Lower Resp, Tb & Trauma Flashcards
What is TB caused by?
And what does it mainly infect?
Mycobacterium Tuberculosis
Lungs
If you heart and lungs are not working, what happens?
Nothing is working
Remember lungs -> effect cardiac
cardiac not working -> lungs effect
What is the ultimate goal worldwide from TB?
The eradication of it
Most of the time we like to selective screening programs to help detect TB, but why do we do this?
Because there are some high risk groups and social determinants
What are some risk factors for TB?
Give some example
Homeless
Foreign born persons
IV injecting drug users
The best measure of peripheral perfusion??
Test question
Urine output
The reason is because the first thing to stop when your heart is pumping well, urine/renal decreased
Test question
What is the best method to show that peripheral perfusion has improved ?
Increased Urine output!!
Test question
If your patient is on a proton pump inhibitor, what is the best measure that it’s being effective?
( remember this is used for ulcers )
Lack of blood in stool !!
( occult blood )
Why do we do ADPIE?
Because it’s effect and can help us understand the patient better than like a lab
Edema
Where is it when laying in bed?
If they are standing ?
Sacral
Feet
Aorta arch and ascending aorta
Where is the lack of perfusion going to be at?
Lower abdominal aneurysm?
Concerned for the perfusion of upper extremities
Lower extremities lack of perfusion
What does the pulse ox measure?
Measures the % of hemoglobin that has oxygen attached to it
If you have blood loss, half of your hemoglobin what happens to you perfusion ?
But your lungs work fine, what’s your pulse ox?
Normal 100 hemoglobin = 100 pulse ox
100 hemoglobin but not all picking up oxygen = 80 pulse ox
Bleeding but lungs are fine = 100 pulse ox
It decreases it because it loses the hemoglobin
It’s gonna be 100%
What is the first thing you will see when someone is not perfusing well?
They are gonna be agitated ( yelling at you, get out of bed )
If you see this, think of perfusion
See a change into agigated think of oxygenation
If your patient has respiratory issues, what position are we gonna do?
Sit them up
Assess their respiratory status
( vital signs, listen to lungs )
If your patient is gonna die, ignore assess and take care of their distress
Who do you talk to when a patient is at risk for aspiration?
Speech therapist
Nursing assessment and interventions by body system
Following flashcards
Before anything we want to collect a history about a patient,
Give example to what things we want to ask about patients?
Signs and symptoms
A baseline
Prior health history
Medications
Past surgeries
Family history
Recent exposure
Cardiac / peripheral perfusion nursing assessment
What are some things we will do to help assess cardiac on a patient?
Capillary refill
Level of consciousness
Skin color ( remember pink !! )
Urine output is your best friend !!!!
Labs
Auscultations breathe sounds
Drains
JVD assessment
Heart rate
Blood pressure
Pulses = bilaterally assessment
( expect neck )
What is the main lab we want to be looking at when it comes to the heart?
Potassium!!
H&H as well as
What are the pulses associated with the ascending aorta and aortic arch? (3)
Carotid
Radial
Temporal
What are the pulses associated with the descending aorta? (4)
Femoral
Popliteal
Posterior tibial
Dorsalis pedis
Vasospams and hypothermia can cause what?
Absense of lower extremity pulses
When edema is a concerned we want to assess the 6Ps which are?
Pain
Pulseleness
Paresthesia
Paralysis
Pallor
Poikilothermia ( cold )
Nursing assessment of respiratory
What should we be doing?
Are they using accessory muscles? Flaring? Retractions?
Positions
Color
Clubbing in fingers
Symmetry
Pulse ox
Lungs
Agitation
Fluid status
What is some nursing assessment of GI?
Abdominal shape
Bowel sounds
Stool character
Aspiration risk
Knowing diet
Early feeds
Stress ulcers
What are some nursing assessment of neurologic status?
LOC
PERRLA - pupils equal round reactive light accommodation
EOM - eyes of motion
orientation
Quality of speech
Facial symmetry
Infection
The biggest thing to know with infection if that some patients, mainly those who are elderly and immunosuppressive they will?
Not present with a fever :(!!
Before you give an antibiotic, you want your make sure the patient doesn’t have a blood culture order first as to why?
It can effect the results
Back to the original presentation of respiratory
How is TB spread?
Airborne ( droplets )
If someone has TB, is it a reportable thing?
Yes, it’s a very serious health condition
We do a skin test, how do we identify as positive for TB?
Normal
immunocompromised
Remember it’s by the size not the color
10mm more + =for normal people
Less than 10mm = negative
5mm + HIV = positive
When doing a skin test, what is the time frame we can read the thing?
Too early or too late doesn’t count and you have to redo the thing
48-72 hours
What’s the vaccine for TB?
What if someone has this vaccine and get a skin test what can happen?
BCG vaccine
TB test usually come out positive on the skin test ; questionable
If a patient comes out positive for a skin test, what’s the next step?
Chest x-ray and symptom screening
If a patient is positive with a skin test for TB but negative on chest x-ray, what does that mean?
Latent TB
If you have latent TB, remember no symptoms, it can become ACTIVE!!
How so
Simply change in symptoms
What is latent vs active TB differences?
Latent
- no symptoms
- not contagious
Active
- symptoms
- contagious
What’s the problem of treating TB?
The resistance is insane
People get tired of taking medication and just simply don’t like the meds
The problem of people not taking their TB meds resulted in what?
DOT
Directed observed therapy
These people come in and watch them take their medications every single day
Can TB he spread by touching, sharing food utensils, kissing or other physical contact?
No
What’s the typical symptoms of active TB?
Fever
Weight loss
Night sweats
Tired
Cough
What’s an acutely ill symptoms of TB?
High fever
Productive cough
Crackles
Adventitious breath sounds
Remember if you are immunosuppressive, what if you get TB?
You are less likely to have a fever and die quicker
What is miliary TB?
Bloodstream to distant organs
Other complications
NOTES
can get bacterial meningitis
Peritonitis
All from having TB
What is the TB test called?
Tuberculin skin test (TST)
What is the blood work for TB?
Interferon release assays - screening tool
Can not be effected by BCG vaccine
What is the gold standard of TB?
How many samples?
To be considered negative they what?
How long does it take to get results?
Do we treat them still?
The sputum culture
3x at 8 to 24 hours intervals
No TB in the cultural
6 weeks
Yes, treat them as they have active TB
What is the 4 medications to remember of Tb we use to treat?
RIPE
rifampin
Isoniazid
Pyrazinamide
Ethambutol
What is the INH side effects? (4)
Do you take with foods or no food?
How do we treat one of their symptoms?
Photosensitivity
Tinnitus
Peripheral neuropathy
Hepatotoxicty
No food, empty stomach
Treat peripheral neuropathy with vitamin B6 ( pyridoxine )
All the 4 TB meds can effect your what?
So what do we do?
What do we tell them to avoid (2)?
Liver
Get them base line of liver
Tyneol & alcohol
What do we tell patients with ethambutol?
What do we do before hand?
Teach them to do what? (2)
Damage to eye causing blurred or changed vision
Eye exams
Sunglasses and call doctor of vision changes
What do we tell patients about rifampin?
What about female patients ?
Every fluid in your body will be orange !!
Oral contraceptives will become ineffective, another form of birth control is needed
Do we tell patients with TB to take meds everyday or stop when they feel better?
YES!!
KEEP GOING!!
Oral preparations may be given with meals to reduce GI upset stomach however we recommend patients to taken them what?
1 hour Before or 2 hours after
Two phases of active TB
first phase ( how long and how many drugs )
Second phase
( how long and how many meds )
8 weeks to 3 months
4 meds
18 weeks
2 meds ( INH & rifampin )