Nursing Exam Study Guide: Anatomy, Physiology, and Pharmacology, Exams of Nursing

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Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE Head to Toe Head & Neck ● Lymph nodes (10) Eyes ● Inspect for color, shape, symmetry, position, & alignment of eyes ○ Corneal light reflex: light appears equally in the same spot on both pupils; strabismus (cross eye) ● Conjunctiva & sclera ○ Bulbar conjunctiva: delicate mucous membrane that covers the exposed surface of the sclera (white) ○ Palpebral conjunctiva: membrane that lines the anterior portion of sclera (uniformly pink) ● Lids: Lacrimal apparatus ○ Nasolacrimal sac: upper dilated end of the nasolacrimal duct; is lodged in a deep groove formed by the lacrimal bone & frontal process of the maxilla ● Confrontation ○ Peripheral vision ○ Pt can see fingers enter visual field (180 degrees) ● CN 2 Optic: S (visual acuity) ○ Snellen (far vision): myopia/nearsightedness ○ Rosenbaum (arms length): hyperopia/farsightedness ○ Ishihara (color vision) ■ od/os/ou ● PERRLA ○ Pupils ○ Equal ○ Round ○ Reactive to Light ■ CN 3 Oculomotor: M Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ■ Pupillary constriction (bringing light in from the side) ○ Accommodation ■ Constrict & converge (focus on something, then refocus on pen) ● Cardinal Positions of gaze (nystagmus or involuntary rapid eye movements, drifting) ○ CN 3 Oculomotor: M ○ CN 4 Trochlear: M ○ CN 6 Abducens: M ● Cataracts: cloudy or opaque areas in the ocular lens, temporary ○ Risk factors: Increasing age, Diabetes, high BP ● Glaucoma: a group of eye conditions that can cause blindness; often caused by an abnormally high pressure in your eye; permanent ○ Risk factors: having high internal eye pressure (intraocular pressure) ● Terms (exam 4) ○ Wk 9 terms: h tt p s : // qui z l e t . c o m / 5 8 5 8 39 8 6 0 / w e e k - 9 - t e rm s - flash-cards/ Ears ● Inspect & palpate auricles for redness, swelling, tenderness ● Inspect external canal for redness, swelling, drainage, cerumen, foreign bodies ● Otitis externa: inflammation of external ear; allergic reaction to beauty/personal care products ● Otitis media: inflammation of middle ear; common in pt’s with environmental/seasonal allergies ● Weber (lateralization) ○ Vibration and sound equal bilaterally ● Rinne (AC>BC 2:1) ○ Pt unable to hear or feel the sensation in one ear during Weber ○ Conduction : air conduction to bone conduction, hear it twice as long as you should be able to feel it ❖ Whisper ➢ Able to identify words Nose ● Inspect nares for symmetry, lesions, tenderness ● Inspect internal nares for inflammation, drainage Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ➢ Tricuspid: 4th intercostal space L sternal border ➢ Mitral: 5th intercostal space Midclavicular line ■ Bell & diaphragm ■ S1, S2 present, no murmurs, no abnormal sounds ❖ Aortic impulse ➢ 5th intercostal space, midclavicular line or MITRAL (palpate) ➢ Small pulsation is normal only in this location ❖ Pulses ➢ Radial pulse at the same time ➢ Dorsalis pedis pulse at the same time ➢ Or all of them? ■ +2, regular, equal bilaterally ❖ Edema ➢ If pt has, grading (+1 to +4: pitting, non-pitting, brawny, dependent) ■ 1+: 2mm, slight imprint/trace; pulse weak (0 or absent) ■ 2+: 4mm, moderate; pulse normal ■ 3+: 6mm, deep; pulse increased ■ 4+: 8mm, leaves deep imprint that slowly returns to normal; pulse bounding ➢ No edema bilaterally (wk 1) Respiratory ❖ Inspection ➢ Inspect color (cyanosis) & respiratory effort (inspect for ease, distress, cough) ➢ Shape & configuration, AP diameter 1:2 ratio (½ transverse diameter); barrel chested ➢ Clubbing of nailsBulging of the last part of the finger with curved, convex nails ➢ Related to reduced oxygen in blood ❖ Palpate anterior & posterior for lumps, masses, tenderness ❖ Auscultate, anterior & posterior ➢ Adventitious sounds: not normally heard in the lungs & result from air moving through moisture, mucus, or narrowed airways ➢ Diminished: hear to hear, dim, “quiet”; pneumonia ➢ Crackles: bubbling, crackling, popping; low- to high-pitched, Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE discontinuous sounds; auscultated during inspiration & expiration; opening of deflated small airways & alveoli; air passing through fluid in the airways (CHF, pulm edema, bronchitis) ➢ Rhonchi: sonorous or coarse; snoring quality, low-pitched, continuous sounds; auscultated during inspiration & expiration; coughing may clear the sound somewhat; air passing through or around secretions (bronchitis, COPD, cystic fibrosis) ➢ Rub: rubbing or grating; loudest over lower lateral anterior surface; auscultated during inspiration & expiration; inflamed pleura rubbing against chest wall ➢ Noting that all lung fields are clear & the pt was breathing regularly w/ no difficulty or use of accessory muscles ❖ Percussion ➢ Anterior and posterior thoracic region (lean forward, round shoulders) ■ Location, shape, size density of tissues ➢ Resonance: the prolongation & intensification of sound produced by transmission of its vibrations to a cavity during percussion; air filled, normal lung tissue ➢ Hyperresonance: greater than normal resonance (the prolongation & intensification of sound produced by transmission of its vibrations to a cavity), often of a lower pitch, elicited during percussion; pneumothorax ➢ Dull: the sound obtained by percussing over a solid body part that does not resonate, usually obtained over a body part or area containing less air than those parts or organs that do resonate; liver, mass, lobar pneumonia ➢ Flat: the sound obtained by percussion over solid areas such as bone; pleural effusion ➢ Noting terms & sounds flat, dull resonance upon percussion; equal ❖ Wheeze: musical or squeaking; high-pitched, musical, continuous sounds; auscultated during inspiration & expiration; air passing through narrowed airways (asthma, COPD) ❖ Stridor: harsh, loud, high-pitched; auscultated on inspiration; narrowing of upper airway (larynx or trachea); presence of foreign Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE body in airway ❖ Inspect shape & configuration, AP diameter ■ Inspect for cyanosis (blue mucous membranes) ■ Inspect clubbing of nails ■ AP diameter ❖ Lobes ➢ L lung 2 lobes ➢ R lung 3 lobes ➢ Main bronchus branches > secondary bronchi (one to each lobe) > bronchioles ■ Alveoli: small air sacs, site of gas exchange ■ Surfactant: reduces surface tension between moist membranes of alveoli; phospholipid ❖ Terms (wk 4) https://quizlet.com/572069000/week-4-5- terms-flash- cards/ Abdominal ❖ Inspect hair, color, scars, bumps ❖ Inspect contour (flat) ❖ Inspect symmetry ➢ Epigastric: Region of the upper abdomen immediately below the ribs ➢ Umbilical: region that surrounds the area around the umbilicus; contains part of the stomach, the head of the pancreas, the duodenum, a section of the transverse colon & the lower aspects of the left & right kidney ➢ Suprapubic: region of the abdomen located below the umbilical region ❖ Auscultate FIRST: 4 quadrants, clockwise (umbilicus midline) ■ Normoactive bowel sounds in all 4 quadrants ■ Bowel sounds ● Normoactive: High pitched, gurgling noises; Considered normal ● Hypoactive: Heard infrequently ● Hyperactive: loud, high-pitched tinkling sounds occurring frequently; Indicative of diarrhea ● Absent: >2 min, absence of motility, Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ○ Knee-jerk reflex ● Babinski’s sign ○ The plantar reflex that is a reflex elicited when the sole of the foot is stimulated with a blunt instrument Musculoskeleta l ● Abduction: moving limb away from midline ● Adduction: moving a limb toward body’s midline ● Supination: the assumption of the supine position (laying horizontal) ● Extension: the state of being in a straight line ● Flexion: the state of being bent ● Dorsiflexion: he action of raising the foot upwards towards the shin ● Crepitus: grating sound/sensation produced by friction between bone and cartilage or the fractured parts of a bone ● Contour: outline ● Symmetry: evenness ● Scoliosis: curvature of a portion of the spine to the side, laterally ● Lordosis: curving inward of the lower back ● Kyphosis: forward rounding of the back; hunchback Terms (exam 4) https://quizlet.com/583151111/week-10-terms-flash- cards/ ❖ Cranial Nerves CN S, M, or B? Assessments Description 1. Olfactory S ● Can smell ⅔ odors ● Patency Olfactory bulb located in frontal lobe of brain 2. Optic S Visual Acuity: ● Snellen ● Rosenbaum ● Ishihara Retina (rods & cones) transmit info to optic nerve to process 3. Oculomotor M ● 6 cardinal positions of gaze (nystagmus, ● Muscle function (around eyes) Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE drifting) ● Pupillary reaction to light (PERRLA) ● Pupil response ○ Controls size of pupil ○ Response to light 4. Trochlear M ● 6 cardinal positions of gaze ● Superior oblique muscle ● Eye movement 5. Trigeminal B ● Symmetry of sharp & dull stimuli ● Corneal (light) reflex: sensory ● Clench teeth tightly: masseter & temporalis strength ● Ophthalmic (forehead/scalp/upper eyelids) ● Maxillary (cheeks/upper lip/nasal cavity) ● Mandibular (ears/lower lip/chin) 6. Abducens M ● 6 cardinal positions of gaze Eye muscle movement: ● Lateral rectus movement ● Pons 7. Facial B ● Symmetry of smile, frown, show teeth, puffed cheeks, raised eyebrows ● Sense of taste (sweet, sour, salty) ● Corneal reflex: motor (Q tip) ● Muscle strength Pons of brainstem is complex ● Facial expressions/jaw muscles ● Sense of taste ● Supplying salivary/tear- producing glands ● Sensations to ear 8. Acoustic (Vestibulocochlear) S Cochlear: ● Weber ● Rinne ● Whisper test Vestibular: ● Romberg test Cochlear: ● Hearing ● Pitch/vibrations Vestibular: ● Balance/equilibrium ● Linear & rotational movements of head Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ● Stage 3 & 4 (under slough/eschar) ● Slough/eschar ◆ Causes difficulty in discerning extent of tissue damage ● Full thickness ❖ Arterial insufficiency vs. venous insufficiency ➢ Arterial insufficiency ■ Chronic condition in which partial or total arterial occlusion deprives the lower extremities of oxygen and nutrients ■ Pulses decreased or absent ■ Pain may be present in feet/legs ■ Ulcerations in area of toes, foot usually turns deep red when dependent ■ Nails may be thick and rigid ■ Pale shiny skin ➢ Venous insufficiency ■ Includes disorders that result from increased venous pressure or valve damage of a vein wall ■ Ulcerations usually around the ankle ■ Pulses present but may be difficult to find because of edema ■ Foot may be cyanotic when dependent ■ Skin may have brownish discoloration ■ Edema may be pitting CRITERIA ARTERIAL VENOUS Pain: Intermittent classification, pain at rest Painful Mechanism: Tissue ischemia Venous hypertension Pulses: Decreased or absent Normal, through may be difficult to feel Color: Pale, dusky red Normal or cyanotic on dependency, petechiae, brown pigmentation Temperature: Cool Normal Edema: Absent/mild Present Skin changes: Thin, shiny, atrophic skin, loss of hair over foot and toes, nails thickened Brown pigmentation around the ankle, dermatitis Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE Ulcerations: If present, toes or trauma on feet Develops at sides of ankle Gangrene: May develop Does not develop Medications ➢ Beta Blockers ■ -olol ■ Decreases blood pressure ■ Side effects ● Fatigue ● Weakness ● Erectile dysfunction ● Bradycardia ● HF ● Pulmonary edema ➢ Benzodiazepines ■ -zepam ■ CNS depressant; controls anxiety; sedative ➢ ACE Inhibitors ■ -pril ■ Decreases blood pressure; treats HF ➢ ARB Blockers ■ -artan ■ Decreases blood pressure ➢ Calcium Channel Blockers ■ -dipine ■ Decreases blood pressure; treats chest pain; treats migraines ➢ Thrombolytics ■ -ase/-plase ■ Dissolves blood clots ➢ Corticosteroids ■ -sone ■ Treats asthma, arthritis, cancer, autoimmune disorders ➢ Bronchodilators (Beta2-agonists) ■ -terol ■ Treats asthma, COPD ➢ DPP4 inhibitors ■ -gliptin Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ■ Decreases blood sugar ■ Sitagliptin ● Side effects ◆ Pancreatitis ◆ Anaphylaxis ◆ Angioedema ◆ Exfoliative skin conditions (Stevens-johnsons syndrome) ● Interactions ◆ Risk of hypoglycemia when also on insulin, glyburide, glipizide, glimepiride ➢ Incretin mimetics ■ -tide ■ Decreases blood sugar ➢ Leukotriene antagonists ■ -ast ■ Treats asthma & allergies ➢ Proton pump inhibitors (PPI’s) ■ -prazole ■ Treats GERD, peptic ulcers & H. pylori ■ Take 30 minutes before meals ➢ Sulfonylureas ■ -ide ■ Decreases blood sugar; treats type 2 diabetes ➢ Biguanide ■ Metformin ■ Decreases blood sugar ➢ Anticoagulant ■ -arin ■ Prevents blood clots ■ Warfarin ● Side effects ◆ Calciphylaxis ◆ Bleeding ● Avoid foods high in vitamin K ◆ Broccoli ◆ Cauliflower ◆ Cabbage ◆ Brussel sprouts ◆ Kale Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ◆ Diuretics ◆ Diabetes ◆ Decreased LOC ● Symptoms ◆ Neurologic impairment, restlessness, weakness, disorientation, delusion, hallucinations ● Assessments ◆ Lab value, VS (BP, HR, Temp), dehydration (skin turgor), I&O ● Interventions IV Fluid replacement (D5W), Monitor VS, I&O, skin breakdown, encourage oral intake ➢ K ■ 3.5-5.1 mEq/L ■ Intracellular ■ Cation ■ Hypokalemia <3.5 ● K+ deficit in ECF ● Symptoms - 5 L’s ◆ Lethargy ◆ Lethal cardiac arrhythmia ◆ Leg cramps ◆ Limp muscles ◆ Low, shallow respirators ● Symptoms: muscle weakness, fatigue, dysrhythmias ● Causes - GRADE ◆ GI loss ◆ Renal/kidney ◆ Alkalosis ◆ Diuretics ◆ Eat (lack of) ● Assessments ◆ VS, labs, I&O, reflexes ● Interventions ◆ VS monitoring, ECG, K administration, labs (Mag level) ■ Hyperkalemia >5.1 ● Excess K+ in ECF (you typically die from having high K+) ● Symptoms - MURDER ◆ Muscle weakness ◆ Urine (oliguria/anuria) Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ◆ Respiratory distress ◆ Decreased cardiac contractility ◆ EKG changes ◆ Reflexes (hyper/hypo) ● Symptoms: nerve conduction changes, paralysis, murder ● Causes - MIKA ◆ Meds ➢ Supplements, ACE inhibitors, Beta blockers, NSAIDs, K+ sparing diuretics ◆ Intake ➢ Excessive intake of bananas, spinach, yogurt, high K+ foods ◆ Kidney ➢ Impaired ability to secrete fluid ◆ Acidosis ➢ Result of an increase in acid components or an excessive loss of bicarbonate ➢ CO2 ● Assessments ◆ Labs, VS, I&O, reflexes ● Interventions ◆ VS monitoring, ECG, labs, meds ■ 23 -29 mEq/L ■ Symptoms: headache, lightheaded, change in LOC, cyanosis, pain during expiration/inspiration, barrel chested, hyperventilating, clubbing, cap refill > ● Heart: organs unable to perfuse d/t < O2 resp ● Lungs: SOB, hyperventilation, AKI, trauma, infection ■ Labs: Na, CO2, GLU, Hgb, Hct, WBC ■ Diagnosis ● Alterations in Oxygenation; ineffective airway clearance, ineffective breathing pattern, impaired gas exchange ■ Outcome identification & planning ● Oxygenation problem ● The patient will: ◆ Demonstrate improved gas exchange in the lungs by an absence of cyanosis or chest pain ◆ Pulse oximetry <95% ◆ Exercise Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ◆ Demonstrate self-care behaviors that provide relief from symptoms and prevent further cardiopulmonary problems. ■ Implementing ● Promote/control coughing, suction, med administration, supplemental oxygen, manage chest tubes, artificial airways, CPR, teaching ■ Teach ● Vaccination, smoking cessation/environment, nutrition, reducing anxiety, positioning, fluid intake, incentive spirometry, breathing techniques, coughing meds, chest physiotherapy oxygen, chest tube, CPR ➢ Cl ■ Meds ● Bronchodilators ● Liquefy or loosen thick secretions ◆ Reduce inflammation in airways ● Metered dose inhaler ● Nebulizer ● Dry powder inhaler ■ 95-105 ■ Anion ■ ECF ■ Hyperchloremia ● Major causes ◆ Metabolic acidosis, head trauma, increased perspiration, decreased GFR ● Tachypnea, weakness, lethargy, decreased awareness, hypertension, decreased cardiac output, dysrhythmias, coma ■ Hypochloremia ● Major causes ◆ Vomiting/diarrhea, drainage of GI tube, metabolic alkalosis, diuretics, burns ● Hyperexcitability, tetany, hyperactive DTRs, weakness, muscle cramps ➢ BUN ■ 7-24 mg/dL ■ Backs up Cr findings ■ Formed in liver from ammonia Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ➢ Hct ■ 35-45% ◆ Sweating, chills, clammy ◆ Shakiness ◆ Confusion ■ Measures percentage by volume of RBCs in a whole blood sample ● 40% = 100mL sample of blood contains 40 mL of RBCs ● 5 below and above; 20% is a big deal ■ General ● Solidifies Hgb (can mean more than one thing) ■ Mean volume & hemoglobin concentration ■ Packed-cell volume ● 60%: ¾ full (many RBCs; do not need to carry as much) ◆ Dehydration ◆ CO2 poisoning ◆ Living at high altitude ● 40%: RBC full (normal) ● 20%: RBC very full (half the amount of RBCs; trying to carry as much oxygen as possible); can’t carry enough affecting oxygenation ◆ Tachycardic: not getting enough O2, tries to compensate ◆ Pregnancy ◆ Anemia ◆ Heavy menstrual cycles ■ Measures ● Polycythemia, anemia, dietary deficiencies ◆ Polycythemia (increase in RBC count) → ➢ Aspirin ➢ Bloodletting (Hct <45) ● Hydration status ◆ Hydration, IV fluids lowers RBCs ● Aid in calculation of erythrocytes ● Monitor response to treatments ● Determining need for blood transfusions ● Baseline before surgery/invasive procedures/treatments ➢ Hgb ■ Males: 12-16 g/dL ■ Females: 10-14 g/dL ■ Protein in RBCs that carries oxygen to organs & tissues Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ■ Transports carbon dioxide from organs back to lungs ● How many RBCs do we have to carry O2 & CO2? ■ Main indicator of general bleeding; specific/localized ● <8 big deal (.1 increments not a big deal) ■ Measures ● Severity of anemia ● Polycythemia (too many RBC) ◆ Causes: ➢ Bone marrow produces too many RBCs → cancer ➢ Autoimmune disorder ● Response to therapy ● Baseline prior to surgery/invasive procedures/treatments ◆ Have we tried some sort of treatment like giving RBCs or iron? ◆ Have we done something to determine the reason why we don't have enough RBCs? ◆ Determine the underlying reason why our RBC is low/low production ➢ GI bleed → colonoscopy to determine where the bleed ➢ Hematoma ➢ Aneurysm ◆ Surgery is invasive (blood loss) ➢ Male patient hemoglobin is 10-11 before surgery and then after surgery it is 6-7 ● Distribution of oxygen to organs & tissues ➢ WBC ■ 5,000 to 10,000/mm3 ■ Respond to infection in the body ■ Symptoms: febrile, change in LOC, confusion, dizziness, swollen lymph nodes, high HB (to compensate), sweaty, pain, BP changes (hypotension), body aches, oliguria/anuria (dehydrated), burning, increase RR, diarrhea ■ Labs: Na (high, dehydrated), K (low, laxatives to get rid of K, 5Ds), BUN, Cr, GLU, WBC ● Heart: tachycardia, HF, MI ● Lungs: pneumonia (tachypnea) ● Kidneys: UTI Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ➢ Plt ➢ Ca ● GI: diverticulitis ■ Cell is dehydrated ■ 145-450K/uL ■ Non-nucleated, cytoplasmic, round or oval disks formed by budding off large, multinucleated cells ■ Essential in coagulation, hemostasis, blood thrombus formation ● Platelets move to vessel injury, hemostasis, bind to fibrinogen causing platelets to stick together, forming a plug ■ Thrombocytopenia ● ↓ platelet count ● When body’s need for platelets exceeds the rate of production ◆ Congenital, cancer, bone marrow diseases, cirrhosis, bleeding disorders (disseminated intravascular coagulation), sepsis, medications ■ Thrombocytosis ● ↑ platelet count ● Causes ◆ Hemorrhage, infectious disorders, iron deficiency anemia, splenectomy, inflammatory disorders ■ Purpose of platelet count ● Evaluate platelet production ● Assess effects of chemotherapy & radiation therapy ● Diagnose & monitor severe thrombocytosis or thrombocytopenia ■ 8-10 mg/dL ■ Cation in ECF ■ Plays role in blood coagulation and transmission of nerve impulses ■ Regulates muscle contraction/relaxation ■ Hypercalcemia (“The body is WEAK”) ● Weakness of muscles ● EKG changes ● Absent reflexes ● Kidney stone formation ■ Hypocalcemia (CRAMP) ● Confusion ● Reflexes (hyperactive) ● Arrhythmias ● Muscle spasms (tetany) Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ● Neuromuscular disease (ALD, muscular dystrophy) ➢ Respiratory Alkalosis (pH = >7.45; CO2 = <35) ■ Hyperventilation causing an increase in alveolar ventilation that is disproportionate to the rate of metabolic carbon dioxide production ■ Causes ● Panic attacks/anxiety ● MI ● Infection ● Asthma ● COPD ● Pain ● Drug use ● Pulmonary embolism Low High pH (7.35-7.45) acidosis alkalosis PaCO2 (35-45) alkalosis acidosis PaO2 (80-100) hypoxemia O2 therapy HCO3 (22-26) acidosis alkalosis ❖ Diseases Heart Disease Symptoms Labs Meds Diet Pt education Nursing intervent ion Risk factors Heart Failur e DRES - Dizziness K, Mg, Na, BUN, Diuretics ACE DASH diet/low Diet Exercise Med regimen VS VS, I&O, weight, labs, wound manage ment, exercise Heart attack, HTN, - Rapid heartbeat Cr, Trop, ARBS Na Diabetes, - Edema BNP BBlockers ↓ Lung - SOB CCBs fluid disease, Digoxin valve disease Effects: Heart: can’t keep up Cell full w/ body’s demands Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE (can’t pump what body needs), BP changes, enlarged heart (tachycardia, palpitations) Lungs: wheezing Kidney: failure (excessive urination) GI: bloating Hypertensi on >130, >80 Headache, fatigue, vision changes, chest pain, difficulty breathing, palpitations, confusion K, Mg, Na, BUN, Cr, GLU, Ca, Troponin Beta blockers Diuretics CCBs ACE ARBs DASH diet Diet Exercise Sedentary lifestylePai n manageme nt Stress VS monitori ng, I&O, diet, weights, labs Race, age sleep apnea, DM, obesity, HLD, alcohol consumptio n Effects: Heart: enlarged ventricles, HF, MI, Stroke (sleep apnea, irregular heartbeat) Kidney: failure (blood in urine) GI: DM2, Obesity, high cholesterol, salt calories Cell full Hypotension <90, <60 Dizziness, tachycardia, pallor, sweating, blurred vision, nausea, confusion Effects: Heart: dehydration, hemorrhage, HF, arrhythmias K, Mg, Na, BUN, Cr, GLU, Ca, Troponin Fluids Vasopress ors Midodrine ↑ sodiu m Diet Exercise Sedentary lifestyle Pain manageme nt Stress Further imaging VS monitori ng I&O Diet Disease process, meds, hemorrhage , athletes Cell isn’t full Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE Kidneys: dialysis GI: diabetes r/t, hypoglycemia Lung Disease Symptoms Labs Meds Diet Pt education Nursing interventio n Risk factors COPD Emphysem a & chronic bronchitis (88%-92% may be their normal) Shallow, rapid breathing, dyspnea, sputum, barrel chest, clubbing of nails, wheezes, rhonchi Effects: Heart: chest pain (chest pressure), perfusion, fatigue Lungs: Resp infections, dyspnea, lack of O2, wheezing (dry or wet cough) GI: malnourished CO2, ABGs, O2 level, WBC, Na Bronchod ilator, steroid, oxygen therapy Smal l meal s , ↑ calo r ie, high prot e in Breathing techniques , pace activities, hydration, smoking cessation Respiration s, VS, O2, ABGs, O2 application, breathing techniques, pace activities, diet changes, ambulation , incentive spirometry Smoking, pollution Asthma Inflammati on, swelling, extra mucus Use of accessory muscles, wheezing, dyspnea, chest pain, cough Effects: Heart: tachycardia, tachypnea, chest tightness, Lungs: wheezing, dyspnea, sputum, production, frequent resp infections GI: meds WBCs, O2 Bronchod ilatorSter oid inhalersO xygen therapy Smal l meal s , ↑ calo r ie Meds, exercise changes, allergies/p ollution Incentive spirometry, resp assess, VS, O2, pace activities, identify triggers Air pollution, triggers, meds, family history, smoker, allergies Cell empty Pneumoni a Wheezing, crackles, WBC, Antibioti Small Lifestyle Standards Age, Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ➢ 7-14 days ➢ Urine output gradually increases & electrolytes adjust ➢ GFR improves ◆ Recovery phase ➢ 3-12 months ➢ Gradual return to normal or near-normal kidney function ➢ Electrolytes return to normal balance, edema ↓ ■ Chronic Kidney Disease (CKD) ● The gradual loss of kidney function ◆ Electrolytes and wastes can build up in your body ● Symptoms ◆ Nausea ◆ Vomiting ◆ Loss of appetite ◆ Fatigue/weakness ◆ Sleep problems ◆ Urine output changes ◆ Change in LOC ◆ Muscle twitches/cramps ◆ Edema ◆ Persistent itching ◆ Chest pain (fluid builds up around the lining of the heart) ◆ SOB (fluid builds up in the lungs) ◆ HTN ● Causes ◆ Type 1 or type 2 diabetes ◆ High blood pressure ◆ Glomerulonephritis (inflammation of the kidney's filtering units) ◆ Interstitial nephritis (inflammation of the kidney's tubules and surrounding structures) ◆ Polycystic kidney disease ◆ Prolonged obstruction of the urinary tract ◆ Vesicoureteral (condition that causes urine to back up into your kidneys) ◆ Pyelonephritis (recurrent kidney infection) Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ➢ Diabetes Mellitus ■ Type 1 ● Absence of insulin production by the pancreas resulting from autoimmune destruction of beta cells ◆ The pancreas does NOT produce insulin ● Affects metabolism → hyperglycemia ● Causes ◆ Genetics ◆ Viruses (Coxsackie virus, mumps, rubella), toxins ◆ Infant weight ■ Type 2 ● Combination of resistance to insulin action & impared insulin secretion ◆ Causing hyperglycemia & other complications ➢ Microvascular: retinal & renal ➢ Macrovascular: coronary & peripheral vascular ➢ Neuropathic conditions ◆ Pancreas still produces insulin ➢ Insulin secreted is either not enough or the body is resistant to the insulin ■ Retinopathy ● Microvascular ● Corneal abnormalities, glaucoma, iris neovascularization, cataracts, neuropathies ● Advances stages include floaters, distortion, blurred vision ■ Nephropathy ● Microvascular ● Leading cause of CKD ● Considered after routine urinalysis & screening ● Albuminuria, decline in GFR, elevated arterial BP ■ Neuropathy ● Most common complication of DM ● Presence of symptoms of peripheral nerve dysfunction ◆ Sensory ◆ Motor ◆ Autonomic ■ Macrovascular ● Coronary and peripheral vascular ■ Labs Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ● Glucose, ketones, pH, Na, BUN/Cr, WBC, HgA1C ■ Meds ● Insulin, oral agents (Metformin, Januvia, Gliptizide, Glyburide) ■ Diet ● Carb control ■ Education ● Diet control, exercise, urine, symptoms ■ Nursing interventions ● VS, blood sugar, urinalysis, exercise, meal planning, med administration ■ Risk factors ● Genetics, age, obesity, meds, toxins ❖ Ostomies/Elimination ➢ Ostomies ■ Stoma’s appearance ● Pink, moist, rounded ■ Diet considerations ● Resume regular diet ● Avoid foods that cause loose stools ● Adjustments for antibiotic therapy ● Low fiber ● Avoid foods that are difficult to digest ● Eat foods that thicken stool ● Foods to avoid: ◆ Stringy, high fiber foods (gas producing) ◆ Membranes on citrus fruit ◆ Fruits & vegetable skins ◆ Peas, popcorn, spinach, dried fruits, nuts, pineapple, seeds ◆ Fish, eggs, beer & other carbonated beverages ■ Emotional ● Body image/sexuality ■ Indications for ostomy surgery ● Congenital anomalies: spina bifida ● Cancer: bladder, colon, rectal ● Inflammatory bowel diseases: Crohn;s, ulcerative colitis ● Ureter obstruction ● Abdominal wounds Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ◆ Cane (COAL) ➢ Cane ➢ Opposite ➢ Affected ➢ Leg ◆ Walker (WWAL) ➢ Walker ➢ With ➢ Affected ➢ Leg ■ Patient education ● Healthy weight ● Exercise ● Eating healthy ● Smoking ● Use of alcohol ● Stress ❖ Embolism, Thrombus & Hemorrhage ➢ Embolism ■ Mobile blood clot; forms somewhere else & travels (usually to fat buildup) ➢ Thrombus ■ Nonmobile blood clot; forms in blood vessel ➢ Hemorrhage ■ Internal/external bleeding ■ Weakened blood vessel ruptures like a balloon (aneurysm that bursts) ■ Cause is usually uncontrolled high BP ❖ Anemia ➢ Iron Deficiency Anemia ■ Iron deficiency anemia is the most common type of anemia, and it occurs when your body doesn't have enough of the mineral iron ● Low red blood cell count ➢ Anemia symptoms ■ Fatigue ■ Pallor (conjunctiva & mucous membranes are light pink, pale) ● Seen in chronic iron deficiency or bleeding disorder Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ■ Headache ■ Weakness (not enough O2 to muscles) ■ Dizziness (brain isn’t receiving enough O2) ■ Palpitations (heart isn't receiving enough O2) ■ Bruising (not perfusing O2) ● Trying to keep as much as it can in internal organs, first priority ● Long time to heal (skin is last priority) ➢ Dyspnea (lungs aren't receiving enough O2) ➢ Epistaxis ➢ Pica ➢ Physical findings: ■ Dull, thinning hair ■ Pallor, ecchymosis, petechiae ■ Occult blood in stool (melena - blood is sticky) ■ Splenomegaly ➢ Patient history ■ Hemorrhage ● Menstrual cycle ■ Chronic Renal Disease ■ Bone Marrow Suppression ■ Poor Nutrition ■ Fluid retention (dilution of blood) ■ COPD (long term) ❖ Hyperthyroidism ➢ Overactive thyroid ➢ Signs/symptoms ■ Intolerance to heat (HOT) ■ Weight loss ■ Changes in menses; short menstrual pattern with scant flow ■ Fine, straight hair; bulging eyes, tachycardia, high systolic BP, localized edema, diarrhea, tremors, finger clubbing ❖ Hypothyroidism ➢ Underactive thyroid ➢ Signs/symptoms ■ Cold intolerance Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ❖ Pai n ■ Weight gain ■ Increased frequency & flow of menses ■ In extreme cases: bradycardia and dyspnea from low cardiac output ■ Receding hairline/hair loss, facial & eyelid edema, dull-blank expression, extreme fatigue, thick tongue-slow speech, anorexia, brittle nails & hair, apathy, dry skin (coarse, scaly), muscle aches/weakness, constipation ➢ Assessing pain ■ Ask ● Simple questions ■ Numerical rating scale ■ Observational tool ● PAINAD ■ Wong-Baker FACES ■ Utilize low doses ➢ Recognize that each person holds various beliefs about pain and that pain is what the patient says it is ➢ Respect the patient’s right to respond to pain in one’s own fashion ➢ Never stereotype a patient’s responses to pain based on the patient’s culture ➢ Be sensitive to nonverbal signals of discomfort, such as holding or applying pressure to the painful area or avoiding activities that intensify the pain ❖ Aging Adult ➢ Sensory changes ■ Vision ● Presbyopia ◆ Decrease focus on near objects and light adaptation ● Decrease in dark adaptation, upward gaze, pupil size, visual field ● Increased eye dryness ■ Eardrum thickens ■ Presbycusis ● Loss of high frequency hearing acuity ■ Hair fibers in ear canal less able to help with earwax removal and protect canal ➢ Taste & smell ■ Fewer taste buds, less saliva, dry mouth, oral conditions, decreased sense Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE Cardiopulmonary ● Atherosclerosis (blood vessels become less elastic, more rigid/hard) ○ Venous return less efficient ○ Fatty plaque deposits continue in lining of blood vessels ○ Lower-extremity edema & cooling ○ Peripheral pulses not palpable ○ Orthostatic hypotension ● Less able to increase HR & cardiac output w/ activity ● Pulmonary elasticity & ciliary action ↓: clearing of the lungs become less efficient ○ RR ↑ w/ diminished depth Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE Gastrointestinal ● Malnutrition & anemia ● Dry mouth (diminished saliva production) ● Constipation & indigestion ○ Reduced muscle tone & ↓ peristalsis ● Digestive juices diminish & nutrient absorption ↓ Dentition ● Tooth decay/loss ● Change in eating habits Genitourinary ● Voiding more frequently ○ Bladder capacity ↓ by 50% ● ↓ in bladder & sphincter muscle control ○ Stress/overflow incontinence ● 75% of men over 65 experience hypertrophy of prostate gland ● ↓ in vaginal secretions ○ Womens genital tract atrophies, thinning ● Blood flow to kidneys ↓ w/ diminished cardiac output ● Functioning nephron units ↓ by 50%: waste products are filtered & excreted slower ● Fluids & electrolytes remain normal BUT balance is fragile ❖ Falls ➢ What is a fall? ■ An unintended, sudden, assisted or unassisted, descent (including rolls & slips) to the floor or on or against a surface (counter, wall, etc.), or another person caused by physiological reasons or environmental reasons— resulting with or without injury to the patient ➢ Intrinsic Factors ■ Medical illness/chronic disease ■ Physical status ■ High risk meds ➢ Extrinsic Factors ■ Floor surfaces ■ Equipment (side rails) ■ Inadequate lighting Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ■ Avoid mandating change ■ Seek cultural assistance ➢ Cultural assessment ■ Beliefs, values, traditions & practices of a culture; culturally defined, health-related needs of individuals, families, & communities; culturally based belief systems of the etiology of illness & disease & those related to health & healing; attitudes toward seeking help from health care providers ❖ Standard Precautions ➢ Standard ■ Precautions used in the care of all hospitalized patients regardless of their diagnosis or possible infection status ■ Guidelines ● Hand hygiene ● Don non sterile gloves ● Wear PPE ● Follow respiratory hygiene/cough etiquette ● Avoid recapping used needles ● Use safe injection practices ● Wear face mask ● Handle used patient care equipment that is soiled with blood or identified body fluids, secretions, and excretions carefully ● Use adequate environmental controls ● Review room assignments carefully ➢ Transmission-Based ■ Airborne (Tuberculosis) ● Patient must be in private room with door closed ● Must wear respirator when entering room ● Only transport pt out of room when necessary; use mask on pt ■ Droplet (Influenza) ● Private room; door may stay open ● PPE for all interactions that involve contact with pt ● Only transport pt out of room when necessary; use mask on pt ● Visitors must stay 3 ft away from pt ■ Contact (C. Diff) ● Private room Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ● PPE for all interactions that involve contact with pt ● Limit movement of pt out of room ● Avoid sharing pt care equipment ■ Reverse/Neutropenic ● Neutropenic precautions are used when a patient has a low number of neutrophils in their immune system ● Pt is immunocompromised ● Neutropenic precautions are comparable to contact precautions in reverse ● Avoid building contaminants in pt room ● Can be caused by chemotherapy ❖ Vital signs ➢ Temperature ■ 35.9° to 38°C (96.7° to 100.5°F) ➢ Heart Rate ■ 60-100 bpm ■ Rate ● Affects the amount of blood ejected by the heart with each beat ■ Rhythm ● Regular or irregular (dysrhythmia) ■ Amplitude ● Quality of the pulse (fullness) ● Grade system ◆ 0: absent ◆ +1: diminished ◆ +2: normal ◆ +3: bounding ■ Tachycardia: >100 bpm ● Decreases filling time, decreases cardiac output ■ Bradycardia: < 60 bpm ● SA node generates a slower-than-normal impulse rate ➢ O2 Sat ■ Diffusion: exchange of O2 & CO2 between the alveoli of the lungs & the circulating blood ■ Perfusion: exchange of O2 & CO2 between the circulating blood & tissue cells ● Oxygenate blood, remove CO2 Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ● Oxygen: cells use to create energy Hemoglobin (RBCs) transport oxygen in the blood; organs need oxygen to survive; oxygen depletion leads to cell death ➢ Respiration Rate ■ 12-20 breaths/min ■ Regular in rate and in rhythm ■ Patterns ● Hyperventilation: ↑ the rate and depth of respirations ◆ Associated with: extreme exercise, fear, diabetic ketoacidosis ● Hypoventilation: ↓ in rate and depth ◆ Associated with: overdose of narcotics or anesthetics ● Tachypnea: ↑ respiratory rate; >24 breaths/min; shallow ◆ Associated with: fever, anxiety, exercise, respiratory diseases ● Bradypnea: ↓ respiratory rate; <10 breaths/min; regular ◆ Associated with: brain damage, depression of respiratory center by medications ● Cheynes-stokes: alternating periods of deep, rapid breathing followed by periods of apnea; regular ◆ Associated with: drug overdose, HF, increased intracranial pressure, renal failure ● Biot’s: varying depth & rate of breathing followed by periods of apnea; irregular ◆ Associated with: meningitis, severe brain damage ➢ Blood Pressure ■ 120/80 mmHg ■ Force of the blood against arterial walls ■ Arterial walls contain elastic tissue -> stretch and distend as blood enters ● Return to their original position between each beat (at rest) ■ Short-term regulation ● Neural and Humoral ◆ Temporary corrections ● Parasympathetic and sympathetic nerves ● Baroreceptors ● Epinephrine & Vasopressin Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ■ Cold extremities ■ Extreme body pain or discomfort (5-7) ❖ Pharmacology ➢ Pharmacokinetics ■ Refers to the kinetics of drug absorption, distribution & elimination (metabolism & excretion) ■ ADME (the time course of the drug concentration in the body) ● Absorption: entry of molecules into blood ● Distribution: movement of molecule between water, lipid & protein constituents of the body ● Metabolism: process of alteration in structure of molecule in the body ● Excretion: removal of drug molecules or metabolites from the body ■ What the body does to the drug ➢ Pharmacodynamics ■ The relationship of drug concentration to pharmacologic effects; what the drug does to the body ➢ Bioequivalence ■ Two pharmaceutical equivalents w/ similar bioavailability ➢ Biotransformation ■ Drug metabolism ■ The chemical alteration of drug structure (mostly in liver) ➢ Bioavailability ■ The rate & extent at which therapeutically active drug reaches systemic circulation in the intact form ➢ Safety ■ Staying aware of ● Potentiative effects ◆ When a pt is taking two medications, one drug may intensify the effects of the other ➢ Beneficial or detrimental ● Inhibitory interactions ◆ Interactions that result in reduced drug effects ➢ Beneficial or detrimental ● Allergic reactions ◆ When the immune system overreacts to a harmless Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE substance called an allergen ● Adverse reactions ◆ An idiosyncratic reaction or other adverse effect of a medication that is not preventable ● Anaphylaxis ◆ Severe allergic reaction ➢ Bronchoconstriction, hypotension & edema of the glottis ◆ Potentially life-threatening allergic reaction; causes your immune system to release a flood of chemicals that can cause you to go into shock ● Medication reconciliation ◆ The process of comparing a list of all medications that a pt is currently taking w/ a list of new medications that are about to be provided (to reduce medication omissions, duplications, dosing errors, adverse drug events, interactions) ● Medication Rights (DR TRADER EMP) ◆ Dose ◆ Route ◆ Time ◆ Reason ◆ Assessment ◆ Documentation ◆ Education ◆ Refuse ◆ Evaluation ◆ Medication ◆ Patient ❖ Nutrition ➢ Macronutrients ■ Nutrients that supply energy & build tissue (such as carbohydrates, fats, proteins) ➢ Micronutrients ■ Vitamins & minerals, are required in much smaller amounts to regulate & control body processes ➢ Basal metabolism Portage Learning NURS 100 Final Exam Study Guide 2024 EXAM GUIDE ■ Energy required to carry on the involuntary activities of the body at rest- the energy needed to sustain the metabolic activities of cells & tissues ➢ Body mass index (BMI) ■ Ratio of weight (kilograms) to height (meters) ■ Reliable indicator of total body fat stores in the general population ■ Healthy weight: BMI 18.5-24.9 ➢ Waist Circumference ■ Measured by placing a measuring tape snugly around the pts waist at the level of the umbilicus ➢ Healthy food groups ■ Fruits & Vegetables ■ Fiber ■ Calcium & Vitamin D ■ Protein ➢ Not so healthy food groups ■ Fats ● Trans fats ◆ Bad fats ● Polyunsaturated fats ◆ Good fats ➢ Carbohydrates ■ Sugars & starches ● Provide energy ■ “Least expensive” ■ Liver stores glucose & regulates entry in blood ■ Glycogenesis ● When muscle or liver glycogen stores are deficient ◆ Glucose → glycogen ■ Glycogenolysis ● Glycogen is broken down → glucose ❖ Diets ➢ DASH (Dietary Approaches to Stop Hypertension) ■ Reduce the sodium in your diet or eat food rich in nutrients that lower BP like K, Ca, Mg ■ 2,300 mg sodium/day ➢ Diabetes & Diet ■ Maintain blood sugar at an appropriate level ■ Prevent chronic conditions such as CAD, AKI, CKD