CT 1 Flashcards
For some people, COPD causes significant destruction of the terminal airways and air sacs (alveoli). This form of COPD is called
emphysema
air spaces are created when the walls of the small respiratory airways and their alveoli are torn
emphysema
Another characteristic of _____ is decreased elasticity of lung tissue
emphysema
Besides reducing the lung area available for gas exchange, ____ leads to hyper-inflated lungs and obstructed airflow
emphysema
inflamed airways that become clogged with mucus
bronchitis
Patients with this variant of COPD develop a chronic cough that brings up sputum
bronchitis
For a COPD patient the POX should be
at least 90%
After securing the COPD patient’s airway, we would then
run an ECG because hypoxemia can cause arrhythmias
For someone in respiratory distress, Semi-Fowler’s position is good because it
helps to open the ribcage and helps respiratory muscle expansion
For someone in respiratory distress, Relaxation is important because
anxiety increases dyspnea
For someone in respiratory distress, Exercises such as deep breathing can facilitate relaxation; if this is ineffective,
an order for an anxiolytic could be recommended
Consideration when giving azithromycin: Monitor IV site for
inflammation and extravasation
Also carefully dilute the medication
Consideration when giving azithromycin: which labs should you assess
liver function/bilirubin levels
Consideration when giving azithromycin: because the drug can be nephrotoxic,
place on strict I and O
Consideration when giving azithromycin: timing?
administer over at least an hour
What’s the theory of carb loading
- CO2 is produced whens carbs are broken down.
- The increase in CO2 means that the body has to breath faster to get rid of it.
- In COPD patients, this is too much stress for their respiratory system
In a COPD patient, the largest portion of the diet should be
Carbs
COPD patient, feeding consideration
- 6 small meals
- Incorporate rest periods
Eating large meals can be an excessive workload for a patient with COPD and can
press down on the diaphragm which restricts lung movement
COPD patient: ___ foods take less energy to eat
Soft
Why does someone with COPD crave chocolate
it has methylxanthine that acts to relax smooth muscles by inhibiting phosphodiesterase, which has a bronchodilating effect
What medication that is sometimes taken by a COPD patient could cause elevated blood sugar
glucocorticoids
The expected ABG for a patient with COPD
partially compensated respiratory acidosis
What do you do for a COPD patient with partially compensated respiratory acidosis
It’s not an urgent situation. It’s the expected finding
What’s a goal for the COPD patient’s weight
Weight within 10% of the patient’s ideal weight
polycythemia
elevated RBC
the COPD patient should Supplement high-energy activities with
O2
Priority nursing dx for COPD patient
Impaired gas exchange
ACS is a term used to describe a situation where
the blood supplied to the heart muscle is suddenly blocked, leading to unstable angina or acute myocardial infarction
occurs primarily at rest, is triggered by smoking, and is thought to be due to coronary vasospasm.
Variant angina (Prinzmetal angina)
can aggravate angina because of potential for ischemia
Low Hgb and Hct levels
In the MI patient, an ECG is to
identify dysrhythmias
identify electrolyte imbalance
identify any myocardial ischemia present
damage to myocardial tissue from the past
a STEMI patient needs to go to cardiac catheterization lab immediately for
angioplasty or stenting
a ____ patient needs to go to cardiac catheterization lab immediately for angioplasty or stenting.
STEMI
In the MI patient, _____ is often an ominous sign of either poor immune response or decompensation
Hypothermia
Although a patient with ACS need to be on continous cardiac monitoring (Telemetry), they should be allowed to ____ as tolerated
mobilize
What is considered a very high Furosemide(lasix) dose
200 mg
part of standard ACS treatment to assess for cardiac structural defects
ECHO
You do not do IV _____ push because it can cause heart failure and death
potassium
Main MI dx
Altered cardiac perfusion related to myocardial ischemia
If ___ ventricular function is significantly impaired,pulmonary congestion and edema can occur
left
For MI patient, Monitor vital signs every __ min during ischemic episodes
5 min
what kind of BP readings might you get with an MI patient
may initially rise because of sympathetic stimulation, then fall if cardiac output is compromised
_____ would indicate the client has chronic constipation, which is a strong risk factor for diverticulosis
Hemorrhoids
Constipation increases the intraluminal pressure in the sigmoid colon, leading to
weakness in the intestinal lining, which, in turn, causes outpouchings, or diverticula
____ susceptibility is an important component for the development of diverticular disease
Genetic
mental risk factor for diverticular disease
stress
Shows thickening of bowel wall, indicative of inflammation
Also shows diverticulosis pouches
Barium enema
Superior to contrast enema in sensitivity and in evaluation of severity of inflammation
CT scan
Test that is suboptimal in obese patients
ultrasound
Contraindicated during an acute diverticular situation.
Used to evaluate healing process 6 weeks after acute episode
Colonoscopy
Diverticula
Small mucosal herniations protruding through the intestines
Diverticular can occur anywhere along the G.I. tract. They are the most common in
the colon, specifically the sigmoid
Diverticulitis
An inflammation of one or more diverticulae
Diverticulitis is caused by
a build up of fecal matter or undigested food particles collecting in diverticulum causing obstruction.
The obstruction leads to an overgrowth of the normal bacteria
obstructions combined with intraluminal pressure cause erosion of the diverticulum leading to inflammation, necrosis and possible
perforation
Diverticulitis: If abscesses are left untreated they may lead to the formation of ____
fistulas
the patient is experiencing the severe crampy pain of acute diverticulitis, Apply a ___ ___ on the lower abdomen
warm pack
the patient is experiencing the severe crampy pain of acute diverticulitis, the diet should be
clear liquid diet for 7 to 10 days
the patient is experiencing the severe crampy pain of acute diverticulitis, give Dicyclomine in order to
relax the smooth muscles
before he takes the initial dose of metronidazole, ask:
Have you had any ____ within the last 24 hours
alcohol
before he takes the initial dose of metronidazole, ask: Do you have any ___ problems
liver
before he takes the initial dose of metronidazole, ask: Are you taking
disulfiram
metronidazole: Do not use if patient has uncorrected ____ or severe renal impairment
hypokolemia
Ciprofloxacin- Do not use if experiencing peripheral
neuropathies
During the acute of of diverticulitis, can the patient take a laxative to help with the constipation
No
Is high fiber good for a diverticulitis patient
not during the acute phase. But later on it is good
What diet would you use for severe diverticulitis in the acute part
NPO
What’s the first diet for a diverticulitis patient and how does it progress
Clear liquid,
then low fiber
then high fiber
After the acute part of diverticulitis, what’s a good laxative
Bulk forming laxative
At discharge, what will you tell the diverticulosis client to eat
high fiber and water
What are ways the can diverticulosis patient can avoid increasing intra-abdominal pressure
bed rest
avoid straining, bending, lifting
diverticulitis nursing dx
Acute pain r/t inflammation of bowel secondary to diverticulitis
The OGTT is performed between
24 and 28 weeks of gestation
OGTT includes a total of __ blood draws
3
OGTT instructions
fast starting at midnight
water is OK
For the OGTT tests, What is the requirement for diagnosing DM
if any one of the 3 draws tests shows elevation, you’re positive
Who should undergo a fasting, 2 hour, 75 g glucose load test
All pregnant women
GDM: After birth, fetus no longer receives mother’s excess blood sugar but still has
excess insulin
causes Neonatal hypoglycemia
GDM risk factor, maternal age of
older than 25
diet used in treating GDM: Incorporating ____ in each meal and snack
protein
In GDM, Ketosis may indicate the need for
insulin
Consequences of persistent ketoacidosis are decreased
psychomotor skills and lower IQ
risks for your baby from gestational diabetes: Increased risk of baby developing
type II DM later in life
risks for your baby from gestational diabetes: spontaneous
abortion
risks for your baby from gestational diabetes: excess amniotic fluid, aka
Hydramnios
risks for your baby from gestational diabetes: something to do with the RBCs
Polycythemia which can lead to hyperbilirubinemia after birth and eventually jaundice
GDM: Don’t use ___ more than once to minimize risk of infection and cellulitis.
lancet
Appearance of short acting (regular) insulin
clear
Appearance of intermediate insulin
cloudy
a meal has to be eaten within __ minutes of the injection of short-acting (clear) insulin
30
Pneumothorax
the presence of air in the pleural space
Pneumothorax causes partial or complete
collapse of the affected lung
Spontaneous pneumothorax occurs when
an air filled bleb or blister on the surface of the lung is ruptured making air enter the pleural cavity
Tension pneumothorax
the intrapleural pressure is greater than the atmospheric pressure. Life threatening.
pneumothorax findings: on auscultation on the affected side
Reduced breath sounds
pneumothorax findings: on percussion
Hyper-resonance
CLOSED pneumothorax findings: Deviation of the trachea
away from the affected side
pneumothorax findings: Prominence of the
involved side of the chest
TREATMENT FOR S. PNEUMOTHORAX
Insertion of a chest tube in order to drain air out of the pleural space allowing lungs to re-inflate
50% of the patients who had spontaneous pneumothorax are at risk to
develop the second one within 3 years
When the ambulance came for the phneumothorax patient she was
intubated, started on intravenous lactated Ringer’s at KVO
Open pneumothorax is where the
pleural cavity is exposed to the outside air through a wound
Closed pneumothorax (spontaneous) is where
a patient with COPD has their lung collapse and the pleural cavity is not exposed to outside air
The physician needs to insert a chest tube. What are your responsibilities: Document and
witness the signing of consent and confirm the client understands procedure
The physician needs to insert a chest tube. What are your responsibilities: Encourage client to
void pre-procedure
After insertion of a chest tube, what if there’s continuous bubbling
this is expected because the hole in the lung is still healing
What if a long time after the chest tube is inserted there’s continuous bubbling
this is bad, there shouldn’t be an air leak at this time
Chest tube: lowering the water level in the suction control chamber ____ the strength of suction
lowers
Pleurodesis
procedure that prevents excess fluid from building up in the pleural space
If still draining greater than ___ ml in 24 hours by 48 hours following pleurodesis, repeat chest x ray and consider repeat pleurodesis
250
After pleurodesis the patient should avoid
NSAIDS
