Mark klimek blue book pdf free download

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Download Mark Klimek Blue book (ALL) NCLEX Study Guide UPDATED 2022 and more Nursing Exams in PDF only on Docsity! Mark Klimek Blue book (ALL) NCLEX Study Guide UPDATED 2022 2022 Mark Klimek Blue Book Name the five/six essential nutrients - carbs, fats, proteins, vitamins, minerals, water The major source of energy for the body is - carbs carbs provide ____________ Kcalories per 1 gram - 4 Sucrose is a sugar found in ____________ and _____________. - fruits, veggies Lactose is a sugar found in ? - milk What is glycogen? - It is a stored formed of glucose/energy manufactured by the liver Is glycogen eaten in foods? - NO! It is a stored form of glucose MANUFACTURED by the liver. When the body does not receive enough carbs it burns ___________ and _____________. - protein, fat The most concentrated source of energy for the body is ___________. - fats Fats provide ___________ Kcalories per 1 gram. - 9 Fats carry vitamins - A,D,E,K (Remember FADE K!) The nutrient needed most for growth and repair of tissues is _____________. - protein (second best is Vit C) Proteins provide __________ Kcalories per 1 gram. - 4 Will the patient be able to close their eye on the affected side? - no Give three eye interventions for the client with Bell's Palsy. - Dark glasses, artificial tears, cover eye at night As the prostate enlarges it compresses the ___________ and causes urinary ________. - Urethra, rentention At what age does BPH occur? - men over 50 years of age What does BPH stand for? - Benign Prostatic Hypertrophy IN BPH the man has (increased/decreased) frequency of urination - increased In BPH the force of the urinary stream is (increased/decreased). - decreased The man with BPH has a _________-stream of urine - forked The man with BPH has hesitancey. What does this mean? - Difficulty starting to void Will the man with BPH have enuresis, nocturia or hematuria? - Enuresis-No, Nocturia-Yes, and Hematuria-Maybe Enuresis - inability to control the flow of urine and involuntary urination What is the best way to screen men for BPH? - Digital rectal exam Should fluids be forced or restricted in BPH? - forced What does TURP stand for? - Transurethral resection of the prostate The most radical prostate surgery is the ____________ prostatectomy. - Perineal What type of diet is used in BPH? - Acid Ash Acid Ash diet - Decrease pH (makes urine acid) Chz, eggs, Meat, fish, oysters, poultry, Bread, Cereal, Whole Grains, Pastries, Cranberries, Prunes, Plums, Tomatoes, Peas, Corn, Legumes. What is the primary purpose of a 3 way continuous bladder irrigation (CBI) after TURP? - To keep the catheter clear of clots and to drain urine What solution is used for CBI? - Normal saline (0.9 NaCl) How fast do you run the CBI? - At whatever rate it takes to keep the urine flowing and free of clots What drug is use to treat bladder spasm? - B&O suppositories (Belladonna & Opiates) Should you take a rectal temp after prostatectomy? Give stool softeners? - No rectal temperatures, yes stool softeners You should call the MD after TURP when you see _________ thick ________, _____________ clots, and ____________ urine drainage on the dressing. - Bright thick blood, persistent clots, persistent urine on dressing (don't call MD for transitory clots and urine on dressing.) If you see an increase in blood content of urine coming out of the catheter, you would first ___________. - Pull carefully on the catheter to apply local pressure on the prostate with the Foley balloon. If you see clots in the tubing you would first ____________. - Increase the flow-rate. What exercises should the post prostectomy patient do upon discharge? Why? - Perineal exercises, start and stop stream of urine, because dribbling is a common but temporary problem post op Will the post prostectomy patient be impotent? - If TURP, no impotence, if perineal prostatectomy, yes impotence How often should the drainage bag be emptied? - Every 8 hours What is the most common problem due to catheterization? - UTI What is the most common organism to cause UTI with catheterization? - E. coli What is the most common route for organisms to enter the blader when a catheterization is used? - Up through the inside of the catheter in the days following catheterization Name foods that make acid urine - Cranberry juice, apple juice (avoid citrus juices- they make alkaline urine) What is important about the level of the urinary drainage bag? - Never have the bag at a higher level than the bladder. How is the catheter taped in a male client? - To the lateral thigh or abdomen How is the catheter taped in a female client? - To the upper thigh What urinary pH prevents UTI? - Acidity, low pH Should the drainage bag ever touch the floor? - No Is it ok to routinely irrigate indwelling catheters? - No What blood test must be done before a transfusion? - Type and cross match What does a type and cross match indicate? - Whether the client's blood and donor blood are compatible. What should the nurse measure before starting a transfusion? - Vital signs With what solution should blood be transfused? - 0.9 normal saline How many nurses are requried to check the blood? - 2 nurses What happens when blood is administered with Dextrose IVs? - The cells clump together & don't flow well If a transfusion reaction occurs what should the nurse do first? - Stop the blood flow & start running the saline How long can a unit of blood be on the unit before it must be started? - Less than 1/2 hour What should the nurse do with the IV line if transfusion reaction is suspected? - Keep it open with saline If a transfusion reaction is suspected, what two samples are collected and sent to the lab? - Urine & blood If a unit of blood is infused through a central line it must be__________. - Warmed Which of the following are signs of transfusion reaction? Bradycardia, Fever, Hives, Wheezing, Increased Blood Pressure, Low Back Pain - Low back pain, wheezing, fever, hives What are three types of transfusion reactions that can occur? - Hemolytic, febrile, allergic What would you do first if you suspected transfusion reaction? - Stop the blood and start the saline What are the signs and symptoms of a hemolytic transfusion reaction? - Shivering, HA, low back pain, increased pulse & respirations, decreasing BP, oliguria, hematuria What are the signs and symptoms of a febrile transfusion reaction? - Low back pain, shaking HA, increasing temperature, confusion, hemoptysis What are the signs of symptoms of an allergic reaction to a transfusion? - Hives- uticaria, wheezing, pruritus, joint pain, (arthralgia) Give three reasons for a blood transfusion - Restore blood volume secondary to hemorrhage, maintain hemoglobin in anemia, replace specific blood components What does blood-typing mean? - Check for surface antigen on the red blood cell When does typing and cross matching need to be done? - Whenever a client is to get a blood product. It is only good for 24 hours. What does blood cross matching mean? - Mixing a little of the client's blood with the donor blood and looking for agglutination. When are hemolytic transfusion reactions likely to occur? - In the first 10 to 15 minutes When is a febrile reaction likely to occur? - Within 30 minutes of beginning the transfusion What test identifies Rh factor? - Coombs test detects antibodies to Rh What is the difference between whole blood and packed cells? - Packed cells don't have nearly as much plasma or volume as whole blood does What would you do if the client had an increasing temperature and was to get blood? - Call the MD because blood is often held with an elevated temperature How long should it take for one unit of blood to infuse? - From one hour to three hours How long should you stay with the patient after beginning a transfusion? - At least 15 to 30 minutes What blood type is the universal recipient? - AB What blood type is the universal donor? - O What is the routine for vital sign measurement with a transfusion? - Once before administration Q15 x 2 after administration is begun Q1 x1 after transfusion has stopped What IV solution is hung with a blood transfusion? - 0.9 normal saline (No glucose) What gauge needle is used with a blood transfusion? - Large gauge, 18 gauge What other things are appropriate after a reaction? - Call MD, get a blood sample, get urine sample, monitor vitals, send blood to lab Can blood be given immediately after removal from refrigeration? - No, it has to be warmed first for only about 20 to 30 minutes. With what solution & when should a breast feeding mother cleanse the areola? - Plain water, before & after each feeding Of first, second and third degree burns which has less pain? Why? - Third degree burns, nerve damage has occured For what purpose do you use the rule of nines? - To estimate the percentage of body surface burned; is NOT used for children. In the rule of nines, the head and neck receive _______: each arm receives_______. - 9%, 9% In the rule of nines, the front trunk gets_____, the posterior trunk gets_____, each leg gets ______ and the genitalia gets________. - 18%, 18%, 18%, 1% What is the only IM given to a burn patient? - Tetanus toxoid- if they had a previous immunization; tetanus antitoxin- if they have never been immunized before (or immune globulin) In the emergent phase do you cover burns? (in the field) - Yes, with anything clean and dry. Should you remove adhered clothing? - No Name the 3 phases of burn - Shock, diuretic, recovery Fluid moves from the___________ to the _______ in the SHOCK phase. - Bloodstream, interstitial space The shock phase lasts for the first ________ to ________ hours after a burn. - 24 to 48 hours During shock phase of a burn is potassium increased or decreased? Why? - Increased, because of all the cells damaged- the K+ is released from damaged cells. What acid-base disorder is seen in the shock phase of a burn? - Metabolic Acidosis What is the #1 therapy in the shock phase? - Fluid replacement/resuscitation What is the simple formula for calculating fluid replacement needs in the first 24 hours? - 3cc X Kg X % burned per day If the MD orders 2,800 cc of fluid in the first 24 hours after a burn, one-_____ of it must be infused in the first 8 hours. - Half (or 1,400 cc) What blood value will dictate IV flow rate? - The hematocrit How will you know the patient has entered the fluid mobilization or diuretic phase? - The urine output will increase How long does the fluid mobilization or diuretic phase of a burn last? - 2 to 5 days In the diuretic phase, K+ levels fall or rise? - Fall- remember diuresis always causes hypokalemia If the nurse accidentally runs the IVs at the shock phase rate during the diuretic phase the patient will experience? - Pulmonary edema The burn patient will be on _______urine output and daily __________. - Hourly, weight Sulfamyon cream__________. - Burns Silver nitrate cream___________ the ________. - Stains, skin Pain medications should be administered _______ before ________ care. - 30 minutes, wound care When using silver nitrate, the dressings must be kept __________. - Wet What is Curlings ulcer? Why is it a problem in burn patients? What drug prevents it? - It is a stress GI ulcer, you get these with any severe physical stress. Tagamet, Zantac, Pepcid (any H2 receptor antagonist), Protonix Prilosec In Abruptio Placenta, the placenta _______________ from the uterine wall ____________. - Separates, prematurely Abruptio Placenta usually occurs in (prima/multi) gravida over the age of ____________. - Multigravida, 35 (HTN, trauma, cocaine) How is the bleeding of Abruptio Placenta different from that in placenta previa? - usually pain; bleeding is more voluminous in previa If you are the nurse starting the IV on the client with Abruptia Placenta, what guage needle should you use? - 18 (in preparation to give blood if necessary) How often should you measure the vital signs, vaginal bleeding, fetal heart rate during Abruptio Placenta>? - Q5-15 minutes for bleeding and maternal VS, continuous fetal monitoring, deliver at earliest sign of fetal distress How is an infant delivered when Abruptio Placenta is present? - Usually C-section Is there a higher or lower incidence of fetal death with Abruptio Placenta compared to Placenta Previa? - Highter In what trimester does Abruptio Placenta most commonly occur? - Third At what age are accidental poisonings most common? - 2 years old If a child swallows a potentially poisonous substance, what should be done first? - call medical help What is the first test for HIV antibodies? - ELISA What test confirms the ELISA? - Western Blot Which test is the best indicator of the progress of HIV disease? - CD4 count A CD4 count of under __________ is associated with the onset of AIDS-related symptoms. - 500 A CD4 count of under _______ is associated with the onset of opportunistic infections. - 200 Give 6 symptoms of HIV disease. - Anorexia, fatigue, weakness, night sweats, fever, diarrhea Which 2 classes of drugs are given in combination for HIV sero-positivity? - NRTI's (nucleoside reverse transcriptease inhibitors) and PI's (protease inhibitors) They prevent viral replication. NRTI (nucleoside reverse transcriptease inhibitors) - an antiviral drug used against HIV (is incorporated into the DNA of the virus and stops the building process; results in incomplete DNA that cannot create a new virus; often used in combination with other drugs) PI's (Protease inhibitors) - most potent of antiviral meds, inhibit cell protein synthesis that interferes with viral replication, does not cure but slows progression of AIDS and prolongs life, used prophylactically, used in AIDS to decrease viral load and opportunistic infections What do NRTI's and PI's do? - They prevent viral replication What does the physician hope to achieve with NRTI's and PI's for HIV? - A delayed onset of AIDS for as long as possible (usually can delay onset for 10-15 years) What is the most common NRTI used? - AZT (zidovudine) What is the most challenging aspect of combination of drug therapy for HIV disease? - The number of pills that must be taken in 24 hours can be overwhelming. The frequency also makes it hard to remember-an alarm wristwatch is used. Clients with AIDS (gain/lose) weight? - lose The typical pneumonia of AIDS is caused by ___________ ____________. - Pneumocystic carinii What type of oral/esophageal infections do AIDS patients get? - Candida What is the #1 cancer that AIDS patients get? - Kaposi's sarcoma Kaposi's sarcoma is a cancer of the ___________. - skin T/F: AIDS patients get lymphomas? - True What lab findings are present in AIDS? - Decreased RBC's, WBC's and platelets If the AIDS patient has leukopenia they will be on _____________ ________________. - protective (reverse) isolation Define Leukopenia - decrease in wbc, indicated viral infection Without leukopenia the AIDS patient will be on ____________ precautions. - Standard precautions or blood and body fluid precautions When the AIDS patient has a low platelet count, what is indicated? - bleeding precautions; No IM's, no rectal temperatures, other bleeding precautions Does AIDS require a single room? - Yes - if WBC counts are low When do you need a gown with AIDS? - If you are going to get contaminated with secretions When do you need a mask with AIDS? - Not usually unless they have an infection caused by an airborne bug When do you need goggles with AIDS? - Suctioning, central line start, arterial procedures If an AIDS patient's blood contaminates a counter top, with what di you clean? - 1:10 solution of bleach and water Are all articles used by AIDS patients double-bagged? - no - only those contaminated with secretions Can AIDS patients leave the floor? - Yes, unless WBC's are very low Is dietary protein limited in AGN? - Not usually, however if there is severe azotemia then it may be restricted Define azotemia? - nitrogenous wastes in the blood (increased creatinine, BUN) What is the best indicator of renal function? - The serum creatinine Do people recover from AGN? - Yes, the vast majority of all clients recover completely from it How can AGN be prevented? - By having all sore throats cultured for strep and treating any strep infections The #1 contracture problem in AKA is ____________ of the _____________ - flexion, hip What will prevent hip flexion contracture after AKA? - Lying prone several times a day What is the #1 contracture problem after BKA? - Flexion of the knee How do you prevent flexion contracture of the knee after BKA? - Remide the patient to straighten their knee constantly while standing To prevent post-op swelling, the stump should be __________. - elevated How long should the stump be elevated to prevent post op swelling? - 12-24 hours How often should a stump be washed? - daily When a stump is wrapped, the bandage should be tightest _____________ and loosest _____________. - distally (far from the center), proximally (neareast to the point) If after a right BKA, the client c/o pain in his right tow, he is experiencing _____________. - phantom limb sensation (which is normal) When will phantom limb sensation subside? - in a few months Name ways to toughen a stump so it will not breakdown due to the wear of the prosthetic leg? - push the stump against the wall, hitting it with a pillow An aneurysim is an abnormal _______________ of the wall of a(n) artery. - widening (it is also weakening) What artery is widened in a thoracic aneurysm? - the aorta An aneurysm can result from an _____________ and from ____________. - infection, syphilis The most common symptom of abdominal aneurysm is: - a pulsating mass above the umbilicus Which aneurysm is most likely to have no symptoms? - the abdominal is most often "silent" Which vital signs are most important to measure in clients with aneurysm? - The pulse and blood pressure An aneurysm will most affect which of the following, the blood pressure or the pusle? - the pulse (many times the aneurysm will rupture and much blood will be lost before the blood pressure starts to change. What activity order is the client with an aneurysm supposed to have? - Bedrest. do not get these people up If the client with aneurysm is physically unstable, should you encourage turning, coughing and deep breathing? - no, bedrest until the client is stable! What class of drugs is the client with an aneurysm most likely to be on? - Antihypertensives What is the BIG danger with aneurysms of any type? - Rupture, leads to shock and death If an aneurysm is ruptured how would you know it? - decreased LOC (restlessness), tachycardia, hypotension - all signs of shock If an aneurysm ruptures what is the #1 priority? - Get them to the operating room ASAP Is there anything that can be done for the client with a ruptured aneurysm before they get to the operating room? - Yes, if available you can get them into antishock trousers but not if this causes a delay in getting them to the operating room The post op thoracic aneurysm is most likely to have which type of tube? - Chest tube, because the chest was opened The post op abdominal aneurysm repair client is most likely to have which type of tube? - NG tube for decompression of bowel If you care for a client who is post-op for a repair of a femoral popliteal resection what assessment must you make every hour for the first 24 hours? - check the distal extremity (far from center) for color, temperature, pain and PULSE, also MUST document What causes angina pectoris? - Decreased blood supply to myocardium, resulting in ischemia and pain Describe the pain of angina pectoris - crushing substernal chest pain that may radiate What drug treates angina pectoris? - Nitroglycerine How do you tell if a client has angina or an MI? - the pain of the two is similar, the way to tell the difference is if nitro and rest relieve the pain. For angina, nitro and rest relieve the pain, for MI, nitro and rest do not relieve the pain How many nitro tabs can you take before you call the doctor? - 3 How many minutes should lapse between the nitro pills you take? - 5 minutes - take one nitro tab every 5 minutes 3 times, if no relief, call MD By what route do you take nitro? - sublingual To get a score of 1 on the APGAR for muscle tone the newborn must place their extremities in _______________. - Flexion A newborn receives a score of 0 on muscle tone when there is__________ - No movement (limp) To score the maximum of 2 points on nueromuscular reflex irritability the infant must ______________. - Cry If the neonate ____________, they will score a 1 on neuromuscular irritability. - Grimaces To receive a 0 on reflex (neuromuscluar) irritability the neonate must exhibit _______ - No response To score a maximum score fo 2 on color the child must be ____________. - Totally pink If the child's _______ are ______ and the trunk -face abdomen are ________, the child scores 1 on color - Extremities are blue (cyanotic), Pink To get a 0 on color the infant is - Totally blue, pale Acrocyanosis - Temporary cyanotic condition, usually in newborns resulting in a bluish color around the lips, hands and fingernails, feet and toenails. May last for a few hours and disappear with warming. Apendicitis is an _________ of the appendix due to __________. - inflammation, obstruction Apendicitis occurs most in what age group? - 15 to 35 What is the most common complication of appendicitis? - Peritonitis Peritonitis - inflammation of the peritoneum What is the first sign of appendicitis? - right upper quadrant pain What follows the RUQ abd pain of appendicitis? - N/V Where does the pain of appendicitis finally end up? - RLQ What is the name of the RLQ abd pain where appendicitis pain finally localizes? - McBirney's point What is present when rebound tenderness is present? - Peritoneal inflammation What is the hightes that the temp will be in appendicitis? - 102 F What blood count is elevated in appendicitis? - WBC What is the name for an elevated WBC? - Leukocytosis What is the only treatment recommended for appendicitis? - surgery - appendectomy Before the client with suspected appendicitis sees the physician what should be avoided? - pain meds, enemas, laxatives, food! NPO To lessen pain place the client in ___________ position. - fowlers (a sitting position) (also use post op) Never apply __________ to the area of the appendix. - heat (it causes rupture) After appendectomy, document in the nurses notes the return of __________ - bowel sounds (peristalsis) What is the primary dietary prescription for calcium nephrolithiasis? - Low calcium diet For the client with calcium nephrolithiasis the diet should be _________ash. - Acid If the kidney stone is calcium phosphate the diet must be low in _____ too. - Phosphorous The primary diet treatment for uric acid nephrolithiasis is _________ -________. - Low pruine The client with uric acid nephrolithiasis should have a diet low in ___________. - Methionine What is methionine? - The precursor of the amino acid cystine (precursor = material out of which something is made) Name two foods high in methionine. - Milk, eggs Clients with cystine nephrolithiasis should have a (n) _________ ash diet. - Alkaline Increasing fluids to over 3000 cc per day is more effective in treating renal calculi ( kidney stones) than any dietary modification. (T/F) - True. It's more important to flush the urinary tract than worry about what you're eating. Neoplasm refers to benign and malignant tumors. (T/F) - True Which type of tumor is more malignant? Differentiated or undifferentiated? - Undifferentiated is worse to have (highly differentiated is better to have) When cancer spreads to a distant site it is called? - Metastasis The cause of cancer is known. (T/F) - False A person should have a yearly work up exam for cancer detection over the age of __________. - 40 Pregnancy requires a __________ increase in the cardiac output. - 30-50% What is the #1 cause of maternal death in CD of pregnancy? - Decompensation What is meant by decompensation? - Failure of the heart to maintain adequate circulation. What will you see when you observe the neck of a client with CD of pregnancy? - Distended neck veins -JVD What will you hear when you auscultate the heart of the client with CD of pregnancy? - Murmurs What will you hear when you auscultate the lungs of the client with CD of pregnancy? - Crackles-rales If the client with CD of pregnancy experiences sudden heart failure what is the MOST common thing you will see? - Sudden onset of SOB (dyspnea). What is the #1 treatment of CD during pregnancy? - Rest What are the three most common drugs given to women with CD in pregnancy? - Diuretics Heparin Digitalis Why are diuretics given to women with CD of pregnancy? - To promote diuresis which will: -lower circulating blood volume -decrease preload -decrease the amount of blood the heart pumps. Why are anticoagulants (heparin only) given to women with CD of pregnancy? - To prevent thrombophlebitis due to venous congestion, usually in legs. Why is digitalis given to women with CD of pregnancy? - To increase the strength of the heart and to decrease the rate, rest the heart while making it more efficient Can a woman with CD of pregnancy be given analgesics during labor? - Yes, in fact they should be given analgesics, may get too anxious which is bad for the patient Can morphine be given to a woman with CD during labor? - Yes, even though it negatively affects the fetus, remember morphine decreases preload and pain which rests the heart. What is the most common dietary modification for the woman with CD who shows signs of decompensation? - Decreased sodium, decreased water (restriction) Is a C-section mandatory for delivery of a woman with CD of pregnancy? - No Second to rest, what is very important treatment for CD of pregnancy? - Weight control How long must the woman with CD of pregnancy be on bed rest after delivery? - At least one week What nutrients should be supplied in the diet of the pregnant woman with CD? - Iron Folic acid Prevent anemia (anemia always makes the heart work more) What are the two most common subjective complaints of the woman who is decompensating during labor? - SOB Palpitations In addition to the things you assess for in every woman during labor, what additional assessment must you make for a woman with CD? - You must assess lungs sounds frequently How often must you assess the lung sounds during the first stage of labor? During active labor? During transition labor? - Every 30 to 10 minutes In which position should a woman with CD in labor be? - Semi recumbent, HOB up The nurse should limit the client's efforts to ________ ______ during labor when CD is present. - Bear down What is the big danger to staff when caring for a client with cesium implant? - Radiation hazard What are the three principles to protect yourself from radiation hazard? - Distance Shielding Time Will the woman with a cesium implant have a foley? - Yes From where should the nurse provide care to the client with cesium implant? - The head of the bed How can the woman with cesium implant move in bed? - Only from side to side What four symptoms in a patient with a cesium implant should be reported to the physician? - Profuse vaginal discharge Elevated temp Nausea Vomiting (these indicate infection and perforation) Should pregnant staff care for a client with a cesium implant? - No Name 3 types of skin traction - Bucks Bryants Pelvic Name 3 types of skeletal traction - Cranial tongs Thomas splints with Peason attachments 90 degrees to 90 degrees What type of traction is most commonly used for hip fracture in adults? - Bucks What type of traction is most commonly used for hip fractures in children? - Bryants In what position should the bed be if the patient is in pelvic traction? - Semi-fowlers with knee gatched To insure that Bryant's traction is working the child's hip/sacrum should be _________ - Off the bed enough to slip a hand between the sacrum and the bed. What is the advantage of balanced counteraction? - You can easily move the patient around in bed Patients in Russell's traction are particularly prone to ____________. - Thrombophlebitis When a patient is in a Buck's traction they may turn to the _________ side. - Unaffected Define cataract - Opacity of the crystalline lens Is surgery done immediately upon diagnosis of cataract? - No, they usually wait until it interferes with ADLs . What three most common visual defects occur with cataract? - Cloudiness Diplopia (double vision) Photophobia (sensitivity to light) What are the two common treatments of cataract? - Laser, surgical removal. Surgery called intraocular or extraocular lens extraction What does the eye look like when a client has cataracts? - Cloudy, milky-white pupil What will the client be wearing after cataract surgery? - A protective patch/shield on the operative eye for 24 hours, then a metal shield (AT NIGHT only) for 3 weeks When the client asks about the use of glassess or contacts after cataract surgery what would you say? - If an introcular lens is implanted they will NOT need glasses. If no lens is implanted, then contacts will be fitted for 3 months post-op, temporary thick glasses given immediately but will get a different prescription in 2 to 3 months What will be a high priority nursing diagnosis for a client post cataract surgery? - Safety Should the client ambulate independently after cataract surgery? - No the patient should not ambulate independently, depth perception is altered. What positions are to be avoided after cataract surgery? - Lying face down. Also, do not lie on operative side for a month. What are the post-operative signs of hemorrhage into the eye? - Severe pain Restlessness What movements are to be avoided after cataract surgery? - Coughing Sneezing Bending at the waist Straining at stool Rubbing or touching eyes Rapid head movements What positions are okay after cataract surgery? - Do not lie on operative side; do not lie on back Should you use talcum powder with a post-operative cataract client? - No, it may cause sneezing; also should avoid pepper. What are the three signs of increased intraocular pressure? - Pain (moderate to severe) Restlessness Increased pulse rate What is the major objective in caring for a client after surgical cataract removal? - To prevent pressure in or on the eyes When the lens is to be extracted for cataracts, what drugs are given preoperatively? - Mydriatics Dilators Antibiotic drugs (gtts) What three drugs are given post-operatively for surgical cataract removal? - Stool softeners Antiemetics Analgesics (mild to moderate) Give five causes of catarcts? - Injury Congenital Exposure to heat Heredity Age How often should central line dressings be changed? - QOD- every other day What type of dressing is applied to a central line insertion site? - Sterile occlusive Can drugs be piggybacked into central --TPN? - No, use another lumen. When changing central line tubing the patient should be told to_________? - Turn his head away from the site, hold breath, and perform the Valsalva maneuver If a central line is found accidentally open the patient should be positioned on his ______ ______. - Left side A CVA is a __________ of the brain cells due to decreased _____ _____ and ______. - Destruction; blood flow and oxygen Women have a (higher/lower) incidence of stroke than men? - Lower Name the three types of CVA - Embolus Thrombus Hemorrhage Use of oral contraceptives increases the risk of CVA (T/F). - True Chronic abuse of alcohol increases risk of CVA. (T/F) - False Obesity increases risk of CVA (T/F) - True Smoking increases the risk of CVA. (T/F) - True Atrial fibrillation increases the risk of CVA (T/F) - True, emboli particularly What is a TIA? - Transient Ischemic Attack Warning sign of impending CVA (transient neurologic deficits of any kind can last 30 seconds to 24 hours) Do patients experiencing a CVA have a headache? - Yes The first sign of CVA is usually a___________. - Change in LOC The activity order in early management of CVA is __________. - Absolute Bed Rest The patient with a recent CVA is most likely to have fluids restricted or forced? - Restricted How far should the HOB be up after CVA? - 30 degrees Can the stroke victim be turned side-to-side? - Yes How often should the CVA patient be turned or repositioned? - Every 2 hours The CVA patient should be turned onto his paralyzed side no longer than 2 hours. (T/F) - False, the patient should not be on their paralyzed side for more than 20 minutes. ROM exercises should occur every 2 hours in CVA patients. (T/F) - False-- every 4 hours or 3 times a day is enough To prevent urinary incontinence; the CVA patient should be catheterized. (T/F) - False- remember incontinence will never be allowed as a reason for catheterization Which type of paralysis is typical of CVA- paraplegia, hemiplegia or quadriplegia? - Hemiplegia What anatomical fact accounts for the left side of the body being controlled by the right brain? - The motor-pyramidal-tracts cross over to the other side (decussate in the medulla) If the patient has right hemiplegia, he cannot move his ____ ____ and ____ ____ and the stroke was on the _________ side of the brain. - Right arm and right leg, left What is hemianopsia? - Not being able to see one half of the field of vision. The client with hemianopsia should be taught to ____________. - Scan What is scanning? - Moving the head from side to side to see the whole field of vision. If the client has right homonymous hemaniopsia, the food on the ____ side of the tray may be ignored. - Right After meals, the nurse must always check _______ of the CVA client for _________. - Mouth (cheek), food Should a CVA patient have all four side rails up at all times? Should they be restrained? - Side rails yes. Restraints- no, unless they are a danger to themselves or others When a patient does not understand INCOMING language he is said to have ______ aphasia. - Receptive When the CVA client understands your question but can't respond verbally correctly, he is said to have ___________ aphasia. - Expressive What is global aphasia? - Both receptive and expressive Aphasia is most common if the stroke occurred in the (dominant/non-dominant) hemisphere of the brain. - Dominant Egg white is (high/low) in cholesterol? - Low Egg yolk is (high/low) in cholesterol? - High The three meats lowest in cholesterol are _________, _________ and __________. - Chicken, pork, mutton Milk is (high/low) in cholesterol. - Low Is cheese high in cholesterol? - Only moderate, not really that high Which oils are high in cholesterol? - Animal oils Is cholesterol a triglyceride? - No Do plant foods contain any cholesterol? - No, not many What is otitis media? - Chronic infectious/inflammatory disease of the middle ear Is otitis a disease of the adult or child? - Usually the child What part of the ear is involved in otitis media? - Middle ear What are the 2 common subjective signs of otitis media? - Hearing loss Feeling of fullness in the ear What are the 2 common objective signs of otitis media? - Hyperpyrexia (fever) Drainage from ear What commonly happens secondary to otitis media? - Perforation of the ear drum Do all the children with otitis media need tubes in their ears? - No What are the two most common medical treatments for otitis media? - Systemic antibiotics Antibiotic ear drops What is the most severe complication of otitis media? - Meningitis or mastoiditis What is cholesteatoma? - An epidemial cyst in the ear highly associated with otitis media. What are the restrictions to be followed when tubes are in a child's ear? - No swimming, no showering, no diving What is cleft lip? - The lip is open to the nares What is cleft palate? - The roof of the mouth is open to the nasopharynx. Is it possible to have only one: cleft lip or cleft palate? - Yes, you can have one or or the other or both When will the cleft lip be repaired? - Between 10 weeks and 6 months When is cleft palate repaired? - Between 1 and 5 years of age Why is cleft lip repaired early? - Feeding is easier after repair and appearance after repair is more acceptable to parents. Describe the nipples on bottles used to feed babies with cleft lip? - Large-holed, soft nipples The infant with cleft lip/palate needs more frequent ___________. - Bubbling, burping Children with cleft lip/palate should be fed in what position? - An almost upright position What is the #1 complication of cleft lip/palate? - Aspiration Children with cleft lip and cleft palate have long-term problems _____, _____ and _____. - hearing speech teeth In how many surgeries is cleft palate repaired? - Two surgeries one at 12 to 18 months the last at 4 to 5 years Why is final repair of the palate delayed until 4 to 5 years? - Earlier surgery would interfere with tooth development. How are cleft lip and cleft palate primarily treated? - Surgical repair Is the infant restrained BEFORE repair? - No, just AFTER repair Should children with cleft palate BEFORE surgery be allowed to cry? To breast-feed? - Yes, they can cry; may breast feed with simple cleft lip however palate interferes with feeding AFTER repair of cleft lip is infant allowed to cry? To breast feed? - No, the infant should be held to PREVENT CRYING; the infant is not allowed to breast-feed because sucking is not good after lip repair. After clep lip repair, what device will the baby wear? - A Logan bow What is the purpose of a Logan Bow? - To prevent stress on the suture line stool very damaging to the skin continuous drainage high risk for fluid/electrolyte imbalances incontinent never irrigate Transverse Colostomy - soft stool typical stool odor stool damages the skin empties several times per day may or may not be at risk for fluid/electrolytes imbalances may irrigate Descending Colostomy - formed stool typical stool odor stool doesn't irrigate unless diarrhea predictable 2 to 3 times per day emptying lowest risk for fluid/electrolyte imbalances continent do irrigate CHF can be right-sided, left sided or both-sided. (T/F) - True- left sided usually comes FIRST What does right sided CHF mean? - Right ventricle has decompensated Dependent Edema (legs and sacrum) Jugular venous distention Abdominal distention Hepatomegaly Splenomegaly Anorexia and nausea Weight gain Nocturnal diuresis Swelling of the fingers and hands Increased BP What does left sided CHF mean? - Left ventricle has decompensated CHF can result from MI. (T/F) - True When cardiac output fails, name three ways the heart will try to compensate. - Ventricle hypertrophy Dilate and heart rate will increase What is meant by "cardiac decompensation"? - It means that the compensatory mechanisms - hypertrophy, dilation, tachycardia are not working and the heart has failed. Name the three groups of drugs used to treat CHF? - Diuretics Vasodilators Digitalis What is the activity order for clients with CHF? - Bed Rest What special item do clients with CHF have to wear to decrease venous stasis in the legs? - TED hose How often should anti-embolism hose (TED) be removed? - Daily When during the day should TED hose be applied? - Before the client gets out of bed Is it okay to use powder with TED hose? - Yes Should you massage the calves of the client with CHF? - Never Before you give digitalis, what action must you take? - Measure the apical pulse If the adult client's apical pulse is below 60, what should you do? - Do not give digitalis For a child don't give for a pulse under 70 For an infant don't give for a pulse under 90 What daily measurement best indicates the amount of fluid the client is retaining? - Daily weight Should clients with CHF have a Foley catheter? - Yes, on diuretics and fluid balance is important What complication is common in CHF? - Pulmonary edema When the client is taking diuretics, what mineral is the CHF client most likely to lose? - Potassium--K+ You should tell the client with CHF to immediately report to his/her doctor if he/she gains _____pounds in one week. - Three Name the four most common toxic effects of digitalis. - Anorexia N&V-- very common Yellow vision Arrythmia Should hearing aids be removed before going for surgery? - Yes, but just before surgery Hearing aids are more useful in sensory or conductive hearing loss? - Conductive What is seen on the abdomen of the patient with Cushings? - Striae--purple horizontal lines Men with Cushings develop______________. - Gynecomastia What is gynecomastia? - Female-type breasts Women with Cushings develop? - Hirsutism Amenorrhea What is hirsuitism? - Hair where you don't want it The Cushings syndrome patient will have a _________ on their upper back. - Buffalo hump The patient with Cushings Syndrome will have (increased/decreased) blood pressure. - Increased, remember retaining water and sodium The Cushings syndrome patient will have ________ natremia, _________kalemia and _______glycemia. - Hyper; hypo; hyper Cushings clients will have (increased/decreased) resistance to infection. - Decreased Chronic _____________therapy imitates Cushings. - Steroid Cushings Man aka Cush Man - moon face with infection buffalo hump on back big trunk thin extremities loses potassium keeps glucose and salt has striations on abdomen and breasts Is CF hereditary? - Yes What glands are affected in CF? - Exocrine glands What is the appearance of the stool in a client with CF? *remember the 4 Fs* - Fat Frothy Foul-smelling Floating Steatorrhea What are the top 2 nursing diagnoses for a client with CF? - Decreased airway clearance Alteration in nutrition or absorption What is the classic test for CF? - Iontophoresis - sweat test In which two systems/organs are the most problems in CF? - Lungs Pancreas How does the client evaluate the activity of their pancreas? - Observe stools for steatorrhea What is the typical diet for CF client? - High calorie High protein Modified fat The major problem in CF is _______________. - Increased viscosity of the secretions of exocrine glands lead to obstruction. The most common intervention for the CF client with a diagnosis of decreased airway clearance is _________________. - Postural drainage What vitamins need to be replaced in CF? - Fat soluble in water soluble form -- A,D,E,K What do CF clients need to do (ingest) in hot weather? - Take NaCl tablets The child with the diagnosis of CF probably had a history of _________ ________ at birth. - Meconium ileus-- bowel obstruction due to the thickness of the stool. Why is the child with CF receiving pancreas/viokase/pancreatin? - They are enzymes which aid absorption of nutrients. When should the child with CF take his pancreatin/viokase/pancreas? - With meals, so it is in the gut while the food is present, the whole purpose is to increase absorption of ingested food. Define Cystoscopy? - Direct visualization of the urethra and bladder through a cystoscope. What would you do if the client had any one of the following after cystoscopy: bladder spasm, burning, frequency? - Record it but no need to call the MD What would you do if the client's urine was pink-tinged after cystoscopy? - Record it in the notes, no need to call the MD. Is the client NPO before cystoscopy? - No, not unless a child with a general anesthetic-- in fact with adults you should encourage fluids. Are enemas required before cystoscopy? - No, but may be ordered. Should you encourage fluids after cystoscopy? - yes What time of day can be particularly dangerous for the Parkinson's patient? - Mealtime, due to choking When a patient is taking Levodopa he should have assistance getting out of bed because... - Of orthostatic hypotension What vitamin should patients on Levodopa avoid? - B6 pyridoxine Levodopa should be given with or without food? - With What might Levodopa do to patients urine? - Make it very dark The tremors of Parkinson's will get better or worse when they purposefully move or perform a task? - Better, they tremor more when not performing an action The client on a PCA pump is less likely to have post-operative complications than the client without a PCA pump. (T/F) - True, because the comfortable patient moves around more and is less likely to get thrombophlebitis, pulmonary embolus, fatigue, ileus and pneumonia Clients with COPD are not good candidates for PCA pumps. (T/F) - True, due to the effects of narcotics on central respiratory control Name the three most common uses of PCA techniques. - Post-operative pain, cancer pain, sickle-cell crisis pain PCA pumps allow a more constant level of serum drug than conventional analgesia. (T/F) - True A major disadvantage of PCA pump is that the client can take too much medication. (T/F) - False, it is not possible for the client to overdose due to the lock-out feature Clients on PCA pumps use more medication than those receiving IM injections. (T/F) - False, they use less A disadvantage of PCA pumps is that the client does not ambulate as early due to the machine. (T/F) - False, PCA clients ambulate earlier and they pull their machine with them. When discontinuing a PCA infusion it is acceptable to discard the drug cartridge. (T/F) - False, the whole cartridge system must be returned to the pharmacy due to federal narcotic control laws. Comfort range or relative humidity is... - 30-60% Which patients should be forbidden to smoke? Smoke alone? - Those with oxygen in the room, confused, sleepy, drugged clients When applying restraints remember to... - Avoid bruising skin, cutting off circulation, accidental entangling List ways to ensure privacy... - Use drapes and screens during care in semi-private rooms Plastic pillow cases are ______. (disadvantages) - Hot and slippery When using restraints with clients who object, don't forget about _____- _____. - False imprisonment Individuals who are ill are ________ sensitive to noise than individuals who are well. - more When you are not at the bedside the bed should always be... - In the lowest position Can nurses be held liable for an accident resulting from a client not being told how to use the call light? - yes Dangers associated with drafts are... - Circulation of micro-organisms on air currents The first thing a nurse should do when a client objects to side rails is... - Explain why they are being used. The comfort range of temperature is... - 68 to 74 degrees Is having the client verbally identify himself considered adequate safety? - No, only identification bands are acceptable. Bed side rails should be up for the following individuals... - Elderly clients, unconscious, babies, young children, restless, confused The symptoms of sensory overload and sensory deprivation are... - Fear, panic, depression, inability to concentrate, restlessness, agitation If a family member asks to have the side rails down while they are in the room you should... - Remember that you are responsible for the client's safety-- not his family, it might be unwise to permit this Pillows are sterilized between uses. (T/F) - False What is the common name for pediculosis? - Lice What is the common finding with pediculosis pubis? - Reddish-brown dust in the underwear What common household solution is used to remove nits? - Vinegar. Nits are the eggs of lice that adhere to the hair shaft What shampoo is used for lice? - Kwell Where are head lice most commonly found? - At the back of the head and behind the ears On what do lice feed? - Blood The solution introduced into the peritoneum during PD is called... - Dialysate Before allowing the dialysate to flow into the peritoneal cavity it must be _____ to _____ temperature. - Warmed, body Before PD it is important the client be... - Weighed, to assess water loss or gain What force is used to introduce the dialysate into the peritoneum? - Gravity only, no pumps How fast does the dialysate usually flow into the peritoneum? - In 10 minutes How long is the dialysate allowed to remain in the peritoneum before it is drained out? - 15-30 minutes How long does it usually take for the dialysate to drain out of the peritoneum? - 10 minutes: (10 minutes flow in, 30 minutes in abdominal cavity, 10 minutes flow out = total of 50 minutes) If the dialysate does not drain out well, you would first... - Have them turn side to side What color is the dialysate when it comes out? - Straw-colored - clear Should you raise the HOB to increase drainage of the dialysate? - Yes How often do you measure vital signs during PD? - Every 15 minutes during the first cycle and every hour thereafter Can a client on PD: Sit in a chair? Eat? Urinate? Defacate? - Yes to all If too much fluid is removed during PD, the client will experience... - Decreased blood pressure (hypotension) If the client absorbs too much of the dialysate the client will experience... - Increased blood pressure (circulatory overload) If the client complains of dyspnea during PD you would first __________, then __________. - Slow the flow, elevate HOB If the client complains of abdominal pain during PD you would first... - Encourage them to move about Cloudy drainage in the dialysate commonly means... - Peritonitis (Not good, call MD) What would you do if you noticed a small amount of blood come out in the first few bottles that were infused? - Nothing, this is normal: the blood is due to the initial puncture of the abdomen What precautions are important in the care of the client receiving PD? - Safety, because they get dizzy. Is I&O important to record during PD? - Yes How high should the dialysate bag be when its infused? - Shoulder height What factor do clients with pernicious anemia lack? - Intrinsic factor. It has no other name. What vitamin is not absorbed in a patient with pernicious anemia? - Vitamin B-12 What is another name for Vitamin B-12? - Extrinsic factor Why isn't Vitamin B-12 absorbed in pernicious anemia? - Because these patients lack intrinsic factor What happens when patients with pernicious anemia don't absorb Vitamin B-12? - Their RBC's do not mature and they become seriously anemic. What other disease can be confused with pernicious anemia? - Angina pectoris What are some classic and unique signs of pernicious anemia? - Beefy red tongue Numbness and tingling of the hands Sores in the mouth Chest pain What is the medical treatment for pernicious anemia? - IM injections of Vitamin B-12 How long must the client receive this medical treatment? - For the rest of life Can we cure pernicious anemia? - No, just treat the symptoms. What unique urine test is done to diagnose pernicious anemia? - The Schilling test Is it okay to give B12 orally to a client with pernicious anemia? - No, it will never be absorbed due to a lack of intrinsic factor What neurologic test do they do for this anemia? - The Romberg test (a test for balance), in normal people this test is negative, in the client with pernicious anemia this test becomes positive What is conservation? In what stage does it develop? - When the child realized that number, weight, volume remain the same even when outward appearances change; Concrete Operational What is the age range of formal operation thinking? - 12-15 What is the sensori-motor stage of intellectual development? - It is the intellectual stage of children from birth to 2 years What is phlebotomy? - Drain off 200-500 cc of blood from body (opposite of transfusion). What type of diet will people with polycythemia vera be on? - Low iron What are three signs of polycythemia vera? - Headache Weakness Itching Is hemoglobin increased or decreased in this disease? - Increased What oral problem will people with polycythemia vera have? - Bleeding mucous membranes What organ will be enlarged in polycythemia vera? - The spleen, because it is destroying the excessive RBC's. Due to increased destruction of RBC's seen in polycythemia vera what blood level will be increased? - Uric acid levels will be high (remember - uric acid levels are always high when cells are being destroyed as in hemolysis, chemotherapy or radiation therapy) What drug is most commonly used in polycythemia vera? - Myleran -- (this is usually used for bone marrow cancer) How often should the client cough and deep breath post-operatively? - Every 2 hours How often should the post-operative patient turn? - Every 2 hours How often should the patient use the incentive spirometer? - Every 1-2 hours How often should the nurse auscultate the lung sounds post-operatively? - Every 4 hours How often should the bedridden post-operative patient do leg exercises? - Every 2 hours The post-operative patient should void by _____hours post-operatively or you must call the MD. - 6 to 8 Will the typical post-operative client have lung sounds? Bowel sounds? Increased temperature? - Lung - yes; bowel sounds - no; Low grade temperature - yes Unless contraindicated the patient should be out of bed no later than ______ hours post-operatively. - 24 Deep vein thrombosis is most common in what type of surgery? - Low abdominal or pelvic The most common complication of deep vein thrombosis _______ ________. - Pulmonary embolism The best way to prevent thrombophlebitis is TED hose. (T/F) - False, ambulation/exercise are the best ways. What is paralytic ileus? - Paralysis of the bowel due to surgery (common --especially in abdominal surgery) If a post-operative patient complains of gas and cramping you should first _______ then ________. - Assess then ambulate The typical post-operative inflammatory temperature elevation is in the range of ________. - 99.8 to 101 degrees The onset of post operative infection is on the ______ or ______ day post-operative day. - 2nd or 3rd, never before that (remember elevated temperatures earlier than the 2nd post-operative day is NOT infection) Define dehiscense - Separation of the incisional edges Define evisceration - Protrusion of abdominal contents through a dehiscence. What do you do for dehiscence? - Decrease HOB (but not flat); cover with sterile gauze moistened with sterile saline, call MD What do you do, in order, for evisceration? - Decrease HOB (but not flat); cover with sterile gauze moistened with sterile saline, call MD ante- - Before in time or place (ie. "antepartal - before giving birth) Im-; in- - "Not" or "into" intra- - Occurring within inter- - Between per- - Throughout, completely, a large amount ec- - Out of e-; ex- - Out from, away from, outside iso- - A combining form meaning 'equal' para- - Similar, beside Pregnancy (decreases/increases) the body's insulin requirements. - Increases Can pregnancy convert a non-diabetic woman into a diabetic? - Yes Why is hypoglycemia such a dangerous problem? - Brain cells die without glucose, brain damage (Multi/prima) gravida clients are most likely to get PIH. - Primagravida Which age group(s) are most likely to experience PIH? - Patients under 18 and over 35 When does pre-eclampsia usually begin in pregnancy (week)? - After 20 weeks Name the three symptoms of PIH. - Hypertension, weight gain (edema), proteinuria If pre-eclampsia is mild will the woman be hospitalized? - No, just rest at home What type of diet is indicated for a woman with pre-eclampsia? - Increased protein/normal salt intake (no restriction typically) What measurement must the woman with pre-eclampsia make every day? - She must weigh herself What is the activity order for a woman with severe pre-eclampsia? - Left side lying What is the dietary order for the woman with severe pre-eclampsia? - Low salt, high protein Are diuretics used for women with pre-eclampsia? - Yes When a woman is hospitalized for severe pre-eclampsia the nurse should test... - #1 reflexes, the urine for protein When pre-eclampsia gets worse the deep tendon reflexes will be (hyper/hypo) reflexia. - Hyper-reflexia Pre-eclampsia makes the neuromuscular system more or less irritable? - More What vision problem do women with pre-eclampsia have? - Blurred vision What types of precautions will be in effect for a woman with severe pre-eclampsia? - Seizure precautions Name 5 things included in seizure precations. - Suction machine in room O2 in room Padded rails up X 4 Must stay on unit Ambulation with supervision only No More than 1 pillow When is pre-eclampsia called eclampsia? - Once convulsions have occured In eclamptic client what ominous sign almost always precedes a seizure? - Severe epigastric pain What are the three major treatment objectives in eclampsia? - Decrease blood pressure Control convulsions Diuresis The urine output of the eclamptic client will (decrease/increase). - Decrease How would you palpate the uterus to see if the eclamptic woman was having contractions? - Place the hand flat on the abdomen over the fundus with fingers apart and press lightly Premature rupture of membranes (PROM) is a ________ break in the amniotic sac __________ the _________ of contractions. - Spontaneous, before, onset Usually labor starts within ________hours of rupture membranes. - 24 What is the danger with PROM? - Infection How would you tell if the woman with PROM had an infection? - Maternal fever Fetal tachycardia Foul smelling vaginal discharge To test amniotic fluid the nurse should check the ________ of the fluid. - pH Amniotic fluid is (acidic/alkaline) - Alkaline Being alkaline means have a (high/low) pH - High Amniotic fluid turns nitrazine paper deep _________ (color). - Blue When PROM occurs, the age of the fetus must be determined. The best way to assess lung maturity is to check the ________ ratio. - L/S (lecithin/sphingomyelin) An L/S ratio greater than _______indicates lung maturity. - 2.0 If labor does not begin within ________ hours after PROM, labor will likely be induced. - 24 If PROM occurs before viability, what is the typical management? - Termination of pregnancy If PROM occurs after viability but before 36 weeks, what is the typical management? - Hospitalize, watch for infection, try to gain time for the infant to mature If there are any signs of infection after PROM, what must occur immediately? - Delivery of fetus What drug is used in pulmonary edema to reduce fluid in the lungs? - A diuretic (Lasix) What drug is used to increase ventilation in clients with pulmonary edema? - Aminophylline (bronchodilator) Is O2 given in pulmonary edema? - Yes Since pulmonary edema is caused by left ventricular failure what drug is given? - Digitalis Why is morphine given to clients with pulmonary edema? - To decrease apprehension and decrease preload, this rests the heart If your client suddenly goes into pulmonary edema what would you do first? - Elevate the HOB, then increase O2, then call the MD Pulmonary embolus is an obstruction of the pulmonary ______ bed by a dislodged _______ or foreign substance. - Capillary, thrombus Where do the emboli that cause pulmonary embolus usually come from? - The legs Besides a thrombus what else can cause an embolus in the lung? - Air, fat, tumor cells What treatment modality can lead to pulmonary embolus? - Bed rest What class of drugs can lead to pulmonary embolus? - Oral contraceptives What heart problem can lead to pulmonary embolus? - Atrial fibrillation (RIGHT atrial fibrillation casues pulmonary embolus; LEFT atrial fibrillation causes cerebral embolus) What genetic disorder can lead to pulmonary embolus? - Sickle cell anemia What is the first sign of pulmonary embolus? - Dyspnea The dyspnea of pulmonary embolus is accompanied by ____ _____. - Pleuritic pain Does the heart rate increase or decrease in pulmonary embolus? - Increase With severe pulmonary embolus the client will look as though they are __________. - In Shock What are the two major treatments of pulmonary embolus? - O2, anticoagulants Name the anitcoagulant given for immediate anticoagulation by IV or SQ route. - Heparin A drug for long term anticoagulation in any disorder would be? - Coumadin What two lab tests monitor coumadin therapy? - Prothrombin time (PT) and the INR When coumadin is therapeutic, the INR should be between _______ and _______. - 2.0 and 3.0 What is lovenox? - It is a low-dose Heparin used for anticoagulation in POST-OP THROMBOPHLEBITIS PREVENTION NOT USED FOR PULMONARY EMBOLUS Heparin therapy is monitored by daily measurement of the _______. - PTT (partial thromboplastin time) Effective heparin therapy rises the PTT to approximately _______ times normal. - 2.5 Clients on heparin should use an electric razor or safety razor? - Electric razor What is the best way to prevent pulmonary embolus in post-operative patients? - Early ambulation Is it appropriate to massage the legs of the client to preven pulmonary embolus? - No, never Heparin is used in the acute phase of pulmonary embolus. What drug is used for 6 months after pulmonary embolus? - Coumadin Coumadin therapy is monitored by what daily test? - PT (prothrombin time) What is pyelonephritis? - A bacterial infection of the kidneys Which organism causes pyelonephritis? - E. Coli Name the symptoms that pyelonephritis and cystitis have in common? - Frequency, urgency, burning, cloudy, foul smelling urine What medical intervention is necessary in pyelonephritis? - IV antibiotics for one to two weeks, must get urine culture 2 weeks after antibiotic therapy is over How does pyelonephritis differ from cystitis in meaning? - Cystitis means bladder infection; pyelonephritis means an infection of kidney pelvis What causes or precedes pyelonephritis? - Cystitis always does Will the client with pyelonephritis have daily weights? - Yes, as would any client with kidney problem Name the five signs/symptoms that pyelonephritis has that cystitis does not have? - Fever, flank pain, chills, increased WBC, malaise What is the BIG danger with pyelonephritis? - Permanent scarring and kidney damage What solution is put onto the skin to protect it from the irritating effects of the tape? - Tincture of benzoin With what is a round closed in first intention? - Sutures or steri-strips, staples What is another name of second intention? - Granulation When swabbing an incision you would start at the incision or 1 Inch away from the incision? - Start at the incision and move outward. After you remove soiled dressings and before you put on the sterile dressing you must.... - Wash your hands and put on sterile gloves What is meant be the phrase "advance the drain 1 inch"? - You pull the drain out 1 inch. After advancing a Penrose drain you (should/should not) cut off the excess drain? - Should When a dressing saturated, germs can enter the wound from the outside. (T/F) - True, by a process called capillary action When is a bad time to change dressings? - Mealtime Define laceration. - Cut Scoliosis is a ______ curvature of the ______. - Lateral, spine Scoliosis is MOST common in the _______ and ______ sections of the spinal column. - Thoracic and lumbar Scoliosis in the thoracic spine is usually convex to the (left/right). - Right Scoliosis in the lumbar spine is usually convex to the (left/right). - Left (*Hint: curve Left in Lumbar) With which other two spine deformities is scoliosis associated? - Kyphosis (humpback), Lordosis (swayback) What is Kyphosis? - Humpback in the thoracic area What is Lordosis? - Swayback in the lumbar region (Lumbar, Lordosis) What is the difference between structural and functional scoliosis? - Structural-you are born with; Functional-you get from bad posture What age group should be routinely screened for scoliosis? - Young teens What are the 3 subjective complaints of clients with scoliosis? - Back pain, dyspnea, fatigue What test/exam CONFIRMS the diagnosis of scoliosis? - X-rays of the spine What type of brace is most commonly used for scoliosis? - Milwaukee Name 4 exercises used to treat mild scoliosis. - Heel lifts; sit-ups; hyperextension of the spine; breathing exercises What kind of treatment is done for severe scoliosis? - Surgical fusion with rod insertion What type of cast is used post-operatively? - Risser cast What kind of rod is used to "fix" curvature? - Harrington Rod Scoliosis MOST commonly affects _____ _____ (type of clients). - Teenage females How many hours a day should the client wear a Milkwaukee brace? - 23 What solution should be used on the skin where the brace rubs? - Tincture of benzoin or alcohol,no lotions of ointments-you want to toughen the skin not soften it Clients with a Milwaukee brace should avoid vigorous exercise. (T/F) - True After corrective SURGERY how is the client turned? - Log rolled (in a body cast) How often should the neurovascular status of the extremities of a client in a Risser cast be measured? Fresh post-operatively? - Every 2 hours What is a common complication of a client in a body cast (like a Risser cast)? - Cast syndrome What is cast syndrome? - Nausea, vomiting and abdominal distention that can result in intestinal obstruction Sickle cell anemia is most commonly seen in (blacks/whites). - Blacks Should a child in sickle-cell crisis wear tight clothes? - No, it can occlude vessels even more. Spinal cord injuries are more common in males. (T/F) - True In what age range is spinal cord injury most common? - 15 to 25 The #1 goal in emergency treatment of spinal cord injury is... - Immobilization of the spine When halo traction is being used to immobilize the spinal cord the client is allowed to _______. - Ambulate When the patient with spinal cord injury is in tongs or on a stryker frame or on a circoelectric bed they are on...... - Absolute bed rest The 2 most common surgeries used to treat spinal cord injury are ____ and ______. - Laminectomy and spinal fusion What is spinal shock? - It is a common occurrence in spinal cord injury in which the spinal cord swells above and below the level in injury When does spinal shock occur? - Immediately or within 2 hours of injury How long does spinal shock last? - 5 days to 3 months When the spinal cord injury is at level of _____ to _____ the patient will be a quadriplegic. - C1 to C8 When the spinal cord injury is between _____ and _____, there is permanent respiratory paralysis. - C1 and C4 Can the patient with spinal cord injury at C7 level have respiratory arrest? - Yes, because even thought his injury was below C4, spinal shock can lead to loss function above the level, however the will not be permanently ventilator dependent-he will breath on when once spinal shock goes away. Spinal cord injury in the thoracic/lumbar regions result in ___plegia. - Paraplegia If airway obstruction occurs at the accident site and you suspect spinal cord injury, what maneuver is used to open the airway? - Modified jaw thrust In spinal cord injury never ______ the neck. - Move, hyperextend How should you change the position of the spinal cord injury patient after he has an order to be up? Why? - Slowly, because of severe orthostatic hypotension (they use a tilt table) For the patient with neurogenic bladder you should straight catheterize every ____ hours. - Every 6 hours The patient with spinal cord injury will have (flaccid/spastic) muscles. - Spastic Name 3 drugs used to treat spasms. - Valium, Baclofen, Dantrium What is automatic dysflexia or hyperreflexia? - A common complication of quadriplegics in response to a fulle bladder or bowel. What are the vital sign changes seen in autonomic dysreflexia? - Sweating, headache, nausea & vomiting, gooseflesh, and severe HYPERtension What do you do first for the client experiencing autonomic dysreflexia? - Raise HOB What do you do secondfor the client experiencing autonomic dysreflexia? - Check the bladder, check the bowel Do you need to call the doctor for autonomic dysreflexia? - No, only call the doctor if draining the bladder & removing impaction does not work What is the #1 treatment for autonomic dysreflexia? - Drain the bladder, empty the bowel What is the purpose of restricting activity after spinal tap? - To prevent headache due to CSF loss Should the client drink after a spinal tap? - Yes, encourage fluids to replace CSF Do you need an informed consent for a spinal tap? - Yes Should CSF contain blood? - No Does the client have to be NPO before a spinal tap? - No

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