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MedSurg 2 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

How often do you assess a IV?

A

-every 4 hours

-every 2 hours for vulnerable patients

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2
Q

How long do you scrub the hub for?

A

-30 seconds

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3
Q

Hypotonic Solution

A

<270

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4
Q

Isotonic Solution

A

-between 270-300

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5
Q

Hypertonic Solution

A

> 300

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6
Q

Isotonic Infusate

A

-water does not move into or out of body’s cells

-risk for fluid overload especially older adults

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7
Q

Hypertonic Infusate

A

-corrects fluid, electrolyte, and acid-base imbalances by moving water OUT of body’s cells, into bloodstream

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8
Q

Hypotonic Infusate

A

-move water into cells to expand them

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9
Q

Types of Catheters for Peripheral and Central IV therapy

A

-short peripheral catheters

-midline catheters

-peripherally inserted central catheters (PICC)

-nontunneled percutaneous central venous catheters (CVC)

-tunneled catheters

-implanted ports

-hemodialysis catheters

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10
Q

Short Peripheral Catheters

A

-superficial veins of forearm and dorsal surface of hands; external jugular if emergent

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11
Q

Length of Short Peripheral Catheters

A

-3/4 to 1 1/4 in length

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12
Q

Sizes of Short Peripheral Catheters

A

-26 gauge (smallest) to 14 gauge (largest)

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13
Q

Aseptic Preparation and Technique for IV insertion

A

-hand hygiene

-clip hair; do not shave

-ensure skin is clean

-wear gloves

-prepare skin with 70% alcohol or chlorhexidine

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14
Q

Midline Catheter

A

-3 to 8 inches long

-double or single lumen

-used for therapies lasting up to 2 weeks

-DO NOT use for vesicant drugs (can cause tissue damage)

-DO NOT use to draw blood

-no greater than 600 mOsm/L

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15
Q

Central IV Catheter

A

-vascular access device places in central circulation, specifically within the superior vena cava near junction with right atrium

-always use 10mL or larger syringe

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16
Q

How is a Central IV Catheter placement confirmed?

A

-x-ray

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17
Q

Peripherally Inserted Central Catheter

A

-length of 18 to 29 inches (45 to 72 cm)

-chest x-ray to confirm placement

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18
Q

Power PICCs

A

-used for contrast injection; can also attach to transducers for CVP monitoring

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19
Q

Nontunneled Percutaneous Central Venous Catheter

A

-inserted through subclavian vein in upper chest or jugular veins in neck

-may require insertion in femoral vein—rate of infection is high

-7 to 10 inches (15 to 25 cm) long; up to 5 lumens

-tip resides in superior vena cava

-chest x-ray confirms placement

-short term use

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20
Q

Tunneled Central Venous Catheter

A

-portion lies in subcutaneous tunnel

-used for frequent and long-term infusion therapy

-has cuff of antibiotic-containing material to help reduce infection

-less chance of infection

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21
Q

Implanted Ports

A

-cancer, long-term medicated patients

-consists of portal body, dense septum over a reservoir, and catheter

-single or double

-usually placed in upper chest/extremity

-flushing after use and at least once per month between therapies prevents clot formation in internal chamber

-up to 2,000 punctures

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22
Q

Hemodialysis Catheter

A

-large lumens accommodate hemodialysis or pheresis procedure (harvests specific blood cells)

-catheter-related bloodstream infections (CR-BSI), vein thrombosis are common problems

-do not use for administering other fluids/medications (except in emergency)

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23
Q

Older Adult Care

A

-skin care

-vein and catheter selection

-cardiac and renal changes

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24
Q

Infiltration

A

-the iv fluid leaked into the surrounding tissue

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25
Q

Phlebitis and Post Infusion Phlebitis

A

-inflammation of vein

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26
Q

Thrombophlebitis

A

-blood clot and inflammation of veins

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27
Q

Ecchymosis and Hematoma

A

-infiltration of blood into surrounding tissue and uncontrolled bleeding

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28
Q

Catheter Embolism

A

-piece of catheter breaks and is in vessels

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29
Q

Speed Shock

A

-the body’s reaction to a substance that is injected into the circulatory system too rapidly

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30
Q

Circulatory Overload

A

-disruption of fluid homeostasis with excess fluid

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31
Q

Common Reasoning for IV Therapy

A

-maintain fluid balance or correct fluid balance

-maintain electrolytes or acid base balance or correct electrolyte or acid imbalance

-administer medications

-replace blood or blood products

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32
Q

24-26 gauge - Smallest, shortest (3/4 -inch length)

A

-not ideal for viscous infusions

-expect blood transfusion to take longer

-preferred for infants or small children

-24 mL/min flow rate

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33
Q

22 gauge

A

-adequate for most therapies

-blood can infuse without damage

-38 mL/min flow rate

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34
Q

20 gauge (1-1 1/4 inch length)

A

-adequate for all therapies

-most providers of anesthesia prefer not to use a smaller size than this for surgery cases

-65 mL/min flow rate

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35
Q

18 gauge

A

-preferred size for surgery

-vein needs to be large enough to accommodate the catheter

-110 mL/min flow rate

36
Q

14-16 gauge

A

-for trauma and surgical patients requiring rapid fluid resuscitation

-needs to be in a vein that can accommodate

-over 200 mL/min flow rate

37
Q

Assessment of the Nose and Sinuses

A

-external nose: deformities or tumors

-nares: symmetry of size and shape

-nasal cavity: color, swelling, drainage, bleeding

-mucous membranes: abnormalities

-septal deviation

38
Q

Assessment of Pharynx, Trachea, and Larnyx

A

-mouth

-posterior pharynx

-neck: symmetry, alignment, masses, swelling, bruises, use of accessory neck muscles for breathing

-trachea: palpate for position, mobility, tenderness, masses

-larynx: voice abnormalities, hoarseness

39
Q

Assessment of Lungs and Thorax

A

-inspect thorax with patient sitting up

-observe chest, comparing one side with the other

-work from the apex, move downward towards base side to side

-rate, rhythm, depth of inspiration as well of symmetry of chest movement

-examine AP diameter with later diameter

-distance between ribs

-palpate to assess respiratory movement, symmetry

40
Q

Adventitious Sounds

A

-crackles

-wheezes

-rhonchi

-pleural friction rub

-striddle (3x wheezing EMERGENCY)

41
Q

Other Indications of Respiratory Issues

A

-clubbing

-unevenly developed muscles

-weight loss

42
Q

Early Signs of Hypoxia

A

S symptoms of restlessness

T tachycardia

R respirations are increased

E elevated blood pressure

S skin and mucous membranes pale

S sounds in lungs

43
Q

Late Signs of Hypoxia

A

C confusion and stupor

R respiration s decreased

A arrhythmias

S skin and mucous membranes cyanotic

H hear rate and blood pressure decrease

44
Q

Testing for Respiratory System

A

-blood: RBCs, Hgb, ABGs

-sputum

-standard chest x-ray, CT scan

-pulse oximetry

45
Q

Normal PETco2 Range

A

-between 20 and 40 mmHg

46
Q

Ideal Pulse Oximetry Range

A

-95% to 100%

47
Q

Invasive Diagnosis Endoscopy

A

-insertion of a tube for visualization and diagnostic purposes

-bronchoscopy most common

-used to stage lung cancer, biopsy lung tissue, place stents to open air way

-done under anesthesia

48
Q

Patient Preparation for Endoscopy

A

-complete blood count, platelet count, electrolytes

-chest x-ray

-NPO 4 to 8 hours before procedure (reduce risk of aspiration)

49
Q

After Procedure Care for Endoscopy

A

-check gag reflex before patient eats

-monitor vitals

-assess breath sounds every 15 minutes for the first 2 hours

-assess for complications such as bleeding, infection, or hypoxemia

50
Q

Invasive Diagnosis Thoracentesis

A

-needle aspiration of pleural fluid or air from pleural space

-pleura may be drained to relieve blood vessel or lung compression

51
Q

Patient Preparation for Thoracentesis

A

-stress the importance of not moving, coughing, or deep breathing during the procedure to avoid puncturing of the pleura or lung

-properly positioning and physically support the patient with using pillows to make the patient comfortable

52
Q

Procedure of Thoracentesis

A

-short 18 to 25 gauge needle

-no more than 1,000 mL of fluid is removed at one time

53
Q

Symptoms of Pneumothorax

A

-pain on the affected side that is worse at the end of inhalation and end of exhalation

-rapid heart rate

-rapid, shallow respirations

-a feeling of air hunger

-prominence of the affected side that does not move in and out with respiratory effect

-trachea slanted more to the unaffected side instead of being in the center of the neck

-new onset of nagging cough

-cyanosis

54
Q

Atelectasis

A

-state of partial or total lung collapse and airlessness

-commonly caused by the obstruction of the bronchus ventilating a segment of lung tissue

-manifestations may include diminished breath sounds over affects side, tachycardia, dyspnea, cyanosis, hypoxemia

-chest x-ray shows an area of airless lungs

55
Q

Obstructive Sleep Apnea

A

-breathing disruption during sleep due to upper airway obstruction by soft palate or tongue

-men more than women

-prevents deeps sleep leading to irritability, day time sleepiness and inability to concentrate

56
Q

Causes of OSA

A

-obesity

-large uvula

-a short neck

-smoking

-enlarged tonsils or adenoids

-oropharyngeal edema

-having certain genetic disorders such as SIDS during there first year of life can lead to OSA in older adults

57
Q

Management of OSA

A

-changes in sleeping position

-weight loss

-positioning fixing devices

-maxillomandibular advancement can improve airflow by supporting the lower jaw in a more forward position

-noninvasive positive pressure ventilation (NPPV) via continuous positive airway pressure (CPAP) to hold open the upper airways is most commonly used

58
Q

Asthma

A

-chronic disease in which reversible acute airway obstruction occurs intermittently reducing airflow

-occurs in two ways; inflammation or airway hyperrepsonsiveness leading to bronchoconstriction

-airway narrows, swells, and produces extra mucus

59
Q

Risk Factors of Asthma

A

-allergies

-environmental factors

-exercise

-stress

-genetic predisposition

-respiratory viruses

60
Q

Diagnostics of Asthma

A

-elevated serum eosinophil count

-elevated immunoglobulin E levels

pulmonary function test: FVC, FEV, PEF

61
Q

Clinical Manifestations of Asthma

A

-wheezing

-tachycardia

-dyspnea

-prolonged expiration

-use of accessory muscles

-hypoxemia

-increased mucus production

-AP diameter increased

62
Q

Treatment of Asthma

A

-bronchodilators and anti inflammatories agents

-avoid allergens and smoking cessation

-peak flow meter

-symptom diary

-oxygen therapy

63
Q

Bronchospasm

A

EMERGENCY

-narrowing of the bronchial tubes by constriction of the smooth muscle around and within the bronchial walls

64
Q

Short-Acting Beta2 Agonist (SABA)

A

-primary used as fast acting reliever drug to be used either during an asthma attack or just before engaging in activity that usually triggers an attack

-PRN, emergency drug

-albuterol (inhaled drug)

-levalbuterol (inhaled drug)

65
Q

Long-Acting Beta2 Agonist (LABA)

A

-causes bronchodilation through relaxing bronchiolar smooth muscle by binding to and activating pulmonary beta2 receptors

-daily meds

-salmeterol (inhaled drug) most common

-indacterol (inhaled drug) COPD only

-formoterol arformoterol COPD only

66
Q

Cholinergic Antagonists

A

-causes bronchodilation by inhibiting the parasympathetic nervous system to relieve and prevent asthma

-lpratropium (inhaled drug for relief and prevention) most common, hospital setting

-aclidinium (inhaled drug for prevention only)

-tiotropium (inhaled drug)

67
Q

Satus Asthmaticus

A

-severe, life threatening acute episode of airway obstruction that intensifies once it begins and often does not respond to usual therapy

68
Q

Chronic Obstructive Pulmonary Disease (COPD)

A

-collection of lower airway disorders that interfere with airflow and gas exchange

-two types; emphysema and chronic bronchitis

69
Q

Emphysema

A

-destructive problems of lung elastic tissue that reduces its ability to recoil after stretching, leading to hyperinflation of the lung, weakening the effectiveness of the muscle

-“air hunger” sensation

70
Q

Chronic Bronchitis

A

-inflammation of the bronchi and bronchioles caused by exposure to irritants, especially cigarette smoke

-only affects the airways not alveoli

-increases the number and size of mucus secreting glands which produce larger amounts of thick mucus

71
Q

Signs and Symptoms of COPD

A

-thin

-lose of muscle mass in extremities

-although neck muscles may be enlarged

-tends to be slow moving and slightly stooped

72
Q

Assessment for Patients w COPD

A

-check patients chest for retractions and asymmetric chest expansion

-auscultate the chest to assess the depth of inspiration and any abnormal breath sounds

-examine for “barrel chest” (ratio between the anteroposterior diameter of the chest and its lateral diameter is 1:1 rather than the normal ratio of 1:5 as a result of lung overinflation and diaphragm flattening

-assess heart rate and rhythm

-check for swelling for feet and ankles

-nail beds and oral mucous membranes

73
Q

Mucolytic Agent

A

look up in book dumbass

74
Q

How often do you assess a patient with COPD?

A

-at least every 2 hours

75
Q

Management of COPD

A

-coughing effectively

-may need O2 flow of 2 to 4 L/min via nasal cannula of up tp 40% via venturi mask

-O2 level between 88 to 92 are normal for COPD patients

-PRN suctioning if needed

-maintain hydration should drink at least 2 L/day

76
Q

Pneumonia

A

-common disorder with many causes that reduce gas exchange; associated with the formation of thick exudate containing proteins and other particles that seriously reduce gas exchange

-can be triggered by infectious organisms and by inhaling irritating agents

77
Q

Community Acquired Pneumonia

A

-older adults

-has never received the pneumonia vaccine or received it more than 5 years ago

-did not have influenza vaccine in the previous year

-has a chronic health problem or other coexisting conditions that reduce immunity

-has been exposed to respiratory viral or infection

-uses tabacco or alcohol is exposed to high amounts

78
Q

Health Care Acquired Pneumonia

A

-older adults

has a chronic lung disease

-has presence of gram-negative colonization of the mouth, throat and stomach

-has an altered level consciousness

-recent aspiration event

-presence of endotracheal, tracheostomy, or nasogastric tube

-poor nutritional status

-reduced immunity

-uses drugs that increase gastric pH

-currently receiving mechanical ventilation

-onset occurs <48hr

79
Q

Causes of Pneumonia

A

-bacteria, viruses, fungi, worms

-inhalation of toxic gases, chemical fumes, and smoke

-aspiration of water, food, fluids, vomit

80
Q

Pneumonia Vaccine

A

-65 and above need 2 vaccines

81
Q

Symptoms of Pneumonia

A

-increased respiratory rate/dyspnea

-hypoxemia

-cough

-purulent, blood-tinges or rusted color sputum

-fever

-pleuritic chest discomfort

82
Q

Tuberculosis (TB)

A

-highly communicable disease caused by infection with mycobacterium tuberculosis, one of the most common bacterial infections worldwide with the top 10 causes of death

-when a person with active TB coughs, laughs, sneezes, whistles, or sings infectious droplets become airborne

83
Q

Symptoms of TB

A

-progressive fatigue

-lethargy

-nausea

-anorexia

-weight loss

-irregular menuses

-low grade fever

-night sweats

-symptoms may have been present for weeks or months

84
Q

Diagnostic Testing for TB

A

-chest x-ray

-sputum cultures of blood or respiratory secretions

-Mantoux test; small amount (0.1 mL) of purified protein derivate (PPD) is placed intradermally in the forearm, test is read in 48 to 72 hours

-area of indurations (localized swelling with hardness of soft tissue), not just redness measuring 10 mm or greater in diameter indicated exposure and possible infection with TB

85
Q

Treatment for TB

A

-page 579

86
Q

Review IV flow rate and Drop Rate Practice

A

-in modules under week 1

MedSurg 2 (1 decks)

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