Exam #1 Flashcards
what should the charge nurse do in relation to staffing?
bed assignments, look at call ins, be aware of LPNs, is their staff being floated out?
what kind of listening should a charge nurse have?
active
what is active listening?
listening to what is being said and responding
what might a nurse have to tell a nurse about their perfomance?
that they are not doing their job
what are the steps in mediating conflict?
accept that conflict happens, be calm, active listening, analyze conflict, be neutral, separate the problems, and work together
when is it a bad time to educate a patient?
after giving bad news or after giving narcotics
what reading level should you break things down to when dealing with patietns?
8th grade
what can stress a nurse out?
inadequate knowledge, floating, death, environment, burnout
what behavioral changes are signs of burnout?
withdrawal, risk taking, impulsive, decreased productivity, career change, tardy, less time with patient
what physiological changes are signs of burnout?
fatigue, sleep problems, appetite changes
what psychological changes are signs of burnout?
blaming others and sterotyping
what cognitive changes are signs of burnout?
decreased judgment, lack of initiative, and forgetful
what emotional changes are signs of burnout?
apathy, anger, anxiety, bored, irritable,
what meds cant a LPN give?
vasoactive drugs
what does ABC stand for?
airway, breathing, cardiac
what is something that needs to be observed on the neck with chest truama?
ensuring that the trachea is midline
what is blunt force trauma?
trauma from hitting an object without penetration
what can blunt force chest trauma lead to?
hypoxemia, hemorrhage, pneumothorax, hemothorax, hypovolemia, and cardiac failure
how serious is blunt force trauma?
can be life threatening
what bone is commonly broken in blunt force trauma?
ribs
what are the most common places for ribs to break?
4-10
what lung disease can rib fractures lead to ?
pneumonia
what makes tenderness/muscle spasms worse in rib breaks?
coughing, moving, deep breathing
what are symptoms of rib/sternal breaks?
point tenderness, muscle spasms, bruising, swelling, crepitus, chest wall deformity, dyspnea XXXXXXXXXXXXXXXXXXXX
what is the treatment for a normal rib fracture?
not splinted, sternal wraps may be used light wraps, intercostal nerve blocks, NSAIDs, Opiods
what is the preferred medication to treat normal rib fractures?
NSAIDs are preferred because they do not cause lowered RR or resp depression
what device might rib fracture patients have for pain?
PCA
can you push PCA button for rib fracture patients?
no
when is a rib fracture considered flail chest?
when there are three of more ribs broken in a row and in two or more places in each rib
what are the symptoms of a flail chest?
dyspnea, cyanotic, impaired gas exhange, sob, anxiety, low pulse ox, bruising, tachycardia, paradoxical chest movement
what does paradoxical chest movement look like?
on inspiration the chest wall caves in, on expiration the chest wall exands, the patient will be in pain
what should be done for both broken rib/flail chest?
TCDB
when is a vent required in flail chest?
if they have severe dyspnea or a big drop in pulse ox
what kind of vent setting will flail chest have?
peep
what kind of lumen trach tube will flail chest have while intubated?
double lumen due to the different pressure in the chest
what surgery might flail chest get?
stabilization surgery with pins/plates
what should be monitored in rib fracture patients?
the vital signsXXXXXXXXXXXXXXXXXXX
what is the pain management for flail chest?
IV pain med, epidural, nerve block
what might be given to flail chest patients?
O2 and iv fluids
what is a pulmonary contusion?
occurs when there is bruising/bleeding into the lungs between the alveoli….the tissue gets oversaturated with blood effecting gas exchange
what causes pulmonary contusion?
any type of chest trauma
what can a pulmonary contusion lead to?
respiratory distress
what are the symptoms of pulmonary contusion?
decreased breath sounds, tachypnea, tachycardia, chest pain, hypoxemia, crackles, frank bleeding, bloody sputum, agitation, respiratory acidosis, decreased lung movement, fatigue, hemoptysis
how do you manage mild pulmonary contusion?
IV or Oral fluids, O2 high flow, moderate fowlers, expansion techniques
how do you manage moderate pulmonary contusion?
ventilation with PEEP, NG tube for GI distention, Bronchoscopy,
how do you manage severe pulmonary contusion?
Vent, diuretic, fluid restriction and antibiotics
what should you monitor for when giving fluids to pulmonary contusion patietns?
make sure they dont get hypervolemic
what are signs of hypervolemia?
elevated BP, edema, weight gain, tachycardia, weak pulse
what expansion techniques are used in moderate contusion?
draining, suction, cough, high flow o2
what is a pneumothorax?
collapsed lung due to their being positive pressured air in the pleural space
what can cause pneumothorax?
blunt, penetrating, bleb
what causes a closed pneumothorax?
blunt force or a bleb
what is occurring during a closed pneumothorax?
air is being trapped into the pleural space not due to penetration
what is a bleb?
a air filled blister on the surface of the lung….when it pops the air then is trapped in the pleural space taking away from the negative pressure
what can cause a bleb?
COPD, TB, CF, CVL, Bypass, Thoracentesis, biopsy
what occurs during a open pneumothorax?
puncture of the skin, pleural space and lung that allows free movement of air
what is commonly paired with open pneumo?
hemothorax
what is a hemothorax?
damage to the vasculature of the chest causing build up of pressure on the lung eventually causing collapse
what are symptoms of the pneumothorax?
cyanosis, accessory use, dyspnea, pain, reduced breath sounds, anxiety, tachypnea, tachycardia, bruising, unequal chest rising
what are the interventions for pneumothorax?
chest tube or thoracostomy
when is a thoracostomy used?
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