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1329 unit 1 study
Terms in this set (143)
Hemorrhagic and nonvascular lesions DO NOT blanch, but ______________________ lesions do.
isolation of a pathogen on culture media
the effect that antimicrobial agents have on a micro-organism
_________fluid makes up 2/3 of the body
fluid outside the cell
_______makes up 1/3 of the fluid in your body
__________fluid is the water that surrounds the cells, INCLUDES LYMPH
What is the fluid called that in inside veins, arteries, capillaries and AKA blood plasma
The primary control of fluid in the body is through, ______________ __________ in the vascular system that stimulate or inhibit the release of ADH from the pituitary gland.
ADH (antidiuretic hormone)
Produced by Posterior lobe of Pituitary Gland. Targets kidneys for water conservation.
If fluid pressure increases, less ADH is released, and what?
the kidneys release more water
Energy-requiring process that moves material across a cell membrane against a concentration difference
ATP adensoine triphosphate
What are the 3 kinds of passive transport?
diffusion, filtration, osmosis
high concentration to low
H20 and particles across SP membrane from area of higher pressure to lower
movement of H20 from area of low concentration to high
same osmolarity as blood
(ie) 0.9% normal saline
What has the same osmolarity as blood?
0.9% normal saline
Lower osmolarity than blood
what happens when a hypotonic solution is given by IV?
the water in solution leaves the blood and goes into the cells
greater osmotic pressure than blood
what happens when a hypertonic solution is given IV?
water leaves the cells and enters the blood stream
What are SENSIBLE LOSSES?
losses the patient is aware of such as urination
What are INSENSIBLE LOSSES?
losses you may not be aware of:
sweating, respiration, defecation
Common reasons for dehydration?
severely draining wounds
Where are most fluids found?
What is an example of an Active transport, ATP pump?
Examples of isotonic fluids
normal saline, lactated ringers
examples of hypotonic fluids
1/2 NS and 1/4 NS
Examples of hypertonic solutions
D10W, 3%NS, 5%NS, D5LR, D5-1/2NS, D5NS, TPN, Albumin
What is atelectasis?
collapse of the alveoli in the lung
prevents normal exchange of O2 and co2
lying on back with legs raised and feet in stirrups, hips and knees flexed, thighs abducted and externally rotated
inflammation of a vein with clot formation
composed of clear, serous portion of the blood and from serous membranes
wound pulls apart at the suture line
The displacement of organs outside of the body.
You will have to maintain an NPO status until the _____ and _______ returns.
gag reflex, peristalsis
thirst, weak rapid pulse, dry skin/mouth, not voiding, elevated temp, confusion, low b/p, tenting skin, cracked lips, not sweating
All these are signs of what?
high b/p, bounding pulse, SOB, increased urine output, weight gain, edema, crackles in the lungs
If a patient is going home after hospitalization for hyper volemia what discharge instructions would you give? Select all that apply.
A. weigh yourself in the AM 3X a week
B. drink extra fluids
C. Reduce your sodium intake
D. Take your diuretics in the AM
a, c, d
tension; prolonged, continuous muscle contraction
what fluid imbalance is hyperactive deep tendon reflexes a sign of?
2 classic signs of hypocalcemia?
Trousseau and Chvostek
Which of the following are functions of sodium in the body? SELECT ALL THAT APPLY
A. maintenance of serum osmolarity
B. formation of bones and teeth
c. control bronchodilation
d. control serum glucose
e. maintenance of cellular function
what is the papilla?
a cluster of connective tissue and blood vessels at the base of a hair follicle
What do sebaceous glands secrete?
contain a duct that leads to a hair follicle instead of the skins surface, located mainly in the axillary and anogenital (groin) areas
glands that produce sweat; found over most of the body
sore that do not heal, moles that change color, or lumps may indicate _________
slow healing could be due to ___________
brown staining of the lower extremities is associated with?
redness of the skin
yellowing of the skin and the whites of the eyes
a bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood.
Primary lesions include
Macule, Papule, Plaque, Tumor, Urticaria, Vesicle, Bulla, Wheal, Cyst, Pustule
result from the changes that take place in the primary lesion due to infection, scratching, trauma, or various stages of a disease
pinpoint purple or red spots from minute hemorrhages under the skin
How does cyanosis present in a dark skinned person?
gray cast to skin, nailbeds, palms, and soles of feet might be bluish
flat, colored spot on the skin
(ex) rubella, scarlet fever, freckles
small, solid skin elevation, less than 1cm
(ex) ringworm, wart, mole
solid elevated lesion, larger and deeper than a papule
(EX) fibroma, intradermal nevi
small, blister-like raise area that contains serous fluid, up to 1 cm
(EX) poison ivy, shingles, chickenpox
Long, coarse, pigmented hair found on the scalp, legs, arms, pubic areas, axillae, and face and chest of men
peach fuzz body hair
clubbing of the fingers may indicate what?
spoon nails may indicate what?
thick nails may indicate what?
what do you describe when assessing abnormal skin conditions?
color of lesions, pain, swelling, redness, location, size, drainage (amount, color, odor), eruption paterns
When bathing elderly patients, why is it important to dry them thoroughly?
water left to evaporate can cause drying, cracking, and fungal infections
If a viral culture is ordered, how is the specimen handled after getting the sample?
must be kept on ice and sent to lab ASAP
Use cream or lotion without perfume to moisturize the feet. DO NOT ___________________
put between the toes..
removal of a small core of tissue using a hollow punch
a technique using a surgical blade to "shave" tissue from the epidermis and upper dermis
deep incision, most always requires suturing to close
how long should a balneotherapy bath last?
colloidal baths are used for?
widely distributed skin lesions, drying and relief of itching
Balnetar, a medicated tar bath, is used for what?
chronic eczema and psoriasis
inflammation of the skin at the base of the nail
The purpose of wet dressings?
to decrease inflammation, cleanse and dry the wound, and promote drainage of infected areas
what are the common solutions for a wet dressing?
saline solution, Burow solution (aluminum acetate), or magnesium sulfate
wet dressing should not be prescribed for more than ___________ b/c the skin may become too dry and macerated
injecting a sterile suspension of medication into or just below a lesion
Continued use of an occlusive dressing can cause what?
skin atrophy, folliculitis, maceration, erthema, and systemic absorption
what are some hydrocolloid dressings?
Use Alginates for?
absorb exudate and form a soft gel to maintain moise environment
-derived from silver, iodine, & polyhexamethylene biguanide
-used in draining, nonhealing wounds that have bacterial contamination
(EX) burns, surgical wounds, diabetic ulcers, pressure injuries, and leg ulcers
Multilayer dressing made from a combination of wound dressing categories, may absorb and also cover a wound
provides a moist environments and thermal insulation
moist environment, allows epithelialization and granulation to form, PROVIDES AUTOLYTIC DEBRIDEMENT
gel forming polymer such as gelatin, pectin, and carboxymethylcellulose with a strong film or foam adhesive backing. absorb exudate by swelling into a gel like mass and vary from being occlusive to semi permeable. does not attach to actual wound itself and is instead anchored to intact skin surrounding the wound. PROVIDES AUTOLYTIC DEBRIDMENT
WHEN IS THE BEST TIME FOR THE NURSE TO APPLY PERSCRIBED OINTMENT TO A PATIENT WITH AN INFLAMED SKIN RASH?
after the pt. bathes
which nursing interventions are essential to achieve max. benefit for the pt. receiving balneotherapy for widespread dermatitis? SELECT ALL THAT APPLY
1. maintain bath water at the highest temp
2. keep pt. in water for 15-30 min
3. keep tub room warm
4. dry the skin vigorously following bath
5. use gentle or emollient soaps
2, 3, 5
which term should the nurse use to document a raised, fluid-filled lesion smaller than 1cm?
what equipment is most important to have avail. when a pt. is undergoing skin testing for allergies?
which nursing intervention is essential to protecting the pt.'s skin integrity when applying occlusive dressings?
remove the dressings for 12 of 24 hours
What are the 2 types of anesthesia?
general and local
the blockage of all body sensations, causing un-consciousness and loss of reﬂexes.
causes the loss of sensation in a limited area by injecting an anesthetic solution near that area
procedure using an instrument that emits a high-powered beam of light used to cut, burn, vaporize, or destroy tissue
OFTEN USED FOR EYE SURGERY
a small flexible tube with a light and a lens on the end, minimally invasive surgery AKA: KEYHOLE SURGERY
surgical procedures within the abdominal or pelvic region using a laparoscope
surgery of the chest and thoracic cavity
removal by cutting
suturing or repair
formation of a permanent artificial opening
formation or repair
4 types of surgery
urgent- within 24-30 hours
optional- requested by patient
lack of oxygen
after surgery what is a high protein diet for?
tissue repair and healing
after surgery what is a diet with high portions of vit-C for?
after surgery what is a diet with high portions of zinc for?
tissue growth, skin integrity, and cell-mediated immunity
patients are asked to quit smoking how long before surgery?
24 hours, 3 to 4 weeks if has chronic lung disease
prothrombin time/international normalized ratio
arterial blood gas
blood urea nitrogen
0.6-1.2 mg/dL nitrogenous waste excreted in the urine
CBC (complete blood count)
a set of tests that include all WBC, RBC and platelet measurements.
A hereditary condition of uncontrolled heat production that occurs when susceptible people receive certain anesthetic drugs.
malignant hyperthermia treatment
-must be prompt
1. Dantrolene sodium (skeletal muscle relaxant) 2-3 mg/kg
2. Stop all inhalant anesthesia agents
3. Intubate, ventilate with 100% O2 with high flow rate
4. packed in ice/cool compresses to remove body temp
Anesthesia and pain meds cant be given until what is signed?
control nausea and vomiting by blocking nerve impulses to the vomiting center of the brain
examples of surgical opioids
what are some preventatives for intraoperative hypothermia?
-prewarming patient's skin before anesthesia
-forced-air warming system
the period of time from when anesthesia is given until full anesthesia is reached
med used with primary anesthesia agents
Complications of spinal block
postdural punture headache
surgical sedation meds
post anesthesia care unit
after surgery, a neurologic assessment consists of?
level of consciousness
orient to person, place and time and event
pupil size and reaction to light
motor and sensory function
Removal of foreign matter or dead tissue from a wound
Pus: indicates a bacterial infection
Moderate, pink ________(consisting of blood and serous fluid) drainage is expected from a Penrose drain
drains that use suction
complete absence of peristaltic movement that may follow abdominal surgery or complete bowel obstruction
Paralytic Ileus S/S
Absent bowel sounds
(NPO until bowel sounds return)
What is Vit K used for?
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