NUR 213 Final Exam Review
1. Steps of a lumbar puncture: Before: Obtain consent, explain to pt that theymust lie very
still during the procedure, have pt empty bladder.
During: Have pt in a lateral recumbent position, explain to pt that there may be somediscomfort
Post-op: Pt must lie flat for 4-24 hrs, encourage fluids up to 3000ml in 24 hrs, educate pt to
report pain early. Take VS, monitor neuro q4hrs x24hrs, monitor site for drainage. ensure
client voids wn 8 hrs. *Keep pt in reclining position for up to 1 hour or several hrs to avoid the
discomfort of potential post-op spinal HA, Instruct ptto turn side to side as long as head is not
raised*
2. Medications for meningitis: *Rapid initiation of ABX* , immediate broad spec-trum
ABX, corticosteroids (decrease inflammation from toxins as bacteria dies), anticonvulsants,
antipyretic, mannitol, rifampin (prophylaxis for exposure)
3. What med is given as prophylaxis for a person exposed to meningococcalmeningitis?:
Rifampin
4. What labs should you monitor for a a pt. with meningitis?: BUN & creatinineratio,
electrolytes
5. My patient has been diagnosed with Sepsis what do now?: Respiratory Stabilization
(Airway), Aggressive fluid resuscitation, (if fluid resuscitation fails to restore MAP & organ
perfusion = VASOPRESSORS), early ABX therapy= given wn1 hr of suspected, notify MD of
pt exhibits 2 SIRS criteria & infection.
6. Abnormal labs r/t to sepsis: Elevated - WBC, WBC differential, C-reactiveprotein,
potassium; low - glucose, sodium, & renal perfusion
7. S/S of Sepsis: 2 SIRS + Confirmed or suspected infectionSIRS: T:>100.4F or <96.8F
RR: >20
HR: >90
WBC: >12,000 OR <4,000
PCO2: <32 mmHg
8. Peritoneal Dialysis: Inserting a catheter through the anterior abdominal wall, is initiated
immediately or delayed for 2 weeks, solution warmed to body temp., three phases Inflow,
dwell, & drain
9. Inflow: Amt of solution infused through catheter over about 10 mins
10. Dwell: Diffusion & osmosis occur btw patient's blood & peritoneal cavity. Dura-tion
varies
11. Drain: Lasts 15-30 mins, facilitated by gently massaging abdomen or changingpositions
12. Complications of PD: Exit site infection, peritonitis, hernias, lower back prob-lems,
, protein loss, bleeding, pulmonary complications
13. Hemodialysis: Two needles place in fistula or graft, one pulls blood from circu-lation to
HD machine and other is used to return dialyzed blood to patient. Assess wt before tx, take
VS q30-60 mins
14. Hemodialysis Complications: Hypotension, muscle cramps, loss of blood,hepatitis,
disequilibrium syndrome
15. Early VS late Septic Shock: Early:BP - normal
HR - Tachycardia Skin color - normal
Skin temp - cool & moist
Sensorium - anxious
Resp - Increased rate & depthLate:
BP - SBP 190 mmHg
HR - Tachycardia & weakSkin color - Pale
Skin temp - cold Sensorium - coma
Resp - Increase rate & shallow
16. What are causes of shock?: Too little blood/fluid volume, 'pump' problem,anaphylactic
reaction, obstruction
17. Lab values related to septic shock: Increased:
WBCBUN
Lactate
Blood glucose
Urine specific gravityCreatinine Procalcitonin Decreased:
PLT
WBC bands
18. Does shock increase or decrease cardiac output?: Decrease
19. Cardiogenic shock S/S: Hypotension, tachycardia/tachypnea, increased oxy-gen demand,
narrowed pulse pressure, decreased cardiac output, crackles on auscultation
20. What are S/S of hypoperfusion?: Weak, peripheral pulses, cool, clammy skin,delayed
capillary refill, cyanosis, pallor, diaphoresis
21. Diagnostics r/t Cardiogenic shock: ABG- resp alk. (early) metabolic acidosis(late), ECG-
dysrhythmias, echo- LV dysfunction, CXR- pulmonary infiltrates
22. Labs r/t to Cardiogenic shock: Increased:Cardiac markers
1. Steps of a lumbar puncture: Before: Obtain consent, explain to pt that theymust lie very
still during the procedure, have pt empty bladder.
During: Have pt in a lateral recumbent position, explain to pt that there may be somediscomfort
Post-op: Pt must lie flat for 4-24 hrs, encourage fluids up to 3000ml in 24 hrs, educate pt to
report pain early. Take VS, monitor neuro q4hrs x24hrs, monitor site for drainage. ensure
client voids wn 8 hrs. *Keep pt in reclining position for up to 1 hour or several hrs to avoid the
discomfort of potential post-op spinal HA, Instruct ptto turn side to side as long as head is not
raised*
2. Medications for meningitis: *Rapid initiation of ABX* , immediate broad spec-trum
ABX, corticosteroids (decrease inflammation from toxins as bacteria dies), anticonvulsants,
antipyretic, mannitol, rifampin (prophylaxis for exposure)
3. What med is given as prophylaxis for a person exposed to meningococcalmeningitis?:
Rifampin
4. What labs should you monitor for a a pt. with meningitis?: BUN & creatinineratio,
electrolytes
5. My patient has been diagnosed with Sepsis what do now?: Respiratory Stabilization
(Airway), Aggressive fluid resuscitation, (if fluid resuscitation fails to restore MAP & organ
perfusion = VASOPRESSORS), early ABX therapy= given wn1 hr of suspected, notify MD of
pt exhibits 2 SIRS criteria & infection.
6. Abnormal labs r/t to sepsis: Elevated - WBC, WBC differential, C-reactiveprotein,
potassium; low - glucose, sodium, & renal perfusion
7. S/S of Sepsis: 2 SIRS + Confirmed or suspected infectionSIRS: T:>100.4F or <96.8F
RR: >20
HR: >90
WBC: >12,000 OR <4,000
PCO2: <32 mmHg
8. Peritoneal Dialysis: Inserting a catheter through the anterior abdominal wall, is initiated
immediately or delayed for 2 weeks, solution warmed to body temp., three phases Inflow,
dwell, & drain
9. Inflow: Amt of solution infused through catheter over about 10 mins
10. Dwell: Diffusion & osmosis occur btw patient's blood & peritoneal cavity. Dura-tion
varies
11. Drain: Lasts 15-30 mins, facilitated by gently massaging abdomen or changingpositions
12. Complications of PD: Exit site infection, peritonitis, hernias, lower back prob-lems,
, protein loss, bleeding, pulmonary complications
13. Hemodialysis: Two needles place in fistula or graft, one pulls blood from circu-lation to
HD machine and other is used to return dialyzed blood to patient. Assess wt before tx, take
VS q30-60 mins
14. Hemodialysis Complications: Hypotension, muscle cramps, loss of blood,hepatitis,
disequilibrium syndrome
15. Early VS late Septic Shock: Early:BP - normal
HR - Tachycardia Skin color - normal
Skin temp - cool & moist
Sensorium - anxious
Resp - Increased rate & depthLate:
BP - SBP 190 mmHg
HR - Tachycardia & weakSkin color - Pale
Skin temp - cold Sensorium - coma
Resp - Increase rate & shallow
16. What are causes of shock?: Too little blood/fluid volume, 'pump' problem,anaphylactic
reaction, obstruction
17. Lab values related to septic shock: Increased:
WBCBUN
Lactate
Blood glucose
Urine specific gravityCreatinine Procalcitonin Decreased:
PLT
WBC bands
18. Does shock increase or decrease cardiac output?: Decrease
19. Cardiogenic shock S/S: Hypotension, tachycardia/tachypnea, increased oxy-gen demand,
narrowed pulse pressure, decreased cardiac output, crackles on auscultation
20. What are S/S of hypoperfusion?: Weak, peripheral pulses, cool, clammy skin,delayed
capillary refill, cyanosis, pallor, diaphoresis
21. Diagnostics r/t Cardiogenic shock: ABG- resp alk. (early) metabolic acidosis(late), ECG-
dysrhythmias, echo- LV dysfunction, CXR- pulmonary infiltrates
22. Labs r/t to Cardiogenic shock: Increased:Cardiac markers
