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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
Kidney Transplant: medication teaching
o How are they managing meds? o Cannot skip o Lifetime meds o Cyclosporine/Neoral = Take it with chocolate milk!
26
use of glucocorticoids
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
Pulmonary Embolism: | RISK FACTORS
- 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
Pulmonary Embolism: CLINICAL MANIFESTATION
- 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
Diagnostic tests: pulmonary embolism
- 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
pulmonary embolism Treatment – considerations during treatmen
- 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
Drug Therapy: for pulmonary embolism
- Analgesics - Diuretics - Anticoagulants (LMWH, IV Heparin, Warfarin) - Fibrinolytics (Tissue plasminogen activator (tPA), Alteplase (Activase)
32
- Surgical interventions for pulmonary embolism
Pulmonary Embolectomy = hemodynamic patients for whom thrombolytic therapy is contradindicated - Inferior Vena Cava Filter = prevents migration of clots in pulmonary system
33
complications of pulmonary embolism
Pulmonary infarction - Alveolar necrosis & hemorrhage - Abscess - Pleural effusion Pulmonary hypertension - Results from Hypoxemia associated w/ massive or recurrent emboli - Right ventricular hypertrophy
34
Tuberculosis: transmission/precautions include
- Spread via airborne particles - Transmission requires close, frequent or prolonged exposure AIRBORNE ISOLATION
35
TUBERCULOSIS DIAGNOSTIC TESTS
- 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
Clinical manifestations of Tuberculosis
- 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
TREATMENT OF TUBERCULOSIS
 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
o Interventions OF TUBERCULOSIS
 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
clinical manifestation of COPD
```  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
o Treatment – pharmacological and other interventions COPD
 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
o Nursing interventions COPD
```  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
• Acute Respiratory Failure RISK FACTORS
```  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
SIGN AND SYMPTOMS OF Acute Respiratory Failure
```  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
HOW TO TREAT Acute Respiratory Failure
 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
ARDS risk factors
Direct or indirect lung injuries
46
sign and symptoms of ARDS
```  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
o Red Flags to look out for ARDS
 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
Chest tubes: What are they used for?
 To remove air or fluid from pleural and/or mediastinal space
49
CHEST TUBE Assessment of different chamber, what’s good vs not good
 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
Measuring CHEST TUBE
 Measure fluid level  Report >100mL/hr  Report fresh blood  If you drain more than 1.5L, obtain vitals to ensure patient is okay
51
Tracheotomy WHAT IS IT USED FOR
 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
Patient limitations TRACHEOSTOMY
 Speech limitation • Alternative forms of communication (paper, pictures, visual alphabet)  Swallowing dysfunction o Suctioning
53
 Respiratory Acidosis
* pH under 7.35 * PaCo2 over 45 * Caused by: Hypoventilation & respiratory failure
54
 Respiratory Alkalosis
* pH over 7.45 * PaCo2 under 35 * Causes: Hypoxemia & hyperventilation
55
 Metabolic Acidosis
* pH under 7.35 * HCo3 under 22 * Caused by: Ketoacidosis, Lactic acid accumulation (shock), severe diarrhea, kidney disease
56
 Metabolic Alkalosis
* 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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