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PCC 2 > Exam 2 > Flashcards

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
Q

What is the STOP BANG Assessment?

A

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?

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26
Q

What is the scoring for the STOPBANG assessment?

A

OSA- Low risk= yes to 0-2 questions
OSA - intermediate risk= yes 3-4 questions
OSA- high risk=yes to 5-8 questions

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27
Q

What is pneumonia?

A

Infection in one or both lungs, bacterial,fungal, viral, CAP or HAP

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28
Q

How is treatment determined for pneumonia?

A

Dependent on cause/type

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29
Q

What is the most Common cause of viral pneumonia?

A

Flu virus

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30
Q

Approximately one ______ of pneumonia cases in the US are caused by respiratory ___________.

A

Third; viruses

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31
Q

Who are the most common pt for viral pneumonia?

A

Children and young adults

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32
Q

What are the five main causes of pneumonia?

A

Bacteria, viruses, mycoplasms, fungi (pneumocystis), various chemicals

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33
Q

What is used to treat bacterial pneumonia?

A

Antibiotics

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34
Q

If you have _______ pneumonia you are at a risk of getting ________ pneumonia

A

Viral, bacterial

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35
Q

S/S of pneumonia?

A

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

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36
Q

What is the first symptom in elderly patients with infection?

A

Confusion

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37
Q

Pneumonia diagnosed by?

A

Auscultation (crackles), chest x ray, elevated WBC, Blood cultures (C&S), ABGs, CT of lungs, sputum culture,low O2 sat

38
Q

Tx for pneumonia?

A

Cough and deep breathing exercise, IS, increase fluid intake, rest, no cough medicines (unless talk to dr), control fever with aspirin or NSAIDS

39
Q

Hypoxia

A

Low oxygen levels in blood

40
Q

Ronchi breathing

A

Low pitch snoring/gurgling noise on exhalation, secretions in lungs

41
Q

Crackles

A

Fine or course, bubbling noise- fluid in lungs

42
Q

Wheezing

A

High pitch, musical- bronchiole constriction

43
Q

Cheyne stokes

A

Apnea period then gradual increase then gradual decrease followed by apnea

44
Q

Kussmauls

A

Full inhale and exhale rapid rate

45
Q

Stage 1 pressure injury

A

Nonblanchable, red spot with no skin breakdown

46
Q

Stage 2 pressure injury

A

Epidermal damage only

47
Q

Stage 3 pressure injury

A

Epidermal and dermal damage

48
Q

Stage 4 pressure injury

A

Deep, all layers are damaged, muscle and bone may be exposed

49
Q

Unstagable

A

Slough and eschar blocks wound bed, cannot be properly staged

50
Q

What do you document regarding a wound?

A

Length, width, and depth; odor? Drainage?

51
Q

Drainage documentation

A

Color, viscosity, odor? Amount

52
Q

What kind of diet is important for those who have healing wounds?

A

High protein diet

53
Q

What kind of dressing do you use for a wet wound?

A

Dry it- foam, alginate, NaCl dressing, negative pressure wound vac

54
Q

What kind of dressing do you use for a dry wound?

A

Moisten it with hydrogel or hydrocolloid

55
Q

What kind of dressing do you use to maintain a wound’s condition?

A

Moist saline gauze, tegaderm; change dressings every 12 hrs-3 days and if saturated, change

56
Q

What are the types of debridement?

A

Autolytic, mechanical, enzymatic, sharp/excisional, biodebridement

57
Q

Wound vac

A

Negative pressure to absorb fluid

58
Q

How do you remove staples?

A

Every other one first- prevent early separation; if starts to separate, stop removing staples and apply steri strips and notify provider

59
Q

How do you remove sutures?

A

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
Q

Describe Biot’s Breathing pattern

A

Period of apnea followed by rapid breathing then another period of apnea

61
Q

What causes Biot’s breathing patterns?

A

Brain injury(CVA)

62
Q

What causes Cheyne Stokes breathing pattern?

A

Cardiac damage (HF, MI)

63
Q

What causes Kussmaaul’s breathing pattern?

A

Ketones, DKA

64
Q

Stridor breathing

A

High pitched seal bark, obstruction or narrowed upper airway

65
Q

What is the BED acronym for?

A

Wounds- Bacterial (wound culture) Exudate (wound description) Debridement (how to clean it out)

66
Q

What is alginate?

A

Seaweed derivative, no allergens, absorbs 20 times its weight- most absorbent! Do not add anything!

67
Q

What are the types of drains?

A

Penrose, Jackson-Pratt, Hemovac

68
Q

What is a Penrose drain?

A

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
Q

What is the most common drainage device?

A

Jackson-Pratt (JP), works with negative pressure (squeeze bulb side to side after removing pin and emptying drainage) “grenade drain”

70
Q

What is a hemovac?

A

A drain that applies negative pressure top to bottom suction, larger areas, “accordion drain”

71
Q

When would a wound culture not be needed?

A

If wound is dry- no bacteria and exudate= no infection !

72
Q

What is the least cytotoxic woundwash product?

A

0.9 saline for wound wash, no debridement needed

73
Q

Cleaning wounds:

A

Never clean towards wound always away, gentle friction when applying solutions, when irrigating, allow to flow from least contaminated area

74
Q

What are the ostomy complications?

A

Candidiasis, caput medusae, mucocutaneious separation,mechanical injury, stoma necrosis,stomal retraction,Stomal stenosis, Stomal hernia,prolapsed stoma

75
Q

What is stomal candidiasis?

A

Yeast infection due to excess moisture and compromised host (immunosuppression, diabetes or medications i.e. chemo)
Dry
Fungal powder
Porous tape

76
Q

What is caput medusae

A

Hypervascularity, liver disease, silver nitrate for bleeding, Vaseline as pouch adhesive(soft pouching system)- serious bleeding risk and bruising!

77
Q

Mucocutaneious separation

A

Skin and fat separating, bacteria seeps into gaps
Caused by malnutrition, steroids, infection, radiation
Treat with fillers (surgical correction)

78
Q

Mechanical injury

A

Skin stripping, friction, pressure, fragile peristomal skin
Use skin sealants
Avoid tape
More common in elderly and long term steroid tx pt

79
Q

Stoma necrosis

A

Compromised circulation
Most common=post op(surgical technique and thick abdominal wall)
Surgical correction

80
Q

Stomal retraction

A

Stoma pulled inside; increase in pt weight (inward pressure) or too tight surgically
Convex or flexible pouching system- belt straps

81
Q

Stomal stenosis

A

Lumen collapse
Stool softeners, may require surgical intervention

82
Q

Stomal hernia

A

Surgical technique, poor stoma placement outside rectus muscle, more common in elderly
Hernia support belt, flexible pouching system

83
Q

Prolapsed stoma

A

One piece pouching system, decrease abd pressure (supine and cool packs), not painful but pouching difficult

84
Q

Wear time for ostomy pouches?

A

3-14 days depending on product

85
Q

Barrier durability

A

Pectin= short wear time, pectin cannot be used with urostomies bc urine dissolves pectin

86
Q

Skin barrier paste

A

Contains alcohol, more is not better, is a caulk not an adhesive , do not use on premature babies (high alcohol content)

87
Q

What do you never use in pouches for odor control?

A

Aspirin! Creates excess gas production and bag explodes!

88
Q

Diet for those with ileostomies

A

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
Q

Colostomies

A

Output soft and pasty, rods support stomas

90
Q

Colostomy irrigations

A

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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