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Krystan: Semester Two Nursing School > 2800 Exam Two > Flashcards

2800 Exam Two Flashcards

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1
Q

What are some consequences of untreated pain?

A

Increased ACH, cortisol, ADH, and epinephrine
Decreased insulin resistance
Increased heart rate, cardiac output, coagulation
Hypoxemia and decreased tidal volume
Decreased urine output and GI motility
Decreased immunity

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2
Q

What are the five dimensions of pain?

A 
Physiologic
Affective
Cognitive
Behavioral
Sociocultural
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3
Q

What is included in the physiologic dimension of pain?

A

Emotional responses to pain, like anxiety, depression, or frustration

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4
Q

Cognitive dimension of pain

A

Beliefs, attitudes, meanings, and thoughts attached to pain

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5
Q

Behavioral dimension of pain

A

Observable actions taken to express or control pain

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6
Q

Sociocultural dimension of pain

A

One’s culture impacts how one expresses and thinks about pain

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7
Q

What is nociceptive pain?

A

Pain at nocioceptor nerves caused by damage to somatic or visceral tissue

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8
Q

What are the two types of somatic pain?

A

Deep and superficial

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9
Q

What is somatic pain?

A

Pain originating from the skin, mucous membranes, subcutaneous tissues, muscles, bones, or tendons

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10
Q

What is visceral pain?

A

Pain from visceral organs

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11
Q

What are some common causes of visceral pain?

A

Swelling or ischemia of internal organs

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12
Q

What is neuropathic pain?

A

Pain from damage to peripheral nerves or CNS structures

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13
Q

How would a patient likely describe neuropathic pain?

A

Burning, shooting, or shock-like

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14
Q

Acute pain

A

Sudden onset
Usually lasts less than 3 months
Usually resolvable with care geared towards recovery
Precipitating event can usually be identidad

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15
Q

Chronic pain

A 
Gradual or sudden onset
Cause may not be known
Pain increases and decreases
Goal is pain control to maximize function
Behavioral manifestations likely
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16
Q

What is sciatica?

A

Pain following the course of the sciatic nerve

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17
Q

What is the most consistent pain indicator in infants?

A

Facial expressions

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18
Q

What are some other ways pediatric clients will express their pain?

A 
Crying
Pain facial expressions
Localized body response/withdrawal
Thrashing
Restlessness
Muscle rigidity
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19
Q

When should pain be reassessed? What are some dependent factors?

A

Frequently, especially after meds are given to gauge effectiveness. Assessment also depends on severity, the patient’s condition, the interventions taken, the risk of side effects, and institutional policy

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20
Q

Who might the nurse collaborate with to manage a patient’s pain?

A 
Anesthesiologist 
Nurse practitioner/doctor
Pharmacist
Psychologist 
PT/OT
Pain specialist
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21
Q

Planning for pain management should always include…

A

Patient goals

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22
Q

What is a multimodal approach to analgesic therapy?

A

Use of two or more classes of analgesics to take advantage of various mechanisms of action or to minimize the amount of narcotic medications needed

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23
Q

What are some barriers to effective pain management that could affect a patient?

A

Fear of addiction/tolerance
Desire to be stoic
Side effects
Inadequate assessment by the nurse

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24
Q

What is an important question to ask when assessing chronic pain?

A

How is the pain impacting patient functionality in day to day life?

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25
Q

What are some ethical issues that arise from pain management?

A

Fear of hastening death by increasing doses of analgesics for terminally ill patients
Assisted suicide requests
Giving placebos
Mismanagement of geriatric pain

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26
Q

Rule of double effect

A

If an unwanted consequence occurs as a result of an action taken to achieve moral good, the action is justified

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27
Q

What is the rule of double effect commonly applied to?

A

Giving increasing doses of pain medications to dying patients with the goal of relieving pain

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28
Q

What are some barriers to adequate gerontologic pain management?

A

Older adults believing pain is inevitable/normal
Use of different descriptive language for pain
Less ability to report pain
Not being believed in their reports of pain

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29
Q

What are some things that could hinder clients from reporting pain?

A 
Hearing/vision deficits
Dementia
Delirium 
Poststroke aphasia 
Communication barriers
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30
Q

What is a primary headache? What are the types?

A

A headache not caused by disease

Tension, migraine, and cluster headaches

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31
Q

What is a secondary headache? What could be some causative factors?

A

A headache caused by another condition or disorder, such as a brain tumor, injury, or sinus infection

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32
Q

Tension headache

A

A stress headache, the most common and least severe form of headache

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33
Q

What are clinical manifestations of a tension headache?

A

Bilateral pain with a pressing or tightening quality
Mild to moderate pain
Lasts for minutes to days
Possible photophobia or photophobia

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34
Q

Photophobia

A

Light sensitivity

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35
Q

Phonophobia

A

Sensitivity to sound

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36
Q

What are premonitory symptoms?

A

Warning symptoms of an impending headache

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37
Q

Migraine headache

A

Recurrent headache characterized by unilateral throbbing

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38
Q

Clinical manifestations of a migraine headache?

A

Aura/premonitory symptoms
Steady, pulsing pain that is usually unilateral
Lasts for 4-72 hours

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39
Q

What is an aura?

A

A premonitory symptom of a migraine, with visual disturbances or experiencing sensory or motor phenomenon

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40
Q

What are cluster headaches?

A

Most severe form of primary headaches. Repeated headaches that occur in clusters, generally at the same time of day

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41
Q

Cluster headache: clinical manifestations

A 
Intense pain lasting for minutes to 3 hours
Sharp, stabbing pain located around the eye that can radiate
Swelling
Tearing 
Facial flushing
Nasal congestion
Agitation
Possible aura
Can occur up to 8 times per day
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42
Q

What are some Interprofessional cares for headaches?

A 
Drug therapy
Meditation
Biofeedback
Cognitive/behavioral therapy
Relaxation training
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43
Q

What are goals for headache management?

A

Reduced/eliminated pain
Understanding of triggers and treatments
Using positive coping strategies
Increased quality of life with decreased disability

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44
Q

What are some patient and caregiver teachings for patients with headaches?

A 
Keep headache log
Avoid triggers
Learn purpose and side effects of drugs
Exercise
Stress management 
Med adherence
Diet education
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45
Q

What is systemic lupus erythematosus?

A

Multisystem autoimmune inflammatory disease mainly affecting skin, joints, serous membranes, plus renal, hematologists, and neurological systems

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46
Q

Is there a characteristic disease progression for lupus?

A

No, it progresses and manifests differently for each patient

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47
Q

Dermatological findings with lupus

A 
Butterfly rash over cheeks and bridge of nose
Vascular skin lesions
Photosensitive skin reactions
Raynaud’s phenomenon 
Oral/nasopharyngeal ulcers
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48
Q

Musculoskeletal findings with lupus

A

Arthritis (95% of patients)
Joint pain
Swelling
Bone loss

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49
Q

Cardiopulmonary findings with lupus

A 
Lung disease 
Pleurisy 
Dysrhythmias 
Pericarditis 
Coagulation disorder (antiphospholipid syndrome)
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50
Q

Renal findings with lupus

A

Kidney damage (75% of patients)

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51
Q

Nervous system findings with lupus

A

Seizures
Cognitive dysfunction (disorientation and memory deficits)
Psychosis
Higher stroke risk

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52
Q

Hematologic findings with lupus

A

Anemia
Leukopenia
Thrombocytopenia
Coagulation disorders

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53
Q

What are some drug therapies used to treat lupus?

A 
NSAIDs
Antimalarials 
Immunosuppressants 
**limited corticosteroids **
Biologic response modifiers
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54
Q

What are some common comorbidities with lupus?

A

Depression
Anxiety
Sjögren’s syndrome
Kidney failure

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55
Q

What are major teaching points for patients with lupus?

A 
Disease process 
Drug treatment information
Pain management
Energy conservation
Stress avoidance 
Relaxation therapy
Counseling services
Community resources
Avoid sun exposure
Self-esteem maintenance
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56
Q

Fibromyalgia

A

Chronic central pain syndrome marked by widespread, non-articular musculoskeletal pain and fatigue with pain at specific tender points

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57
Q

Assessment findings with fibromyalgia

A

Widespread burning pain that worsens and improves
Pain with a location that is hard to pinpoint
Head or face pain
Migraines
Memory lapses
Concentration problems
Pain and tender points

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58
Q

Complications of fibromyalgia

A 
IBS
Swallowing problems
Sleep problems
Urinary frequency/difficulty
Painful menstruation with possible flare ups
Sleep problems
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59
Q

Why is fibromyalgia so difficult to diagnose?

A

Lack of knowledge about disease and manifestations
Need to rule out many other disorders
No diagnostic test for it
Manifestations unique to each person

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60
Q

Treatment for fibromyalgia

A

Drug therapy (often anti seizure meds, SSRI’s, pain management drugs)
Stretching
Hot and cold therapy
Vitamin/mineral supplements

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61
Q

What nursing interventions might help with fibromyalgia?

A

Education
Distraction
Listening
Hot/cold application

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62
Q

What are holistic therapies for pain relief?

A 
Relaxation
Biofeedback 
Heat/cold
Massage
Yoga
Tai chi
Distraction/meditation
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63
Q

Diet suggestions for fibromyalgia

A

Limit sugar, alcohol, and caffeine

Eat balanced, healthy diet

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64
Q

Chronic insomnia definition

A

Difficulty falling asleep or remaining asleep for at least 3 night a week for 3 months or longer, with daytime complaints of interrupted function

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65
Q

Who is most likely to suffer from insomnia?

A

Women
Those divorced, widowed, or separated
Low SES or education level

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66
Q

What are some factors that contribute to poor sleep hygiene?

A 
Irregular sleep/wake schedules
Drinking close to bedtime
Smoking
Medications 
Stress
Psychiatric or medical conditions
Jet lag
Nightmares/PTSD
Exercise close to bedtime
Napping
Genetics
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67
Q

What are clinical manifestations of chronic insomnia?

A 
Difficulty falling asleep
Frequent awakening
Problems staying asleep
Non-restorative sleep
Forgetfulness
Confusion
Grumpiness
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68
Q

What are some nursing diagnoses for sleep disorders?

A

Insomnia
Sleep deprivation
Disturbed sleep pattern
Readiness for enhanced sleep

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69
Q

What are some nursing interventions to help with insomnia?

A

Educate about sleep hygiene
Teach relaxation techniques
Education about sleep medications

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70
Q

What are important teachings related to chronic insomnia?

A 
Don’t go to bed unless tired
Regular sleep schedule
Sleep rituals
Quit drinking alcohol 4-6 hours before bed 
Cool, dark, quiet environment
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71
Q

Systematic exertion intolerance disease (SEID)

A

Formerly chronic fatigue syndrome

Multisystem disease in which any form of exertion can adversely affect multiple organs/systems

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72
Q

Who is most likely to suffer from SEID?

A

Women

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73
Q

What are assessment findings in SEID?

A 
6+ months of profound fatigue
Postexertional malaise
Un refreshing sleep
Brain fog
Orthostatic intolerance
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74
Q

Disease progression of SEID?

A

Does not progress, many often recover or gradually improve

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75
Q

What are complications of SEID?

A 
Anger
Pain
Frustration
Inability to do ADLs
Loss of livelihood 
Depression
Brain fog
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76
Q

What are some common comorbidities with SEID?

A

Fibromyalgia
RA
Depression

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77
Q

Why is SEID so difficult to diagnose?

A

No diagnostic test, so must be diagnosed by elimination. Also shares many symptoms with fibromyalgia

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78
Q

How is SEID treated?

A

No definitive treatment, but NSAIDS, antihistamines, antidepressants, and SSRIs can be used to manage symptoms
Balanced diet and a carefully graduated exercise program are recommended

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79
Q

What nursing interventions might help with SEID?

A

Education
Listening/saying you believe them
Connect them to resources
Discourage total bed rest

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80
Q

Define anemia

A

Deficiency in number of RBCs, quantity/quality of hemoglobin, or volume of packed red blood cells (hematocrit)

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81
Q

What are some causes of chronic anemia?

A 
Iron deficiency 
Blood loss from trauma
Inherited anemia
Medications
Folic acid or B12 deficiency 
Radiation 
Decreased RBC production
Increased RBC destruction
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82
Q

What are some causes of decreased red blood cell production?

A

Decreased hemoglobin synthesis
Defective DNA synthesis
Decreased erythropoietin or iron
Decreased number of RBC production precursors

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83
Q

What are some chronic causes of blood loss?

A

Gastritis
Menstrual flow
Hemorrhoids

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84
Q

What are some conditions that contribute to increased RBC destruction?

A 
Sickle cell disease
Enzyme deficiency
Membrane abnormalities
Trauma
Incompatible blood transfusions
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85
Q

What are common assessment findings/manifestations/complications of anemia?

A 
Palpitations
Dyspnea
Mild fatigue
Pallor/jaundice
Increased HR
Systolic murmurs/bruits
Angina/MI
HF
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86
Q

Normal hemoglobin levels

A

Women: 12-16 g/dL
Men: 14-18 g/dL

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87
Q

Normal hematocrit level?

A

Women: 37-48%
Men: 45-52%

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88
Q

What is a good rule of thumb for determining hct?

A

Generally three times the hemoglobin amount

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89
Q

What are manifestations of mild anemia?

A

Palpitations
Exertional dyspnea
Mild fatigue

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90
Q

Manifestations of moderate anemia?

A 
Palpitations
Bounding pulse
Dyspnea
Fatigue
Roaring in ears
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91
Q

Manifestations of severe anemia

A 
Pallor
Jaundice
Blurred vision
Tachycardia 
Angina
HF
Headache
Vertigo
Irritability
Anorexia
Weight loss
Lethargy
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92
Q

Why is jaundice present in anemia?

A

Hemolysis of RBCs leading to increased concentration of serum bilirubin

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93
Q

What are potential nursing diagnoses related to anemia?

A

Fatigue
Imbalanced nutrition
Anxiety

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94
Q

What are goals for patients with anemia?

A

Assume normal ADLs
Maintain adequate nutrition
Develop no complications r/t anemia

95
Q

What nursing interventions are appropriate for patients with anemia?

A

Diet changes
Oxygen therapy
RBC replacement/blood transfusion if severe
Medication treatment

96
Q

What would a nurse teach about activity and exercise r/t anemia?

A

Alternate rest and activity periods
Prioritize activities
Avoid activity right after meals

97
Q

What are gerontologic considerations for anemia?

A

RBC mass changes with age

Anemia is not normal (usually has underlying cause)

98
Q

What are some underlying causes for anemia in older adults?

A 
Iron deficiency 
Bleeding
Chronic disease/inflammation
Renal insufficiency 
Blood cancer
Decreased testosterone
99
Q

What are some additional clinical manifestations of anemia in older adults?

A 
Pallor
Confusion 
Ataxia (impaired coordination) 
Fatigue
Worsening cardiovascular or respiratory problems
100
Q

How is hypertension defined?

A

Greater than 140/90 or a normal BP but on antihypertensive medications

101
Q

Describe hypertension using normal language

A

Heart pumping with higher force, causing stress on vessels and the heart

102
Q

Primary hypertension

A

No known cause

103
Q

Secondary hypertension

A

Elevated blood pressure caused by an underlying condition (can be corrected)

104
Q

Who is most likely to get hypertension?

A 
African Americans
Mexican Americans 
Middle aged men
Women over 60ish
Women on oral contraceptives
Diabetics
Those with family history of HTN/heart disease
105
Q

Modifiable risk factors for hypertension

A 
Alcohol intake
Tobacco use 
Diabetes/blood sugar control 
Elevated serum lipids and cholesterol
Excess sodium
Sedentary lifestyle
Stress
106
Q

Non-modifiable risk factors for hypertension

A

Age
Gender
Family history
Ethnicity

107
Q

What are assessment findings in hypertension?

A

Usually none

If severe, can cause headache,fatigue, dizziness, palpitations, angina, dyspnea

108
Q

Why is hypertension called the silent killer?

A

It is often asymptomatic until it is severe and begins to cause organ damage

109
Q

What are potential complications with HTN?

A 
CAD
LVH
Cerebrovascular disease 
PVD
Nephrosclerosis
Retinal damage
110
Q

What are lifestyle modification recommendations for HTN?

A 
Weight reduction
DASH diet
Sodium restriction
Moderate alcohol intake
Physical activity
Tobacco avoidance/cessation
Stress reduction
111
Q

What is the DASH eating plan?

A

Dietary approaches to stop hypertension
Less red meat, salt, sweets, and added sugars
Increased fruits, veggies, whole grains, fish, low fat milk, legumes

112
Q

What are physical activity recommendations for hypertension?

A

30 min/day at least 5 days a week. At least 150 minutes a week

113
Q

What are some nursing diagnoses for patients with hypertension?

A

Ineffective health management
Anxiety
Risk for decreased cardiac tissue perfusion

114
Q

What are goal for clients with hypertension?

A

Achieve and maintain goal blood pressure
Follow treatment plan
Experience minimal side effects
Manage/cope with condition

115
Q

What are some reasons clients do not adhere to teaching recommendations for hypertension?

A 
Inadequate teaching
Side effects of meds
Cost
Insurance issues
BP returning to normal 
Lack of trust in healthcare workers
116
Q

Describe coronary artery disease (CAD) in simple language

A

Hardening/narrowing of the coronary arteries

117
Q

Who is most likely to get CAD?

A 
Whites
African Americans (earlier onset)
Native Americans (earlier deaths) 
Men under 75 at higher risk, then risk becomes equal 
Women more likely to die from it
118
Q

Non-modifiable CAD risk factors

A

Age
Gender
Ethnicity
Genetics

119
Q

Modifiable CAD risk factors

A 
Serum lipids
Blood pressure
Diabetes control
Tobacco use
Inactivity
Obesity
120
Q

What are some other modifiable risk factors that contribute to CAD?

A

Fasting blood glucose greater than 100 mg/dL
Depression
Stress
Elevated homocysteine

121
Q

Metabolic syndrome

A

Central obesity + hypertension + abnormal serum lipids + elevated fasting glucose

122
Q

Metabolic syndrome promotes the development of what alteration in tissue perfusion?

A

Coronary artery disease

123
Q

CAD clinical manifestations

A

Often none, maybe chest pain

124
Q

What are assessment findings with CAD?

A

High serum lipids

125
Q

What is a normal total cholesterol level?

A

Less than 200 mg/dL

126
Q

What is a potential complication of CAD?

A

MI

127
Q

What does nursing and interprofessional care consist of for CAD?

A

Health promotion (screening!)
Identifying and managing high risk individuals
Physical activity/weight loss
Nutrition therapy

128
Q

What would be important information to collect in health screening for CAD?

A 
Family history
BP
Cardiovascular symptoms
Lifestyle habits
Psychosocial history (stress)
Employment
Health beliefs
Education level/background
Cholesterol level
129
Q

What are FITT recommendations?

A

Exercise recommendations for CAD.
Stands for Frequency, Intensity, Type, and Time
Involves 30 minutes of moderate activity most days of the week plus two days of weight training per week

130
Q

What are nutrition recommendations for patients with CAD?

A

Decrease saturated fat and cholesterol
Increase complex carbs and fiber
Keep fat between 25 and 35% of total intake, mostly from mono/polyunsaturated fats
Less alcohol and simple sugar intake

131
Q

What are some patient teaching priorities for CAD?

A 
Regular BP checks
Reduce fat intake
Stop smoking
Exercise
Be aware of stress/minimize stress
Obesity reduction
Diabetes control
132
Q

Define Chronic Heart Failure in simple language

A

Heart being unable to provide sufficient blood to meet the oxygen needs of tissues and organs

133
Q

Who is most likely to get CHF?

A

African Americans
Asians
Those with hypertension, CAD, COPD, or diabetes

134
Q

What are assessment findings/manifestations for clients with left sided heart failure?

A 
Increased heart rate
Decreased 02 sats
Increased arterial CO2
Crackles in lungs
Extra heart sounds
Weakness
Fatigue
Anxiety
Dyspnea
Dry, hacking cough
135
Q

What are manifestations of right sided heart failure?

A 
Murmurs
Jugular venous distention 
Edema
Weight gain
Ascites 
Hepatomegaly
Fatigue
Anorexia 
Nausea
GI bloating
Tachycardia
Nocturia 
Confusion
Restlessness
Stasis ulcers
136
Q

What does the FACES acronym pertain to and stand for?

A

Pertains to signs and symptoms of heart failure

Stands for: Fatigue, Activity limitation, Chest congestion/cough, Edema, Shortness of breath

137
Q

What are potential complications associated with heart failure?

A 
Pleural effusion
Dysrhythmias 
Left ventricular thrombus
Hepatomegaly
Renal failure
138
Q

What is nutritional therapy for patients with heart failure?

A

Low sodium diet
DASH diet
Monitoring of fluid/daily weights

139
Q

What are potential nursing diagnoses for patients with CHF?

A

Impaired gas exchange
Decreased cardiac output
Excess fluid volume
Activity intolerance

140
Q

What are goals for clients with heart failure?

A

Decreased symptoms and peripheral edema
Increased exercise tolerance
Treatment adherence
No complications from disease

141
Q

What do we teach CHF patients about activity programs?

A

Increase activity gradually
Consider cardiac rehabilitation
Avoid temperature extremes

142
Q

What do we need to teach CHF patients about ongoing monitoring?

A

Know s/s of worsening heart failure (FACES)
Monitor vital signs and daily weights
Report: weight gain, SOB, dry/hacking cough, fatigue, edema, nausea, dizziness

143
Q

What do we teach CHF patients about health promotion?

A

Flu and pneumonia vaccines

Reduction of risk factors

144
Q

What do we teach CHF patients about rest?

A

Alternate rest and activity
Rest after exertion
Potentially take shorter work hours
Avoid emotional upset

145
Q

What do we teach CHF patients about nutrition?

A

Limit salt
Follow good nutrition plan ( preferably DASH)
Adhere to diuretics

146
Q

What are guidelines for teaching related to drug adherence for CHF?

A

Follow regimen closely
Develop system for adherence
Check pulse before medications
Know s/s of orthostatic hypotension and internal bleeding

147
Q

What is tuberculosis?

A

A bacterial infection normally involving the respiratory system

148
Q

How much of the world’s population has TB?

A

About 1/3

149
Q

Who is at highest risk to get TB?

A

HIV/immunosuppressed patients
Poor
Underserved/minority/homeless patients
Inner city people
Those living in or working in institutions
Those living/traveling to other countries

150
Q

What problems have resulted in drug resistant TB?

A

Incorrect prescribing
Lack of public health awareness/management of TB cases
Non adherence to treatment

151
Q

Primary TB

A

Bacteria are inhaled and start the inflammation reaction. May or may not progress to actual disease (usually doesnt in healthy people)

152
Q

Latent TB

A

TB bacteria are present but disease is not active. Patient will test positive but is not contagious

153
Q

Active TB

A

Patient is contagious and manifesting symptoms

154
Q

Primary active TB

A

Patient gets sick immediately upon initial infection

155
Q

Post-primary active TB

A

Patient has latent period before infection becomes active

156
Q

Assessment findings/manifestations of TB

A 
Dry cough that later becomes productive 
Fatigue
Anorexia
Night sweats
Weight loss
Fever
Dyspnea
Crackles
Chills
Blood in sputum (hemoptysis)
157
Q

How long do TB symptoms take to develop?

A

2-3 weeks

158
Q

How/where can extra-pulmonary TB manifest?

A

Renal TB
Bone TB
Meningitis TB

159
Q

What are complications of TB?

A

Scarring
Pulmonary damage
Death

160
Q

What is miliary TB?

A

Mycobacterium being systemically distributed in the bloodstream (leads to extra pulmonary TB)

161
Q

What are potential long term complications of TB?

A 
Death
Hepatomegaly
Splenomegaly
Spinal destruction
Peritonitis
162
Q

What is the standard method to know if someone has been exposed to TB?

A

TB skin test

163
Q

Induration

A

Palpable, raised, hardened area at site of TB injection (positive result)

164
Q

Other diagnostic studies for TB

A

Chest x-ray

Interferon y blood tests

165
Q

What is the only way to actually diagnose TB?

A

3 sputum cultures (smeared and cultured) collected on 3 different occasions

166
Q

How long can bacteriological diagnosis of TB take?

A

Up to 8 weeks

167
Q

Why is compliance such an issue in TB management?

A

Long duration of treatment

Side effects to meds

168
Q

What are nursing interventions for health promotion related to TB?

A

Screening and follow up
Addressing social and lifestyle factors of TB development
Education

169
Q

Is TB reportable?

A

Yes, it must be reported (public health concern)

170
Q

Directly observed therapy for TB

A

Making sure patients actually take their meds

171
Q

What precautions should be taken for TB patients in acute care settings?

A

Airborne isolation
Drug therapy
Hepa masks

172
Q

What should patients be taught in acute care settings in regard to TB?

A

Cover nose and mouth with paper tissues when coughing
Wash hands
Wear mask when leaving the room
Screen visitors and family members

173
Q

What does ambulatory care consist of for TB patients?

A

Monthly culture and smear
Drug adherence
Reporting to public health department

174
Q

What should ambulatory TB patients be taught?

A

Live in well-ventilated home
Sleep alone while contagious
Spend lots of time outside
Minimize time in crowds or using public transportation

175
Q

What is a reactivating factor for TB?

A

Smoking

176
Q

Asthma definition

A

Difficulty breathing due to overreactive airways (happens in periods of flare ups)

177
Q

Who is most likely to get asthma?

A

Boys before puberty
Women after puberty
African Americans
Puerto Rican’s

178
Q

What are some asthma triggers?

A 
Mold
Pollens
Allergens
Fumes
Chemicals/agriculture/farming
Exercise 
Smoking
Stress
Anxiety
Smog
179
Q

What is exercise induced asthma?

A

Asthma brought on by exercise (usually happens after exertion

180
Q

What are general clinical manifestations of asthma?

A

Cough
Respiratory symptoms
Gastric reflux
Heartburn

181
Q

How could the cough in asthma be described?

A

Hacking
Irritating
Non productive
Rattling

182
Q

What are respiratory related signs in asthma?

A 
SOB
Prolonged exhalation 
Wheeze
Dark red lips
Cyanosis
Restlessness/anxiety
Chest tightness 
Positioning for optimal breathing
183
Q

Lung sounds with asthma

A

Crackles

High pitched wheezes

184
Q

What changes occur after repeated episodes of asthma?

A

Barrel chest
Elevated shoulders/changed musculature
Accessory muscle use
Lung damage

185
Q

What are potential complications with asthma?

A

Death

Permanent lung damage

186
Q

What nursing interventions can help prevent asthma complications?

A

Inhaled medications
Drug therapy
Monitoring
IV fluids

187
Q

What do medication regimens look like for asthma patients?

A

Usually SABAs + long term controller medications (often corticosteroids)

188
Q

What are goals for asthmatic clients?

A 
Minimal symptoms
Acceptable activity levels
Avoidance of triggers
Knowledge about action plan
Maintain above 80% of best peak flow
189
Q

Client teaching about avoiding asthma attacks

A

Know and avoid triggers
Avoid cold
Promptly treat URIs

190
Q

What is included in an asthma action plan?

A

Using peak flow monitoring to determine what to do with medications

191
Q

Why use a peak flow meter?

A

It can tell the patient about airway narrowing before symptoms begin
Can help identify triggers
Can let patient know when to take meds

192
Q

What does the patient need to record with peak flow monitoring?

A

Peak flow numbers and respiratory symptoms

193
Q

Peak flow green zone

A

80% or greater of personal best, take meds as normal

194
Q

Peak flow yellow zone

A

50-80% of personal best, take SABA and call doctor

195
Q

Red zone peak flow

A

Less than 50% of best, take SABA ASAP and call doc immediately

196
Q

What holistic therapies can help with asthma?

A

Breathing techniques
Relaxation
Deep breathing
Yoga

197
Q

What do we teach asthma patients about exercise?

A

Use prophylactic treatment
Do things requiring short bursts of energy
Exercise inside if its cold

198
Q

Define COPD

A

Chronic progressive inflammatory disease of the airways (chronic bronchitis + emphysema)

199
Q

Chronic bronchitis

A

Bronchial inflammation defined as cough and sputum for at least 3 months of the last two consecutive years

200
Q

Emphysema

A

Destruction of the alveoli

201
Q

Most common etiology of COPD

A

Smoking

202
Q

Non-modifiable COPD risk factors

A 
Genetics
Gender
Aging
Infection 
Asthma
203
Q

What is alpha antitrypsin deficiency?

A

Autosomal recessive disorder that is a genetic risk for COPD

204
Q

Modifiable COPD risk factors

A

Smoking
Occupational exposure
Pollution

205
Q

Asthma versus COPD: age of onset

A

Asthma: younger than 40
COPD: usually between 40 and 60

206
Q

Asthma vs COPD: dyspnea

A

Asthma: only during exacerbations or when poorly controlled
COPD: during exertion

207
Q

Asthma vs COPD: sputum production

A

asthma: infrequent
COPD: often

208
Q

What are assessment findings/manifestations of COPD?

A 
Chronic cough with sputum production
Dyspnea/air hunger
Barrel chest
Tripod positioning
Polycythemia
209
Q

What are chronic complications associated with COPD?

A

Cor pulmonale
Acute exacerbations
Acute respiratory failure

210
Q

Cor pulmonale

A

Right sided heart failure due to pulmonary hypertension (often seen with COPD patients)

211
Q

Cor pulmonale assessment findings?

A 
Jugular venous distension 
Peripheral edema
Poor GI drainage
Weight gain
Dyspnea
212
Q

What are collective care therapies for COPD patients?

A 
Spirometry 
Drug therapy
Breathing techniques
Immunizations (especially pneumonia)
Oxygen therapy
Hydration
Infection prevention
213
Q

How can a patient prevent COPD exacerbations?

A

Treatment adherence

Recognize symptoms of exacerbations

214
Q

CO2 narcosis

A

Toxic accumulation of CO2 due to chemorecptor tolerance of CO2

215
Q

With COPD, what should nurses teach in relation to breathing retraining?

A

Pursed lip breathing

Diaphragmatic breathing

216
Q

Pursed lip breathing: how to teach

A

Inhale slowly through nose
Exhale slowly through pursed lips
Exhale for 3 times longer than inhalation
Repeat 8-10 times, for 3 to 4 times per day

217
Q

Why is effective coughing necessary with COPD?

A

To get excess secretions out of the lungs

218
Q

What do we teach COPD clients about huff coughing?

A

Inhale through mouth using diaphragm
Hold for 2-3 seconds
Exhale forcefully like you’re fogging a mirror
Do this until secretions feel looser, then cough normally to get secretions out

219
Q

Why do COPD patients often struggle to eat?

A

Difficulty eating and breathing at the same time

Diaphragm restricted by full stomach

220
Q

What are possible nutrition recommendations for COPD patients?

A 
High calorie foods first 
6 smaller meals per day (high cal + high nutrient)
Limit fluids before meals
Eat cold foods
Rest for 30 minutes before eating
Prepare foods in advance
221
Q

What are activity and exercise goals and recommendations for COPD patients?

A

Upper extremity training is good
Regular exercise and developing endurance is important
Take breaks
Work up to walking for 15-20 minutes per day, 3 days a week)

222
Q

Define cystic fibrosis

A

Recessive genetic disease that causes excess mucous production in lungs, GI tract, and reproductive tract due to exocrine gland dysfunction

223
Q

Respiratory manifestations of CF

A 
Wheezing respirations 
Dry, non-productive cough
Finger clubbing
Hemoptysis 
Dyspnea 
Frequent infections
Difficulty breathing
Cor pulmonale
224
Q

GI manifestations of CF

A 
Bulky/loose/foul smelling stools
Voracious appetite early in disease and no appetite as it progresses
Weight loss
Failure to thrive 
Abdominal distension
Fat soluble vitamin deficiency 
Constipation
Decreased albumin
Hyponatremia
225
Q

Steatorrhea

A

Oily, fatty, foul smelling stools often seen in CF patients

226
Q

Azatorrhea

A

Excess discharge of nitrogenous substances in feces and urine due to decreased pancreatic enzymes (often found in CF)

227
Q

Reproductive changes in CF

A

Delayed puberty/infertility
Normal sperm production but no vas deferens development
Thickened cervical mucous leading to difficulty conceiving
Irregular menstruation

228
Q

Complications associated with CF

A 
Bone disease
Sinus disease
Liver disease 
Renal disease
Lung infections
Respiratory failure 
Diabetes 
Pneumothorax 
HTN
229
Q

Goal for client with CF

A

Adequate airway clearance
Reduced respiratory infection risk factors
Adequate nutrition (may need lots of calories)
Ability to do ADLs
Recognize and treat complications
Active participation in treatment regimen

230
Q

What are treatments to manage respiratory complications of CF?

A

Aerosol/nebulizer treatment
Bronchodilators
Breathing exercises
Percussion/pummeling to loosen secretions

231
Q

What do most CF patients die from?

A

Complications of respiratory infection

232
Q

What is an acapella?

A

Airway clearance device for CF patients

233
Q

What are treatments to mange GI complications of CF?

A

Pancreatic enzyme replacement
Adequate nutrition intake
Upright position after eating
Fat soluble vitamin and salt supplementation

234
Q

What are nursing considerations/recommendations related to CF patients marrying and having children?

A

Genetic counseling is recommended
Shorter life span
Reduced ability to care for children

Krystan: Semester Two Nursing School (13 decks)

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