Hesi

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1

Low gastric pH (high acidity) is necessary for development of stress ulcers. t/f

true

2

Ulcers and pain.. explain duodenal vs. gastric

The principal manifestation of ulcers is an aching, burning, cramp-like, gnawing pain. The pain has a definite relationship to eating. With gastric ulcers, food may cause the pain and vomiting may relieve it. Clients with duodenal ulcers have pain with an empty stomach, and discomfort may be relieved by ingestion of food or antacids. Clients usually describe the pain as circumscribed in an area 2 to 10 cm (0.8 to 4 inches) in diameter, between the xiphoid cartilage and the umbilicus.

3

The primary objective of intervention for peptic ulcer is to?

provide stomach rest.Neutralize or buffer hydrochlorich acid.

4

Foods individuals with ulcers should avoid

coffee, alcohol, protein foods, and milk.

5

what are major complications that develop after pud?

Hemorrhage, perforation, and obstruction

6

digestion of blood in the duodenum is?

black stool.. hemorrhage tends to occur more with gastric ulcers.

7

vagotomy-

Vagotomy is performed to eliminate the acid-secreting stimulus to gastric cells. Truncal vagotomy is each vagus nerve is completely cut. Selective vagotomy The surgeon partially severs the nerves to preserve the hepatic and celiac branches.
3 Proximal vagotomy. Partial cutting is performed, but only the parietal cell mass is denervated; innervation of both the antrum and the pyloric sphincter is preserved.

*Cutting the vagal nerve fibers selectively avoids the problems of impaired emptying and diarrhea that follow the truncal vagotomy. It also eliminates the necessity for a drainage anastomosis to offset gastric stasis. Proximal vagotomy also reduces acid secretion and preserves the function of the antrum.

8

pyloplasty

facilitates emptying of stomach content

9

marginal ulcer

A marginal ulcer can develop where gastric acids come in contact with the operative site, either at the site of the anastomosis or in the jejunum. Ulceration may cause scarring and obstruction. Hemorrhage and perforation can also occur at the surgical site.

10

alkaline reflux gastritis

Alkaline reflux gastritis caused by duodenal contents occurs after gastric surgery in which the pylorus has been bypassed or removed. It also occurs after pyloroplasty and gastrojejunostomy. Usually, an associated vagotomy has been performed, which decreases gastric motility, allowing reflux of duodenal contents into the stomach.

11

dumping syndrome

This postprandial problem occurs after gastrojejunostomy because ingested food rapidly enters the jejunum without proper mixing and without the normal duodenal digestive processing. It usually subsides in 6 to 12 months. Early manifestations, which occur 5 to 30 minutes after eating, involve the vasomotor disturbances of vertigo, tachycardia, syncope, sweating, pallor, palpitation, diarrhea, and nausea with a desire to lie down. The client's blood pressure and pulse may either rise or fall.

12

dumping sydrome late manifestations occur?

Late manifestations, which occur 2 to 3 hours after eating, are a result of rapid entry of high-carbohydrate food into the jejunum, an increase in blood glucose level, and excessive insulin levels.

Management involves decreasing the amount of food taken at one time and maintaining a high-protein, high-fat, low-carbohydrate, dry diet. Gastric emptying can be delayed by eating in a recumbent or semi-recumbent position, lying down after meals, increasing the fat content in the diet, and avoiding fluids 1 hour before, with, or 2 hours after meals.The client may also be given sedatives and antispasmodic agents to delay gastric emptying. When manifestations persist, surgical intervention may include reducing the size of the gastroenterostomy or converting a Billroth II resection to a Billroth I by inserting a short segment of jejunum between the duodenal stump and the stomach.

13

location of duodenal ulcers-

Duodenal ulcers occur on both the anterior and posterior walls; anterior wall ulcers may produce tenderness on palpation of the abdomen. Patients generally complain of localized epigastric pain that occurs when the stomach is empty and that is relieved by food or antacids.

14

Anterior ulcers are more likely to perforate, whereas posterior ulcers are more likely to bleed.

True

15

Peptic ulcer pain is usually described as a gnawing, burning, or aching, usually in the epigastric area, and may radiate around to the back. The pain usually begins when the stomach is empty and may disappear with the ingestion of food or an antacid. Because of this, the pain often occurs at night when the stomach is empty, especially with DUs. t/f

true

16

an obstruction may be manifested by?

weight loss or vomitting

17

PUD refers to an erosion of the GI mucosa by hydrochloric acid and pepsin. t/f

true

18

diets for people with ulcers

Dietary modifications.
1. Encourage small, frequent meals.
2. Nonstimulating, bland foods are generally tolerated better during healing of acute episodes.
3. Assist client to identify specific dietary habits that exacerbate or precipitate pain.
4. Promote good nutritional habits.

19

(dysphagia)

difficulty in swallowing .

20

intrinsic factor

is essential for the absorption of vitamin b-12 which is needed for erythropoesis (formation of RBC's)

21

tagamet and viagra

blood levels and adverse effects may be increased by enzyme inhibitors

22

symmetrel in mild parkinsons

dopamine releasing agent

23

cerubidine

causes urine to turn red

24

nitroglycerin

one tablet can be taken every 5 minutes up to 3 doses. Should be taken at the onset of angina

25

vermox- diet?

A high fat diet increases the absorption

26

Antilirium

drug of choice to treat overdose of tricyclic antidepressants

27

client is recieving ephedrine nasal drops and is having trouble with insomnia what is the nurses best option

administer the dose a few hours before bedtime

28

nystagmus and diplopia are?

clinical manifestations of drug toxicity

29

pilocarpine (cholinergic agent)

causes pupillary constriction (miosis) so outflow aqueous humor in eye is increased ( decreasing intraocular pressure)

30

pyridium

urinary analgesic to relieve pain associated with chronic urinary tract infections. Can be taken with food to decrease gastric irritation.

31

phenobarbital priority with overdose

causes respiratory depression so take vital signs 1st.

32

chloramphenicol

irreversible fatal bone marrow depression so the nurse should monitor platelet count

33

cholinesterase inhibitors

work to increase the availability of acetylcholine at cholinergic synapses, assists in memory formation.

34

Haldol

causes CNS effects of sedation and decreased thirst. Many people take this to control tics and vocalizations

35

avoid abraded skin areas to prevent-

systemic absorption of a medication

36

adriamycin

requires cardiac function studies to monitor cardiac toxic effects

37

synthroid should be withheld if?

pulse is over 100 beats per minute, to prevent insomnia the dose should be taken early in the morning.. glucose is not affected by thyroid preparations.

38

long term dilantin therapy

gum disease is common so brush and floss teeth!

39

drug of treatment for status epilepticus

valium

40

a female with trichonmoniasis recieves flagyl

avoid alcohol ingestion b/c of possibility of antabuse reaction

41

theophylline therapeutic range

10-20

42

mandelamine

acidify the urine, decreasing the incidence of calculi and UTI's.

43

Neuromax (neuromuscular blocker) prolonged muscle relaxation would be identified by the?

kidneys

44

common adverse effect of haldol

photosensitivity

45

teaching a mom about administering ritalin to her son that has ADHD

administer the med at breakfast and after lunch. Doses should be spaced at 8 hour intervals.

46

griseofulvin (used to treat ringworm also has a side effect of)?

photosensitivity

47

lovastatin

med should be taken with evening meal

48

Antimetabolites

inhibit enzymes necessary for cell function and replication

49

client with myasthenia gravis is at greatest risk for respiratory complications t/f

true

50

blood dyscrasias can be an adverse effect of tegretol so if pt develops gingival hyperplasia the hcp should be?

notified

51

1) prototype of the first-generation (traditional) NSAIDs.
2) NSAIDs have four beneficial actions:
3) NSAIDs have three major adverse effects:
4) t/f Cyclooxygenase has two forms: COX-1 (good COX) and COX-2 (bad COX).
5) Inhibition of COX-1 can cause
6) Inhibition of COX-2
â–ª First-generation NSAIDs (e.g., aspirin, ibuprofen) inhibit COX-1 and COX-2.
â–ª Second-generation NSAIDs, also known as coxibs, produce selective inhibition of COX-2, and thereby spare COX-1.
â–ª First-generation NSAIDs cannot suppress inflammation without also posing a risk of serious adverse effects (gastric ulceration, bleeding, and renal impairment).
â–ª By sparing COX-1, second-generation NSAIDs can suppress inflammation while causing fewer side effects than do first-generation NSAIDs.

â–ª Anti-inflammatory doses of aspirin are much higher than analgesic or antipyretic doses.
â–ª Aspirin and other NSAIDs are useful drugs for rheumatoid arthritis and other chronic inflammatory conditions.

â–ª The risk of NSAID-induced gastric ulcers can be reduced by (1) testing for and eliminating H. pylori prior to starting therapy; (2) giving misoprostol, a synthetic prostaglandin, for prophylaxis; and (3) using a coxib instead of a first-generation NSAID.
â–ª Because of its antiplatelet actions, aspirin can protect against MI and other thrombotic events.

â–ª Aspirin can impair renal function, thereby causing sodium and water retention, edema, and elevation of

1)Aspirin
2) suppression of inflammation, relief of mild to moderate pain, reduction of fever, and reduction of thrombus formation (secondary to suppression of platelet aggregation).
3) gastric ulceration, renal impairment, and increased bleeding tendencies (secondary to suppression of platelet aggregation).
4) true
5) gastric ulceration, bleeding, and renal impairment.
6)reduces inflammation and pain.

52

vericrose veins

common in clients older than 30 years of age whose occupations require prolonged standing. Varicose veins are also frequently seen in pregnant women, clients with systemic problems (e.g., heart disease), obese clients, and clients with a family history of varicose veins.

53

test for vericrose veins?

Trendelenburg test assists with the diagnosis. The client is placed in a supine position with elevated legs. As the client sits up, the veins would normally fill from the distal end; however, if there are varicosities, the veins fill from the proximal end.

54

Varicose veins are surgically removed when they are larger than?

4 mm in diameter or are in clusters. The stab avulsion technique may be used if the saphenous veins are competent. The surgeon exposes varices through 2- to 3-mm stab incisions, grasping the veins with hooks, and dividing and avulsing each vein.
postop- client needs to keep legs elevated. perform rom excercises,

55

Varicose veins may be either primary or secondary.

Primary varicose veins often result from a congenital or familial predisposition that leads to loss of elasticity of the vein wall. Secondary varicosities occur when trauma, obstruction, DVT, or inflammation causes damage to valves.

56

perthes test

The Perthes test is used to evaluate the patency of deep veins. With the patient supine and the extremity elevated, occlude the subcutaneous veins with a tourniquet just above the knee to prevent filling of superficial varicosities from above. As the patient walks, muscular tension will act on the deep veins and empty the dilated superficial varicosities. When these superficial veins fail to empty, suspect that the deep veins are also incompetent.

57

hypothyroidism in adults (dosing)

The dosage should be low initially and then increased gradually until full replacement doses have been achieved. A typical dosing schedule consists of 50 μg daily (PO) for 2 weeks followed by 100 μg daily for 2 additional weeks. Thereafter, daily doses of 100 to 150 μg are taken for life. When calculated on a body weight basis, the average adult dose is about 1.7 μg/kg/day.

58

In cretinism, thyroid hormone dosage decreases with age. t/f

true

59

Nausea and vomiting are the most common early symptoms.

Theophylline toxicity.. distractibility, poor school performance, nausea, tachycardia, and irritability; seizures and arrhythmias occur at blood theophylline levels greater than 30 μg/ml.
narrow therapeutic range, less effective but longer duration of action than beta agonists. Smoking cigarettes (one to two packs a day) accelerates metabolism and decreases the half-life of theophylline by about 50%

60

clean catch urine specimen
(cleaning female)

Cleanse meatus with one front-to-back motion with each of three cleansing sponges.

Keep labia separated throughout procedure.

61

clean catch procedure

give patients a sterile urine cup, sterile disinfectant wipes, and clean gloves. The cup and disinfectant wipes are often prepackaged together. The package usually contains instructions, but instruct the patient in how to wash and how to collect the specimen. Anxiety, difficulty or inability to read, or language barriers will prevent the patient from fully comprehending the instructions independently.

Instruct female patients to use the disinfectant wipes to clean from the meatus toward the rectum. Instruct men to clean the meatus in a circular motion moving from the center of the meatus to the outside. Caution the patient against wiping repeatedly with the contaminated cloth. The patient then opens a sterile urine cup. Tell your patient to start and discard the initial stream into a toilet or bedpan. This cleans or flushes the urethral orifice and meatus of resident bacteria. During the midstream, or middle portion of voiding, collect the specimen. Immediately after obtaining the specimen, place a sterile top securely over the container and send it to the laboratory for testing.

62

clean catch procedure from catheter bag

Most urinary drainage systems have a self-sealing, covered specimen collection port built into the top of the drainage tubing. Clean this area, then aspirate the specimen with a sterile needle and syringe. You may need to clamp the tubing below the port for 15 to 20 minutes to allow enough urine to accumulate.

If there is no collection port and the catheter is not rubber-like silicone (Silastic), use a small 25-gauge needle and syringe to aspirate urine from the catheter itself.

63

Once the client is discharged from the PACU, vital signs are often measured every?

15 minutes for four times, every 30 minutes for four times, every 2 hours for four times, and then every 4 hours for 24 to 48 hours if the client's condition is stable. Thereafter, vital signs are assessed according to the facility's policy, the client's condition, and the nurse's judgment.

64

stridor

high pitched crowing sound

65

Snoring and stridor are signs of?

airway obstruction resulting from tracheal or laryngeal spasm or edema, mucus in the airway, or blockage of the airway from edema or tongue relaxation. When neuromuscular blocking agents are retained, the client has muscle weakness, which could affect gas exchange. Indicators of muscle weakness include the inability to maintain a head lift, weak hand grasps, and an abdominal breathing pattern.

66

A pulse deficit

(a difference between the apical and peripheral pulses) could indicate a dysrhythmia.

67

Post op- Report a urine output of less than 30 mL/hr (240 mL per 8-hour nursing shift) to the physician. Decreased urine output may indicate hypovolemia or renal complications. t/f

true

68

The clean surgical wound heals at skin level in about 2 weeks in the absence of trauma, connective tissue disease, malnutrition, or the use of some drugs, such as steroids. t/f

true.. if you are a smoker it takes longer

69

head and facial wounds heal more quickly than abdominal and leg wounds. t/f

true.. healing is not totally complete for up to two years until the scar is strengthened

70

Serosanguineous drainage continuing beyond the fifth day after surgery alerts you to the possibility of dehiscence, and the surgeon should be notified. t/f

true

71

If drainage is pres-ent on a dressing or cast, monitor its progression by

outlining it with a pen and indicating the date and time.. also check the area underneath it may leak!

72

A Penrose drain (a single-lumen, soft, open, latex tube) is a gravity-type drain under the dressing.

Drainage on the dressing is expected with open tube drains but is not expected with closed drainage systems. Assess closed-suction drains, such as Hemovac, VacuDrain, and Jackson-Pratt drains, for maintenance of suction. A T-tube may be placed after abdominal cholecystectomy to drain bile. Figure 22-3 shows commonly used drains. Monitor the amount, color, and type of drainage while the client is in the PACU and at least every 8 hours after the client is transferred to the medical-surgical nursing unit. Large amounts of sanguineous drainage may indicate internal bleeding.

73

delirium meds

Anticholinergics: traditional antidepressants, antiparkinsonian agents, neuroleptics
• Antihistamines: over-the-counter remedies for cold, flu, sleep
• Antiarrhythmics: quinidine
• Sedative-hypnotics: benzodiazepines
• Narcotic analgesics
• Histamine-2 receptor blockers: cimetidine
• Anticonvulsants
• Beta-blockers
• Antihypertensives
• Corticosteroids
• Antibiotics

74

A body temperature greater than 100° F (37.7 C) in the first 24 hours after surgery is frequently caused by atelectasis. t/f

true

75

If the wound healing is to be healed by second or third intention,

then it is left open to heal from the fascia to the skin, and special wound handling must occur. Measures can include wound packing, dressings, drains, ostomy bags, and so on, depending on wound size and location and drainage from the wound. Measure and record the amount of drainage every shift for comparison with earlier assessments to guide potential care plan changes

76

Thus the state of consciousness depends on successful interaction between the brainstem and cerebral hemispheres. T/F

true

77

Locked in syndrome

Locked-in syndrome is a condition in which the motor pathways in the brainstem are destroyed but the RAS and higher cognitive functions remain intact. In this state, patients are unable to move or speak because of destruction of the motor pathways that control those functions, but they are capable of interacting with their environment. The motor functions of blinking and extraocular movements are usually spared because those pathways lie above the level of the pons. Locked-in patients therefore can communicate with eye movements and are capable of full arousal and understanding.

78

decorticate posturing

Abnormal flexion of the arms at the elbows, wrists, and hands with concurrent extension of the legs is called decorticate posturing.

79

decerebrate posturing

Lesions in the motor pathways of the midbrain or upper pons may cause abnormal extension of the arms with hyperpronation of the forearms, which is called decerebrate posturing.

80

The last part of the neurologic examination is the?

cranial nerve examination. Several specific cranial nerve reflexes are particularly important in assessing altered LOC. Protective reflexes, including gag, corneal, and cough, are checked to assess the patient's ability to protect himself or herself from injury and aspiration

81

The Glasgow Coma Scale (GCS)

was developed specifically to evaluate head-injured patients, but it can also be effectively used with a wide variety of other neurologic problems (Box 48-4

82

explain each category and rating of GCS

Glasgow Coma Scale
Eye Opening
4 Spontaneously open
3 Open to verbal request
2 Open with painful stimuli
1 No opening
Best Motor Response
6 Obeys commands
5 Localizes to painful stimulus
4 Withdraws to painful stimulus
3 Abnormal flexion to pain (decorticate posturing)
2 Abnormal extension to pain (decerebrate posturing)
1 No response
scores from three scales: eye opening, verbal response, and motor response. Numbers are assigned to the patient's best response in each area, and notations are made if a scale is not able to be evaluated, such as “eyes swollen shut” or “intubated; unable to test verbal response.” The GCS does not take the place of a comprehensive neurologic examination, but the cumulative results can be graphed and used to identify trends in the patient's overall function and predict outcomes.

83

cystic fibrosis

For formula-fed infants, commercial cow's milk formulas are usually adequate, although frequently a hydrolysate formula with medium-chain triglycerides (e.g., Pregestimil or Alimentum) may be recommended. Enzymes are mixed into cereal or fruit, such as applesauce. Because the uptake of fat-soluble vitamins is decreased, water-miscible forms of these vitamins (A, D, E, K) are given, along with multivitamins and the enzymes. In CF constipation is often a result from malabsorption

84

CF in children- rectal prolapse will occur in the 1st 3 years of life T/F

true
they also have salt depletion when they sweat so salty skin. (Gatorade is good to help with this)

85

The pancreas produces four digestive enzymes:

lipase, amylase, chymotrypsin, and trypsin.
enzymes are secreted into the duodenum, where they help digest fats, carbohydrates, and proteins. To protect these enzymes from stomach acid and pepsin, the pancreas secretes bicarbonate. The bicarbonate neutralizes acid in the duodenum, and the resulting elevation in pH inactivates pepsin.

86

Pancreatic enzymes are available as two basic preparations: pancreatin and pancrelipase.

Pancreatin is made from hog or beef pancreas. Pancrelipase is made from hog pancreas. Pancrelipase has enzyme activity far greater than that of pancreatin. As a result, pancrelipase is the preferred preparation. Trade names for pancrelipase include Viokase, Lipram, Pancrease MT, and Pancrecarb MS.

87

Antacids and histamine2-receptor blockers may be employed as adjuvants to pancreatic enzyme therapy.t/f?

True..Their purpose is to reduce gastric pH, thereby protecting the enzymes from inactivation. However, these adjuvants are beneficial only when secretion of gastric acid is excessive.

88

Before tube feeding, raise the head of the bed to a?

30-degree angle. If elevating the head of the bed is not advisable, then position client on his/her right side.

89

feeding tube..If residual is more than 50 ml, stop infusion for 30 minutes to 1 hour and then recheck.
t/f

true

90

Cystic fibrosis- home IV antibiotics are prescribed

For pulmonary infection, home IV antibiotics are typically prescribed. Home IV care is preferred for willing and competent families, because it reduces tension and usually brings a sense of belonging to the family members. With use of the venous access devices, such as percutaneously inserted central catheters (or PICC lines), the parents and child are taught the technique of direct administration into the IV line.

91

weight loss or flattening in the growth curve associated with loss of appetite, which could indicate a pulmonary exacerbation in children with CF t/f

true

92

patients with CF should receive the influenza vaccine starting at age 6 months and followed by a yearly booster t/f

true

93

confirm CF

The standard method of diagnosis has been the sweat test, which will reveal sweat chloride concentration in excess of 60 mEq/L

94

CF tx-

Treatment is primarily focused on pulmonary health and on nutrition

95

Withholding insulin can cause hyperglycemia, ketosis, and electrolyte problems. T/F

true

96

Drugs such as thiazide diuretics, glucocorticoids (cortisone preparations), thyroid agents, and estrogen increase the blood sugar; therefore insulin dosage may need adjustment. Drugs that decrease insulin needs are tricyclic antidepressants, monoamine oxidase (MAO) inhibitors, aspirin products, and oral anticoagulants. T/F

true

97

This usually occurs in the predawn hours of 2:00 to 4:00 am. When the somogyi effect occurs, a rapid decrease in blood glucose during the night hours stimulates a release of hormones (e.g., cortisol, glucagon, epinephrine) to increase blood glucose by lipolysis, gluconeogenesis, and glycogenolysis. Management of the somogyi effect involves monitoring blood glucose between 2:00 am and 4:00 am and reducing the bedtime insulin dosage.

hypoglycemic

98

dawn phenomenon

The client usually awakens with a headache and reports night sweats and nightmares. Management of the dawn phenomenon involves increasing the bedtime dose of insulin. Hyperglycemia on awakening

99

U-500 insulin is 5 times as strong as U-100 insulin. t/f

true

100

2 kinds of insulin, one syringe..

1 With an insulin syringe and needle, inject air, equal to the dose of insulin to be withdrawn, into the vial of intermediate- or long-acting (cloudy) insulin. Do not touch the tip of the needle to the solution.
2 Remove the syringe from the vial of cloudy insulin.
3 With the same syringe, inject air, equal to the dose of insulin to be withdrawn, into the vial of rapid- or short-acting insulin (clear vial). Then withdraw the correct dose into the syringe.
4 Remove the syringe from the clear insulin vial after carefully removing air bubbles in the syringe to ensure correct dose.
5 Return to the vial of intermediate- or long-acting (cloudy) insulin, and withdraw the correct dose.
6 Administer mixture of insulins within 5 minutes of preparing it. Rapid- or short-acting insulin can bind with intermediate- or long-acting insulin, thus reducing the action of the faster-acting insulin.

101

Alcohol ingestion may be contraindicated in people receiving chlorpropamide therapy, since alcohol use can cause an “Antabuse effect,” in which facial flushing, headaches, and dizziness occur. Nursing interventions for clients taking OHAs include teaching clients to abstain from alcohol consumption and to be aware of the potential for side effects and complications such as hypoglycemia. t/f

true

102

hbg A1C

The level of A1C increases when individuals have prolonged hyperglycemic serum levels. Red blood cells have a life span of 4 months; therefore a measurement of A1C will give the prescriber an evaluation of the client's long-term diabetic control. An elevated A1C indicates inadequate diabetic control for the previous 2 to 3 months

103

insulin pump

The insulin pump is battery-operated and connected to a small computer that is programmed to release small amounts of insulin per hour (see Figure 5-8). It does not analyze the blood glucose level, but it is programmed according to the client's daily insulin needs, diet, and physical exercise. The client can also push a button that releases a bolus dose to cover each meal consumed.

104

list drugs that cause hyperglycemia and hypoglycemia

Drugs Reported to Cause Hyperglycemia or Hypoglycemia

HYPERGLYCEMIA HYPOGLYCEMIA
atypical antipsychotics (e.g., olanzepine, risperidol) ACE inhibitors
β blockers anabolic steroids
calcium channel blocking agents alcohol
clonidine β-adrenergic blocking agents
corticosteroids β blockers
danazol bromocriptine
diuretics clofibrate
epinephrine ketoconazole
estrogen lithium
estrogen-progestin-containing hormonal contraceptives mebendazole
glucagon NSAIDs
growth hormone octreotide
heparin pyridoxine
H2 receptor blockers sulfonamides
morphine theophylline
phenytoin
sulfinpyrazone
thyroid hormones

105

plasma glucose level response symptom hypoglycemia

PLASMA GLUCOSE LEVEL RESPONSE/SYMPTOM[†]
>70 mg/dL None
70 mg/dL Counterregulation (decreased insulin secretion, increased glucagon secretion, initial epinephrine release)
60 mg/dL Autonomic response (sweating, increased heart rate secondary to epinephrine release)
50 mg/dL Neuroglycopenic (lightheadedness)
40 mg/dL Lethargy
30 mg/dL Coma
20 mg/dL Seizures
10 mg/dL Permanent brain damage/death
0 mg/dL Death
*Symptoms masked by β-adrenergic blockers.

106

sulfonylureas

The sulfonylureas enhance the release of insulin from the beta cells in the pancreas, decrease liver glycogenolysis (the breakdown of glycogen stored in the liver to glucose) and gluconeogenesis (the formation of glycogen from fatty acids and proteins rather than from carbohydrates), and increase cellular sensitivity to insulin in body tissues. Therefore they reduce the concentration of blood glucose in people with a functioning pancreas.

glyburide and glipizide are the most commonly used sulfa's

107

The following three insulins normally appear as clear, colorless solutions: regular insulin, insulin lispro (Humalog), and insulin glargine (Lantus); the rest are white opaque (cloudy) solutions. t/f

true

108

Fentanyl is a synthetic opioid preferred for critically ill patients with hemodynamic instability or?
forms?

morphine allergy. It is a lipid-soluble agent which has a more rapid onset than morphine and a shorter duration.
it is an effective and safe opiod
preferred agent for acutely distressed patients.
comes in many forms the duragesic patch is the 72 hour patch, requires 12-16 hours for onset of action

109

duragesic patch applied to?

the upper torso.. indicated for chronic severe pain, such as that associated with cancer. Because analgesia is delayed, fentanyl patches are not suited for acute or postoperative pain. The patches should not be used in children under 12 years old, or in anyone under 18 who weighs less than 110 pounds. Also, patches should not be used for mild pain that responds to a less powerful analgesic.
*antagonist naloxone

110

what schedule is duragesic

schedule 2

111

meperidine

the drug has a short half-life, and hence dosing must be repeated at short intervals. Second, meperidine interacts adversely with a number of drugs. Third, with continuous use, there is a risk of harm owing to accumulation of a toxic metabolite. Accordingly, routine use of the drug should be avoided. However, meperidine may still be appropriate for patients who can't take other opioids, and for patients with drug-induced rigors or post-anesthesia shivering.

112

combination of meperidine with an MAO inhibitor should be avoided. Other drugs that increase serotonin availability (e.g., tricyclic antidepressants, selective serotonin reuptake inhibitors) may also pose a risk. t/f

true

113

Methadone is used to?

relieve pain and to treat opioid addicts. Usual oral analgesic doses for adults range from 2.5 to 20 mg repeated every 3 to 4 hours as needed.

114

is an intravenous opioid with a rapid onset and brief duration. The brief duration results from rapid metabolism by plasma and tissue esterases, and not from hepatic metabolism or renal excretion. Like fentanyl, remifentanil is about 100 times more potent than morphine.

Remifentanil [Ultiva]

115

Hydromorphone [Dilaudid] is available in tablets

2 mg every 4 to 6 hours.

116

Oxymorphone [Numorphan]

is available in solution (1 and 1.5 mg/ml) for parenteral administration and in 5-mg rectal suppositories. The initial IV dose is 0.5 mg.

117

A short half-life (approximately 2 to 7 hours) is recommended for some clients, such as older adults.

Drugs with a short half-life are usually preferred for occasional or unexpected pain because they tend to have a quicker onset of analgesia than drugs with a long half-life.

118

Some of the more commonly used opioids are codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, and oxycodone. T/F
Morphine is the preferred opioid for children. t/f

true
true

119

The fentanyl patch is really indicated for what type of pain?

chronic pain!

120

Codeine is the most commonly given oral opioid for moderate pain. t/f

It is usually given in combination with acetaminophen or aspirin. It can cause constipation, nausea, vomiting, and pruritus

121

Ketorolac

Classification: Nonsteroidal antiinflammatory (NSAID), analgesic.

Action: Blocks prostaglandin synthesis.

Indications: Short-term management of moderate pain.

Dosages and Route: Children older than 2 years intravenous (IV): 0.4-1 mg/kg one time, followed by 0.2-0.5 mg/kg/dose q6h, up to a maximum of 120 mg/24 hr.

Absorption: Absorbed fairly rapidly; peak action in 1 to 2 hr.

Excretion: Excreted in the urine; effects last 4-6 hr.

Contraindications: Contraindicated in patient in whom urticaria, severe rhinitis, bronchospasm, angioedema, nasal polyps are precipitated by other NSAIDs.

Precautions: Cautious use with history of ulcers, impaired hepatic or renal function.

Adverse Reactions: Drowsiness, dizziness, nausea, GI pain, hemorrhage.

Nursing Considerations: Do not administer longer than 5 days; monitor liver function studies, signs and symptoms of GI upset or bleeding.

122

Fentanyl should only be used in clients who are opioid tolerant. t/f
fentanyl patch

true

The patch should not ever be cut and should be disposed of down the toilet, witnessed by two nurses.

123

oral route

ORAL
Preferred because of convenience, cost, and relatively steady blood levels

Higher dosages of oral form of opioids required for equivalent parenteral analgesia

Peak drug effect occurs after 1-2 hours for most analgesics

Delay in onset is disadvantage when rapid control of severe pain or of fluctuating pain is desired

124

SUBLINGUAL/BUCCAL/TRANSMUCOSAL

Tablet or liquid placed between cheek and gum (buccal) or under tongue (sublingual)

Highly desirable because more rapid onset than with oral route

Less first-pass effect through liver than oral route, which normally reduces analgesia from oral opioids (unless sublingual/buccal form swallowed, which occurs often in children)

Few drugs commercially available in this form

125

IV bolus

Preferred for rapid control of severe pain

Provides most rapid onset of effect, usually in about 5 minutes

Advantage for acute pain, procedural pain, and breakthrough pain
Needs to be repeated hourly for continuous pain control

Drugs with short half-life (morphine, fentanyl, hydromorphone) are preferred, to avoid toxic accumulation of drug

126

INTRAVENOUS (CONTINUOUS)

Preferred over bolus and intramuscular injection for maintaining control of pain

Provides steady blood levels

Easy to titrate dosage

127

SUBCUTANEOUS (SC) (CONTINUOUS)

Used when oral and IV routes not available

Provides equivalent blood levels to continuous IV infusion

Suggested initial bolus dose to equal 2-hour IV dose; total 24-hour dose usually requires concentrated opioid solution to minimize infused volume. Use smallest gauge needle that accommodates infusion rate

128

INTRAMUSCULAR.. for pain control?

NOT RECOMMENDED FOR PAIN CONTROL; NOT CURRENT STANDARD OF CARE

129

To avoid stinging sensation associated with lidocaine:

Buffer the solution by adding 1 part sodium bicarbonate (1 mEq/mL) to 9 to 10 parts 1% or 2% lidocaine with or without epinephrine (see Guidelines box on p. 680)
Normal saline with preservative, benzyl alcohol (except neonates), anesthetizes venipuncture site

Use same dose as for buffered lidocaine (see Guidelines box on p. 680).

130

EMLA

covered by occlusive dressing or applied as anesthetic disk for 1 hour or more before procedure

131

Provides skin anesthesia about 15 minutes after application on nonintact skin
Gel (preferable) or liquid placed on wounds for suturing
Adrenaline must not be used on end arterioles (fingers, toes, tip of nose, penis, earlobes) because of vasoconstriction

LAT (lidocaine/adrenaline/tetracaine) or tetracaine/phenylephrine (tetraphen)

132

Vapocoolant

10-15 seconds before needle puncture

133

The most commonly prescribed opioids for intravenous PCA are morphine, hydromorphone, and fentanyl. t/f

true

134

Its important not to get the normal dose of fentanyl and morphine confused!

Fentanyl at a dose of 0.1 mg given intravenously is equivalent to 10 mg of morphine given intramuscularly.

135

why is retinal detachment serious?

Retinal detachment may occur suddenly or develop slowly. Symptoms include showers of floating spots before the eyes, flashes of light, and progressive loss of vision in one area. The so-called floaters are cells that are freed at the time of the retinal tear, casting shadows on the retina as they drift about the eye. The flashes of light are caused by vitreous traction on the retina. The area of vision loss depends entirely on the location of the detachment. If the detachment extends to include the macula, blindness results. When the detachment is extensive and occurs quickly, the patient may have the sensation that a curtain has been drawn before the eyes. No pain is associated with a detachment.

136

causes of retinal detachment?

The most common cause is a retinal break. Retinal breaks are an interruption in the full thickness of the retinal tissue, and they can be classified as tears or holes. Retinal holes are atrophic retinal breaks that occur spontaneously. Retinal tears can occur as the vitreous humor shrinks during aging and pulls on the retina. The retina tears when the traction force exceeds the strength of the retina. Once there is a break in the retina, liquid vitreous can enter the subretinal space between the sensory layer and the retinal pigment epithelium layer, causing a rhegmatogenous retinal detachment. Less frequently, retinal detachment can occur when abnormal membranes mechanically pull on the retina. These are called tractional detachments. A third type of retinal detachment is the secondary or exudative detachment that occurs with conditions that allow fluid to accumulate in the subretinal space (e.g., choroidal tumors, intraocular inflammation)

137

is retinal detachment a urgent situation?

urgent situation, and the patient is confronted suddenly with the need for surgery. The patient needs emotional support, especially during the immediate preoperative period when preparations for surgery produce additional anxiety. When the patient experiences postoperative pain, the nurse should administer prescribed pain medications and teach the patient to take the medication as necessary after being discharged. The patient may go home within a few hours of surgery or may remain in the hospital for several days, depending on the surgeon and the type of repair. Discharge planning and teaching is important, and the nurse should begin this process as early as possible because the patient may not remain hospitalized long.

138

Cataracts
1. Description

a. A cataract is an opacity of the lens that distorts the image projected onto the retina and that can progress to blindness.
b. Causes include the aging process (senile cataracts), inherited (congenital cataracts), and injury (traumatic cataracts); cataracts also can result from another eye disease (secondary cataracts).
c. Intervention is indicated when visual acuity has been reduced to a level that the client finds to be unacceptable or adversely affects lifestyle.

139

Assessment cataracts

a. Opaque or cloudy white pupil
b. Gradual loss of vision
c. Blurred vision
d. Decreased color perception
e. Vision that is better in dim light with pupil dilation
f. Photophobia
g. Absence of the red reflex

140

1. Description
a. Increased intraocular pressure results from inadequate drainage of aqueous humor from the canal of Schlemm or overproduction of aqueous humor.
b. The condition damages the optic nerve and can result in blindness.

Glaucoma

141

Types
a. Acute closed-angle or narrow-angle glaucoma results from obstruction to outflow to aqueous humor.
b. Chronic closed-angle glaucoma follows an untreated attack of acute closed-angle glaucoma.
c. Chronic open-angle glaucoma results from overproduction or obstruction to the outflow of aqueous humor.
d. Acute glaucoma is a rapid onset of intraocular pressure greater than 50 to 70 mm Hg.
e. Chronic glaucoma is a slow, progressive, gradual onset of intraocular pressure greater than 30 to 50 mm Hg.

types of glaucoma

142

Penetrating objects
1. Description: an injury that occurs to the eye in which an object penetrates the eye
2. Interventions
a. Never remove the object because it may be holding ocular structures in place; the object must be removed by the physician.
b. Cover the object with a cup.
c. Do not allow the client to bend.
d. Do not place pressure on the eye.
e. Client is to be seen by a physician immediately.

what to do if object piercing the eye?

143

ICP

Developmental Manifestations of Increased Intracranial Pressure
INFANT
• Poor feeding or vomiting
• Irritability or restlessness
• Lethargy
• Bulging fontanel
• High-pitched cry
• Increased head circumference
• Separation of cranial sutures
• Distended scalp veins
• Eyes deviated downward (“setting-sun” sign)
• Increased or decreased response to pain
CHILD
• Headache
• Diplopia
• Mood swings
• Slurred speech
• Papilledema (after 48 hours)
• Altered level of consciousness
• Nausea and vomiting, especially in the morning

144

visual acuity and age

With advancing age the lens of the eye becomes less flexible and less adjustable. In addition, the sclera changes shape, causing light to fall on the macula (an opaque portion of the cornea). Thus visual acuity declines with age.

145

Changes in the child's normal behavior pattern may be an important early sign of increased ICP t/f

true

146

As ICP rises, compression of the third cranial nerve occurs, resulting in pupil dilation with sluggish or absent constriction in response to light. A fixed dilated pupil is an ominous sign in an unconscious child. This suggests a herniation of the center section of the brain t/f

true

147

Level of consciousness should be described by the nurse using standard terminology:

Full consciousness: awake, alert, oriented, interacts with environment

Confused: lacks ability to think clearly and rapidly

Disoriented: lacks ability to recognize place or person

Lethargic: awakens easily but exhibits limited responsiveness

Obtunded: sleeps unless aroused, and once aroused has limited interaction with the environment

Stupor: requires considerable stimulation to arouse

Coma: vigorous stimulation produces no motor or verbal response

148

Temperature elevation may occur in children with increased ICP. t/f

true

149

cushing's response

Cushing's response, which consists of an increased systolic blood pressure with widening pulse pressure, bradycardia, and a change in respiratory rate and pattern, is usually apparent just before or at the time of brain stem herniation. This usually indicates an alteration in brain stem perfusion, with the body attempting to improve cerebral blood flow by increasing blood pressure. In children, Cushing's response is a late sign of increased ICP.

150

Cheyne-Stokes respiration

refers to a pattern of breathing characterized by increasing rate and depth and then decreasing rate and depth with a pause of variable length

151

Central neurogenic hyperventilation is

identified by a rapid rate despite normal arterial blood gas values. This type of breathing pattern usually indicates midbrain or pontine involvement.

152

Apneustic breathing

occurs when the child demonstrates prolonged inspiration and expiration. As Cushing's response occurs, the child will develop apnea.

Late signs of increased ICP include tachycardia that leads to bradycardia, apnea, systolic hypertension, widening pulse pressure, and decorticate or decerebrate posturing.

153

increased ICP will result in?

progressive neurological deterioration. If the infant's cranial suture lines are open, increased ICP will cause separation of the suture lines and an increase in the circumference of the head.

154

The first sign of a change in the level of ICP is change in level of consciousness; this may progress to a decrease in level of consciousness. t/f

true

155

Ipsilateral:

pupillary changes occurring on the same side as a cerebral lesion.

156

In ICP the infant will display what type of crying?

high pitched

157

Romberg's test:

measures balance. Client stands with feet together and arms at side, first with eyes open, then with eyes closed for 20 to 30 seconds.

158

Maintain semi-Fowler's position (15-30 degrees) to promote venous drainage and respiratory function.
* If the client with increased ICP develops hypovolemic shock, do not place client in Trendelenburg's position.

How should nurse Position patient with ICP?

159

CSF has ___ in it..

glucose and leaves a yellow halo stain

160

the ventriculoatrial (VA) shunt

ventricle to right atrium) is reserved for older children who have attained most of their somatic growth and children with abdominal pathology. The VA shunt is contraindicated in children with cardiopulmonary disease or elevated CSF protein.

161

is a procedure that has potential for greater independence from VA or VP shunting in children with noncommunicating hydrocephalus. In this procedure a small opening is made in the floor of the third ventricle, allowing CSF to flow freely through the previously blocked ventricle, thus bypassing the aqueduct of Sylvius. Children with SB and anatomic ventricular malformations are reportedly poor candidates for this procedure, as are children with bleeding disorders and those who have had previous radiotherapy

Endoscopic third ventriculostomy

162

ICP- Describe how to check the infants head

In infants the head is measured daily at the point of largest measurement—the occipitofrontal circumference (OFC). (See Chapter 7 for technique.) To avoid the likelihood of wide discrepancies, the point at which the measurements are taken is indicated on the head with a marking pen. Fontanels and suture lines are gently palpated for size, signs of bulging, tenseness, and separation. An infant with hydrocephalus and normal ICP will display bulging under certain circumstances such as straining or crying; therefore such accompanying behavior is noted. Irritability, lethargy, or seizure activity, as well as altered vital signs and feeding behavior, may indicate advancing pathology.

163

In the toddler a headache and lack of appetite are two of the earliest common signs of shunt malfunction. T/F

true

164

shunt and sports for child

there need be few restrictions placed on the child's activities (mainly contact sports), and the child is encouraged to live as would any other youngster of the same age and abilities.

165

Late signs of ICP in infant

Setting-sun sign: sclera visible above the iris
Frontal bone enlargement, or bossing
Vomiting; difficulty swallowing or feeding
Increased blood pressure, decreased heart rate
Altered respiratory pattern
Shrill, high-pitched cry
Sluggish or unequal pupillary response to light

166

early signs of ICP in the child

Strabismus
Frontal headache that occurs in the morning and is relieved by emesis or by sitting upright
Nausea and vomiting that may be projectile
Diplopia
Restlessness
Behavior or personality changes
Ataxia
Papilledema
Irritability
Sluggish and unequal pupillary response to light
Confusion
Changes in school work
Lethargy

167

NG tube- smaller-lumen catheters are not used for decompression in adults because they must be able to remove thick secretions t/f

true!

168

Risks for breast cancer

The most important predictor for breast cancer is age; the risk increases as the woman ages.
Female Women account for 99% of breast cancer cases.
Age 50 or over Majority of breast cancers are found in postmenopausal women.
Family history Breast cancer in a first-degree relative, particularly when premenopausal or bilateral, increases risk. Gene mutations (BRCA-1 or BRCA-2) play a role in 5%-10% of breast cancer cases.
Personal history of breast cancer, colon cancer, endometrial cancer, ovarian cancer Personal history significantly increases risk of breast cancer, risk of cancer in other breast, and recurrence.
Early menarche (< age 12); late menopause (> age 55) A long menstrual history increases the risk of breast cancer.
First full-term pregnancy after age 30; nulliparity Prolonged exposure to unopposed estrogen increases risk for breast cancer.
Benign breast disease with atypical epithelial hyperplasia Atypical changes in breast biopsy increase the risk of breast cancer.
Obesity after menopause Fat cells store estrogen.
Exposure to ionizing radiation Radiation damages DNA (e.g., prior treatment for Hodgkin's disease).

169

Physical examination of the breasts by a trained health professional (CBE) every 3 years between ages 20 and 39 and annually thereafter
3 Annual screening mammography beginning at age 40

When should you have physical examination of the breasts?

170

How to do BSE

Breast self-examination and patient instruction. 1, While in the shower or bath, when the skin is slippery with soap and water, exam-ine your breasts. Use the pads of your second, third, and fourth fingers to firmly press every part of the breast. While examining your left breast, use your right hand, and use your left hand to examine your right breast. Us-ing the pads of the fingers on your left hand, examine the entire breast us-ing small circular motions in a spiral or in an up-and-down motion so that the entire breast area is examined. Repeat the procedure using your right hand to examine your left breast. Repeat pattern of palpation under the arm. Check for any lump, hard knot, or thickening of the tissue. 2, Look at your breasts in a mirror. Stand with your arms at your side. 3, Raise your arms overhead and check for any changes in the shape of your breasts, dimpling of the skin, or any changes in the nipple. 4, Next, place your hands on your hips and press down firmly, tightening the pectoral mus-cles. Observe for asymmetry or changes, keeping in mind that your breasts probably do not exactly match. 5, While lying down, feel your breasts as described in step 1. When examining your right breast, place a folded towel under your right shoulder and put your right hand behind your head. Repeat the procedure while examining your left breast. Mark your calendar that you have completed your BSE; note any changes or unique characteristics you want to check with your health care

171

BSE should be done in?

good light and should include inspection before a mirror and careful, systematic palpation. The entire breast, axilla, and clavicle should be examined. The woman should be taught the BSE procedure by a health care provider using the woman's own hand on her breast. A gentle circular motion over wet, soapy skin is particularly useful if she is in the shower. The woman should be told what to look for, such as a lump, nipple discharge, nipple retraction, redness, pain or tenderness, dimpling of the skin, or edema. Some teaching techniques involve using silicone breast models that simulate normal and abnormal breast tissue to help women learn to identify problems. The woman should be shown the normal variations in her own breasts so that she will be able to detect changes. Finally, she should be reminded that most breast problems are not related to malignancy. At every annual physical examination the health care provider should ask the woman to demonstrate how she performs BSE.

172

cultural and ethical considerations of breast cancer

African American women have lower survival rates from breast cancer than white women, even when diagnosed at an early stage.
• African American women are diagnosed at a later stage of breast cancer than white women, but this fact alone does not account for the higher mortality rate.
• White women have a higher incidence of breast cancer than nonwhites.
• Breast cancer is the most commonly diagnosed cancer among Hispanic women.
• Hispanic women, especially Mexican Americans, have the lowest rate of cancer screening of any ethnic group.
• Hispanic women tend to have larger, more advanced tumors, which may relate to their higher mortality rate compared with white women.
• Hispanic women are more likely to be diagnosed at a later stage of breast cancer than white women.

173

invasive ductal carcinoma. Ductal carcinoma originates in the lactiferous ducts and invades surrounding breast structures. The tumor is usually unilateral, not well delineated, solid, nonmobile, and nontender.

The most frequently occurring cancer of the breast is

174

TX

Primary tumor cannot be assessed

175

TO

no evidence of primary tumor

176

Tis

Carcinoma in situ: intraductal carcinoma, lobular carcinoma in situ, or Paget disease of the nipple with node

177

T1

Tumor 2 cm or less in greatest dimension

178

T2

Tumor more than 2 cm but not more than 5 cm in greatest dimension

179

T3
T4

Tumor more than 5 cm in greatest dimension
Tumor of any size with direct extension to chest wall or skin

180

Viagra use and concerns

Sildenafil (Viagra) is a prescription medication that is commonly ordered for ED, but not without concerns and cautions for the patient. This is especially true for geriatric patients, who generally have other medical conditions (e.g., renal disorders, hypertension, diabetes) and are usually taking more than one other prescribed medication.

181

side effects of viagra

headache, flushing, urinary tract infection, diarrhea, rash, and dizziness. Viagra should be used cautiously in patients who have cardiac disease and angina because these patients are at greater risk for complications, even more so if they are also on nitrates for their cardiovascular disease. This is especially problematic for the patient over 65 years of age who is self-medicating.

182

Warm or cool mist is a common therapeutic measure for symptomatic relief of respiratory discomfort. The moisture soothes inflamed membranes and is beneficial when there is hoarseness or laryngeal involvement. However, the use of steam vaporizers in the home is discouraged because of the hazards related to their use and limited evidence to support their efficacy. t/f

true.. also sitting in a bathroom with a steaming shower will help

183

LTB is the most common croup syndrome. t/f

True! It affects children younger than 5 years of age, and the causative organisms are the parainfluenza virus, RSV, influenza A and B, and Mycoplasma pneumoniae. The disease is usually preceded by a URI, which gradually descends to adjacent structures. It is characterized by gradual onset of low-grade fever. Inflammation of the mucosa lining of the larynx and trachea causes a narrowing of the airway. When the airway is significantly narrowed, the child struggles to inhale air past the obstruction and into the lungs, producing the characteristic inspiratory stridor and suprasternal retractions. The classic barking or seal-like cough and acute stridor. Children with severe respiratory distress (traditionally, a respiratory rate greater than 60 breaths/min for infants) should not be given anything by mouth to prevent aspiration and decrease the work of breathing.

184

treat LTB

Nebulized epinephrine (racemic epinephrine) is often used in children with severe disease, stridor at rest, retractions, or difficulty breathing. The α-adrenergic effects cause mucosal vasoconstriction and subsequently decrease subglottic edema. The onset of action is rapid, and the peak effect is observed in 2 hours. Additional doses may be administered every 20 to 30 minutes in the intensive care unit or 3 to 4 hours in the regular hospital unit. The use of corticosteroids is beneficial because the antiinflammatory effects decrease subglottic edema. The onset of action is clinically detectable as early as 6 hours after administration, with continued improvement over 12 to 24 hours.

It is essential to allow children with mild croup to drink beverages they like and to encourage their parents to try whatever comforting measures work best (e.g., holding their child, rocking, singing). If the child is unable to take oral fluids, IV fluid therapy may be indicated.

185

Early signs of impending airway obstruction include

increased pulse and respiratory rate; substernal, suprasternal, and intercostal retractions; flaring nares; and increased restlessness

186

Stages of Separation

Protest:
Child is agitated, resists caregivers, cries, and is inconsolable.

Despair:
Child experiences hopelessness and becomes quiet, withdrawn, and apathetic.

Detachment:
Child becomes interested in the environment, plays, and seems to form relationships with caregivers and other children. If parents reappear, the child may ignore them.

187

separation anxiety is common with

infants and toddlers between 6 and 30 months

188

Bronchitis

Inflammation of the trachea and major bronchi is present in bronchitis. Mucus production is increased, and the mucosa is congested. Because of nonspecific leukocytic migration, purulent secretions can occur even in the absence of a bacterial infection.

Acute bronchitis is a self-limiting disease. Chronic bronchitis in children may indicate an underlying chronic respiratory dysfunction.more common during the winter months

189

Bronchitis is characterized by the

gradual onset of rhinitis and a cough that is initially nonproductive but may change to a loose cough with increased mucus production. Auscultation may reveal coarse and fine, moist crackles and high-pitched rhonchi (resembling the wheezing of asthma). Associated symptoms include malaise, low-grade fever, and increased mucus, which may be purulent.

Chest radiographs are usually normal. The diagnosis is based on the clinical picture.

190

Treatment bronchitis

Treatment is mainly symptomatic and includes rest, humidification, and increased fluid intake. Exposure to cigarette smoke should be avoided. Cough suppressants are not recommended unless the cough interferes with the child's ability to rest. Antihistamines should be avoided because of their drying effect on secretions. Antibiotics should be given only if a bacterial infection is confirmed by culture or if the clinical picture supports the diagnosis.

191

splenomegaly

enlarged spleen..Mild splenic enlargement occurs with congestive heart failure and systemic lupus erythematosus.massive splenic enlargement occurs with chronic myelogenous leukemia, hairy cell leukemia, and thalassemia major.

192

Hereditary hemolytic anemias
Sickle cell disease
Thalassemia

Autoimmune cytopenias
Acquired hemolytic anemia
Immune thrombocytopenia

Infections and inflammations
Bacterial endocarditis
Infectious mononucleosis
Systemic lupus erythematosus
Sarcoidosis
Human immunodeficiency virus infection
Viral hepatitis

Infiltrative diseases
Acute and chronic leukemia
Lymphomas
Polycythemia vera

Congestion
Cirrhosis of the liver
Congestive heart failure

Causes of splenomegaly

193

abdominal discomfort and early satiety.

signs of splenomegaly..

194

When the spleen enlarges, its normal filtering and sequestering capacity increases. Consequently there is often a reduction in the number of circulating blood cells. A slight to moderate enlargement of the spleen is usually asymptomatic and found during a routine examination of the abdomen.

when the spleen enlarges normal filtering and sequestering capacity?

195

After splenectomy, immunologic deficiencies may develop. IgM levels are reduced, and IgG and IgA values remain within normal limits. Postsplenectomy patients have a lifelong risk for infection, especially from encapsulated organisms such as pneumococcus. This risk is reduced by immunization with pneumococcal vaccine (e.g., Pneumovax).

immunologic system after splenectomy.

196

cause of parkinsons disease

The primary cause of PD is an imbalance in two neurotransmitters—dopamine (DA) and acetylcholine (ACh)—in the area of the brain called the basal ganglia. This imbalance is caused by failure of the nerve terminals in the substantia nigra to produce the essential neurotransmitter dopamine. This neurotransmitter acts in the basal ganglia to control movements. Destruction of the substantia nigra leads to dopamine depletion. Dopamine is an inhibitory neurotransmitter, and ACh is an excitatory neurotransmitter in this area of the brain. A correct balance between these two neurotransmitters is needed for the proper regulation of posture, muscle tone, and voluntary movement. Patients who suffer from PD have an imbalance in these neurotransmitters, usually a deficiency of dopamine in the substantia nigra areas of the brain, as mentioned previously. This dopamine deficiency can also lead to excessive ACh (cholinergic) activity due to the lack of a normal dopaminergic balancing effect.

197

drug therapy is aimed at increasing the levels of dopamine as long as there are functioning nerve terminals. It is also aimed at antagonizing or blocking the effects of ACh and slowing the progression of the disease.

parkinsons tx

198

depakote

metabolized in the liver and can cause hepatotoxicity

199

Assist clients to focus on their strengths

helps them become aware of their positive qualities and increase self confidence, also aids in coping with past and present situations.

200

clients in manic phase of bipolar disorder

require decreased stimuli and a structured environment. Plan noncompetitive activities that can be carried out alone

201

prolixin side effect-

photosensitivity

202

delusional clients have difficulty with?

trust and have low self esteem

203

green vaginal discharge

indicative of gonorrhea, so if you see a 8 year old child with this suspect child abuse.

204

schizo's

need med regimen
families need to know the signs of exacerbation
chronic grief associated with long term illness

205

Feelings of hopelessness are characteristics of someone who is?

depressed

206

A client believes someone is out to get them

offer support without judgement or demands
ex) Come with me to your room and I will sit with you.

207

a client is paranoid and thinks someone is stealing his clothes

enroll the client in a excersise class to promote positive self esteem

208

a client believes there tongue is rubber

give the client a liquid diet and do not argue with the clients delusions

209

delusions are false beliefs characteristic of psychosis t/f

true

210

during cocaine withdraw there is?

psychomotor impairment

211

a negative self image is a indicator for depression t/f

true

212

early side effects of lithium carb

levels below 2 meq.. follow a progressive pattern beginning with diarrhea, vomitting, and drowsiness and muscle weakness. Higher levels- ataxia, blurred vision, tinnitis, and large dilute urine.

213

when is hospitalization needed for the schizo client?

when the voices tell him to do things that cause self harm

214

T/f the nurse should constantly reassess the need for constant observation

true

215

depression is associated with?

feelings of guilt so the nurse should help direct awareness to the client

216

NMS

fever, rigidity, encephalopathy, it is a life threatening reaction to neuroleptic drugs.

217

agoraphobia

fear of crowds or being in a open space

218

several atypical antipsychotics can cause?

weight gain, so client should have a well balanced diet and excersise

219

ego defense mechanism used by a client who refuses to leave the home

symbolization

220

in establishing trust with a client with paranoia. Most important nursing interventions

great the client by first name and provide short frequent contact to establish trust.

221

identification

an attempt to be like someone or emulate personality traits of someone.


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