AH2 FINAL

Study Guide

ASTERIXIS
Asterixis (flapping tremor, liver flap) is a hand-flapping tremor that is often seen frequently in hepatic encephalopathy. The tremor is induced by extending the arm and dorsiflexing the wrist causing rapid, non-rhythmic extension and flexion of the wrist while attempting to hold position

S/S ENDOMETRIOSIS
Inability to get pregnant Abodminal pain before menstrual cycle Painful intercourse Painful defacation

LAB VALUE CHANGES IN ELDERY

Increased protein in the urine slightly increased serum glucose levels.

S/S PHEOCHROMOCYTOMA
Headache Diaphoresis Palpitations
These are the typical triad of symptoms of tumors of the adrenal medulla (symptoms depend on the relative proportions of epinephrine and norepinephrine secretion)

PEG TUBE
Check placement Q4h
Tube placement and residual volume should be checked before each feeding . Tube placement is checked by aspiration of stomach contents and measurement of pH. It is important to check for residual volume because gastric emptying is often delayed during illness. There is an increased risk for aspiration of the feeding with increased residual volume.

DRAW PEAKS & TROUGHS..

For gentamicin sulfate (Garamycin)
5 minutes before and 30 minutes after the next dose.

A CLIENT WITH DIABETES MELLITUS IS E X P E R I E N C I N G P O LY P H AG I A .

What nursing diagnosis is the priority for this client?
Diabetes mellitus Type 1 is characterized by hyperglycemia that precipitates glucosuria and polyuria (frequent urination), polydipsia (excessive thirst), and polyphagia (excessive hunger). Polyphagia is a consequence of cellular malnourishment when insulin deficiency prevents utilization of glucose for energy, so the outcome statement should include stabilization of adequate cellular nutrition

L A B VA L U E D E C R E A S E W I T H H Y P E R A L D O S T E RO N I S M
Potassium
Clients with primary aldosteronism exhibit a profound decline in the serum levels of potassium (C) (hypokalemia)--hypertension is the most prominent and universal sign.

SIADH / DI
SIADH weight gain, tachycardia, bounding pulse, (retaining water so everything is diluted) DI weak pulses, hypertension, dry skin

SYMPTOMS WITH..
Meneires Disesase
Tinnitus, vertigo, and hearing difficulties. (CN VIII)

Bells Palsy
Facial weakness and paralysis (CN VII)

Trigeminal Neuralgia (tic douloureux)

Sudden, stabbing, severe pain over the lip and chin. (CN V)

hypoglossal cranial nerve (CN XII)

Difficulty in chewing, talking, and swallowing.

WHAT CLASS OF MEDS CAUSES BRADYCARDIA?

A) Beta blockers (-olol) B) Ace Inhibitors (-pril) C) Loop Diuretic
Inderal (A) is a beta adrenergic blocking agent, which causes decreased heart rate and decreased contractility.

S/S DIGITALIS TOXICITY

anorexia Nausea/vomiting Diarrhea headache fatigue

D Y S R H Y T H M I A S A R E A C O N C E R N F O R A N Y C L I E N T. HOWEVER, THE PRESENCE OF A DYSRHYTHMIA IS MORE SERIOUS IN AN ELDERLY PERSON BECAUSE

Cardiac output is decreased with aging (D). Because of loss of contractility and elasticity, blood flow is decreased and tachycardia is poorly tolerated. Therefore, if an elderly person experiences dysrhythmia (tachycardia or bradycardia), further compromising their cardiac output, they are more likely to experience syncope, falls, transient ischemic attacks, and possibly dementia

DURING LUNG ASSESSMENT, THE NURSE PLACES A STETHOSCOPE ON A CLIENT'S CHEST AND INSTRUCTS HIM/HER TO SAY "99" EACH TIME THE CHEST IS TOUCHED WITH THE STETHOSCOPE. WHAT SHOULD BE THE CORRECT INTERPRETATION IF THE NURSE HEARS THE SPOKEN WORDS "99" VERY CLEARLY THROUGH THE STETHOSCOPE?

May indicate pneumonia.

This test (whispered pectoriloquy) demonstrates hyperresonance and helps determine the clarity with which spoken words are heard upon auscultation. Normally, the spoken word is not well transmitted through lung tissue, and is heard as a muffled or unclear transmission of the spoken word. Increased clarity of a spoken word is indicative of some sort of consolidation process (e.g., tumor, pneumonia)

VASOPRESSIN IS USED TO PROMOTE VASOCONSTRICTION, THEREBY REDUCING BLEEDING. VASOCONSTRICTION OF THE CORONARY ARTERIES CAN LEAD TO ANGINA AND MYOCARDIAL INFARCTION, AND SHOULD BE COUNTERACTED BY

IV nitroglycerin per prescribed protocol (its a vasodilator)

D E C O R T I C AT E P O S T U R I N G I N D I C AT E S. .
Severe dysfunction of the cerebral cortex has occurred.
Decorticate posturing (adduction of arms at shoulders, flexion of arms on chest with wrists flexed and hands fisted and extension and adduction of extremities) is seen with severe dysfunction of the cerebral cortex

D E C E R E B R ATE P O S T U R I N G I S

rigid extension and pronation of arms and legs There is a probable dysfunction of the midbrain.

W H AT L A B VA L U E S I N D I C AT E P T I S T U M O R LY S I S S Y N D RO M E
Hyperkalemia Hypocalcemia (mainly) Hyperuricemia Hyperphosphatemia

W H AT I N T E RV E N T I O N I S I M P O RTA N T F O R M U LT I P L E M Y L E O M A ?

Multiple myeloma is a malignancy of plasma cells that infiltrate bone causing demineralization and hypercalcemia, so maintaining a urinary output of 1.5 to 2 L per day requires an intake of 3 to 4 L (C) to promote excretion of serum calcium.

THROMBOPHLEBITIS PAIN IS RELIEVED BY..

rest and elevation of the extremity

MEDS FOR HYPERLIPIDEMIA SHOULD BE E VA L UA T E D F O R W H A T V I T A M I N DEFICIENCY?

Clients should be monitored for an increased prothrombin time and prolonged bleeding times which would alert the nurse to a vitamin K deficiency (A). These drugs reduce absorption of the fat soluble (lipid) vitamins A, D, E, and K.

GLASGOW COMA SCALE

CUSHINGS TRIAD

R . V S L . S I D E D H E A RT FA I LU R E

S/S R. HEART FAILURE

Dependent Pedal Edema Distended Neck Veins Hepatomegaly (swelling of liver)

POLYCYTHEMIA
TOO many RBCs in the blood (hyperviscous) Blood is poorly oxygenated Polycythemia Vera:
Increased risk of DVT Heart has to work harder to pump blood b/c its thick Venous stasis

Tx: phlebotomy

Check Hematocrit levels

THROMBOCYTOPENIA
Low platelets

CRANIAL NERVES

DIGOXIN LEVELS
0.8 2.0 (confirm w/ book?)

SIADH
Often related to small cell lung cancer Increases ADH

AUTOSOMAL RECESSIVE DISORDER

two copies of an abnormal gene must be present in order for the disease or trait to develop.

DIGITALIS TOXICITY

FAT VS. NON -FAT SOLUBLE VITAMINS

Fat soluble
Vitamins A, D, E, and K

Non-Fat soluble
Vitamins B, C ??

RESPIRATORY SOUNDS

ARTERIAL INSUFFICIENCY
Review Slides

VENOUS STASIS
Review Slides

SUPER VENA CAVA SYNDROME

Superior vena cava syndrome occurs when the superior vena cava (SVC) is compressed by outside structures, such as a growing tumor that impedes the return blood flow to the heart. Superior vena cava syndrome is likely to occur with metastatic cancer

PLEURODESIS
Prevent the formation of effusion fluid

COMPARTMENT SYNDROME

FAT EMBOLISM SYNDROME

BATTLES SIGN

CREDE
Manual pressure over lower abdomen to promote bladder emptying

PSA VALUES
Below 4.0

A D E F I C I E N C Y O F I N T R I N S I C FAC T O R S H O U L D ALERT THE NURSE TO ASSESS A CLIENT'S H I S T O RY F O R W H I C H C O N D I T I O N ?

Pernicious anemia (A) is a type of anemia due to failure of absorption of cobalamin (Vit B12). The most common cause is lack of intrinsic factor, a glucoprotein produced by the parietal cells of the gastric lining.

DUMPING SYNDROME
occurs when the undigested contents of your stomach move too rapidly into your small bowel. Common symptoms include abdominal cramps, nausea and diarrhea.