or anesthesia, complications of labor and delivery, leukemia or disseminated cancer, recent blood transfusion reaction, and severe liver disease.
Symptoms of DIC?
Bleeding, possibly from multiple sites in the body, Thrombosis formation evidenced by bluish coloration of the fingers, Sudden onset of bruising
what do labs show in DIC?
Elevated fibrin and/or fibrinogen degradation products, Decreased serum fibrinogen, Increased prothrombin time, Increased PTT, Platelet count, Thrombin time test
what is the goal of tx in DIC?
The objective of treatment is to determine the underlying cause of DIC and provide treatment for it.
what maybe done to relieve DIC?
Replacement therapy of the coagulation factors is achieved by transfusion of fresh frozen plasma
____may also be used if fibrinogen is significantly decreased in DIC?
Cryoprecipitates
___ a medication used to prevent thrombosis, is sometimes used in combination with replacement therapy in DIC?
Heparin
Vitamin ___ is deficient in Lung cancer
C
what med is used for asthmatic children, it is a mast cell stabilizer, it prevents allergic reactions
Intal (cromolyn sodium)
s/sx of iron deficiency
anemia are pallor, sensitivity to cold, weakness, and fatigue
Monitor _____ in Liver Cancer
alkaline phosphatase
S/sx of liver tumor include
dull ache, RUQ , epigastrium and back pain
If the portal vein is blocked in Liver cancer then ___ will be the complication, if the large bile duct becomes obstructed, the result will be _____.
ascites
obstructive jaundice
S/sx of pernicious anemia include
tingling and paresthesia of hands and feet, weight loss, anorexia, and dyspepsia
Tx for pernious anemia is a diet high in ___ & ___, restricting ____ or extremely hot foods. Increased intake of vitamins
iron and protein
highly seasoned
B12 and B 6, C and folic acid.
S/sx of R sided heart failure include .
edema, swelling, dependent edema, distended neck vein, nocturia, weakness, hepatomegaly and weight gain
S/sx of R sided heart failure include .
edema, swelling, dependent edema, distended neck vein, nocturia, weakness, hepatomegaly and weight gain
S/sx of L sided heart failure (think pulmonary) include
SOB< dyspnea, moist cough, crackles and gallop rhythm (S3 and S40, crackles, coughing, tachycardia, and fatigue-ability.
childhood tumor of the kidney
Wilm’s Tumor
S/sx of wilm's tumor?
palpable firm, smooth mass in the abdomen, hypertension, vomiting.
why palpation contraindicated in wilm's tumor?
it could cause rupture and seeding
Post op concern in wilm's tumor
decreased urine output.
S/sx of ____ tumors includes hypermenorrhea, (dysmenorrhea or leukorrhea may occur) pain, backache, constipation, urinary frequency or urgency or intestinal obstruction.
uterine fibroid
Hx of pt undergoing heart catherization should include allergy to _____ because of use of dye during the procedure
shellfish
invasive procedure where they thread a hollow catheter through the femoral artery/vein
Angioplasty
during ____ a balloon tipped catheter is introduced and used during inflation to “crack” plaque in the vessel and reduce vessel stenosis to not more than 20%.
Angioplasty
chronic reactive airway disease
asthma
____ asthma is an antigen antibody reaction to pollen, dander, feathers, food, house dust and mites
Extrinsic
S/sx of asthma include
tachypnea, tachycardia, dyspnea, wheezing, hypoxemia, diaphoresis, used of accessory muscles
what to have child w/asthma do to increase vital capacity?
to blow pinwheels to incrase vital capacity
An undesirable s/e of premarin used to treat prostate cancer is?
gynocomastia (increased breast size.)
why is Constant irrigation is used post op of TURP?
to prevent obstruction of urine flow, and to prevent clot formation
S/sx of pulmonary embolism include
sudden onset of dyspnea, tachypnea, crackles, chest pain, cough, hemoptysis, tachycardia, anxiety.
what test to dx pulmonary embolism?
V/Q lung scan
____ disease is a form of peripheral vascular disease
Raynaud’s
who gets raynauds?
women between puberty and age 40
what usually precipitates the episodic vasospasm of raynauds?
stress or cold exposure
Raynaud's s/sx include?
tingling and numbness, blanching unrelieved by warming.
Digoxin is a ___?
cardiac glycoside
how does dig work?
It increases cardiac output and contractility (slows the rate
blood level for dig?
Therapeutic range is 0.8 to 2.0 ng/ml, toxicity> 2.4ng/ml
s/sx of dig toxicity?
S/e include nausea, vomiting, cardiac dysrhythmias, hypotension, yellow-green halos, blurred vision
T/F Md should be contacted for irregular heart beats and muscle weakness which could indicate hypokalemia w/dig?
T
what to monitor for if dig is taken with lasix?
watch out for cardiac dysrhythmias
Capoten is an ___?
ACE inhibitor
how does capoten work?
It decreases the work of the heart by promoting vasodilation and diuresis (while retaining potassium)
what labs to monitor w/capoten?
Monitor serum creatine and urine creatine clearance
S/E of capoten include?
S/e include hypotension, hypovolemia, and hyponatremia
T/F Taking capoten with food reduces absorption by up to 30%.
T
Dopamine is a ____. It will increase B/P and cardiac output through blood vessel _______
vasopressor
vasoconstriction
what narc is used for severe pain because it depresses the pain impulse transmission at the spinal cord
Morphine
what med is used to inhibit cell division, common in tx of breast ca.
Tamoxifen
what to have woman do in r/t arm after mastectomy?
After mastectomy elevate the arm on the affected side to reduce tension on surgical incision, promote circulation and prevent venous congestion.
values in tumor lysis include
increased potassium, increased phosphate and uricemia with decreased calcium
Nursing priorities immediately following surgery include recovery from general anesthesia?
patent airway, prevention of aspiration, effective breathing pattern) and pain management.
accelerated clotting process caused depletion of circulating clotting factors and platelets which can provoke severe hemorrhage
DIC
lab test to dx DIC:
PT?
PTT?
Platelet count?
Fibrinogen?
PT greater than 15 seconds, PTT greater than 60-80 seconds, patelets less than 100,000/ul, fibrinogen level less than 150 mg/dl
what test is specific for DIC?
positive D-dimer test specific for DIC
T/F There is an decreased survival rate in chrondosarcoma following amputation
F
increase
S/sx of chronic arterial occlusion include?
intermittent claudication, achy, cramping like pain, fatigue or weakness relieved with rest.
what increases pain in arterial occlusion?
Pain increases with elevation, limbs usually legs hand over the bed at noc to reduce pain
_____ is a common pneumonia. Incidence is greatest in patients with AIDS, and immunosuppression because of cancer tx
Pneumocystis carinii
T/F in PCP the mortality rate is 60-80%, complications include respiratory failure
T
Prevent skin breakdown by
repositioning every 2 hours
S/sx of Pyloric Stenosis includes
projectile vomiting, weight loss and constipation
who gets pyloric stenosis?
Defect is common in male infants between ages 1-6 months
2 foods tha reduce colostomy odor?
Spinach and parsley reduce colostomy odor
Thrombocytopenia is reduced ____. Normal is _____
____is serious,
_____ may be life threatening.
platelets
150,000-400, 000mm3.
<20,000
< 10,000
____ is done to deliver a high dose to a localized area. how long left in place?
Implantable internal radiation.
48-72 hrs
what to do for internal radiation pt?
should minimize their exposure TIME, stand at the side of the bed out of the direct line of radiation, keep their DISTANCE (radiation loses its intensity) and use of lead SHIELDS
how often should placement of internal radiation device be checked
every 4 hours
what should the RN always avoid in internal radiation device?
NEVER TOUCH THE RADIATION SOURCE WITH YOUR BARE HAND
S/sx of MI?
crushing substernal pain that may radiate to the jaw, back and arms
different btwn MI and angina
last longer and no relieved by nitro.
____ is the classic symptom of arteriosclerotic heart disease
Angina
what is the cause of angina?
inadequate oxygenation of the heart due to decreased blood flow to the cardiac vessels that feed the heart.
how does nitro work?
reduces the pain of angina by dilating the coronary arteries and improving blood flow to the heart muscle
should pt keep nitro at all times? what to do if pain lasts longer than 20min? how should nitro be stored? what should pt experience when taking nitro SL?
yes
call ems
cool dark dry place
slight burning/stinging sensation
surgical removal of some or all of the larynx?
preop teaching for?
laryngectomy
alternate methods of communication (writing, lipspeakin and word boards
____ is a developmental anomaly of the placenta. A chorionic tumor
Hydatiform mole
SE of mole?
rapid uterine growth, extremely elevated HCG and US that fails to reveal a fetal skeleton.
T/F w/chest tubes bubbling in the water seal chamber should decrease as the need for the chest tube resolves
T
what does constant bubbling in chest tubes mean?
loose connection, and prompt correction (hemastat at the bedside) is necessary
what to do if chest tube becomes dislodged?
cover the opening immediately with petroleum gauze and apply pressure then call MD
what to assess for @ insertion site w/chest tubes?
subcutaneous emphysema and contact the doctor if it increases
NSG int r/t chest tubes?
Assure integrity of the system, measure the drainage, place below the level of the chest even during ambulation.
p/o pneumectomy care?
Position on operative side to promote full expansion of unaffected lung and to assist in drainage of secretions from operative site. Perform arm exercises to minimize complications and prevent degenerative changes in the joints. The patient should take frequent rest periods, avoid heavy lifting and prevent infection and stop smoking
S/sx of pneumothorax include?
TX?
diminished or absent breath sounds, dyspnea, tachypnea, subcutaneous emphysema, cough, sharp pain that increased with exertion. Bronchus deviated from midline. Tx-chest tube.
Vesicular I>E, both lungs soft and low, Bronchovesicular equal I/E anterior between scapulae, Bronchial E>I loud and relatively high pitch, Tracheal I/E equal very loud.
KNOW
____ is the inflammation of both layers of the pleurae. Causes include
Pleuritis.
pneumonia, TB, collagen disease, primary and metastatic cancers and thoracotomy.
____ shock is compromised tissue perfusion and reduced cardiac output because the heart fails to adequately pump
Cardiogenic
causes of cardiogenic shock?
MI, heart failure, myocarditis, cardiomyopathy and advanced heart block
what might Tx of cardiogenic shock consist of?
Tx can include digoxin, dopamine, diuretics, vasodilators and vasopressors, increased oxygen to maximize cardiac, pulmonary, renal fx and Use of IABP (intra-aortic balloon pum) may be used
In IABP coronary artery perfusion is increased with the aortic valve closes and the balloon inflates during diastole. The balloon is inserted through the femoral artery into the descending aorta
info but know
____ crisis is a vaso-occlusive episode and it is very painful
Sickle cell
Interventions during sickle cell crisis include?
warm compresses to painful areas, (cold aggravates the condition), maintaining bed rest to reduce workload on the heart, and increased fluid intake to prevent dehydration which can precipitate a crisis
pt teaching to avoid sickle cell crisis?
avoid strenuous exercise , high altitude, unpressurized aircraft, cold and vasoconstrictive drugs.
_____ is a diffuse endothelioma or endothelial myeloma forming a fusiform swelling on a long bone
Ewing ’s sarcoma
The largest risk factor in cervical cancer is ____? It can be detected by a ____. Unlike uterine cancer that requires a ____ and the use of ____ test.
multiple partners
pap smear
biopsy
Schiller’s
bradycardia in a newborn (<100), up to 3 months (<80), 3months to 2 years (<70), 2-10 years (<55), adult (<60
info but know
uterine fibroids, hydatiform moles, fibrocystic disease of the breast, pyloric stenosis and prostatic hyperplasia are all ____?
Benign tumors
After the treatment of Basal Cell epithelioma patients should be instructed to___?
avoid sun exposure, use of protective clothing (such as hats, gloves), used of sunscreens (zinc oxide is best) and have all lesions checked promptly.
Squamous cell carcinoma usually affects ___ males over the age of 60
caucasian
causes of Squamous cell carcinoma?
. Causes include sun exposure, x-ray therapy, arsenic ingestion (gardener), carcinogen exposure (tar and oil) and chronic skin irritation and inflammation.
which squamous cell lesions have poor prognosis?
lip and ear
___ is an immunosuppressant anti-neoplastic. Give ___ 24-48 hours after tx to prevent reversal of bone marrow and GI toxicity.
Folex (methotrexate)
Ca+
Nursing care for stomatitis:
Careful mouth care with soft bristled brushes, restriction of foods that may cause trauma or be difficult to chew. Continuous lubr ication of lips. Avoid extreme food temp and spicy foods. Consume foods that are soft and easy to chew.
what to avoid in pku diet?
protein/milk/ nutrasweet
Lab values for chemo pt: CEA> ___ ng, elevated ____, and Beta ___, ACTH, UA would reveal ___ protein, melanin, Decreased platelet count.
10
AFP
HCG
Bence Jones
CA patient nutrition:
small, frequent, high nutrient foods, eat prior to chemo/rad tx. Food consistency should be tolerated and swallowed well, encourage supplemental feeding and reduce lactose in the diet.
Cancer protection(diet):
Increased intake of fresh vegetables, especially cabbage, increase intake of Vitamin A/C, decrease fat, salt, cured, smoked, nitrate foods, decrease alcohol and tobacco use.
life span of rbc?
7-10d
Tetralogy of Fallot aka cyanotic heart disease is associated with ___ and use of ____?
FAS
thalidomide
goal of tx in CF?
improve O2
s/s of CF?
S/sx salty taste on child’s skin (sweat chloride 2-5 x normal), bulky, greasy foul-smelling stools that contain undigested food. Mal-absorption due to enzyme deficiency.
Hirschsprung’ s disease (barium enema bad) considered hereditary
info
in ___ the Bowel segment contracts but feces cannot be pushed forward because the bowel is unable to completely relax, leading to intractable constipation and sometimes overflow diarrhea?
hirschsprungs
T/F in hirschsprungs the Corrective surgery to pull-through normal ganglionic tissue to the anus or management with colonic lavage is necessary to keep the bowel empty.
T
know that losing excess weight is a way to treat ___?

know that smoking is a major cause of ____
hypertension

HTN
what is the difference between how a acute and chronic arterial occlusion feels?
because there is time for development of collateral circulation in chronic.
know that a pulsatile mass in the abdomen is a sign of an ____?
abdominal aortic aneurysm
know that having a person with orthopnea ____ helps them breathe better
hang their legs over the edge of the bed
know that ascites is a sign of ___ side heart failure.

describe the tongue in iron deficient anemia?
right

red, smooth and sore
T/F IM B-12 shots are used to treat deficiency
T
know that you should check ____ in sickle cell anemia patients.
“H&H” hemoglobin and hematocrit
describe the skin in impaired circulation?
shiny, cool skin is a sign of impaired circulation
sudden onset of chest pain and difficulty breathing is a sign of ___?
a pulmonary embolism
that if a patient is on lasix (furosemide) and digoxin that they should be
watched for ____
hypokalemia
that a person taking catopen should ____
change positions slowly
___ is best way to diagnose a pulmonary embolism
arteriography
ph is down and paco2 is up=

that sometimes suctioning is used to remove secretions
respiratory acidosis

info
____ breathing is taught to COPD patients to help them prolong the expiratory cycle and have more positive airway pressure.
pursed lip
definitive sign of COPD is decrease in ___?
FEV (forced expiratory volume
signs of an air leak in a chest tube
-constant bubbling
pink-frothy sputum is a sign of ___
pulmonary edema
pulmonary hypertension is a cause of ____ side heart failure
right
____ sarcoma is more common in immune suppressed persons
Kaposi’s
why are steriods given in asthma?
to reduce inflammation
what to watch for in pt getting steriods?
s/s of infection
___ tumors may cause abnormal vaginal bleeding
fibroid
know definition of HPS (hypertrophic pyloric stenosis)
look up
failure to thrive is a sign of _____.
HPS
40th birthday present for men?
bph
most common sign of bladder CA?
painless hematuria
what might hip pain 1 mo after sx in prostate CA mean?
spread to the bone.
which hormone is assoc w/breast CA?
estrogen
SIADH causes what E imbalance?
low Na
for a child with Wilm’s tumor labs should be checked for __
anemia
you should never palpate the abdomen of a child with ____ tumor
Wilm’s
teenage boy with chronic leg pain may have ____ sarcoma
Ewing’s
T/F treating chrondosarcomas with amputation increases survival
T
exposure to ____ is risk factor for cervical cancer
hpv
which 2 cells are greatly affected by radiation because they grow fast?
GI and hair
what does chemo due to bone marrow
suppresses it
if a chemo drugs extravasated to ____ the infusion and place ___ on the site
stop
ice
sickle cell crisis can be treated with ___ moist compresses
hot
after a prostate surgery the major intervention is to check for ___ and ___
bleeding and shock
describe a healthy stoma

how often to do bse?
beefy red

monthly after period
s/s of patent ductus arteriosis?
constant murmur
what posit for symptomatic TET babies?
knee-chest position-like squatting
chest physiotherapy is an important part of ___ treatment
CF
nursing dx of hirschspring’s disease is?
risk for injury related to lack of intestinal motility”
Down’s syndrome children are often mentally challenged

60. know about clubfoot-nursing interventions

know about DDH (developmental dysplasia of hip)
info


look up
a _____ should be kept moist
meningeoclele
children with a meningeocele usually have ____ problems

Know what CP (cerebral palsy) and MD
neuro


look up
that patients with leukemia should be checked for ___?
thrombocytopenia
pt teaching to decrease oxygen demand.
pace activities or do them in the morning
T/F nitro can be taken before hard work
T
a patient with neutropenia should not eat ___
raw veggies
why is O2 given @ low rate in COPD?
to keep from suppressing their drive to breathe.
a patient with coronary artery disease should avoid exercising outside
when it is _____
very hot or very cold
T/F that orchiectomy does not cause impotence
T
what should pt do if wakes up and HR is below 60
call md
muscle weakness is a sign of which E imbalance?
hypokalemia
concern p/o wilm's tumor?

undesirable sign of hormone therapy for inoperable prostate cancer
is ____
o/p

gynomastia
what is the purpose of constant irrigation of catheter after TURP?
to prevent occlusion of urine flow
cold fingers =____
raynauds
immediate intervention after treatment for basal cell carcinoma treatment?
all lesions should be checked promptly
what type care is important in CA Tx?

CEA (Carcinoembryonic antigen) is a lab used to
dx _____.
po


cancer
To avoid an error of parallax when taking a client's blood pressure, the nurse should
An improper reading of the level of mercury will be obtained if the reader is
not perpendicular to the column. An error of parallax results when an object is
displaced by an observer's altered position
The nurse explains to a client that the mechanism mediating long term blood
pressure regulation is the
If there is a decrease in urinary output with increased conservation of body
fluid, the blood pressure will be increased and vice versa
When taking a client's apical pulse the nurse should place the stethoscope
The heart's apex is between the 5th and 6th ribs at the midclavicular line. It is
closest to the chest wall here, so auscultation is easier
The nurse institutes safety precautions for a client receiving oxygen because
oxygen
An open flame or spark from static electricity can initiate an explosion and
fire in the presence of higher than normal oxygen
When instituting oxygen therapy, the nurse recognizes that the method of
oxygen administration least likely to increase apprehension in the client is
oxygen via nasal cannula is the most comfortable and least intrusive,
because the cannula extends minimally into the nose
The nurse identifies a commonality between the strain on a client's heart with prolonged anemia or polycythemia to be
With anemia there is a greater return of blood to the heart from the
peripheral vessels; the greater volume of blood returning to the heart stretches
it and results in greater cardiac output. With polycythemia the heart must work
harder to propel the more viscous blood through the circulatory system
A client with pyrexia will most likely demonstrate
The pulse increases to meet increased tissue demands for oxygen in the
febrile state
The nurse asses that a client's pulse pressure is decreasing. This would be
evaluated by calculating the
- pulse pressure is obtained by subtracting the diastolic from the systolic
readings after the blood pressure has been recorded
Following open heart surgery a client develops a temperature of 102°F. The
nurse notifies the physician because elevated temperature
temperatures of 102°F or greater lead to an increased metabolism and
cardiac workload
The nurse should teach clients with peripheral vascular disease to stop
smoking because nicotine
Constriction of the peripheral blood vessels and the resulting increase in
blood pressure impair circulation and limit the amount of oxygen being
delivered to body cells, particularly in the extremities
With chronic occlusive arterial disease the precipitating cause for ulceration and gangrenous lesions often is
injured tissue cannot heal properly because of cellular deprivation of
oxygen and nutrients; ulceration and gangrene may result; diminished
sensation decreases awareness of injury
When obtaining data from a client with thromboangitis obliterans (Buerger's
disease), the nurse would expect the client to demonstrate or report
Buerger's disease is characterized by vascular inflammation, usually in the
lower extremities, leading to thrombus formation. As a result of impaired
circulation, there is a burning pain and intermittent claudicaation
A simple test for varicose veins is the
the trendelenburg test evaluates the backflow of blood through defective
valves. If, after raising the legs to empty the veins, the client stands and the
veins fill from above the site of the suspected varicosity, the diagnosis is
supported
Following a vein ligation and stripping, the client should be positioned
the legs should be elevated to promote venous return by gravity
Prolonged bed rest after surgery appears to promote hemostasis, particularly
in the deep veins of the calves. The most likely pathologic result of such
hemostasis may be thrombus formation and
the pulmonary capillary beds are the 1st small vessels (capillary beds) that
the embolus encounters once it is released from the calf veins
the 1st positive deflection after the P wave on the ECG
R wave
atrial depolarization and the time for an impulse to travel through the AV node and the bundle of His
PR interval
atrioventricular (AV) node normally depolarizes at a rate of
(40-60)
60-100
The ability of cardiac cells to spontaneously depolarize without being
stimulated by a nerve describes the property of
automaticity
The dominant pacemaker of the heart is the
sinoatrial (SA) node
in LEAD ____ the left leg is positive and the right arm is negative
II
The waveform that reflects ventricular repolarizarion is the
T wave
The PR interval is measured
beginning of the P wave to the beginning of the QRS complex
The PR interval normally measures
0.12-0.20 second
The ability of cardiac cells to transfer an impulse from cell to cell is
called
conductivity
The duration of a normal QRS complex is
0.08-0.12 second
The vertical axis on ECG paper measures ___. Each small square equals
voltage, 1 mm (0.1 mV)
The horizontal axis on ECG paper measures ___. Each small square
time, 0.04 second
Purkinje fibers normally depolarize at a rate of
20-40/minute
The ability of cardiac cells to respond to an electrical stimulus is called
contractility
The sinoatrial (SA) node normally depolarizes at a rate of
60-100
The process that occurs when the cell membrane actively pumps sodium
out of the cell and potassium into the cell, thus returning the cell to its resting state, is called
repolarization
The process that occurs when an electrical stimulus causes sodium rush
into a resting cell, changing the cell's electrical potential from negative to positive is called
depolarization
The 1st negative deflection after the R wave is the
S wave
Which of the following statements are correct concerning the determination of heart rate from a rhythm strip?
To calculate the heart rate using the six-second count method,
count the number of complete complexes between two vertical
a straight, flat line recorded on the ECG when the electrical activity of
the heart is nor being detected
isoelectric line
What information can be obtained from a single monitoring lead
the effectiveness of myocardial contraction
The dysrhythmia commonly related to the respiratory cycle- gradually
increased with inspiration and decreasing rate with expiration is
sinus dysrhythmia
List 5 steps used in ECG rhythm analysis
rate, regularity, P wave (presence, absence, relation to QRS,deflection),
PR interval, QRS interval
An electrical impulse moving directly toward a positive electrode will
create a(n) _________ deflection on ECG paper.
upward
Which of the following may produce artifact on the ECG
Muscle tremors
loose electrodes
respirations
The electrocardiogram is used to
evaluate electrical activity of the heart
The 3 primary function of the AV node includes which of the following
1 delays conduction to allow the atria to empty their contents into the ventricles
2. act as a “stop gate”
3. act as an escape pacemaker if a higher pacemaker site fails
In normal sinus rhythm, the P wave should have the following 3
characteristics
be present before every QRS complex, uniform size and shape, upward
deflection
When a client is receiving anticoagulants, the nursing care should include
observations for:
epistaxis
client is receiving Dicumarol, a coumarin derivative. The test that would
be most specific for calculating the daily dosage of this anticoagulant
would be the
prothrombin time
client with coronary artery disease has a sudden episode of cyanosis
and a change in respirations. The nurse starts oxygen administration
immediately. In this situation
the nurse's observations were sufficient to begin administration of the
oxygen
.When preparing a client for discharge following surgery for a coronary
artery bypass graft, the nurse should teach that there will be
The client is up more at home so edema usually increases
The nurse suspects a client is in cardiogenic shock. The nurse understands
that this type of shock is
shock may have different etiologies, but always involves a drop in BP
and failure of the peripheral circulation because of sympathetic nervous
system involvement
The nurse assists the physician in treating a client in shock. One modality
of treatment that employs the physical law explaining the increased
venous return accompanying mild vasoconstriction underlies the use of
adrenalin is used to treat shock because the induced arterial
constriction reduces blood pooling and increases venous return and
cardiac output
The nurse finds an injured person, sitting in a chair obviously in shock.
The nurse should
this position is useful in treating shock because it promotes gracity
induced venous return. Warmth and fluids are also supportive to the
person
The adaptations of a client with Adams-Stokes syndrome would most
likely include
Adams-Stokes syndrome is a result of complete AV block. The
ventricles take over the pacemaker function in the heart, but at a much
slower rate than that of the SA node. As a result there is a decreased
cerebral circulation, causing syncope
The nurse is aware that the term bradycardia means
<60 bpm
The nurse should prioritize care and provide treatment first for a client with?
ventricular fibrillation will cause irreversible brain damage then death
within minutes because the heart is not pumping blood
List in order, the structures of the heart as blood would pass beginning at the right atrium
tricuspid valve
pulmonary artery
pulmonary vein
mitral valve
left ventricle
Which of the following would cause the heart rate to decrease
Vagal stimulation
All of the following are properties of the cardiac muscle cells except
secretion
Place the following in order as a normal cardiac electrical impulse would travel through them
SA node
Intra-atrial pathways
AV junction
Bundle of His
Purkinje fibers
Which of the following is considered the dominant pacemaker of the heart
SA node
When the Purkinje fibers function as an escape pacemaker, you would expect the
20-40 beats/minute
The functions of the AV node include which of the following
Delays the conduction to allow the atria to empty their contents into the
ventricles
2. Acts as a “stop gate”
3. Acts as an escape pacemaker
The electrocardiogram shows
electrical activity of the heart
3. rate and rhythm of the heart
The P wave of the normal EKG represents
atrial depolarization
The normal PR interval is
0.12-.20 sec
A “sawtooth” waveform is a distinct characteristic of which of the following
rhythms?
atrial flutter
The P wave in a normal sinus rhythm should have which of the following characteristics?
upright
2. regular in rate
3. similar in shape to each other
preceding the QRS complex
Dysrhythmias can be caused by which of the following
ischemia
2. hypoxia
3. acidosis
4. electrolyte imbalance
5. myocardial infarction
The nurse understands that in the absence of pathology, a client's respiratory center is stimulated by
the respiratory in the medulla responds primarily to increased carbon
dioxide concentration in the blood
The efficacy of the abdominal-thoracic thrust (Heimlich maneuver) to
expel foreign object in the larynx demonstrates the gas volume related to the individual's
the residual volume is the amount of air remaining in the lungs after
maximum exhalation
A client states that the physician said the tidal volume is slightly
diminished and asks the nurse what this means. The nurse explains that tidal volume is the amount of air
tidal volume is defined as the amount of air exhaled normally after a
normal inspiration
Air rushes into the alveoli as a result of the
thoracic pressure is reduced because thoracic volume is increased as
the diaphragm descends
A client is scheduled for a pulmonary function test. The nurse explains
that during the test the respiratory therapist will ask the client to
breathe normally to measure the
5) 1- tidal volume is the amount of air inhaled and exhaled while breathing
normally
Oxygen dissociation from the hemoglobin and therefore oxygen delivery to the tissues are accelerated by
6) 3- the lower the PO2 and the higher the PCO2 , the more rapidly oxygen
dissociates from the oxyhemoglobin molecule
With an oxygen debt, muscle shows
7) 1- with an oxygen debt, a muscle would show primarily low levels of oxygen
and low levels of ATP caused by the low levels of aerobic respiration and
high levels of lactic acid formation
A nurse initially will use an Ambu-Bag in the intensive care unit when
8) 1- An Ambu-Bag is a piece of equipment that can be compressed at regular
intervals by hand for temporary ventilation of the client in respiratory
arrest
To facilitate maximum air exchange, a client should be placed in
the orthopneic position is a sitting position that permits maximum lung
expansion for gaseous exchange, because the abdominal organs do not
provide pressure against the diaphragm and gravity facilitates the
descent of the diaphragm
A client begins to expectorate blood. The nurse describes this episode as
10)3- hemoptysis is expectoration of blood-stained sputum derived from the
lungs, bronchi, or trachea
The position in which a client with dyspnea should be placed is
11)3- orthopneic position refers to sitting up and leaning slightly forward,
which drops the diaphragm, allowing the lungs more room for expansion
Radium is stored in lead containers because
Radium atoms are unstable and spontaneously disintegrate. This
disintegration produces potentially harmful radiation; lead is a barrier to these radiations
A systemic drug that may be prescribed to produce diuresis and inhibit
formation of aqueous humor is
Acetzilamide (Diamox) is a carbonic anhydrase inhibitor that decreases inflow of aqueous humor and controls intraocular pressure
A client is receiving an antihypertensive drug intravenously for control of
severe hypertension. The client's blood pressure is unstable and is at 160/94
before the infusion. Fifteen minutes after the infusion is started the blood
pressure rises to 180/100. The response to the drug would be described as
paradoxical response to a drug is directly opposite to the desired
therapeutic effect
A client is to be discharged on a diuretic and digitalis. The nurse reviewing the
client's diet would be especially careful to look for adequate sources of
potassium because
toxic levels of digitalis overstimulate the vagus nerve, leading to depressed
conduction through the AV node (AV block of any degree) as well as SA node
depression (sinus bradycardia). In addition, ectopic pacemakers are
accelerated, leading to premature beats. Such pathologic effects are
enhanced by low serum potassium levels from diuretics, vomiting, and
nasogastric drainage as well as by chronic arterial hypoxemia and impaired
renal function.
A client complains of fatigue and dyspnea and appears jaundiced. The nurse
questions the client about medications taken routinely. In light of the symptoms, the nurse should be most concerned about
methyldopa is associated with acquired hemolytic anemia and should be
discontinued to prevent progression and complications
A client is receiving amniophylline intravenously to relieve sever asthma. The
nurse should observe for
Amniophylline, a theophylline derivative, promotes diuresis and relaxes
smooth muscles, resulting in hypotension
Before giving a client digoxin, the nurse should obtain the
Because digoxin slows the heart, the apical pulse should be counted for 1
minute before administration. If apical rate is below 60 (bradycardia), digoxin
should be withheld because its administration could further depress the heart
rate. If the heart rate is above 120, digoxin should be withheld because the
client may be in digitalis toxicity.
The nurse should teach a client to suspect that nitroglycerin SL tablets have
lost their potency when
Nitroglycerin tablets are affected by light, heat, and moisture. A loss of
potency can occur after 3 months, reducing the drug's effectiveness in
relieving pain. A new supply should be obtained routinely.
Evaluation of the effectiveness of nitroglycerine SL is based on
Cardiac nitrates relax the smooth muscles of the coronary arteries so that
they can dilate and deliver more blood to relieve ischemic pain.
The drug the nurse should expect the physician to order if symptoms of
Dicumarol overdose are observed would be
Dicumarol depresses prothrombin activity and inhibits the formation of
several of the clotting factors by the liver. Its antagonist is vitamin K, which is
involved in prothrombin formation.
The loop diuretics alter active transport systems in the kidney tubules,
resulting in increased excretion of sodium, and secondarily, water. The
principle explaining secondary water loss(diuresis) is
The presence of excess sodium (a solute) in the nephric tubules effectively
decreases the water concentration of the glomerular filtrate and urine; water
passively diffuses (osmosis) from the kidney tubule cells into the urine to
equalize the water concentration.
A client receiving hydrochlorothyazide (hydroDIURIL) asks what this drug
actually does. The nurse explains that the planned therapeutic effect of the
drug is to
Hydrochlorothiazide (hydroDIURIL) inhibits sodium reabsorption in the
nephron, causing an increased excretion of sodium and chloride
When teaching a client receiving prazosin (Minipress) for hypertension why
orthostatic hypotension occurs, the nurse knows that this antihypertensive
causes vasodilation by
Prazosin blocks the response to norepinepherine bound to alphaadrenergic
receptors relaxing smooth muscle in peripheral vessels, increasing
circulation and decreasing blood pressure
In a patient with leukemia, the blood level is affected is ____.
wbc
A mother cannot afford to buy meat for her family. You suggest she buy ____
corn and beans.
A mastectomy patient would show the beginnings of acceptance when she ____
touches the wound
Compensation for respiratory acidosis would show increased ____
hc03
A patient receiving a blood transfusion develops a fever. The nursing action is to _____
stop the transfusion and infuse with normal saline.
The most important nursing measure intervention hen caring for a patient who is receiving intravenous nitroprusside sodium for sever hypertension would be to compare ____
serial blood pressure readings.
. Expect that a patient with a new colostomy is ready to start self care would be ____
looking at and touching her colostomy
For a child with WBC of 12K, RBC 4 million, Hgb 8, and a resp of 24, you would _____?
limit activity
A patient on diuretics needs further teaching instruction if she states____?
" I void every fours."
For a patient with a radical neck dissection, the immediate concern is ____
respiratory distress
The symptoms usually associated with respiratory acidosis are _____?
irritability, headache, and confusion.
Following laryngectomy, to decrease anxiety and fear you would teach the patient and family ____?
esophageal speech
Your patient whoi had had a pneumonectomy refuses to move or do exercises. You should give ____?
pain medication 30 minutes before activity.
A habit that would increase a patient's risk of colon cancer would be a _____ diet
high fat
At risk to have varicose veins would be a patient who was an _____?
OR nurse for 15 years
A patient taking digoxin and lasix should call the physician when he experiences ____?
muscle weakness
A patient with fibrocystic breast disease should not include ____ and ____.
caffeine and salt
A weight gain of four pounds in 24 hours would most likely be caused by ___
chf
A clinical laboratory finding for a patient with rheumatic fever is increased ____
esr
In a baby having difficulty in breating, the nurse wil see ____
substernal retractions
Nicotine in cigarettes causes decreased ciliary ____
cleaning action
The most common complication of pancytopenia in patients on chemotherapy would be ____&____?
infection and bleeding tendencies.
A patient is receiving cytoxan chemotherapy for ovarian cancer. The lab value that would indicate the need for you to contact the physician is platelet count of _____.
50k/mm3
To evaluate a patient for chest pain, the nurse should ask, ____?
Are you having chect pain?"
Clinical signs of respiratory distress in the newborn are _____
nasal flaring, expiratory grunting, and see-saw retraction.
nursing diagnosis for a female patient with a diagnosis of uterine cancer would be
Body image disturbance
A 78 year old patient with lung cancer is admitted following 48 hours of nausea and vomiting. He has shallow breathing and an irregular pulse. You expect imbalance?
respiratory alkalosis
The drug classification that would be most effective for increasing cardiac output would be a ____
calcium antagonist.
The most likely cause of a decreased PO2 level in a patient with bilateral pneumonia is that the ____
alveoli are blocked by secretions preventing adequate exchange of gases.
To obtain an urine specimen from an infant, you should use a ____
specimen bag.
The discharge health teaching for a patient with a tracheal stoma secondary to pneumonia is to ___
humidify the air at home.
Upom auscultation of the lungs you would expect to hear vesicular breath sounds at the base of the ____ and bronchovesicular sounds between the _____& _____
lungs

scapulae and lateral to the sternum.
Upper abd. distention is most closely associated with what congenital disease.
puloric stenosis
A patient is admitted to the ER with dyspnea, stridor, and wheezing. These symptoms indicate ___?
asthma.
Sickle cell crisis is vaso-____.
occlusive