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584 Cards in this Set

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What are normal neonatal vital signs?
HR = 120-160
RR = 30-60
Acrocyanosis normal 2-6 hours after birth
How is thrush treated?
Good handwashing and nystatin
Nursing interventions for an amniotomy
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.
How is natural family planning done?
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.
How do you care for a plaster cast?
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).
How do you walk with a cane?
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).
How do you take care of a client with TPN?
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.
s/s fracture
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.
How do you walk with a walker?
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.
Normal creatinine kinase
12-70 u/ml
what causes pernicious anemia?
lack of intrinsic factor which causes inability to absorb b12. Monthly IM B12 needed.
What to know about elastic stockings
Remove and reapply 2 times a day. Put on before getting out of bed. Don't apply if there are skin lesions
Nutrition for liver failure
Early: high protein and carbs
Advanced: fiber, protein (amonia), fat and sodium restriction, small frequent feedings, fluid restriction. Reduce ascieties (Na and fluid restrictions).
Normal BUN
6-20 mg/100 mL.

High levels due to protein catabolism, kidney problems, dehydration
Characteristics of narcissistic personality disorder
lack of empathy, indifferent to criticism, sense of entitlement
How to do a 24 hour urinalysis
Save all urine in a container with no preservatives; refridgerate or keep on ice
How to take care of someone with pancreatits
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
What to do about gas after a cholecystectomy
Ambulate!
Nursing responsibilities for client with a cuffed trach
Inject air with syringe into one-way valve in pilot line.
change client position frequently, provide humidification and hydration, suction PRN.
Oliguric phase of renal failure
less than 400 mL/day urine, irritability, restlessness, seizures, high K and BUN, creatinine, Ca, Na, pH, anemia, PE, CHF, HTN
Diuretic phase of renal failure
4-5 L urine/day, high BUN, Na and K loss in urine, high mental and physical activity
How to position client immediately after a CVA
supine with HOB elevated 30-45 degrees. Facilitates venous drainage from the brain, decreases ICP, keeps head midline.
Good exercise for femur Fx
quad setting, isometric
Medication for myasthynesia gravis
Mestinon (cholinesterase inhibitor). Give on time. Early: cholinergic crisis; Late: MG crisis
Gastric ulcers
pain increases with food, relieved by vomiting. Can eat most foods as long as they do not bother stomach.
How often do you administer Cipro?
q12h
Post op after surgical repair of detatched retina
bed rest with eye patch
SE of estrogen therapy
cancer, n/v, rashes, breast secretion, thromboembolytic disorder. Use cautiously in family hx of reproductive d/o.
How to decrease recurrence in Otitis media?
Tx URIs early
Sign that your client may be allergic to dyes
Allergy to shellfish (iodine!)
Where should your patient give themselves IM B12?
vastus lateralus
What is the easiest form of PO nutrition for someone after a CVA?
soft foods. liquids are more difficult
s/s PIH
higher than 30 mmHg systolic or 15 mmHg diastolic increase in BP with proteinemia and/or edema after 20 wks gestation.
who's at risk for PIH?
First time moms under 20 or over 35.
What is an adrenal crisis?
The required adrenal hormones exceed available supply. Usually precipitated by a stressful event.
s/s adrenal crisis
hypotension, palor, increased urine, dehydration
How do you know that medications for client with adrenal crisis are working?
BP increases
What is a dystonic reaction?
This is a reaction to an antipsychotic. s/s: muscle tightness in throat, neck, tongue, mouth, eyes, neck, and back, difficultly talking and swallowing.
How to you treat a dystonic rxn?
IM or IV benadryl or cogentin
(antimuscarinic/anticholinergic)
muscle relaxant
dopamine agonist (carbidopa)
Treatment for dumping syndrome
sedatives, antispasmotics, high protein, high fat, low carbs, dry diet. Eat in semi-recumbent position. Lie down after eating..
PMI for fetal heart tones
fetal back
proper position for brain scan
supine
Best way to reduce arthritis stiffness
warm bath
Major antacid side effect
constipation
Best position for paracentesis
Fowlers
What is a good initial approach to your client's delusions?
clarify meanings of delusions. After that, do not discuss delusions or argue with client. Address delusions that entail injury or death immediately.
Reaction formation
defense mechanism: attitude opposite of unconsious feelings.
ie: homophobic person who later realizes they are gay
Why is a spacer for asthma medication a good thing?
a spacer for an inhaler traps medicine from the inhaler, then breaks up and slows down the medicine particles so you get more medication
What is meniere's disease?
dysfunction of labyrinth leading to severe vertigo. Leads to residual tinnitus and hearing loss
How do you decrease tinnitus in Meniere's disesase?
listen to headphones
What does an EEG measure?
electrical activity in the brain
Advise for client post hip fracture
do not flex hip more than 90 degrees, don't cross legs and have someone help with shoes
Which electrolyte imbalances does a client with Addisonian crisis have?
adrenal insufficiency in Addisonian crisis leads to low aldosterone which leads to hyponatremia and hyperkalemia
Priority nursing diagnosis for patient with Parkinson's disease
Risk for aspiration (of saliva). keep HOB high.
chronic kidney disease diet
restrict fluids, protein, salt and K
Should you administer cytotoxic drugs to a pregnant woman?
no
What is the appropriate INR for coumadin therapy?
2-3.5
Tx for diabetes insipidus
caused by decrease of ADH

give vasopressin
electrolyte imbalance caused by
ACE inhibitors (-pril)
hyperkalemia
position of comfort for pericarditis client
leaning forward while sitting
Stages of Altzheimers
1) confussion
2) difficulty with recent and remote memory/occasional incontinence
3)loss of all cognitive functions
What is myasthenia gravis?
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
s/s myasthenia gravis
diplopia, speech problems, masklike expression, fatigue, respiratory distress,
test for myasthenia gravis
neostigmine (tensilon) temporarily relieves s/s
diabetic foot care
use nail files instead of clippers, water soluble lotions, antiperspirants, no foot soaks
what are the stages of alcoholism?
prealcoholism: drink to medicate
early: sneaking drinks, blackouts
crucial: loss of control and physiological dependence
chronic: emotional and physical deteriorization
Major side effect of MAO inhibitors and nursing diagnosis
they cause hypotension
Risk for injury
what happens to people who OD on tricyclic antidepressants?
fatal arrythmias, hypotension, anticholinergic
When can you expect Buspar to start having an anxiolytic effect?
anxiolytic drug
after 14-30 days
What is generalized anxiety disorder?
anxiety that lasts longer than 6 months
s/s dementia
slow symptom progression
basic personality changes
hard to pay attention to others
what is akathisia?
inner restlessness
administration of terbutaline
take every 4 hours around the clock to supress labor. Report if HR>120 BPM (SE: tachycardia)
sequella for cerebral hyperemia in infants
increased blood in brain leads to increased ICP which leads to brain injury
SE of vincrystine
neurotoxic drug:

weakness and constipation
nursing interventions for prolapsed umbilical cord
elevate hips on 2 pillows, change mom's position, push cord
What do you need to assess before giving meds to premature infants?
maturity of kidney and liver enzyme systems. This makes a difference in the way that drugs are metabolized
pedal and popliteal pulses post cardiac catheterization
site distal to insertion site will be weak, but gradually should increase in strength
how do you test for cystic fibrosis?
sweat test
how do you do a sweat test?
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.
what are presumptive signs of pregnancy?
ammenorria, quickening (mvt)
what are probable signs of pregnancy?
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)
what is a positive sign of pregnancy?
fetal outline on ultrasound
what does the "taking in" stage consist of?
1-3 days after birth, the mom is focused on taking care of herself
When and how to feed an infant after pyloric stenosis surgery
small, frequent feedings 4-6 hours after surgery
occasional emesis is common
what is a hemiangioma?
endothelial tumor
How long does an infant have a plantar grasp reflex?
until 9 months of age
very common sign of ingestion of poisons
edema of lips
after surgical repair for hypospadia, how do you position child?
elevate scrotum
what does impetigo look like?
vesicular lesions with drainage, forming crusts on face and extremities
evidence of fetal wellbeing in non-stress test
2 accelerations with a rise of 15 beats in 20 minutes
stages of labor
1) cervix dilating
2)cervix fully dilated
3)baby and placenta delivered
4)postpartum
definition of infertility in women
25 year old: 1 year of unprotected sex
30 plus: 6 months of unprotected sex without pregnancy
what are low set ears a potential sign of?
renal problems
mental retardation
what are good sources of folic acid?
egg yolks, nuts, seeds, liver
what is PROM?
when membranes rupture before labor instead of before delivery
post eye surgery precautions
avoid lifting things more than 15 lb
no bright lights
no coughing/valsalva
how high above stoma should you place irrigation bag?
18-20 inches
antispasmotic drug frequently used for gall bladder/bile duct
Propantheline bromide (GI anticholinergic)
Effects and side effects of Mag sulfate
relaxes myometrium
SE: flushing, drowsiness, slurred speech, decreased reflexes, decreased GI motility, decresed respiratory rate
most accurate way to calcultate meds for kids
body surface area in relation to weight
what are people with multiple myloma at risk for?
Fx and CRF
Abciximab
inhibits platelet aggregation (good for PTCA)
check APTT when administering
What is a Parkinsonian crisis?
dopamine related symptoms are severely exacerbated, virtually immobilizing the client. Also, excessive drooling and increased risk for airway obstruction
TPN complications
fluid overload, electrolyte imbalances, infection, hyperglycemia, hypoglycemia, air embolism, pneumothorax
where to instill eye drops
conjunctival sac for best absorption
treatment for a compromised skin graft
hyperbaric oxygen therapy can be used to promote wound healing (increased oxygen)
what is the maximum amount of fluid that can be injected IM?
5 mL
What is Wilm's tumor?
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.
stages of Wilm's tumor
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)
How to calculate mean arterial pressure
MAP = {[DBP *2]+ SBP}/3
Why is MAP important?
MAP is organ perfusions pressure. A MAP of 60 or higher can sustain organs.
How do you calculate cerebral perfusion pressure?
CPP = MAP-ICP
What is the glucose tollerance test?
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.
Which clients are at risk for increased uterine cramping?
Breastfeeding (oxytocin release) and multips (less firm uterus)
If the chest tube is obstructed or kinked, what is your client at risk for?
tension pneumothorax
NML CO2
(alkaline)35-45(acid)

respiratory issues
NML HCO3
(acid) 22-26 (alkaline)

kidney issues
NML pO2
80-100
positioning for client with hemiparesis
upright to facilitate drainage of secretions
NML lochia
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)
How do you know if the cervix is favorable for induction of labor?
It's soft, anterior, 50% effaced, dilated at least 2 cm, the fetal head is at +1 station or lower (Bishop score of 9)
glucotrol + ASA=?
hypoglycemia
s/s placenta previa
painless, bright red bleeding
s/s hydidaform mole
high hCG, fast uterine growth, n/v, no baby
mental SE of right hemisphere damage
poor judgement
What is a baby with a lower 5 minute APGAR score at risk for?
residual neurologic depression
What are APGAR scores used for?
To predict the severity of respiratory and neurologic depression
post hydidaform mole
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
which foods are high in B1 (thiamine)?
milk, pork, liver, enriched cereals
how do you know if someone has arterial insufficiency?
palor when limb is elevated
How do you breate in labor?
shallow chest breathing at the peak of the contraction.
chest panting to prevent pushing before fully dilated
How to decrease the chances that your preeclamtic patient will have the a seizure?
decrease visual and auditory seizures
When is a child most at risk for Reye's syndrome?
1 week after a viral infection
What is Reye's syndrome?
Children with viral infections who take ASA are at risk.
Harms multiple organ systems including the liver and the brain. Can cause hypoglycemia.
when are clients with Addison's disease at risk for an Addisonian crisis?
during periods of stress
s/s hypokalemia
weakness, diarrhea, parasthesia, n/v, bradycardia
what is retinosis pigmentosa?
hereditary disease involving visual field loss and night loss
what is prinzmentla angina?
triggered by coronary artery spasm from an unknown amount of activity
How does Tamoxifen work?
It's an estrogen blocker, good for pre and post menopausal breast cancer
nursing diagnosis for client undergoing chemo
thromocytopenia
activity intollerence
impaired tissue integrity
impaired oral mucous membrane
ineffective tissue perfussion (cerebral, cardiopulmonary, GI)
SE of Clozapine
drug for scizophrenia
SE: agranulocytosis
Check WBC qweek
issues with immunity
Tx for hyperkalemia
50% dextrose and insulin. Insulin drives K into cell, dextrose counteracts effects of insulin.
Most sensitive indicator of fluid balance
daily weight
Ballottement
probable sign of pregnancy. press against uterus and feel fetus bounceback.
intermittent claudication
vasospasm blocks vessels to feet, poor circulation in feet. take care of feel
Precautions for SARS
droplet and contact precautions
gown, gloves, mask, goggles
airborne precautions
prevent spread of bacteria/viruses over long distances (TB)
Air ventilation, HEPA filters
Tonsil sizes
1+ barely visible outside of tonsillar pilar
2+ between tonsillar pilar and uvula
3+touching uvula
4+ touching each other
SE of spironolactone
(potassium sparing diuretic)
menstrural irregularities, breast soreness, decreased libido, gynecomastia, impotence
diet for ulcerative colitis
high protein
sign of dehydration in a neonate
urine output less than 1mL/hour
good and bad uses for a heating pad
good for absesses, wounds, edema
bad for active bleeding
SE for aurothiroglucose
(treatment for rheumatoid arthritis)
SE: blood dyscrasias (eosinophilia, thrombocytopenia, aplastic anemia and leukopenia).
diet for alcoholics
high protein
food for people with malabsorption syndrome to avoid
gluten
How to prevent v-fib when defibrillating?
avoid delivering on a t-wave. Put synchronizer on
what is a diagonal conjugate?
Size of the pelvic outlet
what is the crown to rump measurement?
measurement of the embryo until 11 weeks
what is -sarcoma?
cancer of the connective tissue
cardiac output during pregnancy
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
Pentamidine isethionide
antimicrobial to treat pneumocystis
SE: affects glucose levels
check glucose
Which stage of syphillis is not contagious?
tertiary
How does GABA work?
It promotes a balance between dopamine and glutamine: good for decreasing anxiety
What is nesiritide?
It's used for acute heart failure.
Human BNP binds to the receptor in vascular smooth muscle leading to vascular smooth muscle relaxation
What does pulmonary artery wedge pressure measure?
indirect measure of left arterial pressure
This is way to monitory for left ventricular failure
what is introjection?
treating something outside the self as if it is actually inside the self; incorporated others' wishes and values as if they are your own.
when should a child go to the dentist for the first time?
2-3 years old, when all desciduous teeth have errupted
what is thromboangitis obilterans?
thrombi form as the result of vascular inflammation. Burning pain occurs from impaired circulation
purpose of knee-chest position
prevents shock by shunting blood to upper body and vital organs
what is nalbuphrine?
opoid analgesic that doesn't cause fetal or neonatal respiratory depression
How often should DIG be administered?
q12h
what kind of organism causes trichomonas vaginalis?
protozoan
what body functions are controlled by the medulla oblongata?
BP, BV diameter, pulse, breathing
How many doses of dTAP are required?
3
where can the highest O2 content be found in fetal circulation?
umbilical vein (ductus venous)
Diets for clients after internal radiation for cervical cancer
low-residue diets to suppress peristalsis
s/s glomerulonephritis
elevated BP, periorbital edema, hematuria and high urine specific gravity
what is tumor necrosis factor?
* produced by macrophages in synovium
*causes inflammation, destruction of bone and cartilage, joint stiffness and pain
Medications to treat malaria
quinine
pyrimethamide
sulfonamide
how long do NTG tabs last?
3 months
appropriate sedative for person with pulmonary edema
morphine: rapid onset, decreases pulmonary reflexes
Major SE of Ca channel blockers
orthostatic hypotension
ABX for gonorrhea
ceftriasome
advice for someone taking Macrobid (UTI drug)
drink lots of water to prevent crystal formation
Nutritional supplement for someone taking phentoin
folic acid
normal SE of B vitamins
bright yellow pee
how does rantidine work?
decreases gastric secretion by inhibiting histamine at H2 receptors
S/S chronic malaria
in chronic malaria, look for hemoglobinuria, intravascular hemolysis, renal failure as a result of RBC destruction
Prophylactic medicine for chemo patients
ABX
disease associated with long term methyldopa administration
hemolytic anemia
effects and side effects of levadopa
given for parkinson's disease. Reduces sympathetic outflow by limiting vasoconstriction, which may result in ortho hypo
SE vincristine
severe constipation and paralytic ileus. a high residue (fiber) diet is recommended to prevent this complication.
SE of streptomycin
TB Tx
ototoxic to auditory and vestibular portions of 8th cranial nerve
SE of INH
often leads to B6 defficiency
avoid tyramine (wine and aged cheese)
s/s fo hydrochloroquine toxicity
blurred vision
furosemide + ASA =?
compete for same renal excretion sites. dose of ASA may need to be decreased
effect and SE of disopyramide
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
which actions would cause someone with a herniated intervertebral disk to experience pain?
coughing and sneezing, lifting and stooping because they increase intraspinal pressure
what is spinal shock?
flacid paralysis of all skeletal muscles which happens immediately after the spinal cord is transected. Usually lasts 1-6 wks.
s/s autonomic dysflexia
runny nose and severe headache. sometimes precipitated by a full bladder in someone with a spinal injury.
what is the purpose of using a tilt table for a client with quadreplegia?
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.
describe compact and cancelous bone
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.
what instrucitons should the nurse give the client to prevent hip flexion contracture following an amputation
lie on stomach for 30 min, 4X/day. when the client is prone, the hips are in extension
which muscles are used in crutch walking?
lats, triceps, and trapezius muscles (shoulders, back and upper arms)
why is traction used in the treatment of fractured hips?
to align bones (reduction of fracture). If the traction were not used, muscles would go into spasm, shifting bone fragments and causing pain
why are intramedullary nails used?
to maintain the alignment of bones and provide support along the length of a bone (ie a femur)
major cause of immobility in rhematoid arthritis
bony ankylosis of a joint (irreversible)
what are Hebredon nodules?
bonhy or cartilaginous enlargements of the DIPs in osteoarthritis