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Nursing 111 > exam 4 > Flashcards

exam 4 Flashcards

safety, oxygenation, nutrition, infection control

You may prefer our related Brainscape-certified flashcards:
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1
Q

Factors affecting safety

A

-age and development
-lifestyle
-mobility health status
-sensory- perceptual awareness
-cognitive awareness
emotional state
-ability to communicate
-safety awareness
-environmental factors
-life span

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2
Q

Age & development Safety hazards:Fetus

A
  • Smoking
  • Drugs
  • Alcohol
  • X-rays
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3
Q

Age & Development Safety Hazards: Newborn & Infant

A
  • Falls
  • suffocation
  • choking
  • burns
  • electric shock
  • accidents (crib, auto)
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4
Q

Age & Development Safety Hazards: Toddler

A
  • Falling
  • burns
  • poisoning
  • drowning
  • choking
  • electric shock
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5
Q

Age & Development Safety Hazards: Preschooler

A
  • Traffic/playground injury
  • choking
  • airway/ ear canal obstruction
  • poisoning
  • drowning
  • burns/fire
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6
Q

Age & Development Safety Hazards: Adolescent

A
  • Accident- car/ bike
  • firearms
  • substance abuse
  • recreational injuries
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7
Q

Age & Development Safety Hazards: Older Adult

A
  • falling
  • burns
  • auto/pedestrian accidents
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8
Q

Lifestyle that increases susceptibility to injury

A
  • unsafe work environment
  • high crime neighborhood
  • access to guns/ weapons
  • insufficient income for safety equip
  • access to drugs
  • risk taking behaviors
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9
Q

Mobility & health status that increases susceptibility to injury

A
  • Muscle weakness, poor balance,& coordination
  • spinal cord injury ( paralysis)- impaired mobility
  • casts
  • illness/surgery
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10
Q

Sensory- perceptual alterations that increase susceptibility to injury

A 
impaired:
  touch
  vision
  hearing
  taste
  smell
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11
Q

Cognitive awareness that increase susceptibility to injury

A

Impaired awareness:

lack of sleep
unconscious/semi-unconscious
disorientation
medications (narcotics, tranquilizers, sedatives)
confusion (wandering in elderly)
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12
Q

Impaired awareness

A

decreased ability to perceive environmental stimuli and to respond appropriately through thought and action

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13
Q

Emotional state that increase susceptibility to injury

A
  • Stressful situations- decrease level of concentration

- Depression- think and react more slowly to environmental stimuli

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14
Q

Ability to communicate that increase susceptibility to injury

A
  • Aphasia- inability to produce or understand speech
  • language barriers
  • inability to read
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15
Q

Safety Awareness that increase susceptibility to injury

A
  • unfamiliar environments

- unfamiliar equipment- O2 tanks, IV tubing, hot packs

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16
Q

Environmental Factors that increase susceptibility to injury

A
  • Home-flooring, bathtub surface, smoke alarms, swimming pools, lighting
  • Workplace- machinery, chemical, worker fatigue, air pollutions
  • Community- Street lights, safe water & sewage, food sanitation, crime, traffic,dilapidated housing, landfills
  • Healthcare setting-any injury caused by medical management rather than the underlying disease or condition of the client.
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17
Q

Factors that increase risk for human error

A
  • limited short term memory
  • being late/ in a hurry
  • limited ability to multitask
  • interruptions
  • stress
  • fatigue
  • environmental factors
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18
Q

Promoting Safety: Newborns & Infants

A

-accidents are leading cause of death
-teach parents:
amount of observation for safety
ID and remove common hazards in home
CPR training and intervention of airway obstruction

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19
Q

Promoting Safety: Toddlers

A
  • like to feel and taste everything! Lead poisoning
  • todd proof home- outlets, stove tops, cabinets
  • car restraints
  • pools
  • busy streets
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20
Q

Promoting safety: Preschoolers

A
  • active/clumsy
  • continued control of environment: matches, medicine, poisons
  • begin safety education- how to cross street, traffic signals, bike riding, avoiding pools
  • developmental level not at self reliance yet- parents must watch!
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21
Q

Promoting Safety: School age children

A
  • Injuries are leading cause of death: MVA’s, drowning, fires, firearms
  • Minor injuries include: Outdoor activity injuries, recreational equipment (swings, bikes, pools)
  • Parents must monitor closely
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22
Q

Promoting Safety: Adolescents

A
  • parents assess level of responsibility, common sense, ability to resist peer pressure
  • Age doesn’t determine readiness to drive
  • sports injuries are common- coordination not fully developed
  • sports are important for self esteem & overall development: exercise, personal/social needs, teamwork, competition, and conflict resolution
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23
Q

two leading causes of death in adolescents

A

Suicide: firearms, drugs, auto exhaust
Homicide: firearms, cutting/stabbing, tools are used as weapons

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24
Q

Promoting Safety: Young adult- mortality

A
  • leading cause of death-MVA’s
  • drowning, fires, burns, firearms, sun exposure, -suicide r/t inability to cope w/ pressure, responsibilities & expectations of adulthood
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25
Q

Promoting Safety: young adults- nurses role in suicide prevention

A 
-identify behavior indicating potential problems: depression,             
weight loss,
vague physical complaints,
sleep disturbance,
decrease interest in social,
digestive disorders, isolation
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26
Q

Promoting Safety: Middle aged adults

A
  • time of changing physiologic factors: decreased reaction time, and visual acuity
  • MVA’s most common cause of accidental death
  • other causes- falls, fires, burns, poisonings, drownings, and occupational injuries
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27
Q

Promoting Safety: Elders

A

-physiologic changes: limited vision - driving, climbing stairs, walking
-slowed reflexes
-brittle bones
-failing memory- fire hazards d/t cooking, cigs
-reduced sensitivity to pain and heat- burns
-organic brain syndrome- wandering.
Increase medications- analgesics, sedatives

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28
Q

Promoting Safety: elders– suicide

A
  • suicide rate increases
  • unnoticed causes- d/t starvation, overdosing, noncompliance w/ medical care, treatments & meds
  • generally more violent- hanging, gunshot
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29
Q

contributing factors r/t elder suicide

A
  • uncontrolled pain
  • loss of loved one
  • major life changes

white men most often
rarely threaten they just do it

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30
Q

domestic violence

A
  • child abuse
  • intimate partner abuse
  • elder abuse
  • if abused as a child often show abusive behaviors as adult.
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31
Q

common hazards causing burns

A
  • pot handles protruding over stove
  • electric appliances w/ dangling cords
  • excessively hot bath water
  • fires d/t malfunctioning equipment, gases, cigs/ matches, grease, faulty wiring
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32
Q

Nursing interventions: Fire safety

A
  • keep emergency #’s near phone
  • check smoke alarms- batteries
  • family fire drill
  • extinguishers avail. ABC
  • during fire- close windows/ doors, cover mouth & nose w/ damp cloth and stay close to floor
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33
Q

Nursing interventions: Falls

A
  • encourage daily or more frequent contact w/ friends & family
  • install personal emergency response systems
  • maintain physical environment to prevent a fall
  • “get up and go” test to assess fall risk
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34
Q

Get up and go test

A
  1. observe posture in a straight back chair
  2. ask client to stand. observe if leg muscles are used or if need to push off w/ hands
  3. once comfortable standing have client close eyes. do they sway?
  4. client opens eyes. walks 10 ft turns around and returns to chair. observe gait, balance, speed, stability
  5. have client turn and sit in chair. observe how smoothly client preforms
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35
Q

Nursing interventions: falls r/t side rails

A

person’s with memory loss, impairment, altered mobility, nocturia, & other sleep disorders are prone to becoming trapped in rails and more likely to fall getting OOB by going over and around rail

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36
Q

Nursing interventions: Poisoning

A
  • teach parents childproofing and disposal of unused meds
  • provide info & counseling- insects, snakes, spiders, drug use
  • lock up/ keep out of reach potentially dangerous items
  • # ’s of poison control should be available
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37
Q

Nursing interventions: in event of poisoning

A
  • identify poison-search open containers and empty bottles
  • contact poison control
  • keep person quiet, sidelying or sitting w/ head btwn knees to prevent aspiration
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38
Q

carbon monoxide poisoning

A
  • odorless,colorless, tasteless GAS
  • signs & symptoms:
  • headache
  • dizziness
  • weakness
  • N/V
  • loss of muscle control
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39
Q

suffocation/ choking

A
  • food or foreign object becomes lodged in throat- cuts off air source
  • others: drowning, gas/smoke inhalation, covering of mouth w/ plastic, strangulation
  • Heimlich maneuver used to dislodge object
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40
Q

Electrical Hazards

A
  • grounded equipment (3 pronged plugs)
  • check cord fraying
  • don’t overload outlets
  • no appliance near water
  • insulated wires, protective plug covers
  • unplug if have tingling sensation or shock
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41
Q

Fire arms

A
  • store in locked cabinet
  • bullets in different location
  • teach children to stay away/ never touch
  • never point at anyone
  • ensure not loaded before cleaning
  • inspect Q2y by qualified person
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42
Q

Radiation

A
  • limit exposure, use shielding devices

- nurses need to protect themselves

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43
Q

Client restraints: physical vs. chemical

A
  • physical- manual, physical, or mechanical device, material, or equipment attached to pt’s body
  • chemical- meds used to control socially disruptive behavior
  • prevents pt from injuring self or others
  • use everything else before resorting to restraints
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44
Q

legal implications of restraints: behavioral management standards

A
  • client is danger to self and others
  • nurse apply restraints but PCP must come within 1 hr for eval
  • written restraints ordered following eval are valid for 4 hrs
  • if client is restrained and secluded- continual visual & audio monitoring is needed
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45
Q

legal implications of restraints: acute medical & surgical care standards

A
  • temporary immobilization of pt is necessary to preform procedure
  • orders renewed daily
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46
Q

legal implications of restraints

A
  • PRN orders are PROHIBITED
  • used only after everything else to ensure safety was unsuccessful & DOCUMENTED
  • documentation must state clearly the needs for restraint, to client and family
  • not used for staff convenience, punishment of client
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47
Q

selecting restraint

A
  • restrict pt movement as little as possible
  • doesn’t interfere w/ treatment or health problem
  • must be readily changeable
  • restraint is safe for particular pt
  • least obvious to others
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48
Q

Kinds of restraints

A
  • jacket/vest-confused or sedated pt in bed/ wheelchair
  • belt- for pt being moved on stretcher or wheelchair
  • mitt/hand- prevents confused pt from scratching/ injuring self
  • limb- immobilize limb for therapeutic reason (IV)
  • geri chair, wheelchair w/ lap tray
  • bed rails
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49
Q

upper respiratory system

A
  • mouth
  • nose
  • sinus
  • pharynx
  • larynx
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50
Q

Nose

A
  • lined with mucus membranes
  • lined w/ hair follicles- 1st defense
  • air is warmed, humidified and filtered
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51
Q

sinuses

A
  • air filled cavities within bones
  • lined with ciliated epithelium
  • frontal, maxillary- largest & sight of pain and inflammation
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52
Q

pharynx

A
  • combo of oropharynx and nasopharynx

- shared passageway for air and food consumption

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53
Q

larynx

A
  • adam’s apple- thyroid cartilage
  • cricoid cartilage-contains vocal chords
  • speech/voice box
  • epiglottis- open during respiration, closed when swallowing
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54
Q

lower respiratory system

A
  • trachea
  • bronchi
  • bronchioles
  • alveoli
  • pulmonary capillary network
  • pleural membranes
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55
Q

trachea

A
  • windpipe
  • directly below larynx
  • separated by cricoid cartilage
  • leads to right and left mainstem bronchi at the carina
  • aspiration occurs most in right lung
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56
Q

alveoli

A
  • where gas exchange happens
  • lined with thin walls surrounded by pulmonary capillaries
  • blood supplied by right ventricle through pulmonary artery
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57
Q

respiratory membrane

A

divides alveoli from pulmonary capillaries

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58
Q

Smoking:mainstream smoke vs side stream smoke

A
  • inhaled directly from cigarette
  • released from the burning tip of cigarette
  • side stream is more harmful
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59
Q

effects if tobacco use

A

-constricts bronchioles
-increases fluid secretions into airway
-causes inflammation of bronchial lining
paralyzes cilia
=reduced airflow, increase production of secretions

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60
Q

smoking leads to

A
  • chronic bronchitis
  • emphysema
  • over 80% of lung cancer
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61
Q

smoking cessation

A
  • immediate repair begins
  • increased cough at first, as cilia clean up airway
  • O2 levels improved within 8 hrs
  • risk of heart attack decreases
  • risk of lung cancer decreases
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62
Q

cough reflux

A
  • induced by irritants in lower respiratory structures
  • forceful expiration of air, after inspiration of large volume of air
  • purpose- dislodge mucus & any foreign particles from lower respiratory tract
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63
Q

pleural membranes

A

(btwn lungs & ribcage)

  • thin double layer of tissue
  • parietal pleura
  • visceral pleura
  • potential space
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64
Q

parietal membranes

A

lines thorax & surface of diaphragm

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65
Q

visceral pleura

A

covers external surface of lungs

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66
Q

potential space

A

area between layers filled with pleural fluid

50 mL

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67
Q

ventilation

A
  • airway-kept open by sneeze and cough reflexes, and ciliary action
  • respiratory center of brain
  • controls breathing
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68
Q

ventilation compromised by:

A
  • inflammation
  • edema
  • excess mucus production
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69
Q

ventilation depressed by:

A
  • head injury

* drugs (opiates, barbituates)

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70
Q

intrapleural pressure

A

slightly negative, relative to atmospheric pressure, creating suction between visceral and parietal pleura

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71
Q

intrapulmonary pressure

A
  • wants to equalize pressure with atmosphere
  • inspiration
  • expiration
  • tidal volume
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72
Q

inspiration

A

-contraction of diaphragm/intercostal muscles= increase in size= neg pressure in lungs= air rushing in to equalize pressure

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73
Q

expiration

A

Diaphragm/intercostal muscles relax=intrapulmonary pressure increases=air expelled to equalize again

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74
Q

tidal volume

A

amount of air inspired/expired with each breath= about 500mL in adults at rest
-increases with exercise

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75
Q

accessory muscles

A
  • neck, intercostal, abdominal

- employed with: exercise, dyspnea, acute/chronic disease

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76
Q

pulmonary compliance

A
  • elasticity of lungs
  • birth–lungs stiff, loosen w/ each breath
  • compliance decreases w/ age
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77
Q

atelectasis

A

collapse of portion of lung

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78
Q

pulmonary recoil

A

tendency of lungs to want to shrink down, facilitating expiration

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79
Q

surfactant

A
  • lipoprotein produced by alveolar cells
  • reduces surface tension of alveolar fluid
  • facilitates lung expansion-w/o it lungs collapse
  • develops 27-28 week of conception
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80
Q

gas exchange by diffusion

A

movement from area of greater pressure to area of lower pressure

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81
Q

gas transport: oxyhemoglobin

A

97% of O2 loosely combined with hemoglobin (Hgb) and carried to cells

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82
Q

oxyhemoglobin affected by:

A
  • cardiac output: amt of blood pumped out per min
  • # of erythrocytes- hematocrit
  • exercise
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83
Q

Gas transport: CO2

A
  • most(65%) carried in RBC as BICARBONATE (HCO3)
  • Some(30%) combines with Hgb as carbhemoglobin for transport
  • some transported in plasma and as carbonic acid
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84
Q

decreased level of O2=

A

increased ventilation

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85
Q

increased level of CO2=

A

increased rate and depth of respirations

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86
Q

CO2 narcosis

A

sleepy shallow breaths

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87
Q

Respiratory center of brain is more concerned about what levels

A

CO2

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88
Q

hypoxic drive

A
  • A condition in which chronically high levels of C02 cause low levels of oxygen in the blood to stimulate the respiratory drive; seen in patients with chronic lung diseases
  • high concentrations of O2 can knock out this drive
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89
Q

age affecting respiration

A

ELDERLY:

  • airway more rigid
  • air exchange decreased
  • decrease in cough reflex/ ciliary action
  • mucus membranes drier
  • decrease in muscle strength and endurance
  • osteoporosis
  • GERD
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90
Q

environment affecting respiration

A
  • Altitude
  • heat
  • cold
  • air pollution
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91
Q

lifestyle affecting respiration

A
  • exercise/activity

- occupational hazards

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92
Q

health status affecting respiration

A
  • nervous system compromised- Traumatic brain injury
  • cardiac compromise-heart failure
  • chronic pulmonary disease
  • some metabolic processes- cystic fibrosis
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93
Q

medications affecting respiration

A

benzodiazepines- valium

  • antianxiety drugs
  • narcotics-morphine
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94
Q

stress affecting respiration

A
  • psychologic- hyperventilation as response to stress
  • O2 too high and CO2 too low
  • physiologic- epinephrine release, bronchiole dilation, increase O2 delivery to tissue
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95
Q

hypoxia

A

insufficient O2 anywhere in body

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96
Q

symptoms of hypoxia

A
  • increased pulse
  • rapid shallow breaths
  • increased restlessness
  • flaring nostrils
  • intercostal retraction
  • cyanosis
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97
Q

causes of hypoxia

A

hypoventilation- increase CO2

  • decrease gas exchange
  • decreased gas transport–hypoxemia, cyanosis
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98
Q

dyspnea

A

difficulty breathing

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99
Q

apnea

A

absence of breathing

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100
Q

bradypnea

A

Slow breathing

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101
Q

tachypnea

A

rapid breathing

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102
Q

orthopnea

A

ability to breath only in an upright position

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103
Q

what is cyanosis

A

Bluish skin color resulting from inadequate tissue oxygenation.

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104
Q

kussmaul’s breathing

A

hyperventilation with metabolic acidosis

trying to breath off excess CO2

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105
Q

cheyne stokes

A
  • waxing and waning of breathing- very deep to very shallow

- short periods of apnea

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106
Q

biot’s (cluster)

A

shallow breaths and apnea

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107
Q

partial obstructed airway

A

indicated by low pitched snoring during inhalation

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108
Q

complete obstructed airway

A
  • no movement of air

- will see retractions in attempt to breath

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109
Q

COPD

A

chronic obstructive pulmonary disease aka chronic airflow limitations (CAL)

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110
Q

limited reversibility COPD

A

emphysema

chronic bronchitis

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111
Q

reversible COPD

A

asthma

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112
Q

emphysema results in

A
  • increased air retention (CO2 retention)
  • increase airflow resistance
  • alveolar hyperinflation
  • diaphragmatic flattening
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113
Q

emphysema characterized by

A
  • destruction of aveoli
  • loss of recoil
  • narrowing of bronchioles
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114
Q

emphysema

A

-increase in work of breathing
-use of accessory muscles
-increase in need for O2 for increased muscle use
“air hunger”

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115
Q

dyspnea on excursion

A

out of breath from moving small amounts “bed to chair”

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116
Q

emphysema clinical manifestations

A
  • dyspnea
  • orthopnea
  • barrel chest
  • often cough- w/ minimal production
  • pink tinge to skin
  • inadequate nutrition
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117
Q

chronic bronchitis

A
  • affects small/large airways rather than alveoli

- chronic inflammation of airways–mucus gland hypertrophy and thick mucus–blockage of airways

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118
Q

chronic bronchitis clinical manifestations

A
  • cyanosis
  • sputum production
  • clubbing of fingers
  • cor pulmonale- right sided heart failure
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119
Q

asthma is characterized by

A
  • reversible airflow obstruction
  • airway inflammation
  • airway hyperresponsiveness
  • often presented before age 10
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120
Q

asthma

A
  • overreactive airway
  • exercise, fog/smog, smoke, odors/aerosols, upper respiratory tract infections
  • pollen, mold spores, animal dander, dust mites, cockroaches
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121
Q

asthma clinical manifestations

A
  • wheezes
  • chest tightness
  • feeling of suffocation
  • symptoms disappear btwn attacks
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122
Q

complications of COPD

A
  • hypoxemia
  • respiratory acidosis
  • respiratory infections
  • cardiac failure
  • cardiac dysrhythmias
  • status asthmaticus
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123
Q

physical exam for pulmonary assessment

A
  • respiration-rate ease quality
  • use accessory muscles?
  • pursed lip breathing?
  • shape of thorax- barrel chest, retractions w/ inspiration?
  • auscultation-lung sounds. describe sound and location
124
Q

interventions for COPD

A
  • stop smoking
  • annual flu vaccine
  • pheumococcal vaccine
  • teach controlled breathing techniques
  • sm frequent meals
  • frequent rest periods
125
Q

promoting good oxygen: deep breathing and coughing

A
  • used after surgery
  • promotes good pulmonary hygiene
  • may promote good expectoration- (coughing up)
  • prevent/reverse atelectasis
126
Q

promoting good oxygenation: hydration

A
  • maintains moisture to mucus membranes
  • keeps secretions thin
  • humidifier use
127
Q

promoting good oxygenation: medications

A
  • bronchodilators
  • anti-inflammatory drugs
  • expectorants
128
Q

bronchodilators

A
  • short acting beta 2 agonists- rescue med, reduces bronchospasms & dilates bronchial tubes
  • albuterol (proventil)
  • levalbuterol (xopenex)
  • anticholinergic agents
  • ipratropium atrovent
  • watch for increased HR BP anxiety restlessness
129
Q

how much meds are inhaled with spacer and without

A

with- 21%

without-9%

130
Q

anti-inflammatory drugs

A
  • can be given orally, by IV, or inhaler
  • decrease edema and inflammation
  • side effects- tremors, thrush, increased blood glucose, increase HR
  • long term control
  • methylprednisolone (solumedrol)
  • fluticasone (flovent)
  • budesonide (pulmicort)
131
Q

what do you give first anti-inflammatory or bronchodilator

A

bronchodilator because it will open up the lungs for an increase surface area

132
Q

expectorants

A
  • help break up mucus
  • make it more liquid and easier to expel
  • increase the water intake to increase efficacy of drug
  • mucinex
133
Q

incentive spirometry

A
  • improve pulmonary ventilation
  • counteracts effects of anesthesia
  • expands collapsed alveoli
  • facilitates gas exchange
  • loosen secretions
134
Q

chest physiotherapy

A
  • percussion
  • vibration
  • postural drainage
  • used to facilitate movement of secretions in lungs
135
Q

chest physiotherapy percussion

A

forceful striking of skin with cupped hand

avoid flat hand

136
Q

chest physiotherapy vibration

A
  • used after percussion

- mechanically dislodging secretions

137
Q

chest physiotherapy postural drainage

A

drainage by gravity from various lung segments

138
Q

specifications of oxygen therapy order

A
  • concentration
  • method of delivery
  • liters/minute
  • desired oxygen saturation level
139
Q

why must you be careful during oxygen therapy with a COPD patient

A

-need low flow of O2 delivery
-decreased O2 levels stimulate breathing so if it is too high this is knocked out (hypoxic drive)
oxygen concentrations not CO2 play a key role in regulating oxygenation

140
Q

oxygen therapy: nasal cannula

A
  • low concentration of O2 delivery.
  • 2-6L/min, 24-45% oxygen
  • dries and irritates nasal mucosa
141
Q

oxygen therapy: face mask–simple

A

5-8L/min

40-60% oxygen delivered

142
Q

oxygen therapy: face mask–partial rebreather

A
  • has reservoir bag for recycling expired O2. bag must not deflate
  • 6-10L/min
  • 60-90% oxygen delivered
143
Q

oxygen therapy: face mask–nonrebreather

A

-highest O2 level delivered
-95-100%
-10-15L/min
-one way valves attached
bag must not deflate
-doesn’t allow outside air to be breathed in

144
Q

oxygen therapy: face mask– venturi mask

A

specific O2 concentrations by preset percentages (different colors determine percentages)

145
Q

oxygen therapy: face tent

A
  • used when face masks aren’t tolerated by patient
  • dampness on face & chaffing may be a problem
  • can provide high humidity
146
Q

oxygen therapy: oxygen tent

A
  • used for children
  • tent gets warm=use cooling mechanism
  • keep child warm & dry
  • O2 flow will be btwn 10-15L/min and 30%
147
Q

suctioning secretions

A
  • method of removing secretions through a catheter
  • used when pt has trouble removing secretions or when O2 saturations indicates obstructions
  • hyperoxygenate before beginning
  • put in semifowler’s position
  • go through right nostril
148
Q

artificial airways

A

orpharyngeal
nasopharyngeal
endotracheal
tracheostomy

149
Q

tracheostomy

A

surgical creation of an opening in the trachea

150
Q

endotracheal intubation (ET)

A

placing tube through mouth and into trachea to maintain open airway and facilitate artificial ventilation
used after surgery or emergency situation

151
Q

Oropharyngeal

A

becomes opening of oral cavity

used for unconscious person

152
Q

nasopharyngeal

A

pertaining to the nose and pharynx

used when obstructions of the mouth or tongue occur

153
Q

pneumothorax

A

any injury that allows accumulation of atmospheric air into pleural space.
- can be opened or closed

154
Q

pneumothorax clinical manifestations

A
  • diminished breath sounds on affected side
  • diminished chest wall movement
  • deviation of trachea
  • pleuritic pain, tachypnea
155
Q

Tension pneomothorax

A
  • complete collapsed lung on affected side
  • air enters into pleural space on expiration, doesn’t exit on inspiration
  • increase in pressure, shift of heart and vessels, decrease in cardiac output
156
Q

chest tube

A
  • used to reintroduce negative pleural pressure
  • sealed drainage system
  • kept lower than patient’s chest
157
Q

components of chest tube

A
  • suction control system
  • water seal system
  • collection chamber
158
Q

chest tube: suction

A
  • stays constant

- preset by a dial or by water (centimeters)

159
Q

chest tube: water seal

A
  • prevents air from entering sealed system

- allows for air in pleural space to escape

160
Q

chest tube: collection chamber

A

measured every shift or more frequent

161
Q

what if chest tube becomes disconnected

A

stick the tube in sterile water so no air is allowed into air space

162
Q

nursing consideration for test tube

A
  • check connect of tube
  • assess client
  • assess dressing
  • assess for subcutaneous emphysema (poor seal- air in tissue)
  • assess for pain
  • check water seal and suction control
  • assess drainage- mark with time and date
  • avoid milking and clamping tube- increases risk of tension pneumothorax
163
Q

adventitious breath sounds

A

abnormal breath sounds- happens when airway is filled with fluid, mucus, or when pleural linings are inflamed

164
Q

diffusion

A

mixing of molecules or ions of two or more substances as a result of random motion

165
Q

emphysema

A

chronic pulmonary condition in which the alveoli are dilated and distended

166
Q

hematocrit vs hemoglobin

A
  • proportion of RBC’s to total blood volume

- red pigment in RBC that carries oxygen

167
Q

expectorate

A

spit out

168
Q

hemothorax

A

accumulation of blood in pleural cavity

169
Q

hypercapnia/hypercarbea

A

when CO2 accumulates in the blood

170
Q

lung compliance vs recoil

A
  • expansibilty of lung

- tendency of lung to collapse away from chest wall

171
Q

stridor

A

harsh, crowing sound made on inhalation caused by constriction of upper airway

172
Q

pluerisy

A

inflammation of the lining of lungs and chest

-leads to chest pain when taking deep breaths

173
Q

bronchospasm

A

contraction of smooth muscle in walls of bronchioles

-causes narrowing of lumen

174
Q

macronutrients

A
  • carbohydrates
  • fats
  • proteins
  • *need in large amounts to maintain energy
175
Q

carbohydrates

A

carbon, hydrogen, oxygen
simple & complex
major source of bodies energy

176
Q

Simple vs complex carbs

A
  • sugars

- starches and fibers

177
Q

simple carbs: monosaccharides vs disaccharides

A
  • glucose, fructose, galactose

- sucrose, lactose, maltose

178
Q 
glucose
fructose
galactose
sucrose
maltose
lactose
A
  • blood sugar
  • sweetest – fruits
  • part of lactose
  • table sugar (glucose+fructose)
  • beer (glucose+glucose)
  • milk sugar (glucose+galactose)
179
Q

starches

A
  • insoluble, non-sweet

- best source-grains, legumes

180
Q

fiber

A
  • supplies roughage or bulk to diet

- indigestible to humans

181
Q

fiber helps with:

A

-obesity
-constipation
-diverticular disease
-colon cancer
-heart disease
diabetes control

182
Q

digestion of carbs

A
  • digested by enzymes and disacchaidases

- end product= monosacchrides absorbed by small intestine

183
Q

glucose homeostasis

A

levels between 70-120 mg/dL

184
Q

carb storage:glucose

A
  • main source of energy, excess will circulate ready to be accessed
  • insulin enhances it to transport across cell membrane
  • other excess stored as glycogen (in muscle and liver) and fat
185
Q

carb storage: glycogen

A

-can be converted back to glucose, but conversion of glucose to fat is irreversible

186
Q

gluconeogensis

A

fat to glycogen to glucose.

but in small amounts

187
Q

ketone bodies

A

formed to compensate when not enough carbs around

-fruity smell acid base imbalance

188
Q

protein essential vs non essential

A
  • must be ingested from exogenous source (9)

- can be manufactured by body (11)

189
Q

anabolism vs catabolism

A
  • protein synthesis from available amino acids

- degradation of excess amino acids into energy or conversion to fat

190
Q

complete protein vs incomplete protein

A
  • contains all essential amino acids and many nonessential ones-meat fish dairy
  • lack one or more essential amino acids
191
Q

complimentary proteins

A

combo of foods to provide all amino acids

-corn & beans, rice & beans

192
Q

protein digestion: pepsin

A
  • begins in stomach
  • secreted by chief cells, starts digestion of CHO
  • most digestion done in small intestine with enzymes released from pancreas
193
Q

marasmus vs kwashiorkor

A
  • deficiency of overall energy

- deficiency of protein

194
Q

protein storage

A
  • liver uses amino acids to synthesize specific proteins- albumin
  • most go into muscles and cell regeneration
195
Q

Fats

A

-saturated-solid at rm temp
-unsaturated- oils
-sterols-cholesterol
**no more than 30% of daily calories from fat
densest form of energy

196
Q

fatty acids: saturated, monounsaturated, polyunsaturated

A
  • butter, beef, palm oil
  • olive oil
  • vegetable oil, fish
197
Q

Omega 3

A
  • in walnuts, some fruits and veggies, cold water fish, flax seed
  • -decreases symptoms of heart disease, depression, ADHD
198
Q

Omega 6

A
  • in eggs, cereal, veg oils, baked goods, margarine

- supports skin health, lowers cholesterol, helps clotting

199
Q

what should be the ratio of omega 3 to omega 6

A

4: 1 eat more omega 3

- 6-8 g/ week

200
Q

cholesterol

A

highest source: egg yolks and organ meats

not in plants

201
Q

lipoproteins: LDL

A
  • contribute to plaque formation along vessels and arteries

- plaque build up = atherosclerosis, or coronary artery disease CAD

202
Q

lipoproteins: HDL

A

-bind with cholesterol and remove it from circulation

the best kind!

203
Q

Vitamins: B1- Thiamine

A
  • found in brown rice and enriched rice
  • important in nerve function
  • see deficiency with alcohol abuse, excessive vomiting, gastrectomy, anorexia nervosa
204
Q

beriberi

A

lack of thiamine

205
Q

Vitamins: B2 riboflavin

A
  • function similar to B1
  • milk is major source
  • UV rays destroy it
  • enriched grains, broccoli, meats, eggs, poultry
206
Q

cheilosis

A
  • lack of B2

- cracked lip corners

207
Q

glossitis

A
  • lack of B2

- swollen red tongue

208
Q

Vitamin B3: niacin

A
  • tryptophan can be converted to niacin

- if adequate in protein usually adequate in B3

209
Q

pellagra

A
  • lack of B3

- diarrhea, dermatitis, and dementia

210
Q

Vitamins: folate

A
  • green leafy veggies, legumes
  • necessary for formation of fetal neural tubes
  • 400 mg
211
Q

what meds affect absorption of Folate

A
  • anticonvulsants
  • oral contraceptives
  • aspirin
  • NSAID
212
Q

Vitamins B12: cobalamin

A
  • from animals
  • absorptions relies on intrinsic factor
  • produced in stomach mucosa
213
Q

pernicious anemia

A

deficiency of B12

214
Q

Vitamin C: ascorbic acid

A
  • antioxidants and coenzymes

- citrus, peppers, strawberries, broccoli, green leafy veggies

215
Q

Scurvy

A
  • lack of Vitamin C

- bleeding gums

216
Q

Vitamin A

A
  • sources- retinoids- in animal

- carotenoids- plants-deep green, yellow, orange

217
Q

Night blindness

A

Vitamin A deficiency

218
Q

intrinsic factor

A

essential for absorption on vitamin B12

secreted by gastric mucous membrane

219
Q

Vitamin D

A

-sunshine- 10-15min/3X a wk, milk, oily fish

220
Q

rickets, osteomalacia

A

Vitamin D deficiency-linked to colon cancer, prostate cancer, breast cancer, autoimmune disease

221
Q

vitamin E

A
  • vegetable oils

- antioxidants

222
Q

vitamin K

A
  • green veggies, synthesized by bacteria living in intestine
  • cofactor in blood clotting
  • antidote for anticoagulant coumadin (warfarin)
  • newborns don’t produce it
223
Q

Mineral: calcium

A
  • essential to bone formation
  • nerve impulses
  • muscle contraction and relaxation
  • forms blood clots
  • BP regulation
  • from dairy, green leafy veggies,tofu, legumes, small fish w/ bones
224
Q

calcium better absorption if

A
  • sufficient vit D
  • acidity of digestive mass
  • weight bearing exercise
225
Q

osteoporosis

A

deficiency of calcium

226
Q

Mineral: sodium

A
  • maintain BP and volume
  • transmission of nerve impulses
  • overly consumed
227
Q

hyponatremia

A

low blood sodium

-can happen with athletes, neurologic or kidney disease

228
Q

mineral: potassium

A
  • crucial for normal function of nerves and muscles–heart
  • sweet potatoes, bananas, oranges, legumes, dairy products
    3. 5-5mEq/L
229
Q

hypokalemia

A
  • deficiency of potassium

- muscle weakness, confusion, EKG change, cardiac arrhythmias

230
Q

excess hyperkalemia

A

-weakness cardiac arrhythmias

231
Q

mineral: iron

A
  • distributes oxygen throughout body
  • women need more than men
  • sources heme-animal. non-heme- veggies
  • better absorbed with vit C
232
Q

iron deficiency anemia

A
  • iron deficiency

- decreased hemoglobin and hematocrit

233
Q

pica

A
  • iron deficiency

- hunger and appetite for non food items- clay dirt

234
Q

mineral: iodine

A
  • part of hormone thyroxine, produced by thyroid

- seafood, iodinized salt

235
Q

goiter

A

iodine deficiency

enlarged thyroid gland

236
Q

water

A

13 cups/day-men

9cups/day-women

237
Q

superfoods

A

beans, blueberries, broccoli, oats, oranges, pumpkins, salmon, soy spinach, tea, tomatoes, turkey, walnuts, yogurt, quinoa, dark chocolate
-helps with heart disease, cancer, high cholesterol

238
Q

energy balance growing vs dieting

A
  • need + balance intake>output

- need - balance intake<output

239
Q

energy balance intake

A

-measured in Kcals
4 Kcal/gram of CHO
4Kcal/gram of protein
9Kcal/gram of fat

240
Q

energy balance output

A

affected by metabolism, energy expenditure

241
Q

BMR

A

basic metabolism rate

rate at which body metabolizes food to maintain energy needs at rest

242
Q

prebiotics

A
  • non living indigestible polusaccharides metabolzied in intestine
  • stimulate bacteria already present in gut
243
Q

probiotics

A

-living organisms that have beneficial therapeutic effects on host when ingested

244
Q

probiotic role

A
  • antibiotic associated with diarrhea- C. Difficile
  • inflammatry bowel disease (chron’s ulcerative colitis)
  • yeast infection, BV
  • immune system booster
  • cancer
245
Q

prebiotic role

A
  • stimulates absorption of several minerals and improves bone mineraliztion
  • onion banana garlic quinoa
246
Q

Changes through lifespan: neonate

A
  • breast milk/ formula
  • higher needs for fluid intake
  • demand feeding-when infant is hungry
  • be fed every 2.5-4hrs
  • 80-100mL/kg body weight
247
Q

Changes through lifespan: toddler

A
  • adjust to regular meal times
  • fluid needs decrease
  • 900-1800Kcal/day
  • picky eaters
248
Q

Changes through lifespan: preschooler

A
  • fluid needs decrease- 1500 mL/24hrs
  • use utensils
  • require snacks btwn meals
249
Q

Changes through lifespan: school age child

A
  • 2400Kcal/day
  • need protein rich food at breakfast
  • forming eating habits
250
Q

Changes through lifespan:adolescent

A
  • growth spurt-increase need for protein, calcium, vit D, iron, B vitamins
  • concerns- poor self esteem, eating disorders
251
Q

Changes through lifespan: young adult

A
  • female- need for iron -menstration

- need for calcium and vit D continues

252
Q

Changes through lifespan: middle aged adult

A
  • metabolic rate decreases
  • need for higher water intake
  • calcium, protein
  • limit intake of high cholesterol foods
253
Q

Changes through lifespan: elders

A
  • decrease number of calories
  • physical changes- tooth loss, decreased sense of taste
  • psychosocial needs- eating alone, decreased access to food, lowered income
254
Q

anorexia nervosa vs bulimia

A

-loss of at least 15% of original body weight
ammenorrhea - no menstration

-over 3 months w/ at least 2 episodes/wk

255
Q

vegetarian diet lacto, ovo

A

will include eggs and milk in diet

256
Q

vegan

A

omits all food from animal sources

need to get vit B12 from other sources

257
Q

malnutrition, protein calorie malnutrition

A
  • overweight when BMI 25-29.9
  • obese when BMI >30
  • -depressed protein level( albumin, weight loss, muscle wasting)
258
Q

nutritional assessment

A
  • screens-at risk pt
  • anthropometric data ( ht,wt,BMI)
  • biochemical data (labs)
  • clinical assessment (hair, nails,
  • dietary data (24 hr recall)
259
Q

BMI

A
  • body mass index
  • divide weight in kilograms by height in meters squared
  • healthy range-18.5-24.9
  • obese->25
  • underweight<18.5
260
Q

risk factors for nutritional problems

A
  • diet history- difficulty swallowing, eating alone, fad diets
  • medical history- alcohol abuse, teenage pregnancy, chronic illness
  • medication history- antacid use, antidepressants, digoxin, laxatives
261
Q

physical assessment for nutrition

A
  • hair-dull brittle sparse
  • nails- brittle spoon shaped
  • tongue- swollen beefy red smooth
  • gums- bleed easily, swollen inflamed
  • skin- dry flaky petechiae bruises
262
Q

assessment of nutrition labs

A

albumin- slow to change will reflect chronic deficiency- <2.8g/dL

  • prealbumin- acute changes in nutrition status
  • transferrin- changes r/t iron stores
263
Q

conditions that require special diets

A
  • surgery
  • aspiration risks
  • mouth conditions
  • chronic diseases (renal, cardiac, hepatic)
264
Q

special diet: clear liquid

A
  • see through it
  • maintains hydration and carbohydrates
  • doesn’t supply enough protein, fat vitamins, minerals, calories
  • coffee tea soda gelatin popsicles
265
Q

special diet: full liquid

A
  • short term diet
  • clear liquid plus: food that turns liquid at rm temp
  • milk, high calorie drinks-ensure
266
Q

special diet: soft

A
  • clients that have difficulty swallowing or chewing
  • low residue (low fiber) diet, mostly cooked foods
  • pureed diet
267
Q

special diets: other

A
  • no added salt (NAS)
  • ADA- american diabetic association. usually qualified with Kcal count
  • cardiac-low cholesterol, low salt
  • 2g protein-renal or hepatic disease
268
Q

enteral nutrition

A
  • through the gastrointestinal system
  • nasogastric tube
  • nasoenteric tube
  • percutaneous endoscopic gastrostomy tube PEG
269
Q

NG tube for nutrition

A
  • through a nostril down nasopharynx and into stomach

- also used for suction

270
Q

Nasoenteric or nasointestinal tube nutrition

A
  • longer more flexible tube
  • used for clients at risk for aspiration
  • sits beyond pyloric sphincter in sm intestine
  • placement checked with xray
271
Q

PEG tube nutrition

A
  • or jejunostomy
  • directly into stomach through surgical hole
  • long term nutritional support
272
Q

enteral feedings

A
  • 300-500 mL several times a day
  • administer over 30 mins
  • keep in fowlers position
  • check placement
273
Q

parenteral nutritions

A

-PPN- partial parenteral nutrition
can be given through peripheral intravenous access
-TPN- total peripheral nutrition
must be given through central iv

274
Q

parenteral nutrition TPN

A
  • used when gastrointestinal tract nonfunctional
  • given through superior vena cava
  • highly concentrated
  • dextrose 10-50%, water, fat, proteins, electrolytes, vitamins, trace elements
  • high risk of infection
  • gradually infused to prevent hyperglycemia
  • daily labs- basic metabolic panel, complete blood count
275
Q

TPN complications

A
  • pheumothorax from cvc
  • air embolism
  • sepsis
  • hyperglycemia
  • fluid overload
  • rebound hyperglycemia- abrupt interruption or cessation
276
Q

when would you use antimicrobial soap

A

ICU, nursery

  • known multiple resistant bacteria
  • before invasive procedure
  • immunocompromised patients
277
Q

sepsis vs asepsis

A
  • state of infection

- limit growth of organism transmission

278
Q

true pathogen vs opportunistic pathogen

A
  • make anyone sick

- looks for susceptible host

279
Q

nosocomial infections

A

infections associated with healthcare services in a healthcare setting
most common in medical and surgical ICU’s

280
Q

most common entry site for nosocomial infections

A
  • urinary
  • respiratory
  • bloodstream
  • wounds
281
Q

most common infection causing agents

A
  • escherichia coli(intestines)
  • staphylococcus aureus (nasal passage)
  • streptococcus pyogenes
  • lactobacillus (intestines)
282
Q

infectious fungi

A

yeast- candida albicans

molds- penicillins, and aspergillus

283
Q

infectious parasites

A
  • hookworm
  • tapeworm
  • fleas, ticks
  • protozoas (malaria)
284
Q

drug resistant organisms

A

drugs resistant to antimicrobial agents

  • MRSA- methicillin resistant staph aureus
  • VRE- vancomycin resistant enterococcus
285
Q

MRSA

A

susceptible to vancomycin, linezolid–reserved for big infections

286
Q

why resistant organisms spread

A
  • misuse ad overuse of antibiotics
  • used in livestock as growth promoters
  • decreased stay in hospitals
  • poor house keeping in hospitals
  • lack of infection control nurse
287
Q

prevention of spread of infection

A
  • isolation gowns

- many contaminations happen because of scrubs

288
Q

majors sites for MRSA in hospitals

A
  • surgical wounds

- lower respiratory tract

289
Q

community acquired MRSA

A
  • skin infection
  • susceptible to bactrim, bactroban
  • common in children/ adolescents- sports, and pets
290
Q

Multiple drug resistant TB (MDR-TB)

A
  • multiple drug therapies used
  • spread by-cough sneeze singing speaking
  • not spread by kissing smoking
  • need neg air pressure room
291
Q

extended sprectum beta lactase (ESBL)

A

-produced by bacteria resistant to penicillin & cephalosporins
-produced by e-coli, klebsiella, pneumonia, salmonella, enterobacter
at risk- elderly, critically ill, young
-seen in UTI’s
-contact precautions

292
Q

Clostridium difficile

A

often with antibiotic use

  • s/s watery stool, fever, loss of appetite, nausea, abdominal pain
  • contact precautions
  • must wash hands, sanitizer doesn’t work
293
Q

portal of exit for infection

A

sneezing(rhinovirus), feces (hep A), sex(gonorrhea), mosquito bite(malaria west nile)

294
Q

portal of entry

A

-break in skin, iv cath, urinary cath, ingestion, respiration

295
Q

transmission

A

direct- kissing

  • indirect-vehicles-toys surgical tools
  • vector borne-animal insect
  • airborne- droplets, dust
296
Q

3 stages of inflammatory process for defense of infection

A

1) vascular and cellular response- edema, pain, increase of blood flow, luekocytes
2) exudate, escaped fluid from vessel, dead phagocytic and tissue cell, area walled off with platelets, thromboplastins, fibrinogens
3) reparative stage, scar tissue forms

297
Q

universal precautions

A

obstructs spread of bloodborne pathogens

body substance isolation (BSI) for health care workers and patients

298
Q

standard precautions

A
  • blood
  • all secretions, excretions, except sweat
  • broken skin
  • mucus membrane
299
Q

contact precautions

A
  • private room for client
  • gloves, gown
  • dedicated equipment- bp cuff
300
Q

droplet precautions

A

private room, or shared with same infectious organism of another pt

  • mask if within 3 feet
  • surgical mask for pt for transport
301
Q

airborne precautions

A
  • private room with neg air pressure
  • respiratory device to enter room
  • door closed
  • surgical mask for pt for transport
302
Q

reverse precautions

A
  • protects pt from you
  • compromised pts
  • leukemia, major burns
303
Q

penicillin: considerations

A
  • assess allergy to penicillin
  • monitor renal function-most excreted through kidneys– especially elderly
  • decreases effectiveness of BC
304
Q

penicillin: side effects

A
  • nausea vomiting
  • rash
  • diarrhea
305
Q

Penicillin G

A

ordered in units, given IM
typical 600,000 units
adverse reactions: rash, drug fever, anaphylaxis, neuropathy, nephopathy

306
Q

Penicillin V

A

contains potassium
ordered in mg
adverse reactions: GI upset, urticaria, anaphylaxis, check K levels in renal pts

Nursing 111 (2 decks)

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