Complex Med Surg Exam 1 Questions & Answers

Serves as guidelines for critical care nurses, establishes goals for patient care. - ANSWERSAACN Standards for Acute and Critical Care Nursing Practice What makes delirium different from dementia? - ANSWERSDelirium is fast onset, acute in nature, and there is usually a cause to it. True or False: Delirium is associated with low rates of mortality and morbidity? - ANSWERSFalse- it is associated with high rates of mortality and morbidity. 3 Types of Delirium and characteristics - ANSWERSHyperactive- agitated, combative, disoriented Hypoactive- quiet delirium Mixed- fluctuating between hyperactive and hypoactive Risk factors for delirium - ANSWERSOlder than 70, came from a nursing home, hx of substance abuse, renal or liver disease, central lines, physical restraints. Drug of choice for delirium - ANSWERShaloperidol Biggest risk for delirium patients - ANSWERSFALLS ABCDE Bundle for Delirium - ANSWERSA-Awakening B- Breathing Coordination C- Choice of Sedation D- Delirium Monitoring E-Early mobility and exercise living will, advanced directive - ANSWERSA document that indicates what medical intervention an individual wants if he or she becomes incapable of expressing those wishes. Abandonment - ANSWERS-Severing professional relationship when patient is in need of care -Can even happen if you go to lunch and do not transfer care to another nurse Moral conflict - ANSWERS-Nurse not required to practice if situation violates moral or religious beliefs -Must transfer care to another nurse to avoid abandonment Witholding: not ________ Withdrawing: not _________ - ANSWERSNot initiating Weaning or removing True or false: family presence during codes is promoted - ANSWERSTrue! Breast Cancer Early Detection Guidelines - ANSWERS40-44 yrs- women should have the choice to have annual mammograms 45-54- should get mammograms annually 55 and older- should switch to mammograms every 2 years (unless genetically predisposed to breast cancer, then should get an MRI and mammograms) Colon and Rectal Cancer Detection Guidelines - ANSWERSStarting at 50, both men and women should get a colonoscopy every 10 years. Cervical Cancer Detection Guidelines - ANSWERS-Cervical cancer testing should start at age 21 (every 3 years), those under this age shouldn't be tested. -Women between 21 and 29 should also have a Pap done every 3 years. -Women 30-65 should have Pap and HPV every 5 years. Endometrial (uterine) cancer screening - ANSWERSAt time of menopause, women should be educated about signs and symptoms of endometrial cancer and should report any extra vaginal bleeding to doctors. Lung cancer screening - ANSWERS-Done by CT scan -Only for high risk patients, must have all of the following: 1. 55-74 years of age 2. In good health 3. Have at least a 30 pack year smoking history Prostate cancer screening - ANSWERS-If you decide to be tested, you should get a PSA blood test with or without a rectal exam. How often you're tested will depend on your PSA level. -At age 50, men should ask doctors if they are at risk for developing prostate cancer. Where is blood produced? - ANSWERSbone marrow What makes up the majority of blood? - ANSWERSplasma What is hematopoiesis and where does it occur? - ANSWERSThe process of replenishing blood cells Main site is in the bone marrow---makes stem cells which then differentiate into leukocytes, erythrocytes, and thrombocytes Function of the liver? - ANSWERSFilters and stores our blood supply. This is our reserve in case we lose a large amount of blood. What do lymph nodes do? - ANSWERSfilter lymph and foreign matter What does the spleen do? - ANSWERSProduces lymphocytes, filters blood, and destroys erythrocytes when they are too old What do mature erythrocytes consist mostly of? - ANSWERShemoglobin What binds to hemoglobin? - ANSWERSOxygen Lifespan of an erythrocyte is about ___ days. - ANSWERS120 Why will renal failure patients not have a normal erythrocyte lifespan? - ANSWERSBecause of lack of erythropoietin that is produced in the kidneys. What can renal failure patients get in order to normalize erythrocyte cycles? - ANSWERSEpogen----synthetic erythropoietin Normal hemoglobin levels for men and women - ANSWERSMen: 14-18 Women: 12-16 What can an increase and decrease in hemoglobin indicate? - ANSWERSIncrease: polycythemia, living in high altitudes, medications Decrease: bleeding, anemia, medications (antibiotics, aspirin). What is a hematocrit? - ANSWERSPercentage of hemoglobin in relationship to blood volume Normal hematocrit for males and females? - ANSWERSMales: 42-52% Females: 37-47% A patients hematocrit should usually be _____ x _______ - ANSWERS3 x Hgb levels What can a decrease and increase in hematocrit levels indicate? - ANSWERSDecrease: blood loss, anemia, HEMODILUTION, leukemia, meds Increase: erythrocytosis, polycythemia, DEHYDRATION What type of fluids can renal patients not have and why? - ANSWERSLactated ringers because it has potassium in it! Signs and symptoms of low hemoglobin and hematocrit - ANSWERSPallor is the most common Fatigue and poor activity tolerance Dyspnea, chest pain, palpitation Headaches, tinnitus, irritability Difficulty sleeping or concentrating Abnormal menstruation, impotence, loss of libido True or false: elderly people have a delayed response in creating new blood cells, so when they have low WBC, RBC, or platelet counts, it is harder for them to replace it themselves. - ANSWERSTRUE! A diminished response of the elderly regarding blood replacement may be due to a decrease in ____________. - ANSWERSGrowth factor (erythropoietin) True or false: The elderly are NOT more susceptible to myelosuppressive effects of medication - ANSWERSFalse, they are more susceptible. The drugs diminish the bone marrow and cause a decrease in blood cell formation. Which of the following situations would most likely prompt an increase in erythropoietin synthesis? A.A woman is admitted to the hospital with anemia (Hemoglobin down, stimulates erythropoietin production, erythrocyte production). B.A man with atrial fibrillation has begun taking anticoagulants to prevent a stroke. (thrombocytes) C.A child fractures his ulna and radius in a playground accident. D.A woman develops an infection in an arterial ulcer. (leukocytes) - ANSWERSA.A woman is admitted to the hospital with anemia (Hemoglobin down, stimulates erythropoietin production, erythrocyte production). What is anemia? - ANSWERSA decrease in the number of RBC. Can be caused by destruction of RBC, lack of production, or major loss of RBC. What type of anemias cause immature destruction of erythrocytes? And what is an example of this? - ANSWERSHemolytic anemias Sickle cell Treatment options for anemia - ANSWERSBlood transfusion High protein diet RBC booster (Procrit or Epogen) Diet modification (folic acid deficiency anemia) Fatigue management What are some foods high in folic acid - ANSWERSBeef, liver, peanut butter, beans, asparagus, broccoli Treatment for iron deficiency anemia - ANSWERSIron supplementation What are some patient teaching points for giving oral iron supplements? - ANSWERSMonitor for allergic reactions Give with straw to prevent staining Causes skin irritation The symptom of "pica" would refer to which type of anemia? - ANSWERSIron deficiency anemia---pica is the desire to eat non-food items What size IV would you use for someone about to receive a blood transfusion and what fluid would you hang? - ANSWERS18g or 16g (large bore needle) 0.9% sodium chloride Which fluid would you not use during blood transfusions and why? - ANSWERSD5W because the blood will clot True or false: It is safe to add medications to blood products - ANSWERSFALSE When giving blood products, the nurse should stay with the patient for the first _____ to _____ minutes. And what should nurse get at the end of this period of time? - ANSWERS15-30 minutes Full set of vital signs Reactions to blood products normally happen ____ minutes within starting the infusion - ANSWERS15 While the blood infusion is running, the nurse or assistive personnel will obtain vitals how often? - ANSWERSEvery hour Things nurses should look for when monitoring patient receiving blood transfusion. - ANSWERSRespiration status Sudden increase in anxiety Breath sounds Neck vein distension What are some signs that a patient is having a negative reaction to a blood product/transfusion? - ANSWERStemp elevation respiratory difficulty hemolytic reaction: back pain and blood in urine