chaptera 29, 30, 34, 35, 36, 37, 38, 39, 58, 59, 60, 62, 65 Flashcards
to leatn these subjects for the final
Measures to prevent relapse of pneumonia?
Health promotion:
There are many nursing interventions to help prevent the occurrence of pneumonia, as well as the morbidity associated with it. Teaching a client to practise good health habits, such as proper diet and hygiene, adequate rest, and regular exercise, can help the client maintain the natural resistance to infecting organisms. If possible, exposure to URIs should be avoided. If a URI occurs, it should be treated promptly with supportive measures (e.g., rest, fluids). If symptoms persist for more than 7 days, the person should obtain medical care. The individual at risk for pneumonia should be encouraged to obtain both influenza and pneumococcal vaccines.
Assessment of client with COPD? and cardiopulmonary complication?
Diagnosis of COPD is based on a history of exposure to risk factors and the presence of airflow limitation that is not fully reversible, with or without the presence of symptoms. Patients who have chronic cough and sputum production with a history of exposure to risk factors should be tested for airflow limitation, even if they do not have dyspnoea. For the diagnosis and assessment of COPD, spirometry is the gold standard as it is the most reproducible, standardized, and objective way of measuring airflow limitation. FEV1/FVC < 70% and a postbronchodilator FEV1 < 80% predicted confirms the presence of airflow limitation that is not fully reversible. Health care workers involved in the diagnosis and management of patients with COPD should have access to spirometry. Measurement of arterial blood gas tensions should be considered in all patients with FEV1 < 40% predicted or clinical signs suggestive of respiratory failure or right heart failure.
Assessment for pleural effusion?
Pleural effusion: is a collection of fluid in the pleural space. It is not a disease but rather a sign of a serious disease. Pleural effusion is frequently classified as transudative or exudative accord- ing to whether the protein content of the effusion is low or high, respectively. The type of pleural effusion can be determined from a sam- ple of pleural fluid obtained via thoracentesis (a procedure to remove fluid from the pleural space). Exudates have a high pro- tein content and the fluid is generally dark yellow or amber. Transudates have a low protien contecnt or contain no protien, and the fluid is clear or pale yellow. The fluid can also be analyzed for RBC or WBC malignent cells, bacteria and glucose.
Assessment for Pleurisy?
Pleurisy (pleuritis) is an inflammation of the pleura. The most common causes are pneumonia, TB, chest trauma, pulmonary infarctions, and neoplasms. The inflammation usually subsides with adequate treatment of the primary disease. Pleurisy can be classified as fibrinous (dry) with fibrinous deposits on the pleural surface or serofibrinous (wet) with increased production of pleural fluid that may result in pleural effusion. The pain of pleurisy is typically abrupt and sharp in onset and is aggravated by inspiration. The client’s breathing is shallow and rapid to avoid unnecessary movement of the pleura and chest wall. A pleural friction rub may occur, which is the sound over areas where inflamed visceral pleura and parietal pleura rub over one another during inspiration. This sound is usually loudest at peak inspiration but can be heard during exhalation as well. Treatment of pleurisy is aimed at treating the underlying dis- ease and providing pain relief. Taking analgesics and lying on or splinting the affected side may provide some relief. The client should be taught to splint the rib cage when coughing. Intercostal nerve blocks may be done if the pain is severe.
Assessment of client with and cardiopulmonary complication?
complications of CODP: Cor Pulmonale.
cor pulmonale is hypertrophy of the right side of the heart, with or without heart failure, resulting from pulmonary hypertension. In COPD, pulmonary hypertension is caused primarily by constriction of the pulmonary vessels in response to alveolar hypoxia, with acidosis further potentiating the vasoconstriction. Chronic alveolar hypoxia causes pulmonary arteriolar muscle hypertrophy. Chronic hypoxia also stimulates erythropoiesis, which causes polycythemia and increases the viscosity of the blood. Cor pulmonale is a late mani- festation of COPD with a poor prognosis; approximately 40% of clients with severe COPD have cor pulmonale. when pulmonary heypetension develops, the pressures on the right side of the heat must increse to push blood into the lungs. Eventually, right sides heat faliure develops. Heart sound changed include accentuation of the pulmonic component of the second heart sound, right sided ventricular diastolic S3 gallop and early systolic ejection clicking along the left sternal border. Overt manifestations of right sides heart faliure may develop, which include jugular venous distension hepatomegaly with right upper quadrant tenderness, ascites, epigastric distress, peripheral edema, and weight gain. Diuretics are generally used, but serum creatinine and blood urea nitrogen (BUN) must be monitored since diuretics can cause volume depletion. Electrolytes must be monitored, since hypokalemia can predispose to dysrhythmias.
TB skin test?
The body’s immune response can be emonstrated by hypersensitivity to a tuberculin skin test. A positive reaction occurs 2 to 12 weeks after the initial infection, cor- responding to the time needed to mount an immune response. A positive reaction indicated the persence of a turbculosis infection, but it does not show whether the infection is latent or active. Two step testing is recommended for initial screening of health care workers who will be gettig regularly retested in the future, and for those who have decreased reasopnse to allergens.
DVT (Deep Vein thrombosis) invervetions?
Nursing care for the client with venous thrombosis is directed toward the prevention of embolus formation and the reduction of inflammation. While the client is receiving anticoagulation therapy, the nurse should closely observe for any indication of bleeding, including epistaxis and bleeding gingivae. Urine should be assessed for gross or microscopic hematuria. A smoky appear- ance to the urine is sometimes noted if blood is present. A speci- men should be checked daily for hematuria. Particular attention should be paid to the protection of skin areas that may be trauma- tized. Surgical incisions should be closely observed for evidence of bleeding. Stools should be tested to determine the presence of occult blood from the gastrointestinal tract. Mental status changes, especially in the older client, should be assessed as a possible indi- cation of cerebral bleeding. IM injections should not be given.
Assessment of medication effectiveness for client with asthma?
less exaserbations of asthma becuase of continuess drug therapy
Measures to prevent relapse of pneumonia
-be sure to Finnish all prescribed antibiotics
-teach client to cough productively
-practise good health habits, such as proper
diet and hygiene, adequate rest, and regular exercise
-exposure to URIs should be avoided
-should be encouraged to
obtain both influenza and pneumococcal vaccines
Assessment of client with COPD and cor pulmonale complication
listening to heart sounds: Heart sound changes include accentuation of the pulmonic component of the second heart sound, right-sided ventricular diastolic S3 gallop, and early systolic ejection click along the left sternal border. which include distended neck veins (jugular venous distension), hepatomegaly with right upper quadrant tenderness, ascites, epigastric distress, peripheral edema, and weight gain.
Assessment for pleurisy and pleural effusion
Common clinical manifestations of pleural effusion are progressive dyspnea and decreased movement of the chest wall on the
affected side. There may be pleuritic pain from the underlying disease. Physical examination of the chest will indicate dullness to percussion and absent or decreased breath sounds over the affected area. The chest radiograph will indicate an abnormality if the effusion is greater than 250 mL. Manifestations of empyema
include the manifestations of pleural effusion, as well as fever, night sweats, cough, and weight loss. A thoracentesis reveals an
exudate containing thick, purulent material.
tb skin test
- The PPD test is used to determine if someone has developed an immune response to the bacterium that causes tuberculosis
- The standard recommended tuberculin test is the Mantoux test, which is administered by injecting a 0.1 mL volume containing 5 TU (tuberculin units) PPD into the top layers of skin of the forearm.
- Skin tests should be read 48-72 hours after the injection.
- The basis of the reading of the skin test is the presence or absence and the amount of induration (localized swelling).
- a negative test does not always mean that a person is free of tuberculosis. People who have been infected with TB may not have a positive skin test (known as a false negative result) if their immune function is compromised by chronic medical conditions, cancer chemotherapy, or AIDS.
DVT
- A DVT is a blood clot that forms in the deep veins of the legs most commonly, but can also occur in the veins of the upper extremities. That’s because the blood clot, which usually forms in a calf or thigh deep veins, can partially or completely block blood flow back to the heart and cause damage to the one-way valves in the veins.
DVT interventions
Encourage REST, elevate the extremities above the level of the heart (DO NOT PUT THINGS UNDER KNEES)- Moist compress to prevent embolus from dislodging- (DO NOT MASSAGE EXTREMITY) - Use SCD’s and antiembolism stalking- promote blood flow - Administer Meds (comp-bleeding) - LOW MOLECULAR WT HEPARIN, WARFARIN, ANALGESICS -Thrombolytic therepy- must be initiated within 5 days
Assessment of medication effectiveness for client with asthma
Asthma severity levels can change for better or worse over the course of the client’s life. This is particularly true for children with asthma, since asthma severity often decreases with age. Good asthma control correlates with minimal to no symptoms, the abil¬ ity to sleep through the night, and participation in sports, exercise, and strenuous activity. Once asthma control has been maintained for several months, an attempt should be made to reduce medica¬ tion while maintaining acceptable asthma control.
Signs of severe or poorly controlled asthma include a history of a previous near-fatal asthma episode (loss of consciousness, need for intubation); recent hospitalization or emergency department visit for asthma; nighttime symptoms; limitations in daily activities; and the need for inhaled p2-agonists several times each day or night.
