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UTA NURS 3561 Final

UTA NURS 3561 Adults Final Exam

Question	Answer
HIV risk factors	Blood transfusion or clotting factors given prior to 1985; Sharing of drug-using equipment; Unprotected sex (including anal and oral); Previous STI
Early chronic HIV (T-cell count > 500) manifestations	fatigue, headache, low-grade fever, night sweats, persistent generalized lymphadenopathy (PGL)
Intermediate chronic HIV infection (T-cell count 200-500) manifestations	persistent fever, frequent drenching night sweats, chronic diarrhea, recurrent headaches, and fatigue severe enough to interrupt normal routines, localized infections, lymphadenopathy, and nervous system manifestations
AIDS criteria (vs. HIV)	one of the following: CD4 < 200; one opportunistic infections (e.g., candidiasis and PCP) or cancer (e.g., cervical cancer, KS, lymphoma); wasting syndrome (looses 10% or more of ideal body mass); AIDS dementia complex
normal CD4 T cell count	800-1200 cells/μL (>500 still considered “healthy” immune system, <200 criteria for AIDS)
Antiretroviral therapy (ART)	the use of a minimum of three antiretroviral drugs from different drug classes
HIV teaching	signs/symptoms to report (change in LOC, headache, vision changes, SOB, n/v, dehydration, jaundice, bleeding, flank pain, weakness of body part, chest pain, seizures, rash, oral lesions, depression); use of antiretroviral drugs; antibiotic-resistance
Fibroadenoma differentiating manifestations	occurs in young women (Ages 15-40); masses are small, round, well-delineated, and mobile; absense of nipple discharge and retraction
Breast cancer differentiating manifestations	occurs in older women (Age 50 or over); masses are hard, irregularly shaped, poorly delineated, and nonmobile; nipple discharge and retraction can occur
Mastectomy postoperative care considerations	assess for lymphedema, administer analgesics, refer to support groups, protect arm/hand/fingers from trauma, take BP in unaffected arm
Positioning of arm post mastectomy	elevated on a pillow not exceeding shoulder elevation
Lymphedema	complication of mastectomy; an accumulation of lymph in soft tissue with swelling resulting from inflammation, obstruction, or removal of lymph channels and nodes; can cause too much pressure on the veins leading to nerve damage, cellulitis, and fibrosis
BPH manifestations	urinary urgency, decreased force of urination, urinary hesitancy, urine dribbling, urinary retention, incontinence, nocturia, dysuria, feeling as if still has to go, bladder discomfort, and sexual dysfunction
BPH management	“watchful waiting”, dietary changes, avoid decongestants and anticholinergics, restrict evening fluid intake, voiding schedule; drug therapy (5α-reductase inhibitors and α-adrenergic receptor blockers); minimally invasive therapy (TURP)
BPH diet	decrease caffeine and artificial sweeteners, limit spicy or acidic foods
transurethral resection of the prostate (TURP)	a surgical procedure involving the removal of prostate tissue with the use of a resectoscope inserted through the urethra
TURP postoperative care	prevent complications (hemorrhage, bladder spasms, urinary incontinence, and infection); irrigate the bladder; administer analgesics; ensure adequate hydration
Hypothyroidism manifestations	decreased metabolism causing weight gain, puffy face (periorbital edema), coarse facial features, dry skin, and dry coarse hair and eyebrows
Hypothyroidism management	hormone replacement; low-fat, high-fiber diet; warm environment
Myxedema coma	complication of hypothyroidism; manifestations include hypothermia, hypotension, and hypoventilation
Myxedema coma management	Oxygen administered, followed by fluid replacement, keeping the client warm, monitoring vital signs, and administering IV thyroid hormones
Hyperthyroidism (Graves’ disease) manifestations	increased metabolism, goiter, exophthalmos, weight loss, increased nervousness, tremors, palpitations, angina, bound/rapid pulse, systolic murmurs
Thyrotoxic crisis (Thyroid storm)	complication of hyperthyroidism; tachycardia, HF, shock, hyperthermia, restlessness, agitation, seizures, abdominal pain, nausea, vomiting diarrhea, delirium, and coma
Thyrotoxic crisis management	Oxygen administered, followed by fluid replacement, administering antipyretics, and treating the stressor
Thyroidectomy postoperative management	assess for hemorrhage or tracheal compression; assess for tetany secondary to hypoparathyroidism (hypocalcimia), for Trousseau’s sign or Chvostek’s sign; place in semi-Fowler’s, support head with pillows, and avoid neck flexion and tension on suture lines
Hypoparathyroidism manifestations	hypocalcemia causing tetany (Chvostek’s and Trousseau’s signs)
Trousseau's sign	a carpal spasm induced by inflating a blood pressure cuff above the systolic pressure for a few minutes.
Chvostek's sign	contraction of facial muscles in response to a light tap over the facial nerve in front of the ear
Hypoparathyroidism management	Emergency: IV calcium (calcium gluconate or calcium chloride) with ECG monitoring; rebreathing; Long-term: calcium & vitamin D (e.g., calcitriol, calciferol) supplements
Hyperparathyroidism manifestations	hypercalcemia which is either asymptomatic or causes muscle weakness, loss of appetite, constipation, fatigue, emotional disorders, shortened attention span, loss of calcium from bones (osteoporosis), fractures, and kidney stones (nephrolithiasis)
Hyperparathyroidism management	parathyroidectomy; encourage ambulation to prevent renal calculi
Parathyroidectomy postoperative management	assess for hemorrhage and fluid electrolyte disturbance, especially Tetany d/t hypocalcemia, Chvostek’s and Trousseau’s signs
Laryngeal stridor	parathyroidectomy post-op sign of hemorrhage, an acute emergency; a harsh, high-pitched sound heard on inspiration and expiration caused by compression of the trachea, leading to respiratory distress.
Glucocorticoid (cortisol) action	regulate metabolism, increase blood glucose levels, and are critical in the physiologic stress response
Mineralocorticoid (aldosterone) action	regulate sodium and potassium balance
Cushing syndrome	a metabolic disorder resulting from the chronic and excessive production of cortisol by the adrenal cortex or by the administration of glucocorticoids in large doses for several weeks or longer
Cushing syndrome manifestations	centripetal (truncal) obesity or generalized obesity; “moon facies” (fullness of the face) with facial plethora; purplish red striae on the abdomen, breast, or buttocks; hirsutism and menstrual disorders in women; HTN; and unexplained hypokalemia.
Cushing syndrome management	treat underlying cause—transsphenoidal resection and radiation therapy (pituitary adenoma) OR adrenalectomy and ketoconazole (Nizoral) and aminoglutethimide (Cytadren) (adrenocorical adenoma, carcinoma, or hyperplasia)
Cushing syndrome postoperative risks	increased risk for hemorrhage (rapid or significant changes in BP, respirations, or HR), increased susceptibility to infection, delayed wound healing
Cushing syndrome diet	low-carb, low-sodium, high-protein, high-potassium
Addison’s disease	a metabolic disorder resulting from the reduced excretion of all three adrenal corticosteroids
Addison’s disease manifestations	very slow (insidious) onset; progressive weakness, fatigue, weight loss, anorexia, hyperpigmentation, orthostatic hypotension, hyponatremia, salt craving, hyperkalemia, nausea and vomiting, diarrhea, irritability and depression.
addisonian crisis	life-threatening emergency caused by insufficient adrenocortical hormones or a sudden sharp decrease in these hormones
Addison’s disease management	replacement therapy—Daily glucocorticoid replacement; Daily mineralocorticoid; Salt additives for excess heat or humidity; Increased doses of cortisol for stress situations (e.g., surgery, hospitalization)
UTI manifestations	hesitancy, intermittency, postvoid dribbling, urinary retention or incomplete emptying, dysuria, pain on urination, urinary frequency, urgency, incontinence, nocturia, and nocturnal enuresis
UTI risk factors	urinary stasis; foreign bodies; anatomic factors (fistula, obesity); immune factors (aging, HIV, DM); functional disorders (constipation, voiding dysfunction); women (pregnancy, multiple sex partners, spermicidals, short urethra); poor hygiene
Upper UTI differentiating manifestations	fever, chills, and flank pain
Lower UTI differentiating manifestations	no systemic manifestations (fever, chills, etc.)
UTI management	antibiotic therapy, usually Trimethoprim/sulfamethoxazole (TMP/SMX) (Bactrim, Septra) or nitrofurantoin (Macrodantin), adequate fluid intake
Nitrofurantoin (Furadantin, Macrodantin) drug classification/alert	Urinary tract antiinfective; Avoid sunlight; use sunscreen, wear protective clothing; Notify health care provider if fever, chills, cough, chest pain, dyspnea, rash, or numbness or tingling of fingers or toes develops.
urinary tract calculi risk factors	increased urine calcium, oxaluric, uric, or citric acid levels; warm climates; large intake of proteins, tea/fruit juice, calcium and oxalate, and low fluid intake; family hx, cystinuria, gout, or renal acidosis; sedentary occupation, immobility
Reason urine is strained to collect renal stones	important in diagnosing underlying problem
Mild anemia clinical manifestations	palpitations, exertional dyspnea, and possibly mild fatigue
Moderate anemia clinical manifestations	bounding pulse, dyspnea, roaring in ears, and fatigue
Severe anemia clinical manifestations	dyspnea at rest, pallor, jaundice, pruritus, tachycardia, systolic murmurs/bruits, angina, MI, HF, cardiomegaly, pulmonary and systemic congestion, ascites, and peripheral edema
anemia acute management	blood or blood product transfusions, drug therapy (e.g., erythropoietin, vitamin supplements), volume replacement, and oxygen therapy to stabilize the patient.
CKD effect on hematologic system	anemia due to decreased production of the hormone erythropoietin by the kidneys; may require oral iron supplements
Hgb normal levels	Male: 13.2-17.3 g/dL Female: 11.7-15.5 g/dL (Severe anemia: <6, moderate anemia 6-10)
Hct normal levels	Male: 39%-50% Female: 35%-47%
RBC normal levels	Male: 4,300,000-5,700,000/μL Female: 3,800,000-5,100,000/μL
Iron-deficiency differentiating manifestations	pallor, glossitis, cheilitis, headache, paresthesias, burning sensation on tongue
Iron-deficiency anemia management	indentify underlying cause, iron supplements, nutritional and diet therapy, and RBC transfusion if symptomic
Sickle cell disease (SCD) manifestations	chronic health problems and pain; pallor (grayish cast); jaundice; prone to gallstones (cholelithiasis)
Sickle cell disease (SCD) management	alleviating the symptoms from the complications of the disease, minimizing end-organ damage, and promptly treating serious sequelae
Clostridium difficile (C. difficile) manifestations	moderate to severe watery diarrhea, fever, anorexia, nausea, abdominal pain/cramping; can progress to fulminant colitis, intestinal perforation, paralytic ileus or toxic megacolon.
C. difficile management	Flagyl, Vancomycin
C. difficile precautions	contact precautions (gloves and gowns); disinfect with bleach
pancreatitis causes	Biliary tract disease, Alchoholism, Trauma (post surgical & abdominal), Viral infections (mumps & coxsackievirus B), Penetrating duodenal ulcer, Cysts, abscesses, Cystic fibrosis, Kaposi’s sarcoma, Certain drugs
pancreatitis clinical manifestations	Epigastric pain, N/V, Abdominal tenderness, Low-grade fever, Leukocytosis, Hypotension, Tachycardia, Jaundice, ↓ or absent BS, Hypovolemia, Grey Turner’s spots & Cullen's sign
Cullen’s sign	bluish periumbilical discoloration caused by seepage of blood-stained exudate from the pancreas
Grey Turner’s spots	bluish flank discoloration caused by seepage of blood-stained exudate from the pancreas
Pancreatitis complications	pseudocyst, abscess, pleural effusion, Atelectasis, pneumonia, hypotension, hypocalcemia
pancreatic pseudocyst	complication of pancreatitis; a cavity continuous with or surrounding the outside of the pancreas
pancreatic pseudocyst manifestations	abdominal pain, palpable epigastric mass, n/v, anorexia, elevated serum amylase
pancreatic pseudocyst treatment	Internal drainage procedure with an anastomosis between pancreatic duct and the jejunum
pancreatic abscess	complication of pancreatitis; a large fluid-containing cavity within the pancreas
pancreatic abscess manifestations	upper abdominal pain, abdominal mass, high fever, leukocytosis
pancreatic abscess treatment	Prompt surgical drainage to prevent sepsis
Most effective means of relieving pain associated with acute pancreatitis	NPO status
HF manifestations	fatigue (earliest symptom), dyspnea (orthopnea and paroxysmal nocturnal dyspnea), tachycardia, edema, nocturia, skin changes, behavioral changes, chest pain, weight changes
HF exacerbation manifestations	development of dependent edema or a sudden weight gain of more than 3 lb (1.4 kg) in 2 days, behavioral changes
Sodium nitroprusside (Nipride) drug use/complications	IV vasodilator that reduces preload and afterload, improving myocardial contraction, increasing CO, and reducing pulmonary congestion; complications include hypotension and thiocyanate toxicity—monitor BP frequently (5-10 minutes)
Dopamine drug alert	Monitor IV site for signs of extravasation; Tissue necrosis with sloughing can occur with extravasation of the drug; High dosages may produce ventricular dysrhythmias.
Best indicator of fluid status	weight
HF teaching	when to call doctor (weight gain), cluster activity to decrease fatigue, elevate bed to decrease SOB
Tranquilizer effect on surgery/healing	potentiate effect of opioids and barbiturates (anesthetics)
Antihypertensive effect on surgery/healing	predispose to shock when combined with anesthetics
Insulin/hypoglycemic agents effect on surgery/healing	dose may need to be changed d/t increased metabolism, decreased caloric intake, stress, and anesthesia
Aspirin, Plavix, & NSAID effect on surgery/healing	inhibit platelet aggregation, contributing to bleeding problems
Corticosteroid effect on surgery/healing	delayed wound healing
Preop assessment goals	determine physholgoic status, establish baseline, identify site/side, identify medications that may result in interactions, review labs and diagnostic tests, identify cultural and ethnic factors affect surgery, witness consent
Preop labs	ABGs & pulse ox; glucose; BUN/creatinine (renal function); CBC (anemia, immune status, infection); electrolytes; hCG (pregnancy); LFTs; PT, PTT, INR, platelet count (coagulation status); albumin (nutritional status); urinalysis (renal status)
Intraop assessment goals	establish baseline; allergies; skin integrity; skeletal muscle impairments; perceptual difficulties; LOC; NPO status; pain/discomfort
Postop assessment goals	monitoring/managing respiratory and circulatory function, pain, temperature, and the surgical site
HAV transmission	Fecal-oral (primarily fecal contamination and oral ingestion)
HBV transmission	Percutaneous (parenteral)/permucosal exposure to blood or blood products; sexual contact; preinatal transmission
HCV transmission	Percutaneous (parenteral)/mucosal exposure to blood or blood products; High-risk sexual contact; Perinatal contact
HDV transmission	same as HBV: Percutaneous (parenteral)/permucosal exposure to blood or blood products; sexual contact; preinatal transmission
HEV transmission	Fecal-oral
Jaundice	symptom of yellowish discoloration of body tissues that results from an increased concentration of bilirubin in the blood
Asites effect on patient	pushes up diaphragm and affects breathing
Normal Potassium	3.5-5.0 mEq/L
Elevated Potassium etiology	Addison's disease, diabetic ketosis, massive tissue destruction (e.g., burn patients), renal failure
Decreased Potassium etiology	hyperaldosteronism, Cushing syndrome, diarrhea (severe), diuretic therapy, gastrointestinal fistula (colitis), pyloric obstruction, starvation, vomiting
Effect of thiazide and loop diuretics on potassium	risk for hypokalemia; supplements may need to be given with them
Hyperkalemia manifestations	irritability, anxiety, abdominal cramping, diarrhea, weekness of lower extremities, parathesias, irregular pulse, cardiac arrest if sudden or severe
Hypokalemia manifestations	fatigue, muscle weakness, leg cramps, n/v, paralytic ileus, soft, flaby muscles, paresthesias, decreased reflexes, weak, irregular pulse, polyuria, hyperglycemia
Organ affected by Potassium	Heart
Normal Calcium	8.6-10.2 mg/dL
Elevated Calcium etiology	Acute osteoporosis, hyperparathyroidism, vitamin D intoxication, multiple myeloma
Decreased Calcium etiology	tumor lysis syndrome (TLS), Acute pancreatitis, hypoparathyroidism, liver disease, malabsorption syndrome, renal failure, vitamin D deficiency
Hypercalcemia manifestations	apathy, depression, fatigue, muscle weakness, ECG changes, polyuria and nocturia, anorexia, nausea, and vomiting.
Hypocalcemia manifestations	tetany, Chvostek’s sign, Trousseau’s sign, fatigue, diarrhea
Normal sodium	135-145 mEq/L
Hypernatremia manifestations	extreme thirst, decreased urinary output, increased specific gravity
Hypernatremia etiology	Dehydration, impaired renal function, primary aldosteronism, corticosteroid therapy
Hyponatremia sodium etiology	Addison's disease, diabetic ketoacidosis, diuretic therapy, excessive loss from GI tract, excessive perspiration, water intoxication
Hyponatremia manifestations	hyperactive bowel sounds, increased urinary output, decreased specific gravity
Normal phosphorus	2.4-4.4 mg/dL
hyperphosphatemia etiology	Healing fractures, hypoparathyroidism, renal disease, vitamin D intoxication, tumor lysis syndrome
hypophosphatemia etiology	malnutrition/starvation (alcoholism), antacid use, Diabetes mellitus, hyperparathyroidism, vitamin D deficiency
fluid volume deficit etiology	vomiting, diarrhea, conditions that cause increased respirations or increased urinary output, insufficient IV fluid replacement, draining fistulas, and the presence of an ileostomy or colostomy
fluid volume deficit manifestations	increased RR and HR, decreased CVP, weight loss, poor skin turgor, dry mucous membranes, decreased urine volume, increased specific gravity of the urine, increased Hct, and altered LOC
fluid volume deficit management	LR; Isotonic (0.9%) sodium chloride (when rapid volume replacement is indicated); Blood (when volume loss is due to blood loss)
isotonic solutions	D5, NS, D5 1/2NS, LR
hypotonic solutions	1/2NS
hypertonic solutions	D5NS, D5 1/2NS
Lispro (Humalog) classification	rapid-acting insulin
Aspart (Novolog) classification	rapid-acting insulin
Glulisine (Apidra) classification	rapid-acting insulin
Regular (Humulin R, Novolin R, ReliOn R) classification	short-acting insulin
NPH (Humulin N, Novolin N, ReliOn N) classification	intermediate-acting insulin
Glargine (Lantus) classification	long-acting insulin
Detemir (Levemir) classification	long-acting insulin
Rapid-acting insulin Onset/Peak/Duration	Onset: 15 min; Peak: 60-90 min; Duration: 3-4 hrs
Short-acting insulin Onset/Peak/Duration	Onset: 30-60 min; Peak: 2-3 hrs; Duration: 3-6 hrs
Intermediate-acting insulin Onset/Peak/Duration	Onset: 2-4 hrs; Peak: 4-10 hrs; Duration: 10-16 hrs
Long-acting insulin Onset/Peak/Duration	Onset: 1-2 hrs; Peak: none; Duration: 24+ hrs
Impact of exercise on blood sugar	potentiates effect of insulin, putting patient at risk for hypoglycemia up to 48 hrs after; don’t exercise at time of peak drug action, do exercise 1hr after meals or after carb snack and glucose monitoring, carb snacks every 30 minutes during exercise
Insulin pump teaching	monitor blood sugar three or more times a day; watch for complication (infection at insertion site, DKA)
Hypoglycemia manifestations	ANS symptoms including shakiness, irritability, nervousness
Hypoglycemia management	food or glucose (D50)
DKA manifestations	decreased pH, decreased HCO3, elevated glucose, ketones in blood and urine, polyuria, Kussmaul’s respiration’s; can lead to coma
DKA management	Emergent: IV NaCl and regular insulin; Once down to 250-300: reduce fluid rate and change to D5 1/2NS
Electrolyte impacted by DKA	potassium (hypokalemia)
Ineffective Breathing pattern characteristics	Alterations in depth of breathing; three-point position; bradypnea; decreased vital capacity; dyspnea; increased anterior-posterior diameter; nasal flaring; orthopnea; prolonged expiration phase; pursed-lip breathing; tachypnea; use of accessory muscles
Impaired Gas exchange characteristics	Abnormal ABGs, pH; abnormal breathing (rate, rhythm, depth); abnormal skin color (pale, dusky); confusion; cyanosis; decreased CO2; diaphoresis; dyspnea; headache upon awakening; rritability; nasal flaring; restlessness, tachycardia; visual disturbance
Asthma manifestations	wheezing, cough, dyspnea, and chest tightness after exposure to a precipitating factor or trigger
Frequent use of rescue inhalers	Not well controlled: Mild severity (> 2 days/wk); moderate severity (daily), severe (several times per day)
Use of Peak Flow Meter	move indicator to bottom, stand up, take deep breath, place mouthpiece in mouth and close lips around it, and blow as hard and fast as possible; write down number and repeat 2 more times (use best of 3)
β2-Adrenergic Agonists (SABA, LABA) drug classification/alert	Bronchodilators used for rescue (SABA) or long-term control of moderate to severe persistent asthma (LABA); cause increased BP/HR, CNS stimulation/excitation, and increase risk of dysrhythmias; Overuse may cause rebound bronchospasms (short acting).
Theophylline drug classification/alert	bronchodilator used for alternative therapy for step 2 care in mild persistent asthma; Instruct patient to report signs of toxicity: nausea, vomiting, seizures, insomnia; Avoid caffeine to prevent intensifying adverse effects.
Side effects of inhaled corticosteroids	Oropharyngeal candidiasis (Thrush), hoarseness, and dry cough—use spacer and gargle with water or mouthwash after each use; glucose intolerance and diabetes—may need to take insulin
Chronic bronchitis manifestations	“blue bloater”, form of COPD characterized by excessive production of mucus and chronic inflammatory changes in the bronchi
COPD management	smoking cessation, drug therapy (stepwise fashion: bronchodilator, anticholinergic, ICS), O2 therapy, possible surgical therapy, breathing retraining (pursed-lip and diaphragmatic)
Peripheral Artery Disease (PAD) manifestations	intermittent claudication, sexual dysfunction, parathesia; thin, shiny, and taut skin; hair loss on lower legs; diminished/absent pulse; pallor on elevation; redness in dependent position; rest pain
intermittent claudication	manifestation of PAD; ischemic muscle ache or pain that is precipitated by a consistent level of exercise, resolves within 10 minutes or less with rest, and is reproducible
PAD management	cardiovascular disease risk factor modification, treatment of claudication,nutritional therapy, proper foot care; worst case: amputation
Phlebitis	inflammation (e.g., redness, tenderness, warmth, mild edema) of a superficial vein without the presence of a thrombus (clot)
Venous thromboembolism (VTE) risks	Virchow’s triad: venous stasis, damage to inner lining of vein, and hypercoagulability of the blood
VTE manifestations	may have unilateral leg edema, extremity pain, a sense of fullness in the thigh or calf, paresthesias, warm skin, erythema, and/or a systemic temperature greater than 100.4° F, positive Homans’ sign; legs, arms, neck, back, or face edematous and cyanotic.
VTE management	ambulation, graduated compression stockings, SCDs, anticoagulants
HTN manifestation	asymptomatic until severe; fatigue, reduced activity tolerance, dizziness, palpitations, angina, and dyspnea
DASH eating plan	fruits, vegetables, fat-free or low-fat milk and milk products, whole grains, fish, poultry, beans, seeds, and nuts. Compared with the typical American diet, the plan contains less red meat, salt, sweets, added sugars, and sugar-containing beverages
Thiazide and loop diuretic adverse effects	hypokalemia; supplement with potassium-rich foods
Potassium-sparing diuretics and aldosterone receptor blockers adverse effects	hyperkalemia; avoid potassium
Doxazosin (Cardura) classification/alert	α1-Adrenergic Blocker used to treat HTN; Use caution for initial dose; Syncope occasionally occurs 30 to 90 minutes following initial dose, a too-rapid increase in dose, or addition of another antihypertensive agent to therapy.
HTN medication common side effects	orthostatic hypotension, sexual problems
HTN management	follow-up to check BP/adherence to medications
Orthostatic hypotension management	rise slowly, don’t stand still for prolonged periods, do leg exercises (increases venous return), sleep with head of bed raised or on pillows, lie/sit when dizziness occurs
Myelosuppression complications	anemia, leukopenia, thrombocytopenia (can cause infection, hemorrhage, overwhelming fatigue)
Myelosuppression lab monitoring	Hgb/Hct for anemia, CBC (particularly the neutrophil) for leukopenia, platelet counts for thrombocytopenia
Foods that promote RBC growth	red meats (especially liver), fish, poultry, eggs, enriched and whole grains, enriched bread/cereals, green leafy vegetables, legumes, dried fruits, citrus fruits, strawberries, cantaloupe, nuts, potatoes, wheat germ, cornmeal, bananas, milk products
Myelosuppression management	infection prevention (including monitoring temperature); WBC growth factor administration
Care of cast	keep dry; no weight bearing for 48 hrs; ice for 24 hrs; elevate above heart for 48 hrs; regular movement of joints above/below cast
Signs of cast complications	Increasing pain; Swelling associated with pain and discoloration of toes or fingers; Pain during movement; Burning or tingling under cast; Sores or foul odor under the cast
Casting complications	skin irritation/breakdown, neurovascular damage, cast syndrome (body cast too tight)
Cast assessment	circulation, sensation and movement
Compartment syndrome manifestations	6 Ps: (1) paresthesia; (2) pain distal to injury not relieved by opioid analgesics and pain on passive stretch of muscle traveling through the compartment; (3) pressure increases; (4) pallor; (5) paralysis; and (6) pulselessness
Compartment syndrome management	don’t elevate above heart; don’t apply cold compresses; remove/loosen bandage or split the cast; reduce traction weight; surgical decompression; apputation
Open fracture risk	infection
Warfarin (Coumadin) lab monitoring	INR – Therapapeutic value 2-3 (normal 0.75-1.25)
Heparin lab monitoring	aPTT – therapeutic value 46-70 sec (normal 25-35)
Signs of bleeding r/t anticoagulant therapy	hypotension, tachycardia, hematuria (bloody urine), melena (black or bloody stools), hematemesis (coffee-ground or bloody vomit), petechiae, ecchymosis, nosebleeds
Amputation complications	hemorrhage, infection, flexion contractures
Fat embolism manifestations	appear within 24-48 hrs of traumatic skeletal injury, include chest pain, tachypnea, cyanosis, dyspnea, apprehension, tachycardia, and decreased partial pressure of arterial oxygen (PaO2), changes in mental status, petechiae (distinguishing factor)
Fat embolism management	prevention: immobilization of long bone fracture; treatment: fluid resuscitation to prevent hypovolemic shock, correction of acidosis, replacement of blood loss, cough and deep breath, O2 admin
Parkinson’s complications	aspiration and malnutrition risk d/t dysphagia, fall risk d/t orthostatic hypotension and shuffling gait, risk for pneumonia, UTI, skin breakdown d/t debilitation, sleep disorders
Seizure complications	status epilepticus (continuous seizure activity); injury/death from trauma suffered during a seizure
Seizure management	antiseizure drug therapy, airway management (side-lying, nasotracheal suctioning), seizure safety (loosen clothing, remove harmful objects, padded side rails)
Antiseizure medication considerations	titrate up; monitor serum levels; abrupt withdrawal may precipitate seizures
Lymphadenopathy	Lymph nodes are enlarged (>1 cm); may be tender to touch
addisonian crisis triggers	(1) stress (e.g., from infection, surgery, trauma, hemorrhage, or psychologic distress); (2) the sudden withdrawal of corticosteroid hormone replacement therapy; (3) after adrenal surgery; or (4) following sudden pituitary gland destruction.
emphysema	"pink puffer", a form of COPD characterized by overinflation and destructive changes in alveolar walls
Nutrition Labs/Monitoring	Albumin, protein, and daily weights
Normal Albumin	3.5-5.0 g/dL
Elevated Albumin etiology	Dehydration
Decreased Albumin etiology	Chronic liver disease, malabsorption, malnutrition, nephrotic syndrome
Normal Proteins	6.4-8.3 g/dL
Elevated Protein etiology	Burns, cirrhosis (globulin fraction), dehydration
Decreased Protein etiology	Liver disease, malabsorption

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