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MED SURG II > exams 3 study guide > Flashcards

exams 3 study guide Flashcards

1
Q

Addisons Disease clinical manifestation

A

addison = adrenal insufficiency

  • Bronze light pigmentation
  • hyperkalemia
  • hyponatremia
  • anorexia
  • nausea
  • vomiting
  • progressive weakness
  • fatigue
  • weight loss
  • abdominal pain
  • diarrhea
  • headache
  • Orthostatic hypotension
  • salt craving
  • joint pain
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2
Q

Addisons Disease health teaching

A

o If they feel sick, tell provider immediately
 Flu like symptoms should be reported
o Corticosteroids, do not stop them—needs to be tapered
o Medical alert bracelet
o Signs and symptoms of too little or too many steroids
o Emergency kit—100mg hydrocortisone

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3
Q

Addisonian crisis

A

LIFE THREATENING
- insufficient or sudden sharp decrease in hormones

CAN SEE
	Hypotension
	Tachycardia
	Dehydration
	Fever
	Weakness
	Vomiting and diarrhea
	Pain

o Worry about irreversible shock—this can happen if you don’t address the above

NA down, K UP

  • fatigue
  • dehydration
  • vascular collapse ( LOW BP)
  • renal shut down
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4
Q

Lab findings of Addisons Disease

A

o Decreased sodium
o Increased potassium
o Decreased glucose

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5
Q

Cushings Disease loss of bone density

A

opposite of addisons - TOO MUCH HORMONES

o Make sure patient is safe
- Prevent falls
o Monitor calcium levels
o Weight-bearing exercise

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6
Q

Clinical manifestations of cushings disease

A 
o	Trunk obesity
o	Hirsutism—abnormal growth of hair on a person’s face and body
o	Buffalo hump
o	Face
o	Extremities would be thin
o	Muscle atrophy
o	Slow wound healing = ecchymosis, bruises, striae 
o	Weight gain—Addison’s is loss
o	Acne
o	Back pain
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7
Q

diagnostics of cushings disease

A

o Urinary cortisol level
o Serum blood cortisol level
 Both are increased
o ACTH level—abnormal
o Dexamethasone Suppression test—abnormal
o Electrolytes = Hyperglycemia, dyslipidemia, hypokalemia

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8
Q

nursing interventions of cushings disease

A 
o	Monitor vital signs
o	Daily weights
o	Monitor labs
o	Assess for S&S
o	Monitor things that upset the patient—stress is a problem
o	Rest! 
o	Observe for mood swings
o	Protect for trauma
o	Monitor fluid balance
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9
Q

medical management of cushings disease

A

o Did they have surgery for pituitary?

  • Hemorrhage
  • Fluid and electrolyte imbalance
  • Make sure patient has right amount of corticosteroid + knows side effects

o Body image
o Monitor for infection = they are prone because of disease and steroids

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10
Q

Kidney disease assessments of patients

A
  • Abnormal vital signs—priority over other patients

- Labs: focus on potassium (3.4-5.9 mEq)

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11
Q

Nursing interventions: Acute Kidney Injury

A 
o	Fluid intake—intake and output
o	Anemic—monitor blood levels
o	Hyperkalemia—monitor labs
o	Dialysis—check the site
o	Vital signs—check skin and mouth

PERITONEAL DIALYSIS: worry about peritonitis, infection( catheter) -RISK FOR SEPSIS

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12
Q

teachings Acute Kidney Injury

A

Nephrotoxic drugs

  • NSAIDS
  • Antibiotics
  • OTC medications—tell doctor (may be high in salt or other ingredients)
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13
Q

Chronic kidney disease teachings

A 
o	Keep a journal of Is and Os
o	Try not to get too fatigued
o	Walk around to prevent blood clots
o	Daily weights
o	Take meds as directed
o	Keep all medical appointments
o	May have HTN and diabetes—take meds
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14
Q

Chronic kidney disease labs

A 
o	Hyperkalemia
o	Hyperphosphatemia
o	Hypermagnesemia
o	Increased creatinine 
o	Increased BUN
o	Sodium (increase, decrease or normal)—not on exam
o	GFR (glomerular infiltration rate)—DECREASED
o	Increased triglycerides cholesterol
o	↑ BUN/creatinine 
o	↑ cholesterol, TRIG
o	↓ RBCs (prone to anemia)
o	↓ GFR
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15
Q

Chronic kidney disease medical management

A 
o	kayexalate—decrease K levels (NG or rectal, PO is preferred)
o	Fluid overload or deficit
o	Proper nutrition
o	Anemia—blood 
transfusion
  • Careful with transfusion because of fluid overload
  • Iron

o Calcium supplements
o Phosphate binders
o Vitamin D, Antihypertensive, Statins—if needed

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16
Q

Chronic kidney disease contraindcation medications

A

o IV Motrin—tell doc
- procaine

BOTH A NO NO

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17
Q

Chronic kidney disease electrolyte imbalances

A

o Hyperkalemia
o Hyperphosphatemia
o Hypermagnesemia

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18
Q

Peritoneal Dialysis: Assessment

A

o Look for infection
- Check catheter site for redness, swollen, warm
- Peritonitis won’t show on outside
o Monitor for hernia
o Lower back pain
o Bleeding
o If the patient has drainage that is smelly, cloudy—not a good sign

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19
Q

Hemodialysis: Nursing interventions

A

o Baseline weight = WEIGHT BEFORE AND AFTER

o Some meds need to be held = HTN meds, cardia (with dialysis may have hypotention)

o Give patient more protein (urea and creatinine removed)

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20
Q

Hemodialysis: patient concerns

A

o Are reserved and sad
 They know it will help, but listen to them and answer questions and reassure them
o Understand this is a patient’s way of life
o Talk, talk, talk

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21
Q

Hemodialysis: meds patient taking/ diet

A

o They can take a lot of meds—some they can’t
o Antihypertensive drugs are held because they can make the patient more hypertensive

DIET: PROTEIN, EGGS HOEM TOAST

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22
Q

AV Fistula: Nursing care

A

o Ensure patency of av fistula = BRUITS (hear) or THRILL (feel) = teach patient how to feel them
o Auscultate for bruit/thrill
o No BP where fistula is
o Not to wear bracelets—may restrict blood flow to arm
o Do not carry bags—use shopping cart = NO PRESSURE ON ARM WITH FISTULA
o Do not sleep on the affected side

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23
Q

AV Fistula: complications

A

o Infection
o AV fistula may clot
o May bleed
o Let doctor know if any of the above happens
o Fingers are cold, hot, cyanotic—concerning

24
Q

Kidney Transplant: Assessments

A

o Urinary output
o Cognizant about infection
o Pain management

25
Q

Kidney Transplant: medication teaching

A

o How are they managing meds?
o Cannot skip
o Lifetime meds

o Cyclosporine/Neoral = Take it with chocolate milk!

26
Q

use of glucocorticoids

A

o They may need to increase if surgery occurs, patient is in distress,
o Muscle atrophy and weakness
o Peptic ulcer disease
o Trunk Obesity
o Mood and behavior changes
o Steroids can increase glucose—fingerstick

27
Q

Pulmonary Embolism:

RISK FACTORS

A
  • DVT & Previous History of DVT
  • Immobility or reduced mobility
  • Surgery
  • Malignancy
  • Oral contraceptives/hormones
  • Pregnancy/delivery
  • Obesity
  • Smoking
  • Heart failure
  • Clotting disorders
    A Fib
  • Central Venous - Catheters
  • Fractured long bone

Remember that it is highly related and associated with? DVT
This knowledge will need to be incorporated

28
Q

Pulmonary Embolism: CLINICAL MANIFESTATION

A
  • Varied and nonspecific! → Dependent on size and extent of emboli
  • DYSPNEA → most common
  • Tachypnea & Tachycardia
  • Cough
  • Chest pain
  • Hemoptysis
  • Crackles
  • Wheezing
  • Fever
  • Syncope
  • LOC changes
29
Q

Diagnostic tests: pulmonary embolism

A
  • ABG
  • Chest X-Ray
  • ECG
  • Observing
  • Troponin levels
  • B-Type Natriuretic peptide

D-Dimer

  • Elevated with any clot degradation
  • False negs w/ small PE

Spiral (Helical) CT Scan:

  • Most frequently used
  • Requires IV contrast media
30
Q

pulmonary embolism Treatment – considerations during treatmen

A
  • pulmonary toilet = exercises to help clear airways of mucus and secretions
  • Oxygen → mechanical ventilation
  • Fluids

once resolved, patient will need to be on LONG TERM THROMBOLYTIC THERAPY FOR 3 MONTHS

31
Q

Drug Therapy: for pulmonary embolism

A
  • Analgesics
  • Diuretics
  • Anticoagulants (LMWH, IV Heparin, Warfarin)
  • Fibrinolytics (Tissue plasminogen activator (tPA), Alteplase (Activase)
32
Q
  • Surgical interventions for pulmonary embolism
A

Pulmonary Embolectomy =
hemodynamic patients for whom thrombolytic therapy is contradindicated

  • Inferior Vena Cava Filter = prevents migration of clots in pulmonary system
33
Q

complications of pulmonary embolism

A

Pulmonary infarction

  • Alveolar necrosis & hemorrhage
  • Abscess
  • Pleural effusion

Pulmonary hypertension

  • Results from Hypoxemia associated w/ massive or recurrent emboli
  • Right ventricular hypertrophy
34
Q

Tuberculosis: transmission/precautions include

A
  • Spread via airborne particles
  • Transmission requires close, frequent or prolonged exposure

AIRBORNE ISOLATION

35
Q

TUBERCULOSIS DIAGNOSTIC TESTS

A
  • Tuberculin skin test (Mantoux test) → injected intradermally & assess in 48-72 hours
  • POSITIVE > 15 mm induration in low risk individuals
  • POSITIVE: 5 mm induration in
  • Interferon-γ gamma release assays (IGRAs): = DETECT T CELLS
  • chest x rays
  • biological studies
36
Q

Clinical manifestations of Tuberculosis

A
  • Latent tuberculosis infection (LTBI) → asymptomatic

Pulmonary TB

  • Takes 2-3 weeks to develop symptoms
  • initial dry cough that becomes productive
  • Constitutional symptoms: fatigue, malaise, anorexia, weight loss, low-grade fever, night sweats

Late symptoms:

Dyspnea (unusual)
Hemoptysis (not common but advanced disease)

37
Q

TREATMENT OF TUBERCULOSIS

A

 Active disease: aggressive treatment
• Four drug regimen: isoniazid, rifampin (rifadin), pyrazinamide, ethambutol
 Directly observed therapy (DOT)
• Noncompliance = main reason in treatment failure + multidrug resistance
• Requires watching patient swallow drugs
• Preferred strategy to ensure adherence
 Latent TB infection: usually isoniazid for 6-9 months
 Vaccine: not recommended except for very select individuals

38
Q

o Interventions OF TUBERCULOSIS

A

 Drug therapy to prevent/treat active disease
 Monitor for compliance
 Health promotion
 Acute care = airborne isolation
 Teach patient to prevent spread (hand hygiene + cover mouth)

39
Q

clinical manifestation of COPD

A 
	Chronic cough or sputum production
	Dyspnea (usually prompts medical attn)
	Chest breathing (use of accessory & intercostal muscles + inefficient breathing)
	Underweight with anorexia
	Chronic fatigue
	Paroxysmal coughing (patient may faint or fracture ribs)
	Prolonged expiratory phase
	Wheezes
	Decreased breath sounds
	Barrel chest (increased A-P diameter)
	Tripod position
	Pursed lip breathing
	Polycythemia & cyanosis 
•	Hypoxemia
•	Increased RBC production
•	Bluish-red color of skin
40
Q

o Treatment – pharmacological and other interventions COPD

A

 Drugs
• Short-acting bronchodilators (relax smooth muscles; improve ventilation in lungs)
o COPD with FEV < 60%  LABA & inhaled corticosteroids
• Oral systemic corticosteroids
• Antibiotics
o Azithromycin (Zithromax)
• Severe COPD and chronic bronchitis = roflumilast (Daliresp)
 Supplemental oxygen therapy
• Oxygen therapy to keep O2 sat >90%
• Complications: combustion, CO2 narcosis, O2 toxicity, absorptions atelectasis, infection
 Surgical therapy
• Lung Volume Reduction Surgery
• Bronchoscopic lung volume reduction surgery
• Bullectomy
• Lung transplant

41
Q

o Nursing interventions COPD

A 
	Health promotion
•	Smoking cessation
•	Evaluate for environmental or occupational irritants
•	Early detection, diagnosis, and treatment
•	Awareness of family hx.
	Acute care
•	Acute exacerbations, pneumonia, cor pulmonale, acute respiratory failure
•	Degree and severity of underlying respiratory problem should be assessed
	Ambulatory care
•	Teaching	
o	Pulmonary rehab  improve quality of life 
o	Activity considerations
	Walk 15-20 mins a day 3x week 
o	Sexual activity
o	Sleep
o	Psychosocial considerations
	Influenza virus vaccine
	Pneumococcal vaccine
	Respiratory & physical therapy
•	Breathing retraining
•	Effective coughing
•	Chest physiotherapy 
	Postural drainage
	Percussion to move mucus
	Nutritional therapy 
•	(eat 5-6 small meals a day)
•	Avoid foods that require a lot of chewing
•	Avoid exercise 1hr before and after eating
42
Q

• Acute Respiratory Failure RISK FACTORS

A 
	Aging
	Smokers
	Poor nutrition
	Mismatch between ventilation and perfusion (V/Q mismatch)
•	COPD
•	Pneumonia
•	Asthma
•	Atelectasis
•	Result of pain
•	Pulmonary embolus
	Shunt
•	Anatomic shunt
•	Intrapulmonary shunt
	Diffusion limitation
•	Pulmonary fibrosis
•	ARDS
•	Lung disease
•	Hypoxemia present during exercise
	Alveolar hypoventilation
•	CNS disease
•	Chest well dysfunction
•	Neuromuscular disease
	CNS abnormalities
•	Drug overdose
•	Brainstem infarction
•	Spinal cord injuries 
	Chest wall abnormalities
•	Flail chest
•	Kyphoscoliosis
•	Severe obesity
•	Fractures 
•	Mechanical restriction
•	Muscle spasm 
	Neuromuscular conditions
•	Muscular dystrophy
•	Guillain-Barre syndrome
•	Multiple sclerosis
•	Exposure to toxins
•	Muscle wasting
43
Q

SIGN AND SYMPTOMS OF Acute Respiratory Failure

A 
	Mental status changes (often occur early)
	Tachycardia, tachypnea, mild HTN
	Cyanosis
	Rapid, shallow breathing pattern
	Tripod position
	Pursed-lip breathing
	Dyspnea
	Retractions 
	Paradoxical breathing
	Diaphoresis 
	Abnormal breath sounds
44
Q

HOW TO TREAT Acute Respiratory Failure

A

 Respiratory therapy
•  oxygen therapy
•  Mobilize secretion (effective coughing, chest physiotherapy, ambulation, airway suctioning, hydration, and humidification)
 Augmented cough
 Airway suctioning
 Drug therapy
 Nutritional therapy  (maintain protein & energy stores)

45
Q

ARDS risk factors

A

Direct or indirect lung injuries

46
Q

sign and symptoms of ARDS

A 
	Dyspnea
	Tachypnea
	Cough
	Restlessness
	Decrease compliance
	Decreased lung volumes
	Decreased functional residual capacity 
	Increasing work of breathing
	Tachycardia
	Diaphoresis
	Changes in mental status 
	Cyanosis
	Pallor
47
Q

o Red Flags to look out for ARDS

A

 1.If the patient has systemic inflammatory response syndrome (SIRS)
 2. Multiple organ dysfunction syndrome (MODS).
 3. New or worsening respiratory symptom,
 chest x-ray with new bilateral opacities, and a low PaO2/FIO2 (P/F) ratio
 4.Hypercapnia which causes hypoventilation
 5. ABGs indicates respiratory alkalosis caused by hyperventilation

WHAT TO DO?  Endotracheal intubation and PPV

48
Q

Chest tubes: What are they used for?

A

 To remove air or fluid from pleural and/or mediastinal space

49
Q

CHEST TUBE Assessment of different chamber, what’s good vs not good

A

 Water-seal chamber
• Bubbling indicates air leak
• If air leak is a lot, intervention is needed
• Tidaling is normal (reflects change in pressure)
o If no tidaling  suspect obstruction
 Collection chamber
 Suction chamber
 This is an emergency
• Place distal end in sterile water to maintain water seal
 We are concerned about respiratory distress

50
Q

Measuring CHEST TUBE

A

 Measure fluid level
 Report >100mL/hr
 Report fresh blood
 If you drain more than 1.5L, obtain vitals to ensure patient is okay

51
Q

Tracheotomy WHAT IS IT USED FOR

A

 Surgically created stoma opening used to …
• Establish a patent airway
• Bypass an airway construction
• Facilitate secretion removal
• Permit long-term mechanical ventilation
• Facilitate weaning from mechanical ventilation

52
Q

Patient limitations TRACHEOSTOMY

A

 Speech limitation
• Alternative forms of communication (paper, pictures, visual alphabet)
 Swallowing dysfunction
o Suctioning

53
Q

 Respiratory Acidosis

A
  • pH under 7.35
  • PaCo2 over 45
  • Caused by: Hypoventilation & respiratory failure
54
Q

 Respiratory Alkalosis

A
  • pH over 7.45
  • PaCo2 under 35
  • Causes: Hypoxemia & hyperventilation
55
Q

 Metabolic Acidosis

A
  • pH under 7.35
  • HCo3 under 22
  • Caused by: Ketoacidosis, Lactic acid accumulation (shock), severe diarrhea, kidney disease
56
Q

 Metabolic Alkalosis

A
  • pH over 7.45
  • HcO3 over 26
  • Causes: Prolonged vomiting or gastric suction

• First patient to see = Acute Respiratory Failure

MED SURG II (7 decks)

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