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Adult Nursing I (NUR 240) > Final Exam (Exam 4) > Flashcards

Final Exam (Exam 4) Flashcards

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1
Q

What are the different phases of the Postanesthesia Care?

Ch 16

A

Phase I PACU – 15 minutes
* Immediate recovery
* Intensive nursing intervention
* Patient transitions to inpatient unit or phase II PACU

Phase II
* Patient prepared fro transfer to inpatient nursing, extended care facility, or discharge

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2
Q

What is nursing management in the PACU? Describe what is involved.

Ch 16

A

Provide care for the patient until they have recovered from the effects of anesthesia

  • regurn to cognitive baseline, clear airways, controlled N/V, stable vital signs
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3
Q

What are some key responsibilities of PACU nurses?

Ch 16

A

Know patient’s baseline

  • Review pertient infromation, baseline assessment upon admission to the unit
  • Always check ABCs & IV sites
  • Assess airway, level of consciousness, cardiac, respiratory, wound, & pain
  • Check drainage tubes, monitor lines, IV fluids, & meds
  • Assess vital signs at time of arrival to PACU & repeat as per protocol
  • Administer post-op analgesia
  • Provide transfer report to another unit or discharge patient home, continuing or transitional care
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4
Q

What are the different types of shock?

A
  • Hypovolemic
  • Cardiogenic
  • Neurogenic
  • Anaphylactic
  • Septic
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5
Q

What are signs & symptoms of Hypovolemic Shock?

A
  • pallor, cool, moist skin (decreased circulation, heart racing & working hard)
  • rapid breathing
  • cyanosis (lips, gums, extremities, etc.)
  • rapid, weak, thready pulse
  • low blood pressure (less blood circulating = less pressure)
  • decreasing pulse pressure (less ciruclating blood)
  • concentrated urine (dark brown due to dehydration; low blood volume means there is less to be excreted)
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6
Q

What is important to note about geriatric patients in the PACU?

A
  • Increased risk of hypothermia
  • Slower recovery from anesthesia
  • Post-op confusion & delirium can occur
  • Hypoxia may present as confusion & restlessness
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7
Q

**What is the primary nursing goal in the immediate post-op period? **

Ch 16

A
  • Good / Adequate perfusion & oxygenation
  • Maintain pulmonary funciton
  • prevent hypoxemia & hyperapnia (extra CO2 in blood stream)
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8
Q

What is hypercapnia?

Ch 16

A

A build up of CO2 in the blood

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9
Q

What priority assessments should be focused on when managing a hospitalized post-op patient?

Ch 16

A
  • Respriatory
  • Pain
  • Mental status / LOC
  • General discomfort
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10
Q

What needs to be kept in mind when maintaining a patent airway?

Ch 16

A
  • Keep HOB elevated to 15 or 30 degrees unless contraindicated (risk for aspiration)
  • Provide supplemental oxygen
  • Assess breathing at the patient’s mouth (place your hand near their face & feel for air movement)
  • May require suctioning; if vomiting, turn pt to the side
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11
Q

What should be monitored & assessed when maintaining cardiovascular stability?

Ch 16

A

Assess for
* IV sites
* potential hypotension or shock
* hemorrhage
* HTN or arrhythmias

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12
Q

How can nurses go about releiving a patient’s pain & anxiety?

Ch 16

A
  • Control the environment: quiet, low lights, noise level
  • Administer analgesics (usually short-acting IV opioids)
  • Family can visit (only if it’s positive and doesn’t increase anxiety)
  • Nonpharmacologic, emotional, & psychosocial support (breathing, guided imagery, etc.)
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13
Q

During which stage of healing do blood clots form?

Ch 16

A

Inflammatory stage

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14
Q

During which stage of wound healing does granulation tissue form?

Ch 16

A

Proliferative phase

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15
Q

During which phase of wound healing do fibroblasts leave the wound & tensile strength increases?

Ch 16

A

Maturation phase

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16
Q

Functions of the Vascular System

Chapter 26 - NEW MATERIAL

A
  • Blood flow & BP
  • Capillary filtration & reabsorption
  • Hemodynamic resistance
  • Peripheral vascular regulating mechanisms
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17
Q

Gerontologic Considerations of the Vascular System

Chapter 26 - NEW MATERIAL

A

Aging causes changes in the walls of blood vessels that affect transport of oxygen & nutrients to the tissue

Can result in:
* increased peripheral resistance
* impaired blood flow
* increased left ventricular overload

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18
Q

Signs & Symptoms Associated with Vascular Issues
Health Hx & PE

Chapter 26 - NEW MATERIAL

A

Health Hx:
* intermittent claudication
* “rest pain” (usually due to tissue death)
* location of the pain

Physical Exam:
* cool, pale, pallor skin
* rubor (large legs, purple color)
* loss of hair & brittle nails
* dry or scaling skin
* atrophy
* ulcers
* Need to use dopler to locate pulses

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19
Q

List Arterial Disorders

Chapter 26 - NEW MATERIAL

A
  • Ateriosclerosis
  • Atherosclerosis
  • Peripheral Artery Disease (PAD)
  • Aneurysms
  • Aortic Dissection
  • Arterial Embolism & Arterial Thrombosis
  • Raynaud’s phenomenon
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20
Q

What is Ateriosclerosis?

KNOW THIS

Chapter 26 - NEW MATERIAL

A

Hardening of the arteries

  • lining of the walls of arteries & arterioles become thick
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21
Q

What is Atherosclerosis?

KNOW THIS

Chapter 26 - NEW MATERIAL

A

Accumulation of plaque in the arteries

  • Can be caused by an accumulation fo lipids, calcium, blodo componentents, carbohydrates, & fibrous tissue
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22
Q

Modifiable & Nonmodifiable Risk Factors for Atherosclerosis & PAD

Chapter 26 - NEW MATERIAL

A

Modifiable:
* Nicotine use
* Type II diabetes
* HTN
* Hyperlipidemia
* Diet & Exercise
* Stress

Non-modifiable:
* Increasing age
* Genetics (familial predisposition)

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23
Q

What is Peripheral Artery Disease (PAD)?

KNOW THIS

Chapter 26 - NEW MATERIAL

A

Narrowing or occlusion of arteries leading to reduced blood flow

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24
Q

Signs & Symptoms of PAD

KNOW THIS

Chapter 26 - NEW MATERIAL

A
  • Intermittent Claudication (muscle pain due to lack of blood flow)
  • Occurs with exercise or activity
  • Releived with rest
  • Pain is described as aching, cramping, or inducing fatigue or weakness
  • Ischemic rest pain is usually worse at night and often wakes the patient
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25
Q

List the two main types of pharmacologic therapy used in the treatment of PAD

Chapter 26 - NEW MATERIAL

A

Statins & Antiplatelets

Aspiring or Clopidogrel = antiplatelets

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26
Q

The nurse is teaching a patient diagnosed with peripheral arterial disease (PAD). What should be included in the teaching plan?

a.) Evaluate the lower extremities
b.) Exercise is discouraged
c.) Keep the lower extremities in a neutral or dependent position
d.) PAD should not cause pain

Chapter 26 - NEW MATERIAL

A

C.) Keep the lower extremities in a neutral or dependent position

  • for patients with PAD blood flow to lower extremities is ehanced so you want to keep legs in a neutral or dependent position.
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27
Q

What are aneurysms?

Chapter 26 - NEW MATERIAL

A

Localized sac or dilation formed at a weak point in the wall of the artery

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28
Q

What are the most common forms of aneurysms?

Chapter 26 - NEW MATERIAL

A
  • Saccular: projects from only one side of the vessel
  • Fusiform: an entire arterial segment becomes dilated
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29
Q

What is Raynaud’s Phenomenon? What are signs & symptoms of RP?

Chapter 26 - NEW MATERIAL

A

Intermittent arterial vasoocclusion (spasm), usually in the fingertips or toes

S & S: color changes, numbness, tingling, & burning pain

  • frequently occurs in young women
  • episodes brought on by trigger like stress or cold
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30
Q

List some common venous disorders.

Chapter 26 - NEW MATERIAL

A
  • Venous Thromboembolism (VTE) condition (DVT & PE)
  • Chronic venous insufficiency / post-thrombotic syndrome
  • Leg ulcers
  • Varicose veins
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31
Q

What is Venous Thromboembolism?

Chapter 26 - NEW MATERIAL

A

blood clot formation in the vein

  • results in the formation of a DVT or a PE
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32
Q

What is the difference in a DVT & a PE?

Chapter 26 - NEW MATERIAL

A

DVT (deep vein thrombosis): blood clot or thrombus located within a deep vein that causes obstruction or occlusion

PE (pulmonary embolism): blood clot or thrombus within a pulmonary artery that blocks or obstructs blood flow to the lungs

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33
Q

What measures can be used to prevent Venous Thromboembolisms?

Chapter 26 - NEW MATERIAL

A
  • Early ambulation & leg exercises
  • Compression stockings
  • Intermittent pneumatic compression devices
  • Subcutanoeus heparin or LMWH
  • Lifestyle changes (weight loss, smoking cessation, exercise)
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34
Q

Which patient is at highest risk for a venous thromboembolism?

a.) A 50-year-old post-operative patieint
b.) A 25-year-old patient with a central venous catheter in place to treat septicemia
c.) A 71-year-old otherwise healthy older adult
d.) A pregnant 30-year-old woman due in 2 weeks

A

B.) A 25-year-old patient with a central venous catheter in palce to treat septicemia

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35
Q

How can varicose veins be prevented?

Chapter 26 - NEW MATERIAL

A
  • Avoid sitting or standing for long periods
  • Avoid wearing clothes / socks that are too tight
  • Avoid crossing the legs at the thighs
  • Elevate the legs 3-6 inches higher than heart level
  • Encourage walking for 30 minutes each day
  • Wear compression socks
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36
Q

What is lymphangitis?

Chapter 26 - NEW MATERIAL

A

inflammation ro infection of the lymphatic channels

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37
Q

What is lymphadenitis?

Chapter 26 - NEW MATERIAL

A

inflammation or infection of the lymph nodes

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38
Q

What is lymphedema? What are Primary & Secondary lymphedema?

Chapter 26 - NEW MATERIAL

A

tissue swelling related to obstruction of lymphatic flow

  • Primary: congenital
  • Secondary: acquired obstruction
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39
Q

Which of the following is an effective strategy used to promote lymphatic drainage and prevent edema in clients with lymphedema?

a.) Antibiotic therapy for 14 days
b.) Constant elevation of the affected extremity
c.) Application of heat therapy twice per day
d.) Daily exposure to the sun

A

B.) Constant elevation of the affected extremity

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40
Q

What are signs & symptoms of cellulitis? How is cellulitis treated?

Chapter 26 - NEW MATERIAL

A

S & S: localized edema or erythema, warmth, fever, chills, sweating

Treatment: oral or IV antibiotics based on the severity

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41
Q

What blood pressure is considered to be hypertensive as defined by the American College of Cardiology (ACC) / American Heart Association (AHA)?

Chapter 27 - NEW MATERIAL

A

130 / 80 mmHg or higher

  • Systolic BP 130 or over
  • Diastolic BP 80 or over
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42
Q

Define Normal BP, Elevated BP, Stage 1 HTN, & Stage 2 HTN for adults 18 years and older

Chapter 27 - NEW MATERIAL

A
  • Normal BP: 120/80
  • Elevated BP: 120 - 129 / < 80
  • Stage 1 HTN: 130 - 139 / 80 - 89
  • Stage 2 HTN: Sys. > 140 OR Dia. > 90
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43
Q

What is the difference in primary and secondary hypertension?

Chapter 27 - NEW MATERIAL

A

Primary HTN = familial (essential / unknown cause / genetic)

Secondary: has a known cause

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44
Q

What population has the highest prevalence of HTN?

Chapter 27 - NEW MATERIAL

A

African Americans

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45
Q

Describe the signs & symptoms / manifestations of HTN

Chapter 27 - NEW MATERIAL

A

Most of the time there are no other symptoms besides elevated BP

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46
Q

For patients with uncomplicated hypertension and no specific indications for another medication, what is the recommended initial medication?

a.) Thiazide diuretics
b.) Calcium channel blockers
c.) Vasodilators
d.) Angiotensin-converting enzyme (ACE) inhibitors

Chapter 27 - NEW MATERIAL

A

A.) Thiazide diuretics

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47
Q

What are major risk factors associated with the development of hypertension?

Chapter 27 - NEW MATERIAL

A
  • Smoking
  • Obesity
  • Physical inactivity
  • Dyslipidemia (high cholesterol / hyperlipidemia)
  • Diabetes mellitus
  • Microalbuminuria or GFR < 60 mL/min
  • Older age
  • Family history
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48
Q

What are potential collaborative problems or complications associated with hypertension?

Chapter 27 - NEW MATERIAL

A
  • Left ventricular hypertrophy
  • Myocardial infarction
  • Heart failure
  • Transient ischemic attack (TIA)
  • Cerebrovascular disease (CVA, stroke, brain attack)
  • Renal insufficiency & CKD
  • Retinal hemorrhage
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49
Q

The nurse is preparing an education plan for a patient newly diagnosed with hypertension? Which of the following should be included in the education plan?

a.) Engage in regular aerobic physical activity such as brisk walking (at least 30 min/day most days of the week)

b.) Eliminate alcoholic beverages from the diet

c.) Reduce sodium intake to no more than 200 mmol/day

d.) Maintain a normal body weight with BMI between 18 and 30 kg/m2

A

A.) Engage in regular aerobic physical activity such as a brisk walk (at least 30 min/day most days of the week)

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50
Q

What is a hypertensive emergency?

Chapter 27 - NEW MATERIAL

A

Hypertensive Emergency: Blood pressure > 180/120 mmHg and must be lowered immediately to prevent further damage to target organs

  • Reduce BP by no more than 25% in the first hour
  • Reduce to 160/100 mmHg within 2-6 hours, then gradual reduction to normal 24 - 48 hours of treatment (exceptions are ischemic stroke & aortic dissection)
  • Use IV vasodilators (nitroglycerin, etc.)
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51
Q

What is Hypertensive Urgency?

Chapter 27 - NEW MATERIAL

A

Hypertensive Urgency: Blood pressure > 180/120 mmHg but NO evidence of immediate or progressive target organ damage

  • Oral agents can be administered within 24 - 48 hours to hopefully normalize BP
  • Beta-adrenergic blocker
  • Angiotensin-converting-enzyme (ACE) inhibitor
  • Alpha 2 antagonist
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52
Q

Which of the following is a priority nursing assessment when caring for the patient in a hypertensive crisis receiving intravenous vasodilators?

a.) Pain
b.) I & O
c.) Vision
d.) Family history

A

B.) I & O

53
Q

What are the main types of lymphocytes & where do they mature?

Chapter 31 - NEW MATERIAL

A
  • B Lymphocytes mature in the Bone marrow
  • T Lymphocytes mature in the Thymus (and differentiate into cells with various functions)
54
Q

What are the funcitons of the immune system?

Chapter 31 - NEW MATERIAL

A
  • Remove foreign antigens (viruses, bacteria, etc.) to maintain homeostasis
  • Phagocytosis: monocytes (WBCs) responsible for engulfing & destroying foreign bodies & toxins
  • Inflammatory Response
55
Q

What is the difference in natural immunity & acquired immunity?

Chapter 31 - NEW MATERIAL

A
  • Natural Immunity: non-specific response to any invader; no memory
  • Acquired Immunity: specific against a foreign antigen; has memory
56
Q

Which leukocytes are associated with inflammation?

a.) Basophils
b.) Eosinophils
c.) Monocytes
d.) Neutrophils

Chapter 31 - NEW MATERIAL

A

D.) Neutrophils – first cells to arrive at the site of inflammation

57
Q

What are the 4 stages of immune response?

Chapter 31 - NEW MATERIAL

A

1.) Recognition: recognize the antigen as foreign

2.) Proliferation: stimulation of T & B cells to enlarge, divide, & proliferate

3.) Response: begins production fo antibiodies & cellular response stimulates resident lymphocytes to attack

4.) Effector: humoral immunity & cellular immunity

58
Q

What is humoral immunity?

Chapter 31 - NEW MATERIAL

A
  • Antigen recognition
  • Antibodies (IgA, IgD, IgE, IgG, IgM)
  • Antigen-Antibody Binding
59
Q

What are T Lymphocytes responsible for? List examples of T Lymphocytes

Chapter 31 - NEW MATERIAL

A

Cellular immunity

  • attack invaders directly
  • secrete cytokines
  • stimulate immune response

Ex: Helper T Cells (CD4), Cytotoxic T-cells (CD8), Memory Cells (B & T cells), Suppressor T cells

60
Q

What are Null Cells & What are Natural Killer Cells?

Chapter 31 - NEW MATERIAL

A
  • Null Cells: destroy antigen coated with antibody
  • Natural Killer Cells: Defend against microorganisms & some malignant cells
61
Q

What is the complement system?

Chapter 31 - NEW MATERIAL

A

Plasma proteins made in the liver that:

  • Defend against bacterial infection
  • Bridge natural & acquired immunity
  • Dispose of immune complexes & by-products
62
Q

What are some variables that have an effect on the funciton of the immune system?

Chapter 31 - NEW MATERIAL

A
  • Age
  • Gender
  • Nutrition
  • History of infection or immunizations
  • Allergies
  • Presence of conditions / disorders like: autoimmune disorders, cancer, chronic illness, surgery, or trauma
  • Medications & transfusions
  • Lifestyle
  • Psychoneuroimmunologic factors
63
Q

What tests can be used to evaluate immune system functioning?

Chapter 31 - NEW MATERIAL

A
  • WBC Count w/ & w/out differential
  • Bone marrow biopsy
  • Humoral & cellular immunity tests
  • Phagocytic cell function test
  • Complement component tests
  • Hypersensitivity tests
  • Specific antigen-antibody tests
  • HIV infection tests
64
Q

What is Primary Immune Deficiency Disorders (PIDD)?

Chapter 32 - NEW MATERIAL

A

Prevents the body from developing normal immune responses

  • Genetic
  • Majority dx in infancy
  • Male to Female Ratio = 5:1

Severe Combined Immunodeficiency (SCID) is an example

65
Q

What are the signs & symptoms / clinical manifestations of PIDD?

Chapter 32 - NEW MATERIAL

A
  • Multiple infections despite treatment
  • Infection with unusual / opportunistic organisms
  • Failure to thrive / poor growth
  • Family history

Considerable delay between onset of sx & time of diagnosis

66
Q

List some modes of transmission for HIV

Chapter 32 - NEW MATERIAL

A
  • Blood & blood products
  • Seminal fluid
  • Vaginal secretions
  • Mother-to-child: amniotic fluid, breast milk
67
Q

List some modes of transmission for HIV

Chapter 32 - NEW MATERIAL

A
  • Blood & blood products
  • Seminal fluid
  • Vaginal secretions
  • Mother-to-child: amniotic fluid, breast milk
68
Q

Explain HIV Preventive Measures

Chapter 32 - NEW MATERIAL

A

Patient Education
* behavioral interventions
* HIV testing
* Linkage to treatment & care

Goal is to reduce the viral load to reduce transmission

69
Q

Antiretroviral (ART) medications as post-exposure prophylaxis for healthcare workers are started within how many hours of exposure?

a.) 12 hours
b.) 24 hours
c.) 36 hours
d.) 72 hours

Chapter 32 - NEW MATERIAL

A

D.) 72 hours

  • sooner the better
70
Q

Explain the pathophysiology of HIV

Chapter 32 - NEW MATERIAL

A

Retrovirus because it carries genetic material in the form of RNA rather than DNA

Targets CD4 cells (expressed on surgace of T cells, monocytes, dendritic cells, & brain microglia)

71
Q

Explain the Stages of HIV Infection

Chapter 32 - NEW MATERIAL

A

Stage 0 (Early Infection): inferred from lab tests

Stage 1 (Primary / Acute):
* period from infection to development of HIV-specific antibodies
* drop in CD4+ T-cells (normal = 500 - 1500 cells/mm3)

Stage 2: CD4 cells between 200 - 499 cells/mm3

Stage 3: CD4 cells drop below 200
* Considered to have AIDS (for surveillance purposes)

72
Q

What are the clinical manifestations of HIV Stage 1

Chapter 32 - NEW MATERIAL

A

Usually Asymptomatic

May Exhibit:
* skin rash
* fatigue

later stages lead to respiratory issues (SOB, dyspnea, cough, angina)

73
Q

What are the clinical manifestations of HIV Stage 2?

Chapter 32 - NEW MATERIAL

A

Gastrointestinal
* Loss of appetite
* N / V
* Oral candidiasis
* Diarrhea
* Wasting Syndrome

Oncologic
* Kaposi sarcoma
* AIDS-related lymphomas

Neurological
* Effects on cognition, motor function, attention, visual memory, visuospatial function
* Peripheral neuropathy
* HIV encephalopathy

74
Q

What are clinical manifestations of HIV Stage 3?

Chapter 32 - NEW MATERIAL

A

Neurological
* Fungal infection (Cryptococcus neoformans)
* Professive multifocal leukoencephalopathy
* Depression
* Apathy

Integumentary
* Herpes zoster
* Seborrheic dermatitis

Gynecological
* Genital ulcers
* Persistent, recurrent vaginal candidiasis
* Pelvic inflammatory disease
* Menstrual abnormalities

75
Q

What is the treatment used for HIV & AIDS?

Chapter 32 - NEW MATERIAL

A

Anti-retroviral Therapy (ART)

  • restores & preserves immune function
  • Suppresses HIV viral load
  • Prevents HIV transmission
76
Q

What are some adverse effects of HIV & AIDS treatments??

Chapter 32 - NEW MATERIAL

A
  • Hepatotoxicity
  • Nephrotoxicity
  • Osteopenia
  • Increased risk of CVD & MI
  • Fat redistribution syndrome & fat loss in the arms, legs, & buttocks
  • Lymphadenopathy in the abdomen, breast, & dorso-cervical region (buffalo hump)
77
Q

Explain the steps in the life cycle of HIV

Chapter 32 - NEW MATERIAL

A
  • Attachment / Binding: HIV binds to host (uninfected) CD4+ resulting in a fusion of HIV & T-cell membrane
  • Uncoating / Fusion: Only contents from HIV’s viral core enters the cell & viral proteins (reverse transcriptase, integrase, protease)
  • DNA Synthesis: HIV uses reverse transcriptase to form a double stranded DNA
  • Integration: DNA enters the nucleus & integrates into the CD4+ nucleus (now we can call it infected)
  • Transcription: The DNA hijacks the replication inside the cell & once a viral RNA is transcribed, the viruscan replicate
  • Translation: the mRNA creates new proteins, enzymes, & components to make the virus
  • Cleavage: the HIV protease cleaves the polyprotein chain into individual proteins that make up the new virus
  • Budding: new proteins & viral RNA are assembled, migrate to the membrane, & exit the cell to find a new host cell
78
Q

What are potential problems or complications associated with HIV / AIDS patients?

Chapter 32 - NEW MATERIAL

A
  • Development of HAND (HIV-associated neurological disorders)
  • Body image changes
  • Adverse medication reactions
79
Q

What are goals & interventions for patients with HIV / AIDs

Chapter 32 - NEW MATERIAL

A
  • Improve nutritional status
  • Decrease sense of isolation
  • Cope with grief
  • Improve knowledge of HIV / education
  • Monitor & manage potential complications
80
Q

Which of the following is a clinical syndrome that is characterized by a progressive decline in cognitive, behavioral, and motor functions as a direct result of HIV infection?

a.) Cryptococcal meningitis
b.) Neuropathy
c.) HIV encephalopathy (HAND)
d.) Professive multifactorial leukoencephalopathy

A

c.) HIV encephalopathy

  • HIV Associated Neurologic Disorders
81
Q

List different types of Chronic Pulmonary Disease

Chapter 20 - NEW MATERIAL

A
  • Chronic obstructive pulmonary disease (COPD)
  • Chronci Bronchitis
  • Emphysema
  • Bronchiectasis
  • Asthma
  • Cystic fibrosis
82
Q

Explain the pathophysiology of COPD

Chapter 20 - NEW MATERIAL

A
  • Chronic air trapping (reduced gas exchange) due to chronic inflammation in the lungs
  • CO2 is elevated (pt cannot fully exhale)
    * CO2 can’t leave & O2 can’t get in

COPD is IRREVERSIBLE

83
Q

What are the two main types of COPD?

Chapter 20 - NEW MATERIAL

A

Chronic Bronchitis & Emphysema

84
Q

Explain the pathophysiology of Chronic Bronchitis & Emphysema

Chapter 20 - NEW MATERIAL

A
  • Chronic Bronchtis: inflammed bronchi & excessive mucus production leading to chronic hacking cough & recurring infections
  • Emphysema: damaged alveoli due to loss of lung elasticity & loss of tissue recoil (air is trapped in lungs)
85
Q

What are different risk factors for COPD

Chapter 20 - NEW MATERIAL KNOW THESE!!!

A
  • Smoking (including second hand)
  • Older adults
  • Occupational exposure (dust, chemicals, etc.)
  • Pollution
  • Genetic abnormalities
86
Q

What is the pathophysiology fo emphysema? Explain the signs & symptoms of emphysema.

Chapter 20 - NEW MATERIAL

A

Pathophysiology: damaged alveoli caused by loss of lung elasticity & loss of tissue recoil
* air gets trapped in the lungs

Signs & Symptoms:
* Pursed lip breathing
* Increased chest (“barrel chest”)
* No chronic cough (minimal)
* Keep tripoding

Other Symptoms
* clubbing of the fingers
* hyperresonance (high air trapping)

S&S = PINK

87
Q

What is the pathophysiology of chronic bronchitis? Explain the signs & symptoms of chronic bronchitis

Chapter 20 - NEW MATERIAL

A

Pathophysiology: inflammed bronchi & excessive mucus production leads to chronic hacking cough & recurring infection

Signs & Symptoms
* Big & blue skin (cyanosis = hypoxia)
* Long-term “chronic” cough & sputum
* Unusual lugn sounds (crackles & wheezes)
* Edema (peripheral edema due to R-sided HF)

Other Symptoms
* R-sided HF
* JVD
* Weight gain
* Low pulse oxygen (88% - 93%)

S&S = BLUE

88
Q

List the main signs & symptoms of COPD

Chapter 20 - NEW MATERIAL

A

Chronic Cough
Sputum production
Dyspnea

  • weight loss due to emphysema
  • “barrel chest”
89
Q

What are potential complications of COPD?

Chapter 20 - NEW MATERIAL

A
  • Respiratory insufficiency
  • Respiratory failure
  • Pneumonia
  • Chronic atelectasis (total or partial collapsed lung)
  • Pneumothroax
  • Cor pulmonale (causes R-sided HF)
90
Q

What medications are used to treat COPD?

Chapter 20 - NEW MATERIAL

A
  • Bronchodilators / MDIs
    * Beta-adrenergic agonists (albulterol = smooth muscle relaxer)
    * Muscarinic antagonists (anticholinergics; reduce mucus production)
    * Combination agents
  • Corticosteroids (reduce inflammation; not for chronic use)
  • Antibiotics
  • Mucolytics (muxinex; reduces viscosity of sputum)
  • Antitussives (spuress cough)
91
Q

What is Bronchiectasis & what can cause it?

Chapter 20 - NEW MATERIAL

A

Bronchiectasis = chronic, irreversible dilation of bronchi & bronchioles

Causes:
* airway obstruction
* pulmonary infections (like TB)
* diffuse airway injury
* genetic disorders (like CF)
* abnormal host defenses
* idiopathic

92
Q

What is bronchiectasis?

Chapter 20 - NEW MATERIAL

A

Chronic, irreversible dilation of bronchi & bronchioles

93
Q

Explain the management & S&S of bronchiectasis

Chapter 20 - NEW MATERIAL

A

Signs & Symptoms:
* Chronic cough
* Purulent sputum
* Finger clubbing

Management:
* Postural drainage
* Smoking cessation
* Chest physiotherapy
* Antimicrobial therapy
* Bronchodilators
* Mucolytics (reduce sputum viscosity)

94
Q

What is asthma?

Chapter 20 - NEW MATERIAL

A

Chronic inflammatory disease of the airways that causes:

  • hyperresponsiveness
  • mucosal edema
  • mucus production
95
Q

What are signs & symptoms caused by asthma? What is the largest risk factor for asthma?

Chapter 20 - NEW MATERIAL

A

Signs & Symptoms:
* Cough
* Chest tightness
* Wheezing
* Dyspnea

Allergies are the biggest risk factor

Exacerbation S&S = diaphoresis, tachycardia, hypoxemia, cyanosis

96
Q

What medications are used to treat asthma?

Chapter 20 - NEW MATERIAL

A

Quick-Relief:
* beta-2 adrenergic agonists (albuterol)
* Anticholinergics

Long-Acting:
* Corticosteroids
* Long-acting beta-2 adrenergic agonists
* Leukotriene modifiers (montelukast)

97
Q

What is the pathophysiology of cystic fibrosis?

Chapter 20 - NEW MATERIAL

A

**Genetic mutation that changes the sodium & chloride transport leading to thick secretions **

  • build-up from secretions leads to recurring respiratory infection and damages alveoli (causes collapsed lung / pneumothorax)
98
Q

What are signs & symptoms of Cystic Fibrosis?

Chapter 20 - NEW MATERIAL

A
  • Respiratory Failure
    * low pulse ox
    * sudden drop in O2 saturation
  • Recurrent lung infections
  • Blood-tinged sputum
  • Weight loss
  • Loss of appetite
  • Constipation & steatorrhea (loose fatty stool)
99
Q

Which of the following should a patient do after using a metered dose inhaler (MDI) containing a corticosteroid?

a.) Wait at least 5 minutes before drinking any liquid
b.) Use a soft bristle toothbrush fro brushing teeth during the next 24 hours
c.) Rinse mouth with water immediately after use
d.) Monitor for hyperthermia which could be a sign of infection

A

c.) Rinse mouth with water immediately after use

reduces risk of candidiasis

100
Q

What is hypoxemia?

Chapter 20 - NEW MATERIAL

A

Decrease in partial pressure of oxygen in the blood

decrease in arterial oxygen tension

101
Q

What is hypoxia?

Chapter 20 - NEW MATERIAL

A

decrease in oxygen supply to the tissues & cells

102
Q

What is the difference in hypoxia & hypoxemia?

Chapter 20 - NEW MATERIAL

A

Hypoxia is a decrease in oxygen supply to tissues & cells while Hypoxemia is a decrease in the partial pressure of O2 in blood

103
Q

What is atherosclerosis?

Chapter 23 - NEW MATERIAL

A

Accumulation of lipids in arteries

104
Q

What are risk factors for atherosclerosis?

Chapter 23 - NEW MATERIAL

A
  • smoking
  • hypertension
  • hyperlipidemia
  • High LDL,
  • High total cholesterol
  • Low HDL
105
Q

What are risk factors for coronary artery disease?

Chapter 23 - NEW MATERIAL

A
  • Elevated LDL
  • Tobacco use
  • Hypertension
  • Diabetes
  • Metabolic syndrome
106
Q

What is the most common type of heart disease in the US & what causes it?

Chapter 23 - NEW MATERIAL

A

Coronary Artery Disease (CAD)

  • caused by buildup of plaque in the arteries
107
Q

Explain how coronary artery disease (CAD) can be prevented.

Chapter 23 - NEW MATERIAL

A
  • Control cholesterol
  • Dietary measures (reduce sodium & fat intake)
  • Physical activity
  • Medications
  • Smoking cessation
  • Management of hypertention & diabetes
108
Q

What are the signs & symptoms / clinical manifestations of atherosclerosis? What causes these symptoms?

Chapter 23 - NEW MATERIAL

A

Cause = ischemia

  • Angina
  • Epigastric pain (heartburn)
  • Pain with radiation to the jaw or left arm
  • Dyspnea
  • Myocardial infarction
  • Heart failure
109
Q

What is the first line medication to control cholesterol?

Chapter 23 - NEW MATERIAL

A

Statins

110
Q

The nurse is caring for a patient with hypercholesterolemia who has been prescribed atorvastatin (Lipitor). What serum levels should be monitored in this patient?

a.) Complete blood count (CBC)
b.) Blood cultures
c.) Sodium & Potassium levels
d.) Liver enzymes

A

D.) Liver enzymes

many meds are processed in & affect the liver

111
Q

How is angina pectoris treated?

Chapter 23 - NEW MATERIAL

A
  • Medications
  • Oxygen
  • Cardiac catheterization (reperfusion therapy)
112
Q

What medications are used to treat angina?

Chapter 23 - NEW MATERIAL

A
  • Nitroglycerin
  • Beta-blockers
  • Calcium channel blockers
  • Antiplatelet & anticoagulants
  • Aspirin
  • Clopidogrel (plavix)
  • Heparin
  • Glycoprotein IIb/IIIa agents
113
Q

The nurse is caring for a patient who has severe chest pain after working outside on a hot day and is brought to the emergency center. The nurse administers nitroglycerin to help alleviate the chest pain. Which side effect should concern the nurse the most?

a.) Dry mucous membranes
b.) Blood pressure of 86/58 mmHg
c.)Complaints of headache
d.) Heart rate of 88 bpm

A

B.) Blood pressure of 86/58 mmHg

no nitro for systolic < 90 mmHg

114
Q

What is acute coronary syndrome?

Chapter 23 - NEW MATERIAL

A

Reduced blood flow to the heart

115
Q

What is the protocol for an MI?

Chapter 23 - NEW MATERIAL

A
  • M - morphine (relax vessels & decrease anxiety)
  • O - oxygen
  • N - nitroglycerin
  • A - aspirin
116
Q

The nurse is caring for a patient after cardiac surgey. Which nursing intervention is appropriate to help prevent complications arising from venous stasis?

a.) Encourage crossing of legs
b.) Use pillows in the popliteal space to elevate the knees in the bed
c.) Discourage exercising
d.) Apply sequential pneumatic compression devices as prescribed

A

D.) Apply sequential pneumatic compression devices as prescribed

117
Q

What is a Coronary Artery Bypass Graft (CABG)?

Chapter 23 - NEW MATERIAL

A

blood vessel is gracted to an occluded coronary artery so that the blood can flow beyond the occlusion

118
Q

List different types of valvular disorders

Chapter 24 - NEW MATERIAL

A
  • Regurgitation
  • Stenosis
  • Valve prolapse
119
Q

What is Regurgitation?

Chapter 24 - NEW MATERIAL

A

valve does not close properly causing blood to backflow through the valve

120
Q

What is stenosis?

Chapter 24 - NEW MATERIAL

A

Narrowing

  • valve doesn’t open completely causing reduced blood flow through the valve
121
Q

What is a valve prolapse?

Chapter 24 - NEW MATERIAL

A

improper closing of the valve between the Left upper & lower chambers (L atrium & L ventricle) of the heart

122
Q

Nursing management of patients with valvular disorders

Chapter 24 - NEW MATERIAL

A
  • Patient education
  • Monitor trentds, heart & lung sounds, peripheral pulses
  • Monitor complications (HF, arrhythmias, dizziness, syncope, angina, etc.)
  • Plan and educate about medications
  • Monitor weight
123
Q

The nurse is providing education for a patient diagnosed with mitral valve prolapse (MVP). Which of the following should be included in the teaching plan? (select all that apply)

a.) MVP is not hereditary
b.) Caffeine is toelrated in small amounts
c.) Avoid alcohol
d.) Stop use of tobacco products
e.) Prophylactic antibitoics are not prescribed before dental procedures

A

C.) Avoid EtOH
D.) Stop use of tobacco products
E.) Prophylactic antibiotics are not prescribed before dental procedures

124
Q

What is cardiomyopathy? List the different types of cardiomyopathy

Chapter 24 - NEW MATERIAL

A

Disease of the heart muscle that makes it hard for the heart to pump blood properly
* impaired cardiac output

Types:
* Dilated cardiomyopathy (DMC) - most common
* Hypertrophic cardiomyopathy (HCM)
* Restrictive / constrictive cardiomyopathy (RCM)
* Arrhythmogenic R ventricular cardiomyopathy / dysplasia (ARVC/D)
* Unclassified cardiomyopathy

125
Q

Which types of cardiomyopathy can lead to congestive heart failure?

Chapter 24 - NEW MATERIAL

A
  • Dilated
  • Hypertrophic
  • Restrictive
126
Q

What is the main electrolyte involved in cardiomyopathy?

a.) Sodium
b.) Calcium
c.) Phosphorus
d.) Potassium

A

A.) Sodium

127
Q

What are potential problems / complications that can occur in patients with cardiomyopathy?

Chapter 24 - NEW MATERIAL

A
  • HF
  • Ventricular and/or atrial arrhythmias
  • Cardiac conduction defects
  • Pulmonary or cerebral embolism
  • Valvular dysfunciton
128
Q

What is Rheumatic Endocarditis?

Chapter 24 - NEW MATERIAL KNOW THIS

A

inflammation of the inner lining of the heart caused by acute rheumatic fever due to GROUP A BETA-HEMOLYTIC STREP

  • common in school-aged kids
  • Caused by Group A beta-hemolytic strep

Adult Nursing I (NUR 240) (6 decks)

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