tuberculosis, abgs, and blood transfusions (final sg) Flashcards
(21 cards)
tuberculosis
➺ infection by mycobacterium tuberculosis
➺ airborne transmission
➺ tubercle formation and caseous necrosis are notable in cases of tb
➺ test with tuberculin skin test (PPD), sputum culture, chest x-ray
antituberculars first generation (most common)
➺ INH (primary drug used)
➺ ethambutol
➺ rifampin
➺ rifabutin
➺ streptomycin
antitubercular effectiveness depends on…
➺ type of infection (m. tuberculosis, bobos, etc.,)
➺ adequate dosing and sufficient duration of treatment
➺ ADHERENCE!
➺ selection of effective drug combination
PROBLEMS:
➺ drug-resistant organisms (MDR-TB)
➺ drug toxicity
➺ NON-ADHERENCE
isoniazid (INH) (moa, contraindications, and adverse effects)
➺ DRUG OF CHOICE for tb
➺ bacteriocidal
➺ metabolized in the liver through acetylation, watch for “slow acetylators” (some patients do not carry a gene essential to the process of acetylation
CONTRA: liver disease
ADVERSE: peripheral neuropathy (deficiency of vitamin b6 which will lead to essential supplementation), hepatotoxicity
rifabutin + rifampin (rifas)
RIFAMPIN: broad spectrum bacteriocidal
➺ contraindications would include known allergies
➺ will decrease the effects of beta blockers, benzodiazepines, cyclosporine, anticoagulants, oral hypoglycemics, birth control, phenytoin, and theophyllin
RIFABUTINE: better efficacy and lasts longer, bacteriocidal / static
➺ NO BREAST FEEDING
rifampin adverse effects
➺ turns urine, feces, saliva, skin, sputum, sweat, and tears a red-brown-orange color
➺ hepatitis
streptomycin
➺ an aminoglycoside antibiotic
➺ injectable other, may be used with other agents
arterial blood gases
➺ measurement of acidity / alkalinity of arterial circulation
➺ measures gases such as oxygen and carbon dioxide
what are the four elements being measured in abgs and their ranges?
➺ pH (acidity / alkalinity):
7.35 - 7.45
➺ PaCO2 (carbon dioxide “acid”):
35-45
➺ HCO3 (bicarbonate “base”):
22-26
➺ PO2 (oxygen):
80-100%
what value measures regulation by the lungs / kidneys?
➺ respiratory / lungs = PaCO2
➺ metabolic / kidneys = HCO3
how is respiratory / metabolic acidosis / alkalosis defined?
➺ respiratory alkalosis: pH (INC.) + PaCO2 (DEC.)
➺ respiratory acidosis: pH (DEC.) + PaCO2 (INC.)
➺ metabolic alkalosis: pH (INC.) + HCO3 (INC.)
➺ metabolic acidosis: pH (DEC.) + HCO3 (DEC.)
how would you determine compensation?
➺ partially compensated: either PaCO2 or HCO3 is normal while the other value + pH is abnormal
➺ uncompensated: nothing is within normal limits
➺ compensated: when pH is at baseline or neutral but PaCO2 and HCO3 are abnormal
PRACTICE:
1.) pH = 7.50, PaCO2 = 47,
HCO3 = 32
2.) pH = 7.30, PaCO2 = 50,
HCO3 = 30
3.) pH = 7.26, PaCO2 = 32,
HCO3 = 18
4.) pH = 7.44, PaCO2 = 30,
HCO3 = 21
1.) Metabolic alkalosis, partial compensation
2.) Respiratory acidosis, partial compensation
3.) Metabolic acidosis, partial compensation
4.) Respiratory alkalosis, complete compensation
blood transfusions
➺ this therapy involves transfusing blood components or whole blood intravenously
➺ this therapy may be needed following a surgical procedure, a serious injury or natural disaster, or illnesses that cause anemia
➺ transferrable units can include whole blood, RBCs, platelets, granulocytes, etc.,
types of transfusions
➺ standard: from a compatible donor
➺ autologous: blood is collected from client in anticipation of future transfusions
➺ intraoperative: blood that is lost during a procedure that is retrieved and filtered into a bag for transfusions during or after surgery (must be transfused within 6 hrs of collection)
compatibility of blood transfusions
➺ TWO blood markers: ABO + RhD
ABO groups
➺ group a: contains a antigen and anti-B antibody
➺ group b: contains b antigen and anti-A antibody
➺ group ab: contains a and b antigen with no a or b antibodies
➺ group o: contains no antigens, but has anti-a and anti-b antibodies
RhD system
➺ blood types are positive or negative depending on this marker
➺ positive indicates presence of the RhD antigen
universal donor v. recipient
DONOR: O-
RECIPIENT: AB+
explain the process of a blood transfusion
➺ verify doctor’s orders and identify the patient properly, explain the procedure and obtain consent
➺ set up IV system, need IV access at least a 20 G, prime Y-tubing with 0.9 NS ONLY! *(set up should be done before calling blood bank!)
➺ check for cross match with another RN to ensure compatibility and that the patient is receiving the correct blood
➺ ensure blood is being transfused 30 minutes after receiving it
➺ perform vitals 5 minutes before, 15 minutes into infusion, then 30 minutes into the infusion, an hour into the infusion, and then an hour following the infusion
➺ begin infusion SLOWLY (2 mL/min / 120 mL/hr) for the first 15 minutes and remaining at their bedside
➺ blood bags should be transfused in no more than 4 hours
what happens if the patient is experiencing a reaction?
STOP THE TRANSFUSION!
