Term
| Positioning for Arterial insufficiency |
|
Definition
some pts have edema this will prevent arterial flow.
-Elevate feet (not above heart level)
-no leg crossing.
-may sleep with limb hanging or sleep sitting in chair |
|
|
Term
| Positioning for Craniotomy |
|
Definition
HOB-30deg --> prevents venous drainage from head
-avoid xtreme neck + hip flex.
-maintain head at midline
-pt can be moved from side to side. |
|
|
Term
| Positioning for Infratentorial Craniotomy |
|
Definition
-Keep FLAT
-position on either side for 24 to 48 hours to prevent presure on the neck area incision. |
|
|
Term
|
Definition
-similar to crainiotomy
-HOB 30 deg
-maintain head at midline
-neutral pos to to facilitate venous drainage in the brain
-avoid xtreme head and neck flex |
|
|
Term
| Positioning for CVA with Itracranial bleeding |
|
Definition
-Positioning very important to maintain proper body alignment + dec spasticity or to inc muscle tone in flaccid extremities
-May need to splinter any affected extremity to prevent contracture
-DVT is an issue change pos Q 2 hrs
-aspiration percautions (inc HOB) |
|
|
Term
|
Definition
-change positions
-don't cross legs
-similar to arterial insufficiency |
|
|
Term
| Positioning for Hypotension |
|
Definition
| -Legs elevated 30 deg maybe a little more to improve venous return and blood perfusion. |
|
|
Term
| Positioning for Pneumonia |
|
Definition
-upright
-HOB elevated
-orthopnea pos ease work of breathing. Exp arms folded + placed on 2-3 pillows over a nightstand or sitting in chair with feet spread and shoulder width apart while leaning forward with elbows on the knees, arms and hands relaxed, pursed lip breathing. |
|
|
Term
| Positioning for Pneumonectomy |
|
Definition
-pt will NOT have chest tube
-do NOT want them SIDE LYING b/c lung will shift, fluid can leak and press on other lung.
-HOB elevated |
|
|
Term
| Positioning for Post-Angiogram |
|
Definition
-BED REST 4-6h in supine position
-HOB 30 deg or lower
-the catheterized extremity should not be flexed |
|
|
Term
| Positioning for Post Lumbar puncture |
|
Definition
| -BED REST 4-8 h to prevent CSF leakage |
|
|
Term
| Positioning for Post-liver biopsy |
|
Definition
-Apply pressure to site
-have pt roll to rt side for 1 hr to prevent blood and bile leakage |
|
|
Term
|
Definition
Seizure precautions
-Side rails up
-bed lowest position
-if pt loses conciousness turn on side with head to side to prevent aspiration and allow drainage of secretions |
|
|
Term
| Positioning for PUlmonary Edema |
|
Definition
| -If blood pressure adequate place in High fowlers |
|
|
Term
| Positioning for tube feeding |
|
Definition
-Flowlers or sitting in chair
-If contraindicated it is acceptable to have pt slightly elevated in the right side lying position
-remain in fowlers for at least 30 mins after feeding |
|
|
Term
| Positioning for receiving epidural pain control |
|
Definition
| -HOB 30 deg to help drain with gravity |
|
|
Term
| Positioning for Renal transplant |
|
Definition
-Keep off transplant side
-supine (new kidney in the abdom) or side lying on unaffected side |
|
|
Term
| Positioning after total hip replacement |
|
Definition
-immed after surgery keep in supine position, HOB slightly elevated, and pillow between legs to prevent adduction.
Affected leg in neutral rotationing using a cradle boot, Turn to either side as long asa pillow is B/w legs
-Later, pt should sit at or less than 90 deg for proper hip flex, NEVER more than 90 DEG.
-Do not cross legs beyond midline of body. |
|
|
Term
| Postioning after total knee replacement |
|
Definition
-similar to hip replacement supine HOB slightly elevated, but pillow between legs to prevent adduction not necessary.
-continuous passive motion machine is often used. |
|
|
Term
| positioning for the insertion of an NG tube |
|
Definition
-High flowlers
-pt should tilt head foward while drinking water |
|
|
Term
| Positioning for suctioning |
|
Definition
-for pt w/ fuctional gag reflex should be in Fowlers with head turned to side
-if unconcious pt should be in lateral position with head slightly raised. |
|
|
Term
A) norm lab values for NA
B) what conditions have inc NA
C) what conditions have dec NA
D) signs and symptoms of hypernatremia
E) signs and symptoms of hyponatremia |
|
Definition
a) 135-145
b)inc in:
-cardiac + renal failure
-hypertension
-after given too much NS
-Edema
-Dehydration
C)dec NA occurs in/with:
-NVD
-laxative use
-hypotonic IV
-SIADH
D)hyper signs:
-Low Cardiac output
-twitches to absent reflexes
-low urinary output
-high specific gravity
-edema
-mental change
E)hypo signs:
-rapid pulse
-shallow RR
-HA |
|
|
Term
A) norm lab values for K
B) what conditions have inc K
C) what conditions have dec K
D) signs and symptoms of hyperkalemia
E) signs and symptoms of hypokalemia
F) When is a push of K appropriate? |
|
Definition
A) 3.5-5.0
B) inc in:
-dehydration
-renal failure
-acidosis
-cell/tissue damage
-hemolysis
C) dec in:
-NPO w/ inadeq replacement
-excessive use of non k sparing diuretics
-VD
-alkalosis
-malnutrition
D)hyper k signs:
-Bradycardia
-low BP
-Ectopic beat
-low RR
-twitches
-paralysis
E) hypo signs:
-thready pulse
-polyuria
-low sp gravity
F) K should NEVER be given as a PUSH |
|
|
Term
A) norm lab values for Ca
B) what conditions have inc CA
C) what conditions have dec cA
D) signs and symptoms of hypercalcemia
E) what should be monitored if hypo CA is suspected or confirmed? |
|
Definition
A)8.5-10.5
B)inc in:
-alkalosis
-pancreatitis
-hyperphosphatemia
-IBD
-ESRD
-removal of the parathyroid
C) dec ca in:
-Thiazide diuretics
-hyperparathyroid
-cancer
-dehydration
-lithium use
-adrenal insufficiency
D) signs of Hypercalcemia:
-Trousseau's sign
-Chvtk's sign
E) hypo Ca signs/interventions:
-monitor CV status
-monitor neuromuscular status |
|
|
Term
A) norm lab values for Mg
B) what conditions have inc Mg
C) what conditions have dec Mg
D) what will be manipulated to recover Mg levels? |
|
Definition
A) 1.5 - 2.5
B)inc mg in:
-IBD
-Diueretic use
-insulin use
-alkalosis
C) Dec of mg in:
-use of mg anacids
-renal insuff (RI)
D) Ca levels will be manipulated/ balanced |
|
|
Term
A) norm lab values for BUN
B) norm lab values for CRE
C) in what conditions are these 2 levels inc?
D) Dec?
E) which of these lab values do we look at to determine need for dialysis and what is this cut off number? |
|
Definition
A)8-25
B)less than 1.2mg/dl
C)inc in:
-renal damage/disease
-dehydration
-excessive protien diet
-liver failure
D)dec in:
-atrophy of muscle tissue
-over hydration
-malnutrtion
E we look at BUN the value indicating need for dialysis is 100 |
|
|
Term
A) norm lab values for glucose
B) what conditions have inc glucose
C) what conditions have dec glucose
D) signs and treatment of Diabetic ketoacidosis and Hyperosmotic nonketotic coma
E) signs and treatment of insulin shock |
|
Definition
A) 70-110 mg/dl
B)inc in:
-hyperglycemia
-stress
-steriod use
-pancreatic
-hepatic disease
-diabetes
C)Dec in:
-hypoglycemia
-excess insulin
D) signs/treatment of hyperglycemia:
-DKA, BS greater than 300
- for Hyper osmolar nonketotic coma BS greater than 800-1000
for both treat fluid def, then hyper K with insulin, then treat hypo K, correct BS with IV insulin (.1 u /kg bw, correct acidosis)
E) Insulin shock, BS less than 60
-give simple carb
-epineph/glucagon at home
-if bs 20 give D5W
**if ever unsure treat with glucose first
monitor K |
|
|
Term
A) norm lab values for Bilirubin
B) what conditions have inc Bilirubin
C) what does a neg result sugggest
D) In what condition is Bilirubin esp helpful in evaluating
E) what nursing interventions should be done to monitor bilirubin? |
|
Definition
A)less than 0.5 mg/dl
B) inc bilirubin in:
-hepatic disease
-biliary obstruction
-hemolysis
C) a negative results indicates a normal value
D) jaundice
E) nursing interventions:
-monitor PT, RBC's, and guaic stool |
|
|
Term
A) norm lab values for Amylase
B) what condition is known for inc amylase?
C) what does a negative value indicate
D) what number is diagnostic (pretty much) for the above condition?
E) what else should be monitored? |
|
Definition
A) 0-130 IU/L
B) Pancreatitis
C) indicates a normal values
D) 1750
e)check BUN, CRE, and HCT |
|
|
Term
A) norm lab values for CPK-isoenzyme?
B) what conditions have inc CPK-isoenzyme?
C) The levels of CPK inc with _________? |
|
Definition
A) 0-5% or less than 5 ng/ml
B) myocardial damage/infartion (> 5%)
C)the amount of damage |
|
|
Term
A) norm lab values of troponin
B) Troponin is increased when there is_______ _________?
C)after the above event, how long does it take for...
levels to elevate?
Levels to peak?
levels to return to normal? |
|
Definition
A) 0-0.5
B)cardiac damage
C) elevate-4-6h
peak 10-24h
return to norm - 10-14 days |
|
|
Term
| what is the normal lab value for WBC |
|
Definition
|
|
Term
| What CD4 ct does a person with HIV have to reach to be considered to have AIDS |
|
Definition
|
|
Term
A) What is the normal ANC?
B)Name 2 factors that would dec ANC |
|
Definition
A) 3000-7000
B) chemo or AIDS |
|
|
Term
A) What is the ANC criteria to be considered neutopenic?
B) at what ANC level would chemo be delayed? |
|
Definition
A) 1000
B) 500 (very serious) |
|
|
Term
A)what is the norm value for RBC's?
B) in what condition would the RBC's be inc?
C)name 2 things that might dec RBC levels |
|
Definition
A) 4.5-6 mil
B) polychythemia
C) anemia or hemmorrhage |
|
|
Term
A) By how much would RBC's inc from 1 unit of tranfused PRBC?
B) at what rate should this be transfused?
C what size gauge should be used for transfusion? |
|
Definition
A) 10,000
B) 250 cc/ 1-4 hrs
C)19 gauge, IV catheter |
|
|
Term
A)what are normal hemoglobin levels for men? women?
B)when might you see inc HgB?
C) when might you see dec HgB? |
|
Definition
A) males: 14-18mg/dl, Women: 12-16
B) polycythemia, dehydration, COPD, CHF
C)Blood less, RF, anemia |
|
|
Term
| 1 unit of PRBC increases HgB by |
|
Definition
|
|
Term
A)Norm platelet value
B) when might you see inc platelets
C) when might you see dec platelets |
|
Definition
A)150,000--300,000
B)polycythemia or malignancy
C) BM supression, autoimmune disease, hypersplenism |
|
|
Term
| If a pt has a platelet ct of less than 50,000 and is not currently bleeding is a transfusion required? |
|
Definition
| No, a transfusion is only required at that point if the pt is bleeding. |
|
|
Term
at what platelet ct is the pt at risk for a spontaneous bleed and is in need of a transfusion?
What type of medications might you avoid in this pt? |
|
Definition
platelet ct of less than 20,000
avoid meds that cause bleeding (heparin, vit C, IB) |
|
|
Term
for someone with a platelet ct below 20,000 who requires a transfusion, how many units should be given and over how long?
Each unit of platelets should inc the platelet ct by? |
|
Definition
5-10 units over 30 mins
each unit will replace @ 5-10,000 platelets |
|
|
Term
A)what is the normal PT time? PTT?
B)which would you look at for a pt with liver disease?
C)a transfusion will be needed for a PT time greater than ______ or a PTT time greater than_____ |
|
Definition
A)norm PT= 9-11
norm PTT= 25-35
B)PTT
C)PT greater than 15 or PTT greater than 45 |
|
|
Term
A)what is considered a save level of digoxin?
B)At what level is it toxic? what happens?
C)at what HR should you hold Digoxin? |
|
Definition
A)1.2ng/ml
B) 3ng/ml (or by symptoms)
C) less than 60 |
|
|
Term
A)what is the therapeutic dilantin level?
B)why is it given?
C)what drug should never be given with dilantin |
|
Definition
A)10-20mg/L
B) antiepileptic
C) coumadin
PS check CBC and Ca levels when on this drug |
|
|
Term
|
Definition
|
|
Term
| what is the norm level for pCO2 |
|
Definition
|
|
Term
|
Definition
| 95-100% below 95 worrysome unless they have COPD. Never use more than 1-2L oxygen with COPDer or risk knocking out hypoxic drive to breath. |
|
|
Term
| normal bicarb levels (HCO3) |
|
Definition
|
|
Term
|
Definition
gauge 19-25
in 1-3 in typ 1.25
ml 3
locations: deltoid, hip (vent glut), thigh (vast lat), buttocks |
|
|
Term
SC injection
Gauge
inch
locations |
|
Definition
G-26-30
I-1/2 inch to 5/8ths
loc-back of upper arm, upper back abdom, butt, thigh. exp hep and insulin |
|
|
Term
| danger signs during 2nd trimester |
|
Definition
| vaginal bleeding, leakage of fluids, painful urination, fever , dec fetal movement, prolonged vomiting abdominal pain cramping severe swelling visual changes, severe headache epigastric pain. |
|
|
Term
| danger signs in 3rd trimester |
|
Definition
| visual disturbances, hand and facial edema, fever , vaginal bleeding, leakage of fluid, ab pain, uterube contractions, PROM, dec fetal movement |
|
|
Term
| the two typical 8-18 week lab tests for pregnancy |
|
Definition
| ultrasound (aka sonogram) and MMS mult markers screen, triple screen and quad screen. |
|
|
Term
a full bladder is needed to do an abdominal US ... t or f
is this type better to do in early or later preg |
|
Definition
|
|
Term
| a full bladder is necessary for a transvaginal ultrasound. t or f |
|
Definition
|
|
Term
when is CVS sampling performed
what are complications of this procedure |
|
Definition
10-12 weeks
vaginal bleed, spontaneous abortion, PROM (what does this mean?!), chorioamnioitis, limb anomalities |
|
|
Term
| when is the muilt marcer screen / the triple screen/ quad screen performed? what does it screen for |
|
Definition
16-18 weeks
screens for down syndrome and Neural tube defect
there is a new quad screen that looks at inhibin A which is produced by the placenta |
|
|
Term
| in the mult marker screen if there are low levels of msafp and estriol and high levels of hCG and inhibin A what might you suspect |
|
Definition
|
|
Term
| in the mult marker screen if you see HIGH levels of MSAFP what might you suspect |
|
Definition
|
|
Term
| nuchal translucency test is |
|
Definition
| an early screen for down syndrome that looks at fluid level behind fetal neck 3mm+ or greater is considered abnormal |
|
|
Term
| amniocentesis can be used for. when is it preformed how often are there complications? |
|
Definition
down syndrom, ontd (what does the o stand for?), fetal lung maturity. preformed after 14 weeks.
complications in less than 1 percent of caes. second trimester seems safer than CVS |
|
|
Term
| what are the routine lab screenings at 24 to 48 weeks |
|
Definition
hemoglobin, hemacrit, and diabetes screening.
RH screen only if mom is negative.
these only if there is a prob:
3 hour glucose test
rh screen
percutaneous umbilical sampling |
|
|
Term
| normal pregnancy hemoglobin is 11 g/dl and a hemocrit of 33%. t or f |
|
Definition
|
|
Term
| normal levels for 1 hour glucose test are |
|
Definition
|
|
Term
| normal levels for fasting , one hour , two hour, and three hour, for the 3 hour glucose test |
|
Definition
fasting 105
one hour 190
two hour 165
3 hour 145 |
|
|
Term
| if not isoimmunized, will receive Phogam at ___weeks and after invasice procedures or trauma, and within ___ hours of post partum |
|
Definition
at week 28
and 72 hours post |
|
|
Term
| what is the percutaneous umbillical sampling used to detect when is it done? how much blood is needed? |
|
Definition
tests for inherited blood disorders and karyotyping of malformed fetus, detection of fetal infection.
done during the 2nd and 3rd trimester
-1-4 cc of blood |
|
|
Term
| what are the routine labs at 32-36 weeks (5 of them) |
|
Definition
ultra sound
RPR/VDRL (syphalis)
cervical cultures for gonorrhea and chalmydia
repeat hgb and hct
rectal and vaginal swaps for group B strep |
|
|
Term
what is the recommended weight gain during pregnancy
what is a good rate of weight gain. |
|
Definition
25-35 lb
good rate is 10 lb by week 20 and 1 lb per week after that |
|
|
Term
| what happens to uterine muscles that become dehydrated? |
|
Definition
| they contract. ie drink enough water 6-8 glasses |
|
|
Term
| how much should cals increase during pregnancy? |
|
Definition
|
|
Term
| infants breath primarily through there mouth. t or f |
|
Definition
| f. they are obligatory nose breathers |
|
|
Term
| respiratory rate of neonate should be between |
|
Definition
30-60 lower wonder if mom exposed to drigs, or maternal analgesics or anesthetics also may be due to rapid warmning or coolling,
higher may be do to aspiration or diaphragmatic hernia |
|
|
Term
| clamping th umbillical cord increases _______ _________ and _____ _______ pressure, this causes the closing of the _________ ________ and also the _______ ______ |
|
Definition
-vascular resistance
-left arterial pressure
-foramen ovale
-ductus venosus |
|
|
Term
| after birth the newborns ______ inc whcih causes the ductus arteriosus to _____ |
|
Definition
|
|
Term
| range of heart rate in tern infant during sleep, when awake |
|
Definition
sleep 80-100
awake 120-160 |
|
|
Term
| average newborn systolic, average diastolic |
|
Definition
|
|
Term
| the time of umb cord clamping can impact blood values depending if it is done quickly or delayed. T or F |
|
Definition
|
|
Term
| seeing high levels of wbc in newborns is a tell tale sign of infection. t or f |
|
Definition
false, physiologic leukocytosis is normal at birth the range is 9000-30,000/mm3
increase in wbc is unlikely with critical sepsis. look at other factors esp LOW temp |
|
|
Term
| why give vit k to newborns |
|
Definition
| they can't synthesize this yet because GI is sterile |
|
|
Term
| newborns have bllod vessels closer to the surface of the skin, this makes them more susceptible to temperature changes |
|
Definition
|
|
Term
| it is normal for babies to lose up to 10% of their wight in the first 3-5 days of life t or f |
|
Definition
|
|
Term
| stomach capacity of a newborn ranges from |
|
Definition
| 30 to 90 mls so 1-3 ounces |
|
|
Term
| do breastfed babies or formula fed babies need to feed more often |
|
Definition
| breast fed because its more quickly digested |
|
|
Term
| what 2 digestional enzymes are not functional at birth |
|
Definition
| not amylase and not lipase |
|
|
Term
| babies are able to digests simple carbs and protiens but have a limited ability to digest fats . t or f |
|
Definition
|
|
Term
| normal blood sugar for newborns a few hours after birth? by 3-4 days of life |
|
Definition
40-60 (initial dec) although a bit concerning under 45 keep checking it
then 60-70
early feedings help stabalize blood sugar. |
|
|
Term
unconjugated/indirect bilirubin is....
while conjugated/direct ... |
|
Definition
-insoluable and bound to circulating albumen
-can leave vascular system and permeate other tissues (ie skin sclera oral mm) causes jaundice |
|
|
Term
| conjugation of bilirubin refers to |
|
Definition
| the breakdown of fetal rbc's |
|
|
Term
| name 4 jobs of liver in newborn |
|
Definition
-iron storage
-carb metab
-conj of bili
-coagulation |
|
|
Term
| physiologic jaundice occurs after the first 24 hours of life and has a greater incidence in asian native american and eskimo infants. symptoms should resolve by the end of the 7th day. t or false |
|
Definition
|
|
Term
| unconjugated bilirubin should not exceed |
|
Definition
|
|
Term
jaundice present at birth or in the first few hours of life is called:
what are inc risks for this |
|
Definition
called pathologic jaundice
risks are rh incompatibility
abo incompatibility
prematurity |
|
|
Term
| cold stress can cuase albumin binding of bili to ______ this results in _________concentrations of bili. what is the most serious complication of excess billi. what causes this |
|
Definition
albumen
higher
-kerncterus, bili enters neuronal cells and this results in the destruction of neuronal cells -CP epilepsy. MR , death |
|
|
Term
| high levels of bili after the first week of life may result from |
|
Definition
| breastfeeding, prog accum of bili. if this happens take a break from breast feeding. |
|
|
Term
| natural immune barriers not fully developed till week ___-___ after birth |
|
Definition
|
|
Term
| IgG limits bacterial growth in GI tract, obtained if mother is breastfeeding. t or false |
|
Definition
| false its IgA that does this |
|
|
Term
| a simian line on the palm of the hand can indicate |
|
Definition
| down syndrome (although it may be normal for many asian babies) |
|
|
Term
| a baby can see up to about 12 inches t or f |
|
Definition
|
|
Term
| when are the two best stages to initiate breast feeding> |
|
Definition
| quiet alert and active alert |
|
|
Term
| apgar based on these 5 signs |
|
Definition
heart rate
resp rate
muscle tone
reflex irritability
color |
|
|
Term
| breastfeeding triggers __________ which comes from the anterior pituitary, this is responsible for milk ________ , while _______ is responsible for milk letdown and comes from the _________ ___________ |
|
Definition
prolactin
-supply
-oxytocin
-posterior pituitary |
|
|
Term
| normal hemocrit range for mom post partum |
|
Definition
|
|
Term
| maternal wbc count may inc to 20-25000 during first week postpartum, this is normal. t or f |
|
Definition
|
|
Term
| breast swell in response to________ |
|
Definition
|
|
Term
| what are the 4 Ts concerning causes for postpartum hemorrhage |
|
Definition
uterine atony (tone)
trauma to genital tract
coag disorders (thrombin)
retained placenta (tissue) |
|
|
Term
| name the five P's that are factors effecting birth. |
|
Definition
passenger
passageway
powers
position
psyche |
|
|
