CT 1 Flashcards by Richard smith

For some people, COPD causes significant destruction of the terminal airways and air sacs (alveoli). This form of COPD is called

emphysema

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air spaces are created when the walls of the small respiratory airways and their alveoli are torn

emphysema

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Another characteristic of _____ is decreased elasticity of lung tissue

emphysema

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Besides reducing the lung area available for gas exchange, ____ leads to hyper-inflated lungs and obstructed airflow

emphysema

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inflamed airways that become clogged with mucus

bronchitis

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Patients with this variant of COPD develop a chronic cough that brings up sputum

bronchitis

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For a COPD patient the POX should be

at least 90%

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After securing the COPD patient’s airway, we would then

run an ECG because hypoxemia can cause arrhythmias

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For someone in respiratory distress, Semi-Fowler’s position is good because it

helps to open the ribcage and helps respiratory muscle expansion

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For someone in respiratory distress, Relaxation is important because

anxiety increases dyspnea

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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

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Consideration when giving azithromycin: Monitor IV site for

inflammation and extravasation

Also carefully dilute the medication

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Consideration when giving azithromycin: which labs should you assess

liver function/bilirubin levels

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Consideration when giving azithromycin: because the drug can be nephrotoxic,

place on strict I and O

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Consideration when giving azithromycin: timing?

administer over at least an hour

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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

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In a COPD patient, the largest portion of the diet should be

Carbs

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COPD patient, feeding consideration

6 small meals

- Incorporate rest periods

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Eating large meals can be an excessive workload for a patient with COPD and can

press down on the diaphragm which restricts lung movement

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COPD patient: ___ foods take less energy to eat

Soft

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Why does someone with COPD crave chocolate

it has methylxanthine that acts to relax smooth muscles by inhibiting phosphodiesterase, which has a bronchodilating effect

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What medication that is sometimes taken by a COPD patient could cause elevated blood sugar

glucocorticoids

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The expected ABG for a patient with COPD

partially compensated respiratory acidosis

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What do you do for a COPD patient with partially compensated respiratory acidosis

It’s not an urgent situation. It’s the expected finding

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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

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

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

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

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