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Adult Nursing I (NUR 240) > Exam 3 > Flashcards

Exam 3 Flashcards

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1
Q

What is Altruism?

A

Concern for the well-being of others

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2
Q

Give an example of human dignity

A

Not gossiping about patients

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3
Q

List the theories of aging

A
  • Genetics
  • Immunity
  • Cross-linkage
  • Free radicals
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4
Q

Explain the cross-linkage theory of aging

A

chemical reaction damages DNA causing cell death

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5
Q

Explain the free radical theory of aging

A

molecules with separated high-energy electrons harm nearby molecules

  • focuses on cell metabolism & function
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6
Q

What is immunosenescene?

A

age-associated immune changes = increased infections cancer, autoimmune disorders

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7
Q

Development of Middle Adults

A
  • Physiologic: gradual internal & external physioloigc changes occur
  • Cognitive: little change from young to adulthood
  • Psychosocial: time of increased personal freedom, economic stabillity, & social relationships
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8
Q

Which example is a developmental task of the middle adult?

a.) continue an established lifestyle or reorganize one’s life in a period of transition
b.) Adapt to, and face, already completed tasks
c.) Choose a vocation
d.) Develop an ethical system as a guide to behavior

A

a.) continue an established lifestyle or reorganize one’s life in a period of transition

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9
Q

Explain Erikson’s theory on older adults

A
  • ego integrity vs. dispair & disgust
  • Final stage of psychosocial development
  • Contemplate accomplishments & develop integrity if lead a successful life
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10
Q

What are some myths of ageism?

A
  • aging involves severe cognitive decline
  • Urinary incontinence is normal
  • Late life is lonenly and depressing
  • Older people lose interest in sex
  • Most older people do not live independently
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11
Q

Nursing care goals for the older adults

A

#1 Promote independent function

  • support individual strengths
  • prevent complications of illness
  • secure a safe & comfortable environment
  • promote return to health
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12
Q

SPICES tool to identify common problems in older adults

A
  • Sleep disorders
  • Problems with eating or feeding
  • Incontinence
  • Confusion
  • Evidence of falls
  • Skin breakdown
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13
Q

What is the function of the upper airway?

A

Warm, filter, & humidify air

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14
Q

Components of the upper airway

A
  • nose
  • pharynx
  • larynx (vocal cords)
  • epiglottis (covers windpipe)
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15
Q

What are the function of the lower airway?

A
  • Air conduction
  • Mucociliary clearance
  • Production of pulmonary surfactant
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16
Q

Lower airway components

A
  • trachea
  • R & L mainstream bronchi
  • segmental bronchi
  • terminal bronchioles
  • alveoli
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17
Q

Explain what a Nonrebreather mask is

A

Low flow rates, high concentration of O2

  • mask on pt face, has reservoir bag below connected to O2
  • prevents O2 from entering the mask
  • for short term or emergencies
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18
Q

Explain what a simple mask is

A

low to moderate amount of O2

  • holes prevent CO2 from entering mask
  • Doesn’t deliver as high of an O2 concentration as non-rebreather
  • safer in the case of a blockage
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19
Q

Explain what a venturi mask is

A

designed to deliver a fixed O2 concentration

  • mixes O2 with inhaled air
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20
Q

Why don’t we use vasaline / petrolium jelly with an O2 mask?

A

it’s an accelerant

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21
Q

Explain the physics of breathing

A

As volume of lungs shrinks during exhalation, the pressure of the lungs increases (+) above that of the atmospheric pressure (-) & air moves out of the lunsg down the pressure gradient

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22
Q

Which phase of ventilation is inspiration?

A

Active

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23
Q

Which phase of ventilation is expiration?

A

Passive

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24
Q

Which respiratory organ is the site of gas exchange?

a.) Mediastinum
b.) Parietal pleura
c.) Alveoli
d.) Diaphragm

A

c.) Alveoli

The wall of each alveolus is made of a single-cell layer of squamous epithelium. The thin awll allows for exchange of gases within the capillaries covering the alveoli

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25
Q

What is perfusion?

A

The process by which oxygenated capillary blood passes through body tissues

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26
Q

List some potential alterations in the cardiovascular system

A
  • dysrhythmia or arrhythmia
  • myocardial ischemia
  • angina
  • myocardial infarction
  • heart failure
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27
Q

What is the difference in ischemia & infarction?

A

ischemia = reduced blood flow to tissue
* can lead to pain

Infarctoin = end point of ischemia that results in tissue death

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28
Q

What are vesicular breath sounds?

A

low pitched = low on the chest

  • heard during expiration heard over most of the lungs

low pitched = low on the chest

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29
Q

What are bronchiovesicular sounds?

A

medium pitch = heard in medium location on chest

  • heard during expiration over the upper anterior chest & intercostal area
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30
Q

What are bronchial lung sounds?

A

high pitched = heard high in the chest

  • longer sounds
  • heard mainly over the trachea
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31
Q

What is the cause of angina?

A

reduced blood flow to the heart

angnia = chest pain

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32
Q

What is the cause of heart failure?

A

Heart muscle can’t pump enough blood to meet body’s needs for blood & oxygen.

Heart can’t keep up with its workload

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33
Q

What is the difference in wheezes & crackels?

A

Wheezes:
* continuous sounds
* heard on expiration & sometimes on inspiration as air passes through airways constricted by swelling, secretions, or tumors
* classified as sibilant (high [i]) or sonorous (low [o])

Crackles:
* intermittent sounds
* occur when air moves through airways containing fluid
* classified as fine, medium, or coarse

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34
Q

How are wheezes classified?

A
  • sibilant (high)
  • sonorous (low)
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35
Q

How are crackles classified?

A
  • fine
  • medium
  • coarse
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36
Q

What is Tidal Volume (TV)?

A

total amount of air inhaled & exhaled in 1 normal breath

doesn’t require conscious effort

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37
Q

What is Vital Capacity?

A

maximum amount of air that can be expired after inspiration

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38
Q

What is Forced Vital Capacity (FVC)?

A

** maximum amount of air that can be FORCEFULLY exhaled after a full inspiration**

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39
Q

What is Forced Expiratory Volume (FEV …1…2…3)?

A

Volume of air exhaled at a specific interval

EX: after 1 second, 2 sec., 3 sec. after full inspiration

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40
Q

What is Total Lung Capacity (TLC)?

A

Volume of air contained in the lungs at maximum inspiration

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41
Q

What is Residual Volume (RV)?

A

Volume of air left in lungs at maximal expiration

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42
Q

What is Peak Expiratory Flow Rate (PEFR)?

A

Maximum flow attained during FVC (forced vital capacity)

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43
Q

What is atelectasis?

A

collapsed lung or incomplete expansion of alveoli

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44
Q

What are potential causes of atelectasis?

A
  • Diminished breath sounds over collapse
  • Dyspnea
  • Cyanosis
  • Crackles
  • Restlessness
  • Apprehension

atelectasis = collapsed lung (incomplete alveoli expansion)

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45
Q

What can be done to prevent atelectasis

A
  • Incentive spirometry (IS)
  • Coughing
  • Getting out of bed (movement)
  • Turning in bed
  • Maintaining hydration

atelectasis = collapsed lung (incomplete alveoli expansion)

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46
Q

Which lung value is the amount of air contained within the lungs at maximum inspiration?

a.) vital capacity (VC)
b.) total lung capacity (TLC)
c.) residual volume (RV)
d.) peak expiratory flow rate (PEFR)

A

b.) total lung capacity (TLC)

  • TLC = amount of air contained within the lungs at maximum inspiration
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47
Q

What is pneumonia?

A

inflammed alveoli

due to foreign material or infection

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48
Q

What are some of the signs & symptoms associated with pneumonia?

A
  • Fever
  • Cough
  • Rusty or purulent sputum
  • Chills
  • Crackeles (fluid)
  • Wheezes (obstructed airway from inflammation)
  • Dyspnea
  • Angina
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49
Q

Post-Operative Pulmonary Care Program

A

Incentive spirometry
Cough / deep breathing
Oral care
Uunderstanding (patient & staff education)
Get out of bed 3 times per day
Head of bed elevation

ICOUGH

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50
Q

In what instances / scenarios would a chest tube be placed?

A
  • Surgery
  • Trauma
  • Pneumothorax
  • Pleural Effusion
  • Emphysema
  • Chylothorax (lymph fluid in pleural space)
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51
Q

Where is a chest tube placed?

A

any of the 4 pleural spaces

R, L, anterior, or posterior pleural space

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52
Q

List the types of artificial airways

A
  • oropharyngeal airway
  • nasopharyngeal airway
  • endotracheal tube
  • tracheostomy
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53
Q

Is bubbling of a chest tube normal?

A
  • Intermittent Bubbling = Normal (when patient coughs or exhales)
    • Continuous Bubbling = ABNORMAL
      * can indicate a leak
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54
Q

What is the goal of a vasodilator when given in a hypertensive crisis?

A

Lower the blood pressure by 25% in the first hour

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55
Q

What should the nurse do if a chest tube becomes disconnected from its drainage unit?

A

Submerge the end of the tube in sterile water

allows air to escape & prevents a pneumothorax

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56
Q

What part of the brain stem contains the respiratory center?

A

Medulla

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57
Q

What can emphysema result in or lead to?

A

DECREASED (-) lung compliance

compliance = change in volume in the lungs for given change in pressure

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58
Q

What are signs and symptoms of hyperkalemia?

KNOW THIS

A
  • Bradycardia
  • Contracted muscles (including the heart)
  • Diarrhea
  • Hypotention

BCDH

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59
Q

What are signs & symptoms of hypokalemia?

KNOW THIS

A
  • Flushed skin
  • Fever
  • Polydipsia (excessive thirst)
  • N/V
  • Swollen tongue

FFPNS

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60
Q

What are signs & symptoms of hyponatremia?

KNOW THIS

A
  • Coma
  • Respiratory arrest
  • Seizures
  • Tachycardia
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61
Q

What is shock?

A

Body’s reaction to acute peripheral circulatory failure due to an abnormality of circulatory control or to a loss of circulating fluid

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62
Q

What is the difference in elective, urgent, & emergent surgery?

A
  • Elective: delay has no ill effects / improve health or self-concept
  • Urgent: usually done 24-48 hours, remove or rapir body part (cholecystectomy or amputation)
  • Emergent: done immediately to preserve life (hemorrhage, tracheostomy)
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63
Q

What is palliative surgery?

A

Not curative

  • reduce or releive intensity of disease

debride nectrotic tissue, arthroplasty, etc.

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64
Q

What are the 4 different types of anesthesia?

A

1.) General
2.) Moderate Sedation / Analgesia (conscious sedation)
3.) Regional
4.) Topical & Local Anesthesia

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65
Q

When is Moderate Sedation / Analgesia (conscious sedation) used?

A

for short-term, minimally invasive procedures

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66
Q

What are the 3 phases of general anesthesia?

A

1.) Induction: administration of anesthesia –> ready for incision

2.) Maintenance: incision –> near completion of procedure

3.) Emergence: starts when patient emerges from anesthesia & is ready to leave the OR

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67
Q

What is the difference in a living will & a durable power of attorney?

A

Living Will: patient makes choices before incapacitation

DPOA: patient appoints someone else to make decisions once incapacitated

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68
Q

Explain the surgical risks of medications

A
  • Anticoagulants: hemorrhage
  • Diuretics: electrolyte imbalances, respiratory depression from anesthesia
  • Tranquilizers: increased hypotensive effects of anesthetic agent
  • Adrenal Steroids: abrupt withdrawal may cause cardiovascular collapse
  • Antibiotics in -mycin group: respiratory paralysis (when combined with ceratin muscle relaxants)
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69
Q

What are surgical risks associated with anticoagulants?

A

hemorrhage

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70
Q

What are surgical risks associated with diuretics?

A
  • Electrolyte imbalances
  • Respiratory depression (from anesthesia)
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71
Q

What are surgical risks associated with tranquilizers?

A

increased hypotensive effects of anesthetic agents

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72
Q

What are surgical risks associated with adrenal steroids?

A

abrupt withdrawal may cause cardiovascular collapse

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73
Q

What are surgical risks associated with antibiotics in the mycin group?

A

respiratory paralysis (when combined with certain muscle relaxants)

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74
Q

List some teachings nurses can perform pre-op to prevent post-op complications

A
  • Deep breathing
  • Coughing
  • Incentive spirometry (IS)
  • Leg exercises (to prevent clots)
  • Turning in bed
  • Early ambulation
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75
Q

List medication classes that are commonly used post-operatively

A
  • Sedatives (xanax, lunesta, valium, klonopin, ativan)
  • Anticholinergics (bentyl, benztropine, atropine, benadryl, glycopyrrolate)
  • Narcotic analgesics (morphine, codeine, dilaudid, oxycodone, tramadol, fentanyl, hydrocodone)
  • Neuroleptic agents (haldol, risperidone, aripiprazole (abilify))
  • H2 receptor antihistamines (ranitidine & famotidine)
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76
Q

List medication classes that are commonly used post-operatively

A
  • Sedatives (xanax, lunesta, valium, klonopin, ativan)
  • Anticholinergics (bentyl, benztropine, atropine, benadryl, glycopyrrolate)
  • Narcotic analgesics (morphine, codeine, dilaudid, oxycodone, tramadol, fentanyl, hydrocodone)
  • Neuroleptic agents (haldol, risperidone, aripiprazole (abilify))
  • H2 receptor antihistamines (ranitidine & famotidine)
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77
Q

What post-op assessments & interventions should be done every 10 - 15 minutes?

A
  • Respiratory Status (airway, pulse ox)
  • Cardiovascular Status (BP)
  • Temperature
  • CNS Status (level of alertness, movement, etc.)
  • Fluid Status
  • Wound Status
  • GI Status (N/V)
  • General Condition
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78
Q

What are potential post-op cardiovascular complications that can arise?

A
  • Hemorrhage
  • Shock (low BP)
  • Thrombophlebitis (irritation of vein due to clot)
  • Pulmonary Embolus (disloged clot travels to lung)
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79
Q

What actions should be taken when hemorrhage or hypovolemic shock is expected?

A
  • Pressure dressing
  • Contact surgeon or rapid response team
  • prepare patient to return to the OR for stabilization
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80
Q

What are signs & symptoms of a PE?

A
  • Dyspnea
  • Tachycardia
  • Anxiety
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81
Q

What are signs & symptoms of thrombophlebitis?

A
  • Erythema
  • Edema
  • Elevated temperature
  • Pain / cramping in the calf
  • Increased limb diameter
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82
Q

What is the earliest indication of hypovolemic shock?

A

INCREASED heart rate

83
Q

What percentage of fluid in the body consists of ECF vs. ICF?

A

ECF = 30%
ICF = 70%

84
Q

Is there more fluid inside or outside of cells?

A

INSIDE (ICF)

85
Q

What is the difference in a solvent & a solute?

A
  • Solute: substance being dissolved
  • Solvent: substance that is doing the dissolving
86
Q

What are the functions of sodium?

Na

A
  • controls & regulates volume of body fluids
87
Q

What are the functions of potassium?

K

A

regulator of cellular enzyme activity & water content

88
Q

What are the functions of calcium?

Ca

A
  • nerve impulse
  • blood clotting
  • muscle contraction
  • B12 absorption
89
Q

What are the functions of magnesium?

Mg

A
  • proteins & carbohydrate metabolism
  • vital actions involving enzymes
90
Q

What are the functions of chloride?

Cl

A
  • maintain osmotic pressure in blood
  • produce hydrochloric acid
91
Q

What are the functions of bicarbonate?

HCO3-

A

primary buffer system in the body

92
Q

What are the functions of phosphate?

PO4

A
  • involved in chemical reactions of the body
  • cell division
  • hereditary traits
93
Q

What is the average adult fluid intake & loss in 24 hours?

A

1500 - 3500 mL

94
Q

What is a hypertonic solution?

A

cells shrink

  • high osmotic pressure so fluid moves OUT of the cell
95
Q

What is hypotonic solution?

A

cells swell / burst

  • low osmotic pressure so fluid moves INTO cells
96
Q

What is isotonic solution

A

Equal amount of fluid moving into and out of the cell

no movement

97
Q

Where is the thirst control mechanism located?

A

hypothalamus

98
Q

How does the body become hydrated?

A

1.) Drinking
2.) Eating
3.) metabolism of fats, proteins, & carbs

99
Q

Low potassium (K) levels can lead to low levels of what?

A

Chloride

- K = - Cl (directly proportional)

100
Q

List the levels of each electrolyte

(per textbook)

Na, P, Ca, Mg, Cl, HCO3, PO4

A
  • Sodium (Na): 135 - 145
  • Potassium (K): 3.5 - 5 (3.5 - 4.5)
  • Calcium (Ca): 8.6 - 10.2
  • Magnesium: 1.3 - 2.3
  • Chloride (Cl): 97 - 107
  • Bicarbonate (HCO3): 25 - 29
  • Phosphate (PO4): 2.5 - 4.5
101
Q

What is the normal range for sodium (Na)?

Per book

A

135 - 145

102
Q

What is the normal range for potassium (K)?

per book

A

3.5 - 5

usually 3.5 - 4.5

103
Q

What is the normal range for calcium (Ca)?

per book

A

8.6 - 10.2

104
Q

What is the normal range for magnesium (Mg)?

per book

A

1.3 - 2.3

105
Q

What is the normal range for chloride (Cl)?

per book

A

97 - 107

106
Q

What is the normal range for bicarbonate (HCO3-)?

per book

A

25 - 29

107
Q

What is the normal range for phosphate (PO4-)?

per book

A

2.5 - 4.5

108
Q

What is phase I PACU Care?

Ch 16

A
  • immediate recovery
  • intensive nursing care
109
Q

What is Phase II PACU Care?

Ch 16

A

prepared for transfer to inpatient nursing unit, extended care setting, or discharge

110
Q

When is a nasal canula (NC) used?

A
  • short-term use; post-op
  • long-term use (used w/ humidifier)
111
Q

What is the main difference in a partial rebreather mask & a non-rebreather mask?

A

A partial rebreather mask does NOT have flutter valves on the side

  • Non-rebreather mask has flutter valves
112
Q

In what circumstances is a non-rebreather (NRB) used?

A
  • Carbon monoxide poisoning
  • Flutter valves should be closed

if reservoir bag is fully deflated = INCREASE O2 flow

113
Q

What type of oxygen mask provides the most precise oxygen delivery?

A

venturi mask

Venturi mask = Very accurate

114
Q

What is the difference in hypercapnia and hypoxemia?

A
  • Hypercapnia = ELEVATED CO2
  • Hypoxemia = low O2
115
Q

Describe the nursing management in the PACU

Ch 16

A
  • Assess the patient
  • Maintain patent airway
  • Maintain cardiovascular stability
  • Relieve pain & anxiety
  • Control N/V
116
Q

What signs & symptoms are associated with hypovolemic shock?

KNOW THIS

A
  • pallor
  • cool, moist skin
  • rapid breathing
  • cyanotic lips
  • rapid, weak, thready pulse
  • concentrated urine (dark brown, dehydrated due to low blood volume)
  • decreased pulse pressure (less blood circulating)
  • Low BP
117
Q

What are some Gerontologic Considerations when caring for geriatric post-op patients?

Ch 16

A

Older = slower body response

  • Decreased physiologic reserve
  • Monitor carefully & frequently
  • Hydration, Thermoregulation, Hypoxia, HTN, Hypoglycemia
  • Increased likelihood of post-op confusion or delirium
118
Q

What is the difference in first, second, & third intention wound healing?

Ch 16

A
  • First Intention: well-approximated edges, no visible granulation, minimal scar formation
  • Second Intention: visible granulation tissue, wound is left open to heal on its own via granulation
  • Tertiary (third) Intention: wound closure is intentionally delayed (first heals by secondary intention, then surgically closed once risk for infetion is decreased)
119
Q

Which of the following occurs during the inflammatory stage of wound healing?

a.) Fibroblasts leave wound
b.) Tensile strength increases
c.) Blood clot forms
d.) Granulation tissue forms

A

c.) Blood clot forms

120
Q

Give the ranges of normal pH, PaCO2, & HCO3

Ch 17

A

pH: 7.35 - 7.45
PaCO2: 35 - 45
HCO3: 22 - 26

121
Q

What structures make up the upper respiratory tract?

Ch 17

A
  • Nose
  • Paranasal sinuses
  • Pharynx
  • Tonsils & adenoids
  • Larynx (epiglottis, glottis, thyroid cartilage, cricoid cartilage, vocal cords)
  • Trachea
122
Q

What structures make up the lower respiratory tract?

Ch 17

A
  • Lungs
  • Pleura (serous membrane that lines thoracic cavity wall & lungs)
  • Mediastinum
  • Bronchi & Bronchioles
  • Alveoli
123
Q

What is ventilation?

Ch 17

A

mechanical movement of air

124
Q

What is respiration?

Ch 17

A

exhanging of gases in the alveoli

physiologic

125
Q

What is compliance?

Ch 17

A

elasticity & expandability of the lungs & thoracic structures

126
Q

What is the difference in pulmonary diffusion & pulmonary perfusion?

Ch 17

A
  • Pulmonary Diffusion: O2 delivered to blood capillaries & CO2 is removed from blood capillaries (via alveoli)
  • Pulmonary Perfusion: blood flow through pulmonary vasculature
127
Q

What is the common cold and what are associated signs & symptoms?

Ch 17

A

Acute inflammation of nasal cavity

  • rhinorrhea
  • sneezing
  • sore theoat
  • general malaisse
  • nasal congestion
128
Q

What is Forced Expiratory Volume (FEV)?

Ch 17

A

maximum amount of air that can be exhaled over a short period of time

129
Q

What is Residual Volume (RV)?

Ch 17

A

volume of air remaining in the lungs after maximum exhalation

130
Q

What is used to measure Peak Expiratory Flow Rate (PEFR)?

Ch 17

A

Peak Flow Meter

131
Q

List different types of URIs

Ch 17

A
  • Rhinitis & rhinosinusitis
  • Pharyngitis
  • Tonsillitis & adenoiditis
  • Peritonsillar abscess
  • Laryngitis
  • Allergic Rhinitis
132
Q

What is Rhitis? What are the causes? What are common signs & symptoms?

Ch 17

A

inflammation of the nasal cavity

  • Causes: acute, chronic, bacterial, viral
  • S&S: rhinitis, itchy nose, mouth/throat itching
133
Q

What is Pharyngitis? What are the causes? What are signs & symptoms? What should nurses do / be aware of?

Ch 17

A

Sore throat

  • Causes: acute or chronic
  • S&S: pain, fever, edema of the throat
  • Nurses should: check hydration status (ice chips or popsicles)
134
Q

What is Tonsillitis / Adenoiditis?

Ch 17

A

Inflammation of the tonsils or adenoids

  • tonsils are part of the immune system
135
Q

What is a peritonsillar abscess?

Ch 17

A

collection of fluid around the tonsils

136
Q

What is Laryngitis?

Ch 17

A

Sounds hoarse, hard time talking, changes in voice

137
Q

What type of bacteria is the precursor to pharyngitis?

Ch 17

A

Group A Streptococcus

138
Q

What happens if pharyngitis caused by group A strep. is not treated quickly?

Ch 17

A

sepsis can occur

infection in the blood

139
Q

What are potential complications of URIs?

Ch 17

A
  • Nuchal rigidity (neck stiffness – meningitis)
  • Airway obstruction
  • Hemorrhage
  • Sepsis
  • Trismus (lock jaw)
  • Dysphagia
  • Aphonia (loss of ability to speak)
  • Meningitis or brain abscess (severe headache, fever, etc.)
140
Q

What is epistaxis? What is the most common site? How is it managed?

Ch 17

A

nose bleed

  • Most Common Site: anteiror septum
  • Management: pinch soft portion of nose for 5-10 minutes with patient sitting upright; phenylephrine spray (vasoconstrict); silver nitrate or electrocautery; gauze packing or balloon inflated catheter for 3-4 days; antibiotic therapy
141
Q

Patient teaching for epistaxis

Ch 17

A
  • avoid spicy food (vasodilation)
  • Avoid nasal trauma, nose picking, forceful blowing, tobacco
  • Avoid exercise (increases vasodilation & risk of bleeding coming back)
  • Adequate humidification
142
Q

What should patients with pharyngitis do and not do?

Ch 17

A

DO:
* stay hydrated
* wear face mask to filter out small particles
* use lozenges or gargle w/ warm salt water

NOT DO
* ENDS use (vape)
* secondhand smoking
* EtOH
* exposure to cold environments
* occupational pollutants

143
Q

What are common diagnosis statements for patients with URIs?

Ch 17

A
  • Ineffective airway clearance
  • Ineffective breathing patterns
  • Insufficient fluid volume
  • Anxiety
  • Activity intolerance
  • Impaired verbal communication (laryngitis)
  • Impaired swallowing (strep throat)
144
Q

What are crackles?

Ch 17

A

soft, high-pitched popping sounds during inspiration (may be heard on expiration)

145
Q

What are wheezes?

Ch 17

A

high-pitched whistle sound usually heard on expiration

146
Q

What two things can lead to an acidic state in the body?

A
  • Hydrogen acid (H = High acid)
  • Carbon dioxide (CO2 = carbon di-acid)

more carbon dioxide = ** more carbon diacid**

147
Q

What instances can lead to ABG imbalances controlled by the lungs?

A

Alkalotic (basic): hyperventlation

Acidotic: intoxication, overdose, head injury (low respiratory rate)

148
Q

What element can cause the body to become alkalotic?

A

Bicarbonate = Basic

149
Q

What is a laryngectomy & what populations are more susceptible to needing them?

A

removal of the voice box

Common in:
* men (4x higher risk of laryngeal cancer)
* 65+

150
Q

What are potential complications of a laryngectomy?

A
  • Respiratory distress
  • Hemorrhage
  • Infection
  • Wound breakdown
  • Aspiration

prevent aspiration w/ increased suction & 30 degree head elevation

151
Q

What should the nurse prepare a patient for regarding laryngectomy post-op?

A
  • PEG tube for nutritional support
  • NPO for 1 week post-op
  • Check literacy, hearing, & vision
  • Coping skills & available support system
152
Q

What nursing interventions can be utilized with patients having a laryngectomy?

A
  • Preoperative teaching
  • Reduce anxiety
  • Maintain patent airway (suctioning)
  • Support alternative communication
  • Protomote adequate nutrition & hydration
  • Monitor potential complications
  • Encourage coughing & deep breathing
  • Promote positive body image & self-esteem
  • Provide skin care
153
Q

What forms of diagnostic testing can be done for URIs?

A
  • CBC
  • CT of the sinuses
154
Q

What are important things to recall regarding patients who are having / have had a laryngectomy?

A
  • Patient should eat protein before surgery
  • Pt will not be able to laugh, whistle, speak, sing post-op
  • Sense of taste & smell will change
  • Will need more oral care post-op (suction & sit upright)
  • Avoid perfumes, aerosols, & air fresheners
155
Q

Older patients who have GERD are at a higher risk for what complication?

A

Aspiration

156
Q

What medications are commonly used to treat GERD?

A

Proton Pump Inhibitors (PPIs): reduce H2 receptors (decrease gastric backflow)

  • Pepsid, omeprazole, zantac
157
Q

What is atelectasis?

Ch 19

A

closure or collapse of alveoli

158
Q

What is atelectasis? What are the classifications? What are common signs & symptoms?

A

Closure or collapse of alveoli

S&S: increasing dyspnea, cough, sputum

Classifications
* Acute: pleural pain, tachycardia, tachypnea, central cyanosis
* Chronic: pulmonary infection might be present

159
Q

What assessments are used to diagnose atelectasis?

A
  • Chest X-ray
  • Pulse oximetry (low saturation < 90%)
  • Dyspnea & hypoxemia
  • Decreased breath sounds
  • Crackles over affected area
160
Q

What are some interventions for patients with atelectasis?

Ch 19

A
  • Frequent turning / early mobility
  • Strategies to manage secretions
  • Incentive spirometer (lung volume expansion)
  • Pressurized metered-dose inhaler (head of bed as close to 90 degrees as possible; fully express air before taking the dose of medication)
161
Q

What is the acronym ICOUGH used for & what does it stand for?

A

management of actelectasis

  • Incentive spirometry
  • Coughing & deep breathing
  • Oral care
  • Understanding (patient & staff education)
  • Getting out of bed at least 3x daily
  • Head of bed elevation
162
Q

List forms of management for atelectasis

A

First Line: frequent turning, early ambulation, lung volume expansion, coughing

  • ICOUGH
  • CPAB, bronchoscopy
  • Chest Physio Therapy: precussing along back lung fields to move secretions
  • Postural Drainage: tilt head down & feet up (gravity moves secretions)
  • Endotracheal intubation & mechanical ventilation
  • Thoracentesis (to releive compression)
163
Q

What is Acute Tracheobronchitis? What is the cause? What are common signs & symptoms?

A

inflammation of mucous membranes of the trachea after a viral infection

  • Cause: mucopurulent sputum

Signs, Symptoms, & Manifestations:
* initially dry cough with mucoid sputum
* As it progresses: dyspnea, stridor, wheezes, purulent sputum

164
Q

How is acute tracheobronchitis managed?

A
  • antibiotics
  • analgesics
  • increased fluid intake
  • cool vapor therapy or steam inhalations
  • suctioning
165
Q

What is Pneumonia? What are the causes? What are the classifications?

A

inflammation of the lung parenchyma (all parts that make up the lung) caused by various microorganisms, including bacteria, myobacteria, fungi, & viruses

Classifications:
* Community-acquired pneumonia (CAP)
* Health care-associated pneumonia (HCAP)
* Hospital-acquired pneumonia (HAP)
* Ventilator-associated pneumonia (VAP)

166
Q

Explain Community Acquired Pneumonia (CAP)

A
  • community setting or within first 48 hours of hospitalization
  • S. pneumoniae is most common cause
167
Q

Explain Health-Care Associated Pneumonia (HCAP)

A
  • occurs after 48+ hours in the hospital
  • caused by multidrug resistant organisms
  • High mortality rate

Signs & Symptoms: pleural effusion (blockage of air & circulatory system); high fever (102 - 104); tachycardia; increased respiratory rate

168
Q

Explain Ventilator-associated pneumonia (VAP)

A
  • patient has received mechanical ventilation for at least 48 hours
169
Q

What are risk factors for pneumonia?

A
  • patients 65+
  • Heart failure
  • Diabetes
  • Alcoholism
  • COPD
  • AIDS
  • Influenza
  • Cystic Fibrosis
  • Recent antibiotic use
  • Unvaccinated patients
  • Post upper respiratory infection
170
Q

What are common signs & symptoms of pneumonia?

A
  • Low heart rate
  • Fever
  • Headache
  • Myalgia
  • Rash
  • Pharyngitis
  • Orthopnea
  • Crackles
  • Increased tactile fremitus
  • Purulent sputum
171
Q

What signs & symptoms are unique to STREPTOCOCCAL Pneumonia?

A

Sudden onset of:
* Chills
* Pleuritic chest rate
* Tachypnea
* Respiratory distress

172
Q

What symptom is unique to VIRAL pneumonia?

A

Bradycardia

173
Q

Pneumonia Prevention

A

PCV-13 Vaccine (13 strains)
* Recommended for patients 65+ & immunocompromised (19+)
* immunocompromised = HIV, immunosuppresant drugs, leukemia, asplenia (don’t have spleen to filter blood), CKD, sickle cell disease, asthma

PPSV-23 (23 strains)
* later, for older adults
* 65+, immunocompromised (asthma, sickle cell)
* Given 1 year & 1 day after receiving PCV-13

174
Q

Medical management of pnemonia

A
  • Fluids
  • Oxygen for hypoxia
  • Antitussive
  • Antipyretics
  • Decongestants
  • Antihistamines
175
Q

What is the difference in anosmia & ageusia?

A

Anosmia: loss of taste

Ageusia: loss of smell

176
Q

Potential complications of bacterial pneumonia

A
  • Continuing symptoms after initial therapy
  • Sepsis & septic shock
  • Respiratory failure
  • Atelectasis
  • Pleural effusion
  • Delirium
177
Q

What is aspiration? What is key pathophysiology of aspiration?

A

inhalation of foreign material into the lungs that leads to inflammatory reaction, hypoventilation, & ventilation-perfusion mismatch

Key Patho: volume & character of aspirated contents (most often GI contents)

178
Q

Aspiration Prevention

A
  • Keep head of bed elevated
  • Avoid stimulation of gag reflex w/ suctioning & other procedures
  • Soft diet, small bites, no straws
179
Q

What are risk factors associated with aspiration?

A
  • Seizure activity
  • Stroke
  • Brain injury
  • Decreased LOC (trauma, EtOH/drug sedation / anesthesia)
  • Swallowing disorders
  • Cardiac arrest
180
Q

What is the cause of pulmonary tuberculosis? How does it spread? What are common signs & symptoms?

A

**Cause: Myobacterium tuberculosis ** (bacillus)

  • Transmission = airborne via droplets (which move to other parts of the body such as the kidneys, bones, & cerebral cortex)
  • S&S:night sweats, fatigue, low grade fever, cough
181
Q

What is the Mantoux test?

A

intradermal injection used to test for TB

182
Q

How can you test for TB?

A
  • Mantoux test
  • Blood tests (quantifuron gold)
  • Sputum culture
  • Sputum testing
183
Q

Management of TB

A
  • Treated for 6 - 12 months
  • Drug resistance = primary concern
  • Use N95 mask
  • Initiate treatment with 4+ medications
  • Complete all therapy
    * Initial treatment phase = 8 weeks
    * Continuation phase = 4-7 months
184
Q

What is a pleural effusion (PE)? What are common signs & symptoms

A

Fluid collectoin in pleural space (usually secondary to HF, TB, pneumonia, pulmonary infection)

S&S:
* fever
* chills
* pleuritic pain
* dyspnea
* decreased or absent breath sounds
* decreased fremitus
* dull, flat sound on percussion

185
Q

What is emphysema?

A

accumulation of thick, purulent fluid in pleural space

  • usually result of bacterial pneumonia or lung abscess
186
Q

What symptoms are associated with acute respiratory failure

A

respiratory acidosis, hypoxemia, hypercapnia, rapid deterioration

  • Early Signs: restlessness, tachycardia, HTN, fatigue, ehadache
  • Later Signs: accessory muscle use, decreased breath sounds
187
Q

What is endotracheal intubation & what is the goal?

A

Passing an endotracheal tube through the nose or mouth into the trachea

Goals
* provides patent airway
* access for mechanical ventilation
* facilitates removal of secretions

188
Q

How long can endotracheal intubation be for?

A

14 - 21 days

189
Q

What is Acute Respiratory Distress Syndrome (ARDS)? What is the mortality rate?

A

Lung condition causing low blood O2

  • Mortality Rate: 27% - 50%

Symptoms:
* Sudden, progressive pulmonary edema
* Increasing b/l lung infiltrates visible on chest x-ray
* Absence of an elevated atrial pressure
* Rapid onset of severe dyspnea & V/Q mismatch < 72 hours after precipitating event
* Crackles, intercostal reactions, & BNP levels
* Severe hypoxemia that doesn’t respond to supplemental O2

190
Q

List some pulmonary vascular disorders

A
  • Pulmonary Edema
  • Pulmonary Hypertension
  • Pulmonary embolism
  • R-sided Heart Failure (fluid back into lungs)
191
Q

What is the leading cause of cancer death in the US?

A

Lung Cancer

192
Q

What is the classification of lung cancer & what percentage of lung cancer is associated with each classification?

A
  • Small Cell Lung Cancer (SCLC): 13%
  • Non Small Cell Lung Cancer (NSCLC): 84%
193
Q

Describe different types of chest trauma

A
  • Penetrating Trauma
  • Blunt Trauma
    * sternal, rib fractures
    * flail chest
    * pulmonary contusion
    * car accident
  • Pneumothorax
    * simple or spontaneous
    * traumatic
    * tension
194
Q

What is important to know about chest tubes?

A
  • Don’t empty system until it’s full
  • Used in removal of air & fluid from pleural space & re-expansion of lungs
  • Will see tidal wave when breathing if water seal in suction (wave rises with inhale & falls w/ exhale)
195
Q

Which nursing diagnosis would be most appropriate for many middle adults?

a.) Risk for imbalance nutrition
b.) Delayed growth & development
c.) Caregiver role strain
d.) Self-care deficit

A

c.) caregiver role strain

196
Q

What is the first thing a nurse does if there is new, bright red drainage (5” across) on the patient’s surgical dressing?

a.) Notify the surgeon of a potential hemorrhage
b.) Recheck in 1 hour for increased drainage
c.) Remove the dressing & assess the incision
d.) Assess the patient’s BP & heart rate

A

d.) Assess the patient’s BP & heart rate

197
Q

In a hypertensive crisis, what is the goal of a vasodilator?

a.) Reduce BP by 25% in the first hour
b.) Reduce BP as quickly as possible
c.) Reduce the BP to 120/80 in 2 hours
d.) Increase temperature and heart rate

A

a.) Reduce BP by 25% in the first hour

198
Q

Which of the following is the maximum amount of air that can be exhaled over a short period of time?

a.) Residual Volume (RV)
b.) Peak Expiratory Flow Rate (PEFR)
c.) Forced Expiratory Volume (FEV)
d.) Volume of air inhaled into the lungs

A

c.) Forced Expiratory Volume (FEV)

199
Q

Unless contraindicated by the surgical procedure, which position is preferred for the unconscious patient immediately post-op?

a.) Supine
b.) Semi-Fowler’s
c.) Trendelenberg
d.) Lateral

A

d.) Lateral

200
Q

Which electrolyte is responsible for regulating the volume of body fluids?

a.) Potassium
b.) Sodium
c.) Calcium
d.) Magnesium

A

b.) Sodium

201
Q

A patient is suffering from excessive edema. Which fluid would you expect to be ordered?

a.) D5W (5% dextrose in water)
b.) 0.45% Saline (1/2 normal saline)
c.) 5% Saline
d.) 0.9% Normal Saline

A

c.) 5% Saline

202
Q

What is the most reliable indicator for kidney function?

a.) BUN
b.) Creatinine
c.) Sodium
d.) Potassium

A

b.) Creatinine

203
Q

When assessing a patient, chvostek sign is noted. Which imbalance is the patient exhibiting?

a.) Hyperkalemia
b.) Hypocalcemia
c.) Hypermagnesia
d.) Hyponatremia

A

b.) Hypocalcemia

Adult Nursing I (NUR 240) (6 decks)

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