Term
| What type of dressing do you use to cover the site of a bone marrow aspiration? |
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Definition
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Term
| If your pt is complaining of soreness 4 days post bone marrow aspiration, what should you do? |
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Definition
| -give analgesics, soreness lasting 3-4 days is normal |
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Term
| You are monitoring VS and the puncture site of your pt post bone marrow aspiration. If bleeding is present immediately following what should you do? |
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Definition
| instruct the pt to lie on that side, on a firm surface for 30-60 mins |
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Term
| What gauge needle is used for blood transfusion? |
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Definition
19g or larger
-18 or 16 may be needed for rapid infusion
-smaller needles can be used for platelets, albumin, or clotting factors |
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Term
| What all fluids can be run with a blood transfusion? |
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Definition
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Term
| Who must "witness" for identification of pt and blood products for a blood transfusion? |
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Definition
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Term
| How long should the nurse stay with the pt at the beginning of a blood transfusion? |
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Definition
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Term
| What is the maximum rate a blood transfusion should run during the first 15 mins? |
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Definition
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Term
| What is the maximum amount of time blood can be on the unit before the infusion is started? |
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Definition
|
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Term
| How often should VS be taken during a blood transfusion? |
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Definition
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Term
| How often during a blood transfusion should you assess the pt? How long after? |
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Definition
| at least q 30 mins; for up to 1 hr |
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Term
| What should be your initial action if your pt has a blood transfusion reaction? |
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Definition
| stop the blood; keep the saline infusion running |
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Term
| If your pt has a reaction to a blood transfusion you stop the blood and maintain the IV with saline. What other steps must be taken? |
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Definition
-notify the blood bank and MD
-recheck ID tags and numbers
-monitor VS and UOP
-save blood bag and tubing, send to blood bank
-complete transfusion reaction report
-collect blood and urine samples
-document on transfusion reaction form and pt chart |
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Term
| What is the primary nursing consideration with multiple myeloma? |
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Definition
| maintaining hydration to minimize problems from hypercalcemia |
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Term
| In the pt with multiple myeloma, IV fluids may be administered to maintain UOP of what? |
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Definition
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Term
| Why must the RN be careful when moving the pt with multiple myeloma? |
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Definition
| they are at an increased risk for pathological fractures |
|
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Term
| What are produced in excess in multiple myeloma? |
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Definition
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Term
| What happens as malignant plasma cells are produced in multiple myeloma? |
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Definition
| these cells are overproduced in the bone marrow and normal plasma cells are underproduced. This weakens and damages the bone and also weakens the immune system due to a loss of resulting antibodies |
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Term
| What can the hypercalcemia, secondary to multiple myeloma, result in? |
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Definition
| renal, GI, and neuro manifestations such as polyuria, anorexia, confusion, seizures, coma, and cardiac problems |
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Term
| High protein levels, secondary to multiple myeloma, can damage what organ? |
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Definition
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Term
| What is the purpose of Bisphosphonates (Aredia, Zometa, and Didronel) in the treatment of multiple myeloma? |
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Definition
| they are used in the treatment of skeletal pain and hypercalcemia. they inhibit bone resorption without inhibiting bone formation and mineralization |
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Term
| What are the common meds used in the treatment of multiple myeloma? |
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Definition
| corticosteroids, chemotherapy, biologic therapy, and HSCT |
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Term
| Hodgkin's Lymphoma is is a malignant condition characterized by proliferation of abnormal giant, mutlinucleated cells called what? Which are located in lymph nodes |
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Definition
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Term
| Aside from genetics and occupational toxins, what virus is most associated with Hodgkin's? |
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Definition
Epstein Barr virus
-incidence is also increased in pts with HIV |
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Term
| Describe the affected lymph nodes of the pt with Hodgkins. |
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Definition
| enlarged, moveable, and nontender |
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Term
| In classifying Hodgkins, what do the A or B represent? What do the Roman numerals I-IV mean? |
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Definition
| A (absence) B (presence) or symptoms when disease is found; I-IV indicates location |
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Term
| What is the treatment used for Hodgkins? |
|
Definition
chemotherapy
-ABVD regimen for early stage
(Adriamycin, bleomychin, vinblastine, dacarbazine)
-BEACOPP for later stage
(bleomycin, etoposide, Adriamycin, cyclophosphamide, Oncovin, procarbazine, prednisone) |
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Term
| What added to the treatment of Hodgkins has allowed for higher, potentially curative doses of chemo while reducing the risk for leukemia? |
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Definition
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|
Term
| What special consideration needs to be taken with adolescents and young adults with Hodgkins? |
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Definition
|
|
Term
| Why may allopurinol be used with chemotherapy? |
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Definition
| uric acid is released when cancer cells break down; allopurinol helps to prevent the uric acid from damaging the kidneys |
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Term
| At what temperature would you immediately initiate IV anitbiotic therapy for the neutropenic pt? |
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Definition
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Term
| What are some nursing interventions for the pt with neutropenia? |
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Definition
| strict handwashing, private room, limit on visitors, no live flowers, possible contraindication for invasive procedures, HEPA air filter |
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Term
| What should the pt taking nitroglycerin feel when taken, if not the medicine may have lost its potency? |
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Definition
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Term
| What are possible side effects of taking nitroglycerin? |
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Definition
| orthostatic hypotension, increased HR, HA, dizzyness, and flushing |
|
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Term
| Can nitrogylcerin be taken prophylactically? |
|
Definition
| yes, 5-10 mins prior to an activity that causes angina |
|
|
Term
| How quickly should sublingual nitroglycerin relieve angina? How long will relief last? |
|
Definition
| within 3 mins; for 30-60 mins |
|
|
Term
| How long should be given for nitroglycerin to relieve angina before EMS should be called? |
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Definition
|
|
Term
| How much nirtoglycerin can be taken at one time? |
|
Definition
| if symptoms are improved you can take one tab every 5 mins for a maximum of 3 tabs |
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Term
| NTG ointment should be applied where? |
|
Definition
| on the skin over a flat muscle free of hair and scars; (upper arm) |
|
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Term
| How long does NTG ointment provide angina relief? |
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Definition
|
|
Term
| Beta blockers have what effect on the CV system? |
|
Definition
| reduce HR, SVR, BP, and myocardial contractility. all of which reduce myocardial oxygen demand |
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Term
| Beta blockers are contraindicated with what? |
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Definition
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|
Term
| Why should beta blockers be used cautiously in pts with DM? |
|
Definition
| it can mask the symptoms of hypoglycemia |
|
|
Term
| What can happen if Beta blockers are stopped abruptly? |
|
Definition
| an increase in frequency and severity of anginal attacks |
|
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Term
| What are the S&S of an MI? |
|
Definition
| PAIN (severe immobilizing, crushing pain), SOB, clammy cool skin, elevated HR and BP, eventually a drop in BP d/t reduced CO, crackles may be heard, NV, fever |
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Term
| What must be monitored closely while the pt is on nitroglycerin? |
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Definition
| BP, can cause hypotension |
|
|
Term
| What are some sources of saturated fat and cholesterol? |
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Definition
| red meats, eggs, whole milk products |
|
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Term
| Which types of fat should be avoided and which are ok to use? |
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Definition
saturated should be avoided (animal fat:bacon, lard, egg yolk) along with butter, cream cheese and sour cream
polyunsaturated are ok to use: vegetable oils, some fish oil, walnuts, sunflower seeds, margarine |
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Term
| What should you avoid while taking MAOIs? Give nutritional examples. |
|
Definition
tyramine; avocados, bananas, beet, bologna, canned figs, hard cheese, chocolate, liver, papaya, pickled fish, pepperoni, raisins, salami, sausage, sour cream, soy sauce, yogurt, red wine
CAN CAUSE HTN CRISIS!!!! |
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Term
| What level does alcohol intoxication occur? |
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Definition
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|
Term
| How long after cessation of drinking does delirium begin? |
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Definition
|
|
Term
| How long after cessation of drinking do withdrawal symptoms begin? |
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Definition
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Term
| What are the goals of care for the pt with ETOH withdrawal? |
|
Definition
| prevent delirium, correct F&E imbalance, dianostic testing, establish rapport |
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Term
| What is the name of the drug used to induce vomitting when ETOH is consumed? |
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Definition
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|
Term
| What is a command hallucination? |
|
Definition
| auditory hallucination telling a person to perform an act; often times dangerous or destructive to self or others |
|
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Term
| What is the first line drug class for acute mania? |
|
Definition
| benzodiazepines; (lorazepam, diazepam) |
|
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Term
| What drug, used with acute mania, has a direct modd stabilizing effect that can be seen within 24-72 hours? |
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Definition
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|
Term
| What drug can help prevent recurrence of both mania and depression? |
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Definition
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|
Term
| What can occur if Lithium and Haldol are used at the same time? |
|
Definition
| irreversible brain damage |
|
|
Term
| What is the normal Lithium range? |
|
Definition
|
|
Term
| What are adverse effects of Lithium? What can it become when levels are toxic? |
|
Definition
tremor, HA, diarrhea, lethargy, slowed mental function;
when progressing to toxicity: seizure, coma, death |
|
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Term
| What are some nursing implications for Lithium administration? |
|
Definition
-take with meals to reduce NV
-drink 10-12 glasses of water daily
-elevate feet to reduce ankle edema
-maintain consistent sodium in diet, increase intake in the event of major increase in perspiration |
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|
Term
| What is the acronym for determining para? |
|
Definition
TPAL
Term, Premature, Abortion, Living |
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Term
| What are the methods used for kick counting if the mother feels fetal movement has decreased? |
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Definition
| Kick counting methods include the Cardiff method - 10 movements over 12 hour period, and the Sandoff method - 4 movements over a 1 hour period. |
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Term
| Describe the procedure of a nonstress test. |
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Definition
| The NST is done to assess for fetal heart accelerations. External monitoring is applied to the abd of the pregnant mother and, in many cases, she is given a remote event marker, which she will press in the event of fetal movement. The nurse is looking for accelerations of the fetal heart rate at the same time as fetal movement. If accelerations are seen this is a reassuring sign that there is adequate oxgenation, that the heart responds to stimuli, and that there is a healthy neuro pathway. The mother should be in a Semi-Fowlers or side lying position to prevent supine hypotension and the test may take 40 minutes or longer to accomodate fetal sleep patterns. The results are considered nonreassuring if there is no accelerations to movement within 40 minutes |
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Term
| Describe the procedure of a ctx stress test. |
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Definition
| The CST is simulating ctx looking for variable or late decels, which would indicate inadequate oxygen reserves of the fetus to handle the brief hypoxia of a ctx. This test should not be done in cases of preterm labor or woman at risk for preterm labor, preterm membrane rupture, history of extensive uterine surgery or classic incision cesarean birth, and also placenta previa. The pregnant woman is placed supine, probably in a side lying position, and external monitoring is applied. Two methods are used to stimulate ctx either by breast self-stimulation: the woman brushes her palm across one nipple for two minutes or until a ctx begins due to a release of oxytocin. The other method is a low dose IV infusion of oxytocin. Three ctx are needed within a ten minute span. The results are considered reassuring if there are no late decels or major variable decels and nonreassuring if those decels do occur following 50% or more of the ctx. |
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Term
| If there are late or variable decels with a ctx stress test what action should be taken? |
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Definition
| If a CST has a positive result, this means that immediate delivery is necessary by induction of labor or a C-section. The physician will analyze available options and make plans for the birth of an infant who may be compromised because of decreased placental functioning before or during labor. |
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Term
| How is gestational diabetes diagnosed in the pregnant mom? |
|
Definition
| Two tests may be used to diagnose the mother with GDM; glucose challenge test and oral glucose tolerence test. The glucose challenge test requires no fasting or pretest diet the woman ingests 50g of oral glucose solution and then has blood drawn one hour later. If the blood glucose is 140 or greater a 3 hour oral glucose tolerence test is recommended. The oral glucose tolerence test is the most used test for diagnosing GDM. The mother will be NPO and have a fasting blood glucose checked. She will then ingest 100g of oral glucose solution and have her blood glucose checked at 1,2,3 hours. The normal values are 95 for fasting, 180 at 1 hour, 155 at 2 hours, and 140 at 3 hours. |
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Term
| Describe the home care for mother newly diagnosed with pregnancy induced HTN. |
|
Definition
| PIH can be managed at home as long as both mother and fetus remain stable. The mother will need to have follow up visits every 3-4 days and needs to know how to recognize signs or worsening (visual distubances, HA) and she needs to monitor for decreasing fetal movements or onset of labor. Her activity will be restricted but not full bed rest (she should lie on her side for a least 1 1/2 hour per day to maximize blood flow to the fetus. The mother should keep track of the fetal "kick count" and report a significant decrease or absence within a four hour period. She will need to check her blood pressure 2-4 times daily in the same arm seated in the same position. She will need to weigh herself each morning on the same scale in clothing of the same weight. A urine dipstick should be done midstream of the first urine of the day to assess for proteins. |
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|
Term
| What initial assessments should be made upon admission of the pt to L&D with severe PHI? |
|
Definition
| Initial assessment upon admission should include the last time the patient ate, vital signs, fetal membrane status, fetal condition, assessment of cervix, and overall condition of the patient. These are needed to have a baseline in order to monitor for worsening or improving condition...knowing when the patient last had a meal is important in case a C-section is imminent. |
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|
Term
| What meds would be used for the pt in L&D with severe PIH? |
|
Definition
Methyldopa (Aldomet) is the drug of choice for treatment of PIH in pregnant women due to its effectiveness and record of safety. If that doesn’t work, then beta blockers and calcium channel blockers can be prescribed. ACE inhibitors are contraindicated in pregnant women. Hydralazine is reserved only for a hypertensive crisis and diuretics are avoided if possible b/c they may further shrink the blood volume. Any BP med is to be used with caution as it can reduce the placental blood flow to the fetus.
In the case of it progressing to preeclampsia, the nurse should expect to start an IV and administration of Magnesium sulfate is the go-to for decreasing the blood pressure. Her DTRS need to be monitored during this time. |
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|
Term
| What are the concerns of the fetus to a mother in the L&D with severe PIH? |
|
Definition
| risk of mortality, extent of maturity for gestational age, infection, late decels or decreased variability related to placental perfusion. |
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