NURS 133 Final Exam Part 3

jasmine's version from 2016-06-16 06:34

Section 1

Question Answer
Hyperplasia Increased number or density of cells
Metaplasia Change in differentiation- cell type not normal for body part
Dysplasia Loss of DNA control over differentiation- abnormal shape or size
Anaplasia Regress to immature/ undifferentiated cell type- loss of DNA control
Spleen Removes old RBC; Holds a reserves of blood; Recycles iron; Synthesizes antibodies
Liver Produces clotting factor and prothrombin
Hematocrit Women 37-47%; Men 42-52%
Hemoglobin Women- 12-16; Men- 13.5-18
RBC Women- 4.2-5.4; Men 4.7-6.1
WBC 3500-10,500
Platelets 150k-450k
Sodium 135-145
Potassium 97-105
Calcium 8-12
Magnesium 1-2
Dilantin 10-20

Section 2

Question Answer
Warfarin action Interfere with hepatic synthesis of clotting factors
Warfarin side effects Cramps, nausea, dermal necrosis, bleeding, fever
Warfarin interventions Assess for bleeding/hemorrhage, assess resolution of thrombosis/pulmonary embolism, monitor PT/INR, clotting factors, CBC, hepatic function, stool and urine for occult blood. Avoid injections and invasive procedures. Many drug interactions-monitor with any new drugs
Heparin action Prevent conversion of protrhombin to thrombin, potentiates antithrombin
Heparin side effects Hepatitis, alopecia, rash, bleeding, thrombocytopenia, anemia, osteoporosis, fever
Heparin interventions ensure correct vial/drug type, assess bleeding, assess thrombosis/pulmonary embolism, assess injection site for hematoma, monitor aPTT, hematocrit, platelets, potassium, and liver enzymes
Enoxaparin action Potentiate antithrombin
Enoxaparin side effects Dizzy, headache, edema, constipation, elevated liver enzymes, n/v, urinary retention, alopecia, rash, hyperkalemia, bleeding, anemia, hematoma at injection site, osteoporosis, fever
Enoxaparin interventions Assess bleeding, assess thrombosis/pulmonary embolism, assess angina pain, monitor injection site for hematoma, monitor CBC, platelets, stool for occult blood
Acetylsalicyclic Acid action Inhibit production of prostaglandin, decrease platelet aggregation
Acetylsalicyclic side effects Tinnitus, GI bleed, dyspepsia, epigastric distress, nausea, anemia, rash, allergy- anaphylaxis, laryngeal edema
Acetylsalicyclic interventions assess for allergy/asthma/nasal polyps, assess pain or fever, monitor hepatic function, serum drug levels, hematocrit, prothrombin time. Assess for bleeding, Asses for toxicity- tinnitus, headache, hyperventilation, confusion, lethargy, diarrhea, sweating; Instruct to take with food
Clopidogrel action Inhibit binding of ATP to platelet receptor- inhibit aggregation
Clopidogrel side effects Depression, dizzy, headache, epistaxis, cough, dyspnea, chest pain, edema, HTN, GI bleed, diarrhea, exanthematous pustulosis, DRESS, steven Johnson, TEN, bleeding, neutropenia, thrombocytopenia, pupura, hypercholesterolemia, arthralgia
Clopidogrel interventions Assess symptoms of stroke, peripheral vascular disease, and MI, monitor for pupura, monitor bleeding time, CBC, platelets, hepatic function, lipids
HR Controlled by autonomic NS
Contractility Intrinsic ability to contract
Preload End diastolic volume; Amount of stretch in myocyte prior to contraction; Depends on venous BP and rate of return
Afterload Pressure needed in ventricles to eject blood; Depends on pulomary artery pressure (right) or aortic pressure (left); Chronic Increased afterload with lead to ventricular hypertrophy
Arterial Pressure Peripheral resistance x cardiac output

Section 3

Question Answer
Ace Inhibitors (Captopril, Enalapril, Lisinopril: see notes) action Block conversion of angiotensin 1 to 2, vasodilation
Ace inhibitor side effects *Cough; dizziness, fatigue, cough, tachycardia, GI upset, taste disturbance, renal impairment, erectile dysfunction, angioedema, rash, hyperkalemia, agranulocytosis, fever, dyspnea
Ace inhibitor interventions Monitor pulse and BP, monitor compliance, assess for angioedema, monitor for HF-I/O, weight, edema,etc., monitor kidney function, serum potassium, urine protein, CBC; Instruct to take on empty stomach, IV
Calcium Channel Blockers (Diltiazem, Amlodipine: see notes) action Inhibit transport of Ca+ to inhibit excitation/contraction of muscle
CCB side effects Psych disturbances, blurred vision, dizzy, tinnitus, cough, dyspnea, arrhythmia, HF, peripheral edema, chest pain, hypotension, GI upset, polydipsia, sexual dysfunction, steven-johnson, rash, hyperglycemia, gynecomastia, anemia, weight gain, parasthesia, muscle cramps, gingival hyperplasia
CCB interventions Monitor BP/pulse/EKG, Monitor for HF-I/O, weight, edema, crackles, dyspnea, etc., monitor compliance, assess angina, assess for rash, encourage oral hygiene, monitor serum potassium, renal and hepatic function; titrate to HR and BP
Beta Blockers (Atenolol, Propranolol: see notes) action Block stimulations of beta adrenergic receptors-decreases BP and HR
Beta blocker side effects Fatigue, weakness, bronchospasm, bradycardia, HF, pulmonary edema, hypotension, GI upset, ED, rash, Stevens-Johnson, arthralgia, muscle cramps, paresthesia drug induced lupus
Beta blocker interventions Monitor BP/pulse/EKG, monitor for signs of HF, monitor compliance, assess angina, Monitor for overdose- treat with modified trendelenberg, IV fluids, vasopressors, glucagon; Hold if pulse <50. PO, IV

Section 4

Question Answer
Etanercept action Binds and inactivates tumor necrosis factor to decrease inflammation
Etanercept side effects Headache, rhinitis, RTI, cough, dyspepsia, psoriasis, rash, pancytopenia, infection, malignancy, sarcoidosis
Etanercept interventions Test for TB before use, assess arthritis- ROM< swelling, pain. Assess for injection site reaction, monitor for infection, monitor CBCs
Systemic Lupus Erythematosus (SLE) (Lupus) Immune system attacks connective tissue throughout the body. Anti-dsDNA and anti-sm antibodies. Damage begins in capillaries, and affects organ depending where immune complexes lodge
SLE interventions Erythropoietin, dialysis, platelets, infection prevention, fluids, avoid sunlight, pericardio/thoracentesis, NSAIDS, antimalarials, corticosteroids, methotrexate, immune suppressants/modifiers
Belimumab action Binds and inactivates B-lymphocyte stimulator protein
Belimumab side effects Progressive multifocal leukoencephalopathy, depression, migraine, insomnia, nausea, diarrhea, cystitis, leukopenia, extremity pain, rash, anaphylaxis, infection, infusion reaction, fever, facial edema
Belimumab interventions Monitor for anaphylaxis and be ready to treat, monitor for infusion reaction (headache, nausea, skin reactions, bradycardia, myalgia, headache, rash, urticaria, hypotension)-slow the infusion, assess for infection, assess mental status/mood, assess for multifocal leukoencephalopathy (hemiparesis, apathy, confusion, cognitive deficiencies, and ataxia); Slow infusion
Human Immunodeficiency Virus (HIV) Virus attacks CD4 T helper cells, leading to decreased immune system function
Acute HIV Flu like symptoms
Latent HIV Asymptomatic
AIDS Wasting syndrome, opportunistic infections, cancers
HIV complications Pneumonia, fungal infections, Kaposi sarcoma
HIV interventions Educate on disease process, support med compliance, support psycho/social issues, educate to prevent spreading disease, prevent infection- hygiene, protective isolation
Tenofovir action Inhibit reverse transcriptase to disrupt viral DNA synthesis
Tenofovir side effects Depression, headache, weakness, fat redistribution, hepatoegaly, diarrhea, nausea, acute renal failure, fanconia syndrome (renal disorder), lactic acidosis, rash, bone pain, decreased bone density, immune reconstitution syndrome
Tenofovir interventions Monitor HIV symptoms/progression, monitor for infection; Monitor bone density; Monitor hepatic and renal function; Monitor serum phosphate; Monitor for hyperglycemia; Instruct to take with or without food. 2 hours before or 1 hour after didenosine
Rh disease The mother’s immune system is sensitized to RH+ RBCs in first pregnancy and then attacks the RBCs of future fetuses
Rh factor IgM
Rh disease manifestations Hemolysis, low hematocrit, hyperbilirubinemia, kernicterus
Rh disease complications Miscarriage, brain damage from kernicterus
Rh disease interventions Rhogam to all RH- mothers, blood transfusions and fluids and phototherapy for baby, monitor I/O for baby-fluids help excrete bilirubin
Rh Immune Globulin (Rhogam) action Prevent production of anti-RH antibodies
Rhogam side effects Dizzy, headache, hypo/hypertension, rash, diarrhea, n/v, acute renal failure, DIC, intravascular hemolysis, arthralgia, myalgia, fever, injection site pain
Rhogam interventions Type and crossmatch mother and baby’s blood; During pregnancy and once again at labor or if any trauma, uterine bleeding, etc
Glatiramer Acetate action Causes shift from Th1 inflammatory cells to Th2 anti-inflammatory cells to reduce inflammation
Glatiramer side effects anxiety, weakness, chest pain, palpitation, flushing, pruritus, rash, sweating, rhinitis, diarrhea, nausea, throat constriction, urinary urgency, injection site reactions, arthralgia, back pain, hypertonia, dyspnea, flu like symptoms, lymphadenopathy
Glatiramer interventions Assess symptoms of MS, assess for post injection reaction- flushing, chest pain, palpitations, anxiety, dyspnea, constriction of throat, and urticarial- usually last 15-20 minutes, assess for injection site reactions; Assess injection reaction for 15-20 minutes
Beta interferon action Inhibit migration of inflammatory leukocytes, suppress T helper activity
Beta interferon side effects Seizure, depression, dizziness, fatigue, sinusitis, upper RTI, chest pain, abdominal pain, nausea, elevated liver enzymes, UTI, steven Johnson, pancytopenia, injection site reaction, myalgia, anaphylaxis, flu like symptoms
Beta interferon interventions Assess MS symptoms, monitor for depression, monitor Hct, Hgb, WBC, platelets, blood chem, liver function; Instruct and teach IM once weekly, keep refrigerated, rotate sites