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Final Exam Content Guide Latest Update 2025 Top
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- Stroke – CVA – Brain attack disruption of cerebral blood flow secondary to ischemia, hemorrhage, brain attack, or embolism 1) Hemorrhagic – ruptured artery or aneurysm = ischemia and ↑ICP caused by expanding collection of blood. Prognosis poor. 2) Thrombotic – d/t development of blood clot on an atherosclerotic plaque in a cerebral artery. The clot gradually shuts off the artery causing ischemia distal to the occlusion. Symptoms evolve over several hours to days. 3) Embolic – d/t embolus traveling from another part of the body to the cerebral artery. Blood to brain distal to occlusion immediately shuts off causing neuro deficits, or a loss of consciousness can instantly occur. --- This type of stroke may be reversed with rtPA if given within 4.5hrs of initial symptoms. Risk Factors : HTN, DM, smoking == PREVENTION == Early treatment of HTN, maintain BGL, quit smoking. Right vs Left: Right = visual and spatial awareness and propriception. Left = language, math, and analytic thinking (agnosia – inability to recognize familiar objects). Interventions : Have suction equipment avail. Vitals 1-2hrs – Notify MD if BP >180/110. Temp (↑ can cause ↑ICP). O2 and maintain > 92%. Cardiac monitor. Monitor LOC (↑ICP). Elevate HOB >30 to reduce ICP and promote venous drainage. Maintain midline neutral position. SEIZURE Percautions. Assist with communication. Assist with safe feeding. Intervene for complications r/t immobility. Active ROM to unaffected exteemities, and Passive ROM to affected extremities. Vision deficits = instruct scanning techinique (turning head). Prevent DVT. Assist with ADL’s. Provide frequent rest. Complitcations: – Prevent shoulder subluxation if affected arm is not supported. Unilateral neglect (nurse to provide arm sling/foot rest). Dysphagia and aspiration (nurse assess gag reflex, monitor swallowing). MEDS : Anticoagulant: Enoxaparin (Lovenox), warfarin (Coumadin) – Antiplatelet: Aspirin
- Thrombolytic: rtPA – Antiepileptic: phenytoin (Dilantin), gabapentin (Neurontin)
- Traumatic brain injury – major causes, eligibility for federal programs, types, assessment, interventions, rehabilitation, support, interdisciplinary care planning, sympathetic storming prevention
- Mild brain injury – common types, assessment, interventions, patient education, prevention
- Moderate brain injury – common types, assessment, interventions, treatments, interdisciplinary care planning, patient education, prevention
- Increased intracranial pressure – assessment, interventions, unsafe interventions, treatments, monitoring, common medications, what to avoid, interdisciplinary care planning, patient education Treatment: Cooling blankets to lower overall body temperature. By lowering temperature of the body, the metabolic rate in the brain decreases, thus reducing metabolic demands and allowing the brain to begin to recover; Sedative or neuromuscular medications may be needed to prevent shivering and anxiety, which will increase temperature; ICP is measured by placing a small tube in the ventricles of the brain (ventriculostomy) Nursing Interventions: - Monitor the cerebral perfusion pressure, difference between the CPP is the difference between the ICP and the mean arterial pressure (MAP) - CPP is calculated by subtracting the ICP from the MAP - Keep oxygen saturation at 100% - Help with environmental stimuli; keep lights and noise low - Visitors limited to one to two for short time - Institute measures to promote healing and prevent complications; turn every 2 hours & HOB at 30 - Compression stockings - Anticoagulant therapy
- Brain tumor - Cancer usually originates in the lung and breast but can also start in the kidney, prostate, or as lymphoma or melanoma, which then spreads to the brain
- Cirrhosis – Cirrhosis of the liver is a chronic, progressive condition characterized by destruction of the liver cells and subsequent formation of fibrotic tissue that reconfigures normal, healthy liver tissue. This lack of elasticity causes blood, bile, and lymphatic systems to become congested and obstructed, and further damage is incurred. ■ Extensive scarring of the liver caused by necrotic injury or chronic reaction to inflammation over time.
■ Signs and symptoms: Jaundice develops from liver’s inability to handle the flow of bile. Ascites. Petechiae, ecchymosis (large-yellow, purple-blue bruises), nosebleeds. Asterixis (liver flapping tremor – rapid flexion of wrists and fingers). Fetor hepaticus (liver breath – fruity or musty odor). o Causes: 3 major types of cirrhosis, which are differentiated by the underlying pathology. ▪ Laënnec’s cirrhosis - Alcoholic Cirrhosis ▪ Postnecrotic Cirrhosis: caused by viral hepatitis or certain meds or toxins. ▪ Biliary Cirrhosis: chronic biliary obstruction or autoimmune disease. ▪ Cardiac Cirrhosis : Occurs when blood flow out of the liver is restricted by severe right sided- sided failure. Tricuspid regurgitation can be associated with cardiac cirrhosis. A large amount of blood is delivered to the liver each minute. When that blood is not able to exit at a predictable rate, liver engorgement occurs and the pressure in the liver vasculature increases, causing venous congestion, anoxia or hypoxia, and hepatic cell necrosis and subsequent fibrosis. LAB: ALT/AST elevated initially due to inflammation, but then return to normal when liver is unable to produce an inflammatory response.
- RBC, Hbg, hematocrit, platelet are all decreased. - Ammonia ↑ -- cirrhosis prevents conversion to urea DIAGNOSTIC: Ultrasound, Abd X-ray, CT, LIVER BIOPSY, EGD, ERCP ERCP: Endoscopic retrograde cholangiopancreatography -- used to view the biliary tract to assist in removing stones, to collect specimens for biopsy, and for placement of a stent. Interventions: Monitor Resp status – HOB 30. Skin integrity = Pruritus occurs with jaundice (use cold water and lotion to stop scratching). May need to restrict fluids (ascites, peripheral edema). Monitor neuro status for hepatic encephalopathy. DIET: high carb, fat, and protein – low sodium. If ascites – measure abd girth daily. MEDS: General meds admin’d sparingly. Give diuretics. Lactulose may be needed to rid body of ammonia thru stool. Beta Blockers if PT has varices. Procedures: Paracentesis, Surgical bypass/shunt, liver transplant,
- Liver damage – Associated lab values, types, common treatments, assessments, interventions, support, interdisciplinary care planning, patient education
- Liver transplant – Reasons for in children and adults, common medications associated with, lab values, monitoring, interdisciplinary care planning
- Hemochromatosis – Assessment, diagnostic tests, lab values, interventions,
o Liver enzymes can be elevated with conditions such as diabetes, obesity, autoimmune disorders, some viral infections (especially hepatitis), and some genetic diseases. o Prothrombin and hemoglobin prior to liver biopsy
- Portal Hypertension -Assessment of, symptoms of, common diagnostic tests, lab values associated with, common medications, interdisciplinary care planning PH - Is the constant pressure of the blood, bile, and lymphatics within the liver. TREATMENT
- Shunts to relieve the pressure in the portal vein
- Shunts diverted blood from the portal vein to the inferior vena cava, thus bypassing the fibrotic blockage that caused congestion in the liver. distal splenorenal shunt (DSRS)
- Transjugular intrahepatic portosystemic shunt (TIPS)
- Macrovesicular fatty liver – Assessment of, common causes of, risk factors, treatment, diagnostic tests, lab values, patient education, interdisciplinary care planning
- Musculoskeletal injuries – common types, assessment of, treatment for, common symptoms, activity and work related injuries, patient education, common medication
- Casting – What risks are associated with applying a cast for a fracture? a. For unstable fractures casts may not be adequate in maintaining bone alignment. Complications of not maintaining proper alignment include nonunion, delayed union, or displacement of the fracture
- Acid-base imbalance – Assessment of, causes of, different types, lab values associated with, diagnostic tests, treatment, risks associated with, patient education
- COPD – Assessment, symptoms, causes, treatment, common medication, risks associated with, common lab values
- Colon Cancer – Risk factors, assessment, treatment, symptoms of, common treatment, patient education, diagnostic tests
- Chemotherapy – Common side effects, patient education
- Bone Marrow Transplant – Monitor, patient education, common medications, risks associated with, types of
- Lung Cancer – surgical treatments, what to monitor, patient education
- Sinoatrial node – Function, complications of, symptoms of malfunctions of Pacemaker of heart. 60-100bpm (located – junction superior vena cava and Rt Atrium)
- Serum electrolytes –complications associated with abnormal values, symptoms of abnormalities, patient education Magnesium Mg (1.8-3) Phosphorus P (2.5–4.5 mg/dL) -- Ca relationship Potassium K (3.5–5 mEq/L) -- Never give IV push, Highest IV rate 10meq/hr (may burn) Calcium Ca (8.5–10.5 mg/dL) -- Inverse relationship with phosphorus – ex: Low P when Ca is elevated Sodium Na (135–145 mEq/L) Carbon dioxide CO2 (22- mEq/L) Bicarbonate (venous) 23-29 mEq/L Chloride (cl) – (98-107 mEq/L) -- Bromides can cause false elevation of chloride levels - repeat lab draws
- Hemoglobin –symptoms of abnormal values, complications of abnormal values, patient education HBG – 12-17 g/dl (Males: 13.5-18 grams/dL; females: 12-16 grams/dL) -Normally, Hgb and Hct levels parallel each other; Hct is usually 3 times higher than Hgb level 35. Anticoagulant therapy - PT and INR : NORM: 9.6-11.8 seconds --- Females slightly under (9.5-11.3)
- Coumadin= 1.5 to 2.0 times the control in seconds
- INR is similar to PT but standardizes normal values across all lab systems; it measures effectiveness of oral anticoagulation 5. Normal reference ranges are 2.0–3.0 for standard warfarin therapy and 3.0–4.5 for high-dose therapy
- An INR >4 may result in ↑risk for bleeding
- aPTT : NORM: aPTT value is 20 to 35 seconds, Heparin = 1.5 to 2.0 times the control in seconds - LOW= ineffective therapy HIGH=Risk for bleeding or hemorrhage
- Clotting time : normal 8-15minutes
- Platelets - Normal and abnormal values, risks associated with abnormal values,
f. Take blood pressure g. Assess level of consciousness and pupillary response, weakness or paralysis of extremities Treatment for anthrax RED: Priority I or emergent care is needed for victims who need immediate treatment, such as those with cardiac or respiratory distress, trauma and bleeding, or neurological deficits YELLOW: Priority II or urgent care is needed for victims who need treatment within 2 hours, such as clients with simple fractures, lacerations, or fevers; these victims should be reevaluated every 30 to 60 minutes GREEN: Priority III or non-urgent care is needed for victims who need treatment that can wait for hours; those with sprains, rashes, and minor pain should be reevaluated every 1-2 hrs. ORANGE tag indicates a client who has a non-emergent psychiatric condition BLACK: Victims who are deceased should be labeled with a black tag and transported to designated temporary morgue
- Burns – Phases, different types, phases, monitoring and treatment associated with each type and phase, interventions, interdisciplinary care planning, patient education, medication management
- Chest trauma – assessment, clinical manifestations, medication management, diagnostic tests, interventions, lab values
- Mechanical ventilation – How to communicate with a client who is, complications of, what to monitor, patient education, why and when is it used
- Sinus bradycardia – Assessment, symptoms, causes, interventions, treatment, common medication management, patient education 44. ECG tracings
- Shock – The shock syndrome, or acute circulatory failure, can be classified according to etiology into three basic categories: hypovolemic, cardiogenic, and distributive. Sub- categories of distributive shock include neurogenic, anaphylactic, and septic.
pulse & resp rates, keep normothermic. Compensatory - - Body is trying to bring us back to homeostasis maintain BP and tissue perfusion. -Neural changes: SNS activated (epi/norepi activated) -Hormonal changes: (ACTH is released, kidneys affected, K+/Na+ affected) -Chemical compensation (leads to respiratory alkalosis!)
- Monitor heart rate and pulse, blood pressure, central venous pressure (CVP), respiratory rate, core, and peripheral temperature, and urinary output. Pulse oximetry may also be performed. Arterial gases are monitored for accurate assessment. Blood sampling for urea and electrolyte levels, full blood count, and glucose levels may also be performed. Elevated glucose levels are present with release of stress hormones such as cortisol. Progressive - Multi organ dysfunction syndrome (MODS). Organ hypoperfusion Compensating mechanisms begin to fail. Symptoms are evident of inadequate organ perfusion. A full assessment should be done to identify any signs of blood or fluid loss, fluid shift as in ascites, infection, vomiting, or inadequate fluid intake.
Refractory - - Death is inevitable. Failure of compensating mechanisms. No response to treatment. Risk of cardiac arrest. A rising serum lactate is an indicator of inadequate tissue perfusion due to metabolic acidosis. Low arterial oxygen content, chest pain, cardiac dysrhythmias, altered LOC, ↓urinary output. MAPB cannot be maintained without assistance. ASSESSMENT AND CARE OF SHOCK SYNDROME Clinical findings correlated with organs compromised by inadequate oxygen. Regardless of the type of shock, it leads to a SBP of less than 90 mm Hg and the narrowing of pulse pressure that is inadequate to meet the tissue needs. (SBP may be elevated initially.) Myocardial infarction – Coronary artery blood flow is blocked by atherosclerotic narrowing, thrombus formation, or (less frequently) persistent vasospasm; myocardium supplied by arteries is deprived of O2; persistent ischemia may rapidly lead to tissue death" Main cause is coronary artery disease (CAD), buildup of atherosclerotic plaque in coronary arteries that restricts blood flow to heart a. Nonmodifiable risk factors include age, gender, family history, and ethnic background b. Modifiable risk factors include smoking, obesity, stress, elevated cholesterol, diabetes mellitus, and hypertension ECG (12-lead): ST elevation, accompanied by T-wave inversion in leads that monitor affected area of heart; these changes resolve as treatment progresses Lab findings : elevated troponins (early or late diagnosis); elevated CK-MB isoenzymes over 5% (early diagnosis); or elevated LDH with “flipped” isoenzymes (late diagnosis)" Signs and Symptoms: N/V or just nausea, Diaphoresis and dizziness, chest pain lasting more than 15min (squeezing or pressure) and may extend to shoulder, left arm, back or jaw, anxiety and feelings of doom Women: fatigue, sleep disturbance, shortness of breath, back pain, upper abdominal pain, epigastric pain, and nausea with or without vomiting are the most commonly identified atypical symptoms seen in women suffering from an AMI. INTERVENTIONS :
- Assess pain freq; pain is usually first presenting sign of new or extended MI
- Hemodynamic status: BP,HR, LOC, skin color, temp. (Q5min during pain, Q15min post pain, and every 1-2hrs post MI for 24hrs)
- ER treatment = MONA = Morphine (Relieve chest pain), oxygen (↑Oxygenation), nitrates (vasodilate coronary blood vessels and ↑ blood supply), and aspirin (antiplatelet agent to interfere with thrombus formation in affected artery).
- Monitor continuous ECG to detect dysrhythmias (PVC’s and tachy common) With new pain or changes in level or character of pain 12-lead ECG immediately.
- Monitor resp, breath sounds, admin O2 (2-4L/min) to ↑O2 to heart.
- Provide rest to ↓O2 demand to heart
Angina pain quality is typically described as pressure, heavy, squeezing, constrictive, suffocating, vise-like, or “like an elephant sitting on my chest.” Angina is rarely described as pain. Episodes may vary from mild to severe. Several symptoms may accompany angina pain including nausea, diaphoresis, SOB, fatigue, dizziness, weakness, and anxiety. Anginal pain is not stabbing or sharp and does not change with respirations, position change, or pressure applied to the chest wall. To demonstrate anginal pain, the patient may place a clenched fist over the sternum. This is referred to as the Levine’s sign, the universal sign for angina.
- Vasopressin (DDAVP) – What it is used for, when is it ordered, what to monitor, patient education
- Kidney failures – Different types, risk factors, assessment, treatment, monitoring, patient education
- Compartment syndrome –Swelling in the soft tissues and muscles = compromised circulation to that area
- Pathological fractures – Diseases associated with, monitoring of, patient education
- Fractured pelvis – complications of, monitoring, patient education
- Blood Gas Values – Normal and abnormal lab values, signs and symptoms associated with abnormal values causes of abnormalities, treatment of, complications of abnormal values. Normal Arterial Blood Gases: Serum Ph.: 7.35-7. PaCO2 – Carbon Dioxide: 35-45 HCO3 – Bicarbonate: 22- PaO2 – Oxygen: 80- 53. Define: a. Ascites: The accumulation of fluid in the peritoneal cavity. b. Cholangitis: Inflammation of the bile duct c. Cholecystitis: Inflammation of the gallbladder. d. Cholelithiasis: Gallstones. e. Cholestasis: Any condition that impedes bile flowing freely through the bile ducts. f. Gluconeogenesis: The process of the liver converting predominant amino acids to glucose in the fasting state g. Glycogen hydrolysis: Conversion of stored glycogen into usable glucose to meet the immediate energy
needs of the body. h. Glycogen synthesis: Conversion of glucose to glycogen that can be stored in preparation of times of fasting i. Gynecomastia: Breast enlargement in men j. Hepatomegaly: Enlarged liver, palpated below the level of the ribs. k. Icterus: Yellow coloration in the sclera of the eye l. Jaundice: Yellow pigmentation of the skin and sclera. m. Laparoscopic cholecystectomy: A surgical procedure using a laparoscope to remove the gallbladder n. Liver lobule: The functional unit of the liver o. Refractory ascites: Ascites that cannot be effectively managed with normal therapies. p. Steatorrhea: Pale-yellow, greasy, fatty stool, or chronic watery diarrhea Musculoskeletal Trauma Define: o Ankle sprain: When the ankle is displaced or a sudden force is applied, the ligaments are stretched beyond their normal stretching capacity and a sprain of the ligament occurs.
