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Pathophysiology > Final Exam Flashcards > Flashcards

Final Exam Flashcards

1
Q

What are the pain receptors?

A

Nociceptors

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2
Q

What are the four types of pain?

A

Acute, chronic, nociceptive, neuropathic

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3
Q

What are symptoms of acute pain?

A

Tachycardia, hypertension, anxiety, diaphoresis, muscle tension

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4
Q

Which nervous system response is activated in acute pain?

A

Sympathetic nervous system

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5
Q

How is chronic pain defined?

A

Pain lasting longer than 3 months

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6
Q

Symptoms of chronic pain?

A

depression and fatigue

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7
Q

Define nociceptive pain?

A

damage or inflammation of the skin

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8
Q

What are the two types of nociceptive pain?

A

Somatic and visceral

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9
Q

What are pain features of somatic pain?

A

Sharp, swelling, cramping, aching, gnawing, visible bleeding, localized

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10
Q

What are pain features of visceral pain?

A

Dull, deep, squeezing, pressure, aching, gnawing, visible bleeding, localized

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11
Q

Which type of pain can cause referred pain?

A

Visceral

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12
Q

What is neuropathic pain?

A

damaged pain nerves

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13
Q

How does neuropathic pain feel?

A

shooting pain or numbness and tingling

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14
Q

What is breakthrough pain?

A

exacerbation of already present pain

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15
Q

Three causes of breakthrough pain?

A

incident, idiopathic, end of dose medication failure

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16
Q

How does the gate control theory work?

A

When large nerves are stimulated there is enough room only for them to reach the brain, which closes the pain stimulus.

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17
Q

What are risk factors for pain?

A

age, gender, obesity, sedentary lifestyle, stress/anxiety, high risk activities, cultural beliefs

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18
Q

Which pain scale is used for children 6 months-5 years of age?

A

FLACC

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19
Q

Which pain scale is used for children?

A

FACES

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20
Q

Which pain scale is used for newborns?

A

CRIES

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21
Q

Risk factors of injury and poor healing?

A

osteoporosis, bone cancer, lack of vitamin D, calcium and phosphorous, aging, lifestyle choices

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22
Q

Ways to prevent injury and poor healing in fractures?

A

education, safe equipment, exercise, osteoporosis screening, safe living environment, fall prevention

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23
Q

What is the BROKEN acronym for symptoms of a fracture?

A

Bruising w/ pain and swelling, Reduced movement, Odd appearance, Krackling sound (crepitus), Edema and erythema, Neurovascular impairment

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24
Q

What is a complication of fractures?

A

Compartment syndrome

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25
Q

What is the treatment for compartment syndrome?

A

remove tight cast or fasciotomy

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26
Q

What are the 6 p’s of compartment syndrome?

A

pain, pallor, paresthesia, paralysis, pulselessness, poikilothermia

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27
Q

What are the 3 precursors for DVT?

A
  1. venous stasis
  2. injury to blood vessel walls
  3. altered blood coagulation
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28
Q

What are measures of prevention for dvt’s?

A

early immobilization
early ambulation
TEDs and sequential compression devices
anticoagulants

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29
Q

What are symptoms of a FES?

A

neurological dysfunction
Pulmonary insufficiency
petechial rash

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30
Q

what are risk factors for FES?

A

long bone fractures

major trauma

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31
Q

manifestations of FES?

A

dyspnea, hypoxemia, seizure, restlessness

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32
Q

What is the emergency severity index?

A

A process of assessing patients to determine management priorities

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33
Q

What is the nonurgent triage system?

A

Episodic or minor injury or illness in which treatment may be delayed for several hours without increased morbidity

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34
Q

What is the urgent triage system?

A

Serious illness or injury that is not immediately life threatening

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35
Q

What is the emergent triage system?

A

Potentially life threatening injuries or illnesses requiring immediate treatment

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36
Q

What is important to do in the primary survey while triaging patients?

A

ABCDE

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37
Q

What does ABCDE stand for?

A

Airway, breathing, circulation, disability, exposure

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38
Q

how do you assess disability during the ABCDE phase of the primary survey assessment?

A

AVPU, GCS;

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39
Q

How do you complete the exposure portion of the primary survey?

A

undress the patient

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40
Q

What is included in the secondary survey assessment?

A

Health history, HTT, reassessing the patient, arterial lines, catheters, splinting, wound care

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41
Q

What are priority emergency measures?

A

clear, establish and maintaining an airway

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42
Q

What are the different possible types of trauma?

A

Multiple, abdominal, crush injury, heat stroke, thoracic and burns

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43
Q

What is multiple trauma and an important consideration?

A

life threatening injury to 2 or more organ systems; c-spine precautions

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44
Q

What is important to know about abdominal trauma? how is it defined?

A

how the injury occurred and whether it was penetrating or nonpenetrating; blood loss in abdominal cavity

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45
Q

What are the two types of heat strokes?

A

exertional and non-exertional

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46
Q

manifestations of a non-exertional heat stroke?

A

102.5-105 degrees F; hot, dry, tachy, hypotensive

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47
Q

Who is at risk for a heat stroke?

A

those not used to heat, the old or young

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48
Q

How can you cool a patient that is having a heat stroke?

A

with cool sheets or towels, ice to the groin, cold water bath

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49
Q

Ice placement for a heat stroke?

A

Neck, armpits, groin

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50
Q

What are the four types of pneumothorax?

A

Spontaneous, Traumatic, Tension, Hemothorax

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51
Q

Features of a traumatic pneumothorax?

A

penetrating or nonpenetrating

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52
Q

Features of a tension pneumothorax?

A

fully collapsed lung; tracheal deviation, airway compromise

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53
Q

what is a hemothorax?

A

blood in the chest cavity

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54
Q

Which pneumothorax has hyperresonance on percussion?

A

pneumothorax

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55
Q

Which pneumothorax has dull percussion?

A

hemothorax

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56
Q

Diagnostic measures for pneumothorax?

A

ABG’s, chest xray

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57
Q

Additional diagnostic/treatment tool used for a hemothorax?

A

thoracentesis

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58
Q

considerations for nurses to follow regarding procedures/treatment for pneumothorax?

A 
Chest tube placement
O2 therapy
Max ventilation=high fowlers=90 degrees
sedatives
analgesics
emotional support
monitor chest tube drainage
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59
Q

What are complications of pneumothorax?

A

decreased cardiac output
respiratory failure
flail chest

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60
Q

How often should you reassess chemical burns

A

24, 72 hours and 7 days after

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61
Q

How is severity of chemical burns determined?

A

by the strength of the concentration and amount of skin exposed

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62
Q

Which chemicals should be brushed off the skin and not washed?

A

lye and white phosphorous

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63
Q

What can electrical burns lead to?

A

cardiac, respiratory arrest, limb amputation

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64
Q

What are things a nurse must do for thermal cold injuries?

A

Monitor ABC’s, remove wet clothing and provide support

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65
Q

What are active rewarming techniques?

A

cardiopulmonary bypass, warm fluid admin, warm humidified oxygen, warm peritoneal lavage

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66
Q

What are passive rewarming techniques?

A

warm blankets

over the bed heaters

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67
Q

What are potential complications when cold blood returns to the extremities?

A

Because there will be a high lactic acid, it can cause cardiac dysrhythmias and electrolyte disturbances

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68
Q

What are risk factors for thermal cold injuries?

A

old people, babies, homeless, trauma, alcohol

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69
Q

Manifestations of thermal cold injuries?

A

white or mottled skin

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70
Q

How should the rewarming process be controlled?

A

Rapid at 37-40 degrees C and in a circulating bath for 30-40 minutes

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71
Q

what should you NOT do for thermal injuries?

A

massage the area or let the patient walk if the injuries are on the feet

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72
Q

What are features of minor heat thermal injuries?

A

treated at scene, less than 2% full thickness, less than 10% partial thickness

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73
Q

What are features of moderate heat thermal injuries?

A

Treated at the scene and transported to a burn center; 2-10% total body surface of full thickness burns, 15-25% partial thickness burns

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74
Q

What are features of major heat thermal injuries?

A

Emergency treatment at closest facility and then transfer to a burn center; greater than 10% of body surface for full thickness, greater than 25% partial thickness burns OR are over age 60, have cardiac/pulmonary/endocrine comorbidities, electrical burns, inhalation injury, burns to eyes, nose, face, hands, feet or perineum

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75
Q

What do superficial burns look like?

A

pink, red, no blisters, mild edema, painful, sensitive to heat (ex. sunburn)
Damage to epidermis

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76
Q

What do superficial partial thickness burns look like?

A

pink, red, blisters, mild-moderate edema (Ex. scalds)
Heal within 2-3 wks
Damage to epidermis and part of dermis

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77
Q

What do full thickness burns look like?

A

red-white, blisters are RARE, moderate edema, eschar soft and dry, scarring likely, grafting may be needed (ex. flames)
Heals 2-6 wks
Epidermis and Dermis

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78
Q

What do deep full thickness burns look like?

A

no pain, no blisters, severe edema, hard eschar, scarring, grafting (ex. high voltage)
Extends down to nerve tissue/muscles/bones
Heals in wks to months

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79
Q

Rule of 9’s formula:

A 
Head/neck: 9%
Upper limbs: 9% each
Trunk: 36%
Genitalia: 1%
Lower limbs: 18% each
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80
Q

What are secondary complications of burn injuries?

A

pneumonia, PE or pneumothorax, hypotension, tachycardia, decreased cardiac output

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81
Q

What are the systemic complications of burns?

A 
hemodynamic instability because of volume loss and fluid shifts
Impaired respiratory function
Hypermetabolic response
Major organ dysfunction
Sepsis related to infection
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82
Q

What are signs of smoke and CO2 inhalation?

A

singed nasal

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83
Q

How long should a patient with airway compromise after smoke and CO2 inhalation be monitored?

A

24-48 hours because the body can still have a reaction

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84
Q

What are s/s of smoke and CO2 inhalation?

A

hoarseness, wheezing, brassy cough, drooling

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85
Q

What is the hypermetabolic response related to burn injuries?

A

increase of nutritional demands, increased heat production, increased glucose use, increased fat wasting

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86
Q

What is the peak time for a hypermetabolic response in burns?

A

7-17 days post injury

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87
Q

What may patients need that are having a hypermetabolic burn response?

A

enteral or parenteral nutrition

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88
Q

What can major organ dysfunction lead to?

A

renal failure

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89
Q

what is an autograft?

A

using own skin as a skin graft

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90
Q

What is a homograft?

A

skin from a cadaver

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91
Q

What is a heterograft?

A

skin from a different species

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92
Q

When can an escharotomy only be completed?

A

when there is fluid stabilization to limit fluid loss

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93
Q

Calculation for thermal or chemical burn resuscitation?

A

2mL LR x kg X percent total body surface area partial thickness or greater burn

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94
Q

Calculation for electrical burns?

A

4mL LR x kg x percent total body surface area partial thickness or greater burn

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95
Q

how much fluid volume should be administered in the first 8 hours of post burn injury (from the time of burn)

A

1/2 of the total volume

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96
Q

how much fluid volume is administered in the remaining 16 hours post burn injury?

A

the other 1/2 of total volume

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97
Q

What should an adult’s urine output be for fluid resuscitation?

A

0.5-1mL/kg/hr

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98
Q

What should a child’s urine output be for fluid resuscitation?

A

1ml/kg/hr

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99
Q

Important consideration for fluid resuscitation?

A

getting hourly I/O’s

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100
Q

What labs are important to grab for burn patients?

A

CBC, serum electrolytes, BUN, ABG’s, glucose levels, liver enzymes, urinalysis

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101
Q

What are physiologic responses to shock?

A

hypoperfusion of tissues, hypermetabolism, activation of the inflammatory response

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102
Q

What does the activation of the homeostatic response activate?

A

An increased sympathetic response: increased HR, BP, cardiac contractility and output; decreased respiratory rate to increase O2 saturation; increase in catecholamines and cortisol to provide glucose; RAAS activation to reabsorb sodium and water, increased preload and decreased urine output

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103
Q

why are catecholamines and cortisol increased during shock?

A

to increase glucose metabolism

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104
Q

What is the goal of the physiologic responses of shock?

A

restore tissue perfusion and oxygenation

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105
Q

Why is the RAAS system activated in physiologic response to shock?

A

to provide reabsorption of sodium and water, increase the preload and decrease afterload

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106
Q

What are the cellular effects of shock?

A

cell swells, membrane becomes permeable; fluid and electrolytes seep from and into cell

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107
Q

MAP required to maintain adequate tissue perfusion?

A

65 minimum

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108
Q

What is the MEWS (Modified Early Warning System)?

A

A scoring system used to determine severity of illness a person has. The higher the score the worse condition the patient is in. This determines length of ICU state and likelihood of death. Scores are given on a 0-3 scale for each tested area.

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109
Q

What is tested on a MEWS?

A

RR, HR, BP, AVPU, Temp, Hourly urine

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110
Q

What type of fluids should be used for fluid replacement of shock patients?

A

Crystalloid and colloid solutions

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111
Q

What are important management considerations for shock patients?

A

Fluid replacement, nutrition support, intravascular support

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112
Q

What is the crystalloid you use for fluid replacement of shock patients?

A

0.9% Sodium chloride and Lactated Ringers

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113
Q

What is the expensive colloid requiring human donors that is used for fluid replacement of shock patients? What can it cause?

A

Albumin; heart failure

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114
Q

How should vasoactive medications be given to patients and how often should you check vital signs and why?

A

central line if possible; every 15 minutes because vasoactive medications cause an increased HR

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115
Q

What effects do vasoactive medications have? When are they given?

A

support hemodynamic status, stimulate SNS; when fluid replacement is not working

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116
Q

What drug classes are vasoactive agents?

A

Inotropic & vasopressor agents, vasodilators

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117
Q

Why is nutrition therapy important for shock patients?

A

It prevents further catabolism

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118
Q

What does glutamine do for shock patients?

A

help increase protein stores

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119
Q

What do vasodilators do?

A

reduce preload and afterload, reduce O2 demand of heart

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120
Q

What do vasopressors do?

A

Increase BP by vasoconstriction

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121
Q

What do vasopressors do?

A

Increase BP by vasoconstriction

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122
Q

Why do you give H2 receptors to shock patients?

A

to reduce ulcer formation

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123
Q

What are the stages of shock?

A

compensatory, progressive and irreversible

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124
Q

How soon should treatment be initiated for shock patients?

A

within 3 hours

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125
Q

What happens during the compensatory stage of shock?

A

SNS activates and catecholamines release, normal BP and increased HR, increase in contractility and vasoconstriction to maintain output, blood is shunted to important organs, anaerobic metabolism occurs which increases RR resulting in respiratory alkalosis

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126
Q

vital signs during compensatory stage?

A

normal BP, HR >100 bpm, RR >20 breaths/min, CO2 <32, clammy skin, decreased urine output, confusion, respiratory alkalosis

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127
Q

what is the acid base balance for compensatory shock?

A

respiratory alkalosis because of elevated respiration rate

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128
Q

What is the acid base balance for progressive shock?

A

metabolic acidosis because RR are decreased and body cannot get rid of excess CO2

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129
Q

Acid base balance of irreversible shock?

A

Profound acidosis

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130
Q

vital signs during progressive shock?

A

systolic <90, MAP <65, requires fluid resuscitation to support BP, HR >150 bpm, Rapid shallow respirations, paO2 <80, PaCO2 >45, mottled skin, urine output <0.5 ml/kg/h, lethargic, respiratory acidosis

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131
Q

vital signs during irreversible shock?

A

mechanical or pharmacologic support; erratic HR, requires intubation, jaundice, anuria–requires dialysis, unconscious, profound acidosis

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132
Q

What are the classifications of shock?

A

Cardiogenic, hypovolemic, obstructive, distributive

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133
Q

What are the three types of distributive shock?

A

septic, neurogenic, anaphylactic

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134
Q

What are things that can cause cardiogenic shock?

A

Acute Coronary Syndrome/ischemia, Myocarditis, Congenital Heart Disease, Toxins, Sepsis

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135
Q

What are things that can cause hypovolemic shock?

A

hemorrhage, dehydration

136
Q

What are things that can cause obstructive shock?

A

pulmonary embolism, tension pneumo, cardiac tamponade

137
Q

Which type of shock causes the heart rate to decrease?

A

neurogenic shock

138
Q

What are causes of external fluid losses in hypovolemic shock?

A

trauma, surgery, vomiting, diarrhea, diuresis, diabetes insipidus

139
Q

What are causes of internal fluid shifts with hypovolemic shock?

A

hemorrhage, burns, ascites, peritonitis, dehydration, necrotizing pancreatitis

140
Q

goal of treating hypovolemic shock?

A

treating fluid loss and underlying causes

141
Q

Nursing management of hypovolemic shock?

A

administering blood, fluids safely; implementing other measures

142
Q

Medical management of cardiogenic shock? what is the primary goal?

A

correcting underlying causes, initiation of first line treatment; primary goal is to treat the oxygenation needs of the heart muscle to help improve a shock state

143
Q

What are first line treatments for cardiogenic shock?

A

oxygenation, pain control, hemodynamic monitoring, lab marker monitoring, fluid therapy, mechanical assist devices

144
Q

Pharmacologic therapy for cardiogenic shock?

A

dobutamine, nitroglycerine, dopamine, vasoactive and antiarrhythmic medications

145
Q

How does circulatory/distributive shock take place?

A

the blood vessels dilate and blood cannot return to the heart properly. the three types are septic, neurogenic and anaphylactic shock

146
Q

What type of fluid replacements are required for circulatory/distributive shock?

A

0.9% NS, lactated ringers, hypertonic solutions (3% hypertonic)

147
Q

What should the nurse monitor for when patients are receiving large volumes of isotonic fluids?

A

pulmonary edema because of circulatory overload

148
Q

Treatment for multiple organ dysfunction syndrome?

A

controlling initiating event, promoting adequate organ perfusion, providing nutritional support

149
Q

What can multiple organ dysfunction syndrome lead to?

A

DIC (disseminated intravascular coagulation)

150
Q

What are the cardinal movements of birth?

A

descent,

151
Q

What does the mnemonic COLLAPSED stand for for pneumothorax?

A 
Chest pain
Overt tachycardia and tachypnea
Low BP
Low SpO2
Absent lung sounds on affected side
Pushing of trachea to unaffected side
Subcutaneous emphysema, Sucking sound with open pneumo
Expansion of chest rise and fall unequal
Dyspnea
152
Q

What is a coping mechanism?

A

how stress and anxiety is handled; positive: relaxing negative: drinking, smoking

153
Q

difference between defense and coping mechanisms?

Defense mechanisms: compensation, denial, displacement, dissociation, projection, rationalization, regression

A

defense mechanisms protect ourselves and we are not always aware of them
coping mechanisms are for events

154
Q

what is compensation?

A

being bad in one area and focusing on your good area

155
Q

What is denial?

A

subconsciously do not accept the reality; talking about hope when it is not possible

156
Q

What is displacement?

A

redirection of angry or aggressive feelings onto something that is powerless

157
Q

What is dissociation?

A

repression; subconsciously suppressing some painful or traumatic memories

158
Q

What is projection?

A

unwanted thoughts or impulses projected onto someone else

159
Q

What is rationalization?

A

distort the facts to justify something that is unacceptable

160
Q

What is regression?

A

returning to an earlier method of behaving

161
Q

What should a nurse say to a patient who is escalating?

SATA

A

validate the patient’s feelings (be empathetic), remain calm ourselves, speak in slow, soft voice, get them to verbalize the issue

162
Q

How does delirium differ from dementia?

A

Acute onset, has an underlying cause that can be solved

163
Q

Symptoms of delirium?

A

Confusion, irritation, sleep wake disturbances, disorganized thoughts, hallucinations/delusions

164
Q

What is schizophrenia?

A

disorder that affects a persons overall thoughts, feelings and behavior

165
Q

What causes schizophrenia?

A

high levels of dopamine causes positive symptoms; high levels of serotonin cause negative symptoms

166
Q

What are the positive symptoms of schizophrenia?

A

delusions, hallucinations, disorganized thoughts, speech, behavior

167
Q

What are the negative symptoms of schizophrenia?

A

flat affect, anhedonia, apathy, alogia (lack of speech), avolition (lacks motivation), asociality (ALL START WITH A’s PLUS FLAT AFFECT)

168
Q

types of hallucinations?

A

visual, auditory and tactile

169
Q

what are delusions?

A

belief in something that is not real; ex. paranoid delusions or delusions of grandiose

170
Q

difference between hallucinations and delusions?

A

hallucinations are done by senses

delusions are beliefs

171
Q

what is alogia?

A

poverty of speech; a negative symptom of schizophrenia

172
Q

what drug class is used to treat schizophrenia?

A

antipsychotics

173
Q

How do you treat a patient experiencing delusions or hallucinations?

A

Acknowledge the patient hears them, “that must be very scary to hear those voices, what are they telling you to do?” assess safety

174
Q

who is at risk for suicide?

A

adolescents, older white males, mental illness, LGBTQIA, employment

175
Q

risk factors for suicide?

A

unemployment, chronic illness, depression, financial troubles, low socioeconomic status, substance abuse, family history and PREVIOUS ATTEMPTS (highest risk)

176
Q

what is the highest risk factor for suicide?

A

previous attempts

177
Q

how to assess a suicidal patient?

A

ask are you thinking of harming yourself? then if they have a plan in place, which method they would use,

178
Q

symptoms of a suicidal patient?

A

high energy level, giving things away, planning finances, saying things like “i don’t want to live anymore, i’m tired of this”, writing notes, searching for weapons, hoarding pills

179
Q

when does a person begin experiencing alcohol withdrawal?

A

4-12 hrs after their last drink

180
Q

symptoms of alcohol withdrawal?

A

tremors, diaphoresis, agitation, tachycardia, elevated BP, restlessness

181
Q

how do you know when to initiate benzodiazepines for alcohol withdrawal?

A

MINDS protocol

182
Q

treatment for alcohol withdrawal?

A

seizure precautions, benzos, emotional support, calm low stress environment, dim lights, do not close doors

183
Q

nursing care for patients who have experienced sexual assault?

A

provide emotional support, give patient control over situation, ask if there is anyone they want with them and what order they want you to do things, SANE nurse

184
Q

What is included in a rape kit?

A

vaginal swab, swab of skin, mouth, anus, nails, pictures of wounds and abrasions, medications, collect clothes, combing pubic hair

185
Q

What is the order for caring for a sexual assault patient?

A

prophylactic meds
offer sti testing
physical exam
have pt describe what happened, provide emotional support

186
Q

what symptoms may a person experience after sexual assault?

A

rape trauma syndrome (like PTSD)

denial, anger, fear

187
Q

what is pyelonephritis?

A

Upper UTI located WITHIN the kidney

188
Q

important considerations as a nurse for pyelonephritis?

A

it is caused by bacteria crawling up ureters

signs and symptoms

189
Q

signs and symptoms of pyelonephritis? SATA

A

costovertebral flank pain, chills, high fever, UTI symptoms, N/V, pyuria, abd pain

190
Q

diagnostics of pyelonephritis?

A

UA, WBC’s (CBC), urine cultures

191
Q

treatment for pyelonephritis?

A

antibiotics; URINE CULTURE before abx

192
Q

education for pyelonephritis prevention?

A

hydration, do not retain urine, void after sex, wipe front to back, finish abx course, no feminine hygiene sprays or douches

193
Q

what is AKI?

A

injury to the kidney that can be reversed if caught on time

194
Q

symptoms of AKI?

A

inability to concentrate urine, increased BUN and Creatinine (because these are metabolic waste), low GFR, buildup of nitrogenous waste, azotemia, uremia

195
Q

What is azotemia?

A

increased BUN, decreased GFR

196
Q

what does prerenal AKI mean?

A

AKI before reaching the kidney due to hypoperfusion

197
Q

What does intrarenal AKI mean? what causes it?

A

AKI inside the kidney due to

198
Q

What does postrenal AKI mean?

A

AKI after the kidneys stones, BPH

199
Q

four phases of AKI?

A

onset, oliguria, diuretic, recovery

200
Q

What happens during onset phase of AKI?

A

decreased urine output, asymptomatic

201
Q

What happens during oliguric phase of AKI?

A

decreased urine output, edema, fluid retention, electrolyte imbalances, confusion, uremia, high BP, increased BUN/Creat, decreased GFR, high potassium, anemia, dry, itchy skin

202
Q

What happens during diuretic phase of AKI?

A

urine output increases, GFR increases, other labs do not change yet

203
Q

What happens during recovery phase of AKI?

A

GFR 70-80%, recovery

204
Q

What acid base imbalance would be created from AKI?

A

metabolic acidosis

205
Q

How do you treat AKI?

A

Fix underlying causes

206
Q

What is renal calculi?

A

kidney stones

207
Q

Symptoms of kidney stones?

A

renal colic (intermittent pain), flank pain, blood in urine

208
Q

Diagnostics for kidney stones?

A

Xray, urinalysis

209
Q

Treatment for kidney stones?

A

Increase fluids, pain medications, strain all urine, extracorporeal lithotripsy, laparoscopy

210
Q

If a patient has hypercalcemia what will you instruct them to do?

A

stop intake of calcium

211
Q

what is the primary cause of pneumonia?

A

inflammation reaction to infection in the lungs

212
Q

Where will the infection be in the body in pneumonia?

A

exudate In the alveolar sacs

213
Q

What is alveoli responsible for?

A

gas exchange

214
Q

What happens to air in the affected alveoli in pneumonia?

A

the body is not getting oxygen to the rest of the body; gas exchange with the end result of hypoxemia takes place

215
Q

risk factors for pneumonia?

A

recent surgery, elderly, immobility, immunosuppression, chronic conditions

216
Q

risk factors for aspiration pneumonia?

A

stroke patients, feeding tubes, dysphagia, alcoholics, trach’d patients

217
Q

how should patients be positioned that have feeding tubes?

A

sitting up during and after eating

218
Q

what is community acquired pneumonia?

A

gotten in the community

219
Q

What is hospital acquired pneumonia?

A

pneumonia occurs 48 hrs after hospitalization

220
Q

manifestations of pneumonia?

A

crackles, pain upon inspiration, pleuritic pain, sharp pain in area of affected lung, referred shoulder pain, splinting (pressure to try and relieve pain), shallow breathing, fever, egophony, signs of consolidation, sputum production–rusty, blood tinged or purulent, cough, chills, cyanosis

221
Q

diagnostic measures for pneumonia?

A

sputum culture, chest xray, ABG’s

222
Q

prevention of pneumonia?

A

early ambulation, vaccination for high risk, incentive spirometer, coughing, deep breathing

223
Q

what is RSV?

A

respiratory synctovial virus

224
Q

What can RSV cause?

A

bronchiolitis

225
Q

Age group most common to obtain RSV?

A

infants

226
Q

How do you diagnose RSV?

A

nasal swabs

227
Q

s/s of RSV?

A

nasal flaring, use of accessory muscles, decreased appetite, fever, grunting, crying, wheezing, retractions

228
Q

treatment of RSV?

A

oxygen when sats drop below 90% consistently, suctioning, corticosteroids,

229
Q

do we give antibiotics for RSV?

A

no because it is a virus

230
Q

how is RSV spread?

A

droplet

231
Q

prevention of RSV?

A

hand washing, vaccine only if high risk children under 2, position semi-fowler to fowler

232
Q

what is ARDS?

A

acute respiratory distress syndrome that is classified by fluid on lungs; the difference between ARDS and pneumonia is ARDS is diffuse, pneumonia is localized.

233
Q

patho of ARDS?

A

refractory hypoxemia preventing gas exchange in alveoli/ vq mismatching; intrapulmonary shunting of blood, stiff lung/not inflating, increased capillary permeability b/c of damage from fluid buildup

234
Q

manifestations of ARDS?

A

cyanosis, crackles, increased HR, RR

235
Q

how is ARDS diagnosed?

A

chest xray, abg’s

236
Q

nursing management of ARDS?

A

low stimuli, decrease oxygen consumption, provide tpn/fluids, prone position, suctioning, chest physiotherapy

237
Q

what does PEEP do?

A

keeps alveoli from collapsing; stands for positive end expiratory pressure

238
Q

how do you assess if chest percussion and physiotherapy is needed or effective?

A

listen to lung sounds

239
Q

what care should be given to patients who are on a vent?

A

pain medications or sedatives because paralytics do not decrease pain; frequent mouth care (chlorhexidine), positioning (prone or semi to high fowlers)

240
Q

what is cholelithiasis?

A

gallstones caused by cholesterol in the gallbladder

241
Q

negative consequences of cholelithiasis

A

obstruction of the bile duct which causes jaundice and increased bilirubin, pain, inability to digest food, steatorrhea (white or clay poop), dark TEA COLORED urine, itchy skin

242
Q

diagnosis of cholelithiasis?

A

CT scan, ultrasound, ERCP

243
Q

What is an ERCP?

A

dye is injected and visualized through a scope and xray to assess for gallstones and blockage of the bile duct

244
Q

s/s of cholelithiasis?

A

epigastric pain after high fat meals, pain radiating to shoulder

245
Q

what is peritonitis?

A

buildup of fluid in the peritoneal cavity

246
Q

s/s of peritonitis?

A

board like abdomen, shiny belly, pain, no bowel sounds, peristalsis leading to paralytic ileus

247
Q

what do we worry most about after a liver transplant?

A

infection

248
Q

what is pancreatitis?

A

inflammation of the pancreas

249
Q

s/s of pancreatitis?

A

extreme epigastric or periumbilical pain, pain radiates to back, n/v, guarding, tenderness, distention; can cause ARDS

250
Q

what causes pancreatitis?

A

digestive enzymes are eating the pancreas

251
Q

how do patients posture when they have pancreatitis?

A

knees to chest or sitting up

252
Q

does n/v relieve pain of pancreatitis?

A

no.

253
Q

what occurs in the body with pancreatitis?

A

decreased BP and increased HR, hyperglycemia, tachypnea

254
Q

what electrolyte imbalances occur with pancreatitis?

A

hypocalcemia, hyperglycemia,

255
Q

what is grey turner’s sign?

A

flank bruising

256
Q

what is cullen sign?

A

belly button bruising

257
Q

Labs drawn for pancreatitis?

A

Lipase, amylase (3x the upper normal limit)

258
Q

what is HHS?

A

hyperglycemic hyperosmolality syndrome occurring from uncontrolled type II diabetes

259
Q

risk factor for controlled type II diabetes and HHS?

A

being ill

260
Q

s/s of HHS?

A

dehydration, 600+ BS, fluid excretion with glucose and water

261
Q

difference between DKA and HHS?

A

DKA has ketones, HHS has large fluid loss and dehydration

262
Q

tx for HHS?

A

fluid & electrolyte replacements, IV regular insulin

263
Q

What is experienced more by patients with HHS versus DKA?

A

neuro manifestations because of cerebral dehydration

264
Q

What disorders are included under ACS?

A

Unstable Angina
NSTEMI
STEMI

265
Q

What is the pathophysiology of acute coronary syndrome?

A

Unstable plaque from atherosclerosis ruptures and causes thrombus which occludes vessel and leads to inflammation and ischemia and necrosis

266
Q

Why does nitro relieve pain in unstable angina?

A

The vessel is not totally occluded

267
Q

Diagnosis criteria for unstable angina?

A

pain not relieved by nitro, no EKG changes, no biomarkers

268
Q

Diagnosis criteria for NSTEMI:

A

pain relieved by nitro, no EKG changes, elevated biomarkers

269
Q

Diagnosis criteria for STEMI:

A

elevated biomarkers, ST elevation, symptomatic

270
Q

What are the labs used to test for ACS?

A

Troponin I and T, CKMB, myoglobin

271
Q

What are risk factors for ACS?

A

smoking, HTN, obesity, high cholesterol, lack of exercise, family hx, diabetes

272
Q

What are types of reperfusion therapy?

A

PCI, CABG, thrombolytics (AKA fibrinolytics)

273
Q

Why do you give a patient post MI a clear liquid diet?

A

To reduce the metabolic workload of digestion.

274
Q

What happens in the heart with an anterior wall MI?

A

T wave inversion, elevated ST segment, abnormal QRS waves

275
Q

What is BNP and why do we draw it?

A

A lab used to check for heart failure

276
Q

Which age group is most at risk for heart failure?

A

75+

277
Q

Which age group is most at risk for heart failure?

A

75+

278
Q

How many body systems are involved in shock?

A

All of them

279
Q

What are the body’s physiologic responses to shock?

A

Hypoperfusion of tissues, hypermetabolism, activation of inflammatory response

280
Q

What is the primary source needed for cells to produce ATP?

A

glucose

281
Q

What is the end product of anaerobic metabolism?

A

lactic acid

282
Q

How is the clotting cascade activated?

A

By the inflammatory process

283
Q

What happens when catecholamines release?

A

The adrenal medulla releases catecholamines (epi and norepi) to restore BP, increase HR and cause vasoconstriction
The kidneys secrete renin to activate the RAAS system to respond to hypoperfusion
The END RESULT converts angiotensin I to angiotensin II (vasoconstrictor) and aldosterone (promotes Na and water retention)
hypernatremia by aldosterone stimulates secretion of ADH which conserves water to increase BP and volume

284
Q

What is the most significant event in the compensatory stage of shock?

A

Symptoms of fight or flight are activated
HR >100
RR>20 breaths/min
PaCO2 <32

285
Q

What is the most significant event in the progressive stage of shock?

A

Compensation has failed, lactic acid buildup is most significant

286
Q

What is the most significant event in the irreversible Refractory stage?

A

BP and MAP remain low despite fluid resuscitation

287
Q

What is urine output in the progressive stage?

A

<0.5mL/kg/hr

288
Q

What are signs compensation has failed in the progressive stage?

A 
HR >150
RR rapid, shallow, crackles
PaCO2 >45, PaO2 <80
Metabolic acidosis
Skin mottled, petechiae
0.5mL/kg/hr
Declining mental status/lethargy
289
Q

S/S of irreversible refractory stage of shock?

A 
HR erratic
Requires intubation and mechanical vent
Profound acidosis
Skin jaundiced
Anuric urine output (need dialysis)
Unconscious
290
Q

What are s/s of neurogenic shock?

A

vasodilation, bradycardia, skin warm/dry

291
Q

Which types of shock have vasodilation?

A

Distributive shock: anaphylactic, septic, neurogenic

292
Q

Which immunoglobulin is responsible for anaphylactic shock?

A

IgE

293
Q

What are s/s of anaphylactic shock?

A

tachycardia, wheezing, stridor, other shock symptoms

294
Q

How is anaphylactic shock caused (patho wise)?

A

IgE promotes mast cells to release potent vasodilators (histamine, bradykinin) which causes widespread vasodilation and capillary permeability

295
Q

How is septic shock caused (patho wise)?

A

SIRS causes vasodilation and capillary instability

Coagulation cascade activated by inflammatory mediators

296
Q

How is neurogenic shock caused (patho wise)?

A

SNS loses ability to stimulate nerve impulses and control vasculature space
Results in vasodilation and loss of vessel tone

297
Q

Which type of shock are newborns most susceptible to?

A

Septic shock

298
Q

What are the risks of septic shock for newborns?

A

preterm labor

prolonged rupture of membranes

299
Q

How are newborns different when it comes to shock?

A

they do not have an immune system to protect themselves so they will go through shock stages quickly.

300
Q

What are the risks for neurogenic shock?

A

spinal cord injury, spinal anesthesia, hypoglycemia

301
Q

Which nervous system is stimulated in neurogenic shock?

A

PNS

302
Q

Which type of shock requires antibiotics?

A

Septic shock; CULTURE FIRST then abx

303
Q

What should the nurse monitor for while caring for shock patients?

A

fluid overload; monitor heart and lungs

304
Q

What are different forms of fluid replacement for shock patients?

A

Crystalloids, colloids, blood components

305
Q

Three types of vasoactive meds to maintain MAP above 65?

A

inotropics, vasodilators, vasopressors

306
Q

Which form of nutritional support is most supportive of shock patients?

A

enteral or TPN to maintain more than 3000 calories/day

307
Q

Nursing interventions for shock?

A

Abx, fluid replacement, vasoactive meds, maintain body temperature, nutritional support

308
Q

What is MODS?

A

A life threatening complication of shock (irreversible stage) that disrupts hoemostasis and affects the kidneys, heart, liver, brain and lungs

309
Q

What are risks for MODS?

A

Trauma, liver dysfunction, prolonged hypotension, infarcted bowel, advanced age, alcohol use disorder

310
Q

What is nursing management for MODS?

A

supportive therapy for affected organs

311
Q

What are symptoms of pre-eclampsia?

A

proteinuria, n/v, elevated BP, reduction in blood flow to brain, liver, kidneys, placenta and lungs, epigastric pain, elevated liver enzymes, headaches, vision changes, blurred vision, hyperactive DTR

312
Q

What are characteristics that can predispose a newborn to heat loss?

A

Thin skin, lack of shivering ability, limited voluntary muscle use, large body surface area, lack of subcutaneous fat

313
Q

What are the four mechanisms infants can lose heat through?

A

Conduction, convection, evaporation, radiation

314
Q

How do neonates behave at birth?

A

Incomplete vision, close-proximity focus, acute hearing, smell and taste

315
Q

How does a newborn behave in the first period of reactivity (birth to 30 minutes to 2 hours after birth)

A

alert, moving, may be hungry

316
Q

How does a newborn behave within 30 to 120 minutes after birth?

A

decreased responsiveness; period of sleep or decreased activity

317
Q

How does a newborn behave in the second period of reactivity (2 to 8 hours after birth)?

A

awakens and shows interest in stimuli

318
Q

Which infants are at risk for hypoglycemia?

A

SGA, LGA, post-term, pre-term, late-preterm infants

319
Q

What are the s/s of hypoglycemia in an infant?

A

lethargy, tachycardia, respiratory distress, jitteriness, drowsiness, poor feeding, hypothermia, diaphoresis, weak cry, hypotonia, seizures, BG less than 40 for infants, less than 20 for preterm infants

320
Q

What is a complete spinal cord injury?

A

No function below the level of injury

321
Q

What is anterior cord syndrome?

A

The front part of the spinal cord is damaged. No feeling below level of injury but sense of position, vibration and sense of light/deep is intact

322
Q

What is central cord syndrome?

A

The middle part of the spinal cord is damaged causing LOSS OF MOVEMENT AND SENSATIONS IN THE ARMS.

323
Q

What is Brown Sequard syndrome?

A

HALF of the spinal cord is damaged, causing one side of the body to be stronger than the other

324
Q

s/s of autonomic dysreflexia?

A 
severe hypertension
throbbing headache
bradycardia
facial flushing
nasal congestion
piloerection, diaphoresis
325
Q

What spinal cord injury area can cause autonomic dysreflexia?

A

T6 and above

326
Q

Causes of autonomic dysreflexia?

A

Full or distended bladder, constipation, tight clothing

327
Q

Why does autonomic dysreflexia occur?

A

Vasodilation occurs above injury site and vasoconstriction occurs below injury site as SNS and PNS dysregulate

328
Q

Ways to treat autonomic dysreflexia?

A

Bladder assessment, bowel assessment, remove constrictive clothing, give BP meds after assessment

329
Q

Potential complications of having a large baby?

A

over 90th %ile or over 4,000 g; birth trauma, hypoglycemia, polycythemia, hyperbilirubinemia

330
Q

Risk factors for placental previa?

A

maternal age over 35, previous c-section, multiparity, HTN, diabetes, smoking, multiple children, previous surgical abortions, cocaine use, short interval pregnancy

331
Q

What do the cardiac receptor cites control?

A

Alpha, beta, and dopaminergic

332
Q

What is the function of Alpha 1?

A

Causes peripheral vasoconstriction on vascular smooth muscle to increase blood pressure

333
Q

What is the function of Beta 1?

A

Increased heart rate and contractility

334
Q

What is Beta 2?

A

Dilates bronchial smooth muscle

335
Q

What is a dopaminergic receptor?

A

Causes arteries to dilate

336
Q

What is ventricular depolarization and normal QRS?

A

contraction; normal .06 to .10

Pathophysiology (3 decks)

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