Final Weeks 1-7.5 Flashcards Preview

SEMESTER FOUR!! Nursing 214 > Final Weeks 1-7.5 > Flashcards

Flashcards in Final Weeks 1-7.5 Deck (73):
1

Drugs used in caution with renal disorders

diuretics

antibiotics

NSAIDs

2

Kayexalate

Used for hyperkalemia to remove potassium by GI tract. Poops it out.

Monitor K levels

Don't give to: patients with an ileus

Assess: BP, CHF, dig toxicity if taking digoxin, arrythmias, assess bowel function

3

Reglan

Phosphate binder, removes phoshorous.

Give with food so it can bind with food

Monitor phosphate and calcium levels

4

Addison's Disease

Low hormone.

Weight loss

Na: Low

K: High

Hypovolemia

A/N/V/D

Hypotension

Anemia

Fatigue

TNIs: Assess VS, esp. BP, assess for fluid deficit

BP should be: LOW

 

5

Addison's Crisis

Hypotension and shock

6

Cushing's Syndrome

Too much hormone.

Truncal obesity

Thin skin

Moon face

Hirsuitism

Acne

GI upset/ulcers

Mood swings

Poor wound healing

Osteoporosis

Na: high
Water retention

K: low

Can't fight infections

TNIs: assess VS, especially BLOOD PRESSURE, assess for fluid volume excess

BP should be: HIGH

 

7

Prednisone

GI symptoms/ulcers

Poor wound healing

Monitor: daily weights, I/O, s/sx of infection, temperature

Give with milk or food to decrease GI symptoms

Titrated to lowest effective dose

Teach not to d/c abruptly, must be tapered

If long term use: every other day dosing to decrease adverse effects

8

Solumedrol

GI symptoms/ulcers

Poor wound healing

Can be given: PO, IV, IM, PR, intra-articular (avoid SC)

Monitor: weights daily, I/O, s/sx of infection, temperature

Give with milk or food to decrease GI symptoms

One dose given in AM to prevent adrenal suppresion

Titrated to lowest effective dose

Teach not to d/c abruptly, must be tapered

Increase intake of potassium, calcium, vitamin D, protein

If long term use: every other day dosing to decrease adverse effects

9

Asterixis

Flapping tremors of hands/arms associated with hepatic encephalopathy (ammonia levels too high due to liver disease)

10

Fetor Hepaticus

musty, sweet odor on breath due to accumulation of digestive by-products associated with hepatic encephalopathy

11

TNIs Portal Hypertension

  1. Monitor for bleeding from varices
  2. Teach to avoid spicy/rough foods and activites that increase portal pressure (valsalva, sneezing, coughing, retching/vomiting) d/t risk of hemorrhage
  3. Teach to avoid aspirin, hepatotoxic OTC drugs, alcohol to avoid continued liver complications

12

TNIs Portal encephalopathy

  1. Monitor for behavioral/orientation changes, speech changes, blood pH, ammonia levels
  2. Limit physical activity (ammonia is a by-product of protein, exercise)
  3. Lactulose: po or pr ammonia detoxicant. Take on empty stomach, assess stool, monitor lytes

13

Spironolactone

Potassium SPARING diuretic.

Hyperkalemia is a side effect.

Asses: lytes

Give in AM with food if nausea occurs

Monitor: weights, I/O

Used with ascites

14

Liver Biopsy

Needle between ICS on right side with CT guidance

TNIS:

check coagulation status pre-procedure

Ensure blood is typed/cross matched

VS before, during, after

Ensure consent signed

Explain breath holding on expiration when needle is inserted (lungs deflated, liver in normal place)

 Patient lies on R side for 2 hours to splint puncture site; then lie flat 10-14 hours.

Complications: hemorrhage, pneumothorax, shock, peritonitis

15

Paracentesis

Used for those with ascites with impaired respirations or pain

TNIs: teaching, informed consent, empty bladder, measure abdominal girth/weight. High fowler’s during procedure, sterile procedure, measure volume removed (750-1000mL), monitor site, bandaid to site, measure abdominal girth, weight, VS, monitor lytes, s/sx of infection.

Complications: intraperitoneal hemorrhage, perforation of organs, hepatic coma, peritonitis, hypotension/shock from rapid removal of fluid

16

Diet for Cirrhosis

High calorie (3000/day)

High carbs

Low to moderate fat

Sodium/fluid restriction if ascites/edema are present

Protein from animal sources, might be limited flare up of symptoms

17

Neonate RR

 

30-60

18

Infant RR

20-40

19

Retration location

Start at intercostals.

If increased effort is needed supra/infra clavicular seen

20

Children RR

15-25

21

Adult RR

12-20

22

What indicates hypoxia?

Agitation/restlessness

23

What indicates hypercapnia?

Lethargy/somnolence

24

FEV1

amount of air exhaled in the first second of a quick and forceful expiration that is done at the hospital

25

PEFR

maximal airflow during expiration. red, yellow, green zones. helpful in moinitoring bronchoconstriction in asthmatics

26

Ventilation/Perfusion Scan

used to check for presence of PE (not definitive, probable.)

TNIs: undress to waist, no metal, informed consent, check for allergies, void, explain procedure. Inhaled (ventilation) and injected (perfusion) isotopes – diminished radioactivity suggests lack of perfusion of airflow

27

Thoracentesis

used in pleural effusion r/t heart failure (fluid fills the pleural space, can cause infection) to diagnose, remove fluid or instill meds; sterile technique. Chest xray always performed after procedure to check for pneumothorax.

TNIs: signed consent, explain procedure, pain meds, baseline VS, position upright with elbows on overbed table, feet supported. Instruct not to cough or talk. Monitor vs and o2 sat. observe for hypoxia and pneumothorax afterwards. Verify breath sounds in all lung fields. Encourage deep breathing. Chest tube may be used for persistent pleural effusions instead of doing repeated pleural taps

28

The three problems with asthma

  1. bronchoconstriction
  2. increased mucus produciton
  3. inflammation

29

Asthma Triggers

allergens, resp infections, homrones, exercise, ASA, NSAIDs, beta blockers, food additives, air pollution, GI reflux, emotional stress

30

Status Asthmaticus

meds: controllers, rescuers, IV corticosteroids.

Focus on correcting hypoxemia and improving ventilation.

TNIs: frequent LOC assessments, O2 therapy, monitor VS, ABGs, IV fluids, possible SC epi, HOB up, prepare for intubation

31

Acute asthma attack TNIs

HOB 45 degrees, encourage incentive spirometer, monitor RR, ABGs, O2 levels, give O2, meds as ordered.

Teach to perform daily PEFR measurements, when to call the doctor.

32

Rescuers

Albuterol (MDI/NEB): bronchodilator. SE: increased HR, tremors, anxiety, restlessness, insomnia.

Atrovent (MDI, NEB): COPD, bronchodilator, anticholinergic. Dries up secretions. Not as rapid as albuterol. SE: anxiety, dizziness, HA, cough, N/A, bronchospasm

33

Controllers

Flovent (MDI) – asthma, corticosteroid. SE: thrush, URI, angioedema, bronchospasm. Rinse mouth after use.

Singulair (leukotriene blocker): asthma, bronchodilator. SE: dizziness, fatigue, HA, give in PM unless for exercise induced asthma.

Advair (DPI, beta 2 adrenergic), bronchodilator/corticosteroid): SE: tremors, anxiety, increased HR, thrush, bronchospasm

34

MDIs

shake well, slow inspiration, spacer can be used, often 2 inhalations per dose

35

DPIs

don’t shake, rapid inspiration, no spacer, often 1 inhalation per dose (ADVAIR)

36

Complications of COPD

cor pulmonale (right sided back up of fluid), secondary polycythemia, resp. failure, depression, anxiety, GERD/peptic ulcers (COPD patients may develop GERD because they tend to trap air in their chest cavities, which may then increase pressure on the abdomen, which leads to gastric reflux), acute exacerbations r/t respiratory infections

37

Hypercapnia (carbon dioxide necrosis)

increased PaCO2 levels with increased HCO3 levels and pH WNL.

This is a compensated state when chronic – may be asymptomatic unless other problems occur with the primary disease.

Assess VS, mental status, ABG before/during O2 treatment.

38

How often COPD patients perform pursed lip breathing?

8-10 reps, 3-4 X/day

39

COPD TNIs

  • monitor RR, depth, effort, O2 sat,
  • ABGs,
  • ascultate breath sounds
  • monitor client’s LOC
  • lean forward if acutely dyspneic
  • HOB up
  • adequate hydration to liquefy secretions
  • huff cough
  • controlled deep breathing
  • pursed lip breathing
  • bronchodilator/oral care before meals
  • high calorie/protein diet with supplements
  • O2 NC during meals

40

Respiratory Acidosis

build up of CO2 causes carbonic acid to build up in the blood due to HYPOVENTILATION

S/Sx: HA, dyspnea, HTN, tachycardia, fine tremors, warm flushed skin

Associated with: COPD, ARDS, severe pneumonia, anesthesia, atelectasis, pneumothorax

41

ABG normals

pH: 7.35-7.45

pCO2: 35-45

HCO3: 24-30

pO2: 80-100

O2: 92-100%

42

43

Acid-base Regulation

1. Buffer system: immediate change based on hydrogen ions in the body

2. Respiratory system: in acidosis, INCREASE in respiratory rate and depth in an attempt to exhale acids

3. Kidneys: takes hours to days but controls HCO3 by either reabsorbing or excreting hydrogen ions in urine

44

Uncompensated

pH is low

High PaCO2

Normal HCO3

45

Partial Compensated

pH is low

High PaCO2

High HCO3

46

Compensated

pH is normal

high paCO2

High HCO3

47

ARDS

acute respiratory failure where alveolar capillary membrane becomes damaged and more permeable to intravascular fluid

48

Respiratory Acidosis TNIs

correct underlying cause first, intubation, CPAP, BiPAP, O2,

med: bronchodilator, corticosteroid, Lasix (remove pulmonary congestion), antibiotics if infection

decrease in carbs in diet in patient who retains CO2, prevent infection

**assess LOC

maintain HCT/HBG (maximize O2 carrying capacity of blood)

pulmonary toileting to expectorate secretions

monitor CV status, resp status, ABGs, EKG, lytes

49

Epiglottitis

drooling, agitation, tripod position.

Do NOT use tongue depressor to examine throat – can cause bronchospasm.

Airway protection, corticosteroids, antibiotics.

Most dangerous for peds.

50

LTB (croup)

stridor, retractions, barking cough. Maintain airway, cool mist humidifier, nebulized epi, corticosteroids. Rest, fluids, monitor respiratory status.

51

Bronchiolitis

URI symptoms, mild fever, copious secretions (TNI: suction with bulb syringe), caused by RSV.

High humidity, rest, fluids, O2 if hospitalized, aerosolized ribavirin if severe.

Separate room, good hand washing, contact and droplet precautions if RSV (mask within 3 feet of patient)

If in mist tent, watch for hypothermia and change linens frequently (keep them dry); must be a dense fog, patient sitting up

52

Pneumonia

Common with COPD

fever, unproductive cough, rhonchi/crackles, exudates form in lung lobules. Antibiotics, O2, cool mist, fluids, rest, chest physiotherapy, antipyretics. Monitor VS, rsp status, avoid aspiration from frequent coughing, may require suctioning.

53

TB

early identification/treatment for suspected TB cases. Airborne isolation. Negative pressure isolation with protective respirators.

TB infection – latent disease.

TB disease: clinically active TB.

Miliary TB: standard precautions, in bloodstream but not in pulmonary system (no airborne precautions needed)

Isoniazid – antitubercular. Taken for six months, issue is compliance. Hepatic studies weekly: avoid triamines/antacids within 1 hour of med, no alchohol, no aluminum based antacids, no tyramine (chocolate, cheese) with meals, antiemetic, vision changes).

TB is no longer contagious after 3 negative AFBs, 2 weeks of meds, reduction of symptoms. Encourage adequate rest and nutrition, set up follow up care.

54

Anergy

lack of or diminished reaction to an antigen.

Common in older adults.

 

55

Booster Phenomenon

two tests done so second test may have a greater reaction, whereas a first test may have given a false negative.

56

Chest Physiotherapy

postural draining and percussion/cupping to move secretions into central airways for expectoration.

Done 1 hour before or 1-3 hours after meal

Give bronchodilator 15 minutes before

Watch for color changes, hypoxemia, mucous plug, Percuss over ribs only

Evaluate sputum, auscultate lung sounds.

57

Oxygen Tent

open tent as little as possible. Monitor temp inside tent to reduce hypothermia/cold stress. Keep child warm and dry, assess for air leaks in tent

58

Oxygen Hood

to deliver a high concentration of O2 to an infant. O2 can’t blow directly on child’s face, hood shouldn’t rub on neck, head, or shoulders

59

Mist Tent

to moisten airways, minimize fluid loss from lungs, liquefy secretions, allow for small to moderate O2 administration.

Monitor respiratory status, semi-fowlers, frequent temps, empty moisture chamber when full.

At least 10 mL/minute of air or O2 must be supplied at all times to prevent excessive CO2 accumulation

60

ETT

upper airway obstruction, apnea, high risk of aspiration, ineffective clearance of secretions, respiratory distress

Placement confirmed with CO2 detector (if no CO2, tube is in the esophagus)

Assess for bilateral breath sounds, symmetrical chest movement, monitor for tube placement every 2-4 hours

Secured with hydrocolloid membrane over cheeks to protect skin. Tube secured with tape to skin.

TNIs: HOB in semi fowelers unless medically contraindicated, avoid emesis (risk for aspiration), sedation, analgesic, anti-anxiety meds, provide frequent oral  care to prevent VAP, provide alternative ways of communicating (picture boards, note pad, computer) inadvertent extubation: assess LOC, call for help and stay with patient, manually vent with 100% O2

61

Trach

to bypass upper airway obstructor, remove secretions, long term mechanical ventilation, permit oral intake and speech in the patient that requires long-term mechanical ventilation

TNIS: humidify inspired air because normal airway humidification through nose/mouth isn’t present.

Cuffed trach: for patient at risk for aspiration or on mechanical vent. Keep cuff inflated to maintain seal.

Uncuffed: no risk for aspiration, no mechanical vent, can speak with uncuffed trach

Inner/outer cannulas: to secure tube to faceplate, keep clean.

Speaking valve (passy-muir): cuff must be deflated, allows patient to speak. Removed for sleep.

Suctioning: preoxygenate with 100% O2 for 3-4 breaths, sterile technique, keep to less than 10 seconds, 2-3 times/session, suction 4-6 inches.

62

Trach Care

to prevent infection and occlusion of trach.

Leave obturator at bedside at all times in case of accidental decannulation.

Patient in semi fowelers: auscultate to see if suction needed

Clean inner cannula with hydrogen peroxide, then rinse with 4X4 soaked in sterile saline.

Don’t cut 4X4s.

maintain position of trach retention sutures.

Apply new ties before removing old ties to prevent accidental deccanulation of the trach. With tie changes, leave one fingerbreadth underneath

63

Hypoxemic Respiratory Failure

PaO2 less than 60 on 60% oxygen. ARDS, pneumonia, smoke inhalation, PE (others)

64

Causes of hypercapnic respiratory failure

Asthma

COPD

CF

65

V/Q mismatch in PE

in normal lung, ventilation/perfusion is 1:1. With PE, the embolus limits blood flow, but has no effect on airflow to the effect on airflow to the alveoli, causing V/Q mismatch

66

PE

sudden onset chest pain, dyspnea, hemoptysis, anxiety, tachypnea, tachycardia, LOC changes.

TNIs: prevent DVTs: hydration, SCDs/TEDs, early ambulation, prophylactic anticoagulants. HOB up, IV access, continuous SaO2 monitor, telemetry, LOC monitoring, O2 therapy, ABGs, mechanical ventilation, anticoagulation therapy, medication therapy.

67

Respiratory Failure TNIs

Treat underlying cause, HOB O2 therapy, continuous monitoring, possible bronchodilators, chest PT if applicable, fluids, med therapy (corticosteroid therapy), mechanical ventilation (later stages), fluids, monitor pulmonary/cardiac functioning, nutritional support with protein balance

68

BiPap

bilevel positive airway pressure (higher for inspiration, lower for expiration)

69

CPAP

continuous positive airway pressure

70

Tidal Volume

volume of air inspired/expired with each normal respiration

71

PEEP

positive end-expiratory pressure, positive pressure applied at the end of expiration to keep alveoli open in between respirations

72

FiO2

oxygen concentration.

from 21% (room air) to 100%

73

Mechanical vent TNIs

DO NOT TURN OFF VENT ALARMS!

Position patient for comfort and maximum alveolar ventilation, possible soft restraints to avoid accidental extubation, monitor respiratory status for any changes in respiratory effort, ABGs, continuous O2, maintain vent setting as ordered, nutritional/fluid support as ordered, provide frequent oral care, q 2-4 hours to prevent VAP (sedation vacation, high fowlers, peptic ulcer, DVT prophylaxis), suction only as needed with sterile technique, keep ambu bag connected to O2 source at all times, respond to vent alarms immediately – check the client first and then check the vent

Decks in SEMESTER FOUR!! Nursing 214 Class (52):