Exam 1 Flashcards
The metabolic system is regulated by which organ?
The respiratory system is regulated by which organ?
Metabolic system is regulated by the kidneys
Respiratory is regulated by the lungs
What is the relationship between pH and Potassium K?
Does acidosis cause hyperkalemia or hypokalemia?
K+ regulates the pH of intracellular/extracellular fluid.
When K+ goes into a blood cell, the patient experiences acidosis and hyperkalemia.
When K+ leaves the blood cell, the patient experiences hypokalemia and alkalosis
What are the normal ranges for:
K
Ca
Mg
Na
K: 3.5-5
Ca: 8.5-11
Mg: 1.3-2.1
Na: 135-145
What is the definition of third spacing?
Third spacing is fluid that has entered the space between the cells (Intercellular fluid) and becomes trapped
When fluid has leaked into the abdominal cavity, this becomes an issue known as what?
Ascites
What does CVP mean, what does it refer to and what is the normal CVP range?
CVP stands for Central Veinous Pressure and refers to the amount of blood that returns into the right atrium
Normal range is 2-8mmHG
What does a high CVP indicate?
High CVP can indicate right ventricular failure or fluid volume overload.
What does a low CVP indicate?
Low CVP indicates Hypovolemia (low blood volume)
What are some physical examples fluid volume overload effects on the body?
Edema
High blood pressure
High CVP
Crackles in the lungs
Weight gain
Polyurea
Jugular Veinous Distention
How do you treat Fluid Volume Overload?
Diuretics and decreases intake of fluids are the main therapies.
If fluid volume excess leads to pleural effusion, what can be done to solve the issue?
An abdominal paracentesis or a thoracentesis
What is the primary cause/spread of HIV infections?
The Retrovirus that is transmitted via bodily fluids attaches to host cells and kills host T-cells
What are the primary symptoms of HIV infection for the first 2-4 weeks?
Flu-like symptoms, so fever, chills, fatigue
How long can HIV lay dormant before showing signs of infection again?
8-10 years.
After HIV returns from its dormancy, what are the symptoms you would see?
Fever, frequent night sweats, fatigue, and AMS (altered Mental Status)
What is the best prevention method for HIV?
The prophylactic method of Anti-Retroviral drug therapy
What are the 3 types of drugs used for the therapy of HIV?
-Reverse Transcriptase Inhibitors (NRTI’s and NNRTI’s)
-Protease inhibitors
-Integrase inhibitors
What lab levels are important to maintain for the successful survival and treatment of HIV?
T-cell and CD4 count between 200-500 at least, but ABOVE 200 at all times.
If your T-cell count falls below <200 while you are infected with HIV, what is your greatest risk?
Opportunistic infections
A complication of HIV is Kapasi Sarcoma. How would you describe Kapasi Sarcoma?
Purple-brown lesions that are cancerous and can be fluid filled and painful.
Renal Carcinoma, Dementia, and Candida Pneumo Cystitis are all complications of what disease?
HIV
What is the primary cause of TB?
Mycobacterium Tuberculosis
How is TB spread?
Through infected air droplets that are airborne and stay in the air
What are the most basic symptoms of TB?
dry productive cough
fatigue
night sweats
weight loss
dyspnea
crackles
What is the treatment method for TB?
A 4 drug cocktail containing:
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
What are the nursing precautions for a TB patient?
Airborne precautions
What are the physiological complications that can occur in the lungs due to TB?
Scaring of the lung tissue and lung cavity formations.
CNS TB can cause what bacterial disease?
CNS TB can cause bacterial meningitis
What is the primary test used to assess for TB?
What are the other 3 tests?
A Mantoux skin test (TB test)
IGRA test (TB blood test), chest x-ray, sputum culture
Myasthenia gravis is an (____) disease that causes the (____) of (____) muscle. It does this by telling (____) to destroy (____) receptors
Myasthenia gravis is an (Autoimmune) disease that causes the (Weakening) of (Skeletal) muscle. It does this by telling (Antibodies) to destroy (ACH) receptors
What are the signs and symptoms of Myesthenia gravis?
Fluctuating skeletal muscle fatigue
Facial droop
Flat affect
Dysphoria
What 3 medications would be good for the Tx of Myasthenia gravis therapy?
-Corticosteroids like Prednisone
-Pyridostigmine bromide (inhibits ACH breakdown)
-IVIG therapy
What are the main complications of Myasthenia gravis?
-Double vision
-Muscle weakness progressing from good in the day to weak at night
-Aspirations
-Breathing insufficiency
You are assessing for in a patient presenting with myasthenia gravis and schedule a EMG test. What is an EMG test?
EMG stands for Electromyography test to see how your muscles respond to stimuli
What kind of reflex should you assess for in a patient with Myasthenia gravis?
Swallowing reflex
Multiple sclerosis is an (____) disease where viral (____) cross the blood-(____) barrier and target your (____). These cells then target the (____) proteins instead of antigens, causing destruction of the (____) and (____) nerve fibers
Multiple sclerosis is an (Autoimmune) disease where viral (Antigens) cross the blood-(brain) barrier and target your (T-cells). These cells then target the (Myelin) proteins instead of antigens, causing destruction of the (Brain) and (Spinal) nerve fibers
What is the main S/S of multiple sclerosis?
Progressive deterioration.
-Double vision/Blurred vision
-blindness in one eye
-muscle weakness and balance issues
What is the cure for MS?
There is no cure for MS, but there is drug therapy
DMD is the drug therapy model for MS. What is the primary drug in this therapy and what does DMD therapy mean?
Prednisone, a corticosteroid is a primary drug, and DMD is Muscular Dystrophy therapy
What tx for MS is given via an IM injection?
Interferons-B
What is a dx method for testing for MS?
CSF test (Cerebral spinal fluid)
One debilitating complication of MS is Trigeminal Neuralgia. What is Trigeminal Neuralgia?
Trigeminal Neuralgia is a severe debilitating pain of the 5th cranial nerve – The trigeminal nerve)
How is Trigeminal Neuralgia treated (medications)?
Antiseizure medications such as: Carbamazepine (Tegretol)
Gabapentin (Neurontin)
Phenytoin
Antispasmodic medication baclofen (Lioresal)
A 55yr old female patient has been avoiding eating and neglecting their hygiene. When asked why, she reports pain when she washes her face, brushes her teeth, and when she eats. CFS Dx testing reveals she has MS. What is she experiencing?
Trigeminal Neuralgia
What is a surgical treatment option to reduce trigeminal neuralgia?
Microvascular decompression of the trigeminal nerve
Muscles spasms are a hallmark sign for what autoimmune disease?
MS
If during an assessment, a patient reports trouble peeing, and a subsequent test reveals a buildup of CNS plaque, what does this indicate?
MS
Guillan Barre Syndrome is an (____) disorder that kills (____) on nerve cells
Guillan Barre Syndrome is an (Autoimmune) disorder that kills (Myelin) on nerve cells
What are the 3 trademark S/S’s of Guillan Barre syndrome?
-Ascending paralysis: starts with the lower extremities with weakness/paresthesia.
-Weak lungs
-Dysphagia
Are there treatment measures for Guillan barre syndrome?
Just palliative support until the myelin regenerates on the nerve cells, but IVIG can lower the length of symptoms
Complications involving Guillan barre syndrome are very much respiratory related. What are 4 respiratory complications from Guillan barre?
-Respiratory failure that requires mechanical ventilation
-Aspiration
-Respiratory acidosis
-pneumonia
Huntington’s Disease is a progressive (____) disorder that is transmitted (____), aka (____). There is a (___) chance of inheritance.
Huntington’s Disease is a progressive (Brain) disorder that is transmitted (Genetically), aka (Autosomal). There is a (50%) chance of inheritance.
A hallmark sign of HD is Chorea. What is Chorea?
Since it is progressive, what does this mean for prognosis?
Chorea is excessive involuntary writhing and twisting of limbs and face/body
Basically, Extrapyramidal symptoms
For prognosis, since it is progressive, eventually all psychomotor processes will be impaired.
Treatment for HD is palliative and involves drug use to control Chorea. What are these drug types used?
Neuroleptics and Benzodiazepines
Parkinsons Disease is a slow, (____) neurological (____) disorder with severely lowered (____) levels and the presence of (____) bodies.
Parkinsons Disease is a slow, (Progressive) neurological (Movement) disorder with severely lowered (Dopamine) levels and the presence of (Lewy) bodies.
The hallmark sign of Parkinson’s is the (____) and (____) at rest. As well as (____) from the mouth and (____) with passive movement
The hallmark sign of Parkinson’s is the (Parkinsons shuffle) and (Tremors) at rest. As well as (drooling) from the mouth and (Rigidity) with passive movement
What is the drug of choice for the TX of Parkinsons? Why?
Levodopa is the drug of choice for Parkinsons because of its increase to dopamine levels.
What is another treatment method for Parkinsons that requires the use of a tool?
What is Ablation?
Deep Brain Stimulation is the tool used
Ablation is a surgical process to kill the parts of the brain affected by Parkinson’s
Depression, UTI’s, Sexual disfunction, dysphagia and immobility are all complications of what progressive disease?
Parkinsons Disease
If a patient is undergoing an assessment and is showing signs of drooling, tremors at rest, and a blank expression, what are these likely signs of?
Parkinsons
What is Pneumonia? What is it due to?
Pneumonia is fluid in the lungs due to a viral/bacterial infection or due to aspirations
Vocal fremitus is a symptom of Pneumonia. What is vocal fremitus?
Vocal fremitus is chest wall vibrations upon vocalization
Thick, discolored sputum, Lung crackles, fever, chills and dyspnea are all signs of what respiratory illness?
Pneumonia
What tx will be given for a Pneumonia infection that is presumed viral or bacterial?
How long will it take for positive effects to occur?
ABx will be given to treat both Viral and Bacterial Pneumonia.
It should take 48-72 hours for the drugs to work. If there is no sign of Tx, it could mean Pneumonia is related to something else.
What are some additional treatment methods for Pneumonia?
O2 therapy
-Chest PT percussion therapy
-Suction
-Coughing exercises/Incentive spirometry
What dx test could be done to loosen and destroy secretions due to pneumonia?
A Bronchoscopy
A Tension Pneumothorax causes what damage to the trachea?
A Tension Pneumothorax causes tracheal deviation and puts pressure on the opposite side.
What is a Pneumothorax?
A Pneumothorax is when air becomes trapped in the pleural space due to trauma, like being stabbed.
What is a tension Pneumothorax?
What is a Hemothorax?
What is a Chylothorax?
What is a Iatrogenic Pneumothorax?
A Tension Pneumothorax is when the air leaking into the pleural space becomes trapped and can eventually collapse a lung
TX is needle aspiration, like a thoracentesis.
Hemothorax is blood in the pleural space
Chylothorax is when digestive lymph material (chyle) makes its way into the chest cavity
Iatrogenic Pneumothorax is when a surgery causes a pneumothorax
SOB, angina, and a decrease in Blood pressure, O2 and HR can indicate what respiratory distress in a patient?
Pneumothorax
What are the early symptoms of Hypoxia?
Agitation and anxiety/restlessness
When a patient has a self-administered pain control pump (PCA Pump) and other analgesics what safety precautions should be taken at the bedside?
-Verify PCA pump settings, including max dose limits, and explain the use of the pump and side effects.
-Ensure there is a lock out interval and only use when pain is felt.
-Keep Naloxone available in case of overdose symptoms.
What is the BCG vaccine?
The BCG vaccine is the TB vaccine
Is the BCG vaccine available in the U.S?
Where is it available?
No, only in the countries where TB is very common:
sub-Saharan Africa, south Asia, Brazil and Mexico
What side effects are associated with the BCG vaccine?
Side effects of the BCG vaccine are fever, redness, swelling at the injection site and in rare cases, swollen lymph nodes
What is Baclofen?
Baclofen is a skeletal muscle relaxant
What is Baclofen used to treat?
Baclofen is used to treat MS
Angioedema (swelling from fluid), respiratory depression, coma, laryngospasms, and cardio collapse are all major side effect of what medication?
Baclofen
A patient presents with Restlessness, labored breathing, and tachycardia. Upon auscultations you hear crackles and diminished breath sounds.
What does this indicate? What should be done for treatment?
These are signs and symptoms of ineffective airway clearance.
Elevate the head of the bed, and check WBC count and fever. Elevated temp and WBC’s indicate Pneumonia
What is Atelectasis?
Alveolar collapse due to and obstruction, usually sputum or liquid build up
What are 5 effective treatment methods for atelectasis?
-Removal of secretions using low suction
and coughing maneuvers.
-Use Incentive spirometry
-Chest PT
-Ambulation
-Frequent turning to loosen secretions and improve ventilation
What are 3 pleural space issues where a chest tube would need to be used?
A Hemothorax
A Pneumothorax
Pleural Effusion
What is Pleural Effusion?
Pleural Effusion is when fluid has entered the pleural cavity
What are excess drainage levels in a chest tube?
What are typical levels?
100-150mL/hr
Typical levels should be -80 - 100/hr
What does excessive bubbling in a chest tube indicate?
An air leak!
A Mediastinal chest tube is inserted for what purpose?
A Mediastinal chest tube is inserted to relieve heart pressure and prevent cardiac tamponade
What is cardiac tamponade?
Fluid in the heart that stops it from pumping blood
Which cells are responsible for most hypersensitivity reactions?
B-cells
Anaphylaxis involves what lung sounds?
Stridor
What is the emergency medication for Anaphylaxis?
Epinephrine at a ratio of 1;1000
After the emergency medication is given for Anaphylaxis, what are the next 2 common nursing treatments for allergy management?
-IV antihistamines to treat allergy adverse effects
-Corticosteroids to reduce the immune response
After the emergency medication is given for Anaphylaxis, what is the supplementary respiratory tx given?
Supplemental O2 with cooled water
Name the hypersensitivity response as type 1, 2, 3, or 4
1.) Allergic Response: Histamine release; Itchy eyes, runny nose, rash, edema, anaphylaxis
2.) Antibody Response: Cytotoxic T-cells kill normal cells. Type 2 allergies cover autoimmunity and blood transfusion reactions
3.) Immune Complexes: Too many antigens and antibodies “clump” together and deposit themselves in the joints and vessels. This is seen in Lupus.
4.) Delayed Immune Response: TB skin test; Poison ivy and MS
They are in order:
1.) Type 1: Allergic Response: Histamine release; Itchy eyes, runny nose, rash, edema, anaphylaxis
2.) Type 2: Antibody Response: Cytotoxic T-cells kill normal cells. Type 2 allergies cover autoimmunity and blood transfusion reactions
3.) Type 3: Immune Complexes: Too many antigens and antibodies “clump” together and deposit themselves in the joints and vessels. This is seen in Lupus.
4.) Type 4: Delayed Immune Response: TB skin test; Poison ivy and MS
Explain the relationship between dehydration and Tachypnea
Dehydration leads to decreased blood volume, which in turn lowers O2 levels being delivered to tissues. To compensate for this lowering of blood O2, the body with increase respirations (tachypnea-quick, shallow breathing) to balance and improve O2 and acid base levels
What is the #1 nursing intervention for a post-operative patient who underwent a laryngectomy?
Maintain airway patency!
How often should you change the cannula in a post-op patient who underwent a laryngectomy?
Q8hr
For severe mucus plugs in a laryngectomy patient, what procedure should be used to break up formations?
A bronchoscopy
For a post-operative patient who underwent a laryngectomy, what 2 things should you monitor for?
Excessive bleeding drainage (>120mL/day) and swelling
What is passive immunity?
Passive immunity is attaining immunity from already primed antibodies given to you by someone else.
What are 2 examples of passive immunity?
Breastfeeding and IG
Why might passive immunity options like IG (as opposed to a vaccine) be best for patients who are immunocompromised?
The immunocompromised don’t have functioning immune systems, so vaccines would hurt, not help. IG’s would give antibodies to them that are already primed for whatever disease they have.
When is smoking cessation effective?
Almost always
IgG and IgM are the two IG’s that are most responsible for what?
Blood transfusion allergic reactions
A patient is experiencing increased capillary permeability, vasodilation, smooth muscle contractions, hypotension, stridor, and a laryngeal edema/angioedema. What is this most likely?
Anaphylaxis from an allergic reaction
What does angioedema mean?
Angioedema means “swelling of the blood vessels”
What is an angioedema?
Angioedema is a rapid swelling of the deep layers of the skin and mucous membranes.
Where does an angioedema usually manifest?
Mostly angioedema’s target the eyelids, the lips, the tongue, the larynx, GI and genitalia.
What is the procedure for collecting a sputum culture?
Blood culture?
Sputum: patient sits upright. Instruct them to deep breathe and cough, spitting directly into the collection container.
Blood: Choose vein, clean site, tourniquet, needle, draw, seal, label, lab
What is a DVT?
Deep Vein Thrombosis
Where is a DVT usually located?
A DVT is usually located in the Iliac (large abdomen artery) or the femoral veins
What are the 4 main causes of a DVT?
-Immobility
-Trauma
-Heart failure
-Pregnancy
What are 3 non-medication treatments for DVT?
-Compression stockings
-IVC filter
-Elevation of the leg to decrease swelling
What are the drugs of choice for the medication treatments for DVT?
-Anticoagulants like Heparin and Warfarin
-Thrombolytics (clot-busters) like Streptokinase and Streptase
What is the nursing procedure for a Lumbar puncture?
Place the patient in a side-lying position with their knees up to their chest and their chin tucked in.
Have them lay flat for 6-12 hours post-procedure
Before a patient receives a lumbar puncture, they must first be screened for the presence of what?
Bacterial or Viral meningitis
What is a thoracentesis?
Thoracentesis is the removal of fluid or air from the pleural space using a needle and puncturing in-between the lungs and the chest wall.
What is the nursing procedure for a thoracentesis?
Position the patient sitting upright on the edge of the bed and have their arms resting on their pillow or a table.
Clean/disinfect he area of entry for the needle, apply analgesia, start
What should a patient do to avoid damages during the procedure of a thoracentesis?
Stay still and avoid coughing or loud noises
What is Rifampin?
Rifampin is an antibiotic that is a part of the 4-drug medication therapy for the treatment of TB
What can Rifampin do to your secretions?
Turn them orange in color
What harmful effect can Rifampin have on your liver?
Rifampin can cause liver failure
Is hormonal birth control safe to take while on Rifampin?
Technically yes, but Rifampin will decrease the effectiveness of birth control
What exactly does Rifampin do to fight TB?
Rifampin stops bacteria from making the proteins they need to reproduce.
It does this by inhibiting RNA polymerase, an enzyme that is used for bacterial RNA synthesis
