Exam 1 Review pt.1 Flashcards by Isaiah Smith

Can a patient with a laryngectomy eat normally?

Yes, only the larynx is removed

How well did you know this?

Not at all

Perfectly

How do we treat polycythemia?

Drain blood

Drink Plenty of water

Take warfarin

Move

Treat itching with antihistamine

How well did you know this?

Not at all

Perfectly

Nursing Response to Acute Hemolytic Reaction

Stop Tranfusion

Start new line with NS

Assess patient

Notify the blood bank and HCP

Treat shock

Main BP with IV colloids

Obtain blood sample from site

Obtain first void urine: Insert foley

Send unti, tubing, and filter to lab for testing

How well did you know this?

Not at all

Perfectly

Non tunnled CVC’s

Subclavian

Juglar

PICC

How well did you know this?

Not at all

Perfectly

Tunneled CVC’s

Hickman

Groshanh

Broviac

Implanted ports

How well did you know this?

Not at all

Perfectly

What is malignant hyperthermia?

An inherited muscle disorder triggered by certain types of anesthesia that may cause a life threatening crisis

How well did you know this?

Not at all

Perfectly

Most common initial sign of malignant hyperthermia?

Increase in end tidal CO2

How well did you know this?

Not at all

Perfectly

Malignant Hyperthermia: Clinical Manifestations

Hypercarbia

Masseter muscle rigidity

Sinus tachycardia

Sustained muscle contraction and breakdown (rhabdomyolysis)

Anaerobic metabolism

Metabolic acidosis

How well did you know this?

Not at all

Perfectly

Open cholecystectomy

Incision made through right subcostal incision

T-tube place to keep common bile duct open

How well did you know this?

Not at all

Perfectly

Oximetry is measuring

The amount of hemoglobin that is carrying oxygen

How well did you know this?

Not at all

Perfectly

What is normal O2 sat?

95%

How well did you know this?

Not at all

Perfectly

Pulse oximetry can be taken at

finger - earlobe - toe

How well did you know this?

Not at all

Perfectly

What are the three different sputum studies and what are they for?

Culture and Sensitivity (Infection) (PNA)

Cytology (Cancer)

Acid-fast bacillus (Tuberculosis)

How well did you know this?

Not at all

Perfectly

Sputum collection

Must expectorate in sterile container

Should be sent to lab asap

Morning specimen best

Can suction

How well did you know this?

Not at all

Perfectly

What should be done before receiving CT scan?

Check patient BUN and Cr (renal function)

Assess allergy to shellfish or contrast

Teach that they may feel a warm flush feeling

How well did you know this?

Not at all

Perfectly

You should encourage the patient to ______ ______ after a CT scane

Force Fluids

How well did you know this?

Not at all

Perfectly

MRI is used to

assess lesion that are difficult to asses via CT scan

distinguishing vascular from nonvascular structures

How well did you know this?

Not at all

Perfectly

What type of scan looks at function?

PET

uses radioactive substance called a “tracer” to look at function (blood flow - use of oxygen - uptake of sugar)

How well did you know this?

Not at all

Perfectly

Nursing care before bronchoscopy

Consent form

NPO 6-12 hours before test

Give sedative

How well did you know this?

Not at all

Perfectly

Nursing care after bronchoscopy

NPO until gag reflex

Blood tinged mucous is common

Monitor for hemorrhage / pneumothorax (increase HR)

How well did you know this?

Not at all

Perfectly

Lung biopsy can be done via

Bronchoscope

Transthoracic Needle Aspiration

Open biopsy

VATS

How well did you know this?

Not at all

Perfectly

Nursing care before thoracentesis

Consent

Patient upright w/elbows on overhead table in room

Instruct not to talk (be still)

How well did you know this?

Not at all

Perfectly

Nursing care after thoracentesis

CXR to confirm no pneumothorax

Assess for hypoxia / pneumothorax

How well did you know this?

Not at all

Perfectly

FEVI is defined as

Maximum amount of air expired forcefully in 1 second

How well did you know this?

Not at all

Perfectly

Care of anterior nose bleed

Position upright and lean forward Calm Lateral pressure with ICE Nasal Tampons Avoid Blowing Nose

Care of posterior nose bleed

Emergency Posterior packing balloon Humidification O2 Bedrest Pain control

With nose bleeds you should avoid

Saline spray ASA NSAID Strenuous activities

OSA risk facotrs

Increase age Male Obesity Structural abnormalities Smoking

S/S of OSA

Daytime sleepiness Snoring-Choking-Gasping Morning headaches

CPAP vs BiPap

CPAP is for spontaneously breathing patient to improve oxygenation. OSA BiPap uses two pressures; one during inhalation - one during exhalation. OSA + COPD

Types of Trachs

Shiley Jackson

What causes 85% of head and neck cancers?

Tobacco use

Tube dislodgement and accidental decannulation

Keep obturator taped at bedside AAT Insert obturator into outer cannula Extend neck and open tissue; insert Remove obturator immediately Check breath sounds and secure

Ways to restore oral communication after laryngectomy

Artificial larynx Tracheoesophageal Voice Restoration Esophageal speech

Esophageal Speech

Oral air is introduced into the esophague and expelled pas the PE s the driving force for speech production Advantage: -Hands-free and no extra devices Disadvantage: -Length of time that it takes to learn -Quality of speech not as good as other options

Radial Neck Dissection: Post-op care

MAINTAIN AIRWAY - ABC Pulmonary toilet Blood tinged secretions are normal can use Yankauer Pain management Nutrition (feeding tube before surgery) PT and Speech therapy

Hospital Acquired PNA

Begins 48 hours or longer after admission and was not present at time of admission

Community Acquired PNA

Patients who have not been hospitalized or lived in a long-term care facility within 14 days of onset

What is the most common type of PNA

VIRAL

PNA: Clinical Manifestations

Usually preceded by URI Fever - chills - cough - malsie Chest pain on inspiration CONFUSION in elderly

Viral PNA cough

Nonproductive and scanty

Bacterial PNA cough

Purulent

Ways to diagnosis PNA

CXR = infiltrates WBC with Diff Sputum with C&S

TB risk factors

Disproportionately to poor minorities IV drug users Less than ideal sanitation / over crowding Immunosuppression

Primary TB

Bacteria are inhaled and inflammatory reaction encapsulates organisms for rest of live Patient is asymptomatic Non infectious

Latent TB

Persistent state of immune response to bacterium Asymptomatic Non contagious POSTIVE skin test

Reactivated TB

ACTIVE Contagious Symptomatic

Active TB: How to confirm plus symptoms

Confirm with + sputum for AFB Fever Night Sweats Weight loss Productive cough Purulent or bloody sputum

Tuberculosis Testing

First: 1: TB skin or Mantoux Test or 2: Interferon-gamma release blood test (IGRA) Postive one of those test leads to CXR No ghon nodule on CXR = latent + ghon nodule on CXR = Sputum for AFB + AFB = ACTIVE -AFB = Latent

With mantoux test we are looking for

induration (raised bump) NO CLASSIFICATIONS 5mm - 10mm - 15mm

isoniazid side effect

Hepatotoxicity

Rifampin side effect

red/orange discoloration of excretions

ethambutol side effects

inability to tell red and green apart

When a patient has TB they are tested

q2 weeks and are no longer infectious with 3 negative culutres

COPD umbrella

Asthma Emphysema Chronic Bronchitis

COPD Characteristics

Barral chest due to hyperinflation Decreased - Wheezing - Rhonchi Breath sounds Prolonged expiration

Signs of advanced COPD

Pursed lip breathing Neck vein distention Peripheral edema Cachexia

What is the single most effective and cost-effective intervention to reduce risk for COPD

Smoking cessation

Most common symptoms of lung cancer

Persistent cough that produces sputum

Definitive test for lung cancer

Biopsy via: Bronchoscopy Percutaneous Needle VATS

CO2 necrosis

Condition in which COPD patient loose there stimulus to breath. In normal patient there stimulus to breathe is ELEVATED CO2 In COPD there stimulus to breathe LOW O2 If we give COPD patient high level O2 then they can stop breathing

What is the only way to diagnose someone with COPD (CO2 retainer)

Arterial Blood Gas ABG