Adult Health 1 Exam 1 Flashcards
Penecillins
Phlebitis at IV site
superinfection
oral penecillin G should be taken on an empty stomach
probenecid
Probenecid decreases renal excretion, thereby resulting in an increased blood level of the penecillin
Oxacillin sodium
Nafcillin sodium
Cloxacillin sodium
Dicloxacillin sodium
superinfection (sore mouth, vaginal discharge, diarrhea, cough)
Ampicillim
rash
Gentamicin sulfate
Tobramycin sulfate (Nebcin)
Amikacin sulfate
used on gram negative bacteria neuromuscular blockade nephrotoxicity ototoxicity superinfection peak, trough, renal function studies
Cephalosporins
superinfection
thrombophlebitis
Aztreonam (azactam)
Pseudomonas aeruginosa+many otherwise reistent organisms most effective against gram neg phlebitis pseudomembraneous colitis CNS changes EEG changes HA, diplopia Hypotension assess motor sensory function and cardiac rhythm
Macrolides:
Clarithromycin (Biaxin)
Azithromycin (Zithromax)
Erythromycin
pseudomembranous colitis
phlebitis: vescicant
superinfections
space MAOI 14 days before start and end of Biaxin
Fluoroquinolones
CIpro
superinfections CNS disturbances Vescicant Monitor liver, renal, blood counts many drug interactions
Clindamycin
used in PCN and erythromycin allergies agranulocytosis pseudomembranos colitis superinfections liver, renal, blood studies reprot diarrhea immediately
Bronchial breath sounds are heard
over areas of density or consolidation. Sound waves are easily transmitted over consolidated tissue
Early signs of cerebral hypoxia
restlessness and irritability
Chronic Bronchitis
chronic sputum with cough production on a daily basis for a min of 3 months in each of 2 consecutive years.
chronic hypoxemia, cor pulmonale
increase in mucus, cilia produciton
increase in bronchila wall thickness which obstructs airflow
reduced responsiveness of respiratory center to hypoexemic stimuli
Chronic Bronchitis Assessment
right sided heart failure distended neck veins crackles expiratory wheezes generalized cyanosis
Chronic bronchitis and Emphysema nursing interventions
lowest FIo2 possible to prevent CO2 retention
monitor for s/sx of fluid overload
maintain PaO2 55-60
baselines ABGs
Teach pursed lip breathing and diaphragmatic breathing
teach tripod position
administer bronchodilator and anti inflammatory agents
Emphysema
reduced gas exchange surface area
increased air trapping (increased AP diameter)
Decreased capillary network
increased work, increased o2 consumption
Emphesema assessment
barrel chest pursed lip breathers distant, quiet breath sounds wheezes pulmonary blebs on radiograph
COPD is characterized by
bronchospasm and dyspnea
Dietary supplements for COPD
Vit C
Mg and Calcium (role in muscle contraction and relaxation)
Mg and Phosphate r/t role in bone density to avoid osteoporosis
Suctioning key points
apply suction only when wd catheter (and gently rotate the catheter while wd)
never suction for more than 10-15 seconds and pass the catheter only 3 or fewer times
Oxygenate before and after suctioning
Surgery and smoking
it is recommended to quit smoking 2 days prior to surgery, but research shows that to actually decrease post op complications r/t smoking, cessation for 8 weeks prior to surgery is best
Meds that increase surgical risk
anticoags
tranquilizers (risk for hypotension)
heroin (decrease CNS response)
antibiotics (erythromycin/anesthesia incompatibility)
diuretics (may precipitate electrolyte imbalance)
steriods (potential for cardiovascular collapse if dc abruptly, therefore, a bolus may be given before and after surgery
OTC herbs
Vit E (increase bleeding time)
MAOIs (NArdil)
ASA (platelet aggregation decreased)
Liver disease and surgery
liver disease impairs the liver’s ability to detoxify meds used during surgery, to produce prothrombin, or to metabolize nutrients for wound healing
s/sx shock and hemorrhage
hypotension narrow pulse pressure rapid, weak pulse cold, moist skin increased capillary filling time
how often should clients turn, cough, and deep breathe?
q2h
post op vitals schedule
q 15 mins for first hour
q30 mins next 2 hours
temp is measured q4hrs for first 24 hrs post op
cardiac asthma manifests with
expiratory wheezes
fine crackles early in inspiration indicate
bronchitis or pneumonia
wheezes indicate
partial obstruction
meds for OSA
modafinil (provigil) t oreduce daytime sleepiness
Protriptyline (Triptil) at bedtime to increase respiratory drive and improve upper airway muscle tone
Hyperthyroidism: Graves Disease/ Goiter
either hypersecretion of thyroid or Anterior pituitary
thyroid storm
acceleration of body processes: weight loss, increased appetite, diarrhea, heat intolerance, tachycardia, palpitations, increased BP, diaphoresis, wet or moist skin, nervousness, insomnia, exophalamus
T3 and T4 values that indicate hyperthyroidism
T3 > 220 ng/dL
T4 > 12 mcg/dL
Hyperthyroidism caused by anterior pituitary
will have elevated TSH and T3/T4
primary hyperthyroidism has normal or low TSH
Thyroid storm
life threatening event caused by Graves disease, childbirth, CHF, DKA, infection, PE, emotional distress, trauma, surgery
Sx: fever, tachycardia, agitation, anxiety and HTN
Primary Nursing intervention for thyroid storm
maintain airway and adequate aeration
Antithyroid drugs used to treat thyroid storm
PTU and Tapazole block synthesis of T3/T4; Propranolol (Inderal) may be given to decrease excessive SNS.
Hyperthyroidism recommended diet
high calorie, high protein, low caffeine, low fiber if diarrhea present
Post op thyroidectomy
be prepared for possibility of laryngeal edema. Put a tracheostomy set at the bedside along with O2 and a suction machine. calcium gluconate should be easily accessible
signs/Sx laryngeal edema
hoarseness or inability to speak clearly
Thyroidectomy post op assessments
bleeding
irregular breathing
frequent swallowing
do not hyperextend neck
laryngeal edema (hoarseness and inability to speak clearly)
Monitor Troussea and Chvostek signs as removal of parathyroid may lead to tetany
keep drainage devices compressed and empty
