Exam 3 Flashcards
(203 cards)
1
Q
What is Altruism?
A
Concern for the well-being of others
2
Q
Give an example of human dignity
A
Not gossiping about patients
3
Q
List the theories of aging
A
- Genetics
- Immunity
- Cross-linkage
- Free radicals
4
Q
Explain the cross-linkage theory of aging
A
chemical reaction damages DNA causing cell death
5
Q
Explain the free radical theory of aging
A
molecules with separated high-energy electrons harm nearby molecules
- focuses on cell metabolism & function
6
Q
What is immunosenescene?
A
age-associated immune changes = increased infections cancer, autoimmune disorders
7
Q
Development of Middle Adults
A
- Physiologic: gradual internal & external physioloigc changes occur
- Cognitive: little change from young to adulthood
- Psychosocial: time of increased personal freedom, economic stabillity, & social relationships
8
Q
Which example is a developmental task of the middle adult?
a.) continue an established lifestyle or reorganize one’s life in a period of transition
b.) Adapt to, and face, already completed tasks
c.) Choose a vocation
d.) Develop an ethical system as a guide to behavior
A
a.) continue an established lifestyle or reorganize one’s life in a period of transition
9
Q
Explain Erikson’s theory on older adults
A
- ego integrity vs. dispair & disgust
- Final stage of psychosocial development
- Contemplate accomplishments & develop integrity if lead a successful life
10
Q
What are some myths of ageism?
A
- aging involves severe cognitive decline
- Urinary incontinence is normal
- Late life is lonenly and depressing
- Older people lose interest in sex
- Most older people do not live independently
11
Q
Nursing care goals for the older adults
A
#1 Promote independent function
- support individual strengths
- prevent complications of illness
- secure a safe & comfortable environment
- promote return to health
12
Q
SPICES tool to identify common problems in older adults
A
- Sleep disorders
- Problems with eating or feeding
- Incontinence
- Confusion
- Evidence of falls
- Skin breakdown
13
Q
What is the function of the upper airway?
A
Warm, filter, & humidify air
14
Q
Components of the upper airway
A
- nose
- pharynx
- larynx (vocal cords)
- epiglottis (covers windpipe)
15
Q
What are the function of the lower airway?
A
- Air conduction
- Mucociliary clearance
- Production of pulmonary surfactant
16
Q
Lower airway components
A
- trachea
- R & L mainstream bronchi
- segmental bronchi
- terminal bronchioles
- alveoli
17
Q
Explain what a Nonrebreather mask is
A
Low flow rates, high concentration of O2
- mask on pt face, has reservoir bag below connected to O2
- prevents O2 from entering the mask
- for short term or emergencies
18
Q
Explain what a simple mask is
A
low to moderate amount of O2
- holes prevent CO2 from entering mask
- Doesn’t deliver as high of an O2 concentration as non-rebreather
- safer in the case of a blockage
19
Q
Explain what a venturi mask is
A
designed to deliver a fixed O2 concentration
- mixes O2 with inhaled air
20
Q
Why don’t we use vasaline / petrolium jelly with an O2 mask?
A
it’s an accelerant
21
Q
Explain the physics of breathing
A
As volume of lungs shrinks during exhalation, the pressure of the lungs increases (+) above that of the atmospheric pressure (-) & air moves out of the lunsg down the pressure gradient
22
Q
Which phase of ventilation is inspiration?
A
Active
23
Q
Which phase of ventilation is expiration?
A
Passive
24
Q
Which respiratory organ is the site of gas exchange?
a.) Mediastinum
b.) Parietal pleura
c.) Alveoli
d.) Diaphragm
A
c.) Alveoli
The wall of each alveolus is made of a single-cell layer of squamous epithelium. The thin awll allows for exchange of gases within the capillaries covering the alveoli
25
**What is perfusion?**
The process by which oxygenated capillary blood passes through body tissues
26
**List some potential alterations in the cardiovascular system**
* dysrhythmia or arrhythmia
* myocardial ischemia
* angina
* myocardial infarction
* heart failure
27
**What is the difference in ischemia & infarction?**
**ischemia = reduced blood flow to tissue**
* can lead to pain
**Infarctoin =** end point of ischemia that **results in tissue death**
28
**What are vesicular breath sounds?**
**low pitched = low on the chest**
* heard during **expiration heard over most of the lungs**
## Footnote
**low pitched = low on the chest**
29
**What are bronchiovesicular sounds?**
**medium pitch = heard in medium location on chest**
* heard during **expiration** over the upper anterior chest & intercostal area
30
**What are bronchial lung sounds?**
**high pitched = heard high in the chest**
* longer sounds
* heard mainly over the trachea
31
**What is the cause of angina?**
reduced blood flow to the heart
| angnia = chest pain
32
**What is the cause of heart failure?**
Heart muscle **can't pump enough blood to meet body's needs for blood & oxygen**.
| Heart can't keep up with its workload
33
**What is the difference in wheezes & crackels?**
**Wheezes:**
* continuous sounds
* heard on expiration & sometimes on inspiration as air passes through airways constricted by swelling, secretions, or tumors
* **classified as sibilant (high [i]) or sonorous (low [o])**
**Crackles:**
* intermittent sounds
* occur when air moves through airways containing fluid
* **classified as fine, medium, or coarse**
34
**How are wheezes classified?**
* sibilant (high)
* sonorous (low)
35
**How are crackles classified?**
* fine
* medium
* coarse
36
**What is Tidal Volume (TV)?**
**total amount of air inhaled & exhaled in 1 normal breath**
| doesn't require conscious effort
37
**What is Vital Capacity?**
**maximum amount of air that can be expired after inspiration**
38
**What is Forced Vital Capacity (FVC)?**
** maximum amount of air that can be FORCEFULLY exhaled after a full inspiration**
39
**What is Forced Expiratory Volume (FEV ...1...2...3)?**
**Volume of air exhaled at a specific interval**
| EX: after 1 second, 2 sec., 3 sec. after full inspiration
40
**What is Total Lung Capacity (TLC)?**
**Volume of air contained in the lungs at maximum inspiration**
41
**What is Residual Volume (RV)?**
**Volume of air left in lungs at maximal expiration**
42
**What is Peak Expiratory Flow Rate (PEFR)?**
**Maximum flow attained during FVC (forced vital capacity)**
43
**What is atelectasis?**
**collapsed lung or incomplete expansion of alveoli**
44
**What are potential causes of atelectasis?**
* Diminished breath sounds over collapse
* Dyspnea
* Cyanosis
* Crackles
* Restlessness
* Apprehension
| atelectasis = collapsed lung (incomplete alveoli expansion)
45
**What can be done to prevent atelectasis**
* Incentive spirometry (IS)
* Coughing
* Getting out of bed (movement)
* Turning in bed
* Maintaining hydration
| atelectasis = collapsed lung (incomplete alveoli expansion)
46
**Which lung value is the amount of air contained within the lungs at maximum inspiration?**
**a.)** vital capacity (VC)
**b.)** total lung capacity (TLC)
**c.)** residual volume (RV)
**d.)** peak expiratory flow rate (PEFR)
**b.) total lung capacity (TLC)**
* TLC = amount of air contained within the lungs at maximum inspiration
47
**What is pneumonia?**
inflammed alveoli
| due to foreign material or infection
48
**What are some of the signs & symptoms associated with pneumonia?**
* Fever
* Cough
* Rusty or purulent sputum
* Chills
* Crackeles (fluid)
* Wheezes (obstructed airway from inflammation)
* Dyspnea
* Angina
49
**Post-Operative Pulmonary Care Program**
**I**ncentive spirometry
**C**ough / deep breathing
**O**ral care
**U**understanding (patient & staff education)
**G**et out of bed 3 times per day
**H**ead of bed elevation
| **ICOUGH**
50
**In what instances / scenarios would a chest tube be placed?**
* Surgery
* Trauma
* Pneumothorax
* Pleural Effusion
* Emphysema
* Chylothorax (lymph fluid in pleural space)
51
**Where is a chest tube placed?**
any of the 4 pleural spaces
| R, L, anterior, or posterior pleural space
52
**List the types of artificial airways**
* oropharyngeal airway
* nasopharyngeal airway
* endotracheal tube
* tracheostomy
53
**Is bubbling of a chest tube normal?**
* **Intermittent Bubbling = Normal** (when patient coughs or exhales)
* **Continuous Bubbling = ABNORMAL**
* can indicate a leak
54
**What is the goal of a vasodilator when given in a hypertensive crisis?**
Lower the blood pressure by **25%** in the **first hour**
55
**What should the nurse do if a chest tube becomes disconnected from its drainage unit?**
Submerge the end of the tube in sterile water
| allows air to escape & prevents a pneumothorax
56
**What part of the brain stem contains the respiratory center?**
Medulla
57
**What can emphysema result in or lead to?**
**DECREASED (-) lung compliance**
| compliance = change in volume in the lungs for given change in pressure
58
**What are signs and symptoms of hyperkalemia?**
| **KNOW THIS**
* **B**radycardia
* **C**ontracted muscles (including the heart)
* **D**iarrhea
* **H**ypotention
| **BCDH**
59
**What are signs & symptoms of hypokalemia?**
| **KNOW THIS**
* **F**lushed skin
* **F**ever
* **P**olydipsia (excessive thirst)
* **N**/V
* **S**wollen tongue
| **FFPNS**
60
**What are signs & symptoms of hyponatremia?**
| **KNOW THIS**
* **C**oma
* **R**espiratory arrest
* **S**eizures
* **T**achycardia
61
**What is shock?**
Body's reaction to **acute peripheral circulatory failure** due to an abnormality of circulatory control or to a loss of circulating fluid
62
**What is the difference in elective, urgent, & emergent surgery?**
* **Elective:** delay has no ill effects / improve health or self-concept
* **Urgent:** usually done **24-48 hours**, remove or rapir body part (cholecystectomy or amputation)
* **Emergent:** **done immediately to preserve life** (hemorrhage, tracheostomy)
63
**What is palliative surgery?**
**Not curative**
* reduce or releive intensity of disease
| debride nectrotic tissue, arthroplasty, etc.
64
**What are the 4 different types of anesthesia?**
**1.)** General
**2.)** Moderate Sedation / Analgesia (conscious sedation)
**3.)** Regional
**4.)** Topical & Local Anesthesia
65
**When is Moderate Sedation / Analgesia (conscious sedation) used?**
for short-term, minimally invasive procedures
66
**What are the 3 phases of general anesthesia?**
**1.) Induction:** administration of anesthesia --> ready for incision
**2.) Maintenance:** incision --> near completion of procedure
**3.) Emergence:** starts when patient emerges from anesthesia & is ready to leave the OR
67
**What is the difference in a living will & a durable power of attorney?**
**Living Will:** patient makes choices before incapacitation
**DPOA:** patient appoints someone else to make decisions once incapacitated
68
**Explain the surgical risks of medications**
* **Anticoagulants:** hemorrhage
* **Diuretics:** electrolyte imbalances, respiratory depression from anesthesia
* **Tranquilizers:** increased hypotensive effects of anesthetic agent
* **Adrenal Steroids:** abrupt withdrawal may cause cardiovascular collapse
* **Antibiotics in -mycin group:** respiratory paralysis (when combined with ceratin muscle relaxants)
69
**What are surgical risks associated with anticoagulants?**
**hemorrhage**
70
**What are surgical risks associated with diuretics?**
* **Electrolyte imbalances**
* **Respiratory depression** (from anesthesia)
71
**What are surgical risks associated with tranquilizers?**
**increased hypotensive effects** of anesthetic agents
72
**What are surgical risks associated with adrenal steroids?**
abrupt withdrawal may cause **cardiovascular collapse**
73
**What are surgical risks associated with antibiotics in the mycin group?**
**respiratory paralysis** (when combined with certain muscle relaxants)
74
**List some teachings nurses can perform pre-op to prevent post-op complications**
* **Deep breathing**
* **Coughing**
* **Incentive spirometry** (IS)
* **Leg exercises** (to prevent clots)
* **Turning in bed**
* **Early ambulation**
75
**List medication classes that are commonly used post-operatively**
* **Sedatives** (xanax, lunesta, valium, klonopin, ativan)
* **Anticholinergics** (bentyl, benztropine, atropine, benadryl, glycopyrrolate)
* **Narcotic analgesics** (morphine, codeine, dilaudid, oxycodone, tramadol, fentanyl, hydrocodone)
* **Neuroleptic agents** (haldol, risperidone, aripiprazole (abilify))
* **H2 receptor antihistamines** (ranitidine & famotidine)
76
**List medication classes that are commonly used post-operatively**
* **Sedatives** (xanax, lunesta, valium, klonopin, ativan)
* **Anticholinergics** (bentyl, benztropine, atropine, benadryl, glycopyrrolate)
* **Narcotic analgesics** (morphine, codeine, dilaudid, oxycodone, tramadol, fentanyl, hydrocodone)
* **Neuroleptic agents** (haldol, risperidone, aripiprazole (abilify))
* **H2 receptor antihistamines** (ranitidine & famotidine)
77
**What post-op assessments & interventions should be done every 10 - 15 minutes?**
* **Respiratory Status** (airway, pulse ox)
* **Cardiovascular Status** (BP)
* **Temperature**
* **CNS Status** (level of alertness, movement, etc.)
* **Fluid Status**
* **Wound Status**
* **GI Status** (N/V)
* **General Condition**
78
**What are potential post-op cardiovascular complications that can arise?**
* **Hemorrhage**
* **Shock** (low BP)
* **Thrombophlebitis** (irritation of vein due to clot)
* **Pulmonary Embolus** (disloged clot travels to lung)
79
**What actions should be taken when hemorrhage or hypovolemic shock is expected?**
* Pressure dressing
* Contact surgeon or rapid response team
* prepare patient to return to the OR for stabilization
80
**What are signs & symptoms of a PE?**
* Dyspnea
* Tachycardia
* Anxiety
81
**What are signs & symptoms of thrombophlebitis?**
* Erythema
* Edema
* Elevated temperature
* Pain / cramping in the calf
* Increased limb diameter
82
**What is the earliest indication of hypovolemic shock?**
**INCREASED heart rate**
83
**What percentage of fluid in the body consists of ECF vs. ICF?**
**ECF = 30%**
**ICF = 70%**
84
**Is there more fluid inside or outside of cells?**
**INSIDE (ICF)**
85
**What is the difference in a solvent & a solute?**
* **Solute:** substance **being dissolved**
* *Solvent:* substance that is *doing* the *dissolving*
86
**What are the functions of sodium?**
| **Na**
* controls & regulates volume of body fluids
87
**What are the functions of potassium?**
| **K**
regulator of cellular enzyme activity & water content
88
**What are the functions of calcium?**
| **Ca**
* nerve impulse
* blood clotting
* muscle contraction
* B12 absorption
89
**What are the functions of magnesium?**
| **Mg**
* proteins & carbohydrate metabolism
* vital actions involving enzymes
90
**What are the functions of chloride?**
| **Cl**
* maintain osmotic pressure in blood
* produce hydrochloric acid
91
**What are the functions of bicarbonate?**
| **HCO3-**
primary buffer system in the body
92
**What are the functions of phosphate?**
| **PO4**
* involved in chemical reactions of the body
* cell division
* hereditary traits
93
**What is the average adult fluid intake & loss in 24 hours?**
1500 - 3500 mL
94
**What is a hypertonic solution?**
**cells shrink**
* high osmotic pressure so fluid moves OUT of the cell
95
**What is hypotonic solution?**
**cells swell / burst**
* low osmotic pressure so fluid moves INTO cells
96
**What is isotonic solution**
**Equal amount of fluid moving into and out of the cell**
| no movement
97
**Where is the thirst control mechanism located?**
hypothalamus
98
**How does the body become hydrated?**
**1.) Drinking**
**2.)** Eating
**3.)** metabolism of fats, proteins, & carbs
99
**Low potassium (K) levels can lead to low levels of what?**
Chloride
| - K = - Cl (directly proportional)
100
**List the levels of each electrolyte**
(per textbook)
| Na, P, Ca, Mg, Cl, HCO3, PO4
* **Sodium (Na): 135 - 145**
* **Potassium (K): 3.5 - 5** (3.5 - 4.5)
* **Calcium (Ca): 8.6 - 10.2**
* **Magnesium: 1.3 - 2.3**
* **Chloride (Cl): 97 - 107**
* **Bicarbonate (HCO3): 25 - 29**
* **Phosphate (PO4): 2.5 - 4.5**
101
**What is the normal range for sodium (Na)?**
| Per book
135 - 145
102
**What is the normal range for potassium (K)?**
| per book
3.5 - 5
| usually 3.5 - 4.5
103
**What is the normal range for calcium (Ca)?**
| per book
8.6 - 10.2
104
**What is the normal range for magnesium (Mg)?**
| per book
1.3 - 2.3
105
**What is the normal range for chloride (Cl)?**
| per book
97 - 107
106
**What is the normal range for bicarbonate (HCO3-)?**
| per book
25 - 29
107
**What is the normal range for phosphate (PO4-)?**
| per book
2.5 - 4.5
108
**What is phase I PACU Care?**
| Ch 16
* immediate recovery
* intensive nursing care
109
**What is Phase II PACU Care?**
| Ch 16
prepared for transfer to inpatient nursing unit, extended care setting, or discharge
110
**When is a nasal canula (NC) used?**
* **short-term use; post-op**
* long-term use (used w/ humidifier)
111
**What is the main difference in a partial rebreather mask & a non-rebreather mask?**
**A partial rebreather mask does NOT have flutter valves on the side**
* Non-rebreather mask has flutter valves
112
**In what circumstances is a non-rebreather (NRB) used?**
* **Carbon monoxide poisoning**
* Flutter valves should be closed
| if reservoir bag is fully deflated = INCREASE O2 flow
113
**What type of oxygen mask provides the most precise oxygen delivery?**
venturi mask
| **V**enturi mask = **V**ery accurate
114
**What is the difference in hypercapnia and hypoxemia?**
* *Hyper**c**apnia* **=** ELEVATED **C**O2
* Hypoxemia **=** low O2
115
**Describe the nursing management in the PACU**
| Ch 16
* Assess the patient
* Maintain patent airway
* Maintain cardiovascular stability
* Relieve pain & anxiety
* Control N/V
116
**What signs & symptoms are associated with hypovolemic shock?**
| **KNOW THIS**
* **pallor**
* **cool, moist skin**
* **rapid breathing**
* **cyanotic lips**
* **rapid, weak, thready pulse**
* **concentrated urine** (dark brown, dehydrated due to low blood volume)
* **decreased pulse pressure** (less blood circulating)
* **Low BP**
117
**What are some Gerontologic Considerations when caring for geriatric post-op patients?**
| Ch 16
**Older = slower body response**
* Decreased physiologic reserve
* Monitor carefully & frequently
* Hydration, Thermoregulation, Hypoxia, HTN, Hypoglycemia
* Increased likelihood of post-op confusion or delirium
118
**What is the difference in first, second, & third intention wound healing?**
| Ch 16
* **First Intention:** well-approximated edges, no visible granulation, minimal scar formation
* **Second Intention:** visible granulation tissue, wound is left open to heal on its own via granulation
* **Tertiary (third) Intention:** wound closure is intentionally delayed (first heals by secondary intention, then surgically closed once risk for infetion is decreased)
119
**Which of the following occurs during the inflammatory stage of wound healing?**
**a.)** Fibroblasts leave wound
**b.)** Tensile strength increases
**c.)** Blood clot forms
**d.)** Granulation tissue forms
**c.) Blood clot forms**
120
**Give the ranges of normal pH, PaCO2, & HCO3**
| Ch 17
**pH:** 7.35 - 7.45
**PaCO2:** 35 - 45
**HCO3:** 22 - 26
121
**What structures make up the upper respiratory tract?**
| Ch 17
* Nose
* Paranasal sinuses
* Pharynx
* Tonsils & adenoids
* Larynx (epiglottis, glottis, thyroid cartilage, cricoid cartilage, vocal cords)
* Trachea
122
**What structures make up the lower respiratory tract?**
| Ch 17
* Lungs
* Pleura (serous membrane that lines thoracic cavity wall & lungs)
* Mediastinum
* Bronchi & Bronchioles
* Alveoli
123
**What is ventilation?**
| Ch 17
mechanical movement of air
124
**What is respiration?**
| Ch 17
exhanging of gases in the alveoli
| physiologic
125
**What is compliance?**
| Ch 17
**elasticity & expandability** of the lungs & thoracic structures
126
**What is the difference in pulmonary diffusion & pulmonary perfusion?**
| Ch 17
* Pulmonary **Diffusion:** O2 delivered to blood capillaries & CO2 is removed from blood capillaries (via alveoli)
* Pulmonary **Perfusion:** blood flow through pulmonary vasculature
127
**What is the common cold and what are associated signs & symptoms?**
| Ch 17
**Acute inflammation of nasal cavity**
* rhinorrhea
* sneezing
* sore theoat
* general malaisse
* nasal congestion
128
**What is Forced Expiratory Volume (FEV)?**
| Ch 17
maximum amount of air that can be exhaled over a short period of time
129
**What is Residual Volume (RV)?**
| Ch 17
volume of air **remaining** in the lungs **after maximum exhalation**
130
**What is used to measure Peak Expiratory Flow Rate (PEFR)?**
| Ch 17
Peak Flow Meter
131
**List different types of URIs**
| Ch 17
* Rhinitis & rhinosinusitis
* Pharyngitis
* Tonsillitis & adenoiditis
* Peritonsillar abscess
* Laryngitis
* Allergic Rhinitis
132
**What is Rhitis? What are the causes? What are common signs & symptoms?**
| Ch 17
**inflammation of the nasal cavity**
* **Causes:** acute, chronic, bacterial, viral
* **S&S:** rhinitis, itchy nose, mouth/throat itching
133
**What is Pharyngitis? What are the causes? What are signs & symptoms? What should nurses do / be aware of?**
| Ch 17
**Sore throat**
* **Causes:** acute or chronic
* **S&S:** pain, fever, edema of the throat
* **Nurses should:** check hydration status (ice chips or popsicles)
134
**What is Tonsillitis / Adenoiditis?**
| Ch 17
**Inflammation of the tonsils or adenoids**
* tonsils are part of the immune system
135
**What is a peritonsillar abscess?**
| Ch 17
**collection of fluid around the tonsils**
136
**What is Laryngitis?**
| Ch 17
**Sounds hoarse, hard time talking, changes in voice**
137
**What type of bacteria is the precursor to pharyngitis?**
| Ch 17
Group A Streptococcus
138
**What happens if pharyngitis caused by group A strep. is not treated quickly?**
| Ch 17
sepsis can occur
| infection in the blood
139
**What are potential complications of URIs?**
| Ch 17
* **Nuchal rigidity** (neck stiffness -- meningitis)
* **Airway obstruction**
* **Hemorrhage**
* **Sepsis**
* **Trismus** (lock jaw)
* **Dysphagia**
* **Aphonia** (loss of ability to speak)
* **Meningitis or brain abscess** (severe headache, fever, etc.)
140
**What is epistaxis? What is the most common site? How is it managed?**
| Ch 17
**nose bleed**
* **Most Common Site:** anteiror septum
* **Management:** pinch soft portion of nose for 5-10 minutes with patient sitting upright**;** phenylephrine spray (vasoconstrict)**;** silver nitrate or electrocautery**;** gauze packing or balloon inflated catheter for 3-4 days**;** antibiotic therapy
141
**Patient teaching for epistaxis**
| Ch 17
* avoid spicy food **(vasodilation)**
* Avoid nasal trauma, nose picking, forceful blowing, tobacco
* Avoid exercise **(increases vasodilation & risk of bleeding coming back)**
* Adequate humidification
142
**What should patients with pharyngitis do and not do?**
| Ch 17
**DO:**
* stay hydrated
* wear face mask to filter out small particles
* use lozenges or gargle w/ warm salt water
**NOT DO**
* ENDS use (vape)
* secondhand smoking
* EtOH
* exposure to cold environments
* occupational pollutants
143
**What are common diagnosis statements for patients with URIs?**
| Ch 17
* Ineffective airway clearance
* Ineffective breathing patterns
* Insufficient fluid volume
* Anxiety
* Activity intolerance
* Impaired verbal communication **(laryngitis)**
* Impaired swallowing **(strep throat)**
144
**What are crackles?**
| Ch 17
**soft, high-pitched popping sounds during inspiration** (may be heard on expiration)
145
**What are wheezes?**
| Ch 17
**high-pitched whistle sound usually heard on expiration**
146
**What two things can lead to an acidic state in the body?**
* Hydrogen acid **(H = H**igh acid**)**
* Carbon dioxide **(CO2 =** carbon di**-acid)**
| more **carbon dioxide = ** more carbon di**acid**
147
**What instances can lead to ABG imbalances controlled by the lungs?**
**Alkalotic (basic):** hyperventlation
**Acidotic:** intoxication, overdose, head injury **(low respiratory rate)**
148
**What element can cause the body to become alkalotic?**
**B**icarbonate **= B**asic
149
**What is a laryngectomy & what populations are more susceptible to needing them?**
**removal of the voice box**
**Common in:**
* men (4x higher risk of laryngeal cancer)
* 65+
150
**What are potential complications of a laryngectomy?**
* Respiratory distress
* Hemorrhage
* Infection
* Wound breakdown
* Aspiration
| prevent aspiration w/ increased suction & 30 degree head elevation
151
**What should the nurse prepare a patient for regarding laryngectomy post-op?**
* PEG tube for nutritional support
* NPO for 1 week post-op
* Check literacy, hearing, & vision
* Coping skills & available support system
152
**What nursing interventions can be utilized with patients having a laryngectomy?**
* Preoperative teaching
* Reduce anxiety
* Maintain patent airway (suctioning)
* Support alternative communication
* Protomote adequate nutrition & hydration
* Monitor potential complications
* Encourage coughing & deep breathing
* Promote positive body image & self-esteem
* Provide skin care
153
**What forms of diagnostic testing can be done for URIs?**
* CBC
* CT of the sinuses
154
**What are important things to recall regarding patients who are having / have had a laryngectomy?**
* Patient should eat protein before surgery
* Pt will not be able to laugh, whistle, speak, sing post-op
* Sense of taste & smell will change
* Will need more oral care post-op (suction & sit upright)
* Avoid perfumes, aerosols, & air fresheners
155
**Older patients who have GERD are at a higher risk for what complication?**
Aspiration
156
**What medications are commonly used to treat GERD?**
**Proton Pump Inhibitors (PPIs):** reduce H2 receptors (decrease gastric backflow)
* Pepsid, omeprazole, zantac
157
**What is atelectasis?**
| Ch 19
closure or collapse of alveoli
158
**What is atelectasis? What are the classifications? What are common signs & symptoms?**
**Closure or collapse of alveoli**
**S&S:** increasing dyspnea, cough, sputum
**Classifications**
* **Acute:** pleural pain, tachycardia, tachypnea, central cyanosis
* **Chronic:** pulmonary infection might be present
159
**What assessments are used to diagnose atelectasis?**
* Chest X-ray
* Pulse oximetry (low saturation < 90%)
* Dyspnea & hypoxemia
* Decreased breath sounds
* Crackles over affected area
160
**What are some interventions for patients with atelectasis?**
| Ch 19
* **Frequent turning / early mobility**
* **Strategies to manage secretions**
* **Incentive spirometer** (lung volume expansion)
* **Pressurized metered-dose inhaler** (head of bed as close to 90 degrees as possible; fully express air before taking the dose of medication)
161
**What is the acronym ICOUGH used for & what does it stand for?**
**management of actelectasis**
* **I**ncentive spirometry
* **C**oughing & deep breathing
* **O**ral care
* **U**nderstanding (patient & staff education)
* **G**etting out of bed at least 3x daily
* **H**ead of bed elevation
162
**List forms of management for atelectasis**
**First Line:** frequent turning, early ambulation, lung volume expansion, coughing
* ICOUGH
* CPAB, bronchoscopy
* **C**hest **P**hysio **T**herapy**:** precussing along back lung fields to move secretions
* **P**ostural **D**rainage**:** tilt head down & feet up (gravity moves secretions)
* Endotracheal intubation & mechanical ventilation
* Thoracentesis (to releive compression)
163
**What is Acute Tracheobronchitis? What is the cause? What are common signs & symptoms?**
**inflammation of mucous membranes of the trachea after a viral infection**
* **Cause:** mucopurulent sputum
**Signs, Symptoms, & Manifestations:**
* initially **dry cough with mucoid sputum**
* As it progresses: **dyspnea, stridor, wheezes, purulent sputum**
164
**How is acute tracheobronchitis managed?**
* antibiotics
* analgesics
* increased fluid intake
* cool vapor therapy or steam inhalations
* suctioning
165
**What is Pneumonia? What are the causes? What are the classifications?**
**inflammation of the lung parenchyma** (all parts that make up the lung) **caused by various microorganisms, including bacteria, myobacteria, fungi, & viruses**
**Classifications:**
* Community-acquired pneumonia **(CAP)**
* Health care-associated pneumonia **(HCAP)**
* Hospital-acquired pneumonia **(HAP)**
* Ventilator-associated pneumonia **(VAP)**
166
**Explain Community Acquired Pneumonia (CAP)**
* community setting or within first 48 hours of hospitalization
* *S. pneumoniae* is most common cause
167
**Explain Health-Care Associated Pneumonia (HCAP)**
* occurs after 48+ hours in the hospital
* caused by multidrug resistant organisms
* High mortality rate
**Signs & Symptoms: pleural effusion** (blockage of air & circulatory system)**; high fever** (102 - 104)**; tachycardia; increased respiratory rate**
168
**Explain Ventilator-associated pneumonia (VAP)**
* patient has received mechanical ventilation for at least 48 hours
169
**What are risk factors for pneumonia?**
* **patients 65+**
* Heart failure
* Diabetes
* Alcoholism
* COPD
* AIDS
* Influenza
* Cystic Fibrosis
* Recent antibiotic use
* Unvaccinated patients
* Post upper respiratory infection
170
**What are common signs & symptoms of pneumonia?**
* Low heart rate
* Fever
* Headache
* Myalgia
* Rash
* Pharyngitis
* Orthopnea
* Crackles
* Increased tactile fremitus
* Purulent sputum
171
**What signs & symptoms are unique to STREPTOCOCCAL Pneumonia?**
**Sudden onset of:**
* Chills
* Pleuritic chest rate
* Tachypnea
* Respiratory distress
172
**What symptom is unique to VIRAL pneumonia?**
Bradycardia
173
**Pneumonia Prevention**
**PCV-13 Vaccine** (13 strains)
* Recommended for patients 65+ & immunocompromised (19+)
* immunocompromised = HIV, immunosuppresant drugs, leukemia, asplenia (don't have spleen to filter blood), CKD, sickle cell disease, asthma
**PPSV-23** (23 strains)
* later, for older adults
* 65+, immunocompromised (asthma, sickle cell)
* Given 1 year & 1 day after receiving PCV-13
174
**Medical management of pnemonia**
* Fluids
* Oxygen for hypoxia
* Antitussive
* Antipyretics
* Decongestants
* Antihistamines
175
**What is the difference in anosmia & ageusia?**
**Anosmia:** loss of taste
**Ageusia:** loss of smell
176
**Potential complications of bacterial pneumonia**
* Continuing symptoms after initial therapy
* Sepsis & septic shock
* Respiratory failure
* Atelectasis
* Pleural effusion
* Delirium
177
**What is aspiration? What is key pathophysiology of aspiration?**
**inhalation of foreign material into the lungs that leads to inflammatory reaction, hypoventilation, & ventilation-perfusion mismatch**
**Key Patho:** volume & character of aspirated contents (most often GI contents)
178
**Aspiration Prevention**
* Keep head of bed elevated
* Avoid stimulation of gag reflex w/ suctioning & other procedures
* Soft diet, small bites, no straws
179
**What are risk factors associated with aspiration?**
* **Seizure activity**
* **Stroke**
* **Brain injury**
* **Decreased LOC** (trauma, EtOH/drug sedation / anesthesia)
* **Swallowing disorders**
* **Cardiac arrest**
180
**What is the cause of pulmonary tuberculosis? How does it spread? What are common signs & symptoms?**
**Cause: *Myobacterium tuberculosis* ** (bacillus)
* **Transmission = airborne via droplets** (which move to other parts of the body such as the kidneys, bones, & cerebral cortex)
* **S&S:**night sweats, fatigue, low grade fever, cough
181
**What is the Mantoux test?**
intradermal injection used to test for TB
182
**How can you test for TB?**
* Mantoux test
* Blood tests (quantifuron gold)
* Sputum culture
* Sputum testing
183
**Management of TB**
* **Treated for 6 - 12 months**
* **Drug resistance = primary concern**
* **Use N95 mask**
* **Initiate treatment with 4+ medications**
* **Complete all therapy**
* Initial treatment phase = 8 weeks
* Continuation phase = 4-7 months
184
**What is a pleural effusion (PE)? What are common signs & symptoms**
**Fluid collectoin in pleural space** (usually secondary to HF, TB, pneumonia, pulmonary infection)
**S&S:**
* fever
* chills
* pleuritic pain
* dyspnea
* decreased or absent breath sounds
* decreased fremitus
* dull, flat sound on percussion
185
**What is emphysema?**
**accumulation of thick, purulent fluid in pleural space**
* usually result of bacterial pneumonia or lung abscess
186
**What symptoms are associated with acute respiratory failure**
**respiratory acidosis, hypoxemia, hypercapnia, rapid deterioration**
* **Early Signs:** restlessness, tachycardia, HTN, fatigue, ehadache
* **Later Signs:** accessory muscle use, decreased breath sounds
187
**What is endotracheal intubation & what is the goal?**
**Passing an endotracheal tube through the nose or mouth into the trachea**
**Goals**
* provides patent airway
* access for mechanical ventilation
* facilitates removal of secretions
188
**How long can endotracheal intubation be for?**
14 - 21 days
189
**What is Acute Respiratory Distress Syndrome (ARDS)? What is the mortality rate?**
**Lung condition causing low blood O2**
* **Mortality Rate:** 27% - 50%
**Symptoms:**
* Sudden, progressive pulmonary edema
* Increasing b/l lung infiltrates visible on chest x-ray
* Absence of an elevated atrial pressure
* Rapid onset of severe dyspnea & V/Q mismatch **< 72 hours** after precipitating event
* Crackles, intercostal reactions, & BNP levels
* Severe hypoxemia that doesn't respond to supplemental O2
190
**List some pulmonary vascular disorders**
* **Pulmonary Edema**
* **Pulmonary Hypertension**
* **Pulmonary embolism**
* **R-sided Heart Failure** (fluid back into lungs)
191
**What is the leading cause of cancer death in the US?**
Lung Cancer
192
**What is the classification of lung cancer & what percentage of lung cancer is associated with each classification?**
* **Small Cell Lung Cancer (SCLC):** 13%
* **Non Small Cell Lung Cancer (NSCLC):** 84%
193
**Describe different types of chest trauma**
* **Penetrating Trauma**
* **Blunt Trauma**
* sternal, rib fractures
* flail chest
* pulmonary contusion
* car accident
* **Pneumothorax**
* simple or spontaneous
* traumatic
* tension
194
**What is important to know about chest tubes?**
* Don't empty system until it's full
* Used in removal of air & fluid from pleural space & re-expansion of lungs
* Will see tidal wave when breathing if water seal in suction (wave rises with inhale & falls w/ exhale)
195
**Which nursing diagnosis would be most appropriate for many middle adults?**
**a.)** Risk for imbalance nutrition
**b.)** Delayed growth & development
**c.)** Caregiver role strain
**d.)** Self-care deficit
**c.) caregiver role strain**
196
**What is the first thing a nurse does if there is new, bright red drainage (5" across) on the patient's surgical dressing?**
**a.)** Notify the surgeon of a potential hemorrhage
**b.)** Recheck in 1 hour for increased drainage
**c.)** Remove the dressing & assess the incision
**d.)** Assess the patient's BP & heart rate
**d.) Assess the patient's BP & heart rate**
197
**In a hypertensive crisis, what is the goal of a vasodilator?**
**a.)** Reduce BP by 25% in the first hour
**b.)** Reduce BP as quickly as possible
**c.)** Reduce the BP to 120/80 in 2 hours
**d.)** Increase temperature and heart rate
**a.) Reduce BP by 25% in the first hour**
198
**Which of the following is the maximum amount of air that can be exhaled over a short period of time?**
**a.)** Residual Volume (RV)
**b.)** Peak Expiratory Flow Rate (PEFR)
**c.)** Forced Expiratory Volume (FEV)
**d.)** Volume of air inhaled into the lungs
**c.) Forced Expiratory Volume (FEV)**
199
**Unless contraindicated by the surgical procedure, which position is preferred for the unconscious patient immediately post-op?**
**a.)** Supine
**b.)** Semi-Fowler's
**c.)** Trendelenberg
**d.)** Lateral
**d.) Lateral**
200
**Which electrolyte is responsible for regulating the volume of body fluids?**
**a.)** Potassium
**b.)** Sodium
**c.)** Calcium
**d.)** Magnesium
**b.) Sodium**
201
**A patient is suffering from excessive edema. Which fluid would you expect to be ordered?**
**a.)** D5W (5% dextrose in water)
**b.)** 0.45% Saline (1/2 normal saline)
**c.)** 5% Saline
**d.)** 0.9% Normal Saline
**c.) 5% Saline**
202
**What is the most reliable indicator for kidney function?**
**a.)** BUN
**b.)** Creatinine
**c.)** Sodium
**d.)** Potassium
**b.) Creatinine**
203
**When assessing a patient, chvostek sign is noted. Which imbalance is the patient exhibiting?**
**a.)** Hyperkalemia
**b.)** Hypocalcemia
**c.)** Hypermagnesia
**d.)** Hyponatremia
**b.) Hypocalcemia**
