term 2 final

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term 2 final
2012-06-11 01:59:49
term final

term 2 american career college final
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  1. Atelectasis -
    The collapse of alveoli, preventing the respiratory exchange of oxygen and carbon dioxide
  2. pernicious anemia
    • The abscence of a glycoprotien intrinsic factor secreted by the gastric mucosa
    • an autoimmune dsease in which antibodies in the parietal walls of the stomach prevent the production of intrinsic factor
    • intrinsic factor is essential for absorption of vit B12
    • if not treated can cause death
  3. causes of atelectasis
    • occlusion of air to a portion of the lungs
    • common post operative complication
    • results from aspiration of a foreign body
    • can lead to stasis anemia
  4. Hemophilia Treatment
    • a hereditary coagulation disorder, is characterized by a disturbance of the clotting factors
    • transfusions and administration of factor VIII or IX may be prophalactic or used to stop hemmorrhage
  5. polycythemia meds
    • mylosuppressive agents - myleran
    • hydroxyurea - hydrea
    • melphalan - Alkeran
    • and radioactive phosphorus are often given to inhibit bone marrow activity
    • Allopurinol - may reduce the number of acute gouty attacks.
  6. neutropenic percautions
    • standard precaution
    • isolation techniques - reverse isolation - airborne, droplet and contact percautions
    • Gowning, gloving, sterilization, or disinfection of materials brought into the area and other details of housekeeping vary withthe reason for the isolation and the usual practices of the hospital
  7. heparin vs. warfarin
    • heparin - blocks conversion of prothrombin to thrombin and fibrinogen to fibrin - immediate action
    • prophalaxisis and treatment of thrombosis and embolism
    • anticoagulation for vascular cardiac surgery
    • prevention of clotting antidote - protamine sulfate
    • Warfarin - blocks prothombin synthesis - delayed action 2-5 days
    • prophylaxsis and treatment of thrombosis and embolism
    • A-fib w/ embolization adjunction
    • treatment of coronary occlusion antidote - vit. k
  8. schilling test
    • 24 hour urine test - measures the absorption of radioactive Vit. B12 before and after the parental injection of the intrinic factor
    • normal findings are between 8% to 40%
    • used to diagnosis pernicious anemia
  9. Hodgkin's signs and symptoms
    • Enlargement of the cervical, axillary, or ninguinal lymph nodes is the initial development
    • most common location is a medialstinal node mass
    • anorexia, weight loss, fever, night sweats, malaise, extreme pruritis
    • night sweats, weight loss, and fever are refered to as "B" symptoms, are associated with a worse prognosis
    • Anemia and leukocytosis follow, with development of respiratory tract infections
  10. angioplasty / stent insertion
    • angioplasty - technique widens the narrowing in a coronary artery without open heart surgery.
    • flouroscopy is used to guide a catheter from the femoral or brachial artery to the coronary arteries to be treated
    • inflation of a balloon in the catheter is achieved once it is positioned, thus reducing the constriction to improve blood flow
    • Stent Placement - are used to treat abrupt or threatened vessle closure following angioplasty
    • are expandable, meshlike structures designed to maintain vessel patency by resisting vasoconstriction
  11. Theophylline
    • aka: accurbron, bronkodyl, Theo-Dur
    • Bronchodilator
    • Side effects - anxiety, restlessness, insomnia, headache, seizures, tachycardia, cardiac dysrhythmias, nausea, epigastric pain, hematemesis, GERD, tachypnea
    • Nursing implications: DO NOT CRUSH sustained-release preparations; contents of pellet-containing capsules may be sprinkled over food; avoid caffeine; metabolism is affected by other medications (erythromycin, ciprofloxzcin, cimetidine, riframpin);
    • monitor serum concentrations
  12. CABG
    Coronary Artery Bypass Graft
    • grafts are done, depending on the areas of occlusion so blood flow is restored to the occluded areas
    • grafts are taken from sections of saphenous viens in the legs (5-10 years), or the internal mammary artery (last more than 15 years)
  13. Myocardial Infarction
    • an occlusion of a major coronary artery or one of it's branches with subsequent necrosis of myocardium caused by atherosclerosis or an embolus or thrombosis
    • occlusion leads to tissue ischemia - myocardial ischemia lasting more than 355-45 min will produce cellular damage and necrosis
    • cell death brings in inflammation and enzymes are released from the dead cardiac cells
    • pain is the formost symptom, crushing-an oppressive, heavy objects sitting on the chest
    • pain radiates down to left arm and to the neck, jaws, teeth, and epigastric area
    • occurs in conjunction with intense emotin, during exertion, or at rest
  14. PMI
    • Also called the apex beat - is the furthermost point outwards (laterally) and downwards (inferiorly) from the sternum at which the cardiac impulse can be felt.
    • The cardiac impulse is the result of the heart rotating, moving forward and striking against the chest wall during systole.
    • It is also known as the "apical impulse".
  15. Types of Burn injury
    • Superficial - first degree - flash flame, ultraviolet light (sunburn)- dry no vesicles, minimal or no edema - blanches with fingertip pressure- increased erythema - painful
    • Partial thickness - 2nd degree - contact w/hot liquids or solids, flash flame to clothing, direst flame, chemicals and ultraviolet light - large moist vesicles that increase in size - mottled with dull, white, tan, pink, or cherry red areas - very painful
    • Full thickness - 3rd degree- same as 2nd degree but also electrical contact - dry white leathery eschar, charred vessles visible under eschar, thin-walled vesicles that do not increase in size may be present - white, charred, dark tan, black, red - little or no pain, hair easily pulls out
  16. Types of Lesions
    • Macule - freckles papule - wart
    • patch - vitiligo, port wine stains plaque- psoriasis
    • wheal - insect bites, urticaria nodule - lipomas
    • tumor - lipoma, hemangioma vesicle - herpes zoster
    • Bulla - blister pustule - acne, impetigo
    • cyst - sebaceous cyst Telangiectasia - rosacea
    • scale - flacking of skin atrophy - aged skin, striae
    • lichenification - chronic dermatitis
    • keloid - irregular shaped, elevated, progressively enlarging scar
    • scar - healed wound or surgical incision
    • excoriation - abrasion of scratch, scabies
    • fissure-athlete's foot, cracks at the corner of the mouth
    • erosion - rupture of varicella or bulla
    • ulcer - pressure sore crust - scab
  17. Wood's Light
    • causes hairs infected by a fungus to become brilliantly fluorescent
    • supports the diagnosis of all fungal infections of the skin
  18. Acne Meds
    • Benzoyl peroxide -clearasil
    • vitamin A acids, antibiotics, and sulfur-zinc lotions
    • systemic antibiotics - such as tetracycline
    • isotretinoin - accutane - a form of vit A - do not get pregnant!!
  19. Phototherapy care
    • Light used as treatment
    • Photochemotherapy - involves the use of a drug enhanced by exposure to light - PUVA
    • this therapy combines methoxsalen (Oxsoralen), which is given orally, and the concurrent use of ultraviolet light A (UVA)
  20. Psoriasis
    • Non-infectious skin disorder; it is a hereditary, chronic proliferative disease involving the epidermis and can occur at any age.
    • the skin cells divide much more rapidly than normal
    • severe scaling results from the rapid cell division
    • normal sloughing and generation of new cells, is 28 days, with psoriasis the time may decrease to 7 days
    • lesions appear as raised, silvery scaling plaques.
  21. Psoriasis
    Medical Management
    • Aimed at slowing the proliferation of epithelial layers of skin
    • Topical steroids and keytolitic agents are used in occlusive wet dressing to decrease inflammation
    • can also use photochemotherapy
    • methotrexate and vitamin D reduce epidermal proliferationin some cases
  22. Blackheads
    Also called comedo, a wide opening on the skin surface filled with skin debris and sebum, and bacteria
  23. Boils Management
    • also called a furuncle
    • management aimed at preventing the spread of infection
    • Pt are isolated - wound and secretion precautions
    • Surgical treatment may include draining the lesion and applying topical antibiotics
  24. Erikson's Developemental tasks
    • Infancy: TRUST VS. MISTRUST
    • Preschool: INITIATIVE VS. GUILT
  25. Cast Care
    • Handle wet casts gently and support it with the flat of the hand or on pillows to avoid indetions that cause pressure on the skin and lead to skin impairment
    • set cast dryer on warm, never hot
    • elevate cast 24-48 hrs. to reduce edema
    • cast syndrome can occur after application of a spica - involves acute obstruction of the duodenum- if nausea occurs , place pt in prone position to relieve pressure
    • pt often complain of pruritis, provide distraction and or antihistamine
  26. Fracture First Aid
    Pulselessness, paresthesia, paralysis or paresis, polar temperature, pallor, puffiness (edema), pain
  27. Bed Trapeze
    • Skin Traction
    • Sponge rubber, moleskin, and elastic bandage with adherent or plastic materials attached to the skin below the site of the fracture, pull exerted on the limb
    • Buck's Traction - frequently used to maintain the reduction of a hip fx before surgery, treat muscle
    • Russell's Traction - similar to Buck's traction. However, a knee sling supports the affected leg
    • Bryan's Traction - used in pediatrics, under 40 lbs. 1-3 yr. olds - both legs are elevated in soft traction with buttocks off of bed slightly, traction is facilitated be the weight of the child's torso. legs @ 90 degrees. check senstion of feet, toe motion, circulation.
  28. Left vs. Right sided Heart Failure
    • Left sided - dyspnea, PND, Orthopena, cough, frothy, blood tinged sputum, pulmonary crackles
    • Right Sided - distended jugular veins, anorexia, nausea, abd distention, hepatomegaly (enlarged liver), RUQ pain,, cirrhosis, ascites (fluid in peritoneal cavity), edema in ankles, feet, sacrum, splenomegaly, Splenomegaly, increased central venous pressure
  29. Buerger's Disease
    • Occlusive vascular condition in which the small and medium sized arteries become inflamed and thrombotic.
    • Assessment - inflammation of vessel walls, pain w/ exercise affecting the arch of the foot, pain may occur at rest, frequent, persistent, skin is cold, pale, ulcers and gangrene, sensitivity to cold is an outstanding clinical manifestation.
    • Diagnostic Tests - none specific, based on onset, hx of tobacco use, clinic symptoms
    • Medical management - prevent disease progression, smoking cessation, promote exercise, amputation of gangrenous fingers and toes, sympathectomy to relieve vasopasm
    • Nursing Interventions - provide well-fitting shoes and socks, meticulous extremity care, cessation from smoking
  30. Burn Priority Care
    • Stop the burning process, remove clothing and shoes, provide an open airway, control bleeding
    • Priority Nursing Interventions - control pain, support the patient's psychological well-being, IV opioids in small frequent doses, truthful explanations and listening
  31. Maslow's Hierarchy of Needs
    • Self Actualization
    • Esteem
    • Love & Belonging
    • Safety
    • Physiological
  32. Angina Pectoris
    • spasmodic, cramp-like, choking feeling
    • hypoxia or ischemia - chest pain - NO DAMAGE!
    • 5 E's that cause chest pain - exercise, exertion, emotions, excessive smoking, excessive, eating, exposure to cold
    • Assessment - dyspnea, SOB, diaphoresis, patient complain of chest tightness, or left arm or back
  33. Evisceration
    • Protrusion of viscera through the disrupted wound
    • Need to cover in moist sterile gauze then inform the charge nurse, and physician
  34. Laryngitis risk factors
    • inhalation of irritating fumes
    • singers
  35. Colostomy Bag Change
    • 1. Standard percautions
    • 2. gather supplies
    • 3. remove old bag
    • 4. provide ostomy care - cleans skin with warm water and pat dry
    • 5. measure stoma - note color and viability of stoma
    • 6. apply protective skin barrier about 1/8 inch from stoma
    • 7. apply protective wafer with flange
    • 8. gently attach pouch to flange by compressing the two together
  36. Guaiac Test
    • also known as occult blood testing
    • stool collected is examined for presence of bacteria, ova and parasites
    • at least 3 stool specimens are collected for 2 successive days
    • obtain stool sample before barium examination
  37. Hypovplemic Shock
    • Hypovolemic stage- 1st 48 hours - capillaries dilate, increased capillary permability - EDEMA - HYPERKALEMIA - HYPOVALEMIA - LOWERED BP - BLISTERING, CARDIAC ARREEST - ACUTE RENAL FAILURE
    • plasma to interstitial fluid shifting
    • Burns also increase possible renal function deficiency due to lack of blood flow
    • shock = lack of oxygen (hypoxia)
    • normal potassium 3.5-5.0
    • 2nd Stage - DIURETIC STAGE - 48-72 HOURS
    • interstitial to plasma, blood volume increases, increase urine output, low level potassium due to urine output
    • risk of Hypokalemia, and Congestive Heart Failure
  38. NGT Decompression
    Nasojejunal tube in inserted and connected to wall suction to decompress the intestine of gas/fluids
  39. Gastric Residual Measurement
    150ml of residual fluid or more indicates delayed gastric emptying
  40. Liver biopsy prep/lab test
    • Diagnose pathologic liver conditions
    • pt lies supine with the right arm over the head
    • pt should be instructed to exhale fully and not breath while needle is inserted
    • Nursing Intervention - obtain signed consent, ensure that PT, INR, platelet, clotting or bleeding time has been ordered, observe for pneumothorax keep pt on the right side for 2 hours
  41. Heparin lab tests
    • Order PT, PTT
    • normal PT - 10-14 seconds
    • PTT - 60-70 seconds
    • Goal - 1.5 to 2.5 times the control value
  42. Stoma Assessment
    assess color, size, should be pink and moist
  43. Post-op Care, splinting, DBAC
    Deep Breathing, coughing to promote gas exchange, splinting abdomen with pillow when coughing, change position every 2 hours
  44. GERD risk factors
    • Is a backward flow of stomach acid up into the esophagus
    • causes burning pressure behind the sternum, attributed to the inappropriate relaxation of the lower esophageal sphincter in response to an unknown cause
    • most common after meals
    • Diagnostic test - 24 hour pH monitoring to record reflux episodes, bernstein test, barium swallow w/fluroscopy
  45. Pyrosis
    Heartburn - pain described as substernal or retrosternal, occurs 20 minutes - 2 hours after meals
  46. Diverticulosis
    • the presence of pouch-like herniation's through the muscular layer of the colon
    • diverticulitis is inflammation of one or more diverticula (give low fiber/low residue diet during attack)
  47. Psychosocial issues re: colostomy surgery
    Body image issues regarding colostomy
  48. Laryngitis Management
    • Medical Management - Bacterial - antibiotics
    • analgesics, antipyretics for comfort
    • antitussives
    • throat lozenges for comfort
    • Nursing Interventions - warm or cool mist inhalation via vaporizer
    • encourage to rest the voice
    • provide other means of communication, anticipate needs
    • instruct pt to finish entire meds
  49. Oxydenation in COPD
    • Low flow rate 1-2L by nasal cannula to aviod depletion of hypoxic drive
    • Hypoxic drive - is when the pt is used to functioning on higher cO2 levels.
    • two much oxygen will make them hypoxic
  50. PPD
    • Mantoux tuberculin Skin test
    • must be read within 48-72 hours
    • measure and record induration - 5mm or more is considered positive
    • do not measure the errythema
    • skin test - chest x-ray - AFB sputum smear - presumptive diagnosis - culture test comes back in 6-8 weeks
  51. Suction Procedure
    • Suction for 10-15 seconds with 1-2 mins. between sunctioning
    • suction pressure 150mm hg
  52. TB Isolation
    • Hospitalized pt remain in respiratory isolation during their hospital stay
    • after treatment for 2 weeks not considered contagious
  53. Pink Pufer
    pink puffer cuz the reddish complexion and the pt. hyperventilates .....these pts have less hypoxemia compared to chronic bronchitis ( blue bloaters) ....and so in emphysema u will have no carbon dioxide rentention
  54. Chronic Bronchitis
    Blue Bloaters
    blue bloaters is when pts . will be cyanotic hence blue colour of lip and skin ...cuz its chronic bronchitis and they will have co2 retention and more severe hypoxemia .....
  55. Chronic Bronchitis Complication
    Infection, bronchospasm, hypoxia, hypercapnia, impaired gas exchange
  56. Emphysema Assessment
    • characterized by changes in the alveolar walls and capillaries
    • Bronchi and alveoli inflame because of chronic irritation air becomes trapped (bleb/Bullae) ->alveolar distention -> alveoli rupture
    • leads to cor pulmonale (RV failure) due to hypertrophy of the right ventricle, weight loss, pink puffer
  57. Cor pulmonale
    • an abnormal cardiac condition characterized by hypertrophy of the right ventricle of the heart as a result of hypertension of the pulmonary circulation
    • results in edema in the lower extremities and in the sacral and perineal area, distended neck veins, and enlargement of the liver with ascites
    • Late compliction of emphysema!!
  58. Pharyngitis Culture
    Throat culture: two throat swabs are obtained sa a culture can be performed if the rapid strep screen test is negative
  59. Chest Tube
    • Purpose is to remove air and fluid in the pleural space
    • Pneumothorax (gunshots, stab wound)
    • Effusion (HF, lung cancer)
    • Chest tubes re-establish negative pressure
    • closest to the pt is the drainage container
    • middle is water seal (air goes in) - tidaling should be present in this chamber - No continuous bubbling(indicative of air leak)
    • 3rd is suction control chamber; the higher the water the higher the sunction to the patient - continuous bubbling
  60. Chest Tube Management
    • Ensure the patency of the chest tube system
    • Proper system functioning; ensuring that the water in the water-seal chamber fluctuates
    • absence of fluctuation - means there is a leak
    • if tube is disconnected from the chest - cover the chest
    • disconnected from the bottle-reconnect, place in glass of sterile water, clamp for a short time
  61. ABG analysis
    • if pH is low it is acidosis -if high it is alkalosis
    • if CO2 is low it is alkolosis - if high acidosis
    • if HCO3 is low acidosis - if high alkalosis
    • uncompinsated - pH is abnormal and PCO2 is abnormal and HCO3 is normal or pH is abnormal and PCO2 is normal and HCO3 is abnormal
    • P. Compensated - pH is abnormal, PCO2 is abnormal (opposite), HCO3 is abnormal (opposite)
    • F. Compensated - pH is normal, pCO2 is abnormal (opposite), HCO3 is abnormal (opposite)