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178 Cards in this Set
- Front
- Back
patient with impaired visual problem, what is prime objective?
|
patient with impaired visual problem, what is prime objective?
safety, clutter free |
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dry irritated eyes, what is the first implementation nurse will do?
|
dry irritated eyes, what is the first implementation nurse will do?
assess - find the cause |
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what is leukocytosis?
|
what is leukocytosis?
condition of decreased white blood cells |
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after a burn, what do you monitor for?
|
after a burn, what do you monitor for?
first 24 hours monitor fluid shift. after stable - monitor for infection |
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what is the most important way to prevent skin cancer?
|
what is the most important way to prevent skin cancer?
sunscreen, hat, cover up |
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what is the difference between spinal meningitis and encephalitis
|
what is the difference between spinal meningitis and encephalitis
encephalitis is the brain |
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patient severely burnt a couple days ago is now extremely
restless. what is possibility? |
patient severely burnt a couple days ago is now extremely
restless. what is possibility? cerebral hypoxia - lack of oxygen in the brain from fluid shift |
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isolation
|
isolation
protection |
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pt with shingles - what type of isolation?
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pt with shingles - what type of isolation?
private room because it is a virus - both contact and airborne (virus) |
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what degrees is high fowlers position
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what degrees is high fowlers position
90 degrees |
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sims position
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sims position
on side with knees bent |
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prone
|
prone
on belly |
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lateral
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lateral
on side |
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limited mobility. what do you do so not have pressure ulcers?
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limited mobility. what do you do so not have pressure ulcers?
rotate every 2 hours |
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anti-emetic
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anti-emetic
prevent nausea/vomiting |
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antihistamine
|
antihistamine
given for allergies |
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antihypertensive
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antihypertensive
lowers blood pressure |
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antitussive
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antitussive
anti cough |
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who do you not give antitussive meds to?
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who do you not give antitussive meds to?
patients who have productive cough |
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how do you know your patient who is on antitussive, medication is
effective? |
how do you know your patient who is on antitussive, medication is
effective? patient is not coughing |
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what does age have to do with toxicity?
|
what does age have to do with toxicity?
with age, everything slows down. drugs do not metabolise as fast. Old people need less amount of drugs. |
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patient having difficulty breathing but are trying to eat. what position?
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patient having difficulty breathing but are trying to eat. what position?
high fowlers |
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What's teratogenic?
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What's teratogenic?
harmful to the fetus |
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before you give any female medication that is possibly
teritogenic, what to ask? |
before you give any female medication that is possibly
teritogenic, what to ask? are you pregnant? |
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what is one of the primary development tasks of an adolescent?
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what is one of the primary development tasks of an adolescent?
finding one's identity |
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what is maslows heirarchy of needs? (basic necessities of life)
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what is maslows heirarchy of needs? (basic necessities of life)
Physiological: breathing, food, water, sex, sleep Safety: Security of : body, employment, resources, morality, the family, health, property Love/Belonging: friendship, family, sexual intimacy Esteem: self-esteem, confidence, achievement, respect of others, respect by others Self-Actualization: morality, creativity, spontaneity, problem solving, lack of prejudice, acceptance of facts |
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patient has possible infiltrated IV. pulled out IV. what next?
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patient has possible infiltrated IV. pulled out IV. what next?
moist warm cloth to vasodilate |
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first sign of possible thermal injury is?
|
first sign of possible thermal injury is?
erythema (redness) |
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stages of dying
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stages of dying
denial, anger, grief, bargaining, acceptance |
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primary purpose of BVNPT? (board of vocational nursing and physch techs
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primary purpose of BVNPT? (board of vocational nursing and physch techs
safety for the public |
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LVN and RN are working side by side. patient is diabetic, being
diabetic. patient is having chest pain. who does what? |
LVN and RN are working side by side. patient is diabetic, being
diabetic. patient is having chest pain. who does what? RN is assessing |
|
what is patient/nurse best validation of effective communication?
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what is patient/nurse best validation of effective communication?
positive feedback |
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interpreting data collection
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interpreting data collection
understanding information |
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interpreting data, what does the information represent?
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interpreting data, what does the information represent?
health problems of the patient so you can communicate and care for them |
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floaters in the eyes. what do you do?
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floaters in the eyes. what do you do?
inspect eye, put a patch on eyes and send them to opthalmologist |
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subjective data vs. objective data
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subjective data vs. objective data
a. subjective: patient feels b. objective: sees |
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patients express pain differently
|
patients express pain differently
yes |
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how do you collect specimens?
|
how do you collect specimens?
sterile (surgical) |
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clear liquid diet
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clear liquid diet
chicken broth, apple juice |
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full liquid diet
|
full liquid diet
pudding, ice cream, yogurt |
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bland diet
|
bland diet
non spicy |
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putting a pillow under upper leg of pt to keep them in lateral
position, will this help? |
putting a pillow under upper leg of pt to keep them in lateral
position, will this help? yes |
|
patient has possible airborne precautions. until get them in
private room, what to do? |
patient has possible airborne precautions. until get them in
private room, what to do? put mask on them, SHUT THE DOOR |
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prevent spread of microorganisms
|
prevent spread of microorganisms
wash hands |
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What is hypoxia?
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What is hypoxia?
lack of oxygen in the tissues |
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how do you use the catheter for suctioning so it doesn't cause hypoxia?
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how do you use the catheter for suctioning so it doesn't cause hypoxia?
oxygenate first, catheter in (without pushing button), once inside 10-15 seconds to suction on way out |
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why is pain meds the first priority with oncology patient?
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why is pain meds the first priority with oncology patient?
oncology - cancer. pain meds needed; could be palliative |
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what is PPE gear?
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what is PPE gear?
gloves, mask, gown |
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chemotherapy drugs, what PPE used to administer?
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chemotherapy drugs, what PPE used to administer?
gloves |
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what is neutropenic mean?
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what is neutropenic mean?
neutropenia - low white blood cells? |
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pt neutropenic, what precautions?
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pt neutropenic, what precautions?
reverse isolation, wear PPE, no fresh fruit or flowers, disposable utensils |
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BSE?
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BSE?
breast self exam - during shower, after period once a month |
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patient having radium implant. what is it?
|
patient having radium implant. what is it?
radioactive therapy for cancer. flush the toilet 3 times. keep your appointments - followup care. don't touch implants. |
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early sign of cancer?
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early sign of cancer?
painless lesions, painless hematuria, change in moles or skin lesions, change in bowel and bladder habits, hoarseness sounding over period of time |
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myelosuppression?
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myelosuppression?
bone marrow suppression |
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can bleeding gums relate to mylosuppression?
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can bleeding gums relate to mylosuppression?
yes - no clotting, bone marrow suppression |
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tumor marker - T, N, M
|
tumor marker - T, N, M
T = tumor, N = node, M = metastasis |
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T1, N0, M0
|
T1, N0, M0
1 tumor, not in nodes, has not metastasized |
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signs and symptoms of infection?
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signs and symptoms of infection?
fever, chills, sore throat, restlessness, cold sweat |
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HIV
|
HIV
human immunodeficiency virus = viral infection, don't die from virus, die from secondary |
|
prevent infection with HIV
|
prevent infection with HIV
stay away from crowds |
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HIV patient, how do you know going from HIV to AIDS?
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HIV patient, how do you know going from HIV to AIDS?
T cells (CD4) less than 200. want to keep above 200 |
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What do you call that determine CD4 count? what do you check?
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What do you call that determine CD4 count? what do you check?
viral load - how much virus is in the CD4. determines HIV from AIDS |
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HIPPA?
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HIPPA?
confidentiality of diagnosis, name/date of birth, communication, cannot photocopy info or share info. HIPPA is for everyone. no one can talk about the patient |
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vericose vein?
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vericose vein?
contorted vessels - bad valves |
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symptom would have who have been diagnosed with vericose veins?
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symptom would have who have been diagnosed with vericose veins?
achy throbby pain in legs |
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normal H&H?
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normal H&H?
hemoglobin: F 12-16, M 14-18 hematocrit HGBx3 |
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patient having transfusion, complaining of back ache (kidney destruction)
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patient having transfusion, complaining of back ache (kidney destruction)
stop transfusion - having reaction. flush with normal saline, send bag to lab, get urine specimen, vital signs |
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digoxin
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digoxin
cardiotonic - slows down and strengthens the heart rate. get apical heart rate above 60. if above 100 or lower than 60 - hold. |
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before giving digoxin, what to check?
|
before giving digoxin, what to check?
check digoxin lab levels and potassium levels. do not want to toxicate. |
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patient complains "they are not hungry" - anorexia and nausea, related to digoxin toxicity?
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patient complains "they are not hungry" - anorexia and nausea, related to digoxin toxicity?
yes - hold medication of digoxin and check the labs |
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what comes first, left sided or right sided heart failure?
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what comes first, left sided or right sided heart failure?
left sided heart failure |
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classic symptom of left sided heart failure?
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classic symptom of left sided heart failure?
pulmonary edema, pink frothy sputum |
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right sided heart failure
|
right sided heart failure
peripheral edema or anasarca, jugular vein distention (JVD), |
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MI
|
MI
myocardial infarction (heart attack) |
|
what do we ask before we do a coronary angiogram?
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what do we ask before we do a coronary angiogram?
allergies to iodine or shellfish |
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femoral artery
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femoral artery
in groin |
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coronary angiogram through femoral artery - position
|
coronary angiogram through femoral artery - position
flat with leg extended to prevent bending |
|
nitroglycerin
|
nitroglycerin
cardiac - vasodilator. for angina or MI |
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how do you know if your patient is having an MI or angina?
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how do you know if your patient is having an MI or angina?
after taking nitroglycerin 3x 5 min apart, angina lasts no longer than 15 minutes. MI is continuous chest pain |
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what is profuse sweating have to do with MI?
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what is profuse sweating have to do with MI?
fight or flight (epinephrine) |
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what is Questran packs (cholestyramine)?
|
what is Questran packs (cholestyramine)?
for hyperlipidemia - binds intestinal bile acids monitor for constipation |
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CAD
|
CAD
coronary artery disease |
|
significant risk factors for CAD?
|
significant risk factors for CAD?
obesity while you are smoking |
|
what is a calcium channel blocker?
|
what is a calcium channel blocker?
anti-hypertensive drug, ends in "pine" amlodipine diltiazem felodipine |
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what are side effects of calcium channel blocker?
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what are side effects of calcium channel blocker?
blocks calcium across the cells. vessels are more relaxed. blood pressure will lower. side effect: orthostatic hypotension. teach patient slow position changes. |
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number one risk group at risk for hypertension?
|
number one risk group at risk for hypertension?
african american males |
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nose bleed have to do with hypertension?
|
nose bleed have to do with hypertension?
relieving pressure through nose bleeds - bad that it is happening. |
|
unexplained bloody nose
|
unexplained bloody nose
check your blood pressure |
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who is more at risk for respiratory problems post-op?
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who is more at risk for respiratory problems post-op?
obese people - pressure on chest |
|
what is PACU stand for?
|
what is PACU stand for?
post anesthesia care unit - stabilize patient in PACU |
|
until patient is conscious, what position to put post op patient
> (unconscious)? |
until patient is conscious, what position to put post op patient (unconscious)?
laterally while unconscious. if they vomit, they don't aspirate |
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priority immediately after post-op
|
priority immediately after post-op
airway |
|
kayexalate
|
kayexalate
lowers potassium laxative |
|
pyridium
|
pyridium
urinary analgesic urine will be reddish-orange (normal) |
|
cystitis
|
cystitis
inflammation of bladder at risk: females due to shorter urethra and proximity between anus and urethra is shorter |
|
pylonephritis
|
pylonephritis
kidney infection number one cause is strep throat that did not get resolved |
|
if had pyloneophritis, positive leukocytes?
|
if had pyloneophritis, positive leukocytes?
yes |
|
glomularnephritis
|
glomularnephritis
infection of the glomelular |
|
teach patient with glomularnephritis, what do you teach so not have recurring problems?
|
teach patient with glomularnephritis, what do you teach so not have recurring problems?
number one cause strep throat treat strep throat - see a doctor. |
|
kidney transplant - labs that kidneys are functioning properly
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kidney transplant - labs that kidneys are functioning properly
BUN and CRT should be normal if working properly know levels Creatinine 0.5-1.5 BUN 10-25 |
|
accurate way to check O2
|
accurate way to check O2
ABG (arterial blood gas) |
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before ABG
|
before ABG
do allens test |
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ABG accurate way of checking what?
|
ABG accurate way of checking what?
lung function |
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patient has chronic kidney failure. when assessing, what are you
monitoring for? |
patient has chronic kidney failure. when assessing, what are you
monitoring for? I&O, BUN and CRT, edema, hypocalcemia |
|
H pylori
|
H pylori
bacteria in the stomach that causes ulcers |
|
gave patient meds for h. pylori, pulse rate is elevated, bp dropped, what does that mean?
|
gave patient meds for h. pylori, pulse rate is elevated, bp dropped, what does that mean?
bleeding (shock) |
|
how do you get HBV?
|
how do you get HBV?
hepatitis B virus: blood and bodily fluids needle stick - IV, tattoos, drugs, blood transfusion |
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paralytic ileus
|
paralytic ileus
parastalsis stops (stops movement) |
|
what do we do to a pt to prevent paralytic ileus after GI surgery?
|
what do we do to a pt to prevent paralytic ileus after GI surgery?
insert NG tube (nasogastric tube) |
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what is jaundice?
|
what is jaundice?
yellow, liver failure, bilirubin back up |
|
cholelithiasis?
|
cholelithiasis?
gallstones - blocking bile duct will cause jaundice |
|
why would schlera be jaundice (yellow) from cholelithiasis?
|
why would schlera be jaundice (yellow) from cholelithiasis?
bilirubin back up |
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acute pancreatitis - risk factor
|
acute pancreatitis - risk factor
alcohol abuse |
|
chronic cholelithiasis
|
chronic cholelithiasis
fatty greasy foods cause inflammation of gallbladder Tx: low fat high fiber diet, increase fluids |
|
orthopedic
|
orthopedic
bones |
|
what is an NSAIDS?
|
what is an NSAIDS?
nonsteroid anti inflammatory drug motrin, ibuprofen cannot take when having GI ulcer - will cause bleeding |
|
gout
|
gout
buildup of uric acid |
|
what foods or drinks cause gout?
|
what foods or drinks cause gout?
alcohol, organ meats, shrimp and lobster (shellfish) |
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where does gout affect the patient?
|
where does gout affect the patient?
big toe and ears |
|
osteoarthritis
|
osteoarthritis
inflammation of bones |
|
number one spot of osteoarthritis
|
number one spot of osteoarthritis
hips and knees losing bone mass |
|
rheumatoid arthritis
|
rheumatoid arthritis
hands autoimmune disorder |
|
when is the time of day that is mostly affect by pain with rheumatoid arthritis
|
when is the time of day that is mostly affect by pain with
rheumatoid arthritis morning, when waking up |
|
broken leg in long cast, what routinely doing?
|
broken leg in long cast, what routinely doing?
check CSMT (circulation, sensation, movement, temperature) |
|
could swelling of toes be a symptom of compromised circulation with a cast?
|
could swelling of toes be a symptom of compromised circulation with a cast?
yes, being squished, no blood supply |
|
for a patient who has compromised circulation with long cast,
what would he feel? |
for a patient who has compromised circulation with long cast,
what would he feel? numbness and tingling |
|
where is femoral head located?
|
where is femoral head located?
hip socket |
|
prosthesis
|
prosthesis
fake replacement |
|
femoral head prosthesis, what to teach patient what NOT to do
with shoes or socks? |
femoral head prosthesis, what to teach patient what NOT to do
with shoes or socks? do not bend over. will pop out of socket |
|
number one complication of fractured long bone?
|
number one complication of fractured long bone?
fatty emboli |
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why first focus of assessment of pt with fractured exremity to check area distal of fracture?
|
why first focus of assessment of pt with fractured exremity to check area distal of fracture?
compromised circulation |
|
pt has fracture of neck of the femur, what would you expect to see?
|
pt has fracture of neck of the femur, what would you expect to see?
shortened and external rotation |
|
open angle glaucoma. what is problem?
|
open angle glaucoma. what is problem?
too much pressure. will impair vision - peripheral drug of choice: timoptic |
|
snellen chart
|
snellen chart
vision test with letters to read |
|
Delegate
|
Delegate
-Assign |
|
What does saturated mean?
|
What does saturated mean?
-Soaked |
|
What does lipodystrophy mean?
|
What does lipodystrophy mean?
-hardening of fat tissue. |
|
Can a CNA give meds?
|
Can a CNA give meds?
-no |
|
Patient doesn’t speak English language.
|
Patient doesn’t speak English language.
-get a translator. |
|
What does noncompliant mean?
|
What does noncompliant mean?
-not following directions |
|
What is neglect?
|
What is neglect?
-failure to provide care that is necessary to prevent or treat serious physical or emotional injury. Ex. Not changing diaper |
|
What is malpractice?
|
What is malpractice?
-type of negligence in, which the professional under a duty to act fails to follow generally accepted professional standards. -doing something to harm patient |
|
Assault
|
Assault
-physically or mental abuse or harm |
|
Patient has bandage with skin still attached.
|
Patient has bandage with skin still attached.
-don’t rip it off or cut it off. (malpractice) -get an order from the doctor |
|
Before calling dr. about noncompliant patient?
|
Before calling dr. about noncompliant patient?
-Talk to patient, find out what is wrong |
|
Can CNA and UAP do ROM?
|
Can CNA and UAP do ROM?
yes |
|
Can CNA assess skin and assess O2 status?
|
Can CNA assess skin and assess O2 status?
no |
|
Pt with saturated dressing, can CNA do vital signs
|
Pt with saturated dressing, can CNA do vital signs
yes |
|
Can CNA do neurocheck?
|
Can CNA do neurocheck?
no |
|
Teach pts about insulin injections?
|
Teach pts about insulin injections?
-rotate sights to prevent lipodystrophy. |
|
if pt is unstable can CNA take for walk or to bathroom?
|
if pt is unstable can CNA take for walk or to bathroom?
no |
|
What insulin has longest duration?
|
What insulin has longest duration?
-Ultra Lente |
|
What is SIADH?
|
What is SIADH?
-Syndrome of inappropriate antidiuretic hormone |
|
Is SIADH related to pancreas?
|
Is SIADH related to pancreas?
-No, its related to endocrine problem (from tumor, car accident) |
|
Classic S/S of SIADH?
|
Classic S/S of SIADH?
-holding urine, weight gain, edema, hyponatremia, decreased urination |
|
What is pheochromocytoma?
|
What is pheochromocytoma?
Tumor on the adrenal medulla (on top of kidneys). Causes release of catecolamines (norepi and epi) |
|
What to you not do to pt with pheochromocytoma?
|
What to you not do to pt with pheochromocytoma?
Don’t palpate the abdomen (releases more catecolamines) |
|
if pt is visually impaired, can they give themselves insulin injections with insulin pen?
|
if pt is visually impaired, can they give themselves insulin injections with insulin pen?
-no, they can’t dial the insulin pen (question the order) |
|
What is myxedema?
|
What is myxedema?
-severe hypothyroidism |
|
Why would pt with myxedema have dry skin?
|
Why would pt with myxedema have dry skin?
-yes, (fluid leaving bloodstream) hypothyroidism |
|
What is adrenal?
|
What is adrenal?
-gland above kidney |
|
Why in morning does hypoglycemia occur in pt with adrenal insufficiency?
|
Why in morning does hypoglycemia occur in pt with adrenal insufficiency?
-pt has decreased levels of corticosteroids which cause decrease in glucose levels. |
|
Whats Proventil?
|
Whats Proventil?
-Bronchodilator, albuterol |
|
Who gets proventil (albuterol)?
|
Who gets proventil (albuterol)?
-asthma or COPD pts |
|
Whats common S/E of proventil (albuterol)
|
Whats common S/E of proventil (albuterol)
-palpatations |
|
What’s auscultation?
|
What’s auscultation?
-listening |
|
What’s adventitious?
|
What’s adventitious?
-abnormal |
|
Respiratory sounds from asthma patient?
|
Respiratory sounds from asthma patient?
-wheezing (adventitious sounds) |
|
Why need to monitor potassium levels when giving Lasix?
|
Why need to monitor potassium levels when giving Lasix?
-Lasix is potassium depleting (3.5-5.0) |
|
What is spontaneous Pneumothorax?
|
What is spontaneous Pneumothorax?
-unilateral chest pain (air, pus, or fluid in space) |
|
What’s emphysema?
|
What’s emphysema?
-avioli condition. Decrease in surface area. Capillarys die. |
|
What is possible cause of (bilateral) pneumothorax in pt with emphysema?
|
What is possible cause of (bilateral) pneumothorax in pt with emphysema?
-collaspe of lung avioli, Bullae. |
|
Best way to prevent spread of TB.
|
Best way to prevent spread of TB.
-cover mouth and nose |
|
What acid base imbalance in pt with emphysema?
|
What acid base imbalance in pt with emphysema?
-respiratory acidosis |
|
If pt has emphysema and running a fever, what is #1 thing to keep fever in check?
|
If pt has emphysema and running a fever, what is #1 thing to keep fever in check?
-hydrate with fluids and notify doctor. |
|
What is atelectasis?
|
What is atelectasis?
-collapsed lung |
|
after a few days Post op, pt c/o SOB and then no breath sounds?
|
after a few days Post op, pt c/o SOB and then no breath sounds?
-pt has atelectasis (collapsed lung) |