Sara's Mosby Review Flash Cards

Front 1

normal platelet count

Back 1

150,000-500,000

Front 2

normal hematorit

Back 2

women 37-48
men 45-52%

Front 3

the role of the liver in clotting

Back 3

liver cells synthesize prothrombin, fibrinogen, and other clotting factors; adequate amounts of vit K must be present in blood for liver to make protrombin; calcium acts as a catalyst to convert prothrombin to thrombin.

Front 4

extrinsic clotting mechanism

Back 4

trigger is blood contacting damaged tissue

Front 5

intrinsic clotting mechanism

Back 5

trigger is release of chemicals (platelet factors such as thromboplastin) from platelets aggregated at the site of an injury

Front 6

clotting cascade

Back 6

prothrombin is converted to thrombin, which converts fibrinogen to fibrin; fibrin is an insoluble protein formed from the soluble protein fibrinogen in the presence of thrombin; fibrin appears as a tangled mass of threads in which blood cells become emmeshed.

Front 7

where to auscultate aortic valve

Back 7

2nd ics, right of sternum

Front 8

where to auscultate pulmonic valve

Back 8

2nd ics, left of sternum

Front 9

where to auscultate tricuspid valve

Back 9

5th ics, left of sternum

Front 10

pulse deficit

Back 10

difference btw apical and radial pulses

Front 11

systolic bp

Back 11

pressure within arteries when heart is contracting

Front 12

diastolic

Back 12

pressure in arteries when heart is at rest

Front 13

SNS effect on circulatory system

Back 13

increased HR, and contractility, dilates coronary and skeletal muscles, constricts ab and skin vessels

Front 14

PNS effect on circulatory system

Back 14

decreases hr and contractility, vasodilation through cholinergic fibers.

Front 15

role of baroceptors in response to changes in BP

Back 15

baroceptors in aortic arch and carotid sinus respond to increase in BP by stimulating parasympathetic response and are inhibited by decrease in BP, resulting in an increased sympathetic response.

Front 16

functions of spleen

Back 16

1. reticuloendothelial cells form macrophages that protect the body from antigens through phagocytosis.
2. contains B and Ts
3. sequesters newly formed reticulocytes until matured erythrocytes; resevoir for erythrocytes and platelets;
4. resumes hematopoiesis if bone marrow fails to function.

Front 17

therapeutic DIG level

Back 17

.9-2 ng/mL

Front 18

how to calcium channel blockers work?

Back 18

block Ca influx into muscle cells during depolarization; control atrial dysrhythmias by decreasing cardiac automaticity and impulse conduction; reduce peripheral vascular resistance in treatment of hypertension: diltiazem (Cardizem), nifedipine (Procardia), verapamil (Calan), amlodipine, felodipine

Front 19

side effects of antiarrythmics

Back 19

hypotension, dizziness, n/v, heart block, heart failure, anticholinergic effect, blood dyscrasias

Front 20

exercise caution when giving beta blockers to these patients

Back 20

diabetics (may mask hypoglycemia), bronchospasm, heart failure

Front 21

how do ACE inhibitors work?

Back 21

stop conversion of angiotension 1 to 2, blocking vasocontriction and fluid retention from aldosterone secretion; -prils
SE: chronic cough

Front 22

how do angiotension 2 receptor blockers work?

Back 22

block a2 from binding to vascular smooth muscle and adrenal gland receptor sites; stop vasocontriction and fluid retention. less likely to cause chronic cough (-sartan)

Front 23

patient instruction for antihypertensives

Back 23

low sodium, high B vit, change positions slowly, report SE to MD, avoid hazardous activities when initially prescribed

Front 24

SE of lasix (watch for this one especially in diabetics)

Back 24

hyperglycemia

Front 25

lasix competes with which drug for binding sites?

Back 25

ASA

Front 26

therapeutic aPTT for heparin pts

Back 26

1.5 to 2X normal

Front 27

pt instructions for anticoagulents

Back 27

medic alert card, avoid meds w/ ASA, ETOH, green tea, ginseng, st. John's wort; avoid cranberry juice for Warfarin pts, use electric rasor and soft toothbrush; follow schedule for coagulation studies

Front 28

which antiplatelet drug is ototoxic?

Back 28

ASA

Front 29

clot busting drugs

Back 29

tPA, streptokinase, altepase.

Maintain continuous IV infusion of heparin after thromboltic therapy

emergency reversal drug: aminocaproic acid (Amicar)

Front 30

Epoetin method of administration and SE

Back 30

sub q or IV (do not shake vial)
seizures (rise in crit), hypertension, thrombolytic events

Front 31

how long is therapy for pernicious anemia?

Back 31

lifelong

Front 32

SE of antilipidemics

Back 32

n/v, musculoskeletal problems, hepatic toxicity, reduced absorption of fat soluble vitamins and bile

Front 33

when to administer antilipidemics?

Back 33

HS to enhance effectiveness; administer other meds w/ meals to limit GI irritation

Front 34

what is first degree heart block?

Back 34

signals from the atria take a long time to reach the ventricles. Slow HR. usually no treatment

Front 35

what is Mobitz 1 heart block?

Back 35

2nd degree heart block. the signals from the atria take longer and longer to reach the ventricles until a beat is skipped

Front 36

what is mobitz 2 heart block?

Back 36

This is less common than Type I but generally more serious. Because electrical impulses can't reach the ventricles, an abnormally slow heartbeat may result. In some cases a pacemaker is needed.

Front 37

what is third degree heart block?

Back 37

no communication between atria and ventricles

Front 38

things to avoid if you have a pacemaker

Back 38

magnetic fields: high tension wires, hand-held screening devises, MRI, may trigger airport alarms, but won't affect pacemaker.

Front 39

elevated levels of serum enzymes associated with MI

Back 39

1. cardiac troponin T: increase w/in 3-6 hr, elevated for 14-21 days
2) cardiac troponin I: rise 7-14 hr, remain elevated for 5-7 days
3)CK: elevate 3-6 hrs, peak 24 hr, return to NML w/in 72 hr
4)CK-MB: elevate 4-6 hr, peak 24 hr, normal within 72 hr
5) myoglobin: elevate 1-3 hr, return to normal within 12 hours

Front 40

what is a Swan-Ganz catheter?

Back 40

the insertion of a catheter into a pulmonary artery. Its purpose is diagnostic; it is used to detect heart failure or sepsis, monitor therapy, and evaluate the effects of drugs. The pulmonary artery catheter allows direct, simultaneous measurement of pressures in the right atrium, right ventricle, pulmonary artery, and the filling pressure ("wedge" pressure) of the left atrium.

Front 41

what's the difference between systolic and diastolic heart failure?

Back 41

systolic results from impaired pumping, diastolic results from impaired filling

Front 42

BNP

Back 42

brain natureic peptide. rises during heart failure (usually below 100); produced by the myocardium in response to increased ventricular end-diastolic pressure; funcitons to promote diuresis and vasodilation to reduce cardiac workload.

Front 43

pitting edema scale

Back 43

+1 = 2 mm
+2 = 4 mm
+3 = 6 mm (rebounds 10-20 sec)
+4 = 8 mm (rebounds 30 sec)

Front 44

s/s cardiac tamponade

Back 44

decreased arterial pressure, elevated CVP, rapid/thready pulse, diminished output

Front 45

s/s thoracic aneurism

Back 45

hoarseness, cough, aphonia from impingement on laryngeal nerve, unequal pulses and arterial pressure in upper extremities; tracheal may be displaced

Front 46

Romberg's test

Back 46

loss of balance with eyes closed experienced in Pernicious anemia

Front 47

what is disseminated intravascular coagulation?

Back 47

body's response to overstimulation of clotting and anticlotting processes.

massive amount of clotting in small blood vessels and hemmorhaging can occur simultaneously leading to multiple organ failure.

Front 48

potential side effects of radiation

Back 48

n/v, skin rashes, dry mouth, dysphagia, infections, pancytopenia

Front 49

what is forced expiratory volume?

Back 49

volume of air that can be forcibly exhaled within a specific time, usually 1-3 sec; decreased with increased airway resistance

Front 50

instructions for client while chest tube is being removed by MD

Back 50

exhale or strain (airtight dressing will be added immediately too)

Front 51

how to suction an airway

Back 51

1) client in semi-fowlers
2)VS and breath sounds
3)hyperoxygenate with 100% O2
4)lubricate catheter
5)insert til end of trach tube (4 inches), withdraw catheter 2 cm before starting suction
6) apply no suction during insertion
7) rotate and withdraw catheter while suction is applied (don't exceed 10-15 sec)
9. clear catheter with sterile solution and encourage client to breathe deeply
10) hyperoxygenate, reassess client

Front 52

nursing care for client undergoing thoracentesis

Back 52

1) consent
2)x-rays before and after procedure
3)sitting position
4) do not cough during procedure to avoid lung trauma
5)note and record amt, color, clarity of fluid withdrawn
7)position on opposite side, if tolerated, for lung expansion
8) monitor for complications

Front 53

Mantoux test

Back 53

PPD is injected intradermally:
1) determines antibody response to TB bacillus; induration of 10 mm or greater 48 to 72 hr later indicates a positive finding; induriation of 5 mm may also be significant in immunocompromised patients
2) a positive finding indicates prior infection; may or may not indicate active disease state
3)immunocompromised patients may not have a positive reaction
4) clients who have received the BCG vaccine will have a positive rxn

Front 54

preventative therapy needed if close contact has TB

Back 54

INH

Front 55

in tension pneumothorax, which way will trachea deviate?

Back 55

toward unaffected lung

Front 56

how to position client after pneumonectomy

Back 56

on operative side to increase lung expansion; assess position of trachea for mediastinal shift too.

Front 57

patient teaching post laryngectomy

Back 57

1) speech therapy for some clients
2) skills necessary (suctioning, changing, cleaning, care of skin, humidified air (can be achieved by use of a moist dressing near stoma)
3)avoid activities that may permit water or irritating substances to enter (swimming, high wind, hair spray, dust)
4)no constricting colars
5) sipping through a straw, whistling, and blowing the nose will not work
6) drink fluids and use a humidifier to keep secretions loose

Front 58

what is ARDS?

Back 58

respiratory failure as a complicaiont of trauma, aspirations, ventilation, infection, open heart surgery, shock, fat emboli

Involves:
1) alveolar capillary damage with loss of fluid and pulmonary edema
2)impaired alveolar gas exchange causes V/Q mismatch and shunting; tissue hypoxia results
3)alteration in surfactant production; decreased lung compliance
4)atelectasis, resulting in labored and inefficient respirations

Front 59

Tx for ARDS

Back 59

ventilation with PEEP (increases residual capacity, reducing hypoxia)

IL-1 receptor antagonists, surfactant, antioxidants, and corticosteroids

fluids and nutrition

Front 60

nursing interventions

Back 60

1)frequent rest periods
2)tranquil, supportive environment, but keep pt awake
3)observe and assess
4) system of communication once pt is intubated
5) frequent position changes

Front 61

cranial nerves that innervate taste buds

Back 61

facial and glossopharyngeal

Front 62

main functions of liver

Back 62

1. carb metabolism (glucose/glycogen/gluconeogenesis)
2. fat metabolism (ketogenesis, fat storage, synthesis of triglycerides)
3. protein metabolism (anabolism, deamination, urea formation)
4. secretes bile
5. detoxifies drugs/hormones
6. vitamin metabolism (storage of fat solubles/bile needed to absorb)
7. intestinal bacteria produce vit K

Front 63

pancreatic enzymes

Back 63

insulin, glucagon, trypsin (protein), lipase, amylase

Front 64

how do anitemetics work?

Back 64

diminish sensitivity of the chemoreceptor trigger zone to irritants or decrease excitability

EG:
1)centrally acting: ondansetron (Zoloft), prochlorperazine (Compazine)
2)motion sickness: dramamine, meclizine HCl, promethazine HCl
3) agents that promote gastric emptying: Reglan

Front 65

SE antiemetics

Back 65

drowsiness (CNS depression), hypotension/dry mouth/blurred vision (anticholinergic), incoordination (EPS/dopamine)

Caution before engaging in hazardous activities

Front 66

SE antacids

Back 66

constipation (aluminum)
diarrhea (Mg)
alkalosis (systemic antacids eg: sodium bicarbonate
reduced abosorption of calcium, iron, and most medications (increased gastric pH

Front 67

nursing care of clients taking antacids

Back 67

1)instruct re. prevention of overuse which can lead to rebound hyperacidity, need for continued supervision, dietary restrictions re gastric distress, foods high in Ca and Fe, need to take 1 hr before or 2 hrs after oral meds
2)caution client on sodium restricted diet because many antacids contain sodium
3. administer w/ small amount of water to ensure passage to stomach

Front 68

use of anticholinergic for GI disturbances

Back 68

1)inhibit smooth muscle contraction in GI tract
2) aleviates peptic ulcer pain
eg: atropine, dicyclomine, propantheline bromide

Front 69

H2 receptor antagonists and proton pump inhibitor examples

Back 69

1) H2: famotidine (Pepcid), rantidine (Zantc)
2) PPI: omeprazole (Prilosec), lansoprazole, Nexium

Front 70

SE of H2 receptor antagonists and proton pump inhibitors

Back 70

CNS disturbances (decreased metabolism of drug r/t liver/kidney impairment), blood dyscrasias, decrease in bone density with long term use (more w/ PPIs)

Front 71

nursing care of patients on H2 receptor antagonists/PPIs

Back 71

1) do not administer at same time as antacids; allow 1 hour before or 2 hours after other oral drugs
2)give w/meals
3)assess for oral anticoagulent effects
4)do not take for over 8 wks w/o medical supervision

Front 72

examples of antidiarrheals

Back 72

1)fluid absorbants: bismuth, Kaopectate
2)enteric bacteria replacements: Lactobacillus
3) motility supressants: decrease GI tract motility so more water is absorbed: Lomotil, Imodium

Front 73

SE fluid absorbants

Back 73

GI distrubance, CNS disturbance (direct CNS toxic effect)

Front 74

SE enteric bacteria replacements

Back 74

gas, cramps

Front 75

SE Motility suppressants

Back 75

anticholinergic, paralytic ileus, respiratory depression

Warn client of interference of ability to perform hazardous activies

Front 76

SE of laxatives

Back 76

1) dependance
2) GI disturbances
3)intestinal lubricants: less absorption of fat solubles, anal leakage (use peripad)
4)saline: dehydration (hyperosmotic solution draws a lot of water into GI), hypernatremia (increased sodium absorption into circulaiton; shift of fluid from vasculature to intestinal lumen)

Front 77

how to mix bulk forming laxative solution

Back 77

w/8oz of fluid

follow up with another glass of water/juice

Front 78

how to do a colostomy irrigation

Back 78

1) water 105 degrees
2) insert 7-8", bag should be 12-18" above stoma.
3) provide privacy, irrigate, stop if cramping. Allow client to ambulate to stimulate peristalsis
4) apply ostomy bag 1/8" away from stoma. Cleanse area w/soap and water

Front 79

how to do capsule endoscopy

Back 79

1) fast 12 hours before test
2)apply antenna patch and belt holding battery and data recorder
3)hold capsule under tongue until light source is verified
4)then swallow
5) notify MD immediately of n/v, dysphagia, avoid strong EMF until capsule is deficated, avoid strenuous activity, bending or stooping, check that recorder is working q15min
return capsule

Front 80

how much residual is too much when doing a tube feeding

Back 80

more than 1/2 of last feeding. Can vary by agency/MD. May need to reinstall some of it to avoid electrolyte imbalances.

Front 81

what is intralipid therapy?

Back 81

infusion of 10-20% fat mixture that provides esential fatty acids and provides more calories

filter not needed

Front 82

what is TPN?

Back 82

has carbs, amino acids, vitamins, minerals and delivered through central line because of the high osmolality of the solution

filter is needed

monitor temp q4h because infection is common. Rule out other sources by doing sputum, blood and urine cultures

Front 83

what is total nutrient admixture (TNA or 3 in 1)?

Back 83

dextrose, amino acids, lipids in one container
Administered via central line over 24 hours

Front 84

hormones that may influence obesity

Back 84

ghrelin and leptin

Front 85

pregnancy precautions with gastric bypass surgery

Back 85

women should not become pregnant before surgery or for at least 1-2 years post op

Front 86

SE of lipase inhibitors for obesity

Back 86

like olestra

Front 87

nutrients needed after gastric bypass

Back 87

risk for anemia
needs calcium and B12

Front 88

what do Nissen fundoplication and Hill procedures do?

Back 88

tighten LES

Front 89

what is Barett's esophagus?

Back 89

Barrett’s esophagus is a condition in which the tissue lining the esophagus are replaced by tissue that is similar to the lining of the intestine. This process is called intestinal metaplasia.

No signs or symptoms are associated with Barrett’s esophagus, but it is commonly found in people with gastroesophageal reflux disease (GERD). A small number of people with Barrett’s esophagus develop a rare but often deadly type of cancer of the esophagus.

Front 90

care after esophageal scoping (Stretta procedure)

Back 90

airway, elevate HOB, O2, report pain over 5/10 (may indicate perferation), no NSAIDs for 10 days, soft diet for 2 wks, crush all pills

Front 91

what is Zollinger-Ellison syndrome?

Back 91

tumors that secrete gastrin which result in excessive HCl secretion may lead to PUD

Front 92

how to test for H. Pylori?

Back 92

urea breath test or biopsy during GI scopy

Front 93

surgical interventions for PUD

Back 93

Scopy with electrocauterization, vagotomy (remove vagus nerve), bilroth 1 and 2, antrectomy, gastrectomy

Front 94

What are Bilroth 1 and 2?

Back 94

1. removal of lower portion of stomach and attachment of remaining portion to duodenum
2. removal of antrum and distal portion of stomach and subsequent anastomosis of remainis section of jejeuneum

Front 95

how to prevent dumping syndrome

Back 95

1. eat smaller meals
2) avoid high carb stuff
3) consume liquids only between meals
4) remain sitting for 1 hr after meals

Front 96

s/s stomach cancer

Back 96

weight loss, stools have blood, anemia, achlorhydria (no HCl), pale skin and acanthosis nigricans (hyperpigmented velvety skin)

Front 97

what is acute pancreatitis?

Back 97

1)inflammation caused by autodigestion by pancreatic enzymes (mainly trypsin)
2) may result from gallstones, alcoholism, carcinoma, trauma to pancreas, or hyperlipidemia

Front 98

s/s acute pancreatitis

Back 98

abrupt onset of central, epigastric pain that may radiate to shoulder, chest, back, tenderness, pruritus/jaundice, elevated temp, vomiting, change in stools, shock/tachy/hypotension, boardlike ab, grossly elevated serum amylase/lipase, decreased Ca

Front 99

endocrine functions of kidney

Back 99

stimulation of erythropoeitin production, and activation of vitamin D

Front 100

Tx for acute pancreatitis

Back 100

opoids, antacids, NPO/gastric decompression, anticholinergics to suppress vagal stimulaiton, ABX, pancreatic enzymes and bile salts (depends on function), insulin, surgery

position semi-fowler, observe for Ca imbalance, low fat diet, fat soluble vitamins

Front 101

s/s pancreatic cancer

Back 101

jaundice, decreased serum amylase and lipase levels from decreased secretion, increased serum bilirubin and alkalyne phosphatase levels when bile ducts are obstructed

Front 102

what is cholecystojejunostomy?

Back 102

creation of opening btw gallbladder and jejunem to direct bile flow (surgery for pancreatic cancer)

Front 103

incubation period of Hep A and Hep B

Back 103

Hep A: 15-50 days
Hep B: 28-160 days

Front 104

s/s hepatitis

Back 104

Prodromal: malaise, anorexia, n/v, runny nose, intollerence of cigarette smoke
icteric phase: jaundice, dark urine that foams when shaken, acholic (clay)stools
recovery: easy fatigability

Front 105

Tx of hepatic cirrhosis pt

Back 105

1)rest
2) no etoh
3)vitamins (fat soluble and vit Bs, zinc, calcium)
4)diuretics
5)neomycin and lactulose to decrease elevated blood ammonia levels
6)colchicine, antiinflamatory agent
7) maintain respiratory function (paracentesis)
8)surgery: portal caval shunt (shunt excess backed up blood)
9) Baloon tamponade (Sengstaken-Blakemore tube) for esophageal varices
10)sclerotherapy

Front 106

dietary modification for cirrosis pt

Back 106

protein as tolerated (low), high carb, moderate fat, low sodium (ascites), soft foods if esophageal varicies are present

Front 107

hepatic coma diet

Back 107

low protein when amonia >200mcg/dL, high calorie to prevent catabolism and liberation of nitrogen, carefully controlled fluid

Front 108

nursing care for patient with Sengstaken-
Blakemore tube

Back 108

1)maintain traction once baloon is inflated to ensure proper placement
2)maintain at pressures of 30-35 mmHg
3)deflate baloon for a few minutes at specific intervals (if ordered) to prevent necrosis
4)irrigate with saline if ordered
5)maintain patent airway by suctioning to remove saliva

Front 109

electrolye imbalance in some ulcerative colitis patients

Back 109

hypocalcemia

Front 110

nutrition for ulcerative colitis

Back 110

low fat, high protein, low residue, high calorie
may need fat soluble vitamin supplements, avoid food allergens, especially milk
replace iron, calcium and zinc losses with supplements.
If there is ileal involvement, may need B12 supplementation
lots of fluids for dehydration

Front 111

what is a Kock pouch?

Back 111

continent ileostomy that will stretch over time to hold 500 mL. must be cathterized every 4-6 hours to drain it. external appliance unecesary, covered by small dressing.

Front 112

meds for diverticulitis

Back 112

analgesics (avoid morphine because it can increase intracolonic pressure), ABX, antispasmodics, stool softeners, bulk forming laxatives

Front 113

diet for diverticulits

Back 113

high fiber, but avoid foods with small seeds

Front 114

risk factors for hemorrhoids

Back 114

prolonged sitting or standing, obesity, pregnancy, straining, constipation

Front 115

therapeutic interventions for hernias

Back 115

1. manual reduction
2. when a client is a poor surgical risk, a truss (pad to hold the hernia in place may be ordered)
3. herniorrhaphy
4. hernioplasty (making the ab wall stronger to prevent future hernias)

Front 116

where does melanocyte-stimulating hormone come from?

Back 116

pituitary gland

Front 117

classes of oral antidiabetics

Back 117

1)sulfonureas: stimulate beta cells to produce insulin (glyburide, glipizide)
2)biguanides: reduce rate of endogenous glucose production in liver, increase use of glucose in muscle and fat cells (metformin/glucophage)
3)thiazolidinediones: improve insulin sensitivity
4) meglitinides: stimulate quick release of insulin from beta cells; repaglinide, -glinide
5) alpha-glucosidase inhibitors: block carb digestion and slow absorption: acarbose

Front 118

SE of oral antidiabetics

Back 118

hepatotoxicity, thrombocytopenia, vitamin B12 deficiency

Front 119

VS needed before taking thyroid enhancing drugs (synthroid)

Back 119

pulse
if over 100, tell MD

Front 120

care for client undergoing hypophysectomy

Back 120

1)neuro assessments: monitor for increased ICP
2)monitory I and O and check weight daily to check for diabetes insipidus
3)check clear nasal drainage for glucose to determine presence of CSF
4) encourage deep breathing, but not coughing
5) prevent constipation (valsalva increases ICP)
6) maintain client in position no lower than semi-Fowlers

Front 121

what is Simmonds' disease

Back 121

total absence of pituitary gland hormones

Front 122

which hormone does ETOH supress?

Back 122

ADH
advise patients with diabetes insipidus to avoid ETOH because it supresses ADH

Front 123

diet for hypoparathyroidism

Back 123

foods with calcium that have a low phosphorus content (avoid eggs, milk and cheese due to their high phosphorus content)
cream cheese and sour cream are high in calcium and low in phosphorus. avoid whole grains and processed meats

Front 124

blood sugar level associated with DKA

Back 124

300-600

Front 125

blood sugar level assosciated with HHNS

Back 125

500-900

Front 126

how to do alternate site blood glucose testing

Back 126

1) use fingertip if hypoglycemia is expected
2)use site recommended by MD consistantly
3) rub forearm vigorously until warm for testing
4)use monitor designed for alternate site testing
5) avoid use in arm on side of mastectomy; results likely to be low; reduce risk of infection and lymphedema

Front 127

what is the Somogyi effect?

Back 127

insulin-induced hypoglycemia rebounds to hyperglycemia

Front 128

what is the Dawn phenomenon:

Back 128

early morning hyperglycemia attributed to increased secretion of growth hormone
(delay insulin dose at night or give mroe)

Front 129

acid base imbalance in hyperaldosteronism

Back 129

alkylosis

Front 130

s/s primary aldosteronism (Conn's syndrome)

Back 130

muscle weakness, polyuria, polydipsia, paresthesia, HTN, low K, high Na, alkysosis, renal damage proteinuria, decreased urine specific gravity
tx with surgery and spironolactone (temporary)
Bilateral adrenalectomy involving lifelong corticosteroid therapy is necessary

Front 131

s/s pheochromocytoma (adrenal tumor)

Back 131

HTN, posturaly hypotension, tachy, sweating, tremors, hyperglycemia, CVA, increased levels of plasma and urinary catecholamines and vanillylmandelic acid (breakdown product of catchecholamines).

Avoid coffee, beer, wine, citrus fruit, chocolate, bananas, and vanilla before VMA test

Front 132

SE of silver sulfadiazine (skin antiinfective)

Back 132

skin irritation, hemolysis in G6PD clients

Front 133

SE of mafenide acetate (antiinfective for skin)

Back 133

metabolic acidosis

Front 134

SE of silver nitrate

Back 134

electrolyte imbalance

Front 135

SE of retin A

Back 135

visual disturbances, HA, hepatotoxicity

Front 136

nursing care for retin A pts

Back 136

don't take vit A supplements, avoid pregnancy while on this drug (too much vit A is teratogenic), assess for depression

Front 137

pressure ulcer staging

Back 137

1) nonblanchable area of erythema
2) partial thickness of epidermis and/or dermis (blister/shallow crater)
3)full-thickness ulceration involving epidermis, dermis, sub-q
4)full thickness plus damage to bone/muscle/tendon

Front 138

how does the wound VAC system work?

Back 138

uses negative pressure to remove fluid from area surrounding wound, reducing edema and improving circulation to the area

Front 139

what is a minor burn?

Back 139

no hands/feet/genatalia
<15%

Front 140

what is a moderate burn?

Back 140

partial-thickness involvement of 15-25%, but full-thickness burns do not exceed 10% of body area

Front 141

what is a major burn?

Back 141

involvement exceeds 25% partial thickness or 10% full thickness.
hands/feet/genetalia

also may be used if
younger than 18 months, older than 50 years, additional injuries

Front 142

when to suspect pulmonary burn injury

Back 142

1)singed nose hairs
2)trapped in closed space
3)face/nose/lips burned
4)initial blood sample contained carboxyhemoglobin

Front 143

emergent phase of burn injury

Back 143

initial, life threatening stage; 24-48 hr; concerns are respiratory status, hypovolemia and hyperkalemia

Front 144

acute phase of burn injury

Back 144

begins with mobilization of fluids and electrolytes back into cells and ends when burns are healed or covered by skin grafts; may take days, weeks, months; concerns are hypervolemia and hypokalemia

Front 145

rehabilitation phase from burn injury

Back 145

begins when wounds are healed and client is able to resume self-care; may take weeks to months; major concerns are roles and body image

Front 146

basal cell carcinoma

Back 146

waxy red nodule usually on face, common, metastasis rare

Front 147

squamous cell carcinoma

Back 147

upper extremities and face, small/red/nodular
develops rapidly and may metastasize to local lymph nodes

Front 148

malignant melanoma

Back 148

arises from melanocytes, color variation, suspected with changes in size, color or characteristics; metastais via blood can be extensive

Front 149

Tx for scleroderma patients

Back 149

1)immunosupressants (cyclosporine/methotrexate)
2)salicylates
3)vasodilators; ace inhibiltors; Ca channel blockers; alpha blockers; NTG for digits
4)physical therapy

Front 150

nursing care for scleroderma pts

Back 150

1)mild soaps and lotions for skin
2)instruct to avoid smoking and exposure to cold
3)deep breathing exercises
4)observe for SE of immunosupressants
5)monitor function of all vital organs

Front 151

what is the hypothalamus do?

Back 151

1) part of the neural path where emotions and other cerebral functions can alter VS
2)secretes neuropeptides that influence anterior pituitary
3) secretes oxytocin and ADH into posterior pituitary
4)controls appetite
5) heat regulating
6)maintains waking state

Front 152

frontal lobe

Back 152

1) abstract thinking, sense of humor, uniqueness
2)controls contraction of skeletal muscles and synchronization
3)controls hypothalamus
4)controls muscular mvts of speech

Front 153

parietal lobe

Back 153

1) translate nerve impulses into sensations
2)interpret sensations
3)interpret taste

Front 154

temporal lobe

Back 154

1) translates nerve impulses into sound
interprets sound
2)interpret smells
3)control behavior patterns

Front 155

thalamus

Back 155

1)crudely translates sensory impulses but does not localize them
2)processes motor info from cerebral cortex and cerebellum and projects back to motor cortex
3) controls emotional component of sensations (pleasant or unpleasant)

Front 156

cerebellum

Back 156

exerts synergistic control over skeletal muscles, producing smooth, precise mvts; coordinates skeletal muscle contractions; promotes posture equilibrium and balance

Front 157

what is an astigmatism?

Back 157

irregular curvature of the surface of the cornea that focuses rays unevely on the retina

Front 158

which bacteria causes Lyme disease?

Back 158

Borrelia burgdorferi

Front 159

how do bone conduction hearing aids work?

Back 159

they bypass the middle ear and transmit amplified vibrations to the skull bones, which in turn produce vibrations in the ear.

Front 160

SE of phenytoin

Back 160

ataxia, gingival hyperplasia, hirsutism, Hypotension, red urine, therapeutic serum level is 10-20 mcg/mL

Front 161

vitamins and herbs for patients taking anticonvulsants

Back 161

take lots of folic acid, Ca, vit D.
phentoin increases metabolism of oral contraceptives and anticoagulents; ginko decreases phenytoin's effectiveness

Front 162

nursing care for patients taking phenytoin

Back 162

1)don't mix with other IV infusions or 5% dextrose
2)oral hygeine, inspect for infection
3)assess for anticoagulent effectiveness
4)assess urine
5)***** for tissue necrosis because phenytoin is highly irritating to the veins

Front 163

SE mannitol

Back 163

HA, nausea, chills, rebound edema when discontinued, fluid/electrolyte imbalanes (Na and K excretion)

Front 164

nursing care of patients taking mannitol

Back 164

1)I and O, electrolytes
2)question administration in pts w/CHF/renal failure
3)elevate HOB
4)assess for increased ICP

Front 165

which mineral may potentiate DIG?

Back 165

calcium

Front 166

care of patients receiving levodopa

Back 166

1)limit B6 (pork, veal, potatoes, oats, beans, wheat germ)
2)inform client about "holiday" periods
3)monitor for EPS
4)watch for rigidity and fever (NMS)
5)monitor CBC, BP

Front 167

care for patients receiving selegiline

Back 167

(MAOI B for parkinson's patients)
1) inform that selegiline may be started early because neuroprotective actions are expected
2)use safety precautions because drug can cause ortho hypo
3)avoid foods containing tyramine

Front 168

which drug should be used if patient overdoses on cholinesterase inhibitors (ie. Mestinon)?

Back 168

atropine

Front 169

nursing care for patients taking allopurinol, colchicine or probenecid

Back 169

1)administer antiinflamatories in addition
2)increase fluids to discourage formation of uric calculi
3)weight reduciton
4)monitor serum urate levels to determine effectiveness
5)give w/meals to decrease GI irritation
6)instruct to avoid high purine foods

Front 170

examples of high purine foods

Back 170

organ meats, shellfish, sardines, anchovies

Front 171

how do miotics work?

Back 171

constrict pupil, pulling the iris away from the filtration angle and improving outflow of aqueous humor; used to treat chronic open angle glaucoma
1)beta blocer miotic: betxol, timolol
2)anticholinesterase: demecarium (Humorsol)
3)cholinergic: carbachol

Front 172

how do mydriatics work?

Back 172

dilate pupil by causing contraction of dilator muscle of iris with minimal effect on siliary muscle, which lessens the effect on accommodation
1)atropine
2)tropicamide
3)cyclopentolate
4)dipivefrin

Front 173

how do carbonic anydrase inhibitors work?

Back 173

decrease production of aqueous humor
1)acetazolamide
2)brinzolamide
3)dorzolamide

Front 174

how do osmotic agent influence aqueous humor?

Back 174

glycerin, mannitol, urea, and isosorbide are administered systemically to increase blood osmolality, which mobilizes fluid form the eye to reduce volume of intraocular

Front 175

nursing care for patient taking mydriatics

Back 175

vision will be blurred temporarily; wear sunglasses; caution about hazardous activities

Front 176

correct cane sizing

Back 176

highest point should be approximately level with greater trachanter; hand piece should allow 30 degrees of flexion at elbow with wrist held in extension
same measurements for a walker

Front 177

homonymous hemianopsia

Back 177

loss of vision in the same visual field of both eyes.

Front 178

tx of Bell's Palsy

Back 178

1) r/o CVA
2)prednisone
3)heat, massage, electric stimulation (keep face warm)
4)prevent corneal irritation with eye drops and use of protective eye shield
5) support nutritional status by providing privacy, small meals and encourage to use affected side

Front 179

tx for tic douloureux

Back 179

1)anticonvulsants (carbamazepine) to relieve and prevent acute attacks
2)skeletal muscle relaxants (baclofen)
3)sx
a)microscopic reloaction of arterial loop that may cause vascular compression of trigeminal
b)percutaneous radio frequency trigeminal gangliolysis

Front 180

nursing care for tic doloureux

Back 180

1)teach ways to avoid triggering an attack: avoid hot/cold foods, chew soft food on unaffected side, cotton balls to wash face, no drafts, use scarves to protect face from cold
2)provide teaching to clients who have sensory loss as a result of tx: inspect eye for foreign bodies, irrigate eye, dental checkups q6 months because caries won't cause pain.
3)teach about anticonvulsants

Front 181

MS drugs

Back 181

interferon beta-1a, Glatiramer acetate, mitoxantrone (immunomodulators), corticosteroids, baclofen (spasticity), carbamazepine (trigeminal neuralgia)

Front 182

what is Charcot's triad?

Back 182

in MS
intention tremor, nystagmus, scanning (clipped speech)

Front 183

nursing care of MS patients

Back 183

1)rest periods
2)avoid hot baths
3)encourage to be active
4)bowel/bladder regimen
5)how to deal w/mood swings
6)how to deal with loss of hot/cold temp sensation
7)difficulty swallowing: small bites,etc
8)range of motion exercises

Front 184

what is a myasthenic crisis?

Back 184

sudden inability to swallow or breath due to weakness (not enough Ach)

Front 185

how does Guillian-Barre syndrome progress?

Back 185

ascending peripheral neuron weakness starting in the lower extremities, affecting respirations and eyes.

Front 186

tx Guillian Barre

Back 186

1)IV therapy with igG
2) plasmapheresis
3) support of vital funcitons

Front 187

what is multiple myeloma?

Back 187

malignant overgrowth of plasma cells in bone and bone marrow produce a specific nonfuncitonal immunoglobulin (monoclonal protein); osteoclast activating factor produced by plasma cells and other substances cause bone breakdown

Front 188

s/s multiple myeloma

Back 188

anemia, platelet deficiency, weight loss, broken bones, monoclonal protein, Bence Jones protein in urine, hypercalcemia and hyperuricemia which may result in renal damage.
Diagnosis confirmed by bone marrow biopsy

Front 189

nursing care for multiple myeloma

Back 189

1)control pain
2)prevent fx
3)increase fluid intake
4)chemo/radiation
5)good diet

Front 190

nursing care for patient with degenerative disk disease

Back 190

1)firm mattress
2)traction/braces applied correctly
3)fracture bedpan to avoid lifting hips
4)use log rolling to turn
5)high roughage diet to avoid constipation

Front 191

what is a comminuted fx

Back 191

bone broken into several fragments

Front 192

what is a green stick fx

Back 192

bone broken on one side, bent on other. more common in kids

Front 193

stages of fx healing

Back 193

formation of hematoma, fibrocartilage formation, callus formation, ossification, consolidation and remodeling of the callus

Front 194

s/s fx

Back 194

5 ps: pain, pulseless, palor, paresthesias, paralysis

Front 195

care for fx pts

Back 195

1)weights hang freely
2)functional alignment of extremity
3)observe for footdrop in Buck's traction; may indicate nerve damage
4)check site of pin insertion for infection

Front 196

s/s thoracic spinal cord injury

Back 196

paralysis of lower extremities and trunk below diaphragm, loss of bladder and bowel control

Front 197

s/s cervical spine injury

Back 197

quadraplegia; if injury is above C4, absence of independent respirations

Front 198

what is autonomic dysreflexia?

Back 198

exaggerated autonomic response to distended bowel or bladder, etc; leads to bradycardia, HTN, HA, piloerection, diaphoresis, nasal congestion

Front 199

nursing care for client with phantom limb sensation

Back 199

1)pain from severed nerves, gradually decreases over 2 years
2) have client look at limb or close eyes and go through range of motion exercises as if limb was still there to provide pain relief
3)analgesics, surgery may be used to relieve pain

Front 200

how to use an upper extremity prosthesis

Back 200

1)mastery of upper extremity prosthesis more complex
2)bilateral shoulder exercises must be done to prepare for fitting the prosthesis
3) artificial arms can't be used above head or behind back because of harnessing
4)no artifical hand can duplicate all the fine movements of the fingers and thumb of the hand
5)there's a loss of sensory feedback; therefore visual control must be used at all times (blind person can't use the upper extremity prosthesis)

Front 201

care after cataract removal

Back 201

1)prevent pressure on eye by avoiding : touching, rubbing, tightly closing eye, sneezing, bending from waist, coughing, rapid head mvts, straining, lifting, lying on affected side
2) analgesics, antiemetics, stool softeners
3)reduce amount of light and encourage sunglasses when eyepatch is removed
4)teach signs of increased intraocular pressure (pain, restlessness, increased pulse) and infection
5) explain that vision is altered but will clear. glasses may be needed

Front 202

NML intraocular pressure

Back 202

10-21 mm Hg

Front 203

things for glaucoma patients to avoid

Back 203

anything that increases intraocular pressure and mydriatics like atropine and other anticholinergics

Front 204

care after detached retina surgery

Back 204

1) avoid things that increase intraocular pressure
2) eye patch
3)low lights
3)s/s hemorrhage (severe pain/restlessness)

Front 205

s/s otosclerosis

Back 205

hearing loss, tinnitus, use of tuning fork show bone condution better than air conduction (Rinne test), spongy bone in labyrinth

fixation of stapes caused by growth of bone (conductive hearing loss)

Front 206

nursing care for otosclerosis client

Back 206

1)alter position gradually to prevent vertigo
2) assess for pain, vertigo, HA
3) avoid things that increase pressure in ears (swimming, blowing nose, showering, flying, sneezing) until healed
4)explain that because of edema and packing, hearing will be diminished but will improve

Front 207

tx of meniere's disease

Back 207

1)valium, meclizine, diuretics, antihistimines
2) destruction of vestibular nerve which may cause deafness
3)insertion of endolymphatic drainage shunt which may relieve symtoms w/o loss of hearing
4)low-sodium diet

Front 208

nml urine specific gravity

Back 208

1.005-1.030

Front 209

urinary spasmolytics

Back 209

affect smooth muscle of urinary tract, used for symptomatic relief of incontinence (have anticholinergic effects)
eg: flavoxate (Urispas), oxybutynin (Ditropan), tolterodine (Detrol)

Front 210

nursing care of clients on urinary spasmolytics

Back 210

1) do not administer if GI obstruction is pressent
2)caution w/glaucoma pts
3)avoid driving and hot environmentes
4)monitor urinary output

Front 211

foods high in oxalate

Back 211

tea, almonds, cashews, chocolate, cocoa, beans, spinach, rhubarb

Front 212

acid ash diet to create an acidic urinary tract

Back 212

to eliminate alkaline calcium stones:
whole grains, eggs, cranberry juice.
limit milk, veggies, fruit. provide riboflavin, vit A, C, folic acid

Front 213

what is an alkaline ash diet?

Back 213

A diet consisting mainly of fruits, vegetables, and milk with little meat, fish, eggs, cheese, and cereals, that when catabolized leaves an alkaline residue to be excreted in the urine.

Front 214

who should be on the alkaline ash diet?

Back 214

those with uric acid stones or cystine stones

Front 215

nursing care for urolitiasis pts

Back 215

1)analgesics
2)rest periods
3)3000-4000 mL fluid
4)ABX
5)diet
6)daily weight bearing exercise to decrease hypercalcemia

Front 216

side effect of chronic acidosis in renal failure

Back 216

osteodystrophy. Make sure client has plenty of calcium.

Front 217

how to find compatable kidney donor

Back 217

human leukocyte antigen (HLA) and blood test

Front 218

care of client undergoing hemodialysis

Back 218

1)weigh before and after
2)VS before, after and q15min; assess for hypotenstion and hemorrhage
3)surgical asepsis
4)watch site for clotting, check clotting time and give heparin PRN.
5)monitor patency of fistula by palpating thrill, auscultating bruit
6)monitor for K and Na levels

Front 219

care for client undergoing peritoneal dialysis

Back 219

1)accurate flow chart and monitor for clinical findings of peritonitis and resp distress
2)reposition to promote drainage
3)wash catheter site with soap and water during daily shower
4)protect site with gauze dressing
5)monitor serum glucose level

Front 220

care for BPH clients after surgery

Back 220

1) avoid anticholinergics and antihistimines because they can cause urinary retention
2)warm water or warm shower may relax urinary sphincter
3)increased fluid intake
4)assist to standing position to void
5)continuous bladder irrigation
6)stool softeners to prevent straining and pressure on operative site
7)perineal exercises

Front 221

BPH drugs

Back 221

1)5-a-reductase inhibitors: block uptake of androgens - finasteride (Proscar), dutasteride (Avodart)
2)a-Adrenergic receptor blocking agents: terazosin (hytrin)

Front 222

drug sometimes used in prostate cancer

Back 222

estrogen

Front 223

testes cancer and fertility

Back 223

patient may want to bank sperm before testicular cancer tx

Front 224

SE quinine

Back 224

GI irritation, cinchronism (tinnitus, vertigo)
cinchronism = OD on quinine

Front 225

cause of rabies

Back 225

rhabdovirus

Front 226

s/s rabies

Back 226

respiratory difficulty, hydrophobia (sight/thought of water triggers pharengeal spasms that expell fluid from mouth), salivation, nuchal rigidity, seizure, apnea

Front 227

tx rabies

Back 227

1)cleanse wound w/soap and water
2)trach
3)human rabies immune globuin (passive immunity)
4)human diploid cell vaccine (active immunity)

Front 228

care of rabies client

Back 228

1)avoid contact w/saliva
2)monitor ECGs, blood gases
3)keep room dark and quiet to limit agitation
4)suction secretions PRN
5)prevent drafts which may result in spasms

Front 229

what is Rocky Mountain spotted fever

Back 229

transmitted by tick infected with Rickettsia rickettsii
organism attachs endotheial cells and extends into vessel walls, causing thrombi, inflammation, and necrosis

Front 230

s/s Rocky Mountain spotted fever

Back 230

fever; enlarged spleen, hypotension, circulatory colapse, renal collapse, rash (rose colored macules), edema, subcutaneous hemorrhage, necrosis

HA, hearing loss (only lasts several weeks), malaise, joint/muscle pain

Front 231

what bacteria causes Lyme disease?

Back 231

Borrelia burgdorferi (spirochete bacteria)

Front 232

s/s lyme disease

Back 232

chills, muscle aches, stiff neck, fever, red-ringed, circular rash (erythema chronicum migrans); swollen joints, lack of coordination, facial palsy, paralysis, dementia, Western blot assay and other antibody titers with positive result

Front 233

client teaching to avoid lyme disease

Back 233

1)avoid grassy areas, wear light colors to increase identification, pants tucked into boots
2)remove ticks with twezers, grasping close to skin to avoid breaking mouth parts
3)inspect skin
4)at risk clients should take vaccine

Front 234

what is typhoid fever?

Back 234

caused by Salmonella typhii (in feces, shellfish, flies)
invades GI tract and localizes in lymph tissue of the intestinal wall (Peyer's patches); those areas may become thrombosed and tissue sloughs off.
hemorrhage, peritonitis, perforation, and hepatitis are serious complications

Front 235

s/s typhoid fever

Back 235

fever, bradycardia, rose-colored papules on ab, large spleen/liver, delirium, constipation during early stage, diarrhea during late stage

Front 236

activity of Clostridium botulinum

Back 236

blocks neuromuscular transmission in cholinergic nerve fibers by possibly binding with acetylcholine

Front 237

s/s botulism

Back 237

diplopia, muscle weakness, dysphasia, diminished visual acuity and gag reflex, loss of pupilary light reflex

Front 238

tx botulism

Back 238

1)dark room
2)parentral feedings to prevent aspiration
3)trach
4)cathartics and cleansing enemas to remove toxins from the body
5)trivalent antitoxins as necessary
6)gastric lavage
7)elevate HOB
8)prevent contractures and emboli through ROM exercises

Front 239

bacteria that causes syphillus

Back 239

Treponema pallidum

Front 240

which drug delays the excretion of penecillin?

Back 240

probenecid

Front 241

vector for West Nile Virus

Back 241

mosquitos

Front 242

erikson: birth to 1 year

Back 242

trust vs mistrust

Front 243

erikson: 1-3 years

Back 243

autonomy vs shame and doubt: child develops first sense of self as independent or as shameful and doubtful; the struggle of holding on or letting go

Front 244

erikson; 3-6 years

Back 244

initiative vs guilt: child learns ability to try new things and learns how to handle failure; period of intensive activity, play and consuming fantasies

Front 245

erikson: puberty to young adult

Back 245

identity vs confusion

Front 246

erikson: young adulthood

Back 246

intimacy vs isolation

Front 247

erikson: school age

Back 247

industry vs inferiority

Front 248

erikson: middle age

Back 248

generativity vs stagnation

Front 249

erikson: old age

Back 249

integrity vs despair

Front 250

Maslow's hierarchy

Back 250

physiologic, safety, love, esteem, self-actualization

Front 251

what is conversion?

Back 251

emotional conflict is unconsciously changed into a physical symptom that can be expressed openly without anxiety

Front 252

what is introjection?

Back 252

complete acceptance of another's ideas over one's own

Front 253

what is splitting?

Back 253

viewing others or situations as either all good or bad; failure to integrate the positive and negative qualities in oneself

Front 254

precautions with benzodiazepines

Back 254

1)If OD, take flumazenil (Romazicon)
2)a drop in 20 systolic when standing warrents withholding drug and calling MD
3)should not be abruptly d/c
4)don't take if doing ECT

Front 255

drugs given with neuroleptics to decrease TD

Back 255

benzodiazepines

Front 256

care for patients on lithium

Back 256

1)maintain Na and fluid intake because dehydration and hyponatremia predispose lithium toxicity
2)blood levels weekly for 1 month than at 2-3 month intervals (.5-1.5 mEq/L)
3)monitor weight and for signs of dependant edema
4)teach about signs of toxicity: vomiting, tremors, weakness, lassitude, severe thirst, tinnitus, dilute urine
5) don't take if preganant

Front 257

care for patients on valproate

Back 257

1)administer elixer alone
2)teach about SE: sedation, drowsiness, n/v, diarrhea, constipation, heartburn
3) teach about toxicity: visual disturbances, rash, diarrhea, light colored stools, jaundice, protracted vomiting

Front 258

anxiolytic with no identified addictive potential

Back 258

Buspirone

Front 259

barbituates + X = hemmorrhage

Back 259

anticoagulents

Front 260

what is pellagra?

Back 260

Niacin defficiency that causes dermatitis, diarrhea, dementia, death

Front 261

what is a dissociative fugue?

Back 261

sudden, unexplained travel accompanied by an inability to recall one's past, identity confusion, or the assumption of a new identity.

Front 262

what is depersonalization disorder?

Back 262

persistent or recurring feeling of being detached from one's mental processes or body that is accompanied by intact reality testing

Front 263

what is ECT?

Back 263

1)shock to brain resulting in seizure that alters brain chemistry and eventually alters mood
2)used for clients with recurrent, severe depresion who don't respond to drug therapy
3)drugs such as succinylcholine, a depolarizing muscle relaxant causing paralysis are used to reduce muscle contraction during seizure and are given after a short acting barbituate
4)SE: fatigue, muscle soreness, temporary confusion and temporary memory loss

Front 264

what is a personality disorder?

Back 264

enduring pattern of inner experiences and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.

Front 265

what is schizoid personality disorder?

Back 265

1)avoidance of meaningful interpersonal relationships
2)use of autistic thinking, emotional detatchment, daydreaming
3)introverted since childhood but maintiaining fair contact with reality
4) asexual

Front 266

what is schizotypeal personality disorder?

Back 266

1)unattached withdrawn
2)affectively and intellectually diminished
3)frequently part of vagabond or transient groups of society
4)behavior or appearance that is eccentric or peculiar

Front 267

role of clonidine (Catapres) for opiate withdrawal

Back 267

supresses withdrawal symtoms and decreases adrenergic excess while opiate receptors return to normal
1)heroin addicts who are first stabilized on methadone before detox do better than those who go directly from heroin to Catapres
2)catapres should not be used for individuals who abuse ETOH or have unstable psych or heart conditions

Front 268

when does spermatogenesis occur in males?

Back 268

after puberty

Front 269

what is dyspareuina?

Back 269

painful sex, associated with menopause

Front 270

surgical sterilation precautions for men

Back 270

sterilization not achieved until semen is free of sperm. use protection until this time (after 15 ejaculations)

Front 271

what is primary infertility?

Back 271

couple has never had a child

Front 272

what is secondary infertility?

Back 272

couple has conceived but woman can't sustain pregnancy or conceive again

Front 273

what is chordee?

Back 273

painful, downward turning erection. may cause infertility

Front 274

normal creatinine level

Back 274

0.5-1 mg/dL

Front 275

nursing care of patients with a hysterectomy

Back 275

1)encourage weight reduction and routine pelvic exams
2)fluid/lyte balance
3)maintain patency of urinary catheter (blood in urine may mean tear in bladder, watch for urinary retention too)
4)coughing/deep breathing
5)prevent thrombophlebitis
6) postpone driving, sex, heavy lifting and strenuous exercise for 6-8 wks

Front 276

meds for trichomoniasis

Back 276

metronidazole (Flagyl)

Front 277

nursing care for PID patients

Back 277

1) temp/WBC/cluture
2)ABX
3)fowler's position to localize infection and prevent formation of abcesses in abdominal cavity
4)perineal pads (change frequently)
5)avoid tampons and obstain from sex during treatment for PID
6)prenatal care important if pregnancy occurs
7) increased risk of ectopic pregnancy

Front 278

nursing care for prolapsed uterus

Back 278

1)if prolapsed, observe for ulcerations; apply saline or ointment to prevent ulceration
2)if pessary used, must be taken out and periodically cleaned
3)monitor urination and BMs
4)kegel

Front 279

NML WBCs in pregnancy

Back 279

before pregnancy, NML WBC count is 5000. afterwards, should be 12,000

Front 280

NML RBCs in pregnancy

Back 280

physiologic anemia is common. blood volume increases by 50%, but hematocrit will decrease.

Front 281

normal fundal height

Back 281

increases 1 cm/wk up to 30 wks
20 wks/ at umbilicus
36 wks/at xiphoid process

Front 282

calcium during pregnancy

Back 282

hypocalcemia is common. may cause leg cramps.

Front 283

increased nutrients needed during pregnancy

Back 283

folic acid, calcium, iron, 300 cal/day, protein, iodized salt

should gain 25-35 lbs

Front 284

when should practitioner be notified about contractions?

Back 284

when they are 5-8 min appart

Front 285

nursing care for pregnant mom's w/ TB

Back 285

1)take INH and rifampin for the full 9 months
2)ethambutol may be substituted for INH, but no other substitutions
3)take B6
4)infants at risk for tb when being cared for by mom (50%)
5)give babies BCG vaccine

Front 286

what is HELLP syndrome?

Back 286

occurs as a complication of preeclamsia
hemolysis, elevated liver enzymes, low platelets

Front 287

tx gestational HTN

Back 287

frequent rest periods
dietary management with increased fluid intake
treat symptoms

Front 288

tx mild preeclampsia

Back 288

high protein diet
ambulatory care
frequent rest periods with feet elevated
sidelying position to enchance renal and placental perfussion

Front 289

tx severe preeclapmsia

Back 289

bed rest
Mag sulfate (therapeutic level 4-8)
antihypertensives; nifedipine, hydralazine
indwelling catheter (i and o)
induction or cecarian when condition more stable
calcium gluconate if resp depression occurs with mag sulfate
if fetus is less than 34 weeks, stimulation of surfactant with betamethasone
seizures may occur several weeks post-partum

Front 290

tx hellp syndrome

Back 290

same as severe preeclapsia, but with blood products

Front 291

threatened abortion

Back 291

cervix closed, but bleeding, cramping and backache occur

Front 292

imminent abortion

Back 292

bleeding and cramping become more severe, cervix dilates

Front 293

incomplete abortion

Back 293

all products of conception not expelled

Front 294

missed abortion

Back 294

fetus dies in utero but not expelled, client must be monitored for DIC

Front 295

when to d/c pitocin

Back 295

if a sustained uterine contraction occurs; fetal decelerations persist; urinary flow decreases to 30 mL/hr (r/t water intoxication); signs of placenta previa or abrupto placenta develop

Front 296

when to d/c prostaglandin

Back 296

if hypertonic contractions occur

Front 297

Tx PROM

Back 297

1) bed rest
2)amnioinfusion of isotonic saline for some cases
3)ABX

Front 298

negative fetal fibronectin test

Back 298

mom won't go into labor for the next week

Front 299

care for women with dystocia

Back 299

1)relieve back pain caused by prolonged labor by applying pressure to the sacrum during contractions. have client avoid supine position
2)s/s maternal exhaustion such as dehydration and acidosis/alkylosis
3)constantly monitor contractions, FHR, and VS when client is receiving oxytocic stimulation.

Front 300

what to do about a prolapsed cord

Back 300

1)with sterile gloved hand, push the presenting part off cord
2)place in trendelenburg
3)keep cord moist in sterile saline

Front 301

nutritional requirements of a neonate

Back 301

1)fluid: 2-3 oz/lb or 130-200 mL/kg
2)calories: 110-130/kg or 50-60/lb
3)protein: 2-2.2 g/kg up to age 6 months. 1.8/kg at 6-12 months

Front 302

neonatal immunity

Back 302

1)passive immunity through placenta: IgG
2)active immunity in utero: IgM
3) passive immunity after birth: IgA in colostrum

Front 303

what is Erb-Duchenne paralysis?

Back 303

paralysis of the muscles of the upper arm caused by injury to the brachial plexus during a prolonged, difficult labor or traumatic birth; treatment depends on severity of paralysis.

Front 304

ABO incompatibilities

Back 304

most common in type O moms with type A, B or AB babies. antibodies are transfered through the placenta to the fetus which can result in anemia, jaundice and kernicterus in the 1st 24 hours of life. previous exposures to A, B, or AB blood do not increase the formation of antibodies so first pregnancy can be affected

Front 305

tx for hemolytic disorders: mom/fetus blood type incompatabilites

Back 305

1)amniotic fluid determinations are done by chemical and spectrophotometric analysis; elevated readings warrent either intrauterine exchange transfusion or induction of labor, depending on gest age
2)phototherapy
3)exchange transfusions of Rh - blood are done on severely affected infants to decrease the antibody level and increase infant RBCs and hemoglobin levels

Front 306

when to give RhoGam

Back 306

during week 28 and within 72 hours of birth

Front 307

BP, pulse, respirations of children

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pulse: one year = 80-150
childhood 70-110
BP: 100-110/55-70. increases by 2-3 mmHg/year
Respirations: infancy: 30-40
childhood: 20-24

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preventing SIDS

Back 308

do not use soft, moldable bedding
place baby on back to sleep

Front 309

what is meningocele?

Back 309

meninges protrude through defect

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what is myelomeningocele?

Back 310

meninges and spinal nerves protrude through defect

Front 311

nursing care of children with spina bifida

Back 311

1)protect sac from breakdown and infection by keeping it clean, applying sterile, moist, nonadherant dressing and changing it every 2-4 hrs.
2) place in prone position after surgery. provide passive range of motion exercises to decrease undesirable hip flexion.
3)foster elimination for infant with neurogenic bladder

After surgery...
4)measure head circumference frequently (hydrocephalus risk)
5)monitor for s/s increased ICP
6)with skin grafts covering large defect, keep prone and restrict mvt to restrict tension on operative site

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what is galactosemia?

Back 312

1)missing enzyme that converts galactose to glucose
2)s/s: weight loss/vomiting, hepatosplenomegaly, jaundice, cataracts
3)tx: early detection, dietary reduction of lactose: soy milk until 7-8 year of age and other dietary modifications throughout life

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vaccinations for children with HIV

Back 313

only when asymptomatic

Can never receive varicella vaccine

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nursing care for infant with meningitis

Back 314

1)decrease environmental stimuli
2)position on side with head gently supported in extension
3)maintain droptlet precautions for at least 48 hr
4)maintain fluid balance b/c meningeal edema
5)ABX
6)monitor for septic shock/circulatory colapse.

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stages of separation anxiety in toddlers

Back 315

1)protest
2)despair
3)detatchment

Front 316

growth lag in children who suffer burns

Back 316

children with greater than 40% TBSA of burns are at risk for severe growth delays lasting up to 3 years after the burn with no catch up.

Front 317

which nutrients decrease iron absorption?

Back 317

oxalates, caffiene, phosphate

Front 318

what is a sequestration crisis in sickle cell anemia?

Back 318

1)results from spleen pooling large quantities of blood, which causes precipitous drop in BP
2)most common in children btw 8 months and 5 years of age

Front 319

what is chest syndrome in sickle cell anemia?

Back 319

clinically similar to pneumonia

Front 320

why is hydroxurea give to babies with sickle cell anemia?

Back 320

to increase fetal hemoglobin that doesn't sickle

Front 321

how to prevent a sickling crisis

Back 321

hydration, oxygen, don't visit high altitude places, blood transfusions, stay healthy, tx URIs,

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tx for thalassemia

Back 322

1)blood transfusions
2)iron-chelating agents such as deferoxamine to reduce iron storage
3)bone marrow transplantation

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what is Kawasaki syndrome?

Back 323

acute febrile illness of unknown cause principally involving CV system.
s/s: fever 5 days or more, swollen lymph nodes, changes in mucous membrane of oral cavity, strawberry toungue, peeling on hands and soles of feet, joint stiffness, rash on trunk, cardiac complications

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tx Kawasaki syndrome

Back 324

1)CV monitoring
2)IV gamma globulin
3)large doses of aspirin therapy initially, then low-dose therapy
4) cool baths
5) observe for allergic reaction to gamma-globulin

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care for child with tontillectomy

Back 325

1)keep positioned on side
2)give cool liquids that are not red or thick
3)ask to talk
4)apply ice collar
5)during initial post-op days, give soft foods.
6)s/s hemorrhaging: frequent swallowing, etc

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tx hemophilia

Back 326

1)replace factor VIII
2)ibuprofin to relieve joint pain
3)corticosteroids for hematuria, acute hemarthosis and chronic synovitis
4)regular program of exercise and physical therapy to strenthen muscles around joints and minimize bleeding.
5)care for hemarthosis:
a)rest
b)ice
c)compress
d)elevate