Exam 1 Review pt.1 Flashcards
Can a patient with a laryngectomy eat normally?
Yes, only the larynx is removed
How do we treat polycythemia?
Drain blood
Drink Plenty of water
Take warfarin
Move
Treat itching with antihistamine
Nursing Response to Acute Hemolytic Reaction
Stop Tranfusion
Start new line with NS
Assess patient
Notify the blood bank and HCP
Treat shock
Main BP with IV colloids
Obtain blood sample from site
Obtain first void urine: Insert foley
Send unti, tubing, and filter to lab for testing
Non tunnled CVC’s
Subclavian
Juglar
PICC
Tunneled CVC’s
Hickman
Groshanh
Broviac
Implanted ports
What is malignant hyperthermia?
An inherited muscle disorder triggered by certain types of anesthesia that may cause a life threatening crisis
Most common initial sign of malignant hyperthermia?
Increase in end tidal CO2
Malignant Hyperthermia: Clinical Manifestations
Hypercarbia
Masseter muscle rigidity
Sinus tachycardia
Sustained muscle contraction and breakdown (rhabdomyolysis)
Anaerobic metabolism
Metabolic acidosis
Open cholecystectomy
Incision made through right subcostal incision
T-tube place to keep common bile duct open
Oximetry is measuring
The amount of hemoglobin that is carrying oxygen
What is normal O2 sat?
95%
Pulse oximetry can be taken at
finger - earlobe - toe
What are the three different sputum studies and what are they for?
Culture and Sensitivity (Infection) (PNA)
Cytology (Cancer)
Acid-fast bacillus (Tuberculosis)
Sputum collection
Must expectorate in sterile container
Should be sent to lab asap
Morning specimen best
Can suction
What should be done before receiving CT scan?
Check patient BUN and Cr (renal function)
Assess allergy to shellfish or contrast
Teach that they may feel a warm flush feeling
You should encourage the patient to ______ ______ after a CT scane
Force Fluids
MRI is used to
assess lesion that are difficult to asses via CT scan
distinguishing vascular from nonvascular structures
What type of scan looks at function?
PET
uses radioactive substance called a “tracer” to look at function (blood flow - use of oxygen - uptake of sugar)
Nursing care before bronchoscopy
Consent form
NPO 6-12 hours before test
Give sedative
Nursing care after bronchoscopy
NPO until gag reflex
Blood tinged mucous is common
Monitor for hemorrhage / pneumothorax (increase HR)
Lung biopsy can be done via
Bronchoscope
Transthoracic Needle Aspiration
Open biopsy
VATS
Nursing care before thoracentesis
Consent
Patient upright w/elbows on overhead table in room
Instruct not to talk (be still)
Nursing care after thoracentesis
CXR to confirm no pneumothorax
Assess for hypoxia / pneumothorax
FEVI is defined as
Maximum amount of air expired forcefully in 1 second
Care of anterior nose bleed
Position upright and lean forward
Calm
Lateral pressure with ICE
Nasal Tampons
Avoid Blowing Nose
Care of posterior nose bleed
Emergency
Posterior packing balloon
Humidification
O2
Bedrest
Pain control
With nose bleeds you should avoid
Saline spray
ASA
NSAID
Strenuous activities
OSA risk facotrs
Increase age
Male
Obesity
Structural abnormalities
Smoking
S/S of OSA
Daytime sleepiness
Snoring-Choking-Gasping
Morning headaches
CPAP vs BiPap
CPAP is for spontaneously breathing patient to improve oxygenation. OSA
BiPap uses two pressures; one during inhalation - one during exhalation. OSA + COPD
Types of Trachs
Shiley
Jackson
What causes 85% of head and neck cancers?
Tobacco use
Tube dislodgement and accidental decannulation
Keep obturator taped at bedside AAT
Insert obturator into outer cannula
Extend neck and open tissue; insert
Remove obturator immediately
Check breath sounds and secure
Ways to restore oral communication after laryngectomy
Artificial larynx
Tracheoesophageal Voice Restoration
Esophageal speech
Esophageal Speech
Oral air is introduced into the esophague and expelled pas the PE s the driving force for speech production
Advantage:
-Hands-free and no extra devices
Disadvantage:
-Length of time that it takes to learn
-Quality of speech not as good as other options
Radial Neck Dissection: Post-op care
MAINTAIN AIRWAY - ABC
Pulmonary toilet
Blood tinged secretions are normal can use Yankauer
Pain management
Nutrition (feeding tube before surgery)
PT and Speech therapy
Hospital Acquired PNA
Begins 48 hours or longer after admission and was not present at time of admission
Community Acquired PNA
Patients who have not been hospitalized or lived in a long-term care facility within 14 days of onset
What is the most common type of PNA
VIRAL
PNA: Clinical Manifestations
Usually preceded by URI
Fever - chills - cough - malsie
Chest pain on inspiration
CONFUSION in elderly
Viral PNA cough
Nonproductive and scanty
Bacterial PNA cough
Purulent
Ways to diagnosis PNA
CXR = infiltrates
WBC with Diff
Sputum with C&S
TB risk factors
Disproportionately to poor minorities
IV drug users
Less than ideal sanitation / over crowding
Immunosuppression
Primary TB
Bacteria are inhaled and inflammatory reaction encapsulates organisms for rest of live
Patient is asymptomatic
Non infectious
Latent TB
Persistent state of immune response to bacterium
Asymptomatic
Non contagious
POSTIVE skin test
Reactivated TB
ACTIVE
Contagious
Symptomatic
Active TB: How to confirm plus symptoms
Confirm with + sputum for AFB
Fever
Night Sweats
Weight loss
Productive cough
Purulent or bloody sputum
Tuberculosis Testing
First:
1: TB skin or Mantoux Test
or
2: Interferon-gamma release blood test (IGRA)
Postive one of those test leads to CXR
No ghon nodule on CXR = latent
+ ghon nodule on CXR = Sputum for AFB
+ AFB = ACTIVE
-AFB = Latent
With mantoux test we are looking for
induration (raised bump)
NO CLASSIFICATIONS
5mm - 10mm - 15mm
isoniazid side effect
Hepatotoxicity
Rifampin side effect
red/orange discoloration of excretions
ethambutol side effects
inability to tell red and green apart
When a patient has TB they are tested
q2 weeks and are no longer infectious with 3 negative culutres
COPD umbrella
Asthma
Emphysema
Chronic Bronchitis
COPD Characteristics
Barral chest due to hyperinflation
Decreased - Wheezing - Rhonchi Breath sounds
Prolonged expiration
Signs of advanced COPD
Pursed lip breathing
Neck vein distention
Peripheral edema
Cachexia
What is the single most effective and cost-effective intervention to reduce risk for COPD
Smoking cessation
Most common symptoms of lung cancer
Persistent cough that produces sputum
Definitive test for lung cancer
Biopsy via:
Bronchoscopy
Percutaneous Needle
VATS
CO2 necrosis
Condition in which COPD patient loose there stimulus to breath.
In normal patient there stimulus to breathe is ELEVATED CO2
In COPD there stimulus to breathe LOW O2
If we give COPD patient high level O2 then they can stop breathing
What is the only way to diagnose someone with COPD (CO2 retainer)
Arterial Blood Gas
ABG
