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NURSING>NURSING NUR280/NURN3 Final Exam Study Guide/NURSING MISCN3 Final Overview.
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NURSING>NURSING NUR280/NURN3 Final Exam Study Guide/NURSING MISCN3 Final Overview.
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N3: Final Exam Study Guide1. CAM (Complementary & Alternative Medicine)
a. What is Complementary?
i. “In addition to…” modern medicine
b. What is Alternative?
i. “Instead of…” modern medicine
c. Define “Chi”
i. Chinese life force that provides warmth and protection from illness and injury.
d. Reiki
i. Use of hands to correct energy fields/chakras. Energy flows from universe into
patient. Can help increase WBC and RBC production. Realignment of energy
flow.
e. Ayurveda
i. Indian medicine. Preventive medicine that teaches health is balanced by
nature, body, mind and spirit. Uses oils, diet, senses and behavior.
f. Guided Imagery
i. Focusing on an image either created by the therapist or by the patient’s
mind. Uses all 5 senses. S/E are sleepiness and extreme relaxation.
g. Biofeedback
i. Uses thoughts to control physiological body responses. Electrodes are placed
on patient to monitor body response to stress. Patient then relaxes those areas
during times of pain, anxiety, temperature, HTN, TMJ, H/A, etc.
2. Stroke
a. What test needs to be done right away when a stroke patient comes to an ER?
i. CT SCAN immediately! This will help determine what type of stroke has occurred.
ii. CT doesn’t require NPO status or any contrast. Results are immediate.
b. A patient started having a headache at 4am and started slurring their speech
around 0415. If they do, in fact, have an embolic stroke, how long is their
window to be able to get TPA? Hint: First symptom was the headache.
i. “Golden 3-Hour window” from the “last time normal” to the time the TPA
is administered.
3. ICP
a. ICP is…
i. Intracranial Pressure (pressure within the skull)
b. A normal ICP is…
i. 7-15mmHg
c. What things increase ICP?
i. Anything that makes your face RED increases ICP
ii. Blowing nose, sneezing, lowering HOB, swelling (tumors, stroke, meningitis, etc.).
d. If a patient is at increased risk for increased ICP a patient who is intubated will
be at 30-45% and a non-intubated person will be at 15% to 45%. Why?
i. Elevating the HOB improves venous drainage and decreases ICP
e. What do hypertonic saline and Mannitol do for
ICP?
i. Mannitol: takes ICP fluid to kidneys for removal
ii. Hypertonic Saline: pulls fluid from the tissues into the bloodstream, such
as burns, ICP and post-op to reduce swelling.
, f. Why is clustering a bunch of activities together for a patient with increased ICP
a bad idea?
i. This can increase ICP. Therefore the nurse must decrease stimuli and maintain
a calm, low noise, low light, and stress-free environment.
g. Why is giving a stool softener a good idea?
i. We don’t want these patients to STRAIN with their bowel movements, as it
will increase ICP.
h. What are the early indicators of increased ICP? What are the late indicators?
Early Indicators Late Indicators
H/A (usually BAD and Pupillary changes
prolonged) N/V Cheyne Stokes (from lack of O2 to
Blurry Vision brain) Widening Pulse Pressure (sys-
dys=pp) Bradycardia
Bulging Fontanels (in
infants) Irritability (in
infants)
i. What is Cushing’s triad and what does it tell you?
i. Indicates LATE increase in ICP
ii. BAD NEWS!
iii. Symptoms Include:
1. Bradycardia
2. Widening Pulse Pressure
3. Cheyne Stokes (changes in respirations)
j. What are the bad posturing poses we talked about and what might they indicate?
i. Decerebrate Posturing
1. Pointed toes, arms down, wrists are flexed out
ii. Decorticate Posturing
1. Everything is pulled towards the core
4. Liver
a. Know your liver labs
i. ALT: 3-35 IU/L or 8-20 units/L
ii. AST: 5-40 units/L
iii. ALP: 30-120 units/L
iv. Bilirubin: 0.1-1.0 mg/dL
v. PTT: 11-12.5 sec
vi. INR: 0.7 – 1.8
vii. Hemoglobin: 12-18g/dL
viii. Platelets: 100,000 – 400,000
, ix. Ammonia: 15-45mcg/dL (or 11-32 umol/L)
x. Creatinine: 0.5-1.2 mg/dL
xi. Albumin: 3.5 – 5.0 g/dL
xii. Potassium (K+): 3.5-5.5 meq/L
b. What is going on with lab levels in Liver Dysfunction?
Levels that are going UP Levels that are going DOWN
ALT Hemoglobin
AST Platelets
ALP K+ (initially)
Bilirubin Albumin
Creatinine
Ammonia
PTT/INR (prolonged)
c. What do you give to reduce ammonia levels?
i. Lactulose
d. Initially, potassium can be very low in liver failure, but it gets tricky later on in
the disease as kidneys are affected.
e. Why are liver failure patients at such great risk for bleeding? What labs reflect
this problem?
i. Liver is highly vascularized
ii. LOTS of blood vessels!
f. Hepatitis A, B, and C: What are the symptoms, and how are they spread
(vowels versus consonants).
Hep A Hep B Hep C
Symptoms: Mild, flu-like sx Symptoms: anorexia, N/V, Symptoms: Flu-like sx (can
jaundice, fever, rashes, light be severe)
Spread: Fecal – Oral colored stool, dark urine
Route Contaminated Spread: Blood – Body Spread: Blood – Body
food/water, Shellfish Fluids Sex, healthcare Fluids, IV drug users,
workers,
needles, drug users,
hemodialysis pts.,
babies
5. Mobility
a. CMS, CMS, CMS: This is VERY IMPORTANT IN FRACTURES. What does it stand
for and how do you measure it?
i. CMS stands for: Circulation, Motion, Sensation
1. Circulation: pulses, capillary refill
2. Motion: can they move?
3. Sensation: N/T, feeling
b. RICE: What is it? What do we use it for? (almost all injuries, right)?
i. RICE stands for: Rest, Ice, Compression, Elevation
ii. Helps prevent swelling. Vasoconstriction.
c. Hip Surgery. Knee Surgery. What are the risks? What things do you assess
for? Why?
i. Circulation, sensation and motion distal to the affected area.
ii. PT is at risk for: DVT, wound infection, hematoma, hip dislocation,
and neurovascular compromise.
, d. What is the difference between an open or closed fracture? What do you place
on an open fracture?
i. Open Fractures: skin is broken, bone is showing
1. Cover with a sterile saline soaked gauze dressing
2. Stop the bleeding. Analgesia, ABX, Tetanus shot
3. Immobilize & elevate
ii. Closed Fractures: skin is still intact. Bone does NOT penetrate skin.
e. Do you use a cold pack (ice) and the rest of RICE with a fracture?
i. YES! Absolutely!
f. What is compartment syndrome and what would you assess if it was
compartment syndrome? What are the risks to your kidneys (condition that
starts with an “r”)?
i. Compartment Syndrome:
1. Swelling in tissues that compromises perfusion
2. Monitor for the 6P’s
a. Pain
b. Paresthesia
c. Paresis
d. Pressure
e. Pallor
f. Pulse
3. First sign is Extreme pain disproportionate to the injury, along with
change in sensation distal to the affected compartment
4. Can be prevented by…
a. Reducing bleeding and inflammation to site of injury. For
fractures this could be traction, early splinting, early
immobilization, elevation of the limb TO THE LEVEL of the heart
(NOT above it!).
g. Electrolytes & Fluid
i. K+ normal values? 3.5 – 5.5 meq/L
Hyperkalemia Hypokalemia
Twitches and contractions Weak, slowing things
Cramping, irritable dow Fatigue, decreased
Hyperactive bowel respirati
Peaked T Wave Flat T Wave
ii. Na+ normal values: 135-145 mg/dL
Hypernatremia Hyponatremia
Dehydration Symptoms! Neurological Symptoms/BR
Dry mucous membranes, poor skin Confusion, coma, changes
turgor, hypotension LO JVD, bulging fontanels, H
Thirst Excess water accumulatio
iii. Ca+ normal values: 8.5 – 10.5 mg/dL
Hypercalcemia Hypocalcemia
Weak, slowing things down Twitches and
contraction
Fatigue, hyporeflexia, coma Chvostek’s Sign
Hypoactive bowel sounds Trousseau’s Sign
Tetany, diarrhea,
crampin
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