Final Flashcards
Week 1-15
Dull sound in lungs means ____ in lungs
Fluid is in lungs
Hyperresonance in sound lungs mean _____ in lungs
Extra air in lungs
What body parts to assess for a comprehensive respiratory assessment
- nose
- mouth
- throat
- lower resp: thoracic inspection
Order of skills will doing a respiratory assessment
Inspect, auscultate, percuss, palpate
Fluid in the lungs
Pleural effusion
Air in the lungs
Pneumothorax
Pulmonary Function test
(PFT)
- assess resp function
- determine the extent of dysfunction
- response to therapy
- screening test
Arterial Blood gases
- aid in assessing the ability of the lungs to provide adequate oxygen and remove carbon dioxide, reflects ventilation
- oxygen concentration in lungs
End Tidal carbon dioxide
(partial pressure)
noninvasive method of monitoring partial pressure of carbon dioxide at the end of exhalation
Aspiration of fluid or air from the pleural space
Thoracentesis
X-ray images to be generated via camera to video screen
fluoroscopic study
- exercise for the lungs
- helps reduce atelectasis
- inspire through tube and hold breath at the end, then exhale
Incentive spirometry
Chest tube dressing is what kind of dressing
occlusive dressing
Closed air system are used to re-expand the involved lung and to remove excess air, fluid, or blood
Chest tube
Placement of chest tube restores _______ pressure
negative intrathoracic pressure
You should provide extra oral care for a person with oxygen and tracheostomy T or F
TRUE
Characteristics of healthy community
- access to recreation and open space
- access to healthy food
- access to medical services
- access to affordable housing
- safe neighborhoods and public spaces
- tobacco free living, injury/violent free living
- reproductive and sexual health resources
- good environmental quality
- Access to economic opportunity
Methods of community health assessment
- survey
- descriptive epidemiologic studies
- community forums/ town hall meetings (larger groups and questions preselected)
- focus groups(5-15 people)
What oxygen mask is the most reliable for a COPD patient
Venturi Mask
Pulmonary edema
extra fluid/ swelling in the pleural space
pulmonary embolism
Blood clot in the lung
T or F, a nurse should not reposition a patient to facilitate drainage
FALSE, you want to repo patient!!
What can you teach a patient to do while eating to reduce aspiration risk
tuck chin and swallow
Types of community health assessment
- familiarization assessment
- problem-orientated assessment
- community subsystem assessment
- comprehensive assessment
- assets(strength) assessment
Familiarization assessments
- windshield survey
- studying data already available in the community
problem-orientated assessment
- focuses on a single problem and looks at the community in terms of that problem
community subsystem assessment
- focuses on a single dimension of community life
- church, schools, college campuses
Comprehensive assessments
- complicated and often time-consuming, used to discover all relevant community health information
- LONG TERM
Asset assessment
- focuses on strengths of a community as opposed to its deficits
What pts are most at risk for atelectasis
post op patients
What do nurses have to look for before pulling out breathing tube?
- make sure gag reflex and swallow reflex is back!
Where does upstream thinking need to start to create change?
The Lawmakers!
What is atelectasis
- The alveoli’s collapse
- most commonly occurs post op
- intervention: IS
interventions for pneumonia
- no Tylenol/ antibiotics BEFORE culture comes back!
- fluids, oxygen, antitussives, decongestants
- positional changes
- appropriate antibiotics
Another name for pneumothorax
collapsed lung
- air!
Interventions for Pleural effusion
- treat underlying cause
- thoracentesis
- chest tube
- support oxygen
Transudate fluid is
clear
Exudate fluid is
pus/ infection
Asthma interventions/ management
- medications: SABA LABA> inhalers
- corticosteroids
- positioning/ breathing
- know triggers
- Have an action plan ready
- resp support
Peak flow meter> blow hard as fast as you can x2, helps manage asthma
Environmental hazards
- built environment
- land use
- toxic exposure> pollution/ contamination
- toxic waste
- radiation> ionizing(radon gas) & nonionizing
What is a built environment
all aspects not naturally occurring
- roads, buildings, ect
Common s/s of asthma
bilateral wheezes
What position is a colonoscopy
Position pt on the left side we knees crunched toward body
A reversible syndrome that results in decreased glomerular filtration rate and oliguria
AKI, acute kidney injury
pre/ intra/ post renal damage sites
pre: hypoperfusion
intra: actual damage to kidney
post: obstruction
Types of dialysis
- peritoneal dialysis
- hemodialysis
- CRRT
Peritoneal dialysis
- one has to be relatively healthy
- 12-18hrs
- removes toxic substances and metabolic wastes and to reestablish normal fluid and electrolyte balance
Hemodialysis
- used when pt is acutely ill until kidneys resume function and for long-term replacement therapy for chronic kidney disease and end stage kidney disease
CRRT
- ICU setting
- used for pts who are hemodynamically unstable
takes smaller amount of blood and it is continuous
What is the cause of kidney stones
- unknown
- depends on location and presence of obstruction
What are common symptoms of kidney stones
- severe back, flank pain
Common AKI symptoms
- low urine output
- wt gain, fluid overload
- anemia
- hypertension
Management/ interventions for AKI
- run water to assist let down reflex
- sodium polytene sulfonate(meds)
- dialysis> feel thrill, hear bruit
What is a good meal option for a low residue diet
broiled chicken and low-fiber pasta
T or F, elimination directly impacts what we eat and drink
TRUE
With food poisoning what sample is needed to send to the confirm it is from food
- a stool sample
Prevention from foodborne illness
- wash food
- cook properly and all the way
- refrigerate !
- only consume pasteurized diary products
- pasteurized juices
- don’t eat unbaked (raw) dough
High protein diets are beneficial for ______ pts
- low body mass
- burn victims
- wounds
- infections
Low residue diets are for _____
- pts with temp GI/ elimination problems> lower GI issues
- Crohn’s and UC
Stroke pts are often on what diet?
mechanical soft
ERCP is under what type of sedation?
Moderate sedation
Lab tests for evaluating GI tract function
CBC: infection/ inflammation
BMP: how the body is breaking down food
Lipase: breaking down lipids/ fats
What assessment should you do frequently with a pt with an feeding tube
- frequent lung auscultation
- aspiration risks
Meds go into _____ tube and feedings go into _____ tube
Meds: G- tube( stomach)
Feedings: J- tube (jejunum)
PUD s/s and nursing role
- dull pain or buring in stomach
- heartburn and vomiting may occur
Nurse: - assess pain and methods to treat pain
- diagnostic tests: upper endoscopy, cbc, stool sample (occult blood)
- treat with H2 receptors, PPIs, antibiotics(H. pylori)
- question use of NSAIDs
Constipation interventions
- increase fluid and fiber intake
- encourage activity
- patient education
- proper use of laxative
- schedule toiletings
Diarrhea interventions
- avoid irritating foods> diet changes
- Imodium
- hydration
- rest
- probiotics; protect microbiome
- perianal skin care> protect skin
Celiac s/s and role as nurse
- Steatorrhea, abdominal pain, wt loss, fatigue, flatulence, malabsorption
Nurse: - education on gluten elimination
- work with dietician
UC s/s and nurses role
-inflammation and ulcers from rectum and colon
- bloody diarrhea, anemia, wt loss, colicky pain, PSEUDOPOLYPS
Nurse:
- medications, emotional support, lifestyle change education, corticosteroids, immunosuppressants
Crohns s/s and nursing role
- skip lesions, cobble stoning, anywhere along GI tract
- fistulas, abdominal mass, patches of inflammation, abdominal pain, NONbloody diarrhea
Nurse: - medication, emotional support, ostomy, corticosteroids, know triggers(health hx), watch for electrolyte imbalance and cardiac dysrhythmias
A complication for PUD
- perforation of the bowel
Lab to test renal dysfunction
BUN, serum creat
Hyperbilirubinemia can lead to
Jaundice
T or F crohns has bloody stool were UC doesn’t
FALSE;
UC has bloody stools and Crohns doesn’t
What diet would benefit a pt who just underwent a cholystectomy
- low fat diet
What is parental nutrition
- IV route nutrtion
- always hang lipids with it!
restriction of energy intake to requirements leading to significantly low body weight in context of age, sex, development
Anorexia
Recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid weight gain such as purging, fasting, or exercising
Bulimia
S/S of Anorexia
- excessive wt loss
- intense fear of gaining wt
- perfectionism
restricting foods/ fluids
s/s of bulimia
- poor dentation/ teeth enamal erosin
- bad breath, yellow erosin
- social butterflies
- typically normal weight
Complications of eating disorders
- loss of muscle mass
- hypothyroidism
- dry, cracking skin
- bradycardia, hypotension
- bloating, constipation
- electrolyte abnormalities
- dental erosion/ decay
Self concept is assessed through…..
eliciting patient’s thoughts about themselves, their ability to navigate in the world, and their nonverbal behavior
Liver enzyme labs
- AST
- ALT
- GGT
Hepatic encephalopathy can be combated with ……
Lactulose
High prothrombin time indicates
- longer time to clot blood
- inability to use vit K to clot
Most common cause of pancreatitis is____
from excess alcohol consumption
chronic disease characterized by replacement of normal liver tissue with diffuse fibrosis that disrupts the structure and function of the liver
Hepatic cirrhosis
Who is more prone to cirrhosis
- men who have a long-term alcohol and drug use
Most common cause a acute liver failure
- drug induced hepatitis
- acetaminophen is #1 offender
- onset is usually abrupt
Cholelithiasis common in pts who are _____
- fat
- female
- forty
S/S of cholelithiasis
- RUQ pain
- pain may radiate to back or shoulders
- restless
gallbladder contractions/ pain
Chronic vs acute pancreatitis
- one episode vs multiple episodes
- opioids can work for acute episode but not for chronic
- scute attacks can lead to chronic
Primary goal of acute pancreatitis
pain management
Inflammation of the liver is
hepatitis
What can induce hepatitis
excess alcohol use, excess NSAID use, toxins, viruses
Self concept is
the way a person thinks and sees themselves
Self concept is assessed by
eliciting patients thoughts about themselves, their ability in the navigate in the world, and their nonverbal behaviors
A lifelong pattern of dysfunctional behaviors develops in relating and interacting with others
personality disorders
Criteria in order to be diagnosed for a personality disorder
- have to be 18 to diagnose
- CANNOT be traced to physiological source
- behaviors deviate from the normal pattern of interactions
- splitting
- impulsivity
What is a priority intervention for an antisocial P.D.
- express anger in an adaptive, nonviolent manner
Most common trait for a pt with borderline personality
impulsivity
Goal for personality disorders
positive behavioral change
Interventions for personality disorder
SSRIs
benzos
antipshychotics
Cluster B personality disorder is known as the
Dramatic- erratic and attention seeking
Histrionic pts are very
- attention seeking
- dramatic
Interventions for Cluster B P.D.
- limit setting/ boundaries
- de-escalation
- therapeutic> gain trust
- medications
- pt is not having self injuriuos thoughts
The most common chronic disease in the US for adults
Hypertension
In a hypertensive crisis how much do you want to reduce BP by in the first hour
25%
Best diet for a pt with hypertension
broiled chicken and baked potato
- less red meat
- more veggies/ fruit
Beta blockers
‘LOL’
- block synthetic nervous system
- slowers HR
Ace inhibitors
‘PRIL’
- inhibits angiotension 1 conversion to angiotension 2
What medications work best for hypertension
- Betas
- Ace
- Diuretics
What to measure with alpha/ betas and vasodilations
measure K+
T or F use nitro for agnina and a hypertensive emergency
TRUE, nitro is a vasodilator
What position to put a pt in with pulmonary edema
high fowlers
While taking atorvastatin what needs to be checked
liver enzymes
Coronary atherosclerosis is
blockages and narrowing of coronary vessels reduce blood flow
Medications for hypercholesterolemia
- statins
- reduce LDLs and atherosclerosis
Elevated troponin levels indicate
new heart ischemia
- indicates new MI
Obstructive lesions are predominantly confined to segments of the arterial system extending from the aorta below renal arteries
PAD
- relieved with rest
- no edema
- weak pulses
- ischemia> gangrene
- DANGLE LEGS
Reduction in venous blood flow, which results in statis of blood
PVD
- lots of edema
- warm legs
- brown/ yellow skin color
- irregular sore
- ELEVATE LEGS
3 types of crisis
- developmental
- situational
- traumatic
Developmental crisis ex.
- leaving home for first time
- completing school
- potty training
- accepting responsibility
Situational crisis ex.
- loss of spouse or job
- break up with gf/ bf
- job promotion
- terminal illness diagnosis
Traumatic ex.
- natural/ enviromental
- wars
- violent crimes
- assaults
PTSD diagnosis
- intrusive symptoms> avoiding/ numbing
- negative mood or thoughts
- hyperarousal
- sleep deprivation> dreams, can’t sleep
PTSD medication used for off label use
Prazoin (alphal)
Emotional injury caused by an overwhelming stressful event that threatens one’s survival and sense of security
Trauma
- trauma looks different for everyone
Symptoms of PTSD/ trauma disorders
- bedwetting and progress declines in children
- disruptive, disrespectful, destructive behaviors
- avoidance and numbing
- intrusive thoughts
- nightmare/ terrors/ reliving the memory
Role of CPH nurse during the four phases of disaster
- prevent disaster from happening
- prepare for disaster
- disaster planning
- communication on how disaster will be broadcasted - respond to disaster
- rescue and triage - supported recovery
Triage order
- red: immediate, life threatening
- yellow: significant injuries, requires medical care
- green: minimal injuries
- Black: extensive, DNR/DNI
Stages of EPDM
- prevention-migration
- preventing further injuries - preparedness
- know what emergencies are possible, prepared for emergency - response
- emergency happens - recovery
- rebuilding process
Cardiac Labs
- Troponin
- myoglobin
- cardiac enzymes (CK-MB)
- CRP
- BNP(heart failure)
provides a tool to quanitfy health loss from hunfreds of disease, injuries, and risk factors, so that health systems can be improved and disparities can be elimated
Global burden of disease
Population disability minus DALY =
Global Burden of Disease (GBD)
Global health nursing frameworks
- patterns of care> repeated activities
- demographic transitions> population increase and decrease
- epidemiologic transitions> ERAs
Radiation
- curative, control, or palliative
- external/ internal
- radiation reaction
- avoid soap, tight clothing, exposing area to sunlight/ cold
- apply zinc, vit A and D to area
- only use lukewarm water
Chemotherapy
- will kill rapidly growing cells even when they aren’t cancer
- used ina ttempt to destroy cancer cells by interfeing with cellular function and replication
- many side effects
- assess fluids, cognitive state, prevent n/v, manage fatigue, PPE
Surgery: Cancer
- diagnostic cancer
- prophylactic surgery
- palliative surgery
- reconstructive surgery
CAM therapies
- immunotherapy
- stem cell transplant
- targeted therapy
Palliative care
- hospital, long term care facility, outpatient, and home
- can pursue curative care
- death not expected for 6 months or less
Hospice care
- in homes, outpatient
- MUST forgo curative care
- diagnosis of death in 6 months or less
- come to term of illness
- holistic approach
What to communicate with terminally ill pt and families
- education
- support
- assist with life review
- end of life goals
- comfort
Culturally and spiritually sensitive care to terminally ill pts
- address spiritual care
- FICA assessment
- maintaining hope
- give strength to family and pt
physiologic responses to terminal illness
- pain
- dyspnea
- Nausea/ anorexia
- delirium/ anxiety
