Term
| What two terms in test questions categorize it as a priority question? |
|
Definition
|
|
Term
| What are the first level assessment priorities? |
|
Definition
|
|
Term
| What in the nursing process has the highest priority? |
|
Definition
|
|
Term
| What 3 words in a question hint that it is testing nursing assessment? |
|
Definition
|
|
Term
| After physiologic need, what patient issue is next in importance? |
|
Definition
| safety; maslow's hierarchy |
|
|
Term
| What are the 3 steps of delegation? |
|
Definition
| determine task, consider patient's needs, match needs with scope of other provider |
|
|
Term
| What are the 5 rights of nursing delegation? |
|
Definition
| task, circumstances, person, direction/communication, supervision/evaluation |
|
|
Term
| LPN canNOT be delegated to do what? |
|
Definition
|
|
Term
| What skill set is exclusive to nursing (should not be delegated)? |
|
Definition
| TIA: Teach, IVs, Assessment |
|
|
Term
| LPN education is designed to handle what? |
|
Definition
| stable patients with predictable outcomes; simple precautions (contact), monitor VS (when given parameters), sensory deficits |
|
|
Term
T/F:
UAP can care for patient wounds |
|
Definition
| T; if chronic (basic wounds) |
|
|
Term
| What member of the healthcare team can do simple admission assessments? What does that include? |
|
Definition
| LPN; simple history, measuring VS, intake/output, collect specimens |
|
|
Term
| Who can apply and monitor restraints? |
|
Definition
|
|
Term
| What is another term for uremia? Define it |
|
Definition
| Azotemia; high urea and creatinine and waste products in the blood. uremia= urine in blood |
|
|
Term
|
Definition
| sudden (within hours) and rapidly progressive; reversible if managed |
|
|
Term
|
Definition
| slowly progressing, irreversible and leads to ESRF |
|
|
Term
| What 5 categories of patients are most at risk for ARF/AKI? |
|
Definition
| elderly, dehydrated, hypotensive, critcally ill, surgical patients |
|
|
Term
| What is considered oliguria for children? |
|
Definition
|
|
Term
| What is the most common cause of ARF? |
|
Definition
|
|
Term
| What causes prerenal ARF? |
|
Definition
| impaired renal blood flow; GFR declines from decrease in filtration pressure (elevated BUN and creatinine) |
|
|
Term
| Describe the effect of stress on prerenal ARF |
|
Definition
| stress-> less perfusion->RAA triggering-> renal issues |
|
|
Term
| What are some causes of intrarenal ARF? |
|
Definition
| acute tubular necrosis, glomerulonephritis, vascular disease and toxic injury (drugs) |
|
|
Term
|
Definition
| myoglobin muscle injury; toxic and can cause intrarenal ARF |
|
|
Term
| What is a classic finding of intrarenal ARF? |
|
Definition
|
|
Term
|
Definition
| occurs with urinary tract obstructions (increase upstream pressure and reduce GFR) |
|
|
Term
| What is the RIFLE classification for renal failure? |
|
Definition
| Risk Injury Failure Loss End stage kidney disease |
|
|
Term
| What are the phases of acute renal failure? |
|
Definition
| initiation, oliguria, diuresis, recovery; if not revered it will lead to CRF and ESRD |
|
|
Term
| What are some manifestations of oliguria? |
|
Definition
| elevated BUN/creatine, high K, metabolic acidosis, HTN, HF |
|
|
Term
| What is the normal range of GFR? |
|
Definition
|
|
Term
| What is the standard for GFR? |
|
Definition
| >60 (normal for those 60-70yo); less than this is severe to ESRD |
|
|
Term
| When a patient presents with hyperkalemia what else do you want to check? |
|
Definition
| GFR; need IV access and EKG |
|
|
Term
| Hyperkalemia involves what 2 things? |
|
Definition
| peaked t wave, ventricular dysrhythmias, alterations in repolarization |
|
|
Term
| What is the first line treatment for hyperkalemia when the EKG detects abnormalities? |
|
Definition
| electrolyte supllements; CaCl2: doesn't reduce K but stabilizes the heart |
|
|
Term
| What does a narrow QRS indicate? |
|
Definition
| supraventricular issue (stable) |
|
|
Term
| What does a wide QRS indicate? |
|
Definition
| ventricular issue (unstable) |
|
|
Term
| What is the normal QRS width? |
|
Definition
|
|
Term
| What type of access is used for hemodialysis? |
|
Definition
| temporary vascular access; used for ARF/AKI |
|
|
Term
| Why should all meds be held prior to dialysis? |
|
Definition
| they will be removed from the blood during the procedure |
|
|
Term
| What are some dialysis issues? Describe |
|
Definition
| hypotension, dysrhythmias, Disequilibration syndrome (rapid decrease in waste from brain causes cerebral edema, confusion and seizures), avoided with gentle dialysis rate initially |
|
|
Term
| What are the two main indications for dialysis? |
|
Definition
| hyperkalemia and volume excess/HF |
|
|
Term
|
Definition
| continuous renal replacement therapy; only for critically ill ICU patients who can't handle dialysis; continuous dialyzation |
|
|
Term
| What are the uremic symptoms? |
|
Definition
| anorexia, n/v, fatigue, confusion, uremic pericarditis |
|
|
Term
|
Definition
| increase in urinary output as GFR recovers; watch for dehydration |
|
|
Term
| What are some important findings of a ARK eval? |
|
Definition
| decreased GFR, increased K, crackles, dysrhythmias |
|
|
Term
| What are the nursing diagnoses for AKI? |
|
Definition
| infection risk, excess volume, fatigue, electrolyte imbalance |
|
|
Term
| What are the leading causes of CRF? |
|
Definition
|
|
Term
| What are the GFR value ranges with regard to the associated stage of kidney disease? |
|
Definition
| >90 normal, 60-89 mild, 30-59 moderate, 15-29 severe, <15 kidney failure |
|
|
Term
| At what phase of kidney disease do clinical symptoms appear? |
|
Definition
| renal insufficiency; gfr 25% |
|
|
Term
| What is the first treatment option for renal failure? |
|
Definition
| diuretics; then kayexalate |
|
|
Term
| What are some pros of PD? |
|
Definition
| cheaper, better tolerated, more flexible, needleless |
|
|
Term
| What are some cons of PD? |
|
Definition
| continuous therapy, high failure rate, can't life >25 lbs. |
|
|
Term
| PD uses what kind of catheter? |
|
Definition
|
|
Term
| How long do you need to wait to use a PD catheter? |
|
Definition
|
|
Term
| What are the 3 phases of the PD cycle? |
|
Definition
| aka Exchange; inflow, dwell, drain; cloudy drain= likely infection |
|
|
Term
| What is normal for patients to feel during the dwell period? |
|
Definition
|
|
Term
|
Definition
| automated peritoneal dialysis; most popular, can be done while sleeping |
|
|
Term
|
Definition
| continuous ambulatory peritoneal dialysis (manual) |
|
|
Term
| What is an important complication of PD and it's clinical manifestations? |
|
Definition
| peritonitis; board like rigidity, rebound tenderness (bloomberg), distension, paralytic ileus |
|
|
Term
| What type of catheter is used for HD? |
|
Definition
|
|
Term
| What is the best type of HD vascular access site and why? |
|
Definition
| arteriovenous fistulae; allows vein to hypertrophy for easy sticking |
|
|
Term
| What are the normal assessment findings of an AVF? |
|
Definition
| palpate thrill auscultate bruit |
|
|
Term
| Those with CRF are at an increased risk for what? |
|
Definition
|
|
Term
| BUN and creatinine are products of what? |
|
Definition
|
|
Term
| All phosphate lowering agents should be given with what? |
|
Definition
|
|
Term
| Describe the post procedure for renal biopsy |
|
Definition
| watch for bleeding and monitor for drainage on bandage; pt should be supine so pressure in on site |
|
|
Term
| What are the two most common complications of renal biopsies? |
|
Definition
|
|
Term
| Describe the fluid restriction for an adult in kidney failure |
|
Definition
| 1000ml + urine output of previous day |
|
|
Term
| What foods are high in Ph? |
|
Definition
|
|
Term
| What is an important clinical manifestation of high Ph? |
|
Definition
|
|
Term
| What do you see in the assessment of someone with hematologic issues? |
|
Definition
| O2 and perfusion deficit, immunodeficit (fever, WBC abnormality, tachycardia and tachypnea) |
|
|
Term
| What are the signs of immunodeficit in neutropenic patients? |
|
Definition
| fever (check temp q4) hypotension (septic shock) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| carrier protein for iron; control level of free iron in blood |
|
|
Term
|
Definition
| Total iron binding capacity; measure blood's capacity to bind iron with transferrin |
|
|
Term
ID Hgb type
inherited variant in normal adult hgb; most common in asians |
|
Definition
|
|
Term
ID hgb type
found in sickle cell or thalassemia |
|
Definition
|
|
Term
ID hgb type
present in certain types of thalassemia; heavy |
|
Definition
|
|
Term
| What is the purpose of a type and cross? |
|
Definition
| compatibility between donor and recipient; need for blood is eminent |
|
|
Term
| What is the purpose of a type and screen? |
|
Definition
| ABO/rh eval, anibody screen; done when blood need is low |
|
|
Term
| Describe the direct coombs test? |
|
Definition
| tests for autoimmune hemolytic anemia; detects antibodies found on RBC surface |
|
|
Term
| describe the indirect coombs test |
|
Definition
| used in prenatal tests to detect antibodies against RBCs unbound in plasma |
|
|
Term
|
Definition
| normally inside RBC but is found in blood during hemolysis; increased in hemolytic anemia |
|
|
Term
| What happens in intravascular hemolysis? |
|
Definition
| free hgb and haptoglobin bind together and bring haptoglobin levels down |
|
|
Term
| Describe the capillary fragility coag test |
|
Definition
| measures how easily capillaries are damaged; excessive petechiae= cause of bleeding is capillary not platelet deficit |
|
|
Term
| Describe the bleeding time coag test |
|
Definition
| length of time for bleeding to cease from blot site is measured; long time = platelet deficit |
|
|
Term
| A patient can clot well until platelets are below what level? |
|
Definition
| 50k; spontaneous bleeding at 20k |
|
|
Term
| What are the two major risks of BM BX? |
|
Definition
|
|
Term
| What is the hematologic issue with anemia? |
|
Definition
| vulnerable to O2 and perfusion deficit |
|
|
Term
| An increase in RBCs leads to what? |
|
Definition
| polycythemia, thrombocytosis; vulnerability to thromboembolic risk |
|
|
Term
| Why is oral care essential to compromised host patients? |
|
Definition
| normal oral flora can becomes opportunistic if too high in number |
|
|
Term
| Upset of normal flora in the GI tract can cause what? |
|
Definition
| diarrhea/gaseous distension |
|
|
Term
| The physician should be contact if what S&S appear in a compromised host patient? |
|
Definition
| temp >100.4/38, persistent cough, pus/drainage, cloudy foul burning urine |
|
|
Term
| Describe the use of cefipime |
|
Definition
| antibiotic used for neutropenic patients that have fever initially |
|
|
Term
| What is a significant symptom in a patient on bleeding precautions and why? |
|
Definition
| headache, especially one not relieved by tylenol; could be a cerebral bleed |
|
|
Term
| Why are platelet transfusions not routinely given to bleeding risk patients? |
|
Definition
| patients can become refractory and build up antibodies to the platelets |
|
|
Term
|
Definition
| Heparin induced thrombocytopenia; caused by formation of abnormal antibodies that activate platelets |
|
|
Term
| What lab values are monitored when on anticoags? |
|
Definition
|
|
Term
|
Definition
| fibrin split products; positive results mean a clot is breaking down; seen in DIC and PE; aka Fibrin degradation products |
|
|
Term
| What material is responsible for the lysis of fibrin clots? |
|
Definition
|
|
Term
| Describe the patho of DIC |
|
Definition
| widespread clotting with resultant bleeding; release of tissue factor to general circulation with vascular damage; always a secondary issue |
|
|
Term
| What types of patients are most at risk for DIC? |
|
Definition
| septicemia, OB, trauma, oncology |
|
|
Term
| What lab results are seen in someone with DIC? |
|
Definition
| thrombocytopenia, prolonged PTT and aPTT, increased D dimer |
|
|
Term
|
Definition
|
|
Term
| DIC patients benefit from a transfusion of what? |
|
Definition
| platelets, FFP PRBC and vitamin K injection |
|
|
Term
| What are the vitamin k dependent clotting factors? |
|
Definition
|
|
Term
| Describe the use of antifibrolytics to treat DIC and give an example |
|
Definition
| used only after other options have failed; amicar; consequence is clotting |
|
|
Term
| What is the best lab value used to determine if someone is developing malnutrition? |
|
Definition
|
|
Term
| What are some causes of iron deficiency? |
|
Definition
| chronic blood loss, poor GI absorption, in adequate diet, parasitic infection |
|
|
Term
| What are the effects of iron deficiency on coronary artery disease? |
|
Definition
|
|
Term
| What are the effects of iron deficiency in children? |
|
Definition
|
|
Term
| What are the effects of iron deficiency on pregnancy? |
|
Definition
| premature or low birth weight |
|
|
Term
| What are the effects of iron deficiency chronic blood loss? |
|
Definition
|
|
Term
| What is another term for Menorrhagia? |
|
Definition
| abnormal uterine bleeding |
|
|
Term
| What CBC values are low in someone with anemia? |
|
Definition
|
|
Term
| What are some foods with high amounts of iron? |
|
Definition
| Oysters, clams, beef liver, prune juice |
|
|
Term
| IM iron is NOT given where? |
|
Definition
|
|
Term
| What are two important steps in IM iron administration? |
|
Definition
| add .25ml air to seal in med; change needle before admin to prevent burning patient |
|
|
Term
| Describe pernicious anemia |
|
Definition
| reduced vitamin b12; patient tired b/c body does not get enough O2 |
|
|
Term
| What are some symptoms and effects of pernicious anemia? |
|
Definition
| tingling, lack balance, change normal taste, vision and shrink stomach lining |
|
|
Term
| What foods are high in vitamin B12? |
|
Definition
| animal products; beef liver, clams, breakfast cereals |
|
|
Term
| Anemia of chronic disease/inflammation is most often associated with what? |
|
Definition
| chronic infections, malignancies, disturbances of iron cycle |
|
|
Term
| What are the lab values seen in ACD? |
|
Definition
| same as anemia but typically normocytic normochromic |
|
|
Term
|
Definition
| bone marrow failure; pancytopenia (RBC, WBC, platelets) |
|
|
Term
| What is neupogen normally DC'd? |
|
Definition
| when ANC is normal (3k-6k) |
|
|
Term
| Name the sickling stimuli |
|
Definition
| hypoxemia, acidosis, hypertonicity, dehydration, hypothermia |
|
|
Term
| what are the clinical manifestations of a sickle cell crisis? |
|
Definition
| pain, classic signs of anemia (fatigue, pallor, dyspnea) and compensatory manifestations (tachycardia and tachypnea), jaundice |
|
|
Term
| What is the treatment plan for a sickle crisis in order? |
|
Definition
| oxygenation, hydration, prevent/treat thromboembolism, treat infection, give pain meds |
|
|
Term
| What should be avoided to prevent sickle cell crisis? |
|
Definition
| get flu and pneumonia shots, avoid high altitudes, report sleep apnea |
|
|
Term
|
Definition
| spleen shrivels and dies; denoted by thrombocytosis |
|
|
Term
| What form of contraception is most recommended for sickle patients? |
|
Definition
| barrier; oral can pose risk especially for smokers |
|
|
Term
| Sedation often precedes what? |
|
Definition
|
|
Term
| What is the risk of having a PCA with a basal? |
|
Definition
| increased risk of respiratory depression; need continuous pulse ox for at least 24hrs initially |
|
|
Term
| What are the most common side effects of opioids? |
|
Definition
| constipation, respiratory depression, n/v, pruritis |
|
|
Term
| A respiratory assessment includes what? |
|
Definition
| RR, depth, O2 sat, skin and mucous membrane color assessment |
|
|
Term
| What are the PCA risk factors for respiratory depression? |
|
Definition
| <5, >70, sleep apnea, bolus morphine >1mg |
|
|
Term
| Describe the Ramsey Sedation scale |
|
Definition
| Scaled 0-6 from does not respond to test stimulus to agitated |
|
|
Term
| What are the signs of sleep apnea? |
|
Definition
| morning headache; waking in the night gasping for air |
|
|
Term
| What clinical conditions are the risk factors for respiratory depression with IV/PCA use? |
|
Definition
| hemodynamic instability, renal insufficiency, hepatic dysfunction; basal >20 |
|
|
Term
| What is the most commonly used antihistamine and side effect? |
|
Definition
|
|
Term
| Transfusions improve what conditions that sickle cell patients are especially at risk for? |
|
Definition
| enlarged spleen and strokes |
|
|
Term
| What is the closest thing to a cure for sickle cell? |
|
Definition
|
|
Term
| What two conditions are considered to be precursors for leukemia? |
|
Definition
| pancytopenia and polycythemia vera |
|
|
Term
| Describe the purpose of PV treatment |
|
Definition
| reduce blood viscosity and thrombosis |
|
|
Term
|
Definition
| cancer of RBCs; disease with sustained increase in Hgb or Hct |
|
|
Term
| Describe phlebotomy treatment of PV |
|
Definition
| When Hct <70% can be bled twice a week; patients with severe plethora can have daily removal of 500mL |
|
|
Term
| What additional drugs must be used in phlebotomy treatment of PV and why? |
|
Definition
| myelosuppressive agents; blood loss exacerbates elevated blood count |
|
|
Term
| What is the most important myelosuppresive agent used to treat PV? |
|
Definition
|
|
Term
| Describe thrombotic thrombocytopenic purpura |
|
Definition
| autoimmune endothelial cell damage that increases platelet adhesiveness in damaged areas which decreases platelet count |
|
|
Term
| What are the two types of hemophilia? |
|
Definition
| classic (a) and christmas (b) |
|
|
Term
|
Definition
|
|
Term
| Describe leukocyte reduced transfusion therapy |
|
Definition
|
|
Term
| Describe irradiated blood components and who they're for? |
|
Definition
| prevent transfusion associated graft vs host disease; patients being treated for malignancy |
|
|
Term
| What is the purpose of frozen blood units? |
|
Definition
| allows those with rare blood types to store their own for up to 10 years |
|
|
Term
| Describe washed blood components |
|
Definition
| no plasma; for those with history of severe allergic reaction |
|
|
Term
| Transfusion reactions are ____ in PRBC but ____ in platelets |
|
Definition
|
|
Term
| Describe rigors and their treatment |
|
Definition
| attempt to raise body temp; demerol |
|
|
Term
| platelets are given __ and __ why? |
|
Definition
|
|
Term
| What is the earliest sign of circulatory overload? |
|
Definition
|
|
Term
| Describe transfusion related acute lung injury reaction |
|
Definition
| frothy sputum 2-6 or 72 hrs after transfusion; reaction between antileukocyte antibodies and recipient's leukocytes causing pulmonary inflammation |
|
|
Term
| What are the alternatives to giving blood products? |
|
Definition
| erythropoietin or nutritional supplements; will not be enough |
|
|
