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318 Adult Health > Exam 3 Gas Exchange, Perfusion, > Flashcards

Exam 3 Gas Exchange, Perfusion, Flashcards

1
Q

OSA-Obstructive Sleep Apnea

A

-episodes of upper airway obstruction
-reduced ventilation
-snoring
-5 obstructive events an hour during sleep
-breathing cessation greater than 10 seconds
-freq. arousals w/loud snort O2 desats during sleep

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2
Q

OSA CAUSES

A

Reduced diameter of upper airway or dynamic changes in upper airway during sleep

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3
Q

OSA RISK FACTORS

A

-overweight older male
-post menopausal obese women
-neck obesity
-tonsillar hypertrophy
-excessive fat deposits in pharynx walls

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4
Q

OSA INCREASED RISK FOR:

A

-MI
-stroke
-death
-increased insulin resistance
-vascular disease
-CAD CHF
-metabolic syndrome
-type 2 diabetes

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5
Q

OSA Screening

A

Stop bang questionnaire

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6
Q

Note Severity of Symptoms

A

-excess daytime sleepiness
-frequent nocturnal awakening
-insomnia
-loud snoring
-morning headaches

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7
Q

Sleep study

A

Polysomnography

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8
Q

Treatment

A

-weight loss
-avoid alcohol/hypnotics
-oral appliance/CPAP (full detention required) noninvasive
-surgery
-implanted device

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9
Q

Post-Procedural Respiratory Complications

A

-hypoxemia
-atelectasis
-pneumonia
-MI
-cardiac arrythmias
-ICU transfers

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10
Q

PCA-Patient Controlled Analgesia

A

-Smart pump: pt pushes button when light is green
-Meds:morphine, hydromorphone/dilaudid, fentanyl
-Two nurse co-sign approval; start PAC, shift change, syringe, D/C’ing

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11
Q

PCA-patient controlled analgesia cont’d

A

-ETCO2 required for PCA to monitor wave form (35-45mmHg)
-early indicator of sedation
-Q4 hours record amount infused/attempted

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12
Q

PCA IMPORTANT TERMS

A

-loading dose:given at start of PCA
-basal rate:amount automatically given
-PCA dose:amount pt receives when button is pushed
-lockout time:frequency pt can receive dose
-RN bolus dose:extra dose than can be given
-max limit:total amount in 4 hours

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13
Q

OIRD

A

-Opioid induced respiratory depression
-MOSS
-PASERO

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14
Q

OIRD NALOXONE protocol

A

-give according to protocol
-0.04 mg IV PRN stay Q 2minutes
-repeat in 2 minutes PRN until all 4 criteria met: pt alert, RR greater than 10/min, O2 sat. greater than 92% 2/L via nasal cannula, capnography WNL

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15
Q

NARCAN TIPS

A

-giving according to protocol
-dilute/label syringe
-give in small increments
-stay/monitor client
-NARCAN will wear off before opioid

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16
Q

ATELECTASIS

A

Airway inflammation + Edema=alveolar collapse
-reversible collapse of lobe/lung
-obstructive:block airway via tumor, foreign body, mucous plug
-nonobstructive:compression/LOSS OF SURFACTANT

17
Q

ATELECTASIS RISK FACTORS

A

-anesthesia
-ETT endotracheal tube
-pneumonia
-foreign object
-lung disease/mucus plug/tumor in airway
-prolonged bed rest/few position changes/shallow breathing
-pleural effusion:fluid buildup causing pressure on lung

18
Q

ATELECTASIS DIAGNOSTICS

A

-auscultation/percussion(dull sound)
-chest X-ray(density)
-bronchoscopy(remove mucus plugs)
-chest CTI/MRI/ultrasound

19
Q

ATELECTASIS PREVENTION

A

-incentive spirometry
-up to chair for meals
-early ambulatory post-op
-ambulate TID
-deep breathing exercises

20
Q

ATELECTASIS MANIFESTATIONS

A

-dyspnea
-chest pain
-cough
-hypoxemia(late sign of distress)
-absent/diminished breath sounds/crackles
-tactile fremitus
-may/may not fever

21
Q

TREATMENT

A

-broncoscopy (remove mucus plugs)
-postural drainage/head tilt lower than chest ( trendelenburg)
-lie on healthy side
-inhaled medicine ( bronchodilators)
Treat cause of pleural effusion (thoracentesis), empyema (pocket of puss relieved w/chest tube/antibiotics)

22
Q

OUTCOMES

A
23
Q

PERFUSION
Stroke/CVA

A

*Alteration in perfusion (blockage)
*block blood flow to the brain
*no blood, no O2, no nutrients
*cell death (doesn’t regenerate)

24
Q

Stroke/CVA
HEEMORRHAGIC:vessel bursts, blood in brain increases ICP

A

*CEREBRAL ANEURYSM:emergent
*AVM-arterio venous malformation

25
Q

Stroke/CVA
ISCHEMIC:(thrombotic) clot in cerebral artery

A

*embolus from ANOTHER body part travels to the brain
*the occlusion of blood supply is IMMEDIATE
* neuro deficits/LOC happens instantly
*5th leading cause of death
*#1 cause of disability
*blacks with hypertension at greater risk

26
Q

ISCHEMIC RISK FACTORS

A

Hypertension/hyperlipidemia
Elderly
Afib
Diabetes
Smoking/males

27
Q

Continued
AFIB

A

Afib treatment and anticoagulants: prevent artherosclerosis and treat rate control with ablation, warfarin w/ cardio version, tightness, dizziness, faint/syncope, SOB, palpitations

28
Q

ISCHEMIC S/S

A

•numb, weak face, arms, legs, especially on one side of body
•slurred speech
•difficulty with word finding and comprehension

29
Q

Hemorrhagic S/S

A

•exploding headache
•decreased LOC
•N/V
•vision change
•seizures

30
Q

HEMORRHAGIC RISK FACTORS

A

Headache
E younger
AVM and aneurysm
Drugs (cocaine,meth)

31
Q

PRODROMAL

A

Balance
Eyesight
Face
Arm weakness
Speech slurred
Time is brain

32
Q

NURSING FOR BRAIN ATTACK

A

BP monitor for perfusion (not too low)
Respirations: rate and character
Airway:monitor for difficulty swallowing eating chewing
IV access
Normoglycemic (perfusion)

33
Q

NURSING FOR BRAIN ATTACK

A

Aspirin CT of head needs to be negative
Temperature <37degrees treat for good thermoregulation
TEDS, compression stockings, VTE prophylaxis
Assess h2o swallow test, dysphasia decreases ability to swallow NPO immediately
CT scan no contrast within 10 minutes
Keep HOB elevated 30 degrees to decrease aspirations and allow appropriate perfusion

34
Q

MEDICATIONS FOR CVA

A

Anticoagulants
Anti-platelets
Alteplase
Anti-epileptic
Coumadin/heparin drip

35
Q

LEFT CEREBRAL HEMISPHERE

A

•right hemiplegia/paralysis
•aphasia
•agnosia
•alexia

318 Adult Health (1 decks)

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