Exam 3 (w5&6) Flashcards
(160 cards)
1
Q
Chest Tube: purpose
A
Drain whatever is causing lungs to be collapsed that is causing pneumothorax
Tube is placed into plural space
2
Q
Assessments for chest tube
A
Go watch youtube video on slide 55/79 in powerpoint
3
Q
Describe the movement of water in the chest tube
A
Inspiration = water goes up (water goes down with inspiration if patient on vent)
Expiration = water goes down; always bubbling (water goes up with expiration if patient is on vent)
4
Q
What is happening if the water seal chamber is always bubbling
A
Water seal chamber should never constantly be bubbling; if it is, it could be a sign of an air leak, so make sure it is connected to the patient
If you clamp the tubing and the bubbling stops, the leak is coming from the patient. If you clamp the tubing and the bubbling does not stop, the leak of coming from the system
5
Q
What part of the chest tube system is always bubbling?
A
suction control chamber (?)
6
Q
What should the nurse do if the chest tube comes out of the patient?
A
Put sterile gauze dressing out the hole in the patients chest; only tape it down on 3 sides
7
Q
What should the nurse do if the pluravac comes disconnected?
A
The tube coming out of the patient should be put in a bottle/container of sterile saline or water (SHOULD HAVE THIS AT BEDSIDE JUST IN CASE)
8
Q
Sternal and rib fracture: common cause
A
MVA - most are benign and treated conservatively
9
Q
What ribs have the highest mortality if they become fractured and why?
A
they are closest to the subclavian artery or vein - can lacerate –> bleeding
10
Q
Sternal and rub fracture: clinical manifestations and assessment
A
Pain increases with breathing resulting in hypoventilation
crepitus
11
Q
Sternal and rib fractures: medical and nursing management
A
Pain management
Do not decrease respiratory drive
Chest binder to decrease pain
12
Q
What is a common complication of sternal and rub fractures?
A
Pneumonia related to hypoventilation (slow breathing because it is painful)
13
Q
What is flail chest?
A
Blunt chest trauma
Three or more adjacent ribs are fractures in two or more sites resulting in free floating rib segments
14
Q
Flail chest: clinical manifestations and assessment
A
Hypoxia and respiratory acidosis
Asymmetrical chest wall movement (no intercostal or diaphragm support)
15
Q
Flail chest: medical and nursing management
A
Ventilatory support and pain management Rib plating (surgery; metal put in rib to put back together to decrease complications with ventilator)
16
Q
Pulmonary contusion: patho
A
Damage to lung tissues resulting in hemorrhage and edema
Abnormal accumulation of fluid in the interstitial and intra alveolar spaces result from the inflammatory process (leaking proteins change osmotic pressure, capillaries leak fluid which then interferes with gas exchange
17
Q
Pulmonary contusion: clinical manifestations and assessment
A
Constant ineffective cough, unable to clear secretions
Hypoxia, respiratory acidosis
18
Q
Pulmonary contusion: medical and nursing management
A
Hydration to mobilize secretions
May need antibiotics to treat infection r/t fluid leaking into the interstitial tissue
19
Q
How can we prevent pulmonary contusions?
A
Pulmonary hygiene / toileting to prevent
- cough, deep breath, incentive spirometry, chest
- physiotherapy, postural drainage (affected side up)
- Mobilize secretions
- Pain management
20
Q
What is a cardiac tamponade?
A
Compression of the heart resulting from fluid or blood within the pericardial sac; compresses ventricles –> decreased CO (hypotension)
High mortality rate
painful
21
Q
Cardiac tamponade: complications
A
Narrowing pulse pressure & hypotension (complications)
22
Q
Cardiac tamponate nursing management
A
teach to lean forward - Might be able to breath better if they lean forward
23
Q
cardiac tamponade: cause
A
direct assault to chest: air bag, baseball bat, etc.
24
Q
Pneumothorax: patho
A
Parietal or visceral pleura punctures and pleural space exposed to positive atmosphere pressure
25
Pneumothorax: clinical manifestations and assessment
Respiratory distress varies
Tracheal alignment (tension: trachea shifts Away from affected side)
26
Pneumothorax: medical and nursing management
Chest tube
27
Simple pneumothorax
Spontaneous: rupture of bleb on surface of lung or emphysema
28
Traumatic pneumothorax
Air escapes from a laceration in lung itself and enters the pleural space
May occur during a procedure (lung biopsy)
Barotrauma from mechanical ventilation
May be accompanied with a hemothorax
29
Tension pneumothorax
Air that enters the chest can not escape
Each breath increases pressure in the chest
May need decompressed emergently with a needle
Might see trachea deviateion
Put in needle and re-expand that lug
30
What should the nurse keep in mind about ABC with pneumothorax
circulation trumps airway and breathing because there is bleeding occurring in chest
(IV in, ready for fluid and blood replacement before we fix that airway)
31
Subcutaneous emphysema: what?
Air escapes into the subcutaneous tissue
Not an emergency unless enters neck area and airway may become compromised (then patient will need trach)
Can happen with any chest trauma
32
Aspiration: patho
Stomach contents into lung
| Ph of stomach destructive to alveoli and capillaries
33
Aspiration risk factors
Altered level of consciousness
Ng feeding
dysphagia
34
Aspiration: medical and nursing management
Compensating for absent reflexes
Assessing feeding tube placement
- Xray placement and document where the tube exits the nose and checked every medication or feeding
- Air auscultation & ph EBP remains inconclusive
- Must follow institution protocol
35
Where should the nurse listen if she believes someone has aspirated?
Right lower lobe
36
Aspiration: prevention
Prevention = key
Unconscious people --> on side
Tube feed --> bed 35 degrees or higher at all times
37
COPD: emphysema
abnormal enlargement of the airspaces (alveoli) beyond the terminal bronchioles with destruction of the walls of the alveoli
38
COPD: chronic bronchitis
presence of cough and sputum production for at least 3 months in each of 2 consecutive years (chronic infection)
39
What should we keep in mind about tracheostomy suctioning?
only apply suction coming out; sterile; only when needed;
40
COPD: risk factors
Alpha1-antitrypsin deficiency (genetic link)
| Smoking
41
COPD: diagnosis
hx physical exam PFT
| FEV1 lower
42
How do you calculate pack years?
#packs per day x years smoked = pack years
43
COPD: teaching
Get to quit smoking
Modify teaching around their decision to quit or not
-- not going to get 70 year old to quit
44
COPD (emphysema / chronic bronchitis): clinical manifestations and assessment
a. Easily fatigued
b. Frequent respiratory infections
c. Use of accessory muscles
d. Orthopneic
e. Cor Pulmonale (late in disease)
f. Thin appearance
g. Wheezing
H. Pursed-lip breathing
I. Chronic cough
j. Barrel chest
k. prolonged expiratory time
l. bronchitis - increased sputum
m. nail clubbing
45
COPD: tripod position
Promotes getting rid of CO2
46
COPS: RR high 20s-30
patient is in trouble
47
COPD: management
```
Education
Bronchidilators 1st
Inhaled corticosteroids 2nd
Pulmonary rehabilitation
O2
Surgery
```
48
COPD: Bronchodilators
```
laba (long acting beta adrenergic)
lama (long acting muscarinic agent)
saba (short acting beta adrenergic)
sama ( short acting muscarinic agent)
MDI
```
49
COPD: corticosteroids
inhaled or Iv
50
COPD: Roflumilast
?
51
Go look at slide 71
Tells about bronchidilators for COPD
52
COPD: IV steroids and steroids in general
Chronic problems --> increase risk of adrenal insufficiency, not abruptly stop
53
COPD: nutritional concerns
Eating can be very tiring for these individuals
Frequent, small meals that are high in protein
No carb intake because byproduct of carb is co2
54
COPD: resting energy expenditure
10-15%
55
COPD: physical activity
Simple, small goals
| Minimize weight loss d/t low lung reserve
56
Asthma: patho
complex and characterized by recurring and variable symptom and airflow obstruction and hyper-responsiveness
57
Asthma: inflammation is key in underlying feature - how?
leads to recurrent episodes
58
Asthma: clinical manifestations and assessment
cough, chest tightness, wheezing, dyspnea
59
Asthma: prevention
Patients should ID triggers and avoid them
60
Asthma: continuous attack
wheezing not breathing well tight – status asthmaticus (corticosteroids, bronchodilators, IV zanthene such as theophylline (10-20 is correct range)
61
Function and regulation of hormones
Directly released into blood and go to target tissue to initiate function of that target tissue
62
hypothalamus - connection
The hypothalamus is the connection between the nervous system and endocrine system. It controls the pituitary system gland which secretes stimulating hormones
63
Anterior pituitary gland releases what hormones
```
Growth hormone
Follicle stimulating hormone
Lutenizing hormone
Prolactin
Andrenocorticotropic hormone
Thyroid stimulating hormine
Melanocyte stimulating hormone
```
64
Growth hormone
Growth Hormone releasing hormone secreted from hypothalamus to stimulate pituitary to secrete growth hormone (somatotropin) (causes pain
65
Prolactin
Released by anterior pituitary gland
| Control breast milk secretion
66
Adrenocorticotropic hormone
Controlled by anterior pituitary gland
| adrenal stimulating
67
Melanocyte stimulating hormone
controlled by anterior pituitary glan
| skin color
68
Posterior pituitary gland releases what hormones?
1. Vasopressin (ADH) - when released, decrease UOP
| 2. Oxytocin - uterine contractions during labor
69
Thyroid gland releases what hormones?
a. TSH (thyrotropin) = pituitary, then to thyroid to release the hormones thyroxing, triiodothyonine, calcitonin
70
Thyroxine (t4)
released by TSH (thyrotropin) - metabolism
71
Calcitonin
released by TSH (thyrotropin) - lowers blood calcium and phosphate by pushing calcium back into the bone when someone is hypocalcemic
72
Where are the parathyroid glands?
Sit on thyroid
73
Parathyroid hormone releases what hormone?
PTH - regulates serum calcium and phosphate levels
| secreted when someone is hypocalcemic
74
What hormones are released from adrenal cortex
Androgens, mineralcorticoids, glucocorticoids
75
Androgens
Released by adrenal glands; Sex hormones (mainly male)
76
Mineralcorticoids
Released by adrenal glands - ex. is aldosterone; regulates electrolytes and metabolism
77
Glucocorticoids
Released by adrenal glands; example is cortisol - regulates inflammation and glucose metabolism
78
What hormones are released by the adrenal medulla
Catecholamines (epinephrine and NE)
| - fight or flight response
79
Insulin
Hormone released by the pancreas
| Facilitates glucose transport INTO the cells
80
Glucagon
Released by pancreas
increases BG
stimulates gluconeogenesis
81
Somatostatin
Released by pancreas
| Reduced rate food is absorbed from GI tract
82
Gerontological considerations: thyroid
Decreased metabolic rate (not as hungry, cold)
83
Gerontological considerations: parathyroid
Decreased absorption of vitamin D leading to..
| Osteoporosis
84
Gerontological considerations: adrenals
```
Decreased androgens
Decreased glucocorticoids (decreased inflammatory response)
```
85
Gerontological considerations: pancreas
Decreased insulin secretion
| Decreased cell sensitivity
86
Gerontological considerations: pituitary
Decreases TSH, ACTH, FSH, LH (stimulating hormones)
87
What is the main issue with DM
hyperglycemia - goal is to prevent complications by controlling hyperglycemia
88
Type I Diabetes
Onset any age
Cause: genetics, environmental, immunologic
Pancreas producing little to no insulin
Will need life-long insulin
aka ketosis, DKA
89
Why are most people diagnosed with Type I diabetes
patient goes to hospital because they developed DKA
90
Characteristics of type II diabetes: patho
Decrease insulin production
| Decrease cell sensitivity
91
Type 2 diabetes cause
Obesity, genetics and environmental
| pancreas = tired
92
type 2 diabetes management
Oral antidiabetic agents may help
May need insulin (does not require)
May improve with weight loss and diet
Ketosis uncommon
93
Type 2 diabetes: Hyperglycemic Hyperosmolar Non Ketotic Syndrome
idk
94
Secondary diabetes: pancreatic diseases
Cancer of pancreas can lead to diabetes dx
medications such as corticosteroids and estrogen containing meds can lead to DM dx
95
Gestational diabetes
Usually 2 or 3 trimester
Due to hormones secreted by placenta that inhibit the action of insulin
Macrosomia (unusually large babies)
30-40 % of mothers may develop DM II later
All women should be screened 24-28 weeks gestation
96
Impaired glucose tolerance: oral glucose tolerance
test value between 140 mg/dL (7.7 mmol/L) and 200 mg/dL (11 mmol/L)
97
Impaired glucose tolerance: impaired fasting glucose
a fasting plasma glucose between 110 mg/dL (6 mmol/L) and 126 mg/dL (7 mmol/L)
98
Describe what happens to glucose tolerance is someone is on corticosteroids
Glucose tolerance is going to be artificially elevated if someone on corticosteroids
99
Pathophysiology of diabetes
Insulin produced by the pancreas secreted by the beta cells
Transports and metabolizes glucose for energy
Stimulates storage of glucose as glycogen in the liver and muscle cells
Signals liver cells to stop the release of glucose
Enhances storage of dietary fat in adipose tissue
Accelerates transport of amino acids into cells
Facilitates the transport of potassium into the cells
Inhibits the breakdown of stored glucose, protein, and fat
100
Insulin secretion
Approximately 50% of the total insulin secreted daily by the pancreas is secreted under basal conditions, and the remainder is in response to meals.
The estimated secretion rate of basal insulin in the average adult (assume a weight of 70 kg) ranges from 18 to 32 units/24 hours
Minutes after eating, the serum insulin level rises, peaking in 3 to 5 minutes and returning to baseline within 2 to 3 hours
To attain glycemic control, nurses may be required to manage insulin drips based upon the secretion rate of basal insulin.
101
What does the body do if BG gets too low
glucagon, is secreted by the alpha cells
Glucagon stimulates the liver to release stored glucose, thereby increasing the blood sugar.
102
How do insulin and glucagon work together
insulin promotes hypoglycemia; glucagon promotes hyperglycemia. They work in tandem to maintain a constant level of glucose in the blood.
103
Why do we get confused when we are hypoglycemic?
Brain does not store supply of glucose for us
We have to have a constant steady supply of BG because our brain does not store it for us why we get confused when we are hypoglycemic
104
Liver role in diabetes
The liver assists with glucose control by storing glucose in the form of glycogen.
As the level of glucose in the blood begins to drop, the liver produces glucose through the breakdown of glycogen (glycogenolysis)
After 8 to 12 hours without food, the liver forms glucose from the breakdown of noncarbohydrate substances, including amino acids (gluconeogenesis)
105
Clinical manifestations of diabetes
```
Polyuria (most common w type 1)
Polydipsia (most common w type 1)
Polyphagia (most common w type 1)
Dehydration
Weight loss
Fatigue and weakness
Numbness and tingling hands and feet (type 2)
Vision changes (type 2)
Dry skin
Wounds that are slow to heal
Recurrent infections (particlarily yeast)
```
106
Complications of hyperglycemia
Impairs immune function (decreases white blood cell function)
promotes inflammation
increases blood viscosity (increase risk for blood clot)
favors the growth of yeast organisms
associated with changes in the blood vessel walls
- resulting in increased risk for infection
- microvascular and macrovascular complications (eyes --> blind, kidney failure)
- foot ulcers (neuropathy, cant feel)
107
Criteria for diagnosis of DM
A1c of 6.5% or greateror
Symptoms of diabetes plus casual plasma glucose concentration equal to or greater than 200 mg/dL (11.1 mmol/L). “Casual” is defined as any time of day without regard to time since last meal. The classic symptoms of diabetes include polyuria, polydipsia, and unexplained weight loss.or
Fasting plasma glucose greater than or equal to 126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 hours.or
Two-hour postload glucose equal to or greater than 200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test. The test should be performed as described by the World Health Organization, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.
108
Gerontological considerations for DM
Almost 27% of people over 65 years of age have diabetes
Older patients with diabetes are likely to have coexisting illnesses
the goals of diabetes treatment may need to be altered when caring for elderly patients
- Quality not quantity
Focus is on quality of life
109
DM medical management
```
Nutrition
Exercise
Monitoring
Medication
Education
```
110
Stress and BG
The stress response results in hyperglycemia because it activates the sympathetic nervous system. The ensuing increase in catecholamines, systemically derived from the adrenal gland or released locally at the level of the liver, increases hepatic glycogenolysis and the release of large quantities of glucose into the bloodstream while inhibiting the release of insulin. Thus, all patients who are stressed are at risk for hyperglycemia.
111
BG and eating / nutrition
It is important to assess the patient’s blood sugar BEFORE meals when insulin coverage is ordered since the patient’s blood sugars will rise after ingesting food.
Promote eating patterns that help improve glucose, blood pressure, and lipid control.
Tailor therapy to each person’s individual cultural and behavioral needs.
Emphasize the pleasure of eating while changing eating
habits.
Provide practical tools for healthy eating.
Caloric requirements
Carbohydrates
Protein
112
Alcohol and BG
Alcohol is absorbed before other nutrients
Large amounts can be converted to fats, increasing the risk for DKA
Hypoglycemia and drunk can mask each other
113
What should the nurse do if she cannot tell if someone is drunk or hypoglycemic
Treat patient like they are hypoglycemic until she knows for certain
114
Misleading food labels
Foods labeled “sugarless” or “sugar-free” may still provide calories equal to those of the equivalent sugar-containing products if they are made with nutritive sweeteners
Foods labeled “dietetic” still may contain significant amounts of sugar or fat
Read the labels of “health foods”—especially snacks—often contain carbohydrates, such as honey, brown sugar, and corn syrup
115
Exercise benefits and education for DM
Exercise uses glucose, caution for hypoglycemia (teach about ss)
Should not get implement a big exercise regime after being diagnosed
116
SS hypoglycemia
Tachycardia, agitation, confusion
117
Monitoring glucose and keytones
```
Self Monitoring of Glucose
Continuous monitoring (phone apps)
Measuring Glycated Hemoglobin
Urine Glucose
Ketone testing
```
118
Insulin therapy: rapid
Meal coverage
| Onset = 15 minutes
119
insulin therapy: short
Regular is the only insulin that can be given IV (regular insulin is a form of short acting)
used for meal coverage
120
slide 36/50
brush up on insulin types
121
Insulin sites
Rotate sites but keep in same area
SQ is fastest absorbed because high vol. of vessels
Do not massage sites
122
Complications from insulin therapy: Local vs systemic allergy
```
Local = usually NBD
Systemic = not allergic to insulin by allergic to the preservatives in it
```
123
Insulin lipodystrophy
no clue
124
Fasting hyperglycemia: Dawn phenomenon
someone who wakes w hyperglycemia
Intervention = give insulin later at night, no snacking before bed
125
Fasting hyperglycemia: Somogyi effect
morning hyperglycemia because hyperglycemic episode in middle of the night (at 2 or 3 am BG is really low, body responds then you become hyperglycemia.
Intervention = giving long acting or insulin coverage earlier in evening, snack b4 bed
126
Dawn phenomenon and somogyi effect require what?
middle of night BG checks
127
Fast hypoglycemia: insulin waning
no idea
128
Non-insulin anti diabetic agents: sulfonylureas
Sulfonylureas (glipazides)
Stimulate insulin release from pancreas, can cause hypoglycemia
Effective for type II only
These will sulfur antibiotics together increase risk of hypoglycemia
129
Non Insulin Anti Diabetic Agents: Biguanides
```
Metformin
Nephrotoxic
Can cause lactic acidosis
Does NOT cause hypoglycemia
Discontinue in response to needing contrast dye for diagnostic testing
```
130
```
Non Insulin Anti Diabetic Agents:
GLP-1 Agonists
SGLT-2 Inhibitors
Thiazolidinediones
Alpha-Glucosidase Inhibitors
Non sulfonylurea Insulin Secretagogues
```
Did not talk about these not sure if i need to know
131
What does someone require if they have a pancreas transplant
Lifelong immunosuppressants = at risk for infection
132
Diabetes: nursing management
Develop a Diabetic Teaching Plan
- Assess readiness to learn
- Determine teaching methods
Implementing the teaching plan
- Teaching experienced patients
- Teaching patients self care
Providing Continuing Care
133
Acute complications of DM: hypoglycemia
we can over correct hyperglycemia and cause this. We need to know ss and hypoglycemia
134
Acute Complications of DM: DKA
Causes metabolic acidosis
- - body can not use sugar and uses fat instead (?)
- - goal = gets BG down
- - losing a lot of fluid --> replace (fluids, IV, and hyperkalemia treatment)
135
Acute Complications: Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)
Type II
| Hyperglycemia that is not spilling ketones
136
Long term complications of DM
```
Macrovascular
Microvascular
Diabetic Neuropathy
- peripheral and autonomic neuropathies
- complications of legs and feets
```
Renal failure, blindness
137
What is an example of autonomic neuropathy? And what is a treatment
Gastroparesis - stomach does not mTing
| Metaclopromide can promote gastric mTing
138
Adverse side effect of metaclopromide
Extrapyramidal symptoms
139
Gigantism
Pituitary tumor
during puberty, our epiphysis on end of bones close NORMALLY - here, they stay open and grow LONGER
Growth hormone issues
Exessive secretion
Occurs pre-puberity
140
Acromegaly
Pituitary tumor
Occurs post puberty
during puberty, our epiphysis on end of bones close NORMALLY - here, they stay open (?) and grow WIDER
141
Diabetes insipidus
Pituitary disorder
| Not enough ADH (large UOP, hypernatremia, dehydrated)
142
Diabetes insipidus treatment
vasopressin (should see decrease in UOP), Na restriction, high fluids
143
SIADH
Pituitary disorder
| Syndrome of Inappropriate ADH (decrease UOP, edema, hyponatremia)
144
SIADH intervention
Declamyacin – increase UOP
| Increase NA and strict fluid restriction
145
Most common surgery for when someone has pituitary tumor? What are important considerations before and after this surgery?
Most common surgery is hypophysectomy (incision in mouth above teeth, clip tumor, put face back to tumor) – MUST KEEP CLEAN TO DECREASE INCISION or patient could get meningitis
After surgery - no oral care bc they will break surgical scar (more opportunity for bacteria) and CSF can leak potential
146
Hypothyriodism: what? treatment? complication?
Thyroid disorder - cold, fat, slow
Treatment: thyroid replacement
Complication: Myedema --> progress to coma
147
Priapism
Hypothyroid as infant (mental delays / mentally challenged)
148
Hyperthyroidism: what, treatment, goal, complication
Thyroid disorder - hot, fast, skinny
Treatment: PTU -- suppress thyroid hormone until they get to surgery (will most likely need it)
Goal: get TSH down
Complication: thyroid storm -- hypertensive, tachycardic, hot
149
Considerations for Synthroid
can cause cardiac arrhythmia's (monitor HR, esp. geriatric); most common A fib
- do not administer when someone having MI (increase metabolic rate, release of catecholamines)
150
Hyperparathyroidism
Parathyroid Disorders - causes hypercalcemia
151
Hypoparathyroidism
Parathyroid Disorders
| causes hypocalcemia
152
Things to consider with thyroidectomy
If we take out thyroid gland, parathyroids are disrupted because parathyroid sits on top of it, so after surgery asses pt for hypocalcemia (?)
Assess neck incision and back (blood and gravity)
Assess tracheal is midline (blood can move it)
153
Pheochromocytoma
adrenal disorder
| tumor of adrenal glands, benign take it out
154
PHEOCHROMOCYTOMA: considerations b4 surgery
- before surgery, get HR and BP under control (Beta blocker, anti htn meds)
155
PHEOCHROMOCYTOMA: s/s
- causes excessive catecholamine release, HTN, headache , tachycardia
156
PHEOCHROMOCYTOMA: post op considerations
- in post-op , going to have significant HYPOTENSION problem (fluid replacement, vasopressors)
157
Addison's disease
Adrenal disorder
Hypoadrenalism
Not enough cortisol
Cause – daily steroid
158
Addison's disease: s/s
hypoglycemia, hypotension, hyperkalemia
159
Addison's disease: treatment
IV cortocosteroids
160
Cushing Disease
| Primary Aldosteronism
Adrenal disorders
| Go look at these in the endocrine work document
