Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NCM 118 LEC > CHAPTER 2 > Flashcards

CHAPTER 2 Flashcards

1
Q

Recurrent episodes of airway obstruction leading to reduction in ventilation when ASLEEP
Cessation of breath or apnea

A

Obstructive Sleep Apnea (OSA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

RISK FACTORS OF OSA
O, M, P, A, U

A
  • Obesity- parapharyngeal circumference fat; large neck
  • Male
  • Post-Menopausal stains
  • Advance age
  • Unstable respiratory nerves
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PATHOPHYSIOLOGY OF OSA

A
  1. Decreased upper airway muscle tone (asleep)
  2. pharynx is compressed by surrounding tissues
  3. upper airway collapse
  4. obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Clinical signs of OSA
SN, SL, SO, T

A
  • Snoring/ gasping/ choking
  • Sleepiness (hypersomnolence during daytime)
  • Significant other report of sleep apneic episodes
  • Thick neck circumference
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

DIAGNOSTIC TEST (OSA)

A
  • Polysomnogram test (sleep study)
    - RPSGT (Registered polysomnographic technologist)
    - Overnight study
  • Electroencephalogram
  • Electro oculogram
  • ECG
  • Respiratory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Medical management (OSA)
W, A, P, C, O

A
  • Weight loss
  • Avoidance of alcohol and sedatives
  • Positional therapy lateral
  • CPAP or BiPAP (standard treatment)
  • Oxygen inhalation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

CPAP airflow (OSA)

A
  • Continuous positive airway pressure
  • Single set pressure throughout the sleep
  • Generally, more affordable
  • Not as great accommodating changes in breathing
  • Constant pressure during inhale
  • Pressure relief during exhale
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

BiPAP airflow (OSA)

A
  • Stands for Bilevel positive airway pressure
  • Two distich pressure setting for inhale and exhale
  • Comple sleep and breathing
  • Constant set pressure during inhale
  • Constant set pressure during exhale
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

OSA- Surgical Management

A
  • tonsillectomy
  • uvulopalatopharyngoplasty
  • maxillomandibular advance surgery
  • nasal septoplasty
  • tracheostomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pt. w/ larger tonsils but low BMI

A

Tonsillectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

resection of pharyngeal soft tissue, removal of 15mm free edge of the soft palate and uvula

A

Uvulopalatopharyngoplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Repositioning of upper jaw

A

Maxillomandibular advance surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Nasal septum deformities

A

Nasal Septoplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Last option (develops speech diff. and infections’

A

Tracheostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pharmacologic management (not generally recommended in OSA)

A
  • Modafinil (Provigil) Stimulants
  • Medroxy progesterone acetate (Provera) Progestins
  • Protorptylize (triptil) Trycyclic anti-depressants
  • Acetazolamide (Diamox)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Decrease time of sleepiness (drug- OSA)

A

Modafinil (Provigil) Stimulants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hyper alveolar hypoventilation (drug in OSA)

A

Medroxy progesterone acetate (Provera) Progestins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Given @ bedtime to increase respi. Drive and improve muscle tone (drug in OSA)

A

Protorptylize (triptil) Trycyclic anti-depressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Carbonic anhydrase inhibitor; HypeR alveolar hypoventilation

A

Acetazolamide (Diamox)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

NURSING CONSIDERATIONS (OSA)

A

Educate patient on Disorder (daytime sleepiness) and Safe use of equipment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Hemorrhage from the nose, caused by tiny ruptures; distended vessels in the mucous membrane

A

EPISTAXIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

More common on ANTERIOR SEPTUM;

A
  1. Anterior ethmoidal artery (Kiesselbach plexus)
  2. Sphenopalatine artery
  3. Internal maxillary branches
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

RISK FACTORS OF EPISTAXIS

A
  • Local Infections
  • Systemic infections (scarlet fever, malaria)
  • Drying of nasal mucous membranes
  • Nasal inhalation of illicit drugs (cocaine)
  • Trauma (digitalis trauma, picking of nose, blunt trauma, forceful sneezing)
  • Arteriosclerosis
  • Hypertension
  • Tumor
  • Thrombocytopenia- less than the normal (Normal:150,000-450,000 platelets / mcl)
    of blood
  • Use of ASA (aspirin)- Any anti-coagulants
  • Liver Disease- Synthesize molecules for clotting
  • Rendu-Osler weber syndrome- Vascular dysplasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Pathophysiology of Epistaxis

A
  1. Eroded nasal mucosa
  2. Exposed vessels
  3. Rupture of blood vessels
  4. Bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Medical Management of Epistaxis:

A

Applying direct pressure:

  1. Relax
  2. sit
  3. Head tilted forward * To prevent aspiration
  4. Apply direct pressure *Soft portion of the nose: 10- 15 minutes
  5. May insert small gauze pad into the bleeding nostril then apply digital pressure if bleeding continues
  6. Seek medical assistance if bleeding continues
26
Q

Pharmacological management (Epistaxis)

A
  • Determine the site of bleeding
  • Penlight, nasal speculum, and suctioning
    a. Anteroinferior,
    b. Anterosuperior,
    c. posterosuperior,
    d. posteroinferior
  1. Nasal Decongestant (Phenylephrine)- vasoconstrictor
  2. Topical cocaine 4%- anesthetic and vasoconstrictor
    • For combination of oxymetazoline (T.Decongestant)
    and Tetracaine (T.Anesthetic)
  3. Cauterization (Silver nitrate) * burning sensation
  4. Use of nasal tampons/pledgets
  5. Nasal gauze packing *up to 6 days
    - Antibiotics- risk for Ca, iatrogenic (infection d/t medical procedure), sinusitis, or toxic shock syndrome
  6. Balloon inflated catheter
27
Q

Nursing considerations (Epistaxis)

A
  • Monitor VS
  • Provide emesis basins
  • Help reduce anxiety
  • Assess airway and breathing
  • Self-care education
28
Q

Blunt and penetrating trauma

A

Chest trauma

29
Q

Sudden compression or positive pressure inflicted to the chest wall

A

Blunt trauma

30
Q
  • Foreign objects penetrate the chest wall
  • Open injuries- lacerations, stab wound, or amputation
A

Penetrating trauma

31
Q

Common causes of blunt trauma

A
  1. Motor vehicle crashes/accidents
    A. Acceleration
    B. Deceleration
    C. Shearing
    D. Compression
32
Q

moving object hitting the chest or thrown
in an object

A

Acceleration

33
Q

Sudden decrease in motor speed

A

Deceleration

34
Q

stretching forces to areas of the chest causing tear or rupture

A

Shearing

35
Q

direct blow to the chest

A

Compression

36
Q

T/F
7 true ribs
3 false ribs
2 floating ribs

A

True

37
Q

STERNAL/RIB

Common: Motor vehicular crashes via steering wheel

A

Sternal

38
Q

Clinical manifestations of Sternal
A, E, S, S, P

A
  • Anterior chest pain
  • Ecchymosis - bruises (superficial)
  • Subq crepitus
  • Swelling
  • Possible chest wall malformation
39
Q

STERNAL/RIB

  • Common: Chest trauma
  • 5th to 9th ribs are the most common site of fracture
  • Fracture of first, 3 ribs may cause laceration of the subclavian artery
  • Lower ribs may be associated with spleen or liver injuries or lacerations
A

Rib

40
Q

Clinical manifestations (RIBS)
S, P, M, B

A
  • Severe pain
  • Pant tenderness
  • Muscle spasms that aggravate by coughing, deep breathing, and movement
  • Bruise on affected area
41
Q

PRIMARY ASSESSMENT (BLUNT TRAUMA STERNAL/RIB)
A, B, C, D

A
  • Airway
  • Breathing
  • Circulation
  • Disability
    (Neurologic status)
42
Q

SECONDARY ASSESSMENT (BLUNT TRAUMA STERNAL/RIB)

A
  • Exposing the patient (remove all clothing to check for injuries)
  • Environment is a reminder to prevent the patient from losing too much heat (DECREASED temp = DECREASED metabolism)
  • Full set of VS should be obtained
  • Family should be present during the treatment
  • Giving comfort
  • History and head-to-toe assessment
  • Inspection of the posterior surfaces of the patient’s body for injury
43
Q

Assessment (Blunt trauma sternal/rib)

A
  • Auscultation - grating/crackling sound in the thorax (subcutaneous crepitus)
  • Identify underlying cardiac injuries
44
Q

Diagnostics (Blunt trauma sternal/rib)

A
  • Chest x-ray/rib films
  • ECG
  • Continuous pulse oximetry
  • ABG analysis
45
Q

Medical management (Blunt trauma sternal/rib)

A

Relief of pain
- Sedation - epidural anesthesia/non-opioid analgesics

  • Intercostal nerve block
  • Ice compression
  • Use of chest binder - it should be snugly enough so as to not impede respiratory excursion
    • Pain subsides 5-7 days
    • Rib fractures heal in 3-6 weeks
  • Avoid excessive activity
  • Treat associated injuries
46
Q

Nursing considerations (Blunt trauma sternal/rib)

A
  • Educate patient on use of chest binder
  • Ice over the fracture site
47
Q
  • Complication from steering wheel injury/VA/fall
  • Occur when 2 or more adjacent rib, sternum, or costal cartilages are fractured at 2 or more sites resulting in free-floating rib segments.
A

Blunt trauma: Flail chest

48
Q

Pathophysiology of Flail chest

A
  1. Inspiration
  2. Chest expansion
  3. Flail rib segment is pulled inward (Pendelluft movement)
  4. Decreased amount of air Expiration
  5. Flail rib segment bulges outward
  6. Expiratory impairment
49
Q

Clinical manifestations of flail chest
DOB, P, P, R, HYPO, RA, HYPO

A
  • DOB
  • Pain in chest wall
  • Paradoxical chest wall movement
  • Retained airway secretions and atelectasis
  • Hypoxemia (low O2 in the arterial blood)
  • Respiratory acidosis
  • Hypotension, inadequate tissue perfusion and metabolic acidosis
50
Q

Medical management (Flail chest)

A

• Ventilatory support
• Clear airway
• Intubation
• Control pain

51
Q
  • Bruises of Lung Parenchyma
  • Effected lung tissue can be small, large, entire lobe or whole lung
  • More common on blunt type of trauma
A

Blunt trauma: Pulmonary contusion

52
Q

Pathophysiology of pulmonary contusion

A
  1. Injury to Lung Parenchyma & Tissues
  2. Leakage of Serum Protein (Neg. Feedback)
  3. Non-Cardiogenic Pulmonary Edema
  4. Gas Exchange Interference
  5. Intra pulmonary shunting
  6. Hypoxemia
53
Q

Clinical manifestations of Pulmonary contusion
(Mild symptoms)
T, D, C, H, BL

A
  • Tachycardia, Tachypnea
  • Decreased Breath Sounds
  • Chest pain
  • Hypoxemia
  • Blood-tinged secretions
54
Q

Clinical manifestations of Pulmonary contusion
(Moderate symptoms)
L, C, F

A
  • Large amount of secretions
  • Frank Blood in Tracheo blood therapy
  • Constant Coughing
55
Q

Clinical manifestations of Pulmonary contusion
(Severe symptoms in Major Organs)
C, A, P

A
  • Central cyanosis- delivery is affected
  • Agitation
  • Productive cough w/ frothy-bloody secretions
56
Q

DIAGNOSTIC TESTS (PULMONARY CONTUSION)

A
  • ABG
  • CXR
57
Q

Medical management (Pulmonary contusion)

A
  1. Priority: Maintaining Airway oxygen and controlling pain
  2. Mild: Hydration, Pain management, anti-microbial therapy, supplemental oxygen (Nasal, Face mask, for
    24-36 hours)
  3. Moderate: Intubation, NGT insertion, bronchoscopy
  4. Severe: Intubation, Diuretics, anti-biotic meds, fluid restriction
  5. Pain & Antibiotic: According to tolerance of the patient
58
Q
  • Stab wounds are the most common (low-velocity projectile)
  • Gun shot wounds (GSW), consider the distance, caliber, shape, size of the bullet
A

Penetrating trauma

59
Q

Diagnostic tests (penetrating trauma)

A

• Chest X-ray
• Blood Chemistry
• ABG
• ECG
• Pulse Oximeter
• CT Scan
• Blood typing
• Cross matching

60
Q

Management (penetrating trauma)

A

Objective: Restore & Maintain Cardio-Pulmonary
Function

NCM 118 LEC (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions