Review NCLEX RN lippincott

Question Answer
what is buergers disease thromboangiitis obliterans is a nonatherosclerotic inflammatory vasoocclusive disorter. Predominantly affecting men under age 40 with hisory of smoking
Primary prevention in buergers disease is what? due to inflammation thrombus formation and potential occlusion of the vessel are common. embolism becomes a problem once a thrombus has formed as well as thrombophlebitis.
primary prevention in bone fracture fat emboli
how to prevent buergers disease SMOKING CESSATION IN YOUNG MEN. Admnistering bupropion/Zyban which is a non-nicotine med. Avoid all types of nicotine
signs of compartment syndrome pain, pallor, pulselessness. these are signs of acute occlusion of an artery by an embolus or something like compartment syndrome
Signs of atherosclerosis thickening of the intima and media of the artery
Signs of buergers disease/ thromboangiitis obliterans slowly developing claudication, cyanosis, coldness and pain at rest. This disease is characterized by inflammation and fibrosis of arteries, veins and nerves. WBC's infiltrate the area and become fibrotic resulting in vessel occlusion.
reynauds phenomenon/ vasospastic disorder should receive routine f/u monitor symptoms to assess for the development of connective tissue or autoimmune disease. May occur on TIPS OF NOSE
raynauds phenomenon vasospastic disorder. needs f/u for autoimmune and connective tissue disorder
raynauds phenomenon s/s vasospastic disorder. a form of intermittent arteriolar vasoconstriction resulting in coldness, pain, and pallor of the FINGERTIPS, TOES, TIPS OF NOSE and a rebound circulation with redness and pain. Medication: reserpine/Serpasil (causes dizziness)
Raynauds phenomenon risk factors most common in young women (16-40) and associated with collagen disorders such as Lupus and Rheumatoid arthritis/immulogic disorders, COLD CLIMATE
difference btwn buergers and raynauds/vasospastic buergers: common in young men that smoke. Raynauds: young women with connective tissue problems. S/S burgers: cyanosis, coldness and pain at rest. works on arteries and veins. S/S reynauds: vasospasms lasting minutes, numbness in fingertips, toes and nose
raynauds progression of symptoms pallor (grayish, whitish color) followed by cyanosis (bluish), then rubor (red, pain, swelling. sign of injury) lastly gangrene
assessing raynauds when they turn pale assess radial pulse first. DONT CHECK BP as it will further cause vasoconstriction
Education for raynauds live in warm setting. Wear gloves when handing cold things. put hands in warm water when having an episode. Wear loose warm clothing
Meds for raynauds Calcium channel blockers is first line drug. it relaxes smooth muscles and improves perfusion, reducing numbness. beta blockers may be used to decrease sympathatetic response
raynauds disease sympathectomy this surgery is performed when all other treatment alternatives have failed. If its controlled by meds and stress management theres no need for it.
sympathectomy when at least one sympathetic ganglion is removed. Done in raynauds disease when all else fails.
irreversible ischemia complications metabolic acidosis
Post op clients risk of what embolus. If c/o pain in legs, assess for color and temp changes associated with tissue perfusion. Instruct when sitting for long times to do leg pumps and active ankle and foot ROM to facilitate blood return
salpingo-oophorectomy removal of fallopian tube and ovary
Common cause of PE DVT. atheroschlerosis doesn't cause it cause this is related to the arteries which go away from the heart.
bed ridden clients at risk of what thombophlebitis due to venous stasis
signs of thrombophebitis and treatment during IV therapy D/C IV if sign of inflammation. PAINFUL, RED, WARM TO TOUCH. Apply warm compress and administer antiimflamatory agent per MD order. Insert new catheter in opposite extremity
contributing factors to cause of thrombophlebitis and thrombus formation venous stasis (immobility), damage to inner lining of vein (pressure), hyper coagulopathy of the blood (clotting issues)
post op dvt prevention pneumatic compression stockings, early ambulation, leg exercises.
Rubor sign of increased filtration pressure resulting in skin integrity problems
RISKS of thrombophlebitis obesity, use of estrogen based birth control, post op status
varicose veins evidenced by tortuous veins, may result of thrombophlebitis. DONT STAND FOR TOO LONG and if so wear compression hose
Anticoagulant therapy hematuria is one of the first signs of anticoagulant overdose
aneurysm repair signs of rupture sudden chest pain. Assess vital signs for hypovolemia them contact MD
signs of abdominal aortic aneurysm gray turner sign (bruise on flank), rapid pulse, hypotension, tachypnea and severe abdominal or back pain. First intervention is IV insertion
thoracoabdominal aneurysm repair risk spinal cord injury risk, so assess neuro post operatively and assess for numbing in feet
aneurysm enlarged/ ballooning portion of artery. Prepare for surgery. If it ruptures the primary goal is to maintain circulation
loss of conciousness is a sign of what loss of blood flow to the brain.
narrowing pulse pressure shock
widening pulse pressure increased ICP
If there is an aortic valvular insufficiency and the aortic arch is involved what happens? loss of blood to the cerebrum resulting in LOC
dissecting aortic aneurysm complications cardiac tamponade. may experience cardiac arrest.
dissection aorta symptoms severe tearing pain, SOB, pain in back and chest`
Dissecting aorta the innerlining of the aorta vessel begins to tear, it then tears into the middle layer. once in the middle layer the blood begins to fill in the middle layer of the vessel resulting in filling of the pericardium (cardiac tamponade). finally card. arrest
dissecting aorta risks HTN
post op aortic aneurysm risk for alteration in renal perfusion (decreased urine outut). related to renal artery emboli, prolonged hypotension, or prolonged aoric cross clamping during surgery.
pre op aortic aneurysm prep for surgery. have in semi fowlers position or as low as tolerable. teach breathing condition
paralytic ileus causes abdominal surgery. The bowels become obstructed (pseudo obstruction). May occur post operatively. NG suction is to prevent this from occuring.
Risk factors for paralytic ileus post op abdominal surgery. decreased mobility, bowel manipulation, narcotic use. Treatment is insertion of NG tube.
Post op aortic graft Teach that they should inform MD and initiate ABT therapy preoperatively for dental work. Prophylactically for infection control measures.
Stasis ulcer Necrosis of tissue secondary to edema and decreased circulation.
ABI test (ankle brachial index) noninvasive test to determine the degree of peripheral artery disease there is. mild: .71-.90. moderate: .41-.70. Severe: .00-.40. It's performed by measuring the clients highest brachial SBP and dividing it by the ankle SBP
arteriosclerosis: revascularization to get tissue perfusion have the extremity below the bodies horizontal plane. Avoid hard surfaces to prevent tissue breakdown/ulcers. Handle involved extremity gently.
Abrupt withdrawal of beta blockers rebound tachycardia
obtaining samples blood samples must be labeled in front of client. room number isn't appropriate method of ID.
iron deficiency anemia take on empty stomach. Take with OJ. Take ginger for nausea. High fiber diet to prevent constipation. NO STOOL SOFTENERS. No coffee or tea cause it causes decreased absorption of nonheme iron. Activity intolerance occurs over a long time. Compare to past
Side effects of chemotherapy decrease RBC count. Causing fatigue .Take frequent naps
microcytic/hypochromic anemia light in color RBC's. Require iron. Iron sources: eggs, organ memats, shellfish, whole grains, dried fruits, oatmeal, sweet potato.
source of b12 meats and dairy
source of vitamin C brocolli and brussel sprouts and citrus
serum B12 200-900pg/mL
serum folic acid 1.8-9ng/mL
causes of low folic acid level (anemia)/megaloblastic anemia if b12 level is normal its a deficiency anemia. This is caused by oral contraceptives, antiseizure drugs, ETOH, and methotrexate
pernicious anemia/megaloblastic anemia lack of intrinsic factor resulting in atrophy of the stomach wall. So vitamin b12 cant be absorbed in the intestines. Folic acid needs b12 to make RBC. Must get IM B12 shots. Ventrogluteal and dorsogluteal
Schilling test is done to detect if client has clotting factors if its positive than the person has the intrinsic factors
intrinsic factor necessary for absorption of B12 by small intestines
aplastic anemia they are very immunocompromised. Bone marrow doesn't make enough new blood cells. RBC's.
parts of intestines small intestines: duodenum, jejunum, ileum. Large intestines: cecum, ascending colon, transverse colon, descending colon, sigmoid colon
B12 absorption B12 combines with intrinsic factor in the stomach and is then carried to the ileum where its absorbed. Without an ileum B12 cant be absorbed.
dorsogluteal on butt
ventrogluteal on side of butt
position for b12 injection lye on abdomen with toes pointed inwards to promote relaxation
risk for pernicious anemia removed ileum, stomach staple surgery
signs of pernicious anemia numbing and tingling. depression
signs of anemia jaundice, decreased urine output, electrolyte imbalance
cephalosporins, sulfa drugs, rifampin, methyldopa, procainmide, quinidine, and thiazides cause drug induced hemolytic anemia.
shilling test when dye is given 24-48 hour urine test is started. In normal person the dye comes out in urine. In someone with pernicious anemia it'll come out in stool
thalasemia major a hemolytic anemia found in ppl of mediterranean descent. It causes sequestration of RBC's in the liver and spleen resulting in engorgment. They require rest periods to decrease cardiac demands
Congenital enzyme deficiency anemia (G6PD deficiency anemia) Self limiting. G6PD is an enzyme in RBC's. When cells with decreased G6PDs are exposed to certain drugs (bactrim, sulfonamides, thiazide diuretics, Vit K) they hemolyze and anemia and jaundice may occur. Occurs in 10% of black women.
hemochromotosis iron overload disease. The body builds up too much iron. Ppl heterozygous for it rarely develop it. Men and women equally likely. Men diagnosed first causes signs aren't present until after menopause.
Hemolytic blood transfusion reaction no use of vasopressor. collect blood and urine after stopping infusion.