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akhambay
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What causes appendicitis?
obstruction in the lumen
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Why is it important to not give pain medications to someone who c/o abd pain that may be r/t appendicitis?
administering pain meds will mask sxms, increased abd pain is sxm of appendicitis
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Why should we treat appendicitis quickly?
risk for peritonitis
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Who gives report to PACU nurse after surgery?
circulating nurse
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Who suprvises, confirms, and records final sponge and instrument count after surgery?
circulating nurse
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Why should pts ambulate post-op?
prevent complications such as DVT
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Define paralytic ileus
absence of bowel sounds
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How do you correctly use a spirometer?
inhale slowly, deeply, and hold
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Describe a wound healing by primary intention.
incision made by surgeon and it is well approximated
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Describe a wound healing by secondary intention.
not well approximated; needs more tissue replacement, often contaminated, and takes longer time to heal
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Describe a wound healing by tertiary intention.
intentionally left open to promote healing, prevent infection; a delayed primary intention
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Dry mucous membranes, increased RR, flattened neck veins, increased HR and decreased BP are signs that a pt has too much of which electrolyte?
Na+; s/s of hypernatremia
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Peripheral edema and neck vein distention are signs that a patient is deficient in which electrolyte?
Na+; s/s hyponatremia
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Normal sodium level is _____.
135-145
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Normal potassium level is _____.
3.5-5.0
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What sxms do you expect to see with hypokalemia?
muscle wekness; weak/thready pulse, shallow respirations, leg cramps
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What sxms do you expect to see with hyperkalemia?
irregular/slow HR; peaked T waves, muscle cramps
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Too much _____ will cause muscle cramps and irregular/slow HR.
potassium
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What can you give to lower potassium level in a pt with hyperkalemia?
kayexalate; calcium gluconate; IV insulin
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Normal phosphate level is _____.
2.5-4.5
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Normal calcium level is _____.
4.5-5.5
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Normal magnesium level is _____.
1.5-2.5
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Which electrolyte excess manifest flabby muscles?
calcium
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Which electrolyte deficit manifests Chovstek's or Trousseau's?
calcium
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Normal PCO2 is ____.
35-45
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Normal PO2 is ____.
80-100
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Normal HCO3 is ____.
22-26
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If a pt has metabolic acidosis, how will his breathing pattern be to compensate for excess acids?
Kussmaul (deep rapid breathing)
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CNS depression is a symptom exhibited in pts who have what kind of ABB imbalance?
metabolic acidosis
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If a pt is vomiting, had gastric suction, has peptic ulcers, and blood pH >7.35, which ABB imbalance pt exhbiting?
Metabloic Alkalosis; vomiting=losing H+ ions!
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Which oxygen delivery method deilvers 20-40% O2 concentration?
Nasal Cannula
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Which O2 delivery method delivers 40-60% O2 concentration?
Simple Face mask
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Which O2 delivery method delivers most precise O2 concentration?
Venturi Mask
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Which O2 delivery method has a one way valve?
Nonrebreather mask; prevents room air from entering mask
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Which O2 delivery method requires nurse to frequently empty condensation from tubing?
Aerosal Mask/Face Tent/Tracheostomy
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Where is air warmed, filtered, and humidified?
nose
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What are the functional units of the lung?
alveoli
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Which bronichi is aspiration more likely to occur and why?
Right d/t shorter, straighter, and wider structure.
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What is the name of a lung disease that involves damage to alveoli so that they can't completely deflate and fill with fresh air?
Emphysema
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What is a classic sxm of pt with emphysema?
Pink puffer
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What is classic sxm of pt with chronic bronchitis?
"blue bloater"; barrel chest
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How can you be sure that someone has pulmonary edema?
pink, frothy sputum
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What is RSV?
Respiratory syncytial virus; pt wheezes, has deeper cough, and labored breathing.
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What is a COPD pt's drive to breathe?
increased CO2
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What can happen if we give too much oxygen given to a pt with COPD?
compromise drive to breathe; COPD drive to breathe = increased CO2
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Coryza, Malaise, Fever, Cough characterizes (FLU/PNEUMONIA/COLD).
flu
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Thyrotoxicosis is a sign of _____.
hyperthyroidism
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Myxedema is a sign of _____.
hypothyroidism
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Grave's disease is associated with _____.
hyperthyroidism; excessive output of thyroid hormones caused by abnormal stimulation of thyroid gland by circulating immunoglobulins
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Constantly flushed skin, cannot sit still, palpitations, rapid pulse at rst, prespire freely are signs of which thyroid condition?
hyperthyroidism
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Brittle nails, extreme fatigue, hair loss, numbness/tingling of fingers are signs of which thyroid disorder?
hypothyroidism
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Fine tremor of hands, increased appetite, progressive weight loss are signs of what thyroid disorder?
hyperthyroidism
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How do you restore consciousness if myxedema progresses to myxedema coma?
synthroid IV
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What kind of diet is a pt with hyperthyroidism on?
high calorie-high protein
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Chronic thyroiditis is also known as _____
Hashimoto's disease
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After a thyroidectomy, what is always kept at the bedside?
tracheostomy set; edema of glottis my occur leading to resp. difficulty
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What should pt with a thyroidectomy order avoid consuming?
coffee; stimulants like caffeine
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Hypoparathyroidism exhibits what sxms?
tetany, Trousseau's, Chvostek's; rationale: PTH controls release of Ca+, therefore a deficiency of PTH means also deficiency of Ca+
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What BMI range is considered overweight?
25-29.9
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Where is glucose stored in pts with TYpe 1 DM?
stays in blood stream, cannot be stored in liver d/t lack of insulin
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Are ketones more prevelant in Type 1 DM or Type 2 DM?
Type 1; rationale: no insulin to inhibit breakdown of fat. Ketones are byproducts of fat breakdown.
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Which pt are you more likely to see obesity/weight gain? Type 1 or Type 2 DM?
Type 2 DM
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What 3 factors are dx DM?
FPG >=126; casual plasma glucose >200; OGTT: >=200
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What percentage of carbs consumed are converted to glucose?
100%
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A patient with DM should not exercise if what two factors are present?
ketones in urine; BS >250
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pts with IDDM are advised to do what before exercising?
Check BS, eat 15 g carb snack to prevent hypoglycemia
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Onset, Peak, Duration of Rapid Acting Insulin
Onset = 5-15 minutes; Peak=30 min-1 hour; Duration=2-4 hours
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What is the onset of rapid acting insulin?
5-15 minutes
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What action does sulfonylureas & meglitinides have on DM Type II pts?
increases secretion of insulin by beta cells
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What action do biguanides have on DM pts?
increases body tissues' sensitivity to insulin, inhibits glucose prod by liver
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Upon observation of an intermediate insulin vial, how do you know when it should not be used?
if it has a frothy, white coating then it should not be used
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What drug is used to prevent DM or slow destruction of beta cells?
azathioprine
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How do you treat a pt experiencing Somogyi phenomenon?
Decrease insulin level, give bedtime snack
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How do you treat dawn phenomenon?
change evening dose of insulin; give it later so it will peak later
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What happens in the final stage of diabetic retinopathy?
blood vessels velop on surface of eye in vitrious, retinal detachment may occur
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What is Cullen's sign?
periumbilical bruising
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What is Grey Turner's sign?
bruising of the flanks
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How is acute pancreatitis dx?
serum amylase >500; elevated urinary amylase; elevated serum lipase level; WBC, serum glucose, BUN, and LDH elevated; bulky pale foul smelling stool
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Why are pts with acute pancreatitis at risk for skin breakdown?
poor nutrition
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What do alpha cells secrete?
glucagon
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What do beta cells secrete?
insulin
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What are the 4 stages of carcinogenesis?
1. Initiation 2. Promotion 3. Progression 4. Metastasis
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What stage of CA do carcinogens damage the cell's DNA and genes?
Initiation
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All CA cells are a threat. (True/False)
False. Only CA cells that can divide are a threat.
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In what stage do carcinogenesis mutate a cell's genes?
Initiation
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In what stage of oncogenesis is the growth of the CA cell enhanced?
Promotion
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In what stage of carcinogenesis does a tumor produce TAF?
Progression
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What is TAF?
tumor angiogenesis factor; blood vessels branch into tumor to give it nutrition
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In what stage of CA development does CA cells spread to other parts of body?
Metastasis
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What are secondary tumors?
aka metastatic tumors; break off from primary cell and end up in another area of body (i.e. lung cell found in uterus)
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What is grading?
compares CA cell with parent tissue; how close does it resemble the parent cell?
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What is staging?
determines exact location of CA and its degree of metastasis at dx.
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What is carcinoma in situ?
early stage CA cells that has not spread to neighboring tissues
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What does a TIS, N0, M0 staging of CA mean?
TIS=carcinoma in situ (has not spread to neighboring tissue); N0=did not spread to lymph nodes; M0=no metastasis
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What does a T4, N3, M1 staging of CA mean?
larger size, involes lymph nodes, has spread
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What is the exposure of radiation?
amount of radiation delivered to a tissue
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What is the dose of radiation?
amount of radiation absorbed by tissue
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What 3 factors determine absorbed dose of radiation?
intensity, duration, and closeness of exposure
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What is xerostomia?
dry mouth
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Which CA therapy is systemic?
chemotherapy
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Which CA therapy is localized?
radiation, surgery
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What is thrombocytopenia?
low platelet count ----> @ risk for bleeding
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What is NPPV mask?
noninvasive positive pressure ventilation
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