HEHI!! Week 2 Flashcards
Prothrombin Time (PT)
This test is used to monitor warfarin therapy. For a client receiving full anticoagulant therapy, the PT should typically be approximately 2-3x the normal value, depending on the indication for therapeutic anticoagulation.
A nurse is preparing to administer heparin to a client. How should she do it?
She should inject the heparin into the abdomen above the level of the iliac crest, at least 2 inches from the umbilicus.
Black Cohosh
May relieve menopausal symptoms, such as hot flashes, by suppressing the release of LH.
Oral acetylcysteine
Has an odor similar to rotten eggs due to the presence of disulfide linkages
An adverse effect of atenolol
Bradycardia
Levothyroxine
A synthetic thyroid hormone that is chemically identical to T4. Used in treatment of hypothyroidism.
Therapeutic effect of sucralfate
Relief of gastrointestinal pain associated with gastric ulcers. Promotes ulcer healing
What would cause you to think there was an upper airway obstruction upon assessment of a patient?
- Stridor
- Coughing/choking
- agitation (restlessness)
- universal sign of choking
- Hypoxia and potential cyanosis
Causes of upper airway obstruction
- Epiglottis/vocal cords
- Foreign body occlusion
- Head and neck cancer
- obstructive sleep apnea
Epiglottis causes of airway obstruction
Epiglotitis
Why do we want to assess pt’s dentition?
Aspiration
- micro aspiration can cause pneumonia
- other aspiration can cause food chunks to get caught in airway
- many pts have change in mental status in hospital –> can’t chew or don’t have dentures
How do we avoid foreign body occlusion?
- assess pt’s dentition
- consider consistency of food
- chop food into manageable pieces
- sit pt upright (above 30 degrees) to eat
Worries with head and neck cancer
- airway obstruction (from tumor)
- malnutrition
- aspiration (even if they don’t have airway occlusion)
Priority in pt with head and neck cancer
Monitor airway
What can being incredibly anxious signify?
Allergic reaction - impending sense of doom
Common causes of allergic reaction
- Foods (shellfish commonly)
- antibiotics (penicillin – PCN), sulfa drugs (TMP/SMX)
- latex
Adrenergic receptors on lungs
A1
B2
Test for asthma
Pulmonary function test (spirometry)
FEV1
the amount of air a patient is able to forcefully expel in 1 second
What type of diseases is FEV1 a good test for?
Obstructive pulmonary diseases
Treatment for asthma
- short acting beta agonist (to activate B2 receptors and relax smooth muscle in bronchioles)
- inhaled corticosteroids (lots of side effects so not first choice)
- Anticholinergics (inhibiting PsNS which is mediated by acetylcholine –> potentiating function of SNS)
- preventative meds, not just rescue
- leukotriene receptor antagonists to prevent body from responding to leukotriene release
- Mast cell stabilizers to preserve integrity of mast cells so they don’t release histamine
Education for asthma
- Preventative care will prevent irreversible remodeling of the tissue - no long-term effects
“if you can get under contro, we can minimize or get rid of long-term effects”
- avoid triggers (allergens, dust, pollution, exercise)
- Teach proper technique for metered dose inhalers
status asmaticus
severe asthma unresponsive to repeated courses of beta-agonist therapy or subcutaneous epinephrine. It is an emergency and usually require intubation (ETT)
Easiest way to check breathing
- respiratory rate
- SpO2
Want to also listen with stethoscope
What is “breathing?”
The actual neuromuscular act of breathing
Open alveoli capable of carrying out gas exchange (O2 and CO2)
Neuromuscular considerations of breathing
- Brain has to detect changes in gas concentrations and send the correct impulse to the lungs
- The nerves that carry that impulse have to be functioning correctly
- The muscles of the respiratory system have to be working correctly - DIAPHRAGM
Accessory muscle use
(intercostals, sternocleidomastoid)
Usually implies the patient is having to compensate for something
Examples of neuromuscular issues
- rib fractures cause shallow breathing due to pain
- opioid overdose - depress drive to breathe
- excess CO2 levels (result of impaired breathing)(hypercapnia/hypercarbia) can cause sedation
- Neurodegenerative diseases
- Guillan-Barre
- ALS - Diaphragmatic Weakness (older)
- ventilator dependence
- hypophosphatemia (can’t make ATP)
- deconditioning/muscle wasting/malnutrition
Signs of neuromuscular compromise
- altered mental status
- resp rate <12 or >20
- shallow respirations - or absent respirations
- accessory muscle use (depending on the specific cause)
- Nasal flaring
- generalized weakness
What can altered status be a sign of
elevated CO2
Need to check that they aren’t retaining CO2 due to GCS of 8, but also that their altered mental status is not b/c of CO2 retention
What could an elevated resp rate signify in a pt with impaired breathing?
Weak diaphragm b/c trying to breathe more times per minute to make up for weak resp. excursion that muscle is able to achieve
What does an impaired resp drive lead to?
hypoxia and hypercarbia
Why isn’t treating hypoxia enough to treat hypercarbia as well?
Conditions that impair oxygenation with also impair body’s ability to of gas CO2 so just adding O2 will be a temporary fix, but not a permanent one
Oxygen levels will go up, but CO2 levels will stay elevated
What is solution for hypercarbic patient
We have to encourage better ventilation in pt
- Ambu bag will ventilate as well as oxygenate - we physically squeeze bag to inflate pt’s lungs
- Naloxone will treat underlying cause by antagonizing the my-opioid receptors
The nurse is caring for a client with a hiatal hernia. Which risk factor would the nurse assess for in this client?
- obseity
- alcoholism
- chronic bronchitis
- esophageal varices
Obesity causes stress on the diaphragmatic musculature, which weakens and allows the stomach to protrude into the thoracic cavity.
Alcoholism may cause gastritis, an enlarged liver, or pancreatitis, but not a hiatal hernia.
Inflammation of the bronchi will not weaken the diaphragm
Esophageal varices result from increased portal pressure; they do not cause a hiatal hernia
A client presents with gastric pain, vomiting, dehydration, weakness, lethargy, and shallow respirations. lab results indicate metabolic alkalosis. A diagnosis of gastric ulcer is made. Which is the primary nursing concern?
- chronic pain
- risk for injury
- electrolye imbalance
- inadequate gas exchange
electrolyte imbalance:
The stomach prouces about 3 L of secretions per day. Fluid lost thorugh vomiting can produce inadequate fluid volume and electrolyte imbalance, which can lead to dysrhythmias and death.
A client is admitted to the hospital with a diagnosis of peptic ulcer. Which common complication would the nurse assess for in this client?
- Perforation
- Hemorrhage
- Pyloric obstruction
- Esophageal varices
Hemorrhage - because of erosion of blood vessel walls is the most common complication of peptic ulcer disease.
The complication of gastric perforation usually occurs after, and is not as common as, hemorrhage.
Pyloric obstruction is not a common complication of peptic ulcer disease.
Esophageal varices occur with portal hypertension, not peptic ulcer disease.
How does smoking cigarettes contribute to peptic ulcer disease?
Smoking cigarettes increases the acidity of GI secretions, which damages mucosal lining.
How does weight influence peptic ulcer disease?
Being overweight is unrelated to peptic ulcer disease
Which pain description would the nurse expect a client to report when describing pain associated with a suspected duodenal peptic ulcer?
A gnawing sensation in the epigastric area (1.5 - 3 hrs after a meal for duodenal. 30 min for gastric)
Caused by H. pylori and NSAIDs
An older client’s colonoscopy reveals the presence of extensive diverticulosis. What type of diet would the nurse recommend?
High-fiber diet. Fiber promotes passage of residue through the intestine, thereby preventing constipation.
Constipation causes straining at stool; this increases intraluminal pressure, which can precipitate diverticulitis or perforation of diverticula.
