Exam 2 Blueprint Flashcards
Signs and symptoms of covid and the flu
Fever/chills
Cough
SOB / difficulty breathing
Fatigue
Sore throat
Runny or stuffy nose
Muscle pain / body aches
Headache
Vomiting
Diarrhea
Change in / loss of taste or smell (Covid)
Indications of severe covid 19
Elevated C-reactive protein (CRP) and D-dimer
(Higher of these = worse prognosis)
Types of flu vaccines and who each is for
High dose = x4 antigen - 65 & older
Inactivated (IIV4) = quadrivalent - general population
Recombinant (RIV4) = egg free - 18 & older, egg allergy
Live attenuated (LAIV4) = nasal spray - NOT for:
- adults 50 and older
- pregnant women
- Hx of allergic reaction to vaccines
- immunocompromised
- people who have taken influenza antivirals within 48 hrs
- caregivers for immunocompromised
Treatment of the flu
Antivirals within 24-48 hours of symptoms
Tamiflu - oral, IV (usually IV)
Relenza - inhaled
Teach pts prevention of complications and what symptoms to look for that will warn them of complications
Pt teaching for at home flu management
Stay home
Rest
Keep warm
Drink fluids - stay hydrated
Light foods
Do not smoke
Cover coughs and sneezes
To manage symptoms:
Take acetaminophen/NSAIDs
Fever reducers
Gargle; lozenges
Non-pharmacologic nursing management of sinusitis
Drain obstructed sinuses
Humidification
Saline irrigations
Hot wet packs over sinus area
Increase fluids
Neti pot
Surgery (if unresponsive to conservative treatment)
Medications for sinusitis management
Antibiotics: amoxicillin x2 weeks
Decongestants: pseudoephedrine (Sudafed)
Expectorants: guaifenesin (Mucinex)
Nasal corticosteroids: Fluticasone
Saline nasal spray
OTC analgesics: Tylenol, Advil
Antihistamines (if r/t allergies): Loratidine (Claritin)
Post op nursing care for sinusitis surgery
Ice packs (to reduce swelling)
Oral hygiene (b/c dry mouth)
Saline nose spray (no steroids)
Change “mustache” dressing prn
Limit Valsalva maneuver for 2 wks (no coughing, blowing, lifting >20 lbs)
Semi Fowlers position
Eat soft foods
Analgesics - Avoid NSAIDS (risk of bleeding)
S/S of pneumonia
Cough
*Fever, chills
Dyspnea
Tachypnea
Hypoxemia
Pleuritic chest pain
Green, yellow, or rust colored sputum
Change in mentation (for older or debilitated pts)
- (restless, lethargic, or confusion)
Tachycardia
Fatigue
HA
Poor appetite
Symptoms of pneumonia on head to toe assessment
Fine or coarse crackles
Bronchial breath sounds (in wrong areas)
Pleural friction rub
Increased fremitus (over consolidated areas)
Dullness to percussion if pleural effusion
Splinting
Accessory muscles
Types of pharmacologic treatment for pneumonia
Analgesics
Antipyretics
Expectorants
Antivirals or antibiotics (depending on cause)
Types of antibiotics used to treat pneumonia
Vancomycin (Macrolide) - red man syndrome
Levofloxacin (Levoquin, fluroquinolone) - tendon rupture
Ceftriaxone (Rocephan, cephalosporin) - if allergic to penicillin
(IV first, then PO when pt is more stable)
Pneumonia vaccine recommendations for adults
PCV15, PCV20
PPSV23 (Pneumovax 23)
1 dose PCV 15 or PCV20 then 1 year later, 1 dose PPSV23
For adults 19-64 with chronic diseases and all adults >65
Prevention of pneumonia in at risk patients
Supplemental O2
C/DB, IS
BID oral hygiene
Therapeutic positioning (elevate HOB 30 degrees, sit up for all meals, reposition every 2 hours)
Rest & activity / early ambulation
RT: postural drainage and chest percussion
Adequate hydration
High calorie, small, frequent meals
Partial laryngectomy post op care
*High Risk for aspiration
IV fluids initially
NG tube initially
Tracheostomy x 2-5 days
Risk for ineffective airway clearance
Start with semi solids/puréed
HOB up
Head flexed slightly forward
Have suction available
Total laryngectomy post op care
IV fluids initially
NG tube initially
NPO 1-2 weeks (due to swelling)
Tracheostomy permanently
Speech altered permanently
HOB up
Have suction available
Teach pt: can’t taste/smell, blow nose, Valsalva
Teach: stoma care
Laryngectomy post op care in general
Keep patent airway!
Optimize oxygenation
Maintain nutrition (And treat malnourishment that these pts often suffer from)
Enteral feeding (via NGT then PEG tube) may be utilized during this process
Post op care for the tracheostomy after a laryngectomy
Pain management
Monitor wound, flap, reconstructive tissue for hemorrhage or wound breakdown
Assess pt’s body image/self esteem
Promote communication
- speech and language rehab
Methods of communication for pts after laryngectomy
In hospital: communication boards
TracheoEsophageal Puncture (TEP):
- one way valve to prevent aspiration
- pt blocks opening with finger
Esophageal Speech:
- pt burps out sound
- takes a long time to learn
Electronic Larynx:
- can use immediately after surgery
- easy to learn
- mechanical sounding voice
How is a tuberculin skin test read?
Site is assessed for induration 48-72 hours later
Presence of induration at injection site = TB antibodies
induration >15 mm in low risk individuals
Induration >5 mm in immunocompromised individuals
Benefits of taking TB blood test instead of skin test
BCG vaccine may cause false positive reaction to skin test, but Quantiferon Gold will not
What is a chest X-ray used for diagnosing in TB?
It is not diagnostic, but it can show:
Upper lobe infiltrates
- cavity infiltrates
- lymph node involvement
- pleural and/or pericardial effusion
What is a sputum test used for with TB?
For testing if TB is still contagious in pts with active TB
Once 3 negative sputum samples in a row, pt can be taken off airborne precautions
How is TB transmitted?
*Mycobacterium tuberculosis
- Spreads through small airborne particles that enter lungs and travel to alveoli after someone coughs, sneezes, speaks, sings, or laughs
- Can be suspended in air for minutes to hours
- Requires close, frequent, or prolonged exposure
- NOT spread by touching, sharing food utensils, kissing, or other physical contact
What happens after TB particles are inhaled?
Droplets lodge in bronchioles and alveoli (infection stops)
Local inflammatory reaction occurs
Ghon lesion forms (calcified TB granuloma *hallmark)
Only 5-10% develop active TB
When infection is latent, infection is walled off and further spread is stopped
Isolation precautions for pts with TB
Airborne isolation:
- Private room with negative pressure
- airflow exchanges every hour
Healthcare workers fit tested for model of:
- HEPA mask, N-95, or respirator
Teach pt to prevent spread (covering mouth, hand washing)
Pt wears surgical mask if transported outside of room
Considered infections for first 2-3 weeks after starting tx
1st line drugs used to treat TB
Isoniazid
Rifampin
Pyrazinamide
Ethambutol
Side effects of Isoniazid (INH)
Causes B6 to drop, need vitamin B6 supplement
Can cause hepatitis, monitor liver function (avoid alcohol, meds that affect liver function)
Side effects of Rifampin
Causes red-orange body fluids
Can cause hepatitis, monitor liver function (avoid alcohol, meds that affect liver function)
Side effects of Pyrazinamide (PZA)
Sun burn
Can cause elevated uric acid - swollen, painful joints
Can cause hepatitis, monitor liver function (avoid alcohol, meds that affect liver function)
Side effects of Ethambutal (EMB)
Can cause eye/vision problems
Can cause elevated uric acid - swollen, painful joints
How long does drug therapy last for TB?
Treatment aggressive and has 2 phases
Initial 8 weeks
Followed 18 weeks of tx
For a total of 6-12 month treatment
Why is noncompliance with TB drug therapy such a big issue?
Multi drug resistance
Tx failure
(Govt funded program to assure compliance)
S/S of lung cancer
Persistent cough (not responsive to PNA tx)
Blood-tinged sputum
Dyspnea
Wheezing
Chest pain
Late:
Fatigue, weight loss, N/V
Dysphagia
Superior vena cava syndrome
Differences between small cell and non-small cell lung cancers
Small: aggressive, always systemic/metastasis (20%)
Non-small: squamous cell, adenocarcinoma, large cell
Slower growing, uses TNM staging (80%)
Treatments for small cell lung cancer
Chemotherapy
Prophylactic cranial radiation
Treatment for non-small cell lung cancer
Surgery (tumor, lobectomy, pneumonecomy)
Radiation
Chemotherapy
Immunotherapy
Targeted therapy
Diagnostic tests for urine to detect urinary health conditions
Serum BUN & creatinine
Urinalysis (specific gravity)
Culture & sensitivity
Clearance studies
Normal SG of urine
1.005-1.030
Normal pH of urine
4.6-8
Normal Protein amount in urine
0-8 mg/dL
Normal amt of WBC in urine
0-4
Normal amt of RBC in urine
0-2
Urinalysis should be negative for:
Glucose
Ketones
Bilirubin
Casts
Crystals
Nitrates (released by bacteria)
Leukocyte esterase
Diagnostic procedures for bladder that require IV contrast dye
Intravenous urography
Cystogram
Renal scan
Angiography/arteriogram
What is a Cystogram?
Contrast used to view bladder via scope and cath
Nursing considerations for cystoscopy
Surgical consent needed
Pt will be NPO
Can be done as out pt
*Expect pt to have pink urine, but should have no frank bleeding or clots
What is cystoscopy used for?
Used for diagnosis and tx of stones, tumors, large prostate
How is an angiography/arteriogram done?
Contrast used to visualize renal arteries: used in combo with other diagnostic/treatment procedures
Nursing considerations for a pt having a renal biopsy Greatest risk from the procedure
Procedure performed percutaneous lay
Pt will be NPO prior
Check coagulation studies
Prone position
Greatest risk is bleeding post procedure
(Need to monitor urine for bleeding, monitor for increased HR or decreased BP)
S/S of a typical UTI
Frequency
*Dysuria
Urgency
(Pain upon urination)
S/S of complicated cystitis (UTI)
*Fever/chills
*N/V
*Malaise
*Flank pain
*CVA tenderness (upper uti)
*Urine with sediment, blood, odor
What would make a UTI considered complicated?
Any male with a UTI
If UTI turns to upper UTI
Pt teaching for cystitis (UTI)
Alteration in urinary elimination pattern:
- force fluids
- avoid soy, tomato, spicy food
Pain
- warm sitz bath
Knowledge deficit r/t hygiene
- cleanse front to back
- avoid irritating substances
- avoid tight fitting clothing
UTI drugs
*Antimicrobials:
- sulfonamides (Bactrim)
- Fluoroquinolones (Ciprofloxacin)
Urinary *antiseptics:
- Macrodantin
Bladder *analgesics:
- pyridium
*Antispasmodics:
- Ditropan
- Urogesic blue
Reasons pt would have a catheter
Hematuria (monitoring for)
Obstruction
Urologic surgery
Decubitus ulcer (incontinent/immobile)
Intake and output (strict measurements)
No code / comfort care
Immobility / physical constraints
What is pyelonephritis?
Infection of the renal parenchyma and collecting system
Emergency renal disorder
Hydronephrosis
What is hydronephrosis?
Dilation of kidney due to obstruction causing hydroureter / reflux
What is a hydroureter?
Dilation or ureter due to obstruction, causing urethral stricture
Major concern for hydronephrosis
Renal failure
Symptoms of hydronephrosis
Pain
No urine in bladder
Risk factors for bladder cancer
1 = tobacco use
Exposure to toxins
Pharmacologic treatment of bladder cancer
Prophylactic immunotherapy with BCG
Multi-agent chemotherapy, radiation therapy
Clinical manifestations of PKD
Pain
Nocturia
Enlarged kidneys
Enlarged abdomen
Infections
HTN
Hematuria
Constipation
Patient teaching for CKD
Is inherited so 1/2 of offspring will have PKD
Pt is at high risk for injury/trauma
Teach pt knowledge about disease
Help pt and family with coping
Do not need dialysis until stage 5
Risk factors for renal calculi
Stasis of urine
Trauma to urinary lining
Offensive metabolic disease (chronic) - gout, Hypercalcemia
Not normal pH
Excess solute concentration
Dehydration
Family history
Obesity
Diabetes
Diet
What are kidney stones called?
Nephrolithiasis
What are stones in ureters called?
Ureterolithiasis
Complications of kidney stones
Urinary tract obstruction = Emergency and must be treated to preserve kidney function
Pt teaching for urolithiasis
Hydration:
- about 3L/day for ambulatory pt.
- goal = UOP 2L/day
Mobility
Nutrition:
- calcium stones = decrease sodium
- uric acid stones = decrease purine/organ meats, poultry, fish
Nursing actions for urolithiasis
*Strain all urine
Pt will have acute pain when stone is moving
Pt may have altered nutrition
Pt is at high risk for infection
Teach pt about prevention and follow up care
Help pt manage pain with drug therapy, *lithotripsy
What is lithotripsy?
Treatment for urolithiasis that uses shockwaves to break up renal calculi
Pt is placed under spinal or general anesthesia
*Need to monitor pt for bruising, which is common
What is a nephrostomy tube?
Tube placed in pelvis of kidney temporarily for ureteral obstruction
Nursing management of nephrostomy tubes
Irrigate with less than 5 mL (sterile procedure, need order)
*Keep bag below kidney
*Do not clamp
Check for urine flow and make sure *no tubing kinks
S/S of BPH
Urinary retention
Overflow urinary incontinence
Possible sexual dysfunction
Nocturia
Frequency
Hesitancy
Intermittence
Dribbling
Sensation of incomplete emptying
Diminished force and caliber of stream
What does a prostate feel like in a pt with BPH?
Uniform
Elastic
Nontender
Enlarged
Management of BPH
Watchful waiting (teach pt how to avoid over-distended bladder)
Pharmacologic management to slow hyperplasia
Thermotherapy
Lasers
Surgical management
Types of drugs used for BPH
5-alpha-reductase inhibitors
Alpha1-adrenergic antagonist
ED drugs: PDE-5 inhibitors
Examples of 5-alpha-reductase inhibitors for BPH
Finasteride (Proscar)
Dutasteride (Avodart)
Function of 5-alpha-reductase inhibitors
Shrinks prostate gland to improve urinary flow
Example of alpha1-adrenergic antagonists for BPH
Tamsulosin (Flomax)
Function of Tamsulosin (flomax) for BPH
Relaxes bladder neck muscles and smooth muscle fibers of prostate, making it easier to urinate
ED drugs (PDE-5 inhibitors) examples for BPH
Sildenafil (Viagra)
Tadalafil (Cialis)
Function of viagra and cialis
Relax smooth muscle, vasodilation
Pt teaching for pts taking viagra and cialis
Avoid alcohol and high fat meals
*hypotension after taking - *cannot take nitro or related drugs!
Indications for BPH surgery
Acute urinary retention
Chronic UTIs secondary to residual urine
Hematuria
Hydronephrosis
Bladder neck obstruction
Minimally invasive therapy for BPH
Thermotherapy:
- Transurethral needle ablation
- Transurethral microwave therapy
- Transurethral vaporization of the prostate
Lasers - cut, cauterize, vaporize
- photoselective vaporization of prostate (PVP)
Less risk b/c IV anesthesia (no general or regional) and blood loss is minimal
Gold standard prostate therapy
TURP (Transurethral resection of the prostate)
Chip away at prostate through urethra
Preoperative pt teaching for BPH surgery (TURP)
- Possibility of indwelling 3-way catheter with continuous bladder irrigation for about 24 hrs (CBI)
- Some hematuria and clots are normal initially
- Verify meds that have anticoagulant effects have been stopped
Nursing actions for a pt who had TURP
Monitor catheter for patency and hematuria
- *Keep free of clots
- *Assess for bladder spasms (treat with meds)
- If catheter becomes obstructed:
- Turn off CBI
- Irrigate catheter w/ 30-50mL NS - large piston syringe
- Notify MD immediately if obstruction not resolved
- Monitor for S/S of infection (cloudy urine, fever)
- Prevent complications of immobility
- Pain management
Nursing actions involving CBI
Irrigation and urine will be draining out, need to chart it, empty it, etc.
If put in 2,000 mL irritant and 3,000 mL comes out, pee = 1,000 mL
If less than amt put in comes out = problem
S/S of prostate cancer
Burning or pain with urination
Inability to urinate (acute urinary retention) or difficulty starting to urinate
Frequent or urgent need to urinate
Trouble emptying bladder completely
*Gross, painless hematuria
*Continual pain in lower back, pelvis, hips, or thighs = metastases
Diagnostics for prostate cancer
PSA test and DRE for pts age 50 at average risk
Biopsy if:
- PSA levels are continually elevated or abnormal DRE
- to confirm diagnosis
How is a biopsy for prostate cancer performed?
Transrectal ultrasound procedure (TRUS)
Using MRI with US = newer technique
CT scans and bone scans for metastasis
Hormone therapy used to treat prostate cancer
Androgen synthesis inhibitors
Androgen synthesis inhibitor used for prostate cancer
Leuprolide acetate (Lupron)
Function of Leuprolide acetate (Lupron)
For advanced prostate cancer
- Suppresses release of LH, FSH, & reduces testosterone levels
Side effects of leuprolide acetate (Lupron)
CAD
HLD
Osteoporosis
Hot flashes
Decreased libido
ED
Androgen receptor blocker used for prostate cancer
Flutamide (Eulexin)
For metastatic prostate cancer
Function of Flutamide (Eulexin)
Prevent testosterone & DHT from binding to receptors at tumor sites
Side effects of flutamide (Eulexin)
CAD
HLD
Osteoporosis
Gynecomastia
Hot flashes
Loss of libido
(Rarely - fatal liver toxicity)
Pharmacologic therapy for ED
PDE-5 inhibitors
- Sildenafil (Viagra)
- Tadalafil (Cialis)
Side effects of PDE5 inhibitors
Headaches
Leg/back pain
Dyspepsia
Flushing
Nasal congestion
Rare: blurred or blue-green vision, sudden hearing loss, priapism (seek immediate medical attention)
Function of PDE-5 inhibitors
Smooth muscle relaxation and vasodilation
What meds should pt avoid while taking PDE-5 inhibitors?
Vasodilators, nitrates, alpha-adrenergic blockers (for at least 24-48 hrs, depending on which drug was taken)
