Mark Klimek Blue Book Part 1

In Abruptio Placenta, the placenta ____________ from the uterine wall ____________.

Separates, prematurely

Abruptio Placenta usually occurs in (prima/multi) gravida over the age of ____________.

Multigravida, 35 (HTN, trauma, cocaine)

How is the bleeding of Abruptio Placenta different from that in Placenta Previa?

Usually painful; bleeding is more voluminous in placenta previa

If you are the nurse starting the IV on the client with Abruptia Placenta, what guage needle should you use?

18 (in preparation to give blood if necessary)

How often should you measure the VS, vaginal bleeding, fetal HR during Abruptio Placenta?

Q5-15 minutes for bleeding, maternal VS and continuous fetal monitoring

Deliver baby at earliest sign of fetal distress

How is an infant delivered when Abruptio Placenta is present?

Usually C-section

Is there a higher or lower incidence of fetal death with Abruptio Placenta compared to Placenta Previa?

Higher

In what trimester does Abruptio Placenta most commonly occur?

Third

At what age are accidental poisonings most common?

2 years old

If a child swallows a potentially poisonous substance, what should be done first?

Call for medical help

Should vomiting be induced after ingestion of gasoline?

No- not for gas or any other petroleum products

When taking a child to the ER after accidental poisoning has occurred what must accompany the child to the ER?

the suspected poison

An elderly client is a (high/low) risk for accidental poisoning? What about a school age child?

high - due to poor eyesight, high

What types of chemicals cause burns to oral mucosa when ingested?

Lye, caustic cleaners

Children at highest risk for seizure activity after ingestion are those who have swallowed _____________ and ______________.

drugs, insecticides

Can impaired skin integrity ever be an appropriate nursing diagnosis when poisoning has occurred?

Yes, when lye or caustic agents have been ingested

What is the causative organism of acne?

P. acnes (propionibacterium acnes)

What structures are involved in acne vulgaris?

The sebaceous glands

Name 3 drugs given for acne?

Vitamin A, Antibiotics, Retinoids

Dietary indiscretions and uncleanliness are causes of acne?

False

What are the 3 causative factors in acne vulgaris?

Hereditary, Bacterial, Hormonal

Uncleanliness is a cause of acne?

False

What is the most common retinoid given to people with acne?

Accutane

Accutane is an analog of which vitamin?

Vitamin A

What is the most common side effect of accutane? And what is most important in health teaching in adminstration?

Inflammation of the lips; Causes birth defects

What is the antibiotic most commonly given to clients with acne?

Tetracycline

How long will it take for the person to see results when acne is being treated?

4 to 6 weeks

Does stress make acne worse?

yes

How often should the client with acne wash his face each day?

Twice a day

What instructions do you give to a client taking tetracycline?

Take it on an empty stomach and avoid the sunlight (photosensitivity)

What are comedones?

Blackheads and white heads

What virus causes AIDS?

HIV - Human immunodeficiency virus

The AIDS virus invades helper ____________.

T-lymphocytes (or CD4 cells)

AIDS is transmissible through what four routes?

blood

sexual contact

breast feeding

across placenta in utero

HIV is present in all body fluids?

Yes, but it is not transmitted by all, only blood, semen and breast milk

Name the 5 risk groups for AIDS

Homosexual/bisexual men

IV drug users

Hemophiliacs

Heterosexual partners of infected people

Newborn children of infected women

What is the first test for HIV antibodies?

ELISA

What test confirms the ELISA?

Western Blot

Which test is the best indicator of the PROGRESS of HIV disease?

CD4 count

A CD4 count of under __________ is associated with the onset of AIDS-related symptoms.

500

A CD4 count of under _______ is associated with the onset of OPPORTUNISTIC INFECTIONS.

200

Give 6 symptoms of HIV disease.

anorexia

fatigue

weakness

diarrhea

night sweats

fever

Which 2 classes of drugs are given in combination for HIV sero-positivity?

NRTI's (Nucleoside Reverse Transcriptease Inhibitors) and PI's (Protease Inhibitors)

They prevent viral replication.

NRTI (nucleoside reverse transcriptease inhibitors)

An antiviral drug used against HIV

Is incorporated into the DNA of the virus and stops the building process

Results in incomplete DNA that cannot create a new virus

Often used in combination with other drugs

PI's (Protease inhibitors)

Most potent of antiviral meds

Inhibit cell protein synthesis that interferes with viral replication. Does not cure but slows progression of AIDS. Prolongs life, used prophylactically and used in AIDS to decrease viral load and opportunistic infections.

What do NRTI's and PI's do?

They prevent viral replication.

What does the physician hope to achieve with NRTI's and PI's for HIV?

A delayed onset of AIDS for as long as possible (usually can delay onset for 10-15 years)

What is the most common NRTI used?

AZT (zidovudine)

What is the most challenging aspect of combination of drug therapy for HIV disease?

The number of pills that must be taken in 24 hours can be overwhelming. The frequency also makes it hard to remember-an alarm wristwatch is used.

Clients with AIDS (gain/lose) weight?

Lose weight

The typical pneumonia of AIDS is caused by ___________ ____________.

Pneumocystic carinii

What type of oral/esophageal infections do AIDS patients get?

Candida

What is the #1 cancer that AIDS patients get?

Kaposi's sarcoma

Kaposi's sarcoma is a cancer of the ___________.

skin

T/F: AIDS patients get lymphomas?

True

What lab findings are present in AIDS?

Decreased RBC's, WBC's and platelets

If the AIDS patient HAS leukopenia they will be on _____________ ________________.

Protective (reverse) Isolation

Define Leukopenia

Decrease in WBC, indicated viral infection

Without leukopenia the AIDS patient will be on ____________ precautions.

Standard precautions or blood and body fluid precautions

When the AIDS patient has a low platelet count, what is indicated?

Bleeding precautions; No IM's, no rectal temperatures, other bleeding precautions

Does AIDS require a single room?

Yes - if WBC counts are low

When do you need a gown with AIDS?

If you are going to get contaminated with secretions

When do you need a mask with AIDS?

Not usually unless they have an infection caused by an AIREBORNE bug

When do you need goggles with AIDS?

Suctioning

Central line start

Arterial procedures

If an AIDS patient's blood contaminates a counter top, with what do you clean?

1:10 solution of bleach and water

Are all articles used by AIDS patients double-bagged?

no - only those contaminated with secretions

Can AIDS patients leave the floor?

Yes, unless WBC's are very low

Is dietary protein limited in AGN?

Not usually, however if there is severe azotemia then it may be restricted

Define azotemia?

Nitrogenous wastes in the blood (increased creatinine, BUN)

What is the best indicator of renal function?

The serum creatinine

Do people recover from AGN?

Yes, the vast majority of all clients recover completely from it.

How can AGN be prevented?

By having all sore throats cultured for strep and treating any strep infections.

What is the most important intervention in treating AGN?

Bedrest - they can walk if hematuria, edema and hypertension are gone.

What is the most common dietary restriction for AGN?

Moderate Na+ restriction.

Fluid restriction is #2 if edema is severe.

What are the urinalysis findings on AGN?

Hematuria

Proteinuria +3 to +4

Specific Gravity Up

How long after strep infection does AGN develop?

2 to 3 weeks after initial infection

How do you assess fluid excess in the child with AGN?

Daily weight

What organism causes acute glomerular nephritis?

Group A beta hemolytic strep

What happens to the kidney in AGN?

It becomes clogged with antigen-antibody complexes which then cause inflammation and loss of function.

How often are vital sign measurements taken in AGN?

Q4 hours with blood pressure

Will the client have hypo or hyper tension with AGN? Why?

Hypertension, because of fluid retention

What are the first signs of AGN?

Puffiness of face

Dark urine

What are the three adult stages of development called?

Early adulthood

Middle adulthood

Late adulthood

What is the age range for early adulthood?

19 - 35

What is the age range for middle adulthood?

35 - 64

What is the age range for late adulthood?

64 - death

What is the developmental task for EARLY adulthood?

Intimacy vs. Isolation

What is the developmental task for middle adulthood?

Generativity vs. Stagnation

Intimacy vs. Isolation

Erikson's stage in which individuals form deeply personal relationships, marry, begin families

Generativity vs. Stagnation

Erikson's stage of social development in which middle-aged people begin to devote themselves more to fulfilling one's potential and doing public service

What is the developmental task for LATER adulthood?

Ego Integrity vs. Despair

Ego Integrity vs. Despair

(Erikson) People in LATE adulthood either achieve a sense of integrity of the self by accepting the lives they have lived or yield to despair that their lives cannot be relived

"Time is too short to start another life, though I wish I could," is an example of ___________.

Despair

"If I had to do it over again, I'd live my life just about the same," is an example of __________ __________.

Ego Integrity

The result of the positive resolution of the final life crisis.

Viewed as the key to harmonious personality development; the individual views their whole life with satisfaction and contentment.

What does AKA mean?

Above the knee amputation

What does BKA mean?

Below the knee amputation

If the patient had an AKA they should lie ____________ several times per day.

Prone (to prevent flexion contracture)

The #1 contracture problem in AKA is ____________ of the _____________

flexion, hip

What will prevent hip flexion contracture after AKA?

Lying prone several times a day

What is the #1 contracture problem after BKA?

Flexion of the knee