Med Surg Test 2 Second Semester

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Med Surg Test 2 Second Semester
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2013-09-23 16:35:50
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Med Surg Test 2 Second Semester
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  1. Normal potassium level:
    3.5-5.0mEq/L
  2. Hypokalemia critical value:
    <2.5mEq/L
  3. Hyperkalemia critical value:
    >6.5mEq/L
  4. What causes hypokalemia?
    • Excess gi loss: vomiting, diarrhea, ileostomy drainage
    • Renal loss: diuretic, hyperaldosteronism
    • Inadequate intake
  5. Manifestations of hypokalemia:
    • Cardiovascular: dysrythmia, EKG changes
    • GI: n/v, anorexia, decreased bowel sounds
    • Neuromuscular: muscle weakness, leg cramps
  6. Hypokalemia management:
    • Potassium chloride
    • K+ protocol, keep around 3.8
    • If given orally dilute with juice and food
    • If given IV, administer slowly and dilute in IV soln to prevent burning; 10mEq/1hr
  7. High potassium foods:
    Bananas, tomatoes, pork, milk, avocados, dark leafy greens, fish, energy drinks
  8. Hypokalemia nursing diagnoses:
    • Decreased cardiac output
    • Activity intolerance
    • Risk for imbalanced fluid volume
  9. Causes of hyperkalemia:
    • Renal failure
    • Potassium sparing diuretics
    • Adrenal insufficiency
    • Excess potassium intake
    • Aged blood transfusion
    • Medications - nsaids
  10. Manifestations of hyperkalemia:
    • Cardiovascular: Tall, peaked T waves, widened QRS, dysrhythmia, cardiac arrest
    • GI: n/v, abdominal cramping, diarrhea
    • Neuromuscular: muscle weakness, paresthesia, flaccid paralysis
  11. Hyperkalemia management:
    • Medications:
    • - Calcium gluconate for heart
    • - Insulin reg and glucose
    • - Kayexalate (draws K+ into gi tract)
    • - Diuretics
    • Dialysis
  12. Hyperkalemia nursing diagnoses
    • RC: Decreased cardiac output
    • Risk for activity intolerance
    • Risk for imbalanced fluid volume
  13. How is carbonic acid regulated?
    • The respiratory system regulates carbonic acid by retaining or eliminating CO2.
    • Respiratory rate is increased during acidosis and decreased during alkalosis.
  14. How is bicarb regulated?
    • Acidosis: kidneys retain bicarb (base) and excrete hydrogen ions (acid)
    • Alkalosis: kidneys retain hydrogen ions (acid) and excrete bicarb (base)
  15. Four steps of the management process:
    • Planning
    • Organizing
    • Coordinating or directing
    • Controlling
  16. What is the function of a leader?
    To guide people and groups to accomplish common goals. A leader focuses on relationships rather than on tasks required to accomplish a goal.
  17. Traits of a leader:
    • A vision for the future
    • Trust of colleagues and co-workers
    • Excellent communication skills
  18. Leadership vs. Management: Leadership is...
    • More people focused
    • More process focused
    • More concerned with motivation
    • More based on use of self and personality
  19. Leadership vs. Management: Management is...
    • More task focused
    • More goal focused
    • More concerned with plans, policies, rules, procedures
    • More based on position
  20. The effective follower displays...
    • Cooperation
    • Collaboration
    • Teamwork
    • Action aligned with leader
  21. Leadership style: Autocratic
    • Activities determined by leader, dictated to followers
    • Characterized by giving orders
    • "Do as I say because I am the leader"
  22. Leadership style: Laissez-faire
    • Promotes complete freedom of group
    • "Do what you feel is best"
  23. Leadership style: Democratic
    • "We are going to talk about and decide this together"
    • The democratic leader will ask the staff for their ideas and see if they can be part of the solution, such as joining a task force to look at certain issues.
  24. What is ambulatory care?
    • Outpatient basis
    • Hospital-based settings
    • Non-medical-based settings
  25. What is managed care?
    A program that provides structure and focus for managing the use, cost, quality, and effectiveness of health care services.
  26. Managed care: Strategies to lower costs and optimize value
    • Gatekeeper: primary care provider must refer you to a specialist
    • Prior authorization: Must be approved by insurance
    • Capitation: Fixed dollar amount the hospital gets for care
    • An emphasis on preventative care
    • Explicit standards for selecting providers
  27. Five factor to assess when making a decision to appropriately delegate:
    • Potential for harm
    • Complexity of task
    • Problem solving
    • Innovation required
    • Level of patient interaction
  28. Five rights of delegation:
    • Right task
    • Right circumstance
    • Right person
    • Right direction/communication
    • Right supervision
  29. Advantages of teams and groups:
    • Group problem solving:
    • - Greater knowledge of information
    • - Increased acceptance of solutions
    • - More approaches to a problem
    • - Individual expression
    • - Lower costs
  30. Disadvantages of groups:
    • Premature decisions
    • Pressure to conform
    • Individual domination
    • Disruptive conflicts
  31. Group decision making:
    • Autocratic: leader
    • Consultative: group has input
    • Joint: group and leader decide together
    • Delegated: group makes decision without leader
  32. What is patient advocacy?
    Speaking on behalf of a patient in order to protect their rights and help them obtain needed information and services.
  33. What is evidenced based practice?
    Care that nurses provide is based on all available research and identified standards
  34. What is non-evidenced based practice?
    Basing decisions on opinion, past practice and precedent.
  35. Steps of critical thinking:
    • 1. Define the problem by asking the right question
    • 2. Select the information or data necessary to solve the problem
    • 3. Recognize stated and unstated assumptions
    • 4. Formulate and select relevant and/or promising hypotheses
    • 5. Draw valid conclusions
    • 6. Consider the soundness of your decisions
  36. Practice of nursing defined:
    • Pt safety, comfort, hygiene, protection, disease prevention, rehabilitation
    • Administer drugs, therapeutic agents, skin tests, immunizations, draw blood
    • Observe for signs and symptoms, reactions, behavior, general condition
    • Implementation and documentation
    • Use of standard procedures
  37. Purpose of communication:
    • To establish a relationship
    • To be effective in expressing interest/concern for patient/family
    • To provide the needed health info
  38. Essential skills of communication:
    • Personal insight
    • Sensitivity
    • Knowledge of communication strategies
  39. Strategies that ensure mutual understanding:
    • Clarifying
    • Validation
    • Verbalizing implied thoughts and feelings
    • Focusing
    • Using closed questions
    • Summary statements
  40. Barriers to communications:
    • Not listening
    • Reassuring cliches
    • Giving advice
    • Expressing approval/disapproval
    • Requesting an explanation
    • Defending, belittling feelings, stereotyped comments
    • Changing the subject
  41. Purpose of documentation:
    • Continuity of care
    • Legal documentation research
    • Statistics
    • Education
    • Audits
  42. Constructive effects of conflict:
    • Improves decisions
    • Stimulates creativity
    • Encourages interest
    • Forum to release tension
    • Foster change
  43. Deconstructive effects of conflict:
    • Constricts communication
    • Decreases cohesiveness
    • Explodes in fighting
    • Hinder performance
  44. Normal pH range:
    7.35-7.45
  45. Normal carbon dioxide (PaCO2):
    35-45mmHg
  46. Normal oxygen (PaO2):
    80-100mmHg
  47. Normal bicarb (HCO3):
    22-26mEq/L
  48. Normal oxygen saturation (SaO2):
    95-100%
  49. pH < 7.35 with PCO2 > 45 mmHg
    Respiratory acidosis
  50. Manifestations of respiratory acidosis:
    • Dyspnea
    • Headache, restless and confusion
    • Drowsiness and unresponsiveness
    • Tachycardia and dysrhythmias
  51. pH > 7.45 with PCO2 < 35 mmHg
    Respiratory alkalosis
  52. HCO3 <22 mEq/L with pH < 7.35
    Metabolic acidosis
  53. Causes of metabolic acidosis:
    • Diabetic ketoacidosis
    • Starvation
    • Salicylate intoxicatoin
  54. Manifestations of metabolic acidosis:
    • Headache
    • Confusion
    • Restlessness progressing to lethargy, then stupor or coma
    • Kussmaul respirations
    • Cardiac arrythmias
  55. HCO3 > 26 mEq/L and pH > 7.45
    Metabolic alkalosis
  56. Manifestations of metabolic alkalosis:
    • Dizziness
    • Lethargy
    • Weakness
    • Disorientation
    • Seizures
    • Coma
    • Muscle twitching/cramps
    • Tetany
    • Respiratory depression
    • N/V
  57. pH < 7.35 =
    Acidotic
  58. pH > 7.45 =
    Alkalotic
  59. If PCO2 increases while pH decreases...
    the primary cause is respiratory
  60. If HCO3 increases while pH increases...
    the primary cause is metabolic
  61. What is asthma?
    Inflammatory disorder of the airways, which causes attacks of wheezing, SOB, chest tightness, and coughing
  62. Asthma triggers: Intrinsic factors
    • Uncertain
    • Physical stress
    • Psychological stress
    • Exercise
    • Respiratory infection
  63. Asthma triggers: Extrinsic factors
    • Allergens
    • Air pollutants
    • Cold
    • Tobacco smoke
  64. Symptoms of asthma:
    • Wheezing
    • Cough
    • SOB
    • Low O2 sat
    • Intercostal reactions
    • Nasal flaring
    • Chest pain/tightness
  65. Emergency asthma symptoms:
    • Extreme difficulty breathing
    • Bluish color to lips and face
    • Severe anxiety due to SOB
    • Rapid pulse
    • Sweating
    • Decreased LOC
  66. A bronchodilator used to treat asthma:
    Albuterol
  67. Leukotrine antagonists used for long term asthma treatment:
    Accolate, Singular, Zyflo

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