Nursing 308 Exam I

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  1. What quantifies a chronic illness
    lasting more than 3 months
  2. The main focus in the treatment of chronic illnesses include:
    • prevention of complications
    • maitaining ability to function
  3. What disease is the most common cause of disabilty?
  4. _________ is the leading cause of kidney failure, non-traumatic lower extremtity amputations, and blindness amoung adults, aged 20-74
  5. Primary levels of prevention include:
    • balanced nutrition
    • immunizations
    • cessation of smoking
  6. Secondary levels of prevention includes:
    • screenings
    • ex. PAP smears, mammograms, prostate and dental exams
  7. Tertiary levels of prevention include:
    rehabilitation (cardiac, stroke)
  8. 6 QSEN competencies
    • Patient-centered care
    • teamwork and collaboration
    • evidence based pratice
    • quality improvement
    • safety
    • informatics
  9. In chronic illness teaching what is most important?
    Lifestyle changes
  10. Dorothea Orem Theory of Self-Care goal is:
    To render the patient or members of the family capable of meeting the patient's self care needs.

    wholly and partly compensatory care and supporting, educative care
  11. To insure maximum effect while limiting adverse side-effects, pain medications should be ____________
    Titrated for the dose
  12. Barriers from RN or MD with pain includes:
    • fear of lawsuits
    • lack of support from insurance carriers
    • perception of pain "in pt head"
    • fears of addition
    • suspicion of pt when know schedule/drug
  13. Unrelieved pain causes:
    inc in metabolic demands > muscle breakdown> weight loss

    tachycardia, inc BP, inc myocardial 02 demand, hypercoagulation

    Anorexia, fever, dec GI motility, depression and anxiety
  14. Pain threshold
    lowest intensity of pain stimulus that is percieved as pain
  15. Pain tolerance
    amount of pain a person is willing or able to tolerate
  16. Breakthrough pain
    transient, moderate to severe pain, occurs beyond the pain treated by prescribed analgesics. Has a rapid onset and a breif duration with varying intensity and incidence
  17. Nociceptive pain
    from damage to somatic (bone, muscle, skin, connective tissue) or visceral (GI, bladder). Nervous system is functioning properly
  18. Neuropathic pain
    from damage to peripheral nerves or CNS and does not serve a useful purpose
  19. Neuropathic pain is percieved as _________ (descriptive measures)
    tingling, prickling, shooting, electric shock like, jabbing, squeesing, spasm or cold and are cause by trauma, inflammation, metabolic diseases, infections, tumors and toxins
  20. Vasovagal reaction is?
    sudden dizziness or faiting that can be triggered by pain, fright, or trauma

    • Bradycardia
    • treated with atropine and opioid analgesic
  21. Acute pain
    • Short duration (<6 months) and has known cause
    • usually associated with high levels of pathology or tissue damage
    • can evolve into chronic pain
  22. Chronic non-cancer pain
    • extends beyond the period of healing from an acute episode
    • may have no identifiable pathology to explain
    • can be disabling
  23. Chronic Intermittent pain
    Migraines, sickle cell anemia, IBD exacerbation
  24. S&S of acute pain
    • hypertension
    • tachycardia
    • anxiety
    • dilated pupils
    • diaphoresis
  25. S&S of chronic pain
    • No alterations in VS
    • depression
    • fatigue
    • decreased level of functionoing
  26. During a pain assesment on should take:
    • a detailed history of the pain includeing:
    • intenisty
    • characteristics
    • conduct a PE
    • Psych eval
    • dignostic workup
  27. When paitent is describing the pain have them list these 8 things
    • onset
    • duration
    • quality (dull, sharp, aching)
    • pattern
    • loaction
    • intensity
    • associated symptoms
    • exacerbating or alleviating factors
  28. Equianalgesic dosing is?
    • a dose of one analgesic that is equal in pain relieving effect compared with another analgesic
    • larger doses of oral medications given to give the same effect as IV doses
    • Need to be uses with MD consultation by nurse
  29. Titration
    adjusting the dose or administration interval for safety and effectiveness.
  30. Goal of titration
    to use the smallest dose possible to provide the desired effective analgesic control and with minimal side effects
  31. What route is the perferred route when titration a dose?
  32. What is often prescribed for underlying pain?
    extended release morphine
  33. What is often prescribed for breakthrough pain?
    faster-acting narcotic
  34. Short-acting medications are given for what reasons?
    to manage intermittent pain and breakthrough pain that breaks through the pain relief, provides a baseline analgesia
  35. Long-acting and sustained-release
    • continuous pain
    • allows pt to sleep through the night
  36. Non-opioids
    • used for mild pain (1-3 on 10 scale)
    • NSAIDS
    • acetaminophen
    • aspirin
  37. Opioids
    • used for moderate (4-6) to severe (7-10) pain
    • Binds to specific opioid receptors
  38. Adjuvants
    • can be used in any pain state
    • added to primary analgesics to further improve pain control
  39. Common analgesic steps
    • Step1- mild pain (non-opioid with or without adjuvant)
    • Step2- mild to moderate (opioid with or with out non opioid and a adjuvant
    • Step3 moderate to severe (same as step 2)
  40. Acetaninophen (tylenol, excedrin)
    • can cause hepatic toxicity if > 4g/24 hrs;for chronic diseases or > 6g/24 hrs
    • hepatic disease or heavy alcohol use inc risk
    • minimal anti-inflammatory effect
  41. IV acetaminophen (ofirmev)
    • prescribed with opioids for mild to moderate pain and moderate to to severe pain in conjuction with narcotics
    • anti-pyretic
    • infuse over 15 mins
  42. Side effects of IV acetaminophen
    • N&V
    • HA
    • insomnia
    • constipation
    • pruritus
  43. Amount of acetaminophen in common opioids
    • Percocet: 325mg
    • Vicodin and Lartab: 500mg
    • Vicodin ES: 750mg
  44. NSAIDS (ASA, ibuprophen, naproxen)
    • effective step 1
    • inc dose beyound a point does not inc pain relief
    • inhibit cyclo-oxygenase which converts arachidonic acid into prostaglandins
  45. NSAIDS contrindications
    • Hx of gastric ulcers or bleeding
    • bleeding disorders or anticoagulation treatment
    • ensure hydration and urine output to dec renal impairment
    • risk for CV complications
    • use gastric cytoprtection to dec. GI irritation
  46. Opioids
    • controlled drugs, contains natural or synthetic morphine
    • mimic endorphins
    • most effective analgesic
    • alter perception of pain
    • no ceiling effect
  47. Side effects of opioids
    • sedation
    • mental confusion
    • Resp depression
    • N&V
    • constipation and urinary retention
    • pruritis
  48. Contrindications of opioids
    • Impaired ventilation pt.
    • liver and renal failure
    • inc. intracranial pressure (except at end of life)
  49. Methadone with antagonist activity useful in treating nociceptive and neuropathis pain 10 times as potent as high dose of ________
  50. Meperidine (demerol)
    • not indicatied in long term treatment of pain
    • metabo in liver
    • excreted through kidneys
    • in renal dysfuction normeperidine is not excreted and acculamtes in the blood stream and is toxic to the CNS putting pt at risk for seizures
  51. For opioids ATC (around the clock) is recommend after ___________
    est. optimal dose through titration
  52. Opioids reach peak plase concentration
    • 90 min after oral and rectal admin (includes feeding tubes)
    • 30 mins after SubQ or IM
    • 6 mins after IV injection
  53. What medications is used in opioid overdose? How does it work?
    • Naloxone (Narcan)
    • treats opioid-induces respiratory depression
  54. Baclofen
    relief of spasms assoc. with muscle pain
  55. corticosteroids
    • inhibit prostaglandin synthesis and reduce inflammation
    • neuropathis and bone pain
  56. Topical capsaicin
    • relieves pain by circulating and depleting substacne P involved in pain transmission
    • may cause intial pain
  57. Inflammation can occur in response to:
    • infection
    • heat
    • radiation
    • trauma
    • allergens
    • alway present with infection
  58. Inflammation markers include?
    • levels of c-reactive protien (CRP)
    • tumor necrosis factor (TNF)
    • markers dec. after cessation of smoking
    • some markers are assoc. w/ heart disease
  59. Clincal manifestions of inflammation
    local: redness, heat, pain, swelling, loss of function

    systemic: fever, leukocytosis with shift to left, malaise, nausea, anorexia, tachy-cardia/pnea
  60. Nursing care of inflammation
    • monitor VS
    • monitor and treat fever
    • RICE
  61. CBC interpretations with infections:
    ^ neutorphils
    bacterial infection, vascilitis and inflammatory conditions e.g. RA, Lupus, and vasculitis
  62. CBC interpretations with infections:
    dec. neutrophils
    serious infection or meds, e.g. chemo
  63. CBC interpretations with infections:
    ^ eosinophils
    allergies, skin inflammation, parasitic infections or bone marrow disorders
  64. CBC interpretations with infections:
    dec. eosinophils
    can indicate infection
  65. CBC interpretations with infections:
    ^ basophils
    leukemia, chronic inflammation, food allergies or radiation therapy
  66. CBC interpretations with infections:
    ^ lymphocytes
    viral infection, leukemia, bone marrow cancer or radiation therapy
  67. CBC interpretations with infections:
    dec. lymphocyte
    immune system diseases (lupus, HIV infection)
  68. CBC interpretations with infections:
    ^ monocyte
    • infection
    • inflammation
    • cancer
  69. CBC interpretations with infections:
    dec. monocyte
    bone marrow disorders, leukemia
  70. CBC: "shift to right"
    • absence of immature neutrophils
    • more mature neutorphils
    • indicates viral infections
  71. CBC: "shift to lefft"
    • more immature neutrophils
    • acute bacterial infection
  72. Antibiotic-resistant organisims
    • MRSA methicillin-resistant staphyloccus aureus
    • MSSA methicillin-susceptible aureus
    • VRE vancomycin resistant enterococci
    • PRSP penicillin-resistant streptococcus pneumoniae
    • ESB extended spectrum betalactamases
    • HBV
    • HIV and TB
  73. ESBL
    extended spectrum betalactamase
    • poor pt. outcomes
    • mortality 42-100%
    • 3% nationwide prevalence
    • acute and community settings
    • 10-40% of e. coli and klebsiella pneumonia produce ESBL enzymes
    • PCN & cephalosporins resistant
  74. ESBL causes what 2 issues and is treat with what?
    • UTIs
    • resp. infections
    • life-threatening infections

    tx: carbapenems
  75. EBP: pre-op prophylactic antibiotics
    • CDC recoommends giving most prophylactic anitbiotics less than 1 hour before the first surgical incision to reduce surigical site infections
    • exceptions: vancomycin and fluoroquinolones such as cipro and levaquin (give more than 1 hour before)
  76. Isolating pt. under contact precautions is associated with?
    • higher depression rates
    • more med errors
    • fewer daily visits from attending physicians
  77. On contact precautions what is the safe zone parameters?
    3 x 3 feet
  78. What is cellulitis?
    inflammation of subcutaneous tissues possibly from a primary or secondary infection complication
  79. Cellulitis is often caused by what?
    • S. aureus
    • streptococci
  80. Cellulitis is often follows what type of breakdown
    • skin break down
    • could turn into gangrene is untreated
  81. To prevent infection, CDC recommends for peripheral and midline cath to be where in the adult pt? pediatric pt?
    • A: upper extremties
    • peds: upper or lower extremties
    • neonates/young infants: scalp
  82. To prevent infection, CDC recommends when duration is longer than 6 days what should be used?
    a midline cath or PICC
  83. To prevent infection, CDC recommends a cvc with ______________ number of ports or lumens essential for pt. Tx
  84. To prevent infection, CDC recommends catherthers insrted during a medical emergencies where adherance to aseptic tech was not used should be replaced __________?
    as soon as possible within 48 hours
  85. To prevent infection, CDC recommends for non tunneled CVC placement a ___________ site is prefered to a ___________ site in the adult pt.
    subclavian; jugular or femoral
  86. To prevent infection, CDC recommends for a pt with chronic renal failure, _____________ instead of a CVC for permanent access for dialysis to be used
    fistula or graft
  87. To prevent infection, CDC recommends risks and of a central venous device to _________ to be weighed against risk for mechanical complications to ensure.
    reduce infection complications
  88. To prevent infection, CDC recommends __________ needles to be avoided when admin fludis and meds that might cause tissue necrosis if extravastion occurs.
  89. Cellular response to inflammation
    neutrophils arrive to site within 6-12 hours to phagocytize bacteria, foreign material and damage cells and die within 24-48 hours

    monocytes arrive to site within 3-7 days and phagocytize inflammatory debris

    lymphocytes arrive later and produced humoral and cell mediated immunity
  90. Nutritional wound healing barriers include:
    • zinc
    • vit C
    • iron
    • protien
  91. uses of sutures or other wound closures to approximate edges. Thin, flat scar
    primary intention wound healing
  92. wound left open, heal by generation of tissue from edges inward and bottom up
    secondary intention wound healing
  93. delayed primary closure. wound may be contaminated
    tertiary intention wound healing
  94. Complications of healing include
    • exesss granulation tissue that needs to be cauterized or cut off. healing proceeds
    • contractures: necessary for healing but may become abnl and is from excessive fibrous tissue formation close to joints and in burn pt.
  95. Vitamin C deficiency effect on would healing
    delays formation of collagen fibers and capillary development
  96. Protien deficiency effect on would healing
    decreases supply of amino acids for tissue repair
  97. Zinc deficiency effect on wound healing
    impairs epithelization
  98. Corticosteriod drug use effects on would healing
    • impairs phagocytosis by WBCs
    • inhibits fibroblast proliferations and function
    • depress formation of granualation tissue
    • inhibit wound contraction
  99. Red wounds and Tx
    • purpose of treatment is to protect the wound and gentle cleansing if prescribed.
    • Clean wounds that are granulating and re-epitihilzing should be kept slight moist
    • transparent film or adhesive semi-permeable dressings
    • cover with sterile dressing
  100. Yellow wounds and Tx
    • needs absorption dressing that absorbes exudate and cleanse the wound surface
    • wash with sterile saline or water
    • hyrocolloid dressing- designed to be in place for up to 7 days or until leakage occurs around the dressing
  101. Black wounds and Tx
    debridment of nonviable, eschar tissue
  102. Hyperbaric oxygen therapy (HBO) works by:
    • causing constriction of the blood vessels w/o creat hypoxia
    • allows oxygen to diffuse into the serum allowing it to move past narrowed arteries and capillaries where RBCs cannot go
    • Kills anaerobic bacteria and inc killing power of WBC
    • excelerates granulation tissue formation and speeds up would healing
    • stiumlates formation of new blood vessels (angiogenesis)
  103. Stage I pressure ulcer
    nonblanchable redness
  104. Stage II pressure ulcer
    partial-thickness loss of dermis
  105. Stage III pressure ulcer
    full-thickness tissue loss; subQ fat may be visible
  106. Stage IV pressure ulcer
    Full-thickness tissue loss with exposed bone, tendon, and muscle
  107. Water content of the body for Infants? Adults? Elderly?
    • Infants: 70-80%
    • Adults: 60%
    • Elderly: 45-50%
  108. 1 liter of water equals _________
    weight change of 1 pounds equals _________
    • 2.2 lbs (1 kg)
    • 500 cc
  109. Urine specific gravity is a key indicator of hydration and should be in what range
  110. What are the 5 regulatory mechanisms of water balance?
    • hypothalamic-pituitary (ADH, aldosterone)
    • renal (RAAS)
    • caridac (BNP)
    • GI
    • insensible water loss
  111. Hypothalamic-pit system (HPA)
    Hypothalamic > pit to release ADH > regulate waters in kidneys by allowing dital tubules and collecting duct to become more permeable> water reabsored from tubular filtrate
  112. Hormones secreted by the hypothalamus? Ant. Pit? Post. Pit?
    • H: CRF
    • A: ACTH (glucocorticoids- coritsol and mineralcorticoids-aldosterone)
    • P: ADH (vasopressin)
  113. RAAS system
    dec renal blood flow> renin + angiotensiogen> angiotension I + angiotensin converting enzyme (ACE)> Angiotensin II> 1.) adrenal cortex> aldosterone> Na and H20 retention 2.) brain> thirst or vasopressin> Na and H20 3.) blood vessels> vasoconstriction

    restoration of blood pressure is the end result
  114. Natriuretic Peptides
    • respond to ^ blood volume that stretches heart wall (CHF, pulm edema)
    • act on renal tubules to excrete Na and water ^ urine output
    • antagonist to RAAS
    • nL BNP 0-100 picograms and an indicator for HF
  115. Hypovolemia (FVD) causes
    • loss of normal body fluids- diarrhea, vomiting, hemorrhage
    • decreased intake or sig fever
    • inadequate intake due to impaired thirst, nausea, dec LOC
  116. Hemo-concentrated
    • decrease intravascular volume
    • lytes level "higher"
    • hypovolemic shock if left untreated
  117. FVD lab values
    • HCT > 55%
    • NA> 145 mEq/L
    • urine specific gravity> 1.025
    • BUN> 25 mg/dl
    • Plasma osmolarity> 295 mOsm/Kg
  118. FVD Tx
    • hypertonic IV fluids
    • Isotoinc IV fluids in HHNK
    • D5W or LR
    • plasma expanders (albumin, dextran)
    • rapid replacement can stimulate diuresis, hypernatremia, and HF
    • may need oxygen therapy
  119. Fluid overload causes
    • over hydration
    • fluid overload
    • FVE may result from escessive intake of fluid or abnormal fluid retnetion (edema)
  120. Fluid overload occurs in the ___________
    • intravacular space
    • hemodiluted and lytes appear to be "low"
    • FVE refers to inc. fluid in interstitial space (edema) e.g. HF
  121. Fluid spacing
    • 1st space: fluid in intravascular space
    • 2nd space: edema in interstitial space
    • 3rd space: fluid accumulation in areas in which exchange with the rest of ECF cannot easily occur: pleural, pericardial, peritoneal spaces
  122. FVO lab values
    • Plasma osmolarity < 275 mOsm/kg
    • Na < 135 mEq/L
    • BUN < 8 mg/dl
    • HCT < 45%
    • urine specific gravity < 1.010
    • plasma protein alnumin may be low
  123. FVO Tx
    • fluid and Na restricitions
    • diuretucs
    • mointor NA K and Mg levels
    • may need 02 for pulm congestion
  124. CA cause these 5 lytes
    • hypercalcemia
    • hyponatremia
    • hypokalemia
    • hypophosphatemia
    • hypomagnesemia
  125. Cirrhosis causes these 3 lytes
    • Hypovolemia from ascites, dec. oncotic pressure, and edema
    • Hypokalemia from inc intravascular volume
    • hypernatremia
  126. Acute pancreatitis
    • hypovolemia from severe vomiting
    • hyopcalcemia: Ca++ trapped in necrotic tissue around pancreas
    • hypomagnesemia: Mg trapped in necrotic tissue
  127. Brain injury
    SIADH: inc ADH secretion causes hypervolemia, dilutional hyponatremia

    DI: dec ADH secretion causing polyuria and dehydration. Hypernatremia and hemoconcentration
  128. Renal failure
    • FVO
    • hyperkalemia
    • hyperphosphatemia
    • hypocalcemia
    • metabolic acidosis
    • hyponatremia from hemodilution
  129. Heart failure
    • ECF expanded: JVD, liver congestion, pulm crackles
    • dec output> vasoconstrict> Fluid and Na retention
    • stretching of cardiac wall > BNP
  130. Hypernatremia S&S
    >145 mEq/L
    • Diabetes Insipidus (DI)
    • primary hyperaldosteronism
    • Cushings
    • uncontrolled DM

    intense thirst, lethargy, agitation, seizures, and coma
Card Set:
Nursing 308 Exam I
2013-02-17 23:49:42
UL Lafayette

Med-surg test
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