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med surg 1 > exam 1 > Flashcards

exam 1 Flashcards

1
Q

Patient positions in health assessment

A

standing
sitting
supine
dorsal recumbent/lithotomy (face down) (stirrups)
sims (left lateral, butt access)
prone (face down)
Trendelenburg/reverse Trendelenburg (head down, feet up)

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2
Q

heart sounds

A 
Aortic
pulmonic
Erb's point
tricuspid
mitrial (PMI)
APE To Man
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3
Q

examination is used when hands are used to assess skin temp

A

palpation

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4
Q

stages of a helping relationship

A

pre orientation
orientation
working
termination

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5
Q

focused interview to complete an admission hisotry

A

use direct questions

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6
Q

techniques for physical assessment

A

inspection: smells, situation, reactions
palpation: touch, mass/lumps
percussion: listen for diagnostic info
auscultation: listen with stethoscope
- diaphragm
- bell: vascular (fluids, swishing in carotid fistulas)

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7
Q

lung sounds

A

wheeze: constriction in lung
sibilant: classic asthma on inspiration and exspiration
stridor: super loud all above neck
Sonorous / Rhonchi: constriction, chronic bronchitis/inflammation, musical/coarse/dull
friction rub: plura of lungs is inflamed; grating on chest walls on inhale/exhale

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8
Q

. . . inserted to drain fluid or air from any of these three compartments of the thorax

A

chest tubes

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9
Q

Placed in the pleural space to restore the normal negative intrathoracic pressure needed for lung re-expansion after surgery or trauma
Surgery
Tension pneumothorax (most common: lung can’t inflate due to pressure)
Pneumothorax (air in lung)
Hemothorax (blood in lung)
Cardiac tamponade (pericardial sac fills with blood, mediastinal space put pressure on heart)
Penetrating wounds

A

indications for chest tube

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10
Q

two types of catheters

A

small bore: 7-12 Fr

large bore: up to 40 Fr

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11
Q

All chest drainage systems have…

A
  1. suction source
  2. collection chamber for pleural drainage
  3. mechanism to prevent air from reentering the chest with inhalation
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12
Q

amount of suction is determined by the amount of water instilled in the suction chamber
Has a water seal to prevent air from moving back into the chest on inspiration
Drain to gravity
Sucks air out, sends through H2O, can’t get back in

The water level in the water seal chamber reflects the negative pressure present in the intrathoracic cavity
Excessive negative pressure can cause trauma to the tissue

A

wet water seal

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13
Q

Use a one-way valve and may have a suction control dial in place of the water
at -20

A

dry suction

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14
Q

Increase in water levels during inspiration and a return to baseline with exhalation

A

tidaling

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15
Q

A wet suction control chamber
A water seal chamber
Air leak zone
A collection chamber

A

4 chambers of water seal system

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16
Q

Dry suction regulator
Water seal chamber
Collection chamber
Suction monitor/bellow

A

4 chambers in dry suction water seal system

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17
Q

collection chamber
one way mechanical valve
dry suction control chamber

A

3 chambers in dry suction systems with one way valve

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18
Q

The valve allows air and fluid to leave the chest but prevents their movement back into the pleural space
No water seal so it can be set up very quickly in emergencies
=

A

dry suction systems with one way valve

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19
Q

150,000 to 450,000/mm3

Total platelets found in the blood

A

Platelets

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20
Q

11 to 12.5 sec

Detects deficiencies in the extrinsic coag system. Depends on adequate Vit K

A

Prothrombin time (PT)

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21
Q

0-1.1
(therapeutic levels are higher)
Same at PT test, but used internationally in all laboratories. Both monitor Coumadin and can detect liver failure

A

International ratio (INR)

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22
Q

170-340 mg/dL

Protein that converts to fibrin- needed for clots. Screen for DIC

A

Fibrinogen

23
Q

0-250 ng/mL

Degradation product of fibrin clots. It’s presence confirms thrombin and plasmin activation. Diagnoses DIC.

A

D-dimer

24
Q

O: universal donor
A: can receive A or O
AB: universal recipient: can receive AB, A, B, O
B: can receive B or O

A

cross matching

25
Q 
Fever
Chills
Itching
Hives
respiratory distress
low back pain
Nausea
pain at the IV site
anything “unusual”
A

signs of reaction to blood

26
Q

1 degree C increase in temp- caused by donor antibodies and leukocytes- most common, especially with increased number of transfusions
signs and symptoms are chills followed by fever, typically sets in 2 hours after transfusion. Not life threatening. Can give Tylenol preop.

A

febrile nonhemolytic reactions

27
Q

Most dangerous and life threatening!- incompatibility. Antibodies destroy cells. Can happen with very little blood.
fever, chills, low back pain, nausea, chest tightness, dyspnea, hypotension, hematuria, oliguria, bleeding, anxiety- hypotension, bronchospasm, vascular collapse, DIC

A

acute hemolytic reactions

28
Q

Onset 14 days after transfusion- typically not dangerous, difficult to detect
fever, anemia, possibly jaundice

A

delayed hemolytic reactions

29
Q

1-3% of transfusions- mild, responds to antihistamines (Benedryl)
uticaria or itching

A

allergic reactions

30
Q

Hypervolemia- titrate infusion to their tolerance, diuretics, place them upright
dyspnea, orthopnea, tachycardia, anxiety, JVD, crackles, pulmonary edema (pink, frothy sputum)

A

circulatory overload

31
Q

Why for trach

A

Obstructed airway
Mobilize secretions
Deliver oxygen

Measure from chin to jaw

32
Q 
Respiratory failure (COPD, ARDS)
Airway injuries (trauma) 
SEVERE allergic reactions
Head and neck cancer
Neuromuscular disease (ALS) (loss of muscle strength)
Spinal cord injuries
Stroke
A

conditions for trachs

33
Q

One way valve
Allows air in, not out
Forces air around tracheostomy tube, through the vocal cords, out the mouth
Patient can speak
helps air move around trach tubes and vocal chordes

A

passy-muir valve

34
Q 
*Obturator at bedside
Suction equipment
Ambu bag
Spare trach
Dressing change PRN
*Humidified air
A

nursing care for trachs

35
Q

Types of IVs

A 
Peripheral Venous (IV): up to 72096 hours
-terminates in peripheral vein
Central Venous: implanted and externa (95%)l: stay in longer
36
Q

Enter of Venous System

A

peripheral: cephalic or basilica vein

Central (tunneled or non): subclavian, internal jugular, external jugular, femoral vein

37
Q

gauge: 20-22: common IV fluids
gauge: 14-18: blood or trauma

A

types of gauge

38
Q

inflammation of vein
see redness due to irritation of tissue, warm, painful
fix with hot pack

A

phlebitic

39
Q

vessel starting to harden

overtime vessel gets harder and stronger like calcified rock

A

sclerotic

40
Q

Inserted just above or below the antecubital fossa into the basilica or cephalic veins
Catheter longer than 3 inches
Considered a Peripheral IV
Left in from 2-6 weeks

A

midline peripheral catheters

41
Q 
With running IV’s done hourly
With Saline Locked every shift 
Monitor site/running fluid/tubing changes (running IV tube/bag 24 hrs, secondary 96 hrs, IV site q 72 hrs, follow agent policy)
Redness= phlebitis
swelling=infiltration
pain=phlebitis 
coolness = loss of circulation
A

assessment of IV site

42
Q

swelling, firmness, coolness

A

indicates infiltration

43
Q

blood clots in IV line

A

so discontinue infusion

44
Q

Common of dialysis catheters
Usually placed in surgery, may be done under local anesthetic
Two incisions are made on the chest (entrance and exit sites). A tunnel is made under the skin between the two incisions, and the CVC Is threaded through the skin and into a vein under the clavicle.
Sterile dressings are applied and the lumens are flushed with heparin. Caps changed with dressing changes.

tunnel makes difficult for bacteria to track into bloodstream and helps hold catheter in place
sterile due to close <3

A

tunneled CVCS

45
Q

“Central line” or “Triple-lumen”
Placed at bedside w/ sterile technique or in OR by MD, with or without guidewire
Tip lies at superior vena cava of heart
Placed at subclavian or jugular veins
Change dressing 24 hours after placed and weekly
Flush per protocol
TRUE CENTRAL LINE: terminates AT superior vena cava

A

non tunneled CVC

46
Q

Peripherally inserted in the arm, but the end of the catheter lies the sub-clavian vein.
Used for long term therapy with limited IV access who need antibiotics, blood, vasopressors, or parenteral nutrition
Inserted sterilely under local anesthetic, typically ultrasound guided, by specially trained nurse or doctor.
Sutured or tightly secured. Dressing changes are sterile.
=

A

peripherally inserted central catheter (PICC)

47
Q
  1. Pause IV to prevent drawing med that’s lfowing
  2. Largest lumen
  3. Aspirate 10 mL and flush*
  4. Discard 10 mL*
  5. New syringe- Blood draw*
  6. Flush*
  7. Positive pressure technique
A

how to draw blood

48
Q

Thrombus (clot) -> embolism(moving clot)
Infection -> sepsis -> shock

Arterial puncture
Catheter malposition
Pneumothorax/hemothorax: try to put in vein and puncture lung or nic something –> blood in lungs
Air embolism Arrthymias
Nerve/tendon damage
Subcutaneous hematoma (under skin bleeding)
Thrombophlebitis (inflammation of clot)

Local: dermatitis, cellulitis, burns

A

complications

49
Q 
heparin or TPA substances - 5000 U to dissolve clot. Can't give to stroke pt.
change position
raise arm
cough
positive pressure technique
A

occlusions

50
Q

osmolality equal to serum
stays in intravascular space and expands in intravascular compartment
-Expands blood volume only. Stays where “I” put it
Treats hypernatremia, fluid loss and dehydration
not given in head injuries

A

isotonic

DSW

51
Q

osmolality lower than serum. Shifts fluid of intravascular compartment, hydrating cells and interstitial compartments
Goes into cells and sticks there Go “O”ut of the vessel
free water-rids waste in kidneys
decrease BP, cellular edema, cell damage

A

hypotonic solution

0.45% NACL

52
Q

osmolality higher than serum. draws fluid into intravascular compartment from cells and interstitial compartments
water follows salt. fluid goes into cells and back out pulling excess fluid
“E”nter the vessel
treat hypernatrema and swollen cells
be careful: circulatory overload Pulmonary Edema

A

hypertonic solution

3% or 5% NACL

53
Q

Calculated very specifically, typically daily
5-6X the solutes as blood (lots of pressure to veins)
**CVCs only
Not compatible with anything else
Lots of glucose=lots of bacteria!
Glucose monitoring, fluid overload

A

Parental nutrition (PN)
needs to be at least 1 wk of therapy
when weight loss/protein calorie malnutrition show up
use in extensive bowel surgeries or pancreatitis
use if can’t, unwilling, or NG/G tube wont work

med surg 1 (5 decks)

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