Test Ii

Front 1

this is considered the time the decision is made to have surgery until the pt. is transported into the OR

Back 1

Pre-operative phase

Front 2

This form of surgery is when the procedure is w/out significant risk; often done w/ local anesthesia

Back 2

minor

Front 3

this form of surgery is when the procedure of greater risk, usually longer and more extensive than a minor procedure

Back 3

major

Front 4

an incision and drainage, muscle biopsy, implantation of a venous access device (VAD) are all surgical procedures, what category would it fall under

Back 4

minor

Front 5

mitral valve replacement, pancreas transplant, and lymph node dissection are all surgical procedures, what category would they fall under

Back 5

major

Front 6

this surgery has little risk to life

Back 6

minor

Front 7

this may involve risk to life

Back 7

major

Front 8

this is done through fiberoptics, recover time less

Back 8

minimal invasive (bloodless)surgery

Front 9

what are some reasons for sugery?

Back 9

diagnostic, curative, restorative, palliative, cosmetic

Front 10

this surgery is performed to determine the origin and cause of a disorder or the cell type for cancer

Back 10

diagnostic cancer

Front 11

this is performed to resolve a health problem by repairing or removing the cause

Back 11

curative

Front 12

this is performed to improve a client's functional ability

Back 12

restorative

Front 13

this is performed to relieve symptoms of a disease process, but does not cure

Back 13

palliative

Front 14

this is performed primarily to alter or enhance personal appearance

Back 14

cosmetic

Front 15

what are some ex. of someone who may need a diagnositc surgery

Back 15

breast biopsy

Front 16

what are some examples of someone who may need to have a curative surgery

Back 16

laparoscopic cholecystectomy, mastectomy, hysterectomy

Front 17

what are some examples of someone who may need restorative surgery

Back 17

total knee replacement, finger reimplantation

Front 18

what are some examples of someone who may need a cosmetic surgery

Back 18

liposuction, revision of scars, rhinoplasty, blepharoplasty

Front 19

what are some responses to surgery?

Back 19

symathetic NS, also an increase in aldosterone secretion that results in decreased GI activity and sodium retention, Hormonal response, there is also an increase in the secretion of ADH which helps to maintain blood volume, and metabolic responses.

Front 20

when this occurs there is an increase in CHO metabolism, fat metabolism and protein metabolism

Back 20

this is a metabolic response to surgery

Front 21

when there is an increased amount of norepinephrine secreted that results in peripheral vasoconstriction. This helps to maintain blood pressure during surgery by maintaining fluid volume w/ blood loss in surgery

Back 21

this is a sympathetic NS response to surgery

Front 22

when there is an increase in the secretion of glucocorticoid secretion. This results in a mobilization of stored fats and amino acids for energy

Back 22

hormonal response to surgery

Front 23

what are some factors that affect the pt.'s response to surgery

Back 23

age, medications, medical history, prior surgical experiences, health/family history, type of surgery planned

Front 24

in ref to age what are some factors that affect patients's response

Back 24

very old and very young likely to have more complications, cardiovascular changes w/ aging, respiratory changes w/ ages

Front 25

the very old and very young are likely to have what in ref to patients respone towards surgery

Back 25

have more complications

Front 26

in ref to factors that affect patients response what medications should you assess

Back 26

tobacco use, prescription drugs, illegal drugs, over the counter drugs

Front 27

why would you ask a pt. to stop smoking prior to surgery

Back 27

greater incidence for pulmonary problems

Front 28

why would it be important to note if pt. is taking aspirin at home prior to surgery

Back 28

because of platelet

Front 29

what are some things you would assess in ref. to their medical/cardiac history?

Back 29

pulmonary, cardiovascular, renal, endocrine

Front 30

when assessing a pt. what information would you gather in ref. to previous surgery/anesthesia

Back 30

good/bad outcomes,
allergies-what pt. is allergic to, med's, equip.

Front 31

this is an acute, life threatening complication of certain drugs used for general anesthesia.

Back 31

malignant hyperthermia
very important for family history

Front 32

what phase during the surgery may the malignant hyperthermia occur?

Back 32

inter-operative phase,
occur immediately after induction of anesthesia, several hrs. into the procedure, or rarely, even after the anestehetic has been terminated.

Front 33

what are some preoperative assessments?

Back 33

you must set up some base lines, vital signs, allergies, cardiovascular system, respiratory system, renal/urinary system, neurological system, musculoskeletal system, nutritional status

Front 34

during the cardiovascular assessment what should you assess?

Back 34

ck. for hypertension, assess heart rate, rhythm, sounds, look for edema, assess the peripheral vascular system

Front 35

during the respiratory assessment what should you asses?

Back 35

breath sounds, look for lung expansion, evaluate overall respiratory effort, look for clubbing of fingers

Front 36

if a pt. has clubbing of fingers what might this be?

Back 36

decreased oxygenation

Front 37

during the renal/urinary system what would you assess

Back 37

look at BUN and Creatine, monitor F and E status, I and O

Front 38

during the neurologic system assessment what would you assess?

Back 38

overall mental status, assess for risk for falls

Front 39

during the musculoskeletal assessment what would you asses?

Back 39

will mobility be an issue

Front 40

during the nutritional assessment what would you assess

Back 40

malnutrition, and obesity

Front 41

what are some common lab data for surgery?

Back 41

blood tests, urinalysis, x-rays, other

Front 42

a signed informed consent implies what?

Back 42

that the client has the knowledge to understnad the nature fo the surgical procedure as well as teh possible consequences.

Front 43

whose duty is it to obtain an informed consent

Back 43

physician

Front 44

what is the nurse's job in ref. to an informed consent?

Back 44

you ensure that the consent form is signed and you serve as a witness to the signature, not to the fact that the client is informed.

Front 45

the surgeon is responsible for having the consent form signed when?

Back 45

beofre sedation is given and before surgery is performed

Front 46

who could sign the consent if the adult is unable to do so

Back 46

spouse, adult child, parent, sibling

Front 47

consent for minors must be given by who?

Back 47

parents or legal guardians

Front 48

these are minors who are under the age of 18 and are married or living on their own income

Back 48

emancipated minors

Front 49

In an emergency, telephone or telegram authorization is acceptabe and should be followed up w/ written consent as soon as possible. The number of witnesses is usually?

Back 49

two.

Front 50

the preoperative period begins when the client is scheduled for surgery and ends when?

Back 50

at the time of the transfer to the surgical suite

Front 51

what are some questions you may assess of a person who may or may not be psychologically ready for surgery?

Back 51

does the pt. understand the proposed surgery?
what previous experiences has the pt. had w/ surgery?,
does the pt. have any specific concerns?, what support systems does the pt. have available to them?

Front 52

what is some objective data related to preparedness for surgery?

Back 52

speech patterns, degree of interaction w/ others, physical assessment(increased HR and RR, increased hand mov't, increased perspiration, increased voiding)(not uncommon)

Front 53

what are some medical interventions for preparing a pt. for surgery?

Back 53

diet, bowel cleansing, skin prep

Front 54

what are some goals of pre-op teaching?

Back 54

decrease anxiety

Front 55

what should you include in teaching a pt. pre-op

Back 55

should include what to expect during the surgical experience or (where they have to go, family, kids may sometimes have a tour)

Front 56

Amount of information given to a pt. teaching pre-op depends on

Back 56

patient's background, interest, stress level, age
(what can i tell you so it will be a less stressfull day)

Front 57

what are some things a nurse may teach a pt. pre-op

Back 57

goals of pre-op, what to expect,pre-oper. test reason, explanation, pre-op routines-npo, prep, edema, time OR scheduled-have them understand they go to the holding area 1hr. before, info. for family where they should wait, where the surgeon should talk to them, how long it will be, anticipated post op interventions

Front 58

the day of surgery what is included in the final assessment?

Back 58

rt. vs. left, id band, blood band, labs, tests, nail polish off, gown on, bladder emptied, antiembolic stockins, pt. belongings, pre-op med.

Front 59

what are some possible pre-op medications

Back 59

narcotics, barbiturates

Front 60

this med. reduces anxiety and promotes relaxation but depress resp, circulation and GI motility

Back 60

narcotics

Front 61

Demoral and Morphine are ex. of what kind of med.

Back 61

narcotic possible pre-op

Front 62

this med reduces anxiety, promote relaxation adn sleep but cause excitement or confusion in elderly.

Back 62

barbiturates possible pre-op

Front 63

nembutal and seconal are ex. of what kind of med.

Back 63

barbiturates

Front 64

this for of med is a resp. depressant?

Back 64

narcotics

Front 65

this form of pre-op med reduce anxiety and promote relaxation but cause dizziness and headache

Back 65

benzodiazepines

Front 66

valium and librium is what form of pre-op med

Back 66

benzodiazepines

Front 67

this promotes a state of indifference, decreased motor activity, analgesia, antiemetic but also causes resp. depression and hypotension

Back 67

neuroleptanalgesic

Front 68

fentanyl is an ex of what form of pre-op med

Back 68

neuroleptanalgesic

Front 69

during the transport to OR at what point to you ck the band?

Back 69

prior to going to OR and then upon arrival in OR. If having orthopedic surgery must be sure that the correct part is noted. (TIME OUT)

Front 70

this phase begins when the pt. is transferred to the operating table and ends w/ the transfer to the RR

Back 70

intra-operative phase
(if the pt. has left your area and is in the holding area they are still inthe pre-op phase)

Front 71

this may be used as an area where the pt. waits for the OR to be ready,

Back 71

holding area

Front 72

what happens in the holding area?

Back 72

nurse double cks. the chart, procedures are done, visit by the anesthesiologist

Front 73

what are some members of the surgical team?

Back 73

scrub nurse/tech, circulating nurse, anesthesiologist or CRNA, surgeon, second surgeon, others

Front 74

this person coordinates, oversees, and is involved in the client's nursing care in the OR. actions are vital t othe smooth flow o fevents before, during, and after surgery. "conducter"

Back 74

circulating nurse

Front 75

this is a rn w/ additional credentials who delivers anesthetic agents under the supervision of an anesthesiologist, surgeion, dentist, or podiatrist

Back 75

certified registered nurse anesthetist

Front 76

what are some responsibilities of the scrub nurse/tech

Back 76

prepares sterile supplies and equip., assists the surgeon, accts. for equip. (instruments, sponges, etc.)

Front 77

what are some responsibilites of the circulating Nurse

Back 77

upon arrival of pt. in teh OR the circulating nurse should: ask the pt. to state his name, ck. the pt. name and number w/ his ID band, ck the consent, review the chart, ck. for jewelry, glasses, dentures, etc.

Front 78

what are some responsibilities of the anesthesiologist, and the CRNA?

Back 78

admin. of the anesthetic agents.

Front 79

what are some effects of anesthesia?

Back 79

amnesia, analgesia, hypnosis and relaxation

Front 80

what are the types of anesthesia?

Back 80

general, regional, local, conscious sedation

Front 81

this form of anesthesia may be given IV or by inhalation. Blocks the awareness centers in the brain producing unconsciousness, body relaxation and loss of sensation

Back 81

general anesthesia

Front 82

this form of analgesia occurs over a specific body area. May be given via spina, bier block, epidural. Pt. is conscious

Back 82

regional

Front 83

this analgesia is given over a limited tissue area. Pt. is conscious

Back 83

local

Front 84

what are some important considerations for spinal anesthesia?

Back 84

usually done on lower extr.,
pt. remains awake during the procedure, headache

Front 85

this is a common post anesthesia problem

Back 85

headache

Front 86

what should you do to keep the person from having a headache post anesthesia

Back 86

keep the pt. supine, force fluids if allowed.
we can minimize by force fluids, as many fluids as they can as much as 3000cc

Front 87

how is conscious sedation delivered?

Back 87

iv

Front 88

this is the delivery of sedative, hypnotic, and opiod drugs to reduce the level of consciousness but allow the client to maintain a patent airway and to respond to verbal commands.

Back 88

conscious sedation

Front 89

what does the nurse monitor during and after a conscious sedation?

Back 89

O2 stats, EKG, and VS

Front 90

the amnesia action for someone who has had a conscious sedation?

Back 90

is short and the client is usually has a rapid return to activities of daily living.

Front 91

this is a life threatening complication triggered by the anesthetic agent. only occurs in pt. w/ an inherited defect in the membrane of the skeleltal muscle.

Back 91

malignant hyperthermia

Front 92

what happens to the pts. ca and met. rate if they have malignant hyperthermia?

Back 92

The pts. ca level rises and metabolic rate increases dramatically. If this is allowed to continue the pt. may develop renal failure, DIC, neurological damage and ht. failure.

Front 93

what are some clinical manifestations of malignant hyperthermia?

Back 93

Tachycardia (occurs first), unstable BP, Tachypnea, muscle rigidity(ca being released), skin mottling (blue or when you get cold spots), rapidly rising body temp.

Front 94

what are some treatment of malignant hyperthermia?

Back 94

stop the admin. of the causative agent, ice, chilled iv fluids, diuretics, steroids, dantrium

Front 95

what is the first thing that is done w/ someone who has malignant hyperthermia?

Back 95

stop the admin. of the causative agent

Front 96

dressings applied, documentation done, moved from OR to PACU w/ circulating nurse and anesthesiologist; this is what phase of the surgery is this

Back 96

termination of surgery?

Front 97

PACU is also known as?

Back 97

recovering room

Front 98

Upon arrival in PACU who will give report to the PACU nurse?

Back 98

circulating nurse

Front 99

what phase is it when the pt. is in PACU?

Back 99

post-operative

Front 100

Usually in the PACU there is a one to one w/ the pt. why is that?

Back 100

because of the protection of the airway

Front 101

PACU will do quick assessment which will include?

Back 101

assessment of airway, vital signs, LOC, EKG

Front 102

A more detailed report from circulating nurse should include what in the PACU?

Back 102

diagnosis, surgical procedure, type of anesthetic agent used, any meds admin., any problems/complications, amto of fluid lost/given (EBL), drains/lines/tubes, surgical site, dressing, review of medical orders

Front 103

When maintaining a pt. airway what is the goal?

Back 103

to prevent hypoxemia and hypercapnia

Front 104

what is the most common cause of hypoxemia and hypercapnia

Back 104

airway obstruction and hypoventilation

Front 105

what is a nursing intervention when maintaining a pt. airway?

Back 105

keep head hyperextended because of tongue

Front 106

what are some causes of airway obstruction?

Back 106

relaxation of the tongue as a result of anesthesia, secretions,

Front 107

All noisy breathing is a sign of airway obstruction but don't have to have the noise to have an?

Back 107

obstruction

Front 108

while the pt. is in pacu the pt. will have an pulse oximeter on what should the rate be?

Back 108

95 or above

Front 109

what are some types of airways?

Back 109

pharyngeal, endotracheal,

Front 110

this is the most common type of airway, keeps the airway open and the tongue forward until the gag reflex returns,

Back 110

pharyngeal

Front 111

when is the pharyngeal removed

Back 111

when the pt. is awake and has a gaga nd swalowing reflex back

Front 112

this type of airway is not tolerated in a conscious pt. may stimulate vomiting ro a laryngospasm

Back 112

pharyngeal

Front 113

when would you remove the pharyngeal?

Back 113

when you see the pt. reaching up to remove it

Front 114

this keeps the airwayopen by insertion of a tube into the pt's trachea

Back 114

endotracheal

Front 115

describe the endotracheal airway?

Back 115

keeps the airway open by insertion of a tube into the pt's trachea, may or may not be removed prior to leaving the OR, pts may complain of a sore throat, may be left in post operatively in ICU, it goes through your vocal cords

Front 116

what are some positions to promote ventilation

Back 116

depends on the type of surgery, the pt. size, the type of anesthesia used., initially pts are usually supine w/ the head hyperextended and w/ suction equip ready, recovery position-side lying when stable bx of vomiting

Front 117

what is the recovery position

Back 117

side lying when stable

Front 118

this is important and should be started in PACU

Back 118

deep breathing exercises

Front 119

this is almost always given to post oper. pts due to decreased pulmonary expansion and areas of atelectasis?

Back 119

oxygen

Front 120

this should be given until pt. is conscious, can take deep breaths on their own or as determined by blood gases or O2stats (keep between 92-98)

Back 120

Oxygen

Front 121

how may oxygen be given?

Back 121

cannula, mask, ventilator

Front 122

circulatory complications occur due to?

Back 122

hypotension and cardiac dysrhyhmias-reason why vital signs are assessed so frequently in the PACU

Front 123

Hypotension post-operatively my be caused by?

Back 123

moving the pt. from the OR table to the stretcher, the drugs or anesthesia given, loss of blood and fluids, dysrhythmias, pain

Front 124

what are some interventions for hypotension?

Back 124

elevate legs, give fluids, ck for bleeding, notify physician

Front 125

what are some clinical manifestations of shock?

Back 125

weak, rapid, thready pulse, skin cool and clammy, restless(could also mean they are having resp issues)

Front 126

dysrhythmias post-operatively may be caused by

Back 126

decreased oxygen, pain, hypovolemia
treat depending on the cause; new onset may be of concern

Front 127

what are some other interventions for the PACU

Back 127

admin. iv fluids, monitor for F and E imbalances, maintain a safe environment, provide comfort, make sure pain is controlled

Front 128

when is a person ready for discharge from PACU?

Back 128

depends on the hospital policy and procedure, most use-easily aroused, stable vital signs, frequent b.p. complications under control, return of sensation (regional anesthesia)

Front 129

when the pt. is returning to the nursing unit from the PACU what are the nursing interventions?

Back 129

get room ready obtain needed eqip., get report from PACU, obtain VS (know that its stable), perform assessment (look under covers), review and implement orders (because the surgical nurse usually does stat orders)

Front 130

what is the fifth vital sign?

Back 130

assessment of pain

Front 131

what are some things you can do for pain control post op?

Back 131

remember assessment of pain (5th vital sign), maybe a combination of med. and other therapies(distraction, etc,), admin. Opiods/analgesics w/ caution so as not mask another problem (a person who's restless, might be in pain however, could be a resp. problem, may have a PCA pump, assess resp rate, assess pain complaints, assess elderly pt. carefully

Front 132

patients not always need med for pain what are some other things you may do?

Back 132

turning, repositioning,

Front 133

what are some things you might ask the pt in ref to pain?

Back 133

where?, How severe?, anything else that might help w/ pain, when was the last time

Front 134

If the pt. is on a PCA pump and you are assess resp. what number would make you remove the PCA pump bx its a sign of overmedication

Back 134

if its below 10

Front 135

when should you assess pain complaints for someone post op who is going to be on pain med?

Back 135

30 min after you have admin.

Front 136

what are some pain control advantages?

Back 136

pt will be able to move around more w/out pain.

Front 137

what are some disadvantages to pain control?

Back 137

pt. will not want to move around

Front 138

what is the most common post operative complication?

Back 138

pulmonary

Front 139

how would you maintain aeration on the nursing unit?

Back 139

most common post op. complication is pulmonary, most easily prevented also, is prevented by coughing, deep breathing, sighing, and suctioning, Atelectasis, pneumonia

Front 140

this occurs due to alveoli collapsing either due to a mucus plug or a decrease in surfactant. An unexplained rise in temp may be the first sign especially in the immediate post-op phase. Usually occurs in 36hrs after surgery?

Back 140

atelectasis

Front 141

two things happen may happen after surgery due to pulmonary complications what are they?

Back 141

atelectasis, pneumonia

Front 142

this occurs when secretions pool in the lower airway as a result of shallow breathing and immobility and then a pulmonary infections occurs. Usually occurs 3 days after surgery?

Back 142

pneumonia

Front 143

what does sighing release?

Back 143

surfactant and it opens the alveoli

Front 144

when they don't take deep breaths what happens to the alveoli?

Back 144

they collapse

Front 145

how is the post op pulmonary complication prevented?

Back 145

coughing, deep breathing,
sighing, suctioning,

Front 146

what are some risk factors for pulmonary problems?

Back 146

inhaled anesthesia, high abdominal or thoracic surgery, age(older), presence of COPD, smoking, resp. depressant meds, pain-must be controlled for the pt. to breath deeply, decreased mobility, dehydration

Front 147

what are some deep breathing exercises? how would you instruct a pt.?

Back 147

sit in semi fowlers or high fowlers position, hold hand lightly on abdomen, breathe in thru the nose slowly, hold breath for 3 sec., exhale thru pursed lips, repeat

Front 148

how would you instruct someone to cough?

Back 148

unless coughing is contraindictated, place a pillow, towel, or folded blanket over your surgical incision and hold the item firmily in place.,
take three slow, deep breaths to stimulatee your cough reflex, inhale through your nose, then exhale through your mouth. on your third deep breath, cough to clear secretions from your lungs while firmly holding the pillow, towel or folded balnket against your incision

Front 149

when is coughing contraindictated?

Back 149

brain surgery, spinal surgery or eye surgery

Front 150

what should you do first if it helps the pt. cough?

Back 150

medicate

Front 151

this is a mechanical device that promotes sustained maximal inspiration,?

Back 151

incentive spirometer (triflow

Front 152

how does the pt use the incentive spirometer?

Back 152

the client must be able to seal the lips tightly around the mouthpiece, inhale spontaneously, and hold his ro her breath for 3-5 sec. for effective lung expansion. goals can be set ex. pt. trys to hold the ball up

Front 153

this allows the alveolar to be completely opened and therefore increaseing the production of surfactant

Back 153

yawn maneuver or sighing exercises

Front 154

how would you instruct a person on yawning or sighing?

Back 154

taking a deep breath than normal, usually take about 6 sighs/hr.

Front 155

at what point should you encourage a pt. after post op
to ambulate

Back 155

encouraged as soon as possible

Front 156

formation of clots can occur post-op which can be a potentially life threatening complication of surgery, how would you assess?

Back 156

ck for positive homan's sign, ck for redness, increase circumference of calf, complaints of numbness, tingling feeling

Front 157

how could you prevent clot formation

Back 157

TED hose, SCD, do not allow pt. to cross their legs/ankles, no pressure on popliteal area, no massage of the lower ext., legs exercises while in bed, early ambulation, med.-heparin, lovenox, aspirin

Front 158

what are some meds prescribed to prevent clots?

Back 158

heparin, lovenox, aspirin

Front 159

what are some interventions for suspected DVT?

Back 159

notify the physician,
put on bedrest, and elevate the legs until able to contact the physician, anticipate anticoagulant therapy

Front 160

what are some other things to watch for post-op?

Back 160

circulatory overload, ileus, urinary retention/decreased urine output, pain (all pt. have post op pain)

Front 161

this is due to increased IV fluids. watch for congested breath sounds, wt. gain, dyspnea, change in LOC

Back 161

circulatory overload

Front 162

this is due to decreased peristalsis. watch for bowel sounds, nausea

Back 162

ileus

Front 163

this is due to loss of bladder tone and body fluid during surgery. Watch for decreased u.o. distended bladder

Back 163

urinary retention/decreased urine output

Front 164

why are drains used?

Back 164

to drain away excessive fluid which if allowed to accumulate would interfere w/ oxygen delivery, alter the cell wall permeability, disrupt lymph flow and create dead space

Front 165

where are drains placed?

Back 165

one end of the drain is placed in or near the cavity to be drained and the other end is brought out thru the body wall through a stab wound. Drainage not usually measured. ex. drain-penirose

Front 166

these are used to prevent blockage or to add suction in oder to help the tissue layers stay together?

Back 166

tubes

Front 167

what should the documentation include for tubes?

Back 167

what is draining out and how much

Front 168

tubes that have suctioned must have what maintained?

Back 168

suction maintained

Front 169

JP(jackson prat) and hemovac (orthopetic uses for hips and knees) are ex. of what form of drainage?

Back 169

tubes

Front 170

Wound healing:
what are some things that affect wound healing?

Back 170

wt., diabetes, PVD, steroids

Front 171

what are some types of wound healing?

Back 171

primary intent, secondary intent, tertiary intent

Front 172

most wounds heal this way, the incision is clean, straight, all layers of the wound are well approximated by suturing, heal w/ a minimum scarring?

Back 172

primary intent

Front 173

this type of wound is used when the edges can not be approximated, fill in by granulation over a large area, and has more scarring?

Back 173

secondary intent

Front 174

this type of wound delay between injury and suturing

Back 174

tertiary intent

Front 175

this is a partial or total separation of wound edges?

Back 175

dehiscence

Front 176

what is dehiscence caused by?

Back 176

infection, poor wound healing, abdominal distention

Front 177

what are some signs and symptoms of a dehiscence?

Back 177

low grade fever lasting 3-4 days, prolonged, increasing pain, serous fluid on dressing, c/o feeling like someone gave way or pulling at the suture

Front 178

what are the interventions for someone who has a dehiscence?

Back 178

notify MD,
apply binder for support,
remain calm discourage coughing, moving until re-ordered by the physician, prepare for surgery

Front 179

this is a sudden, dramatic, bursting of suture line w/ abdom. contents protruding out?

Back 179

evisceration

Front 180

what is evisceration caused by?

Back 180

infection, poor wound healing, abd. distention

Front 181

what are the s.s. of evisceration?

Back 181

c/o something popping, abdominal contents are outside the abdominal cavity

Front 182

what is the nursing intervention for someone who has an evisceration

Back 182

notify MD stat, stay w/ pt., cover the abdominal contents w/ moist gauze pads or sterile towels, keep the pt. supine remain calm, explain the pt. what happened, prepare for surgery

Front 183

disorders of the resp system:
what form of assessment, what type of questions?

Back 183

*history-personal and family,
*smoking history-pk yrs, exposure to second hand smoke,
*medication history-prescribed, illegal, allergies-environmental allergens
*travel/area of residence,
*occcupational history,
*socioeconomic status
*what is the current problem and how is it manifesting itself

Front 184

how would you determine the pack years?
ex: client smokes a pack a day and has been for the last 9 years?

Back 184

how many pks per day you smoke by the number of years

Answer 9

Front 185

when you ask what is the curent problem and how is it manifesting itself what are some typical answers?(what are you looking for)

Back 185

cough w/ or w/out sputum production (COLA),
dyspnea,
chest pain-sometimes in resp in nature however, could be cardiac

Front 186

what are some diagnostic tests for respiratory disorders?

Back 186

*blood tests-CBC, ABGs,
*Sputum Cultures-find out what's growing (resp therapist),
*CXR
*CT scan, w/ or w/out contrast
*ventilation perfusion scan (V/Q scan)-when they suspect the pt. has a pulmonary embolism

Front 187

when someone says they are in pain???? what should you do

Back 187

assess!!!!
where it is, severe (scale), anything else i can do for you, prn med find out when was the last time they had their med.

Front 188

what are some other diagnostic tests for the respiratory system?

Back 188

pulse oximetry-
pulmonary function tests,
exercise testing,
skin testing,
endoscopy,
thoracentesis,
lung biopsy

Front 189

this should between 95-100%. if less than 91 should treat
very objective data to evaluate the pts condition

Back 189

pulse oximetry

Front 190

this is used to evaluate lung function (runnig on a treadmill) and breathing problems, screening tool, provides very objective data regarding respiratory system

Back 190

pulmonary function (PFTs)

Front 191

this is used to diagnosis infectious diseases (tb, mumps)

Back 191

skin testing

Front 192

this allows the structures of the resp. system to be visualized.

Back 192

endoscopy

Front 193

what are some ex. of endoscopy?

Back 193

bronchoscopy, laryngoscopy, mediastinoscopy, must keep pt. NPO after the procedures until a gag reflex has returned.

Front 194

this is aspiration of pleural fluid or air from pleural space

Back 194

thoracentesis
stick a needle in the pleural cavity relievs pressure removing fluid or instill something in it.

Front 195

this provides tissue for histologic analysis, cultures, or cytotogic exam

Back 195

lung biopsy

Front 196

what is the term used for a nosebleed

Back 196

epistaxis

Front 197

what do you do for a nosebleed

Back 197

have pt. lean forward w/ pressure on the nose

Front 198

problems of oral pharynx and tonsils: describe obstructive sleep apnea;

Back 198

disruption in breathing that lasts at least 10 sec. and that occurs a minimum of 5X/HR,
usually occurs bx the tongue causes airway obstruction
causes lack of good/deep sleep
diagnosis is made w/ sleep study,

Front 199

what are some possible treatment's for someone who has sleep apnea

Back 199

**wt. loss**,
devices that prevent obstruction, CPAP/BiPAP (hold open the airway)
"I'm so tired when I woke up" they don't get a deep sleep

Front 200

this is a group of chronic lung diseases that includes asthma (reversible), chronic bronchitis (non-reversible), and pulmonary emphysema (non reversible)?

Back 200

Chronic airflow limitation CAL

Front 201

this includes emphysema and chronic bronchitis but not asthma. Non reversible lung diseases that cause tissue damage and eventually leads to death?

Back 201

Chronic Obstructive Pulmonary disease

Front 202

Asthma, unlike COPD is an intermittent disease w/ ? airflow obstruction and wheezing

Back 202

reversible

Front 203

what is the problem w/ the asthma? what happens?

Back 203

problem is asthma is that the airflow in the airways becomes obstructed wither due to inflammation or by constriction of the airways (bronchospasms) or by both of these problems

Front 204

what is the trigger for most asthma attacks?

Back 204

inflammation

Front 205

what should you ask in ref. to history for someone w/ resp. disorders?

Back 205

did the adult have asthma as a child?
does the problem occur seasonally, at night or in response to a specific exposure?,
is there a family history?,
is the person a smoker or a nonsmoker? 2nd hand smoke?

Front 206

what are some clinical manifestations for someone w/ asthma?

Back 206

may be asymptomatic,
audible wheezes-you don't need a stethoscope to hear it
increases RR,
Coughing-is it productive or nonproductive,
use of accessory muscles,
barrel chest-anterior posterior size is bigger
dyspnea-SOB,
cyanosis
decreased Oxygen saturation
mild intermittent,
mild persistant,
moderate persistent,
sever persistent

Front 207

this is a clinical manifestations for asthma what step is this;
symptoms or episodes occur twice per week or less.

Back 207

mild intermittent

Front 208

this is a clinical manifestations for asthma what step is this;
symptoms or episodes occur more than twice per week but not daily.

Back 208

mild persistent

Front 209

this is a clinical manifestations for asthma what step is this;
symptoms occur daily

Back 209

moderate persistent

Front 210

this is a clinical manifestations for asthma what step is this;
symptoms are continuosly present

Back 210

severe persistent

Front 211

this is a clinical manifestations for asthma what step is this;
when the physical activity is limited; frequently present at night

Back 211

severe persistent

Front 212

this is a clinical manifestations for asthma what step is this;
symptoms are present at night at least once per week

Back 212

moderate persistent

Front 213

this is a clinical manifestations for asthma what step is this;
symptoms are present at night more than twice per month

Back 213

mild persistent

Front 214

this is a clinical manifestations for asthma what step is this;
symptoms are present at night no more frequently than twice per month

Back 214

mild intermittent

Front 215

what are some goals for treatment for someone w/ asthma?

Back 215

improve airflow,
avoid things that trigger asthma attacks,
active involvement in the case-(important that they are educated fix the environment, how do I monitor what can I do?)

Front 216

what are some medications for someone w/ asthma?

Back 216

broncodilators, anti-inflammatory,
exercise
oxygen therapy

Front 217

this med improve smooth muscle relaxation w/out any effect on inflammation

Back 217

broncodilators

Front 218

this is a severe, life threatening acute episode of airway obstruction that gets worse and may not respond to routine treatment? (usually goes to the ER to get incubated)

Back 218

status asthmaticus

Front 219

if the problem w/ asthma is a constriction of asthma then we give?

Back 219

bronchodilators

Front 220

COPD:
this is the loss of lung elasticity w/ hyperinfaltion of lung resulting in dyspnea and increased RR

Back 220

emphysema

Front 221

this usually occurs w/ emphysema it is an inflammation of the bronchi and bronchioles caused by chronic exposure to irritants, affects only the airways and not the alveoli,
airways become blocked due to production of thick mucus

Back 221

chronic bronchitis

Front 222

what prevention may a person do to not potentially get COPD?

Back 222

smoke,

Front 223

What is the 4th cause of death in women

Back 223

COPD

Front 224

what is the 5th cause of death in men

Back 224

COPD

Front 225

what are some complications for COPD?

Back 225

hypoxemia and acidosis-decrease oxygen, increase carbon dioxide (retain CO2 and they have low levels of O2)

Front 226

This is due to increased mucus and decrease oxygenation

Back 226

respiratory infections

Front 227

what does cor pulmonale mean?

Back 227

cardiac failure:
rt. sided heart failure

Front 228

how would you assess a history of pt. w/ a COPD?

Back 228

Smoking,
environmental exposure
family history

Front 229

when asking a pt. about their COPD what questions do you ask?

Back 229

what is the state of breathing?
What triggered the problem?, Can the pt. talk w/out dsypnea (can they talk w/out sob)
Is there a productive cough?(nonproductive)
Have the ADLs been affected?
How does the pt. sleep?
has the pt. loss wt.?
Does the pt. have a barrel chest?
Is there finger clubbing? (resp. distress)

Front 230

what are some lab tests for someone w/ COPD

Back 230

ABGs will have a decreased oxygen and an increased carbon dioxide (norm. CO2 35-45)
PFTs used to classify COPD from mild to severe (give objective data)

Front 231

COPD pts that have high levels of CO2 will need what deliverd because their primary drive to breathe is the low oxygen level.

Back 231

Oxygen delivery (1-2L/m)
If you give too much oxygen they will stop breathing

Front 232

WHat is the max. amt. of O2 for someone w/ COPD?

Back 232

2L

Front 233

what are some ways to improve breathing?

Back 233

diaphragmatic breathing,
pursed lip breathing,
positioning (high fowlers),
exercise, energy conservation
(they need to have the pace themselves)

Front 234

What are some ways to improve secretion removal for pt. w/ COPD?

Back 234

Cough, (chest, sighing, yawning),
Chest PT and postural drainage,
Suctioning

Front 235

what are some nursing interventions for a pt. w/ COPD in ref. to nutrition?

Back 235

need more calories and protein due to increase work of breathing,
nutrition consult,
rest before meals,
small, frequent feedings,
may need bronchodilator prior to eating,
high calorie, high protein foods,
dietar supplements

Front 236

this term is used for the inflammation of the nasal mucosa

Back 236

rhinitis

Front 237

this term is used for the inflammation of the sinuses

Back 237

sinusitis

Front 238

this term is used for the inflammation of the mucous membranes of the pharynx

Back 238

pharyngitis

Front 239

this term is used for the inflammation of the tonsil

Back 239

tonsillitis

Front 240

this term is used for the inflammation of the mucous membranes of the larynx

Back 240

laryngitis

Front 241

this is an excess of fluid in the lungs due to an inflammatory process which is triggered by an infection

Back 241

pneumonia

Front 242

CAP is?

Back 242

Community Acquired Pneumonia

Front 243

this term is used for an infection from inside the hospital

Back 243

hospital acquired (nosocomial)

Front 244

what happens to the organisms w/ pneumonia

Back 244

they get into the airway and multiply

Front 245

WBC go to the site of infection and cause capillary leakage, edema and exudate causing the infection to spread what happens to the fluid?

Back 245

it collects and interferes w/ gas exchange,
if there is fluid in the alveoli doesn't expand, it collapses,

Front 246

with an pneumonia the infection may get to the point where it goes where?

Back 246

blood stream and spreads

Front 247

what is the 5th leading caused of death

Back 247

Pneumonia

Front 248

who are people at risk for CAP?

Back 248

older people,
no pneumonia/flu vaccine, poor overall health/chronic conditions,
recent exposure to flu,
alcohol and tobacco usage

Front 249

Who are people at risk for Nosocomial?

Back 249

older pt., chronic lung disease, gram negative colonization, altered LOC, aspiration, ET, Trachs, NG tubes, poor nutritional state, compromised immune system, meds that increase gastric pH, mechanical ventilation

Front 250

What are some clinical manifestations of pneumonia?

Back 250

look ill-flushed cheeks, anxious, uncomfortable, joint pain,
chest/pleuritic pain,
fever, chills,
cough w/ sputum production,
tachycardia-weak pulse,
dyspnea,
tachypnea,
congested breath sounds,
need to sit up
hypotension

Front 251

What are some lab tests for pneumonia?

Back 251

CBC,
ABGs
Radiographic tests-CXR
Pulse oximetry

Front 252

What are some nursing interventions for a pt. w/ pneumonia?

Back 252

Cough enhancement-expands their alveoli,
Oxygen therapy,
Respiratory monitoring

Front 253

this works by stimulating the beta 2 adrenergic receptors allowing the smooth muscles of the bronchi to relax:

Back 253

bronchodilators-does not have any effect on the inflammatory process

Front 254

Beta 2 Agonists, cholinergic antagonists, and methylxanthines are all examples of what?

Back 254

bronchodilators

Front 255

this binds to the beta 2 adrenergic receptors causing an increase in the intracellurlar level of cyclic adenosine monophosphate (cAMP) resulting in relaxation of the smooth muscle.

Back 255

beta 2 Agonists

Front 256

beta 2 agonists can be ?or ?

Back 256

short or long acting

Front 257

the short acting beta 2 agonists is most effective if used when ?

Back 257

at the beginning of an attack or if an attack is anticipated

Front 258

this provides rapid but short term relief. Medication is delivered directly to the problem w/ minimal side effects

Back 258

short acting beta2 agonists

Front 259

albuterol (Proventil, Ventolin) is an ex. of what

Back 259

short acting beta 2 agonist

Front 260

bitolerol (Tornalate) and pirbuterol (Maxair) are ex. of what

Back 260

short acting beta 2 agonist

Front 261

these can be administered either as metered dose inhaler (MDI0 or as a dry powder inhaler (DPI)

Back 261

short acting beta 2 agonists

Front 262

what are some side effects of short acting beta 2 agonists

Back 262

may cause tachycardia w/ too much, dry mouth and throat (bx inhaled), must use inhaler correctly to receive the correct amount of med., using a bronchodilator first may make other inhaled med. more effective.

Front 263

these medicines are sometimes referred to as rescue med.

Back 263

short acting beta 2 agonistsnot going to last for more than 4-6 hrs.

Front 264

this med needs time to build up an effect but last long, they also deliver the med. directly to the bronchioles

Back 264

long acting beta 2 agonists lasts about 12 hrs.

Front 265

salmeterol (Serevent) and Formoterol, fumarate (Foradil Aerolizer) are ex. of what kind of med?

Back 265

Long acting beta 2 agonists

Front 266

this form of beta 2 agonists is better used for prevention of attack

Back 266

long acting beta 2 agonists

Front 267

this may also be anticholinergic agents (may cause mouth dryness)

Back 267

cholinergic antagonist
(ex. during surgery: given Atropine your mouth was dry)

Front 268

this works by blocking the parasympathetic nervous system so that the sympathetic nervous system takes over causing bronchodilation and decreaed pulmonary secretions,
usually short acting,
must be used several times a day

Back 268

cholinergic antagonists

Front 269

ipratropiun (Atrovent) is an ex. of what?

Back 269

Cholinergic

Front 270

this is used when the other drugs don't work,
are admin. systemically and have side effects and NARROW THERAPEUTIC RANGES(pill or IV)

Back 270

methylxanthines; theoyphlline

Front 271

theophylline (Theo_Dur) aminophylline (truphylline)

Back 271

methylxanthines (we try to stay away from them bx. of side effects

Front 272

what are some side effects of methlxanthines?

Back 272

narrow therapeutic range which may be very close to what is needed to cause bronchodilation. Monitor blood level often,
THEOPHYLLIN LEVEL SHOULD BE 10-20MCG/ML, Observe for signs of toxicity N/V/D, tachycardia, dysrhythmias, reslessness, caffiene potentiates these systems

Front 273

what should the level of theophyllin be?

Back 273

10-20mcg/ml

Front 274

this is usually the early sign that the person is toxic from theophylline?

Back 274

nausea

Front 275

corticosteroids is an ex. of what kind of agents?

Back 275

anti-inflammatory agent

Front 276

this isgiven to decrease inflammation, they are given systemically or by inhalation, and have many sde effects?

Back 276

anti-inflammatory agents

Front 277

mast cell stabilizers, monoclonal antibodies, leukotriene antagonists, and inhaled anti-inflammatory agents are all ex. of what kind of agent?

Back 277

anti-inflammatory agents

Front 278

this decreases inflammation by preventing the synthesis of mediators, may be given as an inhaler or systemically

Back 278

corticosteroids

Front 279

fluticasone (Flovent) and budesonide (Pulmicort) are ex. of what?

Back 279

corticosteroids

Front 280

what is a side effect of a corticosteroids?

Back 280

make the pt. susceptible to oral infections.

Front 281

Systemic corticosteroids have serious side effects so they are only used when?

Back 281

for severe problems

Front 282

this inhibits the release of inflammatory mediators from respiratory cells and white blood cells,

Back 282

inhaled nonsteroid anti-inflammatory agents

Front 283

nedocromil (Tilade) is an ex of what?

Back 283

inhaled nonsteroid anti-inflammatory agents

Front 284

this prevents attacks more than reverse them, must be used on a regular basis even if there are no symptoms

Back 284

inhaled nonsteroid anti-inflammatory agents

Front 285

this prevents the mast cell membranes from opening when an allergen binds to IgE, helpful in the prevention of attacks more than reversing an attack

Back 285

Mast cell

Front 286

cromolyn sodium (Intel) is an ex. of?

Back 286

mast cell stabilizers

Front 287

this work by binding w/ IgE receptor sites on mast cells and basophils preventing allergens from releasing mediators from the mast cells and basophils,
helpful in the prevention of attacks then during ethe attack,

Back 287

Monoclonal antibodies

Front 288

this works by either preventing leukotriene synthesis or blocking the leukotriene receptors,
given orally

Back 288

leudotriene antagonists

Front 289

zafirlukast (Accolate), montelukast (Singulair) are ex. of?

Back 289

Leukotriene antagonists

Front 290

what must you monitor for pt. on Singulair?

Back 290

liver function

Front 291

these are common anti-infectives med. Used for what;
azithromycin, levofloxacin, ticarcillin, vancomycin, ciprofloxacin

Back 291

medications for pneumonia

Front 292

what must you make sure the pt. does using the inhaler?

Back 292

use it correctly PATIENT EDUCATION

Front 293

this med. must be stopped for 48 hrs prior to and 48 hrs after the pt. has any contrast dye procedure

Back 293

metformin bx. it puts them at the risk for renal failure

Front 294

regardless of what kind of med. you give what kind of pt. education does the nurse do?

Back 294

about the potential side effects (biggest is hypoglycemic for diab),
taking med. in relation to their meals (don't eat greater risk for hypo.),
know the name, dose, control diet, exercise (it decreases the need for med), educate on when to call physician.

Front 295

U-100 means what

Back 295

most common strength
100 units of insulin in 1mL of solution

Front 296

short action insulin's onset is?

Back 296

30 min.

Front 297

short action's peak is

Back 297

2-4hrs.

Front 298

why is it important to know when the onset of insulin (how quickly it is going to work)


duration how long its going to act

Back 298

bx. you need to feed them on the onset of the insulin

Front 299

why is it important to know when the peak of insulin (at where the greater action is going to be)?

Back 299

bx when its doing its most work you should give the person a snack

Front 300

why is it important to know the duration of insulin (how long its going to act)?

Back 300

bx once its gone you need to give them something else

Front 301

hypoglycemic is most likely to occur doing which time of?

Back 301

peak time of insulin

Front 302

make sure you have what when insulin is started?

Back 302

food

Front 303

pts that use HUMALOG is going to start to work when?

Back 303

mostly w/in 15-30 min

Front 304

if you are going to admin. humalog at what point to get the food tray

Back 304

you need it in the room

Front 305

the peak for humalog is what?

Back 305

1-2hr.

Front 306

for the peak of someone given humalog what would you give them if they are feeling shaky, and they had already eaten bkfst. and its now 10 am

Back 306

snack
graham crackers and milk

Front 307

are all diabetics overwt. if not explain?

Back 307

type I are a normal body build and sometimes even skinny,
type II are often overwt.

Front 308

REGULAR insulin is what kind of insulin?

Back 308

short acting

Front 309

what is the onset of regular insulin?

Back 309

30min

Front 310

if you are going to give someone regular insulin at what point do you get the food tray?

Back 310

you must make sure you know the food tray is going to make it there w/in the 30min. for ex. 7am give insulin make sure they have something for 7:30am they need the food bx their blood sugar will fall

Front 311

peak of action for someone w/ regular insulin is what?

Back 311

2-4hrs. they usually have a snack

Front 312

what does regular insulin look like

Back 312

clear

Front 313

what kind of insulin is the only insulin that can be added to the IV

Back 313

Regular insulin

Front 314

NPH insulin is another form of insulin what is the onset?

Back 314

1-4hr

Front 315

Lantus insulin is a long acting form of insulin what is important to know about lantus?

Back 315

it cannot be combined w/ any other else the brand not the long acting

Front 316

What form of insulin is NPH?

Back 316

Intermediate Acting

Front 317

what color is NPH insulin

Back 317

Cloudy

Front 318

we also use a combination insulin an ex. 70/30 what does that mean

Back 318

70 units NPH and 30 units Regular

Front 319

What is the most common complication of diabetes?

Back 319

cardiac problems

Front 320

Which form of diabetics uses insulin

Back 320

TYPE I

Front 321

how do we manage pts. blood sugar in the hospital

Back 321

sliding scale

Front 322

most of the time if the pt. is not npo, or continous feedings, and they are eating when would you ck. w/ the sliding scale

Back 322

before each meals
4 times a day

Front 323

if they are getting continous tube feedings, npo when would you ck accucheck?

Back 323

every 6 hrs.

Front 324

why would a pt. on hyperalimentation and is not a diabetic need to get the blood sugar ck.?

Back 324

bx. we want to make sure the pt. can tolerate it considering a lot of its made of sugar

Front 325

what is the problem w/ diabetes?

Back 325

they don't have insulin or they can't use it efficiently

Front 326

pts. who are diabetics must???

Back 326

understand how their disease process works, failure to control leads to many complications,
must be compliant w/ the TREATMENT MODALITIES, be active in their treatment, lifestyle changes

Front 327

diabetes is a ?? condition?

Back 327

chronic

Front 328

patients w/ diabetics are better treated by whom?

Back 328

Endocrinologist

Front 329

what are some environmental factors for someone w/ diabetes?

Back 329

this is seen more w/ type II as a result of poor eating habits in those that are predisposed, wt. gain, eating habits

Front 330

Type I diabetic pts. are dependent on what?

Back 330

insulin

Front 331

in type I the beta cells is what produces insulin they are destroyed for some reason maybe virus, they were born w/out beta cells, that is why they depend on they require what kind of treatment??

Back 331

insulin its important concept when you think of treatment modalities they can not get oral med.

Front 332

what kind of body build does a Type I diabetic have?

Back 332

normal build, lean, don't always have to be overwt.

Front 333

what is the treatment for type I diabetic?

Back 333

insulin, diet, and exercise

Front 334

what population of people are seeing in increase?why?

Back 334

the us is obese, we see a huge number in young people under the age of 40

Front 335

gestational diabetes is what?

Back 335

when your pregnant you get diabetes

Front 336

these people can control their diabetes w/ diet, exercise and oral med

Back 336

Type II, but they sometimes do need insulin
ex. pt. w/ copd on steroids their blood sugar is going up bx of med. yet their blood sugar is 235 on a sliding scale, and now you need to give them insulin
they don't necessarily have to continue taking insulin once they leave the hospital
DON"T ASSUME JUST BX YOUR GIVING INSULIN IN THE HOSPITAL THEY ARE A TYPE I DIABETIC

Front 337

this is a group of disorders w/ insulin resistance as the primary porblem such as CAD< atherosclerosis, elevated BP

Back 337

metabolic syndrome (syndrome X)

Front 338

complications for diabetics are a huge problem what are some ex.?

Back 338

2.5X more likely to have a stroke,
leading cause of adult blindness,
2-4X more likely to have heart porblems,
leading cause of end stage kidney problems, 80%of lower limb amputations

Front 339

What is the key for the complications in diabetics?

Back 339

EDUCATION

Front 340

what is the most common problem for someone w/ diabetes?

Back 340

heart problems

Front 341

one of the things that people w/ diabetes their complications are microvascular its the small vessels but they cause?

Back 341

macrovascular issues even thou its the small vessels that are affected its the small ones that cause the problem

Front 342

how often should a diabetic have an eye exam?

Back 342

once a year

Front 343

smoking is a problem bx.

Back 343

it affects everything and it makes everything become constricted

Front 344

why would smoking be a problem for a diabetic who lost their sight?

Back 344

safety

Front 345

what is the number 1 reason for dialysis?

Back 345

diabetes

Front 346

how do we treat pts. from heart problems?

Back 346

healthy living, no smoking, control blood sugar, eat low fat foods, regular exercise, control blood pressure,

Front 347

diabetics have bad peripheral neuropathy they don't have the same sensation in their foot and hands, that normal people have they often get sores that don't heal therefore what is important?

Back 347

foot care, inspect, look, they need to be taught, family, ck for blisters, red spots, cuts,
ALWAYS WEAR SHOES pts w/ bad neurothapy aren't going to feel the way we do education

Front 348

diabetics should have their urine ck. at least how many times a yr?

Back 348

once its an early clinical sign of problem-_ micoralbuninuria

Front 349

Pts. w/ diabetics may have male erectile dysfunciton (ED) they can not take VIAGRA if they are on heart med. bx ?

Back 349

it has nitrate and it will lower the blood pressure

Front 350

when a person has insulin deficiency

Back 350

the body has trouble using nutrients to make energy
(can't use carb, fats, glucose, they don't use them correctly its not really sugar problem) so their body starts to break down protein, and their own glycogen supply, and then ketone bodies are formed

Front 351

what organ produces ketones

Back 351

liver

Front 352

what are the clinical manifestations of diabetes?

Back 352

POLYURIA,
POLYDIPSIA,
PLOLYPHAGIA

Front 353

increased urination, glucose and water go together, body is tring to get rid of glucose

Back 353

plolyuria

Front 354

this is increased thirst, occurs due to water lost w/ polyuria, intense thirst?

Back 354

polydipsia

Front 355

this is increased hunger, cells are not being nourished, occurse as the cells become starved of food?

Back 355

polyphagia

Front 356

how do we make a diagnosis there are three different ways for adult man and non pregnant woman?

Back 356

random blood sugar, (any time ck >200 plus 3poly)
fasting blood sugar (npo >126mg/dl on at least 2 occasions)blood sugars change so frequently we don't use it as a base line
2 hr post prandial (after you eat >200 during oral glucose tolerance test)

Front 357

this tells us how the diabetic is doing what test is it?

Back 357

hemoglobin A1C
it works bx the glucose attaches to the hemoglobin,
and it is an average percentage taken for the 2-3 mo period the before the test

Front 358

what is a normal percent for A1C

Back 358

4-6%

Front 359

a person w/ an 8% A1C what would that mean?

Back 359

that the person does not have good control over their diabetes.

Front 360

pts that are diabetic have high blood sugar but when we treat them we put them at risk for what?

Back 360

hypoglycemic

Front 361

hypoglycemia is a blood glucose less than?

Back 361

70mg/dl depends on hospital p&p

Front 362

what are some causes of hypoglycemic?

Back 362

we are giving them insulin that's not physiologically good, inconsistent carb. intake, omission of meal, too much insulin,

Front 363

ex. you look at the sliding scale and the dr. ordered 10 units of insulin and the u looks like an o and you think it says 100 you would have what to the pt.

Back 363

over dose

Front 364

when we exercise what does that do to the requirement of insulin?

Back 364

we need less

Front 365

what are some signs and symptoms of hypoglycemia

Back 365

most common:shaky, very irritable, headache
listen to what the pt. says to you if they say "i think my blood sugar is low"
pallor, diaphoresis, tachycardia, piloerection, palpitations, nervousness, sensation of coldness, weakness, trembling, hunger, irritability, headaches

Front 366

aganergic symptoms are what?

Back 366

its when they are on some other med (ex. cardiac), they may not have the symptom of hypoglycemic
ex. beta blocker slows down heart rate, they may not have tachycardia as a symptom

Front 367

how do you treat the pt. who is hypoglycemic?

Back 367

get blood sugar, (hospital P&P) 1st verify that it is low, if they are awake and conscious give them a 10-15g. of a quick acting carb, then recheck your blood sugar again 15min, if its still below the protocol treat them again, if you suspect that they are hypoglycemic and you don't have an accucheck treat them anyway

Front 368

what is an ex. of a quick acting carb

Back 368

orange juice

Front 369

if pt. is unconscious and they are hypoglycemic what may you do?

Back 369

give 50% glucose IV

Front 370

oral medications in ref to diabetes pts need to understand that they are not taking what?

Back 370

a form of insulin,
oral med are not an oral form of insulin,
they need to know what they are on, dosage, names, multiple different kinds of med.,

Front 371

should the physician should be notified inthe case of suspected hypoglycemia?

Back 371

false,
should ck. blood sugar if below then give OJ or hard candy and ck again

Front 372

these drugs class is sulfonylureas?

Back 372

glucotrol, glucotrol XL, Amaryl, Diabeta, Micronase, Glynase

Front 373

this drug's duration is 24 hrs is good for a pt. who might not be compliant w/ his type II diabetes

Back 373

Amaryl

Front 374

which drugs would you hold for 48 prior to surgery and certain procedures due to contrasts the dye

Back 374

metaformin and glocovance

Front 375

this oral drug stimulates insulin release and its onset is 15 min.

Back 375

Prandin a Repaglinide meglitinide analogs

Front 376

what kind of syringes do we use for insulin?

Back 376

insulin syringe

Front 377

why is it important for you to coordinate insulin action w/ dietary carb. and activity?

Back 377

insulin is available for optimal metabolism when the food that was eaten is absorbed,
food is available while insulin is acting to prevent hypoglycemic reactions

Front 378

what is the only type of insulin that is added to IV

Back 378

short action insulin
REGULAR

Front 379

what is a normal blood sugar?

Back 379

80-120

Front 380

what are the steps to administer an IVPB via a primary line?

Back 380

1. Prime the secondary tubing w/ the IVPB sol. being careful not to waste any of the IVPB fluid. Close the clamp when done
2. Label the tubing w/ the date the tubing was hung,
3. Calculate the infusion rate. use the drop factor that is on teh secondary tubing bein gused
4 Observe the IV site for signs of redness, swelling, infiltration
5 Hange the IVPB on the bedside pole
6 Swab the connecting port of the primary tubing w/ alcohol
7 connect the tubing for the IVPB to the primary tubing. Keep the IVPB clamp close for now.
8 lower the primary IV bag on the hook
9 open up the IVPB roller clamp
11 Regulate the IVPB flow rate using the primary line roller clamp to the predtermined rate
11. Observe the IV infusion
12. At the completion of the IVPB infusion, return to the room and close the roller camp of the IVPB tubing
13 remove the primary IV bag from the hook and raise it up
14. Readjust the primary IV rate to what is ordered
15. Leave the IVPB bag hanging on the IV pole for the next time
16 Doc. med. , time, rate
17 as with all med. you would perform the three cks and the five rights

Front 381

what are the supplies needed to admin. an IVPB via a primary line

Back 381

-alcohol swabs, IVPB bag, secondary tubing, hook to lower the primary IV bag

Front 382

when would you use the SAS in ref to IVPB?

Back 382

adminstering via a saline lock

Front 383

when would you use SASH in ref. to IVPB?

Back 383

IVPB via a central line to a port that is locked

Front 384

when the term locked is used in ref to IV what does that mean?

Back 384

does not have fluid running thru it currently

Front 385

when aspirating prior to admin. saline on a central line and there is no blood return what do you do?

Back 385

attempt to push the saline thru the central catheter. DO NOT FORCE IT. observe the site for swelling and listen for any complaints of pain by the pt.

Front 386

what does SASH mean?

Back 386

(aspirate prior)Saline,
Administer Med.
Saline,
Heparin

Front 387

how would you teach a client on how to use an inhaler w/out a spacer (preferred technique)

Back 387

before each use, remove the cap and shake the inhaler according to the instructions in the package insert.
tilt your head back slightly and breathe out fully
open your mouth and place the mouthpiece 1-2 inc. away.
as you begin to breathe in deeply through your mouth, press down firmly on the canister of the inhaler to release one dose of med.
continue to breathe in slowly and deeply (usually over 3-5sec), hold your breath for at least 10 sec. to allow the med. to reach deep into the lungs, then breathe out slowly,
wait at least 1min. between puffs.
replace cap on the inhaler
at least once a day, remoe the canister and clean the plastic case adn cap of the inhaler by thoroughly rinsing in warm, running tap water

Front 388

what nursing intervention would the nurse do first if they entered a room w/ a patient who had difficulty breathing?

Back 388

place the pt. in the high fowler's position
(take deep breaths, cough)

Front 389

what is the alternative method for using an inhaler w/out a spacer?

Back 389

before each use, remove the cap and shake the inhaler according to the instructions in the pack.
tilt your head back slightly and breathe out fully
place the mouthpiece into your mouth, over your tongue, and seal your lips tightly around it,
as you begin to breathe in deeply through your mouth press down firmly on the canister of the inhaler to release one dose of med.
continue to breathe in slowly and deeply (usually over 3-5sec), hold your breath for at least 10sec. to allow the med. to reach deep into the lungs, then breathe out slowly.
wait at least 1 min. between puffs.
replace the cap on teh inhaler
at least once a day, remove the canister an dclean the plastic case adn cap of the inhaler by thoroughly rinsing in warm, running tap water.

Front 390

when using a spacer if it makes a whistling sound what is happening?

Back 390

you are breathing too rapidly

Front 391

what would you teach client to use prior to w/ asthma?

Back 391

teach client to monitor heart rate,
increase water/fluid intake
intstruct client to use bronchodilator at least 5min. before other inhaled drugs. Teach client the correct technique for using the inhaler and obtain a return demon.