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Clinical nursing final MSentry
nur sci 1 clincal final questions
109
Other
Graduate
12/13/2005

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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
Positioning for CVA
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
Positioning for DVT
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
Positioning post seizure
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
4,000-10,000
Term
What CD4 ct does a person with HIV have to reach to be considered to have AIDS
Definition
less than 200
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
1g/unit
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
what is norm pO2
Definition
80-100mmhg
Term
what is the norm level for pCO2
Definition
35-45 mmhg
Term
Normal O2 sat
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
22-26
Term
IM

Gauge
inch
Ml

locations
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
true

later
Term
a full bladder is necessary for a transvaginal ultrasound. t or f
Definition
false only for abdominal
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
down syndrome
Term
in the mult marker screen if you see HIGH levels of MSAFP what might you suspect
Definition
neural tube defect.
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
true
Term
normal levels for 1 hour glucose test are
Definition
less than 140
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
by 300
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
PO2

contrict
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
sys 60-80

dia 40-50
Term
the time of umb cord clamping can impact blood values depending if it is done quickly or delayed. T or F
Definition
True
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
true
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
true
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
true
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
true
Term
unconjugated bilirubin should not exceed
Definition
12-15 ml/dl
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
3-4
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
true
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
36-48 elevated
Term
maternal wbc count may inc to 20-25000 during first week postpartum, this is normal. t or f
Definition
true
Term
breast swell in response to________
Definition
prolactin
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
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