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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
Phlebitis and Post Infusion Phlebitis
-inflammation of vein
26
Thrombophlebitis
-blood clot and inflammation of veins
27
Ecchymosis and Hematoma
-infiltration of blood into surrounding tissue and uncontrolled bleeding
28
Catheter Embolism
-piece of catheter breaks and is in vessels
29
Speed Shock
-the body's reaction to a substance that is injected into the circulatory system too rapidly
30
Circulatory Overload
-disruption of fluid homeostasis with excess fluid
31
Common Reasoning for IV Therapy
-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
32
24-26 gauge - Smallest, shortest (3/4 -inch length)
-not ideal for viscous infusions -expect blood transfusion to take longer -preferred for infants or small children -24 mL/min flow rate
33
22 gauge
-adequate for most therapies -blood can infuse without damage -38 mL/min flow rate
34
20 gauge (1-1 1/4 inch length)
-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
35
18 gauge
-preferred size for surgery -vein needs to be large enough to accommodate the catheter -110 mL/min flow rate
36
14-16 gauge
-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
Assessment of the Nose and Sinuses
-external nose: deformities or tumors -nares: symmetry of size and shape -nasal cavity: color, swelling, drainage, bleeding -mucous membranes: abnormalities -septal deviation
38
Assessment of Pharynx, Trachea, and Larnyx
-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
Assessment of Lungs and Thorax
-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
Adventitious Sounds
-crackles -wheezes -rhonchi -pleural friction rub -striddle (3x wheezing EMERGENCY)
41
Other Indications of Respiratory Issues
-clubbing -unevenly developed muscles -weight loss
42
Early Signs of Hypoxia
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
Late Signs of Hypoxia
C confusion and stupor R respiration s decreased A arrhythmias S skin and mucous membranes cyanotic H hear rate and blood pressure decrease
44
Testing for Respiratory System
-blood: RBCs, Hgb, ABGs -sputum -standard chest x-ray, CT scan -pulse oximetry
45
Normal PETco2 Range
-between 20 and 40 mmHg
46
Ideal Pulse Oximetry Range
-95% to 100%
47
Invasive Diagnosis Endoscopy
-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
Patient Preparation for Endoscopy
-complete blood count, platelet count, electrolytes -chest x-ray -NPO 4 to 8 hours before procedure (reduce risk of aspiration)
49
After Procedure Care for Endoscopy
-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
Invasive Diagnosis Thoracentesis
-needle aspiration of pleural fluid or air from pleural space -pleura may be drained to relieve blood vessel or lung compression
51
Patient Preparation for Thoracentesis
-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
Procedure of Thoracentesis
-short 18 to 25 gauge needle -no more than 1,000 mL of fluid is removed at one time
53
Symptoms of Pneumothorax
-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
Atelectasis
-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
Obstructive Sleep Apnea
-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
Causes of OSA
-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
Management of OSA
-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
Asthma
-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
Risk Factors of Asthma
-allergies -environmental factors -exercise -stress -genetic predisposition -respiratory viruses
60
Diagnostics of Asthma
-elevated serum eosinophil count -elevated immunoglobulin E levels pulmonary function test: FVC, FEV, PEF
61
Clinical Manifestations of Asthma
-wheezing -tachycardia -dyspnea -prolonged expiration -use of accessory muscles -hypoxemia -increased mucus production -AP diameter increased
62
Treatment of Asthma
-bronchodilators and anti inflammatories agents -avoid allergens and smoking cessation -peak flow meter -symptom diary -oxygen therapy
63
Bronchospasm
EMERGENCY -narrowing of the bronchial tubes by constriction of the smooth muscle around and within the bronchial walls
64
Short-Acting Beta2 Agonist (SABA)
-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
Long-Acting Beta2 Agonist (LABA)
-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
Cholinergic Antagonists
-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
Satus Asthmaticus
-severe, life threatening acute episode of airway obstruction that intensifies once it begins and often does not respond to usual therapy
68
Chronic Obstructive Pulmonary Disease (COPD)
-collection of lower airway disorders that interfere with airflow and gas exchange -two types; emphysema and chronic bronchitis
69
Emphysema
-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
Chronic Bronchitis
-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
Signs and Symptoms of COPD
-thin -lose of muscle mass in extremities -although neck muscles may be enlarged -tends to be slow moving and slightly stooped
72
Assessment for Patients w COPD
-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
Mucolytic Agent
look up in book dumbass
74
How often do you assess a patient with COPD?
-at least every 2 hours
75
Management of COPD
-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
Pneumonia
-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
Community Acquired Pneumonia
-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
Health Care Acquired Pneumonia
-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
Causes of Pneumonia
-bacteria, viruses, fungi, worms -inhalation of toxic gases, chemical fumes, and smoke -aspiration of water, food, fluids, vomit
80
Pneumonia Vaccine
-65 and above need 2 vaccines
81
Symptoms of Pneumonia
-increased respiratory rate/dyspnea -hypoxemia -cough -purulent, blood-tinges or rusted color sputum -fever -pleuritic chest discomfort
82
Tuberculosis (TB)
-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
Symptoms of TB
-progressive fatigue -lethargy -nausea -anorexia -weight loss -irregular menuses -low grade fever -night sweats -symptoms may have been present for weeks or months
84
Diagnostic Testing for TB
-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
Treatment for TB
-page 579
86
Review IV flow rate and Drop Rate Practice
-in modules under week 1

MedSurg 2 (1 decks)

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