Exam 6

Question 1

The nurse is caring for a patient was 30% total body surface area burn. During the first 12 to 36 hours the nurse carefully monitor the patient for which status changes related to capillary leak syndrome?

Answer 1

Tachycardia and hypotension

Question 2

The home health nurse is visiting an older couple for the initial visit. In observing the household the nurse identify several behaviors and environmental factors to address. Which identify factors increase the risk for Burns and for household fires?

Answer 2

Ashtray with all the cigarette butts on the bedside table space heater very close to the bad single smoke detector in the kitchen back exit called the house use of the storage space

Question 3

The nurse is caring for several patients on the burn unit was sustained extensive tissue damage. The nurse should monitor for which electrolyte imbalance that is typically associated with initial third spacing fluid shift?

Answer 3

Hyperkalemia

Question 4

The nurse is reviewing the hemoglobin and hematocrit results for patient recently admitted for a severe burn. Which result is most likely related to vascular dehydration?

Answer 4

Hematocrit a 58%

Question 5

The nurse is performing a morning assessment on a patient admitted for serious burns to the extremities. For what reason does the nurse assess the patient’s abdomen?

Answer 5

To assess for a paralytic ileus secondary to reduce blood flow

Question 6

The nurse is interviewing and assessing an electrician was brought to the emergency department after being electrocuted. By standards are for that he was holding onto electrical source for a long time. Patient is currently alert with no respiratory distress. During the interview, what is the nurse assessed for?

Answer 6

Entrance and exit wounds

Question 7

The patient was involved in a house fire and suffered extensive full thickness burns in the long term, what is she made this patient have trouble with?

Answer 7

Activation of vitamin D

Question 8

During shift report, the nurse learned that a new patient with submitted for an inhalation injury. Auscultation of the lungs has revealed wheezing over the mainstream bronchi since admission. During the nurses assessment of the patient the wheezing sound or absent. What does the nurse do next?

Answer 8

Assess for respiratory distress because of potential airway obstruction

Question 9

What is the maximum temperature of the skin can tolerate without injury?

Answer 9

104°

Question 10

The nurse is caring for several patients who sustained burns. The patient with which initial injury is the least likely to experience severe pain when a sharp stimulus is applied?

Answer 10

Deep full thickness burn from electrical accident

Question 11

The nurse is reviewing arterial blood gas results for patient with 35% TBS they burn in the emergent phase pH is 7.26 PCO2 was 36 MM HG and HCO3 is 19. What condition is the nurse suspect the patient has?

Answer 11

Metabolic acidosis

Question 12

Patient comes to the clinic to be treated for burns from a barbecue fire. Although the patient does not appear to be in any respiratory distress, the nurse suspects and inhalation injury after observing which findings?

Answer 12

1, burns to the face

2. Singed nose hair
3. Adema of the nasal septum
4. Black carbon particles around the mouth

Question 13

The nurses caring for a burn patient received rigorous fluid recessive Tatian in the emergency department for hypotension and hypovolemic shock. In assessing renal function for the first 24 hours, what finding does the nurse anticipate?

Answer 13

Output will be decreased compared to fluid intake

Question 14

A patient sustained a superficial thickness burn over a large area of the body. The patient is crying with discomfort and is very concerned about the long-term effects. What does the nurse tell the patient to expect?

Answer 14

Healing to occur in 3 to 6 days with no scarring or complications

Question 15

The nurse is caring for a patient brought to the emergency department after bending over the engine of the car when it exploded in his face. What is the priority for this patient?

Answer 15

Secure the airway

Question 16

The nurse is caring for a patient who sustained carbon monoxide poisoning while working on his car engine in an enclosed space. What assessment findings as a nurse anticipate?

Answer 16

Patient will report a headache

Question 17

For which patient with the rule of nines method of calculating Burnside be most appropriate?

Answer 17

An adult his weight is proportionate to their height

Question 18

Which criteria describes a full thickness burn wound?

Answer 18

1. There is destruction to epidermis and dermis
2. There are no skin cells for regrowth
3. The burned tissue is a vascular

Question 19

The nurse is assessing a patient with a brown one to the back and chest area. Which assessment findings are consistent with the superficial thickness burn wound?

Answer 19

Redness, pain, mild Adema

Question 20

The nurse observes pealing of dead skin on the length of a patient with a superficial thickness burn. What is the most accurate description of this assessment findings?

Answer 20

Desquamation

Question 21

The epidermis can go back after burn injury due to which component in this layer of skin?

Answer 21

Dermal appendages

Question 22

Which type of burn one damages epidermis, dermis, fashion, and tissues?

Answer 22

Deep full thickness

Question 23

Which type of burn destroy the sweat glands, resulting in decreased excretory ability?

Answer 23

Full thickness

Question 24

During the early phase of a burn injury there is a drastic increase in capillary permeability him. What does this physiologic change place a patient at risk for?

Answer 24

Hypovolemic shock

Question 25

An adult patient is admitted to the burn unit after being branded a house fire. Assessment reveals Branson entire face, back of the head, anterior torso, answer come French O'Briens to both arms. Using the rule of nines what is the extent of the burn injury?

Answer 25

45%

Question 26

What is the most effective intervention for preventing transmission of infection to a burn patient?

Answer 26

Performing hand hygiene correctly and when appropriate

Question 27

Which vaccine is routinely administered want to burn patient is admitted to the hospital?

Answer 27

Tetanus

Question 28

Patient has severe burns the anterior surface of the body from a short exposure to high temps at a worksite furnace. Which area of the body's most Bonable to a deep burn injury

Answer 28

Eyelids

Question 29

The stain the berm much appears right invoice. The nurse gently apply pressure to the area to assess for what sign or symptom?

Answer 29

Blanching

Question 30

What is the primary reason to avoid infection with burn injuries?

Answer 30

Prevent sepsis

Question 31

The nurse is caring for several patients on the burn unit. Which patients have the greatest risk for developing respiratory problems?

Answer 31

1. Patient who was in a storage room where chemicals caught fire 2. Patient was working in an area where steam escape from a pipe 3. Patient sustained a circumferential Brian to the chest area 4. patient was found unconscious in a slow burning house fire

Question 32

The nurse is caring for a firefighter who is trapped by for a prolonged period of time by burning debris. During the shift, the nurse know it's a progressive hoarseness, Brasic off, and the patient reports increased difficulty with swallowing. How does the nurse interpret these changes?

Answer 32

Signs indicating a pulmonary injury and possible airway obstruction

Question 33

The nurses just received a report on a patient admitted for a steam and elation burn. The patient is alert and conversant but reports that his throat feels wrong. His wife says that he sounds hoarse compared to usual. Considering these findings, which order does the nurse question?

Answer 33

Vital signs and airway assessment every shift

Question 34

The nurse is caring for a burn patient was stabilized by and transferred from a small world hospital the patient develops a new complaint of shortness of breath on auscultation the nurse here's crackles throughout the lung fields what does the nurse suspect is causing this patient's symptoms?

Answer 34

Pulmonary fluid overload due to fluid resuscitation

Question 35

The nurse is caring for several patients on the burn unit. Which of these patients has the most acute need for cardiac monitoring?

Answer 35

Young woman who was struck by lightning while jogging on the beach

Question 36

A patient is transported to the emergency department for severe an extensive burns that occurred while he was trapped in a burning building. The patient is severely injured with respiratory distress and the resuscitation team us immediately begin multiple interventions. Which task is delegated to the UAP

Answer 36

Assist the respiratory therapist to maintain a seal during bag valve mask ventilation

Question 37

The nursing student notes on the care plan of the burn patient she is caring for that risk for organist Kenya. Based on the students knowledge of the pathophysiology of Burns, which ideology does the nursing students select?

Answer 37

Related to hypovolemia and myhlobin release

Question 38

The student nurses caring for a patient who is seen in the burn unit for several weeks. The patient needs assistance with the bedpan to have a bowel movement, and then student nurse notes at the store was black with Atari appearance. What does the sooners do next?

Answer 38

Test for the presence of a cold blood with the Hemoccult cards and reagent

Question 39

Patient lives in a rural community sustain several Burns during a house fire at 10 AM. The rule is in MS started a peripheral IV at 11 AM to keep the van open the patient was admitted to hospital at 1 PM. And calculating the fluid replacement at what time is the fluid for the first air. Completed

Answer 39

6 PM

Question 40

A burn patient with which condition is most likely to have mantle ordered as part of drug therapy?

Answer 40

Lexical burn and myoglobin in the urine

Question 41

Patient was admitted to the burn unit approximately six hours ago after being rescued from a burning building and emergency department here according to dry irritated throat from breathing in the fumes complaints. During the shift the nurse notes of the patients only marked strider. The nurse and just been patient for what you

Answer 41

Intubation

Question 42

The patient was admitted for Brian's of the upper extremities after being trapped in a burning structure. The patient is also at risk for an adequate oxygenation related to inhalation of smoke and superheated fumes. Which diagnostic test best mattresses patient gas exchange?

Answer 42

Carboxyhemoglobin level

Question 43

The patient in the burn intensive care unit is receiving Norcuron. What is the primary nursing intervention for this patient?

Answer 43

And sure that all the equipment alarms are on and functional

Question 44

The priority expected outcome during the recess cetacean phase of a burn injury is to maintain which factor?

Answer 44

The airway

Question 45

Which statement about the Risa cetacean phase of a brain injury is accurate?

Answer 45

It continues for about 48 hours after the burn

Question 46

The release of myoglobin from damage muscle in patients with major brands can result in which potential complication?

Answer 46

Acute kidney injury

Question 47

I'll burn patient in the fluid resuscitation phase is experiencing dyspnea what are the priority interventions for this patient?

Answer 47

1. Elevate head of bed 2. Notify the rapid response team 3. Apply humidified oxygen

Question 48

The vasodilating affects the carbon monoxide in patients with Cara monoxide poisoning causes what clinical manifestation?

Answer 48

Cherry red skin color

Question 49

The nurses caring for a burn patient about to undergo hydrotherapy. Which complementary therapies are appropriate for pain management in this patient?

Answer 49

Playing music in the background use of meditative breathing use a guided imagery

Question 50

Burn patient refuses to eat. The potential problem of weight loss related to increased metabolic rate reduced calorie intake is identified for this patient. What method listeners used to quickly with patient?

Answer 50

Where daily without dressings or splints and compared to prepare and wait

Question 51

Nurse is preparing to assist with hydrotherapy forever and patient. The supervising nurse instructs us to obtain the necessary equipment before beginning the procedure. What equipment is your nurse obtain?

Answer 51

1. Scissors and forceps 2. Mild soap or detergent 3. Washcloths and God sponges

Question 52

The nurse is applying addressing to cover a burn patients left leg. What technique does the nurse use?

Answer 52

Consider the depth of the injury and amount of drainage and work distal to proximal

Question 53

The nurses just received a phone report on the burn patient being transferred from the burn intensive care unit to step down burn unit. Which task is appropriate to delegate to UAP in order to prepare the room?

Answer 53

Place a new disposal stethoscope in the room

Question 54

The nurse is monitoring the nutritional status of a burn patient. Which indicators as a nurse use?

Answer 54

1. Amount of food the patient needs 2. Weight to height ratio 3. Sarah I'm albumin 4. Blood glucose

Question 55

The nurses educating the patient was Sanbern said dominant hand. What kind of active range of motion exercises the nurse instruct the patient to perform?

Answer 55

Exercise a hand, thumb, fingers every hour while awake

Question 56

Burn patient must have pressure dressings applied to prevent contractures and reduce scarring. For maximum effectiveness what procedure pertaining to the pressure garments is implemented?

Answer 56

One at least 23 hours a day until the scar tissue matures

Question 57

Family reports of the burn patient unable to perform self-care measures of someone's been doing everything for her. The nurse five the patient has an odd physical capability to independently perform self-care what is the nurses best response

Answer 57

What is been happening since you were discharged from the hospital

Question 58

Basin who sustained severe burns her face with significant scarring and disfigurement will soon be discharged from the hospital. Which intervention is best to help the patient make the transition into the community?

Answer 58

Courage visits from friends and short public appearances before discharge

Question 59

What does the process of a full thickness wound healing include?

Answer 59

1. Healing occurs by wound contraction 2. Eschar must be removed 3. Skin grafting maybe necessary 4. Fathi out of me maybe needed to relieve pressure and allow normal blood flow

Question 60

Which statement about Thursday singer capillary leak syndrome in a patient with severe burns is accurate?

Answer 60

It is a leak a plasma fluids into the interstitial space

Question 61

As a result of third spacing, during the acute phase, which electrolyte imbalance of made her

Answer 61

Hyperkalemia and hyponatremia

Question 62

Because of the fluid shifts and burn patients what effect on cardiac output does the nurse expect to see?

Answer 62

Depressed up to 36 hours after the burn

Question 63

Burn injuries is being discharged from the hospital. What important points does the nurse include in the discharge teaching?

Answer 63

1. Signs and symptoms of infection 2. Drug regimen and potential medication side effects 3. Correct application and Cara pressure garments 4. Dates for follow-up appointments

Question 64

The patient has sustained significant Burns what you've created a hyper metabolic state. And planning care for this patient what does the nurse consider?

Answer 64

Increased caloric needs

Question 65

The nurse is reviewing the lab results for several burn patients were approximately 24 to 36 hours post injury. What lab results related to fluid we mobilize Asian in these patients as a nurse expect to see?

Answer 65

Anemia

Question 66

Local to see resistance to electricity varies in different parts of the body which tissue has the most resistance?

Answer 66

Skin epidermis

Question 67

Patient was rescued from a burning house and treated with oxygen. Initially the patient had audible wheezing and wheezing on awful Tatian but after approximately 30 minutes the wheezing stop the patient now demonstrate subs are no retractions and anxiety. What action does the nurse take it this time?

Answer 67

Recognize an impending airway obstruction and prepare for a meeting at intubation

Question 68

The nurses caring for a young woman who sustained brands on the upper extremities and anterior chest wall attempting to put out a kitchen grease fire. Which lab results of the nurse expect to see you during the recess cetacean phase?

Answer 68

1. Glucose level of 180 2. Hematocrit of 49% 3. pH of 7.20

Question 69

Patient is a saint a branch of the right ankle. The physician is applied the initial dressing to the angle and the nurse assist the patient into bed and positions and go to prevent contracture. What is the correct position the nurse uses?

Answer 69

Dorsey flexion

Question 70

Patient is a saint a severe burn greater than 30% TV essay. What is the best way to assess renal function in this patient?

Answer 70

Measure you're in output and compare this value with fluid intake

Question 71

The nurse is caring for an African-American patient with the burn injury. Patient appears to be having severe pain and discomfort your unrelated to the burned area. The nurse advocate that the physician order which additional test?

Answer 71

Sickle cell for trait

Question 72

The physician has ordered and escharotomy for the patient because of construction around the patient's chest. The nurse is teaching the patient and family about the procedure. Which Steven by the family indicates a need for additional teaching?

Answer 72

He wouldn't do well under general anesthesia

Question 73

The nurses caring for a firefighter who was brought in for burns are on the face and upper chest. Eric maintenance for this patient with respiratory and bald men includes what action?

Answer 73

Monitoring for signs and symptoms of upper airway edema during fluid resuscitation

Question 74

I won't point does fluid mobilization occur in patients with burns?

Answer 74

After 36 hours when the fluid from the interstitial tissue

Question 75

The nurses caring for a patient with chronic pain associated with and I'll burn injury which nonpharmacological interventions as the nurses to help relieve the patient's pain?

Answer 75

Massaging non-burned areas

Question 76

A patient with the burn injury had an autograph. The nurse Lawrence and report with the donor site is on the upper thigh. What type of wine does the nurse expect to find a donor site?

Answer 76

Partial thickness

Question 77

To prevent the complication of curlings all sir, what is the nurse anticipate the physician will order it?

Answer 77

H to histamine blockers

Question 78

Several patients are transported from an industrial fire to a local emergency department. Which factors increase the risk of death for these patients?

Answer 78

1. Age greater than 60 years 2. Burn greater than 40% TBsa 3. Presence of inhalation injury

Question 79

What is the most essential patient data needed for calculating the fluid rates, energy requirements and drug doses for burn patients?

Answer 79

Pre-burn wait

Question 80

Which drug therapy reduces the risk of loan infection for burn patients?

Answer 80

Silver sulfadiazine is on full thickness injuries every four hours

Question 81

Patient has a Santa relatively large burn. The nurse anticipate that the patient's nutritional requirements may exceed how many calories a day

Answer 81

5000

Question 82

Feelings are most typically expressed by the burn patient?

Answer 82

Regression, denial, anger

Question 83

Patient has been depressed and withdrawn since her injury and has expressed that life will never be the same. Which nursing intervention best for mugs a positive image for this burn patient?

Answer 83

Discussing the possibility of reconstructive surgery with the patient

Question 84

A 28-year-old male sustained second and 3rd° burns on his legs 30% on his clothing got fire while he was burning leaves. He was hoes down by his neighbor and his arrival of the emergency department severe discomfort what is the primary problem for this patient at this time?

Answer 84

Acute pain related to damage her exposed nerve endings

Question 85

Which patient has the highest risk for a fatal burn injury?

Answer 85

77-year-old man

Question 86

The patient was burned on the forearm after tripping and falling against the wood-burning stove. They're currently several small blisters over the burn area. What does the nurse advised the patient to do about the blisters?

Answer 86

Leave the blisters intact because they are protecting the one from infection

Question 87

A 70-year-old client with a diagnosis of heart failure and chronic obstructive pulmonary disease is admitted to a unit in a long-term care facility for cardiopulmonary rehabilitation program. Pneumococcal and flu vaccines are administered. The client asked the nurse if the pneumococcal vaccine has to be taken every year like the flu vaccine. How should the nurse respond?

Answer 87

It is unnecessary to have any follow-up injections of the pneumococcal vaccine after this dose

Question 88

A client is receiving albuterol to relieve severe asthma. For which clinical indicators of the nurse monitor the client?

Answer 88

Tremors and palpitations

Question 89

The client states that the healthcare provider said the title volume is slightly diminished and asked the nurse what this means. Which exclamation should the nurse provide about the volume of air being measured to determine title volume?

Answer 89

Exhaled after there is a normal inspiration

Question 90

A nurse is instructing a client to use and incentives barometer. What client action indicates the need for further instruction?

Answer 90

Blowing vigorously end of the mouthpiece

Question 91

A client is scheduled for a pulmonary function test. The nurse explains that during the test one of the instructions the rest of Troy therapist will give the client is to breathe normally. What should the nurse teaches being measured when the client follow these directions?

Answer 91

Tidal volume

Question 92

The nurse identifies the clients hemoglobin level is decreasing and is concerned about tissue hypoxia. An increase in what diagnostic test results indicate an acceleration and oxygen dissociation from hemoglobin?

Answer 92

PCO2

Question 93

What nursing action women hypoxia and sectioning a clients airway?

Answer 93

Apply suction only after catheter is inserted

Question 94

A nurse assesses that several clients have low oxygen saturation apples. Which client would benefit the most from receiving oxygen via nasal cannula?

Answer 94

Receive many visitors while sitting in a chair

Question 95

A nurse reposition the client was diagnosed with emphysema to facilitate breathing. Which position facilitates maximum air exchange?

Answer 95

Orthopenic

Question 96

What nursing action will most help a client obtain maximum benefits after postural drainage?

Answer 96

Encourage coughing deeply

Question 97

A client of emphysema experience is a sudden episode of shortness of breath and is diagnosed with a spontaneous pneumothorax. The client asked how could this have happened? What likely cause of the spontaneous pneumothorax so the nurses response take into consideration?

Answer 97

Rupture of a subpleural blab

Question 98

A client is diagnosed with emphysema. For what long-term problems with the nurse monitor this client?

Answer 98

Carbon dioxide retention

Question 99

What is the underlying rationale my nurse assesses the client with emphysema for clinical indicators of hypoxia?

Answer 99

Loss of aerating surface

Question 100

The nurse administers oxygen at 2 L a minute be a nasal cannula to a client with emphysema. For which clinical indicators of the nurse closely observed the client for?

Answer 100

Drowsiness and mental confusion

Question 101

And there's this teaching breathing exercises to a client with emphysema. What is the reason the nurse should include in the teaching as to why these exercises are necessary to promote effective use of the diaphragm?

Answer 101

The residual capacity of the lungs has been increased

Question 102

While receiving and adrenergic beta-2 agonist drug for asthma the client complains of palpitations chest pain a throbbing headache. What is the most appropriate nursing action?

Answer 102

Withhold the drug until additional orders are obtained

Question 103

What is the priority go for a client with asthma was being discharged from the hospital?

Answer 103

Demonstrate use of a metered dose inhaler and

Question 104

The client with a long history of asthma is scheduled for surgery. What information should be included in preoperative teaching?

Answer 104

There is an increased risk of respiratory tract infections

Question 105

Acclimate asthmas been taught how to use the peak flow meter to monitor how well the house was being controlled. What should the nurse instruct the client to do?

Answer 105

And he'll completely and then blow out as hard and as fast as possible through the mouthpiece

Question 106

A client is admitted for an act laceration of emphysema. The client has fever, chills, difficulty breathing on exertion. What is the priority nursing action based on the clients history and present status?

Answer 106

Encouraging increased fluid intake

Question 107

The arterial blood gases of a client with chronic obstructive pulmonary disease deteriorate, respiratory failure is in pending. For which clinical indicators should the nurse assessed first?

Answer 107

Mental confusion

Question 108

A nurses caring for a client with severe dyspnea who is receiving oxygen via Venturi mask. Which of the nurse to you and Karen for this client?

Answer 108

Monitor oxygen saturation levels when eating

Question 109

The client is admitted to the hospital with a diagnosis of an exacerbation of asthma. What should the nurse plan to do to best help this client?

Answer 109

Give prescribe drugs to promote bronchial dilation

Question 110

And nurses caring for a client with a history of chronic obstructive pulmonary disease. What complications are most commonly associated with COPD?

Answer 110

Cardiac problems

Question 111

After resection of a lower lobe of the long, client is excessive respiratory secretions. What independent nursing action should the nurse implement?

Answer 111

Turning and repositioning

Question 112

A nurses caring for a client experiencing acute episode of bronchial asthma. What outcome should be achieved?

Answer 112

Raising mucus secretions from the chest

Question 113

The nurses caring for a patient admitted to the emergency department of cardiac tamponade. What assessment findings of the nurse expect to see?

Answer 113

1. Jugular vein distention 2. Decreased cardiac output it 3. Muffled heart sounds

Question 114

A patient in the emergency department has been diagnosed with a flail chest following a fall from a two-story height. What findings of the nurse expect to see upon assessment?

Answer 114

1. Dyspnea | 2. Paradoxic chest movement

Question 115

True or false educational materials at discharge instructions should be available at the six grade reading level or lower

Answer 115

True

Question 116

The patient and emergency department has been diagnosed with the flu I'll just following a three-story fall from a ladder. Which interventions as a nurse include for this patient?

Answer 116

1. Requesting pain medication | 2. Providing humidified oxygen

Question 117

The patient has been admitted to the emergency department following a motor vehicle crash and has a history of substance abuse. What must be a priority for the nurse to include an assessment?

Answer 117

Assess the patient's risk factors for suicide

Question 118

Patient admitted to the emergency department has a close tibia fracture from a fall. What question is essential to the requirement of the continuum of care?

Answer 118

With the patient's home medications

Question 119

Patient comes to the emergency department with severe respiratory distress he has a long history of chronic respiratory disease and now requires endotracheal intubation. How does the nurse assesses patient's lung compliance?

Answer 119

Since the degree of difficulty in ventilating with the bag valve mask

Question 120

The patient involved in a boating accident has extensive injuries and comes emergency department and wet clothes the nurse identifies the risk for hypothermia which interventions does the nurse implement?

Answer 120

1. Remove wet clothing 2. Infuse warm IV solutions 3. Use a heat lamp

Question 121

The nurses caring for a patient with a head injury was Glasgow coma scale is three. The score indicates the patient is most likely to do what?

Answer 121

Be totally unresponsive

Question 122

The nurses next-door neighbor has sustained a deep laceration to the right upper arm and there's active bright red bleeding. What does the nurse due to immediately control the bleeding?

Answer 122

1. Have the neighbor lie flat and elevate the arm | 2. Apply direct pressure with a thick, dry towel

Question 123

A patient sustained multiple injuries in a job site accident has a blood pressure of 100/60 and a pulse of 120 per minute. Two large bore IVs are established an IV fluid resuscitation is initiated. After receiving IV fluids, repeat vital signs are blood pressure 94/56, pulse 135, then blood pressure 80/50, pulse 150. with these vital signs, the patient is likely to require blood products after how many liters of IV fluid's?

Answer 123

2 L

Question 124

The nurses helping the physician treat a patient with a tension pneumothorax. What type of equipment is a nurse obtained to Mili alleviate the life-threatening condition?

Answer 124

Chest tube insertion tray

Question 125

The patient comes to the emergency department after falling off the roof. He displays absent breath sounds over the left chest, severe rest of Tory distress, hypotension, jugular vein distention, and tracheal deviation. Based on his assessment findings for which condition does the nurse anticipate the patient must receive immediate treatment?

Answer 125

Tension pneumothorax

Question 126

What is the fastest way for the nurse to estimate the systolic blood pressure and a patient who is being resuscitated?

Answer 126

Palpate for the presence of a radial pulse

Question 127

A 61-year-old patient is brought to the emergency department reporting difficulty breathing and fatigue. The patient is currently receiving radiation treatments for lung cancer. The physician diagnosis is cardiac tamponade. Which assessment findings as a nurse expect the patient to exhibit?

Answer 127

Decreased cardiac output it

Question 128

A parent brings her two-year-old to the birdseed apartment stating she fell and bumped her head and forearm. Which behavior by the child causes the nurses the least concern during the initial triage interview?

Answer 128

Crying and reaching for the parents of the nurse approaches

Question 129

Emergency department trauma team is preparing to receive a motor vehicle crash victim with severe chest drama with coughing up blood and a crush injury to the right leg. What type of personal protective equipment does the nurse assigned to be the recorder put on?

Answer 129

Down, gloves, I protection, facemask, I And shoe covers

Question 130

The nurse is evaluating the lower extremities of several patients. Which description represents the least serious physical presentation?

Answer 130

Decreased sensation , lower leg has wide spread brownish discoloration

Question 131

Three people came to emergency department with the patient had become verbally argumentative and threatening towards each other. Which action Sisson emergency department nurse take to ensure staff safety?

Answer 131

1. Follow the hospital security plan 2. Attempt to de-escalate the situation 3. Look for an escape route

Question 132

A patient died in the emergency department after sustaining multiple injuries that occurred during an aggravated assault. The family arrives after the patient is pronounced dead in the ass to go see the body. What does the nurse do?

Answer 132

Explain what they will see, did the lights, leave the patient's face expose, but cover the rest of the body with a blanket

Question 133

Which functions represent appropriate referrals to the case manager?

Answer 133

1. Facilitate referral to a primary caregiver provider who is taking new patients 2. Investigate whether the patient is abusing and overusing emergency department services

Question 134

Patient is brought to the emergency department by the family because he is verbally threatened other than attempted to stab the neighbors dog. What does the nurse do in order to in sure the safety of the patient and others?

Answer 134

1. Search the patient's belongings and secure personal effects2. Remove dangerous equipment from the room, such as sharps containers or portable instruments. 3. Use a metal detector to search for objects that can be used as weapons 4. Instructed nursing students to avoid wearing a stethoscope around their necks

Question 135

The patient was involved in a high-speed motor vehicle crash. The physician instructs the nurse to prepare for several urgent procedures because of severe injury and physical compromise. Which procedure does the nurse prepare for first?

Answer 135

Endotracheal intubation

Question 136

Emergency department nurse is caring for several patients, all of whom are currently lying on the stretchers either pending discharge or awaiting transfer to a hospital bed. Which patients are at risk for falls?

Answer 136

1. Opioid naïve teenager with a fracture who receive 3 mg IV morphine for painm 2. . Middle-age woman with severe vomiting and frequent watery stools 3. Older adult patient with acute dementia secondary to infection

Question 137

Patient is brought to the emergency department by friends who report he probably overdosed on downers. The patient has a decreased level of consciousness and decreased gait reflux, his face and chest are covered with emesis, he demonstrates spontaneous sonorous respirations and pulls oximetry is 87% on room air. What type of airway management does the nurse expect this patient to receive?

Answer 137

Endotracheal intubation with initial high concentration of oxygen

Question 138

An older couple I'm Acacian come so emergency department. The man appears to be having a stroke and is unable to speak clearly or court hearing. His wife is very distraught and states he has many allergies and takes many medications but I can't remember anything right now. What does the nurse to quickly to obtain accurate drug allergy information?

Answer 138

1. Call the patient's family physician for a phone report about is drugs and allergies 2. Call one of the patients children and stress urgency in Porten's for accurate information 3. Call the pharmacy where the patient obtained his medications 4. Check for a medical alert bracelet and help the wife to look in the patient suitcase

Question 139

An older adult patient has been waiting in the emergency department for over 48 hours due to extremely high-volume. Risk for impaired skin integrity is identified in the charge nurse delegates turning the patient every two hours to the nursing assistance. Since emergency apartments busy the patient is not always turn begin set up a pressure ulcer. What is the charge nurse do to prevent a recurrence of this type of problem for future patients?

Answer 139

1. Make anecdotal Notes and counsel all them Bob nursing assistance 2. File an incident report and seek resolution of the systems level 3. Read educate staff on the need to turn patients at risk for skin breakdown

Question 140

The nurses working in the emergency department with an emergency physician, but the physician is currently involved in the care of several critical patients. Emergency department nurse must initiate care for patients under entered a disciplinary a medical protocols. Which intervention is the least likely to be covered by standing protocol?

Answer 140

Ventilate per Ambu bag with 100% oxygen and intubate

Question 141

The emergency department nurse is caring for a patient was found in an alley with no identification and no known family. The nurse must give medications to the patient. What is the correct procedure?

Answer 141

The patient is designated as John Doe and the nurses use to unique identifier

Question 142

The nurses working alone in triage. It is a busy night in the waiting room is full of people who are restless and unhappy about having to wait. Which situation warrants the nurse to activate the panic button under the triage desk?

Answer 142

A person walks in and starts threatening the registration staff with a weapon

Question 143

The nurse is interviewing a psychiatric patient was been verbally aggressive for the past several hours according to the family. Family states he won't hurt anybody however the patient is pacing appear suspicious and angry. With strategy does the nurse used to conduct the interview?

Answer 143

Conduct the interview standing near the door in a quiet room

Question 144

Emergency department nurse is attempting to transfer a patient to the medical surgical unit. When they're receiving nurse answers the phone he says you people always dump these admissions on us during shift change. Which response by the emergency department nurse represents the best attempt at a respect for negotiation

Answer 144

I apologize for the timing I will call back in 15 minutes

Question 145

A patient received in the emergency department is diagnosed with stroke upon assessment the patient exhibits difficulty swallowing. When taking a sip of water the patient jokes and coughs. What priority safety measure does the nurse implement for this patient?

Answer 145

Set oral suction device

Question 146

Emergency department nurse is preparing a report on a patient being admitted for bacterial meningitis. Which points are included in the emergency department report to the medical surgical nurse?

Answer 146

1. Patient reports severe headache with high fever that started four days ago 2. Patient currently alert and is oriented times two, speech clear, but rambling 3. IV normal saline into left anterior forearm received first dose of IV Cetra flaxen at oh 800 4. Lumbar puncture results are pending but Manning cockle meningitis is suspected 5received 1000 mg acetaminophen for pain nine out of 10 and fever of hundred and three at 400 pain continues seven out of 10 temperature now 10 100.9

Question 147

A nurse discusses the philosophy of Alcoholics Anonymous with the client who has a history of alcoholism. What need must self help groups such as AA meet to be successful?

Answer 147

Belonging

Question 148

A nurse is caring for a client with a diagnosis of acute pancreatitis and alcoholism. The client asks what does my drinking have to do with my diagnosis? What effect of alcohol should the nurse include when responding?

Answer 148

Increases enzyme secretion and pancreatic duct pressure causes backflow of enzymes into the pancreas

Question 149

Acclimated minute with a tentative diagnosis of pancreatitis. The medical and nursing measures for this client our aim toward maintaining nutrition, promoting rest, maintaining fluid and electrolyte balance, and decreasing anxiety. Which intervention should the nurse implement?

Answer 149

1. Administer analgesics 2. Teach relaxation exercises 3. Monitor cardiac rate and rhythm

Question 150

The client is recovering from an acute episode of alcoholism that included esophageal involvement. What are the components of a therapeutic diet that are most appropriate for the nurse include in the teaching plan for this client?

Answer 150

1. Soft diet 2. High protein diet 3. High carb diet

Question 151

Thiamine or vitamin B and nice thin vitamin B three are prescribed for a client with alcoholism. Which body function maintained by these vitamins should the nurse include in the teaching plan?

Answer 151

Neuronal activity

Question 152

A client is admitted to the hospital with a diagnosis of alcohol withdrawal syndrome. By Oregon should the nurse teach the client will be protected by the ingestion of a high calorie diet fortified with vitamins?

Answer 152

Liver

Question 153

The client with a history of alcohol abuse says to the nurse drinking is a way out of my depression. Which strategy probably is most effective for the client at this time?

Answer 153

A self-help group

Question 154

A client who is in an automobile collision is admitted to the hospital with multiple injuries. Approximately 14 hours after admission, the client begins to experience signs and symptoms of withdrawal from alcohol. Which of these signs and symptoms of the nurse relate to alcohol with drawls?

Answer 154

2. Anxiety 2. Diaphoresis 3. Psycho motor agitation

Question 155

A nurse assesses the client recently admitted to an alcohol detoxification unit. What common clinical manifestations of the nurse expect during the initial stage of alcohol detoxification?

Answer 155

Nausea

Question 156

Alcohol dependence is defined by the national Institute of alcohol abuse and alcoholism is a disease with which for symptoms?

Answer 156

1. Craving 2. Loss of control 3. Physical dependence 4. Tolerance

Question 157

What is the alcohol questionnaire called?

Answer 157

The CAGE ( cut annoyed guilty eye) question are

Question 158

What are two additional tools that are being used to identify alcohol use disorders?

Answer 158

The AUDIT and alcohol screening and brief intervention for youth of practitioners God public by the national Institute of health

Question 159

Signs and symptoms of alcohol withdrawal include

Answer 159

Anorexia, chills, craving, muscle cramps, irritability, palpitations, disorientation, tachycardia, hypertension, low-grade fever, mood changes, slurred speech, impaired gait, for dexterity, fatigue, abdominal pain

Question 160

Under diagnostic criteria specified by the day Gnostic statistical manual of mental disorders alcohol withdrawal has what components

Answer 160

1. Cessation are reduction of heavy and prolonged alcohol use 2. Two or more the following developing more than several hours to a few days after criteria (symptoms)

Question 161

What is the most severe form of alcohol withdrawal?

Answer 161

Delirium tremens

Question 162

What is the gold standard with drawl assessment rating scale

Answer 162

The clinical institute withdrawal assessment for alcohol

Question 163

What to all documents with drawl trends

Answer 163

The withdrawal trend profile tool. list of all the nursing

Question 164

What are the most commonly used benzodiazepines

Answer 164

Diazepam , lorazepam, chlordiazepoxide, and oxazepam

Question 165

True or false | Ethanol replacement therapy is out model and not recommended

Answer 165

True

Question 166

True or false | One and five patients admits to a hospital suffering from an alcohol use disorder

Answer 166

True

Question 167

A nurse assesses the client recently admitted to an alcohol detoxification unit. What common clinical manifestations of the nurse expect during the initial stage of alcohol detoxification?

Answer 167

Nausea

Question 168

Normal lab values for ph

Answer 168

pH 7.35 – 7.45

Question 169

Normal lab values for PaCO2 and Pa02

Answer 169

PaCO2 35-45 mm Hg PaO2 80-100 mm Hg HCO3 22-26 mEq/L SaO2 94-100 %

Question 170

Normal lab values for HCO3 and | SaO2

Answer 170

HCO3 22-26 mEq/L | SaO2 94-100 %

Question 171

Difference between asthma and COPD

Answer 171

Asthma is - Intermittent - Reversible airflow obstruction & wheezing ``` COPD is Chronic Bronchitis Pulmonary Emphysema Tissue damage not reversible Increases in severity Leads to respiratory failure ```

Question 172

What is asthma?

Answer 172

Asthma is a disease of the lower airways The airways of people with asthma are extra sensitive to the things they’re allergic to and to other irritating things in the air

Question 173

What causes symptoms of asthma

Answer 173

What causes symptoms of asthma? Asthma symptoms start when allergens or other irritants cause the lining of the airways to swell and narrow. The muscles around the airways can then spasm, causing the airways to narrow even more. When the lining of the airways is inflamed, it produces more mucus. The mucus clogs the airways and further blocks the flow of air. This is called an "asthma attack.”

Question 174

Pathophysilogy of asthma

Answer 174

Airway Inflammation Mucous membrane lining the airway Irritants may also trigger hyper responsiveness Airway Hyperresponsiveness Constricts bronchial smooth muscle Narrows the airway from the outside Irritants may also trigger inflammation

Question 175

Pathophysilogy of asthma

Answer 175

Airway Inflammation Mucous membrane lining the airway Irritants may also trigger hyper responsiveness Airway Hyperresponsiveness Constricts bronchial smooth muscle Narrows the airway from the outside Irritants may also trigger inflammation

Question 176

Path of asthma cont..

Answer 176

Both problems can occur at the same time, and often do Inflammation Response to specific allergens Nonallergenis irritants such as cold air, dry air, particles Microorganisms Aspirin Hyperresponsiveness (Bronchospasm) Can occur with exercise Upper respiratory illness Poor control of asthma with resultant chronic inflammation can lead to damage and hyperplasia of the bronchial epithelial cells and bronchial smooth muscle (Airway remodeling)

Question 177

What is delirium tremens characterized by

Answer 177

Is characterized by altered mental status and severe autonomic hyperactivity that may lead to cardiovascular collapse

Question 178

Path of asthma cont..

Answer 178

Both problems can occur at the same time, and often do Inflammation Response to specific allergens Nonallergenis irritants such as cold air, dry air, particles Microorganisms Aspirin Hyperresponsiveness (Bronchospasm) Can occur with exercise Upper respiratory illness Poor control of asthma with resultant chronic inflammation can lead to damage and hyperplasia of the bronchial epithelial cells and bronchial smooth muscle (Airway remodeling)

Question 179

Asthma whats going on beneath the surface

Answer 179

With asthma, what we see is the tip of the iceberg, the symptoms. At the base of the iceberg is the airway inflammation. This inflammation underlies the bronchial hyperresponsiveness of asthma, the air flow obstruction, and the culmination of the inflammatory process is the tip of the iceberg, the symptoms. *Active inflammation of the airways can be present for 6 to 8 weeks following a severe respiratory infection. *Airflow obstruction results from bronchoconstriction, bronchial edema, mucus hypersecretion, and inflammatory cell recruitment including eosinophils, a key inflammatory cell. Water eyes, itchy nose, throat 6-8 weeks following respiraotyr illness **esinophills (know part they play)

Question 180

How do eosinophils play a part in asthma

Answer 180

hhh

Question 181

What is atopy?

Answer 181

atopy /at·o·py/ (at´ah-pe) a genetic predisposition toward the development of immediate hypersensitivity reactions against common environmental antigens (atopic allergy), most commonly manifested as allergic rhinitis but also as bronchial asthma, atopic dermatitis, or food allergy.

Question 182

What is nonatopic asthma?

Answer 182

Nonatopic Asthma (Non-allergic/intrinsic) Viral-induced inflammation of respiratory mucosa lowers threshold of receptors to irritants Aspirin-sensitive asthma (rhinitis, nasal polyps) Occupational asthma Response may occur hours later No family history

Question 183

What is atopic asthma?

Answer 183

Atopic Asthma (Allergic/extrinsic) Type-I (IgE-mediated) hypersensitivity or allergic reaction Triggered by environmental antigens (dust, pollens, food) Chemical mediators (histamine, cytokines, leukotrienes) Causes acute immediate response Family history of atopy

Question 184

Role of Ige in asthma?

Answer 184

Ige -trigger release of performed mediators Mediators cuase iincreased permability, smooth muscle spasms, tissue infiltation

Question 185

Is age of asthma diagnosis important?

Answer 185

Age at onset is important: Childhood asthma is atopic, after age 30 it is not*** on test

Question 186

What is intrinsic asthma

Answer 186

Intrinsic Asthma a nonseasonal, nonallergic form of asthma, which usually first occurs later in life than allergic asthma and tends to be chronic and persistent rather than episodic. Precipitating factors include inhalation of irritating pollutants, such as dust particles, smoke, aerosols, strong cooking odors, and paint fumes and other volatile substances. Intrinsic asthma may also be triggered by exposure to cold, damp weather; sudden inhalation of cold, dry air; physical exercise; violent coughing or laughing; respiratory infections, such as the common cold; or psychologic factors, such as anxiety.

Question 187

What is extrinsic asthma

Answer 187

Extrinsic Asthma a form of asthma caused by exposure of the bronchial mucosa to an inhaled airborne antigen. The antigen causes the production of antibodies that bind to mast cells in the bronchial tree. The mast cells then release histamine, which stimulates contraction of bronchial smooth muscle and causes mucosal edema. Hyposensitization treatments are more effective for pollen sensitivity than for allergies to house dust, animal dander, mold, and insects. Psychologic factors may provoke asthma attacks in bronchi already sensitized by antigens. Medication, including immunotherapy, can help relieve allergy symptoms. Often a diurnal pattern of histamine release occurs, causing variable degrees of bronchospasm at different times of the day. Also called atopic asthma. ON TEST!!!!!!!!!!!!!!!!

Question 188

What is cough variant asthma

Answer 188

Persistent cough without wheezing or dyspnea Significant airway inflammation Pathophysiologic features of asthma

Question 189

What is a pulmonary function test?

Answer 189

Pulmonary function Test: what is it? Methylcoline test is too evaluate hyper responsiveness ( healthy people wont have a response at all, only if you have asthma will you have a positive response

Question 190

Primary data

Answer 190

“When it’s cold outside I cough and cough and I can’t catch my breath” “My chest feels so tight, it’s hard to take a deep breath” “My nose is constantly full or draining” “When I catch a cold it lasts for a month”

Question 191

Secondary data

Answer 191

``` Audible wheezes and ↑ RR Wheezes louder on exhalation ↑ coughing if inflammation present Longer breathing cycle requiring more effort Use of accessory muscles Barrel chest if symptoms long-term Cyanosis Tachycardia ```

Question 192

Tertiary data

Answer 192

ABGs (arterial blood gases) PaO2 ↓ during attack (normal 80-100 mmHg) PaCO2 ↓ early during attack with ↑ RR PaCO2 ↑ later with CO2 retention(normal 35-45 mmHg) ↑ Eosinophil and IgE levels; mucus plugs PFTs (pulmonary function tests)* ↓ FVC (forced vital capacity) ↓ FEV1 (forced expiratory volume in 1st sec) ↓ PEF (peak expiratory flow)

Question 193

What is FVC?

Answer 193

Forced Vital Capacity (FVC) – full inhalation to full exhalation

Question 194

What is FEV1?

Answer 194

Forced Expiratory Volume (FEV1) - volume of air blown out as hard and fast as possible during the first second of most forceful exhalation following greatest in

Question 195

What is PERF?

Answer 195

Peak Expiratory Rate Flow (PERF) – fastest airflow rate reached at any time during exhalation

Question 196

What is a pulmonary function test?

Answer 196

The most accurate measures for asthma are pulmonary function tests using spirometry including: Forced vital capacity (FVC) Forced expiratory volume in the first second (FEV1) Peak expiratory flow rate (PEFR) 15-20% below expected for age, gender,size

Question 197

What is the most accurate test to diagnose asthma?

Answer 197

MOST ACCURATE TEST TO DIAGNOSIS ASTHMA (pulmonary function)

Question 198

Relievers or Bronchodilators

Answer 198

Relaxes muscles in the airways to help relieve asthma symptoms Should be taken as needed for symptoms Need to wait 1-2 minutes between puffs for best deposition of medication in the lungs Overuse is a sign indicating the asthma may not be well controlled Relax bronchial smooth muscles, resulting in bronchodilation usually within 5 to 10 minutes of inhalation Therapy of choice for relieving acute symptoms and preventing EIA Overuse indicates need to evaluate and possibly increase (or start) long term control therapy ON TEST!!!!! EIA : exercise induced asthma

Question 199

Relievers or Bronchodilators

Answer 199

Relaxes muscles in the airways to help relieve asthma symptoms Should be taken as needed for symptoms Need to wait 1-2 minutes between puffs for best deposition of medication in the lungs Overuse is a sign indicating the asthma may not be well controlled Relax bronchial smooth muscles, resulting in bronchodilation usually within 5 to 10 minutes of inhalation Therapy of choice for relieving acute symptoms and preventing EIA Overuse indicates need to evaluate and possibly increase (or start) long term control therapy ON TEST!!!!! EIA : exercise induced asthma

Question 200

Short-acting Beta 2 Agonists Inhaled Bronchodilators 4- 6 hours

Answer 200

Albuterol (Proventil, Ventolin) Levalbuterol (Xopenex) Pirbutero (Maxair Autohaler) Biolterol (Tornalate) Purpose Relief of acute symptoms for acute bronchospasm or as preventive treatment prior to exercise; bind to & activate pulmonary beta2 receptors Potential adverse effects:Tremors, tachycardia, headache Nursing teaching: Carry at all times; monitor heart rate; take 5 minutes before other inhaled drugs; spacer; correct technique: shake, inhale & hold breath 10 sec, 1 minute between puffs (Chart 32-8)

Question 201

Long-acting Beta2 Agonist Inhaled Bronchodilators 12 hours

Answer 201

Purpose : Relaxes bronchiolar smooth muscle; slow onset Potential adverse effects: Tachycardia, tremors, hypokalemia Nursing teaching: Do not use as a rescue of acute symptoms; Correct technique MDI or DPI Relaxes bronchial smooth muscle. Add-on therapy to inhaled corticosteroids for long term control of symptoms, especially nighttime symptoms. Improves symptoms and reduces need for quick reliefe (reliever) meds. MDI, DPI. Slower onset and longer duration of action than short acting beta2 agonists (approx 12 hours) Salmeterol- is sometimes used by itself (w/o ICS) to prevent EIA for athletes requiring long term bronchospasm relief. Eg. Long distance runners

Question 202

Cholinergic Antagonist orAnticholinergic Inhaled

Answer 202

Meds block the parasympathetic nervous system which allows for increased **NOT INTENEDED FOR FIRST LINE THERAPY: AKA AS A RESCUE MED*** USE ONLY ONCE A DAY Ipratropium (Atrovent) short acting Purpose: inhibits parasympathetic nervous system allowing sympathetic system to dominate releasing norepinephrine that activates beta 2 receptors; relieves and prevents asthma--can be used as rescue several times a day when beta2 agonist not tolerated. Potential adverse effects: blurred vision, eye pain, headache, nausea, palpitations, tremors, unable to sleep Nursing teaching: If used as rescue, carry with; correct technique Tiotropium (Spiriva) long-acting Purpose/adverse effects/teaching same; Use once a day

Question 203

Combination Drugs

Answer 203

Combivent Inhalation aerosol (Ipratropium bromide + Albuterol) ``` Combivent Respimat (Ipratropium bromide + Albuterol ``` Duo-Neb (Albuterol sulfate + ipratropium bromide) inhaled solution Possible additive benefit to inhaled beta2 agonists for severe exacerbations. Possible alternative bronchodilator for patients who do not tolerate inhaled beta2 agonists. (Atrovent) Drug of choice in beta blocker induced bronchospasm Not indicated as first line therapy

Question 204

Combination Drugs

Answer 204

Combivent Inhalation aerosol (Ipratropium bromide + Albuterol) ``` Combivent Respimat (Ipratropium bromide + Albuterol ``` Duo-Neb (Albuterol sulfate + ipratropium bromide) inhaled solution Possible additive benefit to inhaled beta2 agonists for severe exacerbations. Possible alternative bronchodilator for patients who do not tolerate inhaled beta2 agonists. (Atrovent) Drug of choice in beta blocker induced bronchospasm Not indicated as first line therapy

Question 205

Methylzanthines Oral

Answer 205

``` Theophylline Aminophylline Potential adverse effects Insomnia, upset stomach, hyperactivity Therapeutic issues Must monitor blood level concentrations closely Do not use as reliever Used only when other management not effective ```

Question 206

Methylzanthines orla cont..

Answer 206

Produce mild to moderate bronchodilation Add on therapy to anti inflammatory medications for long term control of symptoms, especially nighttime symptoms Theophylline is an alternative, but not preferred, therapy for persistent asthma. Available as tablets, Gyrocaps and syrup (Slophyllin) Slo- bid, Theo-Dur, Theo-Dur Sprinkle, Uniphyl) Monitoring is required to maintain serum levels between 5 and 15 mcg/ml Febrile viral illnesses, age, certain meds (e.g. erythromycin) and diet can increase absorption and bioavailability, thereby increasing serum levels. Adverse affects: Seizures can occur if recommended serum levels are exceeded. Side effects increase w increasing serum levels.

Question 207

“Controllers” Anti-Inflammatory Inhaled Corticosteroids

Answer 207

Reduces airway swelling over time, decreases airway hyper-responsiveness and inflammation Must be taken daily, even if no symptoms Will not relieve acute asthma symptoms Used consistently over time will prevent/control inflammation and acute episodes Dose/strength may need to be increased or decreased depending on season of the year (step up / step down) Inhaled steroids start to work in days to weeks, oral steroids within 6-24 hours

Question 208

“Controllers” Anti-Inflammatory Inhaled Corticosteroids cont....

Answer 208

Most potent and effective long term anti inflammatory medications currently available Available as MDI and DPI Used for management of persistent asthma at all severity levels Broad action on inflammatory processes. Improves symptoms and pulmonary function Reduces the need for quick-relief medications Fewer side effects than oral corticosteroids Spacer/holding chamber devices w MDI’s and mouth washing after inhalation decreases local side effects and systemic absorption from the GI tract. Need to use a spacer, wash mouth after use IT WILL NOT ERLIEVE ACUTE ASTHMA SYMPTOMS!!

Question 209

Examples of Controllers” Anti-Inflammatory Inhaled Corticosteroids

Answer 209

Fluticasone (Flovent MDI) Budesonide (Pulmicort DPI or nebs) Mometasone (Asmanex) Purpose: decreases inflammatory and immune responses & prevent synthesis of mediators. Short term for mod. & long term for severe. Potential adverse effects: Cough, dysphonia, thrush Nursing teaching: Good mouth care; check mouth daily lesions; take daily PREVENTIVE & MUST BE USED ON SCHEDULED BASIS 1. Best to rinse and spit after use (if contains ICS) 2. Pulmicort is DPI or Respules HIGH POTENCY USED ONCE A DAY FOR MAINTANCE, HELPFUL IN CONTROLLING AND THUS PREVENITN G THE MANIFESTATIONS OF ASTHMA NOT EFFECTIVE IN REVERSIIG SYMPTOMS IN AN ASTHMA ATTACK

Question 210

“Controller” InhaledNonsteroidal Anti-inflammatory

Answer 210

Cromolyn (Intal ) Tilade (Nedocromil) Purpose: mast cell stabilizer & prevent release of inflammatory mediators; preventive treatment triggered by inflammation or allergen exposure Potential adverse effects: Tilade tastes bad Nursing teaching: Must be taken up to 4 times a day, maximum benefit after 4-6 weeks; Do not use as reliever; correct technique

Question 211

How do “Controller” InhaledNonsteroidal Anti-inflammatory work

Answer 211

HELP REDUCE NEED FOR ….MEDS Inhaled anti-inflammatory agents. NOT for acute exacerbations Available as Metered dose inhaler( MDI). Cromolyn is also available as neb solution. Alternative therapy to low-doses of inhaled corticosteroids in mild persistent asthma. Nedocromil may also be added to inhaled ICS in moderate asthma. Can be used to prevent symptoms to anticipated exposures (cold air, exercise (EIA), allergens) on an as needed basis. Improves symptoms and pulmonary function Reduces the need for quick relief medications Good safety profiles Nedocromil has an unpleasant taste

Question 212

Leukotriene Antagonists Inhaled

Answer 212

Montelukast (Singulair)-block leukotriene receptor Zafirlukast (Accolate)- block leukotriene receptor Zileuton (Zyflo)-prevents leukotriene synthesis Prevention of symptoms in mild persistent asthma, and/or to enable a reduction in dosage of inhaled steroids in moderate to severe persistent asthma Potential adverse effects None significant, elevation of liver enzymes Therapeutic issues Drug interactions, monitor hepatic enzymes (esp. Zyflo) Nursing Teaching: Do not use as reliever; Do help prevent atopic asthma attack

Question 213

How do Leukotriene Antagonists Inhaled work

Answer 213

Leukotriene receptor antagonists (eg montelukast, zafirulkast) block LTD4 receptors; 5 lipoxygenase inhibitors (block synthesis of all leukotrienes) Tablet form May be considered as alternative therapy to low doses ICS for mild persistent asthma. Has been given as an added tx to ICS’s in the management of moderate persistent asthma and when given the night before exercise to prevent exercise induced bronchospasm. Improves symptoms and pulmonary function Reduces the need for quick relief meds Elevated liver enzymes w/Zyflo- monitoring is highly recommended

Question 214

Immunoglobulin (IgE) Blocker SQ

Answer 214

Omalizumab (Xolair) Used for poorly controlled asthma or non-compliance with standard recommended therapy Monoclonal antibodies directed against IgE molecules—when bind to IgE molecules that have allergens attached, cannot bind to mast cells and basophils preventing release of mediators. Must have evidence of specific allergy sensitivity Used if have high IgE blood levels Delivered by SQ injection every 2-3 weeks Prevent atopic asthma attacks—do not use as rescue. Newly approved in 2003-4. Should most likely be prescribed by an allergy and or pulmonary specialist. Used only in adolescents over 12 yrs and adults. Not for acute exacerbations Use in conjunction with other agents Make them wait For 2 hours and then they will be prescribed an epi pen

Question 215

Examples of Systemic Corticosteroids

Answer 215

Pediapred Prelone Prednisone Orapred Prevents progression of moderate to severe exacerbations, reduces inflammation Potential adverse effects Short-term- increased appetite, fluid retention, mood changes, facial flushing, stomachache. Long term- growth suppression, hypertension, glucose intolerance, muscle weakness, cataracts

Question 216

What are Systemic Corticosteroids used for?

Answer 216

For use as a “reliever” medication in short-term “bursts” on a short-term basis (hospitalization) for moderate asthma Sometimes used daily in patients with severe asthma to control symptoms TREAT MODERATE ASTHMA; USED WHILE HOSPITALS ON A SHORT TERM BASIS

Question 217

Technique for Inhaling Meds

Answer 217

USE BRONCHIODILATORS FIRST WAIT 2-5 MINUTES WASH YOUR MOUTH OUT YOU PUT IT IN WATER, IF IT FLOATS ITS EMPTY IF IT SINKS THERES SOME IN THERE REVIEW HPW TO USE SPACERS AND DRY POWDER INHALERS

Question 218

Status asthmaticus

Answer 218

Status asthmaticus is a severe, life-threatening, acute episode of airway obstruction that intensifies once it begins and often does not respond to common therapy If the condition is not reversed, the patient may develop pneumothorax and cardiac or respiratory arrest Treatment: IV fluids, potent systemic bronchodilator, steroids, epinephrine, and oxygen WHEN YOU DON’T HERE WHEEZING END UP TRACHING PATIENTS, INCREASED RISK FOR AIR TRAPPING BIGGER ET TUBE BECUAS EOF THE MUCOUS THEY NEED TO SUCTION DON’T WANT TO INTUBATE THEM VERY OFTEN AMGNSIUM SULFATE TO TREAT ASTHMA ATTACKS :PREVENT INTUBATION

Question 219

What is COPD?

Answer 219

Characterized by presence of airflow obstruction Caused by emphysema or chronic bronchitis or chronic asthma May be accompanied by airway hyper-reactivity Progressive

Question 220

Etiology of COPD

Answer 220

Cigarette Smoking Alpha1 – Antitrypsin Deficiency (Genetic) Hereditary disorder causes 1% of cases Serum protein produced in the liver and normally found in the lungs. Environmental pollutants—outdoor, indoor, occupational Respiratory infect Age Some degree of emphysema is common, even non-smokers Gradual loss of elastic recoil

Question 221

Etiology of COPD cont..

Answer 221

AAT The proteins would protect the lungs normally. In AAT, the neutrophils and macrophages destroy the lung tissue. People with this type of emphysema are typically of northern European origin Age Some degree of emphysema is common, even non-smokers Gradual loss of elastic recoil Lungs become rounded and smaller Decreased compliance of the chest wall Increased work of breathing Chest becomes barrel shaped in advanced COPD

Question 222

True or false | Exposure to tobacco smoke is the primary cause of COPD in US

Answer 222

True

Question 223

COPD and Cigarette smoking

Answer 223

Clinically significant airway obstruction develops in 15% of smokers 80% to 90% of COPD deaths in the USA are related to tobacco smoking More than one out of every five deaths in the USA is the result of cigarette smoking

Question 224

Emphysema

Answer 224

``` Loss of lung elasticity Hyperinflation of alveoli (KNOW ON TEST) Narrowed airways Destruction of alveolar walls Destruction of alveolar capillary walls Development of blebs and bullae AIR CAN GO IN BUT CANT GET OUT ON TEST Recurrent infectious process that leads to ….nuetrophils and macrophages ```

Question 225

Chronic bronchitits

Answer 225

Hyperplasia of mucus-secreting glands in the trachea and bronchi Increase in goblet cells (mucus secreting cells) Bronchial walls thicken Airflow and gas exchange hindered by mucus plugs, narrow airways

Question 226

Path of emphysema

Answer 226

Emphysema Air goes into the lungs but is unable to come out on its own and remains in the lung Alveoli become hyperinflated and collapse As more alveoli collapse, blebs (outer) and bullae (inner) may develop. Look like larger air pockets Small bronchioles become obstructed Smooth muscle spasm Inflammatory process Collapse of bronchiolar walls Recurrent infectious processes lead to increased production and stimulation of neutrophils and macrophages Surface area for oxygen diffusion in the blood decreases Compensation is achieved by increasing respiratory rate to increase alveolar ventilation Hypoxia develops late in the disease

Question 227

Path of Bronchitits

Answer 227

Bronchitis Chronic inflammatory changes of airways causes: Vasodilation Congestion Mucosal edema Causes narrowing of airway and diminished airflow Cough is often ineffective to remove secretions because the person cannot breathe deeply enough to cause air flow distal to the secretions.

Question 228

Emphysema : death

Answer 228

Bullae if rupture  →tension Pneumothorax (↑ air in pleural space) Death due to compression great vessels of heart to the point of occlusion ( barrel chest, lungs getting bigger)

Question 229

Bronchitis vs emphysema

Answer 229

Chronic bronchitis In this type, chronic bronchitis plays the major role. Chronic bronchitis is defined by excessive mucus production with airway obstruction and notable hyperplasia of mucus-producing glands. Damage to the endothelium impairs the mucociliary response that clears bacteria and mucus. Inflammation and secretions provide the obstructive component of chronic bronchitis. In contrast to emphysema, chronic bronchitis is associated with a relatively undamaged pulmonary capillary bed. Emphysema is present to a variable degree but usually is centrilobular rather than panlobular. The body responds by decreasing ventilation and increasing cardiac output. This V/Q mismatch results in rapid circulation in a poorly ventilated lung, leading to hypoxemia and polycythemia. Eventually, hypercapnia and respiratory acidosis develop, leading to pulmonary artery vasoconstriction and cor pulmonale. With the ensuing hypoxemia, polycythemia, and increased CO2 retention, these patients have signs of right heart failure and are known as "blue bloaters." Emphysema The second major type is that in which emphysema is the primary underlying process. Emphysema is defined by destruction of airways distal to the terminal bronchiole. Physiology of emphysema involves gradual destruction of alveolar septae and of the pulmonary capillary bed, leading to decreased ability to oxygenate blood. The body compensates with lowered cardiac output and hyperventilation. This V/Q mismatch results in relatively limited blood flow through a fairly well oxygenated lung with normal blood gases and pressures in the lung, in contrast to the situation in blue bloaters. Because of low cardiac output, however, the rest of the body suffers from tissue hypoxia and pulmonary cachexia. Eventually, these patients develop muscle wasting and weight loss and are identified as "pink puffers."

Question 230

What are pink puffers and blue bloaters

Answer 230

KNOW ON TEST Pink puffersWhen someone refers to a 'pink puffer', it means that the primary diagnosis within his or her COPD is emphysema.  This is also referred to as type A COPD.  The symptoms of type A COPD include an increased respiratory rate, also called tachypneia (from the Greek for speedy breathing), causing hyperventilation, and increased redness of the skin, leading to the 'pink puffer' description of a sufferer.  There will be less hypoxemia - lack of oxygen in the blood - than in type B, and less storage of carbon dioxide.  (TYPE A COPD, TACHYPNECI, CAUSES HYPERVENTILATION AND INCREASED REDENSS IN HT ESKIN) Blue bloatersBlue bloaters, on the other hand, suffer from type B COPD, with a primary diagnosis of chronic bronchitis.  Sufferers will have had several months of coughing with sputum being produced;  they may experience cyanosis (the skin going blue) related to a lack of oxygen in the blood, and swelling of the ankles and of veins.  They may also develop the symptoms of right-sided heart failure.  Prognosis is notably better for sufferers of type A than type B COPD.  (COUHGHING FITS, CYANOSIS, PATHOGENIC EVIDCNE AND SEVERE EMPHYSEMA)

Question 231

Complications of COPD

Answer 231

``` Hypoxemia & Acidosis ↓ tissue perfusion and function Respiratory Infections ↑ mucus and poor oxygenation Cardiac Failure Cor pulmonale Cardiac Dysrhythmias From cardiac tissue ischemia ```

Question 232

CLinical manifestations: Primary data

Answer 232

“I’ve smoked 1 ½ ppd for 15 years” “My feet are often swollen” “I’m so tired when I’m eating, it’s not worth the effort” “I cough up thick yellow stuff for about a half-hour every morning’ “It’s just easier to sleep in my recliner”

Question 233

Clinical manifestations: Secondary data

Answer 233

``` Chronic Bronchititis: Earliest symptoms Frequent, productive cough during winter Frequent respiratory infections Bronchospasm Dyspnea on exertion History of smoking Normal weight or heavy Cyanosis ``` Emphysema: Dyspnea Minimal cough with none to small amounts of sputum Diaphragm flattens and chest diameter increases (Barrel Chest) Patient relies on accessory muscles Underweight Emphysema Progressive Will first complain of dypsnea on exertion and later will have dyspnea with ADLs and at rest Bronchitis Cough exacerbated by cold air and respiratory irritants ON TEST KNOW THE DIFFERENCES!!

Question 234

Clinical manifestations: tertiary data

Answer 234

``` ABG values for abnormal oxygenation, ventilation, and acid-base status Sputum samples CBC Hemoglobin and hematocrit blood tests Serum electrolyte levels Serum Alpha1-antitrypsin deficiency AAT Chest x-ray Pulmonary function test: vital capacity, forced expiratory vol. 1 sec, residual vol. ```

Question 235

Impaired gas exchange for drug therapy

Answer 235

Drug Therapy (as for asthma) Beta-adrenergics, cholinergics, mast cell stabilizers Methylxanthines & corticosteroids (systemic) Mucolytics to thin secretions (nebulized) Mucomyst, Pulmozyme, Organidin (oral)

Question 236

Drug therapy for COPD

Answer 236

Bronchodilators Beta2-agonists: relax smooth muscle short Salbutamol(4-6 hr); long Salmeterol(12 hr) s/e: sinus tachycardia, dysrhytmias, tremors Anticholinergics: block acetylcholine receptor sites & prevent bronchcoconstriction short Ipratropium (8 hr); long tiotropium (24 + hr) s/e dry mouth, bitter taste Methylxanthines: inhibit phosphodiesterase which increases cyclic adenosine monophosphate, relaxes bronchial smooth muscle, & promotes bronchodilation. Theophylline;s/e headache,insomnia,nausea,heartburn Glucocorticosteroids: anti-inflammatory Limited use in stages III & IV Risk pneumonia Oral form my induce steroid myopathy increasing muscle weakness contributing to respiratory failure.

Question 237

Chronic oxygen therapy at home

Answer 237

``` Goal: Keep O2 Sats ↑ 90% during activity Improved prognosis Improved neurophysical function Increased activity tolerance Reduced pulmonary hypertension DO NOT CHANGE FLOW RATE Call MD if confusion, ↑ sleepiness, headache NO SMOKING WHEN USING OXYGEN ```

Question 238

. When reviewing the arterial blood gases of a patient with COPD, the nurse identifies late stage COPD with which of the following results? 1. pH 7.26, PaCO2 58 mm Hg, PaO2 60 mm Hg, HCO3 30 mEq/L 2. pH 7.30, PaCO2 45 mm Hg, PaO2 55 mm Hg, HCO3 18 mEq/L 3. pH 7.40, PaCO2 40 mm Hg, PaO2 70 mm Hg, HCO3 25 mEq/L 4. pH 7.52, PaCO2 30 mm Hg, PaO2 80 mm Hg, HCO3 35 mEq/L

Answer 238

pH 7.26, PaCO2 58 mm Hg, PaO2 60 mm Hg, HCO3 30 mEq/L

Question 239

What is pulmonary rehabilitation?

Answer 239

????

Question 240

What are normal blood gases?

Answer 240

pH 7.35 - 7.45 7.32 - 7.42 PaO2 80 to 100 mm Hg. 28 - 48 mm Hg HCO3 22 to 26 mEq/liter PaCO2 35-45 mm Hg

Question 241

What are normal blood gases?

Answer 241

pH 7.35 - 7.45 7.32 - 7.42 PaO2 80 to 100 mm Hg. 28 - 48 mm Hg HCO3 22 to 26 mEq/liter PaCO2 35-45 mm Hg

Question 242

How much alcohol can men drink vs women

Answer 242

Standard size drink is a 12 oz beer has 1 oz 5 oz of wine has 5 oz alchol Less than 14 drinks in any given week for men (low risk) High risk for men is 4 or more drinks a day or 28 drinks a week Low risk for women is 3 or fewer a day and no more than 7 drinks a week High risk for women is 2 drinks a day or 14 drinks a week Men can drink more because of weight and percent of body water

Question 243

Long term abuse of alcohol can lead to?

Answer 243

Long term abuse: high BP, complications to heart, nerve damage, pancreatitis, depression

Question 244

CAGE Questions

Answer 244

Tried to CUT DOWN ANNOYED by others criticizing your drinking Felt GUILTY EYE-OPENER (Two positives answers are indicators for alcohol problems).

Question 245

What is alcohol withdrawal syndrome

Answer 245

Alcohol withdrawal syndrome occurs when someone who is dependent on alcohol suddenly stops drinking or rapidly decreases the amount he/she drinks. The autonomic nervous system becomes hyperactive, resulting in many physiologic changes as the body tries to adapt.

Question 246

What are the first signs of alcohol withdrawal?

Answer 246

Nausea and vomiting are the first signs and symptoms of alcohol withdrawal!!!!

Question 247

What medications are used most often in alcohol withdrawal?

Answer 247

Diazepam and lorazepam used most often

Question 248

What medications are used most often in alcohol withdrawal?

Answer 248

Diazepam and lorazepam used most often

Question 249

Signs and symptoms of alcohol withdrawal

Answer 249

``` Autonomic hyperactivity (tachycardia; hypertension, sweating) Increased hand tremor Insomnia Nausea or vomiting Hallucinations or illusions(visual, auditory, tactile) Psychomotor agitation Anxiety Seizures Disorientation ```

Question 250

Alcohol withdrawal timeframe

Answer 250

Minor alcohol withdrawal occurs 6-12 hours 12-24 hours the hallucinations come 24-48 hours you will see withdrawal seizures 48-72 hours the dts (disorentation, confusion, severe anxiety, hallucination, hypertension and severe tremors)

Question 251

Alcohol withdrawal cont

Answer 251

Alcohol withdrawals may range from a mild and uncomfortable disorder to a serious, life-threatening condition. Symptoms usually begin 6-12 hours after the last drink. The symptoms peak in 48-72 hours and may persist for a week or more. Symptoms such as sleep changes, rapid changes in mood, and fatigue may last for 3-12 months or even longer.

Question 252

Clinical Institute of Withdrawal Assessment (CIWA)

Answer 252

The CIWA Scale measures nine categories of symptoms on a scale of 0-7 and one symptom (clouding the sensorium) on a scale of 0-4. Mild symptoms15. Patients with a score of > 8 are usually treated with drug therapy to reduce the risk of seizures and delirium tremors (DT)

Question 253

Random alcohol info

Answer 253

Notify physician if greater THAN 20 or if their experiencing DTS Review literature and take notes Know magnesium, potassium and phosphorous lab values!! Need to look at creatine before giving magnesium Number one supplement will be thiamine and folic acid Managing physical symptoms Management of behavioral symptoms is haladolol

Question 254

What are type A symptoms

Answer 254

Type A Symptoms (CNS Excitation) 1. Anxious, Nervous 2. Restless 3. Bothered by light 4. Bothered by noise

Question 255

What are type B symptoms

Answer 255

Type B Symptoms (Adrenergic Hyperactivity) 5. Nausea or vomiting present 6. Is a tremor visible with or without arm extended. 7. Is a tongue tremor present 8. Is sweat visible on palms or forehead 9. Is systolic B/P > than 140 10. Is diastolic B/P > than 90 11. Heart rate > 100 beats per minute

Question 256

Delirium tremors or DTs

Answer 256

Delirium tremens are the most severe form of alcohol withdrawals (48-72 hours) which are characterized by an altered mental status along with severe autonomic hyperactivity, which lead to cardiovascular collapse. Related to the high mortality DT’s are considered an emergency Usually 48-72 hours See or hear things, confusion, irritability, severe trembling and seizures DTs are considered an emergency and can lead to death I f not treated

Question 257

Alcohol treatment

Answer 257

Treatments are individualized according to the severity of the symptoms. Supportive care consists of fluid and electrolyte replacement, nutrition, thiamine, glucose, and multivitamins. Medications such as benzodiazepines are the main drugs of choice, they have proven to be safe and efficient when treating withdrawals and prevention of seizures.

Question 258

Common benzos used for alcohol withdrawal

Answer 258

1. Diazepam (Valium) 2. Lorazepan (Ativan) 3. Librium These medication are a class of psychoactive drugs that work to slow down the central nervous system by activating the GABA receptors

Question 259

Normal AST level

Answer 259

AST (aspartate aminotransferace) Normal: 5-40 IU/L AST is an enzyme associated with liver parenchymal cells, lab values are raised in acute liver damage.

Question 260

Normal ALT level

Answer 260

ALT (alanine aminotransferase) Normal: 7-56 IU/L ALT is an enzyme present in hepatocytes (liver cells), a decrease in ALT with an increase in cholesterol levels is noted in alcoholism, liver damage and, kidney infection

Question 261

Normal LDH level

Answer 261

LDH (Lactate dehydrogenase) Normal: 45-90 U/L LDH, decreased levels are seen in low tissue and low organ activity

Question 262

Normal ALP level

Answer 262

ALP (Alkaline phosphatase) Normal: 30-120 IU/L ALP, low levels are found in vitamin deficiencies.

Question 263

True or False | An AST/ALT ratio greater than 2 is usually found in alcoholic liver disease.

Answer 263

True

Question 264

What is (CIWAs?

Answer 264

??

Question 265

Foods with high levels of thiamine

Answer 265

Thiamine: green peas, squash, asparagus, and sunflower seeds, pistachios all have thiamine in it

Question 266

Foods with high levels of thiamine

Answer 266

Thiamine: green peas, squash, asparagus, and sunflower seeds, pistachios all have thiamine in it

Question 267

What are the four categories of burn depth?

Answer 267

Four categories of burn depth First degree: epidermis (sun burn) Second degree: Dermis (scald, blistering) most painful (under blister if skin is pale that is bad) Third degree: Full thickness entire dermis and epidermis : heals by contracture (if don’t do rom lose flexibility), needs grafting : xeno graft (pig skin) Fourth degree: Burn into underlying structure, disfigurement, disability ( may need to amputate) Physical therapy is huge for these people and will need it for many years Body will not accept other people skin, has to be your own skin from areas that are not burned

Question 268

True or false | Burn patients have higher incidence of skin cancer

Answer 268

True

Question 269

True or false | All fluids rush to the area of your burn, so giving IV fluids is very important

Answer 269

True

Question 270

Thermal and chemical burns

Answer 270

Adults: thermal and chemical burns U/O 30-50 ml/hr Adults: Hemochromogens in urine U/O 75-100 ml/hr

Question 271

What is an eshirotomy?

Answer 271

Eschirotomy: slit and open burn to allow for chest expansion ect…

Question 272

Average stay for grafting

Answer 272

Average stay for grafting 7 days | Large burns patient can stay for months

Question 273

What is TPA used for?

Answer 273

Give TPA to treat frostbite

Question 274

What is a superficial burn?

Answer 274

Least damage; epidermis is only part of skin that is injured Desquamation (peeling of dead skin) occurs 2 to 3 days after burn

Question 275

Partial thickness burn

Answer 275

``` Involves entire epidermis and dermis (varying depths) Categorized as: Superficial Superficial partial-thickness Partial-thickness Deep partial-thickness injuries ```

Question 276

Full thickness burn

Answer 276

Destruction of entire epidermis and dermis Skin does NOT regrow

Question 277

Injuries to the respiratory system from burns

Answer 277

``` Direct airway injury Carbon monoxide poisoning and cyanide Thermal injury Smoke poisoning Pulmonary fluid overload External factors ```

Question 278

Pulmonary fluid overload

Answer 278

Occurs even when lung tissues have not been damaged directly Histamine, other inflammatory mediators cause capillaries to leak fluid into pulmonary tissue space

Question 279

True or false | Hypovolemic shock common cause of death in early phase in patients with serious injuries

Answer 279

True

Question 280

Kidney/urinary ass.

Answer 280

Changes related to cellular debris, decreased kidney blood flow Myoglobin released from damaged muscle, circulates to kidney Kidney function, BUN, serum creatinine, serum sodium levels. Urine color, odor, presence of particles/foam

Question 281

What is the rule of nines?

Answer 281

“Rule of nines" using multiples of 9% of total BSA

Question 282

GI ass. associated with burns

Answer 282

Changes in GI function expected Decreased blood flow and sympathetic stimulation during early phase cause reduced GI motility, paralytic ileus GI bleeding

Question 283

Vascular chnages ass. with burns

Answer 283

Fluid shift: Third spacing or capillary leak syndrome, usually occurs in first 12 hr, can continue 24 to 36 hr Profound imbalance of fluid, electrolyte, acid-base; hyperkalemia and hyponatremia levels; hemoconcentration Fluid remobilization after 24 hr, diuretic stage begins 48 to 72 hr after injury, hyponatremia and hypokalemia

Question 284

Metabolic changes with burns

Answer 284

Increased secretions of catecholamines, antidiuretic hormone, aldosterone, cortisol Increased core body temperature as response to temperature regulation by hypothalamus

Question 285

Acute phase of Burn Injury

Answer 285

Begins about 36 to 48 hr after injury; lasts until wound closure is completed Care directed toward continued assessment and maintenance of CV and respiratory systems, as well as GI and nutritional status, burn wound care, pain control, psychosocial interventions

Question 286

Rehab phase of burn injury

Answer 286

Begins with wound closure, ends when patient returns to highest possible level of functioning Emphasis on psychosocial adjustment, prevention of scars and contractures, resumption of preburn activity

Question 287

Rehab phase of burn injury

Answer 287

Begins with wound closure, ends when patient returns to highest possible level of functioning Emphasis on psychosocial adjustment, prevention of scars and contractures, resumption of preburn activity

Question 288

Emergent vs urgent

Answer 288

Emergent implies that a condition exists that poses an immediate threat to life or limb. Urgent indicates the patient should be treated quickly but that an immediate threat to life does not exist

Question 289

Common systemic problems associated with burns

Answer 289

fluid and protein loss, sepsis, changes in metabolic, endocrine, respiratory, cardiac, hematologic, immune functioning

Question 290

Extent of local and systemic problems is related to what?

Answer 290

age, general health, extent of injury, depth of injury, specific body area injured

Question 291

Extent of local and systemic problems is related to what?

Answer 291

age, general health, extent of injury, depth of injury, specific body area injured

Question 292

Vitally important with burns wounds

Answer 292

Prevention of infection and closure of burn wound

Question 293

What are dermal appendages?

Answer 293

sweat and oil glands and hair follicles

Question 294

What happens when the entire dermis is destroyed?

Answer 294

all epithelial cells and dermal appendages are destroyed and the skin can no longer restore itself

Question 295

What temp can the skin tolerate up to without injury?

Answer 295

104 degrees

Question 296

What temp and above is cell destruction so rapid that brief exposure damages the skin and tissue below the skin

Answer 296

158 degrees

Question 297

Depth of burn injury is measured how?

Answer 297

- severity determined by how much body surface is involved | - the depth

Question 298

Superficial thickness

Answer 298

- least damage - epidermis only part injured - desquamation (peeling of dead skin) occurs 2-3 days after burn - redness w mild edema - prolonged exposure to low intensity heat or short (flash) exposure to high intensity heat

Question 299

Partial thickness

Answer 299

involves entire epidermis and dermis (varying depths) | -superficial partial OR deep partial

Question 300

Superficial partial- thickness

Answer 300

- injury to upper third of the dermis - red & moist - leaves good blood supply - small vessels damaged-> leakage of large amounts of plasma which cause blisters - nerve endings exposed

Question 301

Deep partial thickness

Answer 301

- extend deep into dermis - no blisters - red & dry with white areas in deeper parts (dry because fewer patent blood vessels) - blanches slowly to touch or not at all - moderate edema - nerve endings destroyed (less pain than superficial partial)

Question 302

When deep partial thickness wounds experience infection, hypoxia, or ischemia

Answer 302

deep partial thickness converts to full thickness wounds

Question 303

Full thickness

Answer 303

- destruction of entire epidermis and dermis - skin does NOT regrow - hard, dry, leathery eschar - edema severe under eschar - waxy white, deep red, yellow, brown, or black - nerve endings destroyed

Question 304

Escharotomies or fasiotomies

Answer 304

- incisions through the eschar | - incisions through eschar and fascia

Question 305

Deep Full thickness

Answer 305

- extend beyond skin and into fascia and tissues - damage bone, muscle, and tendons - blackened, depressed, sensation absent - excision and grafting needed - amputation may be necessary

Question 306

The nurse assesses the wound of a client burned as a result of stepping into a bathtub filled with very hot water. Which assessment finding of the burned areas on the tops of both feed does the nurse use as a bias to document a probable full thickness injury?

Answer 306

thrombosed blood vessels are visible beneath the skins surface

Question 307

Fluid shift

Answer 307

- occurs after initial vasoconstriction because blood vessels near the burn dilating and leaking fluid into the interstitial space - fluid shift w excessive weight gain occurs in first 12 hrs

Question 308

third spacing or capillary leak syndrome

Answer 308

- continuous leak of plasma from the vascular space into the interstitial space - usually occurs in first 12 hrs-> can continue 24-36 hr

Question 309

Hemoconcentration

Answer 309

- elevated blood osmolarity, hematocrit, and hgb - from vascular dehydration - this problem increases blood viscosity, reducing flow through small vessels and increasing tissue hypoxia

Question 310

Hemoconcentration

Answer 310

- elevated blood osmolarity, hematocrit, and hgb - from vascular dehydration - this problem increases blood viscosity, reducing flow through small vessels and increasing tissue hypoxia

Question 311

Fluid remobilization

Answer 311

- starts about 24 hrs after injury when capillary leak stops - diuretic stage starts at 48-72 hrs - increased kidney excretion= hyponatremia/kalemia

Question 312

Resuscitation: Early phase of burn injury

Answer 312

``` -24-48 hrs goals: -secure airway -support circulation (fluid replacement) -prevent infection -maintain body temperature -provide emotional support ```

Question 313

Injuries to the respiratory system

Answer 313

- direct airway injury - carbon monoxide poisoning and cyanide - thermal injury - smoke poisoning - pulmonary fluid overload - external factors

Question 314

Cardiac changes

Answer 314

- heart rate increases and CO decreases | - CO increases with fluid resuscitation

Question 315

Respiratory failure r/t burn injury

Answer 315

- airway edema during fluid resuscitation - pulmonary capillary leak - chest burns that restrict chest movement - carbon monoxide poisoning

Question 316

Reflex closure of vocal cords

Answer 316

-protective reflex reduces the entry of smoke and toxic gases into the lungs

Question 317

Pulmonary fluid overload

Answer 317

- occurs even when lung tissues have not been damaged directly - histamine, other inflammatory mediators cause capillaries to leak fluid into pulmonary tissue space

Question 318

Cardiovascular Assessment

Answer 318

- hypovolemic shock common cause of death in early phase in pts with serious injuries - vital signs - cardiac status, especially in cases of electrical burn injuries - noninvasive BP readings inaccurate in pts with large burns involving upper extremities

Question 319

What happens when the lining of the trachea and bronchi slough w/in 48-72 hrs

Answer 319

-obstructs the lower airways

Question 320

Leaking capillaries cause alveolar edema

Answer 320

- this edema can occur immediately or as late as 1 week after the injury - fluid that diffuses into the lung tissue spaces contains proteins that form fibrinous membranes and lead to resp distress

Question 321

GI changes

Answer 321

- GI has decreased blood flow - paralytic ileus may develop - secretions and gases collect in intestines causing abdominal distention

Question 322

GI changes

Answer 322

- GI has decreased blood flow - paralytic ileus may develop - secretions and gases collect in intestines causing abdominal distention

Question 323

Curling's Injury

Answer 323

acute gastroduodenal ulcer that occurs with the stress of severe injury - may develop 24 hrs after a severe burn b/c reduced blood flow to GI and mucosal damage - hydrogen ion reason

Question 324

metabolic changes

Answer 324

- increases metabolism by increasing secretion of catecholamines, antidiuretic hormone, aldosterone, and cortisol - O2 use and cal needs are high

Question 325

Temperature change in burn pts

Answer 325

- pts are hypermetabolic which increases body core temp but pts loses the heat through the burned area - core body temp "resets" to a higher baseline - low grade fever - regulation by hypothalamus

Question 326

Kidney/Urinary Assessment

Answer 326

- changes related to cellular debris, decreased kidney blood flow - myoglobin released from damaged muscle, circulates to kidney - destroyed RBC release hgb and k - kidney function, BUN, serum creatinine, serum sodium levels - urine color, odor, presence of particles/foam

Question 327

Which assessment does the nurse perform first on the client just admitted after an electrical injury with contact sites on the left hand and left foot?

Answer 327

electrocardiography

Question 328

Skin Assessment

Answer 328

- Size and depth of injury - percentage of total BSA affected - "rule of nines" using multiples of 9% of total BSA

Question 329

The client who tripped while carrying an open kettle of hot water received scald burns to the entire chest, entire anterior section of the right arm, the right half of the abdomen, and the anterior portion of the right leg from the groin to the knee. At what percentage of total body surface area does the nurse calculate the injury using the rule of nines?

Answer 329

22-23% chest: 18% right arm anterior: 4.5 right half of abd: 2 right leg groin to knee: 4.5

Question 330

GI assessment

Answer 330

- changes in GI function expected - decreased blood flow and sympathetic stiumulation during early phase cause reduced GI motility, paralytic ileus - GI bleeding - ausculate for bowel sounds: commonly reduced or absent with severe burns - test for occult blood on any vomit or stool - check NG for coffee ground appearance (digested blood)

Question 331

paralytic ileus manifestations

Answer 331

-nausea, vomiting, abdominal distention

Question 332

Compensatory Response to burn injury

Answer 332

- inflammatory compensation can trigger healing | - SNS compensation occurs when any physical or psychological stressors are present

Question 333

Nonsurgical Management of Burns

Answer 333

- IV fluids - monitoring patient response to fluid therapy - drug therapy

Question 334

Dry heat injuries

Answer 334

- caused by open flame | - house fires and explosions

Question 335

Moist heath (scald) injuries

Answer 335

- caused by contact with hot liquids or steam - more common among older adults than among younger adults - hot liquid-> front areas of body - immersion scald-> lower body

Question 336

contact burns

Answer 336

- occur when hot metal, tar, or grease contacts the skin often leading to a full thickness injury - hot grease injuries

Question 337

chemical burns

Answer 337

- severity depends on duration of contact, concentration of chemical, amount of tissue exposed, and action of the chemical - if dry chemicals DO NOT WET THEM - brush off any dry chemicals present on skin or clothing and remove pts clothing - do not attempt to neutralize chemical unless known for sure

Question 338

Electrical injries

Answer 338

- "grand masquerader" - course of flow defined by locations of the contact sites (entrance and exit wounds) - initiate CPR - obtain ECG (electrical current is ****ed in heart)

Question 339

Radiation burns

Answer 339

- remove the pt from the radiation source - it pt has been exposed to radiation from an unsealed sources, remove clothing with PPE - it pt has radioactive particles on the skin send pt to nearest designated radiation decontamination center - help pt bathe or shower

Question 340

Radiation burns

Answer 340

- remove the pt from the radiation source - it pt has been exposed to radiation from an unsealed sources, remove clothing with PPE - it pt has radioactive particles on the skin send pt to nearest designated radiation decontamination center - help pt bathe or shower

Question 341

General Management for all types of burns

Answer 341

- assess for airway patency - administer oxygen PRN - cover pt with blanket - keep pt NPO - elevate the extremities if no fractures are obvious - vital signs - initiate an IV line and begin fluid replacement - administer tetanus toxoid for prophylaxis - perform a head to toe assessment

Question 342

Factors that increase risk of death with burn injury

Answer 342

older than 60 yrs - burn greater than 40% TBSA - presence of inhalation injury - if pt has all 3 factors then risk for death is very high

Question 343

goals of resuscitation phase

Answer 343

1) secure airway 2) support circulation by fluid replacement 3) keep pt comfortable with analgesics 4) prevent infection through careful wound care 5) maintain body temp 6) provide emotional support

Question 344

dry weight

Answer 344

pts weight before injury and before the edema occurred.

Question 345

Age related changes increasing complications from burn injury

Answer 345

- thinner skin, sensory impairment, decreased mobility - slower healing time - more likely to have cardiac impairments - reduced inflammatory and immune responses - reduced thoracic and pulmonary compliance - more likely to have preexisting med conditions (diabetes, kidney impairment, pulmonary impairment)

Question 346

Factors determining inhalation injury or airway obstruction

Answer 346

- pts who were injured in a closed space - pts with extensive burns or with burns of the face - intra oral charcoal, especially on teeth and gums - pts who were unconscious at the time of injury - pts with singed scalp hair, nasal hairs, eyelids or eyelashes - pts who are cough up carbonaceous sputum - changes in voice such as hoarseness or brassy cough - use of accessory muscles or stridor - poor oxygenation or ventilation - edema, erythema, and ulceration of airway mucosa - wheezing, bronchospasm

Question 347

CRITICAL RESCUE: burn pt in the resuscitation phase who is hoarse, brassy cough, drools or has difficulty swallowing, produces an audible breath sound on exhalation...

Answer 347

-immediately apply oxygen and notify the rapid response team

Question 348

If wheezing sounds disappear..

Answer 348

Intubate immediately!

Question 349

Carbon Monoxide Level: 1%-10% normal

Answer 349

increased threshold to visual stimuli, Increased blood flow to vital organs

Question 350

Carbon Monoxide Level: 11%-20% mild poisoning

Answer 350

headache decreased cerebral function decreased visual acuity slight breathlessness

Question 351

Carbon Monoxide Level: 21%-40% moderate poisoning

Answer 351

``` headache tinnitus nausea drowsiness vertigo altered mental state confusion stupor irritability decreased blood pressure (increased and irregular hr) depressed ST segment on ECG and dysrhythmias pale to reddish purple skin ```

Question 352

Carbon Monoxide Level: 41%-60% severe poisoning

Answer 352

coma convulsions cardiopulmonary instability

Question 353

Carbon Monoxide Level: 61%-80% fatal poisoning

Answer 353

death

Question 354

What creates the cherry red color? Or at least the absence of cyanosis with CO pts?

Answer 354

Carbon monoxide has a vasodilating

Question 355

Thermal (heat) injury

Answer 355

Heat damage of the pharynx is often severe enough to produce edema and upper airway obstruction, espeically epiglottitis. The problem can occur any time during resuscitation. In the unresusciatated pt, supraglottic edema may be delayed because of the dehydration that occurs with hypovolemia. During fluid resusciation, the tissues rehydrate and then swell. When it is known that the upper airways were exposed to heat, intubation may be performed as an early intervention before obstruction occurs.

Question 356

SAFETY PRIORITY: ACTION ALERT

Answer 356

when intubation has not been performed in a pt whose upper airways were exposed to heat or toxic gases, continually assess the upper airway for recognition of edema and obstruction

Question 357

CRITICAL RESCUE: pulmonary edema

Answer 357

when symptoms of pulmonary edema are present, elevate the head of the bed to at least 45 degrees, apply humidified oxygen, and notify the burn team or the rapid response team

Question 358

CRITICAL RESCUE: pulmonary edema

Answer 358

when symptoms of pulmonary edema are present, elevate the head of the bed to at least 45 degrees, apply humidified oxygen, and notify the burn team or the rapid response team

Question 359

Lab Values during resuscitation phase

Answer 359

- elevated hgb, hct, urea, glucose, k, chloride | - decreased na, total protein, albumin

Question 360

Upper airway edema

Answer 360

becomes pronounced 8 to 12 hours after the beginning of fluid resuscitation. These pts often require nasal or oral intubation if crowing, stridor, or dyspnea is present

Question 361

Cyanide poisoning

Answer 361

may occur in pts burned in house fires. An elevated plasma lactate level is one indicator of cyanide toxicity.

Question 362

Pt and increased activity during mechanical ventilation

Answer 362

- use of paralytic drug may be necessary - atracurium (tracrium) or vecuronium (norcuron) - removes all breathing control from pt - pt can still see, hear, fear, pain.. must also give sedation, analgesia, and antianxiety unless contraindicated

Question 363

Most common and most sensitive noninvasive assessment parameter for cardiac output and tissue perfusion

Answer 363

urine output

Question 364

Amount of fluid given depends on how much IV fluid per hour is needed to maintain the hourly urine output of what?

Answer 364

30 ml/hr

Question 365

titration of fluid

Answer 365

adjustment of the IV fluid rate on the basis of urine output plus serum electrolyte values

Question 366

use of diuretics

Answer 366

not typically used in burn pts because we need to give fluids, not take fluids out -electric burns: muscle and deep tissue damage release large protein molecules (myoglobin) which precipitate in and obstruct the renal tubules (manniotol {osmitrol})

Question 367

Considerations for older adults and fluid resuscitation

Answer 367

in OA, especially with cardiac disease, a complicating factor may be heart failure or myocardial infarction. Drugs that increase cardiac output (dopamine- Intropin) or that strengthen the force of myocardial contraction (digoxin- lanoxin) may be used along with fluid therapy

Question 368

Drug therapy for pain management

Answer 368

- opioid analgesics ( morphine, hydromorphone, fentanyl) - non-opioid analgesics - these meds do not provide complete relief - cause resp depression and reduce intestinal motility - nonpharmacologic interventions needed

Question 369

Opioids for pain during resuscitation phase

Answer 369

-only given by IV

Question 370

Acute Phase of Burn Injury

Answer 370

- begins about 36 to 48 hrs after injury; lasts until wound closure is completed - care directed toward continued assessment and maintenance of CV and respiratory systems, as well as GI and nutritional status, burn wound care, pain control, psychosocial interventions

Question 371

Cardiopulmonary assessment

Answer 371

priority assessment is cardio and respiratory | -pt may develop pneumonia

Question 372

Neuro-endocrine assessment

Answer 372

- increased metabolic demands placed on body after severe burn injury depletes body's nutritional stores - 2% loss of body weight indicates a mild deficit - VCO2 taken while pt is at rest (indirect calorimetry)

Question 373

Immune Assessment

Answer 373

- infection is the leading cause of death during the acute phase of recovery - assess for wound appearance changes

Question 374

Musculoskeletal Assessment

Answer 374

result of other injuries, immobility, healing processes, and treatment

Question 375

Debridement

Answer 375

priority nursing intervention include assessing the wound, providing wound care, and preventing infection and other complications

Question 376

Mechanical Debridement

Answer 376

- hydrotherapy the application of water for treatment - showering pt on a specially designed table or washing small areas at bedside - mild soap or detergent water

Question 377

Enzymatic debridement

Answer 377

can occur naturally by autolysis or artifically by the application of exogenous agents -autolysis or collagenase

Question 378

autolysis

Answer 378

disintegration of tissue by the action of the pts own cellular enzymes

Question 379

collagenase (santyl)

Answer 379

- topical enzyme - used for rapid wound debridement - enzyme digest collagen in necrotic tissues

Question 380

Dressing the burn wound

Answer 380

- standard wound dressing - depends on: - depth of injury - amount of drainage expected - area injured - pts mobility - frequency of dressing changes

Question 381

Biologic dressings

Answer 381

- Homograft—human skin (allografts) - Heterograft—skin from other species (xenografts) - Amniotic membrane - Cultured skin: grow in lab - Artificial skin

Question 382

Biosynthetic wound dressing

Answer 382

- combo of biosynthetic and synthetic materials | - biobrane is commonly used and effective with clean of superficial partial thickness

Question 383

Synthetic

Answer 383

- solid silicone and plastic membranes - pain is reduced at site cause agents cover nerve endings from air - faster healing with low infection rates, minimal pain, reduced costs

Question 384

Surgical Excision

Answer 384

- most common treatment for full thickness and deep partial thickness wounds - bleeding indicates healthy tissue

Question 385

Wound covering

Answer 385

- skin graft - may have repeated removla of skin from the same donor site - meshing the split thickness skin grafts to allow a small graft to cover a large area

Question 386

Common burn wound infefction

Answer 386

- occurs through auto-contamination: pts own flora overgrows and invades other body areas - cross-contamination: organisms from other ppl or environments are transferred to the pt

Question 387

Common burn wound infefction

Answer 387

- occurs through auto-contamination: pts own flora overgrows and invades other body areas - cross-contamination: organisms from other ppl or environments are transferred to the pt

Question 388

Priority nursing dx during wound healing

Answer 388

*using principles of asepsis to prevent infection transmission, providing a safe environment, and monitoring for early detection of infection

Question 389

Clostridium tetani

Answer 389

- burn wound conditions promote growth of this dangerous infection - tetanus is recommended

Question 390

topical agents (infection prevention)

Answer 390

Silvadene, flamazine, sulfamylon | -topicals not applied to freshly grafted areas because they may inhibit cell growth

Question 391

Drug therapy for treatment of Infection

Answer 391

- systemic antibiotics used when burn pts have symptoms of actual infection - because of increased metabolism pts may have higher dose of these drugs - for some antimicrobials, serial peak and trough blood levels are monitored to determine the efficacy and evaluate potential ear and kidney toxicity

Question 392

Providing a safe environment

Answer 392

- may include isolation therapy - involves coordinating all members of health care team w/ use of asepsis - monitor for early recognition of actual infection

Question 393

Isolation therapy

Answer 393

- belief it reduces cross contamination - controversial - all isolation methods use proper and consistence hand washing as the most effective technique for preventing infection transmission

Question 394

GLOVES

Answer 394

- change gloves when handling different wounds on different parts of the body - clean gloves vs sterile depends on facility

Question 395

Psuedomonas

Answer 395

- have been found in plants so they are prohibited - some units may not allow pts to ear raw foods (salads, fruit, peppers) - rugs and upholstered articles harbor organisms and not allowed

Question 396

Early detection of infection at wound site

Answer 396

- pervasive odor - color changes (focal, dark red, brown discoloration in the eschar) - change in texture - purulent drainage - exudate - sloughing grafts - redness at the wound edges extending to nonburned skin

Question 397

Quantitative biopsies of eschar and granulation tissue

Answer 397

- performed routinely and as needed to monitor growth of organisms - lab cultures and biopsies recommended

Question 398

Surgical management of infected burn wounds

Answer 398

- infected burn wounds with colony counts of or approaching 10(exponent 5) colonies per gram of tissue may be life threatening even with antibiotic therapy - surgical excision of the burn wound may be necessary

Question 399

ABGs (arterial blood gases) in asthma attack

Answer 399

PaO2 ↓ during attack (normal 80-100 mmHg) PaCO2 ↓ early during attack with ↑ RR PaCO2 ↑ later with CO2 retention(normal 35-45 mmHg)

Question 400

Esoiniphils in asthma attack

Answer 400

↑ Eosinophil and IgE levels; mucus plugs

Question 401

PFTs (pulmonary function tests)* in asthma attack

Answer 401

↓ FVC (forced vital capacity) ↓ FEV1 (forced expiratory volume in 1st sec) ↓ PEF (peak expiratory flow)

Question 402

Short-acting Beta 2 Agonists Inhaled Bronchodilators 4-6 hours

Answer 402

- Albuterol (Proventil, Ventolin) - Levalbuterol (Xopenex) - Pirbutero (Maxair Autohaler) Biolterol (Tornalate)

Question 403

Short-acting Beta 2 Agonists Inhaled Bronchodilators 4-6 hours: PURPOSE

Answer 403

Relief of acute symptoms for acute bronchospasm or as preventive treatment prior to exercise; bind to & activate pulmonary beta2 receptors

Question 404

Long-acting Beta 2 agonist inhaled bronchodilators 12 hours

Answer 404

Salmeterol (serevent)

Question 405

Long-acting Beta 2 agonist inhaled bronchodilators 12 hours: PURPOSE

Answer 405

Relaxes bronchiolar smooth muscle; slow onset

Question 406

Long-acting Beta 2 agonist inhaled bronchodilators 12 hours: NURSE TEACHING

Answer 406

Long-acting Beta 2 agonist inhaled bronchodilators 12 hours: NURSE TEACHING Do not use as a rescue of acute symptoms; Correct technique MDI or DPI

Question 407

Cholinergic Antagonist or Anticholinergic Inhaled: short acting

Answer 407

Ipratropium (Atrovent) short acting

Question 408

Cholinergic Antagonist or Anticholinergic Inhaled: PURPOSE

Answer 408

inhibits parasympathetic nervous system allowing sympathetic system to dominate releasing norepinephrine that activates beta 2 receptors; relieves and prevents asthma--can be used as rescue several times a day when beta2 agonist not tolerated

Question 409

Cholinergic Antagonist or Anticholinergic Inhaled: long acting

Answer 409

tiotropium (spirival)

Question 410

Possible alternative bronchodilator for patients who do not tolerate inhaled beta2 agonists

Answer 410

Atrovent

Question 411

Methylzanthines Oral: meds

Answer 411

Theophylline Aminophylline -added therapy to anti inflammatory meds for long term control of symptoms; especially nighttime symptoms

Question 412

Methylzanthines Oral: THERAPEUTIC ISSUES

Answer 412

- Must monitor blood level concentrations closely - Do not use as reliever - Used only when other management not effective

Question 413

Methylzanthines Oral: When is this the chosen med?

Answer 413

used for management when pt not responsive to other forms of treatment Methylzanthines Oral: What monitoring is necessary? -monitoring required to maintain serum levels between 5 and 15 mcg/ml -seizures can occur with increasing serum levels

Question 414

"controllers" anti-inflammatory inhaled corticosteroids

Answer 414

"controllers" anti-inflammatory inhaled corticosteroids -fluticasone (flovent MDI) - budesonide (pulmicort DPI or nebs) - mometasone (asmanex)

Question 415

"Controller" Inhaled Nonsteroidal Anti-inflammatory: MEDS

Answer 415

"Controller" Inhaled Nonsteroidal Anti-inflammatory: MEDS Cromolyn (intal) Tilade (nedocromil)

Question 416

Leukotriene Antagonists Inhaled: MEDS; block leukotriene receptor

Answer 416

- Montelukast (singulair) | - Zafirlukast (accolate)

Question 417

Leukotriene Antagonists Inhaled: MEDS; prevents leukotriene synthesis

Answer 417

Zileuton (zyflo) LIVER ENZYMES

Question 418

Immunoglobulin (IgE) Blocker SQ: MED

Answer 418

Omalizumab (xolair)

Question 419

Immunoglobulin (IgE) Blocker SQ: PURPOSE

Answer 419

used for poorly controlled asthma or non-compliance with standard recommended therapy

Question 420

blue bloaters

Answer 420

chronic bronchitis - have signs of right side heart failure - type B COPD with primary dx of chronic bronchitis - worse than A - chronic carbon retention

Question 421

pink puffers

Answer 421

pink puffers -primary dx within COPD is emphysema - type A COPD - increased resp rate, tachypnea, hyperventilation, increased redness of skin - less hypoxemia

Question 422

Complications of COPD

Answer 422

hypoxemia and acidosis (decrease tissue perfusion and function) - respiratory infections (increase mucus and poor oxygenation) - cardiac failure (cor pulmonale) - cardiac dysrhythmias (from cardiac tissue ischemia)

Question 423

emphysmea: defining symptoms (secondary data)

Answer 423

- dyspnea - underweight - relies on accessory muscles - barrel chest - no sputum - minimum cough - progressive

Question 424

chronic bronchitis (secondary data)

Answer 424

- productive cough - resp infections - bronchospasm - dyspnea on exertion - hx of smoking - normal weight to heavy - cyanosis - cough exacerbated by cold air and irritants