Term
What is the purpose of the adrenocorticotropic stimulation test? How is it performed |
|
Definition
used to evaluate adrenal function
Performed by drawing blood for baseline, pt is injected with 250mg of cosyntropin (synthetic ACTH), then blood is drawn at 30 and 60 minutes, cortisol level at 60 min should be greater than baseline and >20mcg/dl |
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Term
What are some examples of situations in which a patient with addison's disease might require corticosteroid replacement?
How do you administer these drugs (timing)?
What drigs might cause a patient to need extra glucocorticoid dosage? |
|
Definition
High stress, trauma, surgery
2/3 in the morning, 1/3 in the evening
Dylantin, estrogen, barbituates, antacids, rifampin
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Term
What should the emergency kit contain for a pt with Addison's disease? When do you teach a pt to use this kit? |
|
Definition
100mg IM syringe of hydrocortizone ---teach pts to use under high levels of stress |
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Term
What are signs and symptoms of hyperglycemia? |
|
Definition
polydipsia, polyphagia, polyuria, blurred vision, weakness, headache, glucose in urine, n&v, abd cramps, DKA or HHS |
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Term
Corticosteroid use and replacement |
|
Definition
Non-replacement therapy- give one tab daily or every other day, take in the morning to avoid GI upset, monitor for osteoperosis
Replacement therapy- increase dose when under stress, do not stop abruptly |
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Term
| What is the urine VMA test used to diagnose? What are the nursing considerations? |
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Definition
| measures excretion of catecholamine metabolites and used to diagnose phenochromocytoma (tumor of adrenal medulla, produces excess catecholamines ->severe HTN)Normal=6.8 per day, level of 10-260 indicates phenochromocytoma..Nursing considerations are 24hr urine, off all meds prior to the test, use HCL to keep urine pH level <3 |
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Term
| What is the classic triad of symptoms of phenochromocytoma? |
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Definition
| severe headache, tachycardia, sweating...HTN |
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Term
| What would a pt look like if they had diabetes insipidus? |
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Definition
| low urine specific gravity, low urine osmolality, hypernatremia |
|
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Term
| What things should you teach a patient regarding diabetes insipidus? |
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Definition
| Decrease salt intake, increase fluids, monitor fluid and electrolytes |
|
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Term
| What things (labs) should a nurse be alert for when caring for a pt with SIADH? |
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Definition
| Hyponatremia (<134)serum osmolality <280, urine specific gravity, muscle cramps, decreased urine, increased wt, headache, lethargy, confusion |
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Term
| What are the nursing interventions to consider when a pt is having a radioactive iodine test? |
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Definition
| Check for allergy to shellfish, may cause dry mouth/throat, gargle soda water for symptoms, teach symptoms of hypothyroidism, 80% will experience hypothyroidism |
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Term
| What are the signs and symptoms of thyroid storm? |
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Definition
| Thyrotoxic crisis, tachycardia, hypernatremia, restlessness, agitation, delirium, coma, stress, infections, trauma, surgery |
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Term
| If your pt with adrenal crisis is experiencing hyperkalemia what would be the s/s and how would you respond? |
|
Definition
| ECG heart dysrhythmias, give kaexelate, shock management, adm high dosages of hydrocortisone, give lots of normal saline, d5 to reverse hypotension and electrolyte imbalance until BP returns to normal |
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Term
| Standards of prevention and detection of nephropathy in pts with with diabetes include yearly screening for what? |
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Definition
| Microalbuminuria (MAU) in the urine, serum creatinine, MAD detects protein in urine earlier than standard dipstick for protein indicating kidney damage, creatinine provides estimation of GFR |
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Term
| What is an appropriate treatment for the management of hypoglycemia? |
|
Definition
| 15g of carbs every 15 min 3 times, orange juice, life savers, honey, jelly, follow with protein/carb snack |
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Term
| What electrolyte imbalance can occur during fluid replacement for DKA? |
|
Definition
| Life threatening hypokalemia, levels rapidly decrease as insulin drives potassium into the cells |
|
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Term
| What are the s/s of hyperglycemic hyperosmolar nonketotic syndrome(HHNS)? |
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Definition
| severe hyperglycemia (600-2000 mg/dl), no or only slight ketosis, profound dehydration, hyperosmolality (increased concentration) of plasma and elevated blood urea nitrogen level, excessive thirst, decreased level of consciousness, coma, confusion |
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Term
|
Definition
| a common initial intervention is infusion of normal saline solution over a 2 hour period, followed by adm of hypertonic (0.45%) saline solution. As in diabetic ketoacidosis, potassium, sodium, chloride, and phosphates are administrated intravenously. insulin is given via an infusion pump. b/c of dehydration, blood glucose levels decrease rapidly with fluid adm, Dextrose (D5) is added to the IV fluid when the blood glucose level reaches about 250 mg/dl to prevent hypoglycemia |
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Term
| What does alcohol do to blood sugar levels in the diabetic patient? |
|
Definition
| alcohol inhibits glucose production by the liver, causes hypoglycemia |
|
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Term
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Definition
| potassium sparing diuretic, competes with alsosterone at receptor sites in distal tubule resulting in excretion of NaCl, H2O, retention of potassium, risk of hyperkalemia, need to monitor I&O, daily wts, electrolytes |
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Term
| How do administer DDAVP nasal spray? |
|
Definition
| Make sure nasal passages are clear before administration, adm 2 hours before surgery or before bedtime for enuresis |
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Term
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Definition
| antithyroid, prepares pt for thyroidectomy or for treatment of thyrotoxic crisis, large doses rapidly inhibit synthesis of t2 to t4 and blocks release of these hormones into circulation, decreases vascularity of thyroid gland, making surgery safer, maximal effects in 1-2 weeks |
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Term
|
Definition
| dicyclomine decreases GI motility, anesthetic properties, do not use if breast feeding or in children younger than 6mths, use with caution in heat and humidity, can cause heat stroke |
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Term
|
Definition
| used to treat pancreatitis, pancreatic enzyme, replaces endogenous exocrine pancreatic enzymes and aids digestion of starches, fats and proteins. Do not use with antacids, separation doses of pancreatin and iron, different brand are not interchangeable |
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Term
|
Definition
| used to treat high cholesterol,bile acid sequestrant, prevents absorption of bile acids and causes them to be eliminated in the stool, many drug/drug interactions, give other drugs 1hr before or 4-6hrs after Questran, monitor cholesterol andc triglyceride levels, monitor bowel habits, encourage high fiber and fluids |
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Term
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Definition
| (as it relates to esophageal varices) relieves portal hypertension, vasoconstrictor, beta blocker,(also used for phenochromocytoma) IV into a large vessel, no faster then 1mg per minute, prevents vasodilation |
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Term
|
Definition
| (as it relates to hepatic encephalopathy) ammonia detox, laxative, monitor for hypernatremia |
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Term
| What are the s/s of pancreatitis? |
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Definition
| LUQ pain, sudden piercing onset, eating aggravates, not relieved by vomiting, decreased or absent bowel sounds, cullen sign, turner sign |
|
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Term
| Cullen sign and Turner sign |
|
Definition
Cullen is brownish ring around the umbilicus
Turners signs is bruising |
|
|
Term
| What are the diagnostic tests for acute pancreatitis? |
|
Definition
| "Aces are high", serum amalase, lipase, urinary amalase (2hr collection) |
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|
Term
| What is the treatment for acute pancreatitis? |
|
Definition
| Morphine, rest, NPO, zantac, prilosec, smooth muscle relaxers, fluid and electrolytes |
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|
Term
| Diet recommendations for cholelithiasis? |
|
Definition
| low fat, small meals, avoid milk, cream, butter and fried foods |
|
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Term
|
Definition
| avoid tension and kinking, measure drainage (300-500ml first 24hrs and will decrease to 200mls after 3-4 days), record volume and color of drainage, place drainage bag at level of the abd, excessive drainage=obstruction or biliary fistula, it may require bile return via NG tube or orally in fruit juice, after a few days t tube may be clamped during meals to aid in fat digestion, do not irrigate without MD order, Cholangiography should be done on 7th or 8th post op day to assess for bile duct obstruction |
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|
Term
| What viruses cause 50-60% of all liver cancers? |
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Definition
|
|
Term
| Dietary teaching for cirrhosis? |
|
Definition
| 3000 calorie high carb, low fat, no alcohol, if acities is present then avoid sodium |
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Term
| Nursing care for bleeds varices? |
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Definition
| Ballon tamponade, keep scissors at the bedside, deflate every 8-12 hours, label lumens to avoid confusion, monitor for complications of rupture or erosion of esophagus regurgitation or aspiration of stomach contents, occlusion of airway balloon, perform oral and pharyngeal suctioning, keep bed in semi-fowlers, pt is unable to swallow, encourage pt to expectorate, keep emesis basin and tissues at bedside, perform frequent oral and nasal care to prevent bad taste of blood and irritation from mouth breathing |
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Term
| How to irrigate a colostomy? |
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Definition
| achieve a regular bowel pattern, use 500-1000 ml of fluid, enough to distend bowel, but not to cause pain, pt should be in a comfortable sitting position. Prime tubing with fluid..NO AIR! Hang fluid 18-24 inches above stoma. Apply irrigating sleeve and put open end in toilet or container. Lubricate stoma cone and insert into stoma and hold in place. Allow fluid to flow in for 5-10 min. Clamp fluid when all fluid is in or if pt feels colonic distention. Allow 30- 45 min for irrigation to be expelled. Close of end of irrigation sleeve. Wash and dry peristomal area, clean all equipment, replace stoma cover of choice |
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Term
| Expected output from an ileostomy? |
|
Definition
| liquid, high volume 1000 to 1800 ml per day tapering to 500 per day |
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Term
| Normal appearance of stoma? |
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Definition
|
|
Term
| Clinical manifestations of colorectal cancer? |
|
Definition
| bloody melana, weight loss, cancer on RIGHT side is asymptomatic |
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|
Term
| Treatment of intestinal obstruction? |
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Definition
| insertion of an intestinal tube for decompression, if this does not work the surgery is the only option |
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|
Term
| Symptoms of ulcerative colitis and potential complications? |
|
Definition
IBD, teens to thirties, diarrhea, bleeding, cramping
malabsorption problems, perforation |
|
|
Term
| Gastric vs. Duodenal ulcers (s/s) |
|
Definition
Gastric: anorexia, wt loss, dysphagia, vomiting, food causes more pain, pain is experienced in LEFT epigastrium
Duodenal: gets better with eating, pain occurs on an empty stomach and is relived with food or antacids, normal appetite, pain occurs in RIGHT epigastrium, back pain |
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|
Term
|
Definition
Biaxin or amoxicillin, flagyl..and a proton pump inhibitor (prevacid)
(2 antibiotics and a PPI) |
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|
Term
| Post-gastrectomy Dumping syndrome |
|
Definition
dizziness, fullness, diarrhea, increase HR
small meals, give fluids after meals, increased proteins and fats, rest after meals |
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|
Term
| Teaching for constipation |
|
Definition
| increase fiber and fluid, exercise, wheat bran, avoid caffeine, toileting routine, limit laxatives and enemas |
|
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Term
|
Definition
| Inhibits prostaglandin synthesis responsible for GI hypermobility, stimulates absorption of fluid and electrolytes |
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Term
|
Definition
| give for acute or chronic diarrhea, inhibits peristalsis, if no improvement after 48hrs the stop tx and seek dr., monitor children closely for CNS effects, avoid with breastfeeding |
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|
Term
|
Definition
| increases water absorption in the small intestine by osmotic action, laxative effect occurs by increased peristalsis and water retention, Contraindicated in pts with hyperphospatemia and renal failure |
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|
Term
|
Definition
| antiemetic and antihistamine, works on the blood vessels, GI, respiratory system by competing with histamine fro HI receptor site-->May cause apnea in neonates, infants and young children, can give iv push over 2min |
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Term
|
Definition
| prevents N&V, dilute and infuse over 15min, incompatible with many drugs--> allopurinol, aminophylline, ampicillin, lasix, and ativan |
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Term
|
Definition
| Increases gastric emptying, can cause CNS side effects from anxiety to hallucinations, dopamine antagonist, antiemetic, GERD, dilute and give over 1-2min, lrger doses must be given over 15min, stimulate motility of the upper GI tract, increases lower esophageal tone, many drug interactions ---> lasix, cillin antibiotics, causes neuroleptic malignant syndrome, seizures, suicidal ideations, bradycardia, SVT, agranulocytosis, neutropenia, avoid alcohol use |
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Term
|
Definition
| Synthetic octapeptide, reduces splanchnic blood flow and acid production, give for GI bleeding, synthetically inhibits glucagon and insulin secretion, anti-diarrheal, can give alone in an emergency situation, otherwise dilute and give over 15-30min, do not give with TPN, may cause arrhythmias bradycardia, hypoglycemia |
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|
Term
|
Definition
| take one hour before meals, neutralizes acids |
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|
Term
|
Definition
| pepsin inhibitor, it adheres to and protects surface of ulcer by forming a protective barrier , prevents absorption of other drugs so take 6 hours apart, avoid smoking, use cautiously in renal failure |
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|
Term
| Signs of dialysis disequilibrium syndrome |
|
Definition
| results from very rapid changes in ECF (extra cellular fluid), ECF changes faster than CSF (cerebral spinal fluid) and causes osmotic shift and cerebral edema, N&V, restless, twitching, seizures, slow or stop dialysis and infuse hypertonic to draw fluid back to the tissues from the brain |
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|
Term
| Symptoms of pyelonephritis |
|
Definition
| inflammation of the whole kidney system, fatigue, fever, chills, flank pain, urosepsis |
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|
Term
| Nutritional therapy for urinary tract calculi |
|
Definition
| avoid food high in the content that is causing the stone. Purines: sardines, herring, mussels, liver, kidney, goose, venison, meat soups, sweet breads. Calcium: milk and milk products, beans and lentils, fish with fine bones, dried fruits, nuts ovaltine, chocolate, cocoa. Oxalate: dark roughage, spinach, rhubarb, asparagus, cabbage, tomatoes, beets, nuts, celery, parsley, runner beans, chocolate, cocoa, instant coffee, ovaltine, tea, worcestershire sauce |
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|
Term
| Treatment for hyperkalemia in renal failure? |
|
Definition
| insulin, sodium bicarb= removes from cells, use kaexalate to remove from body, dialysis |
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|
Term
| What are some nephrotoxic medications? |
|
Definition
| NSAID's, digitalis, aminoglycides, Demerol (meperidine) |
|
|
Term
|
Definition
| decreased urinary output, increased BUN and creatinine, increased potassium, Hypertension, dysrhythmias, N&V |
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|
Term
| Teaching regarding urinary tract infection? |
|
Definition
| take all meds, wipe front to back, urinate after sex, frequent urination, no bubble baths, report cloudy urination, don't wear clothes too tight, wear cotton underwear |
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|
Term
|
Definition
| sodium polystyrene sulfonate, pulls potassium from body, can be administered outpatient, expect diarrhea, do not give to pt with hyperactive bowel, monitor for fluid and sodium retention |
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|
Term
| Pertinent health hx information as it relates to hematology? |
|
Definition
| energy level, diet,, abnormal bleeding or bruising, black or bloody stools, numbness or tingling, vision problems |
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|
Term
| What things does blood regulate? |
|
Definition
| transport of O2, nutrients, hormones, waste products, fights pathogens, maintains homeostasis, regulation of fluid and electrolytes and acid base balance, regulates body temp |
|
|
Term
| With a parasitic infection, which type of granulocyte should increase? |
|
Definition
|
|
Term
| How does aging affect the hematological system? |
|
Definition
| diminished response to infection, PIT decreases, decreased iron, normal counts can be maintained, but depleted reserves leave the older adult with diminished ability compensate for acute or chronic illness |
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|
Term
| Which drugs interfere with platelet production? |
|
Definition
| aminoglysides,diuretics, H2 blockers, NSAID's, phenothiazines, saicylates (aspirin), tricyclic antidepressants |
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|
Term
| How does dehydration affect your Hgb & Hct? |
|
Definition
|
|
Term
| Define neutropenia and leukopenia ? |
|
Definition
Neutropenia: defined as neutrophil count < 1000, 500 is serious...b/c of lack of neutrophils there is no
inflammatory response..so fever is the cardinal sign of infection. neutrophils should be 50-70% of WBC. Neutropenia should be treated as on oncologic emergency!!!! Leukopenia is WBC < 4000 (dictionary says 5000)Normal is 4000-11,000 |
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|
Term
| Which lab study measures a fragment of fibrin that is formed as a result of fibrin degradation and clot lysis? |
|
Definition
| D-dimer, used to diagnose hypercoagulable conditons (DIC) ,250ng/ml is normal |
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|
Term
| In which condition might the "sed rate" be elevated |
|
Definition
| acute and chronic conditions when cell destruction is increased, malignancy, MI, ESRD, very non-specific test, only indicates a problem, no were the problem is |
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|
Term
| In which situation might you expect RBC agglutination (blood compatibility reaction)to occur? |
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Definition
| When a pt is given the wrong blood type |
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Term
| When might it be a problem if the mother is RH (-) and the fetus in RH (+) |
|
Definition
| If the baby's blood escapes into the mother, the mother will build up antibodies, when the mother gets pregnant again this could cause the fetus to be miscarried or it can cause the fetus to have anemia, jaundice, mental retardation, and heart failure |
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Term
| What does the retic count measure? |
|
Definition
| A reflection of RBC production, reticulocyte count measures responsiveness of bone marrow to a decreased number of circulating erythrocytes. Specifically, this test measures number of reticulocytes released from bone marrow into blood. |
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|
Term
| What are the nursing responsibilities during and after a bone marrow biopsy? |
|
Definition
| posterior iliac crest, cover sterile pressure dressing and instruct pt to lie on stomach (prone), monitor for bleeding |
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|
Term
| Nursing responsibility for lymph node needle biopsy? |
|
Definition
| sterile technique, apply direct pressure, frequent observation of site and vitals |
|
|
Term
| What is the characteristic cell in hodgkin's disease? |
|
Definition
| Reed Sternberg's cells, abnormal giant, multinucleated located in the lymph nodes |
|
|
Term
| where does Hodgkin's disease originate? |
|
Definition
| in the lymph nodes (usually first in the cervical lymph nodes) |
|
|
Term
|
Definition
| Immune thrombocytopenic purpura, most common acquired thrombocytopenia, a syndrome of abnormal destruction of circulating platelets (purpuric rash, normal BM, sudden onset of petechia in a child who is otherwise healthy) |
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|
Term
| What is the first manifestation of DIC in a person with no previous hx? |
|
Definition
| abnormal bleeding in a person with no obvious cause of hx |
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|
Term
| What is sickle cell disease? |
|
Definition
| group of inherited autosomal..abnormal formed rbc, causes to sickle and stiffen in response to decreased hgb, abnormal shape causes thrombosis |
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|
Term
| What are causes of folic acid deficiency? |
|
Definition
| poor nutrition, lack of leafy green vegetables, liver, citrus fruit, yeast, dried beans, nuts, grains; malabsorption syndromes (small bowel syndrome), drugs that impede absorption (methotrexate), antiseizure drugs (phenobarbital, dylantin), trimethoprim,sulfasalazine, alcohol abuse and anorexia, hemodialysis |
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|
Term
| In what group of people is hemochromatosis most common? |
|
Definition
| Caucasians of European descent |
|
|
Term
| In which populations is iron deficiency anemia most common? |
|
Definition
| Populations in poor countries and people whose diets lack meat are at particular risk for iron deficiency anemia from insufficient dietary intake of iron, the most prevalent hematologic disorder worldwide. |
|
|
Term
| What is the definition of hemolytic anemia? |
|
Definition
| destruction of rbc at a rate that exceeds production |
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|
Term
| The major problem of heparin-induced thrombocytopenia and thrombosis is? |
|
Definition
| DVT, pulmonary embolism (PE), myocardial infarction or cerebrovascular accident, occlusion of limb arteries (possibly requiring amputation), end-organ damage, or death. |
|
|
Term
| How much blood does a person have to lose before clinical manifestations begin to show? |
|
Definition
| 10-20% no signs at rest, 40% you see signs, 50% shock or death |
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|
Term
| What are the s/s of megaloblastic anemia? (Pernicious Anemia) |
|
Definition
| GI manifestations (weight loss, appetite loss, nausea, vomiting, abdominal distention, diarrhea, constipation, steatorrhea), and neurologic disorders (paresthesias of feet and hands, poor gate, memory loss, cognitive problems, depression). |
|
|
Term
| what should pt. expect after cystoscopic procedure? |
|
Definition
| Burning with urination, pink tinged urine, urinary frequency. |
|
|
Term
| What are the s/s of megaloblastic anemia? (Pernicious Anemia) |
|
Definition
| GI manifestations (weight loss, appetite loss, nausea, vomiting, abdominal distention, diarrhea, constipation, steatorrhea), and neurologic disorders (paresthesias of feet and hands, poor gate, memory loss, cognitive problems, depression). |
|
|
Term
| What drugs can cause thrombocytopenia? |
|
Definition
| Thiazide diuretics, estrogen, chemo drugs, digitalis, NSAID's, antibiotics, aspirin, haldol, tagement, zantac |
|
|
Term
|
Definition
| Treatment of hypercalcemia, used in cancer pts with bone metastasis |
|
|
Term
|
Definition
| Granulocyte Colony Stimulating Factor: filgrastim (neupogen) used in pts with neutropenia receiving chemotherapy to stimulate blood cell growth (also stimulates appetite) |
|
|
Term
|
Definition
| Iron, 100mg= 20mg of iron, essential for hemoglobin, stains teeth, take with orange juice, do not take within 2hrs of calcium |
|
|
Term
| What are f/e imbalances you would expect to see with chronic kidney disease? |
|
Definition
| The most common tests to assess renal function are(BUN) and serum creatinine levels and urinalysis. BUN and serum creatinine levels indicate the ability of the kidney to excrete urea and protein wastes. Elevated levels may reflect dehydration, impaired cardiac output, or renal failure. Elevated creatinine level is associated with renal disease. Urinalysis results may indicate urinary tract infection, diabetes, malnutrition, renal disease, or dehydration. Also increased Na & K |
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|
Term
|
Definition
| accelerates formation of antithrombin III-thrombin complex and deactivates thrombin, preventing conversion of fibrinogen to fibrin, thins blood and prevents clotting |
|
|
Term
| Why don't ppl w/kidney disease recieve Demerol? |
|
Definition
| b/c it is very hard on the kidneys due to the fact that it contains toxic metabolites. It is also contraindicated in older adults. |
|
|
Term
| Most common cause of UTIs in women? |
|
Definition
|
|
Term
| What foods should a pt with cancer NOT eat? |
|
Definition
| fresh fruits and veggies, seeds, nuts, fried, highly seasoned foods, gas producing |
|
|
Term
| What is the worst grade of cancer? |
|
Definition
| Grade 4, cells are immature, undifferentiated cells, cell of origin is difficult to find, cancer cells are more prominent than other cells |
|
|
Term
| Cholestatic pain location? |
|
Definition
| Pain in acute cholecystitis may be located in the epigastric, subscapular, or right upper quadrant regions. Sometimes the pain is referred to the right scapula. The pain usually starts suddenly, increases steadily, and reaches a peak in about 30 minutes. Abdominal examination may disclose a tender abdomen with right upper quadrant guarding. Murphy's sign may be elicited when the client is asked to take a deep breath. |
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|
Term
| What is TMN staging for cancer? |
|
Definition
Used to determine the anatomical extent of the disease involvement according to three parameters: T=
tumor size, N=presence or absence of regional spread to lymph nodes, M= metastasis to distant organ sites
Using the TNM classification, cancers can be grouped into one of four stages (I to IV) or indicated as stage 0 for carcinoma in situ (without spread). Higher stages signify more extensive disease, with stage IV representative of distant metastasis and the worst prognosis. |
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|
Term
| What are the most common cancer screening recommendations? |
|
Definition
| Prostrate: PSA and ORE annually at 50, high risk should begin at 45. Mammogram: annually at 40, high risk talk to dr., Cervical: start 3yrs after intercourse, no later than 21, yearly after that, Colon: at age 50, yearly FOBT, sigmoidoscopy 5yrs, barium enema 5yers, colonoscopy 10yrs |
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|
Term
| S/S of perforated peptic ulcer? |
|
Definition
| sudden severe abd pain, tenderness, and rigidity. |
|
|
Term
|
Definition
| is a motor disorder characterized by progressively incomplete relaxation of the lower esophageal sphincter (LES), and progressive, eventually complete, loss of peristalsis in the esophageal body. Food that has been swallowed has difficulty passing into the stomach and the esophagus above the LES becomes enlarged. Food from one or several meals may lodge in the esophagus and pass slowly into the stomach over time. There is danger of aspiration of esophageal contents into the lungs when the person lies down. The client typically presents with progressive (over months to years) dysphagia, usually expressing the feeling that “something is stuck in the throat.” |
|
|
Term
| What are warning signs for cancer? |
|
Definition
| CAUTION: C= change in bowel habits, A= a sore that does not heal, U= unusual bleeding or discharge from any body orfice, T= thickening or lump in breast or elsewhere, I= indigestion or difficulty swallowing, O= obvious change in wart or mole, N= nagging cough or hoarsness |
|
|
Term
| weight gained vs. fluid retained? |
|
Definition
| 1 liter = 2.2 lbs. 500ml = approx. 1 lb. |
|
|
Term
| What should you teach your patients about internal radiation? |
|
Definition
In prostate brachytherapy, when radioactive seeds have been permanently implanted, there is a low, weakly penetrating radiation exposure for others. Therefore the client should use a condom for sexual intercourse in the first weeks after the procedure. Also, the client should avoid close (<6 feet) contact with pregnant women and young children (younger than 3 years) for more than 5 minutes a day during the first 2 months after implantation.The client receiving internal XRT with an unsealed source also needs to have a private room and bath. Further precautions must be taken because all body secretions are radioactive. All surfaces, including the floor on which the client will walk, are covered with protective covering. Foods are served on disposable plates with disposable utensils. Trash and linens are kept in the client's room and are not removed until after the client is discharged. To further decrease the risk of radiation exposure to caregivers, bed linens are generally not changed unless they are grossly soiled. The client is instructed to flush the toilet several times after each use.
Visitor and staff contact is limited, and anyone entering the room wears a new pair of booties each time to avoid tracking the radioactive isotope out into the hallway. Gloves are worn to avoid exposure when handling body fluids. Any emesis (vomiting), especially that occurring shortly after the client has ingested an oral isotope, should be covered with absorbent pads, and the radiation safety officer should be called immediately. Additional precautions may be necessary, depending on the radioisotope used and the policies and procedures of the individual practice setting.Your exposure time should generally be limited to 30 minutes of direct care per 8-hour shift. You need to plan your time in the client's room so you can spend it efficiently while providing care to the client. Time required to organize supplies should be spent outside the room. Care for the client should be rotated among available nursing staff to limit exposure for each employee. Pregnant nurses should not be assigned to care for clients receiving XRT. |
|
|
Term
| What radioactive agent has the longest half-life? |
|
Definition
|
|
Term
| TX for rising ammonia levels r/t liver failure? |
|
Definition
| Lactulose is given to decrease pH to dicourage bacterial growth. It causes 2-3 loose stools/day to excrete the excess ammonia. Antibiotics are also given to reduce bacterial action on the protein which produces ammonia. Cathartics and enemas are used to decrease bacterial action. |
|
|
Term
| How do manage anorexia that accompanies cancer therapy? |
|
Definition
| encourage small meals, high protein, high calorie, pleasant environment, encouragement, no nagging |
|
|
Term
| Pt teaching r/t hiatal hernias to reduce symptoms? |
|
Definition
| eliminate constricting garments, avoid heavy lifting/straining, eliminate alcohol and smoking, elevate HOB, use PPIs,H2-blockers,lose weight if fat, and to eat small meals. |
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Term
| How can u help pts cope with alopecia what accompanies chemo? |
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Definition
| suggest wigs, scarves, avoid shampoo, discuss self image |
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Term
| What should you teach your pts about radiation and skin reactions? |
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Definition
| mild soaps, pat dry, bland lotion, avoid tight clothes, avoid sun, no heat or ice on site, no swimming |
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Term
| How is cancer pain different from other types of pain? |
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Definition
| vital signs may not be indicative of pain level b/c of prevalence of chronic pain |
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Term
| How do you assess the extent of burns? |
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Definition
| Lund-Browder or rule of nines, Lund-Browder is more accurate b/c it takes into account the pts age. Rule of nines is adequate for initial assessment of adult pts |
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Term
| How would you use the rule of nines to calculate burns to head, chest, neck and both arms? |
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Definition
| Head and neck= 9, anterior trunk= 18, each arm = 9 (18)...45% burn |
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Term
| What would an emergency care of a second-degree burn consist of? |
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Definition
| ABC, monitor vitals, remove any clothing that is not stuck, establish IV access, fluid replacement, cover burns with gauze or loose sheets |
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Term
| What happens to fluid and electrolytes during the acute phase of burn? |
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Definition
| plasma shifts into surrounding tissue, sodium ions enter cell and potassium ions exit, osmotic gradient is created which leads to increases in intracellular and interstitial fluid which further depletes intravascular fluid volume, blood is shunted to the brain and heart and away from other vital organs, if fluid is not replaced organs will begin to shut down--> when fluid is replaced quickly then you can expect diuresis |
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Term
| What do we do during the emergent phase for fluid and electrolytes? |
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Definition
| Major fluid replacement with LR or colloidal solutions. Fluids must be replaced that are lost due to shifting, multiple IV lines are used, if burns are >30% TBSA central lines and ART lines should be considered |
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Term
| What are likely complications during the acute phase of a burn? |
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Definition
| Infections, dysrhythmias, shock, ROM contractures, diarrhea, risk of paralytic ileus from sepsis, hypothermia, hyperglycemia from increase cortisol |
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Term
| How to take of pts with Sengstaken Blakemore tube? |
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Definition
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Term
| What is most common cause of complications during the rehabilitation phase? |
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Definition
| skin and joint contractures, hypertrophic scarring |
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Term
| What are some nursing diagnosis for a pt with burns? |
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Definition
| Fluid and electrolyte imbalance, disturbed body image, imbalanced nutrition, less than body requirements, acute pain |
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Term
| Be able to use the parkland formula to calculate fluid resuscitation |
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Definition
4ml (lactated ringers) per kg x TBSA
1/2 the first 8hrs and the rest over the next 16 |
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Term
| What tests confirm prostate cancer? |
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Definition
| a biopsy is the only definitive test fro dx prostate cancer |
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|
Term
| What is the screening test for prostate cancer? |
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Definition
| PSA..prostate specific antigen allows for early detection of prostate cancer |
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Term
| DKA diagnostic criteria and s/s? |
|
Definition
| lethargy, weakness, dehydration, poor skin turgor, dry mucous membranes, tachycardia, orthostatic hypotension, abd pain, n/v, Kussmauls resp., sweet fruity breath, glucose>300, ph <7.3, bicarb <15, ketones in blood and urine. |
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Term
| What are the symptoms of BPH? |
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Definition
| obstructive: difficulty voiding, intermittency and dribbling at the end of urination, all due to urinary retention, or irritating: urinary frequency, urgency, dysuria, bladder pain, nocturia and incontinence |
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Term
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Definition
| painful erection lasting longer than 6hrs. Condition may constitute a medical emergency. May render further erections impossible |
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Term
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Definition
| Type 1 diabetes mellitus, AKA insulin dependent diabetes, tends to run in families: the risk to siblings of an affected individual with type 1 diabetes mellitus or to the offspring of a diabetic father is more than 10 times the population risk. In addition, twin studies show a concordance rate of 30% to 50% in monozygotic (identical) twins with lower rates in dizygotic (fraternal) twins. (The body cannot produce insulin b/c pancreas is ineffective.) onset is normally 11-13. Insulin must be taken for life. |
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Term
| What herb has been used to treat BPH? |
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Definition
| Saw palmetto, appears to be very effective in reducing symptoms of BPH, well tolerated for 3-5 years, may icrease bleeding risk, consult MD |
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Term
| What is testicular torsion s/s/ |
|
Definition
| Twisting of the spermatic cord that supplies blood to the testes and epididymis, most common under 20yrs old, severe scrotal pain, tenderness, swelling, N&V, moving scrotum in any way will not help pain |
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Term
| How long do we treat prostatits? |
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Definition
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Term
| Read about Transurethral resection of prostate including post-op care and complications. (multiple cards) |
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Definition
| use of excision and cauterization to remove prostate tissue cystoscopically, considered the "Gold Standard" for tx of BPH, irrigating fluid is instilled into the bladder to visualize the resection, the irrigating fluid is isotonic, never NS b/c of its poor conductivity, and never hypotonic (water)b/c it can cause transurethral syndrome (see next card) Bleeding is common after procedure and requires constant or intermitten irrigation |
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Term
| Transurethral resection Syndrome (TUR) |
|
Definition
| TUR syndrome is characterized by hyponatremia, hypervolemia, hemolysis, and acute renal failure. Clinical manifestations of TUR syndrome include agitation, acute delirium, bradycardia, tachypnea, and vomiting. Although unusual, it can occur even when isotonic solutions are used, particularly if resection involves surgical times longer than 60 to 90 minutes, allowing extensive absorption of irrigation into the vascular system. If manifestations of TUR syndrome occur, the physician is notified immediately and fluid and other supportive measures are initiated promptly. |
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Term
|
Definition
| Bleeding clot retention, dilutional hyponatremia due to irrigation (from ppts) |
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Term
| Post-op care of pt who had TURP |
|
Definition
Prevent complications (hemorrhage, bladder spasms, UI, infection.
bladder irrigation removes clots manually, intermittently or continuously with isotonic fluid-->manual 50ml of irrigating solution CBI rate is determined by the color of the drainage, looking for pink w/o clots and monitoring outflow to make sure getting a full return |
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Term
| Post-op care for TURP continued |
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Definition
| Aseptic technique: avoid introducing bacteria, don't irrigate the catheter, use leg strap, closed drainage system, cleanse secretions around the meatus, watch for blood clots 24-48hrs vs bright red hemorrhaging (d/t clots, displacement of the catheter, increases in ABD pressure .If having bladder spasms check for clot then give bellodonna and opium suppositories |
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Term
| Post op care for TURP continued (again) |
|
Definition
| post op removal of the 3 way, usually 2-4 days, if no urination after 6hrs, put another catheter in, and straight catch, encourage kegal exercise for UI |
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Term
|
Definition
| urethral meatus is located on the ventral surface of the penis |
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Term
|
Definition
| urethral meatus on dorsal surface of the penis, complex birth defect usually associated with other GU defects |
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Term
|
Definition
| constriction of uncircumcised foreskin inhibiting retraction, caused by edema or inflammation, usually do to poor hygiene |
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Term
|
Definition
| edema retracted foreskin preventing normal return over glans, an ulcer can develop if it remains retracted |
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Term
| How do you do a testicular exam? What can the pt expect? |
|
Definition
| use both hands, feel both testes with thumb and 3 fingers, feel entire surface, should feel round and smooth, like a hard boiled egg, one may be larger, that is normal, no lumps, irregularities or pain, should be done monthly from puberty |
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Term
|
Definition
| male menopause, low androgens, can begin at 40, loss of libido, fatigue, ED |
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|
Term
| What is contraindications to testosterone replacement? |
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Definition
|
|
Term
| What are some causes fro decreased sperm count? |
|
Definition
| STD's, frequently using a hot tub, tight undergarments, weight training and frequent intercourse. |
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Term
| What drugs can decrease sperm count? |
|
Definition
| chemo, anabolic steroids, sulfasalazine, cimetidine, and recreational drugs |
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Term
| DDAVP-pt teaching about things to monitor at haome also what does DDAVP do? |
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Definition
| Monitor I&O and daily weights to prevent fluid retention, promotes reabsorption in the renal tubules, vasopressor effect Used for DI (ADH replacement ) |
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Term
| What does Lugol's solution do? |
|
Definition
| potassium iodide, used to prepare the thyroid for surgery, used in thyrotoxic crisis, raditation protectant for thyroid. A chemical protective shield for the thyroid gland, stops hormone production, prevents iodine transport in |
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Term
| NPH insulin how long does it take to peak and cause hypoglycemia |
|
Definition
peak is 4-10hrs, duration 10-16hrs
How do you store it? Vials in use can be left out in room air (<86 F or above freezing) for 4wks, otherwise keep refrigerated |
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Term
|
Definition
| Type 2 diabetes mellitus accounts for most cases (over 90%) of diabetes. Two major risk factors for this condition are positive family history and obesity; the latter increases insulin resistance, which is a feature of type 2 diabetes mellitus. In contrast to type 1 diabetes mellitus, there is no HLA association and monozygotic twin concordance rates are substantially higher (often exceeding 90%) than in type 1 diabetes mellitus. A subset of type 2 diabetes mellitus, called maturity-onset diabetes of the young (MODY), can be inherited as an autosomal dominant trait. MODY accounts for approximately 2% to 5% of clients with type 2 diabetes mellitus and typically occurs before age 25 years.(Pancreas produces insulin but body can't effectively use it or not enough insulin is produced. can be caused by poor diet, obesity, genetics, and age. It is more common in African Americans.) |
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Term
| What type of insulin can be given IV? |
|
Definition
|
|
Term
|
Definition
| pancreas produces insulin but wither cannot produce enough, or the body cannot use it effectively or a combination of both, over 90% of diabetes cases are type II, becoming more and more frequent in children, prevalence increases with age, contributing factors are poor diet, obesity, genetics, seen more in African Americans, Asian Americans, Hispanic Americans, Native Americans |
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