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Adult 2 test
started with infection
215
Medical
Undergraduate 3
03/01/2012

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Term
endogenous
Definition
infection caused by microbial life, the person himself or herself harbors, e coli
Term
professionalism and dignity..
Definition
always orient the patient, re orient reorient reorient...don't ever say, "it's going to be okay."
Term
what are the aims of teaching and counseling??
Definition
maintaining and promoting health, preventing illness, restoring health, facilitating coping
Term
focuses of patient education..
Definition
preparation for receiving care, preparation before discharge from healthcare facility, documentation of patient education activity
Term
teach acronym
Definition
tune into patient, edit pt. information, act on every teaching moment, clarify often, honor the patient as partner
Term
3 learning domains
Definition
cognitive (change diet), psychomotor (wound care), affective (renewed confidence)
Term
for teaching older adults..
Definition
identify learning barriers, extra time, plan short teaching sessions, accomadate sensory deficits, reduce distractions
Term
COPE model
Definition
creativity, optimism, planning, expert information
Term
lecture, panel, discovery, written materials..
Definition
cognitive domain
Term
role modeling, discussion, audiovisual materials..
Definition
affective domain
Term
demostration, discovery, printed materials..
Definition
psychomotor domain
Term
verbal orders..
Definition
review for accuracy, sign orders with name title page #, date and note time orders signed
Term
purposes of recording data
Definition
facilitate pt care, serve as a financial and legal record, help in clinical research, support decision analysis
Term
Major cations..5
Definition
Na, K, Ca, Mg, hydrogen ions
Term
Major anions.. 5
Definition
chloride, bicarbonate, phosphate, sulfate, protein ions
Term
movement of fluid through capillary walls depends on..
Definition
hydrostatic pressure, osmotic pressure
Term
pressure exerted on the walls of blood vessels..
Definition
hydrostatic pressure
Term
pressure exerted by the protein in the plasma..
Definition
osmotic pressure
Term
regulation of fluid is controlled by
Definition
osmosis, diffusion, filtration, active transport
Term
geriatric considerations in fluid balance..
Definition
reduced cardiac renal and resp function, decreased fluid percentage, medication usage, presence of concomitant conditions
Term
dehydration results in..
Definition
increased serum sodium levels
Term
causes of HVD..
Definition
vomiting, diarrhea, gi suctioning, sweating, decreased intake, and inability to gain access to fluid
Term
risk factors for HVD
Definition
diabtes insepidus, adrenal insufficiency, osmotic diuersis, hemmorhage, coma, and third space shifts
Term
manifestations of FVD
Definition
rapid weight loss, decreased skin turgor, oliguria, concentrated urine, postural hot, rapid and weak pulse, increased temp, cool and clammy skin, vasoconstriction, lassitude, thirst, nausea muscle weakness, and cramps
Term
laboratory data for FVD..
Definition
elevated BUN in relation to serum, creatinine, increased hematocrit, possible serum electrolyte changes
Term
Nursing management for FVD..
Definition
monitor I&O, skin and tongue turgor, mucosa, urinary output, and mental status
Term
the most sensitive indicator of fluid balance is..
Definition
daily weights
Term
risk factors for FVE..
Definition
heart failure, renal failure, and cirrhosis of the liver
Term
contributing factors to FVE..
Definition
excessive dietary sodium, or sodium containing IV solutions
Term
Manifestations of FVE..
Definition
edema, distended neck veins, abnormal lung sounds crackles, tachycardia, increased BP pulse pressure, and CVP, increased weight, increased UO shortness of breath and weezing
Term
management of FVE..
Definition
asses symptoms, fluid restrictions and patient teaching related to sodium and fluid restrictions, promote rest,
Term
categories of IV solutions..
Definition
colloids and crystalloids
Term
colloidal IV solutions..
Definition
do not cross capillary membranes, remain in vascular space
Term
for colloidals, need to assess.
Definition
increased BP, dyspnea, bounding pulses
Term
colloidal solutions..
Definition
albumin, dextran, hetastarch
Term
albumin is a..
Definition
plasma protein, increases plasma oncotic pressure, treatment of shock..
Term
dextran is a..
Definition
plasma volume expander, short lived..
Term
hetastarch..
Definition
clotting time, plasma volume expander.
Term
precautions of blood products..
Definition
may cause hypovolemia
Term
fresh frozen plasma..
Definition
replace clotting factor, correct coagulation deficiencies..
Term
crystalloid solutions..
Definition
cross capillary membrane, differing tonicity of fluids- isotonic, hypotonic, hypertonic..
Term
isotonic crystalloid solutions..
Definition
expands the ECF, no fluid shift, treatment hypotension secondary to hypovolemia, precautions
Term
isotonic solution..
Definition
solute concentration inside the cell is equal to the solution outside the cell
Term
Isotonic IV's treat...
Definition
fluids deficits, hypernatremia, insensible losses, maintenance IV
Term
Isotonic IV precaution..
Definition
renal and cardiac disease
Term
Hypotonic solutions..
Definition
solute concentration inside the cell is HIGH, water rushes into cells, cells inflate and eventually burst.
Term
Hypotonic IV solutions
Definition
replace cellular fluid and provide free water for excretion of body wastes, used for Na and Cl depletion, gastric fluid loss
Term
Hypotonic IV solutions pose a risk of..
Definition
hypovolemia, increased intracranial pressure, contraindication: stroke, head trauma, neurosurgery, liver disease or burn
Term
Hypertonic solutions..
Definition
water is trasported out of cell, solute concentration inside cell is lower.. CELLS SHRINK!
Term
cardiac patients with renal or cardiac disease will not be able to handle..
Definition
increased fluids that result from hypertonic solutions
Term
parenteral nutrition includes..
Definition
protein, glucose, trace elements, and minerals, specific formulation, lipids, fats
Term
sodium normal... hyper/hyponatremia, above below
Definition
135-145
Term
potassium normal... hyper/hypokalemia
Definition
3.5-5.0
Term
who needs TPN..
Definition
debilitating disease lasting more than 2 weeks, 10% body weight loss, serum albumin below 3.5, excessive N loss, renal or hepatic failure.. non function of GI tract 5-7 days
Term
hyperkalemia management>5
Definition
monitor ECG IV sodium bicarbonate, limit dietary potassium
Term
nursing management for hyperkalemia >5
Definition
assess serus potassium levels, mix well IVs, medication effect and initiate K dietary restriction
Term
T wave peaks, and P wave looks flat in..
Definition
hyperkalemia!
Term
hypocalcemia is..
Definition
<8.5 mg
Term
hypocalcemia <8.5 mg is caused by..
Definition
hypoparathyroidism, malabsorption, pancreatitis, alkalosis, massive transfusion of citrated blood, renal failure, meds..
Term
hypocalcemia <8.5 mg manifestations..
Definition
tetany, circumoral numbness, paresthesia, hyperactice DTRs, Trousseaus sign, Chovsteks sign, seizures, abnormal clotting and anxiety
Term
purpose of musculoskeletal system..
Definition
protection of vital organs, mobility and movement, facilitate return of blood to heart, production of RBCs, reservoir for immature blood cells, and vital minerals
Term
how many bones in body
Definition
206, long short, flat irregular bones
Term
PA for MS system..
Definition
posture, gait, bone integrity, joint function, muscle strength and size, skin and neurovascular status
Term
osteoblasts.
Definition
bone formation
Term
osteocytes..
Definition
mature bone cells that function in bone maintenance located in lacunae
Term
osteoclasts..
Definition
multinuclear cells function in destroying, reabsorbing, and remodeling bone. howship's lacuna
Term
what regulates bone formation?
Definition
stress and weight bearing, vitamind/calcitriol, PTH, calcitonin, estrogen, blood supply
Term
diangostic tests for bone density/health
Definition
xrays, ct, bone desitometry, bone scan, mri, arthroscopy, serum lab work- Ca and estrogen
Term
Risk factors for osteoprosis..
Definition
Age, Caucasian/asian, low bone mass/small stature, low BMI, sedentary, meds-corcticosteroids, smoking, diet, menopause
Term
what does bone density screening measure?
Definition
peripheral bones, wrist heel or finger
Term
what does DEXA measure?
Definition
measures spine hip or total body bone density
Term
normal mineral bone density lab value
Definition
>-1.0
Term
low bone mass lab value-osteopenia
Definition
-1 to -2.5
Term
osteoporosis lab value..
Definition
-2.5
Term
severe osteoporosis lab value..
Definition
-2.5 with fracture
Term
estrogen helps bones by..
Definition
increasing bone density
Term
biphosphanate meds..
Definition
fosamax, boniva, actonel
Term
how do biphosphanates work?
Definition
inhibit osteoclastic reabsorption
Term
qualifications for biphosphanate..
Definition
pt must be able to sit upright for 30 minutes, take med on empty stomach
Term
how long is the half life of biphosphanates?
Definition
extremely long, up to one year
Term
what is serm?
Definition
selective estrogen receptor modulators, EVISTA
Term
what does serm do?
Definition
reduces # of osteoclasts, may cause DVT or hot flashes
Term
PTH med, Forteo, does what?
Definition
stimulates osteoblastc activity to build bone matrix, can cause orthostatic hypotension
Term
Side effects of PTH/Forteo
Definition
paget's disease of bone, hx radiation treatment, hypercalcemia, use cautiously with warfarin
Term
stages of fracture healing 6
Definition
fracture hematoma, granulation tissue, callus formation, ossification, consolidation, remodeling
Term
5 neurovascular checks for fracture assesment
Definition
pain, pulses, pallor, paraesthesia, paralysis
Term
postop care for internal fixation..
Definition
encourage early mobilization, coughing and deep breathing
Term
avoiding hip dislocation..
Definition
affected leg should not cross the center of the body, hip should not bend more than 90 degrees, affected leg should not turn inward
Term
having a dislocated hip w ACI (active clinical issues)...
Definition
increases risk for readmittance and DEATH.
Term
compartment syndrome..
Definition
compression of structures, edema leads to pressure within the closed compartment, resulting in obstructed circulation
Term
signs and symptoms of compartment synrdome..
Definition
pain distal to injury-passiveROM- inability to extend digits, parasthesia, pallor, coolness, and absent pulses
Term
treatment for compartment syndrome..
Definition
DO NOT elevate or apply ice, remove casts, fasciotomy, amputation assessment of urine output
Term
fasciotomy?
Definition
fascia is cut to relieve pressure
Term
fractures of the pelvis, long bone, etc can cause what?
Definition
fat emboli
Term
exogenous
Definition
infection caused by microorganism that is acquired from outside the host
Term
iatrogenic..
Definition
infection that occurs as a result of a treatment or diagnostic procedure
Term
the reservoir is..
Definition
the natural habitat of the organism
Term
portal of exit
Definition
point of escape for organism
Term
portal of entry..
Definition
point at which organisms enter a new host
Term
stages of infection. 4
Definition
incubation, prodromal, full stage of illness, convalescent period
Term
medial asespis?
Definition
clean technique
Term
surgical asepsis?
Definition
sterile technique
Term
you should wear a mask for..
Definition
suspected AFB disease.. who knows.
Term
surgical masks are required for droplet precautions when..
Definition
you're within 3 feet of patient
Term
with neutropenic patients, you should..
Definition
avoid standing water in room and fresh fruits and veggies.. restrict visitors with colds or illnesses
Term
tests for latex reactions..
Definition
RAST, skin prick, glove challenge. who knows.
Term
safety precautions for latex allergies..
Definition
written warning, remove wall mounted BP cuffs, sharp containers, injection caps, IV tubing, urinary caths
Term
effects of psychological and physical isolation..
Definition
loneliness, sensory deprivation, altered body image, low self esteem, fear
Term
exposure to needle stick, blood, or body fluid..
Definition
wash the exposed area, report the incident, report client's name and type of exposure, obtain consenting blood test, post exposure prophylaxis, get blood test results
Term
stereognosis is ..
Definition
perceives solidity of objects: size, shape and texture
Term
four conditions to receive data..
Definition
stimulus, receptor, nervous pathway to brain, functioning brain to receive and translate impulse sensation
Term
factors effecting sensory stimulation..
Definition
developmental considerations, culture, personality and lifestyle, stress, medications
Term
RAS means..
Definition
reticular activating system
Term
The RAS..
Definition
extends from hypothalamus to medulla, mediates arousal, monitors and regulates incoming sensory stimuli
Term
what is the optimal arousal state?
Definition
sensoristasis
Term
unconcsious states include..
Definition
asleep stupor and coma
Term
if you're not asleep, stupor or coma..
Definition
you're conscious. includes delirium, locked in syndrome, etc.
Term
factors affecting sensory alterations
Definition
sensory overload, sensory deprivation, sleep deprivation, cultural care deprivation
Term
sensory deprivation causes..
Definition
environment with little or monotonous stimuli, impaired ability to receive stimuli, inability to process stimuli
Term
sensory overload is..
Definition
so much sensory, brain cant process! feels out of control, focus on reducing distressing stimuli
Term
pt outcomes for sensory alteration..
Definition
develop a stimulating environment, level of arousal enabling brain to perceive stimuli, intact functioning of senses, Orientation X3
Term
preventive measures against sensory alterations..
Definition
decrease patient discomfort, offer comfort, be aware of need for sensory aids, enlist aid of family members, encourage physical activity, provide stimulation
Term
with blind/visually impaired patients you should..
Definition
teach self care behaviors, acknowledge your presence in room, speak in a normal tone, explain reason for touching person before doing so, keep call light within reach, orient person to surroundings
Term
assisting the blind continued..
Definition
orient person to room arrangement, assist w ambulation, provide diversion using other senses, tell them when you're leaving
Term
communicating with a pt who is confused...
Definition
use frequent face to face contact to communicate, speak calmly, simply, and directly, orient x 3, offer explanations, reinforce reality
Term
when communicating with an unconscious patient...
Definition
SPEAK NORMALLY, be careful what is said, assume the person can hear you, speak to the person before touching, keep environmental noises at low level
Term
purpose of kidneys..
Definition
maintain composition of body fluids, filter and exrcrete blood constituents not needed-and retain those that are,
Term
the nephrons of the kidneys..
Definition
remove end products of metabolism and regulate fluid balance; urine
Term
factors that effecting urination..
Definition
developmental, food and fluid intake, psychological variables?, activity and muscle tone, meds and pathological conditions
Term
what are some diseases associated with renal problems?
Definition
congenital UT abnormalities, polycystic kidney disease, UTI, kidney stones, High BP, D-mell, gout, connective tissue disorders
Term
what meds effect urination? 3
Definition
diuretics, cholinergics, analgesics and tranqs
Term
how do diuretics effect urine?
Definition
prevents reabsorption of water and certain electrolytes in tubules
Term
how do cholinergic medications effect urine?
Definition
stimulate contraction of detrusor? muscle, producing urination
Term
analgesics effect urination via..
Definition
suppressing the CNS, diminish effectiveness of neural reflex
Term
anticoagulants make your pee..
Definition
red
Term
diuretics make your pee..
Definition
pale yellow
Term
pyridium (azo) make your pee..
Definition
orange to orange red
Term
elavil makes your pee..
Definition
green or blue green
Term
levodopa makes your pee..
Definition
brown or black urine O_O
Term
urinary assessment should include..
Definition
voiding patterns, past history of problems, phy ex of urinary system, skin hydration, urine, compare with diagnostic results
Term
Kidney assessment...
Definition
check for costovertebral tenderness
Term
Bladder assessment...
Definition
palpate and percuss the bladder, or use bedside scanner
Term
urethral meatus assessment..
Definition
inspect for signs of infection, discharge, or odor
Term
skin assessment for urinary assessment..
Definition
asses for color, texture, turgor, and excretion of wastes
Term
urine assessment
Definition
assess for color, odor, clarity and sediment
Term
when measuring urine output..
Definition
void in container, put into measuring container, measure at eye level, document on appropriate form, discard urine unless specimen is needed.
Term
pts at risk for uti's.. 6
Definition
sexually active women, women who use diaphragms (gross), postmenopausal women, urinary caths, diabets mellitus, elderly
Term
What are reasons for catheterization..
Definition
relieving urinary retention, obtaining sterile specimen, emptying bladder before, during, or after surgery, monitoring critically ill patients
Term
what is suprapubic catherization..
Definition
exactly what it sounds like.. AWFUL! inserted above pubis.
Term
Urinary Incontinence/UI caused by an increase in intra abdominal pressure..
Definition
stress incontinence
Term
UI caused by urine being lost during abrupt and strong desire to void
Definition
Urge incontinence
Term
UI caused by urge and stress incontinence
Definition
Mixed incontinence
Term
UI caused by overdistention and overflow of bladder..
Definition
Overflow incontinence
Term
UI caused by factors outside the urinary tract..
Definition
Functional incontinence
Term
UI caused by emptying the bladder without sensation of need to void..
Definition
reflex incontinence
Term
UI caused by continuous, unpredictable loss of urine..
Definition
total incontinence
Term
factors that may compromise the immune system..4
Definition
infection, neutropenia (chemo) meds, nutrition
Term
predisposing conditions for infection..
Definition
indwelling devices(caths), skin/mucous membranes(burns), neutropenia, HIV, very young and very old
Term
pulmonary infections affect risk of other infections bc..
Definition
decreased cough reflex, decreased elastic recoil of lungs, decreased activity of cilia, abnormal swelling reflexes
Term
UTIs are bad bc..
Definition
incomplete emptying of bladder, decreased sphincter control, bladder-outlet obstruction, reduction renal blood flow
Term
skin infections are bad bc..
Definition
loss of elasticity, increased dryness, thinning epidermis, slowing cell replacement, decreased vascular supply
Term
normal WBC count..
Definition
5,000-10,000/mm-3
Term
abnormal neutrophil levels mean..
Definition
60-70% increase, common in infections that produce pus
Term
increased lymphocytes are common in..
Definition
chronic bacterial and viral infections
Term
increased eosinophils means..
Definition
allergic rxn or parasitic infections
Term
increased basophils mean..
Definition
usually unaffected by infection
Term
when inflammation is present there will be..
Definition
elevated erythrocyte sedimentation rate
Term
presence of a pathogen can be found in..
Definition
urine, blood, and sputum
Term
the most important actions to prevent the spread of infection, other than handwashing..
Definition
clean less soiled places first, then more soiled.. avoid raising dust, use PPE
Term
major differences between reg. isolation and droplet..
Definition
droplet- wear surg mask, maintain separation of at least 3 ft for other patients and visitors, place mask on pt.
Term
who can people on droplet isolation be roomed with?
Definition
another person with the same pathogen
Term
ppl with neutropenia normally become infected by..
Definition
pathogens within their own bodies
Term
wear a mask for..
Definition
droplet isolation, TB, Varicella, rubeola, suspected AFB disease in patient
Term
for patients on droplet isolation, the room should be..
Definition
negative air pressure, 6-12 air changes per hour, discharge air outside or monitor filtration if air is recirculated
Term
metabolic acidosis..
Definition
<7.35, low bicarbonate <22,Eq/L
Term
symptoms of metabolic acidosis
Definition
increased respirations (get rid of excess Co2), tachycardia
Term
who is at risk for developing metabolic acidosis?
Definition
diabetics, ppl who consume toxins..
Term
metabolic alkalosis ph
Definition
HIGH PH, >7.45, high bicarbonate >26 meq/L
Term
symptoms of metabolic alkalosis..
Definition
respiratory depression (tries to retain Co2), tachycardia, excessive acid losses
Term
risks for metabolic alkalosis
Definition
loss of acidic gastric juices, ng tubes, vomiting
Term
what may hyperkalemia occur with?
Definition
metabolic acidosis
Term
what may hypokalemia occur with?
Definition
alkalosis
Term
respiratory acidosis ph..
Definition
low pH, <7.35 PaCo2 > 42 mmg HG
Term
symptoms of respiratory acidosis..
Definition
feeling of fullness in head, increased HR, respirtory rate, and Bp,
Term
people at risk for resp. acidosis..
Definition
COPD, poor ventilation increases retention of CO2
Term
respiratory alkalosis ph..
Definition
>7.45, paco2 <35 mmHg.
Term
symptoms of respiratory alkalosis..
Definition
always due to hyperventilation, symptoms include lightheadedness, inability to concentrate, parasthesia,
Term
what helps avoid loss of too much Co2
Definition
breathing through a paper bag
Term
normal K values
Definition
3.5-5
Term
normal Na values..
Definition
135-145
Term
symptoms of hypokalemia
Definition
fatique, anorexia, nausea, vomiting- dysrhytmias (can be lethal)
Term
dysrhythmias from hypokalemia can be fatal..
Definition
at 3.2 K
Term
Hyperkalemia symptoms
Definition
5.0.. manifestations.. cardiac changes, dysrhthmias, bradycardia, muscle weakness w potential respiratory impairment, chest pain, paresthesia (limb falling asleep) anxiety GI issues
Term
what should you avoid in cases of hyperkalemia?
Definition
salt substitutes, and high K food, banana, tomato, eggplant, strawberries, cauliflower and bell peppers
Term
what is the most obvious indicator for a patient with a fluid imbalance..
Definition
daily weight..
Term
hypervolemia symptoms..
Definition
edema, distended neck veins, abrnomal lung sounds, tachycardia, increased weight, BP and CVP, fluid retention, third spacing
Term
5 p's
Definition
pain pulse pallor parasthesia paralysis
Term
what can cause hypokalemia..
Definition
di ya reh tickkkks like Lasix cause K depletion
Term
compartment syndrome is bad bc, why does it happen?..
Definition
patient could lose limb, cast was put on incorrectly
Term
what are deformities of the hand fingers, and wrist cause by injury to the muscles in forearm called?
Definition
Volkmann's ischemic contracture
Term
symptoms of compartment synrdome..
Definition
pain distal to injury, pain w passive ROM, inability to extend digits, paresthesia, pallor, coolness, dimished/absent pulses
Term
you should never do what to a limb w compartment syndrome?
Definition
elevating or applying ice is BAD
Term
symptoms of fat emboli..
Definition
chest pain, tachnypea, dypsnea, cyanosis, decreased PaO2, tachycardia, mental status change, petechia, lower extremity fractures
Term
treatment for fat emboli..
Definition
ICU, fluid maintenance, acidosis, immbobilization, oxygen, CDB exercises
Term
nursing interventions for patient w hip/femur surgery..
Definition
neurovascular checks, check for infcetion, SKIN CARE IS PRIMARY, pain
Term
postop nursing care for patient with an ORIF..
Definition
suture and drain care, incisiona assessment, skin integrity-5ps, pain control
Term
for a client with internal fixation/hip surgery
Definition
hip abduction pillow, inbetween legs strapped, to prevent adduction or turning to affected side
Term
primary nursing diagnosis for pt with open fracture.
Definition
RISK FOR INFECTION
Term
Fosamax generic name..
Definition
alendronate
Term
Actonel generic name..
Definition
risedonate
Term
Boniva generic name..
Definition
ibandronate
Term
what med would not be given to a bed ridden patient?
Definition
biphosphonates (for osteoporosis, inhibit osteoclast resorption)
Term
what is buck's traction?
Definition
used to immobilize, position and align the lower extremity in the treatment of contractures and diseases of hip and knee.
Term
why are bucks traction devices used?
Definition
used for hip fractures that cannot go directly into surgery bc of factors like low potassium levels
Term
with a bucks traction, make sure..
Definition
weights are not touching the floor, styrofoam straps- prevent muscles spasms
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