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Exam 2 Flashcards

1
Q

what is REM?

A

A part of the sleep cycle that occurs after stage 1

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2
Q

What does REM mean?

A

Rapid eye movement

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3
Q

What happens during REM?

A

Real resting phase- best sleep; absent muscle tone, inc gastric secretions, vivid dreaming, difficult to arouse

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4
Q

How do you know you have hit REM sleep?

A

Vivid/lucid dreaming

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5
Q

How long does REM last?

A

About 20 min

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6
Q

How can you promote sleep?

A

Cluster care, environmental control (light, noise, comfort), invasive care—> day; assess first and treat if necessary, do as much outside of the room as possible, reschedule long tx if possible, dont enter unnecessarily

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7
Q

How do you evaluate a patient’s sleep?

A

Ask! “Do you feel rested?”

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8
Q

What kind of data is sleep evaluation?

A

Subjective

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9
Q

What is sleep apnea?

A

Air passages relax during sleep- airflow=blocked, breathing stops

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10
Q

What is the ideal sleep environment?

A

Calm, cool, dark, quiet

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11
Q

Insomnia

A

pt is unable to fall asleep or stay asleep

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12
Q

How is insomnia treated?

A

Calming activities before bed(30 min before), set bedtime routine, reduce stress, get 6-8 hours of sleep at same time each night

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13
Q

What are some common causes for insomnia?

A

Existing medical condition or medication, shift work (i.e. night shift workers), stress, poor sleep hygiene(video games before bed, Loud music before bed, chaotic scheduling,etc.)

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14
Q

What is the last resort for treating sleep disorders?

A

Medication, always use least invasive thing possible first

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15
Q

S/S of sleep apnea?

A

Snoring loud, excessive tiredness during the day, wake up gasping in middle of sleep, frequent headaches during the day

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16
Q

How is sleep apnea diagnosed?

A

Sleep study- only definitive way to diagnose!!!

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17
Q

How is sleep apnea treated?

A

CPAP (continuous positive applied pressure)- keeps airway open

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18
Q

What is the difference between a CPAP and a BIPAP?

A

CPAP= airway never closes, continuous pressure to keep it open
BIPAP= pushes air in and adjusts pressure to let air in and out- biphasic, doesn’t force airway open all the time

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19
Q

what is narcolepsy?

A

Pt falls asleep uncontrollably, no idea when it will come on

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20
Q

What makes narcolepsy worse?

A

Strong emotions

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21
Q

What does a pt experience with narcolepsy?

A

Cataplexy (paralysis)

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22
Q

What is the concern with narcolepsy pt?

A

Safety(fall risk, cannot drive cars, falls)

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23
Q

How do you treat narcolepsy?

A

Meds can treat it, but there is no cure; manage symptoms and decrease episode frequency

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24
Q

What is the assessment used to see if a pt is predisposed to sleep apnea?

A

STOP BANG assessment

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25
What is the STOP BANG Assessment?
S- snore? T- Tired/fatigued during the day O-observed; anyone observed you stop breathing? P-pressure; are you being treated for HTN? B-BMI, is your BMI >35 kg/m^2 A-age? Older than 50? N- neck size? Men >43 cm women >41 cm G- gender; male?
26
What is the scoring for the STOPBANG assessment?
OSA- Low risk= yes to 0-2 questions OSA - intermediate risk= yes 3-4 questions OSA- high risk=yes to 5-8 questions
27
What is pneumonia?
Infection in one or both lungs, bacterial,fungal, viral, CAP or HAP
28
How is treatment determined for pneumonia?
Dependent on cause/type
29
What is the most Common cause of viral pneumonia?
Flu virus
30
Approximately one ______ of pneumonia cases in the US are caused by respiratory ___________.
Third; viruses
31
Who are the most common pt for viral pneumonia?
Children and young adults
32
What are the five main causes of pneumonia?
Bacteria, viruses, mycoplasms, fungi (pneumocystis), various chemicals
33
What is used to treat bacterial pneumonia?
Antibiotics
34
If you have _______ pneumonia you are at a risk of getting ________ pneumonia
Viral, bacterial
35
S/S of pneumonia?
Cough (productive), fever, shaking chills, SOB, sharp/stabbing chest pain that is worse when breathe or deeply cough,headache, excessive sweating and clammy skin, anorexia, low energy, fatigue, confusion (esp. older ppl), hypoxemia
36
What is the first symptom in elderly patients with infection?
Confusion
37
Pneumonia diagnosed by?
Auscultation (crackles), chest x ray, elevated WBC, Blood cultures (C&S), ABGs, CT of lungs, sputum culture,low O2 sat
38
Tx for pneumonia?
Cough and deep breathing exercise, IS, increase fluid intake, rest, no cough medicines (unless talk to dr), control fever with aspirin or NSAIDS
39
Hypoxia
Low oxygen levels in blood
40
Ronchi breathing
Low pitch snoring/gurgling noise on exhalation, secretions in lungs
41
Crackles
Fine or course, bubbling noise- fluid in lungs
42
Wheezing
High pitch, musical- bronchiole constriction
43
Cheyne stokes
Apnea period then gradual increase then gradual decrease followed by apnea
44
Kussmauls
Full inhale and exhale rapid rate
45
Stage 1 pressure injury
Nonblanchable, red spot with no skin breakdown
46
Stage 2 pressure injury
Epidermal damage only
47
Stage 3 pressure injury
Epidermal and dermal damage
48
Stage 4 pressure injury
Deep, all layers are damaged, muscle and bone may be exposed
49
Unstagable
Slough and eschar blocks wound bed, cannot be properly staged
50
What do you document regarding a wound?
Length, width, and depth; odor? Drainage?
51
Drainage documentation
Color, viscosity, odor? Amount
52
What kind of diet is important for those who have healing wounds?
High protein diet
53
What kind of dressing do you use for a wet wound?
Dry it- foam, alginate, NaCl dressing, negative pressure wound vac
54
What kind of dressing do you use for a dry wound?
Moisten it with hydrogel or hydrocolloid
55
What kind of dressing do you use to maintain a wound’s condition?
Moist saline gauze, tegaderm; change dressings every 12 hrs-3 days and if saturated, change
56
What are the types of debridement?
Autolytic, mechanical, enzymatic, sharp/excisional, biodebridement
57
Wound vac
Negative pressure to absorb fluid
58
How do you remove staples?
Every other one first- prevent early separation; if starts to separate, stop removing staples and apply steri strips and notify provider
59
How do you remove sutures?
Cut under the knot and pull the string over to the same side of knot to prevent string sitting on top of skin from being pulled under skin- infection!
60
Describe Biot’s Breathing pattern
Period of apnea followed by rapid breathing then another period of apnea
61
What causes Biot’s breathing patterns?
Brain injury(CVA)
62
What causes Cheyne Stokes breathing pattern?
Cardiac damage (HF, MI)
63
What causes Kussmaaul’s breathing pattern?
Ketones, DKA
64
Stridor breathing
High pitched seal bark, obstruction or narrowed upper airway
65
What is the BED acronym for?
Wounds- Bacterial (wound culture) Exudate (wound description) Debridement (how to clean it out)
66
What is alginate?
Seaweed derivative, no allergens, absorbs 20 times its weight- most absorbent! Do not add anything!
67
What are the types of drains?
Penrose, Jackson-Pratt, Hemovac
68
What is a Penrose drain?
Opening used to prevent wound closure to allow drainage, used for puncture wounds (i.e. animal bites); safety pin so it wont fall inside wound
69
What is the most common drainage device?
Jackson-Pratt (JP), works with negative pressure (squeeze bulb side to side after removing pin and emptying drainage) “grenade drain”
70
What is a hemovac?
A drain that applies negative pressure top to bottom suction, larger areas, “accordion drain”
71
When would a wound culture not be needed?
If wound is dry- no bacteria and exudate= no infection !
72
What is the least cytotoxic woundwash product?
0.9 saline for wound wash, no debridement needed
73
Cleaning wounds:
Never clean towards wound always away, gentle friction when applying solutions, when irrigating, allow to flow from least contaminated area
74
What are the ostomy complications?
Candidiasis, caput medusae, mucocutaneious separation,mechanical injury, stoma necrosis,stomal retraction,Stomal stenosis, Stomal hernia,prolapsed stoma
75
What is stomal candidiasis?
Yeast infection due to excess moisture and compromised host (immunosuppression, diabetes or medications i.e. chemo) Dry Fungal powder Porous tape
76
What is caput medusae
Hypervascularity, liver disease, silver nitrate for bleeding, Vaseline as pouch adhesive(soft pouching system)- serious bleeding risk and bruising!
77
Mucocutaneious separation
Skin and fat separating, bacteria seeps into gaps Caused by malnutrition, steroids, infection, radiation Treat with fillers (surgical correction)
78
Mechanical injury
Skin stripping, friction, pressure, fragile peristomal skin Use skin sealants Avoid tape More common in elderly and long term steroid tx pt
79
Stoma necrosis
Compromised circulation Most common=post op(surgical technique and thick abdominal wall) Surgical correction
80
Stomal retraction
Stoma pulled inside; increase in pt weight (inward pressure) or too tight surgically Convex or flexible pouching system- belt straps
81
Stomal stenosis
Lumen collapse Stool softeners, may require surgical intervention
82
Stomal hernia
Surgical technique, poor stoma placement outside rectus muscle, more common in elderly Hernia support belt, flexible pouching system
83
Prolapsed stoma
One piece pouching system, decrease abd pressure (supine and cool packs), not painful but pouching difficult
84
Wear time for ostomy pouches?
3-14 days depending on product
85
Barrier durability
Pectin= short wear time, pectin cannot be used with urostomies bc urine dissolves pectin
86
Skin barrier paste
Contains alcohol, more is not better, is a caulk not an adhesive , do not use on premature babies (high alcohol content)
87
What do you never use in pouches for odor control?
Aspirin! Creates excess gas production and bag explodes!
88
Diet for those with ileostomies
Increase fluid intake, 10-12 glasses a day, NEVER take a laxative, risk for food blockage- avoid high fiber foods for 6 weeks then slowly introduce, chew carefully
89
Colostomies
Output soft and pasty, rods support stomas
90
Colostomy irrigations
Indicated for bowel control, have to have descending or sigmoid colostomy, normal bowel function, ability to learn

PCC 2 (3 decks)

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