Hondros Nursing 212 Final Exam Study

Guide Graded A 2024

Hypocalcemia - Deficits of Calcium cause Increased Neuromuscular Excitability.
S/S:
Trousseau's
Chvostek Sign
Diarrhea
Circumoral Tingling
Hyperactive Reflex
Muscle twitching
Dysrhythmias
ECG abnormalities
Decreased HF
Decreased BP
Anxiety, Irritability

HyperCalcemia - Moans, Groans & Stones

Constipation
Bone Pain
Stones - Renal Calculi
Decreased DTR
Severe Muscle weakness
Cardiac Arrest: Increased HR then Decreased
ECG Abnormalities: Heart Block, Short ST segments
N/V
Anorexia

Hypernatremia - Big & Bloated

Flush: Red & Rosy skin
Edema
Low grade fever
Polydipsia
Swollen dry tongue (red & beefy)
N/V
Increased muscle tone (Active muscle contraction)
Hyponatremia - Depressed & Deflated
Flat neck veins
Weak, thready pulse
Increase HR
Hyperactive Bowel sounds
Diarrhea
Headache
Seizure
confusion
Coma
Increased Urinary Output
**Can cause increased ICP

Hyperkalemia - Tight & Contracted

MURDER -
M - muscle weakness,
U - urine output(oliguria/anuria),
R - respiratory depression, (d/t Muscle weakness)
D - decreased cardiac contractility (weak pulse/low BP)
E - Early muscle cramps, Late profound weakness
R - Rhythm Changes ST elevation, Tall T waves

Hypokalemia - Low & Slow

7 L's
L - Lethargy & Confusion
L - Low, shallow respirations
L - Lethal Cardiac dysthymias ST depression Flat T waves
- Low, weak HR & Orthostatic Hypotension
L - Lots of Urine
L - Leg Cramps
L - Limp Muscles & decreased DTR
L - Low Bowel sounds & Constipation.
- Can lead to paralytic ileus

Complications of Cancer - Malnutrition

Altered Taste sensation (dysgeusia)
Cancer Cachexia
Infection

Onco Emergencies - Obstructive

-Spinal Cord Compression
-Third spacing syndrome
-Superior vena cava syndrome
Metabolic
-Tumor Lysis syndrome
-SIADH
-Septic Shock
Infiltrative
-Cardiac tamponade
-Carotid artery rupture
Extravasation

Tumor markers: CA-125 - ovarian cancer

Tumor markers: PSA - prostate cancer

Tumor Markers: CA-27-29/CA 15.3 - Breast Cancer

Tumor Markers: CA 19-9 - Pancreatic & Gallbladder Cancer

Breast Cancer Risk Factors - Family hx

Environmental Factors
Genetics
Early Menarche & Late menopause
Age 60 and older
Nulliparity - Late first birth
Obesity
Long term use of contraceptives

Lung Cancer S/S - Coughing

Wheezing
dyspnea
hoarseness
hemoptysis
Chest pain
anorexia
Weakness
Diminished Or absent Breath sounds
Dull Chest percussion

Lung Cancer Nursing interventions - Analgesics for pain

Elevated HOB to ease breathing
Oxygen
Respiratory Treatment
Bronchodilators
Corticosteroids
Increase Calorie & Protein diet
Rest Periods

Surgery CA types - -Prophylactic:

known family hx
-Curative:
-Control:
cytoreduction/debulking
Remove large portion to increase other therapies chances of being successful
-Palliative:
Increase quality of life, decrease pain
-Reconstruction/Rehabilitation:
Increase quality of life by restoring maximum function & appearance

Lymphedema and Breast Cancer - Assess Capillary refill

Avoid overuse of arm
Elevate arm
Protect affected hand & arm
Avoid strong sunlight
Use sling on affected arm
Do not carry anything heavy with arm
Avoid trauma
No blood draws or IV access
Apply hand cream
No BP

Neutropenic Precautions - no live vaccines,

no fresh fruits,
no flowers
No crowds or sick people
Wear a mask
Wash hands often
Fever of 100.3 or greater needs to be reported

8 Hallmarks of Cancer - Sustaining Proliferation growth signal

Evading growth suppressors
Resisting cell death
Avoiding immune destruction
Enabling replicative immortality
Inducing angiogenesis
Activating invasion & metastasis
Deregulating cellular energetics
Genome instability & mutation
Tumor promoting inflammation

Thrombolytic precautions - No dental floss

Soft tooth brush
No razors; use electric
No bearing down
Avoid falls
No rectal exams
Do not insert anything into vagina or rectum
S/S
Petechiae
Purpura
Melena
hematemesis
bleeding from gums
heavy menstrual period

Prostate Cancer - Risks

Old Age
Race: Increased in A.A. men
High fat diet
Obesity
Genetics
S/S
Urinary retention
Hesitance
Frequency
Hematuria
Bladder infections

Always draw labs for PSA before rectal exam

PSA over 4 is suspect for CA, can also be seen in BPH

Tamoxifen - Can cause Uterine & endometrial CA

Monitor for bleeding
Monitor for thrombosis or embolism
May increase Cholesterol and Triglyceride levels

Leuprolide (Lupron) - Prostate cancer Medication

Can cause Gynecomastia & Tumor flare

Mucositis - Inspect Mouth daily

Offer mouth care with every meal & bedtime
Soft bristled toothbrush or Sponge
Provide mouth rinses Q12H
Topical anesthetic agents for mouth sores
Avoid alcohol or glycerin mouthwashes
Offer soft foods that cool to warm
Avoid hard, spicy, cold, or hot foods

Stages of CAD - Fatty streaks

-Lipid filled smooth muscle cells
-Yellow tinge appears
Fibrous Plaque
-Beginning of progressive changes
-Collagen covers the fatty streaks
Complicated Lesion
-Last stage & most dangerous
-Continued inflammation can cause instability

Activity Guidelines for CAD - Warm up/Cool down

-Mild stretching for 3-5 minutes before & 5 min after
Frequency
-Perform physical activity most days of the week
Intensity
-HR determines intensity
-HR should not exceed 20 beats/min over resting HR
unless an exercise stress test has been done
Type of Activity
-Regular, rhythmic & repetitive
-Use large muscles to build up endurance
Time
-At least 30 minutes long
-Begin slowly 5-10 minutes and build up from there

CAD Diet - 25-35% Combined total fat from total calories

<200 mg of Cholesterol
2G of Plant sterols
10-25G of soluble Fiber
Total calories should be enough to maintain healthy weight

Precipitating Factors of Angina - Physical exertion,

temperature extremes,
strong emotions,
consumption of heavy meals,
tobacco use,
sexual activity,
stimulants (cocaine, amphetamines),
circadian rhythm patterns.

Prinzmetal's Angina (variant angina) - often occurs at rest, usually in response to

spasm of a major coronary artery.
Rare form.
Often associated with migraines and Raynaud's phenomenon.
Can occur with or without CAD.

Chronic Stable Angina - chest pain that occurs intermittently over a long period with
the same pattern of onset, duration, and intensity of symptoms

Lactated Ringers - Isotonic Solution

Contraindicated for Patients w/Liver disease
Used to replace Fluids in Burn Patients

Hypotonic Solutions - Lower Serum Osmolality within the vascular space

Causes fluid to shift out the blood into the cells
May deplete Fluid within the circulatory system
May Worsen existing hypovolemia & Hypotension
Monitor for S/S of Fluid Volume Deficit

Hypertonic Solution - Causes the water to come out of cells

Increases Extracellular Volume
Monitor for fluid Volume Overload
Monitor for Pulmonary Edema
Monitor for ICP & Neuro Changes

Letrazole - Causes Endometrial Cancer

Hot Flashes
Osteoporosis

glomerulonephritis - HAD STREP

H-HTN
A-ASO antistreptolysin titer positive
(test for strep infections)
D-Decreased GFR (low urine output)

S-Swelling in face/eyes (periorbital edema)

T-Tea-colored urine (cola colored)...from hematuria
R-Recent strep infection
E-Elevated BUN and creatinine
P-proteinuria

Creatinine Clearance - most accurate test to determine renal function

Nephrotic Syndrome - NAPHROTIC

N-Na+ decrease (hyponatremia)

A-Albumin Decrease (hypoalbuminemia)
P-Proteinuria greater than 3.5 G/day (foamy Urine)
H-Hyperlipidemia, HTN & hypercoagulability
R-Really Big (Edema, Anasarca, & Ascites)
O-Osteomalacia d/t hypocalcemia
T-Too little protein can cause Malnutrition
I-Infection primary cause of mortality
C-Coagulability, thromboembolism & PE

Intrarenal AKI - Acute Tubular Necrosis

Exposure to Nephrotoxins
Acute GNP
SLE
Obstetric Complications
Malignant HTN

Post Renal AKI - BPH

Bladder Cancer
Strictures
Renal Calculi
Trauma
Prostate CA

PreRenal AKI - Decreased Cardiac Output

Hypovolemia
peripheral Vasodilation
Renal Vascular obstruction
Severe Vasoconstriction
Oliguric Phase - Urine Less than 400 mL/day
Hypovolemia
Metabolic Acidosis
Sodium Balance
Potassium Excess
Hematologic Disorders
(leukocytosis)
Waste Product accumulation
Neurologic Disorder
(seizure, stupor, Coma)

Diuretic Phase - 1-3 L of urine Output. Can reach 5 L

Hypovolemia
Hypotension
Hypokalemia
Hyponatremia

Calculating Fluid restriction - Add all losses for previous 24H Plus 600 mL

Hyperkalemia Therapy - Calcium Gluconate

Dietary Restriction
Hemodialysis
Patiromer
Regular Insulin IV
Sodium Bicarb
Kayexalate

S&S of Hypervolemia (FVE) - Neck Vein Distention

Bounding Pulse
Edema
Hypertension
SOB
Crackles
Confusion
Headache
Seizure
S&S of Hypovolemia - -Hypotension
-Tachycardia
-Thready pulse
-Dizziness
-Syncope
-Fatigue & malaise
-Confusion
-Orthostatic hypotension
-Decreased urine output
-Dry skin and mucous membranes
-Decreased skin turgor
-Diminished capillary refill

Glomerulonephritis Tx - Rest
Restrict Na & Fluids
Diuretics
Antihypertensive
Restrict protein if elevated BUN
Early Diagnosis & Treatment

Fistula - Feel the Thrill

Listen to the Bruit
Maturity takes 4-6 weeks
AV steal Syndrome can develop
- Monitor extremity distal to fistula

Goals of AKI - Maintain normal Fluid & Electrolyte Balance

Complete recover w/out any loss of kidney
Control & Decrease stress & Anxiety
Adhere to & Understand need for follow up care

Peritoneal Dialysis Complications - Protein loss

Peritonitis
Hyperglycemia
Exit site & tunnel infections
Catheter can Migrate
Peritonitis S&S - rebound tenderness,
ABD pain
Cloudy peritoneal effluent
N/V
Diarrhea
Fever
Increased WBC

CKD - Psychologic
Cardiovascular
-HTN
-HF
-CAD
GI
-Anorexia
-N/V
Metabolic
-HLD
Hematologic
-Anemia
-Infection
Neurologic
-Fatigue
-Headache
Pulmonary
-Edema
-pneumonia
Integumentary
-Pruritus
-Ecchymosis
-Dry, Scaly skin
Musculoskeletal
-Osteomalacia
Peripheral Neuropathy
-RLS
-Paresthesia
CKD: Uremia - build up on nitrogenous waste d/t GFR <15
azotemia: Uremic Frost/Pruritus
-Uremic Fetor
Electrolyte/Fluid Build up
-N/V, Headache & Change in Mental status
-Bounding pulse & HTN
-Hyperkalemia, Hypernatremia, Hyperphosphatemia
-Metabolic Acidosis w/kussmaul RR
tx with dialysis if symptomatic
infection is #2 cause of death in ESRD.

adrenal cortex hormones - glucocorticoids (Cortisone)

-involved in carbohydrate, protein, and fat metabolism
-anti-inflammatory properties
-insulin antagonists
mineralocorticoids (Aldosterone)
-Increases blood volume & pressure by promoting
-conservation of Na & H2O
sex hormones (Androgen)

DKA - DKAA
D: Dry & High
-High B.S. Over 300
-Dry Dehydration: Polyuria & Polydipsia
-Hypotension w/tachycardia
K: Ketones & Kussmaul RR
A: ABD pain w/NV
A: Acidosis, Metabolic w/Hyperkalemia

Type 1 DM
Rapid Onset
First Priority is Hydration

HHS - HHNS
H: Highest Sugar over 600+
H: Higher fluid loss W/extreme dehydration
H: Head (neuro) Changes
N: No Ketones, No Kussmaul RR, No ABD pain
S: Slow Onset w/stable K+

Alcohol & DM - Can cause Hypoglycemia

inhibits gluconeogenesis
1 per day for women/ 2 per day for men

MS exacerbations - Causes: Infections URI & UTI,

-Trauma,
-immunizations,
-Childbirth,
-stress,
-Change in Climate

TX: Corticosteroids

Cholinergic Crisis - Over Medication

Excessive Secretions
Diarrhea, ABD cramps
N/V
miosis
Weakness
Hypotension & decreased HR

TX: Atropine

myasthenia Crisis - Under Medication

Poor Cough
Respiratory Distress
Increased HR & BP
Weakness
Secretion Aspiration
Decreased Urinary Output
May need Mechanical Ventilation

Tx: "Stigmine"
Parkinson - disease characterized by head nodding, bradykinesia, tremors, and
shuffling gait
Priority Nursing is Breathing and effective airway clearance
Akinesia
Cogwheel Rigidity
Tremors

Gastric Bypass Diet - Low Residual Diet

6 small nutrient dense meals a day,
liquids between meals instead of with meal
High In protein
Low in Carbs
Calorie Dense foods should be avoided
Low Fat
Low Roughage
Stop eating when full

Monitor for dumping Syndrome

Weakness
Dizziness
Tachycardia
Diaphoresis
Occurs 15-30 minutes after eating

Hospice Care - Provides care to increase quality of life

Assist patient to live as fully & comfortably as possible

Emphasis on:
Symptom Management
Supportive Care
Advanced care planning
Spiritual & Family support

TPN - Check BS
Use micron filter
Use Aseptic Technique
Check Solute for particulate or fat emulsion cracking
Good for 24H
Hang D10 if TPN is not available
Do not abruptly stop infusion; tapper up and down

Complications
Pneumothorax
Pneumonia
Refeeding Syndrome
Catheter Infection
Air Embolism
Dislodgement
Occlusion

Carbidopa/Levodopa - Do not administer w/ food. Protein reduces absorption

Effects are delayed weeks
Body fluid will turn dark color
No B6
No MAOI

Synthroid - Give in morning on empty stomach

Never Switch brands
Stick to a schedule
Do not abruptly Stop medication

Peripheral Neuropathy - Test Temperature of water by using a thermometer or elbow

to avoid burns