Final combined Flashcards
(399 cards)
1
Q
What are the components of a neurological assessment?
A
- Interview
- Level of consciousness
- Pupillary assessment
- Cranial nerve testing
- Vital signs
- Motor function
- Sensory function
- Tone
- Cerebral function
2
Q
What should be identified during the neurological assessment interview?
A
Headache, difficulty with speech, altered consciousness, confusion, disorientation, decreased sensation, tingling, pain, motor weakness, decreased strength, change in vision, difficulty swallowing, altered gait, balance, dizziness, tremors, twitches.
3
Q
What is the most sensitive indicator of neurological change?
A
Consciousness.
4
Q
What are the two aspects of consciousness?
A
- Awareness (interaction with the environment)
- Arousal (function of the brain stem)
5
Q
What are some reasons for altered consciousness?
A
- Decreased cerebral metabolism (hypoxia, hypoglycemia)
- Drugs (alcohol, barbiturates)
- Hypotension (decreased cerebral blood flow)
- Structural lesions (infarctions, hemorrhages, tumors)
6
Q
What three components are evaluated in the Glasgow Coma Scale?
A
Eye opening, motor function, speech.
7
Q
What factors are assessed in pupillary assessment?
A
Size, shape, reactivity to light, and comparison of one pupil to the other.
8
Q
What are the potential sizes of pupils in a neurological assessment?
A
Pinpoint, small, large, dilated.
9
Q
What does a normal pupillary shape look like?
A
Normally round.
10
Q
What is a normal finding in extraocular eye movement?
A
Blinking periodically, eyes moving together, no nystagmus.
11
Q
What should be assessed in vital signs during a neurological assessment?
A
Rate, rhythm, and characteristics of respiration; quality of pulse; blood pressure.
12
Q
What neurological conditions can cause changes in respiration?
A
Increased intracranial pressure (ICP) and spinal cord injury.
13
Q
What can cause tachycardia from a neurological standpoint?
A
Multiple trauma or hemorrhage.
14
Q
What can cause bradycardia from a neurological standpoint?
A
Increased ICP and spinal cord injury.
15
Q
What causes hypertension in a neurological context?
A
Increased ICP (widening pulse pressure) and Cushing’s Triad (hypertension, bradycardia, apnea).
16
Q
Are changes in vital signs early warning signs for neurological changes?
A
No.
17
Q
How is motor function graded?
A
5= full ROM against gravity/resistance (normal)
4= full ROM against gravity/moderate resistance
3= full ROM against gravity only
2= full ROM when gravity is eliminated
1= muscle contraction is palpated
b= complete paralysis.
18
Q
What types of sensory function are assessed?
A
Pain/temperature sensation, position sense (proprioception), light touch.
19
Q
What are the grades for reflex response?
A
0= no response
1+= diminished response
2+= average/normal
3+= brisker than normal
4+= very brisk/hyperactive.
20
Q
What tests are used to assess cerebellar function?
A
Finger to finger test, finger to nose test, tandem walking, Romberg test.
21
Q
What should patients be educated about before a CT scan?
A
- Need to lie quietly
- relaxation techniques
- monitoring if sedation is administered
- IV contrast agent/allergy and renal function assessment.
22
Q
What precautions should be taken regarding metal objects during an MRI?
A
No metal objects should be brought into the room due to the risk of dislodging magnetic substances.
23
Q
What can an MRI identify?
A
- cerebral abnormality earlier and more clearly than other tests
- a. Provides information about chemical changes within cells (diagnosis of brain tumor, CVA, MS)
24
Q
What does a Positron Emission Tomography (PET) scan measure?
A
It produces images of organ functioning by measuring blood flow, tissue composition, and metabolism.
25
What is a cerebral angiography?
An X-ray study of cerebral circulation with a contrast agent injected into an artery.
26
What is the purpose of cerebral angiography?
To determine vessel patency, presence of collateral circulation, and vascular anomalies.
27
What complications should be assessed after a cerebral angiography?
- New onset altered level of consciousness
- weakness
- sensory deficits
- speech disturbances
- embolism
- arterial dissection.
28
What do noninvasive carotid flow studies include?
- carotid dopplers
- Transcranial doppler
- EEG
29
What is the purpose of Carotid Doppler studies?
To detect arterial stenosis, occlusion, and plaques.
30
What does Transcranial Doppler assess?
Arterial flow through the temporal and occipital bones of the skull, assessing vasospasm and brain death.
31
What does an EEG do?
Records electrical activity.
32
What should be considered prior to an EEG?
- Avoid caffeine, cola, chocolate, and sedatives.
- Deprive body of sleep the night before.
33
What is a lumbar puncture used for?
To withdraw cerebrospinal fluid (CSF) for culture, measure and reduce CSF pressure, and determine the presence of blood.
34
What are the risks associated with a lumbar puncture?
Risky in the presence of an intracranial mass lesion, as it may cause brain herniation. Administer medications intrathecal.
35
What is the normal appearance of CSF fluid?
Clear and colorless.
36
What is a post-lumbar puncture headache caused by?
Leakage at the puncture site.
37
What characterizes an Altered Level of Consciousness (ALOC)?
- patient is not oriented
- patient does not follow commands
- patient persistent stimuli to achieve alertness
38
Define Coma
A clinical state of unarousable unresponsiveness with no purposeful response to stimuli. Non-purposeful responses to painful stimuli and brain stem reflexes may be present.
39
What is a Persistent Vegetative State?
An unresponsive patient who resumes sleep-wake cycles after coma but lacks cognitive function.
40
What is Locked-in Syndrome?
A condition resulting from a lesion affecting the pons, leading to paralysis and inability to speak, but with intact vertical eye movements.
41
What is the primary goal of medical management for ALOC?
To maintain a patent airway and ensure adequate ventilation and oxygenation.
42
What does the nursing process for assessing ALOC include?
Assessment of alertness, verbal response, pain response, and posturing.
43
What are seizure disorders characterized by?
Episodes of abnormal motor, sensory, autonomic, or psychic activity due to excessive discharge from cerebral neurons.
44
What are the characteristics of a Tonic-clonic seizure?
Contractions, chew tongue, incontinent, subside after 1-2 minutes --> coma.
45
What are the classifications of seizures?
Generalized seizures (e.g., tonic-clonic, absence), focal seizures, unknown.
46
What is the post-ictal state following a seizure?
A state lasting 1-2 minutes after a seizure where the patient relaxes, may breathe noisily, and has abdominal respirations.
47
What nursing responsibilities are important during a seizure?
Observe and record the sequence and timing of the seizure; turn the patient to a side-lying position.
48
What should be assessed in a patient experiencing seizures?
Type of seizure, frequency, severity, and any precipitating factors.
49
What diagnostic test is performed to detect a seizure?
EEG.
50
What are some complications that need to be prevented during a seizure?
Hypoxia and vomiting/aspiration.
51
What are seizure precautions that should be instituted?
Suction, oxygen source, bed in low position, padded side rails.
52
What is Status Epilepticus?
Prolonged seizure activity lasting more than 30 minutes, considered a medical emergency. Complications: Increased metabolic demand, respiratory failure, cerebral anoxia, cerebral edema.
53
What are the two main types of headaches?
Primary headaches (no organic cause identified) and secondary headaches (associated with an organic cause).
54
Examples of primary headaches?
Migraine, tension, and cluster headaches (mainly in men).
55
Examples of secondary headaches?
Brain tumor, subarachnoid hemorrhage (SAH), aneurysm, cerebrovascular accident (CVA), and hypertension.
56
What is a common pathophysiological change in migraines?
Hyper excitable brain leading to cortical spreading depression. Vascular changes, inflammation and pain signal stimulation occur.
57
What triggers can lead to migraines?
Hereditary factors, hormonal changes, low brain magnesium levels, bright lights, stress, sleep deprivation, fatigue, odors, and tyramine.
58
What are the phases of a migraine attack?
1. Prodromal phase 2. Aura phase 3. Headache phase 4. Recovery phase.
59
What occurs in the Prodromal phase of a Migraine?
Irritability, depression, feeling cold, food cravings, anorexia, change in activity level, increased urination.
60
What occurs in the Aura phase of a Migraine?
Bright spots in eyes, lip numbness and tingling, facial and hand numbness, mild confusion, drowsiness, dizziness, diplopia.
61
What occurs in the Headache phase of a migraine?
Unilateral throbbing pain, photophobia, nausea/vomiting.
62
What occurs in the Recovery phase of a migraine?
4 to 72 hours later, muscle aches in neck and scalp - possible extended sleep.
63
What is Tension HA?
Steady, constant pressure that feels band-like.
64
What are the characteristics of Cluster HA?
- Unilateral
- Excruciating pain localized to the eye/orbit, with radiation to the face and temporal region.
65
How can headaches be prevented?
Avoid triggers (ETOH (alchohol), vasodilators, histamine).
66
What is the diagnosis method for a headache?
CT or MRI of the brain.
67
What is the nursing management for headaches?
- Quiet, dark room
- Elevate HOB 30 degrees
- Pain medication
- Symptomatic treatment (antiemetic)
68
What is the definition of a CVA?
Functional abnormality of CNS that occurs when the blood supply to the brain is disrupted. **AKA A STROKE**
69
What are the two categories of CVA?
- Ischemic
- Hemorrhagic
70
Which type of stroke is more deadly?
Hemorrhagic stroke, which accounts for 13% of strokes.
71
What are the four categories of ischemic strokes?
1) Large artery thrombotic strokes (20%)
2) Small artery thrombotic strokes (25%)
3) Cardiogenic embolic stroke (20%)
4) Cryptogenic (30%).
72
What are some risk factors for cerebrovascular disorders?
- Hypertension (HTN)
- Smoking
- Peripheral vascular disease (PVD)
- Aneurysm leading to cranial hemorrhage.
73
What initiates the ischemic cascade in the brain?
Cerebral blood flow dropping below 25 mL per 100 g/min.
74
What does anaerobic respiration lead to?
Production of lactic acid, decreased ATP, vasoconstriction, and free radicals, which enlarge the infarction area.
75
What is the penumbra?
The salvageable area of brain tissue surrounding an ischemic zone.
76
How quickly does ischemic brain tissue age without treatment?
3.6 years per hour.
77
What is the Glasgow Coma Scale (GCS) threshold for intubating a patient?
A GCS of 7.
78
What is Hemianopsia?
- Blindness in half the visual field
- Patient will only see one side of the plate when eating.
79
What is the gold standard for diagnosing a stroke?
CT scan within 25 minutes of ED arrival.
80
What are the medical management options for secondary prevention of stroke?
Coumadin, Pradaxa, Xarelto, ASA, Plavix, and Statins.
81
What is the Coumadin INR goal?
2-3.
82
Which patients are not eligible for thrombolytics (TPA)?
Those on IV heparin or LMWH.
83
What is the goal time frame for administering thrombolytics like TPA?
Within 3 hours, with a maximum of 4.5 hours after symptom onset.
84
What is Expressive (Broca's) Aphasia?
Patient has a loss of ability to produce language but they know what they want to say.
85
What is Receptive (Wernicke's) Aphasia?
Patient is speaking fluently, but the sentences do not make sense.
86
What is a common surgical procedure to prevent stroke in patients with occlusive diseases?
Carotid endarterectomy.
87
What is the purpose of elevating the head of the bed (HOB) for stroke patients?
To manage intracranial pressure (IICP).
88
What causes a hemorrhagic stroke?
- Intracranial aneurysm
- Arteriovenous malformation (AVM)
- Subarachnoid hemorrhage.
89
What is intracerebral hemorrhage?
- Bleeding into brain tissue
- Secondary to HTN/atherosclerosis
- Brain pathology/tumor.
90
What is an intracranial cerebral aneurysm?
- Dilation of the walls of a cerebral artery due to weakness in the wall.
- Usually occurs at bifurcation of large vessels, circle of Willis.
91
What is arteriovenous malformation (AVM)?
An abnormality in development that leads to a tangle of arteries and veins, lacking a capillary bed.
92
What is subarachnoid hemorrhage (SAH)?
Result of AVM, intracranial aneurysm, trauma, HTN.
93
What are the clinical manifestations of a hemorrhagic stroke?
Increased intracranial pressure (ICP), bleeding into brain tissue, and secondary ischemia.
94
What is the gold standard to diagnose a hemorrhagic stroke?
CT/MRI brain.
95
What is cerebral hypoxia?
- Brain function depends on oxygen delivery to tissues
- Supplemental oxygen
- Maintain H/H
- Maintain BP, cardiac output
- Adequate IVF
- Avoid extreme hyper/hypotension
- Treat/prevent seizures.
96
What is vasospasm?
- Complication of SAH
- Leading cause of M&M
- Associated with increasing amounts of blood
- Occurs 7-10 days after initial hemorrhage
- Impedes cerebral blood flow
- S/S: worsening confusion, lethargy, disorientation, aphasia
- Medication: nimodipine, triple-H therapy.
97
What are the complications of hemorrhage?
- Re-bleeding
- Hematoma expansion
- Cerebral vasospasm
- Cerebral ischemia
- Acute hydrocephalus.
98
What is the normal range for intracranial pressure (ICP)?
0-10 mm Hg.
99
What is the target range for cerebral perfusion pressure (CPP)?
70-100 mm Hg.
100
What nursing interventions are important for managing patients with IICP?
- Elevate the head of the bed
- Give patient O2 to combat increased CO2
- Give mannitol (diuretic)
- Avoid giving patients any sedative medications
- Treat fluid and electrolyte imbalances.
101
What is the management of patients with IICP?
Avoid straining by giving stool softeners, avoid activities that increase blood pressure (Valsalva, coughing, straining, sneezing, flexion/rotation of head), monitor for vasospasm, monitor urine output, and treat seizures.
102
What is the definition of meningitis?
Inflammation of the membranes and fluid space surrounding the brain and spinal cord.
103
What are the two main types of meningitis?
Septic (bacterial) and aseptic (viral or due to cancer/weakened immune system).
104
How is meningitis transmitted?
Via secretions/aerosol contamination, more likely in dense community groups (college campuses).
105
What are the manifestations of meningitis?
Headache, very high fever, changes in LOC, behavioral changes, **nuchal rigidity** (stiff neck), positive Kernig sign, positive Brudzinski sign, photophobia, and sometimes petechiae rash.
106
What diagnostic procedure is used for meningitis?
Lumbar puncture (spinal tap), which may show a halo around CSF or dextrose in the fluid.
107
What is the recommended age for the meningococcal vaccine?
Youth aged 11-12 years, with a booster at age 16, especially for college freshmen and military personnel.
108
What is the first-line treatment for bacterial meningitis?
Early administration of high-dose IV antibiotics.
109
What role does dexamethasone play in meningitis treatment?
It is a steroid that improves patient outcomes.
110
What nursing management strategies are important for a patient with meningitis?
Frequent assessment of vital signs and LOC, pain and fever management, protection from injury, monitoring daily weight and serum electrolytes, and infection control with droplet precautions.
111
What are the signs that indicate meningitis?
Kernig's sign (inability to fully extend the leg due to pain) and Brudzinski's sign (hip and knees flex when the neck is flexed).
112
What is encephalitis?
Acute inflammatory brain process.
113
What are the causes of encephalitis?
Viral infections (e.g., HSV), vector-borne infections (e.g., West Nile, St. Louis), and fungal infections.
114
What are the common manifestations of encephalitis?
Headache, fever, confusion, hallucinations, and in vector-borne cases: rash and flaccid paralysis.
115
What is the medical management for encephalitis?
Acyclovir (HSV) and Amphotericin or other antifungal (fungal).
116
What is multiple sclerosis?
An immune-mediated, progressive demyelinating disease of the central nervous system.
117
What are common clinical patterns of multiple sclerosis?
They vary, often relapsing-remitting, with exacerbations and recurrences of symptoms.
118
What are the symptoms of multiple sclerosis?
Fatigue, weakness, numbness, poor coordination, pain, and vision issues.
119
What is the focus of symptom management in multiple sclerosis?
Management of spasms, fatigue, ataxia, and bowel and bladder control.
120
What diagnostic imaging findings are associated with multiple sclerosis?
Patches on the spinal cord.
121
Which demographic is usually more affected by multiple sclerosis?
Young individuals, particularly women.
Australia, NZ, northern
122
In which regions is multiple sclerosis more prevalent?
Europe, New Zealand, Southern Australia, and Northern US.
123
What are some nursing interventions for patients with multiple sclerosis?
Keep them active, encourage normal life, promote daily exercise, and teach catheter insertion and fall safety.
124
What are some interventions for coordination and rest in multiple sclerosis?
Collaboration/referrals, daily exercise, rest, and avoiding strenuous activity.
125
What are some bowel and bladder interventions for multiple sclerosis?
Medications, schedules, bowel training, and ensuring adequate fluids and fiber.
126
What environmental and coping strategies are recommended for multiple sclerosis?
Temperature regulation, assistive devices, and supportive care.
127
What is Guillain-Barré Syndrome?
Autoimmune: acute peripheral nerve demyelination --> Rapid demyelination may produce respiratory failure and autonomic nervous system dysfunction with CV instability. Medical emergency.
128
What triggers Guillain-Barré Syndrome?
Viral infections.
129
What are the symptoms of Guillain-Barré Syndrome?
Ascending weakness, paresthesia, pain, decreased reflexes, bulbar weakness, cranial nerve symptoms, tachycardia, bradycardia, hypertension, or hypotension.
130
What is the management for Guillain-Barré Syndrome?
ICU monitoring, plasmapheresis, and IVIG to reduce circulating antibodies.
131
What are potential complications of Guillain-Barré Syndrome?
**Respiratory failure**, autonomic dysfunction, DVT, PE, and urinary retention.
132
What nursing assessments are important for a patient with Guillain-Barré Syndrome?
Monitoring for **respiratory failure**, dysrhythmias, vital signs, and patient/family coping.
133
What interventions can help with mobility and DVT prevention in Guillain-Barré Syndrome?
Functional positioning, passive ROM exercises, position changes every 2 hours, and compression boots.
134
What is dysphonia?
A difficulty in speaking due to a physical disorder of the mouth, tongue, throat, or vocal cords.
135
What is akathisia?
Restlessness, an urgent need to move around, and agitation.
136
What is bradykinesia?
Very slow voluntary movements and speech.
137
What is dyskinesia?
Impaired ability to execute voluntary movements.
138
What is Parkinson's?
Slow, progressive neurologic movement disorder due to decreased dopamine levels.
139
What are the cardinal manifestations of Parkinson's disease?
Tremor, rigidity, bradykinesia/akinesia, and postural instability.
140
What are some psychiatric manifestations associated with Parkinson's disease?
Depression, anxiety, dementia, delirium, and hallucinations.
141
What must a patient have to diagnose Parkinson's?
A patient must have at least 2 cardinal symptoms.
142
What is the most common cause of dementia?
Alzheimer's disease.
143
What are the three stages of Alzheimer's disease?
- Mild/early
- Moderate
- Severe stages
144
What are the characteristics of the Mild Stage of Alzheimer's?
- Loses or misplaces items consistently
- Can concentrate or organize
- Loses short-term memory
145
What are the characteristics of the Moderate Stage of Alzheimer's?
- Forgets events that happened in own history
- Difficulty performing tasks
- No complex mental math
- Withdrawn
- Wanders and sometimes gets lost
- Incontinence
- More noticeable to others
146
What are the characteristics of the Severe Stage of Alzheimer's?
- Cannot converse with others
- Needs help with ADLs
- Incontinent
- Loses awareness of where they are
- Difficult walking, eating, and swallowing
- Stuporous/comatose
- Death comes with complications of Alzheimer's (Infection, Choking)
147
What is the role of anticholinergic medications in Parkinson's Disease?
They control tremor and rigidity.
148
What is Meniere's disease?
A fluid imbalance in the inner ear.
149
What are the common manifestations of Meniere's disease?
- Tinnitus
- Vertigo
- Increased pressure in the ears
- Nausea
150
What medications are commonly used to treat Meniere's disease?
Antihistamines, antiemetics, Antivert, diuretics, and tranquilizers.
151
What dietary recommendations are given to patients with Meniere's disease?
- Low sodium diet
- Well-hydrated
- Avoid caffeine, alcohol, MSG, and aspirin products.
152
What else is part of patient education with Meniere's disease?
- No driving
- Safety
- Change positions slowly
153
What is a cataract and its common symptoms?
- Affects the lens of the eye, causing blurred vision, poor night vision, and diplopia
- Usually painless
154
What pre-operative teaching is necessary for cataract surgery?
- Cover the eye
- Avoid bending at the waist
- No heavy lifting or straining
- Call the doctor for sudden severe pain.
- Place patient on non-operative side
- Elevate HOB 30-45 degrees
155
Who is at a higher risk for cataracts?
Patients with uncontrolled diabetes.
156
What is glaucoma and what are its types?
Glaucoma is an increase in intraocular pressure (IOP).
## Footnote
Types include acute (closed angle) and open-angle.
157
What are the characteristics of acute/closed angle glaucoma?
- Ocular emergency
- Usually bilateral
- 'Irido corneal angle'
- When fluid does not drain --> obstruction of outflow
- Acute emergency requires surgery.
158
What are the signs of acute glaucoma?
- Painful
- Blurred vision
- One pupil more dilated than the other (affected)
- Sudden onset N/V
159
What are the late signs of acute glaucoma?
- Loss of peripheral vision
- Halos
160
What is open angle glaucoma?
A condition often painless until damage is done.
## Footnote
Drugs such as diuretics may be given (Carbonic anhydrase inhibitors --> po med).
161
What teaching is recommended for open angle glaucoma?
- Avoid straining with stool --> Stool softeners
- Avoid tight clothes
- Heavy lifting/bending
162
What are the signs of danger for glaucoma patients?
Halos, blurry vision, loss of peripheral vision, extreme eye pain or headache, and brow arching.
163
What is a detached retina and its symptoms?
A condition where the retina detaches from the pigmented epithelium, causing flashes of light, blurry vision, and floaters.
## Footnote
This is a surgical emergency.
164
What is the surgical procedure for a detached retina?
Scleral buckling to attach the retina.
165
What pre-operative care is required for retinal surgery?
- Maintain bed rest
- Patch the eye so patient doesn't blink/open/close
- Avoid coughing, sneezing, and straining
166
What post-operative care is required after retinal surgery?
Bed rest with an eye patch, avoid jarring movements, no straining or coughing, antibiotics, anti-inflammatories, and may require antiemetics.
167
What is macular degeneration and its impact on vision?
A condition affecting the central part of the eye, leading to vision loss in the center and legal blindness.
168
What are drusen in relation to macular degeneration?
Tiny yellow spots behind the eye associated with the condition.
169
Electrocardiography is used to diagnose?
dysrhythmias, MI, electrolyte disturbances
170
What are the layers of the heart?
Endocardium (inner layer), Myocardium (middle muscular layer), Epicardium (outer layer).
171
What are the four chambers of the heart?
Right Atrium, Right Ventricle, Left Atrium, Left Ventricle.
172
What is the pressure measure of the Right Atrium?
0-8 mmHg, used to measure fluid overload in patients.
173
What are the Atrioventricular (AV) valves?
Tricuspid (right) and Mitral/Bicuspid (left) valves.
174
What are the semilunar valves?
Pulmonary and Aortic valves.
175
What is the function of coronary circulation?
Supplies oxygenated blood to the myocardium.
176
What are the key components of the cardiac conduction system?
Sinoatrial (SA) Node, Atrioventricular (AV) Node, Bundle of His, Right & Left Bundle Branches, Purkinje Fibers.
177
What occurs during depolarization in cardiac action potential?
Sodium (Na⁺) enters, Potassium (K⁺) exits, activating muscle fibers (systole).
178
What occurs during repolarization in cardiac action potential?
Potassium re-enters, Sodium exits, heart is at rest (diastole).
179
What is stroke volume (SV)?
Blood ejected per heartbeat.
180
What is cardiac output (CO)?
Blood pumped per minute, normal is 4-6 L/min.
181
What is preload?
Ventricular stretch at the end of diastole.
182
What is afterload?
Resistance to blood ejection; pressure the heart needs to overcome to eject blood.
183
What is ejection fraction (EF)?
% of end-diastolic volume ejected per beat, normal is 55-65%.
184
What are age-related changes in the heart?
Increased atrial size, left ventricle hypertrophy, valve calcification, and conduction system fibrosis.
185
What is included in health history assessment?
Chief complaint, history of present illness, past medical & surgical history, family history, social history, medications, nutrition & allergies.
186
What does a physical assessment include?
General appearance, skin & extremities, blood pressure, arterial pulses, jugular venous pulsations, heart inspection & auscultation.
187
What are common clinical manifestations of cardiovascular issues?
Chest pain, dyspnea, peripheral edema, palpitations, fatigue, dizziness, syncope.
188
What factors are assessed in chest pain assessment?
Pain scale, location, quality, duration, associated symptoms.
189
What are cardiac biomarkers?
Creatinine Kinase (CK), Myoglobin, Troponins (T & I) for heart damage.
190
What does a lipid profile measure?
Cholesterol levels (HDL, LDL).
191
What does BNP indicate?
Used to diagnose congestive heart failure (CHF); >100 indicates more fluid.
192
What does a chest X-ray evaluate?
Heart size, shape, lung congestion, position, contour, and calcification.
193
What is the purpose of electrocardiography (EKG/ECG)?
Diagnoses arrhythmias, ischemia, infarction.
194
What is echocardiography used for?
Diagnosing dysrhythmias, heart injury, and enlargement of heart chambers.
195
What is cardiac catheterization?
Invasive test for coronary artery disease to look for blockages.
196
What are complications of cardiac catheterization?
Allergic reactions, contrast-induced nephropathy, hematoma, bleeding, dysrhythmias.
197
What does central venous pressure (CVP) measure?
Preload filling pressure; normal is 2-6 mmHg.
198
What does pulmonary artery pressure (PAP) evaluate?
Left ventricular function; diagnoses shock and pulmonary hypertension.
199
What is the significance of hemodynamic monitoring?
Direct BP measurement in critically ill patients.
200
Defibrillation is the treatment of choice for which cardiac rhythm?
pulseless v-tach
201
Which waveforms on the ECG is indicative of **ventricular repolarization**?
T wave
202
Which of the waveforms on the ECG is indicative of atrial depolarization?
P wave
203
What are the characteristics of sinus Brady?
PR interval between .12-.20 secs, regular rhythm, normal QRS
204
Why are rhythms important?
Regular rate and rhythm are required to circulate oxygenated blood and life-sustaining nutrients to body organs.
205
What info is obtained from an EKG rhythm strip analysis?
HR, Rhythm regularity, impulse conduction time intervals
206
P wave:
- Represents the electrical impulse starting in the SA node and spreading through the atria, atrial muscle depolarization
- <0.11 secs in duration
207
QRS complex:
- Represents ventricular muscle depolarization
- 1st negative deflection Q wave
- 1st negative deflection R wave
- 1st negative deflection after the R wave: S wave
- <0.12 seconds in duration
208
T wave:
- Represents ventricular muscle repolarization
- Resting phase
- Follows the QRS complex
209
PR Interval
- Measured from the beginning of the P wave to the beginning of the QRS complex
- Represents time needed for sinus node simulation, atrial depolarization and conduction through the AV node
- 0.12-0.20 seconds in duration
210
ST Segment:
- Represents early ventricular muscle repolarization
- Lasts from the end of the QRS complex to the beginning of the T wave
- Normally isoelectric
- Analyzed above or below the baseline
211
EKG Waveforms:
- A waveform recorded on the EKG strip refers to movement away from the baseline or isoelectric line and is represented in the following manner:
- A positive deflection is above the isoelectric line
- A negative deflection is below the isoelectric line
- As the electrical impulse leaves the SA nodes, waveforms are produced on the graph paper
212
How many little boxes in a box?
25
213
How long is one little box?
0.04 secs
214
How long is five little boxes?
0.2 secs
215
Five step Approach for EKG Interpretation:
1: HR
2: HR rhythm/ regularity
3: P wave
4: PR interval
5: QRS complex
EVALUATE! CAN ONLY DO 1500 METHOD IF A REGULAR SINUS RHYTHM
216
Arrhythmias/dysrhythmias:
Disorders of the formation or conduction of the electrical impulses in the heart.
217
Why is someone sinus Brady?
- SOB/decreased consciousness
- Angina
- EKG changes
- Vomiting
- Meds
- H&Ts
218
Sinus Brady management:
- Withhold meds
- Decrease vagal stimulation
- Atropine 0.5 mg IV (vagolytic) HR goes UP
- Pacemaker
219
Why is someone sinus tachycardia?
- Exercise
- Fear
- MI
- CHF
- Fever
- Stimulants
- Meds
- Pain
- Infection
220
Management for sinus tachy:
- Beta-blockers
- Calcium channel blockers
- Increased fluid/sodium
- Abolish cause
221
Atrial flutter:
- In atrium
- Creates atrial rate between 250-400 times/min
- Not all impulses conducted to ventricle: therapeutic block at AV node
- 2:1, 3:1, 4:1
222
Why would someone have A flutter?
- Hypoxia
- Pulmonary embolism
- Pneumonia
- MI
- Hyperthyroidism
- Cardiac surgery
223
A flutter management unstable:
Cardio version
224
A flutter management stable:
- Beta-blockers/calcium channel blockers
- Digitalis
- Adenosine (6mg max 12mg)
Basically flatlines and jumpstarts heart.
225
When would you shock a pt?
Only in V tach, V fib.
226
A flutter misc:
Every time on an R shock
- Sedate pt, defibrillator, turn button to cardiovert, shocks on ‘r’
227
A-fib:
Rapid, never regular, disorganized and uncoordinated twitching of atrial muscle, paroxysmal or chronic, rapid ventricular response, loss of atrial kick (25-30% of cardiac output), ventricular rate 120-200 bpm.
228
Why does A fib happen?
- Old age
- Obesity
- Heart issues
- Alcohol use
- Excessive caffeine
- Hypoxia
- Stress
- Electrolyte imbalance
- Pulmonary embolism
229
A fib manifestations:
Palpitations, fatigue, malaise, SOB, very tired, CP.
230
A fib management:
Depends on pt,
- Adenosine, digoxin, calcium channel blockers, beta blockers.
231
Amiodarone protocol:
150mg/10mins, drip 400/500 ml 33.5ml/hrs x6 198ml, 0.5mg (16.7) until MD discontinues.
232
Premature Atrial complex (PAC):
A single ECG complex that occurs when an electrical impulse starts in the atrium before the next normal impulse of the sinus node.
233
Why does PAC happen?
- Caffeine
- Alcohol
- Nicotine
- Anxiety
- Hypokalemia
- Hypovolemia
- Hypermetabolic states
- Atrial ischemia
- Injury or infarction
234
PAC management:
Quit smoking/drinking, reduce stress/stimulants, treat CHF, correcting electrolyte imbalances.
235
Premature ventricular complexes (PVC):
Impulses that start in ventricle and are conducted through the ventricle before the next normal sinus impulse, characterized by a QRS that is wide and bizarre.
236
Bigeminy:
Every other complex is a PVC.
237
Trigeminy:
Every third complex is a PVC.
238
Quadrigemy:
Every fourth complex is a PVC.
239
Why do PVCs happen?
- Can occur on a healthy pt (intake of caffeine, alc, nicotine)
- Cardiac ischemia
- Digitalis toxicity
- Hypoxia
- Acidosis
- Electrolyte imbalance
- Cardiac Cath
240
Management of PVC:
- Correct cause, medicate with amiodarone, sotalol
241
What is AV Nodal reentry tachycardia?
- Impulse conduction in the AV node that causes the impulse to be rerouted back into the same area over and over again at a very fast rate
- Causes very fast ventricular rate
- Paroxysmal
- Atrial rate 150-250
- Ventricular rate 120-200
242
Manifestations of AV Nodal reentry tachycardia:
- Restless
- Chest pain
- SOB
- Pallor
- Hypotension
- Loss of consciousness
243
Management of AV Nodal reentry tachycardia:
- Aimed at breaking reentry impulse
- Vagal maneuvers (carotid sinus massage, gag reflex, breath holding)
- Adenosine
- Cardioversion
244
If there aren't P-waves, it can be identified as what?
Supraventricular Tachycardia (SVT)
245
SVT can be what?
- A fib
- A flutter
- AV Nodal reentry tachycardia
246
What is ventricular tachycardia?
Is defined as 3 or more PVCs in a row, MEDICAL EMERGENCY
247
What are the causes of ventricular tachycardia?
- Large AMI
- Low ejection fraction
248
Management of ventricular tachycardia:
- 12 lead EKG
- Procainamide, amiodarone
- Supportive care
- Cardioversion
- Defibrillation
- Precordial thump
- ICD
- IV mag
- IV amiodarone
249
What is ventricular fibrillation?
Rapid disorganized ventricular rhythm >300bpm, no atrial activity, unrecognizable QRS
250
What are the causes of ventricular fibrillation?
- CAD
- MI
- Untreated VT
- Electrical shock
251
Manifestations of ventricular fibrillation:
- Fatal dysrhythmia
- Pulseless
- Apneic
- No cardiac activity
- Cardiac arrest will occur
252
Management of ventricular fibrillation:
- CPR
- Intubate
- Defibrillation
- Epinephrine
- Anti-arrhythmic drugs
253
What is asystole?
Flatline, absent P and QRS complex, nothing going on, call time of death after 5 mins
254
Management of asystole:
- CPR
- Call code
- Intubation
- Establish IV access
- Epinephrine bolus 3-5 mins
- Vasopressin
255
What does the vascular system include?
The vascular system includes arteries, capillaries, veins, and lymph.
256
What are common problems associated with the vascular system?
Common problems include pump failure, changes in blood/lymph vessels, and circulatory insufficiency, especially in limbs.
257
What is intermittent claudication?
Intermittent claudication is pain or fatigue during exercise due to reduced blood flow.
258
What are the symptoms of arterial insufficiency?
Symptoms include sharp, intermittent claudication, diminished or absent pulses, shiny cold skin, and deep painful ulcers.
259
What are the symptoms of venous insufficiency?
Symptoms include aching or cramping pain, present but hard to feel pulses, red-blue color skin, and superficial irregular ulcers.
260
What is the pathophysiology of arteriosclerosis and atherosclerosis?
Fatty streaks and fibrous plaques build up in arteries, narrowing the lumen and potentially causing inadequate blood supply to tissues.
261
What are modifiable risk factors for arteriosclerosis?
Modifiable risk factors include smoking, poor diet, high blood pressure, diabetes, high cholesterol, stress, and lack of exercise.
262
What are non-modifiable risk factors for arteriosclerosis?
Non-modifiable risk factors include aging, gender (more common in men), and genetics.
263
What are symptoms of Peripheral Arterial Disease (PAD)?
Symptoms include intermittent claudication, cool/pale skin, cyanosis when legs are down, and unequal pulses.
264
What is the management for PAD?
Management includes medications, exercise programs, smoking cessation, and surgical options like endarterectomy or bypass grafts.
265
What is a thoracic aortic aneurysm?
A thoracic aortic aneurysm is often caused by atherosclerosis and can be asymptomatic or cause pain, cough, dyspnea, or hoarseness.
266
What is an abdominal aortic aneurysm?
An abdominal aortic aneurysm occurs below the renal arteries and can be asymptomatic but may cause a pulsatile mass and pain.
267
What are the symptoms of a dissecting aorta?
Symptoms include sudden, severe chest or back pain, tachycardia, and potential for shock.
268
What are the Six P’s of arterial embolism and thrombosis?
The Six P’s are Pain, Pallor, Pulselessness, Paresthesia, Poikilothermia, and Paralysis.
269
What is Raynaud’s phenomenon?
Raynaud’s phenomenon is characterized by bilateral skin color changes in toes and fingers due to vasoconstriction.
270
What is venous thromboembolism (VTE)?
VTE includes deep vein thrombosis (DVT) and pulmonary embolism (PE) and is caused by Virchow’s Triad.
271
What are the symptoms of chronic venous insufficiency?
Symptoms include swelling, pain, pigmentation changes, stasis dermatitis, and ulcers.
272
What are the characteristics of arterial ulcers?
Arterial ulcers are painful, deep, circular, and often located at the toes or between toes.
273
What are the characteristics of venous ulcers?
Venous ulcers are less painful, large, shallow, and often found around the ankle.
274
How is HF diagnosed?
echocardiogram
275
What is the normal EF?
55-65%
276
What is Systolic HF?
Alteration in ventricular function, weakened heart muscle, severely reduced EF.
277
What is Diastolic HF?
Less common, stiff, and noncompliant heart muscle, difficult for ventricle to fill, normal EF.
278
What is right heart failure?
Congestion of peripheral tissues, liver congestion, edema, ascites, GI congestion.
279
What is left heart failure?
Decreased cardiac output, pulmonary congestion, cough with frothy sputum.
## Footnote
LEFT=LUNGS
280
What is chronic HF?
Commonly biventricular.
281
What is the assessment of ventricular function?
Echocardiogram, chest x-ray, 12 lead EKG, CMP, liver tests, BNP.
282
What would you see in an assessment with someone with HF?
Mental status, lung sounds crackles/wheezes, present S3, fluid overload, daily weights, I&O.
283
What lab to diagnose MI?
Troponin.
284
What is bronchoscopy?
Direct inspection of the larynx, trachea, and bronchi using a flexible or rigid fiberoptic bronchoscope.
285
What are the purposes of bronchoscopy?
Tissue visualization to determine location and extent of patho process, secretion selection, biopsy, determine where tumor can be surgically resected, and diagnose source of hemoptysis.
286
What are the pre-bronchoscopy procedures?
Informed consent, NPO 10-12 hours, local anesthetic throat spray, upright position, and may give atropine to dry up secretions.
287
What are the post-bronchoscopy procedures?
Keep NPO, assess for gag reflex, ice chips once gag reflex returns, monitor respiratory rate, and monitor for hypoxia, hypotension, tachycardia, and dysrhythmia.
288
What are common complications of bronchoscopy?
Fresh blood, prolonged fever, infection, aspiration, laryngospasm, bronchospasm, and hypoxemia.
289
What are Pulmonary Function Tests (PFTs) used for?
Used in patients with chronic respiratory disorders to aid diagnosis and evaluate airflow obstruction.
290
What is the percentage of atmospheric O2?
21%.
291
What are noninvasive O2 therapies?
O2, nebulizer, and CPT.
292
What are invasive O2 therapies?
Intubation, mechanical ventilation, and surgery.
293
What is the flow rate and percentage of a simple mask?
5-8 L/min, 40-60%.
## Footnote
Fits over nose and mouth; need to do mouth care.
294
What is the percentage of a non-rebreather mask?
60-100%.
## Footnote
Both valves on.
295
What is the flow rate and percentage range for a Venturi mask?
4-10 L/min, 24-55%.
## Footnote
Interchangeable percentage dials.
296
What is the flow rate and percentage for a partial rebreather mask?
6-15 L/min, 70-90%.
## Footnote
Patient rebreathes CO2; keep reservoir bag 2/3 full; 1 valve off.
297
What is incentive spirometry?
A device encouraging deep breathing for maximum lung expansion to prevent or reduce atelectasis.
## Footnote
10-25 breaths an hour.
298
What is a nebulizer?
A handheld device that delivers medication in mist form, driven by air.
## Footnote
Used for asthma or COPD patients with difficulty clearing secretions.
299
What is a spacer used for?
To prevent medication from getting stuck in the nebulizer.
300
What is chest physiotherapy (CPT)?
Techniques to improve lung function and loosen secretions.
## Footnote
Usually done by respiratory therapist.
301
What is the purpose of chest tubes?
To remove excess air, fluid, or blood and to re-expand the involved lung.
302
What is required for chest tube management?
CXR every morning.
303
What should you notify the HCP about regarding a chest tube?
If it is bright red or draining over 100ml/hr.
304
What does a chest tube drainage system include?
Suction source, collection chamber, and mechanism to prevent air from reentering the chest.
305
What should you do when transferring a patient with a chest tube?
Place the tube below the patient so it can drain by gravity.
306
What does a normal air leak monitor look like?
Tidaling.
307
What does an abnormal air leak monitor look like?
Lots of bubbles or no movement.
308
What do you need at the bedside for a chest tube patient?
Vaseline gauze and padded clamp.
309
What should you monitor for a chest tube?
Respiratory status and check for crepitus.
310
If a patient’s chest tube gets dislodged, what should you do?
Have the patient cough and exhale to prevent air from entering the pleural cavity; plug with Vaseline gauze.
311
If a patient’s chest tube disconnects from the chamber tube, what should you do?
If not contaminated, reconnect quickly with antiseptic swab and monitor for respiratory problems.
312
What should you do if the air chamber is broken?
Put the distal end in 250ml of sterile saline and get a new one.
313
What should you NEVER do with a chest tube?
Milk it.
314
What are the respiratory labs?
ABG, blood cultures, and sputum cultures.
315
What is tuberculosis (TB)?
An infectious disease affecting lung parenchyma, meninges, kidneys, bones, and lymph nodes.
316
What precautions are needed for TB?
Airborne.
317
What precautions are needed for suspected TB?
N95 mask and negative isolation room.
318
What are the manifestations of TB?
Low-grade fever, cough, night sweats, fatigue, weight loss, and hemoptysis.
319
What are the diagnostics for TB?
TB skin test, chest X-ray, QuantiFERON-TB Gold Test, sputum culture (+ AFB), and Mantoux testing.
320
What is the gold standard for TB diagnosis?
3 positive AFBs.
321
What is Mantoux testing?
PPD test, dermal, checked 48-72 hours after.
322
What are the classifications of lung cancer?
1. Small Cell Lung Cancer (SCLC): 10–15%
2. Non-Small Cell Lung Cancer (NSCLC): 85–95%
Survival depends on type/stage.
323
What does the vascular system include?
It includes arteries, capillaries, veins, and lymph.
324
What are common problems of the vascular system?
Problems include pump failure, changes in blood/lymph vessels, and circulatory insufficiency (especially in limbs).
325
What is intermittent claudication?
It is pain or fatigue during exercise due to reduced blood flow.
## Footnote
Caused by blood flow not meeting tissue demands for oxygen and nutrients.
326
What skin changes are assessed during a physical exam of the **vascular** system?
Skin changes include pallor, rubor, loss of hair, brittle nails, dry or scaling skin, atrophy, ulcerations, and edema.
327
What is the purpose of Doppler Ultrasound/ABI?
It helps evaluate the degree of stenosis by comparing blood pressure in the arm and ankle.
328
What are the characteristics of arterial vs. venous insufficiency?
Arterial: Sharp pain, diminished pulses, shiny/cold skin, deep ulcers. Venous: Aching pain, present pulses, red-blue skin, superficial ulcers.
329
What is the pathophysiology of arteriosclerosis and atherosclerosis?
Fatty streaks and fibrous plaques build up in arteries, narrowing the lumen and potentially causing inadequate blood supply to tissues.
330
What are modifiable risk factors for atherosclerosis?
Modifiable risk factors include smoking, poor diet, high blood pressure, diabetes, high cholesterol, stress, and lack of exercise.
331
What are the symptoms of Peripheral Arterial Disease (PAD)?
Symptoms include intermittent claudication, cool/pale skin, cyanosis when legs are down, and unequal pulses.
332
What types of aneurysms are there?
There are saccular (one side bulging) and fusiform (both sides bulging) aneurysms.
333
What is a dissecting aorta?
A tear develops in the aorta, usually in the aortic arch.
334
What are the symptoms of arterial embolism and thrombosis?
Symptoms include severe pain, loss of sensation/movement, cold, and pale skin (Six P’s: Pain, Pallor, Pulselessness, Paresthesia, Poikilothermia, Paralysis).
335
What is Raynaud’s phenomenon?
It is a condition where skin turns white due to vasoconstriction, then cyanotic, followed by redness.
## Footnote
Can be primary (no underlying disease) or secondary (associated with conditions like rheumatoid arthritis or lupus).
336
What is venous thromboembolism (VTE)?
VTE includes deep vein thrombosis (DVT) and pulmonary embolism (PE).
337
What are the symptoms of chronic venous insufficiency?
Symptoms include swelling, pain, pigmentation changes, stasis dermatitis, and ulcers.
338
What are the characteristics of arterial and venous ulcers?
Arterial ulcers are painful, deep, and circular, often at toes. Venous ulcers are less painful, large, shallow, often around the ankle.
339
What are the symptoms of cellulitis?
Symptoms include swelling, redness, pain, and fever.
340
What is posturing?
Posturing is a reflexive response to brain injury, signaling the location and severity of the damage.
341
What characterizes decorticate posturing?
Arms flexed and pulled inward toward the chest; legs extended and internally rotated; feet plantar-flexed.
342
What does decorticate posturing indicate?
Indicates damage to the cerebral cortex or corticospinal tract.
343
What is the clinical implication of decorticate posturing?
Less severe than decerebrate; often a sign of damage above the brainstem.
344
What characterizes decerebrate posturing?
Arms stiffly extended by the sides; hands turned outward (pronated); legs extended with feet plantar-flexed.
345
What does decerebrate posturing indicate?
Indicates damage to the brainstem, particularly below the red nucleus.
346
What is the clinical implication of decerebrate posturing?
More severe than decorticate; indicates deeper and more critical brain injury.
347
What is flaccid posturing?
No motor response in any extremity.
348
What does flaccid posturing indicate?
Indicates severe brain dysfunction or death.
349
What do midposition fixed pupils indicate?
Midbrain injury.
350
What do pinpoint fixed pupils indicate?
Pontine damage.
351
What are signs of a respiratory problem?
Restlessness and confusion; check vital signs and oxygen levels.
352
How much oxygen can COPD patients receive?
1 to 2 L O2.
353
What characterizes COPD?
Gas exchange problem, hyperinflation of lungs, and alveoli obstruction.
354
What does the access fraction include?
6 Ps: inspection, distal pulses, and color (pallor).
355
What is the key symptom of Fat emboli syndrome?
Fever.
356
What indicates compartment syndrome in a patient with a fracture?
6 Ps, leg pale, decreased pulses, and recent surgery.
357
What symptoms alert someone with a circulatory problem when in a cast?
Tingling and no feeling in the arm.
358
When does a rheumatoid arthritis patient feel better?
In the morning.
359
How does osteoarthritis pain progress throughout the day?
Pain gets worse as the day goes on; resting relieves the pain.
360
What is a potential risk for knee replacement?
DVT is the main issue; emboli.
361
What does 'itis' indicate?
Infection.
362
Who is at risk for osteoporosis?
Gastric bypass patients.
363
What is bronchoscopy?
A procedure used to view the airways.
364
What should be done if a chest tube is pulled out from a patient?
Apply Vaseline gauze, cough, and exhale.
365
What indicates a positive result in bronchoscopy?
3 positive sputum cultures AFB.
366
What is the gold standard for TB diagnosis?
3 positive AFBs.
367
What is Mantoux testing?
PPD test, dermal, checked 48-72 hours after.
368
What is involved in TB nursing management?
Promote airway clearance, adherence to treatment, adequate activity/nutrition, and prevent TB transmission.
369
What are the classifications of lung cancer?
Small Cell Lung Cancer (SCLC): 10–15%
Non-Small Cell Lung Cancer (NSCLC): 85–95%
Survival depends on type/stage.
370
What are common manifestations of lung cancer?
**Often asymptomatic until late.**
- Cough (± sputum, ± blood)
- Change in cough
- Dyspnea
- Chest pain
- Persistent ‘infections’
- **Hoarseness, dysphagia**
- Weakness, anorexia, weight loss.
371
What are the diagnostics for lung cancer?
Chest X-ray, CT/MRI, Fine-needle biopsy, PET scan.
372
What are the treatment options for lung cancer?
Surgery, Chemotherapy, Radiation, Palliative care.
373
What conditions are included in COPD?
Chronic bronchitis, Emphysema.
374
How is chronic bronchitis diagnosed?
Cough and sputum for ≥3 months in each of 2 consecutive years.
375
What are the risk factors for COPD?
Tobacco exposure, Age, Occupation, Alpha antitrypsin-genetic disorder, Passive smoking.
376
What are the manifestations of COPD?
Chronic cough, Sputum, Dyspnea, Increased work of breathing, Chronic hyperinflation, Abdominal breathing, Shoulder heaving/retractions.
377
What are the complications of COPD?
Respiratory insufficiency/failure, Pneumonia, Pneumothorax, Pulmonary hypertension (cor pulmonale).
378
What is involved in nursing management for COPD?
Airway clearance, Improved breathing, Activity tolerance.
379
What causes asthma?
Airway hyperresponsiveness, mucosal edema, and mucus production.
380
How is asthma characterized?
Chronic condition characterized by airway inflammation.
381
What are the manifestations of asthma?
Cough, Dyspnea, Wheezing, Prolonged expiration, Diaphoresis, Tachycardia, Life-threatening hypoxemia.
382
What are the diagnostics for asthma?
Episodic airflow obstruction, Partial reversibility, Exclude other causes, Sputum culture & sensitivity, Blood: eosinophilia, ↑ IgE, ABG: Initially: hypocapnia, resp. alkalosis; Later: hypercapnia, ↓ FEV₁ and FVC.
383
How to manage asthma exacerbations?
Written action plans, Quick-acting β2-agonists, Systemic corticosteroids, Oxygen, Antibiotics (if comorbidities), Peak flow monitoring.
384
What is involved in nursing management for asthma?
Assess respiratory status, Take full history, Identify current medications, Administer and monitor response to meds, IV fluids, Patient education: Asthma Action Plan.
385
What is the normal pH range?
7.35-7.45
386
What is the normal PCO2 range?
35-45
387
What is the normal HCO3 range?
22-26
388
What is the normal PAO2 range?
80-100
389
What is pneumonia?
Inflammation of the lung parenchyma caused by many microorganisms.
390
What is Community Acquired Pneumonia (CAP)?
Occurring in the community or within < 48 hours of hospital admission.
391
What is Hospital-Acquired Pneumonia (HAP)?
Occurring > 48 hours after hospital admission that did not appear to be present at time of admission.
392
What is Ventilator Acquired Pneumonia (VAP)?
Type of HAP that develops > 48 hours after endotracheal intubation.
393
What are some reasons a patient might get VAP?
Lack of suction, HOB not elevated, Daily sedation vacations, Prophylactic pepsin, DVT prevention, Oral care.
394
What is Health-Care Acquired Pneumonia (HCAP)?
Hospitalization for > 2 days in an acute care facility within 90 days, Residence in nursing home or LTAC, Antibiotic therapy, chemotherapy, or wound care within 30 days of current infection, Hemodialysis treatment in a hospital or clinic or home infusion therapy, Family member with infection due to MDR bacteria.
395
What is aspiration pneumonia?
Happens in patients who have feedings and are lying flat.
396
How do you prevent aspiration pneumonia?
Hold feed when patient needs to be moved, Keep HOB elevated, Check residual every couple of hours.
397
What are the pneumonia risk factors?
Age > 65 years, Alcoholism, Multiple medical comorbidities, Residency in LTAC, Underlying cardiopulmonary disease, Structural lung disease, Corticosteroid therapy, Malnutrition, Encourage pneumococcal vaccination for all patients > 65 years.
398
What is the gold standard for pneumonia diagnostic?
Chest x-ray with inflammation and infiltration in the lungs.
399
How often is the pneumonia vaccine given?
After 65 years old, 2nd booster by 70.
