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584 Cards in this Set
- Front
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What are normal neonatal vital signs? |
HR = 120-160
RR = 30-60 Acrocyanosis normal 2-6 hours after birth |
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How is thrush treated?
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Good handwashing and nystatin
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Nursing interventions for an amniotomy
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Presenting part should be engaged. Obtain FHR before and after procedure. Assess color, odor, consistancy of amniotic fluid. Check maternal temp q2h, notify healthcare provider if temp 38 or greater.
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How is natural family planning done?
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The fertile period may be determined by a drop in basal temperature before and a slight rise after ovulation and a change in cervical mucous from thick and cloudy to abundant and clear.
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How do you care for a plaster cast?
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Let dry for 48 h, handle w/palms, don't rest on hard surfaces, elevate limb above heart until dry, check for pain/numbness/tingling. If present, elevate limb. If it persists, call MD. Mobilize client, isometric exercises (blood flow).
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How do you walk with a cane?
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flex elbow thirty degrees and hold handle up; tip of cane should be 15 cm lateral to the base of the 5th toe. Hold cane in hand opposite of affected extremity; advance cane and affected leg; lean on cane while moving good leg. to manage stairs, step up on good leg, place cane and affected leg on step; reverse when going (up with good down with bad); same sequence used with crutches).
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How do you take care of a client with TPN?
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Change the site every 4 weeks, change tubing and filters every day, change dressing 2-3 times a week. The initial TPN rate is 50 mL/hr, gradually increase to 100-125 ml/hr; increased rate of infusion causes hyperosmolar state (HA, nausea, fever, chills); slowed rate causes rebound hypoglycemia. If a break in the line is suspected, embolism possible. Trendelenberg.
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s/s fracture
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swelling, palor, echymosis, loss of sensation to other body parts, deformity, pain, spasms, loss of functions, abnormal mobility, shortening of affected limb, decreased pulses distal to injury, affected extremity colder.
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How do you walk with a walker?
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Elbows flexed at a 20 to 30 degree angle when standing with hands on grips. Lift and move walker forward 8 to 10 inches. w/ partial or non-weight bearing limb, put weight on wrists and arms and step forward with affected leg, supporting self on arms and follow with good leg. Nurse should stand behind client; hold onto gait belt at waist as needed for balance. Sit down by grasping armrest on affected side, shift weight to good leg and hand. Lower self into chair. Client should wear sturdy shoes.
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Normal creatinine kinase
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12-70 u/ml
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what causes pernicious anemia?
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lack of intrinsic factor which causes inability to absorb b12. Monthly IM B12 needed.
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What to know about elastic stockings
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Remove and reapply 2 times a day. Put on before getting out of bed. Don't apply if there are skin lesions
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Nutrition for liver failure
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Early: high protein and carbs
Advanced: fiber, protein (amonia), fat and sodium restriction, small frequent feedings, fluid restriction. Reduce ascieties (Na and fluid restrictions). |
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Normal BUN
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6-20 mg/100 mL.
High levels due to protein catabolism, kidney problems, dehydration |
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Characteristics of narcissistic personality disorder
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lack of empathy, indifferent to criticism, sense of entitlement
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How to do a 24 hour urinalysis
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Save all urine in a container with no preservatives; refridgerate or keep on ice
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How to take care of someone with pancreatits
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They may be NPO and need gastric decompression.
Meds: antacids, antibiotics, anticholinergics. Fluid and electrolyte balance. Cough and deep breathe/semi-fowlers treat exocrine insufficiency. Long term: no etoh, low fat bland diet, frequent meals, monitor for signs of DM |
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What to do about gas after a cholecystectomy
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Ambulate!
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Nursing responsibilities for client with a cuffed trach
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Inject air with syringe into one-way valve in pilot line.
change client position frequently, provide humidification and hydration, suction PRN. |
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Oliguric phase of renal failure
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less than 400 mL/day urine, irritability, restlessness, seizures, high K and BUN, creatinine, Ca, Na, pH, anemia, PE, CHF, HTN
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Diuretic phase of renal failure
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4-5 L urine/day, high BUN, Na and K loss in urine, high mental and physical activity
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How to position client immediately after a CVA
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supine with HOB elevated 30-45 degrees. Facilitates venous drainage from the brain, decreases ICP, keeps head midline.
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Good exercise for femur Fx
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quad setting, isometric
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Medication for myasthynesia gravis
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Mestinon (cholinesterase inhibitor). Give on time. Early: cholinergic crisis; Late: MG crisis
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Gastric ulcers
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pain increases with food, relieved by vomiting. Can eat most foods as long as they do not bother stomach.
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How often do you administer Cipro?
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q12h
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Post op after surgical repair of detatched retina
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bed rest with eye patch
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SE of estrogen therapy
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cancer, n/v, rashes, breast secretion, thromboembolytic disorder. Use cautiously in family hx of reproductive d/o.
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How to decrease recurrence in Otitis media?
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Tx URIs early
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Sign that your client may be allergic to dyes
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Allergy to shellfish (iodine!)
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Where should your patient give themselves IM B12?
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vastus lateralus
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What is the easiest form of PO nutrition for someone after a CVA?
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soft foods. liquids are more difficult
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s/s PIH
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higher than 30 mmHg systolic or 15 mmHg diastolic increase in BP with proteinemia and/or edema after 20 wks gestation.
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who's at risk for PIH?
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First time moms under 20 or over 35.
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What is an adrenal crisis?
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The required adrenal hormones exceed available supply. Usually precipitated by a stressful event.
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s/s adrenal crisis
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hypotension, palor, increased urine, dehydration
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How do you know that medications for client with adrenal crisis are working?
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BP increases
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What is a dystonic reaction?
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This is a reaction to an antipsychotic. s/s: muscle tightness in throat, neck, tongue, mouth, eyes, neck, and back, difficultly talking and swallowing.
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How to you treat a dystonic rxn?
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IM or IV benadryl or cogentin
(antimuscarinic/anticholinergic) muscle relaxant dopamine agonist (carbidopa) |
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Treatment for dumping syndrome
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sedatives, antispasmotics, high protein, high fat, low carbs, dry diet. Eat in semi-recumbent position. Lie down after eating..
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PMI for fetal heart tones
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fetal back
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proper position for brain scan
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supine
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Best way to reduce arthritis stiffness
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warm bath
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Major antacid side effect
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constipation
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Best position for paracentesis
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Fowlers
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What is a good initial approach to your client's delusions?
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clarify meanings of delusions. After that, do not discuss delusions or argue with client. Address delusions that entail injury or death immediately.
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Reaction formation
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defense mechanism: attitude opposite of unconsious feelings.
ie: homophobic person who later realizes they are gay |
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Why is a spacer for asthma medication a good thing?
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a spacer for an inhaler traps medicine from the inhaler, then breaks up and slows down the medicine particles so you get more medication
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What is meniere's disease?
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dysfunction of labyrinth leading to severe vertigo. Leads to residual tinnitus and hearing loss
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How do you decrease tinnitus in Meniere's disesase?
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listen to headphones
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What does an EEG measure?
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electrical activity in the brain
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Advise for client post hip fracture
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do not flex hip more than 90 degrees, don't cross legs and have someone help with shoes
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Which electrolyte imbalances does a client with Addisonian crisis have?
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adrenal insufficiency in Addisonian crisis leads to low aldosterone which leads to hyponatremia and hyperkalemia
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Priority nursing diagnosis for patient with Parkinson's disease
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Risk for aspiration (of saliva). keep HOB high.
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chronic kidney disease diet
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restrict fluids, protein, salt and K
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Should you administer cytotoxic drugs to a pregnant woman?
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no
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What is the appropriate INR for coumadin therapy?
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2-3.5
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Tx for diabetes insipidus
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caused by decrease of ADH
give vasopressin |
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electrolyte imbalance caused by
ACE inhibitors (-pril) |
hyperkalemia
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position of comfort for pericarditis client
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leaning forward while sitting
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Stages of Altzheimers
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1) confussion
2) difficulty with recent and remote memory/occasional incontinence 3)loss of all cognitive functions |
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What is myasthenia gravis?
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spastic, progressive weakness of the voluntary muscles caused by disturbance in transmission of nerve impulses at neuromuscular junctions. This is caused by a deficiency in Ach release or decreased number of Ach sites
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s/s myasthenia gravis
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diplopia, speech problems, masklike expression, fatigue, respiratory distress,
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test for myasthenia gravis
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neostigmine (tensilon) temporarily relieves s/s
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diabetic foot care
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use nail files instead of clippers, water soluble lotions, antiperspirants, no foot soaks
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what are the stages of alcoholism?
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prealcoholism: drink to medicate
early: sneaking drinks, blackouts crucial: loss of control and physiological dependence chronic: emotional and physical deteriorization |
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Major side effect of MAO inhibitors and nursing diagnosis
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they cause hypotension
Risk for injury |
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what happens to people who OD on tricyclic antidepressants?
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fatal arrythmias, hypotension, anticholinergic
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When can you expect Buspar to start having an anxiolytic effect?
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anxiolytic drug
after 14-30 days |
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What is generalized anxiety disorder?
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anxiety that lasts longer than 6 months
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s/s dementia
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slow symptom progression
basic personality changes hard to pay attention to others |
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what is akathisia?
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inner restlessness
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administration of terbutaline
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take every 4 hours around the clock to supress labor. Report if HR>120 BPM (SE: tachycardia)
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sequella for cerebral hyperemia in infants
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increased blood in brain leads to increased ICP which leads to brain injury
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SE of vincrystine
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neurotoxic drug:
weakness and constipation |
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nursing interventions for prolapsed umbilical cord
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elevate hips on 2 pillows, change mom's position, push cord
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What do you need to assess before giving meds to premature infants?
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maturity of kidney and liver enzyme systems. This makes a difference in the way that drugs are metabolized
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pedal and popliteal pulses post cardiac catheterization
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site distal to insertion site will be weak, but gradually should increase in strength
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how do you test for cystic fibrosis?
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sweat test
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how do you do a sweat test?
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pilocarpine(cholinergic that induces sweating) is applied to gauze pad and placed on arm, a low intensity painless current is applied for several minutes. If there's a lot of Na and Cl in sweat, they have CF.
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what are presumptive signs of pregnancy?
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ammenorria, quickening (mvt)
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what are probable signs of pregnancy?
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uterine enlargement, Chadwick's sign (bluish discoloration of genitals), positive hCg test, Braxton Hicks contractions, Hegar's sign (bounceback of fetus when uterus is pressed)
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what is a positive sign of pregnancy?
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fetal outline on ultrasound
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what does the "taking in" stage consist of?
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1-3 days after birth, the mom is focused on taking care of herself
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When and how to feed an infant after pyloric stenosis surgery
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small, frequent feedings 4-6 hours after surgery
occasional emesis is common |
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what is a hemiangioma?
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endothelial tumor
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How long does an infant have a plantar grasp reflex?
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until 9 months of age
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very common sign of ingestion of poisons
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edema of lips
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after surgical repair for hypospadia, how do you position child?
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elevate scrotum
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what does impetigo look like?
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vesicular lesions with drainage, forming crusts on face and extremities
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evidence of fetal wellbeing in non-stress test
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2 accelerations with a rise of 15 beats in 20 minutes
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stages of labor
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1) cervix dilating
2)cervix fully dilated 3)baby and placenta delivered 4)postpartum |
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definition of infertility in women
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25 year old: 1 year of unprotected sex
30 plus: 6 months of unprotected sex without pregnancy |
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what are low set ears a potential sign of?
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renal problems
mental retardation |
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what are good sources of folic acid?
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egg yolks, nuts, seeds, liver
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what is PROM?
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when membranes rupture before labor instead of before delivery
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post eye surgery precautions
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avoid lifting things more than 15 lb
no bright lights no coughing/valsalva |
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how high above stoma should you place irrigation bag?
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18-20 inches
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antispasmotic drug frequently used for gall bladder/bile duct
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Propantheline bromide (GI anticholinergic)
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Effects and side effects of Mag sulfate
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relaxes myometrium
SE: flushing, drowsiness, slurred speech, decreased reflexes, decreased GI motility, decresed respiratory rate |
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most accurate way to calcultate meds for kids
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body surface area in relation to weight
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what are people with multiple myloma at risk for?
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Fx and CRF
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Abciximab
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inhibits platelet aggregation (good for PTCA)
check APTT when administering |
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What is a Parkinsonian crisis?
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dopamine related symptoms are severely exacerbated, virtually immobilizing the client. Also, excessive drooling and increased risk for airway obstruction
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TPN complications
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fluid overload, electrolyte imbalances, infection, hyperglycemia, hypoglycemia, air embolism, pneumothorax
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where to instill eye drops
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conjunctival sac for best absorption
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treatment for a compromised skin graft
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hyperbaric oxygen therapy can be used to promote wound healing (increased oxygen)
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what is the maximum amount of fluid that can be injected IM?
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5 mL
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What is Wilm's tumor?
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Most common abdominal tumor in children. highly malignant. Anemia which is secondary to hemmorrhage withing the tumor, causes palor, anorexia, and lethargy. Large ab mass (don't press). HTN occurs occasionally.
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stages of Wilm's tumor
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1. limited to kidney and completely resected
2. beyond kidney but completely resected 3. residual nonhematogenous tumor confined to abdomen 4. hematogenous metastasis with deposits beyond stage 3. (lung, bone, brain, liver) |
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How to calculate mean arterial pressure
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MAP = {[DBP *2]+ SBP}/3
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Why is MAP important?
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MAP is organ perfusions pressure. A MAP of 60 or higher can sustain organs.
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How do you calculate cerebral perfusion pressure?
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CPP = MAP-ICP
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What is the glucose tollerance test?
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It's used to determine DM. 2 hours after glucose, if blood glucose is over 200, you might have DM. Reconfirm this by doing another test.
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Which clients are at risk for increased uterine cramping?
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Breastfeeding (oxytocin release) and multips (less firm uterus)
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If the chest tube is obstructed or kinked, what is your client at risk for?
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tension pneumothorax
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NML CO2
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(alkaline)35-45(acid)
respiratory issues |
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NML HCO3
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(acid) 22-26 (alkaline)
kidney issues |
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NML pO2
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80-100
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positioning for client with hemiparesis
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upright to facilitate drainage of secretions
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NML lochia
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days 1-3: lochia rubra
moderate with small clots (4-8) pads a day days 3-10: lochia serosa (pink) days 11-21: lochia alba (white) |
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How do you know if the cervix is favorable for induction of labor?
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It's soft, anterior, 50% effaced, dilated at least 2 cm, the fetal head is at +1 station or lower (Bishop score of 9)
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glucotrol + ASA=?
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hypoglycemia
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s/s placenta previa
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painless, bright red bleeding
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s/s hydidaform mole
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high hCG, fast uterine growth, n/v, no baby
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mental SE of right hemisphere damage
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poor judgement
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What is a baby with a lower 5 minute APGAR score at risk for?
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residual neurologic depression
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What are APGAR scores used for?
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To predict the severity of respiratory and neurologic depression
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post hydidaform mole
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use birth control for at least a year. due to the risk of choriocarcinoma, monitor hCG levels monthly for 1-2 years. If hCG levels are low after 1 year, get pregnant again
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which foods are high in B1 (thiamine)?
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milk, pork, liver, enriched cereals
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how do you know if someone has arterial insufficiency?
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palor when limb is elevated
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How do you breate in labor?
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shallow chest breathing at the peak of the contraction.
chest panting to prevent pushing before fully dilated |
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How to decrease the chances that your preeclamtic patient will have the a seizure?
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decrease visual and auditory seizures
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When is a child most at risk for Reye's syndrome?
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1 week after a viral infection
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What is Reye's syndrome?
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Children with viral infections who take ASA are at risk.
Harms multiple organ systems including the liver and the brain. Can cause hypoglycemia. |
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when are clients with Addison's disease at risk for an Addisonian crisis?
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during periods of stress
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s/s hypokalemia
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weakness, diarrhea, parasthesia, n/v, bradycardia
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what is retinosis pigmentosa?
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hereditary disease involving visual field loss and night loss
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what is prinzmentla angina?
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triggered by coronary artery spasm from an unknown amount of activity
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How does Tamoxifen work?
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It's an estrogen blocker, good for pre and post menopausal breast cancer
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nursing diagnosis for client undergoing chemo
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thromocytopenia
activity intollerence impaired tissue integrity impaired oral mucous membrane ineffective tissue perfussion (cerebral, cardiopulmonary, GI) |
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SE of Clozapine
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drug for scizophrenia
SE: agranulocytosis Check WBC qweek issues with immunity |
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Tx for hyperkalemia
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50% dextrose and insulin. Insulin drives K into cell, dextrose counteracts effects of insulin.
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Most sensitive indicator of fluid balance
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daily weight
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Ballottement
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probable sign of pregnancy. press against uterus and feel fetus bounceback.
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intermittent claudication
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vasospasm blocks vessels to feet, poor circulation in feet. take care of feel
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Precautions for SARS
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droplet and contact precautions
gown, gloves, mask, goggles |
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airborne precautions
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prevent spread of bacteria/viruses over long distances (TB)
Air ventilation, HEPA filters |
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Tonsil sizes
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1+ barely visible outside of tonsillar pilar
2+ between tonsillar pilar and uvula 3+touching uvula 4+ touching each other |
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SE of spironolactone
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(potassium sparing diuretic)
menstrural irregularities, breast soreness, decreased libido, gynecomastia, impotence |
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diet for ulcerative colitis
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high protein
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sign of dehydration in a neonate
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urine output less than 1mL/hour
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good and bad uses for a heating pad
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good for absesses, wounds, edema
bad for active bleeding |
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SE for aurothiroglucose
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(treatment for rheumatoid arthritis)
SE: blood dyscrasias (eosinophilia, thrombocytopenia, aplastic anemia and leukopenia). |
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diet for alcoholics
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high protein
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food for people with malabsorption syndrome to avoid
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gluten
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How to prevent v-fib when defibrillating?
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avoid delivering on a t-wave. Put synchronizer on
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what is a diagonal conjugate?
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Size of the pelvic outlet
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what is the crown to rump measurement?
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measurement of the embryo until 11 weeks
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what is -sarcoma?
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cancer of the connective tissue
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cardiac output during pregnancy
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increases 30-40 percent, then decreses about 10 weeks before due date, increases again during L/D, decreases back to normal 2 weeks after delivery
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Pentamidine isethionide
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antimicrobial to treat pneumocystis
SE: affects glucose levels check glucose |
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Which stage of syphillis is not contagious?
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tertiary
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How does GABA work?
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It promotes a balance between dopamine and glutamine: good for decreasing anxiety
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What is nesiritide?
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It's used for acute heart failure.
Human BNP binds to the receptor in vascular smooth muscle leading to vascular smooth muscle relaxation |
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What does pulmonary artery wedge pressure measure?
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indirect measure of left arterial pressure
This is way to monitory for left ventricular failure |
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what is introjection?
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treating something outside the self as if it is actually inside the self; incorporated others' wishes and values as if they are your own.
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when should a child go to the dentist for the first time?
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2-3 years old, when all desciduous teeth have errupted
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what is thromboangitis obilterans?
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thrombi form as the result of vascular inflammation. Burning pain occurs from impaired circulation
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purpose of knee-chest position
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prevents shock by shunting blood to upper body and vital organs
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what is nalbuphrine?
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opoid analgesic that doesn't cause fetal or neonatal respiratory depression
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How often should DIG be administered?
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q12h
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what kind of organism causes trichomonas vaginalis?
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protozoan
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what body functions are controlled by the medulla oblongata?
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BP, BV diameter, pulse, breathing
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How many doses of dTAP are required?
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3
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where can the highest O2 content be found in fetal circulation?
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umbilical vein (ductus venous)
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Diets for clients after internal radiation for cervical cancer
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low-residue diets to suppress peristalsis
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s/s glomerulonephritis
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elevated BP, periorbital edema, hematuria and high urine specific gravity
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what is tumor necrosis factor?
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* produced by macrophages in synovium
*causes inflammation, destruction of bone and cartilage, joint stiffness and pain |
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Medications to treat malaria
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quinine
pyrimethamide sulfonamide |
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how long do NTG tabs last?
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3 months
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appropriate sedative for person with pulmonary edema
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morphine: rapid onset, decreases pulmonary reflexes
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Major SE of Ca channel blockers
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orthostatic hypotension
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ABX for gonorrhea
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ceftriasome
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advice for someone taking Macrobid (UTI drug)
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drink lots of water to prevent crystal formation
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Nutritional supplement for someone taking phentoin
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folic acid
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normal SE of B vitamins
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bright yellow pee
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how does rantidine work?
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decreases gastric secretion by inhibiting histamine at H2 receptors
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S/S chronic malaria
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in chronic malaria, look for hemoglobinuria, intravascular hemolysis, renal failure as a result of RBC destruction
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Prophylactic medicine for chemo patients
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ABX
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disease associated with long term methyldopa administration
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hemolytic anemia
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effects and side effects of levadopa
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given for parkinson's disease. Reduces sympathetic outflow by limiting vasoconstriction, which may result in ortho hypo
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SE vincristine
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severe constipation and paralytic ileus. a high residue (fiber) diet is recommended to prevent this complication.
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SE of streptomycin
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TB Tx
ototoxic to auditory and vestibular portions of 8th cranial nerve |
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SE of INH
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often leads to B6 defficiency
avoid tyramine (wine and aged cheese) |
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s/s fo hydrochloroquine toxicity
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blurred vision
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furosemide + ASA =?
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compete for same renal excretion sites. dose of ASA may need to be decreased
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effect and SE of disopyramide
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non-nitrate antidysrhythmic (anticholinergic)
SE: constipation |
|
|
precautions for doxycycline (a tetracycline)
|
any product containing Al, Mg, or Ca ions should not be taken in the hour before or after an oral does because it decreases absorption by as much as 25-50%.
|
|
|
precautions for rifampin
|
TB drug
interferes with metabolism of oral contraceptives, which may result in an unplanned pregnancy |
|
|
acetazolamide
|
carbonic anhydrase inhibitor that decreases inflow of aqueous humor and controls intraocular pressure in an attack of acute angle-closure glaucoma.
|
|
|
where is fundus immediately after birth?
|
btw symphysis pubis and umbillicus,
2 hours later, it will be at the umbilicus |
|
|
s/s adisonion crisis
|
tachycardia, hypotension, hyponatremia, hyperkalemia, postural hypotension
|
|
|
effects and SE of donepezil (Aricept)
|
Altzheimer's drug
cholinergic (cholinesterase inhibitor) SE: n/v, ha, increased salivation, diarrhea |
|
|
where are osmoreceptors located and what do they do?
|
they are located in the hypothalamus and they give you a sense of thirst
|
|
|
s/s CRF
|
parasthesias, oliguria, HTN, metabolic acidosis (can't excrete H)
|
|
|
ulcerations in crohn's disease
|
skip lesions
|
|
|
ulcerations in ulcerative colitis
|
continuous
|
|
|
Erickson's conflict for toddlers
|
dependence vs independence
|
|
|
SE elavil (amitriptyline)
|
tricyclic antidepressant (anticholinergic)
ortho hypo, sedation, tachycardia |
|
|
what is Curling's ulcer?
|
it occurs in 1/2 of clients suffering from severe burns. incidence of ulceration proportional to extent of burns. result of hypersecretion of gastric acid and compromised GI perfusion.
|
|
|
treatment for partial placenta previa
|
bedrest, hydration, monitor bleeding
|
|
|
nutrients that interfere w/levadopa
|
B1 and protein
|
|
|
position for client with cervical radium implant
|
bed rest w/HOB flat
|
|
|
SE of terbutalyne
|
maternal and fetal tachycardia, hypotension, decreased potassium, nervousness, emesis, HA and PE
|
|
|
How do you wean a baby?
|
spend less time nursing each time
|
|
|
activities to avoid after scleral buckling for a detatched retina
|
abrupt head turns
|
|
|
normal breasts after delivery
|
breast milk production begins on days 2-3. breasts should be firm and tender at that time. right after delivery, they will be soft and not tender.
|
|
|
characteristics of the emergent phase of burn care
|
hyperkalema from cell destruction. use foley to accurately measure urine output
|
|
|
when to withhold Mg sulfate
|
when RR<12
|
|
|
wound irrigation
|
use 35 mL syringe & 19 fr catheter.
8 lb pressure/square inch protective gear |
|
|
s/s of post-partum hemmorhage
|
slow trickle of dark red blood
|
|
|
What to give people who have been exposed to Hep A
|
immune serum globulin
|
|
|
when can a baby sit w/o support?
|
7 mo
|
|
|
position to assess inguinal hernia
|
standing
|
|
|
what is a PTCA?
|
opening blocked artery w/inflatable baloon located at the end of a catheter
|
|
|
what is Reglan?
|
used to treat GERD. Stimulates GI motility and reduces V of gastric reflux
|
|
|
purpose of NG tube post gastrectomy
|
reduces pressure on suture lines
|
|
|
Tx OCD
|
1. initially give client a schedule for ritual.
2. suggest substitution to refocus behavior |
|
|
how much should 1 year old weigh?
|
triple birth weight
|
|
|
good ABX for pregnancy
|
rocephlin (cephtriaxone)
|
|
|
when is RhoGam usually given?
|
28th week of gestation
|
|
|
when do NPH, ultralente, semilente and regular insulins peak?
|
regular: 2-4 h
NPH: 8-12 semilente: 4-7 ultralente: 16-18 |
|
|
s/s measles/rubeola
|
fever, runny nose, Koplik spots (white spots) on mouth and rash that starts on face and spreads to the rest of the body
|
|
|
What should you do after assessing pulmonary capillary wedge pressure?
|
deflate baloon
|
|
|
s/s increased ICP
|
bradycardia
|
|
|
How to assess backflow in varicose veins
|
use Trendelenberg test
|
|
|
Are kidneys removed in ESRD?
|
no, unless one is infected
|
|
|
what is a late deceleration?
|
FHR returns to baseline after contraciton ends
It's a sign of uteroplacental insufficiency |
|
|
s/s ectopic pregnancy
|
bleeding and pain (10-12 wks)
|
|
|
how long does it take for MAOIs to reach therapeutic blood levels?
|
2-4 wks
|
|
|
which hormone is responsible for the growth of the endometrial lining?
|
progesterone
|
|
|
what hormone helps breasts and uterus to grow during pregnancy?
|
estrogen
|
|
|
what does hCG do?
|
preserves function of ovarian corpus luteum providing continued production of progesterone and estrogen
|
|
|
SE risperdal
|
hypotension and dizziness
|
|
|
diet for scleroderma pt
|
soft
|
|
|
how to H2 receptors work?
|
inhibit histamine at H2 receptor sites and decreases gastric secretion and prevents pancreatic stimulation
|
|
|
should a client void before a paracentesis?
|
yes
|
|
|
amniotic fluid embolism
|
associated with DIC; both problems may occur after premature separation of placenta
|
|
|
effects and SE prolixin
|
for scizophrenia
SE: extreme photosensitivity |
|
|
Nagele's Rule
|
EDB= (LMP + 1 year) - 3 mo + 7 days
|
|
|
what kind of Fx might your client who is bleeding from the ears have?
|
basaler skull Fx
|
|
|
which disease increase one's risk for osteoporosis?
|
hyper/hypo thyroidism, malabsorption, CRF, acute pancreatitis
|
|
|
how does benadryl work?
|
It competes for histamine receptor sites
|
|
|
how to prevent UTI in client with spinal cord injury
|
advise them to drink lots of fluids (risk for atonic bladder)
|
|
|
what is a good drug to give someone who ODs on Benzos?
|
flumazenil (Ronazicon)
|
|
|
how much drainage/bleeding is expected after after open heart Sx?
|
500 mL is not uncommon
|
|
|
pathologic vs physiologic jaundice
|
pathologic: 24-48 hrs after birth
physiologic: 48-72 hrs after birth |
|
|
s/s acute retroviral syndrome
|
flulike syndrome that occurs 2-4 wks after HIV infection
s/s: malaise, swollen lymph glands, fever, sore throat, diarrhea, rash |
|
|
what is interpersonal theory?
|
relationships and resulting behaviors are considered central factors that influence development
|
|
|
what problems might baby have if oligohydramanos or hydramanos are present?
|
oligohydramanos: renal problems
hydramanos: esophageal atresia |
|
|
what kind of medication do you give someone who is pregnant with heart problems at the time of birth?
|
Prophylactic ABX
|
|
|
should you worry if your post-op surgical patient is jaundiced?
|
yes, becuase they are at risk for hemorrhage because decreased bile salts in the intestine cause inadequate vitamin K absorption, which causes inadequate prothrombin synthesis by the liver.
|
|
|
what is acetazolamide (Dianox)?
|
carbonic anhydrase inhibitor that decreases inflow of aqueous humor and controls intraocular pressure in an attack of acute closed angle glaucoma
|
|
|
how do you do esophageal speech?
|
fill esophagus with air
|
|
|
what to do for your eclamptic patient?
|
1. Maintain airway
2. O2 by facemask |
|
|
Preop instructions for colonoscopy patient
|
clear liquid diet on day before procedure
citrate of magnesia bowel prep NPO after midnight |
|
|
when should breastfeeding mom start on hormonal contraceptives?
|
wait until milk supply is established (4-6 wks)
|
|
|
late decelerations during oxytocin challenge
|
fetus not getting enough o2 during contractions
|
|
|
when should you expect quickening?
|
18-20 wks in primipara
16-18 wks in multip |
|
|
which laxative is too abrasive for use during pregnancy
|
ex-lax
|
|
|
when do you do an amniocentesis
|
12 wks
|
|
|
what does Mg do in the human body?
|
aids in the synthesis of protein, nucleic acids, proteins, and fats. Good for cell growth and neuromuscular function. Mg activates enzymes for metabolism of protein energy.
|
|
|
what does B6 do?
|
aids in amino acid metabolism
|
|
|
when is an alpha fetoprotein test done and what do the results mean?
|
15-18 wks
high = NTD low = downs |
|
|
when is chorioanic vilus sampling done?
|
10 wks
|
|
|
when and why are ultrasounds done during pregnancy?
|
1st trimester: viability
3rd trimester: pelvic adequacy and fetal or placental position |
|
|
what is cholasma?
|
discoloration on face caused by increased melantonocyte stimulating hormones
|
|
|
amniocentesis risks
|
uteroplacental stimulation and preterm labor
other: hemorrhage, infection, harming fetus |
|
|
when is colostrum secreted?
|
wk 16
|
|
|
how can the obstetric conjugate be estimated?
|
by subtracting 1.5-2 cm from the diagonal conjugate
|
|
|
where is the diagonal conjugate measured?
|
from the bottom of the symphysis pubis to the sacral promontory (top of the sacrum)
|
|
|
common psychological experiences of mother during 2nd trimester
|
* sees self as different than fetus
* fantasizes about infant * concerns about changing body image |
|
|
common psychological experiences of mother during 3rd trimester
|
* experimenting with caregiver roles
* concerns about safety |
|
|
cardinal movements of fetus
|
descent, flexion, internal rotation, extention, external rotation, and expulsion.
|
|
|
what does amniotic fluid do?
|
protects fetus, keeps the temperature stable, helps dilate cervix
|
|
|
where are true labor contractions felt?
|
first in the lower back, then in the abdomen
|
|
|
where does the umbilical cord insert?
|
in the center of the placenta
|
|
|
can a mom with Hep B breast feed?
|
yes
Infant needs Hep B immunoglobulin and vaccines though |
|
|
If the fetus dies and remains in utero, what is mom at risk for?
|
DIC! the clotting factors within the maternal system are consumed when a non-viable fetus is retained.
|
|
|
what does hydroxyzine (Vistaril) do?
|
tranquilizing effect and reduces n/v
S/E: sleepiness |
|
|
ways to remove genital warts
|
cryptotherapy, electrocautery, and laser therapy
|
|
|
s/s herpes
|
swollen lymph nodes, increased temperature, red lessions
|
|
|
where should bilirubin be stored?
|
In dark containers to protect it from light
|
|
|
fetal wellness in a non-stress test
|
In 30 minutes, the fetus moves 3 times, breathes for 60 seconds, has an amniotic fluid pocket larger than 1 cm (not including what's in cord loops) and moves from flexion to extension.
|
|
|
diet and treatment for mild pre-eclampsia
|
bed-rest, laying on L side.
Regular diet with ample protein and calories. No need for salt restriction. |
|
|
significance of epigastric pain in a pre-eclampsic patient
|
it's associated with the development of eclampsia and seizures
|
|
|
what to monitor your eclamptic patient for after they have a seizure
|
after the seizure, they may fall into a deep sleep. monitor for signs of impending labor while asleep.
|
|
|
what are pregnant patients with chronic hypertension at risk for?
|
preeclampsia, abruptio placentae, and intrauterine growth retardation
|
|
|
normal aPTT
|
30 seconds
|
|
|
abruptio placentae aggravating factors
|
excessive intrauterine pressure, drugs/etoh, trauma, amniotomy, advanced maternal age, HTN
|
|
|
what does the absence of fetal fibronectin between 22 and 37 weeks signify?
|
low risk of preterm labor within the next week
|
|
|
what is indometacin?
|
an NSAID (cox 1 and 2 inhibitor) used to close PDAs, delay preterm labor, and for retinopathy of prematurity.
|
|
|
what is the shake test?
|
it's a measure of lung maturity. The surfactant is added to a solution and then shaken. If it foams and is stable, the fetus probably has mature lungs.
|
|
|
What is the L/S ratio?
|
this is the ratio of lecithin and sphingomylin (components of surfactant). At 32 weeks, L/S ratio is usually 1. Later on, the L/S ratio reaches 2. at the ratio of 2, it is unlikely that the infant will experience RDS.
|
|
|
what do the results of a contraction stress test mean?
|
If no late decelerations, the results will be negative. This means that your baby will probably do well during the real labor process.
the results are considered suspicious if there are inconsistant late decels. if there are consistent late decels, the results will be positive which indicates uteroplacental insufficiency. this means that the mom will probably need to get a c-section because the baby won't do well during labor. |
|
|
insulin needs of diabetic moms during pregnancy
|
1st trimester: will probably decrease
2nd and third: will increase |
|
|
what is the most common cause of maternal hyperglycemia?
|
infection
|
|
|
should mom change her DIG dose during pregnancy?
|
no, unless she has cardiac decompensation
|
|
|
what anticoagulent is most commonly used during pregnancy?
|
heparin
|
|
|
risk factors for prolapsed cord
|
little baby, ROM, negative station, breech presentation
|
|
|
how quickly does a post-partum mom who is having a hemorrhage saturate one pad?
|
in less than one hour
|
|
|
what are some risk factors for soft tissue dystocia?
|
obesity, distended bladder, and ovarian tumors
soft tissue dystocia is difficulty with birth due to soft tissue getting in the way |
|
|
how long does head molding last?
|
1-2 days
|
|
|
s/s uterine inversion
|
sudden gush of blood from the vagina leading to decreased blood pressure and inability to palpate uterus
|
|
|
normal length of latent (first) stage of labor
|
6 hours (5-8)
|
|
|
how are Leopold's maneuvers done?
|
1) palpate fundus
2)locate back 3)grasp lower portion of the abdomen above the symphisis pubis (is the presenting part engaged?) 4) place fingers on uterus and press downward and inward in the direction of the birth canal (used to determine fetal attitude and degree of extention. should only be done if the fetus is in the cephalic presentation |
|
|
another word for fetal presentation
|
fetal attitude
|
|
|
what does deceleration mean?
|
early: head compression
variable: cord compression late: uteroplacental insufficiency |
|
|
besides amniotic fluid, what should you assess after an amniotomy?
|
FHR for one full minute
|
|
|
how to measure contractions?
|
from the beginning of one contraction to the beginning of the next contraction
|
|
|
if mom gets hypotension during an epidural, what drug should be given?
|
ephedrine sulfate
|
|
|
why is cimetidine given by some anesthesiologists?
|
to decrease the acidity of gastric secretions so if they are aspirated, it's not as damaging
|
|
|
why is betametasone given?
|
to increase fetal lung maturity
|
|
|
what do Bishop scores indicate?
|
if the baby can be delivered vaginally. If the score is less than 6, cervical ripening is probably needed. If it is greater than or equal to 8, this is good. mom may need pitocin.
|
|
|
how far dilated should the cervix be before an epidural is given?
|
3-4 cm
|
|
|
after an amniotomy, what characteristics of the fluid should be charted?
|
time of amniotomy, color, odor, amt, clarity
|
|
|
when do neonates/infants need more milk?
|
during growth spurts (10-14 days, 5-6 wks, 2.5-3 months, 4.5-6 months).
|
|
|
how many calories do neonates need?
|
50 calories/pound
|
|
|
when should baby be burped?
|
15 min after formula feeding
|
|
|
what does the "taking hold" stage consist of?
|
3-7 days after birth, the mother and father will be focused on taking care of the baby
|
|
|
Letting go phase
|
The couple will continue their relationship that they had before the birth of the baby. The older brothers and sisters get to know the baby at this time.
|
|
|
nursing care for perineal bruising
|
ice for the 1st 24 hr
thereafter, sitz baths |
|
|
should voiding be measured after birth?
|
yes, measure the 1st 2 voids to see if there is urinary retention
|
|
|
tx for diastasis recti
|
diastasis recti is separation of the abdominal wall as a result of pregnancy or labor.
Situps should be done to strengthen the ab wall. |
|
|
how long should it take to return to pre-pregnancy weight?
|
6 wks
|
|
|
what are 1st, 2nd, 3rd and 4th degree lacerations?
|
* 1st degree tears are where the fourchette and vaginal mucosa are damaged and the underlying muscles are exposed, but not torn.
* 2nd degree tears are to the posterior vaginal walls and perennial muscles, but the anal sphincter is intact. * 3rd degree tears extend to the anal sphincter that is torn, but the rectal mucosa intact. * 4th degree tears are where the anal canal is opened, and the tear may spread to the rectum. |
|
|
when can a couple resume sex after vaginal delivery?
|
after pain has ceased and lochia stops (usually about 3 wks)
|
|
|
position to relieve pain from hemorroids
|
sims position (on the side with upper knee and arm propped on pillows)
|
|
|
convection
|
heat loss or gain from air (i.e. drafts)
|
|
|
conduction
|
heat loss or gain from objects (cold bed)
|
|
|
radiation
|
heat loss or gain from object not in contact with person (sun)
|
|
|
evaporation
|
heat loss from evaporating fluids
|
|
|
how might sepsis affect a neonate's blood sugar?
|
could lead to hypoglycemia
Check frequently |
|
|
risk associated with using baby powder
|
baby could inhale it and get pneumonia
|
|
|
3 stages a baby goes through in the first 90 minutes of life
|
first 30 minutes = first period of reactivity - feed baby
60 minutes = quiet-alert, get to know baby 90 minutes = deep sleep |
|
|
what sorts of foods have PKU?
|
meat, dairy and eggs
|
|
|
how long should a child with PKU avoid foods with PKU?
|
til brain development is complete (adolesence or longer)
|
|
|
how is PKU inherited?
|
autosomal recessive
|
|
|
when do the fontanels close?
|
posterior: 2-3 months
anterior: 12-18 months |
|
|
problems associated with premature fontanel closure
|
retardation from craniostenosis or premature synostosis
|
|
|
when a baby has corneas of unequal size, what problem might they be experiencing?
|
congenital glaucoma
|
|
|
what if a neonate does not have any tears when they cry?
|
this is normal in neonates
|
|
|
what are the benefits of kangaroo care?
|
increased bonding, VS stability, decreased hospital stay
|
|
|
s/s pneumothorax in a neonate
|
absent apical pulse, cyanosis, grunting, diminished breath sounds
|
|
|
s/s diaphragmatic hernia
|
respiratory distress syndrome soon after birth.
bowel sounds in chest |
|
|
s/s corarctation of aorta
|
poor, lower body perfussion, metabolic acidosis, CHF
|
|
|
retinopathy of prematurity risk factors
|
high arterial blood oxygen levels, prematurity, low birth weight,
In the early stages, retinal vessels constrict. If vasoconstriction is sustained, vascular damage follows and irreversible capillary endothelial damage occurs. |
|
|
Tx for retinopathy of prematurity
|
laser therapy
|
|
|
s/s intraventricular hemorrhage
|
bulging fontanels, apnea, lethargy, weak suck
|
|
|
causes of intraventricular hemorrhage
|
premature birth, trauma, stress.
rare in full term and after 1 month of age. Usually develops a few days after birth |
|
|
s/s necerotizing enterocolitis
|
ab distention w/gastric retention and vomiting
|
|
|
cause of NEC
|
bowel is damaged by lack of oxygen predisposing it to bacterial infection
|
|
|
what measurement is used to determine size of NG tube for neonates?
|
weight
|
|
|
after the baby of a diabetic mother is treated for hypoglycemia, why might he still have tremors?
|
tremors occuring after therapy for hypoglycemia are clinical signs of hypocalcemia. At term, diabetic moms have high calcium levels which cause secondary hypoparathyroidism in neonates.
|
|
|
what is a patent ductus arterioris?
|
an opening between the right and left atria that usually closes after birth
|
|
|
how does a patent ductus arterioris affect a neonate?
|
reoxygenated blood that enters the left atrium mixes with deoxygenated blood in the right atria. this increases the workload on the left side of the heart and increases pulmonary vascular congestion. murmurs may be heart and the heart may become enlarged if the PDA persists
|
|
|
s/s aortic stenosis in a neonate
|
decreased cardiac output, faint peripheral pulses, poor peripheral perfusion, feeding difficulties and severe CHF
|
|
|
s/s tertrology of Falot
|
profound cyanosis over most of the body, fatigue on exertion, feeding difficulties, hypoxemia
|
|
|
what is truncus arteriosus?
|
incomplete division of the great vessel caused by a ventral septal defect
https://health.google.com/health/ref/Truncus+arteriosus |
|
|
s/s truncus arteriosus
|
bounding pulses, widened pulse pressure, harsh systolic murmur with palpable thrill
|
|
|
for which psychological reason might a toddler have pica?
|
anxiety
|
|
|
how do you examine the ears of children under 3?
|
pull the pinna back and down (auditory canals are almost straight)
|
|
|
appropriate discipline for a toddler
|
time out is the most appropriate discipline for a toddler. It removes them from the situation and allows them to regain control. Structuring interaction is good too. Sending the child to their room is like punishment. Not good for tantrums.
|
|
|
when can a child brush their teeth independently?
|
7 years old
|
|
|
when can a child floss their teeth independently?
|
9 years old
|
|
|
how to use an inhaler
|
1)breathe out through mouth
2)inhale through open mouth 3)press canister\ 4) hold breath for 5-10 seconds |
|
|
how is lice spread?
|
through close personal contact and contact with fomites
|
|
|
when is the risk of hemorrhage after a tonsillectomy greatest?
|
1 week after surgery because tissue is sloughing during the healing process
|
|
|
proper position of baby during formula feedings
|
upright to prevent pooling of formula in pharangeal area where it can be drawn into eustacian tubes
|
|
|
3 cardinal signs of choking
|
cyanosis
colapse can't speak |
|
|
early signs of respiratory distress
|
diaphoresis
restless tachypnea tachycardia |
|
|
foods for cystic fibrosis patients to avoid
|
high fat foods are hard to digest
|
|
|
when should postural drainage be done for CF patients?
|
before meals to avoid the possibility of vomiting or regurgiatating food
|
|
|
typical stool movement for patient having CF exacerbation
|
large, smelly, steatorrhea (fatty stool)
|
|
|
when should serum acetaminophen levels be taken in patients who take tylenol?
|
4 hours after ingestion
|
|
|
how many CPR compressions per minute for a 1-8 year old?
|
100/minute. 30 compressions per 2 breaths. compress 1/3 to 1/2 of the depth of the chest
|
|
|
how many CPR compressions per minute for an infant?
|
100/minute
|
|
|
what is Kawasaki disease?
|
Kawasaki disease is an illness that involves the skin, mouth, and lymph nodes, and most often affects kids under age 5. The cause is unknown, but if the symptoms are recognized early, kids with Kawasaki disease can fully recover within a few days.
|
|
|
s/s Kawasaki disease?
|
1) high fever for 5 days, red/inflammed skin, swollen lymph nodes, sore throat, swollen tongue w/white spots and big red bumps
2) 2nd phase: skin on the hands and feet begin to peel, joint pain vomiting diarrehea |
|
|
how to care for children with Kawasaki disease after d/c?
|
take temperature daily because they can have a recurrent fever
|
|
|
how to administer liquid iron to children
|
iron stains the teeth, so administer through dropper or straw
|
|
|
appropriate amount of milk and juice for a toddler each day
|
2-3 c of milk and 8 oz of juice. any more than that, and they may not be getting enough iron
|
|
|
how to check for clotting factors in patients w/ hemophilia
|
PTT measures activity of thromboplastin which is dependent on extrinsic clotting factors
Check PTT |
|
|
Early sign of hemarthrosis in patients with hemophila
|
restricted movement
|
|
|
SE cyclophosphamide (nitrogen mustard alkylating agent)
|
cystitis
|
|
|
cause of anemia in people w/leakemia
|
bone marrow overproduction of immature WBCs at the expense of RBCs and platelets
|
|
|
SE of dantinomycin and vincristine
|
N/V
give antiemetics and oral fluids to decrease dehydration |
|
|
Tx for a patient who has ingested lye
|
lye causes swelling of the pharyx, so a tracheostomy may be necessary to establish an airway
|
|
|
blood levels of lead in children and action that should be taken
|
20-44 mg/dL: investigate home
45 mg/dL: oral chelation 70 mg/dL: hospitalize |
|
|
target serum phenylalanine levels for PKU patients and everyone else
|
3-7
|
|
|
what is hirschsprung's disease?
|
Hirschsprung's disease, or congenital aganglionic megacolon, involves an enlargement of the colon, caused by bowel obstruction resulting from an aganglionic section of bowel (the normal enteric nerves are absent) that starts at the anus and progresses upwards.
|
|
|
s/s hirschsprung's disease
|
small baby with a big belly
|
|
|
post op stoma care
|
stoma may be red, shiney and edematous. this is normal. brown or black may indicate ischemia. everytime the stoma bag is changed, the new pad should be cut to fit because the stoma will shrink over the next 6-8 weeks. clean w/ warm water
|
|
|
normal stoma output
|
urine may be blood tinged right after surgery. A little mucous in urine from a stoma is normal.
There may be a lot of stool (800-1300 mL/day) and the stool may be greenish right after surgery. The amount of stool will be reduced to 500-800 mL over time and resume a more normal consistency. |
|
|
proper positioning for client after appendectomy for ruptured appendix
|
semi-fowlers or right side lying postion to localize infection and decrease incidence of diaphramatic absess
|
|
|
how to assess appendix pain
|
determine where pain was when it started
listen to bowel sounds. May be decreased or absent |
|
|
when do testes normally descend in boys?
|
1 year old
|
|
|
if testes do not descend, which hormone should be given?
|
hCG may be given
|
|
|
what is a hydrocele?
|
a collection of fluid in the tunica vaginalis of the testicle or along the spermatic cord that results from a patent process vaginallis
|
|
|
when is the prefered time for hypospadia surgery?
|
6-18 months
|
|
|
s/s of UTIs in children under 2
|
ab pain, burning urination
|
|
|
vesicourethral reflex
|
abnormal flow of urine from bladder to uretrers
|
|
|
effect of constipation on peritoneal dialysis
|
accumulation of hard stool in the bowel can cause the distended intestine to block the holes of the catheter. Consequently, the diastylate can't flow freely through the catheter.
|
|
|
what is Wilm's tumor?
|
most common ab tumor in children. Highly malignant. Anemia which is secondary to hemorrhage within the tumor causes palor, anorexia and lethargy. Don't press on ab mass!! HTN occurs occasionally
|
|
|
Stages of Wilm's tumor
|
1. limited to kidney and completely resected
2. beyond kidney but completely resected 3: residual, non-hematogenous tumor confined to abdomen 4. hematogenous metastasis occurs with deposits beyond stage 3. |
|
|
position after ab surgery
|
semi-Fowlers (drain ab contents and promote pulmonary expansion)
Risk for intestinal obstruction r/t paralytic ileus |
|
|
chance that a baby with myelomeningocele will be retarded
|
1 in 3
|
|
|
positioning after placement of a shunt
|
supine!!
If you put the patient in semifowlers an this might reduce CSP. |
|
|
common allergies in children w/myelomeningocele
|
latex and food
also risk for UTI |
|
|
SE Dilantin
|
gingival hyperplasia
brush teeth w/ every meal |
|
|
SE valproic acid
|
liver toxicity (jaundice may by a sign)
|
|
|
what is the priority after a near drowning? Fluid aspiration or hypoxia?
|
hypoxia
|
|
|
precautions for varicella pt
|
airborne (negative airflow), droplet, contact
|
|
|
tx of impetigo
|
treat topically by washing affected areas, removing crusts, and applying ABX several times a day
|
|
|
what is torticollis?
|
Torticollis, or wry neck, is a condition in which the head is tilted toward one side (cervical Lateral flexion), and the chin is elevated and turned toward the opposite side (cervical extension). this is cuased by a contraction of the sternocleidomastoid muscle limits the range of motion of the neck.
|
|
|
how to scoliosis pts can strengthen ab and back muscles
|
exercise
|
|
|
first clinical manifestations of Duchenne's muscular dystrophy
|
difficulty w/ age appropriate activities (i.e. bicycling)
|
|
|
What is Gower's sign?
|
child walks hands up legs in attempt to stand (common in MD)
|
|
|
what is Ortolani's click?
|
infant is supine and click is heard when legs are abducted
|
|
|
what is Trendelenberg's sign?
|
may signify developmental dysplasia of the hip
weight bearing causes the pelvis to tilt downward on the unaffected side instead of upward as it would normally |
|
|
prognosis for kids w/juvenille idiopathic arthritis
|
in 1/2 of JA kids, recovery occurs w/o joint deformity, 1/3 continue w/disease into adulthood. 1/6 experience a crippling deformity
|
|
|
How to fit cruches
|
elbows should be at 20 degrees and area above the crutch to child's axilla shoudl be 1-1 1/2 inches
|
|
|
adverse effects of long term, high dose ABX
|
may adversely affect renal, hepatic, and hematopoetic function. urine specific gravity would provide info about the kidney's ability to concentrate urine
|
|
|
what to wear under a scoliosis brace
|
form fitting tee
|
|
|
s/s brain tumor
|
head tilt, vomiting, lethargy
|
|
|
what to do with NTG tablet if client is having an MI
|
client can chew tablet
|
|
|
nutrition during acute phase of MI
|
give small, easily digested meals
|
|
|
nursing priority with PTCAs
|
contrast medium is an osmotic diuretic and K levels should be monitored too. ND: fluid volume deficit.
|
|
|
SE nifedipine (calcium channel blocker/HTN drug)
|
gingival hyperplasia
|
|
|
main goal for a client w/ CHF or pulmonary edema
|
increase cardiac output
|
|
|
s/s atrial fibrilation
|
pulse rate>100, irregular rhythm, and no definite P waves
|
|
|
SE of lidocaine
|
dizziness, tinnitus, blurred vision, tremors, numbness, tingling of extremities, excessive perspiration, hypotension, seizures, coma
|
|
|
how to reduce orthostatic hypotension
|
change positions slowly and avoid long periods of standing
|
|
|
risk factor for CVA
|
long term HTN
|
|
|
post op instructions for pacemaker
|
take and record pulse daily. avoid lifting operative side above shoulder lever for 1 wk post insertion. Takes 2 months for incision site to heal and regain full range of motion
|
|
|
VS needed to determine tx for V tach
|
pulse
|
|
|
how to difibrillate your client
|
use conducting lotion
apply 20-25 pounds of pressure shock record amount of electrical current and resulting rhythm |
|
|
if xiphoid process is damaged during resuscitation, which organ may be injured?
|
liver
|
|
|
which factors determine peripheral blood flow?
|
force of contraction and resistance of vessels
|
|
|
which nervous system regulates blood flow in extremities?
|
sympathetic
|
|
|
where are pedal pulses located?
|
on ventral aspect of the foot and medial aspect of the ankle
|
|
|
how much arterial occlusion will cause s/s intermitent claudication?
|
50-75%
|
|
|
s/s complete arterial obstruction
|
cold feet, pain, no pulse, palor
|
|
|
purpose of wrapping residual limb of amputee
|
to shape the residual limb to accept a prosthesis and bear weight. The compression bandaging should be worn at all times for many weeks after surgery and should be reapplied as needed to keep it free from wrinkles and snug. Don't apply lotions and don't elevate (flexion contractures).
|
|
|
how to help a client change detrimental health behavior
|
learn how the client perceives the situation. he is more likely to change behaviors if he realizes that there is a problem and that these behaviors led to the problem.
|
|
|
What is Buerger's disease?
|
Buerger's disease is characterized by inflammation and fibrosis of arteries, veins, and nerves. WBCs infiltrate the area and become fibrotic which results in occulsion of the vessels. s/s: intermittent claudication, cyanosis, coldness, and pain at rest.
|
|
|
nursing diagnosis for atherosclerosis
|
impaired nursing perfusion
|
|
|
What is the ABI?
|
a noninvasive test that compares systolic BP in the arm with the ankle. It may be done before or after exercise. The client's highest brachial systolic pressure is divided by the ankle systolic pressure.
Scores: 0.71-0.9 = mild peripheral artery occlusion 0.41-.7 = moderate below 0.4 = severe |
|
|
which foods contain iron
|
liver, beef, red meat, brown rice, whole grains/breads, dried fruit, oats, eggs, sweet potatoes
|
|
|
risk factors associated w/aplastic anemia
|
these clients are severely immunocompromised and at risk for infection and possible death r/t bone marrow supression and pancytopenia.
|
|
|
how is B12 absorbed?
|
B12 combines w/intrinsic factor in the stomach and is then carried to the ileum where it is absorbed into the blood stream. If no ileum or no intrinsic factor, B12 must be injected via deep IM route (dorso or ventro gluteal). For increased comfort, have client lie on abdomen with toes pointed inward before you administer the ventrogluteal injection.
|
|
|
what is the Schilling test?
|
Urinary B12 levels are measured after the ingestion of radioactive B12. A 24-to 48 hour urine specimen is collected after administration of an oral dose of radioactive B12 and an injection of non-radioactive B12. In a healthy state, excess B12 is excreted in the urine and in an unhealthy state, it is excreted in stool (NPO 8-12 hours before test, but not during test).
|
|
|
what is glucose-6-phosphate dehydrogenase defficiency?
|
10% of African Americans inherit this X-linked recessive disorder in the G6PD enzyme. When these cells w/less of this enzyme are exposed to certain drugs, anemia and jaundice can occur. The reaction is self limited and will stop when the causative agent is withheld.
|
|
|
what is hemachromatosis?
|
Hemochromatosis (HHC) is a leading cause of iron overload disease. People with Hemochromatosis absorb extra amounts of iron from the daily diet. The human body cannot rid itself of extra iron. Over time, these excesses build up in major organs such as the heart, liver, pancreas, joints and pituitary. If the extra iron is not removed, these organs can become diseased. Untreated hemochromatosis can be fatal.
|
|
|
how do people inherit hemachromatosis?
|
autozomal recessive, except in some rare cases heterozygous individuals can develop the disease
|
|
|
when must infusion of blood products be complete?
|
within four hours
|
|
|
which drugs should you give your client if they have a blood product reaction?
|
aspirin and antihistimines
|
|
|
how does epoetin affect hematocrit?
|
epoetin is a recombinant DNA form of erythropoietin which stimulates RBC production and therefore causes hematocrit to rise. The elevation in crit causes an elevation in BP, therefore, BP should be checked .Crit should not rise more than 4 points in 2 weeks. if it does, there's a problem. initial doses of epoetin should also be adjusted based on BP. Client should avoid driving and performing hazardous activity during initial Tx. This drug should be given alone to avoid reactions.
|
|
|
what is polycythemia vera?
|
an abnormal increase in the number of blood
cells (primarily red blood cells) produced by the bone marrow. |
|
|
s/s polycythemia vera
|
early: HA, dizziness, engorged veins, hypervolemia, increases in hematocrit, hyperviscosity, hypertension, tinnitus, visual disturbances, feeling of fullness in the head, increased clotting time, s/s increased uric acid (painful joints)
late: pruritis, CHF |
|
|
correct dose of protamine sulfate to reverse the action of 100 units of heparin
|
0.5 mg will reverse it within 20 minutes. Give via IVP slowly to avoid dyspnea, hypotension, bradycardia and anaphylaxis
|
|
|
which antibiotics potentiate the effects of heparin?
|
cephalosporin and penicillin
|
|
|
Platelet count under 20,000/uL
|
spontaneous bleeding from mucous membranes
|
|
|
platelet count 15000-30000/uL
|
spontaneous petichiae and bruising on extremities
|
|
|
platelet count 30,000-50,000/uL
|
bruising w/minor trauma
|
|
|
what is idiopathic thrombocytic purpura
|
ITP occurs when antibody coated platelets are identified as foreign bodies and destroyed by macrophages in the spleen.
|
|
|
which drugs prolong bleeding time?
|
aspirin prevents platelet aggregation, so do a bleeding time test to check for platelet deficiency. ETOH, sulfonamides, and thiazide diuretics can also prolong bleeding time.
|
|
|
Tx for ITP
|
treated with steroids to suppress the splenic macrophages from phagocytizing the antibody coated platelets, which are recognized as foreign bodies, so that the platelets live longer. The steroids also supress the binding of the autoimmune antibody to the platelet surface.
|
|
|
take prednisone with or without food?
|
with food to counteract nausea
|
|
|
temperature for platelet storage
|
platelets cannot survive cold temps. they should be stored at room temp for no more than 5 days.
|
|
|
clients who have had a splenectomy are at risk for which complication?
|
they are prone to infection. The reduction of IgM from the spleen leaves the client especially at risk for immunologic deficiency reactions
|
|
|
how is the absolute neutrophil count calculated?
|
multiply total WBC count by the sum of the percentage of neutrophils and the percentage of bands and divide by 100
|
|
|
Absolute neutrophil counts and infection risk
|
100- life threatening
<500 = high <1000 = moderate less than or equal to 1500 = normal |
|
|
for a neutropenic client, what determines their risk for infection?
|
degree and duration of neutropenia
|
|
|
what is the most common source of infection and microbial colonization for neutropenic clients?
|
their own non-pathenogenic normal flora. attention to hygeine is very important
|
|
|
what kinds of things should family members not bring to clients undergoing the induction phase of chemotherapy?
|
flowers, herbs, plants.
the client is severely immunocompromised |
|
|
what is chronic myelogenous leukemia?
|
It is a form of leukemia characterized by the increased and unregulated growth of predominantly myeloid cells in the bone marrow and the accumulation of these cells in the blood. CML is a clonal bone marrow stem cell disorder in which proliferation of mature granulocytes (neutrophils, eosinophils, and basophils) and their precursors is the main finding. It is a type of myeloproliferative disease associated with a characteristic chromosomal translocation called the Philadelphia chromosome. It is now treated with imatinib
|
|
|
s/s chronic myelogenous leukemia
|
confussion, shortness of breath r/t decreased capillary perfusion of brain and lungs
|
|
|
what is chornic lymphoid leukemia?
|
CLL involves a particular subtype of white blood cells, which is a lymphocyte called a B cell. B cells originate in the bone marrow, develop in the lymph nodes, and normally fight infection. In CLL, the DNA of a B cell is damaged, so that it can't fight infection by producing antibodies. Additionally, they grow out of control and accumulate in the bone marrow and blood, where they crowd out healthy blood cells.
|
|
|
s/s chronic lymphoid leukemia
|
unintensional weight loss, fever, drenching night sweats, enlarged, painful lymph nodes, decreased reaction to skin sensitivity tests (anergy) and susceptibility to viral infections.
|
|
|
is aseptic or sterile technique used for biopsies?
|
sterile
|
|
|
what is acute lymphoblastic leukemia?
|
Malignant, immature white blood cells continuously multiply and are overproduced in the bone marrow. ALL causes damage and death by crowding out normal cells in the bone marrow, and by spreading (metastasizing) to other organs. ALL is most common in childhood with a peak incidence at 2-5 years of age, and another peak in old age.
|
|
|
common infections in patients with Hodgekin's disease
|
Herpes zoster
|
|
|
what is Hodgekin's lymphoma?
|
Hodgkin's lymphoma is characterized by the orderly spread of disease from one lymph node group to another and by the development of systemic symptoms with advanced disease. The disease is characterized by the presence of Reed-Sternberg cells (RS cells) on microscopic examination. Hodgkin's lymphoma may be treated with radiation therapy or chemotherapy, the choice of treatment depending on the age and sex of the patient and the stage, bulk and histological subtype of the disease.
The disease occurrence shows two peaks: the first in young adulthood (age 15–35) and the second in those over 55 years old.[3] |
|
|
"B" symptoms of Hodgekin's lymphoma
|
high temperature (above 100.4), profuse night sweats, and unintensional weight loss
|
|
|
how is a biopsy needle inserted?
|
the needle is inserted through a separate incision in the anesthetized area. Should feel pressure, but not pain. Inform the doctor if there is pain and she will add more anesthetizing solution.
|
|
|
survival rate of cancer in relation to second malignancy
|
the survival rate is indirectly proportional
Screen frequently |
|
|
what to do for a patient with an INR of 8?
|
give platelets, vitamin K and fluids
|
|
|
lab values to check while treating a patient for toxic shock
|
blood levels of ABX, WBCs, serum creatinine, and BUN because of decreased perfusion of the kidneys. It is possible that clearance of the ABX has been decreased enough to cause toxicity.
|
|
|
instructions for using nasal spray
|
close off one nostril while administering
|
|
|
non-pharm tx for sinnusitis
|
2 hot showers a day to promote drainage
|
|
|
activities to avoid after nasal surgery
|
valsalva and activities that cause valsalva (exercise, coughing, constipation) to reduce stress on suture line
Also, avoid blowing nose for 48 hours, after packing is removed. Thereafter, blow nose gently using an open mouth technique. Once packing is removed, client can add water soluble jelly to nares and wash gently. |
|
|
post op laryngectomy
|
client can't speak, so alternate mode of communication is needed.
bedside humidifier will also help. |
|
|
s/s TB
|
weight loss, fatigue, low grade fever, night sweats
|
|
|
SE streptomycin (aminoglycoside)
|
ototoxicity
|
|
|
SE INH
|
peripheral neuritis
|
|
|
SE PAS
|
GI disturbance
|
|
|
SE myambutol
|
optic neuritis
|
|
|
people w/a higher risk of contracting TB
|
homeless, HIV, elderly, minority
|
|
|
s/s high CO2
|
flushing (vasodilation), drowsy/lethargic (depressant effect on CNS)
|
|
|
how to breathe to save energy while lifting?
|
lift while exhaling
|
|
|
what is theophylline?
|
bronchodilator that is administered to relax airways and decrease dyspnea
|
|
|
Most common precipitator of asthma
|
URI
|
|
|
what is subcutaneous emphysema?
|
a crackling sensation on the skin after removing chest tube may be subq emphysema. not unusual and not dangerous if confined. label area. notify MD if it progresses markedly in one hour.
|
|
|
how to deep breathe effectively after a lobectomy
|
contract ab muscles, take a slow, deep breath through the nose, hold for 3-5 seconds, exhale
|
|
|
what does fluid fluctuation in the chest tube mean?
|
cesation of fluid fluctuation in the tubing can mean one of several things; the lung has fully expanded and negative intrapleural pressure has been reestablished, chest tube is occluded, or chest tube is not in the pleural space. Fluid fluctuation occurs because, during inspiration, intrapleural pressure exceeds the negative pressure generated in the water-seal system. Therefore, drainage moves towards the client. During expiration, the pleural pressure exceeds that generated by the waterseal system and fluid moves away from the client
|
|
|
what does bubbling in the chest tube mean?
|
constant = air leak;
intermitent = normal |
|
|
what to keep near your patient with a chest tube?
|
a bottle of sterile water in case the system becomes disconnected
|
|
|
how many mL is a unit of blood?
|
250
|
|
|
risk of too rapid blood infusion
|
fluid volume overload and pulmonary edema
|
|
|
risks associated with ARDS
|
renal failure and superinfection. monitor urine output and chemistries.
|
|
|
type of shock that places client most at risk for ARDS
|
hypovolemic
|
|
|
colonoscopy screening
|
annual DRE at 50, baseline colonoscopy/barium enema, annual fecal testing for occult blood
|
|
|
comfort measures after colostomy
|
warm sitz baths
|
|
|
when should the colostomy start functioning after surgery?
|
2-4 days later
Protect skin with Karaya and stomadhesive |
|
|
drugs used to manage acute ulcerative colitis symptoms
|
steroids
|
|
|
ulcerative colitis diet
|
well balanced, high protein, high calorie, low residue
|
|
|
s/s intestinal obstruction
|
projectile vomiting, electrolyte imbalances, dehydration, increased bowel sounds (high pitched and tinkling because of the trapped air and gas) their might be flat sounds too because obstructions also trap a lot of fluid.
|
|
|
s/s oral cancer
|
dysphagia, unexplained mouth pain, lump, leukoplakia (white patches)
|
|
|
what is parotitis
|
inflammation of the parotid gland
elderly with poor oral hygeine are at high risk |
|
|
precautions after surgery for a fractured mandible
|
keep wire cutters and suction available
positioning; side lying and head slightly elevated (secretions) |
|
|
s/s gastric ulcers
|
eating aggrivates (hurts one hour after eating), vomitting, weight loss, melena, burning epigastric pain
|
|
|
s/s duodenal ulcers
|
relieved by eating, hurt at night (insomnia)
|
|
|
complications of gastroscopy
|
hematemisis, epigastric pain, increased temperature
|
|
|
s/s hypovolemic shock
|
tachycardia, narrow pulse pressure, thirst, decreased urine output
|
|
|
what is rantidine (Zantac)?
|
blocks secretion of HCl and provides relief from heartburn and indigestion
take before bedtime |
|
|
should peptic ulcer disease clients avoid any beverage?
|
they should avoid ETOH
|
|
|
best time to take an antacid
|
1-3 hours after a meal and at bedtime. when it is taken on an empty stomach, the duration of the drug's action is greatly decreased.
|
|
|
after gastric bypass surgery, how long does it take dumping syndrome to disappear?
|
6-12 months
|
|
|
after an upper GI series, which drug should be given to the client?
|
A laxative to eliminate the barium from the body
|
|
|
what is Bethanechol (urecholine)?
|
a cholenergic drug used in GERD to increase LES pressure and facilitate gastric emptying
|
|
|
SE Bethanechol
|
urinary urgency, diarrhea, ab cramps, hypothermia, increased salivation
|
|
|
SE of magnesium supplements
|
diarrhea
|
|
|
which substances reduce esophageal tone and should be avoided in a hiatial hernia?
|
smoking and ETOH
|
|
|
action of Reglan
|
increases esophageal sphincter tone and facilitates gastric emptying, reducing reflux
|
|
|
action of Cimetidine
|
histamine receptor antagonist that decreases the quantity of gastric secretions. it may be used for hiatial hernia treatment.
|
|
|
risk factor for osteoporosis
|
steroid therapy
|
|
|
FPG for prediabetes
|
100-125 mg/dL
|
|
|
what sort of insulin should you give someone in a diabetic coma or who has ketoacidosis?
|
regular insulin
|
|
|
what is acytylcystine used for?
|
clients scheduled for radiographic studies requiring contrast because it's an antioxidant that scavenges free radicals released by contrast
|
|
|
effects of glucogon on blood sugar levels
|
raises blood sugar levels because it's an insulin antagonist produced by alpha cells in the islets of Langerhans which leads to the conversion of glycogen to glucose in the liver.
|
|
|
normal glycosated hemoglobin range
|
4.4-6.4%
|
|
|
precautions for client treated with radioactive isotopes for thyroid problem
|
this client becomes mildly radioactive. 48 hour precautions (avoid prolonged and close contact, flush toilet twice, thoroughly wash hands after toileting).
|
|
|
which drug is frequently given before thyroid surgery?
|
potassium iodide because it reduces the thyroid's vascularity and metabolism by adding iodide to body fluids, thus exerting negative feedback on the thyroid
|
|
|
how hot is tepid?
|
98-100 degrees F
|
|
|
tx for malignant melanoma of the eye
|
enucleation
|
|
|
vaccine given to burn patients
|
tetanus
|
|
|
how serious is a partial thickness burn of over 30%?
|
this is considered critical. Shock, infection, electrolyte imbalance and respiratory distress are possible complications
|
|
|
risks associated with necrotizing faciitis
|
this destroys subcutaneous tissue, predisposing the client to infection and sepsis
|
|
|
function of facial nerve
|
the 7th nerve has motor and sensory functions. The motor funciton is concerned with facial movement (smiling and pursing lips). Non-conduction will cause drooping on the side of the problem
|
|
|
where in the brain are temperature, touch and pain interpreted?
|
sensory impulses from temp, touch, and pain travel via the spinothalmic pathway to the thalmus and then to the post-central gyrus of the parietal lobe, the somatosensory area.
|
|
|
what does the Babinski reflex indicate in an injured adult?
|
upper motor neuron injury
|
|
|
what is Queckenstedt's sign?
|
If there is no obstruciton, pressure on the jugular vein causes an increase in intercranial pressure which causes spinal fluid pressure to increase
|
|
|
what do the ciliary muscles of the eye do?
|
contraction of the ciliary muscles permit the lens to return to its normal bulge, increasing focal length and allowing focus on near objects.
|
|
|
cataract surgery precautions
|
avoid vigorous hairbrushing and tooth brushing because this might increase intraocular pressure
|
|
|
what is dysarthia?
|
poor speech articulation due to problems with CNS or muscles
|
|
|
what happens in overflow incontinence?
|
atony permits the bladder to fill without being able to empty. As pressure builds within the bladder, the urge to void occurs, and just enough urine is eliminated to relieve the pressure and urge to void
|
|
|
way to prevent foot drop after a CVA
|
splints and boots
|
|
|
when establishing a bowel training program for a post CVA client, the nurse realizes that it is most important to:
|
plan a definite time for attempted evacuation
|
|
|
what is expressive aphasia?
|
inability to associate words with objects
|
|
|
way to prevent tic doloureux
|
avoid chewing or moving affected side
|
|
|
s/s MS
|
diplopia, nystagmus, weakness, fatigue, facial mask, incontinence
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which actions would cause someone with a herniated intervertebral disk to experience pain?
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coughing and sneezing, lifting and stooping because they increase intraspinal pressure
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what is spinal shock?
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flacid paralysis of all skeletal muscles which happens immediately after the spinal cord is transected. Usually lasts 1-6 wks.
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s/s autonomic dysflexia
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runny nose and severe headache. sometimes precipitated by a full bladder in someone with a spinal injury.
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what is the purpose of using a tilt table for a client with quadreplegia?
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during prolonged inactivity, bone resorption proceeds faster than bone formation, and lack of therapeutic weight bearing on bone results in demineralization. A tilt table provides gradual progressive weight bearing, which counters these effects.
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describe compact and cancelous bone
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the greater density of compact bone makes it stronger than cancelous bone. Compact bone forms from cancelous bone by the addition of concentric rings of bone substance to the marrow spaces of cancellous bone. The large marrow spaces are reduced to haversian canals.
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what instrucitons should the nurse give the client to prevent hip flexion contracture following an amputation
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lie on stomach for 30 min, 4X/day. when the client is prone, the hips are in extension
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which muscles are used in crutch walking?
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lats, triceps, and trapezius muscles (shoulders, back and upper arms)
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why is traction used in the treatment of fractured hips?
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to align bones (reduction of fracture). If the traction were not used, muscles would go into spasm, shifting bone fragments and causing pain
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why are intramedullary nails used?
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to maintain the alignment of bones and provide support along the length of a bone (ie a femur)
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major cause of immobility in rhematoid arthritis
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bony ankylosis of a joint (irreversible)
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what are Hebredon nodules?
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bonhy or cartilaginous enlargements of the DIPs in osteoarthritis
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