Just a Review Flashcards
(99 cards)
1
Q
Med Math Equations
A
- (Dose X Kg X 60) / (mcg/ml)
- (volume (ml) x Drop factor (gtt/ml)) / time (min)
- (Desired/Have) x Form of Drug
2
Q
SBAR
A
Situation:
What’s happening now? Briefly state the reason for the communication.
Example: “I’m calling about Mrs. Jones in room 304. She’s experiencing shortness of breath.”
2. Background:
What’s relevant to the current situation?
Provide relevant background information, such as the patient’s medical history, current medications, and pertinent diagnostic test results.
Example:
“She was admitted yesterday for an acute asthma exacerbation. She has a history of asthma and hypertension, and her current medications include albuterol and salmeterol.”
3. Assessment:
What do you think is going on?
State your professional conclusion or impression based on the situation and background information.
Example:
“Her oxygen saturation is 88% on 2L, and her respiratory rate is 30 breaths per minute. I’m concerned about worsening hypoxia and am worried she may need higher oxygen support.”
4. Recommendation:
What do you want to do? Clearly state what actions you believe should be taken.
Example: “I would recommend increasing her oxygen to 4L and calling the respiratory therapist for a consult.”
3
Q
Diets
A
NPO (Nothing by Mouth) No food or fluids by mouth
(Pre-op, post-op, aspiration risk, GI rest)
Clear Liquid
Transparent liquids: water, broth, clear juice, Jell-O, tea, coffee (no milk) (GI rest, postop, N/V/D, before procedures)
Full Liquid - Clear liquids plus: milk, pudding, ice cream, cream soups, yogurt (Transition from clear to soft, swallowing issues)
Soft / Mechanical Soft Soft-textured foods, (easy to chew & digest Dental issues, dysphagia, post-op
Pureed)
Blended to smooth consistency (Severe dysphagia, stroke, chewing/swallowing issues)
Low Sodium (2g Na) Limits sodium intake (typically <2,000 mg/day) (HTN, CHF, CKD)
Cardiac / Heart Healthy Low fat, low sodium, lean meats, limit cholesterol (CAD, MI, HTN, CHF)
Renal Diet - Restricts Na, K, Phos, protein, fluids (in some cases) (CKD, ESRD, dialysis)
Diabetic (ADA) Balanced carbs, controls blood sugar DM1, DM2, prediabetes
Dash Diet
Fruits- 4–5 servings per day
Vegetables - 4–5 servings per day
Grain - 6–8 servings day
Lean Protein - 6 servings day
Low-fat Dairy - 2–3 servings
Nuts, Seeds, Legumes - 4–5 servings per week
Fats & Oils - 2–3 servings per day
Sweets - <5 servings per week
Sodium - <2,300 mg/dayw
4
Q
Wound (MEASURE)
A
- Measure
- Exudate
- Appearance
- Suffering
- Undermining
- Re-evaluate
- Edge
5
Q
Assessment Finding Chart
A
6
Q
GLU above 100
A
- Increase- DM, stress, steroids, IVFs with Dextrose, diet, chronic renal failure
7
Q
GLU below 60
A
- Decrease- NPO, insulin overdose
8
Q
BUN above 20
A
- Increase- renal failure/kidney disease, dehydration, CHF, MI, GI Bleed, protein ingestion, tube feeds
9
Q
BUN below 10
A
- Decrease- overhydration, liver failure, malnutrition
10
Q
Cr above 1.2
A
- Increase- renal failure/kidney disease
11
Q
Cr below 0.08
A
- Decrease-decreased muscle mass, debilitation
12
Q
Na above 145
A
- Increase- increased intake, dehydration, Cushing’s, DI
13
Q
Na below 135
A
- Decrease- decreased intake, overhydration/3rd space loss, diuretics, vomiting/diarrhea, Chronic Renal Insufficiency, SIADH, Addison’s, NGT loss
14
Q
K+ above 5
A
- Increase- increased intake, renal failure, dehydration, Addison’s (hypoaldosterone)
15
Q
K+ below 3.5
A
- Decrease- decreased intake, diuretics, vomiting/diarrhea, excessive urine output, Cushings, burns, insulin administration
16
Q
Ca increase
A
Increase- increased intake, hyperparathyroid, hyperthyroid (increases absorption), malignancy, Vitamin D supplement
17
Q
Ca decrease
A
Decrease- malnutrition/malabsorption/decreased albumin, hypoparathyroid, increased phosphorous, renal failure, Vitamin D deficiency
18
Q
Mg increase
A
increased intake, hypothyroid, renal insufficiency
19
Q
Mg decrease
A
Decrease-Malnutrition/Malabsorption, alcoholism
20
Q
increase of WBC
Neutrophils:
Segs
Bands
Lymphocytes
Monocytes
Eosinophils
Basophils
A
Increase-infection, inflammation, infarction, stress
N - acute bacterial infection
L - Chronic bacterial, viral, hepatitis
M - TB, ulcerative colitis, viral parasites
E - Parasite, allergic reaction, autoimmune
B - Leukemia, uremia
21
Q
Decreased WBC
Neutrophils:
Segs
Bands
Lymphocytes
Monocytes
Eosinophils
Basophils
A
Decrease-autoimmune disease, bone marrow failure
N -drug therapy
L - leukemia, sepsis, lupus
M - prednisone
E - Adrenosteroid production B - Acute allergic reactions, stress, hyperthyroid
22
Q
Increased RBC
A
polycythemia vera, dehydration, COPD
23
Q
Decreased RBC
A
hemorrhage, chemo, renal disease, dietary insufficiency
24
Q
Increased H&H
A
polycythemia vera, dehydration, COPD
25
Decreased H&H
hemorrhage, chemo, renal disease, dietary insufficiency
26
Platelets increased
polycythemia vera, RA, iron deficiency anemia, infection, malignancy
27
Platelets Decreased
Hemorrhage, infection, chemo
28
PT/INR Increased
liver disease, warfarin administration
29
PTT increased
clotting deficiencies, cirrhosis, Heparin administration
30
Decreased
Total Protein
Prealbumin
Albumin
TP - malnutrition, liver disease
PreA - short term malnutrition
Alb- long term malnutrition
31
Urinalysis:
* Positive Protein- indicator of renal disease
* High Specific Gravity- dehydration, low specific gravity-overhydration/kidney disease
* Positive Nitrates- UTI
* Positive Ketones- poorly controlled DM
* Glucose- indicates DM
* Positive WBC- UTI
32
ABGs Metabolic
***Remember pH and HCO3 move in the same direction if Metabolic***
Normal pH - 7.35 - 7.45
Normal CO2 - 35 - 45
Normal HCO3 - 24-29
***Meta Acid***
Low pH below 7.35
Normal CO2
Abnormal HCO3 below 24
***Meta Akl***
High pH above 7.45
Normal CO2
Abnormal HCO3 above 29
33
Liver Function Tests (LFTs): abnormal
ALT
AST
Alk Phos
Bilirubin (total) _________
conjugated (direct)
unconjugated (indirect)
Serum Ammonia (NH3) _________
Serum Protein (total) _________
Serum albumin __________
Prothrombin time (PT) _________
ALT: increases
AST: increases
Alk Phos: increases
Bili: increases
NH3: increase
Pro: decreases
Albumin: decreases
PT: prolonged
34
Potential EHR Entry
* ABD is firm, tender, absent bowel sounds and pt. c/o n/v. Lungs are clear, breathing is effortless with 02 sat 98% on RA. 14F NGT placed without difficulty in right nare at the 48 cm mark. Nare skin is CDI. NGT is patent and drainage is clear green no odor measuring 200 mls. NGT is to LWS at 60mmHg. NGT is secured to right nare/cheek/gown. Education provided on NGT.
Date/Time/Signature
35
what to monitor in a fracture pt d/t risk of air or fat embolism
chest pain, tachypnea, cyanosis, apprehension, tachycardia, and hypoxemia
36
Fat embolism s/s
-resp insuf
-fine crackles or no lung sounds
-hypoxia
-petechial rash
-confusion
-seizure
37
fat embolism
**supportive**
ICU for oxygen and fluid
38
cast care
-no covering to allow for ventilation
-reposition q1-2 hrs until set
-neurovascular distal to cast checks q1 for 24 hrs
- fit 1-2 fingers into the cast
-ice for the first 24-36 hrs
39
what is performed if pt develops compartment syndrome
emergency fasciotomy
40
a spinal fusion
add bone graft/synthetic product for stabilization & so the bone isn’t sitting on another bone
41
post op hip replacement limitations: posterior approach
avoid the following for at least 6 weeks
-extreme internal rotation
-adduction
->90 flexion
-elevate toilet seat
42
osteoporosis drug therapy: biphosphonates
MOA: inhibit osteoclast resorption
drugs: alendronate & ibandronate
NC: take w/ full glass of water 30 min before food/other meds and then remain upright for 30 mins after
43
osteoporosis collaborative mgt
prevent
-adequate Ca intake (1000mg per meno & post menu taking estrogen, 1500mg for post meno w/o taking estrogen)
-vit D (800-1000 UI daily; diet + sups)
-load bearing exercise for 30 min 3x/w
-avoid tobacco & excessive alcohol
-corset to prevent vertebral collapse
44
osteoporosis drug therapy: selective estrogen receptor modulators (SERM)
-mimic estrogen effects on bone by reducing bone resorption w/o stimulation breast/uterus
drug: raloxifene
45
osteomyelitis dx studies
-bone/tissue biopsy
-blood/wound culture +
-inc WBC & ESR
-x rays (but do not show changes until 10 days into infection)
-radionuclide bone scans preferred
-MRI
46
non drug interventions for OA
-rest/joint protection
-maintain function position prn (orthotic brace)
-avoid prolonged immobilization
-use assistive devices prn
-heat and ice (20 mins on , 20 off)
-weight reduction & aerobic exercise
-yoga, acupuncture, biofeedback
-OTC glucosamine
47
hydroxychloroquine onset time
2-3 months
48
medications for RA
-DMARDs -> substantially reduce inflammation of RA, reduce/prevent joint damage, preserve joint structure & function & help maintain activity
-NSAIDS -> immediate relief but do not reduce long term damage & needs to be taken continuously
once DMARDs work, NSAIDs can be stopped
-steroids (not preferred)
49
methotrexate onset time
improvement of sx in 4-6 weeks
often used in early RA (start asap to lessen permanent effects)
50
how to dx OA
-bone scans, CT, MRI (can show early changes)
-xrays help in staging progression
-no biomarkers
-ESR will be normal (unless synovitis present)
-synovial fluid will be clear yellow & no sign of inflammation
51
labs OA vs RA
OA: neg RF, neg anti CCP & normal ESR & CRP
RA: pos RF, pos anti CCP & elevated ESR & CRP
52
who to consult for OA
-rheumatologist
-physical therapist
-occupational therapist
-nutritionist
53
OA drug therapy
-mild to mod: acetaminophen (if lacking signs of inflammation)
-if not relived by above or signs of inflam: NSAIDs
-if problem w/ GI but need NSAIDs: celecoxib
54
RA collaborative care
-rest (but physical fitness should be maintained)
-8 to 10 hrs of sleep + a nap
-exercise (even if painful bc not exercising makes it worse)
-ROM
-hand & finger splinting
-PT & OT
-heat (max 20 mins), cold (max 10-15 mins)
-good dietary habits
-biofeedback
55
lupus CM
-joint pain (earliest sx): fingers, wrists & knees
-dont feel well for awhile but dont know why
-polyarthralgia in the morning
-pain & stiffness moves through body and usually doesn’t affect both sides in the same way
-joints are swollen and warm
-photosensitivity + butterfly rash
-lupus nephritis w/n 5yrs & lupus cerebritis
-anemia, thrombocytopenia, mild leukopenia
-unexplained fever
-extreme fatigue
-raynauds phenomenon
56
lupus medication therapy
**very individualized**
-hydroxychloroquine (almost all will be on) + NSAIDs & short term steroids (<7.5 mg/d)
-if severe, intensive immunosuppressants (methotrexate) & high dose steroids to halt issue injury
57
lupus CM (objective cues)
-unusual hair loss
-edema in legs or around eyes
-ulcers of mouth & nose
-pleurisy & pericarditis
-diff concentrating, confusion
-depression
-headaces
-seizures
-finger deformities
58
dx of gout
-elevated uric acid
-24 hr urine collection (can tell what is cause)
-synovial fluid tested (gold standard but rarely done)
59
recs for people w/ gout
1) lose wt
2) take meds
3) eat recommended diet
kcal restriction, inc protein, complex carbs & dec sat fat + dec sugar sweetened bevs & avoid flare foods like fatty meals, organ rich foods, beer and distilled spirits
60
gout drug therapy
acute: colchicine (dramatic relief within 12-24 hrs) & NSAIDs
prophylactic: allopurinal (2-6wk onset)
61
Describe what causes Closed-angle glaucoma:
Also known as Angle-closrure
It is a narrow angle between the cornea and iris that prevents aqueous humor from being reabsorbed.
The aqueous humor is unable to get to the trabecular meshwork
62
How does closed-angle glaucoma patient present?
The patient has a painful red eye that must be treated within 24 hours or blindness may be permanent.
EMERGENCY
63
The alternative option if drug therapy does not work for a patient with Chronic Open-angle glaucoma is called:
Argon Laser Trabeculoplasty (ALT) (Out-patient procedure) ; The laser hits the damaged trabecular meshwork and opens the outflow channels
64
Further care associated with Acute Angle-Closure Glaucoma that a patient may experience in the ED includes:
aggressive treatment of pain and nausea
measures to avoid activity and to keep calm
apply a patch or covering to the affected eye
Prepare for iridotomy once the IOP is stabilized
65
Iridotomy
Punching holes in the iris that allows for the aqueous humor to get to the other side
66
Acute Interventions for a patient with Acute Angle-closure Glaucoma
Quick and appropriate drug therapy
For acute pain:
If light sensitive = darken room (after the eye is fully constricted)
Apply cool compress to forehead
Find a quiet/private environment
Keep the patient and family informed
Ensure support and teaching for patient/family
67
diagnostics for benign hyperplasia
History & physical
Digital rectal exam (enlarged, hard & smooth)
Urinalysis and C&S (inc risk of urinary retention and hydronephrosis)
Serum creatinine (elevated)
Serum prostate-specific antigen (PSA)
68
what are the irritative symptoms of the clinical manifestations of BPH
Due to inflammation or infection.
Nocturia (often first symptom), frequency, urgency, dysuria, bladder pain & incontinence
**lower UTI**
69
invasive therapies for BPH
Transurethral Resection of the Prostate (TURP): Gold standard surgical treatment
Removal of prostate tissue
Resectoscope inserted into urethra
70
What test is the only way to distinguish among the various forms of viral hepatitis?
antibody antigen testing
71
HIDA scan
nuclear medicine is injected IV and is taken up by hepatocytes and excreted into bile to show patency of common bile duct and ampulla
72
What are 3 things that should be done before and ERCP and all endoscopies
NPO x 8 hrs
Consent form signed
Administer sedation
73
what is the most common complication of an ERCP
pancreatitis
74
What are 2 things nurses should do after an ERCP
Check VS (looking for manifestations of perforation or infection)
Check for return of gag reflex (usually returns in 2-4 hours. Do this before giving fluid intake)
75
ERCP visualizes and assess the
pancreatic, hepatic, and common bile duct
76
Before a liver biopsy procedure:
Check ____
Ensure patient’s blood is ____ and ______
_____ is signed
Baseline ____ _____
Explain- ___ ____ ____ ______ ___ ____ ____
1) coags (INR and PT)
2) typed and cross-matched
consent
3) vital signs
4) hold breath after expiration when needle inserted
77
What are some nursing teaching points about hepatitis for patients and family?
Maintain sanitation; personal hygiene (wash hands after toileting).
Drink water treated by water purification system.
If traveling to underdeveloped country, drink bottled water only. Avoid food washed in tap water; avoid ice.
Don’t share bed linens, eating utensils, or drinking glasses
Do not share needles for injection, body piercing or tattooing
Don’t share razors, nail clipper, toothbrushes
Use condom during sexual activity (or abstain)
Cover cuts/sores with bandage
If infected, never donate blood, body organs or other body tissues
78
hepatitis diet
When it comes to nutrition for hepatitis patients, there is no special diet.
Patients need a well-balanced, adequate calorie diet.
If fat content not tolerated (due to decreased bile production), decreased fat
Vitamin supplements, esp. B-complex and Vitamin K
79
What is the process with Endoscopic Sclerotherapy & Variceal Banding
Varices injected with a sclerosing agent via a catheter.
Varices may also be managed by endoscopic variceal ligation (banding):
Involves application of a small “O” bands around the base of the varices to decrease the blood supply to the varices.
Patient unaware of bands; cause no discomfort
80
What is a Transjugular intrahepatic portal-systemic shunt (TIPS)
Non-surgical procedure used to control long-term ascites & reduce variceal bleeding
81
Early manifestations of Cirrhosis (6)
Insidious
Weight loss
Weakness
GI disturbances
Anorexia, N/V, flatulence, change in bowel habits
Hepatomegaly
RUQ pain/palpable liver
82
Late manifestations of cirrhosis
Jaundice
decreased serum albumin & PT (2 proteins manufactured by liver)
Portal hypertension
Ascites
Splenomegaly
Spider angiomas & caput
medusae
Esophageal & anorectal varices
Hepatic encephalopathy
Asterixis (liver flap)
83
End stage Hepatic encephalopathy nursing care
Restrict protein intake (20-40 g/daily); otherwise ↑ calorie (particularly carbohydrates)
Control GI bleeding
(another source of protein)
Avoid constipation
(constipation ↑’s ammonia in feces)
Medications: Lactulose (“titrate to 2-4 stools/day”) & Neomycin
Assess EMV (Glasgow Coma Scale) regularly
Safety precautions
Patient & family teaching
84
Nursing Care in patients with Cirrhosis
Measures to manage ascites/excess fluid volume:
Assess/measure abdominal girth*
Sodium restriction/possibly fluid restriction
Diuretics (Spironolactone & loops)
Fluid removal:
Paracentesis*
Portosystemic shunt (TIPS)*
IV albumin
Patient & family teaching
85
Bleed precautions to manage with varices (10)
Monitor platelets, PT, PTT
Assess oral cavity
Monitor for ecchymosis, purpura & petechiae
Protect from falls
No ASA, alcohol, spicy foods, bulky foods; no injections
Avoid vigorous nose-blowing, straining w/ BM’s
Stool softeners
Soft toothbrush; avoid rectal temps/enemas
Apply pressure to any bleeding x 5 mins
Patient teaching r/t above
86
What are the teaching points of PERT enzyme replacement
Take pancreatic enzymes before or with meals and snacks.
Sometimes ordered to administer with antacid or H2 blockers; (because a decreased pH inactivates drug).
Tell the patient to swallow the tablets without chewing to minimize oral irritation.
Avoid lip/skin contact with enzymes. (Wipe lips prn after ingesting.)
Mix the powder form in applesauce or fruit juice at patient’s request.
Do not mix enzyme preparations in protein-containing foods.
Do not crush enteric-coated preparations.
87
What are some considerations with patient weight in chronic pancreatitis
Weight loss can be significant:
Sometimes a candidate for TPN
If taking PO, may need up to 4000 to 6000 calories/day to maintain weight.
88
How do patients need to manage nutrition to prevent exacerbation of chronic pancreatitis
Eat bland, low-fat, high-protein, high carbohydrate meals; avoid gastric stimulants, such as spices.
Eat small meals and snacks high in calories.
89
T/F Hyperglycemia should be monitored in acute pancreatitis
True, due to impact to the exocrine function
90
Clinical manifestations in acute pancreatitis
pain
N/V
low grade fever/ leukocytosis
jaundice
paralytic ileus
cullen’s & turner’s sign
hypovolemia/tachycardia
increase serum amylase & lipase
increase serum triglycerides
decrease in serum calcium
**look back at the whys**
91
MI (Heart attack)
S/S: severe, crushing chest pain that may radiate to the arm, neck or jaw, shortness of breath, nausea, diaphoresis, anxiety, and fatigue.
Diagnostic & Labs: troponin levels increase, ECG changes. Other tests include cardiac monitoring, chest x-ray, echocardiography, cardiac catheterization and coronary angiography.
Stemi: ECG may show ST elevation
Non-Stemi: None ST elevation.
92
FVE
Signs and Symptoms of FVE
Edema (especially in the lower extremities)
Weight gain (rapid and unexplained)
Jugular venous distension (JVD)
Hypertension
Bounding pulse
Tachycardia
Crackles in lungs, dyspnea, shortness of breath
Ascites
Polyuria (in some cases early on)
Confusion or altered mental status (especially in elderly)
S3 heart sound (in severe cases)
Labs and Diagnostic Findings
↓ Hematocrit (hemodilution)
↓ BUN and creatinine (dilutional effect unless renal failure is present)
↓ Serum sodium (dilutional hyponatremia)
Chest X-ray: Pulmonary congestion or pleural effusions
Urine Specific Gravity: ↓ in overhydration
Treatment
Identify and treat the underlying cause
Fluid restriction
Sodium restriction (to prevent further fluid retention)
Diuretics (e.g., furosemide/Lasix)
Dialysis (if related to renal failure and unresponsive to other treatments)
Monitor:
* Daily weight
* Input and output (I&O)
* Electrolytes and renal function
* Respiratory status and oxygen saturation
* Elevate edematous limbs
* Semi-Fowler’s or Fowler’s position for breathing ease
93
FVD
Signs and Symptoms of FVD
Dry mucous membranes
Poor skin turgor
Thirst
Hypotension
Tachycardia
Weak, thready pulse
Orthostatic hypotension
Weight loss
Decreased urine output (oliguria)
Dark, concentrated urine
Cool, clammy skin
Flattened neck veins
Dizziness, confusion, lethargy
Increased respiratory rate
Labs and Diagnostic Findings
↑ Hematocrit (hemoconcentration)
↑ BUN and creatinine
↑ Serum sodium (if water loss exceeds sodium loss)
↑ Urine specific gravity
↓ Urine output
Electrolyte imbalances (e.g., hypokalemia if due to GI losses)
Treatment
Treat the underlying cause
Fluid replacement:
Oral fluids (for mild cases)
IV fluids (e.g., isotonic solutions like normal saline or lactated Ringer’s for moderate/severe cases)
Monitor:
Daily weight
Input and output (I&O)
Vital signs
Mental status
Lab values (electrolytes, renal function)
Safety measures (prevent falls from hypotension)
Skin and oral care (due to dryness and dehydration)
94
Respiratory Distress
Signs and Symptoms of Respiratory Distress
Dyspnea (shortness of breath)
Tachypnea (rapid breathing)
Use of accessory muscles (neck, intercostals, abdominal)
Nasal flaring (especially in children)
Retractions (visible sinking of the skin around ribs/sternum)
Cyanosis (bluish tint to lips, fingertips)
Tachycardia
Restlessness, anxiety, agitation
Decreased oxygen saturation (SpO₂ < 90%)
Grunting or wheezing
Tripod position (sitting forward to ease breathing)
Fatigue or altered mental status (late sign due to hypoxia)
Possible Causes
Asthma
COPD exacerbation
Pneumonia
Pulmonary embolism
Pneumothorax
Heart failure with pulmonary edema
Anaphylaxis
ARDS (acute respiratory distress syndrome)
Airway obstruction
Labs and Diagnostic Tests
Arterial Blood Gases (ABGs):
↓ PaO₂ (hypoxemia)
↑ or ↓ PaCO₂ (depending on whether it's hyper- or hypoventilation)
↓ pH (in respiratory acidosis)
Chest X-ray (to look for pneumonia, fluid, pneumothorax, etc.)
CBC (to check for infection, anemia)
Pulse oximetry
Electrolytes (imbalances can affect respiration)
ECG (to rule out cardiac causes)
Treatment
Positioning: Sit upright or in tripod position
Administer oxygen (via nasal cannula, face mask, non-rebreather, or CPAP/BiPAP depending on severity)
Treat underlying cause:
Bronchodilators (e.g., albuterol for asthma/COPD)
Antibiotics (if infection like pneumonia)
Diuretics (for pulmonary edema)
Anticoagulants (for pulmonary embolism)
Mechanical ventilation if respiratory failure occurs
IV access for emergency meds
Monitor:
Vital signs
Respiratory effort
SpO₂ and ABGs
Mental status
95
COPD
Signs and Symptoms
Chronic cough
Excessive sputum production
Dyspnea on exertion (progressing to at rest)
Wheezing
Prolonged expiratory phase
Barrel chest (in emphysema)
Pursed-lip breathing
Use of accessory muscles
Fatigue
Cyanosis (late stage)
Clubbing of fingers
Frequent respiratory infections
Weight loss (due to increased work of breathing)
Labs and Diagnostics
Pulmonary Function Tests (PFTs):
↓ FEV1 / FVC ratio (<70%)
ABGs (in advanced disease):
↓ PaO₂
↑ PaCO₂ (respiratory acidosis)
Chest X-ray or CT scan:
Hyperinflated lungs, flattened diaphragm (emphysema)
CBC:
Possible polycythemia (↑ Hct) in chronic hypoxia
Alpha-1 antitrypsin level (if <45 y/o or family hx)
Treatment
Non-Pharmacologic
Smoking cessation (most important)
Pulmonary rehab
Vaccinations: Flu, pneumococcal, COVID
Nutritional support
Oxygen therapy (if PaO₂ < 55 mmHg or SpO₂ < 88%)
Pharmacologic
Bronchodilators:
Short-acting (SABA: albuterol, anticholinergics like ipratropium)
Long-acting (LABA, LAMA)
Inhaled corticosteroids (for frequent exacerbations)
Oral corticosteroids (for acute exacerbations)
Phosphodiesterase-4 inhibitors (like roflumilast)
Antibiotics (if infection-related exacerbation)
Advanced Therapies
Non-invasive ventilation (BiPAP)
Lung volume reduction surgery
Lung transplant (end-stage)
Nursing Considerations
Monitor for respiratory distress
Educate on inhaler use and breathing techniques (pursed-lip, diaphragmatic)
Encourage small, frequent meals
Conserve energy
Monitor for signs of CO₂ retention
Support psychosocial needs (anxiety, depression common)
96
A-fib
Goal for A-Fib - Ventricular rate control
Rhythm control & Prevent embolic stroke
Drugs for RATE control: B-adrenergic Blockers(metoprolol),calcium channel Blockers(diltiazem, verapamil)-initially IV route
Drugs for RHYTHM control: amiodarone & doFETilide-initially IV route
Drugs to prevent clots: warfarin
if stable, but symptomatic?
Slow Ventricular rate with IV either calcium channel blocker, beta blocker, digitalis, amiodarone
May be "bolus" & start a drip...
If unstable/hemodynamically compromised?
Synchronized cardioversion
Conduct TEE before Cardioversion to look for clots
How to treat Atrial Fibrillation if has a-fib for >48 hours?
* Anticoagulation therapy with warfarin (Coumadin) is recommended for 3 to 4 weeks before cardioversion and 3 to 4 weeks after successful cardioversion
* 50-100 Joules
Surgical Options
* Catheter ablation
* Radio-frequency
* cryothermal therapy
* Maze procedure
97
Basic Med List
* GERD - pantoprazole
* GOUT - Colchicine
* OSTEOPROSIS - Raloxifene
* T2DM - Metformin
* Metoprolol - Heart Rate
* Aspirin - Stroke & MI risk
* Nitro - Stable Angina
* Pain & Fever - Tylenol
* Naproxen - Pain, Inflammation, RA,
* CHF FVE - Furosemide
* Prevent clot - Warfarin
98
What drugs that you cant give from tubes?
* Extended-/Delayed-release (ER, XR, SR, DR) tablets (e.g., Metformin XR, Cardizem CD, Protonix DR)
* Enteric-coated tablets (e.g., aspirin EC, omeprazole DR caps—unless specific protocol is followed)
* Buccal/sublingual meds (e.g., nitroglycerin SL)
99
Dysrhythmias Treatment
SVT - Vagal Maneuver - Adenosine & Beta Blocker
VT - Amiodarone - Lidocaine
Sinus Brady - Atropine
VF - Defib - Amiodarone
