FINAL EXAM PREP Flashcards
This is characterized by progressive partially reversible airway obstruction with lung hyperinflation.
Chronic Obstructive Pulmonary Disease (COPD)
Differentiate between Chronic Bronchitis and Emphysema.
Chronic Bronchitis - Chronic inflammation of LOWER respiratory tract with excessive secretions, cough and dyspnea
Emphysema - Destruction of Alveoli with the enlargement of the distal airways and the breakdown of alveolar walls (Alveoli get wrecked).
Franz has late COPD. Which of the following clinical manifestations would you expect to see? A/ Death due to infection B/ Fatigue, SOB C/ Sputum production D/ Progressive dyspnea and infections
A/ Death is the most common CM of COPD in the late stages. typically the result of an infection.
Willem has Middle-stage COPD. Which of the following clinical manifestations would you expect to see? A/ Cough/sputum production B/ Progressive dyspnea with infections C/ Chronic respiratory failure D/ Dyspnea, chronic fatigue
B/
Yuri has been diagnosed with ____, because his use of accessory muscles to breathe, pursed lip-breathing, Ø cyanosis, and a distinct Barrel chest.
Emphysema
“Pink Puffer” = Ø cyanosis
How does spirometry test for COPD?
By measuring the amount of air the person can forcefully expire.
*If their Forced exp. volume capacity to forced vital capacity ratio is less than 0.7… they have COPD. (This means they are retaining air.)
How could a nurse improve ventilation in a patient with COPD? list all interventions with brief explanations of each (4)
Diaphragmatic breathing (Abdominal breathing): Focus on using the diaphragm to breathe instead of accessory muscles to achieve max inhalation - use with pursed-lip breathing
Pursed-lip breathing:
Helps prolong exhalation, prevents bronchial collapse and air trapping.
Coughing:
to help remove sputum
Postural drainage:
Helps loosen thick secretions
What are some preventative measures that can be used to delay the progression of COPD? (6)
- Smoking cessation
- PRN short acting-bronchodilators (Salbutamol/ventolin)
- Long-acting bronchodilators (Spiriva)
- Inhaled Corticosteroids (Flovent, Asmanex).
- Oxygen
- Surgery (Last resort)
For a patient with COPD, what arterial pressure of O2 do you want to attain? A/ 50-55 mmhg B/ 45-50 mmhg C/ 55-65 mmhg D/ 50-60 mmhg
C/ 55-65 mmhg is ideal for maintaining a SaO2 of 90%
What can you do to decrease dyspnea and pulmonary hypertension, increase activity tolerance and improve neuropsychological functioning in patients with COPD?
Supply Oxygen therapy
What is the fear of using Oxygen therapy to patients with COPD?
Decreasing their hypoxic drive.
If patient is given O2 to increase PaO2 to greater than 60 mmhg, they actually can decrease their drive to breathe because their body has a tolerance of chronically high CO2 levels -> decreasing the body’s response to breathe deep to release the CO2
Henrik is at the end stage of COPD and requires constant O2. What should we monitor?
Monitor for O2 toxicity: Nausea/emesis Substernal pain Sore throat Malaise
Ensure the Pt.’s PaO2 is above 60 mmhg
Which of the following is a result of hypoxemia? A/ Bradycardia B/ Peripheral Vasoconstriction C/ Hypotension D/ Emesis
B/ Peripheral Vasoconstriction
Wilfred has come into the ER with the Following vitals.
HR: 118 Respirations: 12 Temp: 36.8 SaO2: 76% B/P: 143/98
He is restless and agitated and demonstrating signs of delirium. He is profusely sweating. What should you do?
Apply Oxygen!!!!
obtain ABG and VBG and correct the cause of hypoxemia.
What is Cor pulmonae? How is is associated with COPD? Signs and symptoms?
Hypertrophy of the right side of the heart. Caused by pulmonary hypertension due to exacerbated COPD.
S/S: Dilation of RV, JVD, enlarged liver, Ascites, peripheral edema
How is Cor Pulmonae Treated?
Low flow O2 and Diuretices
Dimitri comes into the Er with the following:
HR: 114 B/P: 137/96 Temp: 39.4 Resp: 23 SaO2: 89
He woke in the night with a sudden onset of Fever and chills and a productive cough with purulent sputum. Upon inspection you notice increased fremitus and crackles. What is his problem and what do you do?
Pneumonia (unspecified).
Chest X-ray to confirm, gram stain of sputum, check CBCs, Blood chem/cultures, etc.
Testing is important to determine what has caused it and how to treat. (I.E. antibiotics).
What are benzodiazepines and barbiturates used for?
Sedative and amnestic agents used in surgery.
Why are anticholinergics used during surgery?
To reduce bodily secretions.
What are common causes of Post-op airway compromise?
Obstruction: Due to tongue or secretions and drowsiness.
Hypoxemia: Decreased amount of O2 in the blood
Hypoventilation: Decreased respirations due to decreased drive (Narcotics, loss of muscle tone, etc).
What is crucial nursing care in the Post-Op period?
Assess head-to-toe!
Vitals, Oximetry, respiratory patterns, and breath sounds are essential!
Airway patency, chest symmetry, depth and rate.
Why are deep breathing and coughing techniques crucial in the post-op period?
Help move resp. secretions for removal and prevents alveolar collapse!
*Remind patient to splint abdominal incision to prevent injury while coughing and reduce potential pain
Explain how the following can occur in the PACU:
Hypotension
Hypertension
Dysrhythmias
Syncope
Hypotension:
Unreplaced fluid and blood loss. (IF EVIDENCE OF BLEEDING POST-OP… TAKE VITALS)
Hypertension: Results from sympathetic stimulation from pain, anxiety, bladder distention or respiratory compromise.
Dysrhythmias: Often from identifiable cause such as: acid-base imbalances, circulatory instability or pre-existing heart disease
Syncope: Decreased cardiac output, fluid deficit, or poor cerebral perfusion
Which of the following stats should you notify the anaesthesiologist about?
A/ Pulse 120 bpm
B/ Systolic 160
C/ Irregular cardiac rhythm develops
D/ Significant variance from preoperative readings
ALL OF THEM. THEY ALL SUCK
How can Hypothermia occur in a PACU? What are risk factors and complications? How do you treat it?
Occurs when there is a significant loss of heat comparative to production of heat.
*Possibly due to exposure of organs to cold air.
Risk factors include:
- Age
- Debility (Weakness)
- Intoxication
- Prolonged anaesthetic administration
Complications:
- Compromised Immune function
- Post-op pain
- Increased Bleeding
- Myocardial ischemia
- Delayed lung metabolism
TX:
- Apply warm devices
- O2 therapy for increasing demands
What can Cause Mild/Moderate and prolonged Hyperthermia during Post-op periods? How can you treat it?
Mild elevation (38 degrees) is caused by stress response
Moderate (>38) caused by respiratory congestion
48 hours post-op signifies possible infection
Tx:
Encourage airway clearance.
Provide antipyretics if fever passes above 39.4 degrees
How do you know your patient may be experiencing septicemia post-op?
Intermittent fever with shaking chills and severe sweating.
What are possible post-op gastrointestinal issues that patient may experience?
- Nausea and Emesis
* can lead to electrolyte imbalance, or decreased fluid volume - Paralytic Ileus
* Peristalsis stops causing severe nausea and vomiting - Hiccups
* Spasm of the diaphragm causes by nervous stimulation of phrenic nerve
What nursing care would you provide to a patient with Nausea and Vomiting post-op?
- Document characteristics of emesis
- Antiemetics
- Keep suction at bedside
- Turn patient to their side if emesis occurs to prevent aspiration (Keep upright if possible)
- NPO until bowel sounds return for abdominal surgery
- Regular mouth care when NPO
- Encourage ambulation to stimulate GI tract
Why do patients often have significantly decreased Urine output post-op for the first 24 hours?
Increased Aldosterone and Anti-diuretic hormone as a result from the stress of surgery, along with fluid restriction and loss, drainage or diaphoresis.
Anaesthesia may depress the nervous system, allowing the bladder to fill more than normal before urge to void is felt
What is the counter-regulatory hormone in the body to insulin?
Glucagon
What is insulin? What does it do?
Hormone secreted by the pancreas that uses glucose for cellular metabolism as well as the metabolism of fat and protein.
*Also increases the permeability of K+/Mg+/P+ ions in cells.
What does Insulin do to the Na+/K+ pump within cells?
Increases the concentration of K+ inside of cells (NOT GOOD).
But if a patient is Hyperkalemic, Insulin can be given to decrease the ECF concentration of K+ and equilibrilize the patient.
____ Increases Blood glucose, while _____ decreases Blood glucose.
Glucagon, Insulin
What is the normal desired range of Insulin within the body?
4-6 mmol/L
Differentiate between the causes of Type 1 and 2 Diabetes. Include the three P’s and which type of predominantly affected.
Type 1:
- *Little to Ø endogenous insulin
- *Polydipsia, Polyuria, Polyphagia (Increased thirst, urine and appetite).
Type 2:
- *Impaired secretory response of insulin
- Hereditary, Obesity or sedimentary lifestyle
What is Hypoglycemia defined as? What are some symptoms at the Mild, Moderate and Severe levels?
Low blood sugar levels (Below 4mmol/L)
Mild:
Pale, sweaty, tachycardic
Moderate:
Impaired concentration, slurred speech, Blurred vision, awkward gait
Severe:
May be incapacitated, uncooperative, seizures
What can cause Hypoglycemia? How do you treat it?
Can occur in a sudden drop of Blood-sucrose (13mmol/L -> 7mmol/L)
Mismatch of food timing and peak action of insulin.
Starvation/decreased caloric intake
Exercise
Menstration
Tx:
Mild-moderate:
Simple carbohydrates (fruit juices, soft drinks)
Severe (unable to swallow):
1mg Glucagon (or D5W)
Once awake , treat orally
