Nursing Review Flashcards
Examination and Course Logistics
The upcoming test consists of exactly questions.
The course is scheduled to finish on the , coinciding with several other classes and Saturday/Sunday groups that were rescheduled from the .
Mental Health and Psychosocial Aspects of Chronic Illness
Osteoarthritis (OA) management goes beyond physical therapy and pain management. Nurses must consider the significant psychosocial effects of the disease.
Patients often suffer from depression linked to chronic pain, persistent fatigue, lack of mobility, loss of income, changes in lifestyle, and a loss of independence.
Nurses should express the need for and offer mental health care, including referrals to therapists or community-based support groups (e.g., an Osteoporosis or Osteoarthritis support group).
Studies show that psychosocial therapy can lead to significant improvements in physical pain levels. Providing mental health support may help patients return to their daily activities or employment.
Respiratory Disorders and Emergency Interventions
Physiology of Asthma and Bronchospasm: Bronchospasm involves three primary physiological changes: inflammation, edema (swelling), and excess mucus production. These factors build up in the bronchi and bronchioles, causing audible wheezing and stridor.
Emphysema Risk Factors: Smoking is the primary risk factor. The duration and frequency of smoking directly correlate to how quickly emphysema develops, but persistent smoking will eventually lead to the disease regardless of the specific amount.
Status Asthmaticus: This is a severe, prolonged asthma attack that is refractory to standard treatments, including inhaled bronchodilators and nebulizer treatments. It is a medical emergency that can lead to acute respiratory failure.
Warning Signs and Symptoms:
"Silent Chest": Absent breath sounds due to severely reduced airflow.
Cyanosis: Bluish-tinted lips and fingers.
Accessory Muscle Use: Switching from abdominal breathing to using neck and chest muscles.
Tachycardia: Increased heart rate.
Tachypnea: Increased respiration rate.
Mental status changes: Confusion, drowsiness, or altered level of consciousness (LOC).
Triggers: Severe airway inflammation, mucus plugs, viral/bacterial infections, pollen, smoke, or non-compliance with maintenance medications (e.g., corticosteroids).
Prognosis: Patients requiring intubation for status asthmaticus have a higher risk of recurrent episodes once extubated.
Skin Integrity, Wound Care, and Burn Management
Infection Sensitivity: Immunocompromised patients (e.g., those with Lupus, HIV, or undergoing chemotherapy) are at the highest risk for skin infections.
Pressure Ulcers and Nutrition: Elderly patients often have decreased protein intake, which severely impacts wound healing. Nurses should recommend high-protein diets or ask a physician to add protein supplements to medications to assist in ulcer recovery.
Electrical Burns: These may present with deceptively small entry and exit wounds on the skin while masking massive internal damage. Assessments such as ultrasounds or CAT scans are necessary to determine the extent of underlying tissue damage.
Toxic Liquid Burns: When dealing with patients burned by gasoline, industrial metals, or toxic liquids, nurses must follow decontamination protocols and wear appropriate Personal Protective Equipment (PPE) to ensure their own safety while providing care.
Priority Frameworks and Nursing Assessment
Post-Shift Prioritization: When inheriting multiple patients, prioritize those with active, unstable conditions.
Example: A patient with a new, unattended laceration from a fall should be seen before stable patients to check for circulation and bleeding issues.
Focused Assessments: Perform quick (, , or -step) focused assessments on specific problems (lungs, abdomen, injury) to ensure the patient is stable and to prevent surprises during the shift.
Emergency Case Study Prioritization:
Patient 1 (Type 2 Diabetic): Elevated glucose, but not extreme.
Patient 2 (Diabetes Insipidus): Balanced intake and output, no electrolyte crisis.
Patient 3 (Graves’ Disease): Stable with mild tremors and heart rate of .
Patient 4 (Left-sided Stroke): New manifestations of a severe headache and confusion.
Outcome: Patient 4 (Stroke) is the priority due to worsening neurological symptoms requiring emergent attention.
Endocrine Disorders: Metabolic and Hormonal Management
Hyperosmolar Hyperglycemic Syndrome (HHS): Primarily characterized by insulin resistance and insufficient medication management.
Symptoms: Blood sugar levels > (can exceed in real-world scenarios), extreme high blood osmolarity (concentrated blood), and severe dehydration.
Note: Unlike DKA, HHS does not typically involve ketoacidosis.
Diabetic Ketoacidosis (DKA): Occurs due to an absence of insulin. The body performs lipolysis to break down fats, leading to ketone production and ketosis. The body attempts to excrete these extra ketones in the blood.
Syndrome of Inappropriate Antidiuretic Hormone (SIADH): The pituitary gland releases excessive ADH regardless of sodium or fluid needs.
Key Manifestation: Sodium concentration below .
Risks: High morbidity and mortality, particularly in critically ill or cancer patients.
Thyroid Emergencies:
Myxedema Crisis/Coma: A life-threatening complication of hypothyroidism. Symptoms include dangerously low blood pressure requiring vasopressors.
Thyroid Storm: A hyperthyroid emergency often triggered by medications like Amiodarone. Symptoms include tachycardia (> ), atrial fibrillation, fever, confusion, seizures, and potential liver failure. Treatment involves anti-thyroid meds and beta-blockers. Patients must avoid iodine-rich foods.
Gastrointestinal and Genitourinary Management
Urinary Incontinence: For bedridden patients, the priority intervention is preventing skin breakdown caused by prolonged exposure to moisture.
Diverticular Disease:
Diverticulosis: The presence of small bulging pouches (diverticula). Management requires a high-fiber diet to prevent constipation and inflammation.
Diverticulitis: Inflammation of these pouches, causing fever, nausea, and severe left lower abdominal pain. This is an escalation of the condition.
Fecal Incontinence: Commonly caused by the weakening of the anal sphincter muscles, often exacerbated by chronic constipation in the elderly.
Postoperative Bowel Surgery: A priority nursing action after colon or bariatric surgery is to confirm the presence of bowel sounds in all four abdominal quadrants. Absent bowel sounds must be reported to the physician immediately.
Renal Conditions:
Polycystic Kidney Disease (PKD): A genetic disorder (often appearing in childhood) where fluid-filled cysts enlarge the kidneys and impair function. Symptoms include hypertension, hematuria, and frequent UTIs. Patients must avoid nephrotoxic NSAIDs and maintain high hydration.
Renal Calculi (Kidney Stones): Most frequently develop in the renal papillae. Key symptoms include severe flank pain, nausea, and vomiting.
Gout and Calculi: Patients with gout, renal calculi, or hypertension must maintain high hydration (especially in heat) to prevent the multiplication and development of stones.
Hydrocephalus: In infants, manifesting as a bulging fontanelle due to increased intracranial pressure. The primary treatment is the placement of a Ventriculoperitoneal (VP) Shunt, which drains cerebrospinal fluid from the brain ventricles to the peritoneal cavity.
Neurological Disorders and Diagnostic Procedures
Cerebral Palsy (CP): In children, it is highly associated with seizure disorders due to abnormal brain development. In adults, it is characterized by spasticity (muscle stiffness/tightness).
Parkinson’s Disease: Caused by a dopamine deficiency.
Symptoms: The cardinal first symptom is a "tremor at rest."
Etiology: A combination of genetics and environmental factors (exposure to pesticides or heavy metals).
Multiple Sclerosis (MS):
Diagnosis: Confirmed via lumbar puncture; the cerebrospinal fluid (CSF) is tested for elevated protein levels (oligoclonal bands).
Post-procedure care: The patient must lie completely flat for up to hours to prevent a lumbar puncture headache. Caffeine and hydration help constrict cerebral vessels to reduce pain. If a headache worsens when sitting up, it may indicate a CSF leak.
Pattern: Relapsing-remitting MS involves periods of active exacerbation followed by periods of remission.
Intracranial Hemorrhage: Symptoms include headache, slurred speech, facial numbness, LOC, and weakness in the upper/lower body.
Transient Ischemic Attack (TIA): For hypertensive patients, stroke risk is reduced by if systolic blood pressure is maintained below .
Peripheral Neuropathy: Primarily caused by degeneration of the myelin sheath due to uncontrolled diabetes. Patients require daily foot checks and regular podiatrist visits.
Cardiovascular Health and Disease Management
Coronary Artery Disease (CAD): Narrowing of coronary arteries reduces blood flow. Angina (chest pain) occurs during exercise when the heart needs more oxygen. If the narrowing is severe, angina can occur at rest (ischemia).
Atrial Fibrillation (AFib): Characterized by rapid, chaotic electrical signals in the atria.
Symptoms: Dizziness and palpitations.
Risk Factors: Advanced age, hypertension, heart disease, obesity, sleep apnea, and hyperthyroidism (excess thyroid hormone alters electrical impulses).
Peripheral Venous Disease: Characterized by poor blood return to the heart.
Symptoms: Lower extremity edema, heavy sensation, varicose/spider veins, and leathery/itchy skin near the ankles. Symptoms improve with leg elevation.
Postoperative Shock: A life-threatening state of inadequate organ perfusion (can be septic or hemorrhagic).
Manifestations: Tachycardia, tachypnea, hypotension, cold/clammy skin, oliguria, confusion, and hyperlactatemia (elevated lactic acid).
Acid-Base Imbalances and Electrolyte Disturbances
Metabolic Acidosis: Potential causes include DKA, salicylate (aspirin) toxicity, lactic acidosis, chronic kidney disease, or severe diarrhea.
Respiratory Alkalosis (pH > 7.45, CO_2 < 35): Caused by hyperventilation (excess loss of ) due to anxiety, pain, or high altitude. Symbols include tingling and lightheadedness.
Respiratory Acidosis (pH < 7.35, CO_2 > 45): Caused by hypoventilation (retaining ) due to COPD, opioid overdose, or pneumonia.
Hypokalemia (Potassium < ): Caused by diuretics, GI loss (vomiting/diarrhea), or excessive laxative use. Symptoms include muscle weakness, cramps, and arrhythmias.
Hypomagnesemia: Increases the risk of ventricular fibrillation (V-fib), especially following a myocardial infarction (MI).
Hypocalcemia: Associated with a positive Chvostek’s sign (neuromuscular irritability). Hypocalcemia and hypomagnesemia often occur together.
Oncology, Immunology, and Infection Control
Cancer Treatment Side Effects:
Lymphedema: Swelling and reduced range of motion.
Nausea: Managed with antiemetics (e.g., Zofran) and a diet of soft, bland foods (e.g., crackers).
Seizures: Increased risk in patients receiving radiation for brain cancer.
HIV/AIDS: A CD4 T-cell count below significantly increases the risk for opportunistic infections such as Tuberculosis (TB) and Candida.
Lupus (SLE): A systemic inflammatory disease.
Cardiovascular: Increased risk of stroke and heart attack due to inflammation.
Renal: Development of Lupus Nephritis.
Skin: The classic "butterfly rash" across the cheeks and nose.
Anaphylaxis: A severe allergic response.
Symptoms: Hypotension, wheezing, hives, throat swelling, and a "sense of impending doom."
Intervention: Carry an EpiPen and wear medical alert jewelry.
Immunity: Vaccinations provide "Acquired Active Immunity" by prompting the immune system to produce antibodies.
Hand Hygiene: Nurses should use to (approximately to pumps) of liquid soap and follow a specific friction-based scrubbing procedure for effective microorganism removal.
Questions & Discussion
Shira: How many questions are gonna be on this test?
Professor: 80 questions, Shira.
Tracy: Could you just please answer your consent in the chat box for the recording?
Tracy: I consent.
Jessica: Just enter your consent into the chat box, please.
Student: What time do we want to do this on Saturday?
Professor: 9:00.
Student: Are we getting any points back from the last test?
Professor: Yes, points on the first test, points on the second, and currently (possibly ) on the third.
Lucy (dialogue): Discussion regarding her daughter and getting onto the call while going to work.